blood pressure
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BLOOD PRESSURE
BLOOD BLOOD PRESSUREPRESSURE
Dr shabeel pnDr shabeel pn
DEFINITIONDEFINITION Blood pressure isBlood pressure is
defined as the lateral pressure defined as the lateral pressure exerted by flowing blood on the walls exerted by flowing blood on the walls of the arteriesof the arteries..
TYPES OF BLOOD TYPES OF BLOOD PRESSUREPRESSURE
Depending on the Depending on the NATURE OFNATURE OF BLOODBLOOD
VESSELVESSEL – –
ArterialArterial B.PB.P
Venous B.PVenous B.P
Capillary B.PCapillary B.P
BLOOD PRESSURE IS BLOOD PRESSURE IS DETERMINED BY:DETERMINED BY:
Force with which heart pumps the Force with which heart pumps the bloodblood
Resistance offered by the vesselsResistance offered by the vessels
B.P = C.O x P.RB.P = C.O x P.R
CARDIAC CYCLECARDIAC CYCLE
Systole - .3sec
Diastole - .5sec
Total - .8 sec
ARTERIAL BLOOD ARTERIAL BLOOD PRESSUREPRESSURE
TYPE TYPE NORMAL RANGENORMAL RANGE
Systolic BP 110-130mmHgSystolic BP 110-130mmHg
Diastolic BP 60-80mmHgDiastolic BP 60-80mmHg
Pulse pressure 40mmHgPulse pressure 40mmHg
Mean arterial 93-100mmHgMean arterial 93-100mmHg
pressurepressure
MEASUREMENT OF MEASUREMENT OF BPBP
DIRECT METHODDIRECT METHOD
INDIRECT METHODINDIRECT METHOD
Palpatory methodPalpatory method Auscultatory methodAuscultatory method
DIRECT METHODDIRECT METHOD
INDIRECT INDIRECT METHODMETHOD
INSTRUMENTSINSTRUMENTS
SPHYGMOMANOMSPHYGMOMANOMETERETER
ANEROID ANEROID BAROMETERBAROMETER
AUTOMATIC AUTOMATIC INFLATION CUPINFLATION CUP
PROCEDUREPROCEDURE
KOROTKOFF’S KOROTKOFF’S SOUNDSSOUNDS
PHASEPHASE NATURE OF NATURE OF SOUNDSOUND
DURATIONDURATION
II Tapping Tapping soundsound
10 mmHg10 mmHg
II II MurmerMurmer 20 mmHg20 mmHg
IIIIII Gong soundGong sound 5 mmHg5 mmHg
IVIV MuffledMuffled RestRest
VV DissappearsDissappears
PALPATORY PALPATORY METHODMETHOD
BASIS OF KOROTKOFF’S BASIS OF KOROTKOFF’S SOUNDSOUND
Sounds are heard due to turbulence Sounds are heard due to turbulence
Cuff pressure > Systolic. P Lumen is Cuff pressure > Systolic. P Lumen is occluded No sounds are heard.occluded No sounds are heard.
Cuff pressure <just below> systolic .PCuff pressure <just below> systolic .P
Blood flow at height of systole Blood flow at height of systole Tapping soundTapping sound
Cuff pressure < diastolic.P Cuff pressure < diastolic.P Streamline flow No sounds.Streamline flow No sounds.
AUSCULTATORY AUSCULTATORY GAPGAP
A gap present after A gap present after tapping soundtapping sound
Seen in hypertensive patientsSeen in hypertensive patients..
VARIATIONSVARIATIONS
PHYSIOLOGICALPHYSIOLOGICAL
PATHOLOGICALPATHOLOGICAL
PHYSIOLOGICALPHYSIOLOGICAL1.1. AGEAGE: in B.P: in B.P Old age Lipid deposition in lamina Old age Lipid deposition in lamina
propria Loss of windkessel effectpropria Loss of windkessel effect2.2. SEX:SEX: Males > Females upto menopause.Males > Females upto menopause. After menopause Equal.After menopause Equal. Plasma cholesterolPlasma cholesterol
Estrogen Estrogen Vasodialator NO [ERF] Vasodialator NO [ERF]
3.3. MEAL: MEAL:
B.P After a meal Due to B.P After a meal Due to in blood volume in blood volume
44 SLEEPSLEEP::
Less due to generalLess due to general
vasodialatation.vasodialatation.
55 EMOTIONS:EMOTIONS:
Rage, anxiety, panic e.t.cRage, anxiety, panic e.t.c
production of adrenaline production of adrenaline
B.PB.P
7. 7. ExerciseExercise
Moderate exerciseModerate exercise Systolic B.P upto 20-Systolic B.P upto 20-30 mmHg.30 mmHg.
Diastolic B.P unaltered.Diastolic B.P unaltered.
SevereSevere exerciseexercise Systolic B.P upto 40-Systolic B.P upto 40-
50 mmHg50 mmHg Diastolic B.PDiastolic B.P
8.8.GravityGravity
Above heart level Above heart level B.P B.P Below heart level Below heart level B.P B.P
Magnitude of Magnitude of gravitational effect gravitational effect
.77mmHg/cm..77mmHg/cm.
..
PATHOLOGICALPATHOLOGICAL1.1. HypertensionHypertension Persistent increase in systemic arterial Persistent increase in systemic arterial
B.P is known as hypertension.B.P is known as hypertension.According to JNC VIIAccording to JNC VII
Normal - 120/80 mmHg.Normal - 120/80 mmHg.Pre hypertension – 120-139/80-90mmHgPre hypertension – 120-139/80-90mmHgStage I Hypertension-140-159/90-99Stage I Hypertension-140-159/90-99
mmHgmmHgStage II Hypertension->/160/100mmHgStage II Hypertension->/160/100mmHg
BenignBenign
PrimaryPrimary
Hypertension Hypertension MalignantMalignant
SecondarySecondary
-Atherosclerosis-Atherosclerosis
-Pheochromocytoma-Pheochromocytoma
-Cushing syndrome-Cushing syndrome
-Glomerulonephritis-Glomerulonephritis
-Gestational-Gestational
-Drug induced-Drug induced
White coat hypertensionWhite coat hypertension
COMPLICATIONS COMPLICATIONS OF HYPERTENSIONOF HYPERTENSION
Renal failureRenal failure
LVHLVH
MIMI
Cerebral Cerebral haemorrhagehaemorrhage
Retinal Retinal haemorrhagehaemorrhage
COMPLICATIONS OF COMPLICATIONS OF UNCONTROLLED UNCONTROLLED
HYPERTENTION DURING HYPERTENTION DURING SURGERYSURGERY
Reflects cardiac status Reflects cardiac status Anaesthetic risk of the patient.Anaesthetic risk of the patient.
Excessive bleeding from operation site Excessive bleeding from operation site
Blood loss.Blood loss.
PRE-OPERATIVE PRE-OPERATIVE INVESTIGATIONINVESTIGATION
Chest x-rayChest x-rayECGECGUSG of kidneyUSG of kidneyOphthalmic evaluation for retinal Ophthalmic evaluation for retinal
haemorrhagehaemorrhageRFTRFT
MANAGEMENT OF MANAGEMENT OF HYPERTENSIONHYPERTENSION
Non drug therapyNon drug therapyStop smokingStop smokingControl obesityControl obesityRegular exerciseRegular exerciseDecrease salt intakeDecrease salt intake
Drug therapyDrug therapyBeta blockersBeta blockersCalcium channel Calcium channel blockersblockersVasodialatorsVasodialatorsDiureticsDiureticsACE inhibitorsACE inhibitorsVMC depressorsVMC depressors
DIETARY APPROACH TO DIETARY APPROACH TO STOP HYPERTENSION.STOP HYPERTENSION.
During surgical During surgical proceduresprocedures::
B.P should be monitored and controlled B.P should be monitored and controlled before,during and after treatment.before,during and after treatment.
Antihypertensives should be continued.Antihypertensives should be continued.
LA solution without adrenaline or LA solution without adrenaline or bupivacaine should be given.bupivacaine should be given.
HYPOTENSIONHYPOTENSION Fall in B.P below normal range is known as Fall in B.P below normal range is known as
hypotension.hypotension. TYPESTYPES
Primary/Essential hypotension.Primary/Essential hypotension.Secondary hypotension.Secondary hypotension.
-MI -MI -Hypoactivity of pituitary gland-Hypoactivity of pituitary gland -Hypoactivity of adrenal gland-Hypoactivity of adrenal gland -Tuberculosis-Tuberculosis
Orthostatic hypotensionOrthostatic hypotension
TREATMENT OF TREATMENT OF HYPOTENSIONHYPOTENSION
Correct the underlying etiology. Correct the underlying etiology.
Orthostatic hypotension Change Orthostatic hypotension Change to supine position with head below the to supine position with head below the heart level & leg raisedheart level & leg raised..
REGULATON OF REGULATON OF ARTERIALARTERIAL
RAPIDLY ACTINGRAPIDLY ACTING
INTERMEDIATE ACTINGINTERMEDIATE ACTING
LONG TERM ACTINGLONG TERM ACTING
B.P
RAPIDLY ACTING RAPIDLY ACTING MECHANISMMECHANISM
Baroreceptor reflexBaroreceptor reflex
Chemoreceptor reflexChemoreceptor reflex
CNS ischeamic responseCNS ischeamic response
BARORECEPTOR REFLEXBARORECEPTOR REFLEX carotid body & aortic carotid body & aortic
archarchB.P impulse to tractus solitariusB.P impulse to tractus solitarius supress VMC&stimulate CICsupress VMC&stimulate CIC
vasodialatation rate and vasodialatation rate and force offorce of contraction contraction
PR COPR CO
LOCATION OF BARORECEPTORS
CHEMORECEPTOR CHEMORECEPTOR REFLEXREFLEX
CAROTID SINUS $ AORTIC CAROTID SINUS $ AORTIC BODYBODY
B.P tissue ischeamiaB.P tissue ischeamia
Po2 and Pco2 in chemoreceptorsPo2 and Pco2 in chemoreceptors
stimulation of VMCstimulation of VMC
B.PB.P
INTERMEDITE ACTINGINTERMEDITE ACTING
CAPILLARY FLUID SHIFT MECHANISMCAPILLARY FLUID SHIFT MECHANISM
STRESS RELAXATIONSTRESS RELAXATION
REVERSE STRESS RELAXATIONREVERSE STRESS RELAXATION
CAPILLARY FLUID CAPILLARY FLUID SHIFT MECHANISMSHIFT MECHANISM
STRESS RELAXATION STRESS RELAXATION MECHANISMMECHANISM
B.P in blood storage organs B.P in blood storage organs
vasodialatation B.P .vasodialatation B.P .
REVERSE STRESS REVERSE STRESS RELAXATIONRELAXATION
B.P vasoconstriction perfusion .B.P vasoconstriction perfusion .
LONGTERM REGULATIONLONGTERM REGULATION
Survey conducted among 120 Survey conducted among 120 inmates of ladies hostel of RDCinmates of ladies hostel of RDC
CONCLUSIONCONCLUSION