Pulse

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Pulse sensing on the forearm
Audio recording of a human heartbeat

The pulse (Latin pulsus , "push", like Latin pulsare "knock", from Latin pellere "beat, push") describes since antiquity (for example with the Alexandrian doctor Herophilos around 300 BC) the mechanical effects of the systolic blood output from the heart , pressure and volume fluctuations (pulse wave) to the direct environment or their transmission to more distant regions of the body through the blood vessel system.

The pulse is both the frequency of the pressure surges that can be recorded during pulse counting (number per minute; for the difference between this pulse frequency and heart rate, see pulse deficit ) as well as its amplitude and course (pulse quality, e.g. "softer", "weaker" or "whirring" " Pulse). The pulse propagates in the vascular system as a wave with local time courses of the pressure, the cross-sectional area and the volume flow or the flow velocity. The pulse variance index is a measure of the fluctuations in the pulse frequency over time .

Pulse types

A distinction is made between a retrograde (backwards, against the blood flow) and anterograde (forwards, with the blood flow) conduction of the heart's action in the vessels. The retrograde conduction determines the venous pulse (see below), the anterograde conduction the arterial pulse. The arterial pulse is given more attention in medicine than the venous pulse. The pulse provides information about the effectiveness of the heart's action, its regularity, the rate of pressure increase in the vessels near the heart during systole , the absolute pressure and the filling volume of the vessels.

Pulse variations

Resting heart rate

The resting heart rate is 50 to 100 beats per minute in a healthy adult. Sometimes the peripherally sensed pulse is slower than the heart rate on the EKG . This has to do with early extra beats that lead to a mechanically ineffective heart action. One then speaks of a pulse deficit . The best way to measure your resting heart rate is in the morning after you wake up and before you get up.

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

Average resting heart rate:

Paradoxical pulse

A paradoxical pulse or pulsus paradoxus is the abnormal drop in blood pressure amplitude by more than 10  mmHg during inhalation . He steps u. a. in larger pericardial effusions and is considered a sign of impending pericardial tamponade . Furthermore, a pulsus paradoxus is found in an armored heart , in a tension pneumothorax and in severe asthma attacks .

The pulse pressure or pulse amplitude is the difference between systolic and diastolic blood pressure , i.e. the blood pressure amplitude as a measure of the elasticity of the arteries .

Venous pulse

There is also a weak pulse in the veins . In contrast to the arterial pulse, which is mainly caused by changes in pressure, the pulsation of the veins is mainly caused by changes in their filling state and causes a so-called volume pulse. However, the vein flow depends on several factors, in particular on breathing, body position and body activity and not so much on the bimodal venous pulse, which is caused by changing pressure conditions in the right atrium of the heart. The venous pulse used to be recorded as a jugular vein pulse curve and can now be derived relatively easily with a Doppler device at various regions of the body. To do this, however, the Doppler frequency must be switched to the low flow velocities in the venous system.

The typical vein pulse curve shows two distinctive valleys that correspond to the systolic and diastolic influx to the heart. Only in a short phase is there a brief return flow into the veins, which manifests itself as a small mountain in the vein pulse curve. This return current corresponds to the atrial systole and is known as the A wave. However, this short return current is only present with sinus rhythm and intact mechanical atrial action. In the case of severe tricuspid regurgitation, a considerable amount of blood flows from the right ventricle in the systole back into the right atrium and the upstream veins, so that the systolic valley of the vein pulse curve can be seen as a mountain.

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

Pulse measurement (sphygmology)

Points suitable for pulse sensing
Pulse sensing on the wrist on an illustration from around 1717
Pulse measurement with a device by Anastasios Filadelfeus , 2nd half of the 19th century
Pulse measurement by the doctor using his pocket watch (from a children's book from 1888)

The heart rate can be measured in different ways. A practically very simple, inexpensive and precise measurement method for recording the instantaneous value is the use of a pulse oximeter , which is attached to a finger as a clip and shows not only the current pulse but also the oxygen saturation in the blood. Other methods are the use of special heart rate measuring devices , which, depending on the version, also allow the pulse rate to be recorded over a longer period of time with automatic data recording. Another simple and common method is manual measurement with the aid of a clock , whereby the number of heartbeats per unit of time is counted. Conversely, however, the time required for a certain number of pulse beats can also be read on the watch. In natural science, for example with Cardano in the 16th century, time measurements were initially carried out with the help of the pulse. With this measurement, the number of pulses per time is measured. The heart rate is usually given in beats per minute . The Belgian theologian, mathematician and astronomer Froidmont determined the human pulse rate in adults with 4450 beats per hour (74 / min) at the latest in 1627 during his investigations into weather phenomena. Johannes Kepler gave the first more precise figures for the pulse rate at the beginning of the 17th century. The first scientific studies of the pulse rate were published in 1707 by John Floyer (1649–1734). It was only after this time that the pulse was measured with the help of watches, according to Power.

There are several places on the body where you can easily feel the arterial pulse for manual measurement, e.g. B .:

In an emergency, the femoral pulse (groin region) and the carotid pulse (on the neck) are most reliably palpable, as they can often be detected even at low blood pressure values. In order to capture the entire pulse wave during the measurement, the pulse should be felt with two or three fingers.

Pulse qualities

In addition to the important information pulse palpable or pulse not palpable , for example in the case of an acute vascular occlusion, a distinction is made between pulse qualities in pulse diagnosis :

regularity
  • regularis (regular)
  • irregularis (irregular heartbeat )
frequency
  • frequens (often)
  • rarus (rare)
Hardness (suppressibility)
amplitude
  • altus (high)
  • parvus (low)
Ascent steepness
  • celer (quickly)
  • tardus (slowly)

Clinically important are z. B. the following pulse qualities:

Pulsus celer, altus, durus
“Water hammer pulse”, fast, high and hard, typical for aortic regurgitation
Pulsus tardus, parvus, mollis
slow, small and soft, typical of aortic stenosis
Pulsus celer et parvus
fast and weak pulse, for example in shock
Pulsus bisferiens, also Pulsus dicrotus (dicrotia)
bipodal in hypertrophic obstructive cardiomyopathy
Pulsus tricrotus (tricrotia)
three-peaks in dicrotia with the following extrasystole
Pulsus alternans
Alternation from strong and weak, possibly with heart failure
Pulsus bigeminus ( Bigeminy )
regular alternation from hard and soft, typical of ventricular extrasystoles
Pulsus trigeminus (trigeminal nerve)
two sinus beats and one extrasystole (or vice versa)
Pulsus anacrotus (anacrotia)
additional pulse wave in the ascending leg, typical of aortic stenosis
Pulsus vibrans
whirring carotid pulse, typical of aortic stenosis
Pulsus filiformis (parvus, frequens, mollis)
thread-like, "thin" pulse, e.g. B. in circulatory collapse
Pulsus intermittens
Suspension of individual blows, cf. Pulse deficit

The Traditional Chinese Medicine describes more sensing locations and pulse qualities (s. Pulse diagnosis ).

17th century doctor (who monitors the pulse) with pocket watch, made from porcelain by Samson in Paris around 1880. Wellcome Institute of the History of Medicine, London

Inexpensive training pulse

There are various formulas for calculating an optimal training heart rate. He hangs u. a. depends on the pursued goals and for endurance sports is between 70% ( extensive training ) and 85% (intensive training) of the individual maximum heart rate . A load of approx. 60% of the maximum heart rate is often given for optimal fat burning . This information is based on a misinterpretation of the fat metabolism training . Practically every sporting activity is also accompanied by fat burning, so that only the total amount of energy consumed in the context of the energy balance is important for weight loss .

The most reliable possible determination of the optimal training pulse takes place with the help of spiroergometry . The anaerobic threshold , which should not be exceeded during training, can be determined by measuring the breathing gases under stress . Since the blood pressure is also determined with this examination method, any excessive increase in blood pressure can be included in the determination of the training pulse.

Rough guidelines for extensive endurance training can be determined using the Karvonen formula , provided that no drugs such as beta blockers are taken:

( Maximum heart rate - resting heart rate) × 0.6 + resting heart rate = training heart rate

According to Lagerstrøm, the individual training heart rate is calculated as follows:

Resting pulse + (220 - 2/3 × age in years - resting pulse) × factor = training pulse

The factor takes into account general physical performance and ranges from 0.55 to 0.75.

literature

  • Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition ibid. 1986, ISBN 3-13-352410-0 , pp. 49–54, 164, 168, 182, 202 f., 206–210, 212 and 221.

Web links

Wiktionary: pulse  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Werner Friedrich Kümmel: The pulse and the problem of time measurement in the history of medicine. In: Medical History Journal. Volume 9, 1974, pp. 1-22.
  2. ↑ John A. Pithis: The writings ΠEPI ΣΦYΓMΩN of Philaretos: Text - translation - comment. (Medical dissertation Berlin) Husum 1983 (= treatises on the history of medicine and the natural sciences. Volume 46).
  3. ↑ Jutta Kollesch , Diethard Nickel : Ancient healing art. Selected texts from the medical writings of the Greeks and Romans. Philipp Reclam jun., Leipzig 1979 (= Reclams Universal Library. Volume 771); 6th edition ibid 1989, ISBN 3-379-00411-1 , p. 31 f.
  4. ↑ Susanne Hahn: Pulse. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1202 f.
  5. ^ Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition ibid 1986, ISBN 3-13-352410-0 , pp. 49-54.
  6. ↑ Libertus Fromondus : Meteorologicorum libri sex. Antwerp 1627, p. 63.
  7. ^ Gary L. Townsend, Sir John Floyer (1649-1734) and His Study of Pulse and Respiration. In: Journal of the History of Medicine. Volume 22, 1967, pp. 286-316.
  8. ↑ Werner Friedrich Kümmel: The pulse and the problem of time measurement in the history of medicine. 1974, pp. 2, 5 f. and 22.
  9. ^ D'Arcy Power: William Harvey. London 1897, p. 215, note 1.
  10. ↑ C. D Deakin: Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study . In: BMJ . tape 321 , no. 7262 , September 16, 2000, p. 673–674 , doi : 10.1136 / bmj.321.7262.673 ( bmj.com [accessed March 8, 2019]).
  11. ↑ HS Füeßl, M. Middeke: Anamnesis and clinical examination. Thieme, Stuttgart 2005.
  12. ^ Jörg Braun: Resuscitation and circulatory stabilization. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 151–183, here: pp. 159–164 ( shock ).
  13. ^ KA Moosburger: "Fat Burning" in Sport - Myth and Truth ( Memento from February 2, 2010 in the Internet Archive ); private publication; (PDF; 63 kB)
  14. ↑ D. Lagerstrøm, J. Graf, J .: The correct training pulse rate in endurance sports. In: Heart, Sport and Health. No. 3, 1986, pp. 21-24.