Pressure systolic

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... 

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. 

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 ... 

In most individuals, the systolic pressure increases sharply with age, whereas the diastolic pressure increases until about age 55 years and then declines. Older individuals with an elevated systolic pressure have a condition known as isolated systolic hypertension (ISH). When the systolic pressure is high, blood vessels become less flexible and stiffen, leading to cardiovascular disease and kidney damage. Research indicates that treating ISH saves lives and reduces illness. The treatment is the same for ISH as for other forms of hypertension. 

When diazoxide or nitroprusside isused fora hypertensve emergency, the nurse placesthe patient in a supine position immediately before, as well as after, administration of the drug. The rate of infusion (nitroprussde) or rate of direct IV administration (diazoxide) and the patient s blood pressure are monitored closely during and after administration of the drug because severe hypotension can occur. The blood pressure and pulse rate may need to be monitored every 15 minutes until the blood pressure is reduced to safe levels The systolic pressure should not drop below 60 mm Hg. 

If a stroke patient receives intravenous (IV) thrombolysis, care often continues in the ED until the patient arrives in the ICU. Close monitoring must continue during this time, with special attention to the blood pressure. The blood pressure is most commonly checked via an arm cuff, since the placement of invasive lines (e.g., arterial catheterization) is relatively contraindicated once the patient has received intravenous thrombolysis (unless the situation is emergent and mandates such treatment). The systolic pressure must not exceed 185 mm Hg, and the diastolic pressure limit should be 110 mm Hg. Should the blood pressure exceed these limits, IV antihypertensive agents should be administered. IV pushes of labetolol (10-20 mg over 1-2 minutes) may be effective, but if patients are refractory to these initial measures then a continuous infusion of labetolol (0.5-2.0 mg/minute), nicardipine (5-15 mg/hour), or nitro-prusside (0.25-10 mg/kg/minute) may be necessary to keep the patient s blood pressure within the range. There will be a more detailed discussion of these antihypertensive agents, including their side effect profiles, later in this chapter. 

To reduce deviations in blood pressure measurement in the clinic, the patient and clinician should not talk during blood pressure readings. The measurement arm is supported and positioned at heart level with the blood pressure cuff encircling at least 80% of arm circumference. If a mercury or aneroid device is used, then the palpatory method must be used first to estimate the systolic blood pressure.18 If an automated device is used, this is not necessary. After the patient s cuff is inflated above the systolic pressure, the mercury column should drop at a rate of 2 to 3 mm per second. A stethoscope placed over the brachial artery in the antecubital fossa identifies the first and last audible Korotkoff sounds, which should be taken as systolic and diastolic pressure, respectively. A minimum of two readings at least 1 minute apart are then averaged. If measurements... 

Pathophysiology Hypotension associated with hemodialysis manifests as a symptomatic sudden drop of more than 30 mm Hg in mean arterial or systolic pressure or a systolic pressure drop to less than 90 mm Hg during the dialysis session. The primary cause is fluid removal from the bloodstream. Ultrafiltration removes fluid from the plasma, which... 

NS (general population) Cardiovascular Increased systolic pressure by 1-2 mm Hg and increased diastolic pressure by 1.4 mm Hg with every doubling in blood lead level effect most prominent in middle-aged white men 7-38 Coate and Fowles 1989 Harlan 1988 Harlan et al. 1988 Landis and Flegal 1988 Pirkle et al. 1985 Schwartz 1988 Proctor et al. 1996... 

A negative correlation was found between PbB and systolic pressure in Belgian men in the Cadmibel study (a cross-sectional population study of the health effects of environmental exposure to cadmium) (Staessen et al. 1991). In this study, blood pressure and urinary cation (positive ions found in the urine, such as sodium, potassium, and calcium) concentration data were obtained from 963 men and 1,019 women multiple stepwise regression analyses were conducted adjusting for age, body mass index, pulse... 

Distinguish among diastolic pressure, systolic pressure, and pulse pressure... 

At rest, the MAP is closer to the diastolic pressure because the diastolic phase of the cardiac cycle lasts almost twice as long as the systolic phase. During exercise when heart rate increases and the length of diastole decreases, systolic pressure contributes more to the MAP. 

Notes CO cardiac output VR venous return HR heart rate SV stroke volume EDV end-diastolic volume ESV end-systolic volume O blood flow AP pressure gradient R resistance r vessel radius P systolic pressure Piiastoik- diastolic pressure MAP mean arterial pressure TPR total peripheral resistance, P venous pressure Era- right atrial pressure Rv venous resistance. 

The incidence of orthostatic hypotension (defined as a greater than 20-mm Hg drop in systolic pressure upon standing) is greatest with low-potency FGAs, especially with IM or IV administration. Diabetics with cardiovascular disease and the elderly are predisposed. 

Stable angina pectoris Decreased myocardial oxygen consumption -decreased LV end-diastolic dimension -decreased LV filling pressure -decreased LV systolic pressure -decreased PVR Increased coronary blood flow -epicardial coronary artery dilation -stenotic segment dilation -coronary collateral vessel dilation -increased subendocardial perfusion... 

Systolic dysfunction Improved hemodynamic performance -decreased end-diastolic dimension -decrease filling pressure -decreased systolic pressure -decreased SVR -decreased mitral regurgitation Arterial vasodilation... 

Explain how one would titrate dopamine starting from 4 mcg/kg/min to maintain a mean systolic pressure between 100-120 mmHg. The patient weighs 165 lb and the IV preparation is dopamine 200 mg in 125 mL of D5W. 

Pulmonary atery (PA) As the catheter moves into the PA, the diastolic pressure will increase owing to the presence of the pulmonary valve. Normal PA systolic pressure is the same as the RV systolic pressure but the diastolic pressure rises to 10-15 mmHg. 

Graphs of ventricular (systolic) pressure versus volume are very useful tools and can be used to demonstrate a number of principles related to cardiovascular physiology. 

The line plotted on a pressure-volume graph that describes the relationship between filling status and systolic pressure for an individual ventricle (ESPVR). 

Factors determining oxygen demand. The heart muscle cell consumes the most energy to generate contractile force. O2 demand rises with an increase in (1) heart rate, (2) contraction velocity, (3) systolic wall tension ( afterload ). The latter depends on ventricular volume and the systolic pressure needed to empty the ventricle. As peripheral resistance increases, aortic pressure rises, hence the resistance against which ventricular blood is ejected. O2 demand is lowered by 3-blockers and Ca-antago-nists, as well as by nitrates (p. 308). 

The drugs of this class (hydralazine and sodium nitroprusside) lower arterial blood pressure primarily by direct spasmolytic action on smooth musculature of arterioles, which leads to a reduction of resistance of peripheral vessels by causing dilation. Diastolic pressure is usually lowered more than the systolic pressure. 

Hypotension Hypotension (postural) occurs regularly in about 50% of patients while they are supine, manifested by dizziness, light-headedness, vertigo, or faintness. Tolerance occurs unpredictably but may be present after several days. Hypotension with supine systolic pressure above 75 mm Hg need not be treated unless symptomatic. If supine systolic pressure falls below 75 mm Hg, infuse dopamine or norepinephrine to increase blood pressure use dilute solution and monitor blood pressure closely because pressor effects are enhanced by bretylium. Perform volume expansion with blood or plasma and correct dehydration where appropriate. Transient hypertension and increased frequency of arrhythmias Transient hypertension and increased frequency of arrhythmias may occur due to initial release of norepinephrine from adrenergic postganglionic nerve terminals. 

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