Pulse

Pulse
Pulse
	Diagram of the rise and lower of blood from a pulse.
Organisms	Animalia*
Biological system	Circulatory system
Action	Involuntary
Method	Heart pumps blood using reciprocating method causing inconstant blood flow throughout the circulatory system that can be recognized. (See Cardiac cycle)
Frequency	60–100 per minute (humans)
Duration	0.6–1 second (humans)
	Animalia with the exception of Porifera, Cnidaria, Ctenophora, Platyhelminthes, Bryozoan, Amphioxus.

Last updated December 09, 2024

In medicine, the pulse is the rhythmic throbbing of each artery in response to the cardiac cycle (heartbeat).^[1] The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the neck (carotid artery), wrist (radial artery or ulnar artery), at the groin (femoral artery), behind the knee (popliteal artery), near the ankle joint (posterior tibial artery), and on foot (dorsalis pedis artery).^[2]^[1] The pulse is most commonly measured at the wrist or neck.^[3] A sphygmograph is an instrument for measuring the pulse.^[4]

Physiology

Claudius Galen was perhaps the first physiologist to describe the pulse.^[5] The pulse is an expedient tactile method of determination of systolic blood pressure to a trained observer. Diastolic blood pressure is non-palpable and unobservable by tactile methods, occurring between heartbeats.

Pressure waves generated by the heart in systole move the arterial walls. Forward movement of blood occurs when the boundaries are pliable and compliant. These properties form enough to create a palpable pressure wave.

Pulse velocity, pulse deficits and much more physiologic data are readily and simplistically visualized by the use of one or more arterial catheters connected to a transducer and oscilloscope. This invasive technique has been commonly used in intensive care since the 1970s.

The pulse may be further indirectly observed under light absorbances of varying wavelengths with assigned and inexpensively reproduced mathematical ratios. Applied capture of variances of light signal from the blood component hemoglobin under oxygenated vs. deoxygenated conditions allows the technology of pulse oximetry.

Characteristics

Rate

The rate of the pulse can be observed and measured on the outside of an artery by tactile or visual means. It is recorded as arterial beats per minute or BPM. Although the pulse and heart beat are related, they are not the same. For example, there is a delay between the onset of the heart beat and the onset of the pulse, known as the pulse transit time, which varies by site. Similarly measurements of heart rate variability and pulse rate variability differ.^[6]

In healthy people, the pulse rate is close to the heart rate, as measured by ECG.^[6] Measuring the pulse rate is therefore a convenient way to estimate the heart rate.^[7]Pulse deficit is a condition in which a person has a difference between their pulse rate and heart rate. It can be observed by simultaneous palpation at the radial artery and auscultation using a stethoscope at the PMI, near the heart apex, for example. Typically, in people with pulse deficit, heart beats do not result in pulsations at the periphery, meaning the pulse rate is lower than the heart rate. Pulse deficit has been found to be significant in the context of premature ventricular contraction ^{[ citation needed ]} and atrial fibrillation.^[8]

Rhythm

A normal pulse is regular in rhythm and force. An irregular pulse may be due to sinus arrhythmia, ectopic beats, atrial fibrillation, paroxysmal atrial tachycardia, atrial flutter, partial heart block etc. Intermittent dropping out of beats at pulse is called "intermittent pulse". Examples of regular intermittent (regularly irregular) pulse include pulsus bigeminus, second-degree atrioventricular block. An example of irregular intermittent (irregularly irregular) pulse is atrial fibrillation.

Volume

The degree of expansion displayed by artery during diastolic and systolic state is called volume. It is also known as amplitude, expansion or size of pulse.

Hypokinetic pulse

A weak pulse signifies narrow pulse pressure. It may be due to low cardiac output (as seen in shock, congestive cardiac failure), hypovolemia, valvular heart disease (such as aortic outflow tract obstruction, mitral stenosis, aortic arch syndrome) etc.

Hyperkinetic pulse

A bounding pulse signifies high pulse pressure. It may be due to low peripheral resistance (as seen in fever, anemia, thyrotoxicosis, hyperkinetic heart syndrome [ de ], A-V fistula, Paget's disease, beriberi, liver cirrhosis), increased cardiac output, increased stroke volume (as seen in anxiety, exercise, complete heart block, aortic regurgitation), decreased distensibility of arterial system (as seen in atherosclerosis, hypertension and coarctation of aorta).

The strength of the pulse can also be reported:^[9]^[10]

0 = Absent
1 = Barely palpable
2 = Easily palpable
3 = Full
4 = Aneurysmal or bounding pulse

Force

Also known as compressibility of pulse. It is a rough indication of systolic blood pressure.

Tension

Determined mainly by mean arterial blood pressure [edited by Elmoghazy] & It corresponds to diastolic blood pressure. A low tension pulse (pulsus mollis), the vessel is soft or impalpable between beats. In high tension pulse (pulsus durus), vessels feel rigid even between pulse beats.

Form

A form or contour of a pulse is palpatory estimation of arteriogram. A quickly rising and quickly falling pulse (pulsus celer) is seen in aortic regurgitation. A slow rising and slowly falling pulse (pulsus tardus) is seen in aortic stenosis.

Equality

Comparing pulses and different places gives valuable clinical information.

A discrepant or unequal pulse between left and right radial artery is observed in anomalous or aberrant course of artery, coarctation of aorta, aortitis, dissecting aneurysm, peripheral embolism etc. An unequal pulse between upper and lower extremities is seen in coarctation to aorta, aortitis, block at bifurcation of aorta, dissection of aorta, iatrogenic trauma and arteriosclerotic obstruction.

Condition of arterial wall

A normal artery is not palpable after flattening by digital pressure. A thick radial artery which is palpable 7.5–10 cm up the forearm is suggestive of arteriosclerosis.

Radio-femoral delay

In coarctation of aorta, femoral pulse may be significantly delayed as compared to radial pulse (unless there is coexisting aortic regurgitation). The delay can also be observed in supravalvar aortic stenosis.

Patterns

Several pulse patterns can be of clinical significance. These include:

Anacrotic pulse: notch on the upstroke of the carotid pulse. Two distinct waves (slow initial upstroke and delayed peak, which is close to S2). Present in AS.
Dicrotic pulse: is characterized by two beats per cardiac cycle, one systolic and the other diastolic. Physiologically, the dicrotic wave is the result of reflected waves from the lower extremities and aorta. Conditions associated with low cardiac output and high systemic vascular resistance can produce a dicrotic pulse.^[11]^[12]
Pulse deficit: difference in the heart rate by direct cardiac ausculation and by palpation of the peripheral arterial pulse rate when in atrial fibrillation (AF).
Pulsus alternans: an ominous medical sign that indicates progressive systolic heart failure. To trained fingertips, the examiner notes a pattern of a strong pulse followed by a weak pulse over and over again. This pulse signals a flagging effort of the heart to sustain itself in systole. It also can be detected in HCM with obstruction.
Pulsus bigeminus: indicates a pair of hoofbeats within each heartbeat. Concurrent auscultation of the heart may reveal a gallop rhythm of the native heartbeat.
Pulsus bisferiens: is characterized by two beats per cardiac cycle, both systolic, unlike the dicrotic pulse. It is an unusual physical finding typically seen in patients with aortic valve diseases if the aortic valve does not normally open and close. Trained fingertips will observe two pulses to each heartbeat instead of one.
Pulsus tardus et parvus, also pulsus parvus et tardus, slow-rising pulse and anacrotic pulse, is weak (parvus), and late (tardus) relative to its expected characteristics. It is caused by a stiffened aortic valve that makes it progressively harder to open, thus requiring increased generation of blood pressure in the left ventricle. It is seen in aortic valve stenosis.^[12]^[13]^[14]^[15]
Pulsus paradoxus: a condition in which some heartbeats cannot be detected at the radial artery during the inspiration phase of respiration. It is caused by an exaggerated decrease in blood pressure during this phase, and is diagnostic of a variety of cardiac and respiratory conditions of varying urgency, such as cardiac tamponade.
Tachycardia: an elevated resting heart rate. In general an electrocardiogram (ECG) is required to identify the type of tachycardia.
Pulsatile This description of the pulse implies the intrinsic physiology of systole and diastole. Scientifically, systole and diastole are forces that expand and contract the pulmonary and systemic circulations.
A collapsing pulse is a sign of hyperdynamic circulation, which can be seen in AR or PDA.

Common palpable sites

Sites can be divided into peripheral pulses and central pulses. Central pulses include the carotid, femoral, and brachial pulses.^[2]

Upper limb

Front of right upper extremity Gray1235.png — Front of right upper extremity

Axillary pulse: located inferiorly of the lateral wall of the axilla
Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants (brachial artery)
Radial pulse: located on the lateral of the wrist (radial artery). It can also be found in the anatomical snuff box. Commonly, the radial pulse is measured with three fingers. The finger closest to the heart is used to occlude the pulse pressure, the middle finger is used get a crude estimate of the blood pressure, and the finger most distal to the heart (usually the ring finger) is used to nullify the effect of the ulnar pulse as the two arteries are connected via the palmar arches (superficial and deep).^{[ citation needed ]}
Ulnar pulse: located on the medial of the wrist (ulnar artery).

Lower limb

Femoral pulse : located in the inner thigh, at the mid-inguinal point, halfway between the pubic symphysis and anterior superior iliac spine (femoral artery).
Popliteal pulse: Above the knee in the popliteal fossa, found by holding the bent knee. The patient bends the knee at approximately 124°, and the health care provider holds it in both hands to find the popliteal artery in the pit behind the knee (popliteal artery).
Dorsalis pedis pulse: located on top of the foot, immediately lateral to the extensor of hallucis longus (dorsalis pedis artery).
Tibialis posterior pulse: located on the medial side of the ankle, 2 cm inferior and 2 cm posterior to the medial malleolus (posterior tibial artery). It is easily palpable over Pimenta's Point.

Head and neck

Arteries of the neck. Gray513.png — Arteries of the neck.

Carotid pulse : located in the neck (carotid artery). The carotid artery should be palpated gently and while the patient is sitting or lying down. Stimulating its baroreceptors with low palpitation can provoke severe bradycardia or even stop the heart in some sensitive persons. Also, a person's two carotid arteries should not be palpated at the same time. Doing so may limit the flow of blood to the head, possibly leading to fainting or brain ischemia. It can be felt between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage.
Facial pulse: located on the mandible (lower jawbone) on a line with the corners of the mouth (facial artery).
Temporal pulse: located on the temple directly in front of the ear (superficial temporal artery).

Although the pulse can be felt in multiple places in the head, people should not normally hear their heartbeats within the head. This is called pulsatile tinnitus, and it can indicate several medical disorders.

Torso

Apical pulse: located in the 5th left intercostal space, 1.25 cm lateral to the mid-clavicular line. In contrast with other pulse sites, the apical pulse site is unilateral, and measured not under an artery, but below the heart itself (more specifically, the apex of the heart). See also apex beat.

History

Pulse rate was first measured by ancient Greek physicians and scientists. The first person to measure the heart beat was Herophilus of Alexandria, Egypt (c. 335–280 BC) who designed a water clock to time the pulse.^[16] Rumi has mentioned in a poem that "The wise physician measured the patient's pulse and became aware of his condition." It shows the practice was common during Rumi's era and geography.^[17] The first person to accurately measure the pulse rate was Santorio Santorii who invented the pulsilogium, a form of pendulum which was later studied by Galileo Galilei.^[18] A century later another physician, de Lacroix, used the pulsilogium to test cardiac function.

Related Research Articles

Aortic stenosis is the narrowing of the exit of the left ventricle of the heart, such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of consciousness, or heart related chest pain occur due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercising. Signs of heart failure include shortness of breath especially when lying down, at night, or with exercise, and swelling of the legs. Thickening of the valve without causing obstruction is known as aortic sclerosis.

Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. The sound differs from normal heart sounds by their characteristics. For example, heart murmurs may have a distinct pitch, duration and timing. The major way health care providers examine the heart on physical exam is heart auscultation; another clinical technique is palpation, which can detect by touch when such turbulence causes the vibrations called cardiac thrill. A murmur is a sign found during the cardiac exam. Murmurs are of various types and are important in the detection of cardiac and valvular pathologies.

The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery and descends along the anteromedial part of the thigh in the femoral triangle. It enters and passes through the adductor canal, and becomes the popliteal artery as it passes through the adductor hiatus in the adductor magnus near the junction of the middle and distal thirds of the thigh.

Systole is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. Its contrasting phase is diastole, the relaxed phase of the cardiac cycle when the chambers of the heart are refilling with blood.

A sphygmomanometer, also known as a blood pressure monitor, or blood pressure gauge, is a device used to measure blood pressure, composed of an inflatable cuff to collapse and then release the artery under the cuff in a controlled manner, and a mercury or aneroid manometer to measure the pressure. Manual sphygmomanometers are used with a stethoscope when using the auscultatory technique.

Pulse pressure is the difference between systolic and diastolic blood pressure. It is measured in millimeters of mercury (mmHg). It represents the force that the heart generates each time it contracts. Healthy pulse pressure is around 40 mmHg. A pulse pressure that is consistently 60 mmHg or greater is likely to be associated with disease, and a pulse pressure of 50 mmHg or more increases the risk of cardiovascular disease. Pulse pressure is considered low if it is less than 25% of the systolic. A very low pulse pressure can be a symptom of disorders such as congestive heart failure.

dextro-Transposition of the great arteries Medical condition

dextro-Transposition of the great arteries is a potentially life-threatening birth defect in the large arteries of the heart. The primary arteries are transposed.

The jugular venous pressure is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease. Classically three upward deflections and two downward deflections have been described.

<span class="mw-page-title-main">Coarctation of the aorta</span> Heart defect of an abnormally narrow aorta

Coarctation of the aorta (CoA) is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus inserts. The word coarctation means "pressing or drawing together; narrowing". Coarctations are most common in the aortic arch. The arch may be small in babies with coarctations. Other heart defects may also occur when coarctation is present, typically occurring on the left side of the heart. When a patient has a coarctation, the left ventricle has to work harder. Since the aorta is narrowed, the left ventricle must generate a much higher pressure than normal in order to force enough blood through the aorta to deliver blood to the lower part of the body. If the narrowing is severe enough, the left ventricle may not be strong enough to push blood through the coarctation, thus resulting in a lack of blood to the lower half of the body. Physiologically its complete form is manifested as interrupted aortic arch.

The cardiac cycle is the performance of the human heart from the beginning of one heartbeat to the beginning of the next. It consists of two periods: one during which the heart muscle relaxes and refills with blood, called diastole, following a period of robust contraction and pumping of blood, called systole. After emptying, the heart relaxes and expands to receive another influx of blood returning from the lungs and other systems of the body, before again contracting to pump blood to the lungs and those systems.

Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart. These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

Bruit, also called vascular murmur, is the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery.

In medicine, the cardiac examination, also precordial exam, is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination.

Pulsus paradoxus, also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. Pulsus paradoxus is not related to pulse rate or heart rate, and it is not a paradoxical rise in systolic pressure. Normally, blood pressure drops less precipitously than 10 mmHg during inhalation. Pulsus paradoxus is a sign that is indicative of several conditions, most commonly pericardial effusion.

Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

A plot of a system's pressure versus volume has long been used to measure the work done by the system and its efficiency. This analysis can be applied to heat engines and pumps, including the heart. A considerable amount of information on cardiac performance can be determined from the pressure vs. volume plot. A number of methods have been determined for measuring PV-loop values experimentally.

The cardiovascular examination is a portion of the physical examination that involves evaluation of the cardiovascular system. The exact contents of the examination will vary depending on the presenting complaint but a complete examination will involve the heart, lungs, belly and the blood vessels.

Arterial blood pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure. Blood pressure values are generally reported in millimetres of mercury (mmHg), though modern aneroid and electronic devices do not contain mercury.

References

1 2 "pulse". The Free Dictionary.
1 2 Berg, Dale; Worzala, Katherine (2006). Atlas of Adult Physical Diagnosis. Lippincott Williams & Wilkins. p. 80. ISBN 9780781741903. Archived from the original on 2023-07-03. Retrieved 2020-10-03.
↑ "Pulse". MedlinePlus Medical Encyclopedia. Retrieved 25 November 2024.
↑ "sphygmograph". The Free Dictionary.
↑ Temkin 165;BBC[a]
1 2 Yuda, Emi; Yamamoto, Kento; Yoshida, Yutaka; Hayano, Junichiro (21 February 2020). "Differences in pulse rate variability with measurement site". Journal of Physiological Anthropology. 39 (1): 4. doi: 10.1186/s40101-020-0214-1 . ISSN 1880-6791. PMC 7035641 . PMID 32085811.
↑ "Pulse Rate Measurement". Healthwise. WebMD. Archived from the original on 23 July 2012. Retrieved 14 March 2011.
↑ Karadavut, Serhat; Altintop, Ismail (30 November 2021). "Pulse deficit in atrial fibrillation — a different perspective on rhythm or rate control strategy". Kardiologia Polska. 79 (11): 1231–1238. doi: 10.33963/KP.a2021.0107 . PMID 34506629.
↑ "www.meddean.luc.edu". Archived from the original on 2008-09-07. Retrieved 2009-05-20.
↑ "Vascular Surgery, University of Kansas School of Medicine". Archived from the original on 2009-02-04. Retrieved 2009-05-20.
↑ Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2016). Mechanisms of Clinical Signs – EPub3. Elsevier Health Sciences. p. 177. ISBN 9780729585613. Archived from the original on 2023-07-03. Retrieved 2018-01-02.
1 2 McGee, Steven (2016). Evidence-Based Physical Diagnosis E-Book. Elsevier Health Sciences. pp. 105–106. ISBN 9780323508711. Archived from the original on 2023-07-03. Retrieved 2018-01-02.
↑ Li JC, Yuan Y, Qin W, et al. (April 2007). "Evaluation of the tardus-parvus pattern in patients with atherosclerotic and nonatherosclerotic renal artery stenosis". J Ultrasound Med. 26 (4): 419–26. doi: 10.7863/jum.2007.26.4.419 . PMID 17384038. S2CID 11562194. Archived from the original on 2020-05-10. Retrieved 2018-01-02.
↑ Toy, Eugene, et al. Case Files: Internal Medicine. McGraw-Hill Companies, Inc. 2007. Page 43. ISBN 0-07-146303-8.
↑ Sanders, Roger C.; Winter, Thomas Charles (2007). Clinical Sonography: A Practical Guide. Lippincott Williams & Wilkins. p. 219. ISBN 9780781748698. Archived from the original on 2023-07-03. Retrieved 2018-01-02.
↑ Hajar, R. (2018). "The Pulse from Ancient to Modern Medicine". Heart Views. 19 (3): 117–120. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_16_19 . PMC 6448473 . PMID 31007864.
↑ "Rumi poem on the afflicted patient". Archived from the original on 2022-12-16. Retrieved 2022-12-16.
↑ Bigotti, Fabrizio; Taylor, David (2017). "The Pulsilogium of Santorio: New Light on Technology and Measurement in Early Modern Medicine". Societate Si Politica. 11 (2): 53–113. ISSN 1843-1348. PMC 6407692 . PMID 30854144.

External links

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[tfd-1] 1 2 "pulse". The Free Dictionary.

[Berg2006-2] 1 2 Berg, Dale; Worzala, Katherine (2006). Atlas of Adult Physical Diagnosis. Lippincott Williams & Wilkins. p. 80. ISBN 9780781741903. Archived from the original on 2023-07-03. Retrieved 2020-10-03.

[3] "Pulse". MedlinePlus Medical Encyclopedia. Retrieved 25 November 2024.

[4] "sphygmograph". The Free Dictionary.

[5] Temkin 165;BBC[a]

[Yuda2020-6] 1 2 Yuda, Emi; Yamamoto, Kento; Yoshida, Yutaka; Hayano, Junichiro (21 February 2020). "Differences in pulse rate variability with measurement site". Journal of Physiological Anthropology. 39 (1): 4. doi: 10.1186/s40101-020-0214-1 . ISSN 1880-6791. PMC 7035641 . PMID 32085811.

[7] "Pulse Rate Measurement". Healthwise. WebMD. Archived from the original on 23 July 2012. Retrieved 14 March 2011.

[8] Karadavut, Serhat; Altintop, Ismail (30 November 2021). "Pulse deficit in atrial fibrillation — a different perspective on rhythm or rate control strategy". Kardiologia Polska. 79 (11): 1231–1238. doi: 10.33963/KP.a2021.0107 . PMID 34506629.

[urlwww.meddean.luc.edu-9] "www.meddean.luc.edu". Archived from the original on 2008-09-07. Retrieved 2009-05-20.

[urlVascular_Surgery,_University_of_Kansas_School_of_Medicine-10] "Vascular Surgery, University of Kansas School of Medicine". Archived from the original on 2009-02-04. Retrieved 2009-05-20.

[11] Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2016). Mechanisms of Clinical Signs – EPub3. Elsevier Health Sciences. p. 177. ISBN 9780729585613. Archived from the original on 2023-07-03. Retrieved 2018-01-02.

[McGee2016-12] 1 2 McGee, Steven (2016). Evidence-Based Physical Diagnosis E-Book. Elsevier Health Sciences. pp. 105–106. ISBN 9780323508711. Archived from the original on 2023-07-03. Retrieved 2018-01-02.

[pmid17384038-13] Li JC, Yuan Y, Qin W, et al. (April 2007). "Evaluation of the tardus-parvus pattern in patients with atherosclerotic and nonatherosclerotic renal artery stenosis". J Ultrasound Med. 26 (4): 419–26. doi: 10.7863/jum.2007.26.4.419 . PMID 17384038. S2CID 11562194. Archived from the original on 2020-05-10. Retrieved 2018-01-02.

[CFIM-14] Toy, Eugene, et al. Case Files: Internal Medicine. McGraw-Hill Companies, Inc. 2007. Page 43. ISBN 0-07-146303-8.

[15] Sanders, Roger C.; Winter, Thomas Charles (2007). Clinical Sonography: A Practical Guide. Lippincott Williams & Wilkins. p. 219. ISBN 9780781748698. Archived from the original on 2023-07-03. Retrieved 2018-01-02.

[16] Hajar, R. (2018). "The Pulse from Ancient to Modern Medicine". Heart Views. 19 (3): 117–120. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_16_19 . PMC 6448473 . PMID 31007864.

[17] "Rumi poem on the afflicted patient". Archived from the original on 2022-12-16. Retrieved 2022-12-16.

[18] Bigotti, Fabrizio; Taylor, David (2017). "The Pulsilogium of Santorio: New Light on Technology and Measurement in Early Modern Medicine". Societate Si Politica. 11 (2): 53–113. ISSN 1843-1348. PMC 6407692 . PMID 30854144.

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