Initial Resting Assessments

Blood Pressure, Heart Rate, Cholesterol

Resting ECG

Used to determine if arrythmias are present

Used to assess HR 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

The three most important variables affecting BP– 1. Stroke Volume– 2. Total Peripheral Resistance– 3. Heart Rate

– BP= HR x SV x TPR

BP

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

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

Systole (cont.)– 2. Ejection

• when P in vent>aorta (~120mmHg)• semilunar valves open• blood ejected from ventricles into aorta and

pulmonary artery

Cardiac Cycle

B. Diastole– 1. Isovolumetric Relaxation

• ventricles are relaxed• semilunar valves closed• ventricular P is • atrial P<vent P• vent P<aorta P

Cardiac Cycle

Diastole (cont.)– 2. Filling

• AV valves open• blood flows into vent• vent P<atrial P

BP**

Resting Systolic 110-140 mmHg Resting Diastolic 60-90 mmHg

BP Assessment (ACSM)

Blood Pressure:Blood Pressure:SystolicSystolic DiastolicDiastolic

OptimalOptimal <120<120 <80<80NormalNormal 120-129120-129 80-8480-84High NormalHigh Normal 130-139130-139 85-8985-89Hypertension:Hypertension:Stage 1 Stage 1 140-159140-159 90-9990-99Stage 2 Stage 2 160-179160-179 100-109100-109Stage 3 Stage 3 >>180180 >>110110

Methods of Assessing BP

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

The sound of blood moving through the vessels is normally silent.

Smooth laminar blood flow - blood in center of vessels moves faster than blood closest to vessel walls (produces little sound)

BP Sounds

Pinching the artery causes turbulence and is noisy

The tendency of the cuff pressure to constrict the artery is opposed by blood pressure

If cuff pressure is greater than systolic pressure the artery is completely constricted and no sounds are heard.

BP Sounds

When pressure is released from the cuff the first sound you hear (1st Kortokoff sound) is when the cuff pressure reaches the systolic pressure

Blood is passing turbulently as the artery becomes unconstricted

BP Sounds

You continue to hear sounds at every systole (contraction of the heart) as long as the cuff pressure remains above diastolic pressure

When sound becomes muffled is called the 4th Kortokoff sound (7-10 mmHg higher than 5th Kortokoff sound)

BP Sounds

When cuff pressure reaches diastolic pressure the sounds disappear (5th Kortokoff sound) since the artery opens and laminar blood flow begins

Use 5th sound as an index of diastolic pressure

Heart Rate Assessment

Classifications for Exercise

HR Assessment

Methods– Auscultation - using stethoscope, count

beats for 30-60 seconds– Palpation - at brachial, carotid, radial, or

temporal artery– Heart Rate Monitors– ECG

Palpation

Use tips of index and middle fingers (not the thumb)

Don’t apply heavy pressure to carotid (baroreceptors will slow the heart)

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

Fats = triglycerides and cholesterol Cholesterol = fat-like substance found in

foods of animal origin Triglycerides = three fatty acids

attached to a glycerol molecule– saturated or unsaturated

Lipoproteins

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

1. Total Cholesterol = VLDL + LDL + HDL– Desirable < 200 mg/dl– Borderline high 200-239– High >240

Measures

LDL– Desirable <130– Borderline 130-159– High >160

Measures

Triglycerides– Desirable <200– Borderline 200-400– High 400-1000– Very High >1000

Measures

HDL– Low <35– Normal 35-60– High >60

Measures

TC/HDL Ratio– ideal <3.5– risk 3.5-5– higher risk - greater than 5

– Page 19 (Heyward) – Pae 44-45 (ACSM)

Blood Profile

Blood Glucose Hemoglobin Hematocrit Potassium Blood Urea Nitrogen Creatinine Iron Calcium