What Could Cause a Bounding Pulse?
Medically reviewed by Anisha Shah, MDMedically reviewed by Anisha Shah, MDA bounding pulse is a strong heartbeat felt over an artery, such as in the neck, wrist, or foot. Possible causes include anxiety, fever, exercise, and an overactive thyroid gland.Though most causes of a bounding pulse are reversible or treatable and not dangerous, in some cases, it may indicate a heart problem, like severe aortic regurgitation (heart valve disease),Keep in mind that the term "bounding pulse" is sometimes interchangeable with "heart palpitations" because the two symptoms have some overlapping causes.That said, heart palpitations are the general awareness of one's heart beating. They are often described as a racing, skipping, or fluttering feeling. A bounding pulse refers more specifically to an exaggerated, powerful, or forceful heartbeat.
Maria Legoshina / Getty Images' title='A healthcare provider takes a person's pulse'>
Maria Legoshina / Getty Images
Common CausesA bounding pulse is caused by an increased stroke volume, which is the volume of blood ejected from the heart muscle with each heartbeat.Bounding (sometimes called hyperkinetic) pulses are considered normal (although they may require treatment) in the following conditions/ scenarios:Anemia (low numbers of healthy red blood cells)Hyperthyroidism (overactive thyroid gland)AnxietyFeverExercisePregnancy
Bounding Pulses in PregnancyBounding pulses in pregnancy may be due to the following:Increased stroke volume, which is a normal response to the hormone-induced widening of the blood vessels throughout the bodyNutritional-related anemia—for example, iron deficiency anemia affects up to 26% of pregnanciesHyperthyroidism—for example, Graves' disease is the most common cause, affecting about 0.2% of pregnancies
More seriously, bounding pulses can signify a heart valve condition called aortic regurgitation (AR).The aortic valve is the opening where oxygenated-rich blood flows from the left ventricle (lower chamber of the heart) into the aorta, the largest blood vessel in the body.In AR, the aortic valve deteriorates, allowing blood to leak backward from the aorta into the left ventricle. This leakage increases blood volume and pressure in the left ventricle, forcing the heart to work harder to pump blood to the rest of the body.Though many people with AR have no symptoms for decades, as the condition progresses, the heart muscle thickens and gets bigger to compensate for its increased workload. The increased stroke volume and forceful pumping of the left ventricle can lead to bounding pulses.
Is "Bounding Pulse" the Same as "Collapsing Pulse"?The pulse of severe AR is sometimes described as "collapsing." This is because the pulse is momentarily forceful ("bounding") before rapidly disappearing ("collapsing") as the blood leaks backward through the damaged aortic valve.
Over time, heart failure can manifest with severe AR, causing the following symptoms:Shortness of breath (dyspnea) with exercise and when lying flatChest discomfort or tightness (angina)Weakness and fatigueSwelling in the ankles and feetPatent ductus arteriosus (PDA) is another potential cause of bounding pulses. It's a congenital (present at birth) heart defect that is more common in preterm babies.PDA occurs when the blood vessel connecting the aorta with the pulmonary artery (the main lung artery) remains open in a newborn baby. This allows oxygen-rich blood in the aorta to flow back into the lungs, straining the heart.Other possible symptoms/signs of PDA in a baby include a heart murmur, low blood pressure, and a fast breathing rate.Other heart-related causes of bounding pulses include:A large arteriovenous (AV) fistula is an abnormal connection between an artery and vein, increasing the heart's stroke volume to compensate for slow blood flow.Complete heart block is a dangerous condition in which electrical signals cannot spread from the heart's top chambers (atria) to the ventricles. This results in minimal or no electrical activity in the heart, causing a very slow, bounding pulse.When to Contact a Healthcare ProviderUndergoing a medical evaluation for bounding pulses is important to ensure that no health condition, such as anemia, thyroid disease, an infection (causing a fever), or a heart problem, is present.
Seek Emergency Medical AttentionSeek medical attention immediately if any of the following symptoms/scenarios accompany your bounding pulses:Lightheadedness or faintingChest painBreathlessnessSevere swelling in your ankles and feetUnusual fatigueHeart rate greater than 120 beats per minute (bpm) or less than 45 bpm while at restHistory of known heart condition, including heart valve disease or arrhythmiaFamily history of recurrent fainting or sudden or unexplained death
Possible Symptoms During an EpisodeIf you are experiencing a bounding pulse, accompanying symptoms depend on the underlying cause.For example, general symptoms of anemia include:Weakness and exhaustionFast heartbeatPale skinCold hands and feet or chillsShortness of breathHeadacheDizzinessLikewise, symptoms of excess thyroid hormone in the body (hyperthyroidism) include:Excessive sweating and feeling warmHeart racing, pounding, or beating irregularlyTremors of the handsLosing weight despite normal or increased appetiteDiarrheaTrouble sleepingIrritability or increased anxietyLastly, if fever is causing bounding pulses, check for signs of infection, such as those of a urinary tract infection, influenza (flu), COVID-19, or viral gastroenteritis (stomach flu), and see a healthcare provider.How to Check Your PulseArteries comprise one part of the circulatory system. They are blood vessels that transport oxygen-rich blood from your heart to your body's tissues and organs.Your pulse represents the sudden widening of an artery as blood is abruptly ejected into the aorta and, subsequently, throughout the body.If you want to check your pulse, do so while lying down in a warm room. Press the tips of your index and middle fingers over one or more of the following arteries:The radial artery can be felt on the front (inside) of each wrist on the thumb side.The brachial artery can be felt on the middle side of each arm, right near the slight groove of the elbow joint.The carotid artery can be felt on either side of your neck, in the depression adjacent to your windpipe.The femoral artery can be felt between the groin and the hip in each upper thigh.The popliteal artery can be felt by pressing into the soft area behind each knee.The dorsalis pedis artery can be felt on top of each foot, after bending the foot toward the knees
Grading the Intensity of PulsesIf a provider is performing the pulse exam, the intensity of the pulse can be graded on a scale of 0 to 4+:0 means no pulse is felt1 + means a pulse is detectable but faint2 + suggests a slightly more diminished pulse than normal is felt3 + means a normal pulse is felt4 + means a bounding pulse is felt
Related: Dangerous Heart Rate: Understanding Your Levels
Diagnosing and Treating Your SymptomsDiagnosing the cause of bounding pulses requires the following:During a medical history, the provider will ask about accompanying symptoms and the presence of other health conditions like anxiety, anemia, thyroid disease, infection, or heart disease.During a physical exam, vital signs (temperature, heart rate, blood pressure, breathing rate) will be taken, and the provider will perform a pulse exam and listen to your heart with a stethoscope.Blood tests will be performed, such as a complete blood count (CBC) to check for anemia and a thyroid-stimulating hormone (TSH) level to evaluate thyroid function.An echocardiogram (ECG) may be ordered to visualize the heart's structure, including its valves, and to assess its pumping efficiency. This is because bounding pulses can mimic heart palpitations.
What Is an ECG?An ECG measures the heart's electrical activity and can help detect abnormal heart rhythms (arrhythmias), which are the most frequent cause of heart palpitations.
Treatment of bounding pulses depends on the underlying cause.Examples include:Identifying and treating any underlying infections (e.g., taking an antibiotic for a urinary tract infection)Managing anxiety disorders with medication, cognitive behavioral therapy, or some combinationTreating anemia depends on the type but may involve therapies such as medicine to weaken the immune system (e.g., steroids), supplements (e.g., iron or vitamin B12), or blood transfusion.Treating hyperthyroidism involves medicine, radioiodine therapy, or thyroid surgery.Treating severe aortic regurgitation includes repairing or replacing the damaged valve with an artificial one.How to Stop Symptoms From ReturningFirst, stopping bounding pulses requires seeing a healthcare provider to determine their root cause. Following through with your provider's care plan afterward is essential.Depending on the cause, there may be no treatment—for example, reassurance if your bounding pulses occur with exercise. In such cases, your bounding pulses should resolve after resting from exercise.Other treatments may include taking a supplement or medication or seeing a specialist, such as a cardiologist (a specialist in heart conditions) or psychiatrist (a physician specializing in mental health conditions).SummaryA bounding pulse is a forceful or exaggerated heartbeat felt over an artery in the arms, legs, feet, or neck. Most causes of bounding pulses are normal compensatory responses of the heart. They include fever, anxiety, pregnancy, exercise, anemia, and hyperthyroidism.Bounding pulses are also classically seen with various heart conditions. A prime example is severe aortic regurgitation, which occurs when the aortic valve doesn't fully close, causing blood to leak back into the heart. As a result of the increased blood pressure and volume, the heart has to beat more forcefully to eject oxygen-rich blood throughout the body.Due to similar causes and sensations, "bounding pulse" is sometimes used interchangeably with "heart palpitations." Technically speaking, heart palpitations are the general awareness of the heart's activity, and their most common cause is abnormal heart rhythms (arrhythmias).Diagnosing the origin of bounding pulses involves a medical history, a physical exam (including a heart and pulse exam), various blood tests, and an echocardiogram. Due to the overlap with "heart palpitations," an ECG is also performed.See a healthcare provider if you are experiencing a bounding pulse and seek emergency medical attention if your bounding pulses are accompanied by chest discomfort, shortness of breath, swelling, or lightheadedness. Read the original article on Verywell Health.
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