Wednesday, August 31, 2022

apical-radial pulse deficit in atrial fibrillation

Q: What is the reason behind an apical-radial pulse deficit in atrial fibrillation (AF)?

Answer: Palpating the apical and radial pulse rates simultaneously commonly gives a lower radial heart rate. This is called apical-radial pulse deficit, and the most probable cause is AF. In AF, some ventricular beats are preceded by shorter diastole periods with reduced left ventricular filling and suboptimum stroke volume. This results in an unpalpable pressure wave down the arm. This also results in wide measurements of Cuff BP. 

Such wide variation in cuff BP measurement should prompt a physician to look for an underlying Subclinical AF (SCAF).

#cardiology


References: 

1. Karadavut S, Altintop I. Pulse deficit in atrial fibrillation - a different perspective on rhythm or rate control strategy. Kardiol Pol. 2021;79(11):1231-1238. doi: 10.33963/KP.a2021.0107. Epub 2021 Sep 10. PMID: 34506629.

2. Mawatari K, Sanada J, Kuroiwa N, Okumiya K, Nakamura K, Hashimoto S. [Mechanism of production of pulse deficit in atrial fibrillation: assessment by blood flow dynamics]. J Cardiol. 1988 Mar;18(1):197-205. Japanese. PMID: 3221309.

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