Pulse is the period of oscillation of artery walls. Arterial pulse

Pulse (beat, push) is a jerky, periodic oscillation of the vascular wall.

There are:

Central pulse: pulse of the aorta, subclavian and carotid arteries;

Peripheral pulse: pulse of the temporal arteries and arteries of the extremities;

Capillary (precapillary) pulse;

Venous pulse.

Pulse examination is of great clinical importance, as it allows one to obtain very valuable and objective information about the state of central and peripheral hemodynamics and the state of other organs and systems.

Properties of pulse

The properties of the pulse of peripheral arteries depend on:
- frequency, speed and force of contraction of the left ventricle;
- stroke volume values;
- elasticity of the vascular wall;
- patency of the vessel (internal diameter);
- the value of peripheral vascular resistance.

The quality of the pulse should be assessed strictly according to the following scheme:
- uniformity of pulse in symmetrical arteries;
- frequency of pulse waves per minute;
- rhythm;
- pulse voltage;
- filling the pulse;
- pulse value;
- pulse shape;
- condition of the vascular wall (vessel elasticity).

You need to know these 8 properties of the pulse perfectly.

Same pulse

In a healthy person, the pulse in the radial arteries is the same on both sides. The difference is possible only with an atypical location of the radial artery, in which case the vessel can be found in an atypical location - lateral or medial. If this fails, then pathology is assumed.

The pathological reasons for the absence of a pulse on one side or different pulse values ​​in symmetrical vessels are as follows:

• anomaly of vascular development,
• inflammatory or atherosclerotic lesion of the vessel,
• compression of a vessel by a scar,
• tumor,
• lymph node

Having discovered a difference in the properties of the pulse, it is necessary to establish the level of damage to the vessel by examining the radial artery at an accessible level, then the ulnar, brachial, and subclavian arteries.

After making sure that the pulse is the same on both hands, further research is carried out on one of them.

Pulse rate

The pulse rate depends on the heart rate. It is better to calculate the pulse rate with the patient sitting after 5 minutes of rest in order to exclude the influence of physical and emotional stress (meeting with a doctor, walking).

The pulse is calculated in 30 seconds, but better in 1 minute.

In a healthy person at the age of 18-60 years, the pulse rate fluctuates between 60-80 beats per minute; in women, the pulse is 6-8 beats per minute more often than in men of the same age.

For asthenics pulse is slightly faster than in hypersthenics of the same age.

In old age In some patients the pulse rate increases, in others it becomes slower.

In tall people the pulse is more frequent than that of short people of the same sex and age.

In well-trained people experience a decrease in heart rate of less than 60 beats per minute.

Every person The pulse rate changes depending on the position of the body - when in a horizontal position, the pulse slows down, when moving from a horizontal to a sitting position it increases by 4-6 beats, when standing up it increases by 6-8 beats per minute. The newly adopted horizontal position slows the pulse again.

All fluctuations in heart rate depend from the predominance of the sympathetic or parasympathetic division of the autonomic nervous system.

• During sleep, the heart rate slows down especially.
• Emotional, physical stress, food intake, abuse of tea, coffee, and tonic drinks lead to an increase in the tone of the sympathetic nervous system and an increase in heart rate.
• The breathing phase also affects the pulse rate: on inhalation the frequency increases, on exhalation it decreases, which reflects the state of the autonomic nervous system - on inhalation the vagal tone decreases, on exhalation it increases.

A pulse of more than 80 beats per minute is called rapid - tachyphygmia, as a reflection of tachycardia, pulse less than 60 - rare, Bradysphygmia, as a reflection of bradycardia.

In practice, the terms tachyphygmia and bradysphygmia have not taken root; doctors use the terms tachycardia and bradycardia.

Frequent pulse

A rapid pulse, not provoked by physical, emotional, nutritional and medicinal stress (atropine, adrenaline, mesaton, etc.) most often reflects trouble in the body.

Tachycardia can be of extracardiac and cardiac origin.

Almost all cases of fever are accompanied by an increase in heart rate; an increase in body temperature by 1 degree leads to an increase in heart rate by 8-10 beats per minute.

Increased heart rate occurs with pain, with most infectious and inflammatory diseases, with anemia, surgical diseases and surgical interventions, with thyrotoxicosis.

Tachycardia in the form of attacks is called paroxysmal tachycardia, the pulse rate reaches 140-200 beats per minute.

Rare pulse

A rare pulse is observed with a significant increase in vagal tone for extracardiac reasons - intracranial injury, some diseases of the gastrointestinal tract, liver, decreased thyroid function (myxedema), cachexia, fasting, meningitis, shock, rapid rise in blood pressure, taking digitalis drugs, beta - adrenergic blockers, etc.

For cardiac reasons, a rare pulse (bradycardia) is observed with weakness of the sinus node, blockade of the conduction system, and narrowing of the aortic mouth.

The pulse rate, especially in cases of deceleration and arrhythmia, must be compared with the number of heartbeats counted in 1 minute during cardiac auscultation.

The difference between the number of heartbeats and pulse is called pulse deficit.

Pulse rhythm

In a healthy person, pulse waves follow at regular intervals, at regular intervals. Such a pulse is called rhythmic, regular, and the heart rate can be different - normal, rapid, slow.

A pulse with uneven intervals is called arrhythmic, irregular. In healthy adolescents and young adults with labile autonomic regulation of blood circulation, respiratory sinus arrhythmia is observed. At the beginning of exhalation, due to an increase in the tone of the vagus nerve, a temporary slowdown in the rate of heart contractions and a slowdown in pulse rate occur. During inhalation, a weakening of the influence of the vagus is observed and the heart rate increases slightly and the pulse quickens. When you hold your breath, this respiratory arrhythmia disappears.

An arrhythmic pulse is most often caused by heart disease. It is most clearly detected in cardiac arrhythmias such as extrasystole and atrial fibrillation.

Extrasystole is a premature contraction of the heart. After a normal pulse wave, a premature small pulse wave passes under the fingers, sometimes it is so small that it is not even perceived. It is followed by a long pause, after which there will be a large pulse wave due to the large stroke volume. Then again there is an alternation of normal pulse waves.

Extrasystoles can be repeated after 1 normal beat (bigeminy), after 2 trigeminies), etc.

Another common variant of an arrhythmic pulse is atrial fibrillation. It appears when the heart contracts chaotically (“delirium of the heart”).

Pulse waves on the vessels have an irregular, chaotic alternation; they also differ in size due to different stroke volumes.

The frequency of pulse waves can range from 50 to 160 per minute. If atrial fibrillation begins suddenly, then we speak of its paroxysm.

The pulse is called arrhythmic when it suddenly increases in a person at rest, to a frequency of 140-180 beats per minute, that is, with paroxysmal tachycardia. Such an attack can stop just as suddenly. The arrhythmic pulse includes the so-called alternating or intermittent pulse, in which there is a regular alternation of large and small pulse waves. This is typical for severe myocardial diseases, a combination of hypertension and tachycardia.

An irregular pulse is also observed with other rhythm disturbances: parasystole, sick sinus syndrome, sinus node failure, atrioventricular dissociation.

Pulse voltage

This property reflects intravascular pressure and the condition of the vascular wall, its tone and density.

There are no objective criteria for assessing pulse tension; the technique is tested empirically in the study of healthy and sick people.

The degree of pulse tension is determined by the resistance of the vessel to finger pressure.

When determining the tension, the third, proximal finger (the one closest to the heart) gradually presses on the artery until the distal fingers no longer feel pulsation.

In a healthy person with normal pulse tension, moderate force is required to compress the vessel. The pulse of a healthy person is assessed as a pulse of satisfactory tension.

If significant strengthening is required and the vascular wall provides significant resistance to compression, then we speak of a tense, hard pulse, which is typical for hypertension of any origin, severe sclerosis or vascular spasm.

A decrease in vascular tension and slight compressibility of the pulse indicate a soft pulse, which is observed with a decrease in blood pressure and a decrease in vascular tone.

Pulse filling

It is assessed by the magnitude of the fluctuation of the vascular wall in systole and diastole, that is, by the difference in the maximum and minimum volumes of the artery. Filling mainly depends on the magnitude of the stroke volume and the total mass of blood and its distribution.

The degree of filling of the pulse can be judged using the following technique.

The proximally located finger compresses the vessel completely, the distally located fingers palpate the empty vessel, determining the condition of the vascular wall. Then the pressure of the proximal finger stops, and the distal fingers feel the amount of filling of the artery. Fluctuations in the filling of the vessel from zero to maximum reflect the filling of the vessel.

Another method for assessing pulse filling is based on determining the magnitude of the vascular wall fluctuation from the level of diastolic filling to the systolic level. All fingers placed on the vessel do not exert pressure on it, but only lightly touch the surface of the vessel during diastole. In systole, at the moment of passage of the pulse wave, the fingers easily perceive the magnitude of the vibration of the vascular wall, that is, the filling of the vessel.

In a person with normal hemodynamics, pulse filling is assessed as satisfactory. During emotional and physical stress, as well as for some time (3-5 minutes) after exercise, due to an increase in stroke volume, the pulse will be full.

A full pulse is observed in patients with a hyperkinetic type of circulation (HCD, hypertension), as well as in aortic insufficiency. Patients with severe hemodynamic disorders (collapse, shock, blood loss, myocardial insufficiency) have a poorly filled pulse - an empty pulse.

Pulse value

The magnitude of the pulse is a reflection of the relationship between such properties of the pulse as filling and tension. It depends on the magnitude of the stroke volume, the tone of the vascular wall, its ability to elastically stretch in systole and collapse in diastole, on the magnitude of the fluctuation in blood pressure in systole and diastole.

In a healthy person, with satisfactory filling and tension of the pulse, the pulse value can be described as satisfactory. However, in practice, the pulse value is spoken about only when there are deviations in the form:

Large pulse (high pulse);

Small pulse (its extreme form is thread-like).

Big pulse occurs with increased stroke volume and decreased vascular tone. The fluctuation of the vascular wall under these conditions is significant, which is why a high pulse is also called high.

In healthy people, such a pulse can be felt after physical activity, a bath, or a sauna.

In pathology, patients with valve insufficiency, aortic insufficiency, thyrotoxicosis, and fever have a high pulse. In arterial hypertension with a large difference between systolic and diastolic pressure (large pulse pressure), the pulse will also be large.

Low stroke volume the left ventricle gives rise to a small amplitude of vibration of the vascular wall in systole and diastole. An increase in vascular tone also leads to a decrease in the oscillation of the vascular wall during the cardiac cycle. All this fits into the concept of a small pulse, which patients with heart defects such as narrowing of the aortic mouth and mitral valve stenosis have. A low pulse is characteristic of acute cardiovascular failure.

In case of shock, acute cardiac and vascular failure, massive blood loss, the pulse value is so small that it is called the threadlike pulse.

Pulse shape

The shape of the pulse depends on the rate of change in pressure in the arterial system during systole and diastole, which is reflected in the rate of rise and fall of the pulse wave.

The shape of the pulse also depends on the speed and duration of contraction of the left ventricle, the condition of the vascular wall and its tone.

In a person with normal functioning of the cardiovascular system, when assessing the pulse, the shape of the pulse is usually not mentioned, although it could be called “normal”.

As options for the pulse shape, fast and slow pulses are distinguished.

In healthy people, only a rapid pulse can be detected after physical and emotional stress. Fast and slow pulses are found in pathology.

Fast (short, jumping) pulse

A fast (short, jumping) pulse is characterized by a steep rise, a short plateau and a sharp decline in the pulse wave. This wave is usually high. A fast pulse is always detected with aortic valve insufficiency, in which there is an increased stroke volume, greater strength and speed of contraction of the left ventricle in a short time, and a large difference between systolic and diastolic pressure (diastolic pressure can drop to zero).

A rapid pulse occurs with reduced peripheral resistance (fever), with thyrotoxicosis, some forms of hypertension, nervous excitability, and anemia.

Slow heart rate

Slow pulse - the opposite of fast, is characterized by a slow rise and fall of a low pulse wave, which is due to the slow rise and fall of blood pressure during the cardiac cycle. This pulse is due to a reduced rate of contraction and relaxation of the left ventricle and an increase in the duration of systole.

A slow pulse is observed when it is difficult to expel blood from the left ventricle due to an obstruction in the path of blood outflow into the aorta, which is typical for aortic stenosis and high diastolic hypertension. A slow pulse will also be small due to the limitation of the amount of oscillation of the vascular wall.

Dicrotic pulse

Dicrotic pulse is one of the features of the pulse shape, when on the falling part of the pulse wave a short-term slight rise is felt, that is, a second wave, but of lesser height and strength.

An additional wave occurs when the tone of the peripheral arteries weakens (fever, infectious diseases); it expresses a reverse wave of blood reflected by the closed aortic valves. This wave is greater, the lower the tone of the arterial wall.

Dicrotic pulse reflects a decrease in peripheral vascular tone with preserved myocardial contractility.

Condition of the vascular wall

The vascular wall is examined after complete clamping of the artery with a proximally located finger, that is, an empty vessel is examined. Distally located fingers feel the wall by rolling over the vessel.

A normal vascular wall is either not palpable or is defined as a tender, soft flattened cord about 2-3 mm in diameter.

In old age, the vascular wall becomes sclerotized, becomes dense, palpable in the form of a cord, sometimes the vessel is tortuous, lumpy in the form of a rosary. A dense, poorly pulsating or non-pulsating artery occurs with Takayasu's disease (pulseless disease), which is caused by inflammation of the vascular wall, as well as with vessel thrombosis.

Pulse deficiency

Pulse deficiency is a discrepancy between the number of heart contractions and the number of pulse waves.

This means that some of the pulse waves do not reach the periphery due to a sharply reduced stroke volume of individual heart contractions.

This happens with early extrasystoles and with atrial fibrillation.

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

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

Venous pulse

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

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

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

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

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

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

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

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

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

Pathological changes in the venous pulse

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

Arterial pulse

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

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

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

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

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

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

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

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

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

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

Arterial pulse examination

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

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

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

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

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

Pathological changes in arterial pulse

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

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

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

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

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

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

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

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

Pulse is the vibration of 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 palpated 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 counting of pulse beats should be carried out 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 beats. 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 with 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 a decrease in peripheral vascular tone, a second, smaller, dicrotic wave can be palpated. This phenomenon is called dicrotia, and the pulse is called dicrotic (pulsus dicroticus). This 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, 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.

The very first actions in providing emergency assistance involve an objective assessment of the situation and the patient’s condition, so the person acting as a rescuer primarily grabs the radial artery (temporal, femoral or carotid) to find out about the presence of cardiac activity and measure the pulse.

The pulse rate is not a fixed value; it varies within certain limits depending on our condition at that time. Intense physical activity, excitement, joy make the heart beat faster, and then the pulse goes beyond normal limits. True, this state does not last long; a healthy body needs 5-6 minutes to recover.

Within normal limits

The normal heart rate for an adult is 60-80 beats per minute, that which is greater is called , less is called . If pathological conditions become the cause of such fluctuations, then both tachycardia and bradycardia are regarded as a symptom of the disease. However, there are other cases. Probably, each of us has ever encountered a situation when the heart is ready to jump out from an excess of feelings and this is considered normal.

As for the rare pulse, it is mainly an indicator of pathological changes in the heart.

The normal human pulse changes in various physiological states:

1. It slows down in sleep, and generally in a supine position, but does not reach real bradycardia;
2. Changes during the day (at night the heart beats less frequently, after lunch the rhythm accelerates), as well as after eating, alcoholic drinks, strong tea or coffee, some medications (heart rate increases in 1 minute);
3. Increases during intense physical activity (hard work, sports training);
4. Increases from fear, joy, anxiety and other emotional experiences. caused by emotions or intense work, almost always passes quickly and independently, as soon as the person calms down or stops vigorous activity;
5. The heart rate increases with increasing body and environmental temperature;
6. It decreases over the years, but then, in old age, it increases slightly again. In women with the onset of menopause, in conditions of reduced estrogen influence, more significant upward changes in pulse may be observed (tachycardia caused by hormonal disorders);
7. Depends on gender (the pulse rate in women is slightly higher);
8. It differs in especially trained people (slow pulse).

Basically, it is generally accepted that in any case the pulse of a healthy person is in the range from 60 to 80 beats per minute, and a short-term increase to 90-100 beats/min, and sometimes up to 170-200 beats/min is regarded as a physiological norm, if it arose due to an emotional outburst or intense work activity, respectively.

Men, women, athletes

Heart rate (heart rate) is influenced by indicators such as gender and age, physical fitness, a person’s occupation, the environment in which he lives, and much more. In general, differences in heart rate can be explained as follows:

• Men and women react to different events to varying degrees(the majority of men are more cold-blooded, women are mostly emotional and sensitive), so the heart rate of the weaker sex is higher. Meanwhile, the pulse rate in women differs very little from that in men, although if we take into account the difference of 6-8 beats/min, then males lag behind, their pulse is lower.

• Out of competition are pregnant women, in which a slightly elevated pulse is considered normal and this is understandable, because while carrying a child, the mother’s body must fully meet the need for oxygen and nutrients for itself and the growing fetus. The respiratory organs, circulatory system, and heart muscle undergo certain changes to perform this task, so the heart rate increases moderately. A slightly elevated heart rate in a pregnant woman is considered normal if, besides pregnancy, there is no other reason for its increase.
• A relatively rare pulse (somewhere near the lower limit) is observed in people who do not forget about daily exercise and jogging, who prefer active recreation (swimming pool, volleyball, tennis, etc.), in general, leading a very healthy lifestyle and watching their figure. They say about such people: “They are in good sports shape,” even if by the nature of their activity these people are far from professional sports. A pulse of 55 beats per minute at rest is considered normal for this category of adults; their heart simply works economically, but in an untrained person this frequency is regarded as bradycardia and serves as a reason for additional examination by a cardiologist.
• The heart works even more economically skiers, cyclists, runners, rowers and adherents of other sports that require special endurance, their resting heart rate can be 45-50 beats per minute. However, prolonged intense stress on the heart muscle leads to its thickening, expansion of the boundaries of the heart, and an increase in its mass, because the heart is constantly trying to adapt, but its capabilities, unfortunately, are not limitless. A heart rate of less than 40 beats is regarded as a pathological condition; ultimately, the so-called “athletic heart” develops, which often becomes the cause of death in young healthy people.

The heart rate depends somewhat on height and constitution: in tall people, the heart under normal conditions works slower than in short relatives.

Pulse and age

Previously, the fetal heart rate was found out only at 5-6 months of pregnancy (listened to with a stethoscope), now the fetal pulse can be determined using the ultrasound method (vaginal sensor) in an embryo measuring 2 mm (normal - 75 beats / min) and as it grows (5 mm – 100 beats/min, 15 mm – 130 beats/min). During pregnancy monitoring, heart rate usually begins to be assessed from 4-5 weeks of pregnancy. The obtained data is compared with tabular norms Fetal heart rate by week:

Gestation period (weeks)	Normal heart rate (beats per minute)
4-5	80-103
6	100-130
7	130-150
8	150-170
9-10	170-190
11-40	140-160

By the fetal heart rate you can determine its condition: if the baby’s pulse changes towards an increase, it can be assumed that there is a lack of oxygen, but as the pulse increases, it begins to decrease, and its values ​​​​less than 120 beats per minute already indicate acute oxygen starvation, which threatens with undesirable consequences, including death.

Heart rate norms in children, especially newborns and preschool children, differ markedly from the values ​​typical for adolescence and youth. We, adults, ourselves noticed that the little heart beats more often and not so loudly. To clearly know whether this indicator is within normal values, there is table of heart rate norms by age which everyone can use:

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

Thus, according to the table, it can be seen that the normal heart rate in children after a year tends to gradually decrease, a pulse of 100 is not a sign of pathology until almost 12 years of age, and a pulse of 90 until the age of 15. Later (after 16 years), such indicators may indicate the development of tachycardia, the cause of which must be found by a cardiologist.

The normal pulse of a healthy person in the range of 60-80 beats per minute begins to be recorded from approximately 16 years of age. After 50 years, if everything is in order with health, there is a slight increase in heart rate (10 beats per minute over 30 years of life).

Pulse rate helps in diagnosis

Diagnosis by pulse, along with temperature measurement, history taking, and examination, belongs to the initial stages of the diagnostic search. It would be naive to believe that by counting the number of heartbeats, one can immediately detect the disease, but it is quite possible to suspect something is wrong and send the person for examination.

Low or high pulse (below or above acceptable values) often accompanies various pathological processes.

High heart rate

Knowledge of the norms and the ability to use the table will help any person distinguish increased pulse fluctuations caused by functional factors from tachycardia caused by disease. “Strange” tachycardia may be indicated symptoms unusual for a healthy body:

1. Dizziness, lightheadedness (indicates that cerebral blood flow is impaired);
2. Chest pain caused by impaired coronary circulation;
3. Visual disorders;
4. Autonomic symptoms (sweating, weakness, trembling of limbs).

Causes of rapid pulse and heartbeat can be:

• Pathological changes in the heart and vascular pathology (congenital, etc.);
• Poisoning;
• Chronic bronchopulmonary diseases;
• Hypoxia;
• Hormonal disorders;
• Lesions of the central nervous system;
• Oncological diseases;
• Inflammatory processes, infections (especially with fever).

In most cases, an equal sign is placed between the concepts of increased pulse and rapid heartbeat, however, this is not always the case, that is, they do not necessarily accompany each other. In some conditions (and,) the number of heart contractions exceeds the frequency of pulse oscillations, this phenomenon is called pulse deficiency. As a rule, pulse deficiency accompanies terminal rhythm disturbances in severe heart damage, the cause of which could be intoxication, sympathomimetics, acid-base imbalance, electric shock, and other pathology involving the heart in the process.

High pulse and blood pressure fluctuations

Pulse and blood pressure do not always decrease or increase proportionally. It would be wrong to think that an increase in heart rate will necessarily lead to an increase in blood pressure and vice versa. There are also options here:

1. Increased heart rate with normal blood pressure may be a sign of intoxication, increased body temperature. Folk remedies and medications that regulate the activity of the autonomic nervous system during VSD, antipyretic drugs for fever and medications aimed at reducing the symptoms of intoxication will help reduce the pulse; in general, influencing the cause will remove tachycardia.
2. Increased heart rate with high blood pressure may be a consequence of various physiological and pathological conditions (inadequate physical activity, severe stress, endocrine disorders, heart and vascular diseases). Tactics of the doctor and the patient: examination, finding out the cause, treating the underlying disease.
3. Low blood pressure and high pulse may become symptoms of a very serious health disorder, for example, a manifestation of development in cardiac pathology or in case of large blood loss, and, the lower the blood pressure and higher the heart rate, the more severe the patient’s condition. It is clear: not only the patient, but also his relatives will not be able to reduce the pulse, the increase of which is caused by these circumstances. This situation requires immediate action (call “103”).

A high pulse that first appears for no reason can be calmed down drops of hawthorn, motherwort, valerian, peony, corvalol (whatever is on hand). A recurrence of an attack should be a reason to visit a doctor, who will find out the cause and prescribe medications that specifically affect this form of tachycardia.

Low heart rate

The causes of low heart rate can also be functional (about athletes, as discussed above, when a low heart rate with normal blood pressure is not a sign of disease), or stem from various pathological processes:

• Vagal influences (vagus - vagus nerve), decreased tone of the sympathetic nervous system. This phenomenon can be observed in every healthy person, for example, during sleep (low pulse with normal pressure),
• In case of vegetative-vascular dystonia, in the case of some endocrine disorders, that is, in a variety of physiological and pathological conditions;
• Oxygen starvation and its local effect on the sinus node;
• Myocardial infarction;

• Toxic infections, poisoning with organophosphorus substances;
• Peptic ulcer of the stomach and duodenum;
• Traumatic brain injuries, meningitis, edema, brain tumor, ;
• Taking digitalis medications;
• Side effect or overdose of antiarrhythmic, antihypertensive and other drugs;
• Hypofunction of the thyroid gland (myxedema);
• Hepatitis, typhoid fever, sepsis.

In the vast majority of cases low pulse (bradycardia) is considered a serious pathology, which requires immediate examination to identify the cause, timely treatment, and sometimes emergency medical care (sick sinus syndrome, atrioventricular block, myocardial infarction, etc.).

Low pulse and high blood pressure - similar symptoms sometimes appear in hypertensive patients taking drugs to lower blood pressure, which are simultaneously prescribed for various rhythm disorders, beta blockers, for example.

Briefly about heart rate measurement

Perhaps, only at first glance it seems that nothing is simpler than measuring the pulse of yourself or another person. Most likely, this is true if such a procedure is required to be performed on a young, healthy, calm, rested person. You can assume in advance that his pulse will be clear, rhythmic, of good filling and tension. Being confident that most people know the theory well and cope well with the task in practice, the author will allow himself to only briefly recall the technique of measuring pulse.

You can measure the pulse not only on the radial artery; any large artery (temporal, carotid, ulnar, brachial, axillary, popliteal, femoral) is suitable for such a study. By the way, sometimes you can simultaneously detect a venous pulse and very rarely a precapillary pulse (to determine these types of pulses, you need special devices and knowledge of measurement techniques). When determining, we should not forget that in an upright position of the body the heart rate will be higher than in a lying position and that intense physical activity will speed up the heart rate.

To measure pulse:

• Usually the radial artery is used, on which 4 fingers are placed (the thumb should be on the back of the limb).
• You should not try to catch pulse fluctuations with only one finger - an error is certainly guaranteed; at least two fingers should be used in the experiment.
• It is not recommended to put undue pressure on the arterial vessel, since squeezing it will lead to the disappearance of the pulse and the measurement will have to be started again.
• It is necessary to measure the pulse correctly within one minute, measuring for 15 seconds and multiplying the result by 4 can lead to an error, because even during this time the pulse frequency can change.

Here is a simple technique for measuring pulse, which can tell you a lot, a lot.

Video: pulse in the program “Live Healthy!”

The normal heart rate of an adult can differ significantly from that of a newborn. For clarity, the article below presents a table by age, but first we will define what a pulse is and how it can be measured.

Pulse - what is it?

The human heart beats rhythmically and pushes blood into the vascular system; as a result of these shocks, the walls of the arteries begin to vibrate.

Such oscillations of the walls of the arteries are usually called pulse.

In addition to arterial ones, in medicine there are also pulse oscillations of the walls of venous and capillary vessels, but the main information about heart contractions is carried by arterial (not venous or capillary) oscillations, therefore, further, when speaking about the pulse, we mean them.

Pulse characteristics

The following pulse characteristics exist:

• frequency - the number of oscillations of the artery wall per minute
• rhythmicity - the nature of the intervals between shocks. Rhythmic - if the intervals are the same and arrhythmic if the intervals are different
• filling - blood volume at the peak of the pulse wave. There are thread-like, empty, full, moderate filling
• tension - characterizes the force that must be applied to the artery until the pulsation completely stops. There are soft, hard and moderate-tension pulses

How are pulse fluctuations measured?

In modern medicine, studies of the manifestations of heart function can be divided into two large groups:

• hardware - using a heart rate monitor, electrocardiograph and other devices
• manual - with all the variety of research methods, palpation is the simplest and fastest method, which also does not require special long-term preparation before the procedure

How to measure the pulse on your hand yourself

You can measure the pulse fluctuations of the arteries yourself.

Where can I measure?

You can measure in the following places:

• on the elbow on the brachial artery
• in the neck on the carotid artery
• in the groin area on the femoral artery
• on the wrist on the radial artery

The most common measurement method is the radial artery at the wrist.

To find the pulse, you can use any fingers except the thumb. The thumb itself has a pulsation, and this can affect the accuracy of the measurement.

Usually the index and middle fingers are used: they are placed under the bend of the wrist in the area of ​​the thumb, moving until pulse fluctuations are detected. You can try to find them on both hands, but keep in mind that the strength of the pulsation may not be the same on the left and right hands.

Features of measurements

During training, your heart rate is usually counted for 15 seconds and multiplied by four. At rest, measure for 30 seconds and multiply by two. If there is a suspicion of arrhythmia, it is better to increase the measurement time to 60 seconds.

When measuring, it should be borne in mind that the frequency of oscillations of the walls of blood vessels may depend not only on physical activity. For example, stress, hormonal release, increased body temperature, even food intake and time of day can affect frequency.

It is better to take daily measurements at the same time. For example, in the first half of the day, an hour after breakfast.

Heart rate norm for women

Due to the physiological differences of the female body, which is subject to significant hormonal fluctuations throughout life that affect the cardiovascular system, the normal heart rate for women differs from the norm for men of the same age. The pulse rate in women at rest is usually 5-10 beats per minute higher.

An increase in heart rate is observed during pregnancy, menstruation, and the onset of menopause. This increase is called physiological tachycardia.

Normal heart rate for athletes

People who exercise regularly have a lower heart rate.

The resting pulse of athletes can be less than forty beats per minute versus sixty to eighty for an untrained person. This heart rate is necessary for the heart to work during extreme loads: if the natural rate does not exceed forty beats per minute, in moments of stress the heart will not have to accelerate more than 150-180 beats.

Over a year or two of active training, an athlete’s heart rate decreases by 5-10 beats per minute. The first noticeable decrease in heart rate can be felt after three months of regular exercise, during which time the rate decreases by 3-4 beats.

Heart Rate for Fat Burning

The human body reacts differently to different intensities of stress. Fat burning occurs at loads of 65-85% of the maximum.

Table of load zones and actions on the human body

There are several ways to calculate the required load for burning fat, which give similar results. The simplest one, taking into account only age:

220 minus your age - we get the maximum heart rate (beats per minute).

For example, if you are 45 years old, your maximum heart rate will be 220-45=175

Determining the boundaries of the heart rate zone that is optimal for burning fat:

• 175*0.65=114 — lower limit
• 175*0.85=149 — upper limit