Download Exam of CVS - 3

BLOOD PRESSURE PRACTICAL
Dr. MOHAMMED SHARIQUE AHMED QUADRI
ASSISTANT PROFESSOR PHYSIOLOGY
ALMAAREFA COLLEGE
1
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
2
OBJECTIVES
1. 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].
3
• 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
4
DIFFERENCE BETWEEN LAMINAR &
TURBULANT BLOOD FLOW
•
•
•
•
LAMINAR
Normal flow.
Blood moves in layers, with
maximum velocity at the
center.
No sound is produced.
Vessel is fully open.
•
•
•
•
TURBULANT
Abnormal flow.
Blood moves in different
directions and strikes the
vessel wall.
Sound is produced.
Vessel is partially open.
5
6
7
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.
8
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.
9
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?
10
Examination of CVS
Auscultation( Heart Sounds )
General Considerations
(1)
A stethoscope with bell + diaphragm
(2)
The earpieces should fit comfortably and firmly
(3)
The tubing should be about 25 cm long
(4)
The tubing should be thick enough to reduce
external sounds
To start …..
What to hear ?
First Heart Sound (S1)
Second Heart Sound (S2)

Closure of M + T valves.


Beginning of ventricular
systole.


Closure of A + P valves.
( A
P)
End of ventricular
systole.
Splitting of the S2.
Timing …..
Abnormalities of the Heart Sounds
1.
2.
3.
4.
5.
Alteration in Intensity.
Splitting.
Extra Heart Sounds.
Additional Sounds.
Murmurs.
* MS
+ TS
* MR
* Systemic HTN. (A2)
* Cong. AS. (A2)
* Pulm. HTN. (p2)
*
AR.
Abnormalities of the Heart Sounds
1.
2.
3.
4.
5.
Alteration in Intensity.
Splitting.
Extra Heart Sounds.
Additional Sounds.
Murmurs.
Inc. N.
Reversed
•delay in Rt vent.
emptying.
•RBBB, PS,
•P
A.
•LBBB, AS.
Abnormalities of the Heart Sounds
1.
2.
3.
4.
5.
Alteration in Intensity.
Splitting.
Extra Heart Sounds.
Additional Sounds.
Murmurs.
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 onethird 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
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.
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.
Abnormalities of the Heart Sounds
1.
2.
3.
4.
5.
Alteration in Intensity.
Splitting.
Extra Heart Sounds.
Additional Sounds.
Murmurs.
1.
2.
3.
4.
Opening snap.
Systolic ejection click
Prosthetic heart valves.
Pericardial friction rub.
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
Ejection click
• – Aortic valve normally opens silently.
• – In aortic stenosis or sclerosis, can open with
a click after first heart sound.
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.
Abnormalities of the Heart Sounds
1.
2.
3.
4.
5.
Alteration in Intensity.
Splitting.
Extra Heart Sounds.
Additional Sounds.
Murmurs.
Murmurs
1.
2.
3.
4.
5.
Timing.
Intensity.
Area of greatest intensity.
Propagation.
Effect of certain maneuvers.
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)
 FOR PROPER DIAGNOSIS OTHER CHARECTERS
OF MURMURS ARE ALSO SEEN AS LISTED
HERE.
 WHICH WILL BE SEEN IN DETAILS IN LATER
BLOCKS
Murmurs (cont.)
1.
2.
3.
4.
5.
Timing.
Intensity.
Area of greatest intensity.
Propagation.
Effect of certain maneuvers.
Murmurs (cont.)
1.
2.
3.
4.
5.
Timing.
Intensity.
Area of greatest intensity.
Propagation.
Effect of certain maneuvers.
Murmurs (cont.)
1.
2.
3.
4.
5.
Timing.
Intensity.
Area of greatest intensity.
Propagation.
Effect of certain maneuvers.
Murmurs (cont.)
1.
2.
3.
4.
5.
Timing.
Intensity.
Area of greatest intensity.
Propagation.
Effect of certain maneuvers.
Be professional.
Treat the pt.
as one of
your
relatives.
Practice,
practice,
practice, and
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