BLOOD PRESSURE PRACTICAL

1. BLOOD PRESSURE PRACTICAL Dr. MOHAMMED SHARIQUE AHMED QUADRI ASSISTANT PROFESSOR PHYSIOLOGY ALMAAREFA COLLEGE

2. BLOOD PRESSURE PRACTICAL • Normal BP = 120/80 mmHg (In Adults) • Range Systolic = 100-140 mmHg Diastolic = 60-90 mmHg • Equipment Stethoscope Sphygmomanometer A Bicycle ergometer and/or a treadmill

3. OBJECTIVES • Measure Blood Pressure using Sphygmomanometer. 2. Recognize the effect of - gravity [take blood pressure during supine, sitting and standing position]. - exercise [take blood pressure before and after exercise].

4. Methods Of Measurement BP 1-Palpatory Method 2-Ausculatatory Method • Note: Palpatory method gives estimate of Systolic BP only • Ausculatory method allows Both Systolic and Diastolic BP to be measured. • KOROTKOFF Sounds • Laminar Flow, Turbulent Flow

5. DIFFERENCE BETWEEN LAMINAR & TURBULANT BLOOD FLOW LAMINAR TURBULANT Abnormal flow. Blood moves in different directions and strikes the vessel wall. Sound is produced. Vessel is partially open. • Normal flow. • Blood moves in layers, with maximum velocity at the center. • No sound is produced. • Vessel is fully open.

8. PRECAUTIONS WHILE TAKING BLOOD PRESSURE • Cuff size – 12 × 24cms for adults [Cuff size is big for obese person and small for children]. • Apply cuff 4cms above elbow joint. • Keep manometer at the level of heart. • Subject should be comfortable. • If subject coming after walking, should take rest for 5 – 10mins, then take BP to avoid effect of sympathetic stimulation.

9. FACTORS AFFECTING BLOOD PRESSURE • BLOOD PRESSURE is affected by the following factors: - Age – BP increases with age - Posture—Supine, Standing - Emotions - Exercise – there is increased cardiac output and decrease in peripheral resistance, {due to vasodilation in skeletal muscle}, therefore systolic BP increases and diastolic BP decreases. Pulse pressure is increased.

10. ANSWER THE FOLLOWING QUESTIONS • BP is 120/80 mmHg Q1. If you raise the mercury level in manometer to 130mmHg, will you listen any sound by stethoscope over brachial artery? Q2. If the mercury level is at 120mmHg, will you listen any sound? Q3. If the mercury level is at 78mmHg, will you listen any sound? Why?

11. Examination of CVS Auscultation( Heart Sounds )

12. General Considerations

13. (1)A stethoscope with bell + diaphragm

14. (2)The earpieces should fit comfortably and firmly

15. (3)The tubing should be about 25 cm long

16. (4)The tubing should be thick enough to reduce external sounds

17. To start …..

19. What to hear ? First Heart Sound (S1) • Closure of M + T valves. • Beginning of ventricular systole. Second Heart Sound (S2) • Closure of A + P valves. ( A P) • End of ventricular systole. • Splitting of the S2.

20. Timing …..

21. Abnormalities of the Heart Sounds • Alteration in Intensity. • Splitting. • Extra Heart Sounds. • Additional Sounds. • Murmurs.

22. S1

23. S2

24. Abnormalities of the Heart Sounds • Alteration in Intensity. • Splitting. • Extra Heart Sounds. • Additional Sounds. • Murmurs.

26. Abnormalities of the Heart Sounds • Alteration in Intensity. • Splitting. • Extra Heart Sounds. • Additional Sounds. • Murmurs.

27. What to hear ? 3RD Heart Sound (S3) Lubb-dupp-da • Slushing in • Caused by turbulent blood flow into ventricles and detected near end of first one-third of diastole (Rapid ventricular filling). • Fluid backing up , as in cardiac failure 4TH Heart Sound (S4) Da-lubb-dupp • A stiff wall • With the atria systole • Non compliant ventricles

28. Third Heart Sound (S3) • Low pitched. @ apex + LLSB. • Mid-diastolic. • Triple rhythm (lub-dub-dum) (= gallop rhythm) • N: children + young people + pregnancy + athletes + fever. • Ab. : LVF, AR, MR, VSD, PDA, Constrictive pericarditis.

29. Fourth Heart Sound (S4) • High pressure atrial wave reflected back from a poorly compliant ventricle. • Late diastolic, high-pitched sound. • NEVER physiological. • Ab. : AS, PS, MR, HTN, IHD, advanced age.

30. Abnormalities of the Heart Sounds • Alteration in Intensity. • Splitting. • Extra Heart Sounds. • Additional Sounds. • Murmurs.

31. Opening snap. • Systolic ejection click • Prosthetic heart valves. • Pericardial friction rub.

32. Opening snap • – Mitral valve normally opens silently after second heart sound. • – In mitral stenosis, sudden movement of rigid valve makes a click, after second heart sound

33. Ejection click • – Aortic valve normally opens silently. • – In aortic stenosis or sclerosis, can open with a click after first heart sound.

34. Pericardial friction rub • A superficial scratching sound. • Occurs at any time during the cardiac cycle. • Sign of PERICARDITIS. • Louder with sitting up and breathing out.

35. Abnormalities of the Heart Sounds • Alteration in Intensity. • Splitting. • Extra Heart Sounds. • Additional Sounds. • Murmurs.

36. Murmurs • Timing. • Intensity. • Area of greatest intensity. • Propagation. • Effect of certain maneuvers.

37. Timing • Systolic: • Innocent.(athletes, pregnancy) • Pansys. (MR, TR, VSD) • Ejection (mid) sys. (AS, PS) • Late sys. (M Prolapse) • Diastolic: • Early. (AR, PR) • Mid.(MS, TS) • Others: • Presys. (MS, TS) • Continuous. (PDA + fistulae)

38. FOR PROPER DIAGNOSIS OTHER CHARECTERS OF MURMURS ARE ALSO SEEN AS LISTED HERE. • WHICH WILL BE SEEN IN DETAILS IN LATER BLOCKS

39. Murmurs (cont.) • Timing. • Intensity. • Area of greatest intensity. • Propagation. • Effect of certain maneuvers.

40. Murmurs (cont.) • Timing. • Intensity. • Area of greatest intensity. • Propagation. • Effect of certain maneuvers.

41. Murmurs (cont.) • Timing. • Intensity. • Area of greatest intensity. • Propagation. • Effect of certain maneuvers.

42. Murmurs (cont.) • Timing. • Intensity. • Area of greatest intensity. • Propagation. • Effect of certain maneuvers.

43. Take home messages Be professional.

44. Take home messages Treat the pt. as one of your relatives.

45. Take home messages Practice, practice, practice, and read