LAPORAN LABORATORIUM PHYSIOLOGY

“Blood Pressure” Group C2

Oleh
Annisa Nur Zamzam (01071170115)
Anderson Cenweikiawan (01071170145)
Anthony Hasim (01071170178)
Anastasia Johanna (01071170061)
Angeline Tancherla (01071170034)
Ammar Galih W (01071170148)
Amanda Salsabila (01071170219)
Anthony Yusuf (01071170067)
Anissa Tanadi (01071170189)
Annette Patricia (01071170119)

FAKULTAS KEDOKTERAN
UNIVERSITAS PELITA HARAPAN
2017/2018
Experiment 1

Objective : To know the effect of position on blood pressure

Equipments :
• Sphygmomanometer
• Small pillow
• Stethoscope

Procedure :
1. With the subject in the recumbent position, determine the palpatory systolic blood
pressure. To confirm that the middle of the cuff on the upper arm is at the level of the
right atrium, the back and the arm are supported using a small pillow.
2. The radial artery is palpated at the wrist. The cuff pressure is then increased until the
radial pulse disappears. The pressure is then allowed to fall at the rate of 2-3 mm per
second. (Note the pressure at which the radial pulse returns as the palpatory systolic
pressure.
3. Then, determine the arterial pulse, and auscultatory systolic and diastolic pressure
using a stethoscope. The pressure of the cuff is raised to about 30 mmHg above the
systolic pressure, which is obtained by palpatory method. Repeat these observations
five minutes after the initials measurements. Record the results.
4. With the subject in the sitting position, repeat these observations. Repeat these
observations at 3 minute intervals with the subject standing stiffly at attention.
5. Draw a chart of systolic and diastolic blood pressure values, plotting blood pressure
against time.

Results :

Measurement
Blood Pressure (mmHg) Heart Rate (beat/min)
(Recumbent Position)
1 110/60 70
2 110/65 75
Table 1 : Blood Pressure and Heart Rate in Recumbent Position
 Measurement
Blood Pressure (mmHg) Heart Rate (beat/min)
(Sitting Position)
1 120/70 80
2 125/70 78
Table 2 : Blood Pressure and Heart Rate in Sitting Position

Measurement
Blood Pressure (mmHg) Heart Rate (beat/min)
(Standing Position)
1 130/80 100
2 125/70 92
Table 3 : Blood Pressure and Heart Rate in Standing Stiff Position

135

130

125
Blood Pressure (mmHg)

120
Systolic of Recumbent
115 Systolic of Sitting

Systolic of Standing
110

105

100
1st Measurement 2nd Measurement
Time

Figure 1 : Systolic Chart of Recumbent, Sitting and Standing Position

 90

80
Blood Pressure (mmHg) 70

60

50
Diastolic of Recumbent
40
Diastolic of Sitting
30 Diastolic of Standing

20

10

0
1st Measurement 2nd Measurement
Time

Figure 2 : Diastolic Chart of Recumbent, Sitting and Standing Position

Analysis
From the experiment, the data suggests there are differences of blood pressure and
heart rate measured from different body positions. There are relations between body positions
and heart rates, also relation between body positions and blood pressure respectively.
Generally, heart rate and blood pressure were higher when measured sitting and standing
position than recumbent position. From the tables and figures above, we can see that blood
pressure in recumbent position is 110/60 mmHg and 110/65 mmHg. Meanwhile, in sitting
position, the blood pressure increased to 120/70 mmHg and 125/70 mmHg. And the highest
is 130/80 mmHg when standing. The heart rate also increased from 70 and 75 during
recumbent, into 80 and 78 during sitting, followed by 100 and 92 during standing. Or we can
also easily observe from the chart that systolic and diastolic blood pressure of standing and
sitting position are higher than recumbent position.
The difference between standing, sitting and recumbent position can be explained as
body physiological adaptation to body part distribution of gravity. In recumbent position, all
body parts share equal gravitional forces which result in equally distributed blood through the
arteries and veins. The result is blood pressure is distributed equally consequently. But, in
sitting and standing position, gravitional forces affects inequally in all body parts with
gravitional force has stronger effect on caudal part on the body, causing the blood to
accumulate in lower part.
The accumulation of blood in the lower part of body will cause higher venous pooling
which will result in decreased venous return to heart and higher blood pressure also blood
volume in the lower part of the body. Decreased venous return will result in lower stroke
volume, and lower blood pressure in the heart consequtively.
Gravity will affect circulation in the arteries above heart negatively due to decreased
venous return of venous pooling in lower part of the body and opossing gravitional force.
This will result in hypotension of higher part of the body due to low pressure. Lower pressure
of higher body will have inadequate oxygen delivery as the consequence yet oxygen is
needed in vast amount in order for brain to function properly.
The compensation of lower blood pressure is done by baroreceptors that can be found
in carotid sinus and aortic arch. Due to venous pooling in lower part of the body and lower
venous return, baroreceptors will send signal to brain and activates sympathetic signaling in
the body. Sympathetic signaling will activate cardioaccelatory and vasomotor control of the
body resulting in higher heart rate, vasoconstriction in arteries and vein, and decreased
venous compliance due to venomotor tone. Contractility of heart also is increased and result
in higher stroke volume. These actions will result in lower amount of blood pooled in the
lower part of body and increased venous return to the heart, hence causing the blood pressure
to be normal again. The maintainance of relatively constant blood pressure (Mean Arterial
Pressure) done by baroreceptor reflex are important in order to ensure that all body parts will
receive adequate oxygenation especially in the one above the heart.
Postural hypotension or can be called as orthostatic hypotension can be explained as
failure or delay of baroreceptor reflex to maintain Mean Arterial Pressure in sudden changes
of body posture (from sitting or lying down to standing). This results in lower blood pressure
due to uncompensated venous pooling. Notably, systolic blood pressure will drop about 20
mmHg and 10 mmHg in diastolic blood pressure due to postural hypotension. This will affect
oxygenation in the brain due to reduced blood flow to the brain and can result in fainting
(syncope). Postural hypotension occurs mostly in hypovolemic patient due to dehydration
which will result in lower blood volume, stroke volume, cardiac output, and blood pressure
consequtively. Disturbance in autonomic nervous system will also affect sympathetic
signaling and result in failed compensation reflex done by baroreceptors.
Experiment 2

Objective : To know the effect of sustained intrathoracic pressure

(Valsalvamanoeuvre)

Equipments :
• Mercury sphygmomanometer
• Stethoscope
• Small Pillow

Procedure :
1. The subject takes a deep breath and then expires against a pressure (Valsava
Maneuver) and hold this maneouvre.
2. Throughout the test and for one minute after, count the radial pulse every 10 seconds.
Also note the character of the pulse, i.e. whether it is full and strong, or weak and
difficult to detect.
3. Determine blood pressure every 20 seconds throughout the test and for one minute
thereafter (one minute after breaking point). Note the character of the respirations that
follow the breaking point.

Results :

Pre-Treatment (Before Doing Maneouvre)

• Blood Pressure : 110/70 mmHg
• Radial Pulse Rate : 14x / 10 seconds
During Treatment (During Doing Maneouvre)

Time
Blood Pressure
(While doing maneouvre)
20th sec 110/70 mmHg
40th sec 90/60 mmHg
60th sec 80/60 mmHg

Table 3 : Blood Pressure and Radial Pulse Rate During Doing Maneouvre

120

100
Blood Pressure (mmHg)

80

60
Systolic

Diastolic
40

20

0
20 40 60
Time (seconds)

Figure 3 : Blood Pressure During Doing Maneouvre

Time
Radial Pulse Rate Character
(While doing maneouvre)
10th sec 14 x Strong
20th sec 14 x Moderate
30th sec 13 x Weak
40th sec 14 x Weak
50th sec 13 x Weak
60th sec - Difficult to Palpate
Table 4 : Radial Pulse Rate While Doing Maneouvre
 Post-Treatment (1 Minute After Breaking Point)

Time
Blood Pressure
(1 Min After Breaking Point )
20th sec 90/60 mmHg
40th sec 100/70 mmHg
60th sec 110/70 mmHg

Table 5 : Blood Pressure 1 Minute After Breaking Point

Time
Radial Pulse Rate Character
(1 Min After Breaking Point)
10th sec 17 x Strong
20th sec 17 x Strong
30th sec 16 x Strong
40th sec 17 x Strong
50th sec 17 x Strong
60th sec 17 x Strong
Table 6 : Radial Pulse Rate 1 Minute After Breaking Point

• Characteristics of Breathing 1 Minute After Breaking Point :

Rapid and Deep

Analysis :

Valsalva manoeuvre is done by closing our glottis and straining down hard. By doing
this, we are unable to breathe. This would also cause the compression of the thoracic organs
by the contracting rib cage, and lead to the increase of intrathoracic pressure. The high
intrathoracic pressure decreases venous return. Simultaneously, the rise of intrathoracic
pressure would increase the aortic pressure during first few seconds. But the pressure would
decrease due to reduced cardiac output. In our experiment, we can see that during the first
20th second, the pressure is still the same with the blood pressure before doing maneouvre,
which is 110/70. This is because there is an initial pressure rise (phase 1) during the first few
seconds, followed by the reduced pressure (phase 2) due to low venous return. The initial
increase and the following decrease in pressure leads to a temporarily stable and normal
blood pressure. However, after the 40th second, we can see that the blood pressure dropped to
90/60 mmHg. This is due to the low venous return, which leads to low strokes volume and
cardiac output. Baroreceptors will then detect the low blood pressure and triggers normal
autonomic response to return the blood pressure to normal level. This causes peripheral
vasoconstriction and tachycardia. In our experiment, the pulse rate didn't have significant
changes. However, they are getting weaker and weaker during the maneouvre. Despite the
compensation of increasing heart rate, the pulse would become weak, due to the reduced
blood pressure. And at the end of maneuver, the blood pressure dropped to 80/60 mmHg. The
radial pulse was also difficult to palpate.
After 1 minute following the breaking point, the blood pressure had increased a little,
which is 90/60 mmHg at the first 20 seconds, followed by increase to 110/70 at the 60th
second. And the radial pulse had become strong and increased to 17x/min. Meanwhile, the
breathing became deep and rapid due to lack of oxygen during the maneouvre. These are the
compensatory response of the body after the increase of intrathoracic pressure.
Experiment 3

Objective : To understand the effect of cold pressor test

Equipments :
• Sphygmomanometer
• Small pillow
• Stethoscope
• Bucket with ice water

Procedure :
1. With the subject sitting, measure the blood pressure every minute for 5 minutes.
2. Immerse the subject’s left hand and wrist in a bucket of water at 40°C for 3 minutes.
3. Record blood pressure and pulse rate every minute during the 3 minutes, and at
minute intervals afterwards until the measurements come back to normal.

Results :

Pre-Treatment (Before Cold Pressor Test)

Time Blood Pressure (mmHg) Pulse Rate (bpm)
1st minute 110/60 90
2nd minute 110/60 108
3rd minute 100/60 102
4th minute 100/60 108
5th minute 100/60 102
Table 7 : Blood Pressure and Pulse Rate Before Cold Pressor Test

During Treatment (During Cold Pressor Test)

Time Blood Pressure (mmHg) Pulse Rate (bpm)
1st minute 110/70 108
2nd minute 110/80 108
3rd minute 110/80 102
Table 8 : Blood Pressure and Pulse Rate During Cold Pressor Test
 Post-Treatment (After Cold Pressor Test)
Time Blood Pressure (mmHg) Pulse Rate (bpm)
1st minute 110/70 90
2nd minute 110/60 108
Table 9 : Blood Pressure and Pulse Rate After Cold Pressor Test

Analysis :

When human body gets in contact with cold, it will activate fight or flight response, or
it is known as sympathetic nervous system response. Cold would also cause pain to the skin,
therefore it stimulates the sympathetic nervous system too. Vasomotor center will be
receiving signal from receptors to activate the sympathetic nervous system. This causes the
blood vessels to vasoconstrict and the heart rate to increase. Vasoconstriction is also one of
the thermoregulations in our body to prevent heat loss. We can compare the results in table 7
and table 8. The blood pressure had increased from 100/60 mmHg to 110/80 mmHg after
immersing the hand into the bucket. However, there is no significant change in pulse rate.
This may be due to the action of baroreceptor receiving signal from the increased blood
pressure and it will cause heart rate to decrease, in order to compensate the increasing blood
pressure.
An increase of about 10 mmHg in both systolic and diastolic pressure is to be
expected. However, if the increase in systolic is more than 20mmHg and increase in diastolic
is more than 15 mmHg, it indicates that the person has a hyper-reactive vasomotor system.
Our subject had an increase of about 10 mmHg in systole and 20 mmHg in diastole, which
indicates that our subject has a slightly hyper-reactive vasomotor system. After removing the
hand from cold, the diastolic pressure decreased from 80 mmHg to 60 mmHg. This indicates
that the subject's body is slowly recovering into normal state. From this experiment, we can
conclude that environmental stressor, such as temperature, is an important factor and can
affect the regulation of blood pressure and heart rate.
Experiment 4

Objective : To know the effects of psychological stress on blood pressure

Equipments :
• Sphygmomanometer
• Small pillow
• Stethoscope

Procedure :
1. Measure the blood pressure and pulse rate of the sitting subject every minute for 5
minutes.
2. Have the subject count backwards by 7’s from 666 as fast as possible, for 2 minutes.
3. Give 1 mark for each correct answer, and deduct 10 marks for each wrong answer.
4. Record the subject’s blood pressure and pulse rate minute during the test, and each
minute afterwards until the measurements come back to normal.

Results :
Pre-Treatment
Time Blood Pressure Pulse Rate
1st min 110/60 mmHg 84 bpm
2nd min 110/60 mmHg 78 bpm
3rd min 110/70 mmHg 77 bpm
4th min 110/70 mmHg 84 bpm
5th min 110/70 mmHg 72 bpm
Table 10 : Blood Pressure and Pulse Rate Before Stress

During Treatment
Time Blood Pressure Pulse rate
1st min 120/70 mmHg 90 bpm
2nd min 120/70 mmHg 85 bpm
Table 11 : Blood Pressure and Pulse Rate During Stress
 Post Treatment
Time Blood Pressure Pulse rate
1st min 120/70 mmHg 84 bpm
2nd min 110/70 mmHg 85 bpm
Table 12 : Blood Pressure and Pulse Rate After Stress

Analysis
Based on the data received from the experiment, stress could affect the blood pressure
in the human body. We measured the sitting subject every minute for 5 minutes. The blood
pressures and pulse rates have no significant changes. The blood pressure in the first and
second minute is 110/60 mmHg. In the third, fourth and fifth minute, the systole and diastole
has the same number, which is 110/70 mmHg. Meanwhile, the pulse rate increases and
decreases various times, which results to different rates.
Afterwards, the subject counted backwards for 2 minutes. The first minute shows the
blood pressure is 120/70 mmHg and the pulse rate is 90 bpm. And the second minute shows
that the blood pressure is 120/70 mmHg and the pulse rate is 85 bpm. There is an increase of
blood pressure and pulse rate. This occurs because stress activates sympathetic nervous
system. This would lead to the release of stress hormones, such as adrenaline, cortisol and
norepinephrine, wherein blood vessels will vasoconstrict, heart rate will increase and
breathing will be rapid.
After the subject finished counting, we re-measured the blood pressure and heart rate.
During the 1st minute, the blood pressure and pulse rate are still similar to the ones during
counting. On the 2nd minute, the blood pressure had dropped to normal state (pre-treatment),
which is 110/70 mmHg. This is because the subject had already recovered from the stress
condition and the sympathetic nervous system response would be decreased.
Experiment 5

Objective : To know the effects of exercise on blood pressure and heart rate.

Equipments :
• Sphygmomanometer
• Small pillow
• Stethoscope
Procedure :
1. Measure the subject’s blood pressure and pulse rate in resting condition while sitting.
2. Take two measurements.
3. Have the subject run stationary with high speed for 2 minutes.
4. Record blood pressure and pulse rate in sitting position every 2 minutes for 6 minutes.
5. Continue until heart rate and blood pressure return to normal.
6. Plot systolic and diastolic blood pressure and heart rate against time, indicating the
resting value as a baseline.

Results :

Pre-Treatment (Before Exercise)

Measurement Blood Pressure Heart Rate Respiratory Rate
1st 120/80 mmHg 66 bpm 18 x/min
2nd 120/80 mmHg 66 bpm 17 x/min
Table 10 : Blood Pressure, HR and RR Before Exercise

Post Treatment (After Exercise)

Time Blood Pressure Heart Rate Respiratory Rate
2nd Minute 150/90 mmHg 130 bpm 22 x/min
4th Minute 130/80 mmHg 90 bpm 20 x/min
6th Minute 120/80 mmHg 80 bpm 13 x/min
Table 11 : Blood Pressure, HR and RR After Exercise
Figure 4 : Systolic Blood Pressure After Exercise (With Resting Value At Baseline)

Figure 5 : Diastolic Blood Pressure After Exercise (With Resting Value At Baseline)
 Figure 6 : Heart Rate After Exercising (With Resting Value At Baseline)

Analysis :

The result above shows that there is a significant change in blood pressure, heart rate

and respiratory rate before and after exercise. Before exercising, the heart rate is 66 bpm. And

it had increased to 130 bpm at the 2nd minute after exercise. Heart rate increases as you

exercise, in order to deliver more blood and oxygen to your working muscles. The increased

heart rate will cause the blood pressure to increase as well, because they are directly

proportional. The results show that the blood pressure had increased from 120/80 mmHg to

150/90 mmHg (during the 2nd minute after exercise). Aside from that, exercising would

increase demand in oxygen in order to gain energy. Therefore, this would stimulate our

respiratory system to breath rapidly to increase our oxygen intake. From the experiment, we

can see that the respiratory rate had increased from 17 times to 22 times per minute after

exercising. However, if the oxygen supply is not enough, our body would perform short and
fast metabolic processes by producing lactic acid. This causes the decrease of body pH,

which would be detected by chemoreceptors. The chemoreceptors will then activate cardiac

vasomotor centers to increase heart rate, strokes volume and will eventually cause cardiac

output to rise. Therefore, our blood pressure would increase. After a few minutes of recovery,

the heart rate will return into normal level. And similar to the heart rate, blood pressure

returns to normal resting level a few minutes after exercising. People who are fit can easily

return their heart rate to normal level.