Pulse fluctuations in the vascular bed. factors that ensure blood movement through the vessels. Arterial pulse, its properties Briefly about measuring pulse

15. Method of determining pulse. Name the main characteristics of the pulse in normal and pathological conditions.

The pulse is a periodic expansion and contraction of the arteries, synchronous with cardiac activity.

Pulsation of the carotid, temporal, brachial, ulnar, radial, femoral, popliteal, posterior tibial and dorsal arteries of the feet is available for palpation examination.

Examination of the pulse in the common carotid arteries should begin with simultaneous palpation on both sides of the neck. The index finger of the palpating hand is placed above the apex of the lung, parallel to the collarbone, and the flesh of the nail phalanx is used to carefully press the carotid artery posteriorly to the outer edge of the sternocleidomastoid muscle. Also, the common carotid arteries are palpated at the inner edges of the sternocleidomastoid muscle at the level of the cricoid cartilage. Palpation of the carotid arteries must be done carefully.

Examination of the pulse in the temporal arteries - both temporal arteries can be palpated at the same time; Using the pulp of the nail phalanges of the second to fourth fingers of both hands, carefully press the temporal arteries to the facial part of the skull at the anterior edges and slightly above the auricles.

Study of the pulsation of the aortic arch through the jugular fossa - the index finger of the right hand is lowered deep to the bottom of the jugular notch; when the aortic arch expands or lengthens, the finger feels pulse beats.

Examination of the pulse on the brachial artery - palpate with the flesh of the nail phalanges of the second to fourth fingers of one hand as deep as possible in the lower third of the shoulder at the inner edge of the biceps brachii muscle, the other hand holds the patient’s hand.

Examination of the pulse in the ulnar artery - palpating the flesh of the nail phalanges of the second to fourth fingers of one hand in the middle of the ulnar fossa, the other hand holding the patient’s extended arm by the forearm.

The pulsation of the femoral artery is determined by the pulp of the nail phalanges of the second to fourth fingers below the Pupart's ligament 2-3 cm outward from the midline.

Examination of the pulse in the popliteal artery is best done with the patient in the supine or prone position with the knee joint bent at an angle of 120-140º; performed with the pulp of the nail phalanges of the second to fourth fingers, installed in the middle of the knee fossa.

Examination of the pulse on the dorsal artery of the foot - is performed with the flesh of the nail phalanges of the second to fourth fingers on the dorsum of the foot between the first and second metatarsal bones, less often - lateral to this area or directly on the bend of the ankle joint.

The pulsation of the posterotibial artery is determined by the pulp of the nail phalanges of the second to fourth fingers in the space between the posterior edge of the inner malleolus and the inner edge of the Achilles tendon.

It is customary to evaluate the properties of the pulse only on radial artery.

Technique for palpating the pulse on the radial artery:

The radial artery is located under the skin between the styloid process of the radius and the tendon of the internal radial muscle. The thumb is placed on the back of the forearm, and the remaining fingers are placed at the site of the radial artery. Do not apply too much pressure to the patient’s hand, as the pulse wave will not be felt in a pinched artery. You should not feel the pulse with one finger, because... it is more difficult to find the artery and determine the nature of the pulse.

If the artery does not immediately fall under the fingers, you need to move them along the radius and across the forearm, since the artery can pass outward or closer to the middle of the forearm. In some cases, the main branch of the radial artery passes on the outside of the radius.

Begin examining the pulse by simultaneously palpating it on both hands. If there is no difference in the properties of the pulse, proceed to examining the pulse on one arm. If there is a difference in the properties of the pulse, then it is studied in turn on each hand.

The following pulse characteristics need to be assessed:

1) presence of a pulse;

2) the sameness and simultaneity of pulse waves on both radial arteries;

3) pulse rhythm;

4) pulse rate per minute;

6) filling the pulse;

7) pulse value;

8) speed (shape) of pulse;

9) pulse uniformity;

10) correspondence of the number of pulse waves to the number of heart contractions per unit of time (in 1 minute);

11) elasticity of the vascular wall.

Presence of pulse.

Normally, pulse impulses are palpable on both radial arteries.

Absence of pulses in both upper extremities occurs with Takayasu's disease (aortoarteritis obliterans).

The absence of a pulse in the artery of one of the extremities occurs with obliterating atherosclerosis, thrombosis or embolism of the artery proximal to the section of the artery with the absence of pulsation.

Sameness and simultaneity of pulsewaves on both radial arteries.

Normally, the pulse impulses are the same and appear simultaneously on both radial arteries.

The pulse on the left radial artery may be smaller (pulsus differens) - observed in patients with pronounced mitral stenosis or with an aortic arch aneurysm (Popov-Savelyev symptom).

Pulse rhythm.

Normally, pulse impulses follow at regular intervals (correct rhythm, pulsus regularis).

1. Arrhythmic pulse (pulsus inaecqualis) – a pulse in which the intervals between pulse waves are unequal. It may be caused by cardiac dysfunction:

a) excitability (extrasystole, atrial fibrillation);

b) conduction (2nd degree atrioventricular block);

c) automatism (sinus arrhythmia).

2. Alternating pulse (pulsusalternans)) is a rhythmic pulse in which the pulse waves are uneven: large and small pulse waves alternate. Such a pulse occurs in diseases accompanied by a significant weakening of the contractile function of the left ventricular myocardium (myocardial infarction, cardiosclerosis, myocarditis).

3. Paradoxical pulse (pulsus panadoxus) - a pulse when pulse waves during the inhalation phase decrease or disappear altogether, and are clearly palpated during the exhalation phase. This symptom occurs with constrictive and exudative pericarditis.

Pulse rate per minute.

The number of pulse beats is counted for 15 or 30 seconds and the result is multiplied by 4 or 2, respectively. If the pulse is rare, it is necessary to count at least 1 minute (sometimes 2 minutes). In healthy adults, the heart rate ranges from 60 to 90 per minute.

Frequent pulse (pulsus frequens) – a pulse whose frequency is more than 90 per minute (tachycardia).

Rare pulse (pulsusrarus) - a pulse whose frequency is less than 60 per minute (bradycardia).

Pulse voltage.

Pulse tension is the tension of the arterial wall, which corresponds to the force of its resistance when pressed with fingers until the pulse waves cease. The intensity of the pulse is determined by the tone of the arterial wall and the lateral pressure of the blood wave (i.e., blood pressure). To determine the pulse voltage, use the 3rd finger to gradually press on the artery until the 2nd finger stops feeling the pulsating blood flow. Normal pulse is of good tension.

A tense (hard) pulse (pulsus durus) occurs with increased systolic blood pressure, sclerotic thickening of the artery wall, and aortic insufficiency.

A soft pulse (pulsus mollis) is a symptom of low systolic blood pressure.

Pulse filling.

Pulse filling is the amount (volume) of blood that forms a pulse wave. By pressing on the radial artery with varying strength, one gets a feeling of the volume of its filling. Healthy people have a good pulse.

Full pulse (pulsus plenus) is a symptom of conditions accompanied by an increase in the stroke volume of the left ventricle and an increase in the mass of circulating blood.

An empty pulse (pulsus vacuus) is a symptom of conditions accompanied by a decrease in stroke volume, a decrease in the amount of circulating blood (acute heart failure, acute vascular failure, acute posthemorrhagic anemia).

Pulse value.

The pulse value is the amplitude of oscillations of the arterial wall during the passage of a blood wave. The pulse value is determined based on an assessment of its filling and tension. A large pulse is characterized by good tension and filling, a small pulse is a soft and empty pulse. In healthy people, the pulse value is sufficient

Large pulse (pulsus magnus) - occurs in conditions accompanied by an increase in the stroke volume of the heart in combination with normal or decreased arterial tone (pulse pressure is increased).

Small pulse (pulsus parvus) - occurs in conditions accompanied by an increase in stroke volume of the heart or normal stroke volume in combination with an increase in arterial tone (pulse pressure is reduced).

Pulse speed (shape).

The speed (shape) of the pulse is determined by the rate of contraction and relaxation of the radial artery. Normally, the pulse shape is characterized by a smooth and steep rise and the same descent (normal pulse shape).

Rapid or jumping pulse (pulsus celer at attus) - a pulse with a rapid rise and fall of the pulse wave, occurs with insufficiency of the aortic valves and in conditions accompanied by an increased stroke volume of the heart in combination with normal or decreased arterial tone.

Slow pulse (pulsustardus) - a pulse with a slow rise and fall of the pulse wave, occurs with stenosis of the aortic mouth and in conditions accompanied by arterial hypertension caused by increased arterial tone (diastolic blood pressure is increased).

Correspondence of the number of pulse waves to the number of heart contractions per unit of time (in 1 minute).

Normally, the number of pulse waves corresponds to the number of heartbeats per unit of time (per 1 minute).

Pulse deficiency (pulsusdeficiens) - the number of pulse waves per unit time is less than the number of heart contractions, characteristic of extrasystole and atrial fibrillation.

Elasticity of the vascular wall.

There are 2 ways to assess the condition of the radial artery wall.

1. First, use 2 or 3 fingers of one hand to press the radial artery so that its pulsation stops below the point of compression. Then, with 2 or 3 fingers of the other hand, make several careful movements along the artery distal (below) the place where it is compressed and assess the condition of its wall. The radial artery with an unchanged wall in a state of exsanguination cannot be palpated (elastic).

2. The second and fourth fingers of the palpating hand compress the radial artery, and with the 3rd (middle) finger, using sliding movements along and across it, the properties of its wall are studied.

Normal pulse characteristics:

1) pulse waves are clearly palpable;

2) pulse waves on both radial arteries are identical and simultaneous;

3) rhythmic pulse (pulsus regularis);

4) frequency 60-90 per minute;

5) average in voltage, filling, size and speed (form);

6) uniform;

7) without deficit (correspondence of the number of pulse waves to the number of heart contractions);

8) the artery wall is elastic.

Pathological changes in pulse:

1) absence of pulse;

2) the pulse on both radial arteries is not the same (p. differens);

4) soft pulse (p. mollis);

5) full pulse (p. plenus);

6) empty pulse (p. vacuus);

7) large pulse (p. magnus);

8) small pulse (p. parvus);

9) rapid pulse (p. celer);

10) slow pulse (p. tardus);

11) frequent pulse (p. frequens);

12) rare pulse (p. rarus);

13) arrhythmic pulse (p. inaecqualis);

14) pulse deficiency (p. deficiens);

15) paradoxical pulse (p. panadoxus);

16) alternating pulse (p.alternans);

17) thread-like pulse (p. filiformis).

Inextricably linked with the cardiac cycle is the rhythmic fluctuation of blood pressure in large arteries and veins, causing the walls of these vessels to oscillate, called the pulse. Graphic recording of these oscillations on moving paper or photographic film using special instruments allows for their detailed analysis, which is used in the diagnosis of diseases of the cardiovascular system.

The technique of graphically recording the arterial pulse is called sphygmography (from the Greek sphygmos - pulse), and the venous pulse - phlebography (from the Greek phlebs - vein). The central arterial pulse is often recorded above the carotid arteries (carotid sphygmography), and the central venous pulse is often recorded above the jugular veins (jugular venography).

Venous pulse

There are no pulse fluctuations in blood pressure in small and medium veins. In large veins near the heart, pulse fluctuations are observed - the venous pulse, which is caused by difficulty in the outflow of blood to the heart during systole of the atria and ventricles. When these parts of the heart contract, the pressure inside the veins increases and their walls vibrate. It is most convenient to record the pulse of the jugular vein (v. jugularis).

On the pulse curve of the jugular vein - jugular venogram - of a healthy adult, each cardiac cycle is represented by three positive (a, c, v) and two negative (x, y) waves (Fig.), reflecting mainly the work of the right atrium.

The “a” wave (from the Latin atrium - atrium) coincides with the systole of the right atrium. It is caused by the fact that at the moment of atrium systole, the mouths of the vena cava flowing into it are clamped by a ring of muscle fibers, as a result of which the outflow of blood from the veins into the atria is temporarily suspended. Therefore, with each atrial systole, a short-term stagnation of blood occurs in the large veins, which causes stretching of their walls.

The “c” wave (from the Latin carotis - carotid [artery]) is caused by the impulse of the pulsating carotid artery, which lies near the jugular vein. It occurs at the beginning of right ventricular systole when the tricuspid valve closes and coincides with the beginning of the rise of the carotid sphygmogram (systolic wave of the carotid pulse).

During atrial diastole, blood access into them again becomes free and at this time the venous pulse curve falls sharply, a negative “x” wave (systolic collapse wave) appears, which reflects the accelerated outflow of blood from the central veins into the relaxing atrium during ventricular systole. The deepest point of this wave coincides in time with the closure of the semilunar valves.

Sometimes, on the lower part of the “x” wave, a notch “z” is determined, corresponding to the moment of closure of the pulmonary artery valves and coinciding in time with the II sound of the FCG.

The “v” wave (from the Latin ventriculus - ventricle) is caused by an increase in pressure in the veins and difficulty in the outflow of blood from them into the atria at the moment of maximum filling of the atria. The top of the "v" wave coincides with the opening of the tricuspid valve.

The subsequent rapid flow of blood from the right atrium into the ventricle during cardiac diastole manifests itself in the form of a negative wave of the venogram, which is called the wave of diastolic collapse and is indicated by the symbol “y” - rapid emptying of the atria. The deepest negative point of the “y” wave coincides with the III tone of the PCG.

The most striking element on the jugular venogram is the wave of systolic collapse “x”, which gave reason to call the venous pulse negative.

Pathological changes in the venous pulse

• with bradycardia, the amplitude of waves “a” and “v” increases, another positive wave “d” can be recorded
• with tachycardia, the “y” wave decreases and flattens
• in case of tricuspid valve insufficiency, a positive venous pulse or a ventricular form of the venous pulse is recorded, when an additional positive wave i is recorded between waves “a” and “c”, which is caused by regurgitation of blood through an open valve. The severity of wave i correlates with the degree of deficiency.
• with mitral stenosis, there is an increase in the amplitude of the “a” wave and a decrease in the amplitude of the “v” wave
• with adhesive pericarditis, a double negative wave of the venous pulse is observed - increased amplitude of the “a” and “v” waves and deepening of the “x” and “y” waves
• with atrial fibrillation and flutter - a significant decrease in the amplitude of the “a” wave and an increase in its duration
• in the atrioventricular form of paroxysmal tachycardia, waves “a” and “c” merge, forming one large wave
• with an atrial septal defect – an increase in the amplitude of the “a” wave, and when blood is shunted from left to right, its bifurcation
• circulatory failure - changes in waves “a”, “v”, “y”
• aortic stenosis - decreased amplitude of the "c" wave
• insufficiency of the aortic valves, patent ductus arteriosus - increased amplitude of the “c” wave, etc.

Arterial pulse

Rhythmic oscillations of the arterial wall, caused by a systolic increase in pressure in the arteries, are called the arterial pulse. The pulsation of the arteries can be easily detected by touching any artery that can be felt: the radial, femoral, digital artery of the foot.

A pulse wave, in other words a wave of increased pressure, occurs in the aorta at the moment of expulsion of blood from the ventricles, when the pressure in the aorta rises sharply and its wall is stretched as a result. The wave of increased pressure and the resulting vibration of the arterial wall propagates at a certain speed from the aorta to the arterioles and capillaries, where the pulse wave dies out.

The speed of propagation of the pulse wave does not depend on the speed of blood flow. The maximum linear speed of blood flow through the arteries does not exceed 0.3-0.5 m/sec, and the speed of propagation of the pulse wave in young and middle-aged people with normal blood pressure and normal vascular elasticity is 5.5-8.0 m in the aorta /sec, and in peripheral arteries - 6-9.5 m/sec. With age, as the elasticity of blood vessels decreases, the speed of propagation of the pulse wave, especially in the aorta, increases.

A detailed analysis of arterial pulse fluctuations is performed on the basis of a sphygmogram.

In the pulse curve (sphygmogram) of the aorta and large arteries, two main parts are distinguished:

• anacrotic, or rising curve
• catacrota, or descent of the curve

Anacrotic rise reflects the flow of blood into the arteries ejected from the heart at the beginning of the ejection phase, which leads to an increase in blood pressure and the resulting stretch to which the arterial walls are subjected. The top of this wave at the end of ventricular systole, when the pressure in it begins to fall, turns into a descent of the curve - catacrota. The latter corresponds in time to the phase of slow expulsion, when the outflow of blood from the stretched elastic arteries begins to prevail over the inflow.

The end of ventricular systole and the beginning of its relaxation leads to the fact that the pressure in its cavity becomes lower than in the aorta; blood thrown into the arterial system rushes back to the ventricle; the pressure in the arteries drops sharply, and a deep notch appears on the pulse curve of large arteries - an incisura. The lowest point of incision corresponds to the complete closure of the semilunar valves of the aorta, which prevent blood from flowing back into the ventricle.

The wave of blood is reflected from the valves and creates a secondary wave of increased pressure, again causing stretching of the arterial walls. As a result, a secondary, or dicrotic, rise appears on the sphygmogram - stretching of the aortic walls due to the reflection of the blood wave from the closed semilunar valves. The subsequent smooth descent of the curve corresponds to a uniform outflow of blood from the central vessels to the distal ones during diastole.

The shapes of the pulse curve of the aorta and the large vessels extending directly from it, the so-called central pulse, and the pulse curve of the peripheral arteries are somewhat different (Fig.).

Arterial pulse examination

By simply palpating the pulse of superficial arteries (for example, the radial artery in the hand area), important preliminary information about the functional state of the cardiovascular system can be obtained. In this case, a number of pulse properties (pulse quality) are assessed:

• Pulse rate per minute - characterizes the heart rate (normal or fast pulse). When assessing heart rate, remember that children have a higher resting heart rate than adults. Athletes have a slower heart rate. An acceleration of the pulse is observed during emotional excitement and physical work; at maximum load in young people, the heart rate can increase to 200/min or more.
• Rhythm (rhythmic or arrhythmic pulse). Your heart rate may fluctuate according to your breathing rhythm. When you inhale, it increases, and when you exhale, it decreases. This “respiratory arrhythmia” is observed normally, and it becomes more pronounced with deep breathing. Respiratory arrhythmia is more common in young people and in people with a labile autonomic nervous system. Accurate diagnosis of other types of arrhythmias (extrasystoles, atrial fibrillation, etc.) can only be made using an ECG.
• Height - pulse amplitude - the amount of oscillation of the arterial wall during a pulse impulse (high or low pulse). The amplitude of the pulse depends primarily on the magnitude of the stroke volume and the volumetric velocity of blood flow in diastole. It is also influenced by the elasticity of shock-absorbing vessels: with the same stroke volume, the greater the elasticity of these vessels, the smaller the pulse amplitude, and vice versa.
• Pulse speed is the speed at which the pressure in the artery increases at the moment of anacrotic and decreases again at the moment of catacrotic (fast or slow pulse). The steepness of the rise in the pulse wave depends on the rate of pressure change. At the same heart rate, rapid changes in pressure are accompanied by a high pulse, and less rapid changes are accompanied by a low pulse.

  A fast pulse occurs with aortic valve insufficiency, when an increased amount of blood is ejected from the ventricles, part of which quickly returns through the valve defect into the ventricle. A slow pulse occurs when the aortic ostium narrows, when blood is expelled into the aorta more slowly than normal.

• Pulse tension or hardness (hard or soft pulse). Pulse voltage depends mainly on mean arterial pressure, since this characteristic of the pulse is determined by the amount of force that must be applied so that the pulse in the distal (located below the point of constriction) section of the vessel disappears, and this force changes with fluctuations in mean arterial pressure. Pulse voltage can be used to approximate systolic pressure.

The pulse waveform can be examined using relatively simple techniques. The most common clinical method involves placing sensors on the skin that record either changes in pressure (sphygmography) or changes in volume (plethysmography).

Pathological changes in arterial pulse

By determining the shape of the pulse wave, it is possible to draw important diagnostic conclusions about the hemodynamic shifts occurring in the arteries as a result of changes in stroke volume, vascular elasticity and peripheral resistance.

In Fig. The pulse curves of the subclavian and radial arteries are shown. Normally, the pulse wave recording shows a rise during almost the entire systole. With increased peripheral resistance, such a rise is also observed; when the resistance decreases, a primary peak is recorded, followed by a lower systolic rise; then the amplitude of the wave quickly decreases and passes into a relatively flat diastolic section.

A decrease in stroke volume (for example, as a result of blood loss) is accompanied by a decrease and rounding of the systolic peak and a slower rate of decrease in wave amplitude in diastole.

A decrease in aortic distensibility (for example, in atherosclerosis) is characterized by a steep and high leading edge, a high location of the incisura and a gentle diastolic decline.

With aortic defects, changes in the pulse wave correspond to hemodynamic shifts: with aortic stenosis, a slow, gentle systolic rise is observed, and with aortic valve insufficiency, a steep and high rise is observed; in severe cases of insufficiency - disappearance of incisura.

The time shift of pulse curves recorded simultaneously at different points (the slope of the dashed lines in the figure) reflects the speed of propagation of the pulse wave. The smaller this shift (i.e., the greater the slope of the dashed lines), the higher the speed of propagation of the pulse wave, and vice versa.

Practically important data for judging cardiac activity in some of its disorders can be obtained by simultaneously recording an electrocardiogram and a sphygmogram on the same photographic film.

Sometimes a so-called pulse deficit is observed, when not every wave of ventricular excitation is accompanied by the release of blood into the vascular system and a pulse impulse. Due to a small systolic ejection, some ventricular systoles turn out to be so weak that they do not cause a pulse wave reaching the peripheral arteries. In this case, the pulse becomes irregular (pulse arrhythmia).

Pulse is the vibration of arterial vessels that is 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 a norm or deviation in the state of activity of the heart muscles.

Main characteristics of pulse

Heart vibrations have six main indicators that can be used to diagnose the functioning of the heart muscles. The pulse and its characteristics are the rhythm and frequency of the beats, the force of the beats and tension, as well as the shape of the vibrations. The level of blood pressure is also characterized by the properties of the pulse. Based on the fluctuations in heartbeat, specialists can determine the disease that the patient is suffering from.

Rhythm

Heart rhythm is the cyclic alternation of “beats” of the heart muscles over the course of 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 tibia and other places where arteries pass close to the surface of the body. In patients, the rhythm of heart beats is often disturbed.

Frequency

The pulsation frequency is the number of “beats” per minute. It can be counted by pressing on the arterial vessels. Heart rate (pulse) over a wide range of loads characterizes the speed at which blood is pushed through. There are two types of heart rate deviations:

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

The contraction interval can be calculated with a tonometer, and not just by 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. With physical activity, the frequency also increases.

If your heart rate is high, you need to find out what your blood pressure is. If it is low, it is necessary to use drugs that reduce the rate of contractions by any of the methods available to the patient, since too rapid heartbeats are very dangerous.

Heart beat size

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

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

Voltage

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

• hard contractions observed at high pressure levels;
• soft ones occur when the artery is easily blocked without effort.

Filling

This parameter is influenced by the quantitative volume of blood released into the artery. It affects the strength of 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. During a hypertensive crisis, the heartbeats are very full.

Pulse form

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:

• rapid heartbeats occur when a large volume of blood enters from the ventricles and the elasticity of the arteries (This leads to a decrease in diastolic pressure);
• slow with slight changes in blood pressure (with a decrease in the cross-section of the aortic walls or mitral valve dysfunction);
• speech attacks are observed during the passage of an additional wave.

Parvus, tardus means “slow, small”. This filling of pulsations is typical when the amplitude of oscillations decreases and the speed decreases. Pulse tardus parvus is characteristic of patients with mitral valve disease or suffering from 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 there are many fewer options for studying it at home. It is possible to examine the pulse without using instruments only by palpation. You can find and measure the quality and strength of your heartbeats at:

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

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

Normal pulse frequency

The rate of heart beat fluctuations varies depending on age. For a newborn baby, the number of beats is about 110 beats. At 5 years of age, 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 beating in the jugular veins, in the fossa of the neck and several other places that are located close to the heart. It is impossible to measure it at the site of small veins.

The properties of the venous pulse, like the arterial pulse, are characterized by frequency, rhythm and other parameters. A study of the veins is carried out to determine what the pulse wave is and to assess venous pressure. The easiest way to examine is the right internal jugular vein. Venous pulse is measured as follows:

• the person is placed on the bed at an angle of 30 degrees;
• the 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 venography. This is a way of recording cardiac vibrations associated with the filling of large veins that are located near the heart. Registration is carried out in the form of a venogram.

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

Diagnostic value

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

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

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

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

Identification technique

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

There are several ways to detect this type of pulse.

Pulse rate

There are no normal characteristics of the capillary pulse. It is simply impossible to see such pulsation with the naked eye if the circulatory system is healthy.

The arterial pulse is a rhythmic, jerky oscillation of the vessel wall that occurs as a result of the ejection of blood from the heart into the arterial system. Pulse from lat. рulsus - push.

Ancient doctors paid great attention to studying the properties of the pulse. The scientific basis for the doctrine of the pulse received after Harvey's discovery of the circulatory system. The invention of the sphygmograph and especially the introduction of modern methods of pulse recording (arteriopiesography, high-speed electrosphygmography, etc.) 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 its pressure. This change in pressure spreads through the aorta and its branches to the arterioles. In the arterioles, the pulse wave stops, because there is high muscle resistance here. The pulse wave propagates much faster than the blood flows. The pulse wave travels 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 when the heart works, blood is not pumped into the vessels constantly, but in portions. Pulse examination allows us to judge the functioning of the left ventricle. The greater the systolic volume, the more elastic the artery, the greater the wall oscillations.

Vibrations of arterial walls can be recorded using a sphygmograph. The recorded curve is called a sphygmogram. On the pulse recording curve - sphygmogram - you can always see an ascending knee - anacrotic, plateau, descending knee - catacrotic, dicrotic rise and incisura (tenderloin).

Anacrosis occurs as a result of increased pressure in the arteries and coincides in time with the phase of rapid expulsion of blood into ventricular systole. At this time, there is more blood inflow than outflow.

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

In the proto-diastolic interval (end of systole, beginning of diastole), when the pressure in the ventricles decreases, blood rushes back to the heart. Outflow decreases. An incisura arises. During ventricular diastole, blood closes the semilunar valves and, as a result of the impact on them, a new wave of blood outflow begins. A short-term wave of increased pressure appears in the aorta (dicrotic rise). After this, the catacrota continues. The pressure in the aorta reaches its original level. The outflow is increasing.

Properties of the pulse.

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). The emergency rate characterizes the heart rate. Normal HR = 60 – 80 beats/min. When the heart rate increases above 90 beats/min, they speak of tachycardia. If there is a decrease (less than 60 beats/min), this indicates bradycardia.

Sometimes the left ventricle contracts so weakly that the pulse wave reaches the periphery, then the number of pulse beats becomes less than the heart rate. This phenomenon is called bradysphygmia. And the difference between heart rate and emergency rate is called pulse deficit.

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

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

3. Heart rate. The speed of the pulse is determined by the rate of increase and decrease in 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 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 ventricular myocardium, fainting, collapse, etc.

4. Pulse voltage. 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 in hypertension, and a relaxed (soft) pulse, which occurs in hypotension.

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

There are many more properties of the pulse that you will become familiar 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.

Arterial pulse are called rhythmic oscillations of the arterial wall, caused by the ejection of blood from the heart into the arterial system and the change in pressure in it during the left ventricle.

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

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

Since arterial (including pulse) pressure decreases in the vessels with distance from the heart, the amplitude of pulse oscillations also decreases. At the level of arterioles, pulse pressure drops to zero and there is no pulse in the capillaries and then in the venules and most venous vessels. The blood flows evenly in these vessels.

Pulse wave speed

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

Table 1. Velocity of pulse wave propagation

The speed of propagation of the pulse wave significantly exceeds the linear speed of blood movement, which in the aorta is 20-30 cm/s under resting conditions. The pulse wave, having arisen in the aorta, reaches the distal arteries of the limbs in approximately 0.2 s, i.e. much faster than the portion of blood the ejection of which by the left ventricle caused the pulse wave will reach them. With hypertension, due to increased tension and stiffness of the arterial walls, the speed of propagation of the pulse wave through the arterial vessels increases. Pulse wave velocity measurement can be used to assess the condition of the arterial vessel wall.

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

Properties of pulse

Pulse recording is of great practical importance for clinical practice and physiology. The pulse makes it possible to judge the frequency, strength and rhythm of heart contractions.

Table 2. Pulse properties

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

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

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

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

Pulse filling (amplitude)- a subjective indicator assessed by palpation by the height of the arterial wall and the greatest stretch of the artery during cardiac systole. Pulse filling depends on the magnitude of pulse pressure, stroke volume, circulating blood volume and the elasticity of the arterial walls. It is customary to distinguish between the following options: a pulse of normal, satisfactory, good, weak filling and, as an extreme variant of weak filling, a thread-like pulse.

A well-filled pulse is palpably perceived as a pulse wave of high amplitude, palpated at some distance from the line of projection of the artery onto the skin and felt not only with moderate pressure on the artery, but also with a weak touch to the area of ​​​​its pulsation. A thread-like pulse is perceived as a weak pulsation, palpated along a narrow line of projection of the artery onto the skin, the sensation of which disappears when the contact of the fingers with the surface of the skin weakens.

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

Heart rate is determined by the steepness of the increase in pressure and the achievement by the arterial wall of the maximum amplitude of pulse oscillations. The greater the steepness of the increase, the shorter the period of time the amplitude of the pulse oscillation reaches its maximum value. The pulse rate can be determined (subjectively) by palpation and objectively according to the analysis of the steepness of the increase in anacrosis on the sphygmogram.

The pulse rate depends on the rate of increase in pressure in the arterial system during systole. If during systole more blood is ejected into the aorta and the pressure in it increases rapidly, then the greatest amplitude of arterial stretch will be achieved more quickly - the severity of anacrota will increase. The greater the steepness of the anacrotic (the angle a between the horizontal line and the anacrotic is closer to 90°), the higher the pulse rate. This pulse is called fast. With a slow increase in pressure in the arterial system during systole and a low rate of increase in anacrosis (small angle a), the pulse is called slow. Under normal conditions, the heart rate is intermediate between fast and slow heart rates.

A fast pulse indicates an increase in the volume and speed of blood expulsion into the aorta. Under normal conditions, the pulse can acquire such properties when the tone of the sympathetic nervous system increases. A constantly present fast pulse may be a sign of pathology and, in particular, indicate aortic valve insufficiency. With aortic stenosis or decreased ventricular contractility, signs of a slow pulse may develop.

Fluctuations in blood volume and pressure in the veins are called venous pulse. The venous pulse is determined in the large veins of the chest cavity and in some cases (with a horizontal body position) can be recorded in the cervical veins (especially the jugular). The recorded venous pulse curve is called phlebogram. The venous pulse is caused by the influence of contractions of the atria and ventricles on the blood flow in the vena cava.

Pulse study

Pulse examination allows you to assess a number of important characteristics of the state of the cardiovascular system. The presence of an arterial pulse in a subject is evidence of myocardial contraction, and the properties of the pulse reflect the frequency, rhythm, strength, duration of systole and diastole of the heart, the condition of the aortic valves, the elasticity of the arterial vessel wall, blood volume and blood pressure. Pulse fluctuations in the walls of blood vessels can be recorded graphically (for example, using sphygmography) or assessed by palpation in almost all arteries located close to the surface of the body.

Sphygmography— method of graphical recording of arterial pulse. The resulting curve is called a sphygmogram.

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

Rice. Graphic registration of arterial pulse (sphygmogram): CD-anacrotic; de - systolic plateau; dh - catacrota; f - incisura; g - dicrotic wave

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

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

The pulsation of the vascular wall carries information about the state and functioning of the cardiovascular system. Therefore, analysis of the sphygmogram allows one to evaluate a number of indicators reflecting the state of the cardiovascular system. From it you can calculate the duration, heart rhythm, and heart rate. Based on the moments of the onset of anacrota and the appearance of incisura, one can estimate the duration of the period of expulsion of blood. The steepness of anacrota is used to judge the rate of blood expulsion by the left ventricle, the condition of the aortic valves and the aorta itself. The pulse rate is estimated based on the steepness of the anacrotism. The moment of registration of the incisura makes it possible to determine the beginning of ventricular diastole, and the occurrence of dicrotic rise - the closure of the semilunar valves and the beginning of the isometric phase of ventricular relaxation.

With synchronous recording of a sphygmogram and phonocardiogram on their records, the onset of anacrotic coincides in time with the appearance of the first heart sound, and the dicrotic rise coincides with the appearance of the second heartbeat. The rate of increase in anacrota on the sphygmogram, reflecting the increase in systolic pressure, is under normal conditions higher than the rate of decrease in anacrota, reflecting the dynamics of the decrease in diastolic blood pressure.

The amplitude of the sphygmogram, its incisura and dicrotic rise decrease as the SS recording site moves away from the aorta to the peripheral arteries. This is caused by a decrease in blood pressure and pulse pressure. In places of vessels where the propagation of the pulse wave meets increased resistance, reflected pulse waves occur. Primary and secondary waves traveling towards each other add up (like waves on the surface of water) and can strengthen or weaken each other.

Examination of the pulse by palpation can be carried out in many arteries, but the pulsation of the radial artery in the area of ​​the styloid process (wrist) is especially often examined. To do this, the doctor wraps his hand around the hand of the person being examined in the area of ​​the wrist joint so that the thumb is located on the back side and the rest on its anterior lateral surface. Having felt the radial artery, press it with three fingers to the underlying bone until pulse impulses are felt under the fingers.