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PET4551 Exam I 04 28 2014 Systolic Blood Pressure maximal pressure in arteries during heart contraction first sound heard while conducting a blood pressure test Diastolic Blood Pressure minimum pressure in arteries during heart contraction last sound heard before complete disappearance of sound while conducting a blood pressure test Taking Blood Pressure Stethoscope Ear pieces should be pointing towards nose Position manometer at eye level Always record even numbers and round off upward to the nearest 2mmHg 1 Patient should be seated for 5 minutes in a chair with back and arms supported arms at heart level feet flat on the floor 2 Wrap cuff firmly around upper arm at heart level align cuff with brachial artery cuff should be able to circle at least 2 3 of the arm 3 Have patient hyperextend arm to allow protrusion of brachial artery 4 Feel for brachial artery on inside of elbow 5 Place stethoscope over brachial artery 6 7 Release cuff at a rate of 2 5mmHg sec 8 Listen for first Korotkoff sound SBP 9 Continue until sound disappears DBP 5th Korotkoff sound Inflate cuff pressure to 20mmHg above estimated SBP Pressure in cuff 120 or 70 no sound audible sound only audible between 70 120 The healthier the artery the less pressure needed to cut off circulation Resting Heart Rate 1 Take pulse over radial artery thumb side 2 Use tips of fingers do not apply too much pressure do NOT use thumbs 3 Count for 30 to 60 seconds 4 Always start counting with zero 5 When you change positions supine seated standing the heart rate changes Q HR SV Supine Standing When an individual stands their blood begins to pool in their lower extremities due to gravity leading to a drop in venous return and a decreased stroke volume since cardiac output is equal to heart rate times stroke volume when the stroke volume decreases after standing the heart rate must increase to compensate and maintain cardiac output Supine Position HR is lowest SV is highest Standing Position HR is highest SV is lowest Well trained individuals 40 50b min Untrained individuals 70b min Variables and Equations Systolic Blood Pressure mmHg Diastolic Blood Pressure mmHg Heart Rate b min Mean Arterial Blood Pressure mmHg 1 MAP Q TPR Total Peripheral Resistance indirect measure of cardiac output systolic blood pressure SBP and Q with exercise indirect measure of TPR diastolic blood pressure TPR and DBP with exercise 2 Indirect Measure of MAP HR 100b min MAP 1 3 SBP DBP DBP HR 100b min MAP 1 2 SBP DBP DBP about 2 3 of time is spend in diastole and 1 3 spent in systole therefore we cannot simply add the two and divide by two to find the mean Pulse Pressure mmHg Pulse Pressure SBP DBP pulse pressure increases with exercise due to an increase in systolic BP while diastolic BP remains the same or decreases Rate Pressure Product RPP indirect measure of myocardial oxygen consumption how hard the heart is working RPP HR SBP 100 Fick Equation VO2 Q a vO2 diff a vO2 diff increases with exercise Ankle Brachial Index ABI evaluate peripheral vascular disease aka intermittent claudication and severity of it two places to take blood pressure for ABI posterior tibial artery and dorsalis pedis artery while patient lies on gurney ratio ankle SBP brachial SBP normal about 1 1 1 ankle pressure higher than arm If ABI drops with exercise it means you have PVD loss of blood flow to lower limbs Legs may need to be amputated with severe PVD Selected Blood Variables Hemoglobin g dL men 13 5 17 women 11 5 15 5 Hematocrit men 40 52 women 36 48 the ratio of red blood cells to overall blood volume Fasting Glucose mg dL 60 99 Kidney Test Blood Urea Nitrogen BUN creatinine Liver Tests Bilirubin SGOT Serum Glutamine Oxaloacetic Transaminase SGPT Serum Glutamic Pyruvic Transaminase Pathophysiology for CVD Source of Injury to Vascular System Dislipidemia abnormal lipid levels high LDL and low HDL Hypertension wear and tear on the vessels Immune Response body attacks vessels Smoking pollutants Vasoconstrictor Substances smoking chewing tobacco air pollutants Viral or Bacterial Infections Homocysteine in red meat High Level of Glucose Low Estrogen male menopause all sources are damaging to the epithelial cells in the lining of the blood vessel walls infiltrate through the lining to affect the smooth muscles and cause atherosclerosis thrombosis and abnormal growth CAD Risk Factors non modifiable Advancing Age 45 men 55 women Male Gender Family History Male first degree relative father or brother 55 years Female first degree relative mother or sister 65 years at risk for CVD if diagnosed before this age CAD Risk Factors modifiable Hypertension Displipidemia HDL 40mg dL Obesity Smoking Physical Inactivity Impaired Fasting Glucose fasting 8 hours even if you have no non modifiable risk factors just one modifiable risk factor could substantially increase the likelihood of disease Hypertension diabetes smoking ect leads to arterial narrowing nitric oxide dilates blood vessels to allow for blood flow Nitric Oxide potent vasodilator working on smooth muscle exercise causes the most potent nitric oxide synthesis Emerging Risk Factors Triglycerides Lipoproteins a Lipoprotein remnants Small LDL particles HDL subspecies Apolipoproteins Total cholesterol to HDL ratios Homocysteine Inflammatory markers Thrombogenic and hemostatic factors Classification of total serum cholesterol levels Classification Desirable cholesterol Borderline high High cholesterol Total cholesterol 200 mg dL 200 239 mg dL 240 mg dL Classification of serum low LDL and high density lipoprotein HDL cholesterol levels Classification LDL cholesterol Optimal Near optimal Borderline high Classification Low HDL cholesterol Normal High Classification Normal Borderline High High Very High 100 mg dL 100 129 mg dL 130 159 mg dL HDL cholesterol 40 mg dL 40 59 mg dL 60 mg dL Triglycerides 150 mg dL 150 199 mg dL 200 499 mg dL 500 mg dL Classification of Fasting Serum Triglyceride Levels Blood Pressure mmHg Optimal Hypertension Stage 1 Hypertension Stage 2 Hypertension 160 Systolic 120 120 139 140 159 and or or or Diastolic 80 80 89 90 99 100 Black individuals are at a higher risk for hypertension Family history plays a large role in developing high blood pressure Life style habits add to this likelihood Hypertension can lead to strokes congestive heart failure and renal disease More than half of the people living with high blood pressure do not know they have it and many times stroke can be the first symptom of high blood pressure


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FSU PET 4551 - Exam I

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