Stephen J. Schueler, M.D.

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Left Bundle Branch Block Pulse Checks

If you have left bundle branch block, it is important to learn how monitor your pulse at home.

How to Take Your Pulse
The pulse can be determined in a number of locations, but the neck and the wrist are usually best.

Using the flat of your index and middle fingers, position your fingers over the artery. Press firmly without excessive pressure or rubbing.

Locations for Taking a Pulse

  • Carotid Artery: to either side of the thyroid cartilage (Adam's apple) and just in front of the large muscle in the neck (Sternocleidomastoid muscle) you will feel the pulsations. Check only one side at a time. See carotid sinus hypersensitivity for additional information.
  • Brachial Artery: located in the elbow crease, on the inner aspect of the biceps tendon (tighten up your biceps muscle and then palpate adjacent to it). The brachial artery is an excellent location for assessing the pulse in smaller children and infants.
  • Radial Artery: located on the underside of the wrist, on the thumb-side. This is a first choice for pulse measurement by many individuals (and health professionals), due to accessibility.
  • Femoral Artery: located on either side of the groin in the midline, this large vessel carries oxygenated blood to the lower extremities. It normally produces a strong pulse that can be easily felt in the upper (middle) inguinal area. Palpating the femoral pulse must be done when the patient is lying flat (supine). Although the location is not as easily accessible, it is commonly used by physicians when assessing a critically ill patient, who may be in shock or cardiac arrest.
  • Posterior Tibial Artery: located just under and slightly behind (posterior) the inner prominence (medial malleolus) of the ankle. Although not typically useful in routine pulse measurement, the posterior tibial pulse is often used to assess the extent of blood flow to the lower extremities. Those individuals with peripheral vascular disease may show diminished, or absent, posterior tibial pulsations.

Interpreting Pulse Results
Count the number of pulsations for 10 seconds. Multiply this number by six. This will give you the number of heartbeats per minute.

When measuring your pulse you should notice not only the rate (beats/minute), but the rhythm. Is it steady and regular or are there extra beats? You may also notice that the pulse rate varies with breathing. Normally, the pulse rate will increase slightly on inhalation and decrease on the exhalation of air. This variation is known as a respiratory-dependent arrhythmia and is usually more obvious in smaller children.

Normal Values for Resting Pulse
Age RangeAverage Beats Per Minute
1 month120-130
6 months120-130
1-2 years110-120
2-3 years100-110
4-5 years95-105
6-8 years90-100
10-12 years85-95
14 years75-85

Report all extra beats, or abnormally rapid heart rates, to your doctor. Any irregular pulse, palpitations, or rapid pulse that is associated with symptoms (e.g. chest pain, breathing difficulty, fainting, lightheadedness, dizziness, sweating, and nausea) may be an emergency and should be evaluated right away.

Continue to Left Bundle Branch Block Taking Control

Last Updated: Apr 13, 2009 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Left Bundle Branch Block References
  1. Guerrero M, Harjai K, Stone GW, Brodie B, Cox D, Boura J, Grines L, O'Neill W, Grines C. Comparison of the prognostic effect of left versus right versus no bundle branch block on presenting electrocardiogram in acute myocardial infarction patients treated with primary angioplasty in the primary angioplasty in myocardial infarction trials. Am J Cardiol. 2005 Aug 15;96(4):482-8. [16098297]
  2. Lee SJ, McCulloch C, Mangat I, Foster E, De Marco T, Saxon LA. Isolated bundle branch block and left ventricular dysfunction. J Card Fail. 2003 Apr;9(2):87-92. [12751128]
  3. Nguyen K, Cigarroa JE, Lange RA, Hillis LD, Keeley EC. Presence and extent of angiographic coronary narrowing in patients with left bundle branch block. Am J Cardiol. 2004 Jun 1;93(11):1426-7, A10. [15165932]
  4. Reuben AD, Mann CJ. Simplifying thrombolysis decisions in patients with left bundle branch block. Emerg Med J. 2005 Sep;22(9):617-20. [16113178]
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