Hyperemia or Congestion

Capillary Resistance Test (CRT)

Anatomy of the Heart
Cardiac Cycle
Blood Pressure (BP)
Pulse Rate (PR)
Heart Sounds
ASST. PROF. FLORENCE CO NAVIDAD, MSMT, MEd, RMT, RN

HYPEREMIA OR CONGESTION
HEMODYNAMIC DISORDER
(DISORDER OF BLOOD FLOW)

Hyperaemia vs Congestion
Both = Increased volume of blood in tissue
Hyperaemia
active process
arteriolar dilation
e.g. skeletal muscle
during exercise
(physiologic),
inflammation
(pathologic)

Congestion
passive process
impaired venous
outflow
e.g. cardiac failure
(systemic), venous
obstruction (local)

Normal
ARTERIOLE

CAPILLARY BED

Hyperaemia

Arteriolar dilation engorgement with oxygenated blood

VENULE

Normal
ARTERIOLE

Congestion

CAPILLARY BED

VENULE

IMPAIRED VENOUS
OUTFLOW

Impaired outflow accumulation of deoxygenated blood (cyanosis)

Consequences of Impaired Venous Outflow

Acute
Stasis

CONGESTION

Chronic

NECROSIS

HYPOXIA
FIBROSIS

CAPILLARY RESITANCE TEST

determine the presence of vascular disorder

Capillaries
Connect arterioles and venules
AKA: exchange vessels permit exchange of nutrients and
waste between body cells and blood
Areas with high metabolic requirements have extensive
capillary networks
muscles, liver, kidneys, nervous system

Areas with very low metabolic requirements lack

capillaries
cornea and lens of the eye, nails, hair follicles, cuticles,
cartilage

Structure of Capillaries
Walls consist of single layer of endothelial cells
Precapillary sphincters rings of smooth muscle at
meeting point of capillary to arteriole

Capillaries
Exchange nutrients and waste with tissues.
~ 10 billion capillaries with 500 700 m2 total surface
area in whole body.

Capillary fragility (resistance) test:

Torniquet test; Rumpel-Leede Capillary-Fragility Test
a circle 2.5 cm in diameter, the upper edge of which is 4 cm
below the crease of the elbow, is drawn on the inner aspect
of the forearm, pressure midway between the systolic and
diastolic blood pressure is applied using
sphygmomanometer above the elbow for 15 minutes, and a
count of petechiae within the circle is made: 10, normal;
1020, marginal; more than 20, abnormal.

ANATOMY OF THE HEART

The Heart

Structure
Layers; epicardium, myocardium, endocardium
Chambers: two atrias, two ventricles
Valves
Two atrioventricular valves: tricuspid and bicuspid
(mitral)
Two semilunar valves: pulmonary and aortic

The Heart

Figure 8.8

Pulmonary Circuit: Oxygenation of Blood

Deoxygenated blood through the vena cava to the
right atrium
Deoxygenated blood through the right
atrioventricular valve to the right ventricle
Deoxygenated blood through the pulmonary
semilunar valve to the pulmonary trunk and the
lungs
Oxygenated blood through the pulmonary veins to
the left atrium
Oxygenated blood through the left
atrioventricular valve to the left ventricle

Systemic Circuit: Delivery of Oxygenated Blood to

Tissues and Return of Blood to the Heart
Oxygenated blood through the aortic semilunar
valve to the aorta
Oxygenated blood through branching arteries and
arterioles to the tissues
Oxygenated blood through the arterioles to
capillaries
Deoxygenated blood from capillaries into venules
and veins
Ultimately to the vena cava and into the right
atrium

CARDIAC CYCLE

Cardiac Cycle

Figure 8.12

Contractions of the Heart

BLOOD PRESSURE

What is blood pressure?

Blood pressure refers to the force exerted by
circulating blood on the walls of blood vessels.
The pressure of the circulating blood decreases as
blood moves through arteries, arterioles,
capillaries, and veins.
Blood pressure values are reported in millimetres
of mercury (mmHg).
Blood pressure is recorded as systolic over
diastolic e.g. 120/60.
Measurement: sphygmomanometer

What is blood pressure?

How is blood pressure controlled

Short term control ANS barareceptors

vagus nerve.
Intermediate control - Trans-capillary shift
osmosis/plasma proteins.
Long term control Renin/angiotensin system;
aldosterone.

Systolic versus Diastolic

Systolic (contraction) measures maximum arterial pressure
occurring during contraction of the left ventricle of the
heart
Average = 120mm Hg
High end begins = 140mmHg

Diastolic (relaxation) measures arterial pressure during the

interval between heartbeats
Average = 80mm Hg
High end begins = 90mmHg

Systole is the contraction of

heart chambers, driving
blood out of the chambers.
The chamber valves are
closed.

Diastole is the period of time

when the heart fills with blood
after systole (contraction).
The chamber valves are open.
The heart is at rest.

The silent killer

Causes death from:
Strokes
Heart Attacks
Peripheral Vascular Disease
If untreated, leads to:
Renal failure, heart failure

Blood Pressure classification

Category
Systolic BP
Diastolic BP
Optimal
<120
<80
High normal BP
<130
<85
High normal BP
130-139
85-89
Grade 1 (mild)
140-150
90-99
Grade 2 (moderate)
160-179
100-109
Grade 3 (severe)
180
110
ISH (Grade 1)
140-159
<90
ISH (Grade 2)
160
<90

Thresholds for intervention

BP 220/120 mmHg: treat immediately
BP >180-189/110/119 mmHg: confirm over 1-2
weeks, then treat
BP 160-179/100-109 mmHg: with CVD
complications: confirm over 3-4 weeks, then
treat
BP 140-159/90-99 mmHg: with CVD risk
confirm over 12 weeks, then treat.

Risk factors for developing hypertension

Obesity
Physical inactivity
High consumption of alcohol
High intake of dietary sodium
Low intake of dietary potassium
Stress
Increasing age
Cigarette smoking
Increased blood cholesterol
Patients with systemic diseases including: Diabetes
mellitus; renal disease; peripheral vascular disease
Family history of hypertension, CHD or stroke

Blood pressure measurement sources of error

Errors due to manometer

Errors due to cuff

Errors due to the observer

Errors due to the patient.

Cuff sizes
Type

Size

Suitability

Adult

12cm by 23cm

for smaller arms

12cm by 36cm

will cover 95%

arms

15cm by 36cm

Often too wide for

fat arms

Alternative cuff

Large adult

Which arm?

6% of hypertensives can have as much as a 10 mmHg

difference between arms
If BP higher in one arm than the other, this arm must
be used from then on
Document this in records so that everyone uses the
same arm.

Technique
Patient seated and relaxed, not talking, legs
uncrossed
Tight arm clothing removed
Correct cuff size
Arm supported with cuff horizontal with heart
Inform patient of discomfort and that several
measurements will be taken
Mercury manometer on firm and level surface
at eye level
Locate brachial or radial pulse.

Technique contd
Place stethoscope gently over brachial artery
Inflate mercury rapidly, 30 mmHg above occlusion
of pulse
Deflate very slowly, 2 mmHg per second
Record first of regular sounds (systolic BP)
Record diastolic as disappearance of sound
Record measurements to the nearest 2 mmHg
Repeat twice more and average last two.

HEART SOUNDS

Heart Sounds and Heart Valves

Lub-dub
Heart murmurs

Cardiac Conduction System Coordinates Contraction

SA node: cardiac
pacemaker
AV node: relay impulse
AV bundle and Purkinje
fibers: carry impulse to
ventricles

Figure 8.14

The normal heart beat

PULSE RATE

 Pulse occurs through the alternate expansion and

elastic recoil of an artery after each contraction and
relaxation of the left ventricle
Normal range for pulse rate/heart rate
70 to 80 beats per minute at rest
Tachycardia rapid resting heart or pulse rate over
100 beats/minute
Bradycardia slow resting heart or pulse rate under
60 beats/minute

 The pulse may be palpated at any place that allows an

artery to be compressed against a bone.
Pressure waves generated by the heart in systole
moves against the arterial wall.
The pulse can be used as a tactile guide to determine
the systolic blood pressure (diastolic not palpable).

 The pulse pattern can be clinically significant, so it is

important to note;
1. The rate in beats per minute.
2. The rhythm of pulse.
Fast
Slow
irregular
3. The strength of the pulse.
1. Absent
2. Barely palpable
3. Easily palpable
4. Full
5. bounding

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Your pulse varies depending on

your age, level of fitness and how
active you are being.
A resting pulse is used in practice to
record rate.
The pulse rate needs to be taken
over 1 full minute.

1.
2.
3.
4.
5.
6.
7.
8.
9.

Temporal
External maxillary (facial)
Carotid
Brachial
Radial
Femoral
Popliteal
Posterior tibial
Dorsal pedis

Equipment for measuring pulse/heart rate.

What else can aect the heart rate?

Caffeine & alcohol increases the strength and frequency of
the heartbeat therefore increasing the rate
Exercise increases the heart rate, but someone who exercises
regularly may have a low resting rate.
Disease affect the heart rate. Thyroid disease can either make
the rate faster or slower depending type of disease.
Drugs (medical & recreational) e.g. digoxin & bets blockers
slow the HR. Recreational drugs tend to increase HR.

Thanks