Pulse physiology. arterial pulse. Pathological changes in the venous pulse

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:

Slows down in sleep, and indeed in the supine position, but does not reach real bradycardia;
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);
Increases during intense physical activity (hard work, sports training);
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;
The heart rate increases with an increase in body temperature and the environment;
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);
It depends on gender (the pulse rate in women is slightly higher);
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:

Pregnancy (weeks)	Norm of heart rate (beats per 1 minute)
4-5	80-103
6	100-130
7	130-150
8	150-170
9-10	170-190
11-40	140-160

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:

Age	Limits of normal values (bpm)
newborns (up to 1 month of age)	110-170
from 1 month to 1 year	100-160
from 1 year to 2 years	95-155
2-4 years	90-140
4-6 years old	85-125
6-8 years old	78-118
8-10 years old	70-110
10-12 years old	60-100
12-15 years old	55-95
15-50 years old	60-80
50-60 years old	65-85
60-80 years old	70-90

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:

Dizziness, pre-syncope, (they say that cerebral blood flow is disturbed);
Pain in the chest caused by a violation of the coronary circulation;
visual disturbances;
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:

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.
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.
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 cope well 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!”

The arterial pulse is a rhythmic jerky oscillation of the vessel wall resulting from the ejection of blood from the heart into the arterial system. Pulse from lat. pulsus - push.

Physicians of antiquity paid great attention to the study of the properties of the pulse. The scientific basis of the doctrine of the pulse was received after the discovery of the circulatory system by Harvey. 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 ejected into the aorta. This blood stretches the initial part of the elastic aorta and increases the pressure in it. This change in pressure propagates along the aorta and its branches to the arterioles. In the arterioles, the pulse wave stops, because. there is high muscle resistance. The propagation of the pulse wave occurs much faster than the blood flows. The pulse wave goes at a speed of 5-15 m / s, i.e. it runs 15 times faster than blood. That. the occurrence of a pulse is due to the fact that during the work of the heart, blood is pumped into the vessels inconsistently, but in portions. The study of the pulse allows you to judge the work of the left ventricle. The greater the systolic volume, the more elastic the artery, the greater the wall oscillations.

Vibrations of the walls of the arteries can be recorded using a sphygmograph. The recorded curve is called a sphygmogram. On the pulse recording curve - sphygmogram, an ascending knee is always visible - an anacrota, a plateau, a descending knee - a catacrot, a dicrotic rise and an incisura (notch).

Anacrota occurs due to an increase in pressure in the arteries and coincides in time with the phase of rapid expulsion of blood into the systole of the ventricles. At this time, the inflow of blood is greater than the outflow.

Plateau - coincides with the phase of slow expulsion of blood into the systole of the ventricles. At this time, the inflow of blood into the aorta is equal to the outflow. After systole, the semilunar valves close at the beginning of diastole. The inflow of blood stops, but the outflow continues. The outflow predominates, so the pressure gradually decreases. This causes catacrosis.

In the proto-diastolic interval (end of systole, beginning of diastole), when the pressure in the ventricles decreases, the blood tends back to the heart. Outflow is decreasing. An incisura occurs. During diastole of the ventricles, the semilunar valves close and, as a result of the impact on them, a new wave of blood outflow begins. There is a short-term wave of increased pressure in the aorta (dicrotic rise). After that, the catacrosis continues. The pressure in the aorta reaches the initial level. Outflow increases.

Pulse properties.

Most often, the pulse is examined on the radial artery (a.radialis). In this case, pay attention to the following properties of the pulse:

1. Pulse rate (HR). PE characterizes the heart rate. Normal PR = 60 - 80 beats / min. With an increase in HR over 90 beats / min, they speak of tachycardia. With a decrease (less than 60 beats / min) - about bradycardia.

Sometimes the left ventricle contracts so weakly that the pulse wave does not reach the periphery, then the number of pulse beats becomes less than the heart rate. This phenomenon is called bradysphygmia. The difference between heart rate and HR is called pulse deficit.

According to the state of emergency, you can judge what T a person has. An increase in T by 1 0 C leads to an increase in heart rate by 8 beats / min. The exception is the change in T in typhoid fever and peritonitis. With typhoid fever, there is a relative slowing of the pulse, with peritonitis - a relative increase.

2. The rhythm of the pulse. The pulse may be rhythmic or arrhythmic. If pulse beats follow one after another at regular intervals, then they speak of a correct, rhythmic pulse. If this period of time changes, then they speak of an incorrect pulse - the pulse is arrhythmic.

3. The speed of the pulse. The speed of the pulse is determined by the rate of rise and fall of pressure during the pulse wave. Depending on this indicator, a fast or slow pulse is distinguished.

A fast pulse is characterized by a rapid rise and a rapid decrease in pressure in the arteries. A fast pulse is observed with aortic valve insufficiency. A slow pulse is characterized by a slow rise and fall in pressure, i.e. when the arterial system slowly fills with blood. This happens with stenosis (narrowing) of the aortic valve, with weakness of the myocardium of the ventricle, fainting, collapse, etc.

4. Pulse tension. It is determined by the force that must be applied to completely stop the propagation of the pulse wave. Depending on this, a tense, hard pulse is distinguished, which is observed with hypertension, and an unstressed (soft) pulse, which occurs with hypotension.

5. Filling or amplitude of the pulse is a change in the diameter of the vessel during the pulse push. Depending on this indicator, a pulse with a large and small amplitude is distinguished, i.e. good and bad content. The filling of the pulse depends on the amount of blood ejected by the heart and on the elasticity of the vascular wall.

There are many more properties of the pulse, which you will get acquainted with in therapeutic departments.

Venous return.

One of the important indicators of systemic hemodynamics is the venous return of blood to the heart. It reflects the volume of venous blood flowing through the superior and inferior vena cava. Normally, the amount of blood flowing in 1 minute is equal to the IOC. The ratio of venous return and cardiac output is determined using special electromagnetic sensors.

With the contraction of the heart muscle (systole), blood is ejected from the heart of the BO and the artery departing from them. The elasticity of the walls of the vessel leads to the fact that during systole the blood is pushed out by the heart, stretching the aorta, arteries, because. large vessels perceive more blood during systole than its edema in the periphery.

Human systolic blood pressure is normally 16 kPa. During the weakening of the heart (diastole), the stretched blood vessels subside and, therefore, the potential energy through the blood passes into the kinetic energy of the blood flow, while maintaining a diastolic pressure of 11KPa.

Pulse wave - a wave of increased pressure propagating through the aorta and arteries, caused by the ejection of blood from the left ventricle during systole.

The pulse wave propagates at a speed of 5-10 m / s, therefore, during a systole of 0.3 seconds, it should spread to 1.5-3 m.

The pulse wave front reaches the limb before the pressure drop in the aorta begins.

Harmonic pulse wave equation:

P 0 - pressure amplitude in the pulse wave

X - distance to the derivative point to the sources of oscillations

ω - circular oscillation frequency

E - modulus of elasticity

λ – vessel wall thickness

D - vessel diameter

Thermodynamics

Basic concepts:

The beginning of thermodynamics is the state of a thermodynamic system, characterized by physical quantities (volume, temperature, pressure). If the parameters of the system during interaction with the surrounding bodies do not change over time, then this system is stationary. In the system, thus maintaining constant gradients of certain parameters, a chemical reaction can proceed at a constant rate.

In a stationary state, there can be such systems that exchange matter with the environment. A system is called closed if it exchanges energy. An isolated system does not exchange matter with its surroundings. System parameters do not change over time.

The amount of heat of neurotransmission of energy of the heat exchange process

Let us calculate the elementary work done by the elementary volume.

The first law of thermodynamics: the amount of heat of the transferred system is used to change the internal energy and to do work.

Internal energy is understood as the sum of potential and kinetic energy.

The amount of heat and the work of a process function, not a state.

The second law of thermodynamics.

The first principle is the conservation of energy, it does not indicate the direction, the course of processes. According to the first principle, during heat transfer, spontaneous heat transfer from warmer to colder is equally possible.

The second law of thermodynamics - heat by itself cannot pass from a body with a lower temperature to a body with a higher temperature, therefore, a perpetual motion machine is impossible, i.e. periodic process the only result would be the conversion of heat into work.

In a heat engine, work is done due to the heat received from the heater, but at the same time, part of the heat will go to the refrigerator

Consider concepts to express the law of thermodynamics

A 1-2 process is said to be reversible if the reverse process 2-1 can be performed.

A cycle (circular process) is a process in which everything returns to its original state. This cycle is called direct. It corresponds to a heat engine, because the device that receives the amount of heat from the heater does work and gives part of the heat to the refrigerator.

In process 1A-2, the gas expands. A>00

In progress 2-B-1, A<0

The reverse cycle corresponds to refrigeration machines, in such a system that takes heat from the refrigerator and transfers it to the heater

The efficiency of a heat engine is called the ratio of the work done to the amount of heat received from the heater

The transfer of the amount of heat from the heater to the gas occurs at a temperature T1, and from the working substance to the cooler T2.

The efficiency of all reversible machines operating on a cycle that consists of 2 isotherms and 2 diobates with the same refrigerator and heater.

The efficiency of an irreversible machine is less than that of a reversible machine.

Entrophy is a function of the state of the system, the difference in values, which is reduced to the amount of heat during the reverse process of the system

If the process is not reversible, then

If part of the cycle is irreversible, then the whole cycle is also irreversible.

Thermodynamic potentials.

Knowing the expressions of these potentials in terms of independent parameters, it is possible to calculate the remaining parameters and characteristics of thermodynamic processes.

Using 1 formula of thermodynamics

General expression

Variable x system

If the differential Hel'nhaltz energy and the Gibbs energy are upheld:

The chemical potential is equal to the change in 1 particle in the corresponding space.

During the contraction of the heart, another portion of blood is pushed into the vascular system. Its blow to the wall of the artery creates vibrations, which, propagating through the vessels, gradually fade to the periphery. They got the name of the pulse.

What is the pulse like?

There are three types of veins and capillaries in the human body. The ejection of blood from the heart affects each of them in one way or another, causing their walls to oscillate. Of course, arteries, as the vessels closest to the heart, are more affected by cardiac output. The fluctuations of their walls are well defined by palpation, and in large vessels they are even visible to the naked eye. That is why the arterial pulse is most significant for diagnosis.

Capillaries are the smallest vessels in the human body, but even they reflect the work of the heart. Their walls fluctuate in time with heartbeats, but normally this can only be determined with the help of special devices. A capillary pulse visible to the naked eye is a sign of pathology.

The veins are so far from the heart that their walls do not oscillate. The so-called venous pulse is a transmission vibration from closely spaced large arteries.

Why determine the pulse?

What is the significance of the fluctuations of the vascular walls for diagnosis? Why is it so important?

The pulse allows you to judge hemodynamics, how effectively it is reduced about the fullness of the vascular bed, about the rhythm of heart beats.

In many pathological processes, the pulse changes, the characteristic of the pulse ceases to correspond to the norm. This allows you to suspect that not everything is in order in the cardiovascular system.

What parameters determine the pulse? Pulse characteristic

Rhythm. Normally, the heart contracts at regular intervals, which means that the pulse should be rhythmic.
Frequency. Normally, there are as many pulse waves as there are heart beats per minute.
Voltage. This indicator depends on the value of systolic blood pressure. The higher it is, the more difficult it is to squeeze the artery with your fingers, i.e. pulse pressure is high.
Filling. Depends on the volume of blood ejected by the heart in systole.
Value. This concept combines content and tension.
The shape is another parameter that determines the pulse. The characteristic of the pulse in this case depends on the change in blood pressure in the vessels during systole (contraction) and diastole (relaxation) of the heart.

Rhythm disturbances

With violations of the generation or conduction of an impulse through the heart muscle, the rhythm of heart contractions changes, and with it the pulse also changes. Separate fluctuations of the vascular walls begin to fall out, or appear prematurely, or follow each other at irregular intervals.

What are rhythm disturbances?

Arrhythmias with a change in the work of the sinus node (a section of the myocardium that generates impulses leading to a contraction of the heart muscle):

Sinus tachycardia - an increase in the frequency of contractions.
Sinus bradycardia - a decrease in the frequency of contractions.
Sinus arrhythmia - contractions of the heart at irregular intervals.

Ectopic arrhythmias. Their occurrence becomes possible when a focus appears in the myocardium with an activity higher than that of the sinus node. In such a situation, the new pacemaker will suppress the activity of the latter and impose its rhythm of contractions on the heart.

Extrasystole - occurrence of sudden cardiac contractions. Depending on the localization of the ectopic focus of excitation, extrasystoles are atrial, atrioventricular and ventricular.
Paroxysmal tachycardia - a sudden increase in rhythm (up to 180-240 heart beats per minute). Like extrasystoles, it can be atrial, atrioventricular and ventricular.

Violation of impulse conduction in the myocardium (blockade). Depending on the location of the problem that prevents normal progression from the sinus node, blockades are divided into groups:

(the impulse does not go beyond the sinus node).
(the impulse does not pass from the atria to the ventricles). With complete atrioventricular blockade (III degree), a situation becomes possible when there are two pacemakers (the sinus node and the focus of excitation in the ventricles of the heart).
Intraventricular block.

Separately, one should dwell on the flicker and flutter of the atria and ventricles. These states are also called absolute arrhythmia. The sinus node in this case ceases to be a pacemaker, and multiple ectopic foci of excitation are formed in the myocardium of the atria or ventricles, setting the heart rhythm with a huge contraction rate. Naturally, under such conditions, the heart muscle is not able to adequately contract. Therefore, this pathology (especially from the side of the ventricles) is a threat to life.

Heart rate

The pulse at rest in an adult is 60-80 beats per minute. Of course, this figure changes throughout life. The pulse varies significantly with age.

There may be a discrepancy between the number of heart contractions and the number of pulse waves. This happens if a small volume of blood is ejected into the vascular bed (heart failure, a decrease in the amount of circulating blood). In this case, oscillations of the vessel walls may not occur.

Thus, the pulse of a person (the norm for age is indicated above) is not always determined on the peripheral arteries. This, however, does not mean that the heart also does not contract. Perhaps the reason is a decrease in the ejection fraction.

Voltage

Depending on the changes in this indicator, the pulse also changes. The characteristic of the pulse according to its voltage provides for the division into the following varieties:

Solid pulse. Due to high blood pressure (BP), primarily systolic. It is very difficult to pinch the artery with your fingers in this case. The appearance of this type of pulse indicates the need for urgent correction of blood pressure with antihypertensive drugs.
Soft pulse. The artery compresses easily, and this is not very good, because this type of pulse indicates too low blood pressure. It can be due to various reasons: a decrease in vascular tone, inefficiency of heart contractions.

Filling

Depending on the changes in this indicator, the following types of pulse are distinguished:

means that the blood supply to the arteries is sufficient.
Empty. Such a pulse occurs with a small volume of blood ejected by the heart in systole. The causes of this condition can be a pathology of the heart (heart failure, arrhythmias with too high a heart rate) or a decrease in the volume of blood in the body (blood loss, dehydration).

Pulse value

This indicator combines the filling and tension of the pulse. It depends primarily on the expansion of the artery during the contraction of the heart and its subsidence during the relaxation of the myocardium. The following types of pulse are distinguished by magnitude:

Big (high). It occurs in a situation where there is an increase in the ejection fraction, and the tone of the arterial wall is reduced. At the same time, the pressure in systole and diastole is different (for one cycle of the heart, it increases sharply, and then decreases significantly). The causes leading to the occurrence of a large pulse may be aortic insufficiency, thyrotoxicosis, fever.
Small pulse. Little blood is ejected into the vascular bed, the tone of the arterial walls is high, pressure fluctuations in systole and diastole are minimal. Causes of this condition: aortic stenosis, heart failure, blood loss, shock. In especially severe cases, the value of the pulse may become insignificant (such a pulse is called thready).
Even pulse. This is how the value of the pulse is normal.

Pulse shape

According to this parameter, the pulse is divided into two main categories:

fast. In this case, during systole, the pressure in the aorta rises significantly, and quickly drops in diastole. A fast pulse is a characteristic sign of aortic insufficiency.
Slow. The opposite situation, in which there is no place for significant pressure drops in systole and diastole. Such a pulse usually indicates the presence of aortic stenosis.

How to properly examine the pulse?

Probably everyone knows what needs to be done to determine what kind of pulse a person has. However, even such a simple manipulation has features that you need to know.

The pulse is examined on the peripheral (radial) and main (carotid) arteries. It is important to know that with a weak cardiac output in the periphery, pulse waves may not be detected.

Consider how to palpate the pulse on the arm. The radial artery is accessible for examination at the wrist just below the base of the thumb. When determining the pulse, both arteries (left and right) are palpated, because. situations are possible when pulse fluctuations are not the same on both hands. This may be due to compression of the vessel from the outside (for example, by a tumor) or blockage of its lumen (thrombus, atherosclerotic plaque). After comparison, the pulse is evaluated on the arm where it is better palpated. It is important that when examining pulse fluctuations, not one finger, but several, is on the artery (it is most effective to clasp the wrist so that 4 fingers, except for the thumb, are on the radial artery).

How is the pulse on the carotid artery determined? If the pulse waves are too weak on the periphery, you can examine the pulse on the main vessels. The easiest way is to try to find it on the carotid artery. To do this, two fingers (index and middle) must be placed on the area where the indicated artery is projected (at the front edge of the sternocleidomastoid muscle above the Adam's apple). It is important to remember that it is impossible to examine the pulse from both sides at once. Pressing two carotid arteries can cause circulatory disorders in the brain.

The pulse at rest and with normal hemodynamic parameters is easily determined both on peripheral and central vessels.

A few words in conclusion

(the norm by age must be taken into account in the study) allows us to draw conclusions about the state of hemodynamics. Certain changes in the parameters of pulse fluctuations are often characteristic signs of certain pathological conditions. That is why the study of the pulse is of great diagnostic value.

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.