Monday Blood Pressure Systolic Blood Pressure maximal pressure in the arteries during contraction of the heart measured by the onset of sound Diastolic Blood Pressure minimum pressure in the arteries during the relaxation of the heart complete disappearance of sound We will be doing resting as well as exercise blood pressure Systolic really important Heart has to work harder when high as opposed to diastolic Cuff over brachial artery forearm inner side of elbow medial Can do leg ankle blood pressure as well Arm up palpate brachial artery not with thumb not vein Put stethoscope over that support arm palpate put stethoscope over artery crossing legs can effect blood pressure Measurements of Blood Pressure Ideally measurement should be against skin Locate brachial artery and mark Place stethoscope over artery not under cuff Earpieces should be pointing towards nose Position manometer at eyelevel Always record even round off to the nearest 2 mmHg Patients should be seated 5 minutes in a chair with back and arms supported Arm should be at heart level feet flat on floor Wrap cuff firmly around upper arm at heart level align cuff with brachial artery Cuff should be able to circle at least 2 3rds of arm small cuffs cause higher readings Place stethoscope over brachial artery Inflate cuff pressure to 20mmHg of mercury above estimated SBP Release cuff at a rate of 2 to 5 mmHg per second Listen for Kortikoff sound systolic BP know sounds These are the 2 we need to know 1 1st starting of rhythm tapping 2 5th Kortikoff sound diastolic sound disappears Decrease diastolic blood pressure means very healthy Very 1st sound when blood starts to squeeze through artery When artery back to normal won t hear sound anymore diastolic Variables Systolic blood pressure mmHg Diastolic blood pressure mmHg Heart rate beats minute whenever you count it start at ZERO Mean arterial blood pressure mmHg KNOW Pulse Pressure mmHg KNOW Rate pressure product indirect measure of myocardial oxygen consumption or how hard the heart is working KNOW Resting heart rate feel pulse 1 Carotid face gently 2 radial on thumb Resting heart rate 30 seconds or 1 minute Equations Pulse pressure SBP DBP With exercise SBP increases and DBP stays the same or decreases Direct measure of MAP MAP CO x TPR CO systolic BP stress test Increase systolic increase CO SBP indirect measure of CO Cardiac output heart rate x stroke volume TPR total peripheral resistance Indirect measure MAP DBP gives us impression of what TPR is doing Calculate MAP can t take mean of DBP and SBP Exercise decreases TPR TPR decreases or remains same when DBP decreases If you exercise and TPR and DBP increases it is BAD CO HR x SV Changes in cardiac output with body position Low lying down b c gravity blood not having to go up HR decreases and SV increases Pass out not getting blood flow to head stand up HR increases and SV decreases Indirect measure of MAP HR 100 b min MAP 1 3 SBP DBP DBP HR 100 b min MAP 1 2 SBP DBP DBP Rate Pressure Product RPP HR x SBP 100 Cardiac output Fick Equation VO2 CO x a v O2 difference CO and a v O2 difference increase when exercise 5 11 10 Tuesday CAD Risk Factors non modifiable Advancing age Male gender Family history CAD Risk Factors Modifiable Hypertension Hyperlipidemia HDL 40 mg dl Male first degree relative 55 years Female first degree relative 65 years Obesity Impaired Fasting Glucose Smoking Physical inactivity Emerging Risk Factors Triglycerides Lipoprotein a Lipoprotein remnants Small LDL particles HDL subspecies Apolipoproteins Total Cholesterol to HDL ratios Homocysteine a lot of red meat Inflammatory markers Thrombogenic and Hemostatic factors As you increase cholesterol level the risk of heart disease increases Classificarion of total serum cholesterol levels Total Cholesterol 200 mg dL 5 2 mmol L 200 239 mg dL 240 mg dL Classification Desirable cholesterol Borderline high High cholesterol Classification of serum low LDL and high density lipoprotein HDL cholesterol levels LDL Cholesterol 100 mg dL 100 129 mg dL 130 159 mg dL 160 189 mg dL 190 mg dL Classificaltion Optimal Near Optimal Borderline high High Very high HDL Cholesterol 40 mg dl Classification Low HDL cholesterol 60 or better decreases your risk Triglycerides Classification 150 mg dl 150 199 200 499 500 Blood Pressure Optimal Prehypertension Hypertension Stage 1 Stage 2 Normal Borderline high High Very high SYSTOLIC 120 120 139 SYSTOLIC 140 159 160 DIASTOLIC 80 80 89 DIASTOLIC 90 99 100 always go with the higher number for classification ex 120 91 and 140 89 are both considered stage 1 hypertension decreasing SBP even a small amount can decrease CHF stroke and renal disease Hypertension Recent studies show that SBP has a greater influence on risk Treatment of Hypertension Reduce dietary fat especially saturated fat and cholesterol as well as total calories promotes weight loss and better CV health Increase physical activity o Reduces BP as well as risk for CVD o Recommendations for frequency duration and intensity are the same as for apparently healthy Lose weight if overweight Limit alcohol intake to no more than 1 oz of alcohol per day small amounts of alcohol moderately are better than just one large serving occasionally Reduce sodium intake 2 3 grams of sodium or 6 grams sodium chloride Be careful to maintain electrolyte balance supplements may help Stop smoking not just smoking yourself second hand smoke can increase BP 1 cigarette can decrease your HDL increase your LDL TG and increase the work of your heart Even when your just in the room with smokers your heart goes through vasoconstriction Makes platelets sticky increasing growth factor Reduce saturated fat and cholesterol Cigarette Smoking Tobacco is the only legal product that kills 1 3 of its users when used as directed Causes vasoconstriction Increases platelet aggregation Promotes oxidation of LDL s Smoking Decreases lung function o Increase in BP by 10 15 mmHg o Increase of HR by 10 15 bpm o Increased myocardial contractility o Constriction of coronary arteries Promotes oxidation of LDL C Increases sympathetic nerve activity and catecholamine release resulting in Cigarette smokers are at a greater risk for more severe MI s and more likely to die from an MI myocardial infarction heart attack Increases constriction b c of increase SN activity and increase cholesterol Cig smokers are at greater risk for more severe MI s and are more likely to die from MI Once they have that heart attack they are
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