Pulse

pulse measurement
Fig. 1. Methods of measurement of pulse at various arteries: 1 - temporal; 2 - shoulder; 3 - dorsal artery of the foot; 4 - beam; 5 - posterior tibial; 6 - femoral; 7 - popliteal.

The pulse fluctuations in the walls of blood vessels, associated with changes in their blood during the cardiac cycle. There are arterial, venous and capillary pulse. The study of arterial pulse gives important information about the work of the heart, the state of circulation and characteristics of the arteries. The main research method of pulse - digital arteries. For palpation of the radial artery brush investigated freely grasping hand in the area of the wrist joint , so that your thumb is on the back of the forearm, and other fingers - on the front surface of the radial bone, where under the skin probed throbbing radial artery. Pulse probes simultaneously on both hands, as sometimes on the right and left hand he expressed differently, due to vascular anomalies, constriction or blockage of the subclavian or brachial artery). In addition to the radial artery, the pulse is investigated from the carotid, femoral, the temporal arteries, the arteries of the feet and other (Fig. 1). The objective characteristic of the pulse gives a graphical its registration (see Stegnography). In a healthy person pulse wave relatively rises up and slowly falls down (Fig. 2, 1); for some diseases form of pulse wave changes. In the study of the pulse is determined frequency, rhythm, filling, voltage and speed.


Fig. 2. Graphic registration of pulse: 1 - normal; 2-arrhythmic (a-b - various kinds); 3 - intermittent; 4 - a large and rapid (a), small and slow (b); 5 - mikrotechna.

In healthy adults, the frequency of the pulse corresponds to the heart rate and is equal to 60-80 per 1 minute. With the increase of heart (see Tachycardia) or decrease (see Bradycardia) pulse rate changes accordingly, and the pulse is called frequent or rare. When the temperature of the body at the 1st pulse rate increases by 8-10 beats per 1 minute. Sometimes the number of pulse beats less than the number of heart rate (pulse deficit). This is because during a very weak or premature contractions of the heart into the aorta does so little blood that pulse wave it does not reach the peripheral arteries. The higher pulse deficit, blagopriatnoe this affects the circulation. To determine heart rate believe it within 30 seconds. and the result is multiplied by two. Violation of a heart rhythm, the pulse is considered within 1 minute.
In a healthy person, the rhythmic pulse, i.e., pulse wave follow each other through equal intervals of time. For disorders of the heart rhythm (see Arrhythmias) pulse wave usually follow through irregular intervals, the pulse becomes arrhythmic (Fig. 2, 2).
Filling pulse depends on the amount of blood ejected during systole into the arterial system and the elasticity of the arterial wall. Normal - pulse wave of well-there - full pulse. If the arterial system enters blood is lower than normal, the pulse wave decreases, the pulse becomes small. In severe blood loss, shock, collapse of pulse wave can hardly be prosuvalisya, such a pulse is called a thread. The decrease of filling the pulse is marked also diseases, leading to seal the walls of the arteries or to a narrowing of the clearance (atherosclerosis). In severe damage to the heart muscle is observed alternation of large and small pulse wave (Fig. 2, 3) - alternating pulse.
Voltage pulse is associated with elevation of blood pressure. In hypertension requires some effort to squeeze the artery and to stop its pulsation - solid, or intense pulse. When low blood pressure artery is compressed easy, pulse disappears with a little effort, and called soft.
Pulse rate depends on the pressure fluctuations in blood system during systole and diastole. If during the systolic pressure in the aorta is increasing rapidly, and during diastole quickly falls, you can observe the rapid expansion and losing the artery walls. This pulse is called an ambulance, at the same time it happens and large (Fig. 2, 4). Most often a rapid and large pulse is observed in case of insufficiency of the aortic valve. The slow increase of pressure in the aorta during systole and slower decline in diastole causes a slow expansion and slow losing the artery walls - slow heart rate; at the same time he is small. Such pulse appears when the narrowing of the aortic due to the difficulties of exile blood from the left ventricle. Sometimes after the main pulse wave appears a second, smaller wave. This phenomenon is called dicrotism pulse (Fig. 2,5). It is connected with change of the voltage of the walls of arteries. Dicrotism pulse occurs with fever, some infectious diseases. By touching arteries examine not only the properties of the pulse, but the state of the vascular wall. So, significant deposition of calcium salts in the vessel wall artery felt in the form of dense, tortuous, rough tube.

Heart rate in children under 1 minute
Age Pulse rate
Newborn
6 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13
14 years
15 years
120-140
130-135
120-125
110-115
105-110
100-105
98-100
90-95
85-90
80-85
80-85
78-85
78-84
75-82
72-80
72-78
70-76

The pulse of children is more frequent than in adults. This is due not only a less influence of the vagus nerve, but also more intensive metabolism.
With age, the pulse rate is gradually decreasing. Girls of all ages pulse rate more than boys. Cry, anxiety, muscle movements cause children significant increased heart rate. In addition, in childhood has known uneven pulse periods associated with breathing (respiratory arrhythmia).


Pulse (from lat. pulsus - push) - rhythmic, jerky fluctuations of blood vessels, resulting from discharge of blood from the heart to the arterial system.
The doctors of antiquity (India, Greece, Arab East) paid much attention to the study of the pulse, giving it a crucial diagnostic value. Scientific basis of the doctrine of the pulse received after the opening of the Harvey W. Harwey) circulation. The invention sphygmograph and especially the introduction of modern methods of registration of the pulse (arteriography, high electrothermography and others) significantly deepened knowledge in this area.
Each systole heart into the aorta rapidly thrown a certain amount of blood, stretching the initial elastic part of the aorta and increases in system pressure. This change in pressure is distributed in the form of a wave on aorta and its branches to the arterioles, where the norm due to their muscle resistance pulse wave stops. Distribution of pulse wave occurs at speeds from 4 to 15 m/sec, caused by stretching and lengthening of the arterial wall and is arterial pulse. There are Central arterial pulse (aorta, carotid and subclavian arteries) and peripheral (femoral, radiation, temporal, dorsal artery of the foot, and so on). The difference between these two forms of pulse is detected at its graphic registration method sphygmography (see). On the curve of the pulse - spirogramma - there is ascending (anacleto), downward (the decaying limb) part and discretions wave (Decreto).
Most often explore the pulse on a radial artery (a. radialis), which is located superficially under the fascia and skin between the styloid process of the radial bone and sinew of internal radiation muscles. When anomalies artery, there bandages on his hands or massive swelling the study of the pulse spend on other arteries, available palpation. Pulse on a radial artery late in comparison with systolic heart of about 0.2 seconds. The study of the pulse on a radial artery it is necessary to carry out both hands; only if there is no difference in the properties of the pulse can restrict further research it on one hand. Usually brush investigated freely grab the right hand in the area of the beam-carpal joint and placed at the heart level of the studied. At that, the thumb should be placed with the elbow of the hand, and the index, middle and ring - with radiation, directly on the radial artery. OK get the feeling soft, thin, smooth and elastic tube, pulsating under your fingers.
If the pulse on the left and right hand found it's size or a delay P. on the one hand, compared to the other, such a pulse is called different (pulsus differens). It occurs most often when a unilateral anomalies vessels, squeeze their tumors or enlarged lymph nodes. Aneurysm of the aorta arch, if it is located between the nameless and the left subclavian arteries, causing dilation and reduction of pulse wave in the left radial artery. In mitral stenosis enlarged left atrium can compress the left subclavian artery, reducing pulse wave on the left radial artery, especially in position on the left (sign Popov Savelyeva).
Qualitative characteristic of the pulse depends on the activity of the heart and vascular system. In the study of the pulse pay attention to the following.
Heart rate. Counting pulse beats should be not less than 1/2 minutes, with the resulting figure is multiplied by 2. When the wrong P. calculation should be made within 1 minutes; when a sudden excitement of the patient in the beginning of the study, it is desirable to repeat the calculation. Normally the number of pulse beats in adult males average 70, women - 80 in 1 min For automatic counting pulse rate currently applied photovoltaic pulsatoare, which is very important, for example, to monitor the condition of the patient during the operation. Like body temperature and heart rate gives two day ascent first about 11 o'clock, the second between 6 and 8 p.m.. With increasing pulse rate more than 90 per 1 minute of talk about tachycardia (see); such a rapid pulse is called the p. frequens. When the heart rate less than 60 per 1 minute of talk about bradycardia (see), and the pulse is called the p. rarus. In cases when the individual left ventricular contraction so weak that pulse waves do not reach the periphery, the number of pulse beats becomes less than the number of heart contractions. This phenomenon is called predispose, the difference between the number of heart rate and pulse beats in 1 minute call deficiency of pulse and the pulse - p. deficiens. When the temperature of the body every degree above 37 usually corresponds increased heart rate, on average, 8 beats per 1 minute. The exception is the fever of typhoid fever and peritonitis: in the first case there is often a relative slow pulse, the second - its relative frequency. With the fall of body temperature frequency P. normally decreases, but (for example, when the collapse) it is accompanied by a significant increase P.
The rhythm of the heartbeat. If the pulse beats follow each other through equal intervals of time, they say is correct, rhythmic P. p. regularis), otherwise there is improper, irregular pulse (p. irregularis). In healthy people often noted increased P. on the breath and its curtailment on the exhale - respiratory arrhythmia (Fig. 1); the breath eliminates this type of arrhythmia. Changes P. you can diagnose many types of arrhythmias (see); more precisely they are determined by electrocardiography.
Pulse rate is determined by the character of the rise and fall of pressure in the artery during the passage of the pulse wave.
Soon, leaping pulse (p. celer) is accompanied by a feeling very fast rise and the same rapid reduction of pulse wave that is directly proportional to the time rate of change of pressure in the radial artery (Fig. 2). As a rule, P. this is simultaneously a large, high (p. magnus, s. altus) and is most pronounced in aortic insufficiency. This finger exploring feels not only fast, but also large rises and lower pulse wave. In its pure form of large, high-P. observed sometimes on exertion and often in complete atrioventricular blockade. Sluggish, slow P. p. tardus), accompanied by a sense of slow slow rise and lowering of pulse wave (Fig. 3)sometimes when narrowing of the aortic when the arterial system is filled slowly. This P., usually small in size (height) - p. parvus that depend on small-scale increase of pressure in the aorta during left ventricular systole. This type of pulse characteristic of mitral stenosis, severe weakness of the left ventricle, fainting, collapse.
Voltage pulse is determined by the force needed to stop the spread of the pulse wave. In the study of the distal located forefinger fully squeeze vessel in order to prevent the penetration of backward waves, and the most proximally lying ring finger are gradually increasing the pressure up until "groping" third finger ceases to feel the pulse. There are stressful, solid pulse (p. durum) and loose, soft P. p. mollis). The degree of tension P. we can roughly estimate the maximum blood pressure; the higher it is, the P. harder.
Filling pulse consists of the size (height) of the pulse and partly it
voltage. Filling P. depends on the amount of blood in the arteries and of the total volume of circulating blood. There are the pulse of full (p. plenus), usually large, high, and empty (p. vaccuus), usually small. With massive bleeding, collapse, shock P. may be barely apparently, filiform (p. filiformis). If the pulse wave varies in size and degree of filling, then talk about uneven P. p. inaequalis), in contrast to the uniform P. p. aequalis). Irregular pulse is observed almost always when arrhythmic., in cases of atrial fibrillation, early PVCs. A kind of uneven P. is alternating P. p. alternans on), when there is a correct alternation of pulse beats of different size and content. This pulse is one of the early signs of severe heart failure; he is best revealed sphygmographic at low compression shoulder cuff sphygmomanometer. In cases falling tone of peripheral vessels can be palpated second, smaller, decrations wave. This phenomenon is called microtia, and P. - mikrotechna (p. dicroticus). This Isthmus is often seen with the fever (the relaxing effect of heat on the muscles of the arteries), hypotension, sometimes in the recovery period after heavy diseases. Almost always there is a decrease in the minimum blood pressure.
Pulsus paradoxus - reduction of pulse waves on the inhale (Fig. 4). In healthy people at the height of inspiration, due to negative pressure in the chest cavity is reduced volume of the left heart and a little more complicated systolic heart, which leads to a decrease in the extent and content of the pulse. When narrowing of the upper respiratory tract or weakness of the myocardium this phenomenon is expressed more clearly. When the adhesive pericarditis inhaling heart is stretched by binding with the chest, spine and diaphragm, which leads to difficulty systolic reduction, reduction of blood to the aorta and often to the complete disappearance of the pulse at the height of inspiration. For adhesive pericarditis characteristically, in addition to this phenomenon, expressed the jugular veins due to compression of the top growths and ring hollow vein.
Capillary, rather pseudocyphellaria, pulse, or heart rate Kwinke,rhythmic expansion of the small arterioles (not capillaries) in the result of the rapid and substantial increase in blood pressure in the system during systole. Much of the pulse wave reaches the smallest arterioles, but in the capillary blood flow remains continuous. Pseudocyphellaria pulse most pronounced in aortic insufficiency. However, in some cases in pulsatory fluctuations are involved capillaries and even venules ("true" capillary P.), which is sometimes with severe thyrotoxicosis, fever or in healthy young people at thermal procedures. It is considered that in such cases, venous stagnation expands blood knee capillaries. Capillary P. it is best revealed when lightly down her lips slide when it encounters alternate corresponding P., redness and blanching it mucosa.
Venous pulse reflects fluctuations in the volume of veins in the systole and diastole right atrium and ventricle, causing the slowdown, the acceleration of blood outflow from the veins in the right atrium (respectively swelling and losing veins). Study of venous pulse spend on the veins of the neck, necessarily at the same time exploring P. external carotid artery. OK there is very little visible and almost tangible fingers ripple, when bulging jugular vein is preceded by pulse wave in the carotid artery - pravoberejny, or "negative", - governmental P. In case of insufficiency of tricuspid valve-governmental pulse becomes right ventricle, "positive"because of the defect tricuspid valve has the opposite (centrifugal) the flow of blood from the right ventricle into the right atrium and Vienna. Such governmental P. characterised by a marked swelling of the jugular veins in parallel with the rise of pulse wave in the carotid artery. If you press jugular vein in the middle, bottom cut it continues to pulsate. Similar situation may occur in severe right ventricular failure and without damage to the tricuspid valve. A more accurate representation of venom P. can be obtained using the graphics methods of registration (see Flebogamma).
Hepatic pulse is determined by inspection and palpation, but much more accurate his character is revealed with the graphics Desk ripple liver and especially rentgenostrukturnyi. Normal hepatic the pulse is determined with great difficulty and depends on the dynamic of "stagnation" in the hepatic veins in the result of the activity of the right ventricle. When vices tricuspid valve may increase the systolic (with valve insufficiency) or to occur presistolic ripple (stenosis holes) liver as a consequence "of the hydraulic valve" her ways outflow.

The pulse in children. In children pulse much more often than adults, because of more intensive metabolism, fast contractility of heart muscle and less influence of the vagus nerve. The highest frequency of P. in newborns (120-140 beats per 1 minute), but they 2-3-day lives are very slow points to 70 to 80 beats per 1 minute (A. F. Round). With age, the pulse rate decreases (table.).
In children P. most convenient to explore on radiation or temporal artery. The very young and the restless children to count P. you can use auscultation tones heart. Most accurately the frequency P. determined at rest, during sleep. The child on one breath has a 3.5-4 cardiac impulse.
The frequency of P. in children subject to large fluctuations.
Increased P. easily occurs when anxiety, cry, muscle exercises, eating. The pulse rate is also influenced by the ambient temperature and barometric pressure (A. L. sakhnovskaya, M. G. Guliyev, E. C. Tkachenko). When the temperature of the body of the child on 1 pulse raised on 15-20 shock (A. F. Round). Girls P. more often than boys, 2-6 shock. Especially clearly expressed this difference in the period of sexual development.
In assessing the pulse in children it is necessary to pay attention not only to its frequency, but the rhythm, the degree of filling of vessels, their stress. The sharp increase P. (tachycardia) is observed at the endo -, and myocarditis, heart disease, infectious diseases. Paroxysmal tachycardia up 170-300 beats per 1 min. can be observed in children of early age. Ischemia P. (bradycardia) is observed at increase of intracranial pressure, severe forms of malnutrition, with uremia, epidemic hepatitis, typhoid fever, overdose of digitalis. Slow pulse of more than 50 to 60 beats per 1 min. makes you suspect a heart block.
Children have the same types of arrhythmias of the heart as adults. In children with unbalanced nerve system in puberty, as well as on the background of bradycardia in the period of recovery from acute infections often respiratory sinus arrhythmia: increased P. during inspiration and deceleration during exhalation. Arrythmia in children, often ventricular are common with myocardial damage, but can wear and functional character.
Weak pulse bad filling, often with tachycardia, indicates phenomena heart weakness, decreased blood pressure. Intense pulse, pointing to a rise in blood pressure that occurs in children often for jade.