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Quantitative and qualitative characteristics of arterial pulse. Tension and pulse filling

Pulse rate is an important indicator in assessing heart function. Its determination is a component in the diagnosis of arrhythmia and other diseases, sometimes quite serious. This publication discusses methods for measuring pulse, norms by age in adults and children, and factors influencing its change.

What is pulse?

The pulse is the vibration of the vascular walls that occurs as a result of contractions of the heart muscles. This indicator allows you to evaluate not only the strength and rhythm of the heartbeat, but also the condition of the blood vessels.

In a healthy person, the intervals between pulsations should be the same, but the unevenness of heartbeats is regarded as a symptom of disorders in the body - this can be either a heart pathology or another disease, for example, a malfunction of the endocrine glands.

Pulse is measured by the number of pulse waves, or beats, per minute and has certain values - in adults it is from 60 to 90 at rest. The pulse rate in children is slightly different (the indicators are presented in the table below).

The pulse is measured by the beats of pulsating blood in the radial artery, most often on the inside of the wrist, since the vessel in this place is located closest to the skin. For greatest accuracy, the indicators are recorded on both hands.

If there are no rhythm disturbances, then it is enough to count the pulse for 30 seconds and multiply it by two. If the heartbeats are irregular, then it is more advisable to count the number of pulse waves in a whole minute.

In more rare cases, counting is carried out in places where other arteries pass - brachial, femoral, subclavian. You can measure your pulse by placing your fingers on your neck at the site of the carotid artery or on your temple.

If a thorough diagnosis is necessary, for example, if serious diseases are suspected, then other examinations are performed to measure the pulse - Voltaire mount (counting per day), ECG.

The so-called treadmill test is also used, when the work of the heart and blood pulsation are recorded by an electrocardiograph while the patient moves on a treadmill. This test also shows how quickly the functioning of the heart and blood vessels returns to normal after physical activity.

What affects heart rate values?

If the normal heart rate in women and men at rest remains within the range of 60-90, then for many reasons it may temporarily increase or acquire slightly increased constant values.

This is affected by age, physical activity, food intake, changes in body position, temperature and other environmental factors, stress, and the release of hormones into the blood. The number of pulse waves occurring per minute always depends on the number of heart contractions (abbr. HR) during the same time.

Typically, the normal pulse rate in men is 5-8 beats lower than in women (60-70 per minute). Normal indicators differ in children and adults, for example, in a newborn child, a pulse of 140 beats is considered normal, but for an adult this is tachycardia, which can be either a temporary functional state or a sign of a disease of the heart or other organs. Heart rate also depends on daily biorhythms and is highest between 15:00 and 20:00.

Table of heart rate norms by age for women and men

Age	Pulse min-max	Average value	Normal blood pressure (systol./diastol.)
Age	Pulse min-max	Average value	Women	Men
0-1 month	110-170	140	60-80/40-50
From 1 month up to a year	102-162	132	100/50-60
1-2 years	94-155	124	100-110/60-70
4-6	86-126	106	100-110/60-70
6-8	78-118	98	110-120/60-80
8-10	68-108	88	110-120/60-80
10-12	60-100	80	110-120/70-80
12-15	55-95	75	110-120/70-80
Adults under 50 years old	60-80	70	116-137/70-85	123-135/76-83
50-60	65-85	75	140/80	142/85
60-80	70-90	80	144-159/85	142/80-85

The table of blood pressure and heart rate norms by age shows values for healthy people at rest. Any changes in the body can provoke a deviation of the heart rate from these indicators in one direction or another.

For example, women experience physiological tachycardia and a slight increase in blood pressure, which is associated with changes in hormonal levels.

When is your heart rate high?

In the absence of pathological changes affecting the heart rate, the pulse may increase under the influence of physical activity, be it intense work or sports. The following factors can also increase it:

stress, emotional impact;
overwork;
hot weather, stuffy indoors;
severe pain.

With a functional increase in heart rate, there is no shortness of breath, dizziness, headaches or chest pains, there is no darkness in the eyes, the heartbeat remains within the maximum normal range and returns to its normal value within 5-7 minutes after cessation of exposure.

Pathological tachycardia is spoken of if there is any disease, for example:

pathologies of the heart and blood vessels (for example, rapid pulse in hypertensive patients, people with coronary artery disease);
arrhythmia;
nervous pathologies;
heart defects;
presence of tumors;
infectious diseases, fever;
hormonal disorders;
anemia;
(menorrhagia).

A slight increase in the number of pulse waves is observed in pregnant women. In children, functional tachycardia is normal, observed during active games, sports and other activities and allows the heart to adapt to changing conditions.

An increase in heart rate, and therefore a high pulse, is observed in adolescents with. During this period, it is important to pay close attention to any changes - chest pain, the slightest shortness of breath, dizziness and other symptoms are a reason to show the child to the doctor, especially if there are diagnosed heart diseases.

What is bradycardia?

If tachycardia is an increase in heart rate, then bradycardia is its low levels compared to the norm (less than 60 pulsations per minute). Depending on the causes, it can be functional or pathological.

In the first case, the pulse is reduced during sleep and in trained people - among professional athletes, even 40 beats are considered as the norm. For example, for cyclist Lance Armstrong it is in the range of 35-38 pulsations.

A decrease in heart rate can also be a manifestation of heart and vascular diseases - heart attack, age-related pathological changes, inflammation of the heart muscle. This is cardiac bradycardia, caused in most cases by a disturbance in the conduction of impulses between the nodes of the heart. In this case, the tissues are poorly supplied with blood, and oxygen starvation develops.

Associated symptoms may include weakness, dizziness, fainting, cold sweat, and blood pressure instability.

Bradycardia also develops as a result of hypothyroidism, gastric ulcers, myxedema, and increased intracranial pressure. Bradycardia of less than 40 beats is considered severe; this condition often causes the development of heart failure.

If the beat rate is reduced and no cause is found, then the bradycardia is called idiopathic. There is also a medicinal form of this disorder, when the pulse decreases after taking pharmacological drugs, for example, Diazepam, Phenobarbital, Anaprilin, tincture of valerian or motherwort.

With age, the heart and blood vessels wear out, become weaker, and pulse deviations from the norm are diagnosed in many people after 45-50 years. Often this is not only a physiological feature, but also a symptom of serious changes in the functioning of organs. Therefore, during this age period, it is especially important to regularly visit a cardiologist and other specialists to monitor and treat existing diseases and timely identify new health problems.

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 that was released by the left ventricle causing 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 rise 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 a 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 anacrosis 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 testing allows you to evaluate 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.

An individual normal pulse in healthy people is formed based on the characteristics of the body - internal factors. The cardiovascular system is sensitive to external stimuli. The reaction is always the same - a change in heart rate (HR).

A person's heart rate depends on many factors.

Has your heart rate increased? There are enough reasons:

The body position has changed. It is easiest for the heart to pump blood while lying down. There is no blood stagnation in parts of the body, therefore the pulse is calm and low. The vertical position increases the heart rate. Some of the blood settles in the legs, and the heart pumps a smaller volume of fluid over the same circulation area. What does it mean? The number of red blood cells carrying oxygen is less. The area of the body and blood flow is the same. For normal oxygen supply, the heart is forced to pump blood faster.
Air temperature. Hot and cold weather – increased heart rate. With closed pores, rapid blood flow retains body heat in winter, and in summer, with open pores, it releases it.
Physical and mental stress. Daytime loads adjust the heart rate in the evening. A sleeping person has a minimal heart rate that persists in the morning. Activities during the day (sports, study, mental work) fluctuate it within acceptable values. More stress means faster heartbeat before bed. An increase of 8-15 beats indicates an average intensity of the day, more than 15 indicates high tension.
Physical activity increases a person's heart rate
Emotional outbursts. Stress makes the heart beat well. And positive ones too. Doctors conducted an experiment: they measured the singer’s pulse and blood pressure before the concert and during the show. The first indicator turned out to be slightly overestimated (excitement), the second was characteristic of a pre-infarction state. The patient, on the contrary, experienced euphoria from what was happening. This indicates an equal influence of positive and negative emotions on the heart muscle.
Altitude. The higher you are above the sea, the less oxygen there is in the air. The heart adapts in 2 stages. The first is rapid heartbeat. It is easier to cope with oxygen starvation by increasing the speed of blood flow. Gradually, the body adapts to new conditions and in response the heart slows down.
Bad habits. Smoking. A cigarette smoked changes physiological parameters. Blood pressure and pulse increase due to nicotine. It also stimulates the body, just like caffeine.
Smoking affects blood pressure and pulse
As a symptom of a disease. A rapid or slow pulse is the result of an ongoing illness:

infection, intoxication;
cardiac disorders (arrhythmia, tachycardia, bradycardia);
blood pressure problems;
brain injuries;
anemia;
problems with the endocrine glands;
overstrain, overfatigue (in athletes).

A changing heart rate may indicate blood pressure problems.

Medicines, doping (in sports). The side effects of medications can be much stronger than the therapeutic ones. The instructions for most drugs warn about the effect of the tablets on the heart muscle.

Normal heart rate by age

A normal human pulse is 60 heart beats per minute. A common but erroneous opinion. The norm is individual for men, women and different age categories.

The baby's heart rate is higher due to its tiny size. The cameras capture too little blood. To enrich the body with oxygen, they have to contract more often. A record high heart rate is observed in babies under 1 month of age – 140 beats per minute. For the same reason, women’s pulse is a priori 8-12 units higher than that of the stronger sex. What should the pulse be?

Table 1. “Minimum, average and maximum heart rate limits by age”

Age	Average value	Boundary norm
1-12 months	130	102-162
1-2 years	125	94-154
2-4 years	115	90-140
4-6 years	105	86-126
6-8 years	98	78-118
8-10	88	68-108
10-12	80	60-100
12-15	75	55-95
15-50	70	60-80
50-60	74	64-84
60-80	79	69-89

Table 2. “Pulse during physical activity”

Age	Maximum number of hits	Average number of strokes
20	200	130-160
25	195	127-157
30	190	124-152
35	185	120-148
40	180	117-144
45	175	114-140
50	170	111-136
55	165	107-132
60	160	104-128
65 and more	150	98-120

The normal heart rate during exercise is also determined by the simplest formula: 220 – your age.

The main characteristic of the pulse is the frequency or how many beats per minute the heart makes. For measurement, the patient's hands are prepared: clothing is removed from the wrists and jewelry. They remove everything that drags on their hands. Three fingers (index, middle, ring) are aligned in a straight line on the patient’s wrist. Listen to the place of pulsation on both hands. Measure on the one where the beat is stronger. The fingers press tightly, pressing the vein to the radius. Countdown: 10 sec or 20 sec. The number of beats is multiplied by 6 or 3 to obtain the number per minute.

High pulse and tinnitus are a sign of disorder in the body

Under the gun and an unreasonable rapid rhythm. For example, it is not accompanied by mental agitation or twin symptoms of the disease. It occurs spontaneously when a person is at rest and doing routine activities. The initial sign of internal disorder in the body.

Reasons for increased heart rate

A common cause of rapid heartbeat is dehydration. The blood thickens and moves more slowly, so the heart rate is forced to increase. In hot weather, the problem befalls many who do not monitor their water balance. More clean water and the problem goes away.

In hot weather, your heart rate may increase due to dehydration

What does tachycardia depend on:

inflammation in the respiratory system;
infectious infection;
purulent formations;
problems with the thyroid gland;
disorder of the cardiovascular system;
hormonal disorders;
increased body temperature;
anemia;
improper treatment of any disease;
long-term stress.

High pulse with normal blood pressure: what to do?

Tachycardia is dangerous. Under some conditions, the rapid rhythm gives way to cardiac arrest and death. What to do if an attack takes you by surprise?

First of all, we pay attention to additional symptoms: shortness of breath, chest pain, darkness in the eyes - a reason to call “103”. Before the ambulance arrives, the patient is given heart drops: tincture of valerian, motherwort, Corvalol, valocordin (30 drops). Validol under the tongue, corvaltab, corvalment. Taking magnesium B6 is considered a great help.

Take off tight clothes, unbutton your collar, open the windows wide - the flow of oxygen will make the heart work easier. Wet the back of the head and the bends of the joints with cold water, and prepare ammonia in case of fainting. Ensure vertical rest.

The resting pulse is different for each person. Paired with blood pressure, it is a powerful indicator of health. This working mechanism tends to change, whose indicators can warn of a threat to the body.

The correct functioning of the cardiovascular system is shown by the pulse characteristic. This is the first thing that is checked in a person who seeks emergency help. Although, at first glance, it seems that this indicator does not carry much information about the state of the body and is not so important, it is still worth paying special attention to. The frequency of pulsations determines the malfunction of the heart, the presence of inflammation and other serious diseases. The pulse pattern gives a general picture of the state of the body. It is impossible to diagnose a specific disease using pulse readings alone, but it is possible to identify the direction of the problem.

What is it?

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

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

Briefly about the characteristics that are determined during the study:

Enter your pressure

Move the sliders

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

How to measure?

The method of measuring heart rate is palpation of the pulse. More often, a pulse examination is carried out on an artery located on the wrist under the thumb, which is called the radial artery. The hand should be relaxed, and the hand should be clasped so that the thumb is on the back side and the rest are on the front surface. To obtain an accurate result, measurements are taken simultaneously on both hands. You can measure pulse impulses in other arteries:

sleepy;
femoral;
temporal;
brachial.

All accessible places for palpation of the pulsation of the arteries, which are closest to the surface of the body.

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

During normal heart function, the number of pulsations is calculated in 30 seconds and the result is doubled. If there are rhythm disturbances, then measurements are carried out for a minute. A person who knows independently carries out measurements and it is even possible to detect deviations: is the blood pump rhythmic and what is the frequency? The accuracy of the diagnosis depends on the quality of the measurements.

What does it depend on?

The nature of the pulse depends on various factors - environmental influences, physiological, pathological factors and age. Gender also has an effect - the frequency is higher in women than in men. The main reasons that influence the rate of reductions:

Physiological. Physical activity, stress, eating and digesting food, drinks such as coffee, Coca-Cola, alcohol, and smoking increase the heart rate. During sleep and monotonous quiet work, a slowdown occurs.
Pathological. An increase in heart rate is provoked by infectious diseases, hypertension, tumors, asthma, bronchitis, and blood loss. Heart attack, side effects from various drugs slow down the pulse. If the heart malfunctions, the pulse wave becomes irregular. When there is blockage of blood vessels in the extremities, it may be completely absent.

Age norms

The pulse rate is affected by a person's age. Newborn children usually have a high frequency, unlike adults. It is also believed that before death the frequency of pulse waves increases, for what reasons there is no exact explanation. The table shows the normal heart rate depending on age. But it is worth understanding that these indicators relate exclusively to a healthy person, without pathologies and in a normal, calm state.

Reasons for change

The pulse can speed up or slow down depending on the presence of physiological and external factors and age.

With age, the normal heart rate changes. This is due to the fact that a small newborn baby has a very small heart, so it must contract more often in order to pump the required amount of blood into the body. As the body grows, the heart becomes larger, which means it can work more slowly. Therefore, in adults under 50 years of age, the frequency averages 70 beats/min. Under the influence of stress on the body, the heart also has to work faster to cover oxygen consumption. Athletes who have a pumped up strong heart have a low contraction frequency - 40 beats and this is the norm for them.

Pulse is the vibration of the walls of blood vessels associated with changes in their blood supply during the cardiac cycle. There are arterial, venous and capillary pulses. The study of the arterial pulse provides important information about the work of the heart, the state of blood circulation and the properties of the arteries. The main method of studying the pulse is palpation of the arteries. For the radial artery, the hand of the person being examined is clasped loosely in the area so that the thumb is located on the back side, and the remaining fingers are on the anterior surface of the radial bone, where the pulsating radial artery is felt under the skin. The pulse is felt simultaneously in both hands, since sometimes it is expressed differently on the right and left hands (due to vascular abnormalities, compression or blockage of the subclavian or brachial artery). In addition to the radial artery, the pulse is examined in the carotid, femoral, temporal arteries, arteries of the feet, etc. (Fig. 1). An objective characteristic of the pulse is given by its graphical registration (see). In a healthy person, the pulse wave rises relatively steeply and falls slowly (Fig. 2, 1); In some diseases, the shape of the pulse wave changes. When examining the pulse, its frequency, rhythm, filling, tension and speed are determined.

How to measure your heart rate correctly

Rice. 1. Method of measuring pulse in various arteries: 1 - temporal; 2 - shoulder; 3 - dorsal artery of the foot; 4 - radial; 5 - posterior tibial; 6 - femoral; 7 - popliteal.

In healthy adults, the pulse rate corresponds to the heart rate and is 60-80 per minute. When the heart rate increases (see) or decreases (see), the pulse rate changes accordingly, and the pulse is called frequent or rare. When body temperature increases by 1°, the pulse rate increases by 8-10 beats per minute. Sometimes the number of pulse beats is less than the heart rate (HR), the so-called pulse deficit. This is explained by the fact that during very weak or premature contractions of the heart, so little blood enters the aorta that the pulse wave does not reach the peripheral arteries. The higher the pulse deficit, the more adversely it affects blood circulation. To determine the pulse rate, count it for 30 seconds. and the result obtained is multiplied by two. If the heart rhythm is abnormal, the pulse is counted for 1 minute.

A healthy person has a rhythmic pulse, that is, pulse waves follow one another at regular intervals. In case of heart rhythm disorders (see), pulse waves usually follow at irregular intervals, the pulse becomes arrhythmic (Fig. 2, 2).

The filling of the pulse depends on the amount of blood ejected during systole into the arterial system and on the distensibility of the arterial wall. Normally, the pulse wave is well felt - a full pulse. If less blood enters the arterial system than normal, the pulse wave decreases and the pulse becomes small. In case of severe blood loss, shock, or collapse, pulse waves can be barely palpable; such a pulse is called threadlike. A decrease in pulse filling is also observed in diseases that lead to hardening of the arterial walls or narrowing of their lumen (atherosclerosis). With severe damage to the heart muscle, an alternation of large and small pulse waves is observed (Fig. 2, 3) - an intermittent pulse.

Pulse voltage is related to the height of blood pressure. With hypertension, a certain force is required to compress the artery and stop its pulsation - a hard, or tense, pulse. With low blood pressure, the artery is easily compressed, the pulse disappears with little effort and is called soft.

The pulse rate depends on the pressure fluctuations in the arterial system during systole and diastole. If the pressure in the aorta rises rapidly during systole and falls rapidly during diastole, then rapid expansion and collapse of the arterial wall will be observed. Such a pulse is called fast; at the same time it can also be large (Fig. 2, 4). Most often, a fast and large pulse is observed with aortic valve insufficiency. The slow increase in pressure in the aorta during systole and its slow decrease in diastole causes a slow expansion and slow collapse of the arterial wall - a slow pulse; at the same time it can be small. Such a pulse appears when the aortic mouth narrows due to difficulty in expelling blood from the left ventricle. Sometimes after the main pulse wave a second, smaller wave appears. This phenomenon is called pulse dicrotia (Fig. 2.5). It is associated with changes in arterial wall tension. Dicrotic pulse occurs with fever and some infectious diseases. When palpating the arteries, not only the properties of the pulse are examined, but also the condition of the vascular wall. Thus, with a significant deposition of calcium salts into the wall of the vessel, the artery is palpable in the form of a dense, convoluted, rough tube.

The pulse in children is more frequent than in adults. This is explained not only by the lesser influence of the vagus nerve, but also by a more intense metabolism.

With age, the heart rate gradually decreases. Girls at all ages have a higher heart rate than boys. Screaming, restlessness, and muscle movements cause a significant increase in heart rate in children. In addition, in childhood there is a known unevenness of pulse periods associated with breathing (respiratory arrhythmia).

Pulse (from Latin pulsus - push) is a rhythmic, jerk-like oscillation of the walls of blood vessels that occurs as a result of the release of blood from the heart into the arterial system.

Doctors of antiquity (India, Greece, the Arab East) paid great attention to the study of the pulse, giving it decisive diagnostic importance. The doctrine of the pulse received a scientific basis after the discovery of blood circulation by W. Harwey. 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 rapidly ejected into the aorta, stretching the initial part of the elastic aorta and increasing the pressure in it. This change in pressure propagates in the form of a wave along the aorta and its branches to the arterioles, where normally, due to their muscular resistance, the pulse wave stops. The pulse wave propagates at a speed of 4 to 15 m/sec, and the stretching and elongation of the arterial wall it causes constitutes the arterial pulse. There are central arterial pulses (aorta, carotid and subclavian arteries) and peripheral (femoral, radial, temporal, dorsal arteries of the foot, etc.). The difference between these two forms of pulse is revealed by its graphical registration using the sphygmography method (see). On the pulse curve - sphygmogram - there are ascending (anacrotic), descending (catacrotic) parts and a dicrotic wave (dicrotic).

Rice. 2. Graphic recording of pulse: 1 - normal; 2 - arrhythmic (a-c- various types); 3 - intermittent; 4 - large and fast (a), small and slow (b); 5 - dicrotic.

Most often, the pulse is examined in the radial artery (a. radialis), which is located superficially under the fascia and skin between the styloid process of the radius and the tendon of the internal radial muscle. In case of anomalies in the location of the artery, the presence of bandages on the arms or massive edema, a pulse examination is carried out on other arteries accessible to palpation. The pulse at the radial artery lags behind the systole of the heart by approximately 0.2 seconds. Pulse examination on the radial artery must be carried out on both arms; Only if there is no difference in the properties of the pulse can we limit ourselves to further study of it on one arm. Typically, the hand of the subject is freely grasped with the right hand in the area of the wrist joint and placed at the level of the subject’s heart. In this case, the thumb should be placed on the ulnar side, and the index, middle and ring fingers should be placed on the radial side, directly on the radial artery. Normally, you get the feeling of a soft, thin, smooth and elastic tube pulsating under your fingers.

If, when comparing the pulse on the left and right hands, a different value is detected or a delay in the pulse on one hand compared to the other, then such a pulse is called different (pulsus differens). It is observed most often with unilateral anomalies in the location of blood vessels, compression by tumors or enlarged lymph nodes. An aneurysm of the aortic arch, if it is located between the innominate and left subclavian arteries, causes a delay and decrease in the pulse wave in the left radial artery. With mitral stenosis, the enlarged left atrium can compress the left subclavian artery, which reduces the pulse wave on the left radial artery, especially in the position on the left side (Popov-Savelyev sign).

The qualitative characteristics of the pulse depend on the activity of the heart and the state of the vascular system. When examining the pulse, pay attention to the following properties.

Pulse rate. The pulse beats must be counted in at least 1/2 minute, and the resulting figure is multiplied by 2. If the pulse is incorrect, the count should be made within 1 minute; if the patient is suddenly excited at the beginning of the study, it is advisable to repeat the count. Normally, the number of pulse beats in an adult man is on average 70, in women - 80 per minute. Photoelectric pulse tachometers are currently used to automatically calculate the pulse rate, which is very important, for example, for monitoring the patient’s condition during surgery. Like body temperature, the pulse rate gives two daily rises - the first around 11 o'clock in the afternoon, the second between 6 and 8 o'clock in the evening. When the pulse rate increases to more than 90 per minute, they speak of tachycardia (see); such a frequent pulse is called pulsus frequens. When the pulse rate is less than 60 per minute, they speak of bradycardia (see), and the pulse is called pulsus rarus. In cases where individual contractions of the left ventricle are so weak that the pulse waves do not reach the periphery, the number of pulse beats becomes less than the number of heart contractions. This phenomenon is called bradysphygmia; the difference between the number of heart contractions and pulse beats per minute is called pulse deficiency, and the pulse itself is called pulsus deficiens. When body temperature rises, each degree above 37 usually corresponds to an increase in heart rate by an average of 8 beats per minute. The exception is fever during typhoid fever and peritonitis: in the first case, a relative slowdown in the pulse is often observed, in the second, its relative increase. With a drop in body temperature, the pulse rate usually decreases, but (for example, during collapse) this is accompanied by a significant increase in heart rate.

Pulse rhythm. If the pulse beats follow one after another at equal intervals of time, then they speak of a regular, rhythmic pulse (pulsus regularis), otherwise an incorrect, irregular pulse (pulsus irregularis) is observed. Healthy people often experience an increase in heart rate when inhaling and a decrease in heart rate when exhaling - respiratory arrhythmia (Fig. 1); Holding your breath eliminates this type of arrhythmia. By changes in pulse, many types of cardiac arrhythmia can be diagnosed (see); more accurately, they are all determined by electrocardiography.

Rice. 1. Respiratory arrhythmia.

Heart rate determined by the nature of the rise and fall of pressure in the artery during the passage of the pulse wave.

A fast, jumping pulse (pulsus celer) is accompanied by a sensation of a very rapid rise and an equally rapid decrease in the pulse wave, which is directly proportional at this moment to the rate of change in pressure in the radial artery (Fig. 2). As a rule, such a pulse is both large and high (pulsus magnus, s. altus) and is most pronounced in aortic insufficiency. In this case, the examiner’s finger feels not only fast, but also large rises and falls of the pulse wave. In its pure form, a large, high pulse is sometimes observed during physical stress and often during complete atrioventricular block. A sluggish, slow pulse (pulsus tardus), accompanied by a feeling of a slow rise and slow decrease of the pulse wave (Fig. 3), occurs when the aortic mouth is narrowed, when the arterial system fills slowly. Such a pulse, as a rule, is small in size (height) - pulsus parvus, which depends on the small increase in pressure in the aorta during left ventricular systole. This type of pulse is characteristic of mitral stenosis, severe weakness of the left ventricular myocardium, fainting, and collapse.

Rice. 2. Pulsus celer.

Rice. 3. Pulsus tardus.

Pulse voltage determined by the force required to completely stop the propagation of the pulse wave. When examining, the distally located index finger completely compresses the vessel to prevent the penetration of backward waves, and the most proximally located ring finger produces gradually increasing pressure until the “palpating” third finger ceases to feel the pulse. There is a tense, hard pulse (pulsus durum) and a relaxed, soft pulse (pulsus mollis). By the degree of pulse tension one can approximately judge the value of maximum blood pressure; The higher it is, the more intense the pulse.

Pulse filling consists of the magnitude (height) of the pulse and partly its voltage. The filling of the pulse depends on the amount of blood in the artery and on the total volume of circulating blood. There is a full pulse (pulsus plenus), usually large and high, and an empty pulse (pulsus vaccuus), usually small. With massive bleeding, collapse, shock, the pulse may be barely palpable, thread-like (pulsus filiformis). If the pulse waves are unequal in size and degree of filling, then they speak of an uneven pulse (pulsus inaequalis), as opposed to a uniform pulse (pulsus aequalis). An uneven pulse is almost always observed with an arrhythmic pulse in cases of atrial fibrillation and early extrasystoles. A type of uneven pulse is an alternating pulse (pulsus alternans), when a regular alternation of pulse beats of different sizes and contents is felt. Such a pulse is one of the early signs of severe heart failure; it is best detected sphygmographically with slight compression of the shoulder with a sphygmomanometer cuff. In cases of decreased peripheral vascular tone, a second, smaller, dicrotic wave can be palpated. This phenomenon is called dicrotia, and the pulse is called dicrotic (pulsus dicroticus). Such a pulse is often observed during fever (the relaxing effect of heat on the muscles of the arteries), hypotension, and sometimes during the period of recovery after severe infections. In this case, a decrease in minimum blood pressure is almost always observed.

Pulsus paradoxus - decrease in pulse waves during inspiration (Fig. 4). And in healthy people, at the height of inspiration, due to the negative pressure in the chest cavity, the blood supply to the left parts of the heart decreases and cardiac systole becomes somewhat more difficult, which leads to a decrease in the size and filling of the pulse. With narrowing of the upper respiratory tract or myocardial weakness, this phenomenon is more pronounced. With adhesive pericarditis during inspiration, the heart is greatly stretched by adhesions with the chest, spine and diaphragm, which leads to difficulty in systolic contraction, a decrease in the ejection of blood into the aorta and often to the complete disappearance of the pulse at the height of inspiration. In addition to this phenomenon, adhesive pericarditis is characterized by pronounced swelling of the jugular veins due to compression by adhesions of the superior vena cava and innominate veins.

Rice. 4. Pulsus paradoxus.

Capillary, more precisely pseudocapillary, pulse, or Quincke's pulse, is the rhythmic expansion of small arterioles (not capillaries) as a result of a rapid and significant increase in pressure in the arterial system during systole. In this case, a large pulse wave reaches the smallest arterioles, but in the capillaries themselves the blood flow remains continuous. Pseudocapillary pulse is most pronounced in aortic insufficiency. True, in some cases, capillaries and even venules are involved in pulsatory oscillations (the “true” capillary pulse), which sometimes happens in severe thyrotoxicosis, fever, or in healthy young people during thermal procedures. It is believed that in these cases, the arterial knee of the capillaries expands due to venous stagnation. The capillary pulse is best detected by lightly pressing the lip with a glass slide, when alternating redness and blanching of its mucous membrane, corresponding to the pulse, is detected.

Venous pulse reflects fluctuations in the volume of the veins as a result of systole and diastole of the right atrium and ventricle, which cause either a slowdown or acceleration of the outflow of blood from the veins into the right atrium (swelling and collapse of the veins, respectively). The study of the venous pulse is carried out on the veins of the neck, always simultaneously examining the pulse of the external carotid artery. Normally, a very subtle and almost imperceptible pulsation is observed when the bulging of the jugular vein precedes the pulse wave on the carotid artery - the right atrial, or “negative”, venous pulse. In case of tricuspid valve insufficiency, the venous pulse becomes right ventricular, “positive”, since due to a defect in the tricuspid valve there is a reverse (centrifugal) flow of blood - from the right ventricle to the right atrium and veins. Such a venous pulse is characterized by pronounced swelling of the jugular veins simultaneously with a rise in the pulse wave in the carotid artery. If you press the jugular vein in the middle, then its lower segment continues to pulsate. A similar picture can occur with severe right ventricular failure and without damage to the tricuspid valve. A more accurate picture of the venous pulse can be obtained using graphical recording methods (see Phlebogram).

Hepatic pulse determined by inspection and palpation, but its nature is revealed much more accurately by graphical recording of liver pulsation and especially by X-ray electrokymography. Normally, the hepatic pulse is determined with great difficulty and depends on the dynamic “stagnation” in the hepatic veins as a result of the activity of the right ventricle. With tricuspid valve defects, systolic pulsation may increase (with valve insufficiency) or presystolic pulsation (with orifice stenosis) of the liver may occur as a result of a “hydraulic seal” of its outflow tract.

Pulse in children. In children, the pulse is much higher than in adults, which is explained by a more intense metabolism, rapid contractility of the heart muscle and less influence of the vagus nerve. The highest pulse rate is in newborns (120-140 beats per minute), but even on the 2-3rd day of life, the pulse rate may slow down to 70-80 beats per minute. (A.F. Tour). With age, the heart rate decreases (Table 2).

In children, the pulse is most conveniently examined on the radial or temporal artery. In the smallest and most restless children, auscultation of heart sounds can be used to count the pulse. The most accurate pulse rate is determined at rest, during sleep. A child has 3.5-4 heartbeats per breath.

The pulse rate in children is subject to large fluctuations.

Increased heart rate easily occurs with anxiety, screaming, muscle exercise, or eating. The pulse rate is also influenced by ambient temperature and barometric pressure (A. L. Sakhnovsky, M. G. Kulieva, E. V. Tkachenko). When a child’s body temperature rises by 1°, the pulse increases by 15-20 beats (A.F. Tur). Girls have a pulse higher than boys, by 2-6 beats. This difference is especially pronounced during puberty.

When assessing the pulse in children, it is necessary to pay attention not only to its frequency, but also to the rhythm, degree of filling of blood vessels, and their tension. A sharp increase in heart rate (tachycardia) is observed with endo- and myocarditis, with heart defects, and infectious diseases. Paroxysmal tachycardia up to 170-300 beats per minute. may be observed in young children. A decrease in heart rate (bradycardia) is observed with increased intracranial pressure, with severe forms of malnutrition, with uremia, epidemic hepatitis, typhoid fever, and with an overdose of digitalis. Slowing of the pulse to more than 50-60 beats per minute. makes one suspect the presence of a heart block.

Children experience the same types of cardiac arrhythmias as adults. In children with an unbalanced nervous system during puberty, as well as against the background of bradycardia during the period of recovery from acute infections, sinus respiratory arrhythmia is often found: an increase in heart rate during inhalation and a slowdown during exhalation. Extrasystoles in children, most often ventricular, occur with myocardial damage, but can also be functional in nature.

A weak pulse with poor filling, often with tachycardia, indicates signs of cardiac weakness and decreased blood pressure. A tense pulse, indicating an increase in blood pressure, is most often observed in children with nephritis.