test 3 blood pressure Flashcards
BP
blood pressure
blood pressure
the pressure blood exerts on the walls of blood vessels
where is blood pressure normally measured
in the brachial artery in the arm
blood pressure changes a lot depending whether
the heart has just eaten or not
blood pressures are measured with what 2 numbers
systolic blood pressure, diastolic blood pressure
systolic blood pressure
the pressure at the peak of ventricular contraction
diastolic blood pressure
the pressure where ventricles are relaxed
blood pressures are measured in
mmHg
what are blood pressures listed as
systolic/diastolic
normal blood pressure
is around 120/80
what do you use to take blood pressure
use a sphygmomanometer
how do you use a sphygmomanometer
- inflate to slightly above expected range(140-160 mmHg)
- hold u stethoscope or feel for pulse
- slowly deflate until a pulse is sensed
- continue deflating until a pulse is no longer sensed
systolic BP
systolic is the number at which pulse is sensed
diastolic BP
diastolic is the number at which pulse disappears
if blood pressure is too high….
cuff totally blocks blood flow
just right blood pressure…
cuff blocks blood flow unless heart has just pumped
too low blood pressure
cuff does not block blood flow
blood pressure should ideally fall where in adults
between 110-140/70-80
hypotension
a person with a resting systolic BP under 100
hypertension
a person with a resting systolic BP over 130
BP relies on what factors
- how big is the container ( affects vasodilation/vasoconstriction)
- how much stuff is in the container (how much water in blood)
- how fast/hard is stuff being pumped (cardiac output)
bigger container
lower blood pressure
cardiac output is…
heart rate times the stroke volume
cardiac output formula
CO=HR x SV
one reading is ________
not enough to make diagnosis of hypertension or hypothension
orthostatic hypotension
when you stand suddenly, blood falls to the lower portion of the body and decreases flow to the head. quickly vessels contract and increase blood pressure, returning blood flow to the body
another word for orthostatic hypotension
head rush
long-term hypertension
especially dangerous, hypertension linked to CAD, CHF, and other arterial disease
CAD
coronary artery disease
CHF
congestive heart failure
hypertension makes the heart
work unnecessarily hard and puts extra strain on artery wallas
with hypertension over time….
the heart swells to large sizes and artery walls lose their elasticity
generally.. the _____ have a major role
kidneys, major role in regulating blood pressure
when BP is low, what does the kidneys do
release renin
what does renin do
initiates a cascade releasing angiotensin II
angiotensin II functions
- directly causing vasoconstriction ( BP up)
- stimulating release of hormone aldosterone
aldosterone
causes kidneys to leave ore sodium in the blood, causing water to enter blood through osmosis ( BP ^)
what is also involved in BP regulations
temperature, sympathetic nervous system
how does temperature affect BP
the higher is is the higher BP is
sympathetic nervous system
epinephrine release increases BP
HOW TO TAKE BLOOD PRESSURE
- wrap sphygmomanometer around upper arm, tubes distal
- inflate to -140 mmHg
- place stethoscope on the inside of the elbow
- slowly deflate until you hear pumps. record this # as systolic Bp
- continue delating until pump stops. record this number as diastolic BP
final step in the renin cascade
ACE turns inactive angiotensin I to active angiotensin II
ACE
angiotensin converting enzyme
popular way to treat hypertension
ACE inhibitors
normally the heart beats how much
60-100 times per minute
skeletal muscle must be
stimulated by a nerve to contract
cardiac muscle can…
generate its own signal to contract
any one cell along the electrical wiring of the cardiac muscle
can fire and will send its signal to the rest of the heart
different parts of the heart contract
on their own different intervals
arterial tissue will contract
50-60 times a minute
ventricular tissue will contract about
20-40 times a minute
how are the lub/dub contractions coordinated
the heart has a built in conduction system to pass signals
the conduction pathway is a series of
nerve-like, muscle-like fibers called cardiomyocytes
what do cardio myocytes do
carry the signal to make cardiac muscle contract
the signal to make cardiac muscle contract is normally generated by what
sionoatrial node (SA node) which is located on the right atrium
the signal to make cardiac muscle contract runs across…….
the left and right atria, causing them to contract, and then is captured by the atrioventricular node (AV node)
how long are signals held in the atrioventricular node
0.12 seconds
what happens after the signal is held by the AV node
it passes through a strand of fibers called the bundle of His
what does the bundle of His do
breaks into two bundle branches (one for each ventricle), which travel to the apex of the heart and then run back up the outer walls
the bundle branches….
break into small strands called Purkinje fibers
what do Purkinje fibers do
tell the heart muscle nearby to contract
the electrical pathway !!!
SA Node»AV Node»Bundle of His»Bundle Branches»Purkinje Fibers
who which part of pathway is lub and dub
OKK
generally cardiomyocytes have a ____ charge compared to their environment
negative
how do cardiomyocytes transmit signals
by briefly changing their charge from a negative charge to a positive charge (DEPOLARIZATION)
can depolarization be measured
yes
EKG can called
electrocardiography or ECG
EKGs do what
detect and record depolarization of cardiac cells under the skin
in an EKG usually………
10 electrodes are placed around the torso for different looks and are summed up into one signal
many leads on EKG lead to…
many outputs
what are the 3.5 parts of an EKG
P wave, QRS complex, T wave, U wave
P wave
shows the depolarization of atrial cells
QRS complex
shows the depolarization of ventricular cells
T wave
shows the depolarization of ventricular cells
U wave
the enigma of EKGs, cause it unsure but it PROBS a depolarization of other cells in the heart, and it is OFTEN entirely absent
why is there a delay between the P wave and the QRS complex
there is a delay when the signal sits on the AV node
what is a healthy heart’s rhythm called
normal sinus rhythm
the SA node is supplied w/ nerves by
the sympathetic and parasympathetic nervous systems
the sympathetic and parasympathetic nervous systems can
influence how quickly (SNS) or slowly (PSNS) it generates a siganal
tachycardia
a heart rate is elevated above 100 beats/ minute (bpm)
sinus tachycardia
tachycardia that occurs because the SA node is transmitting a signal faster than 100 bpm
Bradycardia
a heart rate tat is below 60 bpm
sinus bradycardia
bradycardia that occurs because the SA node is transmitting a signal slower than 60 bpm
5 components of rhythm analysis (key features to look for when analyzing EKG)
Regularity Rate P wave morphology PR interval QRS interval
regularity
the pulses occur at roughly even intervals, there is some natural fluctuation
a fluctuation of more than ___________ when looking at regularity
1.5 boxes (.3 seconds) is considered abnormal
KNOW the difference between regular contraction and irregular contraction
OK STUDY picture on powerpoint
Rate
how many times the heart beats in one minute , normal rate is between 60-100
counting squares between pumps…
will help determine bradycardia or tachycardia, but is not precise and can be complicated in cases of arrythmia
to calculate regular rate
is 1500 rule
1500 rule
count the number of small boxes between QRS and QRS in regular rhythms to get a precise rate
to calculate irregular rate
count how many contractions you see in 6 second strip and multiply by 10
P wave morphology
the shape
the P wave is usually
short, round, and compact (no more than .1 seconds)
usual size of P wave
.5-2.5 small squares
Common changes to P wave
Burial, Inversion, notched waves, Biphasic waves, Flutter waves, After QRS, Multiple
Burial
P wave is stuck inside T/U wave
Inversion
P wave is upside down
Notched waves
P wave has multiple peaks
Biphasic waves
up and down or down and up
Flutter waves
P waves happen very quickly
After QRS
P waves happen after the QRS complex
Multiple
many types of P waves present
PR interval
the amount of time that passes between beginning of P wave and beginning of QRS complex
the PR interval should be
between .12 and .20 second (3-5) small boxes
it’s important to measure PR interval …….
for every contraction on a strip, even one irregular PR can have a diagnostic potential
QRS duration
length of QRS complex
QRS should be between
0.06 and 0.10 seconds
how can you describe the QRS complex
wide and bizzare, wide and inverted
what are the common rhythyms
- sinus rhythms
- atrial rhythms
- junctional rhythms
- ventricular rhythms
- heart blocks
- other
the SA (sinoatrial) node is supposed to be the ________
pacemaker of the heart
when the SA is the pacemaker of the heart
it is in sinus rhythm
normal sinus rhythm
all things are normal. heart rate is 60-100, rhythm is regular
sinus bradycardia
all things normal, heart rate is below 60, rate is regular
sinus tachycardia
all things normal, heart is above 100, rate is regular, sometimes coupled with a P wave burial
how can you check bradycardia
more than 5 big boxes, less than 60
how to check for sinus tachycardia
less than 3 big boxes, over 100
sinus arrhythmia
P wave, PR interval, QRS are all normal, IRREGULAR CONTRACTIONS
Sinus arrest
SA node and rest of the heart does not contract for a span of time
how are sinus arrests reported
reported w/ a duration, such as sinus arrest, 3.5 second delay
with each passing second of sinus arrest
blood pressure rapidly drops
when the SA node fails to function as the pacemaker
other cardiomyocytes can take over
when other cardiomyocytes take over when the SA node fails to be the pacemakre
said to be an escape rhythmn
the cells that release the new signal in an escape rhythm
called ectopic pacemakers
escape rhythms occur in a variety
of shapes and sizes
sometimes rogue atrial cells will
take over as the pacemaker for just one beat
when rogue atrial cells take over as the pacemaker for just one beat
premature atrial complex
how to distinguish a premature arterial complex
because there will one early beat w/ a modified P wave morphology that is not inverted
wandering atrial pacemaker
an escape rhythm where the SA node fails to generate a signal, so different parts of the atria created a signal to compensate
WAP
wandering atrial pacemaker
WAP is defined by
3 unique types of P waves across the strip
multifocal tachycardia
WAP (3 or more P wave morphologies) with heart rate over 100
where is multifocal atrial tachycardia
typically only seen in elderly patients with COPD
atrial flutter
when the atria rapidly contract, but the QRS complexes happen normally
atrial fibrillation
similar to atrial flutter, but the atria just quiver instead of rapidly contracting
both A-Fib and A-Flutter
happen unknowingly
what often happens in atria flutter
the electricity in the atria forms a loop an causes continuous contraction. This rhythm is thrombogenic, but not life threatening if the ventricles still readily contract
A-Fib and A-Flutter generally
affect elderly people and come and go in waves, a primary symptoms are shortness of breath where lying down
often the ______ will take over as a pacemaker
AV node!!1 not shen the AV node takes over as the pacemaker only the atrial tissues can do this
when he AV node takes over as the pacemaker
junctional rhythm
PJC
premature Junctional Complex
PJC
when the AV node releases one signal quickly above another contraction
how to tell if its a junctional rhythm
short PR interval, inverted P wave
Junctional escape beat
like PJC, but not premature, these are usually later than when a bet would occur
PJC and junctional escape rhythm can both be identified by
inverted P wave
junctional escape rhythm
when the AV node works as the pacemaker long term, (not just one beat), still an INVERTED P wave
junctional escape rhythms are always
below 60 bpm (bradycardia)
accelerated junctional rhythm
like junctional escape rhythm, but from 60-100, still inverted P wave
when do atrial usually only create a signal
40-60 times a minuet
junctional tachycardia
like other junctional rhythms, but from 100-180 bpm, still inverted P wave
supraventicular tachycardia
in tachycardia when the P-wave is buried, you can’t tell if its normal, inverted, flat, buried
supraventricular tachycardias
all tachycardias whose P wave morphology is buried, the signal s above the ventricles, but we cannot tell where its from
