BPH 1104 HUMAN PHYSIOLOGY

PULMONARY FUNCTION TEST

Name of student : Hong Chuan Rui

Student ID : QIU-202210-005983

Lecturer’s Name : DR. NASRIN HABIB

Date of Submission : 23th FEBRUARY 2021

Title: Measurement of blood pressure

Objective:

1. To measure the blood pressure using the palpatory and auscultatory methods,

Introduction:

The cardiac cycle involves increasing aortic blood pressure above the veins,

causing blood flow through the systemic circulation. Blood flow (pulse) through the

pulmonary circulation is caused by higher pressure in the pulmonary arteries than in

pulmonary veins. Systolic blood pressure, the maximum blood pressure, arises when

the heart contracts, pumping blood into the aorta (systole). Diastolic blood pressure, a

minimum blood pressure level, in which the ventricles relax causes arterial pressure to

decrease resulting in the heart refilling with blood (diastole).

The mean arterial pressure (MAP) can be calculated by taking into account the

diastolic and systolic blood pressures. However, this value is not just the average of the

two determinants. Both these pressures can be determined by implanting a pressure

catheter into an artery and measuring pressure changes as the heart beats. This

process though accurate can be both uncomfortable and invasive and is rarely used.

Hence, blood pressure is more commonly measured by way of auscultation, an indirect,

non-invasive technique.
 Auscultation depends on silent streamlined flow but the production of Korotkoff

sounds during turbulent flow, by listening through a stethoscope placed on the brachial

artery, and recorded by a sphygmomanometer. This method involves placing an

inflatable cuff around the patient’s upper arm, which is slowly inflated until the pulse

cannot be felt (cuff pressure higher than systolic pressure). The pressure inside the cuff

is steadily lowered until a tapping sound is heard (systolic blood pressure) where the

artery pressure is now adequate to rise above that in the cuff. As cuff pressure is further

reduced, the heart sounds become louder and then abruptly become weakened as

diastolic pressure is approaching and flow is more streamlined. The point at which the

heart sounds stop altogether is the diastolic blood pressure, in which normal flow has

been resumed. Normal blood pressure should be around 120/80 mmHg.

Principle:

The principle of the experiment involves the balancing of air pressure against the

pressure of blood in the brachial artery; the air pressure is estimated by a mercury or air

(aneroid) manometer.

Apparatus:

Sphygmomanometer (Mercury / Aneroid), stethoscope, blood pressure cuff (appropriate

size for newborn, infant, child, adult, large adult)

Figure 1: Mercury and Aneroid Sphyygmomanometer

Sphygmomanometer

The sphygmomanometer consists of a mercury manometer and an inflatable cuff called

a “Riva Rocci” cuff. The manometer is a U-shaped tube, one limb is broader than the

other. The broader limb is the reservoir for mercury and the narrow limb is graduated

from 0 to 300 mm, with the smallest division corresponding to a reading of 2mm. The

cuff consists of an inflatable rubber bag covered by non-distensible cotton fabric. The

cuff is connected to the manometer and to a hand bulb (rubber bulb) by rubber tubing.

The cuff can be inflated to any desired pressure with the help of a rubber bulb which

also permits the reduction in cuff pressure.

Cuff sizing: The width of an adult cuff is 12.5cm. The length of a rubber cuff in an adult

is 23 cm.

The blood moves in waves hence, there are two blood pressure measurements:

Systolic pressure (SP) - due to ventricular contraction

Diastolic pressure (DP) - due to ventricular relaxation Difference between diastolic and

systolic pressure is Pulse Pressure (PP).

The normal blood pressure of a healthy adult is about 120/80 mmHg

Pulse Pressure (PP) =SP – DP = 120 – 80 = 40 mm Hg

Method:

The patient was greeted and I was introduced to the patient. The procedures were

explained to the patient.

Patient position

Ideally, the patient should be in a sitting position with the back and legs well supported

and feet resting on a firm surface. Rest the patient’s arm on a table so the brachial

artery is at the level of the heart and ensure no tight clothing that will constrict the upper

arm. Blood pressure is recorded by two methods:

a. Palpatory method

b. Auscultatory method
a. Palpatory method:

Figure 2: Palpatory method

The appropriate size cuff was selected. The cuff was wrapped on the bare arm 2-3 cm

above the elbow crease, and the centre of the rubber bag manometer should be lover

the brachial artery. The Mercury manometer was connected to the cuff by tubing and

the lock of the manometer was opened. The radial pulse was felt. After closing the valve

on the inflating bulb (i.e. turning the knob clockwise), the rubber bag was inflated to

raise the pressure 20 – 30 mm above the point when the pulse was no longer felt. This

was the state when the cuff pressure obliterates the arterial lumen and blood flow

through the brachial artery stopped. Then the cuff pressure was slowly reduced by

unscrewing the valve of the bulb. The radial pulse reappeared and the pressure of the

manometer was noted. This pressure was the systolic pressure. Now the cuff pressure

was equal to the pressure of arterial blood pressure and blood began escaping beyond

the cuff into the peripheral part of the artery. The pressure was released completely in

the cuff and waited 1 to 2 minutes before making further measurements.

Advantages of the palpatory method:

It gives a rough estimation of systolic pressure It helps to avoid taking the wrong less

systolic value in the Auscultatory gap (Auscultatory 80 gap is a period of abnormal

silence or diminished intensity during one of the Korotkov sound phases).

Disadvantages of the palpatory method:

Palpatory method gives an estimation of systolic blood pressure which is about 6-10

mm Hg less than that recorded by the auscultatory method.

b. Auscultatory method

Figure 3: Auscultatory method

The cuff was wrapped on the upper arm. The Mercury manometer was connected with

the cuff and the lock of the manometer was opened. The diaphragm of the stethoscope

was placed over the brachial pulse in the cubital fossa. The cuff was inflated rapidly

and steadily, 30-40 mmHg above the estimated systolic pressure measured by the

Palpatory method, The valve was released carefully so that the pressure was felt at 2 to

3 mmHg per second until a regular tapping sound (Korotkoff’s sounds, Phase 1) was

heard. This pressure on the manometer, when the sound appeared, corresponds to the

systolic pressure (SBP). Manometer reading was made in even numbers. The cuff was

continue to deflate until the sounds become muffled and finally disappeared. At the

reading of the mercury manometer, when the sound disappears corresponds to diastolic

pressure (DBP). 10 to 20 mmHg below this level as the mercury level felt was continued

to listen to confirm the reading. The cuff was deflated rapidly and completely. The sound

heard was called “Korotkoff’s sounds”. The recorded blood pressure with systolic

pressure was documented as the numerator and diastolic pressure in the denominator.

2 to 3 minutes were waited before repeating the pressure measurement on the same

arm, this allowed blood trapped in the veins to be released.

Korotkoff’s Sounds

These are sounds that are heard by the stethoscope in the Auscultatory method

between systole and diastole, as the artery re-opens gradually from the completely

collapsed state with each heartbeat. There are five (5) phases:

Phase 1: The first tapping sound heard during the deflation of the cuff is the Systolic BP

(SBP). These sounds gradually become more intense.

Phase 2: It is the period when the sounds turn to murmur-like on further deflation.

Phase 3: It is the period during which the blood flows freely through an increasingly

open artery. The sounds become more intense and again assume a clear thumping

quality but are softer than in Phase 1.

Phase 4: It is the time when the sounds become muffled and have a soft, blowing

quality.

Phase 5: It is the pressure level at which the sound becomes faint and disappears. It is

called Diastolic BP (DBP). This is followed by a period of silence.

Precautions:

1. Ensure the examination room is quiet.

2. Instruct the patient to be relaxed for 5 to 6 minutes.

Result:

Blood pressure by the palpatory method:

Reading I: 140 Reading II: 110 Reading III: 130

Blood pressure by the auscultatory method:

Reading I: 140 Reading II: 120 Reading III: 130

The blood pressure of the given subject is (140+120+130)/3 mm Hg. = 130 mmHg

Normal range of blood pressure = 100-140 / 60-90 mm Hg

Discussion:

From the result obtained, the blood pressure of the given subject was 130

mmHg, which was in the normal range of blood pressure which was 100-140/60-90

mmHg.

Blood pressure is the lateral pressure of blood exerted on the walls of arteries

during cardiac muscle contraction and is expressed in terms of the systolic pressure

over diastolic pressure as well as the measurement unit in millimetres of mercury

(mmHg). Systolic pressure is the maximum blood pressure when the ventricle of the

heart is contracted to pump blood into the pulmonary artery or aorta and its normal

range is 100 – 140 mmHg. Diastolic pressure is the minimum blood pressure when the

ventricle of the heart is relaxed. The normal range for diastolic pressure is 60 –

90mmHg. There are two methods that can be used to determine blood pressure which

are the auscultatory method and the palpatory method. The result obtained from the

auscultatory method is more accurate than the palpatory method as a

sphygmomanometer and stethoscope are used to hear the “Korotkoff’s sounds”. An

individual is said to have hypertension if the blood pressure recorded is higher than the

normal range. Hypertension can cause severe heart disease and death. Hypertension

can be categorized into multiple stages. Stage 1 Hypertension is when systolic pressure

is at a range of 140-159 mmHg while diastolic pressure is at 90-99 mmHg. Stage 2

Hypertension occurs when the systolic pressure is more than 160mmHh whereas the

diastolic pressure is more than 100mmHg. Hypertensive Emergency is when the

systolic pressure is more than 180mmHg and the Diastolic pressure is more than

120mmHg.
 Hypertension Stage 1 is when blood pressure consistently ranges from 130-139

systolic or 80-89 mm Hg diastolic. At this stage of high blood pressure, doctors are likely

to prescribe lifestyle changes and may consider adding blood pressure medication

based on your risk of atherosclerotic cardiovascular diseases (ASCVD), such as heart

attack or stroke (Understanding blood pressure readings,2022).

Hypertension Stage 2 is when blood pressure consistently ranges at 140/90 mm

Hg or higher. At this stage of high blood pressure, doctors are likely to prescribe a

combination of blood pressure medications and lifestyle changes (Understanding blood

pressure readings,2022).

This stage of high blood pressure requires medical attention. If your blood

pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and then test

your blood pressure again. If your readings are still unusually high, contact your doctor

immediately. You could be experiencing a hypertensive crisis. If the blood pressure is

higher than 180/120 mm Hg and you are experiencing signs of possible organ damage

such as chest pain, shortness of breath, back pain, numbness/weakness, change in

vision or difficulty speaking, do not wait to see if your pressure comes down on its own.

See the doctors immediately (Understanding blood pressure readings,2022).

Questions:

Calculate and interpret the findings of your subject.

Reading Systolic blood Diastolic blood Pulse Mean blood

pressure pressure Pressure pressure (mmHg)

(mmHg) (mmHg) (mmHg)

1.
140 90 50 107

2.
120 80 40 93

3.
140 80 60 100

Additional information:

Pulse Pressure = Systolic blood pressure – Diastolic blood pressure

Mean blood pressure = Diastolic blood pressure + 1/3 Pulse Pressure

Conclusion:

In conclusion, the blood pressure of the subjects are within the normal range.
Practical: Measurement of ECG

Objective:

1. To understand the functions and importance of an electrocardiogram (ECG).

2. To interpret the electrocardiogram (ECG) graph.

Introduction:

An ECG, which is Electrocardiogram, is a way to record the electrical signals in

the human heart. It was invented to detect heat problem or monitors the heart. It

happened to show a lot in movie scenes where the characters were in the operating

room or in the ambulance. The machine which has many waves on the screen is the

ECG. It is very important to have the ECG in the ambulance or in the operating room for

the doctor to know if anything happens to the heart. It is easy to use ECG it is the

painless and fastest way to monitor the human heart (Electrocardiogram (ECG),n.d).

The SA contract generates an electrical impulse that travels to the heart wall. It

made the atria contract and that lead to the impulse of the AV node. Then the impulses

sent the signal to the atrioventricular bundle. This bundle branches off into two bundles

and is carried to the centre of the heart to both sides. At the base of the heart, the

atrioventricular bundles start to branch into many fibres and trigger the ventricles to

contract. Then the right ventricle will send blood to the lungs and the left ventricle

pumps blood to the aorta (Electrocardiogram (ECG),n.d).

 The ECG that we learn today is called three-lead ECG. It has 3 lead pads placed

on the wrist, and ankles of the subjects that we will record the signal. This work is

based on the bipolar limb leads. The positive will be on the left ankle, the negative on

the right wrist and the ground will be on the right ankle. According to “Basic ECG

Theory, 12-Lead Recordings and Their Interpretation” we can see these lead

placements as viewing the electrical dipole from three different directions the three

leads now made up a plane. As the cardiac cycle begins the firing of the SA node in the

right atrium will be the first step on the sequences but its electrical signalling is not

strong enough to create an electrical potential with an amplitude high enough to be

recorded with distal electrodes. The depolarization of the SA node is conducted rapidly

throughout both the right and left atria, giving rise to the P-wave. the right and left

ventricles begin to depolarize resulting in the recordable QRS complex. The first

negative deflection (if present) is the Q-wave, the large positive deflection is the R-

wave, and if there is a negative deflection after the R-wave, it is called the S-wave. As

the QRS complex ends, the ventricles are completely depolarized and are beginning

contraction. Importantly, the exact shape of the QRS complex depends on the

placement of electrodes from which the signals are recorded (Electrocardiogram

(ECG),n.d).
Principle:

Electrocardiogram is a graphical record of electrical impulses generated by the cardiac

muscle during each cardiac cycle. The low amplitude potentials are detected on the

body surface through the electrodes that are attached to the chest wall, and upper and

lower limbs. These low amplitude signals are amplified by an electrocardiograph

machine which is then displayed on the monitor screen and the special graph paper.

There are a variety of systems available for the storage of vast amounts of digital ECG

data as part of electronic medical records.

Equipements:

Multiple lead ECG machines including cables and lead, electrodes (disposal suction

cups), electrically conductive gel, and cotton balls

Preparation of patient:

• Centre the patient on the bed, no part of the body should touch the side rails, head or

foot end of the bed.

• To obtain a good tracing, place the head end of the bed as flat as can be tolerated.
Method:

The patient was greeted and I was introduced. The procedures were explained to the

patient. The patient was reassured that the machine would not cause any discomfort or

electrocution. The patient was asked to remove all the metallic belongings to avoid

electrical interference during the recording, The conductive gel was applied over the

specific sites before placement of the limb leads or cups. The limb leads were applied

according to the colour codes. The limb leads were placed on the medial aspect of each

lower leg and forearm. The chest was assessed for the placement of precordial leads.

The electrodes were connected to the appropriate lead wires before pressing onto the

patient’s chest. This prevents the pressure from being applied to the chest area

(especially following open heart surgery or chest trauma). The patient was instructed to

relax and lied as still as possible. The ECG began recording by pressing the appropriate

button. When completed, the cables from the electrodes were removed. The electrodes

were left in place if the patient was likely to have repeated ECG, otherwise, the

electrodes were removed. The skin was cleansed using cotton bills or gauze.
Recording of ECG

- A standard 12-lead ECG records simultaneously the limb leads and precordial

leads Electrical changes are recorded on mm square graph paper moving at a

speed of 25mm/sec. The instrument is calibrated in such a way that 1 mv

produces 1 cm deflection in the vertical direction. Thus the X-axis is time (1mm =

0.04 sec) and the Y-axis is potential difference (1 mm = 0.1 mv).

Limb leads

o It include 3 bipolar leads (I, II, III) and 3 unipolar leads (aVR, AVL, aVF).

• Lead I: The electrode is placed between the right arm (white) and left

arm (black) with the left arm being positive.

• Lead II: The electrode is placed between the right arm (white) and left leg

(red) with the left leg being positive.

• Lead III: The electrode is placed between the left arm (black) and left leg

(red) with the left leg again being positive.

Precordial leads

o consist of 6 unipolar leads: V1, V2, V3, V4, V5 and V6.

o Placement of the precordial leads

▪ V1: Fourth intercostal space to the right of the sternum.

▪ V2: Fourth intercostal space to the left of the sternum.

▪ V3 : Midway between leads V2 and V4.

▪ V4 : Fifth left intercostal space at mid-clavicular line.

▪ V5:Level with V4 at the left anterior axillary line.

▪ V6 : Level with V5 at left mid-axillary line.

 Figure 4: Placement of limb lead and precordial leads

Components of ECG
Result:
Discussion:

From the result, a normal ECG wave is obtained. However, factors that contribute to

abnormalities of ECG are irregular heart, irregular heart rhythm, electrolyte imbalance,

heart attack, medication side effects and high blood pressure.

Questions:

a) Interpret normal ECG (duration and amplitude of its various components).

The figure shows a normal ECG diagram.

A normal ECG consists of

- P wave which has a normal duration of less than or equal to 0.11 seconds, with

an amplitude of 0.05-0.15mV

- PR interval which is normally between 0.12 and 0.20 seconds

 - QRS complex which has a duration of less than or equal to 0.12 seconds, with an

amplitude greater than 0.5 mV in at least one standard lead and greater than 1.0

mV in at least one precordial lead. The upper limit of normal amplitude is 2.5 –

3.0 mV.

- ST segment which can be slightly elevated (up to 2.0 mm in some precordial

leads), does not normally depress greater than 0.5 mm in any lead

- T wave which has an amplitude of at least 0.2 mV in leads V3 and V4 and at

least 0.1 mV in leads V5 and V6, Duration normally is 0.27 seconds.

- QT interval in which the duration is normally less than or equal to 0.40 seconds

for males and 0.44 seconds for females.

b) Calculation of the Heart rate.

Method 1: Counting the small boxes between two QRS complex

Heart rate = 1500/number of small boxes = 1500/14=107 bpm

 Method 2: Counting time interval between two QRS complex

1 small square = 0.04 s

1 large square = 0.2 s

Time interval between successive QRS waves = 0.04 x 14 = 0.56s

Heart rate = 60/Time interval between successive QRS waves = 60/0.56=107bpm

Method 3: Counting the large boxes between two QRS complex

Heart rate = 300/number of large boxes = 300/3=100 bpm

c) Calculation of the mean electrical axis of heart.

From the above diagram, it is concluded that the aVL is biphasic. The positive

perpendicular axis to aVL is +60o. Therefore, the mean electrical axis is +60 o. This is a

normal reading.
Conclusion:

The ECG graph was interpreted. P wave indicated atrial depolarization, PR interval

indicated the time taken for the impulse to travel from the SA node to the ventricles,

QRS complex indicated ventricular depolarization and T wave indicated ventricular

repolarization.
References:

Electrocardiogram (ECG) (n.d). NHS choices. Retrieved January 21, 2023, from

https://www.nhs.uk/conditions/electrocardiogram/#:~:text=An

%20electrocardiogram%20(ECG)%20is%20a,heart%20each%20time%20it

%20beats.

Understanding blood pressure readings. www.heart.org. (2022, October 31). Retrieved

January 21, 2023, from https://www.heart.org/en/health-topics/high-blood-

pressure/understanding-blood-pressure-readings