From the Guidelines
A pulse deficit is a significant finding that warrants further evaluation for underlying conditions such as thoracic aortic dissection, particularly in patients presenting with sudden onset of severe chest, back, or abdominal pain. According to the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1, a pulse deficit is considered a high-risk examination feature associated with aortic dissection.
Key Points to Consider
- A pulse deficit is a difference between the heart rate and the peripheral pulse rate, which can indicate that some heartbeats are not strong enough to generate a palpable peripheral pulse.
- The presence of a pulse deficit, along with other high-risk features such as severe chest, back, or abdominal pain, should prompt an evaluation for thoracic aortic dissection, especially in patients with a history of connective tissue disease or aortic valve disease.
- The guidelines recommend a focused examination to identify findings associated with aortic dissection, including pulse deficit, systolic blood pressure limb differential, and focal neurologic deficit 1.
- Management should focus on treating the underlying cause of the pulse deficit, rather than the deficit itself, and may involve diagnostic imaging and consultation with a specialist.
Clinical Implications
- Patients presenting with a pulse deficit and symptoms suggestive of thoracic aortic dissection should be promptly evaluated and managed to prevent morbidity and mortality.
- The presence of a pulse deficit in patients with suspected or confirmed aortic dissection warrants a thorough examination to identify associated neurologic injury or pericardial tamponade 1.
- Documentation and monitoring of pulse deficits over time are crucial, as increasing deficits may indicate worsening cardiac function or progression of underlying disease.
From the Research
Significance of Pulse Deficit
- Pulse deficit is the difference between the apical and peripheral pulse rates, and it can signal an arrhythmia 2.
- A pulse deficit can be a significant indicator of underlying cardiovascular conditions, such as aortic dissection, and can be associated with increased risk of in-hospital complications and mortality 3.
- In patients with atrial fibrillation, a pulse deficit can be a crucial clinical finding, and higher pulse deficits are associated with exercise intolerance 4.
- Pulse rate, including pulse deficit, is an important factor in heart failure with reduced ejection fraction, and high pulse rates are associated with increased risk of adverse outcomes 5.
Clinical Implications
- Monitoring pulse deficit is essential in patients with irregular pulse rhythms 2.
- Pulse deficit can be a simple clinical sign that directs physicians to consider a diagnosis of aortic dissection in patients with acute chest pain 3.
- In patients with atrial fibrillation, rhythm control strategy should be considered to increase left ventricular filling pressures in those with high pulse deficit and exercise intolerance 4.
- Reducing heart rate may improve outcomes in heart failure with reduced ejection fraction patients 5.