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PULSE

A young lady has complained of headache . Attending physician was at a loss while was examining her pulse & BP, both of which could not be recorded Pulse less Disease - bvoxwenxb Takayasus Disease

bvix -

RATE
Normal:

60-100 b/min Bradycardia: <60 b/min Tachycardia: >100 b/min

BRADYCARDIA

RHYTHM REGULAR Physiological -athlete -sleep Drugs -beta blocker -digoxin Hypothyroidism Hypothermia Raised ICP Third degree heart block Jaundice

BRADYCARDIA
IRREGULARLY IRREGULAR Atrial fibrillation( with AV block) REGULARLY IRREGULAR Sinus arrythmia 2nd degree AV block (type 1)

TACHYCARDIA

REGULAR RHYTHM Hyperdynamic circulation CCF Drugs eg. Salbutamol Normal variant Hypovolaemic shock SVT VT

TACHYCARDIA
IRREGULAR RHYTHM Atrial fibrilation Multifocal atrial tachycardia Atrial fluter with variable block

VOLUME AND CHARECTER


LARGE VOLUME PULSE Aortic regurgitation High cardiac output due to any cause -fever -anaemia -thyrotoxicosis

VOLUME AND CHARECTER


SMALL VOLUME PULSE -heart failure -hypovolaemia

VOLUME AND CHARECTER


PULSUS ALTERANS -beat to beat variation in pulse volume in the presence of a regular rhythm. -advanced heart failure PULSUS BISFERINS - AS+AR

VOLUME AND CHARECTER


PULSUS

PARADOXUS -increase in volume on expiration and decrease in volume in inspiration - exacerbation of normal phenomenon. -assessed by measuring the difference in systolic BP during inspiration and expiration. ->15mm of Hg is pathological CAUSE: -acute severe asthma -pericardial tamponade

VOLUME AND CHARECTER


Slow rising pulse

-aortic stenosis Collapsing pulse -aortic regurgitation

BLOOD PRESSURE
Ayoung boy of 12 years living in the 3rd
floor,while returning from school every day he leans back on the wall to take rest on the 2nd floor. On one fine morning ,while going to school , he developed severe headache. On examination ,his blood pressure was recorded as 200/120- mm Hg. What is the Possible Diagnosis?

BLOOD PRESSURE
Indirect

measurement of systolic and diastolic BP is done by a sphygmomanometer. Systolic pressure : peak pressure in the artery following ventricular systole. Diastolic pressure :level to which arterial pressure falls during ventricular diastole. Normal blood pressure is defined as systolic BP <140mm of Hg and diastolic BP < 90mm of Hg.

KOROTKOFF SOUND
PHASE

1: the first appearance of the sounds marking systolic pressure PHASE 2 AND 3 : increasingly loud sound PHASE 4: abrupt muffling of the sound PHASE 5 : disappearance of the sound

HYPERTENSION

Hypertension is an arbitrary term Persons having systolic BP >140mm of Hg and diastolic BP >90mm of Hg, considered to be hypertensive. Essential hypertension: Patients with arterial hypertension with no definable cause. - Synonym: primary HTN, idiopathic HTN. - 95% of all HTN Secondary hypertension: consequence of a specific disease or abnormality. -5% of all HTN.

WHITE COAT HYPERTENSION

Significant percentage of individuals whose BP, measured in the office by a professional, is persistently higher than when measured at home or under casual circumstances. Current estimate 10-20%

ACCELARETED HYPERTENSION
Significant recent increase over previous hypertensive levels associated with evidence of vascular damage over fundoscopic examination but without papilloedema.

LABILE HYPERTENSION

Patients who have sometimes, but not always, arterial pressure in the hypertensive range.

MALIGNANT HYPERTENSION
Marked elevation of BP (usually diastolic BP >130 mm of Hg) in association with papilloedema, retinal haemorrhage, and exudates Hypertensive encephalopathy: neurological menifestation along with malignant HTN.

POSTURAL HYPOTENSION
Dropping of blood pressure on standing for 3 mins (systolic >20mm of Hg, diastolic >10 mm of Hg) is called postural hypotension. -diuretics -vasodilators -autonomic neuropathy -hypovolemia

SHOCK / HYPOTENSION
When the oxygen delivery fails to meet the metabolic requirements of the tissues. classification: - hypovoaemic - cardiogenic - obstructive - neurogenic - anaphylactic - sepsis/SIRS

JUGULAR VENOUS PRESSURE

Flactuations in right atrial pressure during the cardiac cycle generate a pulse which is transmitted backwards in jugular veins. No valve between right atrium and jugular vein. Best examined while the patients reclines at 45 degrees. Mean right atrial pressure is normally <7mm of Hg, 9 cm of water.

JVP. CONT

Causes of elevated jugular venous pressure CCF Iatrogenic fluid over load constrictive pericarditis tamponade

Abdominojugular reflux test


Firm pressure for 10s or more. In normal person it does not rise significantly. Best defined as rapid drop of pressure of 4cm of blood on release of compression.

Ayoung man Has got widening of neck Engorged vessels over the trunk Direction Above downwards Lymphadenopathy-Due to Lymphoma Negative- Abdomino jugular Reflux

Kussmauls sign
An increase rather than the decrease
in the JVP during inspiration. CCF Constrictive pericarditis Right ventricular infarction

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