University of Santo Tomas

Faculty of Pharmacy – Department   of Pharmacy

 
PHA 618 : Human Physiology   and Pathophysiology
 
  CARDIOVASCULAR   EXERCISES
 
   
ANATOMY  OF  THE  HEART   o   Second  Heart  Sound  (S2/Dupp)  =  aortic  (A2)  
  +  pulmonary  (P2)  valve  closure  (semilunar)  
  §   Left  2nd  intercostal  space  
  §   Best  heard  when  body  is  at  30-­‐40o  
  angle,  quiet  inhalations  
   
   
   
   
   
   
   
   
   
   
   
   
  •   Heart  murmurs  
  o   Gold  standard  for  diagnosis:  
PATH  OF  BLOOD  THROUGH  THE  HEART   Electrocardiogram  (ECG/EKG)  
  o   Turbulent  blood  flow  due  to  failure  of  valve  
  closure  
  o   Described  by:  
  §   Intensity,  pitch,  configuration,  
  location+radiation,  timing  
  o   Heart  murmur  causes  the  ff:  
  §   Valvular  heart  disease  (VHD)  
  §   Regurgitation:  backwards  leaking  
  §   Stenosis:  narrowing  
  §   Arrhythmia  
  §   Embolism  
  §   Septal  defects  
  §   Prosthetic  valve  problems  
  §   Tumor  
  §   Fistula  
   
  CARDIAC  CYCLE  
  •   Systole  –  contraction    
  o   Increased  pressure,  decreased  volume  
  •   Diastole  –  relaxation    
HEART  RATE   o   Decreased  pressure,  increased  volume  
•   ↑/↓  (autonomic  NS,  chemical,  others)    
•   Normal:  physical  activity  (↑),  food  (↓)    
•   Not   normal:   heart   disease,   other   disease/infection,    
fever,  meds    
  BLOOD  PRESSURE  
HEART  BEAT    
•   Heart  sounds   •   Methods  
o   First   Heart   Sound   (S1/Lubb)   =   mitral/bicuspid   –   Office-­‐based  BP  measurement  
(M1)   and   tricuspid   (T1)   valve   closure   •   White-­‐coat  HTN  
(atrioventricular)   –   Ambulatory  BP  monitoring  (ABPM)  –  24/7  
§   Left  5th  intercostal  space   –   Home  BP  monitoring  
§   M1   mitral   valve   closure   is   main   sound   heard   •   Diagnosis  
(louder)    
 –   At  least  3  visits,  1  week  apart   SUPPLEMENTAL:  
   
•  Techniques    
–   Palpatory  Method  –  can  only  get  systolic  BP    
•   Useful  estimate  for  auscultory    
method  to  avoid  problems  with    
auscultory  gap  (Korotkoff  sounds  
disappear  transiently  during  cuff  
deflation)  
–   Auscultory  Method  
•   Place  stethoscope  lightly  over  
brachial  artery    
–   Excess  pressure  can  
increase  blood  turbulence  
à  Artificial  reduction  of  
diastolic  BP    
•   Inflate  to  30  mmHg  greater  than  
est.  systolic,  deflate  2-­‐3  mmHg  per  
second  
•   Korotkoff  phase  I:  when  pulse  first  
hear;  systolic  BP  
•   Korotkoff  phase  V:  disappearance  
of  sound;  diastolic  BP  
–   Oscillometric  Method  –  electric  pressure  
sensors  
 
Mean  Arterial  Pressure  (MAP)  
•   Average  BP  in  arteries  
•   MAP  =  (Systolic  +  2Diastolic)/3  
•   MAP  =  Cardiac  Output  (CO)  /  Systemic  Vascular  
Resistance  (SVR)  
–   From  original  formula:  Cardiac  Output  (CO)  
=  Stroke  Volume  (SV)  x  Heart  Rate  (HR)  
–   MAP  =  SV  x  HR  x  R  
•   SV:  Preload,  contractility,  afterload  
•   HR:  autonomic,  chemical,  others  
•   R:  size  of  blood  vessel  lumen,  
blood  viscosity,  total  blood  vessel  
length  
 
 
BLOOD  PRESSURE  INTERPRETATION  GUIDELINES