blood pressure

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