Name: MARQUEZ, MICHELLE D. Student no.

: 20181385
Block: BSN 3 BLOCK 4

ASYNCHRONOUS LEARNING ACTIVITY: SIGNS AND

SYMPTOMS WITH PHYSICAL ASSESSMENT CARDIOVASCULAR
DISORDERS NOTES (OCTOBER 9, 2020, FRIDAY)

A. Discuss the concepts of Pulse Pressure, what are the

significances/interpretation if Pulse Pressure is below and above the normal
range.

Pulse pressure is the difference between the systolic and diastolic blood pressures.
Pulse Pressure = Systolic Blood Pressure – Diastolic Blood Pressure
The systolic blood pressure is defined as the maximum pressure experienced in the
aorta when the heart contracts and ejects blood into the aorta from the left ventricle
(approximately 120 mmHg). The diastolic blood pressure is the minimum pressure
experienced in the aorta when the heart is relaxing before ejecting blood into the
aorta from the left ventricle (approximately 80 mmHg). Normal pulse pressure is,
therefore, approximately 40 mmHg.
A change in pulse pressure (delta Pp) is proportional to volume change (delta V) but
inversely proportional to arterial compliance (C):
Delta Pp =  Delta V/C
Because the change in volume is due to the stroke volume of blood ejected from the
left ventricle (SV), we can approximate pulse pressure as:
Pp = SV/C
A normal young adult at rest has a stroke volume of approximately 80 mL. Arterial
compliance is approximately 2 mL/mm Hg, which confirms that normal pulse
pressure is approximately 40 mm Hg.
Arterial compliance is equal to the change in volume (Delta V) over a given change in
pressure (Delta P):
C = Delta V/Delta P
Because the aorta is the most compliant portion of the human arterial system, the
pulse pressure is the lowest. Compliance progressively decreases until it reaches a
minimum in the femoral and saphenous arteries, and then it begins to increase again.
This concept requires an understanding of the effect of pressure wave reflection on
amplification of aortic pressure and thus pulse pressure. The phenomenon mainly
occurs in the lower body, especially the lower extremities where pressure waves
reflect back due to vessel branching, and the vessels are less compliant (stiffer)
When a reflected wave is in phase with a forward wave, it generates a wave with
higher amplitude. An analogy here is waves bouncing off a seawall and interacting
with an incoming wave. If they are in phase, the wave height is greater.
A pulse pressure that is less than 25% of the systolic pressure is inappropriately low
or narrowed, whereas a pulse pressure of greater than 100 is high or widened.
B. Discuss pulsus alternans and pulsus paradoxus.

PULSUS ALTERNANS
Variation in pulse amplitude occurring with alternate beats due to changing
systolic pressure. The best appreciated to apply light pressure on peripheral arterial
pulse, and can be confirmed by measuring blood pressure.

 Etiology
- the most important cause is in the left ventricular failure
- Clinical Practice: true pulsus alternans is rarely seen in absence of significant
left ventricular myocardial failure. And prompt further investigation to determine
severity and cause of left ventricular dysfuntion
-Pulsus alternans occurs, the exclusively systolic heart failure (low left ventricular
ejection fraction). while the rarely is diastolic heart failure (preserve ejection fraction)
- the left ventricle pulsus alternans w/out systemic arterial pulsus alternans-
hypertrophic cardiomyopathy and significant rest/ provocable outflow gradient
- the cardiac tamponade is rare
- tachypnea, pulse abnormality disappears when respiration is held transiently
-severe aortic regulation
-absence of left ventricular systolic dsynfunction it is rare
 Mechanism
- the mechanism is unclear and incomplete relaxation.
-changes in afterload (lower before strong beat) because of lower output during
weak beat, may also contribute.
- the primary mechanism is to change in ventricular contracitility
PULSUS PARADOXUS
Is defined as an abnormal decrease in pulse strength and blood pressure during
inspiration. It is commonly seen in patients with hyperinflamation and air trapping and
may also be observe in those with pericarditis or cardiac tamponade.
-The variable reduction in blood pressure also can cause some peripheral pulses
to be ‘lost’, accounting for the irregularity.
- this is not to be confused with pulsus alternans, in which alternating strong and
weak beats are palpated. Pulsus alternans, in which alternating strong and weak
beats are palpated. Pulsus alternans almost always indicates left ventricular systolic
failure, as can occur in mitral or aortic valve disease and hypertrophic and
congrestive cardiomyopathy.

C. Create a concept/mind map for us to be familiar with pulse quality.

PULSE QUALITY

RHYTHM RATE STRENGTH

 REGULAR -WITHIN THE NORMAL -STRONG
 IRREGULAR LIMITS -BOUNDING
-THREADY
Create a summary notes/synopsis paper for Cardiac Auscultation.

Auscultation of the heart requires excellent hearing and the ability to distinguish
subtle differences in pitch and timing. Hearing-impaired health care practitioners can
use amplified stethoscopes. High-pitched sounds are best heard with the diaphragm
of the stethoscope.
A stethoscope is used to auscultate for heart sounds. The diaphragm of the
stethoscope is used to identify high-pitched sounds, while the bell is used to identify
low-pitched sounds.
Auscultating (how to listen to heart sounds) heart sounds for assessing S1, S2,
S3, and S4 along with heart murmurs. Listening to the heart with a stethoscope is the
best way to conduct the heart assessment during a nursing assessment of the
cardiovascular system. Auscultation of heart sounds allows the nurse to assess valve
closure of the aortic, pulmonic, tricuspid, and mitral (bicuspid) valves. S1 is the
closure of the AV valves which are the tricuspid and mitral valves, and S2 is the
closure of the SL valves aortic and pulmonic. During the assessment of heart sounds
it is important to position the patient correctly to increase sound quality and to be
familiar with the heart auscultation sites.