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What is the equation for pulse pressure?

- Systole - Diastole
-ex: PP= 120-80 = 40


What is an abnormal pulse pressure? What does it indicate?

Greater than 50-60mmHg
- this is known as Wide Pulse Pressure
- often indicates Isolate Systolic Hypertension (most common in elderly)


What are the numbers for hypotension in adults?

BP less than 90/60


What are symptoms of hypotension?

- lightheadedness (pre-syncope)
- fainting (syncope)
- blurry vision
- possibly confusion


What are 3 possible causes of hypotension?

- dehydration (especially elderly)
- standing for long periods
- medications


Severe hypotension &/or shock can be indicative of what?

Multisystem organ hypoperfusion


What could cause severe hypotension/shock?

- Sudden loss of large amount of blood
- Allergic reaction (severe)
- Infection
- Myocardial infarction


Explain Orthostatic Hypotension.

greater than a 20 mmHg fall in SBP and/or 10mmHg DBP within 3 mins of going from supine to upright position
aka- postural hypotension
(most common in elderly)
= an abnormal finding
** some authors include an elevation in pulse rate as part of the criteria


What are some possible causes of orthostatic hypotension?

- medications
- prolonged bed rest
- autonomic nervous system dysfunction (decreased baroreceptor sensitivity)
- cardiovascular disorders
- anemia


What is normal HR? bradycardia? tachycardia?

Normal= 60-100bpm
Bradycardia= less than 60
Tachycardia= greater than 100


What is the regular rhythm of pulse called?



What does a normal pulse imply of the heart?

normal pacemaker function of the SA node (no variation from beat to beat- evenly spaced)


What is arrhythmia? How is it elevated?

Irregular pulse (beats are uneven)
EKG test will support finding


What are the 2 types of arrhythmias and what are their subtypes?

(has a definitive pattern)
- physiologic sinus arrhythmia
- bigeminal pulse
- trigeminal pulse
Irregularly- irregular (no pattern)
- atrial fibrillation


Explain physiological sinus arrhythmias.

- typical for younger fit individuals
- corresponds to breathing
- asymptomatic pulse abnormalities are usually benign


Explain bigeminal pulse.

coupled rhythm of beats in pairs
- first beat= sinus beat
- second= premature, usually ventricular beat


Explain trigeminal pulse.

coupled rhythm of beats in triplets followed bya pause
- often benign in young, healthy people
- may indicate conduction problem in elderly patients with heart disease


Combination of ______ and ______ is suggestive of a pathological arrhytmia

Palpitations & pre-syncope


If you discover that your patient has an irregularly-irregular heart beat what is your next step?

suggests atrial fibrillation
- rapid, unsynchronized contraction of heart muscle fibers
** find out if they know they have a-fib first
- requires urgent EKG evaluation if patient did not previously have known a-fib


Explain atrial fibrillation

Can lead to stroke or death
- increased risk of blood clot formation when unsynchronized atria
- it if travels to brain (embolus) = stroke
** afib causes 15% of strokes


What are the 3 types of a-fib?

Lone episode- young & healthy patients. may be due to stress, alcohol, or stimulant
Paroxysmal= a sudden attack- intermittent episodes that last minutes to hours
Chronic, sustained - requires long term anti-coagulant and rate control medication


Match the medical terms for the listed grading pulse amplitudes:
- 0 (not palpable)
- 1 (barely palpable)
-2 (normal)
- 3 (full or increased)

0= absent
1= thready
2= strong
3= bounding


What is peripheral arterial disease and what does it indicate?

- stenosis, occlusion, or aneurysm in the limb arteries or aorta
- indicates high risk for cardiovascular morbidity or mortality
- with PAD= 6x increased risk of heart attack


Is PAD the leading cause of artherosclerosis?

- usually occlusions in the large & medium sized vessels


How does atherosclerosis start and progress?

as a fatty streak= LDL deposition in walls
- progresses with chronic inflammation


What are the modifiable risks of PAD?

Smoking & diabetes
- also includes hypertension & hyperlipidemia


What is the Non-Modifiable risk of PAD?

age over 60
(sometimes also includes being African-American)


What is the pathophysiology of PAD?

plaque build-up leads to narrowed arteries= decreased blood supply= poor oxygen delivery= ischemia (painful)
- especially when exercising (due to tissue demand)
PAD= oxygen supply & demand mismatch


What is the symptom of PAD?

Main symptom= INTERMITTENT CLAUDICATION = exercise induced extremity pain (due to ischemia)
most common location= calf


With PAD will the pain be distal or proximal to the occlusion?