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Blood Pressure and HeartSounds Dr . Loay Abudalu. MD.

MSc (UK)

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Heart Sounds

Blood Pressure

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The MechanicalSystem

ModulatingSystems

CardiacMeasurements

vasculaturechanges

blood pressuremeasuring

Blood Pressure

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The force exertedby blood against thewalls of the vessels

in which it iscontained

The pressure isdetermined by the

force and theamount of blood

pumped and thesize and flexibility of

the arteries

What is Blood Pressure?

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The Mechanical System

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The autonomous nervoussystem

The hormonal system

Mechanical factors

Electrical factors

Other factors

sympathetic system& parasympatheticsystem

like insulin and

epinephrine

peripheralresistance of the

blood vessels

ectopic pacemakercells, conduction

problems

Body temperature

,CO2 levels and Ions( Ca and K )

Modulating Systems

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vasculature changes

Structureof

vasculature changesinresponse

todifferentneeds

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Heart rate: is the number of heartbeats per unit oftime, typically expressed as beats per minute.

stroke volume : is the volume of blood pumped fromone ventricle of the heart with each beat.

End-diastolic volume (EDV) :is the volume of bloodin the right and/or left ventricle at end load or filling in(diastole).

End-systolic volume (ESV) : is the volume of bloodin a ventricle at the end of contraction, or systole.

Important Definitions

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Cardiac output :is the volume of blood being pumped bythe heart, in particular by a left or right ventricle in thetime interval of one minute.

Afterload :is the tension or stress developed in the wall ofthe left ventricle during ejection

preload : is the end volumetric pressure that stretchesthe right or left ventricle of the heart to its greatestgeometric dimensions under variable physiologic demand

Important Definitions

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Cardiac Measurements

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Stroke volume = End-diastolic volume End-

systolic volume

Cardiac output = Heartrate Stroke volume

Afterload

Preload

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patients blood pressure

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Blood Pressure An

Overview

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Korotkoff Sounds

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Korotkoff Sounds

First PhaseA clear tapping sound; onset of the sound for two

consecutive beats is considered systolic

Second Phase

The tapping sound followed by a murmurThird Phase

A loud crisp tapping sound

Fourth Phase

Abrupt, distinct muffling of sound, gradually

decreasing in intensity

Fifth Phase

The disappearance of sound, is considered

diastolic blood pressure- two points below the last

sound heard

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Korotkoff Sounds

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Technique for Measuring BloodPressure

Seated for 5 minutes

Patient PositionExpose Upper arm

Centre of upper arm at

heart level

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Technique for Measuring BloodPressure

Cuff applied 1 inch abovecrease at elbow

Locate brachial artery

Palpate radial pulse

Inflate cuff until pulsedisappears

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Technique for Measuring BloodPressure

Let air out

Place stethoscope on brachial artery

Pump up cuff to 20-30 above point ofobliteration

Let air out at 2 mmHg per second

Note 1st and 5th Korotkoff sounds

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AuscultationAreas

Cause of theheart sounds Calculations

Extra heartsounds

Heart sounds

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Auscultation

Placing a stethoscope to the heart sound we

can hear: Lub (first heart sound) which is associated

with the closure of the AV valves.

Dub (second heart sound) which is associatedwith the closure of the semilunar valves.

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The causes of the 1st heart sound:

Cause of the heart sounds

During systole the AV valves are closed &blood tries to flow back to the atrium backbulging the AV valves. But the taut chordaetendinae stop the back bulging and causes

the blood to flow forward.This will cause vibration of the valves, blood &

the walls of the ventricles which is presentedas the 1st heart sound.

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The causes of the 2nd heartsound:

Cause of the heart sounds

During diastole, blood in the blood vesselstried to flow back to the ventricles this will

cause the semilunar valves to bulge. But the

elastic recoil of the arteries cause the blood tobounce forward which will vibrate the bloodthe valves and the ventricle walls.

This is presented as the 2nd heart sound.

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Difference between the 1st and 2ndheart sounds

The 1st sound lasts longer because the AVvalves are less taut than the semilunar valves

which will enable them to vibrate for longertime.

The 2nd heart sound had higher frequencydue to:

1. The semilunar valves are more taut.2. The great elastic coefficient of the taut

arteries which provides the principlevibrations of the 2nd heart sound.

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Aortic: base- 2nd Rt ICS, sternalborderPulmonic: base- 2nd Lt ICS, sternal

border

3rd Lt ICS, sternal border

Tricuspid: lower Lt sternal border(4-

5ICS)Mitral: cardiac apex (LV) 5 ICS, MCL

Auscultation Areas

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Auscultation

Areas

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The 3rd heart sound: is the heard in the middiastole due to the blood that fills the ventricles.(when the rush of blood into the filling ventricle is

suddenly halted),normally disappears before middleage.a sign of a failing left ventricle as in dilated

congestive heart failure (CHF)

The 4th heart sound: also known as atrial heartsound. It occur when the atrium contracts &pumps blood to the ventricles(blood being forced

into a stiff/hypertrophic left ventricle)It is a sign of apathologic state, usually a failing left ventricle

Extra heart sounds

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A gallop rhythm refers to a (usuallyabnormal) rhythm of the heart on

auscultation

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