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