Test One Material:- Blood Pressure (brachial artery)o Systolic BP= the maximum pressure in the arteries during contraction of the heart (indirectly measures CO)o Diastolic BP= the minimum pressure in the arteries during relaxation of the heart (indirectly measures TPR)- Measurements of BPo Ideal = against the skin (no shirt)o Locate brachial artery and mark ito Place the stethoscope over the artery (not under the cuff)o Earpieces should be pointing toward the noseo Position the manometer to eye levelo Always record even numbers and round up to the nearest 2 mmHgo Patients should be seated for at least five minutes with their feet flat on the floor with their back and arms supported The arm should be at heart levelo Wrap the cuff firmly around the upper arm at the heart level and alignthe cuff with the brachial arteryo The cuff should circle at least 2/3 of the armo Place the stethoscope on the brachial artery o Inflate the cuff to 20 mmHg above the estimated SBP (180-200 mmHg)o Release the cuff at 2-5 mmHg/secondo Listen for the 1st Korotkoff sound (systolic BP)o Listen for the disappearance of sound (diastolic BP) 5th Korotkoff soundresting heart rateo take pulse over radial artery (thumb side)o tips of fingers do not apply too much pressure (do not use thumb)o count for 30-60 seconds (AT REST, during exercise count for 15)o always start with zero- Variables o Systolic and diastolic BPo Heart rate Be sure to start at zero when countingo Mean arterial pressureo Pulse pressureo Rate pressure product ***The indirect measurement of myocardial oxygen consumption- Equations (memorize all of these)o Pulse pressure = (SBP-DBP)*** During exercise, SBP increases while DBP will either decrease or remain the sameo Direct measurement of MAPMAP = CO x TPR - CO = HR x SV- TPR = total peripheral resistanceo Indirect measurement of MAP HR < 100 bpm -MAP = ( 1/3 (SBP-DBP))+DBP HR > 100 bpm***-MAP= ( 1/2 (SBP-DBP))+DBP o Rate pressure product = (HR x SBP)/100 *** MYOCARDIAL OXYGEN CONSUMPTIONo Changes in CO with body position to maintain CONSTANT CO! (CO = HR x SV) Supine/resting = highest SV, and lowest HR (Blood located thoracicly!) Standing = blood flow to the whole body so HR increases and SV decreases***o Fick equation VO2 (maximal oxygen consumption) = CO x (a-v) O2 difference*** VO2 increases with exercise; (a-v) O2 also increases with exercise- Sources of Injury for arterieso Dyslipidemia (abnormal cholesterol levels)o Hypertension (HIGH BP) o Immune responseso Smokingo Vasoconstrictor substanceso Viral/ bacterial infectiono Homocysteine (byproduct of red meat)o High levels of glucoseo Loss of estrogenHypertension, diabetes, smoking and hyperlipidemia decrease nitric oxide synthase (production of NO) = risk factor for atherosclerosis (narrowing of arteries) Sources cause DYSFUNCTION: Vasoconstriction (DEC diameter of lumen of BV), thrombosis (platelet aggregation - halt blood flow), lipid accumulation & growth, blood cell adhesion (atherosclerosis due to dysfunctional endothelium) = IMPEDE BLOOD FLOW to heart (HEART ATTACK)-Nitric Oxide = vasodilator***- CAD Risk Factors (non-modifiable)o Advanced age (INC # free radicals)o Male gendero Family history of CVD/MI/Revascularization Male 1st degree relative < 55 years Female 1st degree relative < 65 years- CAD Risk Factors (modifiable – can change with behavior/lifestyle choices)o Hypertension (HIGH BP)o Dyslipidemia (abnormal lipid levels)o HDL < 40 mg/dLo Obesityo Impaired fasting glucose (100-125 mg/dL)o Smokingo Physical inactivity/Sedentary lifestyle- Emerging Risk Factors (no-conclusive evidence/correlation)***o Triglycerides o Lipoprotein (a)o Lipoprotein remnantso HDL subspecieso Apolipoproteins o Total cholesterol to HDL ratioo Homocysteineo Inflammatory markers (C reactive proteins)o Thrombogenic and hemostatic factors - Classification of Total Serum Cholesterol LevelsTotal Cholesterol < 200 mg/dL Desirable 200-239 mg/dL Borderline High > 240 mg/dL High- Classification of Serum Low (LDL) and High (HDL) Cholesterol***LDL Cholesterol < 100 mg/dL Optimal 100 - 129 mg/dL Near optimal 130 - 159 mg/dL Borderline high 160 - 189 mg/dL High > 190 mg/dL Very highHDL Cholesterol < 40 mg/dL Lowo > 60 mg/dL HDL= a negative risk factor (good thing, it cancels out a positive risk factor)***o High HDL and low LDL is optimal- Classification of Fasting Serum Triglyceride Levels***Triglyceride < 150 mg/dL Normal 150 - 199 mg/dL Borderline high 200 - 499 mg/dL High > 500 mg/dL Very high- Blood Pressure***Systolic DiastolicOptimal <120 and <80Prehypertension 120-139 or 80-89HYPERTENSION Stage 1 140-159 or 90-99 Stage 2 > 160 or > 100- Treatment for Hypertension***o Reduce dietary fat, especially saturated fat and cholesterol, as well as total calories- this promotes weight loss and better CV healtho Increase physical activity Decrease BP as well as risk for CVDo Lose weight if overweighto Limit alcohol intake to no more than 1 oz. a dayo Reduce sodium intake (<2.3 grams Na or <6 grams NaCl)o Be careful to maintain electrolyte balanceo Stop smokingo Reduce saturated fat and cholesterol- Smoking*****Tobacco is the only legal product that kills 1/3 of its users when used as directedo Causes vasoconstriction o Increases platelet aggregationo Promotes oxidation of LDLo Decreases lung function- Additional Actions of Smoking***o Promotes oxidation of LDL-co Increases sympathetic nerve activity and catecholamine release resulting in: Increase BP by 5-10 mmHg Increase HR by 10-15 bpm Increase myocardial contractility Constriction of coronary arterieso A smoker is more likely to be at risk for a more severe MI and more likely to die from MI- Type I Diabeteso Insulin dependent diabetes mellitus (IDDM) Used to be called juvenile onseto An autoimmune disease affecting the beta cells of the islet of Langerhans of the pancreas, in which the body doesn’t produce insulin (most often occurring in children and young adults)o These patients require insulin injections to stay aliveo Comprises 5-10% of diabetic patients- Type II Diabeteso Non-insulin dependent diabetes mellitus (NIDDM) Used to be called adult onseto A metabolic disorder in which the body can’t make enough insulin
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