Pulse fluctuations in the vascular bed

In the arteries, oscillations of their walls periodically occur, called arterial pulse. Recording an arterial pulse is called sphygmography. On the sphygmogram, anacrota, catacrota, incisura and dicrotic rise are distinguished. Its nature is associated with a change in blood pressure in the aorta when it is released from the heart. At the same time, the aortic wall is slightly stretched, and then returns to its original size due to its elasticity. The mechanical vibration of the aortic wall, called a pulse wave, is transmitted further to the arteries, arterioles, and here, before reaching the capillaries, it attenuates. The speed of propagation of the pulse wave is higher than the speed of blood flow, on average it is 10 m / s. Therefore, the pulse wave reaches the radial artery in the area of \u200b\u200bthe wrist (the most commonly used pulse registration site) in about 100 ms at a distance of 1 m from the heart to the wrist.

The main factor that ensures the movement of blood through the vessels: the work of the heart as a pump.

Supporting factors:

1.the closedness of the cardiovascular system;

2. the difference in pressure in the aorta and vena cava;

3. elasticity of the vascular wall (transformation of the pulsating ejection of the crogwie from the heart into continuous blood flow);

4. valve apparatus of the heart and blood vessels, providing unidirectional blood flow;

5. the presence of intrathoracic pressure - "suction" action, providing venous return of blood to the heart.

Muscle work - pushing blood and a reflex increase in the activity of the heart and blood vessels as a result of the activation of the sympathetic nervous system.

Respiratory system activity: the more often and deeper breathing, the more pronounced the suction effect chest.

Blood pressure, its components. Determination methods.

Arterial blood pressure- this is the pressure that the blood in the artery exerts on its wall, the norm should be 120/80 mm Hg

Distinguish arterial blood pressure top and bottom.

Upper pressure (systolic).

The word " systole”Means contraction, and systolic pressure is the pressure of blood flow against the walls of the vessels at the moment when the heart contracts and with which the heart injects blood into the arteries. It directly depends on the ability of the heart to contract normally.

Lower blood pressure (diastolic) is the level of blood pressure when the heart relaxes. It shows with what force the muscular apparatus of the vessels resists the blood pressure in them, that is, what is the tone of the vessels.

Normally, the lower pressure should be between 60 and 90 mm Hg. Art.

DEFINED:tonometer, carotid artery, wrist, stethoscope

47. External respiration. The mechanism of inhalation and exhalation. .
Breathing is a set of processes of oxygen entering the internal environment of the body, using it for oxidative processes and removing carbon dioxide from the body. Breathing is: -pulmonary (external) and -cellular (tissue). Inhalation is provided by contraction of the respiratory muscles (intercostal muscles and diaphragm). The volume of the chest increases. The diaphragm, contracting, flattens (goes down) and the volume of the chest increases. The pleura follows the chest and diaphragm. As a result, the lungs passively follow the growing chest and the volume of the lungs increases, the intrapulmonary pressure drops. The atmospheric pressure becomes greater than the intrapulmonary pressure and the lungs are filled with air along the pressure gradient. Moreover, the greater the pressure gradient, the larger the volume of air enters the lungs. Exhalation occurs as a result of relaxation of the respiratory muscles, the ribs go down, the sternum returns to the back, the diaphragm again takes on a dome-shaped shape (under pressure abdominal organs). The volume of the chest decreases (in the frontal, sagittal and vertical directions). The pleural leaves follow the rib cage and diaphragm. The volume of the lungs decreases, the intrapulmonary pressure increases, it becomes more than the atmospheric pressure, and the air leaves the lungs along the pressure gradient. The movement of air in the lungs during breathing is called pulmonary ventilation.

48. Indicators of the function of external respiration and methods of their determination.
Breathing is a set of processes of oxygen entering the internal environment of the body, using it for oxidative processes and removing carbon dioxide from the body. Tidal volume is the amount of air a person breathes in and out at rest. Inspiratory reserve volume - the amount of air that a person can additionally inhale after a normal inhalation. Expiratory reserve volume - the amount of air that a person can additionally exhale after a calm exhalation. Residual volume is the amount of air remaining in the lungs after maximum expiration. The vital capacity of the lungs is the maximum amount of air that can be exhaled after the largest inhalation, consisting of the sum of the tidal volume and the reserve volumes of inhalation and exhalation. Total lung capacity - The maximum amount of air contained in the lungs during the greatest inhalation is the sum of vital capacity and total lung capacity. Of all the listed functional components, the tidal volume and vital capacity of the lungs are of the greatest practical importance. The vital capacity of the lungs (VC) is an indicator of the mobility of the lungs and chest. It depends on many factors: constitution, age, sex, fitness level. With age, VC decreases, which is associated with a decrease in lung elasticity and chest mobility. In women, VC is on average 25% lower than in men. For men with a height of 180 cm, it averages 4.5 liters. The main methods for determining the parameters of external respiration spirometry and spirography

49. Gas exchange in the lungs.

The movement of gases provides diffusion. According to the laws of diffusion, gas propagates from an environment with a high partial pressure to an environment with a lower pressure. Partial pressure is the part of the total pressure that a given gas has in the gas mixture. The higher the percentage of gas in the mixture, the higher its partial pressure. For gases dissolved in a liquid, the term “stress” is used, corresponding to the term “partial pressure” used for free gases.

In the lungs, gas exchange takes place between the air contained in the alveoli and the blood. The alveoli are braided with a dense network of capillaries. The walls of the alveoli and the walls of the capillaries are very thin. For gas exchange, the determining conditions are the surface area through which the diffusion of gases takes place, and the difference in the partial pressure (voltage) of the diffusing gases. The lungs perfectly meet these requirements: with a deep breath, the alveoli are stretched and their surface reaches 100–150 square meters. m (the surface of the capillaries in the lungs is no less large), there is a sufficient difference in the partial pressure of the gases of the alveolar air and the voltage of these gases in the venous blood.

50. Mechanisms of respiration regulation.

Breathing is a set of processes of oxygen entering the internal environment of the body, using it for oxidative processes and removing carbon dioxide from the body. In the lungs, oxygen from the alveolar air passes into the blood, and carbon dioxide from the blood enters the lungs.

Regulatory respiration - a set of physiological processes aimed at adapting the system to the needs of the body. Components: - receptors (receive and transmit), - central regulator (respiratory center), - effectors (ventilation). Respiratory regulation mechanisms, in addition to humoral regulation mechanisms, distinguish reflex mechanisms. Reflex mechanisms: 1) mechanisms of working adjustment of breathing. center: - regulation by deviation; -regulation by disturbance (regulation by means of working muscles); - prediction regulation (conditioned reflex influence). 2) mechanisms of respiratory self-regulation. : reflex influences from the receptors of the lungs and respiratory muscles themselves.

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

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

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

Since arterial (and including pulse) pressure decreases in the vessels with distance from the heart, the amplitude of the pulse oscillations also decreases. At the level of arterioles, the pulse pressure drops to zero and the pulse in the capillaries and then in the venules and most venous vessels missing. The blood in these vessels flows evenly.

Pulse wave speed

Pulse fluctuations spread along the wall of arterial vessels. Pulse wave velocity 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 muscle layer (for example, in the radial), it is about 12 m / s. With age, the extensibility of the 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. The speed of propagation of the pulse wave

The speed of propagation of the pulse wave significantly exceeds the linear speed of blood movement, which in the aorta is 20-30 cm / s at rest. The pulse wave, arising in the aorta, reaches the distal arteries of the limbs in about 0.2 s, i.e. much faster than that portion of blood will be delivered to them, the release of which by the left ventricle caused a pulse wave. With hypertension, due to an increase in 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 wall.

Figure: 2. Age changes pulse waves caused by a decrease in the elasticity of the arterial walls

Pulse properties

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

Table 2. Pulse properties

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

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

Rhythm - an indicator reflecting the frequency of the pulse fluctuations one after another 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 the intervals at normal rhythm should not exceed 10% of their average value. If the duration of the intervals between pulse beats is different, then the pulse and contractions of the heart are called arrhythmic.Normally, "respiratory arrhythmia" can be detected, in which the pulse rate changes synchronously with the phases of breathing: it increases with inspiration and decreases with expiration. Respiratory arrhythmia is more common in young people and in individuals with a labile tone of the autonomic nervous system.

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

Filling (amplitude) of the pulse - a subjective index, assessed by palpation by the height of the arterial wall rise and the greatest stretching of the artery during heart systole. Pulse filling depends on the value of pulse pressure, stroke volume of blood, volume of circulating blood and elasticity of arterial walls. It is customary to distinguish between the options: the pulse of normal, satisfactory, good, weak filling and, as an extreme variant of weak filling, a threadlike pulse.

A pulse of good filling is palpated as a high-amplitude pulse wave, palpable at some distance from the line of projection of the artery onto the skin and felt not only when the artery is pressed moderately, but also when the area of \u200b\u200bits pulsation is lightly touched. A threadlike pulse is perceived as a weak pulsation, palpable along a narrow line of the artery's projection onto the skin, the sensation from which disappears when the contact of the fingers with the skin surface is weakened.

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

Heart rate is determined by the steepness of the pressure increase and the achievement of the maximum amplitude of pulse oscillations by the arterial wall. The greater the slope of the rise, 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 growth of the anacrot 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 thrown into the aorta and the pressure in it rises rapidly, then a faster achievement of the maximum amplitude of the artery stretching will be observed - the steepness of the anacrot will increase. The greater the steepness of the anacrot (the angle a between the horizontal line and the anacrot is closer to 90 °), the higher the pulse rate. This pulse is called fast.With a slow increase in pressure in the arterial system during systole and a low steepness of the growth of the anacrot (low angle a), the pulse is called slow. Under normal conditions, the heart rate is intermediate between a fast and slow heart rate.

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

Fluctuations in the volume and pressure of blood 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 the horizontal position of the body) 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

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

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

To register a sphygmogram, special sensors are installed on the area of \u200b\u200barterial pulsation, which capture 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 site is distinguished - anacrota, and a descending one - katakrota.

Figure: Graphic registration of arterial pulse (sphygmogram): cd-anacrot; de - systolic plateau; dh - catacroth; f - incisura; g - dicrotic wave

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

There are incisura (sirloin) and dicrotic lift on the katakrota. Incisura occurs as a result of a rapid drop in arterial pressure at the onset of ventricular diastole (protodiastolic interval). At this time, with the semilunar valves of the aorta still open, the left ventricle relaxes, causing rapid decline there is blood pressure in it, and under the action 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 cusps of the semilunar valves away from the aortic wall and causes them to close. Reflecting from the slammed valves, a wave of blood will momentarily create a new short-term increase in pressure in the aorta and other arterial vessels, which is recorded on the sphygmogram catacroth by a dicrotic rise.

The pulsation of the vascular wall carries information about the state and functioning of the cardiovascular system. Therefore, the analysis of the sphygmogram allows one to evaluate a number of indicators reflecting the state of the cardiovascular system. It can be used to calculate the duration, heart rate, heart rate. From the moments of the beginning of the anacrot and the appearance of incisura, the duration of the period of blood expulsion can be estimated. The steepness of the anacrot is used to judge the rate of blood expulsion by the left ventricle, the state of the aortic valves and the aorta itself. The steepness of the anacrot is used to estimate the pulse rate. The moment of registration of incisure allows you to determine the onset 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 registration of a sphygmogram and a phonocardiogram on their recordings, the beginning of the anacrot coincides in time with the appearance of the I heart sound, and the dicrotic rise - with the appearance of the II rut of the heart. The growth rate of the anacrot on the sphygmogram, which reflects the increase in systolic pressure, under normal conditions is higher than the rate of decrease in catacroth, reflecting the dynamics of the decrease in diastolic blood pressure.

The amplitude of the sphygmogram, its incisure and dicrotic rise decrease with the removal of the registration site from the aorta to the peripheral arteries. This is caused by a decrease in the values \u200b\u200bof arterial and pulse pressures. In places of the vessels, where the propagation of the pulse wave meets increased resistance, reflected pulse waves appear. Primary and secondary waves traveling towards each other add up (like waves on the surface of water) and can increase or weaken each other.

Pulse examination by palpation can be performed on many arteries, but pulsation of the radial artery in the area of \u200b\u200bthe styloid process (wrist) is especially often examined. To do this, the doctor wraps his hand around the examinee's hand in the area of \u200b\u200bthe wrist joint so that the thumb is located on the back side, and the rest - on its front lateral surface. Having felt the radial artery, press it against the underlying bone with three fingers until a sensation of pulse jerks under the fingers appears.

2. Name the features of pain in angina pectoris and myocardial infarction.

3. Give a description of pain in myocarditis, pericarditis, cardioneurosis, dissecting aortic aneurysm.

4. How is the occurrence of palpitations and heart failure explained?

5. Name the patient's complaints in cardiac asthma and pulmonary edema.

6. Name the clinical variants of cardiac dyspnea.

7. Name the patient's complaints arising from stagnation of blood in the systemic circulation.

8. Name the mechanism of edema in heart failure.

9. List the clinical variants of headache in diseases of the cardiovascular system.

10. Give the clinical characteristics of the symptom of "dead finger".

11. What is a symptom of intermittent claudication?

12. What is a Stokes collar?

13. List the characteristic changes in the patient's face with heart disease.

14. Name the types of forced position of the patient with heart failure, angina pectoris, pericarditis.

15. Method of determining the pulse. What are the main characteristics of the pulse in health and disease.

16. What is cardiac hump, apical impulse, negative apical impulse, cardiac impulse? The diagnostic significance of these symptoms.

17. Palpation of the heart area.

18. Under what conditions is the displacement of the apical impulse to the left, right, up?

19. What is the symptom of "feline purr"? Diagnostic value.

20. What are the rules of heart percussion? How the boundaries of absolute and relative dullness of the heart are determined.

5 Pulmonary artery; 6 - aorta; 7 - superior vena cava

21. What are the limits of absolute and relative dullness of the heart in a healthy person?

22. Under what pathological conditions is the expansion of the borders of the heart to the right observed? Left? Up?

23. What is the configuration of the heart in a healthy person? List the pathological configurations of the heart.

24. Determination of the size of the vascular bundle.

25. Under what pathological conditions is the measurement of the boundaries of absolute and relative dullness of the heart observed?

26. Questions for self-control of knowledge.

7. For exudative pericarditis, it is not typical:

10. Left ventricular hypertrophy is characterized by:

25. Stagnation in a large circle is most often observed with:

15. Method of determining the pulse. What are the main characteristics of the pulse in health and disease.

Pulse is a periodic expansion and collapse of arteries, synchronous with cardiac activity.

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

The study of the pulse on the common carotid arteries should begin with a simultaneous palpation of it on both sides of the neck. The index finger of the palpating hand is placed over the apex of the lung, parallel to the clavicle, and the pulp of the nail phalanx gently 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 should be done carefully.

Pulse study on temporal arteries - both temporal arteries can be palpated simultaneously; with the pulp of the nail phalanges of the second and fourth fingers of both hands, gently press the temporal arteries to the front of the skull at the front 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.

Study of the pulse on the brachial artery - palpate with the pulp of the nail phalanges of the second-fourth fingers of one hand as deep as possible in the lower third of the shoulder at the inner edge of the biceps muscle of the shoulder, the second hand holds the patient's hand.

Study of the pulse on the ulnar artery - palpate with the pulp of the nail phalanges of the second-fourth fingers of one hand in the middle of the ulnar fossa, the second hand - hold the patient's unbent 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 pupar ligament 2-3 cm outward from the midline.

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

The study of the pulse on the dorsal artery of the foot is performed with the pulp of the nail phalanges of the second to fourth toes 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 posterior tibial artery is determined by the pulp of the nail phalanges of the second to fourth fingers in the interval between the posterior edge of the inner ankle and the inner edge of the Achilles tendon.

The properties of the pulse are usually evaluated only for radial artery.

Technique for probing the pulse on the radial artery:

The radial artery is located under the skin between the styloid process radius and the tendon of the internal radial muscle. The thumb is placed on the back of the forearm, and the rest of the fingers are placed on the place where the radial artery passes. It is impossible to squeeze the patient's hand strongly, since the pulse wave will not be felt in the pinched artery. Do not feel the pulse with one finger, because it is more difficult to find an 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 run outward or closer to the middle of the forearm. In some cases, the main branch of the radial artery runs from the outside of the radius.

Begin the study of the pulse by simultaneously probing it on both hands. In the absence of a difference in the properties of the pulse, proceed to the study of the pulse on one hand. If there is a difference in the properties of the pulse, then it is studied in turn on each hand.

The following heart rate characteristics should be assessed:

1) the presence of a pulse;

2) the same and simultaneous pulse waves on both radial arteries;

3) pulse rhythm;

4) pulse rate in 1 minute;

6) filling the pulse;

7) the value of the pulse;

8) the speed (shape) of the pulse;

9) the uniformity of the pulse;

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

11) elasticity of the vascular wall.

The presence of a pulse.

Normally, pulse tremors are felt on both radial arteries.

The absence of a pulse on both upper limbs occurs with Takayasu's disease (obliterating aortoarteritis).

The absence of a pulse on the artery of one of the extremities occurs with obliterating atherosclerosis, thrombosis or embolism of the artery proximal to the artery with no pulsation.

Identity and simultaneity of pulsewaves on both radial arteries.

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

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

Pulse rhythm.

Normally, pulse tremors follow at regular intervals (correct rhythm, pulsusregularis).

1. Arrhythmic pulse (pulsus inaecqualis) - a pulse in which the intervals between pulse waves are not the same. It can be caused by dysfunction of the heart:

a) excitability (extrasystole, atrial fibrillation);

b) conduction (atrioventricular block II degree);

c) automatism (sinus arrhythmia).

2. Alternating pulse (pulsusalternans)) - 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 (pulsuspanadoxus) - a pulse when pulse waves in the inhalation phase decrease or disappear altogether, and in the exhalation phase they are palpated clearly. This symptom occurs with constrictive and exudative pericarditis.

Heart rate in 1 minute.

The number of pulse pulses is counted in 15 or 30 s and the result obtained is multiplied by 4 or 2. With a rare pulse, it is necessary to count at least 1 min (sometimes 2 min). In healthy adults, the pulse rate ranges from 60 to 90 per minute.

Frequent pulse (pulsus frequens) - a pulse with a frequency of more than 90 per minute (tachycardia).

Rare pulse (pulsusrarus) - a pulse with a frequency of less than 60 per minute (bradycardia).

Pulse tension.

Pulse tension is the tension of the arterial wall, which corresponds to the force of its resistance when pressed with fingers until the moment the pulse waves stop. Pulse tension is due to arterial wall tone and lateral pressure of the blood wave (i.e. blood pressure). To determine the pulse voltage, the third finger is gradually pressed on the artery until the second finger stops feeling the pulsating blood flow. Normal pulse of good tension.

Intense (hard) pulse (pulsus durus) - happens with increased systolic blood pressure, sclerotic hardening of the artery wall, aortic insufficiency.

A soft pulse (pulsusmollis) 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 different strengths, one gets a sense of the volume of its filling. Healthy people have a good filling 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.

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 post-hemorrhagic anemia).

Pulse value.

The pulse rate is the amplitude of the arterial wall oscillations during the passage of the blood wave. The value of the pulse 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 a normal or decreased tone of the arteries (pulse pressure is increased).

Small pulse (pulsusparvus) - happens in conditions accompanied by an increase in the stroke volume of the heart or normal stroke volume in combination with an increase in the tone of the arteries (pulse pressure is lowered).

Heart rate (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 ascent and the same descent (normal pulse shape).

Fast or jumping pulse (pulsus celer at attus) - a pulse with a rapid rise and fall of the pulse wave, it happens 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, it happens with stenosis of the aortic opening 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 heartbeats per unit of time (in 1 minute).

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

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

The elasticity of the vascular wall.

Two methods are used to assess the condition of the radial artery wall.

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

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

Heart rate characteristics are normal:

1) pulse waves are felt clearly;

2) pulse waves in both radial arteries are the same and simultaneous;

3) rhythmic pulse (pulsus regularis);

4) frequency 60-90 per minute;

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

6) uniform;

7) no deficit (correspondence of the number of pulse waves to the number of heart contractions);

8) the wall of the artery is elastic.

Pathological changes in the pulse:

1) lack 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) fast pulse (p. Celer);

10) slow pulse (p. Tardus);

11) rapid pulse (p. Frequens);

12) rare pulse (p. Rarus);

13) arrhythmic pulse (p. Inaecqualis);

14) pulse deficit (p. Deficiens);

15) paradoxical pulse (p. Panadoxus);

16) alternating pulse (p.alternans);

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

Arterial pulse- rhythmic oscillations of the artery wall due to increased pressure during systole. Pulsation of the arteries can be easily detected by touching any artery accessible to palpation: radial (a. Radialis), temporal (a. Temporalis), external artery of the foot (a. Dorsalis pedis), etc.

The following properties of the pulse are characterized:

frequency; rhythm; voltage; filling; the form .

The heart rate varies with the age of the child.

Heart rate Newborn 140 - 1601 year 1205 years 10,010 years 9012-13 years 80-70 beats per minute

1 Rhythm beheart rate is assessed by the uniformity of intervals between pulse beats. Normally, the pulse is rhythmic, pulse waves follow at regular intervals.

2 Pulse voltage is determined by the force that must be applied to squeeze the palpable artery. Distinguish between tense, or hard (p. Durus), and relaxed, soft pulse (p. Molis).

3 Pulse filling is determined by the amount of blood forming a pulse wave. The pulse is examined with two fingers: the proximal finger squeezes the artery until the pulse disappears, then the pressure is stopped, and the distal finger gets a sensation of the artery filling with blood. Distinguish between a full pulse (p. Plenus) - the artery has a normal filling - and empty (p. Vacuus) - the filling is less than usual.

4 Heart rate is determined on the basis of the total assessment of the filling and the voltage of the pulse wave. In terms of size, the pulse is divided into large (p. Magnus) and small (p. Parvus).

5 The shape of the pulse depends from the rate of change in pressure in the arterial system during systole and diastole. With the acceleration of the increase in the pulse wave, the pulse becomes, as it were, a jumping character and is called fast (p. Seler), with the slowing down of the increase in the pulse wave, the pulse is called slow (p. Tardus).

A pulse wave, or oscillatory change in the diameter or volume of arterial vessels, is caused by a wave of pressure increase that occurs in the aorta at the time of expulsion of blood from the ventricles. At this time, the pressure in the aorta rises sharply and its wall is stretched. Wave high blood pressure and the vibrations of the vascular wall caused by this stretching propagate with a certain speed from the aorta to arterioles and capillaries, where the pulse wave is extinguished.

The speed of propagation of the pulse wave does not depend on the speed of blood movement. The maximum linear velocity of blood flow through the arteries does not exceed 0.3-0.5 m / s, and the velocity of pulse wave propagation in young and middle-aged people with normal blood pressure and normal vascular elasticity is 5.5-8.0 m in the aorta / s, and in the peripheral arteries - 6.0-9.5 m / s. With age, as the elasticity of the vessels decreases, the speed of propagation of the pulse wave, especially in the aorta, increases.

In the pulse curve (sphygmogram) of the aorta and large arteries, two main parts are distinguished - rise and fall.

Curve rise - anacrota - arises due to an increase in blood pressure and the resulting stretching, which the walls of the arteries are exposed to under the influence of blood ejected from the heart at the beginning of the expulsion phase. At the end of the systole of the ventricle, when the pressure in it begins to fall, the pulse curve falls - katakrota... At the moment when the ventricle begins to relax and the pressure in its cavity becomes lower than in the aorta, the blood released into the arterial system rushes back to the ventricle; pressure in the arteries drops sharply and a deep notch appears on the pulse curve of large arteries - incisura... The movement of blood back to the heart is obstructed, since the semilunar valves, under the influence of the reverse flow of blood, close and prevent it from entering the heart. The wave of blood reflects off the valves and creates a secondary wave of pressure increase, which causes the arterial walls to stretch again. As a result, a secondary appears on the sphygmogram, or dicrotic, rise... 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

During the contraction of the heart in vascular system the next portion of blood is pushed out. Its blow to the wall of the artery creates vibrations, which, spreading through the vessels, gradually fade towards the periphery. They also got the name of the pulse.

What is the pulse?

There are three types of veins and capillaries in the human body. The release of blood from the heart somehow affects each of them, causing their walls to vibrate. Of course, the arteries, as the vessels closest to the heart, are more affected by cardiac output. Oscillations of their walls are well defined by palpation, and in large vessels they are even noticeable with the naked eye. That is why the arterial pulse is most important 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 the heartbeat, but normally this can only be determined with the help of special devices. Capillary pulse noticeable to the naked eye is a sign of pathology.

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

Why take a pulse?

What is the importance of vibrations of the vascular walls for diagnosis? Why is it so important?

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

With many pathological processes, the pulse changes, the pulse characteristic ceases to correspond to the norm. This allows one to suspect that cardiovascular system not everything is fine.

What parameters determine the heart rate? Pulse characteristic

1. Rhythm. Normally, the heart contracts at regular intervals, which means that the pulse should be rhythmic.
2. Frequency. There are normally the same number of pulse waves as heart beats per minute.
3. 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; pulse tension is great.
4. Filling. Depends on the volume of blood ejected by the heart during systole.
5. The magnitude. This concept combines filling and tension.
6. Shape is another parameter that determines the heart rate. 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

In case of disturbances in the generation or conduction of an impulse through the heart muscle, the rhythm of heart contractions changes, and with it the pulse also changes. Individual vibrations of the vascular walls begin to fall out, or appear prematurely, or follow each other at irregular intervals.

What are the rhythm disturbances?

Arrhythmias when the work of the sinus node changes (the part of the myocardium that generates impulses leading to the contraction of the heart muscle):

1. Sinus tachycardia is an increase in the frequency of contractions.
2. Sinus bradycardia is a decrease in the frequency of contractions.
3. Sinus arrhythmias are 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 own rhythm of contractions on the heart.

1. Extrasystole - the appearance of an extraordinary heartbeat. Depending on the localization of the ectopic focus of excitation, extrasystoles are atrial, atrioventricular and ventricular.
2. Paroxysmal tachycardia is 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 through the myocardium (blockade). Depending on the localization of the problem that prevents normal progress from the sinus node, blockages are divided into groups:

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

Separately, one should dwell on atrial and ventricular fibrillation and flutter. These conditions are also called absolute arrhythmias. In this case, the sinus node ceases to be a pacemaker, and in the myocardium of the atria or ventricles, multiple ectopic foci of excitation are formed, which set the heart rhythm with a huge contraction frequency. Naturally, in such conditions, the heart muscle is not able to contract adequately. therefore this pathology (especially from the ventricles) is life threatening.

Heart rate

The resting heart rate in an adult is 60-80 beats per minute. Of course, this indicator changes throughout life. The pulse rate differs significantly by age.

There may be a discrepancy between the number of heartbeats and the number of pulse waves. This happens if a small volume of blood is released into the vascular bed (heart failure, a decrease in the amount of circulating blood). In this case, vibrations 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 ejection fraction.

Voltage

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

1. Firm pulse. It is caused by high blood pressure (BP), primarily systolic. In this case, it is very difficult to pinch the artery with your fingers. The appearance of this type of pulse indicates the need for urgent correction of blood pressure with antihypertensive drugs.
2. Soft pulse. The artery contracts 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 the decrease in vascular tone, ineffectiveness of heart contractions.

Filling

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

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

Pulse value

This indicator combines filling and heart rate tension. It depends primarily on the expansion of the artery during the contraction of the heart and its collapse when the myocardium relaxes. In terms of size, the following types of pulse are distinguished:

1. Large (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 magnitude of pressure in systole and diastole is different (for one cycle of the heart, it sharply increases, and then significantly decreases). The reasons leading to the appearance of a large pulse may be aortic insufficiency, thyrotoxicosis, and fever.
2. Small pulse. A little blood is thrown into the vascular bed, the tone of the arterial walls is high, pressure fluctuations in systole and diastole are minimal. The reasons for this condition: stenosis of the aortic mouth, heart failure, blood loss, shock. In especially severe cases, the pulse size may become insignificant (such a pulse is called threadlike).
3. Uniform pulse. This is how the pulse rate is normal.

Pulse waveform

For this parameter, the heart rate is divided into two main categories:

1. Fast. In this case, during systole, the pressure in the aorta rises significantly, and rapidly decreases in diastole. Rapid pulse is a characteristic sign of aortic insufficiency.
2. Slow. The opposite situation, in which there is no place for significant pressure drops in systole and diastole. This pulse usually indicates the presence of aortic stenosis.

How to study the pulse correctly?

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

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

Let's consider how to palpate the pulse on the arm. The radial artery is accessible for examination on the wrist just below the base thumb... When determining the pulse, both arteries (left and right) are palpated. situations are possible when pulse fluctuations are not the same on both hands. This may be due to squeezing of the vessel from the outside (for example, a tumor) or blockage of its lumen (thrombus, atherosclerotic plaque). After comparison, the pulse is assessed on the hand where it is best palpated. It is important that when examining pulse oscillations on the artery there is not one finger, but several (it is most effective to grab the wrist so that 4 fingers, except for the thumb, are on the radial artery).

How is the carotid pulse determined? If the pulse waves are too weak at the periphery, you can examine the pulse on the main vessels. The easiest way to try to find it is 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 you cannot examine the pulse from both sides at once. Compression of the two carotid arteries can cause poor circulation in the brain.

Pulse at rest and at normal performance hemodynamics is easily determined both on peripheral and central vessels.

A few words in conclusion

(the norm for age must be taken into account in the study) allows you to draw conclusions about the state of hemodynamics. These or those 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.