Physical Exam

Heart Rate

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Video coming September 2026

How to Perform

Palpate a peripheral pulse, commonly the radial artery, with the pads of two fingers and count the beats over a timed interval — 30 seconds doubled, or a full 60 seconds if the rhythm is irregular. Note the rhythm (regular or irregular) along with the rate. Listening at the cardiac apex gives the rate when peripheral pulses are weak or the rhythm is irregular.

How to Interpret

Adverse Short-term Outcome in Confirmed Pulmonary Embolism

Tachycardia (heart rate >=100 bpm) in a patient with confirmed acute pulmonary embolism

Rule in

Minimally helpful

Rule out

Minimally helpful

Evidence:Limited

Atrial Fibrillation

Irregularly irregular pulse on palpation

Rule in

Helpful

Rule out

Very helpful

Evidence:Strong

Hypothyroidism

Bradycardia (resting heart rate <60 bpm)

Rule in

Somewhat helpful

Rule out

—

Evidence:Limited

Pneumonia

Tachycardia (pulse rate >100 bpm)

Rule in

Somewhat helpful

Rule out

—

Evidence:Strong

References

Cooke G, Doust J, Sanders S. Is pulse palpation helpful in detecting atrial fibrillation? A systematic review. J Fam Pract. 2006;55(2):130-134. PMID: 16451780. Quality-assessed and tabulated by the Centre for Reviews and Dissemination (DARE summary NBK73105 on NCBI Bookshelf), which describes Cooke as 'a well-conducted review.' Three included primary studies (n=2,385 total): Wheeldon NM, Tayler DI, Anagnostou E, Cook D, Wales C, Oakley GD. Screening for atrial fibrillation in primary care. Heart 1998;79:50-55; Sudlow M, Rodgers H, Kenny RA, Thomson R (1998); Morgan S, Mant D. Randomised trial of two approaches to screening for atrial fibrillation in UK general practice. Br J Gen Pract 2002;52:373-380. All 3 included studies used nurse-led pulse palpation as the index test with 12-lead ECG as the reference standard, in UK primary-care screening cohorts.
Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does this patient with a pericardial effusion have cardiac tamponade? JAMA. 2007;297(16):1810-1818. PMID 17456823.
Htun TP, Sun Y, Chua HL, Pang J. Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Sci Rep. 2019;9(1):7600. doi:10.1038/s41598-019-44145-y. PMID: 31110214. PMC: PMC6527561. Open access. PRISMA-compliant systematic review with QUADAS-2 quality assessment. 13 included studies (n=11,144 total adult participants in primary care, outpatient, and emergency department settings). Pooled at the >100 bpm threshold per Htun's Table 2 random-effects bivariate model. Reference standard for pneumonia: chest radiograph in 13 studies.
Hobohm L, Becattini C, Ebner M, Lerchbaumer MH, Casazza F, Hasenfuss G, Konstantinides SV, Lankeit M. Definition of tachycardia for risk stratification of pulmonary embolism. Eur J Intern Med. 2020 Dec;82:76-82. doi:10.1016/j.ejim.2020.08.009. PMID: 32843290.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.