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Dr ingle examination of blood pressure
1. Examination of blood pressure
Dr Shilpa K Ingle.
Asst.Prof. Kriyasharir dept.
GAC, Nanded.
2. Definition
Arterial blood pressure is defined as the lateral
pressure exerted by the column of blood on
wall of arteries.
The pressure is exerted when blood flows
through the arteries.
Generally, the term ‘blood pressure’ refers to
arterial blood pressure.
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6. Importance of B.P.
It gives valuable information regarding the CVS
under normal as well as abnormal conditions.
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7. Arterial blood pressure is expressed in
four different terms:
1. Systolic blood pressure
2. Diastolic blood pressure
3. Pulse pressure
4. Mean arterial blood pressure. „
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8. 1. SYSTOLIC BLOOD PRESSURE :
Systolic blood pressure is defined as the maximum
pressure exerted in the arteries during systole of
heart.
Normal systolic pressure: 120 mm Hg (110 mm Hg
to 140 mm Hg)
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9. 2. DIASTOLIC BLOOD PRESSURE :
Diastolic blood pressure is defined as the minimum
pressure exerted in the arteries during diastole of
heart.
Normal diastolic pressure: 80 mm Hg (60 mm Hg to
80 mm Hg)
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10. 3. PULSE PRESSURE:
Pulse pressure is the difference between the systolic
pressure and diastolic pressure.
Normal pulse pressure: 40 mm Hg (120 – 80 = 40).
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11. 4. MEAN ARTERIAL BLOOD PRESSURE:
It is the ave. pressure existing in the arteries.
It is not the arithmetic mean of systolic and diastolic
pressures.
Mean arterial B.P. = D.B.P. + 1/3 of pulse pressure
= 80 + 1/3 of 40
= 93.3 mm of Hg
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12. VARIATIONS
• Blood pressure is altered in physiological and
pathological conditions.
• Systolic pressure is subjected for variations easily &
quickly and its variation occurs in a wider range.
• Diastolic pressure is not subjected for easy and quick
variations and its variation occurs in a narrow range.
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13. PHYSIOLOGICAL VARIATIONS
1. Age : Arterial B.P. increases as age advances.
Systolic pressure in different age ---------
In Newborn : 70 mm Hg
After 1 month : 85 mm Hg
After 6 month : 90 mm Hg
After 1 year : 95 mm Hg
At puberty : 120 mm Hg
At 50 years : 140 mm Hg
At 70 years : 160 mm Hg
At 80 years : 180 mm Hg
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14. Diastolic pressure in different age-----------
In Newborn : 40 mm Hg
After 1 month : 45 mm Hg
After 6 month : 50 mm Hg
After 1 year : 55 mm Hg
At puberty : 80 mm Hg
At 50 years : 85 mm Hg
At 70 years : 90 mm Hg
At 80 years : 95 mm Hg
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15. 2. Sex:
In females, up to the period of menopause, arterial
pressure is 5 mm Hg, less than in males of same age.
After menopause, the pressure in females becomes equal
to that in males of same age.
3. Body Built:
Pressure is more in obese persons than in lean persons.
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16. 4. Diurnal Variation:
In early morning, the pressure is slightly low.
It gradually increases and reaches the maximum at noon.
It becomes low in evening.
5. After Meals:
Arterial blood pressure is increased for few hours after
meals due to increase in cardiac output.
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17. 6. During Sleep:
Usually, the pressure is reduced up to 15 to 20 mm Hg
during deep sleep.
However, it increases slightly during sleep associated
with dreams.
7. Emotional Conditions:
During excitement or anxiety, the blood pressure is
increased due to release of adrenaline.
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18. 8. After Exercise:
• After moderate exercise, systolic pressure increases by 20
to 30 mm Hg.
• Normally, diastolic pressure is not affected by moderate
exercise.
• It is because, the diastolic pressure depends upon
peripheral resistance, which is not altered by
moderate exercise.
• After severe muscular exercise, systolic pressure rises by
40 to 50 mm Hg above the basal level.
• But, the diastolic pressure reduces because the peripheral
resistance decreases in severe muscular exercise.
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19. PATHOLOGICAL VARIATIONS
Hypertension - S.B.P. > 150 mm of Hg
D.B.P > 90 mm of Hg
Hypotension - S.B.P. < 100 mm of Hg
D.B.P. < 50 mm of Hg
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With DP below 90 mm Hg:
SP below 140 mm Hg = Normal
140–159 mm Hg = Borderline isolated systolic hypertension.
160 or higher = Isolated systolic hypertension.
Diastolic pressures
Below 85 mm Hg = Normal
85–90 mm Hg = High normal.
90–104 mm Hg = Mild hypertension.
105–114 = Moderate hypertension.
115 and above = Severe hypertension
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Classification of hypertension...............
1. Essential hypertension.
About 90–95% of hypertensives belong to this
category in which the cause of the high pressure is not
known—
although obesity,
high salt intake,
alcohol ingestion,
heredity, and
mental make-up (tense, irritable and over-ambitious
individuals; the Type I personality).
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2. Secondary hypertension.
The remaining 5–10% of hypertensives belong to this group, in
which the cause of high BP is known. Secondary hypertension,
which is curable, should always be considered in patients under
age 30 years or those who develop hypertension after age 55 years.
a. Renal diseases. Parenchymal disease; polycystic kidney;
narrowing of renal artery.
b. Coarctation of aorta
c. Endocrine diseases. hyperaldosteronism; Cushing syndrome;
hyperthyroidism,OCP
d. Toxemias of pregnancy.
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Malignant hypertension
In some patients, the blood pressure, especially the
diastolic pressure, is accelerated and rises to very high
levels within a short time (diastolic pressure above 120
mm Hg is a medical emergency).
If untreated, the patient may die. within 1–2 years.
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Complications of Hypertension.
Hypertension has been called a “silent killer”.
It may go unnoticed and undiagnosed for years when
permanent damage has already occurred in vital organs.
( # regular medical checkups).
The common causes of death are myocardial infarction i.e.
Heart attack.
Hemorrhage or occlusion of a blood vessel in the brain i.e.
brain attack and renal failure.
Hemorrhages in the retina may cause blindness.
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Hypotension, or low blood pressure, is hardly, if ever,
considered a disease or a cause of alarm in otherwise
healthy individuals.
However, the BP may show low readings under certain
conditions.
a. Sudden fall in BP. may be due to
myocardial infarction,
acute loss of large amounts of blood,
severe diarrhea and vomiting,
excessive intake of diuretics.
The person may go into a state of shock.
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b. Postural hypotension
When the SBP falls by 20 mm Hg or more on sudden
standing from supine position, it is called postural
hypotension.
It is usually due to autonomic insufficiency as a result of
diabetic polyneuropathy, and during treatment with
sympatholytic drugs in hypertension.
Rising from bed after prolonged illness may also cause
fall in BP.
c. Chronic primary hypotension
It is seen in some elderly persons, but its cause is not
known.
28. Factors affecting on blood pressure
1. Cardiac output
2. Heart rate
3. Peripheral resistance
4. Blood volume
5. Venous return
6. Elasticity of blood vessels
7. Velocity of blood flow
8. Diameter of blood vessels
9. Viscosity of blood.
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29. Factors.......
Arterial blood pressure is directly proportional to
1. Cardiac output
2. Heart rate
3. Peripheral resistance
4. Blood volume
5. Venous return
6. Velocity of blood flow
7. Viscosity of blood
Arterial blood pressure is inversely proportional to
1. Elasticity of blood vessel
2. Diameter of blood vessel
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Regulation of arterial BP
Short term
regulation
(nervous)
Vasomotor center
Baroreceptor
mechanism
Long term
mechanism
(renal)
Regulation of ECF
Renin –
angiotensin
mechanism
Hormonal
regulation
Vasoconstrictor
hormone
Vasodilator
hormone
Local regulation
Local substances
(vasoconstrictor /
vasodilator)
32. Principle
• A sufficient length of a single artery is selected in the
arm or in the thigh.
• The artery is first compressed by inflating a rubber
bag which is connected to a manometer, placed
around the arm/thigh to stop the blood flow through
the occluded section of the artery.
• The pressure is then slowly released and the flow of
blood through the obstructed segment of the artery is
studied by different methods.
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36. The rubber bag is 12 cm wide which is enough to form
a pressure.
Width of the bag should be 20% more than the
diameter of the arm.
The recommended width of the bag in different age
groups is as under:
Infants (below 1 year) : 2.5 cm
Below 4 years : 5 cm
Below 8 years : 8 cm
Adults : 12 cm
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37. 2. Stethoscope
Stethoscope (Steth = chest, scope = to inspect)
Laennec in 1819, it was not until 1905 that Korotkoff
used it for recording the blood pressure.
The sounds produced in the chest and in other parts of
body are heard with a stethoscope.
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40. Methods
Direct Method:
The direct method of recording blood pressure (BP),
in which an femoral artery is punctured with a
cannula connected to a manometer, was first used by
Rev Stephen Hales, a British priest, in horses and
dogs, in 1733.
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41. Indirect Methods
The direct method is not suitable as a routine
clinical procedure. Indirect methods were, therefore,
introduced; methods that are variations of a procedure
called sphygmomanometry.
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Indirect Methods are.........................
1. Palpatory Method (Riva Rocci 1896)
2. Oscillatory Method
3. Auscultatory Method (Korotkoff, 1905)
43. Procedure
• The patient may be lying down (supine) or sitting, but
should be mentally and physically relaxed and free
from excitation.
• Lay the arm bare up to the shoulder and record the
blood pressure first with the palpatory method,
followed by auscultatory method.
• The upper arm on which the BP cuff is to be tied must
be at the level of the heart.
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45. 1. Palpatory Method (Riva Rocci 1896)
1. Ask patient to sit or lie supine and allow 5 minutes for mental
and physical relaxation.
3. Place the cuff around the upper arm (3 cm above the elbow)
and wrap it but not very tight nor very loose.
4. Palpate the radial artery at the wrist and feel its pulsations
with the tips of your fingers. Keeping your fingers on the
pulse, hold the air bulb in the palm of your other hand and
tighten the leak valve screw with your thumb and fingers.
5. Inflate the cuff slowly until the pulsations disappear.
6. Open the leak valve and control it so that the pressure
gradually falls.
7. Note the reading when the pulse just reappears. The pressure
at which the pulse is first felt is the systolic pressure.
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47. 2. Oscillatory Method
• Riva Rocci, in 1896 (i.e. before Korotkoff sounds were
described) measured S.P. by the palpatory method while D.P.
was recorded from the oscillations of the mercury column.
• As the cuff pressure was raised and then lowered, oscillations
appeared which became maximum and then disappeared.
• Take the midpoint of maximum oscillations as the DP while
others considered the lower level of these oscillations as the
DP.
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49. 3. Auscultatory Method (Korotkoff, 1905)
1. Place the cuff over the upper arm.
2. Locate the bifurcation of brachial artery in the cubital space
just medial to the tendon of the biceps which can be easily
palpated in a semiflexed elbow as a thick, hard, elongated
structure. Mark the point of arterial pulsation with a sketch
pen.
3. Place the chest-piece of the stethoscope on this point and keep
it in position with your fingers and thumb of the left hand.
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4. Inflate the cuff rapidly, by compressing and releasing
the air pump alternately (sounds may be heard as
the mercury column goes up). Raise the pressure to
40 to 50 mm Hg above the systolic level as
determined by the palpatory method.
5. Lower the pressure gradually until a clear, sharp,
tapping sound is heard. Continue to lower the
pressure and try to note a change in the character of
the sounds.
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These sounds are called Korotkoff sounds and show the
following phases:
Phase I: starts with a clear, sharp tap when a jet of blood
is able to cross the previously obstructed artery.
(Sometimes this phase may start with a faint tap,
especially when the systolic pressure is very high).
As the pressure is lowered, the sounds continue as sharp
and clear taps. This phase lasts for 10–12 mm Hg fall in
pressure
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Phase II: The sounds become
murmurish and remain so
during the next 10–15 mm Hg
fall in pressure when they again
become clear and banging.
Phase III: It starts with clear,
knocking, or banging sounds
that continue for the next 12 to
14 mm Hg pressure, when they
suddenly become muffled.
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Phase IV: The transition
from phase III to phase IV
is usually very sudden. The
sounds remain muffled,
dull, faint and indistinct
until they disappear.
The muffling of sounds and
their disappearance occurs
nearly at the same time,
there being a difference of
4–5 mm Hg (i.e. phase IV
lasts for 4–5 mm Hg).
55. Observation
First reading
S.B.P =...............mm of Hg
D.B.P =...............mm of Hg
Second reading
S.B.P =...............mm of Hg
D.B.P =...............mm of Hg
Third reading
S.B.P =...............mm of Hg
D.B.P =...............mm of Hg
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56. Result
• The blood pressure of the volunteer/patient is
.................mm of Hg.
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