This document discusses blood pressure, including an overview, variations, determinants, regulation, and measurement. It defines systolic and diastolic blood pressure and other related terms. The key factors that determine and regulate blood pressure are described, including cardiac output, peripheral resistance, blood volume, hormones, the nervous system, kidneys, and local mechanisms. Methods for measuring blood pressure are outlined, including palpatory, auscultatory, and oscillometric techniques. Special considerations for taking blood pressure in certain populations are also noted.
Clinical examination of Radial pulse by Pandian M, Tutor, Dept of Physiology,...Pandian M
Introduction
Ideal graph which represented radial pulse
Importance
Method of examination
Procedure
The following aspects (parameters) of the pulse are studied
Precautions:-
Discussion
Applied aspects
Other peripheral pulses
Definition
Classification Of Salivary Glands
Anatomy of salivary glands
Development of salivary glands
Structure Of Salivary Glands
Histology of major and minor salivary glands
Clinical examination of Radial pulse by Pandian M, Tutor, Dept of Physiology,...Pandian M
Introduction
Ideal graph which represented radial pulse
Importance
Method of examination
Procedure
The following aspects (parameters) of the pulse are studied
Precautions:-
Discussion
Applied aspects
Other peripheral pulses
Definition
Classification Of Salivary Glands
Anatomy of salivary glands
Development of salivary glands
Structure Of Salivary Glands
Histology of major and minor salivary glands
Muscles of mastication are the group of muscles that help in movement of the mandible as during chewing and speech. We need to study these muscles as they control the opening & closing the mouth & their role in the equilibrium created within the mouth. They also play a role in the configuration of face.
Muscles of mastication are the group of muscles that help in movement of the mandible as during chewing and speech. We need to study these muscles as they control the opening & closing the mouth & their role in the equilibrium created within the mouth. They also play a role in the configuration of face.
Physiology of the stomatognathic system / prosthodontic coursesIndian dental academy
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Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation, usually measured at a person's upper arm. A person’s blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure and is measured in millimeters of mercury (mm Hg). Normal resting blood pressure for an adult is approximately 120/80 mm Hg.
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One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
This presentation gives you a brief, understandable, captivating and presentable idea on the physiology of blood pressure regulation both on hypertension and hypotension cases.
BLOOD PRESSURE
BY: SAIYED FALAKAARA
ASSISTANT PROFESSOR
DEPARTMENT OF PHARMACY
SUMANDEEP VIDYAPEETH
Definition
Arterial blood pressure can be defined as the lateral pressure exerted by moving the column of blood on the walls of the arteries.
Significance
To ensure the blood flow to various organs
Plays an important role in exchange of nutrients and gases across the capillaries
Required to form urine
Required for the formation of lymph
Normal values
Normal adult range can fluctuate within a wide range and still be normal
Systolic/diastolic
100/60 – 140/80
Unit - mmHg
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Surgical Site Infections, pathophysiology, and prevention.pptx
Blood pressure and Its Applied Physiology In Dentistry (Prosthodontics)
1. BLOOD PRESSURE AND ITS
APPLIED PHYSIOLOGY
Dr. Soham Prajapati
1st Year PG,
Dept. of Prosthodontics
& Maxillofacial Prosthesis
Including Oral Implantology
1
3. • Measurement of Arterial Blood Pressure
• Blood pressure recording in special situations
• Conclusion
• References
3
4. • Local Anesthesia With Vasoconstriction
• White Coat Hypertension
• General Principles of Hypertensive Therapy
• Hypotension
• Orthostatic Hypotension
• Supine Hypotensive Syndrome
• Hypertension and Implants
• Conclusion
• References
4
5. Introduction
• Blood is a connective tissue in fluid form.
• It is considered as
– Fluid of life
– Fluid of growth
– Fluid of health
scanning electron microscope (SEM) image
of a normal red blood cell, a platelet, and a
white blood cell.
5
6. Blood Pressure
• Blood pressure (BP), sometimes referred to as
arterial blood pressure , is the pressure
exerted by circulating blood upon the walls of
blood vessels, and is one of the principal vital
signs.
• Blood pressure consists of three types:
– Arterial pressure
– Venous pressure
– Capillary Pressure
6
7. Properties of Blood
1.Colour :- Arterial blood is scarlet red.
Venous blood is purple red.
2.Volume:- Average blood volume is 5 L.
New born Baby = 450 ml.
Females :- 4.5 L
3.Reaction and pH: Slightly Alkaline and its pH is
7.4 in normal conditions.
7
8. • Viscosity:- Five times more viscous than water
• Specific Gravity:- Total Blood : 1.052 to 1.061
Blood Cells : 1.092 to 1.101
Plasma : 1.022 to 1.026
8
9. 1.Arterial Blood Pressure is defined as the lateral
pressure exerted by the contained column of
blood on the wall of arteries.
9
10. 2.Venous Pressure is the pressure exerted by the
contained blood in the veins. The pressure in
vena cava and right atrium is called central
venous pressure. And the pressure in peripheral
veins is called peripheral venous pressure.
10
12. • SYSTOLIC BLOOD PRESSURE is defined as
maximum pressure exerted in the arteries
during systole of the heart.
• DIASTOLIC BLOOD PRESSURE is defined as the
minimum pressure in the arteries during
diastole of the heart.
12
14. • PULSE PRESSURE is the difference between
the systolic pressure and diastolic pressure.
Normally it is 40 mm of Hg.
14
15. • MEAN ARTERIAL BLOOD PRESSURE is the
average pressure existing in the arteries. It is
the arithmetic mean of systolic and diastolic
pressures.
• Calculated as DIASTOLIC PRESSURE + 1/3 of
PULSE PRESSURE.
• Normally
it is 93 mm
of Hg (80 + 13).
15
16. • SBP: systolic blood
pressure; DBP:
diastolic blood
pressure.
• Table 1.
Classification of
blood pressure in
subjects over 18
years of age
(National Committee
on Prevention,
Detection,
Evaluation, and
Treatment of High
Blood Pressure)
• e98
• J Clin Exp Dent.
2011;3(2):e97-105.
CLASSIFICATION OF BLOOD PRESSURE IN
ADULTS
Classification of blood
pressure
SBP
(mmHg)
DBP
(mmHg)
Normal
< 120
< 80
Prehypertension
120-139
80-89
AH
T
Stage 1
140-159
90-99
Stage 2
≥ 160
≥ 100
16
18. Physiological Variation• Age:- Increases as age advances
Systolic pressure
NEW BORN – 40 mm of Hg
AFTER 15 DAYS – 70 mm of Hg
AFTER 1 MONTH – 90 mm of Hg
AT PUBERTY –120 mm of Hg
50 YEARS – 140 mm of Hg
Diastolic pressure
AT PUBERTY –80 mm of Hg
50 YEARS – 85 mm of Hg
18
19. • Gender: In females up to the period of
menopause, the arterial pressure is low (up to
5 mm of Hg) as compared to males of same
age. After menopause, the pressure in females
become equal to that in males of same age.
19
20. • Body Built: The pressure is more in obese persons
than in lean patients.
• Diurnal Variations: In early morning, the pressure
is slightly low. It gradually increases and reaches
the maximum at noon. It becomes low in
evening. 20
21. • After Meals: It is increases for few hours due
to increase in cardiac output.
• During Sleep: Reduces 15-20 mm of Hg during
sleep. However, it increases slightly during
sleep associated with dreams.
21
22. • Emotional Conditions: During anxiety or
excitement, the blood pressure increases due to
release of adrenaline.
• After Exercise: After moderate exercise, systolic
pressure increases by 20- 30 mm of Hg above the
basal level due to increase in force of contraction
and stroke volume. Normally, diastolic is not
affected.
22
23. • Pathological variation:
-Renal Artery Stenosis
-Pheochromocytoma
-Preclamptic toxemia
• Drug induced:
-Stimulants (sympathetic) ex:-adrenaline,
noradrenalin, phenyl epinephrine, >s B P
-Relaxants (of vascular smooth muscle) < s B P
-Diuretics <s B P( due to reduction in blood volume )
23
24. DETERMINANTS OF ARTERIAL BLOOD
PRESSURE – FACTORS MAINTAINING
ARTERIAL BLOOD PRESSURE
– CENTRAL FACTORS (PERTAINING TO THE HEART)
– PERIPHERAL FACTORS (PERTAINING TO BLOOD &
BLOOD VESSELS)
24
25. • IT INCLUDES:
– Cardiac output
– Heart Rate
Cardiac output : Systolic blood pressure is directly
proportional to cardiac output. Increases during
muscular exercise and emotional condition and rise
in systolic pressure. In myocardial infarction, the
cardiac output decreases and fall in systolic
pressure.
CENTRAL FACTORS
25
26. • Heart Rate: Cardiac output is the product of
stroke volume and heart rate. And in turn
depends upon blood volume, venous return,
heart rate and force of contraction.
• Moderate changes in heart rate do not affect
arterial blood pressure much. However, marked
alteration in the heart rate affects the blood
pressure by altering diastolic period and stroke
volume.
26
27. Peripheral Factors
• It includes:
– Peripheral resistance
– Blood volume
– Venous return
– Elasticity of blood vessels
– Velocity of blood flow
– Diameter of blood vessels
– Viscosity of blood
27
28. Regulation of Arterial Blood Pressure
• Arterial blood pressure varies even under
physiological conditions. However,
immediately it is brought back to normal level
because of the presence of well organized
regulatory mechanisms in the body.
28
29. 29
Regulation of
Blood Pressure
Nervous
Mechanism
By Vasomotor
center and
impulses from
periphery
Renal
Mechanism
By regulation
of ECF volume
and renin-
angiotensin
mechanism
Hormonal
Mechanism
By
vasoconstriction
and vasodilator
hormones
Local
Mechanism
By local
vasoconstrictors
and
vasodialators
30. Nervous Mechanism
• Rapid among all mechanisms.
• Although quick in action, it operates only for a
short period of time and then it adapts to the
new pressure. Hence, it is called short term
regulation.
• Operates through the vasomotor system.
30
31. 31
REGULATION OF BLOOD PRESSURE BY BARORECEPTORS
INCREASE IN
BLOOD PRESSURE
BARORECEPTORS
IMPULSES VIA
IX AND X
CRANIAL
NERVES
NORMAL BLOOD PRESSURE
DIALATION OF BLOOD
VESSELS
BRADYCARDIA AND
REDUCTION IN
CARDIAC OUTPUT
INCREASE IN
VASOMOTOR TONE INCREASE IN VAGAL TONE
INHIBITION OF
VASOCONSTRICTION
AREA
STIMULATION OF
VASODIALATOR AREA
NUCLEUS OF TRACTUS
SOLITARIUS
STIMULATION
32. Renal Mechanism
• Kidney plays an important role.
• When Blood Pressure alters slowly in several
days/months/years, the neural mechanism
adapts to the altered pressure and looses the
sensitivity for the changes.
• Kidney regulates blood pressure by two ways:
– By regulation of ECF volume
– Through renin-angiotensin mechanism
32
33. 33
REGULATION OF BLOOD PRESSURE BY RENIN ANGIOTNESIN MECHANISM
DECREASE IN
BLOOD PRESSURE
JUXTAGLOMERULAR
APPARATUS
RENIN
NORMAL BLOOD PRESSURE
VASOCONSTRICTION
INCREASE IN BLOOD
VOLUME
INCREASE IN ECF
VOLUME
REABSORTION OF
WATER AND SODIUM
KIDNEY
STIMULATION
ALDOSTERONE
ANGIOTENS
INOGEN
ANGIOTENS
IN I
ANGIOTENS
IN II
ADRENAL CORTEX
CONVERTING
ENZYME
36. Local Mechanism
• Local substances regulate the blood pressure by
vasoconstriction or vasodilation.
• Vasoconstrictor substances are endothelins (ET).
• Vasodilators are carbon dioxide, hydrogen ions,
lactate, adenosine and nitric oxide.
36
37. Measurement of Arterial Blood Pressure
• Blood Pressure was first measured in horse in
1733.
• In 1847, Ludwig placed a float on the top of
mercury column and made continuous
recording possible.
• Measured by two methods:
– Direct method
– Indirect method
37
39. Indirect Method
• Apparatus: The apparatus
used to measure blood
pressure is called
sphygmomanometer. Along
with this, stethoscope is also
necessary to measure blood
pressure.
Consists of:
-Inflatable cuffs
-Pressure gauge or
mercury manometer ,has
long and short arm each
-Hand pump
Stethoscope:
Consists of End piece;
Connect by tubes to Ear piece
39
40. • Principle:
– When an external pressure is applied over the
artery, the blood flow through it is obstructed.
And the pressure required to cause occlusion of
blood flow indicates the pressure inside the
vessel.
40
41. – Brachial artery is usually chosen!!!!(convenience).
– The arm cuff is tied around the upper arm above
the cubital fossa.
41
42. • Cuff should not be too tight or too loose.
• Measured by three methods:
– Palpatory method
– Auscultatory method
– Oscillatory method
42
43. Palpatory Method
• First, the radial pulse is felt.
• While feeling the pulse, the pressure is increased
in the cuff by inflating air into it, with the help of
hand cuff.
• When the radial pulse
disappears,
the pressure is further
Increased by
about 20 mm Hg.
43
44. • Then, the pressure in the cuff is slowly
reduced by releasing the valve of hand pump.
• Pulse is noted when the pulse reappears.
• This pressure indicates systolic pressure.
• DISADVANTAGE: DIASTOLIC PRESSURE
CANNOT BE MEASURED.
44
45. AUSCULTATORY METHOD
• MOST ACCURATE METHOD
• After determining the systolic pressure in
Palpatory method, the pressure in the cuff is
raised by about 20 mm Hg above the level so
that, the brachial artery is occluded due to
compression.
45
46. • Now the chest piece of the stethoscope is
placed over the cubital fossa, and the pressure
is released from the cuff.
• While doing so, series of sounds are heard
through the stethoscope. These sounds are
called Korotkoff’s sounds.
• While reducing the pressure, Korotkoff’s
sounds appear in five phases.
46
47. Korotkoff’s Sounds
• Phase 1: Appearance of tap sound, this marks the
systolic BP
• Phase 2: Sound takes up the murmuring quality,
Auscultatory gap may appear in this phase.
• Phase 3: Sound becomes very loud and gauging in
quality.
• Phase 4: Sound suddenly becomes muffled.
• Phase 5: All sounds disappear, DBP recorded here.
47
48. • Thus, in Auscultatory method, the appearance
of the clear tapping sound during the first
phase indicates systolic pressure and the
disappearance of the muffling sound shows
diastolic pressure.
48
49. Oscillatory Method
• Inaccurate for routine clinical practice.
• By connecting the manometer to an
appropriate recording device the oscillation of
the mercury column can be recorded
graphically.
49
50. NOWDAYS
• Automatic blood pressure instrument is
AVAILABLE.
• The instrument has a microprocessor- driven
air pump which automatically inflates the air
cuff and a fixed pressure valve.
• Then, it records the pressure oscillation
pattern during a stepwise deflation.
50
51. • The sensors in the instrument detect the
oscillatory waves and determine the systolic
and diastolic pressure. Also pulse rate is
measured.
• The microprocessor controlled blood pressure
monitors that are fixed around the wrist or
finger are also available.
51
55. EFFECT OF THE BODY POSITION
• BP measurement is most commonly made in
either the sitting or supine position, but the
two positions give different measurements.
• It is widely accepted that diastolic pressure
measured while sitting is higher than when
measured supine (by about 5 mm Hg),
although there is less agreement about
systolic pressure.
55
56. • When the arm position is meticulously
adjusted so that the cuff is at the level of the
right atrium in both positions, the systolic
pressure has been reported to be 8 mm Hg
higher in the supine than the upright position.
• If the back is not supported, the diastolic
pressure may be increased by 6 mm Hg.
• Crossing the leg may raise systolic pressure by
2 to 8 mm Hg.
56
57. Effects of Arm Position
• Major influence, when BP is measured.
• If the upper arm is below the level of the right
atrium (when the arm is hanging down while
in the sitting position), the readings will be too
high.
• If the arm is above the heart level, the
readings will be too low.
57
58. • This is due to effect of the hydrostatic
pressure.
• Other physiologic factor is muscular tension.
• If the arm is held up by the patient(being
unsupported) , the isometric exercise will raise
the pressure.
58
59. Blood Pressure recording in Special
Situations
• Elderly Patients
– BP Should be measured while seated, 2 or more
times at each visit, and the readings should be
averaged.
– Also measured in standing position routinely,
because may have postural hypotension.
– Hypotension is more common in diabetic
patients.
– It can help elucidate some symptoms such as
episodic faintness and nocturnal dyspnea.
59
60. Obese Patients
• A Longer and wider cuff is needed for adequate
compression of brachial artery with a very large
arm.
• In the rare patients with an arm
circumference>50 cm, when even a thigh cuff
cannot be fitted over the arm, it is recommended
that the practioner wrap an appropriately sized
cuff around the patient’s forearm, support it at
heart level, and fell for the appearance of the
radial artery pulse at the wrist.
60
61. Children
• BP is most conveniently measured in children
by auscultation with a standard mercury
sphygmomanometer.
• The stethoscopes is placed in the same way as
an adult.
• Should be conducted after 3 to 5 minutes of
rest.
• Measured for 2 times and average is
calculated.
61
62. Pregnant Women
• Hypertension is most common medical
disorder of pregnancy and occurs in 10-12% of
all pregnancies.
• Measured in seated position.
• Measurement of BP in left recumbence, on
the left arm , does not differ substantially
from the BP that is recorded in the sitting
position.
62
63. Conclusion
• Hypertensive is usually a symptomatic and is
the major risk factor for coronary heart
disease and cerebrovascular accidents.
• Patients with essential hypertension are more
susceptible to 3 times as much coronary
disease, 4 times as much cardiac failure and 7
times as many strokes as normotensive
patients
63
64. References
• Essential of Medical Physiology, K
Sembulingam and P Sembulingam, 4th
Edition.
• Textbook Of Medical Physiology, Guyton and
Hall, 11th Edition.
• Principles and Practice of Medicine,Davidson,
20th Edition.
64
65. • Contemporary Implant Dentistry,Misch, 3rd
Editition.
• Essential of Medical Physiology, K. D. Tripathy, 6th
Edition.
• Dental considerations in patients with heart
disease Marta Cruz-Pamplona 1 , Yolanda
Jimenez-Soriano 2 , Maria Gracia Sarrión-Pérez 1
• Infective endocarditis prophylaxis and the current
AHA, BSAC, NICE and Australian guidelines .
journa! Oif the Irish Dental Association 2008; 54
(6): 264-270.
65
66. • Classification of blood pressure in subjects over 18 years of
age (National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure), e98, J
Clin Exp Dent. 2011;3(2):e97-105.
• Banaś T, Godula Z, Herman R (2004). "[Aortocaval
compression syndrome as an explanation of sudden
intrauterine death of mature twins at term. Case report]".
Ginekol Pol 75 (8): 633–7.
• SUPINE HYPOTENSIVE SYNDROME IN DENTAL TREATMENT,
Dr. Kapil Sharma, Dr. Jaya Pamboo Department and
institution: Assistant Professor Dept of oral and
maxillofacial surgery Jodhpur Dental College
66
67. • Recommendations for Blood Pressure
Measurement in Humans and Experimental
Animals : Part 1: Blood Pressure Measurement in
Humans: A Statement for Professionals From the
Subcommittee of Professional and Public
Education of the American Heart. Association
Council on High Blood Pressure Research .Thomas
G. Pickering, John E. Hall, Lawrence J. Appel,
Bonita E. Falkner, John Graves, Martha N. Hill,
Daniel W. Jones, Theodore Kurtz, Sheldon G.
Sheps and Edward J. Roccella
67
FOL-– BECAUSE IT CARRIES oxygen from lungs to all parts of the body and carbon dioxide from all parts of the body to the lungs.
FOG-- BECAUSE IT CARRIES nutritive substances from the digestive system and hormones from endocrine gland to all the tissues.
FOH—BECAUSE IT PROTECTS the body against the diseases and gets rid of the waste products and unwanted substances by transporting them to the excretory organs.
Arterial blood pressure is usually refered
Colour: Scarlet red:- more oxygen
Purple red:- more carbon dioxide
Volume:- It increases during growth and reaches 5 L at the times of puberty.8 % of the body weight in normal healthy adult weighing 70 Kg.
Viscosity:- due to blood cells and plasma protein.
Highest Capillary hydrostatic pressure is observed at the arteriolar end of the capillary and lowest pressure is observed at the venular end.
Hydrostatic = fluid at rest.
So capillary hydrostatic pressure is considered when interstitial fluid and capillary pressure are at a difference.(osmotic pressure mechanism)
Highest Capillary hydrostatic pressure is observed at the arteriolar end of the capillary and lowest pressure is observed at the venular end.
Hydrostatic = fluid at rest.
So capillary hydrostatic pressure is considered when interstitial fluid and capillary pressure are at a difference.(osmotic pressure mechanism)
Systolic blood pressure Significance:
Extent of work done by heart
The force with which the heart is working
The degree of pressure to which the arterial wall have to withstand
Diastolic blood pressure Significance: It’s the measure of peripheral resistanceIndicates constant load against heart during its functionDBP is of
DIASTOLIC PRESSURE IS CONSIDERED BECAUSE THE DIASTOLIC PERIOD OF CARDIAC CYCLE IS LONGER. (0.53 SECONDS) THAN SYSTOLIC PRESSURE (0.27 SECONDS)
So Low Blood Pressure patients should be called in the afternoon and High Blood Pressure patients should be called In Morning or Evening
Moderate exercise, diastolic pressure depends upon peripheral resistance, which is not altered
After severe muscular exercises,systolic pressure rises by 40- 50 mm Hg,diastolic presure reduces because peripheral resistance decreases in severe muscle exercise
Moderate exercise, diastolic pressure depends upon peripheral resistance, which is not altered
After severe muscular exercises,systolic pressure rises by 40- 50 mm Hg,diastolic presure reduces because peripheral resistance decreases in severe muscle exercise
Cardiac output Increases, systemic pressures increases and vice versa.
Stroke volume increases, ventricular filling is more and pressure rises.
Force of contraction is more, cardiac output is more and systolic pressure rises.
Diastolic pressure directly related to peripheral resistance (blood volume, venous returnsame)
Blood pressure inversely proportional to elasticity of blood vessels
Directly proportional to the velocity of blood flow
Inversely proportional to diameter of blood vessels
Directly proportional to viscocity of blood.
Pg 583
Nervous mechanism or short term regulatory mechanism
Renal mechanism or long term regulatory mechanism
Baroreceptors are the receptors which give response to change in BP
Glossopharyngeal and vagus
Other way acts by, fall in blood pressure…. occlusion of common carotid arteries, resulting in decrease in the pressure of carotid sinus. This causes inactivation of baroreceptors.
Pressure buffer mechanism
Long term Regulation
Ecf mechanism: bp increases, kidney excrets large amount of water and salt, particularly sodium bymeans of pressure diuresis and pressure natriuresis. Resulting in decrease in ecf volume and blood volume..
Bp decreases, reabsorption of water from renal tubules is increases. In turn increase in ecf volume, blood volume and cardiac output resulting in restoration of bp
Auscultatory gap is the interval of pressure where korotkoff sound indicating true systolic pressure fade away and reaapper at a lower pressure point during the manual measurement of BP
Depends upon the non linear properties of the brachial arterial wall