Physiology

1.
Blood Pressure:
Blood pressure is a measure of the force that
your heart uses to pump blood around the
body or the pressure of blood pushing
against the walls of arteries.
1.1 Importance:
Normal pressure is very important for the
proper flow of blood from the heart to the
body's organs and tissues. Each heart beat
forces blood to the rest of the body. Near
the heart pressure is higher, and away from the heart the pressure is lower.
2. Measurement Of Blood Pressure:
Blood pressure is measured in millimeters of mercury (mm Hg).
2.1 Blood pressure is measured as two numbers:
2.2 Systolic Blood Pressure:
"Systolic" is derived from the Greek systole which means "a drawing together or a
contraction." The term has been in use since the 16th century for the contraction of
the heart muscle.
It measures the pressure in the arteries when the heart beats.
Systolic means the blood pressure when the heart is contracting. It is the maximal
arterial pressure during contraction of left ventricle of heart.
2.2.1 Systole:
The time during which ventricular contraction occurs is known as systole.
2.2.2 Reading:
In a blood pressure reading, systolic blood pressure is the first number recorded.
The blood pressure normal range is 120/80 over which 120 is the systolic blood
pressure. Normal systolic blood pressure is 120 millimeters of mercury
(120mmHg).
2.2.3 Systolic Murmur:
A systolic murmur is a murmur when the blood leaves the heart and is also known
as innocent heart murmur.
2.3 Diastolic Blood Pressure:
It measures the pressure between arteries when the heart rests between the beats.
Diastolic means the blood pressure when the heart is relaxing.
2.3.1 Diastole:
The phase of the heartbeat when the heart muscle relaxes and allows the chambers
to fill with blood.
2.3.2 Reading:
In a blood pressure reading, diastolic blood pressure is the second number
recorded. The blood pressure normal range is 120/80 over which 80 is the diastolic
blood pressure. Normal diastolic blood pressure is 80 millimeters of mercury
(80mmHg).
2.3.2 Diastole Murmur:
A diastolic heart murmur is an unusual “whoosh” sound in your heart. occurs
during heart muscle relaxation between beats.
Figure 2:
Position of heart during contraction and relaxation
2.4 Manual Blood Pressure Measurement:

To begin, place the cuff on your bare upper arm one inch above the bend of your
elbow. Pull the end of the cuff so that it's evenly tight around your arm. You
should place it tight enough so that you can only slip two fingertips under the top
edge of the cuff. Make sure your skin doesn't pinch when the cuff inflates.
Figure 3: Manual measurement of Blood pressure
2.5 Digital Blood Pressure Measurement:

Oscillatory devices produce a digital readout
and work on the principle that blood flowing
through an artery between systolic and
diastolic pressures causes vibrations in the
arterial wall which can be detected and
transduced into electrical signals.
3. Classification:
3.1 Systemic Arterial Pressure:
In general, an individual's “blood pressure,” or systemic arterial pressure, refers
to the pressure measured within large arteries in the systemic circulation.
I. Fetal blood pressure:
During pregnancy, it is the fetal heart but not the mother's heart that develops the
fetal blood pressure to operate blood through the fetal circulation.
The average blood pressure for full-term infant:
 Systolic 65–95 mmHg
 Diastolic 30–60 mmHg
II. Childhood:
In children, the normal values for blood pressure are lower as compared to adults
and it depend on height of an individual.
Ranges for blood pressure (BP) in children
Systolic BP, Diastolic BP,

Stage Approximate age
mmHg mmHg
Infants 0 to 12 months 75–100 50–70
Toddlers and
1 to 5 years 80–110 50–80
preschoolers
School age 6 to 12 years 85–120 50–80
Adolescents 13 to 18 years 95–140 60–90
III. Senescent adults:

In aging adults, systolic blood pressure begins to rise from early adulthood onward,
up to at least age 70 whereas diastolic pressure starts to rise at the same time but to
start to fall earlier in mid-life, approximately age 55.
3.2 Systemic Venous Blood Pressure:
Systemic Venous pressure is the vascular pressure in a vein or the atria of the
heart. It is much lower than arterial pressure, with common values of 5 mmHg in
the right atrium and 8 mmHg in the left atrium. Variants of venous pressure
include:
1. Central venous pressure, Central venous
pressure (CVP) is the pressure in the
thoracic vena cava near the right atrium.
2. Jugular venous pressure (JVP), provides
indirect measurement of central venous
system. It is important in differentiating
varieties of heart and lung diseases.
3. Portal venous pressure or the blood
pressure in the portal vein. Its value is 5–
10 mmHg.
3.3 Pulmonary Pressure:

The pressure in pulmonary artery is pulmonary pressure.
Its normal value is 15 mmHg at rest.
Pulmonary hypertension happens when
the pressure in the blood vessels leading
from the heart to the lungs is too high. It
leads to interstitial edema if the pressure
exceeds to above 20 mmHg, and
to pulmonary edema at pressures above
25 mmHg.
4. Harmones that regulate blood pressure:
Hormones produced either by the kidney or in other parts of the body affect kidney
function to maintain fluid and electrolyte balance and blood pressure.
The hormones that regulate kidney function are as follows:
4.1 Renin:
The macula densa cells sense a drop in blood volume or blood pressure and signal
the juxtaglomerular cells to release renin in the blood. The renin activates the
renin-angiotensin-aldosterone system which increases the sodium and water
reabsorption thereby increasing the blood volume and blood pressure.
4.2 Angiotensin II:
Renin converts angiotensinogen to angiotensin I. Angiotensin I moves to the lungs

where it is converted into angiotensin II by the angiotensin-converting enzyme.
Angiotensin II is very potent and leads to constriction of blood vessels. stimulates
the adrenal cortex to release aldosterone and the posterior pituitary gland to release
the anti-diuretic hormone (ADH). The increase in peripheral resistance due to
vasoconstriction increases blood pressure. The increase in sodium reabsorption by
aldosterone and water reabsorption by ADH increases the blood volume and blood
pressure.
4.3 Anti-diuretic hormone (ADH):
It controls the concentration and dilution of the urine. A low blood volume
indicates high osmolarity of the blood. The hypothalamus signals the pituitary
gland to release ADH which increases water reabsorption in the kidney thereby
increasing the blood volume and concentrating the urine.
4.4 Aldosterone:
This hormone is produced via the renin-angiotensin-aldosterone system in response

to low blood volume and a high concentration of potassium in the serum.
Aldosterone increases sodium reabsorption by stimulating the sodium-potassium
ATPase and the epithelial sodium channels that increase sodium reabsorption and
potassium secretion.
4.5 Atrial natriuretic peptide (ANP):
The atria release ANP when the atrial pressure is high. It inhibits the renin-
angiotensin-aldosterone system which decreases sodium reabsorption and increases
sodium excretion in the urine to stabilize the blood volume and blood pressure.

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1.

2.4 Manual Blood Pressure Measurement:

Figure 3: Manual measurement of Blood pressure

2.5 Digital Blood Pressure Measurement:

Ranges for blood pressure (BP) in children

Systolic BP, Diastolic BP,

Infants 0 to 12 months 75–100 50–70

School age 6 to 12 years 85–120 50–80

Adolescents 13 to 18 years 95–140 60–90

III. Senescent adults:

3.3 Pulmonary Pressure:

4. Harmones that regulate blood pressure:

Renin converts angiotensinogen to angiotensin I. Angiotensin I moves to the lungs

4.3 Anti-diuretic hormone (ADH):

This hormone is produced via the renin-angiotensin-aldosterone system in response

4.5 Atrial natriuretic peptide (ANP):

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