Pulse

In medicine, describes the pulse ( hitting the " knock " from the Latin pellere; PPP Pulsum ) primarily qualitative, the mechanical effects of cardiac activity to the immediate environment or their propagation to distant parts of the body through the vascular system. Pulse is referred to as both the pulse rate ( number of pulses per minute, the difference between this number of pulses to the heart pulse rate, see deficit ) and the quality of the pulses ( for example, " soft", "weak " or " buzzing " pulse).

Pulse types

A distinction is retrograde ( backwards against the blood stream ) from an anterograde (forward, with the bloodstream ) conduction of the cardiac action in the vessels. The retrograde conduction determines the venous pulse (see below), the anterograde conduction of the arterial pulse. The arterial pulse is in medicine more attention than the venous pulse. The pulse provides information about the effectiveness of the heart action, their regularity, the rate of pressure rise in the vessels close to the heart during systole, the absolute pressure and the filling volume of the vessels.

Pulse variations

Resting heart rate

The heart rate at rest is in a healthy person 50 to 100 beats per minute. Sometimes the peripheral keyed pulse is slower than the heart rate in the ECG. This is connected with early incident Extra beats that lead to a mechanically ineffective heart action. This is called a pulse deficit. The best you measure the resting heart rate in the morning.

The resting heart rate of a trained endurance athlete is usually 32-45 beats per minute. Rare is a resting heart rate of less than 30 beats per minute. The stroke volume and usually the lung volume of these athletes are thereby increased.

Average resting heart rate:

• In fetuses: approx 150/min
• In infants: approx 130/min
• In children: about 100/min
• In adolescents: about 85/min
• In adults: about 70/min
• In the elderly: about 90/min

Paradoxical pulse

As paradoxical pulse or pulsus paradoxus is defined as the abnormal drop in blood pressure amplitude by more than 10 mmHg during inspiration. It occurs inter alia in larger pericardial effusion is considered a sign of impending cardiac tamponade. Furthermore, a pulsus paradoxus is at heart a tank, tension pneumothorax and severe asthma attacks.

Venous pulse

Also in the vein there is a weak pulse. However, the venous flow of several factors is dependent, in particular respiration, body position and body activity and not so much from the bimodal venous pulse that comes through changing pressure conditions in the right atrium of the heart into being. The venous pulse was previously recorded as Jugularvenenpulskurve and can be relatively easily derived using a Doppler device to the various regions of the body today. This, however, the Doppler frequency must be switched to the low flow rates in the venous system.

The typical venous pulse curve shows two distinct valleys that correspond to the systolic and diastolic flow to the heart. Only for a brief period there will be a short reverse flow in the veins, which manifests itself as a small mountain in the venous pulse curve. This reverse current corresponds to the atrial systole, and is referred to as the A- shaft. This brief return current is, however, available only in sinus rhythm and intact atrial mechanical action. In severe tricuspid regurgitation the blood from the right ventricle flows in systole to a considerable extent back into the right atrium and the upstream veins, so that the systolic Valley of the venous pulse curve canceled or even reversed as a mountain is visible.

A very similar venous pulse curve can also be recorded from the pulmonary veins by means of transesophageal echocardiography (TEE ). It can be used to assess the severity of mitral regurgitation.

Pulse measurement ( Sphygmologie )

The pulse can be measured in different ways: either using a heart rate monitor, or the measurement is carried out manually. In measuring the number of pulses per minute is measured. They can also be measured in other units of time and converted into pulses per minute.

There are several places on the body where you can easily palpate the arterial pulse, for example:

• Radial pulse / radial artery - wrist pulse ( thumb side)
• Carotid / common carotid artery - carotid pulse
• Femoral / femoral artery - strips pulse
• Popliteal artery - pulse in the popliteal fossa (with angled leg )
• Posterior tibial artery - Behind the medial malleolus
• Arteria dorsalis pedis - Middle instep
• Apexpuls - (also known as apical impulse ) over the apex of the heart as an expression of mechanical cardiac activity on the immediate environment.
• Superficial temporal artery - temporal
• Facial artery - nose or lower jaw
• Subclavian artery - clavicle
• Axillary artery - armpit
• Brachial artery - the inside of the upper arm
• Ulnar artery - wrist ( side of the little finger)
• Abdominal aorta - abdominal aorta

In an emergency, the femoral ( groin ) and the carotid pulse are ( at the neck ) most reliable palpable, as he is still detectable up to blood pressure by 60 mmHg systolic, peripheral pulses to 80 mmHg. To capture the entire pulse wave in the measurement, the pulse should be palpated with two / three fingers.

Pulse qualities

In addition to the major statement palpable pulse or pulse not palpable, for example, in acute vessel closure, one distinguishes the pulse qualities:

• Regularity: regularis ( regularly)
• Irregularis (irregular) (abnormal heart rhythm )

• Frequens (common)
• Rarus (rare)

• Duris (hard)
• Mollis ( soft) (with high or low blood pressure)

• Altus (high)
• Parvus (low)

• Celer (fast)
• Tardus ( slow)

Clinically significant are eg the following pulse qualities:

• Pulsus celer, altus, durus: "Water hammer pulse ", fast, high and hard, typical of aortic regurgitation
• Pulsus tardus, parvus, mollis: slow, small and soft, typical of aortic stenosis
• Pulsus bisferiens, also pulsus dicrotus ( dicrotism ): two peaks, in hypertrophic obstructive cardiomyopathy
• Pulsus tricrotus ( Trikrotie ): dreigipfelig at dicrotism with the following extrasystole
• Pulsus alternans: alternating of strong and weak, possibly in heart failure
• Pulsus bigeminus ( bigeminy ): regular alternation of hard and soft, typical of ventricular extrasystoles
• Pulsus trigeminus ( trigeminy ): two sinus beats and ectopic (or vice versa)
• Pulsus anacrotus ( Anakrotie ): additional pulse wave in the ascending limb, typical of aortic stenosis
• Pulsus Vibrans: buzzing carotid pulse, typical of aortic stenosis
• Pulsus filiformis ( parvus, frequens, mollis ): thready, "thinner" pulse, eg circulatory collapse
• Pulsus intermittens: exposing individual strokes, cf pulse deficit

Traditional Chinese medicine describes more sensing locations and pulse qualities (see pulse diagnosis ).

Travel training pulse

For the calculation of an optimal training pulse are different formulas. It depends, inter alia, of the objectives pursued and is for endurance sports between 70 % ( extensive training ) and 85 % ( intensive training ) of the individual maximum heart rate. Often a load of about 60 % of the maximum pulse is given for optimal fat burning. This information is based on a misinterpretation of the lipid metabolism training. Virtually every sports activity is also associated with burning fat, so that is for weight loss, only the total number of calories consumed as part of the energy balance is important. A most reliable determination of the optimum training pulse is performed using the cardiopulmonary exercise testing. Here, under the measurement of respiratory gases under load, the anaerobic threshold can be determined, which should not be exceeded under a workout. Rough guide for an extensive endurance training can be determined using the Karvonen formula, if no drugs such as beta blockers be taken:

After Lagerstrøm the individual training heart rate calculated as follows:

The factor takes into account the general physical performance, ranging from 0.55 to 0.75.