*5.1.3 Pulse volume recordings*

Pulse rate records are also used to identify the presence of arterial disease. The amount of pulse wave corresponds to the cardiac cycle-rapid upstrokes and sharp spikes occur during systole, gradually slopes down during diastole, followed by reflective waves (dicrotic notches). In the presence of arterial disease, the waveform flattens and the pulse width widens. When pulse volume recordings are used in lower limbs, the changes in the waveform denotes the general location of significant disease, whereas it assesses the total blood flow through the area and cannot give accurate information regarding the exact location of the disease [30]. Pulse volume recordings are useful in patients with Diabetes who have falsely elevated Ankle brachial pressure index because of calcified vessels [37], as the effect of calcification on the waveform is usually distinguishable from that because of obstructive arterial disease.
