During the contraction of the heart, another portion of blood is pushed into the vascular system. Its blow to the wall of the artery creates vibrations, which, propagating through the vessels, gradually fade to the periphery. They got the name of the pulse.
What is the pulse like?
There are three types of vessels in the human body: arteries, veins and capillaries. The ejection of blood from the heart affects each of them in one way or another, causing their walls to oscillate. Of course, arteries, as the vessels closest to the heart, are more affected by cardiac output. The fluctuations of their walls are well defined by palpation, and in large vessels they are even visible to the naked eye. That is why the arterial pulse is the most significant for diagnosis.
Capillaries are the smallest vessels in the human body, but even they reflect the work of the heart. Their walls fluctuate in time with heartbeats, but normally this can only be determined with the help of special devices. A capillary pulse visible to the naked eye is a sign of pathology.
The veins are so far from the heart that their walls do not oscillate. The so-called venous pulse is a transmission oscillation with closelocated large arteries.
Why take a pulse?
What is the significance of fluctuations in the vascular walls for diagnosis? Why is this so important?
The pulse allows you to judge hemodynamics, how effectively the heart muscle contracts, about the fullness of the vascular bed, about the rhythm of heart beats.
In many pathological processes, the pulse changes, the characteristic of the pulse ceases to correspond to the norm. This allows you to suspect that not everything is in order in the cardiovascular system.
What parameters determine the pulse? Pulse characteristic
- Rhythm. Normally, the heart contracts at regular intervals, which means that the pulse should be rhythmic.
- Frequency. Normally, there are as many pulse waves as there are heart beats per minute.
- Voltage. This indicator depends on the value of systolic blood pressure. The higher it is, the more difficult it is to squeeze the artery with your fingers, i.e. pulse tension is high.
- Filling. Depends on the volume of blood ejected by the heart in systole.
- Value. This concept combines content and tension.
- Shape is another parameter that determines the pulse. The characteristic of the pulse in this case depends on the change in blood pressure in the vessels during systole (contraction) and diastole (relaxation) of the heart.
Rhythm disturbances
When the generation or conduction of an impulse through the heart muscle is disturbed, the rhythm of the heart contractions changes, and the pulse changes with it. Separatefluctuations in the vascular walls begin to fall out, or appear prematurely, or follow each other at irregular intervals.
What are rhythm disturbances?
Arrhythmias when the work of the sinus node changes (a section of the myocardium that generates impulses that lead to contraction of the heart muscle):
- Sinus tachycardia - increased heart rate.
- Sinus bradycardia - decreased heart rate.
- Sinus arrhythmia - heartbeats at irregular intervals.
Ectopic arrhythmias. Their occurrence becomes possible when a focus appears in the myocardium with an activity higher than that of the sinus node. In such a situation, the new pacemaker will suppress the activity of the latter and impose its rhythm of contractions on the heart.
- Extrasystole – the appearance of an extraordinary heartbeat. Depending on the location of the ectopic focus of excitation, extrasystoles are atrial, atrioventricular and ventricular.
- Paroxysmal tachycardia - a sudden increase in heart rate (up to 180-240 heart beats per minute). Like extrasystoles, it can be atrial, atrioventricular and ventricular.
Violation of impulse conduction in the myocardium (blockade). Depending on the localization of the problem that prevents the normal progression of the nerve impulse from the sinus node, the blocks are divided into groups:
- Sinoauricular blockade (impulse does not go beyond the sinus node).
- Intra-atrial blockade.
- Atrioventricular blockade (the impulse does not pass from the atria to the ventricles). With complete atrioventricular block (III degree), a situation becomes possible when there are two pacemakers (sinus node and excitation focus in the ventricles of the heart).
- Intraventricular block.
Separately, one should dwell on the flicker and flutter of the atria and ventricles. These states are also called absolute arrhythmia. The sinus node in this case ceases to be a pacemaker, and multiple ectopic foci of excitation are formed in the myocardium of the atria or ventricles, setting the heart rhythm with a huge contraction rate. Naturally, under such conditions, the heart muscle is not able to adequately contract. Therefore, this pathology (especially from the side of the ventricles) poses a threat to life.
Heart rate
The pulse at rest in an adult is 60-80 beats per minute. Of course, this figure changes throughout life. The pulse varies significantly by age.
| Pulse Chart | |
| Age | Heart rate (beats per minute) |
| 1st month of life | 130 - 140 |
| 1 month – 1 year | 120 – 130 |
| 1 – 2 years | 90 – 100 |
| 3 – 7 years old | 85 – 95 |
| 8 – 14 years old | 70 – 80 |
| 20 – 30 years | 60 – 80 |
| 40 – 50 years | 75 – 85 |
| Over 50 | 85 – 95 |
There may be a discrepancy between the number of heartbeats and the number of pulse waves. This happens if a small volume of blood is ejected into the vascular bed (heart failure, a decrease in the amount of circulating blood). In this case, oscillations of the vessel walls may not occur.
Thus, the pulse of a person (the norm for age is indicated above) is not always determined on the peripheral arteries. This, however, does not mean that the heart also does not contract. Perhaps the reason is a decrease in the ejection fraction.
Voltage
Depending on the changes in this indicator, the pulse also changes. The characteristic of the pulse according to its voltage provides for the division into the following varieties:
- Solid pulse. Due to high blood pressure (BP), primarily systolic. It is very difficult to pinch the artery with your fingers in this case. The appearance of this type of pulse indicates the need for urgent correction of blood pressure with antihypertensive drugs.
- Soft pulse. The artery compresses easily, and this is not very good, because this type of pulse indicates too low blood pressure. It can be due to various reasons: a decrease in the volume of circulating blood,decrease in vascular tone, inefficiency of heart contractions.
Filling
Depending on changes in this indicator, the following types of pulse are distinguished:
- Full. This means that the blood supply to the arteries is sufficient.
- Empty. Such a pulse occurs with a small volume of blood ejected by the heart in systole. The causes of this condition can be heart pathology (heart failure, arrhythmias with too high a heart rate) or a decrease in blood volume in the body (blood loss, dehydration).
Pulse rate
This indicator combines the filling and tension of the pulse. It depends primarily on the expansion of the artery during the contraction of the heart and its subsidence during the relaxation of the myocardium. The following types of pulse are distinguished by magnitude:
- Big (tall). It occurs in a situation where there is an increase in the ejection fraction, and the tone of the arterial wall is reduced. At the same time, the pressure in systole and diastole is different (for one cycle of the heart, it increases sharply, and then decreases significantly). Aortic insufficiency, thyrotoxicosis, fever can be the causes leading to the appearance of a large pulse.
- Small pulse. Little blood is ejected into the vascular bed, the tone of the arterial walls is high, pressure fluctuations in systole and diastole are minimal. Causes of this condition: aortic stenosis, heart failure, blood loss, shock. In especially severe cases, the value of the pulse may become insignificant (suchthe pulse is called thready).
- Even pulse. This is how the normal pulse value is characterized.
Pulse shape
According to this parameter, the pulse is divided into two main categories:
- Quick. In this case, during systole, the pressure in the aorta rises significantly, and quickly drops in diastole. A rapid pulse is a characteristic sign of aortic insufficiency.
- Slow. The opposite situation, in which there is no place for significant pressure drops in systole and diastole. Such a pulse usually indicates the presence of aortic stenosis.
How to examine the pulse correctly?
Probably everyone knows what needs to be done to determine what pulse a person has. However, even such a simple manipulation has features that you need to know.
The pulse is examined on the peripheral (radial) and main (carotid) arteries. It is important to know that with a weak cardiac output in the periphery, pulse waves may not be detected.
Let's consider how to palpate the pulse on the hand. The radial artery is accessible for examination at the wrist just below the base of the thumb. When determining the pulse, both arteries (left and right) are palpated, because. situations are possible when pulse fluctuations will be unequal on both hands. This may be due to compression of the vessel from the outside (for example, by a tumor) or blockage of its lumen (thrombus, atherosclerotic plaque). After comparison, the pulse is evaluated on the arm where it is better palpable. It is important that whenIn the study of pulse fluctuations, there was not one finger on the artery, but several (it is most effective to clasp the wrist so that 4 fingers, except for the thumb, are on the radial artery).
How is the pulse on the carotid artery determined? If the pulse waves are too weak on the periphery, you can examine the pulse on the main vessels. The easiest way is to try to find it on the carotid artery. To do this, two fingers (index and middle) must be placed on the area where the indicated artery is projected (at the front edge of the sternocleidomastoid muscle above the Adam's apple). It is important to remember that it is impossible to examine the pulse from both sides at once. Compression of two carotid arteries can cause circulatory problems in the brain.
The pulse at rest and with normal hemodynamic parameters is easily determined on both peripheral and central vessels.
A few words in conclusion
The pulse of a person (the norm for age must be taken into account in the study) allows us to draw conclusions about the state of hemodynamics. Certain changes in the parameters of pulse fluctuations are often characteristic signs of certain pathological conditions. That is why the study of the pulse is of great diagnostic value.
