physiology of cardiovascular system - imbm
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Physiology of cardiovascularsystem
Blood pressure, pulse, hyperemia
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Blood pressureOne of the oldest measured parameters
„creator“ of BP is heart
Value of BP depends on 3 determinants:
heart output
diameter of vessels
amount of blood
generally when we say pressure we mean
arterial blood pressure
Values of BP should be lower than120/80 mmHgsystolic blood pressure (sBP) / diastolic pressure (dBP)
Peripheral
resistance
Observation of BP allows dynamical observation of disease/pathology of
cardiovascular system, and its influence on other system in the organism
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Blood pressure
Pulse pressure (PP) = sBP-dBP
MAP = dBP+PP/3
Mean arterial pressure (MAP)
average pressure during 1 heart cycle
movement force of peripheral perffusion
sBP and dBP can vary in arterial system, but MAP should be under
normal circumstances normal, i.e. it is responsible for perffusion
Higher values increase the risk of AMI and stroke
Lower values increase the risk of lower perfusion and oxygen
delivery to organs such as brain resulting in stroke
„Normal“ values of BP are INDIVIDUAL
MAP = 2/3 dBP+1/3 sBP
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Movement force of blood flow
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Pressure and flow gradient
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Blood vessels type
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Blood flow and arteriols diameter
– The flow will change dependently on vascularresistancy
• resistancy = vasodilatation = blood flow = BP
• resistancy = vasoconstriction = blood flow = BP
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Blood Pressure (3)
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Means of blood pressuremeasurement
Invasiv
eN
onin
vasiv
e
Blood pressure Blood flow
palpatory
(Riva-Rocci method)
auscultation
USG
oscilometric
tonometric
intravascular
sensor
extravascular
sensor
USG - Doppler
Laser Doppler flowmetry
dye
temperature
Electric impedance
pletysmografia
Photoelectric pletysmografia
radioisotopes
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Indirect methods of BP measurement
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BP measurement
Non-invasive
Brachial artery – most often used
near heart
simple
Other sites:
forearm / radial artery
wrist
Auscultation + oscilatory method – most often used
techniques
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Palpatory method (Riva-Rocci)
When deflating cuff we can palpate pulse on the
wrist P = sBP
+) BP can be measured in loud room
Adantages
-) only sBP can be measured
Disadvantages
-) in hyptensive and newborns, it is not very precise
cuff
+) you need only cuff
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Auscultation method
Pulse waves are proptagated
through brachial artery and
Korotkoff phenomenas are
created /turbulent flow/
5 phases can be auscultated, that
will define sBP and dBP
Precision is +/- 2mmHg (sBP)
and +/- 4mmHg (dBP)
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Auscultation method
-) results are different from observer to observer
-) mechanical error increases the risk of erro
-) result not always corresponds to real intraarterial pressure
-) cannot be usedin loud environments
+) simple
+) precise
Advantages
Disadvantages
-) not precise in newborns and hypotensive patients
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• Pulse is measured whole agesbut standard it is from the 19th century
Information it gives:1. frequency, regularity2. artery passage3. characteristics of arterial pulse
pressure and so blood flow
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Arterial pulse
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During pulse palpation, heartauscultation serves as „control“
Factors, that determine pulse:cardiac outputspeed od outputvessels complianceperipheral resistencyheart frequency
, pulse pressurevessel diamaterdistance from heart
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Normal arterial pulse wave
incisura
Anacrotic
notch
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Arterial pulse
Steeper increase, higher systolic peak in periphery
Dicrotic notch is decreased towards periphery
So for pulse characteristics you need central arteries
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Reactive hyperemy• When arteriols are closed for a short time, then after opening the blood
flow is increased because of metabolites in affected part.
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Significance
• Payment of oxygen debt and/or removal ofmetabolites
– Which ones?
• Clinical practice
– Indicator of blood vessels „health“
– „marker“ of cardiovascular problems/diseases asis atherosclerosis, DM
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Humoral regulation
• adrenalin (alpha, beta)
• noradrenalin
• angiotensin
• vazopresin
• bradykinin
• histamine
• prostaglandins
• endotelin
• atrial natriuretic peptid
• NO
permeability