Pulse

Description

Pulse describes an “echo” of the heart beat transmitted by peripheral vessels. Pulse rate and heart rate are usually identical.

Use

– Documentation of pulse rate and heart rate
– In context of ambulant sector- 
– Actual or past measurements
– Use for palpatoric or device measurement of pulse and pulse-characteristics
– Use to record the presence or absence of a pulse rate or heart rate
– Use to record the measurement of the pulse rate or heart rate
– Long-term and 24-hour pulse measurements
– observation about the associated rhythm
– Use to record a simple description of characteristics that are associated with the pulse or heartbeat, that might be commonly recorded as part of a vital signs observation
– In practice, the terms heart rate and pulse rate are often used interchangeably. This archetype allows either term to be used when the measurement site is not specified, to suit clinician preferences.
– In certain situations, however, it is important to differentiate between a pulse rate observed at a peripheral artery, such as the radial artery, in contrast to the centrally observed heart rate. This archetype allows the data to be very specific and differentiate between central heart rate and the pulse rate recorded at a specified artery.

Not use

– Do not use for pulse wave and more specific documentation of pulse.

Data Model

Name Type M Description Example
parameterCode CodedEntry X Name and List of Codes (e.g.LOINC) for the observed parameter, as defined below “parameterCode”:{“catalogName”: “LOINC”,“catalogVersion”: “2.48”,“code”: “8867-4”,“codeText”: “LOINC 8867-4”,“description”: “Heart Rate”}
startDate DateTime The startDate defines the point in time when the measurement is executed. “2014-10-13T11:24:56.143”
endDate DateTime The endDate is only needed in case of using a timespan and defines the end of the measurement period. “2014-10-13T11:24:57.143”
value UnitValue X The value is the measured value and the belonging unit. “value”: {“value”: 80,”unit”: “bpm”,”valueText”: “80 bpm”}
informationSource CodedEntry kind of source as defined in 3.2.4.1.1 information source> MeasuredByPhysician
calculationFormula String In case of calculated data, e.g. BMI, the formula of calculation should be specified to check the validity of the value.
comment String See general data model description. “This is a comment”
device Device The device is an inherited object to describe the device used for the measurement. See device for example.
PulseRythm String judgment of pulse-frequence, as listed in <3.2.4.1.2 pulseRythm> “regular”
pulseQuality String Judgment/Observation of pulse characteristics, as listed in  <3.2.4.1.3 pulseQuality> “hard”
location String list of anatomic locations for pulsemeasurement, as specified in <3.2.4.1.4 location> “right A.carotis”
method String list of commonly used measurement methods, as used in <3.2.4.1.5 method> “by device”

Rules

The value must be documented.

Parameter Codes

Following LOINC codes can be used to specify the parameter code:
loinc_num component system property time_aspct scale_typ method_typ
11327-4 Heart rate method XXX Type Enctr^frst Nom
11328-2 Heart rate Arterial system NRat Enctr^frst Qn
11633-5 Biophysical profile.heart rate reactivity ^Fetus Fcn Pt Ord US
11948-7 Heart rate ^Fetus NRat Pt Qn US.measured
18708-8 Heart rate Arterial system Cmplx Enctr^frst Set
18709-6 Heart rate special circumstances ^Patient Type Enctr^frst Nom
19946-3 Heart rate max setting Apnea monitor.alarm NRat Pt Qn
19947-1 Heart rate min setting Apnea monitor.alarm NRat Pt Qn
20331-5 Cardiac output/Heart rate.2 chamber Heart.ventricle.left Vol Pt Qn US.2D.mod.single-plane.calculated
20332-3 Cardiac output/Heart rate.4 chamber Heart.ventricle.left Vol Pt Qn US.2D.mod.single-plane.calculated
32402-0 Heart rate^10M post birth ^Patient Fcn Pt Ord Apgar
32407-9 Heart rate^1M post birth ^Patient Fcn Pt Ord Apgar
32412-9 Heart rate^5M post birth ^Patient Fcn Pt Ord Apgar
40442-6 Heart rate^post exercise XXX NRat Pt Qn
40443-4 Heart rate^resting XXX NRat Pt Qn
40587-8 Heart rate^post exercise XXX NRat Pt Qn Oximetry
41920-0 Heart rate XXX NRat 1H^mean Qn
41921-8 Heart rate XXX NRat 8H^mean Qn
41922-6 Heart rate XXX NRat 10H^mean Qn
41923-4 Heart rate XXX NRat 12H^mean Qn
41924-2 Heart rate XXX NRat 24H^mean Qn
43149-4 Heart rate device panel ^Patient Pt
44609-6 Heart rate Capillary bed NRat Episode^max Qn Oximetry
44610-4 Heart rate Capillary bed NRat Episode^min Qn Oximetry
44611-2 Heart rate Capillary bed NRat Episode^mean Qn Oximetry
44969-4 Heart rate rhythm XXX Type Pt Nom Palpation
55283-6 Heart rate ^Fetus NRat Pt Qn
55422-0 Heart rate Arterial system NRat Enctr^max Qn
55425-3 Heart rate Arterial system NRat XXX^mean Qn Pedometer
55426-1 Heart rate Arterial system NRat XXX^max Qn Pedometer
57068-9 Heart rate ^Fetus NRat Pt Qn Auscultation
59086-9 Ejection^^corrected for heart rate Heart.ventricle.left Time Pt Qn US
59087-7 Pre ejection period^^corrected for heart rate Heart.ventricle.XXX Time Pt Qn US
59118-0 Circumferential fiber shortening.mean^^corrected for heart rate Heart.ventricle.left Vel Pt Qn US
66440-9 Heart rate XXX NRat 10M^mean Qn Palpation
67129-7 Heart rate^resting Peripheral artery NRat Pt Qn Palpation
68999-2 Heart rate^supine Arterial system NRat Pt Qn
69000-8 Heart rate^sitting Arterial system NRat Pt Qn
69001-6 Heart rate^standing Arterial system NRat Pt Qn
69408-3 Orthostatic heart rate Arterial system RatDiff Pt Qn
73795-7 Heart rate Bld.postductal NRat Pt Qn Pulse oximetry
73799-9 Heart rate Bld.preductal NRat Pt Qn Pulse oximetry
8861-7 Work/Heart rate Heart.ventricle.left Enrg Pt Qn
8862-5 Work/Heart rate Heart.ventricle.right Enrg Pt Qn
8863-3 Work/Heart rate/Body surface area Heart.ventricle.left ArEnrg Pt Qn
8864-1 Work/Heart rate/Body surface area Heart.ventricle.right ArEnrg Pt Qn
8867-4 Heart rate XXX NRat Pt Qn
8869-0 Heart rate XXX NRat 1H^max Qn
8870-8 Heart rate XXX NRat 8H^max Qn
8871-6 Heart rate XXX NRat 10H^max Qn
8872-4 Heart rate XXX NRat 12H^max Qn
8873-2 Heart rate XXX NRat 24H^max Qn
8874-0 Heart rate XXX NRat 1H Qn
8875-7 Heart rate XXX NRat 8H Qn
8876-5 Heart rate XXX NRat 10H Qn
8877-3 Heart rate XXX NRat 12H Qn
8878-1 Heart rate XXX NRat 24H Qn
8879-9 Heart rate XXX NRat 1H^min Qn
8880-7 Heart rate XXX NRat 8H^min Qn
8881-5 Heart rate XXX NRat 10H^min Qn
8882-3 Heart rate XXX NRat 12H^min Qn
8883-1 Heart rate XXX NRat 24H^min Qn
8884-9 Heart rate rhythm XXX Type Pt Nom
8885-6 Heart rate measurement site ^Patient Anat Pt Nom
8886-4 Heart rate method Heart rate measure Type Pt Nom *
8888-0 Heart rate measure duration Heart study Time * Qn
8889-8 Heart rate Capillary bed NRat Pt Qn Oximetry
8890-6 Heart rate Cardiac apex NRat Pt Qn Auscultation
8891-4 Heart rate Cardiac apex NRat Pt Qn Palpation
8892-2 Heart rate Peripheral artery NRat Pt Qn US.doppler
8893-0 Heart rate Peripheral artery NRat Pt Qn Palpation
If no specific code is needed use for exact measurements LOINC 8867-4 for heart rate.

Enums

The information source is based on a coded entry please have a look at the description of Measurement.

PulseRythm, pulseQuality, Location and Method are based on enumerations. Therefore it is recommended to use an entry of the list if possible.

pulseRythm

List of common used judgments of pulse frequency.

Code/ID Name
Regular regular
Irregular irregular
Bigeminal bigeminal
Other other
Dropouts dropouts
NoJudgementPossible no judgment possible

pulseQuality

List of some parameters, characterizing pulse during palpation.

Code/ID Name
NotPalpable not palpable
NotMeasureableByDevice not measurable by device
Normal normal
Hard hard
Soft soft
Filiform filiform
Other other

Location

List of commonly used anatomic locations for pulse measurement.

Code/ID Name
LeftARadialis left A. radialis
RightARadialis right A. radialis
LeftABrachialis left A. brachialis
RightABrachialis right A. brachialis
LeftAAxillaris left A. axillaris
RightAAxillaris right A. axillaris
LeftACarotis left A.carotis
RightACarotis right A.carotis
LeftADorsalisPedis left A. dorsalis pedis
RightADorsalisPedis right A. dorsalis pedis
LeftATibialisPosterior left A. tibialis posterior
RightATibialisPosterior right A. tibialis posterior
LeftAFemoralis left A. femoralis
RightAFemoralis right A. femoralis
RightAPoplitea right A. poplitea
LeftAPoplitea left A. poplitea

Method

List of commonly used measurement methods

Code/ID Name
Palpatoric palpatoric
ByDevice by device
Ascultation auscultation

Catalogs

See Measurement Catalogs for more information.

Update Rhythm

The blood pressure measurement can be updated up to several times a day.

Schema

{
“id”: “/core/cardiovitals/Pulse”,
“$schema”: “http://json-schema.org/draft-04/schema#”,
“type”: “object”,
“properties”: {
“parameterCode”: {
“$ref”: “/core/CodedValue”
},
“startDate”: {
“$ref”: “/core/DateTime”
},
“endDate”: {
“$ref”: “/core/DateTime”
},
“value”: {
“$ref”: “/core/UnitValue”
},
“informationSource”: {
“$ref”: “/core/CodedValue”
},
“calculationFormula”: {
“type”: “string”
},
“comment”: {
“type”: “string”
},
“device”: {
“$ref”: “/core/Device”
},
“pulseRythm”: {
“type”: “string”
},
“pulseQuality”: {
“type”: “string”
},
“location”: {
“type”: “string”
},
“method”: {
“type”: “string”
}
},
“required”: [“parameterCode”, “value”],
“additionalProperties”: false
}

Compatible Standards

The pulse object is compatible to openEHR-EHR-OBSERVATION.pulse.v1.