Systole

Fig. 25. An example of Doppler color flow mapping, a real-time ultrasound technique that displays the dynamics of blood flow in color along with static tissue information in black and white. The image shows the record of a leaky mitral valve during systole.

Finally, drug treatment in the elderly is of great importance and warrants special attention with regard to safety and tolerability, since systolic blood pressure is recognized as an important target for treatment, particularly in older persons. The benefits of antihypertensive treatment in the elderly and in patients with isolated systolic hypertension are greater than in younger persons. 

Diuretics - Beta blockers (non-ISA) - ACE inhibitors (with systolic dysfunction)... 

As a result of such studies hypertension has been operationally defined as the blood pressure level above which therapeutic intervention has clinical benefit. As increasingly aggressive intervention has continued to demonstrate benefits, this level has gradually reduced over time and is commonly defined as systolic blood pressure>l40 mmHg and/or diastolic blood pressure >90 mmHg (Table 1). Isolated systolic hypertension is defined as systolic blood pressure >140 mmHg and diastolic blood pressure <90 mmHg. 

Category Systolic [mm Hg] I Diastolic [mm Hg] Stroke mortality relative risk... 

The higher category applies, if systolic and diastolic blood pressure values of a patient fall into different categories. 

The amide local anaesthetic lidocaine may also be used as an antianhythmic for ventricular tachycardia and exra-systoles after injection into the blood circulation. Drugs with high lipid solubility such as bupivacaine cannot be used for these purposes because their prolonged binding to the channel may induce dysrhythmias or asystolic heart failure [3]. Systemically applied lidocaine has also been used successfully in some cases of neuropathic pain syndromes [4]. Here, electrical activity in the peripheral nervous system is reduced by used-dependent but incomplete sodium channel blockade. 

Systolic and Diastolic Blood Pressure and Pulse Pressure 1175... 

Systolic pressure, or maximum blood pressure, occurs during left ventricular systole. Diastolic pressure, or minimum blood pressure, occurs during ventricular diastole. The difference between systolic and diastolic pressure is the pulse pressure. While diastolic blood pressure has been historically been used as the most relevant clinical blood pressure phenotype, it has now been clearly established that systolic blood pressure is the more important clinical predictor for cardiovascular morbidity and mortality. More recently, additional attention is focussed on the importance of pulse pressure, i.e. the blood pressure amplitude, as a predictive factor for cardiovascular disease. 

A significant decrease in blood pressure (systolic or diastolic) or a systolic pressure below 100 mm Hg... 

Headache, nausea, increased heart rate, increase in systolic blood pressure, palpitations, anginal and nonspecific chest pain Nausea, vomiting, ectopic beats, tachycardia, anginal pain, palpitations, hypotension, dyspnea Anxiety, insomnia, tenseness, restlessness, headache, light-headedness, dizziness, nausea, dysuria, pallor... 

Adjust die rate of administration according to die patient s blood pressure The rate of administration of die IV solution is increased or decreased to maintain die patient s blood pressure at the systolic level ordered by the primary healdi care provider. 

Regardless of the actual numerical reading of the blood pressure, a progressive fall of the blood pressure is serious The nurse reports to the primary health care provider any progressive fall of the blood pressure, a fall in systolic blood pressure below 100 mm Hg, or any fall of 20 mm Hg or more of the patient s normal blood pressure. 

Explains that a slight change in readings is normal, but if a drastic change in either or both the systolic or diastolic readings occurs, the patient should contact the primary health care provider as soon as possible. 

Left ventricular dysfunction, also called left ventricular systolic dysfunction, is the most common fonn of heart failure and results in decreased cardiac output and decreased ejection fraction (the amount of blood that the ventricle ejects per beat in relationship to the amount of blood available to eject). Typically, the ejection fraction should be greater than 60%. With, left... 

Until recently, the cardiotonics and a diuretic were the treatment of choice for HE However, other dragp such as the angiotensin-converting enzyme (ACE) inhibitors, and beta blockers have become the treatment of choice during the last several years. See Figure 39-1 for an example of a method of determining treatment for left ventricular systolic dysfunction. See Chapters 23, 42, and 46 for more information on the beta blockers, ACE inhibitors, and diuretics, respectively. 

Managing Heart Failure in Patients with Left Ventricular Systolic Dysfunction ... 

FIGURE 39-1. Management of left ventricular systolic dysfunction. (Adapted from Ammon, S [2001], Managing patients with heart failure, AJN 101 [12] 35.)... 

ADMINISTERING PROPRANOLOL. Cardiac monitoring is recommended when the drug is given IV because severe bradycardia and hypotension may be seen. The nurse obtains written instructions from the primary health care provider for propranolol administration. For example, tire primary health care provider may want the drug to be withheld for a systolic blood pressure less than 90 mm Hg or a pulse rate less than 50 bpm. 

ADMINISTERING HRETYLIUM. The nurse monitors cardiac rhythm and blood pressure continuously during administration. Hypotension and postural hypotension occur in about 50% of die patients receiving bretylium. If systolic pressure is less than 75 mm Hg, the nurse should notify the primary health care provider. The patient is kept supine until tolerance of postural hypotension develops. The nurse instructs the patient to change position slowly. Most individuals adjust to blood pressure changes within a few days. 

The nurse takes Hie patient s vital signs before die drug is administered and frequentiy during administration of die antiaiiginals or die calcium channel blockers. If die heart rate is below 50 bpm or die systolic blood pressure is below 90 mm Hg, the drug is widiheld and die primary health care provider notified. A dosage adjusdnent may be necessary. 

In the United States, African-Americans are twice as likely as Caucasians to experience hypertension. After age 65 years, African-American women have the highest incidence of hypertension. Essential hypertension cannot be cured but can be controlled. Many individuals experience hypertension as they grow older, but hypertension is not a part of healthy aging. For many older individuals, the systolic pressure gives the most accurate diagnosis of hypertension. Display 42-2 discusses the importance of the systolic pressure ... 

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