The pulse is distinguished. Heart rate and its norm by age. The main characteristics of the pulse

The human heart is a muscular organ that pumps blood through the vessels due to rhythmic contractions. The duration of one cardiac cycle (muscle contraction) is about one second.

Longtime physicians drew attention to this indicator and it turned out that it can act as an indicator of the state of the body. In the third century BC, Herophilus of Chalcedon published the work “Peri spigmon pragmateias”, which stated that the movement of the arteries (as the scientist called the pulsation) can determine the presence of diseases in the body and predict their development in the future.

Now the pulse is one of the basic biomarkers that allows you to make an initial assessment of the state of the cardiovascular system.

Types of pulse

The pulse is of three types:

• arterial,
• venous,
• capillary.

The arterial pulse shows jerky (the word comes from the Latin pulsus - push) oscillations of the arterial walls with a certain rhythm, which correspond to the rhythm of the contraction of the heart muscle - the basis of the circulatory system.

The venous pulse is fixed on large veins, which are located near the heart. It is his measurements that are most often shown in films, when a pulse is felt on the jugular vein in the neck to determine the death of a person.

Capillary pulse - the most different from the classical understanding of this term. This term refers to the intensity of the color of the skin under the nail when pressed. His presence is not permanent. It appears with certain problems.

All types of vascular pulsations are synchronous with each other and with contractions of the heart muscle. Most often, speaking of the pulse, they understand the arterial type. We will consider it in more detail.

Pulse Characteristics

The pulse is evaluated according to six characteristics. The best known is the frequency, not the only indicator for assessing the ripple. In terms of importance, the frequency is also not the most important. More precisely, they are all equally important in assessing this parameter.
Arterial pulse is assessed by:

• frequency
• rhythm,
• filling,
• voltage
• height,
• speed.

Let's consider each characteristic separately.

Pulse rate

The most demanded characteristic of the pulsation of the arteries. It owes this to the simplicity of evaluation.
The pulse rate is the number of pulse oscillations per minute. Normally, it corresponds to the heart rate.
The general table of normal heart rate indicators looks like this:

What can be seen from the table? A wide range of normal heart rates is presented for each group. But even with such a spread, not all of them are taken into account.
The pulse rate can go beyond the norm not only in patients, but also in trained athletes. With health problems, the frequency of pulse fluctuations goes beyond the range of normal values, with fitness it decreases.

Rhythm of the pulse

This indicator characterizes the rhythm with which pulse fluctuations occur. By rhythm, the pulse is rhythmic and arrhythmic.
Rhythmic is called a pulse with the same intervals between pulse waves. If the duration of the intervals differs, then the pulse is arrhythmic.

Filling the pulse

A subjective characteristic, which is evaluated by the sensations of the one who performs the palpation.
By filling, the pulse happens:

• moderate,
• filiform,
• empty,
• full.

It is determined by clamping the artery and restoring pulsation after releasing the clamped vessel. In a healthy person, this indicator is moderate. A full pulse occurs with an increase in the stroke volume of the heart muscle and with an increase in blood volume. This happens during physical exertion: instant or constant.
A weak pulse, respectively, is characteristic of a low level of circulating blood and a weak shock output.
Threadlike pulse - a person is on the verge of life and death. Life systems are practically non-functional.

Pulse voltage

A subjective measure of the force with which an artery must be pressed in order to completely occlude it. By filling, the pulse happens:

• moderate
• hard,
• soft.

Shape or speed of the pulse

Characteristic of the arterial pulse, which shows the rate at which the volume of the artery changes when the pulse wave passes through it. The shape is measured using a special procedure - sphygmography. The pulse speed is:

• ambulance
• slow
• dicrotic.

Pulse height

This characteristic shows the range in which arterial wall oscillations occur and is fixed by a general assessment of the tension and filling of the pulsation. The height of the pulse is:

• moderate,
• big,
• small.

Pulse Rate Measurement Method

Since the most common and demanded characteristic of arterial pulsation is frequency, it will be analyzed in more detail.
The popularity of the frequency is due to the ease of its measurement.

Everyone can measure the pulsation of the arteries. To do this, you need to sit in a quiet corner, put a stopwatch near you and press the radial artery on your wrist with two fingers (middle and index). Finding it is easy: it is located on the inside of the wrist from the side of the thumb. Pressing it, a distinct pulsation will be felt with your fingers. Having caught it, you begin to count the blows, while marking one minute. Someone advises to detect 30 seconds and multiply the result by two, but a minute measurement will still be more accurate.

In addition to the radial artery, the pulse can be measured in almost all arteries. The popularity of radiation is due to the ease of access to it.

What determines the pulse rate?

The arterial pulse of a person is an indicator that depends on many indicators. Therefore, the ranges of normal values ​​of the indicator for different age categories are very wide. To clearly show the dependence of the heart rate on various factors, we present them in the form of a table:

Influence on the pulse The age curve of the pulse resembles the letter "U". In babies, the pulse is high - the heart is just forming and it needs more contractions to pump blood. In a healthy adult, the pulse decreases, and in an elderly person it rises again due to the fact that the heart muscle can no longer pump blood efficiently enough. At low ambient temperatures, blood vessels narrow and blood circulation slows down. To maintain normal blood circulation, fewer contractions of the heart muscle are needed - the pulse decreases.

At high temperatures, the process occurs in the reverse order: the vessels expand, and in order to fill them, the heart needs to pump blood more often. Dehydration of the body makes the blood thicker. To pump it, the heart begins to work harder, the arterial pulsation quickens. Stress provokes the excitation of the sympathetic division of the autonomic nervous system, which activates the work of most vital systems, including the heart. The pulse rises. The mechanism is similar to stressful situations. With emotional stress, the pulsation becomes more frequent. The genetic factor has not been thoroughly studied. But the fact that in two healthy people of the same age and the same level of fitness, the pulse can differ significantly, indicates a great influence of genetics on this indicator. One of the main factors influencing the pulse rate. In professional athletes, the resting heart rate can differ significantly from that of a person who does not play sports. This is due to the fitness of the heart muscle, which pumps a larger volume of blood in one cycle.

Normal human heart rate by year

Normal values ​​of arterial pulsation over the years are set in fairly wide ranges. They came to them experimentally: they took a fairly large sample of healthy people of the same age, measured everyone's pulse at rest, discarded extremely low and extremely high rates, and got a range taken as the norm.

Consider the normal indicators for each age category and see why they differ in one direction or another from neighboring age groups.

Newborn pulse

In newborns, the pulse fluctuations of the arteries at rest are the highest in comparison with other age categories. The range of 100-150 beats per minute is considered normal. But even it does not fit all situations.

There are quite common cases when a newborn's pulse slowed down to 70 beats per minute. At the same time, no pathologies were observed, and they did not develop in the future.
Such a high normal pulse is explained simply: the child first encounters the outside world, his body is in a constant state of emotional excitement, a small heart is just learning to fully pump blood.

baby pulse

Between the ages of three and six months, a baby's resting heart rate begins to slow down and 90-120 beats per minute are considered normal. The body gets used to a new life, the level of emotional stress decreases, the heart grows and gets used to working in new conditions.
As with newborns, significant differences from the norm are also possible in children at this age, but they are no longer so frequent.

Pulse of a child up to ten years

Normal indicators of the frequency of arterial pulsation are numbers in the range of 70-130 beats per minute. This is the largest range among all age categories. This is due to the large differences in the growth and development of each child.

For some, the body develops faster and muscles, including the heart, are formed at an earlier age. And there are children who, even by the age of ten, are absolutely not physiologically formed.

Pulse of a teenager aged 10-20 years

At this age, the human body is fully formed. Children are almost leveled in development. Their main indicators become proportionate. At this age, the range of normal values ​​of pulse fluctuations at rest is 60-100 beats per minute. In comparison with the previous age group, one can see a narrowing of the range and a lowering of the lower limit.

The heart of teenagers becomes an adult capable of working optimally. The number of exits outside the normal range is minimal.

Human pulse at 30 years old

In the general classification of normal heart rate indicators for different age categories, a range of 60-100 beats per minute is indicated for all adults. It is unconditionally accepted by almost all doctors.

But there is also a narrower distribution. According to it, for people aged 21-30 years, a pulse in the range of 65-80 beats per minute is considered normal. In women, the indicators are more often shifted to the upper limit, in men - to the lower one. The latter fact is explained by the average statistically large size of the heart compared to a woman of similar build. A larger heart pumps more blood in one contraction, so fewer contractions are needed.

At this age, the human body is in its prime. The heart is fully formed, working optimally. There are no age-related deteriorations in the functioning of vital systems. We can consider the pulse rate of a healthy person aged 20-30 years as a reference.

Human pulse at 40

In the fourth decade of life, the normal frequency of pulse fluctuations at rest remains in the same range as in the previous age group - 65-80 beats per minute. At the same time, there are slightly more cases of pulse dropping beyond the upper limit, which is associated with the beginning of the development of the first age-related changes in the body.

Human pulse at 50

In the period of 40-50 years, the limits of the range of normal values ​​of the arterial pulse begin to expand along the upper limit and approach the indicator that is generally accepted for adults. The normal heart rate is 65-90 beats per minute. A wider gradation is due to many individual characteristics of the onset of aging of the body, as well as the increased importance of other factors that at a young age could be compensated by internal resources.
As before, women have a slightly higher heart rate than men, but at the age of about 50, this difference is almost leveled.

The pulse of a person aged 60 and older

Normal heart rate limits in the elderly are the most difficult to identify. At an older age, it is difficult to find an absolutely healthy person, including those without heart problems. And any health problems can affect the frequency of arterial pulsation.

The generally accepted norm for the pulse rate in old age is the range of 60-90 beats per minute at rest. Changes in either direction are a reason to immediately consult a doctor, as this is one of the first signals of heart problems.

Cases of going beyond the norm of the pulse in healthy people in this age category are rare.

Summary table of normal heart rate values ​​at different ages

Let's summarize all of the above in the form of a pivot table:

Pulse, or, in other words, heart rate is the most important indicator of a person's health. The figures obtained during the measurement are of great importance in the diagnosis of various diseases. However, these indicators can change under the influence of many factors, therefore, it is necessary to know the norms of a person’s pulse by age in order not to miss the onset of the development of pathology.

The frequency of the heart rhythm is called the fluctuations of the walls of blood vessels at the time of contraction of the heart and the movement of blood through them. In this case, the measured value signals the work of the cardiovascular system. By the number of beats per minute, the strength of the pulse and its other parameters, one can evaluate the elasticity of blood vessels, the activity of the heart muscle. Together with indicators (BP), these figures allow you to make a complete picture of the state of the human body.

The norms of the heart rate in the male and female parts of the population are slightly different. Ideal values ​​are rarely fixed. A healthy person is on the move most of the time, experiencing, so the indicators vary up or down.

When determining the pulse and comparing it with tabular norms, it should be remembered that each organism has individual characteristics. As a result, even in a calm state, the performance may differ from the optimal. If at the same time the patient feels normal, there are no unpleasant symptoms, then such deviations from the norm are not considered a pathology.

If the normal pulse deviates in an adult, the cause that led to such changes is determined. Independent cardiac arrhythmias are quite rare, most often they are the result of a disease. There are the following deviations:

• rapid heart rate, over 100 beats per minute (tachycardia);
• slow heartbeat, less than 60 beats per minute ().

Important: After the age of 40, it is necessary to visit a cardiologist at least once a year and undergo a thorough examination. Many pathologies of the cardiovascular system are asymptomatic and their early diagnosis will help to avoid the development of complications.

Pulse: influence of various factors

The change in heart rate occurs under the influence of external and internal factors. Age, gender, physical and psycho-emotional stress, air temperature, body temperature, and much more can affect the number of heartbeats per minute.

Age

The pulse at rest or at night during sleep, depending on the age of the person, is significantly different. In newborns, the heart rate is the highest - over 130 beats / min. This is due to the fact that the heart is small and needs to contract more often to feed the whole body with blood.

As the heart rate grows older, it becomes much less frequent and by the age of 18, the pulse rates are normally 60-90 beats / min. This frequency, with slight fluctuations, persists for many years. Changes that are noted in older people depend not only on age, but also on the presence of existing diseases.

The very first actions in the provision of emergency care provide for an objective assessment of the situation and the condition of the patient, therefore, the person acting as a rescuer grabs the radial artery (temporal, femoral or carotid) in order to find out about the presence of cardiac activity and measure the pulse.

The pulse rate is not a fixed value, it varies within certain limits depending on our state at that moment. Intense physical activity, excitement, joy make the heart beat faster, and then the pulse goes beyond normal limits. True, this state does not last long, a healthy body needs 5-6 minutes to recover.

Within normal limits

The normal pulse rate for an adult is 60-80 beats per minute. what is more is called , less is called . If pathological conditions become the cause of such fluctuations, then both tachycardia and bradycardia are regarded as a symptom of the disease. However, there are other cases as well. Probably, each of us has ever encountered a situation where the heart is ready to jump out from an excess of feelings and this is considered normal.

As for the rare pulse, it is mainly an indicator of pathological changes in the heart.

The normal pulse of a person changes in various physiological states:

1. Slows down in sleep, and indeed in the supine position, but does not reach real bradycardia;
2. Changes during the day (at night, the heart beats less often, after lunch it speeds up the rhythm), as well as after eating, alcoholic beverages, strong tea or coffee, and certain drugs (heart rate rises in 1 minute);
3. Increases during intense physical activity (hard work, sports training);
4. Increases from fright, joy, anxiety and other emotional experiences. caused by emotions or intense work, almost always passes quickly and on its own, as soon as a person calms down or stops vigorous activity;
5. The heart rate increases with an increase in body temperature and the environment;
6. Decreases over the years, however, then, in old age, again slightly rises. In women with the onset of menopause, under conditions of reduced estrogen influence, more significant upward changes in the pulse may be observed (tachycardia due to hormonal disorders);
7. It depends on gender (the pulse rate in women is slightly higher);
8. It differs in especially trained people (rare pulse).

Basically, it is generally accepted that in any scenario, the pulse of a healthy person is in the range from 60 to 80 beats per minute, and a short-term increase to 90 - 100 beats / min, and sometimes up to 170-200 beats / min is regarded as a physiological norm, if it arose on the basis of an emotional outburst or intensive labor activity, respectively.

Men, women, athletes

HR (heart rate) is influenced by indicators such as gender and age, physical fitness, occupation of a person, the environment in which he lives, and much more. In general, the differences in heart rate can be explained as follows:

• Men and women respond differently to different events.(the bulk of men are more cold-blooded, women are mostly emotional and sensitive), so the heart rate of the weaker sex is higher. Meanwhile, the pulse rate in women differs very little from that of men, although, if we take into account the difference of 6-8 beats / min, then the males are lagging behind, their pulse is lower.

• Out of competition are pregnant women, in which a slightly increased pulse is considered normal, and this is understandable, because during the bearing of a child, the mother's body must fully satisfy the need for oxygen and nutrients for herself and the growing fetus. The respiratory organs, the circulatory system, the heart muscle undergo certain changes to perform this task, so the heart rate increases moderately. A slightly increased pulse in a pregnant woman is considered normal if, apart from pregnancy, there is no other reason for its increase.
• A relatively rare pulse (somewhere near the lower limit) is noted in people who do not forget about daily physical exercise and jogging, who prefer outdoor activities (pool, volleyball, tennis, etc.), in general, leading a very healthy lifestyle and watching their figure. They say about such people: “They have a good sports uniform”, even if, by the nature of their activity, these people are far from professional sports. A pulse of 55 beats per minute at rest is considered normal for this category of adults, it’s just that their heart works economically, but in an untrained person, this frequency is regarded as bradycardia and serves as a reason for an additional examination by a cardiologist.
• The heart works even more economically skiers, cyclists, runners, rowers and adherents of other sports that require special endurance, their resting heart rate can be 45-50 beats per minute. However, a long-term intense load on the heart muscle leads to its thickening, expansion of the boundaries of the heart, an increase in its mass, because the heart is constantly trying to adapt, but its possibilities, unfortunately, are not unlimited. A heart rate of less than 40 beats is regarded as a pathological condition, and eventually the so-called "sports heart" develops, which often causes the death of young healthy people.

The heart rate is somewhat dependent on height and constitution: in tall people, the heart under normal conditions works more slowly than in short relatives.

Pulse and age

Previously, the fetal heart rate was recognized only at 5-6 months of pregnancy (listened with a stethoscope), now the fetal pulse can be determined using the ultrasound method (vaginal sensor) in an embryo 2 mm in size (the norm is 75 beats / min) and as it grows (5 mm - 100 beats / min, 15 mm - 130 beats / min). During pregnancy monitoring, heart rate is usually measured from 4-5 weeks of gestation. The data obtained is compared with tabular norms Fetal heart rate by week:

By the heart rate of the fetus, you can find out his condition: if the baby's pulse changes upward, it can be assumed that there is a lack of oxygen, but as the pulse increases, the pulse begins to decrease, and its values ​​\u200b\u200bare less than 120 beats per minute already indicate acute oxygen starvation, which threatens with undesirable consequences up to death.

The pulse rates in children, especially newborns and preschoolers, differ markedly from the values ​​​​typical for adolescence and youth. We, adults, have noticed ourselves that a small heart beats more often and not so loudly. To clearly know whether a given indicator is within the normal range, there is heart rate table by age that everyone can use:

Thus, according to the table, it can be seen that the rate of heart rate in children after a year tends to gradually decrease, a pulse of 100 is not a sign of pathology until almost 12 years old, and a pulse of 90 is up to 15 years of age. Later (after 16 years), such indicators may indicate the development of tachycardia, the cause of which is to be found by the cardiologist.

The normal pulse of a healthy person in the range of 60-80 beats per minute begins to be recorded from about 16 years of age. After 50 years, if everything is in order with health, there is a slight increase in heart rate (10 beats per minute for 30 years of life).

Pulse rate helps in diagnosis

Pulse diagnosis, along with temperature measurement, history taking, examination, refers to the initial stages of a diagnostic search. It would be naive to believe that by counting the number of heartbeats, you can immediately find the disease, but it is quite possible to suspect something is wrong and send a person for examination.

A low or high pulse (below or above the allowable values) often accompanies various pathological processes.

high heart rate

Knowledge of the norms and the ability to use the table will help any person to distinguish increased pulse fluctuations due to functional factors from tachycardia caused by the disease. About "strange" tachycardia may indicate symptoms that are unusual for a healthy body:

1. Dizziness, pre-syncope, (they say that cerebral blood flow is disturbed);
2. Pain in the chest caused by a violation of the coronary circulation;
3. visual disturbances;
4. Vegetative symptoms (sweating, weakness, trembling of the limbs).

Increased heart rate and palpitations can be caused by:

• Pathological changes in the heart and vascular pathology (congenital, etc.);
• poisoning;
• Chronic bronchopulmonary diseases;
• hypoxia;
• Hormonal disorders;
• Damage to the central nervous system;
• Oncological diseases;
• Inflammatory processes, infections (especially with fever).

In most cases, an equal sign is placed between the concepts of a rapid pulse and a rapid heartbeat, however, this is not always the case, that is, they do not necessarily accompany each other. In some conditions ( and , ), the number of heartbeats exceeds the frequency of pulse fluctuations, this phenomenon is called a pulse deficit. As a rule, a pulse deficit accompanies terminal arrhythmias in severe heart damage, which could be caused by intoxication, sympathomimetics, acid-base imbalance, electric shock, and other pathologies involving the heart in the process.

High pulse and pressure fluctuations

The pulse and pressure do not always proportionally decrease or increase. It would be wrong to think that an increase in heart rate will necessarily lead to an increase in blood pressure and vice versa. There are also options here:

1. Rapid pulse at normal pressure may be a sign of intoxication, fever. Folk and medications that regulate the activity of the autonomic nervous system during VVD, antipyretic drugs for fever and drugs aimed at reducing the symptoms of intoxication will help to reduce the pulse, in general, the impact on the cause will remove tachycardia.
2. Rapid pulse with high blood pressure may be the result of various physiological and pathological conditions (inadequate physical activity, severe stress, endocrine disorders, diseases of the heart and blood vessels). The tactics of the doctor and the patient: examination, finding out the cause, treatment of the underlying disease.
3. Low blood pressure and high heart rate can become symptoms of a very serious health disorder, for example, a manifestation of development in cardiac pathology or in case of large blood loss, and, the lower the blood pressure and the higher the heart rate, the more severe the patient's condition. Definitely: to reduce the pulse, the increase of which is caused by these circumstances, will not work on its own not only for the patient, but also for his relatives. This situation requires urgent action (call "103").

A high pulse that first appeared for no reason can be tried to calm drops of hawthorn, motherwort, valerian, peony, corvalol (what is at hand). The repetition of an attack should be a reason to visit a doctor who will find out the cause and prescribe medications that affect this particular form of tachycardia.

Low heart rate

The reasons for a low heart rate can also be functional (athletes were discussed above, when a low heart rate at normal pressure is not a sign of a disease), or stem from various pathological processes:

• Vagus influences (vagus - vagus nerve), decreased tone of the sympathetic department of the nervous system. This phenomenon can be observed in every healthy person, for example, during sleep (low pulse at normal pressure),
• With vegetative-vascular dystonia, in the case of some endocrine disorders, that is, in a variety of physiological and pathological conditions;
• Oxygen starvation and its local effect on the sinus node;
• myocardial infarction;

• Toxicoinfections, poisoning with organophosphorus substances;
• Peptic ulcer of the stomach and duodenum;
• Traumatic brain injury, meningitis, edema, brain tumor,;
• Taking digitalis preparations;
• Side effect or overdose of antiarrhythmic, antihypertensive and other drugs;
• Hypofunction of the thyroid gland (myxedema);
• Hepatitis, typhoid fever, sepsis.

In the vast majority of cases low heart rate (bradycardia) is considered a serious pathology, which requires immediate examination to identify the cause, timely treatment, and sometimes emergency medical care (sick sinus syndrome, atrioventricular blockade, myocardial infarction, etc.).

Low pulse and high blood pressure - similar symptoms sometimes appear in hypertensive patients taking drugs to lower blood pressure, which are simultaneously prescribed for various rhythm disturbances, beta-blockers, for example.

Briefly about measuring the pulse

Perhaps, only at first glance it seems that there is nothing easier than measuring the pulse of oneself or that of another person. Most likely, this is true if such a procedure is required to be carried out in a young, healthy, calm, rested person. It can be assumed in advance that his pulse will be clear, rhythmic, of good filling and tension. Being sure that most people know the theory well and do an excellent job with the task in practice, the author will only briefly recall the technique of measuring the pulse.

You can measure the pulse not only on the radial artery, any large artery (temporal, carotid, ulnar, brachial, axillary, popliteal, femoral) is suitable for such a study. By the way, sometimes along the way you can detect a venous pulse and very rarely a precapillary one (to determine these types of pulse, you need special devices and knowledge of measurement techniques). When determining, one should not forget that in the vertical position of the body, the heart rate will be higher than in the prone position and that intense physical activity will accelerate the pulse.

To measure the pulse:

• Usually, the radial artery is used, on which 4 fingers are placed (the thumb should be on the back of the limb).
• You should not try to catch pulse fluctuations with only one finger - an error is surely guaranteed, at least two fingers should be involved in the experiment.
• It is not recommended to press too hard on the arterial vessel, since its clamping will lead to the disappearance of the pulse and the measurement will have to be started again.
• It is necessary to measure the pulse correctly within one minute, measuring for 15 seconds and multiplying the result by 4 can lead to an error, because even during this time the frequency of pulse oscillations can change.

Here is such a simple technique for measuring the pulse, which can tell a lot about a lot.

Video: pulse in the program “Live Healthy!”

Pulse is a fluctuation of the walls of blood vessels associated with a change in their blood supply during the cardiac cycle. There are arterial, venous and capillary pulses. The study of the arterial pulse provides important information about the work of the heart, the state of blood circulation and the properties of the arteries. The main method of studying the pulse is probing the arteries. For the radial artery, the hand of the subject is freely wrapped around the area so that the thumb is located on the back, and the remaining fingers are on the anterior surface of the radius, where the pulsating radial artery is palpated under the skin. The pulse is felt simultaneously on both hands, since sometimes it is expressed differently on the right and left hands (due to vascular anomalies, 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, arteries of the feet, etc. (Fig. 1). An objective characteristic of the pulse is given by its graphic registration (see). In a healthy person, the pulse wave rises relatively steeply and slowly falls (Fig. 2, 1); in some diseases, the shape of the pulse wave changes. When examining the pulse, its frequency, rhythm, filling, tension and speed are determined.

How to measure your heart rate correctly

Rice. 1. Method for measuring the pulse on various arteries: 1 - temporal; 2 - shoulder; 3 - dorsal artery of the foot; 4 - beam; 5 - posterior tibial; 6 - femoral; 7 - popliteal.

In healthy adults, the pulse rate corresponds to the heart rate and is 60-80 per 1 minute. With an increase in heart rate (see) or a slowdown (see), the pulse rate changes accordingly, and the pulse is called frequent or rare. With an increase in body temperature by 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 due to the fact that during very weak or premature contractions of the heart, so little blood enters the aorta that its pulse wave does not reach the peripheral arteries. The higher the pulse deficit, the more adversely it affects blood circulation. To determine the pulse rate, consider it for 30 seconds. and the result is multiplied by two. If the heart rhythm is disturbed, the pulse is counted for 1 minute.

In a healthy person, the pulse is rhythmic, i.e., pulse waves follow one after another at regular intervals. With heart rhythm disorders (see), pulse waves usually follow at irregular intervals, the pulse becomes arrhythmic (Fig. 2, 2).

The filling of the pulse depends on the amount of blood ejected during systole into the arterial system, and on the extensibility of the arterial wall. Normal - pulse wave is well felt - full pulse. If less than normal blood enters the arterial system, the pulse wave decreases, the pulse becomes small. With severe blood loss, shock, collapse, pulse waves can barely be felt, such a pulse is called filiform. A decrease in the filling of the pulse is also noted in diseases that lead to thickening of the walls of the arteries or narrowing of their lumen (atherosclerosis). In severe damage to the heart muscle, an alternation of a large and small pulse wave is observed (Fig. 2, 3) - an intermittent pulse.

The tension of the pulse is related to the height of blood pressure. With hypertension, a certain effort is required to squeeze the artery and stop its pulsation - a hard, or tense, pulse. With low blood pressure, the artery is compressed easily, the pulse disappears with 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 increases rapidly, and during diastole falls rapidly, then there will be a rapid expansion and collapse of the arterial wall. Such a pulse is called fast, at the same time it can be large (Fig. 2, 4). Most often, a fast and large pulse is observed with insufficiency of the aortic valve. A slow increase in pressure in the aorta during systole and a slow decrease in diastole causes a slow expansion and slow collapse of the arterial wall - a slow pulse; at the same time it is small. Such a pulse appears when the aortic orifice narrows due to the difficulty in expelling blood from the left ventricle. Sometimes, after the main pulse wave, a second, smaller wave appears. This phenomenon is called dicrotia pulse (Fig. 2.5). It is associated with a change in the tension of the arterial wall. Dicrotia of the pulse occurs with fever, some infectious diseases. When probing the arteries, not only the properties of the pulse are examined, but also the state of the vascular wall. So, with a significant deposition of calcium salts in the vessel wall, the artery is probed in the form of a dense, twisted, rough tube.

The 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 intense metabolism.

With age, the heart rate gradually decreases. Girls of all ages have a higher heart rate than boys. Cry, anxiety, muscle movements cause a significant increase in heart rate in children. In addition, in childhood there is a known irregularity of pulse periods associated with breathing (respiratory arrhythmia).

Pulse (from Latin pulsus - push) is rhythmic, jerky vibrations of the walls of blood vessels that occur as a result of the ejection of blood from the heart into the arterial system.

Doctors of antiquity (India, Greece, the Arab East) paid great attention to the study of the pulse, giving it a decisive diagnostic value. The scientific basis of the doctrine of the pulse received after the discovery by Harvey (W. Harwey) of blood circulation. The invention of the sphygmograph and especially the introduction of modern methods of pulse recording (arteriopiezography, high-speed electrosphygmography, etc.) have significantly deepened knowledge in this area.

With each systole of the heart, a certain amount of blood is rapidly ejected into the aorta, stretching the initial part of the elastic aorta and increasing pressure in it. This change in pressure propagates in the form of a wave along the aorta and its branches to the arterioles, where normally, due to their muscular resistance, the pulse wave stops. The propagation of the pulse wave occurs at a speed of 4 to 15 m/s, and the resulting stretching and elongation of the arterial wall constitutes the arterial pulse. There are central arterial pulse (of the aorta, carotid and subclavian arteries) and peripheral (femoral, radial, temporal, dorsal artery of the foot, etc.). Difference of these two forms of pulse comes to light at its graphic registration by a method of a sphygmography (see). On the pulse curve - sphygmogram - there are ascending (anacrota), descending (katacrota) parts and a dicrotic wave (dicrota).

Rice. 2. Graphic registration of the pulse: 1 - normal; 2 - arrhythmic (a-c- various types); 3 - intermittent; 4 - large and fast (a), small and slow (b); 5 - dicrotic.

Most often, the pulse is examined on the radial artery (a. radialis), which is located superficially under the fascia and skin between the styloid process of the radius and the tendon of the internal radial muscle. With anomalies in the location of the artery, the presence of bandages on the hands or massive edema, the pulse is examined on other arteries accessible to palpation. The pulse on the radial artery is delayed compared to the systole of the heart by approximately 0.2 seconds. 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 one confine oneself to further research on one arm. Usually, the subject's hand is freely grasped with the right hand in the area of ​​the wrist joint and placed at the level of the subject's heart. In this case, the thumb should be placed on the ulnar side, and the index, middle and ring fingers - on the radial, directly on the radial artery. Normally, you get a feeling of a soft, thin, even and elastic tube, pulsating under your fingers.

If, when comparing the pulse on the left and right hands, its different value or delay of the pulse on one hand compared to the other is found, then such a pulse is called different (pulsus differens). It is observed most often with unilateral anomalies in the location of blood vessels, their compression by tumors or enlarged lymph nodes. An aneurysm of the aortic arch, if it is located between the innominate and left subclavian arteries, causes a delay and a decrease in the pulse wave on the left radial artery. With mitral stenosis, an enlarged left atrium can compress the left subclavian artery, which reduces the pulse wave on the left radial artery, especially in the position on the left side (Popov-Saveliev sign).

The qualitative characteristic of the pulse depends on the activity of the heart and the state of the vascular system. When examining the pulse, pay attention to the following properties.

Pulse rate. The counting of pulse beats should be done in at least 1/2 min., while the resulting figure is multiplied by 2. If the pulse is incorrect, the counting should be done within 1 min.; with a sharp excitation 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 man is on average 70, in women - 80 in 1 min. Photoelectric heart rate monitors are currently used to automatically calculate the pulse rate, which is very important, for example, to monitor the patient's condition during surgery. Like body temperature, the pulse rate gives two daily 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 speak of tachycardia (see); such a frequent pulse is called pulsus frequens. At a pulse rate of less than 60 per minute, they speak of bradycardia (see), and the pulse is called pulsus rarus. In cases where individual contractions of the left ventricle are so weak that pulse waves do not reach the periphery, the number of pulse beats becomes less than the number of heart contractions. This phenomenon is called bradysphygmia, the difference between the number of heartbeats and pulse beats in 1 minute is called a pulse deficit, and the pulse itself is called pulsus deficiens. With an increase in body temperature, each degree above 37 usually corresponds to an increase in heart rate by an average of 8 beats per 1 minute. The exception is fever in typhoid fever and peritonitis: in the first case, a 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 regular intervals, then they speak of a regular, rhythmic pulse (pulsus regularis), otherwise an irregular, irregular pulse (pulsus irregularis) is observed. In healthy people, an increase in the pulse on inhalation and its decrease on exhalation are often noted - respiratory arrhythmia (Fig. 1); holding the breath eliminates this type of arrhythmia. On changes of pulse it is possible to diagnose many types of arrhythmia of heart (see); more precisely, they are all determined by electrocardiography.

Rice. 1. Respiratory arrhythmia.

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, jumping 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 pressure change in the radial artery (Fig. 2). As a rule, such a pulse is both large, high (pulsus magnus, s. altus) and is most pronounced in aortic insufficiency. At the same time, the researcher's finger feels not only fast, but also large rises and falls of the pulse wave. In its pure form, a large, high pulse is sometimes observed with physical exertion and often with complete atrioventricular blockade. A sluggish, slow pulse (pulsus tardus), accompanied by a feeling of a slow rise and a slow decrease in the pulse wave (Fig. 3), occurs when the aortic orifice narrows, when the arterial system is filled slowly. Such a pulse, as a rule, is small in size (height) - pulsus parvus, which depends on a small increase in pressure in the aorta during left ventricular systole. A similar type of pulse is characteristic of mitral stenosis, severe weakness of the myocardium of the left ventricle, fainting, collapse.

Rice. 2. Pulsus celer.

Rice. 3. Pulsus tardus.

Pulse voltage is determined by the force necessary to completely stop the propagation of the pulse wave. When examining the distally located index finger, the vessel is completely squeezed to prevent the penetration of reverse waves, and the most proximal lying ring finger produces gradually increasing pressure until the “groping” third finger ceases to feel the pulse. There is a tense, hard pulse (pulsus durum) and a relaxed, soft pulse (pulsus mollis). According to the degree of pulse tension, one can approximately judge the magnitude of the maximum arterial pressure; the higher it is, the more intense the pulse.

Filling the pulse consists of the magnitude (height) of the pulse and partly its voltage. The filling of the pulse depends on the amount of blood in the artery and on the total volume of circulating blood. Distinguish pulse full (pulsus plenus), as a rule, large, high, and empty (pulsus vaccuus), as a rule, small. With massive bleeding, collapse, shock, the pulse can be barely palpable, threadlike (pulsus filiformis). If the pulse waves are not the same in size and degree of filling, then they speak of an uneven pulse (pulsus inaequalis), as opposed to a uniform pulse (pulsus aequalis). An uneven pulse is observed almost always with an arrhythmic pulse in cases of atrial fibrillation, early extrasystoles. A kind of uneven pulse is an alternating pulse (pulsus alternans), when the correct alternation of pulse beats of different sizes and filling is felt. Such a pulse is one of the early signs of severe heart failure; it is best detected sphygmographically with slight compression of the shoulder with a sphygmomanometer cuff. In cases of a drop in peripheral vascular tone, a second, smaller, dicrotic wave can be palpated. This phenomenon is called dicrotia, and the pulse is called dicrotic (pulsus dicroticus). Such a pulse is often observed in 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, there is almost always a decrease in the minimum arterial pressure.

Pulsus paradoxus - decrease in pulse waves on inspiration (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 systole of the heart is somewhat difficult, which leads to a decrease in the magnitude and filling of the pulse. With narrowing of the upper respiratory tract or myocardial weakness, this phenomenon is more pronounced. With adhesive pericarditis on inspiration, the heart is strongly stretched by adhesions to the chest, spine and diaphragm, which leads to difficulty in systolic contraction, a decrease in the ejection of blood into the aorta, and often to the complete disappearance of the pulse at the height of inspiration. Adhesive pericarditis is characterized, in addition to this phenomenon, by a pronounced swelling of the cervical veins due to compression by adhesions of the superior vena cava and innominate veins.

Rice. 4. Pulsus paradoxus.

Capillary, more precisely pseudocapillary, pulse, or Quincke's pulse, is the rhythmic expansion of small arterioles (not capillaries) as a result of a rapid and significant increase in pressure in the arterial system during systole. In this case, 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 (the “true” capillary pulse) are involved in pulsatory oscillations, which sometimes happens in severe thyrotoxicosis, fever, or in healthy young people during thermal procedures. It is believed that in these cases, from venous stasis, the arterial knee of the capillaries expands. The capillary pulse is best detected by lightly pressing the lip with a glass slide, when alternating, corresponding to the pulse, redness and blanching of its mucous membrane is detected.

Venous pulse reflects fluctuations in the volume of the veins as a result of systole and diastole of the right atrium and ventricle, which cause either a slowdown or an acceleration of the outflow of blood from the veins into the right atrium (swelling and collapse of the veins, respectively). 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 a very little noticeable and almost imperceptible 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. With insufficiency of the tricuspid valve, the venous pulse becomes right ventricular, "positive", since due to a defect in the tricuspid valve there is a reverse (centrifugal) blood flow - from the right ventricle to the right atrium and veins. Such a venous pulse is characterized by pronounced swelling of the jugular veins simultaneously with the rise of the pulse wave on the carotid artery. If at the same time the neck vein is pressed in the middle, then its lower segment continues to pulsate. A similar picture can occur with severe right ventricular failure and without damage to the tricuspid valve. A more accurate idea of ​​the venous pulse can be obtained using graphic registration methods (see Phlebogram).

hepatic pulse is determined by inspection and palpation, but much more accurately its nature is revealed by graphic registration of the pulsation of the liver and especially by X-ray electrokymography. 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. With malformations of the tricuspid valve, systolic (with valve insufficiency) or presystolic pulsation (with stenosis of the orifice) of the liver may increase as a result of the “hydraulic lock” of its outflow tracts.

Pulse in children. In children, the pulse is much faster than in adults, which is explained by a more intense metabolism, rapid contractility of the heart muscle and less influence of the vagus nerve. The highest heart rate in newborns (120-140 beats per 1 minute), but on the 2nd-3rd day of life, their pulse may slow down to 70-80 beats per 1 minute. (A. F. Tur). With age, the pulse rate decreases (table 2.).

In children, the pulse is most conveniently examined on the radial or temporal artery. In the smallest and most restless children, auscultation of heart sounds can be used to calculate the pulse. The most accurate pulse rate is determined at rest, during sleep. A child has 3.5-4 heart beats per breath.

The pulse rate in children is subject to large fluctuations.

Increased heart rate easily occurs with anxiety, screaming, muscle exercises, eating. The ambient temperature and barometric pressure also influence the pulse rate (A. L. Sakhnovsky, M. G. Kulieva, E. V. Tkachenko). With an increase in the child's body temperature by 1 °, the pulse quickens by 15-20 beats (A. F. Tour). In girls, the pulse is more frequent than in boys, by 2-6 beats. This difference is especially 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 heart rate (tachycardia) is observed with endo- and myocarditis, with heart defects, infectious diseases. Paroxysmal tachycardia up to 170-300 beats per 1 min. may be seen in young children. A slowing of the pulse (bradycardia) is observed with an increase in intracranial pressure, with severe forms of malnutrition, with uremia, epidemic hepatitis, typhoid fever, with an overdose of digitalis. Deceleration of the pulse to more than 50-60 beats per 1 min. leads to 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 the period of recovery from acute infections, sinus respiratory arrhythmia is often found: an increase in the pulse during inhalation and a slowdown during exhalation. Extrasystoles in children, more often ventricular, occur with myocardial damage, but can also be functional.

A weak pulse of poor filling, often with tachycardia, indicates the phenomena of cardiac weakness, a decrease in blood pressure. A tense pulse, indicating an increase in blood pressure, is observed in children most often with nephritis.

Pulse is the vibrations of arterial vessels that are associated with the work of the heart. But doctors consider the pulse more broadly: all changes in the vessels of the cardiac system that are associated with it. Each characteristic of the pulse indicates the norm or deviation in the state of activity of the heart muscles.

The main characteristics of the pulse

Heart fluctuations have six main indicators by which it is possible to diagnose the functioning of the heart muscles. The pulse and its characteristics are the rhythm and frequency of beats, the strength of beats and tension, as well as the shape of the oscillations. The level of blood pressure is also characterized by the properties of the pulse. By fluctuations in heartbeats, specialists can determine the disease that the patient suffers from.

Rhythm

The heart rate is called the cyclical alternation of "beats" of the heart muscles for a minute. These are vibrations of the walls of the artery. They characterize the movement of blood through the arteries during heart contractions. For diagnostic purposes, the pulse is measured at the temple, thigh, under the knee, posterior tibial and in other places where the arteries pass close to the surface of the body. In patients, the rhythm of heart beats is often disturbed.

Frequency

The pulse frequency is the number of "beats" per minute. It can be counted by pressing on the arterial vessels. Heart rate (pulse) in a wide range of loads characterizes the speed of blood pushing. There are two types of heart rate deviations:

• bradycardia (slow heartbeat);
• tachycardia (rapid heartbeat).

The interval of contractions can be calculated with a tonometer, and not just with simple palpation. The frequency rate depends on the age of the person whose pulse is measured. The frequency depends not only on age and pathologies. During exercise, the frequency also increases.

With a high pulse rate, it is necessary to find out what blood pressure is. If it is low, you need to use means that reduce the rate of contractions in any way available to the patient, since too frequent heartbeats are very dangerous.

The value of heart beats

The magnitude of "blows" is characterized by the tension of oscillatory movements and filling. These indicators are the state of the arteries, as well as their elasticity. There are such deviations:

• a strong pulse if a large amount of blood is ejected into the aorta;
• weak pulse if the aorta is narrowed, for example, or vascular stenosis;
• intermittent, if large heartbeats alternate with weak ones;
• filiform, if vibrations are almost not palpable.

Voltage

This parameter is determined by the force that must be applied to stop the blood flow in the artery. Voltage is determined by the level of systolic blood pressure. There are different types of deviations:

• hard contractions seen at high pressure levels;
• mild occur when the artery closes off easily without effort.

Filling

This parameter is affected by the quantitative volume of blood ejected into the artery. It affects the strength of the vibration of the vascular walls. If the filling during the study is normal, the pulse is considered full. If the filling of the arteries is weak, the pulse will be weakly filled. For example, with a large loss of blood. In a hypertensive crisis, the heartbeat is very full.

Pulse shape

This indicator depends on the value of pressure vibration between vascular contractions. There are several options for deviation from the normal value of the indicator:

• fast heartbeats occur when a large volume of blood comes from the ventricles and the elasticity of the arteries (This leads to a decrease in diastolic pressure);
• slow with small changes in blood pressure (with a decrease in the cross-section of the walls of the aorta or mitral valve dysfunction);
• dictoric seizures are observed during the passage of an additional wave.

Parvus, tardus means "slow, small" in translation. Such filling of pulsations is typical with a decrease in the amplitude of oscillations, a decrease in speed. Pulse tardus parvus is typical for patients with a defect in the mitral valve or suffering from a narrowing of the main artery.

Where and how can you explore?

There are a limited number of places on the human body where pulse contractions can be examined. And many fewer options to study it at home. To examine the pulse without the use of instruments is possible only with the help of palpation. You can find and measure the quality and strength of heartbeats at:

• wrist (near the radius);
• elbow;
• brachial or axillary arteries;
• temples;
• feet;
• neck (where the carotid artery is located);
• jaws.

In addition, the pulsation is easily felt in the groin or popliteal fossa.

The norm of the frequency of pulse oscillations

The rate of fluctuations of heart beats depending on age is different. For a newborn child, the number of beats is about 110 beats. At the age of 5, their rate fluctuates around 86, and for 60 years, heartbeats fluctuate around 65 per minute. Doctors compiled a table of pulse fluctuation values:

This pulse is a beat in the jugular veins, in the fossa in the neck, and in several other places that are close to the heart. In place of small veins, it cannot be measured.

The properties of a venous pulse, like an arterial pulse, are characterized by frequency, rhythm, and other parameters. The study of the veins is carried out in order to determine what the pulse wave is, to assess the venous pressure. The right internal jugular vein is most easily examined. The venous pulse is measured as follows:

• a person is laid on a bed at an angle of 30 degrees;
• neck muscles need to be relaxed;
• the neck is positioned so that the light falls tangentially to the skin of the neck;
• The hand is applied to the veins in the neck.

To compare the phases of the venous and cardiac cycles and not confuse them, the left vein is palpated.

Other research methods

One of the main ways to study the venous pulse is phlebography. This is a method of fixing heart vibrations associated with the filling of large veins, which are located near the heart. Registration is carried out in the form of a phlebogram.

More often the device for this purpose is fixed near the jugular veins. There, the pulse is more pronounced and can be felt with the fingers.

Diagnostic value

The phlebogram evaluates the quality of the pulse, which characterizes the state of the vascular wall of the veins, allows you to establish the shape and length of blood waves, to judge the functioning and pressure of the right heart sections. In pathology, the graphic representation of individual waves changes. They increase, decrease, even sometimes disappear. For example, with difficulty in the outflow of blood from the right atrium, the force of contractions increases.

This type of pulse is nothing more than reddening of the edge of the nail plate when pressed on it. A similar action can be performed with a special glass on the lips or forehead of the patient. With a normal capillary rhythm in the area of ​​pressure along the border of the spot, one can observe rhythmic reddening - blanching, which manifests itself in time with the contractions of the heart. These manifestations on the skin were first described by Quincke. The presence of a capillary flow rhythm is characteristic of insufficient functioning of the aortic valves. The higher the degree of insufficiency of the work of the latter, the more pronounced the capillary pulsation.

Distinguish precapillary pulse and true. True is the pulsation of the branches of the capillaries. It is easy to identify: a noticeable pulsating reddening of the nail at the end of the nail plate in young patients after exposure to the sun, in a bath, etc. Such a pulsation often indicates thyrotoxicosis, a lack of blood flow in the arteries or veins.

Precapillary pulsation (Quincke) is characteristic of vessels larger than capillaries, it manifests itself with pulsation of arterioles. It can be seen on the nail bed and without pressure, it is also visible on the lips or forehead. Such a pulsation is observed in aortic dysfunction in systole with a large stroke volume and a powerful wave that reaches the arterioles.

Detection technique

This pulsation is determined, as mentioned above, by pressing on the patient's nail plate. The pressure methods are described above. A test for the presence of these heartbeats is carried out in case of suspicion of a pathology of the circulatory system.

There are several ways to identify this type of pulse.

Pulse rate

Characteristics of the capillary pulse is not normal. It is simply impossible to see such a pulsation with the naked eye if the circulatory system is healthy.