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The stethoscope… ‘I see the chest’ Listening to the heart sounds Alternatives to the stethoscope? Accuracy of heart rate monitors Option D: Blood pressure and heart disease Blood pressure Blood pressure Systolic: • the maximum arterial pressure during contraction of the left ventricle of the heart Diastolic • the minimum arterial pressure during relaxation and dilatation of the ventricles of the heart when the ventricles fill with blood Blood pressure Measuring blood pressure • Using sound (Doppler Effect) • Using electronics – non-invasive blood pressure (cuff technology) • BOTH methods use a cuff in order to block blood flow transiently in an artery • Then sound or ‘oscillometry’ is used to produce a quantitative measurement Doppler (sound) techniques Oscillometric blood pressure measurement Control of blood pressure • Think of some reasons why blood pressure might rise or fall? Many factors impact on blood pressure Cardiac output • Cardiac output = volume of blood pumped by the heart (in L/minute) • Cardiac output is is the product of HEART RATE (BEATS/MINUTE) and STROKE VOLUME (ml/BEAT) • Cardiac output can thus be increased by increasing heart rate (within limits) OR stroke volume Tissue oxygen delivery:‘the bottom line’ • depends on cardiac output (cardiac function and forward flow) and arterial oxygen content (CaO2) • Oxygen delivery (DO2) = cardiac output multiplied by the oxygen content of blood DO2= CO X [Hb] X SpO2 X 1.34 (each 1 g of haemoglobin can carry 1.34 g of oxygen) Cardiovascular disease 1. Arrhythmia (e.g. ventricular fibrillation) 2. Thrombosis 3. High blood pressure (hypertension) 4. Coronary heart disease When thinking about heart disease, remember the principal aim of the whole system is oxygen delivery to the tissues… Coronary heart disease The heart muscle is nourished by the coronary arteries Taking a look at coronary arteries… Venous and arterial emboli • When venous return is impaired (e.g. long time spent sitting and not moving), blood flow can slow down in certain veins. • A clot may then form, called an embolus • If the clot breaks and moves to the lungs, it can block in the pulmonary arterioles – pulmonary embolism, which can cause death serena williams embolism Coronary (and other) arteries can be narrowed by plaques, leading to sclerosis and thrombosis • Sclerosis: abnormal thickening or hardening – Arteriosclerosis:…. • Thrombosis: localised clotting of blood in a region of the cardiovascular system. • A thrombus is a mass of platelets and fibrin that forms locally in a vessel – Deep venous thrombosis – Coronary thrombosis • Embolus – a piece of a thrombus that has broken free and lodged in a blood vessel Coronary heart disease Coronary artery disease is diagnosed by angiography… What do you know of as risk factors in coronary heart disease? How do we study risk factors in heart disease? The epidemiology of hert disease… • Epidemiology (Greek): – :epi – upon/ Demos: The people/ Logos: the study of – The basic science of ‘public health’ – The branch of medicine that deals with the incidence, transmission and control of disease Epidemiology I: Risk factors for heart disease • • • • • • • • Age Gender Exercise Body mass Diet Smoking Stress Genetic predisposition Epidemiology II: Factors which reduce incidence of heart disease…