blood pressure

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blood pressure

  1. 1. BLOOD PRESSURE
  2. 2. BLOOD PRESSURE <ul><li>Dr shabeel pn </li></ul>
  3. 3. DEFINITION <ul><li>Blood pressure is defined as the lateral pressure exerted by flowing blood on the walls of the arteries . </li></ul>
  4. 4. TYPES OF BLOOD PRESSURE <ul><li>Depending on the NATURE OF BLOOD VESSEL – </li></ul><ul><li>Arterial B.P </li></ul><ul><li>Venous B.P </li></ul><ul><li>Capillary B.P </li></ul>
  5. 5. BLOOD PRESSURE IS DETERMINED BY: <ul><li>Force with which heart pumps the blood </li></ul><ul><li>Resistance offered by the vessels </li></ul><ul><li>B.P = C.O x P.R </li></ul>
  6. 6. CARDIAC CYCLE Systole - .3sec Diastole - .5sec Total - .8 sec
  7. 7. ARTERIAL BLOOD PRESSURE <ul><li>TYPE NORMAL RANGE </li></ul><ul><li>Systolic BP 110-130mmHg </li></ul><ul><li>Diastolic BP 60-80mmHg </li></ul><ul><li>Pulse pressure 40mmHg </li></ul><ul><li>Mean arterial 93-100mmHg </li></ul><ul><li>pressure </li></ul>
  8. 8. MEASUREMENT OF BP <ul><li>DIRECT METHOD </li></ul><ul><li>INDIRECT METHOD </li></ul><ul><li>Palpatory method </li></ul><ul><li>Auscultatory method </li></ul>
  9. 9. DIRECT METHOD
  10. 10. INDIRECT METHOD
  11. 11. INSTRUMENTS
  12. 12. SPHYGMOMANOMETER
  13. 13. ANEROID BAROMETER
  14. 14. AUTOMATIC INFLATION CUP
  15. 15. PROCEDURE
  16. 16. KOROTKOFF’S SOUNDS Dissappears V Rest Muffled IV 5 mmHg Gong sound III 20 mmHg Murmer II 10 mmHg Tapping sound I DURATION NATURE OF SOUND PHASE
  17. 17. PALPATORY METHOD
  18. 18. BASIS OF KOROTKOFF’S SOUND <ul><li>Sounds are heard due to turbulence </li></ul><ul><li>Cuff pressure > Systolic. P Lumen is occluded No sounds are heard. </li></ul><ul><li>Cuff pressure <just below> systolic .P </li></ul><ul><li>Blood flow at height of systole Tapping sound </li></ul><ul><li>Cuff pressure < diastolic.P Streamline flow No sounds. </li></ul>
  19. 19. AUSCULTATORY GAP <ul><li>A gap present after tapping sound </li></ul><ul><li>Seen in hypertensive patients . </li></ul>
  20. 20. VARIATIONS <ul><li>PHYSIOLOGICAL </li></ul><ul><li>PATHOLOGICAL </li></ul>
  21. 21. PHYSIOLOGICAL <ul><li>AGE : in B.P </li></ul><ul><li>Old age Lipid deposition in lamina propria Loss of windkessel effect </li></ul><ul><li>SEX: </li></ul><ul><li>Males > Females upto menopause. </li></ul><ul><li>After menopause Equal. </li></ul><ul><li>Plasma cholesterol </li></ul><ul><li>Estrogen </li></ul><ul><li>Vasodialator NO [ERF] </li></ul>
  22. 22. <ul><li>MEAL: </li></ul><ul><li>B.P After a meal Due to in blood volume </li></ul><ul><li>SLEEP : </li></ul><ul><li>Less due to general </li></ul><ul><li>vasodialatation. </li></ul><ul><li>EMOTIONS: </li></ul><ul><li>Rage, anxiety, panic e.t.c </li></ul><ul><li>production of adrenaline </li></ul><ul><li>B.P </li></ul>
  23. 23. <ul><li>7. Exercise </li></ul><ul><li>Moderate exercise Systolic B.P upto 20-30 mmHg. </li></ul><ul><li>Diastolic B.P unaltered. </li></ul><ul><li>Severe exercise </li></ul><ul><li>Systolic B.P upto 40-50 mmHg </li></ul><ul><li>Diastolic B.P </li></ul>
  24. 24. <ul><li>8. Gravity </li></ul><ul><li>Above heart level </li></ul><ul><li>B.P </li></ul><ul><li>Below heart level </li></ul><ul><li>B.P </li></ul><ul><li>Magnitude of gravitational effect </li></ul><ul><li>.77mmHg/cm. </li></ul><ul><li>. </li></ul>
  25. 25. PATHOLOGICAL <ul><li>Hypertension </li></ul><ul><li>Persistent increase in systemic arterial B.P is known as hypertension. </li></ul><ul><li>According to JNC VII </li></ul><ul><li>Normal - 120/80 mmHg. </li></ul><ul><li>Pre hypertension – 120-139/80-90mmHg </li></ul><ul><li>Stage I Hypertension-140-159/90-99 </li></ul><ul><li>mmHg </li></ul><ul><li>Stage II Hypertension->/160/100mmHg </li></ul>
  26. 26. <ul><li>Benign </li></ul><ul><li>Primary </li></ul><ul><li>Hypertension Malignant </li></ul><ul><li>Secondary </li></ul><ul><li>-Atherosclerosis </li></ul><ul><li>-Pheochromocytoma </li></ul><ul><li>-Cushing syndrome </li></ul><ul><li>-Glomerulonephritis </li></ul><ul><li>-Gestational </li></ul><ul><li>-Drug induced </li></ul><ul><li>White coat hypertension </li></ul>
  27. 27. COMPLICATIONS OF HYPERTENSION <ul><li>Renal failure </li></ul><ul><li>LVH </li></ul><ul><li>MI </li></ul><ul><li>Cerebral haemorrhage </li></ul><ul><li>Retinal haemorrhage </li></ul>
  28. 28. COMPLICATIONS OF UNCONTROLLED HYPERTENTION DURING SURGERY <ul><li>Reflects cardiac status Anaesthetic risk of the patient. </li></ul><ul><li>Excessive bleeding from operation site </li></ul><ul><li>Blood loss. </li></ul>
  29. 29. PRE-OPERATIVE INVESTIGATION <ul><li>Chest x-ray </li></ul><ul><li>ECG </li></ul><ul><li>USG of kidney </li></ul><ul><li>Ophthalmic evaluation for retinal haemorrhage </li></ul><ul><li>RFT </li></ul>
  30. 30. MANAGEMENT OF HYPERTENSION <ul><li>Non drug therapy </li></ul><ul><li>Stop smoking </li></ul><ul><li>Control obesity </li></ul><ul><li>Regular exercise </li></ul><ul><li>Decrease salt intake </li></ul><ul><li>Drug therapy </li></ul><ul><li>Beta blockers </li></ul><ul><li>Calcium channel blockers </li></ul><ul><li>Vasodialators </li></ul><ul><li>Diuretics </li></ul><ul><li>ACE inhibitors </li></ul><ul><li>VMC depressors </li></ul>
  31. 31. DIETARY APPROACH TO STOP HYPERTENSION.
  32. 32. During surgical procedures : <ul><li>B.P should be monitored and controlled before,during and after treatment. </li></ul><ul><li>Antihypertensives should be continued. </li></ul><ul><li>LA solution without adrenaline or bupivacaine should be given. </li></ul>
  33. 33. HYPOTENSION <ul><li>Fall in B.P below normal range is known as hypotension. </li></ul><ul><li>TYPES </li></ul><ul><li>Primary/Essential hypotension. </li></ul><ul><li>Secondary hypotension. </li></ul><ul><li>-MI </li></ul><ul><li>-Hypoactivity of pituitary gland </li></ul><ul><li>-Hypoactivity of adrenal gland </li></ul><ul><li>-Tuberculosis </li></ul><ul><li>Orthostatic hypotension </li></ul>
  34. 34. TREATMENT OF HYPOTENSION <ul><li>Correct the underlying etiology. </li></ul><ul><li>Orthostatic hypotension Change to supine position with head below the heart level & leg raised . </li></ul>
  35. 35. REGULATON OF ARTERIAL <ul><li>RAPIDLY ACTING </li></ul><ul><li>INTERMEDIATE ACTING </li></ul><ul><li>LONG TERM ACTING </li></ul>B.P
  36. 36. RAPIDLY ACTING MECHANISM <ul><li>Baroreceptor reflex </li></ul><ul><li>Chemoreceptor reflex </li></ul><ul><li>CNS ischeamic response </li></ul>
  37. 37. BARORECEPTOR REFLEX carotid body & aortic arch <ul><li>B.P impulse to tractus solitarius </li></ul><ul><li>supress VMC&stimulate CIC </li></ul><ul><li>vasodialatation rate and </li></ul><ul><li>force of </li></ul><ul><li>contraction </li></ul><ul><li>PR CO </li></ul>
  38. 38. LOCATION OF BARORECEPTORS
  39. 39. CHEMORECEPTOR REFLEX CAROTID SINUS $ AORTIC BODY <ul><li>B.P tissue ischeamia </li></ul><ul><li>Po2 and Pco2 in chemoreceptors </li></ul><ul><li>stimulation of VMC </li></ul><ul><li>B.P </li></ul>
  40. 40. INTERMEDITE ACTING <ul><li>CAPILLARY FLUID SHIFT MECHANISM </li></ul><ul><li>STRESS RELAXATION </li></ul><ul><li>REVERSE STRESS RELAXATION </li></ul>
  41. 41. CAPILLARY FLUID SHIFT MECHANISM
  42. 42. STRESS RELAXATION MECHANISM <ul><li>B.P in blood storage organs vasodialatation B.P . </li></ul><ul><li>REVERSE STRESS RELAXATION </li></ul><ul><li>B.P vasoconstriction perfusion . </li></ul>
  43. 43. LONGTERM REGULATION
  44. 44. Survey conducted among 120 inmates of ladies hostel of RDC
  45. 45. CONCLUSION

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