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Название: The Extremities (Technique and Diagnosis)
Автор: White R.
Assessment of the peripheral vascular system is done to determine the characteristics of the pulse, to ascertain the presence of an arterial bruit(s), and to detect the occurrence of venous inflammation with possible secondary thrombosis of that vein.
Increases in pulse rate (tachycardia) may suggest hyperthyroidism, anxiety, infection, anemia, or arteriovenous fistula. Slowing of the pulse rate (bradycardia) may be seen in heart block, hypothyroidism, or with the use of certain drugs (e.g., propranolol). Irregularities in the pulse suggest the presence of premature beats, and a completely irregular pulse implies the presence of atrial fibrillation. Diminished or absent pulses in the various arteries examined may be indicative of impaired blood flow due to a variety of conditions.
Bruits are rushing sounds heard over large and medium-sized arteries as a result of vibration in the vessel wall caused by turbulent blood flow. The sound may originate from a local narrowing or dilation of the vessel itself, or it may be transmitted along the artery from a more proximal lesion in the vascular system. The intensity and duration of the bruit relate to the degree of vessel wall distortion. In general, bruits are not audible until an artery is approximately 50% occluded. The sound increases in pitch as the lumen becomes more narrowed to a critical size. Thereafter, the sound may no longer be detectable as the volume of blood flow becomes greatly reduced.