Pulse examination is a fundamental diagnostic tool in both modern medicine and Ayurveda, offering valuable insights into cardiovascular health, systemic diseases, and neurological conditions. While Ayurveda focuses on Nadi Pariksha (dosha-based pulse assessment), modern medicine classifies pulse abnormalities based on rate, rhythm, volume, and arterial wall characteristics.

This discussion explores modern pulse examination methods, pulse variations in different diseases, and advanced diagnostic techniques.

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I. Parameters of Modern Pulse Examination

In modern clinical practice, the pulse is assessed based on multiple parameters:

Parameter	Clinical Importance
Rate (beats per minute)	Bradycardia (<60 bpm), Tachycardia (>100 bpm)
Rhythm	Regular vs. Irregular (Arrhythmias)
Volume	Weak (low cardiac output), Bounding (hyperdynamic circulation)
Tension	Hard pulse (hypertension), Soft pulse (hypotension)
Character	Normal, slow-rising, collapsing, bisferiens, etc.
Symmetry	Comparing both radial arteries for occlusive diseases
Arterial Wall Condition	Atherosclerosis (rigid arteries), Vasculitis

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II. Types of Pulse in Different Conditions

1. Rate Abnormalities

Condition	Pulse Type	Clinical Features
Bradycardia (<60 bpm)	Slow pulse	Seen in hypothyroidism, heart block, athlete’s heart
Tachycardia (>100 bpm)	Rapid pulse	Common in fever, hyperthyroidism, dehydration, shock

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2. Rhythm Abnormalities

Condition	Pulse Type	Clinical Significance
Atrial Fibrillation (AF)	Irregularly irregular	Common in elderly, hypertension, atrial enlargement
Ventricular Arrhythmia	Rapid, irregular pulse	Indicates serious cardiac disease
Sinus Arrhythmia	Regularly irregular	Normal in young individuals, varies with breathing
Heart Block	Slow, irregular	Seen in conduction disorders

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3. Volume & Character Abnormalities

Condition	Pulse Type	Clinical Implication
Aortic Regurgitation	Collapsing pulse (Water Hammer)	Strong pulse with sudden collapse
Aortic Stenosis	Slow-rising pulse	Low-volume, delayed upstroke
Hypertension	High-volume, bounding pulse	Seen in systolic hypertension, hyperthyroidism
Shock (Hypovolemia)	Weak, thready pulse	Indicates low cardiac output
Septic Shock	Bounding pulse	Due to high cardiac output and vasodilation
Cardiac Tamponade	Pulsus paradoxus	Drop in pulse volume during inspiration
HOCM (Hypertrophic Obstructive Cardiomyopathy)	Bisferiens pulse	Double-peaked pulse

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4. Arterial Wall Abnormalities

Condition	Pulse Feature	Clinical Relevance
Atherosclerosis	Rigid, non-compressible pulse	Indicates arterial stiffness
Vasculitis (Takayasu’s Arteritis)	Absent or weak pulse	Seen in large vessel inflammation
Coarctation of Aorta	Radial-femoral delay	Delayed femoral pulse compared to radial pulse

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III. Advanced Diagnostic Techniques in Pulse Examination

1. Doppler Ultrasound
   • Measures blood flow velocity & arterial patency
   • Used in peripheral artery disease (PAD), deep vein thrombosis (DVT)
2. Pulse Oximetry
   • Measures oxygen saturation (SpO2)
   • Low SpO2 suggests hypoxia, lung disease, heart failure
3. Arterial Tonometry
   • Assesses arterial stiffness & pulse wave velocity
   • Helps in hypertension & cardiovascular risk assessment
4. Ambulatory Blood Pressure & Pulse Monitoring
   • Records variations over 24 hours
   • Useful for detecting masked hypertension & nocturnal BP changes
5. ECG (Electrocardiogram) Correlation
   • Confirms pulse abnormalities like atrial fibrillation, arrhythmias

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IV. Correlation Between Ayurvedic Nadi Pariksha & Modern Pulse Diagnosis

Ayurvedic Pulse Type	Modern Equivalent	Disease Associations
Vata Pulse (Fast, irregular, weak)	Tachycardia, thready pulse	Anxiety, arrhythmias, dehydration
Pitta Pulse (Strong, warm, bounding)	Bounding pulse	Fever, hypertension, hyperthyroidism
Kapha Pulse (Slow, steady, full)	Bradycardia, slow-rising pulse	Hypothyroidism, heart failure

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V. Disease-Specific Case Examples

1. Case of Atrial Fibrillation

• Pulse Findings: Irregularly irregular pulse, varying intensity
• Possible Causes: Hypertension, atrial enlargement, thyrotoxicosis
• Confirmatory Tests: ECG, echocardiography

2. Case of Aortic Regurgitation

• Pulse Findings: Collapsing, water-hammer pulse
• Possible Causes: Valvular heart disease, Marfan syndrome
• Confirmatory Tests: Echocardiography, Doppler study

3. Case of Septic Shock

• Pulse Findings: High-volume, bounding pulse
• Possible Causes: Sepsis, systemic inflammatory response
• Confirmatory Tests: Blood culture, lactate levels

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