Pulse is the fluctuations of the vascular wall associated with changes in their blood supply during the cardiac cycle. There are arterial, venous and capillary pulses. The study of arterial pulses gives important information about the work of the heart, the state of blood circulation and the properties of arteries. The main method for studying the pulse is probing of the arteries. For the palpation of the radial artery, the hand of the examined person is wrapped freely in the wrist area so that the thumb is located on the back of the forearm and the other fingers on the anterior surface of the radial bone, where the pulsating radial artery is felt under the skin. The pulse is probed simultaneously on both hands, as sometimes on the right and left hand it is expressed unequally (due to the anomaly of the vessels, compression or blockage of the subclavian or brachial artery). In addition to the radial artery, the pulse is examined on the carotid, femoral, temporal arteries, foot arteries, etc. (Fig. 1). An objective characteristic of the pulse is given by its graphic registration (see Sphygmography ). In a healthy person, the pulse wave rises relatively steeply and slowly decreases (Fig. 2, 1); in some diseases, the pulse wave shape changes. In the study of the pulse determine its frequency, rhythm, filling, tension and speed.
How to measure your heart rate
Fig. 1. The method of measuring the pulse on different arteries: 1 - temporal; 2 - shoulder; 3 - dorsal artery of the foot; 4 - beam; 5 - tibialis posterior; 6 - femoral; 7 - popliteal.
In healthy adults, the pulse rate corresponds to the heart rate and is 60-80 in 1 minute. With increasing heart rate (see Tachycardia ) or their decrease (see Bradycardia ), the pulse rate changes accordingly, and the pulse is called frequent or rare. With an increase in body temperature of 1 °, the pulse rate increases by 8-10 beats per 1 minute. Sometimes the number of pulse beats is less than the heart rate (HR), the so-called pulse deficit. This is explained by the fact that during very weak or premature contractions of the heart, so little blood flows into the aorta that its pulse wave does not reach the peripheral arteries. The higher the pulse deficit, the more unfavorable it affects the blood circulation. To determine the pulse rate, consider it for 30 seconds. and the result is multiplied by two. In case of a heartbeat violation, the pulse is counted for 1 minute.
In a healthy person, the pulse is rhythmic, that is, the pulse waves follow one after another at regular intervals. In cardiac rhythm disorders (see Arrhythmias of the heart ), pulse waves usually follow at irregular intervals, the pulse becomes arrhythmic (Fig. 2, 2).
|Age||normal average pulse at rest, frequency of beats per minute|
|in men||among women||athletes|
|18-25 years old||70-73||74-78||49-55||54-60|
|26-35 years old||71-74||73-76||49-54||54-59|
|36-45 years old||71-75||74-78||50-56||54-59|
|56-65 years old||72-75||74-77||51-56||54-59|
|Over 65 years old||70-73||73-76||50-55||54-59|
The filling of the pulse depends on the amount of blood released during systole into the arterial system, and on the elasticity of the arterial wall. Normally, the pulse wave feels good - full pulse. If less blood enters the arterial system than normal, the pulse wave decreases, the pulse becomes small. In severe blood loss, shock, collapse, pulse waves can hardly be felt, such a pulse is called filamentous. A decrease in the filling of the pulse is also noted in cases of diseases that lead to a thickening of the arterial wall or to a narrowing of their lumen (atherosclerosis). With severe damage to the heart muscle, there is an alternation of a large and a small pulse wave (Fig. 2, 3) - an intermittent pulse.
The voltage of the pulse is related to the height of the blood pressure. When hypertension requires a certain effort to squeeze the artery and stop its pulsation - a hard, or intense, pulse. With low blood pressure, the artery is compressed easily, the pulse disappears with a little effort and is called soft.
The pulse rate depends on the pressure fluctuations in the arterial system during systole and diastole. If, during systole, the pressure in the aorta quickly increases, and during diastole it drops rapidly, then there will be a rapid expansion and collapse of the arterial wall. Such a pulse is called fast, and at the same time it is large (Fig. 2, 4). Most often, rapid and large pulses are observed with aortic valve insufficiency. Slow increase in pressure in the aorta during systole and its slow decrease in diastole causes a slow expansion and a slow collapse of the arterial wall - a slow pulse; at the same time it is small. Such a pulse appears when a narrowing of the aorta mouth occurs due to difficulty in expelling blood from the left ventricle. Sometimes after the main pulse wave, a second, smaller wave appears. This phenomenon is called pulse dicrotism (Fig. 2.5). It is associated with changes in arterial wall tension. Dicrotism pulse occurs in fever, some infectious diseases. When probing arteries examine not only the properties of the pulse, but also the condition of the vascular wall. So, with a significant deposition of calcium salts in the vessel wall, the artery is palpated in the form of a dense, convoluted, rough tube.
Pulse in children is more frequent than in adults. This is due not only to the lesser influence of the vagus nerve, but also to a more intensive metabolism.
With age, the pulse rate gradually decreases. Girls of all ages have a higher heart rate than boys. Creek, anxiety, muscle movements cause a significant increase in pulse in children. In addition, in childhood there is a known irregularity of the pulse periods associated with breathing (respiratory arrhythmia).Go
Pulse (from lat. Pulsus - push) is a rhythmic, jerky vibrations of the walls of blood vessels, resulting from the release of blood from the heart into the arterial system.
The doctors of antiquity (India, Greece, the Arab East) paid much attention to studying the pulse, giving it a decisive diagnostic value. The scientific basis for the study of the pulse was obtained after the discovery by Harvey (W. Harwey) of blood circulation. The invention of the sphygmograph and especially the introduction of modern methods of pulse registration (arteriography, high-speed electrophysmography, etc.) have greatly enhanced knowledge in this area.
At each heart systole, a certain amount of blood is rapidly ejected into the aorta, stretching the initial part of the elastic aorta and increasing the pressure in it. This change in pressure spreads in the form of a wave along the aorta and its branches to the arterioles, where the pulse wave ceases due to their muscular resistance. The propagation of a pulse wave occurs at a speed of 4 to 15 m / s, and the stretching and elongation of the arterial wall caused by it makes up the arterial pulse. There are central arterial pulses (aorta, carotid and subclavian arteries) and peripheral (femoral, radial, temporal, dorsal arteries of the foot, etc.). The difference between these two forms of the pulse is detected when it is graphically recorded by sphygmography (see). On the curve of the pulse - a sphygmogram - they distinguish an ascending (anacrot), a descending (catacrot) parts and a dicrotic wave (dicrote).
Fig. 2. Graphic registration of the pulse: 1 - normal; 2 — arrhythmic (a — b — various species); 3 - intermittent; 4 - big and fast (a), small and slow (b); 5 - dicrotic.
The most commonly examined pulse is the radial artery (a. Radialis), which is located superficially under the fascia and skin between the styloid process of the radial bone and the tendon of the internal radial muscle. With anomalies of the location of the artery, the presence of bandages on the hands or massive edema, the pulse is examined on other arteries that are palpable. The pulse on the radial artery is delayed by approximately 0.2 sec compared with the systole of the heart. The study of the pulse on the radial artery must be carried out on both hands; only in the absence of a difference in the properties of the pulse can we restrict ourselves to further research on one hand. Usually, the hand of the subject is freely grasped with the right hand in the area of the wrist joint and placed at the heart level of the subject. At the same time, the thumb should be located on the elbow side, and the index, middle and ring fingers should be placed directly from the radial artery on the radial artery. Normally, the feeling is a soft, thin, smooth and elastic tube, pulsing under the fingers.
When comparing a pulse on the left and right hands, a different value of it is found, or a pulse on one hand lags compared to the other, then such a pulse is called different (pulsus differens). It is observed most often with unilateral anomalies of the location of vessels, compression of their tumors or enlarged lymph nodes. Aneurism of the aortic arch, if it is located between the nameless and left subclavian arteries, causes a delay and a decrease in the pulse wave in the left radial artery. In mitral stenosis, the enlarged left atrium can squeeze the left subclavian artery, which reduces the pulse wave on the left radial artery, especially in the position on the left side (Popov – Savelyev sign).
The qualitative characteristic of the pulse depends on the activity of the heart and the state of the vascular system. In the study of the pulse pay attention to the following properties.
Pulse rate . The counting of pulse beats should be made not less than 1/2 min., While the resulting figure is multiplied by 2. If the pulse is incorrect, the count should be made within 1 min; with a sharp arousal of the patient at the beginning of the study, it is desirable to repeat the count. Normally, the number of pulse beats in an adult male is on average 70, in women - 80 in 1 min. For automatic counting of the pulse rate, photoelectric pulse meters are currently used, which is very important, for example, to monitor the patient's condition during surgery. Like body temperature, the pulse rate gives two daytime rises - the first around 11 o'clock in the afternoon, the second between 6 and 8 o'clock in the evening. With an increase in the pulse rate of more than 90 in 1 minute, they talk about tachycardia (see); such a frequent pulse is called pulsus frequens. With a pulse rate of less than 60 in 1 minute, they speak of bradycardia (see), and the pulse is called pulsus rarus. In cases where the individual contractions of the left ventricle are so weak that the pulse waves do not reach the periphery, the number of pulse beats becomes less than the number of heart contractions. This phenomenon is called bradisfigmia, the difference between the number of heartbeats and pulse beats per 1 minute is called pulse deficiency, and the pulse itself is called pulsus deficiens. When the body temperature rises, each degree above 37 usually corresponds to an increase in pulse rate by an average of 8 beats per minute. The exception is fever in typhoid fever and peritonitis: in the first case, the relative slowing of the pulse is often observed, in the second - its relative increase. With a drop in body temperature, the pulse rate usually decreases, but (for example, during collapse) this is accompanied by a significant increase in the pulse.
Pulse rhythm . If pulse beats follow one after another at equal intervals of time, then they speak of a correct, rhythmic pulse (pulsus regularis), otherwise an irregular, irregular pulse (pulsus irregularis) is observed. In healthy people, there is often an increase in inhalation of the pulse and inhibition of it on the inhalation — respiratory arrhythmia (Fig. 1); holding your breath eliminates this kind of arrhythmia. By changing the pulse, many types of cardiac arrhythmias can be diagnosed (see); more precisely, they are all determined by electrocardiography.
Fig. 1. Respiratory arrhythmia.
The pulse rate is determined by the nature of the rise and fall of pressure in the artery during the passage of the pulse wave.
A fast, galloping pulse (pulsus celer) is accompanied by a feeling of a very rapid rise and the same rapid decrease in the pulse wave, which is directly proportional at this moment to the rate of change of pressure in the radial artery (Fig. 2). As a rule, such a pulse is simultaneously large, high (pulsus magnus, s. Altus) and is most pronounced for aortic insufficiency. In this case, the finger of the investigator feels not only fast, but also large rises and decreases in the pulse wave. In its pure form, a large, high pulse is sometimes observed during physical exertion and often with complete atrioventricular block. A sluggish, slow pulse (pulsus tardus), accompanied by a feeling of a slow rise and a slow decrease of the pulse wave (Fig. 3), occurs when the aortic aperture narrows when the arterial system fills slowly. Such a pulse, as a rule, is small in magnitude (height) - pulsus parvus, which depends on a small increase in pressure in the aorta during systole of the left ventricle. This type of pulse is characteristic of mitral stenosis, marked weakness of the myocardium of the left ventricle, fainting, collapse.
Fig. 2. Pulsus celer.
Fig. 3. Pulsus tardus.
The pulse voltage is determined by the force required to completely stop the propagation of a pulse wave. In the study of the distal index finger, the vessel is completely squeezed to prevent the penetration of reverse waves, and the most proximally lying ring finger produces a gradually increasing pressure until the “groping” third finger ceases to feel the pulse. There are tense, hard pulse (pulsus durum) and unstressed, soft pulse (pulsus mollis). According to the degree of pulse voltage, one can approximately judge the magnitude of the maximum blood pressure; the higher it is, the more intense the pulse.
The filling of the pulse is the sum of the magnitude (height) of the pulse and in part its voltage. The filling of the pulse depends on the amount of blood in the arteries and on the total circulating blood volume. Pulse full (pulsus plenus), as a rule, is large, high, and empty (pulsus vaccuus), as a rule, is small. With massive bleeding, collapse, shock, the pulse can be barely palpable, filiform (pulsus filiformis). If the pulse waves are not the same in magnitude and degree of filling, then they speak of an uneven pulse (pulsus inaequalis), as opposed to a uniform pulse (pulsus aequalis). Uneven pulse is almost always observed with an arrhythmic pulse in cases of atrial fibrillation, early extrasystoles. A variation of uneven pulse is the alternating pulse (pulsus alternans), when you feel the right alternation of pulse beats of different size and filling. Such a pulse is one of the early signs of severe heart failure; it is best detected sphygmographically with a slight compression of the shoulder with a sphygmomanometer cuff. In cases of falling tone of peripheral vessels it is possible to palpate the second, smaller, dicrotic wave. This phenomenon is called dicrotism, and the pulse - dicrotic (pulsus dicroticus). Such a pulse is often observed during fever (the relaxing effect of heat on the muscles of the arteries), hypotension, sometimes during the recovery period after severe infections. At the same time, a decrease in minimal blood pressure is almost always observed.
Pulsus paradoxus - reduction of pulse waves during inhalation (Fig. 4). And in healthy people at the height of inhalation due to negative pressure in the chest cavity, the blood filling of the left parts of the heart decreases and the heart systole becomes difficult, which leads to a decrease in the size and filling of the pulse. With the narrowing of the upper respiratory tract or myocardial weakness, this phenomenon is more pronounced. In the case of adhesive pericarditis, the heart is strongly stretched by inhaling with the chest, spine and diaphragm, which makes the systolic contraction difficult, reduces the flow of blood into the aorta, and often leads to a complete disappearance of the pulse at the inspiratory height. For adhesive pericarditis is characterized, in addition to this phenomenon, pronounced swelling of the cervical veins due to compression of the superior vena cava and nameless veins.
Fig. 4. Pulsus paradoxus.
Capillary, more precisely pseudocapillary, pulse , or Quincke's pulse, is a rhythmic expansion of small arterioles (not capillaries) as a result of a rapid and significant increase in pressure in the arterial system during systole. At the same time, a large pulse wave reaches the smallest arterioles, but in the capillaries themselves the blood flow remains continuous. Pseudocapillary pulse is most pronounced in aortic insufficiency. True, in some cases, capillaries and even venules (“true” capillary pulses) are involved in pulsatory oscillations, which sometimes happens with a severe form of thyrotoxicosis, fever or in healthy young people during thermal procedures. It is believed that in these cases the arterial knee of capillaries expands from venous congestion. Capillary pulse is best detected when lightly pressing the lip with a glass slide, when alternate, corresponding to the pulse, redness and blanching of its mucous membrane is detected.
Venous pulse reflects fluctuations in the volume of veins as a result of systole and diastole of the right atrium and ventricle, which cause either a slowdown or an acceleration of outflow of blood from the veins into the right atrium (respectively, swelling and subsidence of the veins). The study of the venous pulse is carried out on the veins of the neck, necessarily simultaneously examining the pulse of the external carotid artery. Normally, there is very little noticeable and barely perceptible pulsation with the fingers, when the bulging of the jugular vein precedes the pulse wave on the carotid artery - the right atrial or “negative” venous pulse. In case of tricuspid valve insufficiency, the venous pulse becomes right ventricular, “positive”, since, due to the tricuspid valve defect, there is a reverse (centrifugal) blood flow from the right ventricle to the right atrium and veins. Such venous pulse is characterized by pronounced swelling of the jugular veins simultaneously with the rise of the pulse wave in the carotid artery. If at the same time, press the neck vein in the middle, then its lower segment continues to pulsate. The similar picture can take place at the expressed right ventricular insufficiency and without damage of the three-leaved valve. A more accurate picture of the venous pulse can be obtained using graphical registration methods (see Flebogram).
Hepatic pulse is determined by inspection and palpation, but much more accurately, its character is detected by the graphic recording of the liver pulsation, and especially by X-ray electroscopy. Normally, the hepatic pulse is determined with great difficulty and depends on the dynamic "stagnation" in the hepatic veins as a result of the activity of the right ventricle. In case of tricuspid valve malformations, systolic (with valve insufficiency) or presystolic pulsation (with stenosis of the opening) of the liver may occur as a result of the "hydraulic shutter" of its outflow paths.
Pulse in children . In children, the pulse is much more common than in adults, due to a more intense metabolism, rapid contractility of the heart muscle and less influence of the vagus nerve. The greatest pulse rate in newborns (120-140 beats per 1 min.), But even on the 2-3rd day of life, their heart rate may slow to 70-80 beats per 1 min. (A.F. Tour). With age, the pulse rate decreases (table 2.).
In children, the pulse is most convenient to explore on the radial or temporal artery. In the smallest and most restless children, auscultation of heart sounds can be used to count the pulse. Most accurately, the pulse rate is determined at rest, during sleep. In one child, there are 3.5-4 heartbeats per breath.
The pulse rate in children is subject to large fluctuations.
Increased pulse easily occurs with anxiety, screaming, muscle exercises, eating. The ambient air temperature and barometric pressure also influence the pulse rate (A. L. Sakhnovsky, M. G. Kuliyeva, E. V. Tkachenko). When the child's body temperature rises by 1 °, the pulse quickens to 15-20 beats (A.F. Tour). In girls, the pulse is more frequent than in boys, by 2-6 beats. This difference is particularly pronounced in the period of sexual development.
When assessing the pulse in children, it is necessary to pay attention not only to its frequency, but also to the rhythm, the degree of filling of the vessels, their tension. A sharp increase in pulse rate (tachycardia) is observed with endo- and myocarditis, with heart defects, and infectious diseases. Paroxysmal tachycardia up to 170-300 beats per 1 min. may occur in young children. A decrease in pulse (bradycardia) occurs with an increase in intracranial pressure, with severe forms of malnutrition, with uremia, epidemic hepatitis, typhoid fever, and overdose of digitalis. Slowing the pulse to more than 50-60 beats per 1 min. makes suspect the presence of a heart block.
In children, the same types of cardiac arrhythmias are observed as in adults. In children with an unbalanced nervous system during puberty, as well as against the background of bradycardia during recovery from acute infections, sinus respiratory arrhythmia often occurs: an increase in pulse rate during inhalation and slowdown during exhalation. Extrasystoles in children, often ventricular, occur with myocardial damage, but may also be functional.
A weak pulse of poor filling, more often with tachycardia, indicates symptoms of cardiac weakness, a decrease in blood pressure. A tense pulse indicating an increase in blood pressure is observed in children most often with jade.