PULSE

PULSE - jerky periodic fluctuations of walls of blood vessels (arteries, veins) caused by heart contractions. Arterial pulse is formed by pressure fluctuations and blood supply in the arteries during the cardiac cycle: systole phase pressure and blood flow in the arteries increased, stretching the walls of the arteries in the diastolic phase - falling. Arterial pulse determined by palpation of the great arteries, often radial. The radial artery in the bottom quarter of the forearm just before its articulation with the wrist joint is superficial and can be easily pressed against the radial bone. The muscles of the hands examiner should not be strained. On artery put two or three fingers and squeeze it with different strengths to the full blood flow cessation; then the pressure on the artery is gradually reduced, assessing the basic properties of the pulse frequency, rhythm, stress (on the resistance of the vessel compressed), the height and filling, as well as features of the pulse wave, which is best revealed when graphic registration of heart rate (sphygmography). According to these changes the properties of the pulse is often possible to assume presence at the patient of certain diseases, such as atherosclerosis, heart disease, Takayasu's disease, certain pathological conditions, especially hypertension or hypotension (in the collapse, syncope, shock), and cardiac arrhythmias.

The frequency of the pulse at the correct timing is determined by counting the number of pulse beats for 30 seconds and multiplying the result by 2; when arrhythmia number of pulse beats are counted for a full minute. Normal heart rate at rest in the adult is 60 - 80 beats per minute; for longer stays in the standing position, and when it is agitated up to 100 beats per minute. In children, the pulse more often: in newborns and it normally hit about 140 beats per minute; by the end of the first year of life, the heart rate is reduced to 110 - 130 beats per minute to 6 years - to about 100 beats per minute, and to 16-18 years in heart rate closer to normal for an adult. Increased heart rate corresponds tachycardias, slowing heart rate - bradycardia.

The rhythm of the pulse is evaluated by the intervals between heart beats. Normally, differences between the intervals not to exceed 0.15, they are almost not trapped in healthy adults and is defined as a rhythmic heartbeat. However, in healthy individuals, especially during childhood and adolescence, during inspiration pulse quickens somewhat and during exhalation slows (physiological, or breathing, arrhythmia associated with irritation when breathing out endings of the vagus nerve). Of irregular heartbeat is detected at various arrhythmias.

The voltage pulse is determined as follows. Pads mounted on the artery of two or three fingers and hands positioned finger proximally progressively to compress the artery until the distally located pins (or a finger) will not cease to receive the pulse beats. pulse voltage is determined by the force that must be applied to stop the flow through the arteries of the pulse wave. With high blood pressure pulse becomes hard (tight), low - soft.

The height, or the value of pulse amplitude is characterized by oscillations of the arterial wall. It is directly proportional to the pulse pressure and inversely proportional to the tonic stress the artery wall. High or high, the pulse is determined in aortic insufficiency, hyperthyroidism, fever, and in healthy individuals - during physical exertion. Low or small, heart rate observed in the aortic and mitral stenosis, tachycardia, decreased pulse pressure. It is a small, thread-like or, the pulse is observed in massive blood loss, collapse, shock. Sometimes, particularly when arrhythmia or severe lesions of the heart or heart failure, the pulse strikes the larger and smaller quantities alternate.

Filling of the pulse is determined by the volume of arterial pulse oscillations, which depend on the stroke volume. In normal conditions and in an increase in stroke volume pulse full. With a sharp decrease in cardiac output, especially as a result of blood loss, filling the pulse falls until the complete disappearance of the sensation changes artery volume. This pulse is called empty.

Of the features of the pulse wave palpation can determine how quickly the rise and fall of the wall of an artery, whether a smooth transition from lift to descend if additional arterial wall vibrations are felt at this transition and on the descent of the wave. If the pulse wave increases rapidly and almost as fast falls, pulse called an ambulance, or quick, short. Usually, rapid pulse at the same time there is high; this pulse is typical for aortic valve insufficiency. Slowly and slowly sloping increasing pulse wave is referred to as a slow heartbeat; it is observed for example in patients with severe aortic stenosis. Upon check the pulse of a healthy person on the slope of the pulse wave is determined by an additional small rise (dicrotism), which is not felt by palpation. With a sharp decrease in the tone of arterial walls, for example in febrile patients, palpation may be observed two peaks of pulse wave - dicrotism pulse.

To investigate the properties of the pulse must be on different arteries, comparing them to the arteries symmetrical sections. To do this, either sequentially or simultaneously (with two hands) determine the pulse on the right and left radial artery, then to the elbow, shoulder, carotid, femoral, popliteal, posterior tibial arteries and the arteries of the rear foot. In diseases that lead to a narrowing of the lumen of the large arteries (compression of the artery tumor or hematoma, blockage or narrowing of the lumen of the atherosclerotic plaque, thrombus, etc..), Height and filling pulse on the affected side are reduced, and the complete closure of the artery lumen probe pulse is not possible.