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BiomedicalInstrumentation:BLOODPRESSURE
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BiomedicalInstrumentation
Sunday,January30,2011

BLOODPRESSURE
Thedeterminationofanindividual'sbloodpressureisoneofthemostusefulclinical
measurementsthatcanbetaken.By"bloodpressure"wemeanthepressureexerted
bythebloodagainstthevesselwalls,thearterialbloodpressurebeingthemostuseful,
andhencethemostfrequentlymeasuredpressure.Oneshouldbecomefamiliarwith
thefollowingpressuresusedincardiovascularphysiology.

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Systolicbloodpressure.Thehighestpressureintheartery,producedinthe
heart'scontraction(systolic)phase.Thenormalvaluefora20yearoldmanis
120mmHg.
Diastolicbloodpressure.Thelowestpressureintheartery,producedinthe
heart'srelaxation(diastolic)phase.Thenormalvaluefora20yearoldmanis
80mmHg.
Pulsepressure.Thedifferencebetweenthesystolicanddiastolicpressures.
Thenormalvalueis40mmHg.
Meanbloodpressure.Diastolicpressureplusonethirdofthepulsepressure.
Thisistheaverageeffectivepressureforcingbloodthroughthecirculatory
system.Thenormalvalueis96to100mmHg.

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2011(10)
January(10)
CardiacOutput

IMPORTANCEOFBLOODPRESSUREMEASUREMENT:
Themeanbloodpressureisafunctionoftwofactorscardiacoutput(CO)andtotal
peripheralresistance(TPR).Peripheralresistancedependsonthecalibre(diameter)of
thebloodvesselsandtheviscosityoftheblood.
MeanBP=Cardiacoutput(ml/sec)xTPR
Cardiacoutput(ml/min)=Heartrate/minxStrokevolume(ml)
Thus,themeasurementofbloodpressureprovidesuswithinformationontheheart's
pumpingefficiencyandtheconditionofthesystemicbloodvessels.Ingeneral,we
saythatthesystolicbloodpressureindicatestheforceofcontractionoftheheart,
whereasthediastolicbloodpressureindicatestheconditionofthesystemicblood
vessels(forinstance,anincreaseinthediastolicbloodpressureindicatesadecreasein
vesselelasticity).
MEASUREMENTOFBLOODPRESSURE:
Bloodpressurecanbemeasuredbyseveraltechniques.Basicallytheyarecategorized
intotwomethods,
1.Directmethod
2.Indirectmethod

BLOOD
PRESSURE
EEG
EMG
HeartSounds
ECG
BloodGas
analysis(part
2)
BloodGas
analysis(part
1)
Generalized
Medical
Instrumentation
System
VIVA
QUESTIONS
FORDESIGN
PROJECTLAB
(CYCLEI)

1.Directmethod

2010(4)

Thedirectmethodinvolvesdirectlyinsertingatubeorcatheterintoabloodvessel.
Thecatheterisconnectedtoabloodpressuretransducer,whichgeneratesanelectrical
signal.

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2.Indirectmethod
Inthismethod,wemeasurethearterialbloodpressureusingtwodifferentmethods:

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BiomedicalInstrumentation:BLOODPRESSURE

1.Thefirstmethodusesthesenseoftouch:itisthuscalledthepalpatory
method.
2.Thesecondmethodusesthesenseofhearing:itisthuscalledthe
auscultatorymethod.
Ineitheroftheseindirectmethods,pressureisappliedtothearteryusingan
instrumentcalledthesphygmomanometer.
Asphygmomanometer,aninstrumentthatmeasurespressure,isneededinboth
methods.Eachsphygmomanometerconsistsofacuffwhichisconnectedbylengths
oftubingtoaninflatingbulbwithaneedlevalveandtoamercurymanometer.
PALPATORYMETHOD:
1.Havethesubjectseated,withhisorherarmrestingonatable.Wrapthe
pressurecuffsnuglyaroundthebareupperarm,makingcertainthatthe
inflatablebagwithinthecuffisplacedovertheinsideofthearmwhereitcan
exertpressureonthebrachialartery.Wraptheendofthecuffaroundthearm
andtuckitintothelastturn,orpressthefastenerstogethertosecurethecuff
onthearm.Closethevalveonthebulbbyturningitclockwise.
2.Withonehand,palpate(feel)theradialpulseinthewrist.Slowlyinflatethe
cuffbypumpingthebulbwiththeotherhandandnotethepressurereading
whentheradialpulseisfirstlost.Thenincreasethepressuretoaround20mm
Hgabovethispoint.Slowlyreducethepressureinthecuffbyturningthe
valvecounterclockwiseslightlytoletairoutofthebag.Notethepressure
whentheradialpulsefirstreappears.Thisissystolicbloodpressure,the
highestpressureinthesystemicartery.
3.Letalltheairoutofthecuff,allowthesubjecttorest,andthenrunasecond
determination.Donotleavethecuffinflatedformorethan2minutes,because
itisuncomfortableandwillcauseasustainedincreaseinbloodpressure.
4.Thesystolicpressurerecordedwiththepalpatorymethodisusuallyaround5
mmHglowerthanthatobtainedusingtheauscultatorymethod.Amajor
disadvantageofthepalpatorymethodisthatitcannotbeusedtomeasurethe
diastolicpressure.
AUSCULTATORYMETHOD:
1.Placethebellofthestethoscopebelowthecuffandoverthebrachialartery
whereitbranchesintotheradialandulnararteries.Useyourfingers,rather
thanyourthumb,toholdthestethoscopeoverthearteryotherwiseyoumay
bemeasuringthethumbarterialpressureratherthanthebrachialartery
pressure.Withnoairinthecuffnosoundscanbeheard.
2.Inflatethecuffsothepressureisabovediastolic(8090mmHg),andyouwill
beabletohearthespurtingofbloodthroughthepartiallyoccludedartery.
Increasethecuffpressuretoaround160mmHgthispressureshouldbe
abovesystolicpressuresothatthearteryiscompletelycollapsedandno
soundsareheard.
3.Now,openthevalveandbegintoslowlylowerthepressureinthecuff.As
thepressuredecreasesyouwillbeabletohearfourphasesofsoundchanges
thesewerefirstreportedbyKorotkoffin1905andarecalledKorotkoff
sounds.
Phase1.Appearanceofafairlysharpthuddingsoundthatincreasesin
intensityduringthenext10mmHgofdropinpressure.Thepressure
whenthesoundfirstappearsisthesystolicpressure.
Phase2.Thesoundsbecomeasoftermurmurduringthenext10to15
mmHgofdropinpressure.
Phase3.Thesoundsbecomelouderagainandhaveasharperthudding
qualityduringthenext10to15mmHgofdropinpressure.
Phase4.Thesoundssuddenlybecomemuffledandreducedin
intensity.Thepressureatthispointistermedthediastolicpressure.
Thismuffledsoundcontinuesforanotherdropinpressureof5mm
Hg,afterwhichallsounddisappears.Thepointwherethesound
ceasescompletelyiscalledtheenddiastolicpressure.Itissometimes
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BiomedicalInstrumentation:BLOODPRESSURE

recordedalongwiththesystolicanddiastolicpressuresinthismanner:
120/80/75.
ANALYSIS:
Theauscultatorymethodhasbeenfoundtobefairlyclosetothedirectmethodinthe
pressuresrecordedusuallythesystolicpressureisabout3to4mmHglowerthan
thatobtainedwiththedirectmethod.
Bloodpressurevarieswithaperson'sage,weight,andsex.Belowtheageof35,a
womangenerallyhasapressure10mmlowerthanthatofaman.However,after40to
45yearsofage,woman'sbloodpressureincreasesfasterthandoesaman's.Theold
ruleofthumbof100plusyourageisstillaagoodestimateofwhatyoursystolic
pressureshouldbeatanygivenage.Aftertheageof50,however,theruleisinvalid.
Theincreaseinbloodpressurewithageiscausedlargelybytheoveralllossofvessel
elasticitywithage,partofwhichisduetotheincreaseddepositofcholesteroland
otherlipidsinthebloodvesselwalls.
PostedbyB.HemaKumarat12:52AM
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