Pulse deficit of more than 10 per minute is seen in:
Answer is C (Atrial Fibrillation) Atrial Fibrillation is the most common cause of Pulse Deficit and the pulse deficit is often more than 10 per minute. Pulse deficit refers to the difference between the radial pulse rate and the hea rate counted by auscultation (Apical Ventricular Rate). Pulse deficit is produced when ventricular contractions are preceded by sho diastoles such that poor ventricular filling results in insufficient stroke volume to transmit the pressure wave out to the radial pulse. The radial pulse rate is always lower than the ventricular pulse rate. The most common cause ofpulse deficit is atrial fibrillationand pulse deficit has traditionally been believed to be a classical bedside sign for diagnosis of atrial fibrillation. Pulse deficit may however be produced by any tachyarrhythmia (fast hea rate) or Extra-systoles (Premature Ventricular Contractions). Typically Pulse deficits generated by Multifocal PVC or PAC are small (<10/min) while those generated by Atrial Fibrillation are larger (>10/ min). Pulse deficits of more than 10 per minute are frequent in Atrial Fibrillation with a fast hea rate. Major Causes of Pulse Deficit (Tachyarrhythmias) Atrial fibrillation Premature Ventricular Contraction Differentiating clinical features between VPCs and AFP Features VPCs AF Pulse deficit <10/min >10/min `a' wave in JVP Present Absent Effect of exeion Decrease or disappear Persists or increases Rhythm Sho pause (between normal beat and VPC) followed by a long pause (following VPC) Pauses are variable and c wave chaotic Note : Multifocal Premature atrial contractions (PAC) may also produce small pulse deficits.
Ventricular Premature Contraction (VPC) (NBE)
Bradyarrhythmias
Atrial Fibrillation (AF)
Ventricular Fibrillation (VF)