Can you Feel it?
Karen George
Clinical Nurse Advisor/Independent
Providers
Overview of the session
Atrial Fibrillation
Early signs and symptoms of stroke and TIA
Theory of taking a pulse
Practical session on taking pulses
Recording findings when to refer
Karen George
Clinical Nurse Advisor/Independent Providers
Learning Outcomes
 Define Atrial Fibrillation (AF)
Understand the causes of AF
List some of the common symptoms
Recognise the complications associated with AF
Can You Feel it?
Atrial Fibrillation is the most common heart rhythm
disturbance and affects up to 500,000 people in the UK
AF can affect adults of any age and becomes more common
the older you get
In the over 75–year- old age group it affects about 10% of
people
It accounts directly for over 96,000 hospital admissions per
year
It consumes 1% of the NHS total budget
Left untreated AF can lead to serious complications such as
heart failure and stroke
The Heart
The heart is a muscular organ that generally situated in the
middle of the chest, slightly towards the left
Structurally, the heart consists of two sides, a right and left
The right side pumps the blood through the lungs to
collect oxygen before travelling to the left side of the heart
From here it is pumped through the body. To return
eventually to the right side once more
Both sides of the heart contract at the same time in a single
coordinated action to produce a heart beat
What happens in AF?
When the heart beats normally, its muscular walls
contract (tighten and squeeze) to force blood out and
around the body. Then they relax, so that the heart can
fill with blood again. This process is completed every
time the heart beats
In AF, the upper chambers of the heart (the atria)
contract randomly and sometimes so fast that the
heart muscle cannot relax properly between
contractions
What causes AF?
High blood pressure
Coronary heart disease
Mitral valve disease (caused by rheumatic heart
disease, valve problems at birth, or infection)
Congenital heart disease (abnormality of the heart
present since birth)
Pneumonia
Lung cancer
Pulmonary embolism
Overactive thyroid
Symptoms of AF
Palpitation
Tiredness
Shortness of breath
Dizziness
Chest pain (angina)
Low blood pressure
Heart failure
Some AF patients have no symptoms at all and it is only
discovered at a routine medical examination
Complications of AF
When the atria (upper chambers of the heart) are not
pumping efficiently, as in AF, there is a risk of blood clots
forming
The blood clots may move into the ventricles (lower
chambers of the heart) and get pumped into the lungs or
the general blood circulation
Clots in the general circulation can block arteries in the
brain, causing a stroke
The risk of stroke in people with AF is about double that of
the general population
Complications of AF
However the risk depends on a number of factors,
including:
Your age
Whether you have high BP
Heart failure
Diabetes
Previous history of embolism
Karen George
Clinical Nurse Advisor/Independent Providers
Learning Outcomes
Define what a Stroke and TIA is
Understand the causes of a stroke/TIA
Recognise the signs and symptoms of a Stroke/TIA
Understand why recognition of the onset of signs and
symptoms is essential
Justify the need to access emergency/urgent services
for prompt assessment.
Understand F.A.S.T
Stroke/TIA causes and risk
factors
High blood pressure
Smoking
Cardiovascular disease
Unhealthy diet
Diabetes
Lack of exercise
Age
Alcohol
Gender
Ethnic background
Genetic inheritance
What is a Stroke/TIA?
A stroke is an attack on the brain.
It happens when the blood supply to part of your brain
is cut off.
For the brain to function, it needs a constant blood
supply.
Which supplies vital nutrients and oxygen.
A stroke happens when the blood supply to part of the
brain is cut off.
 The brain cells die or are damaged.
Types of Stroke
There are two main types of stroke.
The most common type of stroke (about 80% of cases) is
caused by a blockage. This is called an Ischaemic stroke
and may be caused by:
 cerebral thrombosis - when a blood clot (thrombus)
forms in a main artery to the brain.
cerebral embolism - when a blockage forms in a blood
vessel somewhere else in the body . Caused by a blood clot,
air bubble or fat globule (embolism) and is carried in the
bloodstream to the brain.
Types of Stroke
The second type of stroke is caused by a bleed (in about
20% of cases).
This is called a Haemorrhagic stroke and happens when a
blood vessel bursts, causing bleeding (haemorrhage) in the
brain. May be caused by:
1. intracerebral haemorrhage, when a blood vessel bursts
within the brain.
2. subarachnoid haemorrhage, when a blood vessel on the
surface of the brain bleeds into the area between the
brain and the skull (subarachnoid space).
Transient ischaemic attack (TIA)
A Transient Ischaemic Attack (TIA) happens when your
brain’s blood supply is interrupted for a very brief time.
This is often called a mini-stroke.
It is an episode where some brain function is temporary
lost due to a short lived disruption in the blood supply to
the brain.
With a TIA, part of your brain goes without oxygen for just
a few minutes.
A TIA is a sign that this part of your brain is not getting
enough blood and that you may be at risk of a more serious
stroke in the future.
What are the common symptoms of
stroke?
 Sudden, severe headache
Numbness, weakness or paralysis on one side of
your body (signs of this may be a drooping arm, leg or
lower eyelid, or a dribbling mouth)
Slurred speech or difficulty finding words or
understanding speech
Sudden blurred vision or loss of sight
Confusion or unsteadiness
Recognition !
Karen George
Clinical Nurse Advisor/Independent Providers
Can You Feel it?
The opportunistic detection of
Atrial Fibrillation (AF)
to prevent the risk of stroke and
other serious medical
conditions associated with the
presence of AF
Learning Outcomes
Understand how to detect a pulse
Identify /describe a regular pulse
Identify/ describe an irregular pulse
Demonstrate manual palpation of a radial pulse
Explain how to document your residents pulse
readings
Identify what action to take when an irregular pulse is
detected
Record outcome of action taken
What is your pulse?
When the heart beats blood is pushed out of the heart
into the body causing a bulge in the arteries. This
bulge of pressure is called a pulse, and the pulse can be
felt anywhere an artery passes close to the skin.
The pulse indicates the heart rate and the heart
rhythm. Being aware of your pulse is important
because it may indicate an abnormal heart rate or
rhythm. The pulse can be taken in several points on
your body. Can you name two of the easiest places?
On the neck: below the earlobe
between the muscle of the neck
and the wind pipe (carotid pulse)
On the wrist: between the end
of the thumb and where a watch
strap would rest (radial pulse)
Regular/Irregular Pulse
The pulse should be regular, i.e. the bulges caused by
the heart beating occur with the same rhythmical
timing.
Irregular pulse when palpated will not have the
rhythmical timing of the regular pulse and therefore
should be palpated for longer.
Bom – bom – bom – bom – bom – Regular
Bom – bom – bombom – bom –bombom - Irregular
Why it is important?
An irregular pulse strongly indicates that the heart is
not beating in a uniformed way and moving the blood
through its chambers swiftly, this can result in the
blood flow becoming sluggish and lead to clots which
can break loose and travel to the brain or to other
parts of the body.
Can you think of things that can affect our pulse rate?
What Can affect your pulse
rate?
Age
Medication
Caffeine
Level of fitness
Anxiety
Stress
Exercise
How to take a Pulse
How to take a Pulse
Using three fingers, place them on the inside of the wrist
between the watch strap and the base of the thumb.
Keep firm pressure on the wrist with your fingers in order
to feel the pulse.
The rate of the pulse can be found by counting for 60
seconds and multiplying by two, this can give the number of
beats per minute
 The heart rate naturally varies, depending on activity and
time of day.
Normal pulse rate falls between 60 bpm and 100 bpm.
GROUP ACTIVITY
To assess the resting pulse rate in your wrist,
sit down for 5 mins beforehand. Remember
that any stimulus taken before the reading
will affect the rate. You will need a watch/clock
with a second hand.
With your hand, place your index
and middle fingers on your wrist
at the base of your thumb. Your
fingers should sit between the bone
on the edge of your wrist and the
stringy tendon attached to your thumb.
Once you have found your pulse, keep
firm pressure on your wrist with your
fingers in order to feel your pulse
Bone
Pulse
Tendon
GROUP ACTIVITY
Count for 30 seconds and multiply
by 2 to get your heart rate in beats
per minute. If your heart rhythm is
irregular, you should count for 60 seconds
and do not multiply.
Record your findings and
follow the pathway.
Pulse Check Pathway
Weekly pulse
checks or resident
has a fall
Pulse
Regular
If fall assess and
take
appropriate
action
Pulse
Irregular
weekly
pulse check
and record
If resident
well refer to
GP or OOH
12 Lead ECG
If resident
unwell
999
karen.george@shropcom.nhs.uk
Further Information:
www.nice.org.uk
www.heartrhythmcharity.org.uk
www.bhf.org.uk