Odd pulse

Introduction Refers to the phenomenon that the pulse is obviously weakened or even disappeared when inhaling, and it appears or returns to its original state when exhaled. Observing odd veins with a sphygmomanometer is often more noticeable than finger palpation.

Cause

1, a large number of pericardial effusion with pericardial tamponade.

2, constrictive pericarditis.

3. Restrictive cardiomyopathy.

4, in addition, emphysema, a large number of pleural effusion can also occur odd pulse.

mechanism

The odd pulse is mainly produced with the left. O stroke volume is related. When the normal person inhales, due to the expansion of the lungs, the blood flow from the pulmonary veins to the left ventricle decreases, the left ventricular stroke volume decreases by about 7% on average, and the arterial systolic pressure decreases by an average of 3%. At this moment, the radial artery The pulsation weakens. When exhaling, the lungs return to their original state. The amount of blood from the pulmonary veins to the left ventricle increases. This changes periodically with the breathing, but under normal circumstances, the pulse does not change significantly. According to clinical hemodynamics, echocardiographic observations and animal experiments in recent years, it is believed that in the pericardial tamponade, inspiratory increases the right heart reflow, and left ventricular filling decreases to produce odd veins.

1. In pericardial effusion and constrictive pericarditis, diastolic ventricular filling is limited. When inhaled, the blood volume of the pulmonary circulation increases, and the blood stays in the blood vessels. The blood flowing to the superior and inferior vena cava cannot be increased correspondingly to the right heart. The amount of left ventricle in the pulmonary veins is reduced compared to normal.

2. When the inspiratory muscles fall, the tensioned pericardium is involved, so that the pressure in the pericardial cavity is further increased, the ventricular filling is restricted, and the left ventricular filling volume is further reduced. Experiments have shown that as the pericardial pressure increases, the normal pulse gradually weakens and the odd pulse appears.

3. The right ventricular filling is increased, and the ventricular septum is displaced to the left ventricle, thus limiting the left ventricular filling. As a result, the aortic blood flow is reduced, and the pressure is reduced and the odd pulse occurs.

4, emphysema, asthma, pleural effusion, etc. affect the right ventricle to the lungs can also occur when the blood is discharged.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) ECG

First, medical history

Patients with irregular fever, dyspnea in the heart, and pain in the precordial area should consider pericardial effusion and constrictive pericarditis after exclusion of other infections; adolescent onset with dyspnea in the heart may indicate restrictive cardiomyopathy, but it is less common.

On the basis of the original cough, cough and other symptoms, there is a gradual increase in dyspnea. In the late stage, there is also prolonged exhalation during rest, often with wheezing, suggesting chronic obstructive emphysema; It suggests bronchial asthma; those with fever, chest pain, and difficulty breathing suggest pleural effusion.

Second, physical examination

Qimai with jugular vein engorgement, Kussmaul sign (inhalation of jugular vein engorgement) positive in pericardial effusion and constrictive pericarditis, restrictive cardiomyopathy, but the heart is not large, more consideration for narrowing Sexual pericarditis or restrictive cardiomyopathy; accompanied by the expansion of the heart to both sides, heart sounds distant, Ewart sign, Rotch sign positive indicates pericardial effusion.

Barrel chest, weakened vocal fibrillation, lung percussion was unvoiced, heart sounds narrowed, lung and liver voiced down, respiratory sounds weakened, exhalation prolonged, heart sounds distant, suggesting emphysema; trachea moved to the healthy side, tremor Attenuated, the lungs were percussed as a real sound, and the breath sounds weakened or disappeared, suggesting pleural effusion.

Third, laboratory inspection. Pericardial effusion, constrictive pericarditis and pleural effusions have increased white blood cell counts and rapid erythrocyte sedimentation rate, while restrictive cardiomyopathy has more obvious eosinophilia. Blood gas analysis, chronic obstructive emphysema, such as the occurrence of significant hypoxia and carbon dioxide alcohol retention, there is a decrease in arterial oxygen partial pressure, carbon dioxide partial pressure.

Fourth, equipment inspection

1. X-ray: chest or photo, the heart shadow is enlarged to the sides, and it is in the shape of a flask. The heart beats weakly or disappears to indicate pericardial effusion; the heart shadow is triangular, the pericardium has calcification, suggesting constrictive pericarditis; Increased flaky density, uniform shadows suggest pleural effusion; enhanced lung field transmittance suggests emphysema.

2, ECG: low voltage, alternating electricity, marking the height of the bow under the back of the bow to remind the pericardial effusion.

3, echocardiography: specific changes can be found in constrictive pericarditis, pericardial effusion, cardiomyopathy. B-ultrasound has a specific diagnostic value for pleural effusion.

4, left ventricular angiography: restrictive cardiomyopathy showed endocardial hypertrophy and cardiac cavity shrinkage. Cardiac radionuclide examination has an auxiliary diagnostic value for pericardial effusion and cardiomyopathy.

5, pulmonary function test: obstructive emphysema showed diffuse disorder, maximum ventilation decreased, residual gas volume increased.

Differential diagnosis

Micro-pulse: The pulse is very thin and soft, and it seems to be like nothing. The yang is weak and weak, so it is incapable of agitation. A kind of pulse. Very fine and soft, just like it, if there are none, the number is unknown. Caused by qi and blood deficiency. More common in shock, collapse and other chronic weakness.

Substitute: a pulse with a slow, regular interval and a long pause. The generation of the main venous qi is weak, wind syndrome, pain syndrome, panic, and bruises. Dirty qi, blood loss, lack of vitality, resulting in the pulse can not be connected to the modern pulse. It can also be caused by wind syndrome, pain syndrome, seven sentimental panic, bruises and injuries, and the pulse can not be connected. Abnormal physique or pregnant women can also see the subpulmonary, but the pulse is powerful, soft and even, and can not be regarded as a diseased vein. When the pain is worse or the stroke is frightened, the blood and blood are reversing and the modern pulse is temporarily released. It is different from the generation of the dirty gas, which is a temporary phenomenon. The generation originates from premature beats or atrioventricular block in the heart, and is found in various organic heart diseases.

A few pulses: the pulse is fast, and it is five or more. "Pulse": "The pulse is coming to promote the emergency." Because of the evil heat, the blood is accelerated, the pulse is powerful and the heat is strong; if the illness is yin, the heat is endogenous, the blood is accelerated, the pulse is weak, and the heat is weak.

The virtual pulse: the inch of the inch, the pressure of the pulse. It is a general term for powerlessness. The main deficiency of the virtual pulse is mostly lack of blood or viscera. Insufficient qi and blood, the gas is not enough to promote the blood, the pulse is weak; the blood is not enough to fill the vein, so the pulse is empty. The function of the viscera is low, and the loss of blood and body fluid is a variety of chronic wasting diseases. High fever, yin, water loss, bleeding, or vomiting and diarrhea after the lack of fluid, blood is difficult to fill, its virtual pulse weakness is more significant.

String pulse: refers to the pulse with the bowstring feeling, the hand does not turn, the long end of the string is straight, if it is ill, how to recognize it, it means soft and hard on the string. The pulse vein is the main vein of hepatobiliary disease, the liver is just dirty, and the disease is urgent through the veins, so the pulse ends straight and string. The pain syndrome is also more like a string, because the stomach and abdominal pain is mostly caused by the liver and gas stagnation of the spleen. In addition, the pain syndrome is mostly caused by cold evil, and the cold master receives the blood, so that the meridians are urgent, so the pulse string. The two ribs that sip in the liver are called hanging drinks, and they are also stringed. Modern patients with arteriosclerosis are more typical chords.

Slide vein: The slide vein is fluent from the pulse, and should be smooth, such as the bead, the roller is smooth. Slide the main sputum, sip. Because of the internal resistance of sipping, in the case of righteousness, there may be a surge of blood and blood, so the pulse is smooth. Patients with high fever, hot blood and blood, smooth and smooth, women after pregnancy, blood flow to raise the fetus, more visible typical slippery veins.

Real pulse: The pulse is likely to appear in floating, medium and volt, referring to the filling and powerful pulse. The beginning of the main course of disease, the righteousness is not empty, the yang poisoning or the evil spirits.

There is no waiting for the scattered pulse shape. If you find the number of people who are uncertain, the full finger will be scattered and the first one will be scattered. It is difficult to return according to the dispersal. The production is the birth of the baby, and the disease will be lost.

Weak veins: sinking soft and soft like weak veins, lightly searching for no board to regain knowledge, vitality loss and blood deficiency, juveniles can consider white-headed scorpion.

: Float is extremely weak, according to the hand and empty, the main disease of blood deficiency yang deficiency, sweat more night bone steaming. The pulse is verified by the mirror, and the scholar is proficient in the heart. The veins are floating on the skin, and the pulse force is weak. Generally, it is more than 3 to 4 pulse units. The veins are thinner and sometimes doubled than the normal veins. The width of the normal veins is two squares. The width is only one grid on the wave base, and there is no special case for the pulse rate.

: The pulse is difficult to dredge, the shape is short and short, and the wet stagnation is like scraping bamboo. The disease is slow and difficult to eat, and it is not difficult to damage the blood and hurt the fine.

Disease, pulse name. Also known as the urgency. The pulse is rushing, especially when it is more than a few pulses. Adults are dying. More common in acute fever. If the injured person is injured, see the disease, and most of them are critical syndromes. If the pregnant woman sees this pulse without disease, it is the pulse of the birth, called the meridian.

Tight pulse: a kind of pulse. The pulse is strong and strong, and it should be referred to as an emergency, such as turning a rope. Common in the cold evil outside the bundle or cold in the cold, cold and stagnation food, abdominal pain, joint pain and other symptoms.

Knot: refers to a composite vein of arrhythmia. The formation of the collaterals is derived from various premature beats or conduction blocks in arrhythmias, and can also be found in normal people (but must exclude heart disease) and emotional disorders, excessive alcohol and tobacco.

vein: wide and with a pulse in the middle. More common in the pulse after the bleeding.

A vein, a kind of pulse. The pulse is really long, the chord is long, the float is taken, the middle is not taken, the sinking is obtained, and it is firm. More common in the accumulation of cold and cold, such as symptoms, sputum, sputum and so on.

Floating pulse: refers to the finger press, press the slightly weak pulse.

Volt, pulse noun. Refers to a pulse. The veins come to the vague, and the press of the tendons is the beginning. Because the evil spirits are inward, the pulse can not be circulated, and the stagnation of the pulse is not obvious and the volcanic pulse appears; if the yang is declining, the blood can not be encouraged. The former is more common in the evil violent disease, the latter is more common in chronic illness.

Leather vein: a pulse. That is, floating and pointing, hollow and strong, such as the pulse of the drum. A woman is half-produced and bleeds, and the man is bloody or "dream".

Promoting pulse: A kind of pulse, which means that the pulse is urgent and there are irregular intervals. More common in yang stagnation and qi stagnation, blood stasis, stagnation, food and rheumatic heart disease, coronary heart disease.

Long vein: a kind of pulse, whose pulse appears as the length of the head and tail, exceeding the standard. It is mostly by the evil spirits, the righteousness is not bad, and the evil is fighting.

Shenmai: one of the pulse. The pulse position is low, and the light should not be referred to, and the original pulse is re-pressed. "Pulse": "The lack of sinking pulse, according to more than enough." Because of illness and stagnation in the blood, the blood is trapped inside, the pulse is heavy and powerful, for the evidence; if the viscera is weak, the blood is not full, the pulse is weak, the pulse is weak and weak, for the deficiency.

Delayed pulse: It means that each beat has less than four beats, that is, the pulse is less than sixty times per minute. Direct pathological factors are sinus bradycardia and atrioventricular block; vagus nerve excitability such as jaundice, vomiting, neurosis, pain, etc., can cause neuropathic delayed veins.

If the pulse is more than 100 times per minute, it is called a fast pulse. May have tachycardia, hyperthyroidism or severe anemia. The cause of tachycardia: physiological factors: such as stimulating exercise; disease factors: such as abnormal cardiac conduction, viral myocarditis, hyperthyroidism and other factors such as lack of exercise, mental and other factors. At present, only symptomatic supportive treatment is needed, and adjustment is made in conjunction with diet and moderate exercise.

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