LAB 1- HR + BP Flashcards
cardiovascular system is composed of what 3 things
-heart
-blood
-vasculature
arteries carry blood toward/away from the heart
away from
veins carry blood toward/away from the heart
toward
capillaries are arteries or veins
NEITHER
-capillaries are neither arteries nor veins
**flow of blood through the heart
- superior + inferior vena cava
right atrium
tricuspid valve - right ventricle
pulmonary semilunar valve - pulmonary trunk
- pulmonary arteries
lung tissue (pulmonary circulation) - pulmonary veins
left atrium - bicuspid valve
- left ventricle
aortic semilunar valve - aorta
coronary arties
either body tissues (systematic circulation) or heart tissue (coronary circulation)
flow of blood through the heart- pulmonary valve goes to what
pulmonary trunk
flow of blood through the heart- bicuspid valve to what
aortic arch + out into circulation
**anatomy of heart
-4 chambers
-UPPER: left and right atrium
-LOWER: left and right atrium
**4 valves of the heart
-tricuspid
-pulmonary
-mitral
-aortic
**what are the 2 circuits for blood flow
-systemic: goes to whole body
-pulmonary: goes to lungs
systemic circuit: serves ____
entire body
systemic circuit: low/high resistance
high resistance
systemic circuit: low/high pressure head
high pressure head
systemic circuit: hypoxic vasodilation/vasoconstriction
vasodilation
systemic circuit: few/many vasomotor control
many vasomotor control
pulmonary circuit: serves ____
only the lungs
pulmonary circuit: low/high resistance
low resistance
pulmonary circuit: low/high pressure head
low pressure head
pulmonary circuit: hypoxic vasodilation/vasoconstriction
vasoconstriction
pulmonary circuit: few/many vasomotor controls
few vasomotor controls
hypoxic
body doesn’t receive enough oxygen
-lack of oxygen
systole
period of ventricular contraction
what occurs in the ventricles during systole
blood is ejected from ventricles
diastole
period of ventricular relaxation
what occurs in the ventricles during diastole
blood fills the ventricles
systole is on top or bottom of blood pressure
top
diastole is on top or bottom of blood pressure
bottom
differences in pressure are based on what 2 things
-contraction
-relaxation
blood pressure
the FORCE exerted by circulating blood on the walls of the vessels
blood pressure is 1 of ___ major factors that determine the regulation of blood in the cardiovascular system
3
what are the 3 major factors that determine the regulation of blood in the cardiovascular system
-blood pressure
-blood flow
-blood resistance
what is the biggest influence short term for blood pressure
diameter
vasoconstriction/vasodilation occurs from muscular contractions
vasoconstriction
volume Renin-Angiotensin-Aldosterone (RAAS system)
increase of sympathetic nervous system activity
viscosity
-seen in blood doping, thus increasing RBC count by 2x
-high risk of stroke + heart attack
blood pressure equation
Q = change in pressure/resistance
aka Q= delta P/R
blood pressure stays the same/changes throughout the cardiovascular system
changes
blood pressure iin healthcare
integral part of any health screening or fitness assessment
blood pressure should be based on how many properly measured recording
2 or more
what 2 numbers make up blood pressure
-systolic blood pressure
-diastolic blood pressure
systolic blood pressure
pressure exerted against arterial walls when the heart is contracting
peak blood pressure occurs during ____
systole
diastolic blood pressure
pressure exerted against arterial walls when heart is relaxing
lowest blood pressure is during ____
diastole
pulse pressure
the difference between systolic and diastolic blood pressure
how is blood pressure written
systolic/diastolic
ex: 120/80
in what unit is blood pressure measured
millimeters of mercury (mmHg)
even though all blood pressure is still measured in mmHg, most blood pressure monitors no longer use mercuery in the apparatus due to what
due to the toxic nature of mercury
what influences blood pressure
-changes in blood flow (Q)
-resistance
the direct factors that influence blood pressure can be seen in what equation
Hagaen-Pouiselle’s equation
Hagaen-Pouiselle’s equation
delta P = (8Ln) /(pi r^4)
variables of Hagaen-Pouiselle’s equation
-L = length of vessel
-n = viscosity of blood
-r = radius of blood vessel
**what variable has the biggest impact on blood pressure and is the variable the body uses to regularly control blood pressure
radius
-think of boba metaphor
gold standard of measuring blood pressure
direct measure of INTRA-ARTERIAL blood pressure
-best way to measure blood pressure
-intra-arterial because arteries are where blood pressure is found
clinically, what 2 ways do we measure blood pressure INDIRECTLY
-auscultation
-oscillometry
auscultation
stethoscope + sphygmomanometer
oscillometry
automated electronic manometer
stethoscope- fat side
drum
stethoscope- small side
bell
when taking blood pressure using a stethoscope, what side do we usually use
drum (fat side)
stethoscope- when hole is closed
on drum setting
stethoscope- when hole is open
on bell setting
sphygmomanometer
blood pressure cuff
mobile (exercise) sphygmomanometer
exact same function as a standard aneroid sphygmomanometer just has a stand with wheels and a bigger display
-recommended during any exercise test
oscillometric automated blood pressure cuff
-use the maximum volume change as an indication of the average of the systolic + diastolic blood pressure within the artery
-by combining this average with the rate of change of the pressure wave, the machines then use a variety of algorithms to estimate the systolic + diastolic blood pressure
dynamics of taking blood pressure
NO FLOW -> TURBULENT FLOW -> LAMINAR FLOW
- no blood flow (no flow, no sound, cuff pressure above 110 mmHg)
- turbulent flow in compressed artery makes audible vibrations aka Korotkoff sounds (turbulent flow, Korotkoff sounds, cuff pressure between 70-110 mmHg)
- laminar flow in noncompressed artery makes no sounds (laminar flow, no sound, cuff pressure below 70 mmHg); the state we are naturally in
how to take blood pressure
-pump it to a certain pressure when there is no blood flow (high enough pressure where the artery is completely cut off)
-when entering turbulent flow, there is still some pressure that can get through, KNOW that the thumps are the Korotkoff sounds
-after last Korotkoff sound, we enter laminar aka natural state
**first Korotkoff sound/thump when taking a blood pressure reading is ____
systolic
**last Korotkoff sound/thump when taking a blood pressure reading is ____
diastolic
-after last thump, returns to laminar, which is the state we are naturally in right now
what blood pressure state are we naturally in
laminar
protocol for measuring blood pressure PRE-READING
-ensure hands are clean before starting
-ask client if there are any injuries that would prevent the use of a pressure cuff on their arm
-ensure client is relaxed + seated comfortably, with their back supported + feet uncrossed + flat on the floor
-ensure the blood pressure cuff is the correct size
-try to have the client’s arm at roughly heart level
protocol for measuring blood pressure- DURING reading
-wrap the cuff so that the bottom is roughly 2-3cm above the palpation point of the brachial artery
-locate the brachial or radial pulse -> then inflate the cuff until the pulse can no longer be felt; this is a rough estimation of systolic pressure
-deflate the cuff completely + wait for 30 seconds
-palpate the BRACHIAL artery + place the center of the stethoscope drum on top
-inflate the cuff to about 30 mmHg above the rough estimation of systolic
-deflate the cuff at a rate of 2 mmHg
-once no sound is heart deflate the cuff fully + remove it from the client’s arm
factors that can artificially change blood pressure
-caffeine
-stress
-medications
-bladder
-etc.
blood pressure categories table are accepted by what organization
American Heart Association
ACSM recognizes what blood pressure as a cardiovascular risk factor
130/80 mmHg
hypertension
high blood pressure
what are the 5 blood pressure categories
-normal
-elevated
-high blood pressure (hypertension) stage 1
-high blood pressure (hypertension) stage 2
-hypertensive crisis (consult your doctor immmediately)
**normal blood pressure
systolic: less than 120
AND
diastolic: less than 80
**elevated blood pressure
systolic: 120-129
AND
diastolic: less than 80
**hypertension stage 1
systolic: 130-139
OR
diastolic: 80-89
*only need 1 of these values to be considered this
**hypertension stage 2
systolic: 140 or higher
OR
diastolic: 90 or higher
*only need 1 of these values to be considered this
**hypertensive crisis
systolic: higher than 180
AND/OR
diastolic: higher than 120
*only need 1 of these values to be considered this
**blood pressure ex: 119/85
-119 is normal
-85 is stage 1 hypertension
SO, we would classify as stage 1 hypertension
what physiological thing determines blood pressure + heart rate
PRESSURE GRADIENTS
-ex: bladder can affect heart rate
**classes of blood pressure medications for hypertension (5)
-diuretics
-beta-blockers
-calcium channel blockers
-angiotensin-converting enzyme (ACE) inhibitors
-vasodilators
diuretics
increasing excretion, therefore reducing total body water + reducing pressure
beta-blockers
blocking beta-receptors that function in the sympathetic nervous system, thereby reducing sympathetic response
calcium channel blockers
blocking the calcium channels in the heart to reduce heart contractility
angiotensin-converting enzyme (ACE) inhibitors
stopping the creation of angiotensin II + the increase release of aldosterone
vasodilators
increasing the diameter of arterial walls by inducing relaxation in smooth muscle + therefore vasodilation
white-coat hypertension
clients who have a normal blood pressure outside of a clinical environment + are not taking any prescribed antihypertensive medications develop higher than normal values when their blood pressure is measured by a health professional
masked hypertension
clients who exhibit higher than normal blood pressure readings outside of a clinical environment yet have normal reading in a clinical setting
masked hypertension is more common in younger/older adults
younger
miscuffing (undercuffing/overcuffing)
caused by using a blood pressure cuff with a bladder that is not appropriately scaled for the client
undercuffing
when the bladder of the blood pressure cuff is too small for the client
-this can also lead to cuff hypertension, because there is SO much pressure trying to contain the artery
overcuffing
when the bladder of the blood pressure cuff is too large for the client
-this can lead to an underestimation of blood pressure
undercuffing can lead to
cuff hypertension
overcuffing can lead to
underestimated blood pressure
sources of measurement error
-inaccurate sphygmomanometer
-improper cuff width or length
-cuff not centered, too loose, or over clothing
-back, feet, or arm unsupported
-poor auditory acuity or reaction time of the technician
-improper rate of inflation or deflation of the cuff pressure
-improper stethoscope placement or pressure
-background noise leading to error
-parallax error in manometer
-client has a full bladder
parallax error in manometer
when the pointer of the meter looks like it’s a different reading because the angle of view the technician has
-leads to blood pressure measurement error
if a client has a full bladder, it would increase/decrease systolic + diastolic blood pressure
increase
after measuring blood pressure, what can be estimated
mean arterial pressure (MAP)
MAP (mean arterial pressure)
average pressure occurring in the arteries during one cardiac cycle
what else does MAP indicate
the number for full organ perfusion
-SO, we don’t want an abnormally high MAP
to perfuse vital organs requires what
requires the maintenance of a minimum MAP of 60 mmHg
what can estimation of MAP can help decide what
if a blood pressure is too low
equation 1 for MAP
MAP = [SBP + (2 x DBP)] / 3
equation 2 for MAP
MAP = DBP + [(SBP - DBP) / 3]
we spend more time in systole or diastole
diastole
heart rate
the number of times the heart beats per minute
-number of full cardiac cycles per minute
what units is heart rate expressed in
beats per minute (bpm)
what is heart rate regulated by
automatic nervous system (ANS)
heart rate increases ____ + therefore ____
cardiac output
VO2
besides manually, what other ways can heart rate be measured
-EKG
-chest strap that measures electrical activity
-photoplethysmography in smartphones + wearable sensors
what 3 pulse points are commonly used for measuring heart rate
-carotid pulse
-brachial pulse
-radial pulse
-think ABC- radial, brachial, carotid
what fingers must be used to take heart rate
index + middle finger
-not thumb, because thumb has its own pulse
carotid pulse
-located along the anterior border of the sternocleidomastoid muscle + lateral to the larynx
-the common carotid artery can be located + pushed against the thyroid cartilage
-however, too much pressure can stimulate baroreceptors activating a carotid sinus reflex
brachial pulse
-located directly above superior border of the antecubital fossa (roughly 1 inch) + inferomedial to the biceps brachii
-the artery location used for measuring blood pressure
radial pulse
-located on the anterolateral aspect of the forearm directly in line with the thumb
-this point is used most often for resting + exercise measurements
chest strap wired monitors
-these monitors have electrode sensors embedded in the strap + accurately detect depolarization
-in 1978 Polar released the 1st wearable heart rate monitor
-these are a terrific option for exercise testing as they are valid + reliable option for measuring heart rate
-the majority of cardiovascular equipment have the capability to read any chest strap monitor that has an ANT signal
wrist/forearm/finger monitors
-these monitors use photoplethysmography to monitor heart rate
-using an infrared light to see the expansion of the artery as blood pumps through it
-many of these devices can estimate oxygen saturation levels of the blood as well
protocol for measuring resting heart rate PRE-READING
-wash your hands before starting
-explain what you’re about to do + why it is important
-ask whether the client has walked for an extended period of time, climbed any stairs or heavily exerted themselves in the past 20 minutes; if the answer is yes, wait 5-10 minutes at a minimum before proceeding
-make sure the patient is relaxed + comfortable
protocol for measuring resting heart rate DURING READING
-place the tips of your first + second finger on the radial artery pulse point; don’t use the thumb because it may result in counting your own pulse due to the priceps pollicis artery in the thumb
-press against their wrist + take your time to note any irregularities in strength or rhythm
-for resting measurements, count the number of beats for at least 30 seconds (measuring for 1 minute will yield the most accurate results); if you start timing on a beat, begin counting at 0
-compare the results to normative data
**what artery is in your thumb that has a pulse
priceps pollicis
on the practical, how must we take heart rate
using 30 by 2
-solid 30 seconds to let body relax
heart rate
a vital sign that holds important prognostic value, with a lower resting HR being associated with lower all-cause + cardiovascular mortality
what does the American Heart Association define normal sinus heart rate as
60-100 bpm
does outside the normal range of heart rate indicate a medical problem
not always
-people with higher levels of cardiorespiratory fitness generally have a bradycardiac heart rate
bradycardiac heart rate
less than 60 bpm
normal heart rate
60-100 bpm
tachycardiac heart rate
greater than 100 bpm
what is the “normal within the normal” heart rate
72 bpm
why are elite individuals bradycardiac
due to higher stroke volume
-heart is working more efficiently
brady = low/high
tachy = low/high
brady = low
tachy = high
**bradycardiac/tachycardiac is more dangerous
tachycardiac
are heart rate + blood pressure dramatically influenced by exercise
yes
-but the type of exercise can significantly alter the response
dynamic exercise
-rhythmic pumping action of muscles
-any exercise where the muscle is consistently changing lengths while contracting is dynamic
-ex: running, resistance training
dynamic exercise on the body
-historically known as volume work for the cardiovascular syste,
-increase in skeletal muscle pump = increase in venous return
static exercise
-isometric contractions of skeletal muscle
-any exercise where the muscle stays the same length throughout contraction
static exercises on the body
-historically known as pressure work for the cardiovascular system
-the heart rate + blood pressure response with static exercise is largely proportionate to the tension exerted
-prevents skeletal muscle pump = decrease in venous return
all exercise, REGARDLESS OF TYPE, will increase what 2 things
-heart rate
-systolic blood pressure (SBP)
with exercise, SBP should increase in what manner
linearly
TPR
also known as systemic vascular resistance
TPR (systemic vascular resistance)
the amount of force exerted on circulating blood by the vasculature of the body
3 factors that determine the force of TPR (systemic vascular resistance)
-length of blood vessels
-diameter of blood vessels
-viscosity of blood
cardiac output equation
Q = heart rate x stroke volume
what does cardiac output change based on
stroke volume
-heart rate is CONSTANT, so therefore Q much change based on stroke volume
**dynamic exercise effects on heart rate
increase
**static exercise effects on heart rate
increase
stroke volume
the amount of blood ejected from the ventricle with each cardiac cycle
**dynamic exercise effects on stroke volume
increase
**static exercise effects on stroke volume
decrease
**dynamic exercise effects on cardiac output (Q)
increase
**static exercise effects on cardiac output (Q)
decrease
**dynamic exercise effects on TPR (systemic vascular resistance)
decrease
-relative to static
**static exercise effects on TPR (systemic vascular resistance)
increase
**dynamic exercise effects on MAP
increase
**static exercise effects on MAP
increase
**dynamic exercise effects on SBP
increase
**static exercise effects on SBP
increase
**dynamic exercise effects on DBP
decrease or stays the same
**static exercise effects on DBP
increase
rate pressure product is also called what 2 things
-cardiovascular product
-double product
rate pressure product
the product of heart rate + SBP
what is rate pressure product sometimes used as
an indirect index of myocardial oxygen consumption, predicting cardiac function
typically a low RPP (rate pressure product) indicates what
a healthy client
most research shows what about RPP
-RPP should be below 10,000 at rest
-during maximal exercise the value can reach over 30,000
while isometric exercise is still warned against with clients who are hypertension, what has research shown about RPP
that RPP is lower in maximal isometric resistance exercise than in maximal aerobic exercise
**RPP requation
RPP = HR x SBP
what variable changes RPP
SBP
-because heart rate is constant
