Sorry I did not read your question well. Basically, discrepancy in the rate cannot happen as the origin of the pulse in both sides is the same, the heart. But actually we may see in some conditions discrepancy in the rate in the same cases mentioned above, with discrepancy in volume (aortic dissection, coarctation, ... etc.), if they had in addition a cause of variability in the pulse volume (like atrial fibrillation or frequent extrasystoles). In this case the strong beat will be felt in both sides while the weak one will be felt in the normal side only which may create a discrepancy in the heart rate between the both sides. It similar to the pulse deficit we may found between the apical and radial pulsations in cases of atrial fibrillation and frequent extrasystoles.
Other causes of unequal may include:
- Coarctation of the aorta if it involves the arch after the origin of inominate artery.
- Disease of the subclavian or brachial arteries: like atheromas, Burger's disaes, or Takayasu's disease.
Thank you Dr. Mohammad for your answer, yes these are the causes of discrepancy of pulse (in volume) between both limbs> srong & weak. But my question; is there any possibility to have unequal pulses in their rates like Rt radial: 90 bpm and Lt radial: 60 bpm?
Sorry I did not read your question well. Basically, discrepancy in the rate cannot happen as the origin of the pulse in both sides is the same, the heart. But actually we may see in some conditions discrepancy in the rate in the same cases mentioned above, with discrepancy in volume (aortic dissection, coarctation, ... etc.), if they had in addition a cause of variability in the pulse volume (like atrial fibrillation or frequent extrasystoles). In this case the strong beat will be felt in both sides while the weak one will be felt in the normal side only which may create a discrepancy in the heart rate between the both sides. It similar to the pulse deficit we may found between the apical and radial pulsations in cases of atrial fibrillation and frequent extrasystoles.
Agree that pulse rate should be the same between the two side. Any difference in the rate could be from impalpability of the pulse on one side.
Potentially if the pulses were not checked contemporaneously but rather one after the next - a false deduction that the pulse rate is differing may be drawn - potentially in a paroxysmal arrhythmia ?
yes, sometimes a dissection flap may close or compromize the flow to usually the left subclavian artery, but than its arrythmic.
The flap can extend into the its first branch leading to obstruction and non conduction of a beat
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