There are different pulses in the hands. Arterial pulse examination

Our body works continuously throughout our lives. Even while we sleep or just relax, internal systems they know no rest. At the same time, it is impossible to monitor the activities of most of them without special devices, but the heart constantly transmits direct signals to us. We hear it beating in chest, we feel an increase in rhythm, but the best way to monitor cardiac activity yourself is to measure the pulse. It is no coincidence that even in schools they explain to children how to find the pulse correctly and practice this skill in class. medical training. True, without regular practice the skill is forgotten, and many only remember that the pulse can be felt on the wrist. To fill in the gaps and remember how to correctly find and measure bullets, read our tips.

What is pulse? Where to look for a pulse?
Pulse, or heart rate (HR), is the reflection of the heartbeat in the blood circulation. A completely natural phenomenon, considering that the heart causes blood to circulate through circulatory system rhythmically. Each time the heart pumps out blood, the blood vessels fill more, and this can be felt by touching their walls. This can only be done where the vessels are as accessible to touch as possible, that is, there is no fat or muscle layer between them and the thin skin. That's why, before measuring your pulse, you need to find right place to measure it.

However, even this is not enough to measure your pulse. Because blood vessels differ not only in location, but also in size (volume) and functions performed. So the pulse can be different:

Arterial pulse - vibrations of the walls of the arteries, that is, blood vessels, carrying blood from the heart to the internal organs.
Venous pulse is a contraction of the veins, the task of which is to push blood “from the periphery” to the heart.
Capillary pulse - even the smallest vessels experience fluctuations in heartbeat. But it is undesirable to determine the pulse from them due to many interferences. In particular, the blood pressure in the capillaries remains almost unchanged, and only strong changes can be noticed. Therefore, obvious changes in blood circulation are usually called capillary pulses: blue lips or nails, fingertips, etc.

Actually, the phrase “find the pulse” in most cases means the arterial pulse, while other types are needed in special medical research.

How to find and measure your pulse correctly?
There are not many places on the human body where these conditions are met. And further fewer ways pulse measurements available in everyday (non-clinical) conditions. In fact, you can measure your pulse yourself only by palpation, that is, using superficial tactile sensations. You can find and palpate the pulse in the following places on the body:

At the wrist: the most common, or radial pulse (radial artery pulsation).
On ulnar artery: in the other part of the wrist, a little higher.
On brachial artery: in the area of the elbow, on the inside of the arm, next to the biceps.
On axillary artery: passes into armpit, hence the name “axillary pulse”.
On the temples: above the eyebrow, where the temporal artery is visible.
On the neck: the carotid artery makes it possible to perfectly feel the so-called “carotid pulse”.
On lower jaw: between its edge and the corner of the mouth (facial pulse).
In the groin: on inside hips, "femoral pulse".
Below the knee: in the hollow in the bend of the leg, along the popliteal artery.
On the feet: above the arch, in the middle of the instep or behind, just below the ankle.

IN different circumstances certain areas of the body are available that are suitable for manually measuring the pulse.

How to correctly find the pulse on your hand
Most often, the pulse is measured precisely on the radial artery, in the area of the wrist, passing so close to the skin that it is visible to the naked eye. You can find and check the pulse in this place at any time, even for yourself:

Turn left hand palm up. It is the left one - in most cases they try to find the pulse on it. Ideally, the pulse on both hands should be the same, but in practice on the left hand, located closer to the heart, it can be seen better.
Keep your left hand in this position at approximately chest height (you can place it on a horizontal surface, but do not rest it on it). Index and middle finger Place your right hands, straightened and clasped together, lightly on the wrist of your left hand, just below the base of the thumb.
Feel the artery under the fingertips of your right hand: it should feel like a thin tube under the skin, soft but elastic.
Lightly press the fingers of your right hand on the artery of your left wrist - this will make the blood pushes inside the artery more noticeable.
Mentally count the number of blood pumps that will occur within 1 minute. Another option: count only for 30 seconds, then double the amount.

Similarly, in the “mirror” image you can find the pulse on the second hand. A different pulse on the right and left arms indicates problems in the development and/or functioning of the cardiovascular system. On right hand The pulse may be weaker than on the left, or felt asynchronously, with a delay.

Please note that you need to find the pulse with two relaxed fingers, the index and middle. Determine pulse on hand thumb the second hand is incorrect, because the pulsation is also felt quite strongly in the thumb. Therefore, it is easy to make a mistake and mistake the pulse of the thumb for the pulse of the hand. But by feeling the pulsation with your index and middle fingers, you will not be mistaken when measuring the pulse of yourself or another person.

How to find the pulse correctly carotid artery
The radial artery at the wrist is prominent but not the thickest of the arteries. human body. Therefore, it may not be palpable if a person has lost consciousness or lost a lot of blood. In such circumstances, the pulse is measured at the carotid artery and proceed as follows:

The patient should not stay in vertical position, sit him up or lay him on his back.
If you are right-handed, with the index and middle fingers of your right hand folded parallel, slowly move down the patient’s neck from top to bottom. Move from the base of the lower jaw to the place where the throat passes.
The pulse should be felt in a small hole - in this place the pulsation is most pronounced.
Do not apply too much pressure with your fingers to the artery, as this may cut off circulation and cause the patient to faint.
For the same reason, they do not probe both carotid arteries at the same time, limiting themselves to one side, which gives a sufficient picture.

In addition to palpation of the wrist, carotid artery and other areas of the body listed above, the pulse is determined using a monitor heart rate, or, more simply, a heart rate monitor. The sensors of this device are attached to the chest, thumb hand or earlobe. Finding your pulse using a heart rate monitor is not difficult; just fasten it with a specially designed belt, after which the sensitive sensor will “grope” the body’s pulsation.

Why measure your pulse? Pulse rate
Finding and measuring your pulse is important, and in some situations, simply necessary. Pulse is one of the main signs of life, and in less extreme circumstances it helps to monitor health and performance sports training and so on. As is known, normally the pulsation frequency corresponds to the frequency of the heartbeat (contraction of the heart muscle). And when palpating the pulse, it is important to know how to count the pulse correctly, and what pulse is considered normal:

60-90 beats per minute for a healthy adult;
40-60 beats per minute for physically trained adults and athletes;
75-110 beats per minute for adolescents over 7 years old;
75-120 beats per minute for preschoolers over 2 years old;
80-140 beats per minute for one-year-old babies and younger;
120-160 beats per minute - this is the rate at which a newborn’s heart beats.

As you can see, as you age, your heart rate decreases due to the growth of your cardiovascular system. The more and stronger heart- the fewer contractions it needs to ensure blood flow. For the same reason, the pulse of athletes, that is, people accustomed to cardio exercise, is lower.

But pulse is an unstable parameter. It can change literally instantly under the influence of external and/or internal factors. The most common causes of heart rate changes are:

Emotions. The stronger they are, the faster the pulse.
Health status. An increase in body temperature of just 1°C speeds up the pulse by 10-15 beats per minute.
Food and drinks. Coffee, alcohol and other central nervous system stimulants speed up the heart rate, as do hot foods.
Body position. The pulse of a lying person is slightly slower than that of a sitting person, and that of a sitting person is slower than that of a standing person.
Times of Day. The maximum heart rate occurs between 8 and 12 am and from 6 to 8 pm. The slowest heart rate is at night.

And, of course, the heart rate increases when the body experiences physical activity. In this case, it is important not to exceed the maximum permissible value, so as not to overexert the heart. vascular system. The maximum permissible heart rate is a purely individual parameter, depending on physical training, health status, body weight, age. But it is customary to focus on age in order to correctly determine the maximum heart rate for each person:

Subtract your age from 220, for example, 220-30=190 - this is the maximum heart rate for a 30-year-old person. But this is the limit, and optimal value will be 0.7 from the maximum, that is, 190x0.7 = 133. So during sports activities, it is advisable to keep your heart rate around 130-133 beats per minute. But if in Everyday life, without much physical effort your pulse “goes through the roof” or “falls short” of the average, then the right decision Do not look for the pulse on your own, but consult a doctor. A professional will take your pulse medical methods and determine the causes of tachycardia or bradycardia and prescribe adequate treatment. Be healthy and may your heart rate always be normal!

From bronchitis to heart disease

Normal heart rate for an adult healthy person- 60-80 beats per minute. A pulse less than 60 may be a sign reduced function thyroid gland, a decrease in the amount of its hormones (hypothyroidism). At increased function thyroid gland (hyperthyroidism), on the contrary, the pulse is rapid: over 100-120 beats per minute. A pulse rate of 81-100 beats may indicate hypertension. An increased heart rate is also observed when bronchial asthma And chronic bronchitis, with a decrease in the level of hemoglobin in the blood. At elevated temperature the body usually increases by 10 beats with each degree - this is normal reaction body.

An important indicator is not only the frequency, but also the filling of the pulse. If one beat of the pulse is strong and the next weak, or if the pulse differs in filling on the right and left hand, this may indicate a heart defect. A barely palpable pulse in both arms is sometimes a symptom of anemia or low blood pressure. If you believe folk medicine, pregnant women may have different pulse strengths in different hands normal occurrence, indicating the sex of the child. A stronger pulse on the right hand foreshadows the birth of a boy, on the left - expect a girl.

Taking into account temperament

For heart rate readings to be reliable, you need to be able to measure it correctly. First of all, you need to press the vein not with one finger, as many are used to, but with three (index, middle and ring). The pulse should be measured while sitting (in a lying position it is lower, in a standing position it is higher). The most suitable period for pulse diagnostics- from 11 to 13 hours. At this time of day, the pulse is calmer and more stable.

To avoid distortions, do not measure your pulse immediately after eating or drinking alcohol, during an acute feeling of hunger, or after a heavy physical work or tense mental work, after a massage, shower, bath, sex, and also on menstrual days.

The “behavior” of the pulse is also influenced by a person’s temperament. It is believed that choleric people are characterized by a strong pulse with a frequency of 76-83 beats per minute, for sanguine people - a strong pulse with a frequency of 68-75 beats, for phlegmatic people - a weak pulse with a frequency of less than 67 beats, for melancholic people - a weak pulse with a frequency of more than 83 beats .

By the way

One common cause of increased heart rate is stress. To pacify an “agitated” heart, it is not necessary to resort to the help of calming pills and drops. You can try to breathe essential oil lemon, ylang-ylang or basil. Garlic also reduces heart rate: you need to crush one clove and inhale its scent for two to three minutes.

Reader reviews (2)

thank you, very clear

Victor Veniaminovich	15 January 2014, 15:36:26
e-mail: [email protected], city: Ryazan

Thank you for your kind and useful tips! They came in handy!

If the pulse is the same in both hands, then the study of its characteristics is carried out on one hand.

The pulse in symmetrical areas may be various(p.differents). Pathological processes(one-sided anomalies of structure and location peripheral vessels, compression of arteries by tumors, scars, enlarged lymph nodes, aneurysm of the aorta and its branches, tumors of the mediastinum, retrosternal localization of goiter) can deform arterial vessel along the path of pulse wave propagation. A unilateral decrease in pulse filling appears with or without a simultaneous delay in the pulse wave.

Popov-Savelyev symptom: the pulse on the left arm is less full (especially in the position on the left side) with mitral stenosis, since the hypertrophied left atrium compresses the left subclavian artery.

· Pulse rhythm.

After determining the sameness (uniformity) of the pulse in both hands, determine the rhythm.

Rhythm pulse does not depend on the condition of the arteries, but reflects the nature of contraction of the left ventricle of the heart.

Pulse rhythmic, regular (p.regularis) - pulse beats are felt at regular intervals.

Pulse uniform – pulse waves are equal to each other.

Impaired pulse regularity - arrhythmic pulse ( p.irregularis).

Pulse waves become different in size - uneven pulse.

Some types of arrhythmias are relatively easily detected by palpation. These include:

Respiratory arrhythmia - pulse at breathing movements sometimes it quickens (when you inhale), sometimes it slows down (when you exhale). It is characteristic that by holding the breath this type of arrhythmia is eliminated;

Extrasystole - pulse waves, smaller in magnitude, appear earlier than usual ( premature contractions), followed by a longer pause (compensatory pause);

Atrial fibrillation– the pulse is arrhythmic, its individual waves are of different sizes;

Paroxysmal tachycardia - suddenly begins in the form of an attack and also ends suddenly, the pulse reaches a frequency of more than 140 beats per minute, which does not happen with other rhythm disturbances;

Third degree atrioventricular block is a very rare (less than 40 beats per minute), regular and constant pulse rate.

· Pulse rate.

For determining frequencies pulse, three fingers of the palpating hand (second, third, fourth) are placed on the radial artery and the number is counted pulse beats for 15 seconds or 30 seconds and the resulting number is multiplied by 4 or 2, respectively (with a rhythmic pulse). If the pulse is arrhythmic, count for at least 1 minute.

Normal heart rate is 60-90 per minute.

Normally, the pulse rate fluctuates significantly depending on age, gender, and height. In newborns, the pulse rate reaches 140 beats per minute. The pulse rate is often higher the higher the patient is.

In the same person, depending on the time of eating, movements, depth of breathing, mental state, body position, heart rate is constantly changing.

Pulse frequent(p.frequens) – pulse rate more than 90 per minute.

Pulse rare(p.rarus) – pulse rate less than 60 per minute.

Frequent pulse occurs during physical and mental stress, with sinus tachycardia, heart failure, drop in blood pressure, anemia, thyrotoxicosis, attack paroxysmal tachycardia, at pain. When body temperature rises by 1ºC, the pulse rate increases by 8-10 beats per minute.

A rare pulse occurs during sleep, in athletes, and with negative emotions. It is an indicator of pathology in case of blockade of the conduction system of the heart, hypothyroidism, and increased intracranial pressure, with jaundice (parenchymal and mechanical).

· Pulse deficiency.

Pulse deficiency– the number of heart contractions and the number of pulse waves in the periphery may not coincide (with atrial fibrillation).

Pulse deficiency is determined by palpation and auscultation in patients with arrhythmia.

There are two ways to determine pulse deficit.

First way. ABOUT At the same time, place a stethoscope on the area of the apex of the heart to count the number of heartbeats, and palpate the pulse on the radial artery with the other hand (Fig. 5.5.2).

After counting the pulse rate for a minute, for the next minute those heartbeats that were not accompanied by the appearance of a pulse wave on the radial artery are counted - that is, a pulse deficit.

Second way. Within a minute, the number of heartbeats is counted, the second minute - the pulse rate on the radial artery (Fig. 5.5.2). Then the pulse rate is subtracted from the number of heart contractions and the result is a pulse deficit.

The presence of a pulse deficit indicates weakness contractile function heart - not all contractions of the left ventricle are accompanied by the formation of a pulse wave in the periphery.

· Condition of the vascular wall.

Definition state of elasticity of the vascular wall.

To determine the condition of the wall of the radial artery, three fingers of the palpating hand (second, third, fourth) are placed on it. First, the artery is compressed with the second finger until the reverse flow of blood from the vessels of the hand stops, and then the blood is squeezed out of the vessel with the fourth finger and squeezed until the passage of the pulse wave stops (Fig. 5.5.3). The third finger lies freely on the empty artery and rolls along the wall of the vessel with sliding movements.

Normally, the arterial wall is soft, elastic, smooth.

With atherosclerotic hardening of the artery, a dense, rough, twisted tube is felt under the third finger.

· Pulse filling.

Filling pulse depends on the stroke volume, the total amount of blood in the body and its distribution throughout the vascular system.

To determine the filling of the pulse, three fingers of the palpating hand (second, third, fourth) are placed on the radial artery. First, the artery is compressed with the second finger until the reverse flow of blood from the vessels of the hand stops, and then the blood is squeezed out of the vessel with the fourth finger and squeezed until the passage of the pulse wave stops. The third finger rests freely on the empty artery. The fourth finger is released, and the pulse wave, passing under the third finger, lifts it and hits the second. The filling of the pulse is assessed by the degree of elevation of the third finger (Fig. 5.5.4.).

Normal pulse is satisfactory filling. In this case, an indentation of the soft tissues of the finger is felt without lifting it.

Full pulse (p.plenus) – vibration of the entire palpating finger is felt.

A full pulse occurs in athletes during sports competitions and during physical activity.

Empty pulse (p.inanis) – raising the vessel wall does not cause a sensation of indentation of the soft tissues of the palpating finger.

Pulse filling decreases with a decrease in cardiac output (left ventricular failure) and a decrease in the volume of circulating blood (blood loss).

An empty pulse occurs with hypotension, acute cardiac vascular insufficiency(collapse, cardiogenic shock), aortic stenosis.

· Pulse voltage.

Voltage pulse depends on the value of systolic blood pressure and the tone of the vascular wall.

The degree of pulse tension is judged by the force that is necessary to compress the artery until the pulsation completely stops.

To determine the pulse voltage, the second - third - fourth fingers of the palpating hand squeeze the artery until the pulsation in it stops (Fig. 5.5.5.).

Normal pulse is of satisfactory tension. The pulsation can be suppressed by applying a certain amount of force.

Solid pulse (p. durus) – preservation of the pulsation of the artery when it is strongly compressed.

A hard pulse occurs when arterial hypertension, atherosclerosis of the arteries.

Soft pulse (p. mollis) – required minimum effort to suppress the pulse.

A soft pulse occurs with hypotension, acute bleeding, mitral stenosis, insufficiency mitral valve, stenosis of the aortic mouth.

· Pulse value.

Palpation evaluate size pulse is very difficult, and therefore about it judge indirectly based on a summary assessment of the filling and voltage of the pulse wave.

The pulse value is influenced by pulse pressure and arterial filling.

By size they are distinguished:

big pulse (p.magnus) – pulse of good filling and tension;

small pulse (p.parvus) – pulse of low filling and tension;

filiform pulse (p. filiformis) – a barely palpable small and soft pulse.

Big pulse occurs when the work of the heart increases (failure aortic valve, thyrotoxicosis, fever). In these conditions, the stroke volume of blood and the frequency of pressure fluctuations in the artery increase or the tone of the arterial wall decreases.

A small pulse occurs when the stroke volume of the left ventricle decreases, pulse pressure. It can occur when there is an obstruction between the heart and peripheral arteries - aortic stenosis or aneurysm.

Thread-like pulse occurs when large blood loss, acute vascular failure (collapse), acute heart failure (cardiogenic shock).

· Pulse shape.

Form The pulse is determined by a sphygmogram and depends on the speed and rhythm of the rise and fall of the pulse wave.

The pulse is distinguished by its shape:

Fast (r.celer),

Slow (r.tardus),

Dicrotic (p.dycroticus).

Fast pulse - jumping, rapidly increasing, may be the result of increased stroke volume of the left ventricle (aortic valve insufficiency, thyrotoxicosis, anemia, fever), pathologically rapid ejection of blood (open ductus arteriosus, arteriovenous fistulas).

Slow the pulse is characterized by a slow rise and fall of the pulse wave and occurs with slow filling of the arteries (aortic stenosis, mitral stenosis).

Dicrotic the pulse consists of two systolic peaks: the main pulse wave is followed by a new, like a second (dicrotic) wave of lesser strength, they correspond to only one heartbeat. The second wave of the pulse is caused by the reflection of blood in peripheral parts arteries and the more, the lower the tone of the arterial wall. Dicrotic pulse indicates a drop in tone peripheral arteries while maintaining the contractile function of the myocardium ( severe infections, collapse). It also occurs in dilated cardiomyopathy, aortic insufficiency with very low stroke volume.

Venous pulse

Venous pulse reflects fluctuations in the volume of veins as a result of systole and diastole of the right atrium and ventricle, when the outflow of blood from the veins into the veins slows down and accelerates right atrium(respectively, swelling and collapse of veins).

The venous pulse is detected and assessed by inspection, palpation and venography.

The study of the venous pulse is carried out on the veins of the neck, always simultaneously examining the pulse in the carotid artery.

Normally, there is a subtle and almost imperceptible pulsation.

Right atrial, or negative venous pulse – normal bulging jugular vein precedes the pulse wave on the carotid artery.

Right ventricular, positive The venous pulse becomes due to tricuspid valve insufficiency. Due to a defect in the tricuspid valve, there is a reverse flow of blood from the right ventricle into 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. More accurate ideas about the venous pulse can be obtained from a venogram.

Capillary pulse

Under capillary pulse refers to the periodic redness (in the systole phase) and blanching (in the diastole phase) of the nail bed with light pressure on the edge nail phalanx(Fig.5.5.6).

You can detect a change in color of the hyperemic spot obtained after rubbing the skin on the forehead, as well as on the mucous membrane of the lips when pressing on them with glass (Fig. 5.5.6).

Based on their origin, a distinction is made between true and precapillary pulses.

Cause true capillary pulse - varying degrees filling of the veins during the systole and diastole phase of the heart, due to which the arterial knee of the capillaries pulsates rhythmically. Appears in individuals young with thyrotoxicosis, high temperature, after applying thermal procedures.

Precapillary pulse (Quincke pulse) occurs only in patients with aortic valve insufficiency. It is caused by release in the systole phase large quantity blood into the aorta and transmission of pulse oscillations to arterioles rather than capillaries. Combined with pulsation of large arteries (“pulsating man”).

When measuring the pressure on both hands, you can see that the indicators are different. The permissible difference should not exceed 5 mm Hg. Art. Why are there different things on my hands? arterial pressure– is this a pathology or the norm?

Causes

Different blood pressure readings can be caused by a number of reasons - serious and not so serious.

The main ones:

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

Sometimes different indicators arise against the background chronic insomnia, overwork. Disturbances in the vegetative nervous system with vegetative-vascular dystonia can cause discrepancies in values. The same reasons can provoke not only different pressures, but also pulses on the left and right hands.

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

What does the difference indicate?

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

The difference in indicators may be accompanied by a deterioration in health - 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 activity. Vascular diseases appear constantly with cold fingers.

But often vascular pathologies are not clearly pronounced signs and they can only be detected by measuring 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 to panic. If there is a discrepancy of 15–20 positions, it is urgent to undergo a full medical examination.

Nonspecific aortoarteritis is another serious pathology, at which there are different pressure indicators. The disease is often diagnosed in women childbearing age. The disease is characterized by severe inflammatory processes in the walls of blood vessels - subsequently they become clogged. Disturbances in the blood flow lead to irreversible changes in internal organs who do not receive enough blood and oxygen. Without proper treatment, every fourth patient dies.

Different blood pressure values during pregnancy

Blood pressure is measured in pregnant women at every hospital visit. Future mom should know your normal indicators and if there is the slightest change, inform your doctor.

Important! In pregnant women, changes in systolic pressure should not exceed 10%. The normal range for 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 see

Even if, apart from the difference in the tonometer readings, there is nothing else to worry about, it is necessary to visit a cardiologist. Atherosclerosis on early stages has no pronounced 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 brain. During the examination, you can detect the location of narrowed vessels and cholesterol plaques, 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 blood vessels of the upper extremities;
chest x-ray;
scanning of the aortic arch.

Basic rules and mistakes when measuring pressure

It is better to use 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, and should be worn exclusively on bare areas of the body. The room should have a comfortable temperature. It is better to carry out measurements strictly certain time, air is pumped in quickly and forcefully, and released slowly.

How to measure pressure correctly:

Sit comfortably, both feet should be firmly on the floor, legs should not be crossed. Talking during the procedure is not recommended.
Lean your back on the back of the chair.
Place your left hand flat on the table or armrest.
The interval between measurements is 5–7 minutes.
If the values are ambiguous or alarming, you need to take the measurement again, but you should start with the right hand.

The blood pressure monitor 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 his back on, then the indicators will be overestimated. A too tight cuff may distort the measurement results.

The device's performance is affected by caffeine-based drinks, nicotine, some medications, and eye and nasal drops. An increase in pressure may be caused by complete bladder and intestines.

It is normal to check the pressure on both arms. This should be done when measuring at home. It is also necessary to ask the doctor during the examination to take measurements on the left and right hands.

Introduction to the problem

Data from numerous studies convincingly show: a difference in pressure of more than 10 mm Hg. Art. between the right and left arms may be a marker of vascular disease of the extremities. With a stable systematic difference of 15 mmHg. Art. and higher, the probability of having significant damage to the cerebral vessels, and therefore 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 hand, rapid fatigue when performing physical activity, chilly 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 It can also occur on different arms in patients who do not suffer from high blood pressure.

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

Causes of pressure difference

If you notice a difference in pressure in your hands, you shouldn’t panic right away: the difference in pressure is a symptom of many conditions, both serious and not so serious, including, for example, different tone of the hands. By using additional examination you can understand what causes the difference.

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

1. Excitement. When our blood pressure is taken, we may be 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 on 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 associated with pressure differences

As mentioned above, if the difference when 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 a reason for examination. For example, for young people this may mean the presence of vascular abnormalities, for middle-aged and elderly people - most often atherosclerosis. Ischemic disease heart disorder cerebral circulation, hypertension, intermittent claudication (muscle pain when walking) - this is what vascular atherosclerosis often leads to.

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

Response measures

A timely detected deviation from the norm will help to make a timely diagnosis and take action. necessary measures For effective treatment, in some situations will help prevent a stroke or heart attack. The difference in pressure between the right and left hands makes it possible to identify atherosclerosis in the early stages, which speeds up the start of treatment and increases its effectiveness. We should not forget 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, as well as for taking medicines prescribed by a doctor.

Diagnosis of stenosis of the subclavian arteries

To find out whether you have stenotic artery lesions or not, your doctor will examine you. Even if you have no symptoms, your doctor may listen for a murmur over the carotid or subclavian arteries caused by blood flowing through the stenotic area. If necessary, a duplex ultrasound scan will be prescribed first. main arteries head and initial parts of the upper extremities (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 angiography ( X-ray examination blood vessels). This test is performed 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 stenotic lesions of the arteries are diagnosed and it is no longer possible to do without surgery, there are two methods surgical treatment. First - open surgery 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 No. 1

A patient complains of dizziness, lack of pulse in the left arm, periodic spasms in the shoulder, weakness in the left arm during physical activity, paresthesia in the fingers, hand and forearm. The angiogram shows severe (up to 90%) stenosis of the left subclavian artery in the initial segment.

A balloon-expandable stent is installed into the area of stenosis under local anesthesia through a femoral approach (puncture on the thigh) (see before and after photos below).

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

The patient's well-being improved significantly.

Clinical case No. 2

A patient complains of weakness in the left hand, worsening with minimal physical activity, chilliness of the fingers of the left hand, episodes of dizziness, and headaches. At the time of measurement before angiography, the pressure on the right arm was 190/100, on the left – 110/75. The difference in systolic pressure between the arms is 80 mm! The angiogram shows occlusion (blockage) of the left subclavian artery in the initial segment (Fig. 1 - angiography from the aorta, Fig. 2 - angiography from the left arm). Due to 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, the brain was robbed.

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 through the blocked area, expand it and install a balloon-expandable stent (Fig. 3).

Adequate blood flow through the subclavian artery (and therefore 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. At control measurement pressure – there is no more pressure difference between the hands.

The patient's health improved significantly.

Clinical case No. 3

A similar case. A patient complains of weakness in the left hand, which worsens with physical activity, chilliness of the fingers of the left hand, episodes of dizziness, and headaches. The difference in systolic pressure between the arms is 40 mm. The angiogram shows subocclusion ( critical stenosis) left subclavian artery in the initial segment (Fig. 1 - angiography before intervention). Due to 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 - along the vertebral artery, that is, the brain was stolen.

Using special instruments to minimize the risks of intervention, using only local anesthesia and access only through the radial artery (at the wrist) of the right upper limb, managed to get through the blocked area, expand it and install a self-expanding stent.

Adequate blood flow through the subclavian artery (and therefore 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. With a control pressure measurement, there is no longer a difference in pressure between the hands.