Blood Pressure o Systolic Blood pressure Max pressure upon arteries measured on the onset of sound o Diastolic Blood pressure Minimum pressure on arteries measured at complete disappearance of sound Indicates relaxation of the heart o BP measured at great artery brachial artery o Palpate brachial artery if necessary Brachial artery located in the medial inside of the elbow in upright position o Try hyper extending elbow to bring artery closer to the skin if artery cannot be found BP can also be taken at the ankle or inner thigh o Pump cuff enough to reduce blood flow once you let go you will be able to hear the sounds o Measurement o Taken against skin Under armor and other tight shirts may be acceptable but the best reading is done against the skin o When exercising mark where the artery is so that it is easy to locate where the stethoscope will be places o Remember Always place the stethoscope at artery and NOT under the cuff This may caused pain and pressure for the person Earpiece of the stethoscope will always point towards the nose Round to the nearest 2 even Position monometer at eye level o Procedures o Person should be allowed to rest and sit 5 10 prior to taking BP Factors such as cold weather and rushing in may cause a higher BP reading o Make sure person has their legs UNCROSSED and that they are sitting in an upright position with support for both their back and arms o Wrap cuff at upper arm upper arm in order to leave space for the stethoscope and artery o Align the cuff with brachial artery o Cuff should circle at least 2 3 of the persons arm there are different sizes If a cuff is too tight higher readings may be a result o Place stethoscope on artery NOT under cuff o Inflate cuff to about 20 mmHg above what it thought to be the systolic BP if you still In a young healthy individual you shouldn t have to surpass about 160 hear a beat keep pumping o Release cuff at a rate of 2 5mmHg o Listen for first Korotkoff Sound There are a total of 5 but only the first systolic and last diastolic are the most important o Variables o Systolic BP o Diastolic BP o Heart rate o Heart Rate Mean arterial pressure MAP Pulse pressure mmHg Rate Pressure Product o When measuring heart rate place pointer and middle finger on the inner groove at the base of the thumb their own the radial artery DO NOT use your own thumb to measure heart rate our thumbs have a pulse of Heart rate can also be taken at the corotic artery or the brachial but easiest is at o If the person is at rest count beats starting at ZERO 0 for 30 sec or a minute If only counting for 30 seconds multiply your answer by 4 o If the person is exercising count beats starting at ZERO 0 for 15 sec or 30 sec Multiply by 4 if counting for 15 sec o Equations o Pulse Pressure SBP DBP o Direct Measure of MAP CO TPR CO Cardiac output which is also HEART RATE STROKE VOLUME TPR Total Peripheral Resistance o Indirect measurement of MAP When heart rate is below 100 1 3 SBP DBP DBP When heart rate is above or equal to 100 1 2 SBP DBP DBP Why add DBP at the end When our heart is constricting and full circulation of the blood occurs diastolic takes much longer than systolic Meaning it takes longer for blood to exit the heart than it does to enter Because of this diastolic has a greater contribution to the measurement and is added o Rate Pressure Product HR SBP 100 SBP will increase with exercise and diastolic will either remain the same or decrease after a long period of time after exercise o Cardiac Output HR SV Heart rate Stroke Volume o Fick Equation C0 av02 difference o Changes in cardiac output with body positions o Blood pressure should remain about the same as you change body positions o Standing up too quickly may result in feeling dizzy or faint this is usually an indication o Heart rate is lowest in the morning while laying down unless you get scared by the that your BP has dropped alarm clock Some fit people may have a heart rate as low as in the 40 s or 50 s this could be because of some aerobic training o Stroke volume is lowest while standing because of gravity Simply put blood will rush to the lower extremities when standing This is why it is suggested to military and others that stand for a while to move their toes around so as to cause circulation When someone is feeling faint the best solution is to lay them down and put their legs over their heads so that blood can reach the heart and circulate once more Pathophysiology Cardiovascular Disease o Sources of injury o Dyslipidemia abnormal cholesterol o Hypertension High BP o Immune responses some conditions where body may begin to attack itself o Smoking could cause stroke o Vasoconstriction substances air we breath inhale Could cause smooth muscle to constrict around the arteries o Viral or bacterial infection o Homocysteine byproducts of eating red meats o High levels of glucose diabetes o Loss of estrogen risks get closer to that of men for women o All sources will cause a dysfunction in epithelial cells and its lining o Artery may become smaller because of contraction of smooth muscle o Blood cell adhesion starts to stick to cells o Thrombosis and clotting o Proliferation o Platelets accumulate and could create a fibrous cap that will close off lumen o Affects Nitric Oxide by inhibiting it Nitric Oxide is a basal dilator that increases relaxation of the smooth muscle and blood flow without constriction of the lumen o Cardiovascular disease is the number killer of men and women in the nation o Risk Factors non modifiers meaning you can not do much about them o Advancing age wear and tear of the body o Male gender o Family history Male first degree like a brother or father 55 Female first degree like a sister or mother 65 o Risk Factors modifiable meaning lifestyle changes can help o Hypertension o Dyslipidemia o Obesity o Impaired fasting glucose o Smoking o Physical inactivity o Right kind of diet and exercise can fix these factors o Emerging risk factors Not enough information to directly correlate o Triglycerides o Lipoproteins a o Lipoprotein remnants o Small LDL particles o HDL subspecies HDL3 HDL2 o Apolopoproteins o Total cholesterol to HDL ratios o Homocysteine o Inflammatory markers C reactive protein o Thrombogenic and hemostatic factors I e fibrinogen higher in obese individuals Total Serum Cholesterol Levels Total Cholesterol 200 mg dL 200 239 mg dL Classification Desirable Borderline High 240 mg dL High LDL AND HDL numbers would trump total cholesterol
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