Initial Resting Assessments Blood Pressure, Heart Rate, Cholesterol

Resting ECG n Used to determine if arrythmias are present n Used to assess HR n General assessment

Electrocardiogram (ECG)  Records the heart's electrical activity and monitors cardiac changes  The P wave—atrial depolarization  The QRS complex—ventricular depolarization and atrial repolarization  The T wave—ventricular repolarization

PHASES OF THE RESTING ECG

Assessing Blood Pressure Classifications for Exercise

BP n The three most important variables affecting BP –1. Stroke Volume –2. Total Peripheral Resistance –3. Heart Rate –BP= HR x SV x TPR

BP n A measure of the pressure exerted by the blood on the arteries –systolic BP - the pressure in the arteries during systole (the contractile phase of the cardiac cycle) –diastolic BP - the pressure in the arteries during diastole (the relaxation phase of the cardiac cycle)

Cardiac Cycle  Events that occur between two consecutive heartbeats (systole to systole)  Diastole—relaxation phase during which the chambers fill with blood (T wave to QRS)  Systole—contraction phase during which the chambers expel blood (QRS to T wave)

Cardiac Cycle n A. Systole –1. Isovolumetric (no change in volume) Contraction ventricles are excited and begin to contract (no blood moving) valves are closed ventricular P is 

Cardiac Cycle n Systole (cont.) –2. Ejection when P in vent>aorta (~120mmHg) semilunar valves open blood ejected from ventricles into aorta and pulmonary artery

Cardiac Cycle n B. Diastole –1. Isovolumetric Relaxation ventricles are relaxed semilunar valves closed ventricular P is  atrial P<vent P vent P<aorta P

Cardiac Cycle n Diastole (cont.) –2. Filling AV valves open blood flows into vent vent P<atrial P

BP** n Resting Systolic mmHg n Resting Diastolic mmHg

BP Assessment (ACSM) Blood Pressure: SystolicDiastolic Optimal<120<80 Normal High Normal Hypertension: Stage Stage Stage 3 >180>110

Methods of Assessing BP n Auscultation using a stethoscope and sphygmomanometer –1. Seated for at least 5 minutes with arm the level of the heart (no caffeine or smoking 30 min prior) –2. Align cuff with brachial artery (the bladder should encircle 80% of an adults arm and 100% of a child’s arm)

Methods of Assessing BP –3. Place stethoscope bell over the brachial artery beneath the cuff –4. Inflate cuff quickly to 20 mmHg above estimated systolic –5. Slowly release valve (2-3mmHg/s) noting first Korotkoff sound)

Methods of Assessing BP –6. Continue releasing until sound becomes muffled (4th) and then disappears (5th) –7. Wait 30s and repeat (use the average)

What causes the sounds you here?

BP Sounds n The sound of blood moving through the vessels is normally silent. n Smooth laminar blood flow - blood in center of vessels moves faster than blood closest to vessel walls (produces little sound)

BP Sounds n Pinching the artery causes turbulence and is noisy n The tendency of the cuff pressure to constrict the artery is opposed by blood pressure n If cuff pressure is greater than systolic pressure the artery is completely constricted and no sounds are heard.

BP Sounds n When pressure is released from the cuff the first sound you hear (1st Kortokoff sound) is when the cuff pressure reaches the systolic pressure n Blood is passing turbulently as the artery becomes unconstricted

BP Sounds n You continue to hear sounds at every systole (contraction of the heart) as long as the cuff pressure remains above diastolic pressure n When sound becomes muffled is called the 4th Kortokoff sound (7-10 mmHg higher than 5th Kortokoff sound)

BP Sounds n When cuff pressure reaches diastolic pressure the sounds disappear (5th Kortokoff sound) since the artery opens and laminar blood flow begins n Use 5th sound as an index of diastolic pressure

Heart Rate Assessment Classifications for Exercise

HR Assessment n Methods –Auscultation - using stethoscope, count beats for seconds –Palpation - at brachial, carotid, radial, or temporal artery –Heart Rate Monitors –ECG

Palpation n Use tips of index and middle fingers (not the thumb) n Don’t apply heavy pressure to carotid (baroreceptors will slow the heart) n Count beats for 6 (x10), 10 (x6), 15 (x4), 30 (x2), or 60 second (6 and 10 when exercising or immediately post-exercise; 15, 30, 60 for resting)

Assessing Cholesterol Classifications for Exercise

Fats/Cholesterol n Fats = triglycerides and cholesterol n Cholesterol = fat-like substance found in foods of animal origin n Triglycerides = three fatty acids attached to a glycerol molecule –saturated or unsaturated

Lipoproteins n Transport fat-like substances (cholesterol/triglycerides) through the blood –Very Low Density Lipoproteins (VLDL) - major carrier of triglycerides –Low Density Lipoproteins (LDL) - major carrier of cholesterol deposited on artery walls.

Lipoproteins –High Density Lipoproteins (HDL) - carry cholesterol to liver to be disposed of

Cholesterol Measures n 1. Total Cholesterol = VLDL + LDL + HDL –Desirable < 200 mg/dl –Borderline high –High >240

Measures n LDL –Desirable <130 –Borderline –High >160

Measures n Triglycerides –Desirable <200 –Borderline –High –Very High >1000

Measures n HDL –Low <35 –Normal –High >60

Measures n TC/HDL Ratio –ideal <3.5 –risk –higher risk - greater than 5 –Page 19 (Heyward) –Pae (ACSM)

Blood Profile n Blood Glucose n Hemoglobin n Hematocrit n Potassium n Blood Urea Nitrogen n Creatinine n Iron n Calcium