Exam 1 392 Outline
bruce protocol
Description: The Bruce protocol is one of the most commonly used treadmill protocols, especially in clinical exercise testing. It starts at a moderate speed with a significant incline, and both the speed and incline increase every 3 minutes. It is designed to progressively stress the cardiovascular system. Stage 1: 1.7 mph at 10% incline Stage 2: 2.5 mph at 12% incline Stage 3: 3.4 mph at 14% incline And so on, with both speed and incline increasing every 3 minutes. Use Case: The Bruce protocol is primarily used for maximal stress tests, such as in cardiac stress testing or VO₂ max testing to assess cardiovascular function and aerobic fitness. It is appropriate for individuals who are reasonably fit or can handle the progressively increasing intensity. Example: A patient undergoing a cardiac stress test to determine heart function or detect coronary artery disease.
RPE (rate of perceived exhaustion)
!!!!!!RPE Implies that it is a subjective measurement - two scales: the BORG scale (from 6-20)!!! correlates with HR; the other scale is way better for the patient - OMMI RPE scale (0-10) 0 at rest not moving, 10- calls for stop, I is walking at the slowest pace) - 10 is being chased by a bear and would rather stop than continue
heart failure!!!!
- HF is a complex and progressive clinical syndrome representing a common final stage of many different disorders of the heart with no absolute cure short of cardiac transplantation - Physiological characteristics: increased filling pressure and/or insufficient oxyegn delivery - HF can present with a reduced left ventricular ejection fraction or with a preserved left ventriculiar ejection fraction (preserved - because increase in ESV - more blood already present before filling)
HTN - genetics vs epigenetics
- Limited success in identifying specific genes that contribute to the development of the HTN - genetics alone cannot explain the development of HTN - Multifactorial disorder and dependent on several behavioral and environemntal factors operating independently and/or synergustically with genetics - Epigenetics - behaviors and environmental stresses that can change how codons express - one of the worst epigenetic factor is smoking - affects phenotypicaly produced traits from genes
explain how PAD affects different demographics
- Men and women are equally affected - Prevalence - Black people have a higher risk of developing PAD than Caucasian people, whereas Asians and Hispanics tend to have a lower risk - High healthcare costs related to PAD ACS occurs in the coronary artery - this is a syndrome which means it is a collection of signs and symptoms
what are signs of PAD
- Pain in legs with exertion (intermiddent claudication) - Muscle atrophy - Hair loss - Smooth shiny skin - dead skin cells - Skin that is cool to the touch especially if accompanies by pain while walking - Decreased or absent pulses in the feet - nonhealing ulcers or scores in the legs or feet - Cold or numb toes
how does stress affect HTN
- Two systems involved with the stress response are the hypothalamic-pituitary-adrenocortical axis (HPA) and the sympatho-adrenomedullary (SAM) system. - Both of these systems regulate vascular tone and totaly peripheral reistance ultimately influencing systemic BP
how does acetylcholine relate to the SA
- acetylcholine (hormonal) primary parasympathetic hormone
naughton protocol
Description: The Naughton protocol is even more gradual than the Balke-Ware protocol, and it is specifically designed for individuals who may have heart disease or are at high risk for cardiovascular events. The speed and incline both start very low, and adjustments are small.Stage 1: 2.0 mph at 0% incline for 2 minutesStage 2: 2.0 mph at 3.5% incline for 2 minutesStage 3: 2.0 mph at 7.0% incline for 2 minutesThe incline increases in small increments every 2 minutes. Use Case: This protocol is primarily used in cardiac rehabilitation or in patients who need a gentler test due to cardiovascular disease. It can also be used in elderly populations or those with physical limitations.Example: A post-cardiac surgery patient undergoing a low-intensity, controlled treadmill test to assess cardiovascular recovery.
modified bruce protocol
Description: The modified Bruce protocol is similar to the original Bruce protocol but starts with lower speeds and inclines. It is designed for people who may not be able to tolerate the high starting intensity of the Bruce protocol.Stage 1: 1.7 mph at 0% inclineStage 2: 1.7 mph at 5% inclineStage 3: 1.7 mph at 10% inclineAfter Stage 3, the protocol continues as the standard Bruce protocol. Use Case: This protocol is used in populations where a slower, gentler start is needed, such as older adults or individuals recovering from illness or surgery.Example: A patient in cardiac rehabilitation who requires a more gradual start but can eventually handle the increased intensity of the full Bruce protocol.
Ischemia
Diminished blood (and therefore oxygen) supply to an organ Associated with narrowing of coronary Arties due to atherosclerotic plaques Also can occur due to vasospasm (smooth muscle around a portion of the coronary artery contract intensely)
Adrenergic
Epid and norepi primary SNS neurohormones
discuss cycle ergometers as it relates to exercise modalities
Good option for patients who have ambulatory, orthopedic, or peripheral vascular limitation Compared with treadmills: - less expensive, more portable, and provide easier BP and ECG readings, less intimidating - lower max MET value (9% lower than treadmill), typicaly lower HR and higher SBP Concerns: localized leg fatigue before reaching CV max difficulty in maintaining pedal rate (benefit of electronicaly braked cycle ergonmeters) Diagnostic acuracy may be slightly better on a treadmill;
Parasympathomimetic
HR goes down
Sympatholytic
HR goes down
Parasympatholytic
HR goes up
Physical inactivity to be associated with increased incidence of _____
HTN why? Decreased risk HTN with active lifestyles - when you're active you release less sympathomimetic at rest), HR decreases at rest after exercise
what are the most frequent causes of essential hypertension
HTN include genetics, aging (loss of arteriol elasticity), psychosocial stress (sympathomimetic: cortisol, endorphins, norep/ep, etc.), obesity, DM, insulin resistance (this can be caused by the sharp suagr molecules scraping walls, causing wall damage, inflammation, clot, loss or neuropathy, and necrosis of tissues), alcohol abuse, sedentary lifestyle high salt consumption, and low potassium consumption
myocardial oxygen uptake
Myocardium extracts almost all of the oxygen from the blood and thus with increasing work, addition oxygen must come from increasing rate of blood flow via the coronary arteries
pulmonic system
Remove carbon dioxide from the blood Reoxygenate the blood
what is the pathophysiology of a stroke
Occurs when blood flow to a poart of the brain is obstructed, which can lead to loss of breain function and death - restrictive blood flow for the brain, increases the risk for long term disability - ischemic and hemorrhagic
what is the third leading causes of cardiovascular morbidity following MI and stroke
PAD
methods of revascularizing the myocardium
PCI and CABG
PCI
Percutaneous coronary intervention A catheter with a balloon is introduced via a peripheral artery, the balloon is inflated in the area of the blocked artery to dilate the lumen - In most cases a coronary stent is placed to prevent vascular recoil and restenosis - Concerns: restenosis and clots developing in the stent
what causes a plaque to rupture
Precipitated by hemodynamic shear forces, vasoconstriction, possibly by circulating substances Plaques that take up 40-50% of lumen - more likely to rupture than larger plaques!!!!!!!!!!!!!!!!!!!! - causes clots
what is stroke volume
Q̇ = HR x SV - Q = Cardiac Output Ml of blood/min!!!!! - HR = Heart Rate (Beats/min) - SV = Stroke Volume (mL per beat)
what is atherosclerosis (restatement of central theme)
Response to injury hypothesis Damaged endothelium leading to inflammation High BP, stress hormones, smoking/nictone, high, levels of circulating glucose and insulin can damage endothelium - Platelets adhere to damaged area and release growth factors that trigger smooth muscle cell proliferation, monocyte binding, and low density lipoprotein receptor activation - Monocytes infiltrate and become macrophages that accumulte cholesterol and become foam cells - Smooth muscle cells release growth factors that lead to development of fibrous connective tissue - Plaque forms most cause MI
shared risk factors for HF and CAD what are additional HF risk factors
Shared risk factors for HF and CAD: advanced age, male sex, hypertension, left ventircular hjypertrophy, obesity, DM (diabetes), smoking, dysplidemia (a lot of fat in BV), poor diet, sedentary lifestyle, and physcological stress Additional HF risk factors: a previous MI, valvular heart disease, and alcohol abuse
stroke epidemiology - provide prevalence and risks factors
Stroke is a cause of death for about 130,000 Americans each year - accounts for about 1 in 20 deaths The risk of having a stroke - varies by age, race, and ethnicity - High health care costs - Leading cause of serious long-term disabiluty - Major risk factors: high blood pressure, smoking, and inactivity
system circulation
Supply oxygenated blood and nutrients to brain and body Collect CO2 and other waste products
balke-ware protocol
Description: The Balke-Ware protocol is more gradual compared to the Bruce protocol, with speed remaining constant and only the incline increasing every minute. It starts with a low speed and a flat grade, with the incline increasing by 1% per minute.Stage 1: 3.3 mph at 0% inclineStage 2: 3.3 mph at 1% inclineStage 3: 3.3 mph at 2% inclineThis pattern continues, keeping the speed the same but progressively increasing the incline. Use Case: The Balke-Ware protocol is ideal for submaximal testing or for individuals who may not be able to handle the intensity of the Bruce protocol. It is often used for fitness assessments in populations with lower fitness levels, the elderly, or those with physical limitations.Example: A senior citizen undergoing a fitness assessment to determine baseline endurance and physical capacity without being pushed to maximal effort.
frank-starling mechanism of the heart (full review)
The Frank-Starling ventricular function curve in a normal heart (Top) An increase in left ventricular end-diastolic (LVED) pressure produces an increase in cardiac output (curve B) by means of the Frank-Starling mechanism The maximum force of contraction and increased SV are achieved when diastolic filling causes the muscle fibers to be strecthed about two and one half times their resting length After 2.5 resting length, the force will actually go down!!! This will get you the final points on the test In curve A, an increase in cardiac contractility produces an increase in cardiac output without a change in LVED volume and pressure (Bottom) Stretching of the actin and myosin filaments at the different LVED filling pressures As bloof volume increase, Q or SV increases as well
layers of the pericardium
The pericardium, a sac that surrounds the heart, has two layers: the fibrous pericardium and the serous pericardium: Fibrous pericardium The tough, outermost layer of the pericardium, made of connective tissue. This layer prevents the heart from expanding too much and helps anchor the heart in place. Serous pericardium The inner layer of the pericardium, made of two layers:Parietal layer: The outer layer of the serous pericardium, which is fused to the fibrous pericardium.Visceral layer: The innermost layer of the serous pericardium, which directly covers the heart and the roots of the great vessels
what does ability to participate in high intensity exercise reveal
When the exercise capacity, >9 METS, the 5-year value ~100% 1 MET = 3.5 ml/kg/min
inotropic factor
affects SV
Stable angina
angina symptoms provoked only during exertion
unstable angina
angina symptoms with or without provocation
what is a chronotropic factor
any factor that influences HR Chrono: time - tells you this has to do with HR and not SV
what is the main theme of the course
atherosclerosis will kill you Smoking/vaping nictonine will increase BP, and reduces the elasticity of the bloof vessels, with increased BP, damage will occur, then repair is necessary, inflammation, plaque, then reduced blood flow, turbulent blood flow, then the plaque may break off, then repair process, but instead of laying down fat cells, we lay down blood cells which then creates a clot, then moral thrombus, and then it breaks off and may cause a clot!!!!!!!!
-lytic
break apart/ the opposite
hypotensive values
but blood pressure readings of 90/60 mm Hg or less are generally considered low
CVD
cardiovascular disease
what is bad about antioxidant supplementation
causes body to stop producing antioxidant endogenously
CABG
coronary artery bypass graft Veins taken from the leg (saphenous vein) artery taken from within the chest (internal thoracic or mammary artery) or the forearm (radial artery) are used to bypass the coronary artery blockages
Hypertension
defined as a systolic BP > or less 130 mmHg and/or diastolic BP > 80 mmHg while at rest in a seated position confirmed by measurements taken on two separate days or taking antihypertensive medication!!!!!!! To ensure accurate readings, ensure standard conditions are in place, including 5-10 minutes of rest in a seated position with feet flat to the floor prior to measurement
distinguish the difference between diagnosis, prognosis, and therapeutic
diagnostic (identifies abnormal responses) - prognosis (identify the likely outocomes with a given pathology) - therapuetic (identify the impact of intervention)
90% of hypertension cases are
essential hypertension - idiopathic "the cause is unknown"
what speeds up the SA node
norepinephrine and epinephrine, and sometimes (slightly), dopamine
ABI value of .9-1
normal
what is the correlation between aging and HTN
people become increasingly exposed to factors such as inflammation, stress, prehypertension, and renal disorders the longer they live, and as a result, will have a greater change of developing HTN Aging also results in characteristic anatomical and physiological changes in the vasculature
PAD
peripheral artery disease Caused by atherosclerotic lesions/plaque buildup in the arteries of the lower extremities that restrict your blood flow distally
what are the most common causes of MI
plaque rupturing - Plaque from LDL/Cholesterol getting stuck - Blood vessel wall damage, plaque biproduct of - healing process
where does VD/VC occur
pretty much only occurs in arterioles, because this part of the blood vessel has the smooth muscle
10% of hypertensive cases are classified as
secondary hypertensive has a definitive cause such as renal failure, endocrine disorders, sleep apnea, neoplasms, and many more (secondary or directly caused by to another disease/condition)
< 0.4
severe disease
two systems of circulation
systemic and pulmonary
what is ejection fraction
the amount of blood ejected from the LV as a percentage of the EDV (SV/EDV) - what was pumped/what was there originally
Atherosclerosis
the pathological process whereby lesions (or plaques) from within arteries creating a narrow lumen and thus impairing blood flow rate of flow?/ atherosclerosis? is impacted by: lifestyle choices, especially smoking/nicotine use, level of PA, and diertary habits
ABI value of .7-.89
mild disease
-mimetic
mimic/ the same
ABI value of .4-.69
moderate disease
what affects the rate of the SA node
neural and hormonal influences, conducts electrical impulses the fastest
define ACS
Define Syndrome (a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms) -> in this case -> - Group of signs and symptoms indicative of prolonged restricted coronary blood flow - Symptoms: include chest discomfort, angina (chest pain or pressure), arm pain, diaphoresis, dyspnea, jaw pain, nausea, and vomiting - Women with myocardial ischemia may present with completely atypical symptoms (e.g., neck, jaw, and back pain; weakness; nausea; and fatigue)
Exercise testing contraindication
- Absolute contraindications: except in extraordinary cases, the patient should perform the exercise test - Relative contraindications: exercise tests should be considered if benefits gained outweigh the risks!!! There is a low absolute risk of exercise stress testing, about 1.5/10,000 tests for fatal or life-threatening events
diagnosis of PAD
- Ankle-brachial index (ABI): a measure of the ratio between the systolic BP at the ankle and at the brachium (arm) - Noninvasive vascular assessment (NIVA): combine ABI with visual ultrasounds
what is the difference between arteriosclerosis and atherosclerosis!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- Arteriosclerosis: hardening, thickening, and loss of elasticity of the arteries - Athersclerosis: fatty plaque buildup - Arteriolopathy: diseases of the arterioles
why is a high-sodium diet a risk factor for HTN
- Consider salt sensitivity which is defined as a 10 mmHg or greater increase in mean BP several hours after ingesting sodium - Two competing pathophysiologic mechanisms explain the strong correlation between sodium intake and BP: reduced clearance and endothelial dysfunction - Is salt bad for you? - yes it's the devil, recent evidence suggests that consuming excess sodium leads to hypertension, even if you are sodium-resistant
what is the pathophysiology of PAD
- Endothelial damage and arthersclerosis result in a stenosis or blockage of a peripheral artery - Impaired blood flow can prompt symptoms that vary - according to location, severity and number of blockages - Risk factors are like those for CAD and cerebrovascular disease, which share endothelial damage and atherosclerosis as underlying causes - Cigaerette smoking is the most potent risk factor for developing PAD
exercise testing indications
- Evaluating the causes of symptoms (angina pectoris, dyspnea, leg pain) suggestive of cardiopulmonary diseases - Identifying CAD in those at elevated risk 1st sign may be fatal, affects about 30% of men when women have less than 10% risk of being affect, - Risk stratification(e.g. post MI patients-therapy and intervention; patients considered for CABG) - Theraputic interventions (exercise interventions) - Risk stratification before in patients with known/suspected CAD or those at high risk for CAD - Evaluating the effectiveness of therapuetic interventions - Developing an exercise prescription - Evaluating individuals prior to returning to work for those whose jobs require physically demanding labor - Ruling out myocaridal infarction upon presentation to the emergency room with signs and symptoms diagnosic - find what caused the disease prognostic - how long until they'r gonna have another incident therapeutic - testing which one is the best for treatment
what is rate pressure product
- mV̇O2 would require invasive procedures so a simple indicator is rate-pressure product (HR x SBP) - this is myocardial VO2!!!! bpm x systolic blood pressure (mmHg) a measurement of myocardial oxygen consumption (MOC) and is used to indicate how much work the heart is doing. It's calculated by multiplying heart rate by systolic blood pressure. RPP is a reliable indicator of MOC and is widely used in clinical settings Rate pressure product (RPP) Indirect measure of myocardial oxygen consumption Calculated by multiplying HR x SBP - prevents you from having to do a thoracotomy for this measurement RPP at which angina (ischemia) occurs is very reproducible Normal range for RPP is 25,000 to 40,000
what are the possible contributors/effect modifiers
-oxidative stress (caused by oxidants - what antioxidants fight), - endothelial dysfunction (through hemodynamic movement (blood flow) is going to VC or VD, which scratches the surface, damage, etc) - arterial stiffness - these three things will contribute to hypertension!
Cholinergic
ACH is primary PNS neurohormone
exercise modalities (chat GPT)
. Exercise Modalities: Definition: This refers to the type or form of exercise. It is the broader category that describes the specific physical activity or training method being used. Examples:Cardio-based modalities: Running, cycling, swimming, walking Strength-based modalities: Weightlifting, resistance band training, bodyweight exercises Flexibility-based modalities: Yoga, Pilates, stretching exercises Mixed modalities: High-intensity interval training (HIIT), circuit training, CrossFit Modalities are often selected based on specific goals, such as improving cardiovascular endurance, building muscle, or enhancing flexibility. 2. Exercise Protocols: Definition: This refers to the structured plan or procedure followed during the exercise. It outlines the specifics of how the exercise is performed, including duration, intensity, rest periods, repetitions, sets, and progression. Examples: Strength training protocol: 3 sets of 10 reps at 80% of 1RM (one-rep max) with 60-second rest intervalsCardio protocol: Running for 30 minutes at 75% of maximum heart rateHIIT protocol: 30 seconds of high-intensity sprinting followed by 60 seconds of rest for 10 roundsStretching protocol: Hold each stretch for 30 seconds, repeat 3 times In summary: Exercise modalities are the types of exercises you do. Exercise protocols are the specific details on how those exercises are performed.
The Relationship Between METs and Relative VO₂:
1 MET = 3.5 mL/kg/min of VO₂ (this is the oxygen consumption at rest). To calculate the oxygen consumption for any given MET level:Relative VO₂ (mL/kg/min) = METs × 3.5For example, if you are performing an activity at 5 METs:Relative VO₂ = 5 × 3.5 = 17.5 mL/kg/min. to find met from VO2, divide by 3.5
what does CVD include
1). Acute coronary syndrome 2). Heart failure 3). Peripheral artery disease 4). Hypertension 5). Stroke 6). several other disorders
how is cardiac muscle different than skeletal muscle
1. Higher mitochondrial density - a) function? 2. Higher myofibril-to-capillary ratio - function?? 3. Intercalated discs - connect individual heart muscle cell to work as one function unit: cardiomyocytes
at what systolic and diastolic pressure is someone considered to be hypertensive
130-190 80-89
what are the normal systolic and diastolic ranges
< 120 < 80 no antihypertensive druge indicated
clinical exercise testing guidelines
As a diagnostic procedure, exercise testing must ultimately be supervised and evaluted by a physician, and a physican should always be immediately avaliable, even if the direct supervision (and even preliminary interpretation) is provided by other appropriately trained health care personnel, including CEPs Provide for - Modality should utilize large muscle groups, unless the patient has orthopedic or peripheral limitation, in which case arm ergonemtry is indictaed - Avoid isometric contractions (e.g., gripping handrails or handlebars) - decrease the likelihood and disproportionate increase in HR and BP - Start well below maximal (levels-starting point for the bruce treadmill protocol is about 5 METS, whcih may represent a near-maximal exercise level in some patients - Should last 8-12 minutes - 2-3 minute stages - Ramped protocols should have a gradual and regular increase in workload (1 MET per minute, although this may differ depending on exercise capacity) - Room temperature should be about 20 °C (72 F) with less than 60% relative humidity Ideal if there is a general movement of air over the patient - Exercise laboratory should contain approproate exercise modalities (treadmill, cycle ergometer, arm-ergometer), monitoring (ECG, blood pressure) equipment, and necessary emergency items (defibrillator, drug cart) - Appropraitely trained personnel (physicians, nurse practitioners, physician assistants, CEPs) should either be present or rapidly available (in less than one minute) to assure patient safety
when to use each treadmill modality
Bruce Protocol: Use when testing for maximal cardiovascular fitness or for diagnostic purposes (e.g., cardiac stress tests). Balke-Ware Protocol: Use for submaximal tests or for individuals with lower fitness levels, elderly populations, or those with physical limitations. Naughton Protocol: Use for patients with known cardiovascular disease or those in cardiac rehabilitation. Modified Bruce Protocol: Use for individuals who need a slower, more gradual introduction to exercise but can handle moderate intensities later. Each of these protocols serves different populations based on fitness level, clinical needs, or the specific goals of the test.
what were the treadmill modality protocols discussed
Bruce protocol, modified bruce, modified balke protocol, and modified naughton treadmill protocol
what is the number 1 cause of death for men and women in the US
CVD
evalute the use of a treadmill as an exercise modality
Common + familar mode of exercise - Compared to cycling, use greater muscle mass and so greater max MET level ~9% greater max MET level (better indicator of probability of future use) as well as typically higher maximal HR and rate pressure product - May be more increased myocardium demand, so increased stress on the heart - Realize use of handrails can impact estimation of exercise capacity
how does insulin resistance affect HTN
Impaired glucose tolerance and insulin resistance are strongly correlated with arteriolopathy that can develop into HTN (spiky glucose accumulating vs very small arterioles)
look at this image
In A, the catheter is inserted across the lesion. In B, the balloon is inflated, expanding the stent and compressing the plaque. In C, the catheter and deflated balloon have been removed. Before-and-after cross-sections of the artery show the results of the stent placement.
what kind of relationship lies bewteen obesity and BP
Linear relationship between BMI and BP Obesity-related HTN is caused by several probable pathogenic mechanisms including increased sympathetic nervous system activity and excessive production of pro-inflammatory cytokines acting on the endothelium (cytokines are small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells)
discuss arm ergometry as it relates to exercise modalities
Use if patient cannot perform lower body exercise - only time this is more useful Concerns: - less muscle mass involved (so lower VO2peak: 5-20% lower than treadmill values) - NOT VO2 MAX - difficulty in obtaining BP and ECG test endpoint often arm fatigue rather than CR max Because of the difficulties involved in performing arm ergometry testing, this modality has largely been replaced with pharmacologic stress testing, However: arm exercise capacity, like whole-body exercise capacity, is a strong indicator of prognosis may be prefersaable to pharmological stres stesting in some situations
stroke volume
Volume of blood ejected with each contraction!!! Difference between EDV and ESV (EDV-ESV)
Sympathomimetic
goes up
frank-starling mechanism of the heart - overview
in general, greater (left ventricle end of diastolic volume) LVED = higher stroke volume ( more volume that enters ventricle, higher the SV will be!!!!
what are things that affect SV
inotropic factors, frank-starling mechanism, adrenergic factors (ONLY at the SA node is there a higher density of adrenergic than the ventricles
Silent ischemia
is when no angina develops during ischemia and thus lack a major warning sign of CAD asymptomatic
ABI =
lower extremity systolic pressure ------------------- brachial artery pressure
Stroke/CVA
the sudden death of brain cells following either ischemia or hemorrhage
At rupture of plaque....
thrombus form - incorporated into plaque and/or forms mural thrombus (protrudes into the lumen) Mural thrombus (only refers to clot on the wall) may continue to increase in size ans can rapidly progress to completely occlude artery
ankle-brachial index measurement (ABI) used
to detect peripheral artery disease (PAD). Sensitivity: identify someone with disease as "positive" Specificity: identify someone without the disease as negative !!!!!!!!!!!!WHAT WILL BE ON THE EXAM IS THE ABILITY TO DIAGNOSE SOMEONE WITH PAD BASED ON THE VALUES PROVIDED IN THE CHART TO THE LEFT OF THE DIAGRAM, AS WELL AS THE ABI CALCULATION FORMULA: SYSTOLIC/BRACHIAL ARTERY PRESSURE!!!!!!!!! - Understanding the sensitivity and specificity - 95 % of true positive (sensitivity) and 99% true negative (specificity - when its positive, its positive, and when its negative, its negative.)
what slow does the SA node
vagus nerve and acetylcholine - neural and hormonal
Vagal
vagus nerve is the PNS nerve
vagus nerve in relation to the SA node
vagus nerves (neural) - important for parasympathetic nerve!!!!! High vagal tone, low BP, low HR, low resp rate - high sympathetic tone - everything the opposite
