Pulse check

It's my understanding that once an afib diagnosis has been made - an irregular pulse indicates

afib - conversely, a pulse in sinus rhythm surely indicates that there's no afib present. Is this correct or have I been misled? I understand there are people who are not aware they're in afib - how is that so if it is seemingly as simple as a pulse check?



24 Replies

  • Hi Musetta

    Because almost no-one checks their own pulse unless they have a reason to, and because doctors use blood pressure machines which do not detect an irregular pulse.

    I have been in AF for at least 6 years and in that time underwent a "full medical" at my GPs which did not pick up AF.

    I recently changed doctors, and as usual you have to go for a nurses "medical" before you sign on, I thought I would see what happened, they have a machine which checks pulse and BP (and by the way is almost certainly incorrect if you are in AF) and if I had not told them I was in persistent AF they would have never discovered it.

    Regrettably those stethoscopes that hang around doctors necks are usually no more than badges of rank, or jewellery, unles they are actually used.

    I am hoping that the AFA will start campaigning to either ban those ruddy BP machines from surgeries, or at the very least replace them with models which will flag irregular pulses.

    I see you are struggling a little with the persistent asymptomatic AF those of us in 24/7 who either do not know or do not feel it. I can only say I have had one paroxsymal attack and it put me in A & E and it was very very different and very scary.

    Be well


  • Hi Ian,

    Thanks for your reply - I agree paroxysmal episodes are no picnic. My first (incidentally Nov 2012!) episode landed me in casualty as well. After 10 hours and iv drugs I was discharged and my life continued on it's merry little way. I'm now in my 68th year and would like another 30 years! There's just so much to enjoy.



  • Ian, Reading the above I think you are saying that you cannot detect your asymptomatic AF by taking your pulse, or your GP didn't anyway. So how do you detect it, is ECG the only way or can you feel an irregular pulse? Or would the stethascope do it?


    Just asking because I have had AF without feeling it, so would like to know what you do.

  • Hi Koll

    Sorry if I was not clear, if you take my pulse then you will know IMMEDIATELY I am in AF, or at least that I have an arrythmia.

    My complaint is that doctors don't take pulses, machines do, if they put their fingers on my wrist, or a stethoscope on me, then it's umistakeable.

    After my nurses medical story (see above) when I got to see the doctor, I said to him the BP and HR readings from the machine were probably useless, and certainly incorrect. He said yes you are in AF. So I said why do you use the machines then, and he said because we can ask all the staff to book you in and not just a nurse.

    Be well mate


  • Thanks Ian.

  • Hi Ian,

    As you may have noticed from some of my replies to recent posts, I was in hospital recently for a gallbladder op that didn't take place because of the heart problems. Only ONE staff nurse actually took my pulse with her fingers on my wrist. When I commented, her reply was, it is the only way to take the pulse of patients that are in AF, the machines are no use. All the rest just took the reading from the BP machine even although it was varying between 50 and 68 as you watched it. At least one nurse had been trained correctly and was taking the time to do it correctly.


  • That's encouraging. I must have a clued up GP. He always checks me with an old fashioned pump up BP machine and listens at the same time with his stethoscope on my wrist.

  • If your pulse is steady and in rhythm your not IN afib, doesnt mean you dont have it though.

    Those that are not aware, have no symptoms. Its usually discovered when they go into hospital for something else.

  • Japaholic, I don't think what you said is correct. If you have a regular pulse you are note in AFib. AFib is characterised by an irregular pulse. If you have paroxysmal AFib and you have a steady pulse you are not in AFib. You are only in AFib when you have an irregular pulse.

    Do you agree with this or disagree? Thanks.

  • I think what he is saying is that you can have paroxysmal AF but check your pulse when in NSR and if you keep missing events think you don't have AF. Works for me.


  • I agree with Michael 1234 - Whether one has been diagnosed with with persistent AF, paroxysmal AF or lone AF - the fact remains - regular pulse - no AF - irregular pulse - you're in AF.

  • Yes and no. What Bob, Japaholic and Ian are all saying is that you can detect AF from taking a pulse and if it is irregular, it is obvious you are in AF. And you can take a pulse (which is only held for a minute) and feel a regular pulse and STILL be in AF. This has happened to me when I would get what I called very short runs of what I could feel, but they were so quick, when pulse was checked they weren't felt.

    If you have a holter ECG over a period of more than 48 hours, you will find that many people report they had far more episodes of AF than they had imagined.

    AF is an irregular, irregularity.

  • I advised my GP in my twenties I was aware of an irregular pulse, but I think as my ventricular rate has always been slow my AF was never picked up until two years ago and I am now 57! My consultant said it's difficult in my situation to pick up AF on ECG and could easily be missed. I was interested to read Ian's post to you, I am in persistent AF and guess that's why not always picked up by health care professionals? So perhaps it isn't always as easy as a pulse check but I wish more medics would investigate further if any patient presents with an irregular pulse.

  • Hi Bryonny

    It's not hard as I understand it to pick up persistent AF on an ECG, even I can read them now and see if I am in AF (surprise yes I am) and that's just wandering between the ECG taking back up to the receptionist.

    It's not picked up as doctors stopped taking pulses, they started using those machines which inflate automatically so they can chat to you and write while it's happening, and even the very best of them (until recently) was very hit and miss if you were in AF. I understand the latest machines at last have an arrythmia check built in, and they tell the doctor to do it manually.

    When I bought a Omron BP recorder I rang up their technical department as asked which machine they would recommend for someone in AF. Their reply was None of them they will all give false readings and even those with an arrythmia "flag" are only as a guide.

    But I agree with your sympathies, I wish more medics would investigate further, and in order for that to happen, I want them to use a stethoscope or their fingers on my pulse.

    Be well


  • The cheap(ish) Microlife WatchBP Home blood pressure monitor (cuff) that I purchased for £96 last December (it is the only one recommended by NICE) is specifically designed for those with AF and it also shows if you are in AF each time you use the monitor. From memory the accuracy was high (98%?). It has a usual mode for individuals such as us and also a diagnostic mode which restricts use to Mon to Fri for testing. There is a professional model as well and one that is recommended for work use for testing people. There are also other versions such as a Night version for 24 hour monitoring. Can't check the manufacturer's site as it is down at the moment.

    I was given a general anaesthetic last year when I was in AF because the BP monitor was not one capable of detecting AF and the nurse did not check pulse with fingers.

    This would seem a good way forward at a reasonable price.

  • Dear Ian, many thanks for your reply. I asked my consultant why my condition hadn't been picked up on ECG years ago (and in subsequent years) and he told me that my arrythmia wouldn't be identified unless the medic checking it was a cardiologist. My understanding is that I have AF and infrahisian disease, that my arrythmia is very rare. The axis along which the electrical impulse travels is not normal either so contraction of the ventricles is abnormal. Prior to confirmation of my diagnosis back in 2013 initial investigations seemed to confuse medics I was seeing.

    I find it frustrating that for years I have informed different medics about my symptoms. I was made to feel as though I was imagining things. With hindsight the symptoms I had make complete sense, undoubtedly linked to AF.

    I found it quite frightening at first when I was told my condition is really rare and if my pauses continue to increase they will consider inserting a pacemaker although they want to hold off doing this for as long as possible because there is such a high risk it may make me worse - I guess this partly based on the cardioversion stopping my heart for 7 seconds - when I went for a second opinion I was told they should never have done the cardioversion. Since then I get more chest pain and pulse is weaker than it used to be.

    I find it odd when I go to the GP now and they often comment that I'm in sinus rhythm, I'm not but I am bradycardic which I guess confuses them!

    Not reassuring is it?

    I am a nurse, cardiology is not my speciality, but I am gradually learning more as the months go by. I still find it extraordinary the lack of information and support I was given compared to what we offer to cancer patients. Health unlocked, which I discovered, has been an amazing source of support and I am really not sure how I would have been if not for the members of this forum. I would really like to find some way to support raising medical knowledge about AF, support and information that is available to people with AF particularly if my experience is typical of what is happening in most Trusts.

    Sorry, I think I have some pent up feelings there! Thanks once again for your message. Wishing you well.

  • I just wanted to say that you can detect it with a pulse/oxometer. That is how I was able to know when I was in af. It also tells me when I am in svt and when I was having spells of bigiminy. I have been diagnosed with all three and have been fitted with a pacemaker for the bigiminy.

  • The answer here is simple - when you check your pulse if its irregular then you are most likely in AF. If not then you are not in AF. Rate will also be a key indicator.

    The point that you could still be having episodes of AF (despite the pulse check) is that you may be asymptomatic and could have an episode in your sleep (for example).

    I have had one incidence of AF and no further lapses to my knowledge. I check my pulse at least 3 times a day!

  • "A pulse in sinus rhythm surely indicates no afib.......?"

    Hmm, let's not leave anyone in any doubt that whatever your pulse is doing at the moment, if you have been diagnosed with AF then you have AF for the rest of your life and you should be taking appropriate medication. AF 'episodes' (the irregular heartbeats) occur periodically for some, persistently for others, along that journey.

    But you don't stop taking the medicine when you drop into normal sinus rhythm! You've still got AF. You knew that of course.....

  • Not sure about this. I've been prescribed the pill in pocket medication. I feel terrible when I get AF, but it is lone PAF and I feel OK when I don't have it.

    Maybe you are right. One cardiologist I saw said the stroke risk was the same regardless of whether you have one AF episode per year or are in permanent AF.

    It's definitely a complex problem and everyone seems to have a different story.

  • You're right Michael, for some a 'pill in the pocket' (flecainide?) is a perfectly valid prescription, particularly for rhythm control medication methods. I suppose I was really referring to anti-coagulation. As someone diagnosed with AF, you don't stop being significantly exposed to stroke just because you are in NSR.

  • On the other hand consider a friend of mine who is an athlete aged 55. He was prescribed thyroid pills for 10 years because of alleged marginal hypothyroidism. He went into permanent AF for six months and had an ablation and stopped the thyroid pills. He was initially put on anti coagulants, but after the ablation NSR returned and he no longer uses anti coagulants because his cardiologist told him he didn't need them.

  • Thankfully, he hasn't had a stroke. Ablation is not a cure for AF. He still has it I'm afraid. I couldn't take that risk, particularly when taking a NOAC is so simple and straightforward but, each of us must make our own decisions.

  • The latest update to the AliveCor app now has AF detection included and most times indicates I am in AF. However there have been some traces where AF is not detected and when I look at the trace I have a regular ventricular rate of around 42. If I was taking my pulse, at my wrist, during that minute I would say I was in NSR. However, upon examination of the ecg trace it shows that my atria are fibrillating at around 5 or 6 times faster than my ventricular rate. So, taking your pulse, ventricular rate, doesn't always show that you are still in AF. An ecg is the only real method to detect it.


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