Arterial pulse is normal. human arterial pulse
Normally, pulse fluctuations are symmetrical on both corresponding arteries. Different characteristics of the pulse on the right and left radial arteries underlie the different pulse (p. difference). This difference concerns the filling and tension of the pulse, as well as the time of its appearance. If on the one hand the pulse is of lesser filling and tension, one should think about the narrowing of the artery along the path of the pulse wave. A significant weakening of the pulse on the one hand may be associated with dissecting aortic aneurysm, peripheral embolism, or vasculitis, including damage to the aorta (most often aortitis) at different levels. In the latter case, a gradual lesion of the mouth of one of the large arteries leads to the disappearance of the pulsation on the radial artery (Takayasu's syndrome).
During the period of the decline in the pulse wave, a slight new rise may be felt. This double pulse is called dicrotic. A dicrotic rise is also inherent in a normal pulse, which is recorded on a sphygmogram. When feeling the pulse, dicrotia is rarely determined, the dicrotic wave is explained by the fact that at the beginning of diastole, part of the aortic blood makes a slight backward movement and, as it were, hits the closed valves. This impact creates a new peripheral wave following the main one.
With the correct rhythm, but significant fluctuations in the magnitude of cardiac output, the so-called alternating pulse (p. alternans) is ascertained, in which the filling of individual pulse waves fluctuates.
Thus, various changes in the properties of the pulse are noted. Among them highest value, in addition to frequency and rhythm, have filling and tension of the pulse. In typical cases, healthy person register a rhythmic pulse of moderate (or satisfactory) filling and relaxed.
Evaluation of the properties and basic characteristics of the pulse
The pulse rate is determined by counting the pulse beats for 15-30 seconds, multiplying the resulting figure by 4-2. If the rhythm is wrong, the pulse should be counted for the entire minute. The normal heart rate in men is 60-70 beats per minute, in women up to 80 beats per minute, in children and the elderly, the pulse is more frequent. When assessing the pulse rate, it should be borne in mind that its frequency increases with mental arousal, in some people - when communicating with a doctor, with physical exertion, after eating. With a deep breath, the pulse quickens, with exhalation it becomes less. Increased heart rate is observed in many pathological conditions.
The rhythm of the pulse can be correct (p. regularis) and irregular (p. irregularis). Usually, pulse waves follow at intervals of close duration. In this case, the pulse waves are normally the same or almost the same - this is a uniform pulse (p. aequalis). In pathological conditions, pulse waves can have different sizes - unequal pulse (p. inaequalis), which depends on the difference in the size of diastolic filling and systolic ejection of the left ventricle.
The systolic ejection during individual contractions of the heart can be so different that the pulse wave during contractions with a small ejection may not reach the radial artery, while the corresponding pulse fluctuations are not perceived by palpation. Therefore, if you simultaneously determine the number of heartbeats during auscultation of the heart and during palpation of the pulse on the radial artery, a difference will be revealed, i.e., a pulse deficit, for example, the number of heartbeats during auscultation is 90 per minute, and the pulse on the radial artery is 72 per minute, i.e. The pulse deficit will be 18. Such a deficit pulse (p. deficiens) occurs with atrial fibrillation with tachycardia. In this case, there are large differences in the duration of diastolic pauses and, consequently, in the amount of filling of the left ventricle. This leads to a significant difference in cardiac output during individual systoles. Cardiac arrhythmias can best be characterized and evaluated by electrocardiography.
The voltage of the pulse is characterized by the pressure that must be exerted on the vessel in order to completely interrupt the pulse wave at the periphery. The pulse pressure depends on blood pressure inside the artery, which can be roughly estimated by the voltage of the pulse. There is a tense or hard pulse (p. durus), and a soft pulse (p. mollis), or relaxed.
The filling of the pulse corresponds to fluctuations in the volume of the artery in the process of heart contractions. It depends on the magnitude of systolic ejection, the total amount of blood and its distribution. The filling of the pulse is estimated by comparing the volume of the artery with its complete compression and with the restoration of blood flow in it. According to the filling, the pulse is full (p. plenus), or satisfactory filling, and the pulse is empty pp. vacuum). The most striking example of a decrease in pulse filling is the pulse during shock, when the amount of circulating blood and at the same time systolic output decrease.
The value of the pulse is determined on the basis of a general assessment of the tension and filling of the pulse, their fluctuations with each pulse beat. The value of the pulse is greater, the greater the amplitude of the arterial pressure. In size, the pulse is large (p. magnus) and the pulse is small (p. parvus).
The shape of the pulse is characterized by the rapid rise and fall of pressure inside the artery. The ascent may be more rapid, depending on the rate at which the left ventricle ejects blood into the arterial system. The pulse, characterized by a rapid rise in the pulse wave and a rapid fall, is called fast (p. celer). Such a pulse is observed with aortic valve insufficiency, to a lesser extent with significant nervous excitement. In this case, the pulse is not only fast, but also high (p. celer et altus). The opposite form of the pulse - p. tardus et parvus is characterized by a slow rise in the pulse wave and its gradual decrease. Such a pulse occurs with stenosis of the aortic orifice.
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Auscultation of the arteries
Auscultation of the arteries is performed without significant pressure, since high pressure artificially causes stenotic noise. The following main places of listening are noted: carotid artery- at the inner edge of the sternocleidomastoid muscle at the level of the upper edge of the thyroid cartilage; subclavian - under the collarbone; femoral - under the pupart ligament; renal - in the umbilical region on the left and right. Under normal conditions, tones are heard over the carotid and subclavian arteries: tone I depends on the passage of the pulse wave, tone II is associated with the closing of the aortic valves and pulmonary artery. Noises in the arteries are heard during their expansion or narrowing, as well as during the conduction of noises generated in the heart.
Vibrations in the walls of blood vessels caused by the contraction of the heart. Arterial pulse is formed due to fluctuations blood pressure and blood filling in the arteries during the cardiac cycle. Normal heart rate is 60-80 beats per minute. Biology. Modern Encyclopedia
Pulse (blow, push) is a jerky, periodic oscillation of the vascular wall.
Distinguish:
Central pulse: pulse of the aorta, subclavian and carotid arteries;
Peripheral pulse: pulse of the temporal arteries and arteries of the extremities;
Capillary (precapillary) pulse;
venous pulse.
The study of the pulse is of great clinical importance, as it allows you to obtain very valuable and objective information about the state of central and peripheral hemodynamics and the state of other organs and systems.
Pulse Properties
The properties of the pulse of the peripheral arteries depend on:
- frequency, speed and force of contraction of the left ventricle;
- magnitude of stroke volume;
- elasticity of the vascular wall;
- patency of the vessel (the value of the inner diameter);
- the value of peripheral vascular resistance.
The quality of the pulse should be evaluated strictly according to the following scheme:
- the same pulse on symmetrical arteries;
- frequency of pulse waves per minute;
- rhythm;
- pulse voltage;
- filling the pulse;
- the value of the pulse;
- the shape of the pulse;
- condition of the vascular wall (vessel elasticity).
These 8 properties of the pulse must be known impeccably.
Pulse uniformity
In a healthy person, the pulse on the radial arteries is the same on both sides. The difference is possible only with an atypical location of the radial artery, in which case the vessel can be found in an atypical place - lateral or medial. If this fails, then pathology is assumed.
Pathological reasons for the absence of a pulse on one side or different pulse sizes on symmetrical vessels are as follows:
- anomaly in the development of the vessel,
- inflammatory or atherosclerotic vascular disease,
- compression of the vessel by a scar,
- a tumor
- lymph node.
Having found a difference in the properties of the pulse, it is necessary to establish the level of damage to the vessel by examining the radial artery at an accessible level, then the ulnar, brachial, subclavian arteries.
After making sure that the pulse is the same on both hands, further research is carried out on one of them.
Pulse rate
The pulse rate depends on the heart rate. It is better to count the pulse rate in the patient's sitting position after 5 minutes of rest in order to exclude the influence of physical and emotional stress (meeting with the doctor, walking).
The pulse is counted in 30 seconds, but better in 1 minute.
In a healthy person at the age of 18-60 years, the pulse rate ranges from 60-80 beats per minute, in women the pulse is 6-8 beats per minute more often than in men of the same age.
Asthenics the pulse is somewhat more frequent than in hypersthenics of the same age.
In old age in some patients, the pulse rate increases, in some it becomes less frequent.
For tall people the pulse is more frequent than in short people of the same sex and age.
Well trained people have a decrease in heart rate of less than 60 beats per minute.
Every person the pulse rate changes from the position of the body - in a horizontal position, the pulse slows down, when moving from a horizontal to a sitting position, it quickens by 4-6 beats, when standing up, it still quickens by 6-8 beats per minute. The newly adopted horizontal position again slows down the pulse.
All fluctuations in heart rate depend on from the predominance of the sympathetic or parasympathetic division of the autonomic nervous system.
- During sleep, the pulse especially slows down.
- Emotional, physical stress, eating, abuse of tea, coffee, tonic drinks leads to an increase in the tone of the sympathetic nervous system and an increase in heart rate.
- The phase of respiration also affects the pulse rate, on inspiration the frequency increases, on exhalation it decreases, which reflects the state of the autonomic nervous system - on inspiration the tone of the vagus decreases, on expiration it increases.
A pulse over 80 beats per minute is called fast. tachyphygmia, as a reflection of tachycardia, pulse less than 60 - rare, bradysphygmia as a reflection of bradycardia.
In practice, the terms tachyphygmia and bradysphygmia have not taken root; doctors, with the indicated deviations in the pulse rate, use the terms tachycardia and bradycardia.
Frequent heart rate
A frequent pulse that is not provoked by physical, emotional, nutritional and drug stress (atropine, adrenaline, mezaton, etc.) most often reflects trouble in the body.
Tachycardia can be of extracardiac and cardiac origin.
Almost all cases of fever are accompanied by an increase in heart rate, an increase in body temperature by 1 degree leads to an increase in heart rate by 8-10 beats per minute.
An increase in the pulse occurs with pain, with most infectious and inflammatory diseases, with anemia, surgical diseases and surgical interventions, with thyrotoxicosis.
Tachycardia in the form of seizures is called paroxysmal tachycardia, while the pulse rate reaches 140-200 beats per minute.
rare pulse
A rare pulse is noted with a significant increase in the tone of the vagus for extracardiac reasons - intracranial trauma, some diseases of the gastrointestinal tract, liver, decreased thyroid function (myxedema), cachexia, starvation, meningitis, shock, rapid rise in blood pressure, taking digitalis preparations, beta - adrenoblockers, etc.
For cardiac reasons, a rare pulse (bradycardia) is observed with weakness of the sinus node, blockade of the conduction system, and narrowing of the aortic orifice.
The pulse rate, especially in cases of slowing down and arrhythmia, must be compared with the number of heartbeats counted in 1 minute during auscultation of the heart.
The difference between the number of heartbeats and the pulse is called pulse deficit.
Pulse Rhythm
In a healthy person, pulse waves follow at regular intervals, at regular intervals. Such a pulse is called rhythmic, regular, while the heart rate can be different - normal, rapid, slow.
A pulse with uneven intervals is called arrhythmic, irregular. In healthy adolescents and young people with labile autonomic regulation of blood circulation, respiratory sinus arrhythmia is noted. At the beginning of expiration, due to an increase in the tone of the vagus nerve, there is a temporary slowdown in the rate of heart contractions, a slowdown in the pulse rate. During inspiration, there is a weakening of the influence of the vagus and the heart rate increases slightly, the pulse quickens. When holding the breath, such respiratory arrhythmia disappears.
Arrhythmic pulse is most often caused by heart disease. It is most clearly detected in such heart rhythm disturbances as extrasystole and atrial fibrillation.
Extrasystole is a premature contraction of the heart. After a normal pulse wave, a premature small pulse wave slips under the fingers, sometimes it is so small that it is not even perceived. It is followed by a long pause, after which there will be a large pulse wave due to a large stroke volume. Then again there is an alternation of normal pulse waves.
Extrasystoles can be repeated after 1 normal beat (bigeminia), after 2 trigeminia), etc.
Another common variant of an arrhythmic pulse is atrial fibrillation. It appears with a chaotic contraction of the heart ("nonsense of the heart").
Pulse waves on the vessels have an irregular, chaotic alternation, they are also different in size due to the different stroke volume.
The frequency of pulse waves can range from 50 to 160 per minute. If atrial fibrillation begins suddenly, then they talk about its paroxysm.
An arrhythmic pulse is called in cases of its sudden increase in a person at rest, up to a frequency of 140-180 beats per minute, that is, with paroxysmal tachycardia. Such an attack can just as suddenly stop. Arrhythmic include the so-called alternating or intermittent pulse, in which there is a correct alternation of large and small pulse waves. This is typical for severe myocardial diseases, a combination of hypertension with tachycardia.
An irregular pulse is also observed in other rhythm disturbances: parasystole, sick sinus syndrome, sinus node failure, atrioventricular dissociation.
Pulse voltage
This property reflects intravascular pressure and the state of the vascular wall, its tone and density.
There are no objective criteria for assessing pulse tension, the technique is being worked out empirically in the study of healthy and sick people.
The degree of pulse tension is determined by the resistance of the vessel to the pressure of the finger.
When determining tension, the third, proximal finger (the one closest to the heart) gradually presses on the artery until the distally located fingers no longer feel the pulsation.
In a healthy person with a normal pulse tension, a moderate effort is required to clamp the vessel. The pulse of a healthy person is estimated as a pulse of satisfactory tension.
If significant strengthening is required and the vascular wall has a significant resistance to clamping, then they speak of a tense, hard pulse, which is typical for hypertension of any genesis, severe sclerosis or vasospasm.
A decrease in vessel tension, slight squeezing of the pulse indicates a soft pulse, which is observed with a decrease in blood pressure, a decrease in vascular tone.
Filling the pulse
It is estimated by the magnitude of the fluctuation of the vascular wall in systole and diastole, that is, by the difference between the maximum and minimum volumes of the artery. Filling mainly depends on the magnitude of the stroke volume and the total mass of blood, its distribution.
The degree of filling of the pulse can be judged using the following technique.
The proximal finger pinches the vessel completely, the distally located fingers feel the empty vessel, determining the state of the vascular wall. Then the pressure of the proximal finger stops, and the distal fingers feel the amount of filling of the artery. Fluctuations in the filling of the vessel from zero to the maximum reflects the filling of the vessel.
Another method for assessing the filling of the pulse is based on determining the magnitude of the fluctuation of the vascular wall from the level of diastolic filling to the level of systolic. All fingers placed on the vessel do not exert pressure on it, but only lightly touch the surface of the vessel during diastole. In systole, at the time of the passage of the pulse wave, the fingers easily perceive the magnitude of the fluctuation of the vascular wall, that is, the filling of the vessel.
In a person with normal hemodynamics, the filling of the pulse is assessed as satisfactory. With emotional and physical stress, as well as for some time (3-5 minutes) after exercise, due to an increase in stroke volume, the pulse will be full.
A full pulse is noted in patients with a hyperkinetic type of blood circulation (NCD, hypertension), as well as in aortic insufficiency. Poor filling pulse - empty pulse - patients with severe hemodynamic disorders (collapse, shock, blood loss, myocardial insufficiency) have.
Pulse value
The value of the pulse is a reflection of the relationship between such properties of the pulse as filling and tension. It depends on the magnitude of the stroke volume, the tone of the vascular wall, its ability to elastic stretch in systole and fall in diastole, on the magnitude of blood pressure fluctuations in systole and diastole.
In a healthy person with satisfactory filling and tension of the pulse, the pulse value can be described as satisfactory. However, in practice, the value of the pulse is spoken only when there are deviations in the form:
Large pulse (high pulse);
Small pulse (its extreme form is filiform).
big pulse occurs with increased stroke volume and reduced vascular tone. The fluctuation of the vascular wall under these conditions is significant, so a large pulse is also called high.
In healthy people, such a pulse can be felt after exercise, baths, baths.
In pathology, patients with valve insufficiency, aorta, thyrotoxicosis, and fever have a large pulse. In hypertension with a large difference between systolic and diastolic pressure (large pulse pressure), the pulse will also be large.
Small stroke volume of the left ventricle gives rise to a small amplitude of oscillation of the vascular wall in systole and diastole. An increase in vascular tone also leads to a decrease in the oscillation of the vascular wall during the cardiac cycle. All this fits into the concept of a small pulse, which patients with heart defects such as narrowing of the aortic orifice, mitral valve stenosis have. A small pulse is characteristic of acute cardiovascular insufficiency.
In shock, acute heart and vascular insufficiency, massive blood loss, the pulse is so small that it is called a thready pulse.
Pulse shape
The shape of the pulse depends on the rate of pressure change in the arterial system during systole and diastole, which is reflected in the rate of rise and fall of the pulse wave.
The shape of the pulse also depends on the speed and duration of contraction of the left ventricle, the state of the vascular wall and its tone.
In a person with normal functioning of the cardiovascular system, when assessing the pulse, one usually does not talk about the shape of the pulse, although it could be called “normal”.
As options for the shape of the pulse, fast and slow pulses are distinguished.
In healthy people, only a fast pulse can be detected after physical and emotional stress. Fast and slow pulses are found in pathology.
Fast (short, jumping) pulse
Fast (short, jumping) pulse is characterized by a steep rise, a short plateau and a sharp decline in the pulse wave. Such a wave is usually high. A fast pulse is always detected with aortic valve insufficiency, in which there is an increased stroke volume, a large force and speed of contraction of the left ventricle in a short time, a large difference between systolic and diastolic pressure (diastolic may drop to zero).
A fast pulse occurs with reduced peripheral resistance (fever), with thyrotoxicosis, some forms of hypertension, nervous excitability, and anemia.
slow pulse
Slow pulse - the opposite of a fast pulse, characterized by a slow rise and fall of a low pulse wave, which is due to the slow rise and fall of blood pressure during the cardiac cycle. Such a pulse is due to a reduced rate of contraction and relaxation of the left ventricle, an increase in the duration of systole.
A slow pulse is observed when the expulsion of blood from the left ventricle is difficult due to an obstruction in the path of blood outflow into the aorta, which is typical for aortic stenosis, high diastolic hypertension. A slow pulse will also be small due to the limitation of the magnitude of the oscillation of the vascular wall.
Dicrotic pulse
A dicrotic pulse is one of the features of the pulse shape, when a short-term slight rise is felt on the falling part of the pulse wave, that is, the second wave, but of lesser height and strength.
An additional wave occurs when the tone of the peripheral arteries is weakened (fever, infectious diseases), it expresses a reverse blood wave reflected by the closed aortic valves. This wave is the greater, the lower the tone of the arterial wall.
Dicrotic pulse reflects a decrease in peripheral vascular tone with preserved myocardial contractility.
The state of the vascular wall
The vascular wall is examined after complete clamping of the artery with a proximal finger, that is, an empty vessel is examined. Distally located fingers feel the wall by rolling through the vessel.
A normal vascular wall is either not palpable or is defined as a tender, soft, flattened band about 2–3 mm in diameter.
In old age, the vascular wall sclerotizes, becomes dense, palpable in the form of a cord, sometimes the vessel is convoluted, bumpy in the form of a rosary. A dense, poorly pulsating or non-pulsating artery occurs with Takayasu's disease (pulseless disease), which is caused by inflammation of the vascular wall, as well as vascular thrombosis.
Pulse deficit
Pulse deficit is a discrepancy between the number of heartbeats and the number of pulse waves.
This means that part of the pulse waves does not reach the periphery due to a sharply reduced stroke volume of individual heart contractions.
This happens with early extrasystoles and with atrial fibrillation.
15. Method for determining the pulse. Name the main characteristics of the pulse in normal and pathological conditions.
The pulse is a periodic expansion and contraction of the arteries, synchronous with cardiac activity.
The pulsation of the carotid, temporal, brachial, ulnar, radial, femoral, popliteal, posterior tibial and dorsal arteries of the feet is available for palpation.
The study of the pulse on the common carotid arteries should begin with the simultaneous palpation of it on both sides of the neck. The index finger of the palpating hand is placed over the apex of the lung, parallel to the clavicle, and the carotid artery is gently pressed posteriorly to the outer edge of the sternocleidomastoid muscle with the pulp of the nail phalanx. Also, the common carotid arteries are palpated at the inner edges of the sternocleidomastoid muscle at the level of the cricoid cartilage. Palpation of the carotid arteries must be done carefully.
Study of the pulse on the temporal arteries - you can palpate both temporal arteries at the same time; the pulp of the nail phalanges of the second-fourth fingers of both hands gently presses the temporal arteries to the front of the skull at the front edges and slightly above the auricles.
Examination of the pulsation of the aortic arch through the jugular fossa - the index finger of the right hand is lowered deep to the bottom of the jugular notch; with the expansion of the aortic arch or its lengthening, the finger feels pulse beats.
Examination of the pulse on the brachial artery - palpate with the pulp of the nail phalanges of the second-fourth fingers of one hand as deep as possible in the lower third of the shoulder at the inner edge of the biceps muscle of the shoulder, the second hand holds the patient's hand.
Examination of the pulse on the ulnar artery - palpate with the pulp of the nail phalanges of the second-fourth fingers of one hand in the region of the middle of the cubital fossa, the second hand - hold the patient's extended arm by the forearm.
The pulsation of the femoral artery is determined by the pulp of the nail phalanges of the second to fourth fingers below the pupart ligament 2-3 cm outward from the midline.
The study of the pulse on the popliteal artery - it is better to perform in the position of the patient on the back or on the stomach with the knee joint bent at an angle of 120-140º; performed with the pulp of the nail phalanges of the second or fourth fingers, installed in the middle of the knee fossa.
Examination of the pulse on the dorsal artery of the foot - is performed by the pulp of the nail phalanges of the second to fourth fingers on the dorsum of the foot between the first and second metatarsal bones, less often - lateral to this area or directly on the bend of the ankle joint.
The pulsation of the posterior tibial artery is determined by the pulp of the nail phalanges of the second to fourth fingers in the gap between the posterior edge of the medial malleolus and the inner edge of the Achilles tendon.
It is customary to evaluate the properties of the pulse only on radial artery.
Technique for probing the pulse on the radial artery:
The radial artery is located under the skin between the styloid process of the radius and the tendon of the internal radial muscle. The thumb is placed on the back of the forearm, and the remaining fingers are placed on the passage of the radial artery. You can not strongly squeeze the patient's hand, since the pulse wave will not be felt in the pinched artery. You should not feel the pulse with one finger, because. it is more difficult to find the artery and determine the nature of the pulse.
If the artery does not immediately fall under the fingers, they need to be moved along the radius and across the forearm, since the artery can pass outwards or closer to the middle of the forearm. In some cases, the main branch of the radial artery passes from the outside of the radius.
The study of the pulse begins with the simultaneous probing of it on both hands. If there is no difference in the properties of the pulse, they proceed to the study of the pulse on one arm. If there is a difference in the properties of the pulse, then it is studied in turn on each hand.
It is necessary to evaluate the following characteristics of the pulse:
1) the presence of a pulse;
2) the sameness and simultaneity of pulse waves on both radial arteries;
3) pulse rhythm;
4) pulse rate in 1 minute;
6) filling the pulse;
7) the value of the pulse;
8) speed (shape) of the pulse;
9) the uniformity of the pulse;
10) correspondence of the number of pulse waves to the number of heartbeats per unit of time (in 1 minute);
11) elasticity of the vascular wall.
The presence of a pulse.
Normally, pulse shocks are palpable on both radial arteries.
The absence of a pulse in both upper limbs occurs with Takayasu's disease (aortoarteritis obliterans).
The absence of a pulse on the artery of one of the limbs occurs with obliterating atherosclerosis, thrombosis or embolism of the artery proximal to the artery with no pulsation.
The sameness and simultaneity of pulsewaves on both radial arteries.
Normally, pulse shocks are the same and appear simultaneously on both radial arteries.
The pulse on the left radial artery may be smaller (pulsus differens) - observed in patients with severe mitral stenosis or aneurysm of the aortic arch (Popov-Saveliev symptom).
Pulse rhythm.
Normally, pulse shocks follow at regular intervals (correct rhythm, pulsus regularis).
1. Arrhythmic pulse (pulsus inaecqualis) - a pulse in which the intervals between pulse waves are not the same. It may be due to dysfunction of the heart:
a) excitability (extrasystole, atrial fibrillation);
b) conduction (atrioventricular block II degree);
c) automatism (sinus arrhythmia).
2. Alternating pulse (pulsus alternans)) - a rhythmic pulse, in which the pulse waves are uneven: large and small pulse waves alternate. Such a pulse occurs in diseases accompanied by a significant weakening of the contractile function of the left ventricular myocardium (myocardial infarction, cardiosclerosis, myocarditis).
3. Paradoxical pulse (pulsuspanadoxus) - a pulse when the pulse waves in the inhalation phase decrease or disappear altogether, and are clearly palpated in the exhalation phase. This symptom occurs with constrictive and exudative pericarditis.
Pulse rate in 1 minute.
The number of pulse shocks is counted in 15 or 30 s and the result obtained is multiplied by 4 or 2, respectively. With a rare pulse, it is necessary to count at least 1 minute (sometimes 2 minutes). In healthy adults, the pulse rate ranges from 60 to 90 per minute.
Frequent pulse (pulsus frequens) - a pulse whose frequency is more than 90 per minute (tachycardia).
Rare pulse (pulsusrarus) - a pulse whose frequency is less than 60 per minute (bradycardia).
Pulse tension.
Pulse tension is the tension of the arterial wall, which corresponds to the strength of its resistance when pressed with fingers until the pulse waves stop. The intensity of the pulse is due to the tone of the arterial wall and the lateral pressure of the blood wave (i.e. blood pressure). To determine the voltage of the pulse, the 3rd finger gradually presses on the artery until the 2nd finger ceases to feel the pulsating blood flow. Normal pulse of good tension.
Intense (hard) pulse (pulsus durus) - occurs with increased systolic blood pressure, sclerotic thickening of the artery wall, aortic insufficiency.
A soft pulse (pulsusmollis) is a symptom of low systolic blood pressure.
Pulse filling.
Pulse filling is the amount (volume) of blood that forms a pulse wave. By pressing on the radial artery with different force, they get a feeling of the volume of its filling. Healthy people have a good filling pulse.
Full pulse (pulsus plenus) is a symptom of conditions accompanied by an increase in the stroke volume of the left ventricle and an increase in the mass of circulating blood.
Empty pulse (pulsus vacuus) is a symptom of conditions accompanied by a decrease in stroke volume, a decrease in the amount of circulating blood (acute heart failure, acute vascular insufficiency, acute post-hemorrhagic anemia).
The value of the pulse.
The pulse value is the amplitude of the oscillations of the arterial wall during the passage of a blood wave. The value of the pulse is determined on the basis of an assessment of its filling and tension. A large pulse is characterized by good tension and filling, a small pulse is a soft and empty pulse. Healthy people have an adequate heart rate.
Large pulse (pulsus magnus) - occurs in conditions accompanied by an increase in the stroke volume of the heart in combination with normal or reduced arterial tone (pulse pressure is increased).
Small pulse (pulsusparvus) - occurs in conditions accompanied by an increase in the stroke volume of the heart or normal stroke volume in combination with an increase in arterial tone (pulse pressure is reduced).
The speed (shape) of the pulse.
The speed (shape) of the pulse is determined by the rate of contraction and relaxation of the radial artery. Normally, the shape of the pulse is characterized by a smooth and steep rise and the same descent (normal pulse shape).
Fast or jumping pulse (pulsus celer at attus) - a pulse with a rapid rise and fall of the pulse wave, occurs with insufficiency of the aortic valves and in conditions accompanied by an increased stroke volume of the heart in combination with normal or reduced arterial tone.
Slow pulse (pulsustardus) - a pulse with a slow rise and fall of the pulse wave, occurs with stenosis of the aortic orifice and in conditions accompanied by arterial hypertension due to increased arterial tone (diastolic blood pressure is increased).
Correspondence of the number of pulse waves to the number of heartbeats per unit of time (per 1 minute).
Normally, the number of pulse waves corresponds to the number of heartbeats per unit time (per 1 minute).
Pulse deficit (pulsusdeficiens) - the number of pulse waves per unit time is less than the number of heartbeats, characteristic of extrasystole and atrial fibrillation.
Elasticity of the vascular wall.
Two methods are used to assess the condition of the wall of the radial artery.
1. First, with the 2nd or 3rd finger of one hand, the radial artery is pressed down so that its pulsation stops below the place of clamping. Then, with the 2nd or 3rd finger of the other hand, several careful movements are made along the artery distally (below) the place of its clamping and the state of its wall is assessed. The radial artery with an unchanged wall in a state of bleeding is not palpable (elastic).
2. With the second and fourth fingers of the palpating hand, they squeeze the radial artery, and with the 3 (middle) finger, they study the properties of its wall with sliding movements along and across it.
Characteristics of the pulse is normal:
1) pulse waves are clearly palpable;
2) pulse waves on both radial arteries are the same and simultaneous;
3) rhythmic pulse (pulsus regularis);
4) frequency 60-90 per minute;
5) average in voltage, content, size and speed (shape);
6) uniform;
7) without deficit (correspondence of the number of pulse waves to the number of heartbeats);
8) the wall of the artery is elastic.
Pathological changes in the pulse:
1) lack of pulse;
2) the pulse on both radial arteries is not the same (p. differens);
4) soft pulse (p. mollis);
5) full pulse (p. plenus);
6) empty pulse (p. vacuus);
7) large pulse (p. magnus);
8) small pulse (p. parvus);
9) rapid pulse (p. celer);
10) slow pulse (p. tardus);
11) frequent pulse (p. frequens);
12) rare pulse (p. rarus);
13) arrhythmic pulse (p. inaecqualis);
14) pulse deficit (p. deficiens);
15) paradoxical pulse (p. panadoxus);
16) alternating pulse (p.alternans);
17) threadlike pulse (p. filiformis).
During the contraction of the heart, another portion of blood is pushed into the vascular system. Its blow to the wall of the artery creates vibrations, which, propagating through the vessels, gradually fade to the periphery. They got the name of the pulse.
What is the pulse like?
There are three types of veins and capillaries in the human body. The ejection of blood from the heart affects each of them in one way or another, causing their walls to oscillate. Of course, arteries, as the vessels closest to the heart, are more affected by cardiac output. The fluctuations of their walls are well defined by palpation, and in large vessels they are even visible to the naked eye. That is why the arterial pulse is most significant for diagnosis.
Capillaries are the smallest vessels in the human body, but even they reflect the work of the heart. Their walls fluctuate in time with heartbeats, but normally this can only be determined with the help of special devices. A capillary pulse visible to the naked eye is a sign of pathology.
The veins are so far from the heart that their walls do not oscillate. The so-called venous pulse is a transmission vibration from closely spaced large arteries.
Why determine the pulse?
What is the significance of the fluctuations of the vascular walls for diagnosis? Why is it so important?
The pulse allows you to judge hemodynamics, how effectively it is reduced about the fullness of the vascular bed, about the rhythm of heart beats.
In many pathological processes, the pulse changes, the characteristic of the pulse ceases to correspond to the norm. This allows you to suspect that not everything is in order in the cardiovascular system.
What parameters determine the pulse? Pulse characteristic
- Rhythm. Normally, the heart contracts at regular intervals, which means that the pulse should be rhythmic.
- Frequency. Normally, there are as many pulse waves as there are heart beats per minute.
- Voltage. This indicator depends on the value of systolic blood pressure. The higher it is, the more difficult it is to squeeze the artery with your fingers, i.e. pulse pressure is high.
- Filling. Depends on the volume of blood ejected by the heart in systole.
- Value. This concept combines content and tension.
- The shape is another parameter that determines the pulse. The characteristic of the pulse in this case depends on the change in blood pressure in the vessels during systole (contraction) and diastole (relaxation) of the heart.
Rhythm disturbances
With violations of the generation or conduction of an impulse through the heart muscle, the rhythm of heart contractions changes, and with it the pulse also changes. Separate fluctuations of the vascular walls begin to fall out, or appear prematurely, or follow each other at irregular intervals.
What are rhythm disturbances?
Arrhythmias with a change in the work of the sinus node (a section of the myocardium that generates impulses leading to a contraction of the heart muscle):
- Sinus tachycardia - an increase in the frequency of contractions.
- Sinus bradycardia - a decrease in the frequency of contractions.
- Sinus arrhythmia - contractions of the heart at irregular intervals.
ectopic arrhythmias. Their occurrence becomes possible when a focus appears in the myocardium with an activity higher than that of the sinus node. In such a situation, the new pacemaker will suppress the activity of the latter and impose its rhythm of contractions on the heart.
- Extrasystole - occurrence of sudden cardiac contractions. Depending on the localization of the ectopic focus of excitation, extrasystoles are atrial, atrioventricular and ventricular.
- Paroxysmal tachycardia - a sudden increase in rhythm (up to 180-240 heart beats per minute). Like extrasystoles, it can be atrial, atrioventricular and ventricular.
Violation of impulse conduction in the myocardium (blockade). Depending on the location of the problem that prevents normal progression from the sinus node, blockades are divided into groups:
- (the impulse does not go beyond the sinus node).
- (the impulse does not pass from the atria to the ventricles). With complete atrioventricular blockade (III degree), a situation becomes possible when there are two pacemakers (the sinus node and the focus of excitation in the ventricles of the heart).
- Intraventricular block.
Separately, one should dwell on the flicker and flutter of the atria and ventricles. These conditions are also called absolute arrhythmia. The sinus node in this case ceases to be a pacemaker, and in the myocardium of the atria or ventricles, multiple ectopic foci of excitation are formed, setting the heart to a rhythm with a huge contraction rate. Naturally, under such conditions, the heart muscle is not able to adequately contract. Therefore, this pathology (especially from the side of the ventricles) is a threat to life.
Heart rate
The pulse at rest in an adult is 60-80 beats per minute. Of course, this figure changes throughout life. The pulse varies significantly with age.
There may be a discrepancy between the number of heart contractions and the number of pulse waves. This happens if a small volume of blood is ejected into the vascular bed (heart failure, a decrease in the amount of circulating blood). In this case, oscillations of the vessel walls may not occur.
Thus, the pulse of a person (the norm for age is indicated above) is not always determined on the peripheral arteries. This, however, does not mean that the heart also does not contract. Perhaps the reason is a decrease in the ejection fraction.
Voltage
Depending on the changes in this indicator, the pulse also changes. The characteristic of the pulse according to its voltage provides for the division into the following varieties:
- Solid pulse. Due to high blood pressure (BP), primarily systolic. It is very difficult to pinch the artery with your fingers in this case. The appearance of this type of pulse indicates the need for urgent correction of blood pressure with antihypertensive drugs.
- Soft pulse. The artery compresses easily, and this is not very good, because this type of pulse indicates too low blood pressure. It can be due to various reasons: a decrease in vascular tone, inefficiency of heart contractions.
Filling
Depending on the changes in this indicator, the following types of pulse are distinguished:
- means that the blood supply to the arteries is sufficient.
- Empty. Such a pulse occurs with a small volume of blood ejected by the heart in systole. The causes of this condition can be a pathology of the heart (heart failure, arrhythmias with too high a heart rate) or a decrease in the volume of blood in the body (blood loss, dehydration).
Pulse value
This indicator combines the filling and tension of the pulse. It depends primarily on the expansion of the artery during the contraction of the heart and its subsidence during the relaxation of the myocardium. The following types of pulse are distinguished by magnitude:
- Big (high). It occurs in a situation where there is an increase in the ejection fraction, and the tone of the arterial wall is reduced. At the same time, the pressure in systole and diastole is different (for one cycle of the heart, it increases sharply, and then decreases significantly). The causes leading to the occurrence of a large pulse may be aortic insufficiency, thyrotoxicosis, fever.
- Small pulse. Little blood is ejected into the vascular bed, the tone of the arterial walls is high, pressure fluctuations in systole and diastole are minimal. Causes of this condition: aortic stenosis, heart failure, blood loss, shock. In especially severe cases, the value of the pulse may become insignificant (such a pulse is called thready).
- Even pulse. This is how the value of the pulse is normal.
Pulse shape
According to this parameter, the pulse is divided into two main categories:
- fast. In this case, during systole, the pressure in the aorta rises significantly, and quickly drops in diastole. A rapid pulse is a characteristic sign of aortic insufficiency.
- Slow. The opposite situation, in which there is no place for significant pressure drops in systole and diastole. Such a pulse usually indicates the presence of aortic stenosis.
How to properly examine the pulse?
Probably everyone knows what needs to be done to determine what kind of pulse a person has. However, even such a simple manipulation has features that you need to know.
The pulse is examined on the peripheral (radial) and main (carotid) arteries. It is important to know that with a weak cardiac output in the periphery, pulse waves may not be detected.
Consider how to palpate the pulse on the arm. The radial artery is accessible for examination at the wrist just below the base of the thumb. When determining the pulse, both arteries (left and right) are palpated, because. situations are possible when pulse fluctuations are not the same on both hands. This may be due to compression of the vessel from the outside (for example, by a tumor) or blockage of its lumen (thrombus, atherosclerotic plaque). After comparison, the pulse is evaluated on the arm where it is better palpable. It is important that when examining pulse fluctuations, not one finger, but several, is on the artery (it is most effective to clasp the wrist so that 4 fingers, except for the thumb, are on the radial artery).
How is the pulse on the carotid artery determined? If the pulse waves are too weak on the periphery, you can examine the pulse on the main vessels. The easiest way is to try to find it on the carotid artery. To do this, two fingers (index and middle) must be placed on the area where the indicated artery is projected (at the front edge of the sternocleidomastoid muscle above the Adam's apple). It is important to remember that it is impossible to examine the pulse from both sides at once. Pressing the two carotid arteries can cause circulatory disorders in the brain.
The pulse at rest and with normal hemodynamic parameters is easily determined both on peripheral and central vessels.
A few words in conclusion
(the norm by age must be taken into account in the study) allows us to draw conclusions about the state of hemodynamics. Certain changes in the parameters of pulse fluctuations are often characteristic signs of certain pathological conditions. That is why the study of the pulse is of great diagnostic value.
