The Cardiovascular System and its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Auscultation involves listening for sound within the body. It can be as simple as using a stethoscope to detect Korotkoffsounds (the sounds of blood flow through compressed veins when measuring blood pressure with a sphygmomanometer) or more complex such as listening to the heart with a stethoscope to detect unusual sounds and analyze the phases of the cardiac cycle. Variations in the four basic heart sounds, the presence of opening snaps from the valves, ejection sounds, systolic clicks of the mitral valve, or the more prolonged sounds of murmurs can aid the diagnosis of mitral valve disease, valvular regurgitation, and various cardiomyopathies. The use of microphones on the chest wall allows the graphic display of heart sounds and phonocardiography allows further refinement in determining the source of irregular heart sounds and isolating the focus of a disorder.
Chronic hypertension and acute hypertensive crisis
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Two readings should be taken, separated by 2 minutes. Systolic blood pressure should be noted with the appearance of Korotkoff sounds (phase I) and diastolic blood pressure with the disappearance of sounds (phase V). In certain patients, the Korotkoff sounds do not disappear but are present to 0 mmHg. In this case, the initial muffling of Korotkoff sounds (phase IV) should be taken as the diastolic blood pressure. In order to reduce inaccurate readings, an appropriately sized cuff should be used (length 1.5 times upper arm circumference or a cuff with a bladder that encircles 80% or more of the arm). The appropriate position in which to measure blood pressure is sitting, with the arm at the level of the heart. Measuring BP in the “up” arm with the patient side lying gives an artifactually lower reading, which does not represent a true decrease in BP.
Measuring and monitoring vital signs
Nicola Neale, Joanne Sale in Developing Practical Nursing Skills, 2022
Although many clinical settings predominantly use electronic devices, it is imperative to learn the technique of manual BP recording and ensure you are competent in this skill. This will also allow you to be able to gain a better understanding of Korotkoff sounds and what we refer to as systolic and diastolic BP readings. Although BP can be measured at several sites, in most clinical situations, the brachial artery is used as it is convenient and easily accessible, so it is the artery you are most likely to have seen used in practice. Some electronic devices measure BP at the radial artery. It is advisable to avoid recording the BP on an arm that is affected by disability (e.g. weakness due to a stroke, lymph node removal), or where an intravenous infusion is in place. When a person has suffered trauma or surgery affecting both arms, the thigh can be used for which a larger cuff is needed. Skinner et al. (2013) explain that BP is a key vital sign that should be recorded in trauma. Measuring BPs in both arms is sometimes practised when a person presents with chest pain or unexplained back pain (Skerrett 2012). This practice can help establish blood flow issues around the person’s body.
Respiratory waveform variation can prevent pulsus paradoxus measurement by sphygmomanometry
Published in Journal of Asthma, 2019
Jonas Alexander Pologe, Kara Lynn Wolley, Donald H. Arnold
PP is defined in clinical medicine as an exaggerated increase in the normal fluctuation of left ventricular stroke volume (LVSV) during the respiratory cycle that results in a change in systolic pressure of at least 10 mmHg [7, 8]. Clinically, manual measurement of PP is made by inflating a sphygmomanometer, placed on the upper arm, above systolic pressure and slowly deflating the cuff while listening for heart sounds with a stethoscope in the antecubital space below the cuff [7, 8]. The highest systolic pressure during the respiratory cycle will be heard as an intermittent first Korotkoff sound. As the cuff is very slowly deflated to pressures approaching the lowest systolic pressure, typically seen during the inspiratory phase of the respiratory cycle, first Korotkoff sounds will be heard more frequently. Once the lowest systolic pressure is reached first Korotkoff sounds will be heard continuously throughout the respiratory cycle. PP is the pressure difference between the first intermittent Korotkoff sound (at the maximum systolic pressure) and the point at which these sounds are heard continuously (at the minimum systolic pressure).
Serum elabela and apelin levels during different stages of chronic kidney disease
Published in Renal Failure, 2020
Xuehong Lu, Shengmao Liu, Rumei Luan, Wenpeng Cui, Yu Chen, Yixian Zhang, Yue Lu, Hong Zhang, Lin Shi, Lining Miao, Feng Xu
Demographic, clinical, and biochemical data of the subjects were obtained from medical records and queries (e.g., gender, age, and history of hypertension), physical examination (e.g., height, weight, and blood pressure), and laboratory tests (e.g., hemoglobin (Hb), serum albumin, blood urea nitrogen (BUN), serum creatinine (Cre), ELA and apelin levels). Body mass index (BMI) was defined as weight/height2 (kg/m2). Blood pressure was measured in the right arm, with the subjects in a sitting position after a 10-min rest period; a mercury sphygmomanometer and a stethoscope were used for the measurement, following the recommendations of the American Heart Association [23]. Systolic and diastolic blood pressures were defined at the first and fifth phases of Korotkoff sounds, respectively. Blood samples were collected before taking any antihypertensive medications. The serum levels of Hb, BUN, and Cre were analyzed using UniCel DxH 800 (Beckman Coulter, Miami, FL) and Hitachi 008AS Autoanalyzer (Hitachi, Tokyo, Japan). Enzyme-linked immunosorbent assay was used to evaluate serum ELA and apelin levels. Venous blood samples were collected in EDTA/acetic acid-containing tubes and centrifuged at 3000 rpm for 10 min at 4C. ELA and apelin assays were performed using the ELABELA (human)-EIA kit (Peninsula Laboratories International Inc., San Carlos, CA, USA) and Apelin (human) C-Terminus EIA kit (RayBiotech Inc., Norcross, GA, USA) according to the manufacturers’ instructions.
Hypertension among obese children and youth age 8-12:Project EDDY-Kids 2019
Published in Child and Adolescent Obesity, 2021
G. Wolske, M. Joseph, H. Rosenauer, K. Widhalm
In the course of the pursued Viennese EDDY-Kids Project 2019 (Widhalm et al. 2018) we took one measurement at the beginning of the study in January (t0, baseline) and followed up in 2-month intervals (t1, t2), finishing in June. To receive more reliable blood pressure values and to oversee progress in those values, there were taken three measurements over the period of the project (Negroni-Balasquide et al. 2016). The sample included a control group in third grade (age ~9, 58 children, 33 boys and 25 girls) and an intervention group in fourth grade (age ~10, 65 children, 37 boys and 28 girls). Blood pressure was measured using auscultation according to international guidelines (Flynn et al. 2017), using a stethoscope with a blood pressure monitor (sphygmomanometer). A cuff of appropriate size was attached to the upper arm and inflated up to the expected arterial blood pressure. During the subsequent slow deflation, the manifestation and disappearance of Korotkoff sounds can be detected via the stethoscope at the brachial artery. The systolic pressure corresponds to the value indicated at the first appearance of Korotkoff sounds: at that moment, systolic pressure exceeds cuff pressure. Conversely, the Korotkoff sounds disappear when cuff pressure falls below arterial pressure, indicating a diastolic value.
Related Knowledge Centers
- Auscultation
- Blood Pressure
- Stethoscope
- Heart Sounds
- Ventricle
- Heart
- NON-Invasive Procedure
- Heart Valve
- Brachial Artery
- Cubital Fossa