Blood Pressure, Heart Tones, and Diagnoses
The primary purpose of this chapter is to familiarize the reader with the basic concepts of blood pressure, heart tones, and some commonly associated diagnoses. Furthermore, it is important to reinforce the need for a deep understanding of basic physiolog
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18
Jacob Hutchins
Abstract
The primary purpose of this chapter is to familiarize the reader with the basic concepts of blood pressure, heart tones, and some commonly associated diagnoses. Furthermore, it is important to reinforce the need for a deep understanding of basic physiological principles when interpreting physical examination findings. Commonly employed invasive and noninvasive methods for assessing blood pressure are discussed, as well as some of the newer technologies on the horizon. It remains the general consensus that even the most sophisticated electronic monitors cannot fully reduce the need for sound clinical skills such as: proper patient inspection, palpation, percussion, and/or auscultation. Keywords
Blood pressure measurement • Palpation • Doppler effect • Auscultation • Oscillometry • Plethysmography • Arterial tonometry • Arterial cannulation • Heart tones
18.1
Blood Pressure
Fundamental to providing comprehensive care to patients is the ability to perform a physical examination. The optimal selection of further tests and treatments depends on a welldeveloped patient history and one’s physical examination skills. Two key elements of a physical examination are: (1) properly measuring a patient’s blood pressure and (2) careful auscultation of their heart sounds. These assessments provide important information about the patient’s hemodynamics and aid in diagnosing anatomical or physiological pathologies. Naive ideas concerning human circulation and blood pressure date as far back as ancient Greece. It took until the eighteenth century before the first official report describing an attempt to measure blood pressure was written, when Stephen Hales published a monograph on “Haemastatics” in 1733. He conducted a series of experiments involving
J. Hutchins, MD (*) Department of Anesthesiology, University of Minnesota, MMC 294, 420 Delaware St. SE, Minneapolis, MN 55455, USA e-mail: [email protected]
invasive cannulation of arteries in horses, in which he directly monitored blood pressure. Unfortunately, such a method was not applicable for humans. During the subsequent two centuries, there were many contributions to medical science associated with blood pressure control and its assessment. One of the greatest of these contributions was a publication in Gazetta medica di Torino in 1896, called “A New Sphygmomanometer” by Dr. Riva-Rocci; this publication is still recognized as the single most important advancement in the field of practical noninvasive methods for blood pressure estimation. In 1916, French physician Rene Laennec invented the first stethoscope, which was constructed from stacked paper rolled into a solid cylinder. Prior to his invention, physicians around the world would place an ear directly over the patient’s chest to hear the heart and/or lung sounds. After Dr. Laennec’s initial success, several new models were produced, primarily made of wood; this stethoscope was called a monaural stethoscope. The binaural stethoscope was invented in 1829 by a doctor from Dublin and later ga
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