Different pulses on different hands. Ways to measure pulse on hands

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 (unilateral anomalies in the structure and location of peripheral vessels, compression of arteries by tumors, scars, enlarged lymph nodes, aneurysm of the aorta and its branches, mediastinal tumors, retrosternal localization of goiter) can deform the arterial vessel along the path of the pulse wave. 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 – an arrhythmic pulse, its individual waves of varying 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 of pulse beats is counted in 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.

A rapid pulse occurs during physical and mental stress, when sinus tachycardia, heart failure, drop in blood pressure, anemia, thyrotoxicosis, attack of paroxysmal tachycardia, 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 (if 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 cardiovascular failure (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.

A large 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 with large blood loss, acute vascular insufficiency (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 - different degrees of filling of the veins in the systole and diastole phases 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”).

Pulse is vibrations of the walls of blood vessels associated with changes in their blood supply during cardiac cycle. There are arterial, venous and capillary pulses. Arterial pulse examination 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 palpation of the arteries. For the radial artery, the hand of the person being examined is loosely clasped in the area with the hand so that the thumb is located on back side, and the remaining fingers are on the front surface radius, where the pulsating radial artery is felt under the skin. The pulse is felt simultaneously in both hands, since sometimes it is expressed differently on the right and left hands (due to vascular abnormalities, compression or blockage of the subclavian or brachial artery). In addition to the radial artery, the pulse is examined in the carotid, femoral, temporal arteries, arteries of the feet, etc. (Fig. 1). An objective characteristic of the pulse is given by its graphical registration (see). In a healthy person, the pulse wave rises relatively steeply and falls slowly (Fig. 2, 1); In some diseases, the shape of the pulse wave changes. When examining the pulse, its frequency, rhythm, filling, tension and speed are determined.

How to measure your heart rate correctly

Rice. 1. Method of measuring pulse in various arteries: 1 - temporal; 2 - shoulder; 3 - dorsal artery of the foot; 4 - radial; 5 - posterior tibial; 6 - femoral; 7 - popliteal.

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

A healthy person has a rhythmic pulse, that is, pulse waves follow one another at regular intervals. In case of heart rhythm disorders (see), pulse waves usually follow at irregular intervals, the pulse becomes arrhythmic (Fig. 2, 2).

The filling of the pulse depends on the amount of blood ejected during systole into the arterial system and on the distensibility of the arterial wall. Normally, the pulse wave is well felt - a full pulse. If less blood enters the arterial system than normal, the pulse wave decreases and the pulse becomes small. In case of severe blood loss, shock, or collapse, pulse waves can be barely palpable; such a pulse is called threadlike. A decrease in pulse filling is also observed in diseases that lead to hardening of the arterial walls or narrowing of their lumen (atherosclerosis). With severe damage to the heart muscle, an alternation of large and small pulse waves is observed (Fig. 2, 3) - an intermittent pulse.

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

Pulse speed depends on pressure fluctuations in arterial system during systole and diastole. If the pressure in the aorta rises rapidly during systole and falls rapidly during diastole, then rapid expansion and collapse of the arterial wall will be observed. Such a pulse is called fast; at the same time it can also be large (Fig. 2, 4). Most often the fastest and high pulse observed with aortic valve insufficiency. The slow increase in pressure in the aorta during systole and its slow decrease in diastole causes a slow expansion and slow collapse of the arterial wall - a slow pulse; at the same time it can be small. Such a pulse appears when the aortic mouth narrows due to difficulty in expelling blood from the left ventricle. Sometimes after the main pulse wave a second, smaller wave appears. This phenomenon is called pulse dicrotia (Fig. 2.5). It is associated with changes in arterial wall tension. Dicrotic pulse occurs with fever, some infectious diseases. When palpating the arteries, not only the properties of the pulse are examined, but also the condition of the vascular wall. Thus, with a significant deposition of calcium salts into the wall of the vessel, the artery is palpated in the form of a dense, convoluted, rough tube.

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

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

Pulse (from Latin pulsus - push) is a rhythmic, jerk-like oscillation of the walls of blood vessels that occurs as a result of the release of blood from the heart into the arterial system.

Doctors of antiquity (India, Greece, Arabic East) great attention devoted to the study of the pulse, giving it decisive diagnostic importance. Scientific basis The doctrine of the pulse received after the discovery of blood circulation by W. Harwey. The invention of the sphygmograph and especially its implementation modern methods pulse recording (arteriopiesography, high-speed electrosphygmography, etc.) significantly deepened knowledge in this area.

With each systole of the heart, a certain amount of blood is rapidly ejected into the aorta, stretching the initial part of the elastic aorta and increasing the pressure in it. This change in pressure propagates in the form of a wave along the aorta and its branches to the arterioles, where normally, due to their muscular resistance, the pulse wave stops. The pulse wave propagates at a speed of 4 to 15 m/sec, and the stretching and elongation of the arterial wall it causes is arterial pulse. There are central arterial pulses (aorta, carotid and subclavian arteries) and peripheral (femoral, radial, temporal, dorsal arteries of the foot, etc.). The difference between these two forms of pulse is revealed by its graphical registration using the sphygmography method (see). On the pulse curve - sphygmogram - an ascending (anacrotic), descending (catacrotic) part and a dicrotic wave (dicrotic) are distinguished.

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

Most often, the pulse is examined in the radial artery (a. radialis), which is located superficially under the fascia and skin between the styloid process of the radius and the tendon of the internal radial muscle. In case of anomalies in the location of the artery, the presence of bandages on the arms or massive edema, a pulse examination is carried out on other arteries accessible to palpation. The pulse at the radial artery lags behind the systole of the heart by approximately 0.2 seconds. Pulse examination on the radial artery must be carried out on both arms; Only if there is no difference in the properties of the pulse can we limit ourselves to further study of it on one arm. Usually the hand of the person being examined is grasped freely right hand in 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 should be placed on the radial side, directly on the radial artery. Normally, you get the feeling of a soft, thin, smooth and elastic tube pulsating under your fingers.

If, when comparing the pulse on the left and right hands, a different value is detected or a delay in the pulse on one hand compared to the other, then such a pulse is called different (pulsus differens). It is observed most often with unilateral anomalies in the location of blood vessels, compression by tumors or enlarged lymph nodes. An aneurysm of the aortic arch, if it is located between the innominate and left subclavian arteries, causes a delay and decrease in the pulse wave in the left radial artery. With mitral stenosis, the enlarged left atrium can compress the left subclavian artery, which reduces the pulse wave on the left radial artery, especially in the position on the left side (Popov-Savelyev sign).

The qualitative characteristics of the pulse depend on the activity of the heart and the condition vascular system. When examining the pulse, pay attention to the following properties.

Pulse rate. The counting of pulse beats should be carried out in at least 1/2 minute, and the resulting figure is multiplied by 2. If the pulse is incorrect, the count should be made within 1 minute; if the patient is suddenly excited at the beginning of the study, it is advisable to repeat the count. Normally, the number of pulse beats in an adult man is on average 70, in women - 80 per minute. Photoelectric pulse tachometers are currently used to automatically calculate the pulse rate, which is very important, for example, for monitoring the patient’s condition during surgery. Like body temperature, the pulse rate gives two daily rises - the first around 11 o'clock in the afternoon, the second between 6 and 8 o'clock in the evening. When the pulse rate increases to more than 90 per minute, they speak of tachycardia (see); such rapid pulse called pulsus frequens. When the pulse rate is less than 60 per minute, they speak of bradycardia (see), and the pulse is called pulsus rarus. In cases where individual contractions of the left ventricle are so weak that the pulse waves do not reach the periphery, the number of pulse beats becomes less than the number of heart contractions. This phenomenon is called bradysphygmia; the difference between the number of heart contractions and pulse beats per minute is called pulse deficiency, and the pulse itself is called pulsus deficiens. When body temperature rises, each degree above 37 usually corresponds to an increase in heart rate by an average of 8 beats per minute. The exception is fever during typhoid fever and peritonitis: in the first case, a relative slowdown in the pulse is often observed, in the second, its relative increase. With a drop in body temperature, the pulse rate usually decreases, but (for example, during collapse) this is accompanied by a significant increase in heart rate.

Pulse rhythm. If the pulse beats follow one after another at equal intervals of time, then they speak of a regular, rhythmic pulse (pulsus regularis), otherwise an incorrect, irregular pulse (pulsus irregularis) is observed. U healthy people There is often an increase in heart rate during inspiration and a decrease during exhalation - respiratory arrhythmia (Fig. 1); Holding your breath eliminates this type of arrhythmia. By changes in pulse, many types of cardiac arrhythmia can be diagnosed (see); more accurately, they are all determined by electrocardiography.

Rice. 1. Respiratory arrhythmia.

Heart rate determined by the nature of the rise and fall of pressure in the artery during the passage of the pulse wave.

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

Rice. 2. Pulsus celer.

Rice. 3. Pulsus tardus.

Pulse voltage determined by the force required to completely stop the propagation of the pulse wave. When examining distally located index finger completely compress the vessel to prevent the penetration of backward waves, and the most proximally lying ring finger apply gradually increasing pressure until the “palpating” third finger ceases to feel the pulse. There is a tense, hard pulse (pulsus durum) and a relaxed, soft pulse (pulsus mollis). By the degree of pulse tension one can approximately judge the value of maximum blood pressure; The higher it is, the more intense the pulse.

Pulse filling consists of the magnitude (height) of the pulse and partly its voltage. The filling of the pulse depends on the amount of blood in the artery and on the total volume of circulating blood. There is a full pulse (pulsus plenus), usually large and high, and an empty pulse (pulsus vaccuus), usually small. With massive bleeding, collapse, shock, the pulse may be barely palpable, thread-like (pulsus filiformis). If the pulse waves are unequal in size and degree of filling, then they speak of an uneven pulse (pulsus inaequalis), as opposed to a uniform pulse (pulsus aequalis). An uneven pulse is almost always observed with an arrhythmic pulse in cases of atrial fibrillation and early extrasystoles. A type of uneven pulse is an alternating pulse (pulsus alternans), when a regular alternation of pulse beats of different sizes and contents is felt. Such a pulse is one of the early signs of severe heart failure; it is best detected sphygmographically with slight compression of the shoulder with a sphygmomanometer cuff. In cases of decreased peripheral vascular tone, 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 during fever (the relaxing effect of heat on the muscles of the arteries), hypotension, and sometimes during the recovery period after severe infections. In this case, a decrease in minimum blood pressure is almost always observed.

Pulsus paradoxus - decrease in pulse waves during inspiration (Fig. 4). And in healthy people, at the height of inspiration, due to the negative pressure in the chest cavity, blood flow to the left parts of the heart decreases and heart systole becomes somewhat more difficult, which leads to a decrease in the size and filling of the pulse. When the upper respiratory tract or myocardial weakness, this phenomenon is more pronounced. With adhesive pericarditis during inspiration, the heart is greatly stretched by adhesions with the chest, spine and diaphragm, which leads to difficulty in systolic contraction, a decrease in the ejection of blood into the aorta and often to the complete disappearance of the pulse at the height of inspiration. In addition to this phenomenon, adhesive pericarditis is characterized by pronounced swelling of the jugular veins due to compression by adhesions of the superior vena cava and innominate veins.

Rice. 4. Pulsus paradoxus.

Capillary, more precisely pseudocapillary, pulse, or Quincke's pulse, is the rhythmic expansion of small arterioles (not capillaries) as a result of a rapid and significant increase in pressure in the arterial system during systole. In this case, a large pulse wave reaches the smallest arterioles, but in the capillaries themselves the blood flow remains continuous. Pseudocapillary pulse is most pronounced in aortic insufficiency. True, in some cases, capillaries and even venules are involved in pulsatory oscillations (the “true” capillary pulse), which sometimes happens in severe thyrotoxicosis, fever, or in healthy young people during thermal procedures. It is believed that in these cases from venous stagnation the arterial branch of the capillaries expands. The capillary pulse is best detected by lightly pressing the lip with a glass slide, when alternating redness and blanching of its mucous membrane, corresponding to the pulse, is detected.

Venous pulse reflects fluctuations in the volume of the veins as a result of systole and diastole of the right atrium and ventricle, which cause either a slowdown or acceleration of the outflow of blood from the veins into the right atrium (swelling and collapse of the veins, respectively). The study of the venous pulse is carried out on the veins of the neck, always simultaneously examining the pulse of the external carotid artery. Normally, a very subtle and almost imperceptible pulsation is observed when the bulging of the jugular vein precedes the pulse wave on the carotid artery - the right atrial, or “negative”, venous pulse. In case of tricuspid valve insufficiency, the venous pulse becomes right ventricular, “positive”, since due to a defect in the tricuspid valve there is a reverse (centrifugal) flow of blood - from the right ventricle to the right atrium and veins. Such a venous pulse is characterized by pronounced swelling of the jugular veins simultaneously with a rise in the pulse wave in the carotid artery. If you press the jugular vein in the middle, then its lower segment continues to pulsate. A similar picture can occur with severe right ventricular failure and without damage to the tricuspid valve. A more accurate picture of the venous pulse can be obtained using graphical methods registration (see Phlebogram).

Hepatic pulse determined by inspection and palpation, but its nature is revealed much more accurately by graphical recording of liver pulsation and especially by X-ray electrokymography. Normally, the hepatic pulse is determined with great difficulty and depends on the dynamic “stagnation” in the hepatic veins as a result of the activity of the right ventricle. With tricuspid valve defects, systolic pulsation may increase (with valve insufficiency) or presystolic pulsation (with orifice stenosis) of the liver may occur as a result of a “hydraulic seal” of its outflow tract.

Pulse in children. In children, the pulse is much higher than in adults, which is explained by a more intense metabolism, rapid contractility of the heart muscle and less influence of the vagus nerve. The highest heart rate is in newborns (120-140 beats per minute), but even on the 2-3rd day of life, the heart rate may slow down to 70-80 beats per minute. (A.F. Tour). With age, the heart rate decreases (Table 2).

In children, the pulse is most conveniently examined using radiation or temporal artery. The youngest and restless children To count the pulse, you can use auscultation of heart sounds. The most accurate pulse rate is determined at rest, during sleep. A child has 3.5-4 heartbeats per breath.

The pulse rate in children is subject to large fluctuations.

Increased heart rate easily occurs with anxiety, screaming, muscle exercise, or eating. The pulse rate is also influenced by ambient temperature and barometric pressure (A. L. Sakhnovsky, M. G. Kulieva, E. V. Tkachenko). When a child’s body temperature rises by 1°, the pulse increases by 15-20 beats (A.F. Tur). Girls have a pulse higher than boys, 2-6 beats. This difference is especially pronounced during puberty.

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

Children experience the same types of cardiac arrhythmias as adults. In children with 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: the heart rate increases during inhalation and slows down during exhalation. Extrasystoles in children, most often ventricular, occur with myocardial damage, but can also be functional in nature.

A weak pulse with poor filling, often with tachycardia, indicates signs of cardiac weakness, decreased blood pressure. A tense pulse, indicating an increase in blood pressure, is most often observed in children with nephritis.

Our body works continuously throughout our lives. Even while we sleep or just relax, internal systems do not know 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 its beating in the chest, we feel an increase in rhythm, but the best way to monitor cardiac activity on our own 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 the 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 the inner thigh, “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 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. Different pulse on the right and left hand indicates problems in the development and/or functioning of the cardiovascular system. On the right hand, the pulse may be weaker than on the left, or it may be felt asynchronously, with a delay.

Please note that you need to find the pulse with two relaxed fingers, the index and middle. It is incorrect to determine the pulse on the hand with the thumb of the other hand, because the pulsation in the thumb is also felt quite strongly. Therefore, it is easy to make a mistake and mistake the thumb pulse for the pulse on 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 correctly find the pulse on the 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 heart rate monitor, or, more simply, a pulsometer. 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 overstrain the cardiovascular 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 limiting value, and the 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 “does not reach” the average, then the right decision Do not look for the pulse on your own, but consult a doctor. A professional will measure your pulse using medical methods and determine the causes of tachycardia or bradycardia and prescribe adequate treatment. Be healthy and may your heart rate always be normal!

Article publication date: December 31, 2016

Article updated date: 12/18/2018

From this article you will learn: what causes different pressure on hands; when it's normal and when it's not. Why is it necessary to measure blood pressure on both hands?

Many people who measure and monitor blood pressure do not do the right thing if they perform tonometry on only one arm. But even those who do this from both sides, noticing the difference in numbers, cannot correctly assess the significance of such a phenomenon.

Rules for measuring pressure on both hands

The difference in pressure on the left and right hand can be absolutely normal occurrence, and evidence of disease. According to some literature data, about 50% of patients with a pronounced difference in indicators (more than 20 mm Hg) die within 10 years. Having learned about this, many people for whom this condition may be a variant of the norm begin to panic and independently treat a non-existent disease, although in fact there is no need to do anything - after all, they are healthy. A 15–20% difference in pressure on the hands is really alarm signal diseases requiring immediate clarification of the cause and special treatment.

A specialist - a therapist or family doctor - will help you understand the situation. If necessary and depending on the suspected cause, they will prescribe a consultation with other specialists: a cardiologist, vascular surgeon, neurologist. Correct diagnosis and treatment not only normalize blood pressure, but also prevent more serious threats . It is possible to be cured.

How to figure out whether this is normal or pathological

If, after measuring the pressure of yourself, your loved ones, or any other people, you notice a difference in numbers between your right and left hands, pay attention to several facts that are described and deciphered in the table:

What to look for	Features of the influence of the factor on pressure
The magnitude of the difference (by how many mmHg do the indicators differ)	The permissible range of fluctuations is 5–10 mm Hg. Art. both upward and downward. The greater the difference, the more it indicates pathology.
On which arm is blood pressure changed?	In both normal and pathological conditions, pressure asymmetry is recorded equally often on both the right and left
Increased or decreased blood pressure	If it is normal or high on one hand, and even higher on the other, the problem is less dangerous than a decrease in numbers below normal on one side against the background of normal ones on the other.
Age	In teenagers and older people age group blood pressure difference occurs more often
Right-handed or left-handed	The pressure increases mainly on the main working hand
Is the person connected to active sports and physical work	If so, it is more likely that the BP asymmetry is a result of them
Presence of complaints and symptoms	If they exist, this indicates the pathological nature of the pressure asymmetry

If you measure your blood pressure rarely, but because of some complaints or out of curiosity, be sure to do it on both hands. If you perform tonometry daily, then measure the indicators on the right and left at least once a month.

Who can be calm and why?

From the table above, we can conclude that a discrepancy in blood pressure between the right and left arms is always a variant of the norm, only if the difference in indicators does not exceed 5–10 mm Hg. Art. (it is typical for 50–60% of people). In all other cases, the interpretation of data must be approached individually.

On which hand should the pressure be higher normally?

Pressure asymmetry in the form of a unilateral increase is less dangerous than a unilateral decrease if the numbers on the second arm are normal or elevated (from 100/60 to 140/90 and above).

Increased pressure may be on the left arm

In healthy, right-handed young people who are not involved in intense physical activity, the pressure on the left hand may be higher than on the right. In actively working left-handers, this difference may be even greater (about 20 mm Hg).

Explanation: main artery, the blood supply to the arm - the subclavian - on the left departs directly from the aorta, so the blood pressure in it is higher. The right moves away from less large vessel– brachiocephalic trunk, so the pressure in it is lower.

Increased pressure may be on the right arm

In right-handed people associated with active physical activity, the indicators on the right should be higher than on the left, but within the acceptable numbers. Explanation: against the background of systematic loads, the muscles of the shoulder and shoulder girdle, through which the subclavian and brachial arteries pass, increase in volume and become dense. This causes mechanical compression of the vessels, due to which the pressure in them increases.

Who should be wary

Suspect that the blood pressure is different different hands- this is a symptom of pathology, it is possible in cases where the indicators differ by more than 10–20 units. The greater this difference, the more serious problem. Possible situations and reasons are described in the table.

Most frequent illnesses, in which the patency of the arteries of the upper extremities is impaired:

Atherosclerosis – cholesterol plaques.
Thrombosis and thromboembolism - the formation of blood clots on the walls or their entry from the heart.
Aortoarteritis is inflammation of the vascular wall.
An aneurysm is a sac-like expansion and destruction of the arterial wall.
Scalenus syndrome is a thickening of the muscle fibers through which the subclavian artery passes.
Tumors of soft tissue and bones in the chest and shoulder area.
Injuries and operations on blood vessels.

Possible manifestations

Due to the fact that a strong decrease in pressure in one arm indicates blockage of the arteries and impaired circulation in it, the following symptoms arise:

The brush loses strength.
Fingers become cold, pale and numb.
There may be cyanosis of the fingertips or the entire hand.

But if the pressure decreases on the right hand, in addition to these symptoms, signs of cerebrovascular accident occur. This is due to the fact that the vessels supplying blood to half of the brain and the upper limb, on this side, depart from the aorta through a common trunk. These are the signs:

headache;
dizziness;
protracted speech;
memory loss;
paralysis of half the body;
facial distortion.

Symptoms of impaired blood supply to the brain and arm

Conclusion: the true pressure in a person with different indicators on the left and right hand is the one that is higher. Therefore, if you want to evaluate the current hypertension and the effectiveness of treatment with antihypertensive drugs, focus only on it.

Who needs treatment

If the pressure difference between the left and right hand does not exceed 10 mmHg. st – no treatment is required at all. If this difference increases by more than 15–20 points, you need to contact a specialist. This could be a family doctor or internist. You may need specialized treatment under the supervision of a vascular surgeon, neurologist, or cardiologist.

This may require:

Regular tonometry (measurement of indicators).
Taking medications that restore vascular patency, slow the progression of atherosclerosis or aortoarteritis, thin the blood and improve blood circulation.
Drug treatment of hypertension and vegetative-vascular dystonia.
Gymnastics and physiotherapy for the belt upper limb and physiotherapeutic procedures for this area.
Surgical treatment – removal of blood clots, cholesterol plaques, placing stents and even replacing damaged arteries with an artificial prosthesis.

Treatment for pressure differences between the right and left hands

If you seek help immediately after detecting such a deviation, treatment will help eliminate not only the pressure deviation, but also its cause. Targeted treatment completely solves the problem - you can be cured.

Forecast

If the difference in pressure on different hands is acceptable, there is nothing to be afraid of - there are no threats.

If, simultaneously with a disturbance in the blood supply to the arm, cerebral circulation is disrupted, a stroke often occurs against this background, and with widespread atherosclerosis coronary vessels a heart attack may also occur. That is why a pronounced difference in pressure on the hands often precedes these dangerous diseases, which in 50% of cases end in the death of patients.

Most people only measure their blood pressure on one arm. This is not entirely true, since different pressures on the right and left hands often indicate serious disorders. If you detect this deviation, you should definitely consult a doctor. The doctor will conduct a more detailed examination and select adequate therapy. So what does different pressure mean?

Only a doctor can clearly determine why different arms have different blood pressure. However, there are symptoms that allow you to suspect the presence of problems yourself. First of all, it is worth assessing the magnitude of the difference. If the range does not exceed 10 points, this is considered a variant of the norm.

Also, when measuring blood pressure, it is worth considering the following features:

Age category. In adolescents and older people, the difference in parameters is noted much more often.
Left-handed or right-handed. Usually there is more high rate pressure in the working hand.
Activity. If the pressure determination is carried out after physical work or sports loads, the difference can be quite serious.

Important: Great importance has presence additional symptoms. If the patient's health seriously deteriorates, the likelihood of developing dangerous pathologies much higher. In such a situation, you should immediately consult a doctor.

Reasons for the difference in blood pressure readings

If the pressure on different hands is very different, it is worthwhile to promptly determine the causes of this condition. In most cases, this disorder is observed in adult patients. Moreover, women are predominantly susceptible to it.

A difference in pressure in the hands can be a symptom of the following conditions:

In any case, all provoking factors are physiological or pathological character. In the first case, the cause may also be a temporary effect on the body of drinks containing caffeine or alcohol.

If the parameters change due to internal violations, provoking factors include:

ischemic disease;
heart attack;
Availability excess weight and obesity;
heart failure;
diabetes;
sunstroke;
excessive salt consumption.

In some cases, different blood pressure levels are observed during pregnancy. To make sure there are problems, it is worth taking measurements several times. If a symptom persists, it is important to determine its causes.

In any case, there is no need to panic. In the body of a pregnant woman, there is an increase in venous blood flow and an increase in the total amount of blood. Therefore, an increase in blood pressure in the first trimester does not always indicate the presence of problems.

At the same time, the occurrence of symptoms of arterial hypertension for more than later It can be a sign of pathologies of the cardiovascular system and kidneys. The parameters directly depend on the severity of the anomaly. This is what determines the level of threat to intrauterine development fetus

Rules for measuring blood pressure

To obtain correct result, you need to take measurements several times, following certain recommendations. Pressure parameters should be determined in calm state. If deviations from the norm are detected, you should consult a therapist.

Quite often, people accidentally detect an increase in blood pressure, which then normalizes on its own. This condition may indicate the first degree of hypertension.

At this stage, an increase in pressure is observed sporadically, and the parameters on the tonometer are not very high. The person does not take any action to normalize the indicators, and the pressure independently returns to the usual parameters.

However, this does not mean that this condition should be ignored. In such a situation, it is necessary to make adjustments to your lifestyle - eat right, eliminate bad habits, and regularly exercise. If measures are not taken, the disease will begin to progress. Controlling blood pressure is necessary to prevent hypertension.

To obtain correct values, you should measure your blood pressure 2 times a day. This must be done at the same time. To perform a characteristic measurement, the easiest way is to use an automatic device. Before the procedure, you must stop smoking for 1 hour. Also on this day you should not drink alcoholic beverages.

What to do to measure pressure? When using a mechanical tonometer, the algorithm for this procedure consists of the following manipulations:

Place the cuff on your arm so that it is in the area of your heart. It is permissible to fix it 20 mm from the bend of the elbow.
Pump the pear with air. To feel as comfortable as possible, you should contact an assistant.
You need to pump air until the pulse disappears while listening.
When the manipulations are completed, the air is released. This is done until the pulse is heard again. This indicates the top pressure.
When the pulse sounds disappear, the lower pressure is recorded.

Important: The parameters will not be correct if the hand is located above or below the heart area. If a person has nothing to rely on during measurement, the indicators will be high. Also, the parameters on the tonometer are affected by a tightly tightened cuff.

In addition, incorrect values are caused by the use of nasal drops. Eye drops have a similar effect.

If everything is done correctly, but the pressure on the hands is different, it is worth determining what exactly provokes the deviation. The cause is a violation of the patency of the arteries that are located in the arms.

The disease is caused by thrombosis, atherosclerosis, and tumor formations in the tissues of the sternum and shoulder. Traumatic injuries and scalene muscle syndrome are also provoking factors. In addition, various deformations of blood vessels lead to problems.

In what cases is therapy needed?

If the pressure on the hands is different, but the difference does not exceed 10 points, no special treatment is required. If the difference is greater, you should first consult a therapist.

A constant difference of 15 points indicates a high probability of developing a stroke. If the difference is 20 units, this indicates occlusion of the subclavian artery.

Based on the results of preliminary diagnostics, the therapist refers to other specialists. Often there is a need to consult a neurologist or cardiologist. In some situations, it is not possible to do without the help of a vascular surgeon.

Treatment includes the following components:

Systematic tonometry. This procedure involves daily measurements of pressure parameters.
Application medicines. To cope with the problem, medications are used that normalize the patency of blood vessels, help thin the blood, and improve blood circulation.
Drug therapy of hypertension. There is also often a need for treatment of vegetative-vascular dystonia.
Physiotherapy. Usually correct complex exercises are selected by the doctor.
Physiotherapy for hands.
Surgical intervention. In some situations, it is not possible to do without replacing the affected arteries with an artificial prosthesis.

A person is not able to independently make decisions regarding the use of medications. Many people, even after seeing a doctor, try to find cheaper drugs with the same spectrum of action. Doing this is strictly prohibited. Treatment will at the very least be ineffective, and in some cases it will even worsen the patient’s health condition.

If differential pressure in the arms is diagnosed, the cause and treatment of this condition is determined by the doctor. To cope with the violation, it is worth carrying out a number of additional diagnostic procedures and select effective treatment methods. This will restore your health and minimize the likelihood of dangerous consequences.