Pulsates near the heart. Palpation of the heart area

Other types of pulsation in the area of ​​the heart and in its vicinity. In healthy people, aortic pulsation is not detectable, with the rare exception of people with an asthenic build who have wide intercostal spaces. By palpation, you can determine the pulsation of the aorta when it expands, and if the ascending part is expanded, the pulsation is felt to the right of the sternum, and when its arch expands, in the area of ​​the manubrium of the sternum. With an aneurysm or significant expansion of the aortic arch, pulsation is detected in the jugular fossa (retrosternal, or retrosternal, pulsation). Sometimes you can detect thinning (usura) of the ribs or sternum caused by the pressure of the dilated aorta. Epigastric pulsation, i.e., visible raising and retraction of the epigastric region, synchronous with the activity of the heart, may depend not only on the hypertrophy of the right ventricle, but also on the pulsation of the abdominal aorta and liver. Epigastric pulsation, caused by right ventricular hypertrophy, is usually detected under the xiphoid process and becomes more pronounced with deep inspiration, while pulsation caused by the abdominal aorta is localized somewhat lower and becomes less pronounced with deep inspiration. Pulsation of the unchanged abdominal aorta is detected in malnourished patients with a relaxed abdominal wall. Palpation can reveal pulsation of the liver. A distinction is made between true liver pulsation and transfer pulsation. True pulsation in the form of the so-called positive venous pulse occurs in patients with tricuspid valve insufficiency. With this defect, during systole, a reverse flow of blood occurs from the right atrium into the inferior vena cava and hepatic veins, so with each heartbeat the liver swells. Transmission pulsation is caused by the transmission of heart contractions. Trembling of the chest, or the “cat purring” symptom, reminiscent of the sensation obtained when stroking a purring cat, is of great importance for the diagnosis of heart defects. This symptom is due to the same reasons as the formation of noise due to stenosis of the valve openings. To identify it, you need to place your hand flat on those points where it is customary to listen to the heart. “Cat purring”, detected above the apex of the heart during diastole, is characteristic of mitral stenosis (diastolic, presystolic tremors), above the aorta during systole - for stenosis of the aortic mouth (systolic tremors).

38. Heart percussion. Determination of the boundaries of relative dullness of the heart. Using the percussion method, it is possible to determine the projection area of ​​the heart and its individual chambers onto the anterior chest wall, as well as the position and configuration of the heart and vascular bundle. When percussing the area of ​​the heart covered by the lungs, a dull cercutory sound is formed. This zone is called the zone of relative dullness of the heart. When percussing over an area of ​​the heart not covered by the lungs, an absolutely dull sound is detected. This zone is called the zone of absolute dullness of the heart5.

The right contour of the relative dullness of the heart and vascular bundle is formed from above by the superior vena cava (to the upper edge of the third rib), from below - by the right atrium; the left contour from above is formed by the left part of the aortic arch, the pulmonary trunk, at the level of the third rib - by the appendage of the left atrium, and below by a narrow strip of the left ventricle. The anterior surface of the heart is formed by the right ventricle. Relative dullness of the heart is a projection of its anterior surface onto the chest and corresponds to the true boundaries of the heart, absolute - the anterior surface of the heart, not covered by the lungs. Percussion can be performed in horizontal and vertical positions of the patient: it should be taken into account that the size of cardiac dullness in a vertical position is smaller than in horizontal. This is due to the mobility of the heart and the displacement of the diaphragm when changing position. Determination of the boundaries of relative dullness of the heart. When determining the boundaries of relative dullness, it is necessary to percussion along the intercostal spaces to avoid lateral propagation of vibrations along the ribs. The percussion blow should be of medium strength. It is necessary to ensure that the pessimeter finger is pressed tightly against the chest wall (to achieve a deeper distribution of blows). When determining the boundaries of relative dullness, the most distant points of the cardiac contour are found, first on the right, then on the left, and finally on top (Fig. 40). Since the location of the borders of cardiac dullness is influenced by the height of the diaphragm, first determine the lower border of the right lung along the midclavicular line, which is normally located at the level of the VI rib; the position of the lower border of the lung gives an idea of ​​the level of the diaphragm. Then the pessimeter finger is moved one intercostal space above the lower border of the right lung and placed parallel to the determined right border of the heart (normally in the fourth intercostal space). Percussion is performed, gradually moving the pessimeter finger along the intercostal space, towards the heart until a dull percussion sound appears. Along the outer edge of the finger, facing the clear percussion sound, the right border of the relative dullness of the heart is marked. Normally, it is located 1 cm outward from the right edge of the sternum. The left border of the relative dullness of the heart is determined in the same intercostal space in which the apex beat is located. Therefore, first, the apical impulse is found by palpation, then the pessimeter finger is placed outward from it parallel to the desired border and percussed along the intercostal space towards the sternum. If the apical impulse cannot be determined, percussion should be performed in the fifth intercostal space from the anterior axillary line towards the sternum. The left border of the relative dullness of the heart is located 1-2 cm medially from the left midclavicular line and coincides with the apex beat.

The upper limit of relative cardiac dullness is determined by moving 1 cm to the left of the left sternal line. To do this, a pessimeter finger is placed perpendicular to the sternum near its left edge and moved downward until the percussion sound becomes dull. Normally, the upper limit of relative cardiac dullness is located on the third rib.

Having established the boundaries of relative dullness of the heart, the diameter of the heart is measured with a centimeter tape, for which the distance from the extreme points of the boundaries of relative dullness to the anterior midline is determined. Normally, the distance from the right border of relative dullness, usually located in the fourth intercostal space, to the anterior midline is 3-4 cm, and the distance from the left border of relative dullness of the heart, usually located in the fifth intercostal space, to the same line is 8-9 cm. These values in total they form the diameter of the relative dullness of the heart, normally it is 11-13 cm. An idea of ​​the configuration of the heart can be obtained by percussion determining the boundaries of the vascular bundle in the second intercostal space on the right and left and the relative dullness of the heart in the fourth-third intercostal spaces on the right and in the fifth, fourth and third intercostal space on the left. To do this, the pessimeter finger is moved parallel to the boundaries of the expected dullness and the boundary of the emerging dullness of percussion sound is marked with dots on the patient’s skin. By connecting these points, the contours of the relative dullness of the heart are noted. Normally, along the left contour of the heart, there is an obtuse angle between the vascular bundle and the left ventricle. In these cases, they speak of a normal configuration of the heart. In pathological conditions, with expansion of the heart, its mitral and aortic configurations are distinguished.

Constant discomfort in the heart and strong pulsation

Floor: not specified

Age: not specified

Chronic diseases: not specified

Hello! I was 21 years old, when I came back from the army, I worked out in the gym, after half a year I first started to have pain in the heart area, at first I didn’t pay attention to it periodically, but just in case I stopped working out in the gym, it was such that when I took a deep breath I felt such pain a feeling that something had torn under the heart and let go, when the pain resumed, I went to the hospital, they did an ECG and fluorography was said to be normal, this summer the pain was usually after sleep, some kind of unpleasant sensation in the left chest or shoulder, but when I walked around during I didn’t feel any pain for a day and didn’t have any physical effects. The summer passed in October, the deterioration began more significant and more protracted, at first such a malaise kept floating in my head as if everything was happening in reality and there was no clear consciousness, all the sensations became somehow weak, it became like a zombie, at times this feeling intensified and vice versa... Weakness, blood pressure became lower usual, my blood pressure was 100 over 60 or 110 over 70, the pain in my chest became almost constant and radiated to my left arm, I woke up in the morning with pain and stiffness in the left thoracic region, I noticed that when I took a warm bath the pain went away a little and not for long, I went again They sent him to a cardiologist for an echo. Conclusion: There is an additional chord in the cavity of the left ventricle, myocardial contractility is preserved. Severe tachycardia. Magne B6 and afobazole were prescribed. I also caught a little cold and didn’t have a fever. The heart was beating both dynamically (walking, studying)... And at rest, it was strongly 90-100 beats and it felt like it was straining a lot. The pulse was felt throughout the body (stomach, head, arms). I continued to do the usual things, although I felt that now everything was more difficult... And then one day while studying, when I was sitting in a state of rest, I felt very bad that I was about to lose consciousness, there seemed to be a hole in my chest or something like a stop for a second or two... I thought something with my heart, got up in a panic, went out and walked around, I was literally in a storm, I moved a lot because if I stopped, it seemed like I would fall. I went to the hospital in a minibus again, it started to happen again, only my heart was beating at a wild speed, as if it was going to fly out now, I wanted to get out, but when I got there, it became easier, my heart wasn’t beating like that, only I was weak, in the hospital they did an ECG and they said it was normal. I took blood and thyroid tests and everything was normal. One day at home I had such an attack again, I got up so as not to lose consciousness, the sensation was incomprehensible, I began to move, as if I were studying, I thought it would be easier too, but I couldn’t lie down for a long time, it became even worse, I was talking some kind of nonsense, my tongue became numb, trembling appeared throughout my body, I became cold it looked like a mini-stroke, an ambulance arrived, but by that time it was better, the doctor said to do a spinal examination, measured the pressure and left. .. Then finally I fell ill for 2 weeks, I didn’t even go to school, I was scared that everything would happen again, I always slept a little, I moved a little, everything went to bed, I was weak... I was examined by a neurologist, he says signs of panic attacks, he prescribed fluoxetine, vitamin injections, adaptol, pantogam, did additional echocardiogram: Now they have discovered prolapse of the anterior valve leaflet of the 1st stage with regurgitation of the 1st stage, the leaflets are thickened... Strange, but the chord was not identified... And they didn’t talk about prolapse before either... Passed the stress test Conclusion: The test has a very high negative load tolerance . Normotonic type of reaction to stress. Rhythm disturbances were not induced. Ch 5 min. Resting ECG: normal, tachycardia. As the doctors say, there’s nothing wrong, they said to drink Magne 6 and come back in 2 years... Holter also didn’t reveal any violations, only episodic migration of the pacemaker through the atria and tachycardia, the doctor said there’s nothing wrong... But with prolapse, people write on the Internet that there is no pain or sometimes And it can be congenital and as a result of stress or what? They say it’s not scary if the prolapse is congenital, it’s a structure of the heart, but they didn’t tell me that it’s congenital, but in my friend it’s acquired? And how to recognize this? And what is the difference between acquired and congenital anterior leaflet prolapse? And why do you think your heart still hurts? I also noticed different types of pain... The heart hurts like colitis or pressure, if not the heart then somewhere in the left shoulder or behind the shoulder... Then in the back area where the hump is, or the left arm, or all together then there is horror and the heart is still beating It’s like it’s pulsating strongly.... When I went out into the street, I’m walking and bang, it’s like I was stunned, but my heart wasn’t beating strongly at these times... Doctor, is it prolapse, so is it working????????? Or neurosis?????? Previously, everything was perfect, and even in the army there was physical and psychological stress, but it wasn’t like that... Even if there was this prolapse from birth, maybe it has nothing to do with it at all. Now I feel better and I don’t seem to have any panic attacks, but this discomfort in my chest got me up to my throat and it always hurts. I forgot what it means to feel calm in the left chest.... It’s still strange that there is pain when pressing on the rib in the area of ​​the heart or along the rib... Like intercostal neuralgia, but it also doesn’t fit... What else would you recommend the doctor undergo? What additional examinations? Sorry for making you read so much(((((((but I will wait for your answer))))

22 answers

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Hello! I would advise you to find a good neurologist. All your troubles are due to problems with the spine (intercostal neuralgia or osteochondrosis, you need to figure this out). All the symptoms you describe are neurological in nature. And tachycardia is a consequence of constant, long-term pain. As for the results of echocardiography... They may differ if you were tested on different devices and/or by different doctors. Mitral valve prolapse has nothing to do with your pain, you can believe me (I have it too) :) MVP is a slight “sagging” of the mitral valve leaflets due to their elasticity, usually detected at a young age (when the tissues grow); calling it congenital or acquired is not entirely correct, because this condition is often temporary, appears at a young age and goes away in old age. Moreover, the first degree is the most minimal. And then, the heart is located behind your sternum, physically it cannot hurt for longer than 30 minutes, and it does not react when you press on your chest. In addition, according to the results of all heart examinations, you have excellent results, so why not examine other organs in the same detail? The very fact that your pain went away in a hot bath indicates that the pain is muscular in nature. Magne B6, adaptol and no “heart” drugs will help you. Contact another neurologist, buy an orthopedic mattress and pillow and be healthy!!!

Temirkhan 2013-07-03 17:33

I also have the same condition, only + with a body temperature of 37.4 for three years now (with anxiety), I went to a neurologist, he did not reveal any pathologies, and the cardiologist diagnosed 1st degree mitral valve prolapse with 1st degree regustation. I also worked out in the gym, can a physical person? Do loads affect prolapse? Previously, I did not feel any pain in the chest area, there was no dizziness ((

Hello. Grade 1 mitral valve prolapse cannot affect your life in any way; exercise is not contraindicated. Body temperature is alarming. If it only occurs when you are nervous, try seeing a psychotherapist, he will teach you how to relax and meditate. If the temperature is constant or at some time of the day, you need to look for the cause. Most often inflammatory in nature.

Vitaly 2013-12-03 16:05

Hello, your problems are not related to the heart, you have another disorder, it’s not a matter of nerves, I had this, I can say it will get worse, the problem is solved quickly, literally in three months and everything is fine with your psyche, you will have the desire I can help!!!

Victory victory 2014-09-03 07:44

Vitaly tell me the solution to the problem

Alexander 2014-03-03 02:19

Guys, it's most likely gall.

Timur Klimashevich 2014-05-06 21:11

You know,! I was the first to catch this condition 2.5 years ago, the same condition, a little crazy. Let's go! Also after serious exertion, then everything seemed to calm down, but to this day my heart is still very naughty and it seems to me that it is getting worse and worse, but the doctors say everything is normal, shortness of breath has appeared, something similar to tachycardia, in general it’s a disaster! If anyone has been diagnosed, please tell me!

Alexander 2015-01-11 18:48

I have a completely similar situation. I changed 4 hospitals and to no avail. I feel pain in my heart, feel dizzy, my legs go numb, and it seems like I’m about to lose consciousness. Sometimes I even feel like I’m going to die. I have been suffering for a year and 2 months. The heart itself is said to be normal. I took a lot of things from tablets (painkillers, nicotinic acid, Grandaxin, magnesium and much more, vitamin injections, heating, nanoplast, etc. Nothing helps. Help, I want to return to professional sports

Hello. Most likely it is neurological. Contact a neurologist and psychotherapist.

Yuri 2015-02-10 01:58

Hello, the symptoms are very similar to mine, they practically only radiate to the shoulder and arm and fingers and veins, as if stabbing from the inside, sometimes a dull aching pain under the armpit and there is a pulsation in the stomach and in the arm on the fingers near the head, I can just feel the pulse . I did an echo, doppler and hotler, everything was almost normal, everyone says that it is most likely not the heart. But I never found the reason. It has been going on for 2.5 years, sometimes it subsides for a month, then it starts again. By the way, over time, the intervals between exacerbations of pain become shorter and shorter, and this is scary. If someone solved the problem, please post. And which doctors to go to and what research to do. Thanks in advance. Yuri is 29 years old. Sometimes your heart rate increases at night.

Hello. Try going to a neurologist.

Alexander 2019-11-06 23:58

That's the problem, we won't get an answer. I have been running around with such problems since I was 11 years old, but why and why all this is happening I have never received an answer. You can open a pharmacy at home, there are so many medications accumulated. Doctors only visit each other and each one supposedly treats you, but you, like a fool, want to believe that it will help and get treated, replenishing their pocket.

Give at least one positive treatment with similar symptoms. People ask the question, and not just one person, there are many of us. Find the answer, Give an example of at least one patient how you helped him. All you can do is chase each other. Convene a consultation and respond here. Once again, more than one patient wrote to you. But you unsubscribed from everyone and supposedly helped.

Arthurs 2015-06-17 13:36

Hello! Three months ago I began to feel my pulse in my chest. Extrasystoles appeared, and noise in the head and ringing in the left ear also appeared. Sleep disturbance, arrhythmia, tachycardia. If I was a little late in falling asleep, my blood pressure would jump. There were crises of the hypertensive type, with strong tachycardia up to 160, during the attack. In addition to the feeling of a pulse in the chest, there is constant discomfort. If I suddenly get up from a sitting position, my pulse slows down significantly and a strong pulsation begins in my head and chest, and a feeling of loss of consciousness appears. At the same time, tremors of both the limbs and the sensation of a second pulse bother me before going to bed. I visited all the doctors, a neurologist, a cardiologist, a psychotherapist, and so on. As a result of a visit to a lot of doctors, it was revealed: stage 1 myocardial infarction, dystonic type of heartbeat, tachycardia 80-90 beats per minute, gastrobulbit, insufficiency of the gastric cardia, chronic gastritis, non-ulcerative dyspepsia against the background of chronic disease. Gastritis, VSD, NSC, grade 1 hiatal hernia, gall bladder polyps, chronic prostatitis, osteochondrosis of the thoracic and cervical spine, with instability in the cervical spine, rhino-sinusitis. I underwent a course of treatment in the gastroenterology department, spent time in the neurology department, and everyone answered unequivocally: I was overworked, I was very overworked, my nerves need to be treated. After treatment, it became much better, the pressure stopped jumping, and the tachycardia went away, but the feeling of heartbeat in the chest and ringing in the head remained. Tell me what else I need to check to exclude pathologies and so on. Could problems with hormones, poor circulation in the head, osteochondrosis, and everything in that vein give such symptoms? There is no longer time to go to hospitals and get examined. My family therapist cannot say anything sensible; he has not encountered such cases.

PULSATION, pulsations, plural. no, female Action under Ch. pulsate. Heart pulsation. Current ripple. || Presence of pulse. Ushakov's explanatory dictionary. D.N. Ushakov. 1935 1940 … Ushakov's Explanatory Dictionary

PULSATION- (cf. century lat., from pulsus pulse). The beating of the pulse, the heart, the arteries, the beating of the pulse. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. PULSATION heartbeat, i.e. alternating contraction and expansion of the heart and blood vessels;… … Dictionary of foreign words of the Russian language

pulsation- and, f. pulsation f. , lat. pulsatio pushing. 1. Repeated beating (heart, arteries), rhythmic movement (blood); pulse beat. BAS 1. The number of pulsations varies among different birds. Turov Bird life. || Feeling of beating, twitching in the patient,... ... Historical Dictionary of Gallicisms of the Russian Language

Ripple- I Ripple (lat. pulsatio beating, beats) jerky movements of the walls of the heart and blood vessels, as well as transmission displacements of soft tissues adjacent to the heart and blood vessels, resulting from contractions of the heart. The concept of “pulsation” is more... ... Medical encyclopedia

precardiac pulsation- (p. praecardialis; synonym P. precordial) P. the anterior wall of the chest in the area of ​​​​the projection of the heart onto it, arising from a cardiac aneurysm ... Large medical dictionary

Ripple- (pulsatio heartbeat) – rhythmic changes in the volume of the heart, blood vessels, vibrations of adjacent tissues... Glossary of terms on the physiology of farm animals

pulsation- (pulsatio; lat. pushing, blows) rhythmic change in the volume of the heart or blood vessels or the associated oscillatory movement of adjacent tissues; in some pathological conditions characteristic types of P are observed... Large medical dictionary

true liver pulsation- (p. hepatis vera; synonym: hepatic expansion pulse, venous liver p.) Hepatic p., caused by the reverse flow of part of the blood from the right ventricle of the heart into the vena cava or obstruction of the outflow from them; observed with defects... ... Large medical dictionary

liver pulsation is false- (p. hepatis spuria; synonym: hepatic pulsation pulse, hepatic pulsation, transmission liver) P. of the liver, caused by the spread of pulsation of a hypertrophied heart or pulsation of the aorta to it through adjacent tissues ... Large medical dictionary

Ripple- and. 1. Repeated beating (heart, arteries), rhythmic movement (blood); pulse beat. Ott. Sensation of beating, twitching in a sore, affected part of the body. 2. Rhythmic change of something (size, shape, speed, pressure, etc.). Intelligent... ... Modern explanatory dictionary of the Russian language by Efremova

HEART DEFECTS- Aconite, 3x, 3 and bvr exacerbation of rheumatic carditis with valvular heart disease. Stitching pain in the chest, radiating to the left shoulder. Palpitation with loss of strength. The pulse is full, hard, tense, galloping, intermittent. State of fear... Handbook of Homeopathy

Inspection. There is no visible pulsation in the region of the heart, base of the heart, jugular fossa, or epigastric region. A positive venous pulse, Mussy's sign, and "carotid dance" were not detected.

Palpation. The apical impulse is located 1.5 cm medially from the left midclavicular line, of medium strength, limited. The heartbeat is not palpable.

Systolic and diastolic tremor are not palpable. Epigastric pulsation is palpable; it is caused by pulsation of the abdominal aorta.

Percussion.Relative dullness of the heart:

Borders of relative dullness of the heart: right - along the right edge of the sternum (IV intercostal space); left - in the 5th intercostal space, 1 cm outward from the midclavicular line; upper - at the level of the third intercostal space along a line located 1 cm outward from the left sternal line.

The diameter of the relative dullness of the heart is 12 cm.

The width of the vascular bundle is 6 cm.

The heart configuration is normal.

Absolute dullness of the heart:

Borders of absolute dullness: right - along the left edge of the sternum; left - 1 cm inward from the left border of relative dullness of the heart; upper - at the level of 4 ribs.

Auscultation. Heart sounds on auscultation are muffled and rhythmic. III and IV heart sounds are not heard. Pathological cardiac and extracardiac murmurs are not heard. Heart rate (HR) 80 per minute.

Vascular examination

Examination of the arteries: moderate pulsation of the aorta in the jugular fossa, no pulsation of the aorta to the right and left of the sternum. The pulsation of the temporal, carotid, radial, popliteal arteries, arteries of the dorsum of the foot is not changed, there is no rigidity or pathological tortuosity.

Arterial pulse: the same on both radial arteries. Pulse rate 80 beats per minute, rhythmic, moderate filling and tension. Blood pressure 130/70 mm. rt. Art.

Digestive system

Oral examination:

1. The tongue is wet, covered with a white coating.

2. Teeth: dentures, etc. none

Abdominal examination:

Pancreas: not palpable.

The abdomen is symmetrical and participates in the act of breathing. Abdominal circumference - 90 cm. There is no protrusion of the navel. There are no dilated saphenous veins. Scars, stretch marks, hernial formations are absent.

Auscultation. No bowel sounds are heard. Percussion

A tympanic percussion sound is detected over the entire surface of the abdominal cavity. Ascites is not determined by the fluctuation method.

Palpation. Superficial indicative palpation: the abdomen is soft, there is no pain, muscle tension is absent, the presence of a hernia of the white line, no umbilical hernia was detected. Shchetkin-Blumberg's symptom is negative. There are no superficially localized tumor formations. Methodical deep sliding palpation according to Obraztsov - Strazhesko: the sigmoid colon is palpated as a painless, dense, smooth cylinder, about 2-3 cm in size, rumbling is not detected. Cecum: elastic consistency, painless, about 3 cm in size. Transverse colon: soft elastic consistency, painless, easily displaces, does not rumble, size 5-6 cm. Ascending and descending sections of the colon: palpated in the shape of a cylinder of dense, elastic consistency, 2-3 cm in size, the greater curvature and the pylorus of the stomach are not palpable.

Urinary system

Inspection. When examining the kidneys in the lumbar region, redness, pain upon palpation and a feeling of oscillation (fluctuation) were not detected. When examining the bladder area, no bulge is detected in the suprapubic region.

Percussion. Pasternatsky's sign (tapping in the lumbar region) is negative on both sides.

Palpation. The kidneys are not palpable. No pain was detected on palpation in the kidney area. The bladder is not palpable.

Endocrine system

There is no visible enlargement of the thyroid gland. Upon palpation, its isthmus is determined in the form of a soft, mobile, painless roller. There are no symptoms of hyperthyroidism or hypothyroidism. There are no changes in the face and limbs characteristic of acromegaly. There are no weight disorders (obesity, wasting). No skin pigmentation characteristic of Addison's disease was found. The hairline is developed normally, there is no hair loss.

Good afternoon.
Complaints of weakness, flickering spots in the eyes, periodic pressing pain in the heart area during physical activity, lack of appetite, dizziness, dry skin.
Medical history: Suffering from chronic anemia due to ulcerative colitis for approximately 40 years. She received outpatient and inpatient treatment in October 2014. Periodically takes totema, sorbifer durules. Deterioration in health over the past 2 weeks, when the above-described complaints intensified. She sought medical help at the hospital, was examined, and was sent as planned to the hospital.
Life history: more than 40 years - nonspecific ulcerative colitis, constantly takes salofalk 500 mg, 2 t. * 2 r. per day, the last hospitalization for this disease was 5 years ago (AMOCH No. 1), blood pressure has been increasing for many years to 190 - 210/100 -110 mm. rt. st., constantly takes Egilok 50 mg 2 rd, Arifon 1 tsut, chronic venous insufficiency 2 tbsp. In June 2014 - a traffic accident, subcapsular hematoma of the spleen.

diabetes mellitus type 2. Pensioner. Has no bad habits. Denies tuberculosis and viral hepatitis. Drug intolerance: denies. Epidemiological history: Denies contact with infectious patients. Everyone in the family is healthy. There were no blood transfusions. Has not traveled outside the city of Astrakhan for the last 2 months. There were no bites from ticks or other insects. He drinks boiled water and milk. I did not swim in open waters.
Objectively: Temperature 36.3. Condition unsatisfactory. Conscious, she answers questions correctly, in full, her voice is quiet, her speech is correct. The pupils are equal and react well to light. The gait is sluggish, in the Romberg position it sways. Correct physique, subcutaneous fat is normal. Normosthenic constitution. The musculoskeletal system is not changed. The skin is clean, dry, pale in color with a yellowish tint, turgor is reduced. Peripheral lymph nodes (submandibular, cervical, axillary, inguinal) are not enlarged, painless. The thyroid gland is not enlarged. The isthmus is palpated. The chest is of the correct shape. Lungs: respiratory rate - 18 per minute. When percussing the lungs, the sound is pulmonary, of equal sonority on both sides. Auscultation reveals vesicular breathing, no wheezing. The area of ​​the heart is not changed, the limits of relative cardiac dullness are: upper - at the level of 3 m/ribs; right - right edge of the sternum; left - 1 cm medially from the left midclavicular line. Heart: heart rate 78 per minute. Blood pressure in the right arm is 170/90 mmHg.
on the left arm 160/90 mmHg. Heart sounds are muffled, the rhythm is correct. The tongue is moist, thickly coated with white coating. The abdomen is soft and painless on palpation. The lower edge of the liver along the edge of the right costal arch. The spleen is not enlarged. There is no peripheral edema. Pasternatsky's test is negative on both sides. The pulsation of the vessels of the lower extremities is preserved and weakened. Urination is painless and free. The stool is periodic, not always formed.
PRELIMINARY DIAGNOSIS:
Main: Anemia of mixed origin (iron-, folate-deficiency, against the background of a systemic disease), of moderate severity.
Background: Nonspecific ulcerative colitis.
Associated: Secondary arterial hypertension 2 tbsp. Atherosclerosis of the aorta. Sideropenic cardiomyopathy. Diabetes mellitus type 2, compensated. Planned: - Carrying out anti-anemic, detoxification therapy,
COLONOFIBROSCOPY dated March 17, 2015.
He is aware of the nature of the study, and he is warned about a possible biopsy. Consent has been received.
Conclusion: Chronic external and internal hemorrhoids without visible exacerbation. The tone of the anal sphincter is reduced. Catarrhal sigmoiditis?/UC? (the mucosa of the entire sigmoid colon is hyperemic, swollen, against the background of general hyperemia there are areas of brighter hyperemia, in places there is viscous mucus on the mucosa, the lumen of the sigmoid colon is somewhat narrowed, it looks like a tube, there are no folds). A separate biopsy was performed in the proximal and distal parts of the s-colon.
and performing a biopsy, the mucous membrane is structureless and fragmented. In the proximal part of the s-colon, at the place of transition to the descending colon, there is a wide diverticulum, which is a continuation of the intestinal lumen, the mucous membrane in it is the same as in the entire sigmoid colon. Chronic hypotonic colitis / folds throughout the entire colon are smoothed / without visible exacerbation. In the rectum and behind the sigmoid, to the cecum, without inflammatory and organic changes. The result of histological examination after 7 days.
COLONOFIBROSCOPY dated 10/03/2014.
I am aware of the nature of the research. Warned about a possible biopsy. Consent has been received.
Conclusion: Erosive-catarrhal sigmoiditis / mucous membrane of the sigmoid colon throughout, edematous, eroded along the entire perimeter,
in some areas in the form of cobblestone pavement/. A biopsy was performed. Further to the dome of the cecum and in the rectum without features. Histology result after 7 days.
Could you give your conclusion?
Thank you.

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For those who love light effects, I propose to assemble a simple device that, when turned on, resembles a pulsating heart. The device contains 58 color LEDs arranged in the form of three hearts.
The circuitry that drives the LEDs gives the appearance of "pulsing".

In each of the three hearts, the LEDs are connected in series. The LEDs in the large heart are red, the middle one is green, and the smallest one is yellow. It is very important to install the LEDs correctly. If installed incorrectly, the circuit will not work and additional installation check will be required. Therefore, to facilitate the installation of LEDs, the board indicates the places where the anode should be and where the cathode should be. In the new LED, the anode leg is longer than the cathode lead. If the leads have already been shortened, you need to look at the LED in good lighting and you will see that one lead with a cup is the cathode, the second is the anode.

Device circuit board:

All parts are installed on the side of the printed conductors, except for the microcircuit and LEDs. The LEDs are inserted into the board all the way.

Soldering the LEDs must be done quickly (2-3 seconds) to avoid damaging the LEDs. If installed correctly, no adjustments are required. The device is powered by a voltage of 12..14V. If the voltage is less than 12V, the circuit does not work.

Appearance of the assembled device:

List of radio components for assembling a pulsating heart:

Microcircuit - CD4093 (analogous to KR1561TL1)
Resistors:
R1,R2 - 68 kOhm
R3 - 150 kOhm
R4,R5,R6 - 3.3 kOhm
R7,R8,R9,R10,R11 - 270 Ohm
R12, R13,R14,R15 - 100 Ohm
R16,R17 - 47..56 Ohm
Transistors - VS547 (KT3107).
Capacitors:
C1, C2, C3 - 1 µF, 25V
C4 - 100 µF, 25V

Download PCB file: Pulsir.-serdce.lay6 (downloads: 203)

In conclusion, a video of the pulsating heart in action:

radioaktiv.ru

PULSATION(lat. pulsatio) - jerky movements of the walls of the heart and blood vessels, as well as transmission displacements of soft tissue adjacent to the heart and blood vessels, resulting from contractions of the heart.

The concept of “pulsation” is broader than “pulse”, since the latter refers only to P. of the walls of blood vessels, caused by the passage of a pressure pulse wave formed in the aorta through the vessel. At the same time, these concepts do not completely coincide due to more in-depth knowledge of the pulse, which is studied not only within the framework of the mechanical movement of vascular walls (see Pulse, Plethysmography, Sphygmography). The transmission of movements of the contracting heart and pulsating walls of blood vessels over a certain distance depends on the elastic properties of the tissues through which this transmission occurs. The displacement is most quickly absorbed by the air-bearing pulmonary tissue; it is transmitted somewhat better through adipose tissue, and even better through muscles, fascia, cartilage tissue and skin. The displacement force is unable to lead to momentary deformation of the bone tissue (in any case, to a noticeable momentary deformation), although prolonged and strong pulsation of the organ directly adjacent to the bone can cause degenerative changes in the latter, thinning and deformation (for example, urination of the ribs, cardiac hump).

For diagnostic purposes, both the normal P. of the heart and blood vessels and the P. observed in pathology of other organs and tissues are studied. Of the main research methods for studying P., inspection and palpation are used; the choice of additional research methods is determined by its objectives, the localization of the pulsating object, and the reasons causing the pulsation.

P. of the heart is studied in many ways.

In particular, wedge, the study of pulsating heart beats into the chest wall is important. Since most of the surface of the heart is surrounded by a layer of airy pulmonary tissue, its pulsation in healthy people can usually be detected only in the apex, where the amplitude of heart movements is greatest and the layer of pulmonary tissue is insignificant. The moment of visible protrusion of the chest wall or a palpable impulse, localized in the fifth intercostal space (approximately 1.5 cm medial to the left midclavicular line), corresponds to the systole of the ventricles of the heart. P. in the area of ​​the apical impulse is clearly visible visually in thin people, especially in children and young people. In the presence of even a moderate layer of fat, P. in the area of ​​the apex beat cannot always be determined by eye. In these cases, it can usually be detected by palpation, especially with the patient standing, sitting with the torso tilted forward, or lying on the left side.

With the patient lying on his left side, the area of ​​detection of P. shifts 3-4 cm laterally than when lying on his back. The apex beat is more difficult to determine in obese individuals, with a decrease in the stroke volume of the heart, the presence of pleuropericardial adhesions, exudate in the pleural or pericardial cavity; in healthy individuals it is not detected in cases where it is localized behind the rib. When examining the apex beat, pay attention to the location and nature of the pulsation. When the heart is displaced as a result of the formation of adhesions, its displacement by fluid located in the pleural cavities, massive space-occupying formations located in the lungs or mediastinum, or by an elevated diaphragm (with severe flatulence or ascites), the localization of the apical impulse changes in the direction of the displacement force. Enlargement of the left ventricle of the heart leads to a displacement of the apex impulse to the left and down (sometimes to the seventh intercostal space); as the right ventricle enlarges, the apex impulse is also pushed to the left (but not down) due to the pushing of the left ventricle.

The pulsation in the area of ​​the apex beat is characterized by area, height and strength. The height of the apical impulse is the amplitude of the displacement of the chest wall, and the force is the pressure exerted by the apex impulse on the fingers or palm applied to the area of ​​the P. The area and height of the apex impulse are assessed taking into account the structure of the chest: with narrow intercostal spaces they are smaller, with a thin-walled chest more.

the height of inspiration due to an increase in the airiness of the lung tissue separating the apex of the heart from the chest wall, the apical P. is determined on a smaller surface and has a smaller amplitude; sometimes with a deep breath, as well as with pulmonary emphysema, the apical P. is not detected. The main and most common reason for an increase in the area and height of the apex beat is an increase in the left ventricle. A strong (elevating) apical impulse is the only sign of left ventricular hypertrophy accessible to direct medical examination, although P. of a similar nature is also possible with severe cardiac hyperkinesia. A very high and strong (dome-shaped) apical impulse is characteristic of significant eccentric hypertrophy of the myocardium of the left ventricle of the heart, observed, for example, with aortic valve insufficiency. A weakened and diffuse (increased in area) apical impulse is noted with dilatation of the dystrophically altered left ventricle of the heart. Undoubtedly patol signs include P. of intercostal spaces in the precordial region, observed with aneurysms of the anterior wall of the left ventricle (see Cardiac Aneurysm). With obliteration of the pericardial cavity or massive fusion of the pericardium with the pleura, P. in the area of ​​the apical impulse can be paradoxical in nature (negative apical impulse) due to the fact that such changes prevent the movement of the apex of the heart during systole forward and upward, and the contracting heart draws in the tissues fused to it chest wall.

Objective and in-depth characteristics of P. in the area of ​​the apical impulse are carried out using apexcardiography (see Cardiography). To assess the activity of the heart by the displacement of various pericardial media or the entire body associated with its P., ballistocardiography (see), dynamocardiography (see), pulmocardiography (see) and other methods of special studies are also used. To study P. of the contours of the heart, rentgenol is used. research methods, especially x-ray kymography (see) and electrokymography (see). Echocardiography allows you to get an idea of ​​the P. of various structures of the working heart (see).

In healthy people, especially young and thin people, pulsation in the epigastric region is often visually and palpably detected, sometimes spreading to the lower third of the sternum and the adjacent parts of the anterior chest wall - a cardiac impulse. This P. is caused primarily by contractions of the right ventricle of the heart. After significant physical exertion, a cardiac impulse can also be detected in healthy individuals of older age groups who are prone to obesity. However, sharp and strong P. in the epigastric region at rest, accompanied by shaking of the lower third of the sternum and the adjacent area of ​​the anterior chest wall, serves as a reliable sign of severe hypertrophy of the right ventricle. P. in the epigastric region can also be associated with the passage of a pulse wave through the aorta (such P.

more visible when the patient lies on his back) and with pulsating changes in liver volume caused by the retrograde passage of the pulse wave through the veins and pulse changes in the blood supply to the liver. In the first case, deep palpation of the abdominal cavity allows one to detect an intensely pulsating aorta. To distinguish between P. of the liver and its displacements caused by the cardiac impulse, two techniques are used. The first is that the edge of the liver is grasped between the thumb and the other fingers of the palpating hand (the palm is placed under the lower edge of the liver) and, if there is hepatic P., changes in the volume of the liver area grasped by the hand are felt. The second technique comes down to placing slightly spaced index and middle fingers of the palpating hand on the front surface of the liver: if at the moment of sensation of P. the fingers move apart, then this indicates pulse changes in the volume of the liver, and not its displacement. An auxiliary role in identifying P. detected in the epigastric region is played by rheohepatography (see Rheography), as well as the detection of a positive venous pulse (see Sphygmography), which, together with P. of the liver, is observed in tricuspid insufficiency (see Acquired heart defects). With simultaneous palpation of the liver and apical impulse, it is possible to determine the temporary relationship between the liver and cardiac systole only with considerable skill. Synchronous recording of an ECG and a rheohepatogram allows one to distinguish between liver P. associated with ventricular systole (systolic P.) and with atrial systole (presystolic P.).

In people of asthenic physique, P. is sometimes visible in the jugular fossa (retrosternal P.), caused by the passage of a pulse wave along the aortic arch. In patol, conditions, retrosternal P. visible to the eye is observed with pronounced lengthening or expansion of the aorta, especially with its aneurysm (see Aortic Aneurysm). With a syphilitic aortic aneurysm, the tissue of the anterior chest wall may become thinner, and in this case P. is determined over a large area adjacent to the manubrium of the sternum. In practically healthy individuals with a short chest, retrosternal P. is often determined by palpation (with a finger placed behind the manubrium of the sternum). In this case, retrosternal P. itself is characterized by impulses directed upward; In healthy people, the pulse of the brachiocephalic trunk and the left common carotid artery is often simultaneously palpated on the lateral surfaces of the finger. In most cases, retrosternal P. is patol, in nature, being associated with lengthening of the aorta, its expansion, or a combination of these changes.

In aortic insufficiency (see Acquired heart defects), thyrotoxicosis, severe cardiac hyperkinesia, superficial location of arteries or their aneurysms, and the presence of arteriovenous shunts, P. over different vascular areas can be visually determined. Thus, aortic insufficiency is characterized by pronounced P. - the so-called. dancing of the carotid arteries, sometimes P. pupils, P. spots of hyperemic skin (precapillary pulse) are observed.

In some cases, the P. of the large superficial veins of the neck is visually determined. P. veins can be presystolic (with tricuspid stenosis) and systolic (with tricuspid insufficiency). An accurate idea of ​​the nature of the P. veins can be obtained by synchronous recording of a phlebosphygmogram and an ECG.

V. A. Bogoslovsky.

bme.org

Heart rate indicators

The pulse is characterized by several values.

Frequency – number of beats per minute. It must be measured correctly. The pulse in a sitting position and in a lying position may differ. Therefore, use the same posture when taking measurements, otherwise the data obtained may be misinterpreted. Also, the frequency increases in the evening. Therefore, do not be alarmed if its value is 75 in the morning and 85 in the evening - this is normal.

Rhythm - if the time interval between adjacent beats is different, then arrhythmia is present.

Filling - characterizes the difficulty of detecting the pulse, depends on the volume of blood distilled by the heart at one time. If it is difficult to palpate, this indicates heart failure.

Voltage – characterized by the effort that must be applied to feel the pulse. Depends on blood pressure.

Height - characterized by the amplitude of vibration of the arterial walls, a rather complex medical term. It is important not to confuse heart rate and heart rate; these are completely different concepts. The cause of a high pulse (not rapid, but high!) in most cases is improper functioning of the aortic valve.

Increased heart rate: causes

The first and main reason, as is the case with many other diseases, is a sedentary lifestyle. The second is a weak heart muscle, which is unable to maintain normal blood circulation even with mild physical exertion.

In some cases, a rapid heart rate may be normal. This happens in old age and during the first years of life. Thus, in newborn babies, the heart rate is 120-150 beats per minute, which is not a deviation, but is associated with rapid growth.

Often, a rapid pulse is a symptom of tachycardia if it manifests itself in a calm state of the human body.

Tachycardia can result from:

• Fever;
• Improper functioning of the nervous system;
• Endocrine system disorders;
• Poisoning the body with toxins or alcohol;
• Stress, nervousness;
• Oncological diseases;
• Cachexia;
• Anemia;
• Myocardial lesions;
• Infectious diseases.

Factors that can cause rapid heart rate:

• Insomnia or nightmares;
• Use of drugs and aphrodisiacs;
• Use of antidepressants;
• Use of drugs that stimulate sexual activity;
• Constant stress;
• Alcohol abuse;
• Overwork;
• Excess weight;
• High blood pressure;
• Colds, ARVI or flu.

When can a rapid heart rate be considered normal?

There are several conditions of the body when a high heart rate may not be an alarming signal, but a normal phenomenon:

• Age - as you get older, the frequency decreases, but in children it can be 90-120 beats per minute;
• Physical development - people whose bodies are trained have a higher heart rate compared to those who lead a less active lifestyle;
• Late pregnancy.

Tachycardia

When identifying the causes of a rapid pulse, one cannot help but talk in detail about tachycardia. Rapid pulse is one of its main symptoms. But tachycardia itself does not arise out of the blue; you need to look for the disease that caused it. There are two large groups of these:

• Cardiovascular diseases;
• Diseases of the endocrine system and hormonal disorders.

Whatever the cause of tachycardia, it must be identified and treated immediately. Currently, unfortunately, cases of paroxysmal tachycardia, which is accompanied by:

• Dizziness;
• Acute pain in the chest in the region of the heart;
• Fainting;
• Shortness of breath.

The main group of people susceptible to this disease are alcoholics, heavy smokers, people who have been taking drugs or strong medications for a long time.

There is a separate type of tachycardia that healthy people can suffer from, it is called neurogenic, and is associated with disorders of the peripheral and central nervous systems, which leads to a deterioration in the function of the conduction system of the heart, and, as a result, a rapid pulse.

Increased heart rate with normal blood pressure

If your blood pressure is not alarming, but your pulse is going through the roof, this is an alarming signal and a good reason to visit a doctor. In this case, the doctor will order an examination to identify the cause of the rapid heartbeat. As a rule, the cause is thyroid disease or hormonal imbalance.

An attack of rapid heart rate with normal blood pressure can be eliminated by doing the following:

• Cough;
• Pinch yourself;
• Blow your nose;
• Wash with ice water.

Treatment for palpitations

If the heartbeat is frequent due to high temperature, then antipyretic drugs and methods will help.

If your heart is ready to jump out of your chest due to excessive physical exertion, you should stop and rest a little.

Acupressure in the neck area is a very effective remedy. But it should be done by an experienced person, massaging the area of ​​pulsation of the carotid artery from right to left. By breaking the sequence, you can make a person faint.

There are medications that help reduce heart rate:

• Corvalol;
• Vaocordin;
• Hawthorn tincture.

Folk remedies to combat rapid heart rate

1. Pour 1 teaspoon of celandine and 10 grams of dried hawthorn into a glass of boiling water, leave well.
2. Mix 1 share of chokeberry juice, 3 shares of cranberry juice, 2 shares of carrot juice and 2 shares of alcohol. Squeeze 1 lemon into the mixture.
3. A mixture of lemon and honey is incredibly effective. You need to take 1 kg of lemons, 1 kg of honey, 40 apricot kernels. Grate the lemons, peel the seeds and crush them. Mix everything with honey.

A rapid heart rate can be the cause of many diseases. Timely detection of the disease is the key to its successful treatment!