blood pressure 10-11-2012
TRANSCRIPT
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Blood Pressure and HeartSounds Dr . Loay Abudalu. MD.
MSc (UK)
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Heart Sounds
Blood Pressure
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The MechanicalSystem
ModulatingSystems
CardiacMeasurements
vasculaturechanges
blood pressuremeasuring
Blood Pressure
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The force exertedby blood against thewalls of the vessels
in which it iscontained
The pressure isdetermined by the
force and theamount of blood
pumped and thesize and flexibility of
the arteries
What is Blood Pressure?
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The Mechanical System
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The autonomous nervoussystem
The hormonal system
Mechanical factors
Electrical factors
Other factors
sympathetic system& parasympatheticsystem
like insulin and
epinephrine
peripheralresistance of the
blood vessels
ectopic pacemakercells, conduction
problems
Body temperature
,CO2 levels and Ions( Ca and K )
Modulating Systems
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vasculature changes
Structureof
vasculature changesinresponse
todifferentneeds
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Heart rate: is the number of heartbeats per unit oftime, typically expressed as beats per minute.
stroke volume : is the volume of blood pumped fromone ventricle of the heart with each beat.
End-diastolic volume (EDV) :is the volume of bloodin the right and/or left ventricle at end load or filling in(diastole).
End-systolic volume (ESV) : is the volume of bloodin a ventricle at the end of contraction, or systole.
Important Definitions
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Cardiac output :is the volume of blood being pumped bythe heart, in particular by a left or right ventricle in thetime interval of one minute.
Afterload :is the tension or stress developed in the wall ofthe left ventricle during ejection
preload : is the end volumetric pressure that stretchesthe right or left ventricle of the heart to its greatestgeometric dimensions under variable physiologic demand
Important Definitions
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Cardiac Measurements
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Stroke volume = End-diastolic volume End-
systolic volume
Cardiac output = Heartrate Stroke volume
Afterload
Preload
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patients blood pressure
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Blood Pressure An
Overview
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Korotkoff Sounds
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Korotkoff Sounds
First PhaseA clear tapping sound; onset of the sound for two
consecutive beats is considered systolic
Second Phase
The tapping sound followed by a murmurThird Phase
A loud crisp tapping sound
Fourth Phase
Abrupt, distinct muffling of sound, gradually
decreasing in intensity
Fifth Phase
The disappearance of sound, is considered
diastolic blood pressure- two points below the last
sound heard
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Korotkoff Sounds
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Technique for Measuring BloodPressure
Seated for 5 minutes
Patient PositionExpose Upper arm
Centre of upper arm at
heart level
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Technique for Measuring BloodPressure
Cuff applied 1 inch abovecrease at elbow
Locate brachial artery
Palpate radial pulse
Inflate cuff until pulsedisappears
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Technique for Measuring BloodPressure
Let air out
Place stethoscope on brachial artery
Pump up cuff to 20-30 above point ofobliteration
Let air out at 2 mmHg per second
Note 1st and 5th Korotkoff sounds
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AuscultationAreas
Cause of theheart sounds Calculations
Extra heartsounds
Heart sounds
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Auscultation
Placing a stethoscope to the heart sound we
can hear: Lub (first heart sound) which is associated
with the closure of the AV valves.
Dub (second heart sound) which is associatedwith the closure of the semilunar valves.
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The causes of the 1st heart sound:
Cause of the heart sounds
During systole the AV valves are closed &blood tries to flow back to the atrium backbulging the AV valves. But the taut chordaetendinae stop the back bulging and causes
the blood to flow forward.This will cause vibration of the valves, blood &
the walls of the ventricles which is presentedas the 1st heart sound.
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The causes of the 2nd heartsound:
Cause of the heart sounds
During diastole, blood in the blood vesselstried to flow back to the ventricles this will
cause the semilunar valves to bulge. But the
elastic recoil of the arteries cause the blood tobounce forward which will vibrate the bloodthe valves and the ventricle walls.
This is presented as the 2nd heart sound.
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Difference between the 1st and 2ndheart sounds
The 1st sound lasts longer because the AVvalves are less taut than the semilunar valves
which will enable them to vibrate for longertime.
The 2nd heart sound had higher frequencydue to:
1. The semilunar valves are more taut.2. The great elastic coefficient of the taut
arteries which provides the principlevibrations of the 2nd heart sound.
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Aortic: base- 2nd Rt ICS, sternalborderPulmonic: base- 2nd Lt ICS, sternal
border
3rd Lt ICS, sternal border
Tricuspid: lower Lt sternal border(4-
5ICS)Mitral: cardiac apex (LV) 5 ICS, MCL
Auscultation Areas
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Auscultation
Areas
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The 3rd heart sound: is the heard in the middiastole due to the blood that fills the ventricles.(when the rush of blood into the filling ventricle is
suddenly halted),normally disappears before middleage.a sign of a failing left ventricle as in dilated
congestive heart failure (CHF)
The 4th heart sound: also known as atrial heartsound. It occur when the atrium contracts &pumps blood to the ventricles(blood being forced
into a stiff/hypertrophic left ventricle)It is a sign of apathologic state, usually a failing left ventricle
Extra heart sounds
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A gallop rhythm refers to a (usuallyabnormal) rhythm of the heart on
auscultation
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