What is the significance of the following abnormal findings: radio-radial delay; radio-femoral delay; presence of an arterial bruit?
Radio-radial delay and radio-femoral delay is associated with aortic coarctation (aortic narrowing) or dissection.
Presence of arterial bruit (hearing a sound due to turbulant flow with the stethoscope) are caused by arterial narrowing.
These are the LO's dodo brain
- Describe how to measure and record blood pressure
- Describe the significance of the following abnormal findings: radio-radial delay; radio-femoral delay; presence of an arterial bruit
- Describe the rate, rhythm, volume and character of relevant pulses on examination
- Describe the potential difficulties associated with measuring blood pressure accurately
Examination sequence for all pulses?
Wash hands, introduction, patient identification, explain procedure, gain consent
Radial pulse – rate and rhythm
Radio femoral delay
Carotid pulse – character, waveform
What is BP, SBP, DBP and units of BP?
- The force circulating blood has on a wall of a vessel.
- BP: CO (blood pumped out per minute from left ventricle) x Total Peripheral Resistance
- Systolic BP: Pressure on all the vessels when the heart is in systole- contracting.
- Diastolic BP: Pressure on all the body's vessels when the heart is relaxed. So the relative ease at which blood flows from the arterioles to the capillaries.
- Everyone has a different normal BP. Must compare to individual's own normal.
- The units are milimeters of mercury/ mmHg.
What is hypertension?
A BP of over 140/90.
What is hypotension?
Low BP, below 90/60 mm Hg.
What are the steps in a BP Exam?
- Hand gel
- Introduce self: name, medical student
- Check patient's name and age
- Explain procedure and get informed consent: I will inflate this cuff around your arm, and feeling and listening to your pulse. It might be a little uncomfortable but should not hurt. Are you ok for me to go ahead?
- Place arm at heart level (on table) and attach cuff
- Palpate radial artery. Inflate cuff untill no longer hear pulse. This is the approximate systolic BP.
- Now palpate the brachial artery. Place stethoscope over the brachial artery.
- Inflate the cuff to 20 mm Hg over the origan approximate systolic BP value.
- Deflate the cuff extremely slowly by winding the wheel extremely gently. When the first sound is heard, this is the systolic BP.
- When the noise dissappears, this is the diastolic BP.
- Remove cuff, tell the patient the procedure is completed.
- Thank patient and re-apply hand gel.
What is pulse pressure?
The difference between systolic BP and diastolic BP. Important as pulse pressure changes in certain conditions.
What is a pulse?
A pulse wave, vessel dilates, then contracts.
What are the ways of describing a pulse?
- Absent/ Present
- Character: slow rising pulse (seen in aortic stenosis), collapsing pulse (in aortic regurgitation due to backflow of blood from aorta to left ventricle).
- Volume: Power of the pulse. If have large volume then have inscreased stroke volume and vica versa. Get large volume in bradycardia, exercise, pregnancy, fever, thyrotoxicosis, anaemia: conditions where the heart has to work harder.
- Rate: a number (normal 60-100 BPM)
- Rhythym: regular, irregular. regularly irregular. In sinus arrythmia you observe a regularly irregular pulse: a quickining in inspiration and slowing in expiration.
What are the reasons for tachycardia and bradychardia?
What are the reasons for an irregular pulse?
What are the potential difficulties associated with measuring BP accurately?
Blood pressure varies throughout the day as part of our natural circadian rhythm.
Factors such as smoking, stress, drugs, disease, and nutrition also affect blood pressure
What is mean arterial pressure?
Average pressure in the arteries in one cardiac cycle. Not simply an average of systolic and diastolic BP because the heart spends a longer time in diastole each cardiac cycle.
So MAP: DBP + 1/3 (SBP - DBP)