Quantitative and qualitative characteristics of the arterial pulse. Pulse study

arterial pulse called the rhythmic oscillations of the wall of the arteries, due to the ejection of blood from the heart into the arterial system and the change in pressure in it during the left ventricle.

A pulse wave occurs at the mouth of the aorta during the expulsion of blood into it by the left ventricle. To accommodate the stroke volume of blood, the volume, diameter of the aorta and in it increase. During ventricular diastole, due to the elastic properties of the aortic wall and the outflow of blood from it into peripheral vessels, its volume and diameter are restored to their original dimensions. Thus, in time, a jerky oscillation of the aortic wall occurs, a mechanical pulse wave arises (Fig. 1), which propagates from it to large, then to smaller arteries and reaches the arterioles.

Rice. 1. Mechanism of occurrence pulse wave in the aorta and its distribution along the walls of arterial vessels (a-c)

Since arterial (including pulse) pressure decreases in the vessels as it moves away from the heart, the amplitude of pulse fluctuations also decreases. At the level of arterioles, the pulse pressure drops to zero and the pulse in the capillaries and further in the venules and most venous vessels missing. The blood in these vessels flows evenly.

Pulse wave speed

Pulse oscillations propagate along the wall of arterial vessels. Pulse Wave Velocity depends on elasticity (extensibility), wall thickness and vessel diameter. Higher pulse wave velocities are observed in vessels with a thickened wall, small diameter, and reduced elasticity. In the aorta, the speed of propagation of a pulse wave is 4-6 m/s, in arteries with a small diameter and a muscular layer (for example, in the radial one), it is about 12 m/s. With age, the extensibility of blood vessels decreases due to the compaction of their walls, which is accompanied by a decrease in the amplitude of pulse oscillations of the artery wall and an increase in the speed of propagation of a pulse wave through them (Fig. 2).

Table 1. Velocity of pulse wave propagation

The speed of propagation of the pulse wave significantly exceeds the linear speed of blood movement, which in the aorta is 20-30 cm/s at rest. The pulse wave, having arisen in the aorta, reaches the distal arteries of the extremities in approximately 0.2 s, i.e. much faster than they receive that portion of blood, the release of which by the left ventricle caused a pulse wave. With hypertension, due to an increase in tension and stiffness of the walls of the arteries, the speed of propagation of the pulse wave through the arterial vessels increases. Measurement of pulse wave velocity can be used to assess the state of the arterial vessel wall.

Rice. 2. Age changes pulse wave caused by a decrease in the elasticity of the walls of the arteries

Pulse Properties

Registration of the pulse is of great practical importance for the clinic and physiology. The pulse makes it possible to judge the frequency, strength and rhythm of heart contractions.

Table 2. Properties of the pulse

Pulse rate - the number of pulse beats in 1 min. In adults in a state of physical and emotional rest normal frequency pulse (heart rate) is 60-80 beats / min.

The following terms are used to characterize the pulse rate: normal, rare pulse or bradycardia (less than 60 bpm), rapid pulse or tachycardia (more than 80-90 beats / min). In this case, age norms must be taken into account.

Rhythm- an indicator that reflects the frequency of pulse oscillations following each other and the frequency. It is determined by comparing the duration of the intervals between pulse beats in the process of palpation of the pulse for a minute or more. At healthy person pulse waves follow each other at regular intervals and such a pulse is called rhythmic. The difference in the duration of the intervals in a normal rhythm should not exceed 10% of their average value. If the duration of the intervals between pulse beats is different, then the pulse and contractions of the heart are called arrhythmic. Normally, "respiratory arrhythmia" can be detected, in which the pulse rate changes synchronously with the phases of respiration: it increases on inhalation and decreases on exhalation. Respiratory arrhythmia is more common in young people and in individuals with a labile tone of the autonomic nervous system.

Other types of arrhythmic pulse (extrasystole, atrial fibrillation) indicate and in the heart. Extrasystole is characterized by the appearance of an extraordinary, earlier pulse fluctuation. Its amplitude is less than that of the previous ones. An extrasystolic pulse fluctuation may be followed by a longer interval until the next, next pulse beat, the so-called "compensatory pause". This pulse beat is usually characterized by a higher amplitude of oscillation of the arterial wall due to a stronger contraction of the myocardium.

Filling (amplitude) of the pulse- a subjective indicator, assessed by palpation according to the height of the rise of the arterial wall and the greatest stretching of the artery during the systole of the heart. The filling of the pulse depends on the magnitude of the pulse pressure, stroke volume, circulating blood volume and the elasticity of the walls of the arteries. It is customary to distinguish between options: the pulse is normal, satisfactory, good, weak content And How last resort weak filling - thready pulse.

A pulse of good filling is perceived by palpation as a high-amplitude pulse wave, palpable at some distance from the line of projection of the artery on the skin and felt not only with moderate pressure on the artery, but also with a slight touch on the area of ​​​​its pulsation. The threadlike pulse is perceived as weak pulse ation, palpable along the narrow line of the projection of the artery on the skin, the sensation of which disappears when the contact of the fingers with the surface of the skin is weakened.

Pulse voltage - a subjective indicator, estimated by the magnitude of the pressing force on the artery, sufficient for the disappearance of its pulsation distal to the place of pressing. Pulse tension depends on the value of the average hemodynamic pressure and to a certain extent reflects the level systolic pressure. At normal arterial blood pressure, the pulse tension is assessed as moderate. The higher the blood pressure, the more difficult it is to completely compress the artery. At high pressure the pulse is tense or hard. With low blood pressure, the artery is compressed easily, the pulse is assessed as soft.

Pulse rate is determined by the steepness of the increase in pressure and the achievement by the arterial wall of the maximum amplitude of pulse oscillations. The steeper the rise, the more short span time, the amplitude of the pulse oscillation reaches its maximum value. The pulse rate can be determined (subjectively) by palpation and objectively according to the analysis of the steepness of the increase in anacrosis on the sphygmogram.

The pulse rate depends on the rate of pressure increase in arterial system during systole. If during systole it is ejected into the aorta more blood and the pressure in it increases rapidly, then there will be more quick reach the greatest amplitude of arterial stretching - the steepness of the anacrota will increase. The steeper the anacrota (the angle between the horizontal line and the anacrota is closer to 90°), the higher the pulse rate. This pulse is called fast. With a slow increase in pressure in the arterial system during systole and a low steepness of anacrotic rise (small angle a), the pulse is called slow. AT normal conditions pulse rate is intermediate between fast and slow pulse.

A fast pulse indicates an increase in the volume and speed of ejection of blood into the aorta. Under normal conditions, the pulse can acquire such properties with an increase in the tone of the sympathetic nervous system. Constantly available fast pulse can be a sign of pathology and, in particular, indicate insufficiency aortic valve. With stenosis of the aortic orifice or reduction contractility ventricles may develop signs of a slow pulse.

Fluctuations in the volume and pressure of blood in the veins are called venous pulse. Venous pulse is determined in large veins chest cavity and in some cases (with horizontal position body) can be registered in the jugular veins (especially the jugular). The registered venous pulse curve is called phlebogram. The venous pulse is due to the influence of atrial and ventricular contractions on blood flow in the vena cava.

Pulse study

The study of the pulse allows you to evaluate a number important features states of cardio-vascular system. Availability arterial pulse in the subject, it is evidence of myocardial contraction, and the properties of the pulse reflect the frequency, rhythm, strength, duration of systole and diastole of the heart, the state of the aortic valves, the elasticity of the arterial vessel wall, BCC and blood pressure. Pulse oscillations of the vessel walls can be registered graphically (for example, by sphygmography) or assessed by palpation on almost all arteries located close to the surface of the body.

Sphygmography- method of graphic registration of arterial pulse. The resulting curve is called a sphygmogram.

To register a sphygmogram, special sensors are installed on the area of ​​the pulsation of the artery, which capture the mechanical vibrations of the underlying tissues caused by changes in blood pressure in the artery. During one cardiac cycle, a pulse wave is recorded, on which an ascending section is distinguished - an anacrot, and a descending section - a catacrot.

Rice. Graphic registration of arterial pulse (sphygmogram): cd-anacrota; de - systolic plateau; dh - catacrot; f - incisura; g - dicrotic wave

Anacrota reflects the stretching of the artery wall by the increasing systolic blood pressure in it in the period of time from the beginning of the expulsion of blood from the ventricle until the maximum pressure is reached. Catacrot reflects the restoration of the original size of the artery during the time from the beginning of the decrease in systolic pressure in it until the minimum diastolic pressure is reached in it.

The catacrot has an incisura (notch) and a dicrotic rise. Incisura occurs as a result of a rapid decrease in arterial pressure at the onset of ventricular diastole (proto-diastolic interval). At this time, with the semilunar valves of the aorta still open, the left ventricle is relaxed, causing rapid decline there is blood pressure in it, and under the action of elastic fibers, the aorta begins to restore its size. Part of the blood from the aorta moves to the ventricle. At the same time, it pushes the leaflets of the semilunar valves away from the aortic wall and causes them to close. Reflecting from the slammed valves, the blood wave will create for a moment in the aorta and other arterial vessels a new short-term increase in pressure, which is recorded on the sphygmogram catacrot with a dicrotic rise.

The pulsation of the vascular wall carries information about the state and functioning of the cardiovascular system. Therefore, the analysis of the sphygmogram allows us to evaluate a number of indicators that reflect the state of the cardiovascular system. According to it, you can calculate the duration, heart rate, heart rate. According to the moments of the onset of anacrosis and the appearance of incisura, one can estimate the duration of the period of expulsion of blood. According to the steepness of the anacrota, the rate of expulsion of blood by the left ventricle, the condition of the aortic valves and the aorta itself are judged. According to the steepness of the anacrota, the speed of the pulse is estimated. The moment of incisura registration makes it possible to determine the beginning of ventricular diastole, and the occurrence of dicrotic rise - the closing of the semilunar valves and the beginning of the isometric phase of ventricular relaxation.

With synchronous registration of the sphygmogram and phonocardiogram on their records, the onset of anacrota coincides in time with the onset of the first heart sound, and the dicrotic rise coincides with the onset of the second heart rut. The rate of anacrotic growth on the sphygmogram, which reflects the increase in systolic pressure, is under normal conditions higher than the rate of decrease in catacrot, which reflects the dynamics of the decrease in diastolic blood pressure.

The amplitude of the sphygmogram, its incisura and dicrotic rise decrease as the place of cc registration moves away from the aorta to the peripheral arteries. This is due to a decrease in arterial and pulse pressures. In places of vessels where the propagation of a pulse wave encounters increased resistance, reflected pulse waves occur. Primary and secondary waves running towards each other add up (like waves on the surface of water) and can increase or weaken each other.

The study of the pulse by palpation can be carried out on many arteries, but the pulsation of the radial artery in the region of the styloid process (wrist) is especially often examined. To do this, the doctor wraps his hand around the hand of the subject in the area wrist joint so that thumb located on the back side, and the rest - on its anterior lateral surface. Having felt for the radial artery, press it against the underlying bone with three fingers until a pulse sensation appears under the fingers.

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. Level blood pressure 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. At physical activity 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 of the ways available to the patient, since too frequent heartbeats 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:

• strong pulse if ejection is made into the aorta a large number blood;
• 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 with high level pressure;
• 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 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 ways to deviate from normal value 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 dysfunction mitral valve);
• 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?

On the human body limited quantity places where you can examine the pulse contractions. And more fewer options 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 easiest way to study the right inner jugular vein. 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 venous and cardiac cycles and not to confuse them, palpate the left vein.

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. Similar action can be produced with a special glass on the patient's lips or forehead. 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. She can be seen on 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 species 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 circulatory system healthy.

Rhythmic oscillations of the arterial wall, caused by a systolic increase in pressure in the arteries, are called arterial pulse. The pulsation of the arteries can be easily detected by touching any palpable artery: a. radialis, a. temporalis, a. dorsalis and others.

A pulse wave, in other words, a wave of pressure increase, occurs in the aorta at the moment of expulsion of blood from the ventricles, when the pressure in the aorta rises sharply and its wall, as a result, stretches. Wave high blood pressure and the oscillations of the arterial wall caused by this propagate at a certain speed from the aorta to the arterioles and frames, where the pulse wave goes out.

The speed of propagation of the pulse wave does not depend on the speed of the blood flow. The maximum linear velocity of blood flow through the arteries does not exceed 0.3-0.5 m/sec, and the velocity of pulse propagation in young and middle-aged people at normal pressure and normal elasticity of the vessels is equal to 5.5 - 8 m / s in the aorta, and 6-9.5 m / s in the peripheral arteries. With age, as the elasticity of the vessels decreases, the speed of propagation of the pulse wave, especially in the aorta, increases.

For a detailed analysis of an individual pulse oscillation, its graphic registration is performed on moving paper or photographic film using special devices - sphygmographs. There are various models of them. Some of them register pulse oscillations using a system of light levers, others - pneumatically using a cuff worn on an arm or leg, and others - optically. Currently, sensors are used to study the pulse, which convert the mechanical vibrations of the arterial wall into electrical changes, which are recorded.

In the pulse curve (sphygmogram) of the aorta and large arteries There are two main parts: anakrota, or the rise of the curve, and katakrot, the descent of the curve.

Anacrotic rise is a consequence of an increase in blood pressure and the resulting stretching that the walls of the arteries undergo under the influence of blood ejected from the heart at the beginning of the exile phase. At the end of the systole of the ventricle, when the pressure in it begins to fall, a catacrotic descent of the curve occurs. At that moment, when the ventricle begins to relax and the pressure in its cavity becomes lower than in the aorta, the blood ejected into the arterial system rushes back to the ventricle; the pressure in the arteries drops sharply, and a deep notch, an incisura, appears on the pulse curve of the large arteries.

However, the movement of blood back to the heart is blocked, as the semilunar valves close under the influence of the return wave of blood and prevent its flow to the heart. The wave of blood bounces off the valves and creates a secondary pressure wave that causes stretching arterial walls. As a result, a secondary, or dicrotic, rise appears on the sphygmogram.

When examining the pulse, you can set a number of its properties: frequency, speed, amplitude, tension and rhythm. The pulse rate per minute characterizes the heart rate. The speed of the pulse is the rate at which the pressure in the artery rises at the time of anacrosis and decreases again at the time of catacrosis. On this basis, pulsus celer (fast pulse) and pulsus tardus (slow pulse) are distinguished. The first occurs with aortic valve insufficiency, when an increased amount of blood is ejected from the ventricles, some of which quickly returns through the valve defect to the ventricle. The second occurs when the aortic orifice narrows, when blood is expelled more slowly than normal into the aorta.

The amplitude of the pulse is called the amount of fluctuation of the arterial wall during the pulse shock.

The tension of the pulse, or its hardness, is determined by the force with which it is necessary to squeeze the artery so that the pulse disappears in it.

Practically important data for judging cardiac activity in some of its disorders can be obtained by simultaneously recording an electrocardiogram and a sphygmogram on the same film. Sometimes there is a so-called pulse deficit, when not every wave of excitation of the ventricles is accompanied by the release of blood into vascular system and pulse impulse. Some ventricular systoles are so weak due to a small systolic ejection that they do not cause a pulse wave reaching the peripheral arteries. In this case, the pulse becomes irregular (pulse arrhythmia).

There are arterial, capillary and venous pulses.

arterial pulse- these are rhythmic oscillations of the artery wall, due to the release of blood into the arterial system during one contraction of the heart. There are central (on the aorta, carotid arteries) and peripheral (on the radial, dorsal artery of the foot and some other arteries) pulse.

For diagnostic purposes, the pulse is also determined on the temporal, femoral, brachial, popliteal, posterior tibial and other arteries.

More often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process of the radial brush and the tendon of the internal radial muscle.

When examining the arterial pulse, it is important to determine its quality: frequency, rhythm, filling, tension, and other characteristics. The nature of the pulse also depends on the elasticity of the artery wall.

Frequency is the number of wave pulses per minute. Normally, in an adult healthy person, the pulse is 60-80 beats per minute. An increase in heart rate of 85-90 beats per minute is called tachycardia. A decrease in heart rate below 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. With an increase in body temperature by 1 0 C, the pulse increases in adults by 8-10 beats per minute.

Rhythmpulse determined by the intervals between pulse waves. If they are the same - the pulse rhythmic(correct), if different - pulse arrhythmic(wrong). In a healthy person, the contraction of the heart and the pulse wave follow each other at regular intervals. If there is a difference between the number of heartbeats and pulse waves, then this condition is called a pulse deficit (with atrial fibrillation). The counting is carried out by two people: one counts the pulse, the other listens to the tops of the heart.

Value is a property that consists of a joint assessment of filling and stress. It characterizes the amplitude of oscillations of the wall of the arteries, i.e. the height of the pulse wave. With a significant value, the pulse is called large, or high, with a small value - small, or low. Normally, the value should be average.

Filling the pulse is determined by the height of the pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then it is probed normal pulse(full); if not, then the pulse empty.

Pulse voltage depends on the magnitude of blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with a moderate increase, so the pulse is normal moderate(satisfactory) voltage. High blood pressure compresses the artery strong pressure- such a pulse is called tense.

It is important not to be mistaken, since the artery itself can be sclerosed (hardened). In this case, it is necessary to measure the pressure and verify the assumption that has arisen.

At low pressure, the artery is compressed easily, the voltage pulse is called soft (unstressed).

An empty, relaxed pulse is called small filiform.

Pulse data are recorded in two ways: digitally - in medical records, magazines and graphics - in the temperature sheet with a red pencil in the column "P" (pulse). It is important to determine the price of pressure in the temperature sheet.

Research data in two ways: digital - in medical records, journals, and graphic - in the temperature sheet with a red pencil in the column "P" (pulse). It is important to determine the price of pressure in the temperature sheet.

Arterial pressure.

Arterial called the pressure that is formed in the arterial system of the body during heart contractions and depends on the complex neurohumoral regulation, magnitude and speed cardiac output, frequency and rhythm of heart contractions, as well as vascular tone.

Distinguish between systolic and diastolic blood pressure.

systolic called the pressure that occurs in the arteries at the moment of maximum rise in the pulse wave after ventricular systole.

diastolic called the pressure maintained in the arterial vessels in ventricular diastole.

Pulse pressure represents the difference between systolic and diastolic blood pressure measurement (study) of blood pressure is performed by an indirect sound method proposed in 1905 by the Russian surgeon N.G. Korotkov. Devices for measuring pressure have the following names: Riva-Rocci apparatus (mercury), or tonometer, sphygmomanometer (pointer), and now electronic devices are more often used to determine blood pressure by a non-sound method.

For the study of blood pressure, it is important to consider the following factors:

§ cuff size, which should correspond to the circumference of the patient's shoulder: M - 130 (130 x 270 mm) - adult medium shoulder cuff, shoulder circumference is 23-33 cm. In small children and adults with a small or large shoulder circumference, blood pressure is corrected when using an adult cuff M - 130 (130 x x 270 mm) according to a special table or a device with special size cuffs. The length of the cuff chamber should correspond to 80% of the coverage of the upper arm in centimeters, and the width should correspond to about 40% of the length of the cuff chamber. A cuff with a smaller width overestimates with a larger one - underestimates the pressure indicators (Appendix 2);

§ The condition of the membrane and tubes of the phonendoscope (stethophonendoscope),

which may be damaged;

§ Serviceability of the pressure gauge, which requires regular verification at least once a year or at intervals specified in its technical characteristics.

Evaluation of results.

The evaluation of the results is carried out by comparing the obtained data with the established standards (according to the technology for performing simple medical services, 2009)

It must be remembered.

During the first visit, blood pressure is measured on both arms.

The multiplicity of measurements is observed. If the first two measurements differ from each other by no more than 5 mm Hg. Art., measurements are stopped and the average value of these values ​​is recorded.

If asymmetry is detected (more than 10 mm Hg for systolic and 5 mm Hg for diastolic blood pressure, all subsequent measurements are taken on the arm with higher blood pressure. If the first two measurements differ from each other by more than 5 mm Hg st., then a third measurement and (if necessary) a fourth measurement are taken.

If a progressive decrease in blood pressure is observed with repeated measurements, then it is necessary to allow time for the patient to relax.

If multidirectional fluctuations in blood pressure are noted, then further measurements are stopped and the arithmetic mean of the last three measurements is determined (excluding the maximum and minimum blood pressure values).

Normally, blood pressure fluctuates depending on age, environmental conditions, nervous and physical stress during the period of wakefulness (sleep and rest).

Level classification

blood pressure (BP)

In an adult, the norm systolic pressure ranges from 100-105 to 130-139 mm Hg. Art.; diastolic- from 60 to 89 mm Hg. Art., pulse pressure normally is 40-50 mm Hg. Art.

arterial pulse in medical practice characterizes the state of human health, so with any disturbances in the circulatory system, a change in rhythm and fullness occurs in the peripheral arteries. Thanks to the knowledge of the characteristics of the pulse, it is possible to control heartbeat on one's own. How to correctly determine the number of heartbeats and normal parameters heart rate for different age groups?

general characteristics

The arterial pulse is the rhythmic contraction of the arterial wall due to the ejection of blood during the contraction of the heart muscle. Pulse waves are formed at the mouth of the aortic valve during the ejection of blood by the left ventricle. The stroke volume of blood occurs at the moment of an increase in systolic pressure, when the diameter of the vessels expands, and during the period of diastole, the dimensions of the vascular walls are restored to their original parameters. Consequently, during the period of cyclic contractions of the myocardium, there is a rhythmic oscillation of the walls of the aorta, which causes a mechanical pulse wave that spreads to large and then to smaller arteries, reaching the capillaries.

The farther the vessels and arteries are located from the heart, the lower the arterial and pulse pressure becomes. In the capillaries, pulse fluctuations decrease to zero, which makes it impossible to feel the pulse at the level of arterioles. In vessels of this diameter, blood flows smoothly and evenly.

Beat Detection Options

Registration of heart beats great importance to determine the state of the cardiovascular system. By determining the pulse, you can find out the strength, frequency and rhythm of myocardial contractions.

There are the following properties of the pulse:

• Frequency . The number of contractions that the heart makes in 60 seconds. In an adult at rest, the norm is 60-80 heartbeats in 1 minute.
• Rhythm. Regular repetition of pulse fluctuations and the frequency of contractions of the heart muscle. In a state of health, pulse beats follow one after another at regular intervals.
• Filling. The characteristic depends on the pressure values, the amount of circulating blood and the elasticity of the arterial walls. Depending on the presented parameters, a good, normal, satisfactory and insufficiently full pulse is distinguished.
• Voltage . It can be determined by the force that must be applied to stop the propagation of a pulse wave through the artery at the site of pressing. At high rates blood pressure pulse becomes tense and hard. At low rates pressure pulse can be assessed as soft.
• Speed ​​. It is determined at the peak of the rise in pressure, when the wall of the artery reaches a maximum of pulse fluctuations. The rate depends on the increase in pressure during systole in the arterial system.

Age-related changes in heart rate

As a rule, the heart rate changes with age due to degenerative disorders in the circulatory system. In elderly people, the pulse becomes less frequent, which indicates stretching of the walls of blood vessels and a decrease in their blood supply.

At the beginning of life, the heart rate is unstable and very often non-rhythmic, but by the age of seven, the pulse parameters become stable. This feature associated with functional imperfection of the neurohumoral activity of the myocardium. In emotional and physical rest in children 7-12 years old, heart contractions do not tend to slow down. Besides, in puberty pulse rate increases. And only from the age of 13-14, processes are activated that contribute to a slowdown in heart rate.

AT childhood the heart rate is more frequent than in adults, which is associated with a fast metabolism and a high tone of the parasympathetic nervous system. Accelerated pulse plays leading role in providing a minute volume of blood, which guarantees the necessary blood flow to tissues and organs.

Methods for determining

The study of the arterial pulse is carried out on the main (carotid) and peripheral (carpal) arteries. The main point for determining heart rate is the wrist, on which the radial artery is located. For precise research it is necessary to palpate both hands, since situations are possible when the lumen of one of the vessels can be compressed by a thrombus. After comparative analysis of both hands, the one on which the pulse is best palpated is selected. During the study of pulse shocks, it is important to place the fingers in such a way that 4 fingers are on the artery at the same time, with the exception of the thumb.

Determination of pulse fluctuations on the radial artery

Other ways to determine the pulse:

• Hip area. The study of pulse shocks is carried out in a horizontal position. To do this, you need to place the index and middle finger in the pubic area, where the inguinal folds are located.
• Neck area. Study carotid artery carried out with two or three fingers. They need to be placed on the left or on the right side neck, retreating 2-3 cm from mandible. Palpation is recommended inside neck in the region of the thyroid cartilage.

Determining the pulse on the radial artery can be difficult in case of weak cardiac activity, so it is recommended to measure heart rate on the main artery.

Limits of the norm

The normal frequency of pulse fluctuations in a person in a state of health is 60-80 beats per minute. The deviation of these norms to a smaller side is called bradycardia, and to a larger one - tachycardia. These deviations indicate the development of pathological changes in the body and act as signs various diseases. However, there are cases when situations arise that cause physiological acceleration of pulse shocks.

The frequency of pulse fluctuations in women is slightly higher than in men, which is associated with instability of the nervous system.

Conditions that cause physiological change heart rate:

• Sleep (in this state, everything slows down metabolic processes, the heart does not experience additional loads, so the frequency of its contractions becomes less frequent).
• Daily fluctuations (at night, the heart rate slows down, and accelerates in the afternoon).
• physical activity (heavy physical work provokes an increase in the frequency of heart activity, increasing mainly the work of the left ventricle).
• Emotional and mental stress ( anxiety states and periods of joy cause an increase in pulse fluctuations, which disappear on their own after the restoration of a normal emotional background).
• Fever (with each degree of temperature increase, heart contractions accelerate by 10 beats per minute).
• Drinks (alcohol and caffeine speed up the work of the heart).
• Medications (taking drugs that increase libido and antidepressants can cause frequent pulse shocks).
• Hormonal imbalance (in women in menopause there is tachycardia caused by a change in the hormonal background).
• Athletes (the cardiovascular system of this category is trained, therefore it does not lend itself to drastic changes, they are characterized by a rare pulse).

Diagnostic methods

The study of heart rate allows you to assess the state of the cardiovascular system and identify possible deviations from the norm. According to the generally accepted characteristics of the pulse, you can find out about the state of the myocardium, heart valves and the elasticity of the vascular walls. Pulse shocks are recorded using graphic research methods, as well as by palpation of vessels located on the surface of the body.

The main method of studying the pulse is palpation, which allows you to evaluate its properties.

There are two main methods for determining pulse fluctuations:

• Sphygmography. A method that allows you to graphically display the arterial pulse. With the help of special sensors, the pulse wave is recorded.
• Palpation. During the examination, the pulse on the radial artery is determined. With the help of fingers, the frequency of pulse shocks is determined.

Determining the arterial pulse plays an important diagnostic role in assessing the patient's health status. Knowledge of the properties of pulse fluctuations makes it possible to identify possible hemodynamic disorders and pathological changes in the work of the heart.