4.2: Heart Rate

Vital signs

Measurement of basic functions of the most vital organ systems

Physiological responses

Change vital signs, such as when one’s heart beats fast while running or when frightened

Telemetry

The automatic measurement and transmission of vital signs and EKG from a remote source to a telemetry unit or nurse station

Telemetry unit

A special unit of the hospital where patients who are suffering from specific cardiac conditions can be under constant monitoring

Class I telemetry patients

Show signs of cardiac issues such as acute coronary syndrome, new arrhythmia, atrial fibrillation or flutter, and severe electrolyte imbalance

Class II telemetry patients

Present with chest pain caused by acute decompensated heart failure with stable hemodynamic status, have a surgical to medical diagnosis with underlying paced rhythms, chronic arrhythmia, and usually have a pacemaker

Class III telemetry patients

Have underwent cardiac surgery, usually have no history of cardiac disease or arrhythmia, syncope, stroke, critical illness, or palpitations

Heart rate (HR)

The number of timed a heart beats in one minute

BPM

Beats per minute (unit of measurement for heart rate)

Normal BPM range for a healthy adult

60 to 100 BPM

Bradycardia

Less than 60 BPM

Tachycardia

More than 100 BPM

Sweep speed

The speed at which an EKG machine records the heartbeat over a given duration of time

Standard sweep speed of an EKG machine

25 mm per second

Why does tachycardia make it difficult to record an EKG?

Makes it difficult to differentiate EKG waves at standard sweep speed

Heart rates for some conditioned athletes

Less than 60 BPM

Premature heart rate

120-170 BPM

0-3 months heart rate

100-150 BPM

3-6 months heart rate

90-120 BPM

6-12 months heart rate

80-120 BPM

1-3 years old heart rate

70-110 BPM

3-6 years old heart rate

65-110 BPM

6-12 years old heart rate

60-95 BPM

12 years old and above heart rate

60-100 BPM

Bounding pulse

Feels as if the pulse leaping out and then quickly disappearing with each beat of the heart; 4+ volume pulse

0 pulse volume

No palpable pulse

1+ pulse volume

Weak pulse

2+ pulse volume

Faint pulse

3+ pulse volume

Normal pulse

Radial pulse

Right above the wrist joint near the base of the thumb

Brachial pulse

On the front side of the elbow, between the upper and lower arm

Femoral pulse

Located deep in he groin

Popliteal pulse

Located behind the knee

Apex of the heart

Located on the left side of the chest, down anterior to the axilla, at the 5th intercostal space

Point of maximum impulse (PMI)

Site where you can feel the pulse the strongest, compared to other pulse point

When should you palpate the apex of the heart?

If the patient has a very weak pulse or if the pulse rate an infant has to be measured

Apical heart rate

The heart rate measured by counting the tapping caused by the heart twisting anteriorly for one minute

What kind of situation would you need to measure apical heart rate?

Count and use a stethoscope for one minute if the patient’s peripheral pulses are undetectable

Step 1 of measuring heart rate

Ensure that the patient has not taken a stimulant in the past 30 minutes, otherwise you must wait half an hour to let the stimulant clear out of their system

Stimulant

Caffeine or nicotine, which increase the heart rate and result in an inaccurate resting heart rate

Step 2 of measuring heart rate

Cardiac hemodynamic demand

The physical factors that determine blood flow

Step 4 of measuring heart rate

Resting will allow the extra energy demand to go down to null so that you can get the data at rest to compare it to normal values

Step 5 of measuring heart rate

Feel the rhythm and strength of the patient’s heart rate

Step 6 of measuring heart rate

Differentiate the patient’s rhythm

Arrhythmia

A pulse that lacks a regular rhythm (unequal spacing of the heart beats), which must be noted and documented because they may indicate heart disease

Regular heart rate

Consistent and predictable heart rate

Regularly irregular heart rate

Heart rate is irregular but consistent and predictable

Irregularly irregular heart rate

Heart rate is chaotic with unpredictable patterns

Step 7 of measuring heart rate

Count the patient’s pulse for 60 seconds

Step 8 of measuring heart rate

Document the patient’s measured pulse rate

Determining a regular heart rate

Count the pulse for 30 seconds and multiply it by 2

Determining an irregular heart rate

Count the pulse for a full 60 seconds