Why is pulse taken at neck or wrist instead of the heart?
May 25, 2010 3:58 PM   Subscribe

Why do we typically take our pulses at the neck or wrist as opposed to the chest or side right at the heart? At least from my n = 1 self-observations, it's both an order of magnitude stronger and easier to find if you just stick your hand on your chest and count off that instead of trying to find the right spot on the neck or wrist.

It would seem to me that if I wanted to train someone to reliably take a pulse with minimum practice, that'd be the way to go. The only thing I could imagine is that perhaps the beating you can feel at the heart itself might have extra vibrations to it that could throw you off that you wouldn't at an artery, but that hasn't been a problem for me. I'm guessing there's some even more obvious answer that somehow as eluded me. Or some other medical explanation for why the heart is bad place to do it. I've given this about 2.5 seconds of thought a few times a year for years, so it might be even more obvious.
posted by floam to Health & Fitness (11 answers total) 1 user marked this as a favorite
I take my pulse at the base of my right thumb with my right index finger. There is no wrong place to take one's own pulse- so I'm as confused as you are. You only have one heart rate and any place you can feel a pulse- that's your pulse.
posted by ethnomethodologist at 4:01 PM on May 25, 2010

My understanding as someone who is rapidly forgetting my Red Cross certification is that the neck and wrist are the places where the pulse is the closest to the surface. I have breasts that impede taking my pulse at chest level, personally. And clothing.
posted by jessamyn at 4:01 PM on May 25, 2010 [1 favorite]

Bulky clothes, don't want to grope strangers. That's probably good enough and somehow didn't occur to me.
posted by floam at 4:02 PM on May 25, 2010

"Taking someone's pulse" is sometimes an excuse to observe their involuntary breathing. Touching the chest or side could interfere with that.
posted by Phssthpok at 4:04 PM on May 25, 2010 [1 favorite]

I cannot feel my pulse on my chest, never have been able to.

In fact, my fifth grade teacher became hysterically angry with me for getting curious and patting myself all around the left part of my chest trying to find my pulse one day during the pledge of allegiance.
posted by jamjam at 4:11 PM on May 25, 2010 [1 favorite]

For those people with advanced lifesaving training, we know your pulse shows up in different places differently as you start to fade away. For example, I know if you've got a pulse in your ankle/foot, that you've got good blood pressure. No pulse in your ankle but pulse in your wrist means you're fading, but hanging in. When you start to show just brachial or femoral, you're in bad shape, and if the only place I can find it is your neck, well then I need to be exacerbating your extraction post haste.

Of course, this is mostly useful in wilderness response settings...

Oh, and when I take your pulse with 2 fingers I'm less likely to get a false beat from sensing my own pulse, especially when your heart is pounding and lives are on the line.
posted by TomMelee at 4:12 PM on May 25, 2010 [7 favorites]

Feeling the beat of your heart through your chest is not only likely to be impeded by clothing etc., especially with "well-endowed" females, but even with skinny guys it's way more diffuse than in the wrist and neck. The sensation of the pulse is far more pronounced in those veins than it is through the sternum.
posted by valkyryn at 4:28 PM on May 25, 2010

I'm a non-overweight dude with high blood pressure and I can't feel my pulse anywhere on my chest, but it's trivial at my neck or wrist. Your anatomy may be non-standard.
posted by 0xFCAF at 4:45 PM on May 25, 2010

As others have alluded to, there are a number of places to take a pulse and in a really complete physical it will be taken in several places and any differences in strength noted. For example, a bounding pulse in the wrist or neck and a weak pulse in the groin (femoral artery) or foot (dorsalis pedis artery) might be a sign of coarctation of the aorta. Diminshed peripheral pulses (wrist and foot) relative to central pulses (groin and neck) can indicate the early onset of shock with blood being shunted from the arms and legs to vital organs (as TomMelee explained). After a cardiac cath and other procedures involving the femoral artery the dorsalis pedis pulse is monitored to make sure there hasn't been blood clot or other problem involving the femoral artery or distal vessels. The heart itself can be felt, once again as part of a really thorough exam. Its beat is often called the point of maximal impulse (PMI), and as the link mentions an abnormal PMI can be indicative of a number of conditions.

Unfortunately this sort of physical diagnosis is becoming a lost art, as physicians rely more on imaging studies and lab values rather than the laying on of hands. Not only does this drive the cost of care up but also removes a large amount of humanity from the practice of medicine.
posted by TedW at 4:53 PM on May 25, 2010 [5 favorites]

I have breasts that impede taking my pulse at chest level, personally. And clothing.

The first time I took a first aid class, every technique that the instructor demonstrated seemed to require two-hands on the chest of a young female student. It was much later, when I retook cpr/first aid classes for a job, that I learned just how pervy that instructor was.
posted by Forktine at 9:18 PM on May 25, 2010

In a trauma situation locational pulses can tell you a lot. If someone's got a palpable radial (wrist) pulse then they've got a blood pressure of at least 80mmHg which in the absence of a brain injury causing raised intracranial pressure is a good enough blood pressure to keep the brain oxygenated.

f they've got a palpable carotid pulse it means they've got a blood pressure of at least 50mmHg which isn't good but it means you can concentrate on getting the blood pressure up either with drugs, blood, or fluid rather than having to worry about the heart not beating.
posted by Silentgoldfish at 1:07 AM on May 26, 2010

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