Different pulse on the hands. How to correctly count in the area of the left half of the chest

When we feel bad, we “listen” to our pulse, trying to understand whether and how often the heart beats, whether there are any interruptions ... As a rule, there is not enough fantasy for more. Here is an expert pulse diagnostics, examining your pulse, can tell what you have been ill with throughout your life, what kind and at what stage you have today and what awaits you in the future. By pulse, he will easily determine your character and find out the sex of the unborn child if you are pregnant ...

Unusual diagnosis

The physicians of China and India learned to recognize diseases by the pulse more than five thousand years ago. According to legend, one of the first specialists in pulse diagnostics was a Chinese doctor Bian Qiao. Somehow he was invited to the sick wife of the emperor, and in those days, no one except her husband was allowed to touch Her Majesty's hand, or even look at her. Then the doctor asked that a thin rope be tied around the woman's wrist, and the end of it passed behind the screen where he stood. The court healers played a trick on the healer and tied the end of the rope to the dog's paw. Bian Qiao put three fingers on the rope and calmly stated that this is not a human pulse, but some animal, which also suffers from worms, and it must be treated in such and such a way. After the admiration of all those present, the emperor's wife was entrusted to the doctor. And after a while, everyone learned the joyful news about the imminent birth of the heir to the throne ...
Still unusual method pulse diagnostics is used by Eastern healers. The heart, contracting, pushes the blood out, and the walls of the vessels rhythmically either expand or contract. We feel this impulse of blood as a pulse. It is believed that the nature of the pulse reflects the state individual bodies and the organism as a whole, as well as the physical and mental constitution of a person. Any imbalance in the work of the body is manifested in the strength of the impulses of the pulse, its frequency and regularity. And you can find out about any problems even on the most early stages illness.
To make a diagnosis, the doctor touches the patient's wrists with three fingers. Then, changing the force of pressing and the place of contact of the fingertips, one by one “interrogates” all the internal organs of a person. Experienced specialist can "hear" more than 300 signals that the pulse gives him. Comparing the results of the “survey” with the “innate pulse” of a person (here the pulses are male, female and neutral), taking into account also the seasonal and daily features of biorhythms, the diagnostician makes his verdict.

Count your pulse

Of course, only an experienced doctor can make a complete diagnosis by pulse. On your own, you can use a simplified version of this method, it will teach you to determine your temperament, to understand whether you are healthy or if you have a disease, and where it is then hidden. The main thing for this is attention to yourself and daily practice.
For starters, a few mandatory conditions. Since the pulse is a “subtle” matter, even the simplest actions can distort its readings. Remember: you should not check your pulse if you have not had enough sleep, have recently eaten or, on the contrary, are too hungry, have taken alcohol or medication; worked hard and hard; overcooled or overheated; did a massage; had sex; took a bath or shower. Women's pulse readings change on critical days.
The best time for pulse diagnostics is from 11 am to 1 pm, i.e. between breakfast and lunch. During this period, the pulse is the most calm and stable.
So let's start. Relax, take off your watch, rings, bracelets. Sit comfortably so that no one disturbs you. You can find your pulse in different places: pressing the palm to the heart, putting the fingertips to the bend of the elbow or temples. But the best place- on the wrist. It is necessary to tightly clasp the wrist of the other hand with one hand from the bottom side, three fingers - index, middle and ring fingers - attach just below the bend of the wrist (approximately at a distance of the width of the thumb) on the radial artery (see Fig.). The pads of the fingers should be in line with a very small gap between them. Each finger should clearly feel the pulse wave.
The pulse readings on the right and left hands are not the same, so you need to check it on both hands. Count the number of beats in one minute. Be sure to remember on which hand and under which finger you feel the strongest jolts.

The rhythms of our heart

In a healthy person, the following (average) pulse rates are considered the norm:
Child after birth - 140 beats / min
From birth to 1 year - 130 bpm
From 1 year to 2 years - 100 bpm
From 3 to 7 years - 95 bpm
From 8 to 14 years old - 80 bpm
Adults - 72 beats / min (in women, the pulse is faster than in men)
Elderly people - 65 beats / min
In case of illness - 120 beats / min

Melancholic and Choleric

It is noticed that in people of different temperaments, the rhythm and movements of the pulse differ from each other. At choleric pulse beats resemble the movements of a jumping frog. His pulse rate is 76-83 beats per minute, the beats are very strong, active, regular.
sanguine has a similar pulse: strong active beats come with the correct regularity, but the pulse rate is lower - about 68-75 beats per minute.
If the pulse is less than 67 beats per minute, the pulse beats are regular and weak, and its movement resembles the movement of a swimming swan, then a person can be called phlegmatic .
melancholic same has rapid pulse- more than 83 beats per minute, his beats are weak, irregular, with undulating movements, similar to those of a snake.
True, it is possible to determine temperament in this way only in healthy people. In patients, the pulse changes depending on what is in the body in his body.

Like a string of even pearls

This is what experts see oriental medicine pulse of a healthy person. Throughout the stabilization, it must remain even in all its parameters: strength, fullness, tension, rhythm. The irregularity of the pulse beat (arrhythmia) warns of an illness earlier than others.
And you can understand where the disease is hiding by determining under which of the three fingers and on which hand the most strong pulsation. If you feel a strong pulse on your left wrist, then the causes of malaise should be sought on the left half of the body, if on the right wrist, you should look on the right side. If you feel a pulsation under the pad of your index finger (no matter which hand), then you are suffering top part body including head, heart, lungs. The middle finger feels disorders of the stomach, liver, spleen, gallbladder, and the ring finger "hear" diseases of the kidneys, lower back and genital organs.
Interestingly, in men and women, the results of a strong pulse in the same place can mean different diseases. So, men have a strong pulsation under index finger on the left hand indicates possible defeat hearts or small intestine, on the right hand - the lungs or large intestine. In women, everything is exactly the opposite.
It is also very important for correct diagnosis to learn to distinguish between superficial and deep pulses, that is, the strength of pulsations with a superficial touch and with strong pressure. top finger pads. The result largely depends on this. (see table).

Finger	Left hand		Right hand
	Surface pulse	deep pulse	deep pulse	Surface pulse

Pointing	Small intestine	Heart	Lungs	Colon

Pointing	Colon	Lungs	Heart	Small intestine
Average	Stomach	Spleen	Liver	gallbladder
Nameless	Sex organs	Left kidney	Right kidney	Bladder

For example, if the index finger feels a strong pulsation when touching the surface (surface pulse) of the right wrist, your problem is colon. If, in the same position, a strong pulsation is felt only with pressure (deep pulse), the lungs are affected.
According to the table, you can determine the area yourself possible diseases. But you are unlikely to be able to diagnose yourself. So, if you find that the heart or stomach is to blame, consult a cardiologist or gastroenterologist, do a cardiogram or gastroscopy. The purpose of simplified pulse diagnostics is to identify the problem, but it will have to be solved jointly with doctors.

Diseases of cold and heat

There are many nuances in professional pulse diagnostics. And most importantly, perhaps, is a different understanding of the Eastern and western medicine causes of disease and principles of their treatment. in Tibetan and Chinese medicine there are concepts unusual for us: a hollow pulse, a darkened or splashing pulse. Heat diseases that affect the heart, lungs, liver, spleen, kidneys. And cold diseases, when the small and large intestines, stomach suffer, gallbladder, sexual organs. But the usual diseases, such as gastritis or heart failure, they, on the contrary, do not have. All this creates great difficulties in the perception of pulse diagnostics.
Chinese doctors also believe that the pulse also depends on the time of year, when the rhythms of energy circulation change in the body and in nature. Here, for example, is how an ancient author describes the pulses: “The spring pulse is like a nightingale trill, the tremors are thin and energetic, the pulse is fast, slippery, a little tense and vibrating ...” In general, oriental doctors take into account five seasons: spring, summer, autumn, winter and off-season, defining each season to the nearest day. But this is a completely different level of diagnostics, in order to master it, you need to spend many years and effort ...

Pulse instead of a thermometer

Most infectious diseases increase body temperature and increase heart rate. According to this reaction of the body, if there is no thermometer at hand, you can approximately determine the temperature of a sick person. You just need to know the value of your pulse in a normal state.
It is noticed that an increase in body temperature by 1 degree accelerates the pulse by about 8 beats per minute. When you feel that your temperature has risen, but it is not possible to accurately measure it, measure your pulse. Determine the difference - how much compared to your normal value pulse has changed. Divide this difference by 8 to get the number of degrees your body temperature has risen. For example, 12 extra punches pulse means that the temperature has reached 38 degrees; 20 strokes - 39 degrees; 30 strokes - 40 degrees.

Boy or girl?

This question always worries parents. But Chinese doctors could determine the sex of the unborn child without any ultrasound. If the strong pulse of a pregnant woman was felt under ring finger on the wrist of the right hand - a boy will be born, under the same finger on the wrist of the left hand - a girl. So expectant mothers burning with curiosity (unless they have health problems) have a chance to test the wisdom of the ancient Aesculapius.

When measuring the pressure on both hands, you can see that the indicators are different. The allowable difference in this case should not exceed 5 mm Hg. Art. Why is it different on the hands arterial pressure Is it a pathology or a norm?

Causes

Different pressure indicators can be provoked by a number of reasons - serious and not so.

The main ones are:

tonometer error;
excitement, anxiety, severe stress;
heavy physical work- people whose activities are related to physical activity, pressure indicators on the right hand are higher;
fibrosis in the muscles of the shoulder girdle - pathology leads to clamping of nerves and blood vessels, which is reflected in pressure indicators;
vascular diseases, atherosclerosis;
osteochondrosis of the thoracic region.

Sometimes different indicators appear in the background chronic insomnia, overwork. Disturbances in the autonomic nervous system in vegetative-vascular dystonia can cause discrepancies in the values. The same reasons can provoke not only different pressure, but also the pulse on the left and right hands.

Important! Every second person has lower systolic pressure on the left arm.

What does the difference mean

The constant difference in the indicators of the tonometer indicates the need to visit a doctor. If the difference between the values obtained on the left and right hand is more than 10 units, it is necessary to fully check the vascular system. A constant difference of 15 units indicates the risk of stroke. Differences of 20 units are observed with occlusion of the subclavian artery. Discrepancy even in 1 unit between indicators on different hands increases the risk of death from vascular disease and heart disease by 9%.

The difference in indicators may be accompanied by a deterioration in well-being - weakness appears, dizziness, tinnitus occurs, reactions slow down. The weakening of one of the limbs also indicates the affected vessels - this is noticeable during physical exertion. Vascular diseases are manifested by constantly cold fingers.

But often vascular pathologies do not have bright pronounced signs and they can only be detected by measuring the pressure on different hands. In older people, a strong difference in indicators may indicate the development of atherosclerosis, ischemia, and hypertension.

Important! A difference in tonometer readings of 5–10 units is not a reason for panic. With a discrepancy of 15-20 positions, it is urgent to undergo a full medical examination.

Nonspecific aortoarteritis is another serious pathology in which there are different pressure indicators. The disease is often diagnosed in women childbearing age. The disease is characterized by inflammatory processes in the walls of blood vessels - in the future, they are clogged. Disturbances in blood flow lead to irreversible changes in internal organs who receive less blood and oxygen. Without proper treatment, every fourth sick person dies.

Different values of blood pressure during pregnancy

Measurement of blood pressure is carried out in pregnant women at each visit to the hospital. The mother-to-be should know her normal performance And at the slightest change, report it to the doctor.

Important! In pregnant women, changes in systolic pressure should not exceed 10%. The norm of indicators in pregnant women is from 90/60 to 140/90.

Fluctuations in systolic pressure over 15% can be caused by:

late toxicosis:
fetal pathologies;
complications of pregnancy, gestosis.

What to do and which doctor to contact

Even if, apart from the difference in tonometer readings, nothing else worries - it is necessary to visit a cardiologist. Atherosclerosis in the early stages does not have a bright severe symptoms.

After the examination, the doctor will prescribe duplex scanning vessels - this will allow you to scan the condition of the main arteries that supply blood to the limbs and the brain. During the examination, you can find the location of narrowed vessels and cholesterol plaques, the degree of damage. Based on the data obtained, the correct diagnosis will be established and adequate therapy will be prescribed.

Additional research:

Ultrasound of the heart and vessels of the upper extremities;
chest x-ray;
scan of the aortic arch.

Basic rules and errors in measuring pressure

Better with a mechanical tonometer, and before starting the procedure, you need to sit in a relaxed state for 5 minutes. The cuff of the device should be in line with the heart, cover at least 80% of the circumference of the forearm, put it on only on bare areas of the body. The room should be at a comfortable temperature. It is better to take measurements in strict certain time, air is pumped in quickly and with effort, released slowly.

How to measure pressure correctly:

It is comfortable to sit down, both feet should clearly stand on the floor, legs cannot be crossed. Talking during the procedure is not recommended.
Lean back against the back of a chair.
Place your left hand flat on a table or armrest.
The interval between measurements is 5–7 minutes.
For ambiguous or alarming values, the measurement should be taken again, but it should be started from the right hand.

The tonometer readings will be incorrect if the arm is below or above the level of the heart. If during the measurement a person has nothing to lean on with his back, then the indicators will be overestimated. A tightly tightened cuff can distort the measurement results.

The performance of the device is affected by caffeine-based drinks, nicotine, certain medications, drops for eyes and nose. An increase in pressure can be caused by complete bladder and intestines.

Checking the pressure on both hands is the norm. You need to do this at home measurement. It is also necessary to ask the doctor during the examination to make measurements on the left and right hand.

Do you have different pressure on different hands? Nothing surprising. Indicators often differ on the left and right limbs. And there is nothing anomalous in this. As a rule, doctors in such cases take the maximum figures for blood pressure as indications.

Reasons for discrepancies in testimony

Different pressure on different hands can be due to a number of factors. Eg, important role excitement plays. Starting to measure the pressure on the first hand, we are nervous at first, until it comes to the second hand, we calm down, the excitement subsides. Hence the different readings.

This phenomenon has anatomical reasons. Studies show that most people, especially those who perform physical work, fibrosis occurs in the muscles of the shoulder girdle, as a result of which the so-called neurovascular bundle is infringed. It is this that can cause the blood pressure on the right hand to rise higher than on the left. Stronger muscles in one of the arms can also affect blood pressure.

And, of course, all kinds of errors in our body can cause different pressure on different hands: atherosclerotic plaques, circulatory disorders and others.

When should you sound the alarm?

The difference in pressure on the hands according to the indicators of the tonometer is a warning for the body.

If it does not exceed 5 mm Hg. st, no need to worry. However, if this difference is significant, it is better to consult a doctor.

A difference of up to 10 mm may be due to atherosclerosis. If the indicators are even higher, differ, for example, by 15-20 mm, then this is fraught with much more dangerous diseases. In young people, vascular defects can be detected, the older generation is threatened with a violation cerebral circulation or, no less seriously, Early detection of abnormalities will help to avoid a stroke or heart attack.

Latest doctor research

A new study conducted by British doctors has shown that a significant difference in pressure on the two limbs can lead to serious vascular disease with the possibility of death.

Scientists came to the conclusion that different pressure on different hands in 10 mm between the indicators may be characteristic of a person who has high risk occurrence serious problems in the peripheral vascular system.

A difference of 15 mm not only indicates the risk of cerebrovascular disease, but also increases the risk of death from heart disease by 70%, and by 60% from various problems in the vascular system.

Diseases of the peripheral vascular system associated with the narrowing and loss of flexibility of the arteries that supply blood to the arms and legs. It happens that such diseases proceed imperceptibly, without visible symptoms.

Early detection of pathology is very important, since it is possible to reduce the risk by quitting smoking, using a reduction procedure, or being treated with statins.

Measurement of human pressure

For both hands, it is necessary, first of all, to sit comfortably in a chair, initially check one hand, and after four or five minutes - the second.

People who have hypertension are simply obliged to know by heart the differences in pressure on both hands that are acceptable for them, because for each normal readings are set individually. If deviations occur, it is urgent to consult a doctor who will help diagnose and take timely measures to effective treatment.

Introduction to the problem

The data of numerous studies convincingly show: a difference in pressure of more than 10 mm Hg. Art. between the right and left hands can be a marker of vascular disease of the extremities. With a stable systematic difference of 15 mm Hg. Art. and higher, the probability of having a significant lesion of cerebral vessels, and hence the risk of stroke, increases by 1.5 times, and the probability of death from cardiovascular diseases - by 70%.

The difference in pressure on the right and left hands can make itself felt by discomfort, weakness, dizziness, tinnitus, decreased reaction, weakness in the arm, fatigue when performing physical activity, chilliness of the fingers. But, sometimes the pressure difference does not manifest itself in any way, and it can only be detected by regularly measuring the pressure on both hands. Wherein, different pressure on different hands can be in patients who do not suffer from high blood pressure.

But, in practice, pressure on both hands is measured extremely rarely, even in medical institutions.

Causes of pressure difference

When identifying a difference in pressure on your hands, you should not immediately panic: the difference in pressure is a symptom of many conditions, both serious and not so, among which, for example, different tone of the hands. By using additional examination you can understand what caused the difference.

The results of pressure measurements on different hands may differ due to a number of reasons:

1. Excitement. When our blood pressure is measured, we can get a little worried. Then we calm down, and the indicator on the second hand can return to normal.
2. Anatomical features. For many people, blood pressure measured on the right arm will be higher than on the left. This is especially true for those who often work physically. Sometimes fibrosis can develop in the muscles of the shoulder girdle. It causes compaction and thickening of the legs of the left scalene muscle. In this regard, the neurovascular bundle, which runs in the left side of the body, may be infringed.
3. More developed muscles on one of the arms.
4. Impaired blood circulation, including due to atherosclerosis.

Risks related to pressure difference

As mentioned above, if the difference in measuring pressure on the hands does not exceed 5-10 mm, there is no reason to worry. If the indicators differ by 15-20 mm or more, then this is the reason for the examination. For example, for young people this may mean the presence of vascular anomalies, for people of middle and old age - most often atherosclerosis. Ischemic disease heart, impaired cerebral circulation, hypertension, intermittent claudication (pain in the muscles when walking) - this is what often leads to atherosclerosis of blood vessels.

The difference is more than 20 mm Hg. Art. between the results obtained on the right and left hand, may indicate atherosclerotic narrowing or occlusion of the subclavian artery. And this pathology already significantly increases the risk of stroke.

Response

A timely detected deviation from the norm will help to make a diagnosis in a timely manner and take necessary measures for effective treatment, in some situations it will help prevent a stroke or heart attack. The difference in pressure between the right and left hand makes it possible to detect atherosclerosis in the early stages, which speeds up the start of treatment and increases its effectiveness. It should not be forgotten that atherosclerosis in the early stages, regardless of the target organ, often occurs without noticeable symptoms.

Early diagnosis of pressure differences can be additional reason for smoking cessation, for lifestyle changes, and for taking medicines prescribed by the doctor.

Diagnosis of stenosis of the subclavian arteries

To find out if you have arterial stenosis or not, your doctor will examine you. Even if you don't have any symptoms, your doctor may listen to a murmur over your carotid or subclavian arteries caused by blood flowing through the stenotic area. If necessary, an ultrasound duplex scan will be ordered first. main arteries head and initial sections of the upper limbs (ultrasound-DS). It allows you to determine the localization of the narrowing, its degree and significance.

For a more detailed assessment of the condition of the arteries, the doctor may recommend an angiogram ( x-ray examination blood vessels). This study is carried out by catheterization, usually femoral artery, or arteries on the wrist, under local anesthesia in a special operating room equipped with an angiographic unit.

Treatment of stenosis of the subclavian arteries

For those cases when a stenotic lesion of the arteries is diagnosed and it is already impossible to do without surgery, there are two methods surgical treatment. First - open operation bypass performed vascular surgeons. The second is a modern, low-traumatic, X-ray surgical operation - stenting, performed by X-ray endovascular surgeons (under local anesthesia through a puncture). Both methods have their indications and contraindications. Therefore, the question of choosing one of them is always decided individually.

Clinical Cases

Clinical Case #1

A patient complaining of dizziness, no pulse in the left arm, occasional cramps in the shoulder, weakness in the left arm on exertion, paresthesia in the fingers, hand and forearm. On the angiogram - pronounced (up to 90%) stenosis of the left subclavian artery in the initial segment.

A balloon-expandable stent was placed in the area of stenosis under local anesthesia through the femoral access (puncture on the thigh) (see before and after photos below).

The stenosis (and the associated pressure difference in the arms) is completely eliminated.

The patient's condition improved significantly.

Clinical Case #2

The patient complained of weakness in the left hand, aggravated by minimal physical activity, chilliness of the fingers of the left hand, episodes of dizziness, headaches. At the time of measurement before angiography, the pressure on the right hand was 190/100, on the left - 110/75. The difference in systolic pressure between the arms is 80 mm! On the angiogram - occlusion (blockage) of the left subclavian artery in the initial segment (Fig. 1 - angiography from the side of the aorta, Fig. 2 - angiography from the side of the left hand). Due to the complete blockage of the subclavian artery, the blood supply to the left arm was carried out according to an emergency scheme, bypassing through the brain - according to vertebral artery, that is, there was a stealing of the brain.

With the help of special tools, to minimize the risks of intervention using only local anesthesia and access only through the vessels of the upper extremities (!), it was possible to pass the occluded area, expand it and install a balloon-expandable stent (Fig. 3).

Adequate blood flow through the subclavian artery (and hence the blood supply to the left arm and brain through it) was completely restored. By restoring the physiological direction of blood flow, brain stealing was eliminated. During the control measurement of pressure - there is no more pressure difference between the hands.

The patient's condition improved significantly.

Clinical Case #3

Similar case. A patient complains of weakness in the left hand, aggravated by physical exertion, chilliness of the fingers of the left hand, episodes of dizziness, headaches. The difference in systolic pressure between the arms is 40 mm. On the angiogram - subocclusion ( critical stenosis) of the left subclavian artery in the initial segment (Fig. 1 - angiography before intervention). Due to the complete blockage of the subclavian artery, the blood supply to the left arm was carried out according to an emergency scheme, bypassing through the brain - through the vertebral artery, that is, the brain was being stolen.

With the help of special instruments, to minimize the risks of intervention, using only local anesthesia and access only through the radial artery (on the wrist) of the right upper limb, managed to pass the occluded area, expand it and install a self-expanding stent.

Pulse is a fluctuation of the walls of blood vessels associated with a change in their blood supply during cardiac cycle. There are arterial, venous and capillary pulses. The study of the arterial pulse gives 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 probing the arteries. For the radial artery, the hand of the subject is freely wrapped around the area with the thumb so that the thumb is located on back side, and the rest of the fingers - on the front surface radius where the pulsating radial artery is palpable under the skin. The pulse is felt simultaneously on both hands, since sometimes it is expressed differently on the right and left hands (due to vascular anomalies, compression or blockage of the subclavian or brachial artery). In addition to the radial artery, the pulse is examined on the carotid, femoral, temporal arteries, arteries of the feet, etc. (Fig. 1). An objective characteristic of the pulse is given by its graphic registration (see). In a healthy person, the pulse wave rises relatively steeply and slowly falls (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 for measuring the pulse on various arteries: 1 - temporal; 2 - shoulder; 3 - dorsal artery of the foot; 4 - beam; 5 - posterior tibial; 6 - femoral; 7 - popliteal.

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

In a healthy person, the pulse is rhythmic, i.e., pulse waves follow one after another at regular intervals. With 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 extensibility of the arterial wall. Normal - pulse wave is well felt - full pulse. If less than normal blood enters the arterial system, the pulse wave decreases, the pulse becomes small. With severe blood loss, shock, collapse, pulse waves can barely be felt, such a pulse is called filiform. A decrease in the filling of the pulse is also noted in diseases that lead to thickening of the walls of the arteries or narrowing of their lumen (atherosclerosis). In severe damage to the heart muscle, an alternation of a large and small pulse wave is observed (Fig. 2, 3) - an intermittent pulse.

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

The pulse rate depends on the pressure fluctuation in arterial system during systole and diastole. If during systole the pressure in the aorta increases rapidly, and during diastole falls rapidly, then there will be a rapid expansion and collapse of the arterial wall. Such a pulse is called fast, at the same time it can be large (Fig. 2, 4). Most often the fastest and big pulse observed in aortic valve insufficiency. A slow increase in pressure in the aorta during systole and a slow decrease in diastole causes a slow expansion and slow collapse of the arterial wall - a slow pulse; at the same time it is small. Such a pulse appears when the aortic orifice narrows due to the difficulty in expelling blood from the left ventricle. Sometimes, after the main pulse wave, a second, smaller wave appears. This phenomenon is called dicrotia pulse (Fig. 2.5). It is associated with a change in the tension of the arterial wall. Dicrotia of the pulse occurs with fever, some infectious diseases. When probing the arteries, they examine not only the properties of the pulse, but also the state vascular wall. So, with a significant deposition of calcium salts in the vessel wall, the artery is probed in the form of a dense, twisted, rough tube.

The pulse in children is more frequent than in adults. This is due not only to the lesser influence vagus nerve but also a more intensive metabolism.

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

Pulse (from Latin pulsus - push) is rhythmic, jerky vibrations of the walls of blood vessels that occur as a result of the ejection of blood from the heart into the arterial system.

Doctors of antiquity (India, Greece, Arabic East) paid great attention to the study of the pulse, giving it a decisive diagnostic value. scientific basis the doctrine of the pulse received after the discovery by Harvey (W. Harwey) of blood circulation. The invention of the sphygmograph and especially the introduction modern methods pulse registration (arteriopiezography, high-speed electrosphygmography, etc.) have 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 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 propagation of the pulse wave occurs at a speed of 4 to 15 m/s, and the resulting stretching and elongation of the arterial wall constitutes the arterial pulse. There are central arterial pulse (of the aorta, carotid and subclavian arteries) and peripheral (femoral, radial, temporal, dorsal artery of the foot, etc.). Difference of these two forms of pulse comes to light at its graphic registration by a method of a sphygmography (see). On the pulse curve - sphygmogram - there are ascending (anacrota), descending (katacrota) parts and a dicrotic wave (dicrota).

Rice. 2. Graphic registration of the pulse: 1 - normal; 2 - arrhythmic (a-b- different kinds); 3 - intermittent; 4 - large and fast (a), small and slow (b); 5 - dicrotic.

Most often, the pulse is examined on 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. With anomalies in the location of the artery, the presence of bandages on the hands or massive edema, the pulse is examined on other arteries accessible to palpation. The pulse on the radial artery is delayed compared to the systole of the heart by approximately 0.2 seconds. The study of the pulse on the radial artery must be carried out on both hands; only in the absence of a difference in the properties of the pulse can one confine oneself to further research on one arm. Usually, the hand of the subject is freely grasped with the right hand in the area 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 - on the radial, directly on the radial artery. Normally, you get a feeling of a soft, thin, even and elastic tube, pulsating under your fingers.

If, when comparing the pulse on the left and right hands, its different value or delay of the pulse on one hand compared to the other is found, then such a pulse is called different (pulsus differens). It is observed most often with unilateral anomalies in the location of blood vessels, their 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 a decrease in the pulse wave on the left radial artery. With mitral stenosis, an 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-Saveliev sign).

The qualitative characteristic of the pulse depends 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 done in at least 1/2 min., while the resulting figure is multiplied by 2. If the pulse is incorrect, the counting should be done within 1 min.; with a sharp excitation of the patient at the beginning of the study, it is desirable to repeat the count. Normally, the number of pulse beats in an adult man is on average 70, in women - 80 in 1 min. Photoelectric heart rate monitors are currently used to automatically calculate the pulse rate, which is very important, for example, to monitor 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. With an increase in the pulse rate of more than 90 in 1 minute, they speak of tachycardia (see); such a frequent pulse is called pulsus frequens. At a pulse rate of 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 pulse waves do not reach the periphery, the number of pulse beats becomes less than number heart contractions. This phenomenon is called bradysphygmia, the difference between the number of heartbeats and pulse beats in 1 minute is called a pulse deficit, and the pulse itself is called pulsus deficiens. With an increase in body temperature, each degree above 37 usually corresponds to an increase in heart rate by an average of 8 beats per 1 minute. The exception is fever in typhoid fever and peritonitis: in the first case, a relative slowing of 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 the pulse.

Pulse Rhythm. If pulse beats follow one after another at regular intervals, then they speak of a regular, rhythmic pulse (pulsus regularis), otherwise an irregular, irregular pulse (pulsus irregularis) is observed. In healthy people, an increase in the pulse on inhalation and its decrease on exhalation are often noted - respiratory arrhythmia (Fig. 1); holding the breath eliminates this type of arrhythmia. On changes of pulse it is possible to diagnose many types of arrhythmia of heart (see); more precisely, they are all determined by electrocardiography.

Rice. 1. Respiratory arrhythmia.

Pulse rate is 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 the same rapid decline pulse wave, which is directly proportional at this moment to the rate of pressure change in the radial artery (Fig. 2). As a rule, such a pulse is simultaneously large, high (pulsus magnus, s. altus) and is most pronounced when aortic insufficiency. At the same time, the researcher's finger feels not only fast, but also large rises and falls of the pulse wave. IN pure form big, high heart rate sometimes observed in physical stress and often with complete atrioventricular block. A sluggish, slow pulse (pulsus tardus), accompanied by a feeling of a slow rise and a slow decrease in the pulse wave (Fig. 3), occurs when the aortic orifice narrows, when the arterial system is filled slowly. Such a pulse, as a rule, is small in size (height) - pulsus parvus, which depends on a small increase in pressure in the aorta during left ventricular systole. This type of pulse is typical for mitral stenosis, severe weakness of the myocardium of the left ventricle, fainting, collapse.

Rice. 2. Pulsus celer.

Rice. 3. Pulsus tardus.

Pulse voltage is determined by the force necessary to completely stop the propagation of the pulse wave. When examining the distally located index finger, the vessel is completely squeezed to prevent the penetration of reverse waves, and the most proximal lying ring finger produces gradually increasing pressure until the “groping” third finger ceases to feel the pulse. There is a tense, hard pulse (pulsus durum) and a relaxed, soft pulse (pulsus mollis). According to the degree of pulse tension, one can approximately judge the magnitude of the maximum arterial pressure; the higher it is, the more intense the pulse.

Filling the pulse 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. Distinguish pulse full (pulsus plenus), as a rule, large, high, and empty (pulsus vaccuus), as a rule, small. With massive bleeding, collapse, shock, the pulse can be barely palpable, threadlike (pulsus filiformis). If the pulse waves are not the same 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 observed almost always with an arrhythmic pulse in cases of atrial fibrillation, early extrasystoles. A kind of uneven pulse is an alternating pulse (pulsus alternans), when the correct alternation of pulse beats of different sizes and filling 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 loss of tone peripheral vessels 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 in fever (the relaxing effect of heat on the muscles of the arteries), hypotension, sometimes during the recovery period after severe infections. At the same time, there is almost always a decrease in the minimum arterial pressure.

Pulsus paradoxus - decrease in pulse waves on inspiration (Fig. 4). And in healthy people, at the height of inhalation, due to negative pressure in the chest cavity, the blood filling of the left parts of the heart decreases and the systole of the heart is somewhat difficult, which leads to a decrease in the magnitude and filling of the pulse. When narrowing the upper respiratory tract or weakness of the myocardium, this phenomenon is more pronounced. With adhesive pericarditis on inspiration, the heart is strongly stretched by adhesions to 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. Adhesive pericarditis is characterized, in addition to this phenomenon, by a pronounced swelling of the cervical 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 (the “true” capillary pulse) are involved in pulsatory oscillations, which sometimes happens in severe thyrotoxicosis, fever, or in healthy young people during thermal procedures. It is believed that in these cases, from venous stasis, the arterial knee of the capillaries expands. The capillary pulse is best detected by lightly pressing the lip with a glass slide, when alternating, corresponding to the pulse, redness and blanching of its mucous membrane is found.

Venous pulse reflects fluctuations in the volume of veins as a result of systole and diastole of the right atrium and ventricle, which cause either a slowdown or an acceleration of the outflow of blood from the veins into right atrium(respectively, swelling and collapse of the veins). The study of the venous pulse is carried out on the veins of the neck, be sure to simultaneously examine the pulse of the external carotid artery. Normally, there is a very little noticeable and almost imperceptible pulsation with the fingers, when the swelling jugular vein precedes the pulse wave on the carotid artery - right atrial, or "negative", venous pulse. With insufficiency of the tricuspid valve, the venous pulse becomes right ventricular, "positive", since due to a defect in the tricuspid valve there is a reverse (centrifugal) blood flow - 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 the rise of the pulse wave on the carotid artery. If at the same time the neck vein is pressed 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 representation of the venous pulse can be obtained using graphic methods registration (see Phlebogram).

hepatic pulse is determined by inspection and palpation, but much more accurately its nature is revealed by graphic registration of the pulsation of the liver 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 malformations of the tricuspid valve, systolic (with valve insufficiency) or presystolic pulsation (with stenosis of the orifice) of the liver may increase as a result of the “hydraulic lock” of its outflow tracts.

Pulse in children. In children, the pulse is much faster 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 heart rate in newborns (120-140 beats per 1 minute), but on the 2nd-3rd day of life, their pulse may slow down to 70-80 beats per 1 minute. (A. F. Tur). With age, the pulse rate decreases (table 2.).

In children, the pulse is most conveniently examined on the radial or temporal artery. The smallest and 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 heart beats per breath.

The pulse rate in children is subject to large fluctuations.

Increased heart rate easily occurs with anxiety, crying, muscle exercises, eating. The ambient temperature and barometric pressure also influence the pulse rate (A. L. Sakhnovsky, M. G. Kulieva, E. V. Tkachenko). With an increase in the child's body temperature by 1 °, the pulse quickens by 15-20 beats (A. F. Tour). In girls, the pulse is more frequent than in boys, by 2-6 beats. This difference is especially pronounced in the period of sexual development.

When assessing the pulse in children, it is necessary to pay attention not only to its frequency, but also to the rhythm, the degree of filling of the vessels, their tension. A sharp increase in heart rate (tachycardia) is observed with endo- and myocarditis, with heart defects, infectious diseases. Paroxysmal tachycardia up to 170-300 beats per 1 min. may be seen in young children. Decrease in heart rate (bradycardia) is observed with an increase intracranial pressure, at severe forms malnutrition, with uremia, epidemic hepatitis, typhoid fever, with an overdose of digitalis. Deceleration of the pulse to more than 50-60 beats per 1 min. leads to suspect the presence of a heart block.

In children, the same types of cardiac arrhythmias are observed as in 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 common: an increase in the pulse during inhalation and a slowdown during exhalation. Extrasystoles in children, more often ventricular, occur with myocardial damage, but can also be functional.

A weak pulse of poor filling, more often with tachycardia, indicates the phenomena of cardiac weakness, a decrease blood pressure. A tense pulse, indicating an increase in blood pressure, is observed in children most often with nephritis.