Pulse is the period of oscillation of the walls of the arteries. Arterial pulse, its origin and characteristics

3. Pulse and its characteristics

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. radius and tendon of the internal radial muscle.

When examining the arterial pulse, it is important to determine its 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 pulse waves per minute. Normal in an adult healthy person pulse 60-80 beats per minute. An increase in heart rate over 85-90 beats per minute is called tachycardia. A heart rate slower than 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. With an increase in body temperature on GS, the pulse increases in adults by 8-10 beats per minute.

The rhythm of the pulse is determined by the intervals between pulse waves. If they are the same, the pulse is rhythmic (correct), if they are different, the pulse is arrhythmic (incorrect). 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 heart sounds.

The filling of the pulse is determined by the height pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then a normal pulse (full) is felt; if not, then the pulse is empty. The voltage of the pulse depends on the value of arterial 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 effort, therefore, the pulse of moderate (satisfactory) tension is normal. At high pressure artery is compressed strong pressure- such a pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.

At low pressure, the artery is squeezed easily, the voltage pulse is called soft (non-stressed).

An empty, relaxed pulse is called a small filiform.

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

4. Counting the arterial pulse on the radial artery and determining its properties

Purpose: to determine the basic properties of the pulse - frequency, rhythm, filling, tension.

Indications: evaluation functional state organism.

Equipment: clock or stopwatch, temperature sheet, pen with red stem.

Explain the essence and course of the procedure

Prepare the necessary equipment.

Wash and dry hands.

Grab the patient's hands at the same time with your fingers above wrist joint so that the 2nd, 3rd and 4th fingers are over the radial artery (2nd finger at the base of the thumb). Compare the oscillations of the walls of the arteries on the right and left hands.

Count pulse waves on the artery where they are best expressed for 60 seconds.

Assess the intervals between pulse waves.

Assess the filling of the pulse.

Compress the radial artery until the pulse disappears and evaluate the tension of the pulse.

To register the properties of the pulse in the temperature sheet in a graphical way, and in the observation sheet - in a digital way.

Communicate the results of the study to the patient.

Wash and dry hands.

5. Blood pressure measurement

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

Distinguish between systolic and diastolic pressure. Systolic pressure is the pressure that occurs in the arteries at the moment of maximum rise in the pulse wave after ventricular systole. The pressure maintained in the arterial vessels during ventricular diastole is called diastolic.

Pulse pressure is the difference between systolic and diastolic pressure.

Measurement of blood pressure is performed by an indirect sound method, proposed in 1905 by the Russian surgeon N.S. Korotkov. Apparatus for measuring pressure are the following names: Riva-Rocci apparatus, or tonometer, or sphygmomanometer.

Currently, electronic devices are also used to determine blood pressure by a non-sound method.

For the study of blood pressure, it is important to consider the following factors: the size of the cuff, the condition of the membrane and tubes of the phonendoscope, which can be damaged.

Purpose: to determine blood pressure indicators and evaluate the results of the study. Indications: as directed by a doctor.

Establish a trusting relationship with the patient.

Explain the essence and course of the forthcoming actions.

Obtain patient consent for the procedure.

Warn the patient about the upcoming procedure minutes before it starts.

Prepare the necessary equipment

Wash and dry hands.

Give the patient comfortable position sitting or lying down.

Lay the patient's arm in an extended position with the palm up, placing the roller under the elbow.

Place the tonometer cuff on the patient's bare shoulder 2-3 cm above the elbow so that 1 finger passes between them.

Note: Clothing should not squeeze the shoulder above the cuff. The lymphostasis that occurs when air is forced into the cuff and the vessels are clamped is excluded.

The cuff tubes are facing down.

Connect the pressure gauge to the cuff, fixing it on the cuff.

Check the position of the pressure gauge pointer relative to the "0" mark on the scale.

Determine the pulsation in the cubital fossa with your fingers, attach a phonendoscope to this place.

Close the pear valve, pump air into the cuff until the pulsation in the ulnar artery disappears + 20-30 mm Hg. Art. (i.e. slightly above the expected blood pressure).

Open the valve, slowly, let out air, listening to the tones, follow the readings of the pressure gauge.

Note the number of the first beat of the pulse wave corresponding to systolic blood pressure.

Release the air slowly from the cuff.

"Mark" the disappearance of tones, which corresponds to diastolic blood pressure.

Note: weakening of tones is possible, which also corresponds to diastolic blood pressure.

13. Release all air from the cuff.

14. Repeat the procedure after 5 minutes.

1. Remove the cuff.

2. Place the pressure gauge in the case.

3. Disinfect the head of the phonendoscope by wiping twice with 70% alcohol.

4. Evaluate the result.

5. Inform the patient of the measurement result.

6. Register the result in the form of a fraction (in the numerator - systolic pressure, in the denominator - diastolic) in the necessary documentation.

7. Wash and dry your hands.

II. Breath monitoring

When observing the breath, special attention should be paid to the change in color. skin, determining the frequency, rhythm, depth respiratory movements and assess the type of breathing.

Respiratory movement is carried out by alternating inhalation and exhalation. The number of breaths per minute is called the respiratory rate (RR).

In a healthy adult, the rate of respiratory movements at rest is 16-20 per minute, in women it is 2-4 breaths more than in men. The NPV depends not only on gender, but also on the position of the body, condition nervous system, age, body temperature, etc.

Breathing monitoring should be carried out imperceptibly for the patient, as he can arbitrarily change the frequency, rhythm, depth of breathing. NPV refers to heart rate on average as 1:4. With an increase in body temperature by 1 ° C, breathing quickens by an average of 4 respiratory movements.

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. By knowing the characteristics of the pulse, you can control your heart rate yourself. 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 form at the mouth aortic valve during the ejection of blood from the left ventricle. Stroke volume occurs when there is an increase in systolic pressure when there is an expansion of the diameter of the vessels, and during the period of diastole, the dimensions vascular walls restored to original settings. 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 status of cardio-vascular 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 horizontal position. To do this, you need to place the index and middle fingers 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 right side of the neck, retreating 2-3 cm from mandible. Palpation is recommended to be carried out from the inside of the neck in the area 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 of 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 exercise(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.

Like pressure, the pulse is arterial, capillary and venous.
The arterial pulse is determined in the projection of large and medium, superficially located arteries, which in most respond to the work of the heart. The fluctuations of their walls are caused by the passage of blood through them, the flow of which is enhanced by contractions of the ventricles.
The pulse wave does not pass through the arterial bed at once, but as the blood flow spreads, so the pulse can be recorded not at the same time as the heart beats, but with a slight delay. If you simultaneously listen to a person’s heart and determine the pulse, for example, on the carotid artery, then the difference will not be noticeable, since this vessel is located very close to it and immediately reacts to the release of blood. Going to the radial artery, which is located on the wrist, you can already catch some difference, but it is less than a second and is practically not perceived. The greatest differences are noticeable if you determine the pulse on the foot - here the delay can be caught quite clearly.
Depending on which vessel the arterial pulse is measured, it is called central or peripheral. The central pulse is determined on large vessels such as the carotid (carotid) arteries or the aorta. The peripheral one is recorded in the projection of the middle arteries - the brachial, radial, tibial, etc.
The capillary pulse is the oscillation of the walls of the capillaries. Even in such small vessels"echoes" of the work of the heart can still be noticeable. It is determined with the help of special equipment and by eye. healthy patient not noticeable. However, in some diseases it can be observed quite clearly. There is a heart defect called aortic insufficiency. When it occurs, the destruction of the valve located between the left ventricle and the aorta. As a result, the blood, which great strength ejected into the aorta, partially returned back. The blood flow from side to side increases not only the arterial, but also the capillary pulse. In sick people, it can be seen in the form of a pulsation of the pupils in rhythm with the heart - an interesting symptom and in some cases even a little frightening. If such patients lightly press on the nail so that it forms white spot, this spot will also change rhythmically - either increase or decrease in size. This is also a manifestation of the capillary pulse.
The veins, separated from the pulsating ventricles by a network of capillary vessels, no longer receive blood in the form of shocks, so their walls themselves cannot oscillate. However, on large vessels, a pulsation can be noted, which is transmitted to them from the arteries. This is called the venous or venous pulse. It is most noticeable on the jugular veins - vessels that are located on the neck next to the carotid arteries. At thin people and during physical exertion, they are visible under the skin in the form of pulsating tourniquets 5-6 mm thick.
The arterial pulse, compared to the capillary or venous pulse, is the most useful for diagnosis. The elastic, well-palpable walls of the arteries make it possible to evaluate the work of the heart by a variety of parameters. Sometimes only one assessment of the pulse can help in setting correct diagnosis. Chinese medicine describes about a hundred characteristics of the pulse, according to which the definition of diseases is carried out.
Despite the fact that the task of determining the arterial pulse seems very simple, in some cases people cannot find it and measure it correctly. In order to capture pulse waves, you need to follow a few rules. Firstly, the pulse is always determined not by one, but by several fingers - this way you can quickly and accurately detect fluctuations in the arteries. Never participates in the measurement thumb. This is necessary because it contains more large arteries than in other fingers, as a result of which a person trying to find the patient's pulse may mistake his own for someone else's.
Fingers, from the index to the little finger, are placed in a line along the artery and lightly pressed with pads to the skin. You should not press hard, as this can pinch the vessel. In this case, the pulsation in it will stop altogether, and an attempt to measure will lead to nothing. If the projection zone of the vessel is determined correctly, and there are no errors in the technique, the oscillations are determined very easily. They are recommended to be counted within a minute, using a stopwatch or a watch with a second hand. If there is not enough time, the pulse is counted for 30 s, in emergency situations- 15 s, and then multiplying by 2 or 4 respectively to calculate the minute indicator. However, it should be remembered that when measuring short term errors are possible, therefore, if the situation allows you to carry out the procedure slowly, it is still better to count it within a minute.

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Arterial pulse can be determined at several points.
The most common place for determining the pulse is on the radial artery. The measurement is carried out on the right or left hand, in the lower part of the forearm, practically in the wrist area. The artery lies under the skin parallel to the radius, closer to the thumb.
In addition, pulsation can be determined on the carotid arteries. In search desired point as a guide, you should use the thyroid cartilage - "Adam's apple", which is better visible in men. At fat people and women it is detected not visually, but by probing the trachea. This cartilage is located just below the middle of the neck. For ease of measurement, the patient's head is turned to the side, opposite side measurements. For example, if the pulse is measured on the right carotid artery, the patient turns his head to the left. When turning the head, a muscular roller becomes noticeable on the neck, starting behind the ear and going down to the inner end of the collarbone. This is the sternocleidomastoid muscle, our second landmark. Having found both formations, you can start measuring. Fingers, from the index to the little finger, line up between the trachea and the muscle, at the level of the thyroid cartilage. They are placed along the artery, that is, parallel to the neck. If everything is done correctly, a person can clearly feel the pulse.
Very clearly pulse waves are visible on the aorta. In slender people and adolescents, the pulsation of this vessel is noticeable even visually - anterior abdominal wall rises and falls in time with the beating of the heart. The pulse on the aorta can be determined with the whole palm. She is placed on upper part the patient's abdomen, parallel to the axis of the body, while the fingers are directed towards the sternum, and the base of the palm is closer to the navel. With a slight pressure of the palm on the abdomen, the researcher may feel vibrations.
If necessary, the pulse can be measured on the axillary artery. Since it is quite large, its pulsation can usually also be seen with the naked eye. The axillary artery is located in the projection of the anterior edge of the deltoid muscle - the one that forms the roundness of the shoulder and covers shoulder joint above. More simply, it lies almost parallel to the front hairline when the patient is standing or lying with his hand behind his head. It is very easy to determine oscillations in this zone.
Another artery that lies superficially and is suitable for measuring the pulse is the femoral. She is in inguinal region. In order to find the desired zone, it is necessary to determine the location of the inguinal ligament. On the one hand, it is attached to pubic bone(approximately along the midline of the body), on the other - to the upper spine ilium, the bony protrusion of the pelvis, which is so clearly visible in slender Girls. When a person sits, a fold forms along the line of the inguinal ligament. Having found the inguinal ligament, it is conditionally divided into three equal segments. The desired point is located on the border between the middle and inner segments. The fingers are placed in a line perpendicular to the ligament and lightly pressed against the skin. The pulsation of the artery is immediately detected.
On the leg, pulse waves can be fixed in three more zones. The first of them is under the knee; despite the fact that an artery of a rather large diameter passes here, it can be quite difficult to find it, since it lies deep, covered with adipose tissue and lymph nodes. It is much easier to determine the pulse below.
In the lower part of the lower leg, to the right and left of the foot, there are two bony protrusions - the inner and outer ankle. Behind the medial malleolus is the posterior tibial artery, where pulse waves can also be seen. In addition, sometimes the pulse is found on the dorsal artery of the foot - it lies between the first and second metatarsal bones, in other words, on the back of the foot between the first (big) and second toes. In some people, there is no pulsation in this zone, since this vessel can lie both superficially and deep under the skin.
Probably every person experiencing headache put his fingers to his temples and felt the vibrations. The last zone in which vascular pulsation can be detected is on the head, in temporal region. Here you can almost always feel it.
So, we have learned how to correctly determine the pulse. Why is this procedure necessary? When measuring the pulse, you can not only calculate how often the heart contracts, but also draw other conclusions. This will help evaluate its characteristics.
The pulse rate is the number of vibrations recorded in a minute. In a healthy adult, it is 60-80 per minute, plus or minus 3-5 beats. If a person's pulse is more than 85-90, this condition is called tachycardia, less than 50-55 - bradycardia. During deep sleep it decreases to about 50 beats. This is the norm and is called physiological bradycardia. A decrease in frequency also occurs in professional athletes; even in normal conditions, their pulse can reach 45-55 beats per minute. With physical and emotional stress the figures, on the contrary, can increase significantly, in some cases by 2-3 times or more. For example, for a sprinter running a distance of 100 m, the frequency increases to 200-220 beats in a few seconds. Tachycardia can also be noted with excessive heating - for example, in a person in a bath, with an increase in body temperature per degree, the pulse increases by about 10 beats.

Practice shows that in extreme situation only 2-3 people out of 10 can correctly determine the pulse of the victim. The rest either do not find it, or “feel” the pulse where it does not exist. This speaks to the need for practice - after all, everyone can find themselves in a situation where the appropriate skill is required.

The next characteristic is rhythm. The pulse may be rhythmic or non-rhythmic (arrhythmic). Normally, the intervals between oscillations of the vessel walls are the same. In healthy people, extrasystoles can sometimes occur - extraordinary contractions of the heart that appear due to the appearance of an additional impulse in the atrium. At the time of the extrasystole, the pulse becomes irregular, but then levels off again. Such phenomena can occur several times a day, but they are always rare and single, therefore, it is most often not possible to register them during random measurements. Thus, arrhythmia always indicates the presence of a disease in a person.
Filling is a characteristic that reflects the degree of filling of the vessel with blood and is estimated by the height of the pulse fluctuation. The pulse may be more or less full. Normally it is full.
Many people confuse the filling of the pulse with its tension. Voltage is a property that can vary with blood pressure numbers. It is determined by pressing the vessel with your fingers until it stops pulsing, passing blood. The more effort you put into it, the more arterial pressure and, consequently, the tension of the pulse. In healthy people with average BP tension is defined as satisfactory - in order for the artery to stop pulsing, an average pressure force is sufficient, at which the researcher's hand does not experience a large load. If enough pressure is required to compress a vessel great power, this indicates increased tension, otherwise it is relaxed, or soft. A change in this characteristic does not always indicate the presence of a disease. With age, the walls of the arteries gradually thicken and become less pliable. For this reason, in the elderly and old people, the intensity of the pulse can be high even with normal pressure figures.
However, in any case, if there is an assumption about an increase in tension, the guess must be confirmed by its measurement. Normally, a soft pulse can be found in adolescents, women and people with an asthenic physique, i.e., those who show a tendency to reduced pressure but still feel good. For some severe violations when a critical decrease in blood pressure occurs, a threadlike pulse can be recorded, which has a small filling (empty) and low voltage (soft).
The next characteristic of the pulse is its symmetry. In order to evaluate this, it is necessary to measure it simultaneously on both hands. Normally, the pulse is always symmetrical. If the pulse wave on one of the sides is at least a little delayed, this may indicate various diseases- from heart defects to tumors. Sometimes the so-called asymmetric pulse (that is, different on the right and left hand) can be a consequence of an injury to the upper limb, when a scar has formed during the healing process that interferes with blood flow.
If an asymmetric pulse is found in a person, then all its characteristics are determined from the side in which the fluctuations of the walls of the vessel are better captured.
Another definition that needs to be learned is the value of the pulse. The value is a property that is the sum of the joint assessment of filling and tension. 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.
The height of the pulse waves must be the same. If the pulse value in the same patient is either larger or smaller, this indicates violations heart rate. Such a pulse is called uneven.
The next characteristic is the shape of the pulse. For exact definition forms exist special device- sphygmograph. It determines the rise and fall of the pulse wave and depicts them on a graph, where the wall oscillations that occur in this case are clearly visible. However, the shape can also be determined with the help of fingers. In healthy people, the expansion and narrowing of the arteries occurs evenly and at a moderate rate. If the wave rises quickly and falls quickly, which is felt in the form of sharp shocks, such a pulse is called fast, or jumping. This violation can talk about heart disease, but sometimes such a change in shape is possible with strong excitement.
When the wall of the artery fluctuates at a low speed and rises low, they speak of a slow pulse, which is also not the norm.
These are the basic properties of the arterial pulse. Separately from the rest, two more violations are distinguished, which occur when not one, but several characteristics change at once. This is a dicrotic and paradoxical pulse. Since both of these varieties are signs of pathology, they will be described in the chapter on patient complaints.

The correct functioning of the cardiovascular system shows the characteristics of the pulse. This is the first thing that is checked in a person who asked for an ambulance. Although, at first glance, it seems that this indicator does not carry much information about the state of the body and is not so important, it should still be given special attention. By the frequency of pulsations, malfunctions in the work of the heart, the presence of inflammation and other serious illnesses. Pulse character gives big picture state of the body. It is impossible to diagnose a specific disease only by reading the pulse, but it is possible to identify the direction of the problem.

What it is?

The heart pumps blood continuously throughout the body. When it passes through the veins and arteries, it hits their walls due to resistance. These shocks are felt in those places where the vessels pass close to the surface of the skin. This is called the pulse and is indicated by beats per minute. The properties of the pulse depend on a number of factors and they determine the heart rate. There are such types of pulse:

• - jerky oscillation in the artery, which occurs when filled with blood and has the characteristics of a pulse;
• venous - pulsation of large veins in the neck and close to the heart;
• capillary is a change in the color of the nail bed.

Briefly about the characteristics that are determined during the study:

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• frequency reflects the number of full oscillations of the walls of the vessel, determined by palpation;
• rhythm is determined by the interval between tremors of blood, shows the correct functioning of the heart;
• the filling of the pulse characterizes the volume of blood that entered the artery;
• tension refers to the force that is needed to clamp the artery;
• the shape of the pulse means the rate at which the volume of the artery changes;
• height - a value that combines tension and content, it corresponds to the sum of their indicators.

How to measure?

The way to measure heart rate is by palpation of the pulse. More often, the study of the pulse is carried out on the artery located on the wrist under the thumb and which is called the radial one. The hand should be relaxed, and the hand should be clasped so that the thumb is on the back side, and the rest on the front surface. For getting exact result measurements are taken simultaneously on two hands. You can measure pulse shocks in other arteries:

• sleepy;
• femoral;
• temporal;
• brachial.

With a slow, weak heartbeat, the peripheral pulse will be faintly felt, so it is difficult to find and determine it. In this case, the study should be done on the carotid artery. On the area where this artery is located - on the front edge of the sternocleidomastoid muscle, slightly above the Adam's apple - you need to put two fingers, index and middle. In this case, it is impossible to simultaneously determine the frequencies of pulse waves simultaneously from two sides.

At normal operation of the heart, the number of pulsations is calculated in 30 seconds and the result is doubled. If there are rhythm disturbances, then measurements are taken for a minute. A person who knows, independently carries out the measurement, and even deviations can be detected: is the blood impulse rhythmical and what is the frequency? The correctness of the diagnosis depends on the quality of the measurements.

What does it depend on?

The nature of the pulse depends on various factors- actions environment, physiological, pathological factors and age. Gender also has an influence - in women, the frequency is higher than in men. The main reasons that have an impact on the reduction rate:

• Physiological. Physical activity, stress, eating and digesting food, drinks such as coffee, coca-cola, alcohol, smoking increase the heart rate. During sleep and monotonous quiet work, a slowdown occurs.
• Pathological. An increase in heart rate is provoked infectious diseases, hypertension, tumors, asthma, bronchitis, blood loss. heart attack, side effects from different drugs slow down the pulse. When the heart is disturbed, the pulse wave becomes irregular. With blockage of blood vessels in the limbs, it may be completely absent.

Age norms

The age of a person affects the heart rate. Newborn children usually have a high frequency, in contrast to the adult. It is also believed that before death, the frequency of pulse waves increases, for what reasons, there is no exact explanation. The table shows the normal pulse depending on age. But it should be understood that these indicators relate exclusively to a healthy person, without pathologies and in a normal calm state.

Reasons for change

With age, there is a change in the value of the pulse in the norm. This is due to the fact that small newborn a child's heart is very small, so it must contract more often to pump right amount blood into the body. As the body grows and the heart becomes large sizes, which means that it can work more slowly. Therefore, in adults under 50 years of age, the frequency is on average 70 beats / min. Under the influence of loads on the body, the heart also has to work faster to cover the oxygen consumption. Athletes who have pumped up strong heart, the frequency of contractions is low - 40 beats and this is the norm for them.

Pulse- These are vibrations of the walls of the arteries, which are associated with cardiac cycles. Such vibrations are jerky. AT clinical practice distinguish capillary, venous and arterial pulse. normal pulse a healthy person is from 60 to 80 beats per minute.

Physicians have been aware of the importance of measuring the pulse since ancient times. Scientists created treatises on the pulse, expressed various theories and assumptions. For example, a doctor from Constantinople described the relationship of the pulse with malaria, dehydration, anemia. Special attention the pulse was given by the doctors of Tibet and Ancient China. Pulse diagnosis was used in surgical practice and was part of the clinical examination. There was even a rule that pulse diagnostics only a man who has studied for at least thirty years can learn. Many centuries ago, a technique for palpation of the pulse was already invented, which is still used today.

To date, there are several methods that allow you to measure the pulse. All methods are somehow connected with the analysis of the pulse wave and the heartbeat. At the same time, they develop hardware techniques when various devices are used for analysis: an electrocardiograph, a pulse oximeter, a heart rate monitor, and traditional approaches which are similar to those used in traditional medicine. Thus, all research methods can be divided into two groups:

• Hardware research methods

• Manual research methods

To date practical medicine identifies a number of areas that are associated with the analysis of the rhythmicity of the functions of the heart:

• Diagnosis of conduction disorders
• Screening of gross cardiac pathologies, various cardiomyopathies
• Monitoring of cardiac functions in the operating room and in seriously ill patients
• Functional control in sports and general medical practice
• Control of cardiotoxicity of drugs and other substances

The study of the heart rate is also widely used to assess the level of stress. The cognitive aspects of the pulse, which connect the structure of the heart rate and the mental sphere, are being explored.

arterial pulse

arterial pulse represents the fluctuations of the arterial walls, which are associated with the fact that the arteries change their blood supply. Arterial pulse can be studied using the following methods:

• Inspection

• Palpation

In some cases, the pulsation of the arteries is pronounced, and it can be seen even during examination. An example is the so-called dance carotid- pronounced pulsation on the neck in the region of the carotid artery.

Palpation, with all the variety of hardware methods for studying the pulse, is the simplest and most reliable method, since it does not require special preparation before measurement. Palpation can be performed in several places human body where superficial arteries can be felt.

On the upper extremities, the pulse can be measured on the axillary artery - this is the axillary pulse, the brachial pulse is measured on the brachial artery, near the elbow, this method is usually used as an alternative to the carotid pulse measured in infants. The ulnar pulse is measured on the medial part of the wrist - on the ulnar artery. The radial artery allows you to measure the radial pulse, which is palpated on the lateral part of the wrist.

On palpation, the doctor is opposite the patient, probing the pulsations on the left and right hands. After that, he simultaneously grasps the pulsation area of ​​the patient's right hand with three fingers of his left hand, and right hand, respectively, on the left. Based on his own sense of touch, the specialist determines the absence or presence in the grandeur and filling of the arterial pulse, thus determining the symmetry of the pulse. Then the doctor gives the rest of the characteristics: shape, height, tension, rhythm. Available different ways counting the pulse, but it is recommended to carry out a full count within a minute, so the frequency can change dramatically at. The next step in palpation of the pulse is to determine the absence or presence of a pulse deficit. Such a study is carried out simultaneously by two people. One counts heart rate, and the other is pulse rate. Next, the results are compared. Normally, they should be equal, but with various diseases, such as arrhythmias, for example, they differ.

Except upper limbs the pulse can be measured on the head and neck (temporal pulse - on the superficial temporal artery, facial pulse - on the facial artery at the lower edge of the jaw, carotid pulse - on the carotid artery, which is located in the neck, however, excessive squeezing of such an artery can lead to cerebral ischemia or fainting), trunk (the apical pulse is measured, which is palpated outside of the midclavicular line).

Pulse rate a is the value that reflects the number of oscillations of the walls of the arteries per unit of time. Distinguish rapid pulse- over 90 beats per minute, rare - less than 60, and moderate - 60-80 beats per minute.

In addition, distinguish rhythmic pulse, the intervals between successive waves are different, and rhythmic pulse at the same intervals.

By filling, that is, the volume of blood in the artery, the following types of pulse are distinguished: threadlike, that is, a barely perceptible pulse; an empty pulse that is poorly palpated; a full pulse, in which the artery is filled beyond the norm and a pulse of moderate filling.

Venous pulse

A venous pulse is a pulsation in the neck, as well as other large veins that are located directly near the heart. In the peripheral veins, such a pulse is not traced.

In clinical practice, a negative and positive venous pulse is distinguished. The filling of the arteries is normally accompanied by the collapse and emptying of the veins, in this case there is a negative venous pulse. When the tricuspid valve has any pathology, the filling of the veins can be combined with the filling of the arteries - this is a positive venous pulse.

capillary pulse

capillary pulse- this is a change in the intensity of the color of the bed of the nail, hyperemic skin, which occurs synchronously with the arterial pulse. Since the blood flow in the capillaries in a healthy person is continuous, the presence of such a pulse is not the norm. Its appearance is associated with a large difference between diastolic and systolytic pressure, so the precapillary sphincters do not cope with their work. Many pathological condition accompanied by this deviation, but first of all, the capillary pulse is observed with aortic valve insufficiency.

There are several methods that allow you to identify the presence of this type of pulse:

• With slight pressure on the end nail bed in a healthy person, half of the pressed part becomes pale, in addition, a clear border appears that does not change its position until the pressure is weakened. With aortic valve insufficiency, there is a rhythmic redness and blanching of the pressed nail bed.

• Also, the presence of a capillary pulse can be detected by pressing the cover slip against the mucous membrane of the lip. If there is a rhythmic contraction, then the capillary pulse.

• The capillary pulse is also detected by rubbing the skin on the forehead. If in the hyperemic area there is blanching, then redness is a capillary pulse.