Here are the normal parameters : Pressure          = 50-180 mmH2O Color                = clear RBC count       = 0-4 x 10^6/L WBC count      = 0-4 x 10^6/L Glucose            = >60% of the serum level Protein             = < 0.45 g/L Microbiology   = sterile//no growth Subarachnoid haemorrhage : Pressure increased, bloody, RBC count increased, WBC = normal/increased, glucose = normal, protein = increased, [...]

Complete heart block, also referred to as third-degree heart block, or third-degree atrioventricular (AV) block, is a disorder of the cardiac conduction system where there is no conduction through the AV node as shown below:    When you see this, emergently place temporay pacing in a hospital setting where plans for permanent pacer and cardiovascular [...]

Second-degree heart block, or second-degree atrioventricular (AV) block, refers to a disorder of the cardiac conduction system in which some atrial impulses are not properly conducted to the ventricles. Some P waves are not followed by a QRS. Second-degree AV block is composed of 2 types: Mobitz I or Wenckebach block, and Mobitz II. The [...]

First-degree heart block, or first-degree atrioventricular (AV) block, is defined as prolongation of the PR interval on the ECG to more than 200 msec.   While the conduction is slowed, there are no missed beats. ECG of a patient with first-degree heart block is shown below. First-degree AV block is more common among African Americans compared [...]

Left bundle branch block (LBBB) occurs when transmission of the cardiac electrical impulse is delayed or fails to be conducted along the rapidly conducting fibers of the main left bundle branch or in both left anterior and posterior fascicles.  Thus, the left ventricle slowly depolarizes by means of cell-to-cell conduction that spreads from the right [...]

Ventricular filling during atrial contraction Due to decreased ventricular compliance  (CAD, AS, MR, HCM, Diabetic Cardiomyopathy) ****No S4 during Atrial Fibrillation The S4 heart sound is associated with any process that increases the stiffness of the ventricle including: –>hypertrophy of the ventricle –>long-standing hypertension (causes ventricular hypertrophy) –>aortic stenosis (causes ventricular hypertrophy) –>overloading of the [...]

May be normal in people under 40 years of age and some trained athletes but should disappear before middle age.   Caused by the oscillation of blood back and forth between the walls of the ventricles initiated by in-rushing blood from the atria. Due to: 1.Rapid ventricular filling   Ventricular decompensation (acutely)   Ventricular Septal [...]

Closure of aortic and pulmonic valves just after systole. Persistently split S2 (widened S2) is due to pulmonic stenosis, PE, or RBBB (all cause delayed function of right ventricle.) A young girl with a split S2 and with RBBB on ECG is Pulmonic Stenosis. Not ASD or VSD. Normally heard as split during inspiration. The split [...]

Normally heard as a single sound, occasionally a narrow split Heard during the onset of systole Due to closure of the mitral and tricuspid valve Loud S1 : pregnancy, anemia, anxiety, thyrotoxicosis, mitral stenosis Soft S1 : heart failure, mitral regurgitation

Blood Pressure Control Rates  Hypertension is the most common primary diagnosis in America (35 million office visits as the primary diagnosis).5 Current control rates (SBP <140 mmHg and DBP <90 mmHg), though improved, are still far below the Healthy People goal of 50 percent, which was originally set as the year 2000 goal and has [...]

Evaluation of hypertensive patients has three objectives: (1) to assess lifestyle and identify other cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment (table 6); (2) to reveal identifiable causes of high BP (table 7); and (3) to assess the presence or absence of target organ damage and CVD.  Patient evaluation [...]

The accurate measurement of BP is the sine qua non for successful management. The equipment—whether aneroid, mercury, or electronic—should be regularly inspected and validated. The operator should be trained and regularly retrained in the standardized technique, and the patient must be properly prepared and positioned. The auscultatory method of BP measurement should be used.58 Persons [...]

The relationship between BP and risk of CVD events is continuous, consistent, and independent of other risk factors. The higher the BP, the greater the chance of heart attack, HF, stroke, and kidney diseases. The presence of each additional risk factor compounds the risk from hypertension as illustrated in figure 12. The easy and rapid [...]

Because of the new data on lifetime risk of hypertension and the impressive increase in the risk of cardiovascular complications associated with levels of BP previously considered to be normal, the JNC 7 report has introduced a new classification that includes the term “prehypertension” for those with BPs ranging from 120–139 mmHg systolic and/or 80–89 [...]

Data from the National Health and Nutrition Examination Survey (NHANES) have indicated that 50 million or more Americans have high BP warranting some form of treatment. Worldwide prevalence estimates for hypertension may be as much as 1 billion individuals, and approximately 7.1 million deaths per year may be attributable to hypertension. The World Health Organization [...]