Podcast
Questions and Answers
What is the term for the difference between systolic and diastolic pressures?
What is the term for the difference between systolic and diastolic pressures?
What is the primary factor that affects the pulse pressure?
What is the primary factor that affects the pulse pressure?
Which of the following is NOT a factor that affects blood pressure?
Which of the following is NOT a factor that affects blood pressure?
What is the term for the device used to measure blood pressure?
What is the term for the device used to measure blood pressure?
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Why are pulses in the arms and legs unsuitable for timing events in the cardiac cycle?
Why are pulses in the arms and legs unsuitable for timing events in the cardiac cycle?
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What is the name of the graph that shows the blood pressure variation during the cardiac cycle?
What is the name of the graph that shows the blood pressure variation during the cardiac cycle?
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What is the primary function of the jugular veins in relation to the heart?
What is the primary function of the jugular veins in relation to the heart?
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Which of the following best reflects the pressure in the right atrium?
Which of the following best reflects the pressure in the right atrium?
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What is the name of the elevation in the jugular veins caused by retrograde blood flow into the neck veins?
What is the name of the elevation in the jugular veins caused by retrograde blood flow into the neck veins?
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What is the characteristic of the jugular veins in a patient with tricuspid stenosis?
What is the characteristic of the jugular veins in a patient with tricuspid stenosis?
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What is the name of the elevation in the jugular veins caused by the inflow of blood from the vena cava during right ventricular systole?
What is the name of the elevation in the jugular veins caused by the inflow of blood from the vena cava during right ventricular systole?
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What is the characteristic of the jugular veins in a patient with atrial fibrillation?
What is the characteristic of the jugular veins in a patient with atrial fibrillation?
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What is the best way to estimate jugular venous pressure?
What is the best way to estimate jugular venous pressure?
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What is the characteristic of the jugular veins in a patient with tricuspid regurgitation?
What is the characteristic of the jugular veins in a patient with tricuspid regurgitation?
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In which age group is the apical impulse usually easily palpated?
In which age group is the apical impulse usually easily palpated?
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What is the significance of the cervical systolic murmur or bruit in children?
What is the significance of the cervical systolic murmur or bruit in children?
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What is the characteristic of most murmurs that occur in individuals?
What is the characteristic of most murmurs that occur in individuals?
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What is the origin of the jugular venous hum?
What is the origin of the jugular venous hum?
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What is the significance of knowing the patterns of murmurs that vary with age?
What is the significance of knowing the patterns of murmurs that vary with age?
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Study Notes
Cardiac Cycle and Blood Pressure
- With each contraction, the left ventricle (LV) ejects a volume of blood into the aorta, which then perfuses the arterial tree.
- The ensuing pressure wave generates the arterial pulse, but a palpable delay between ventricular contraction and peripheral pulses makes them unsuitable for timing events in the cardiac cycle.
- Blood pressure in the arterial system varies during the cardiac cycle, peaking in systole and falling to its lowest trough in diastole.
- The levels measured with the blood pressure cuff, or sphygmomanometer, are the peak (systolic) and lowest (diastolic) pressures.
- The difference between systolic and diastolic pressures is known as the pulse pressure.
Factors Affecting Blood Pressure
- Left ventricular stroke volume affects blood pressure.
- Distensibility of the aorta and the large arteries influences blood pressure.
- Peripheral vascular resistance, particularly at the arteriolar level, impacts blood pressure.
- Volume of blood in the arterial system also affects blood pressure.
- Changes in any of these four factors alter systolic pressure, diastolic pressure, or both.
Blood Pressure Fluctuations
- Blood pressure levels fluctuate significantly throughout a 24-hour period.
- Factors contributing to blood pressure fluctuations include:
- Physical activity
- Emotional state
- Pain
- Noise
- Environmental temperature
- Use of coffee, tobacco, and other drugs
- Time of day
Jugular Venous Pressure (JVP) and Cardiac Function
- JVP reflects right atrial pressure, which equals central venous pressure and right ventricular end-diastolic pressure.
- JVP is best estimated from the right internal jugular vein, which has the most direct channel into the right atrium.
Jugular Venous Pulsations
- Changing pressures in the right atrium during diastole and systole produce oscillations of filling and emptying in the jugular veins.
- Atrial contraction produces an a wave in the jugular veins just before S1 and systole.
- The x descent occurs during continued atrial relaxation.
- The v wave occurs as right atrial pressure begins to rise with inflow from the vena cava during right ventricular systole.
- The y descent occurs as blood passively empties from the right atrium into the RV during early and middiastole.
Simplified Way to Remember the Three Peaks
- a wave: atrial contraction
- c wave: carotid transmission (or closure of the tricuspid valve)
- v wave: venous filling
Abnormal JVP Patterns
- Abnormally prominent cannon a waves: increased resistance to right atrial contraction, tricuspid stenosis, severe AV block, supraventricular tachycardia, junctional tachycardia, pulmonary hypertension, and pulmonic stenosis.
- Absent a waves: atrial fibrillation.
- Increased v waves: tricuspid regurgitation, atrial septal defects, and constrictive pericarditis.
Effects of Aging on Cardiovascular System
- Aging affects the location of the apical impulse, making it harder to find in older adults due to the deepening of the chest in its anteroposterior (AP) diameter.
- The pitch of heart sounds and murmurs changes with age.
- Arterial stiffness increases with age.
- Blood pressure is affected by aging.
Heart Murmurs and Age
- Almost everyone has a heart murmur at some point in their life.
- Most murmurs are normal variants and occur without other evidence of cardiovascular abnormality.
- Murmurs vary with age, and understanding their patterns helps distinguish normal from abnormal.
- Murmurs can originate in large blood vessels as well as in the heart.
Age-Related Murmurs
- The jugular venous hum is common in children and may still be heard through young adulthood.
- The cervical systolic murmur, or bruit, may be innocent in children but suspicious for atherosclerotic disease in adults.
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Description
Learn about the cardiac cycle, including the ejection of blood into the aorta, arterial pulse, and variations in blood pressure during systole and diastole.
