Rob MacLeod
The purpose of the lab is to learn about measuring the ECG and blood
pressures and observing the effects of exercise on blood pressure, heart
rate, and electrocardiogram (ECG).
This lab will build on the class material we have covered on blood flow and
pressure, cardiac contraction, regulation of heart rate and function, and
the ECG.
To prepare, please review the notes and text on the ECG, the cardiac cycle,
and blood pressure measurements and also read the section in your text (or
any other good physiology book) on exercise.
See the web site
www.ktl.fi/publications/ehrm/product2/part_iii3.htm
for a
description of this measurement.
Arterial blood pressure is measured by a sphygmomanometer. This consists of:
Figure 1 below shows how blood pressure is measured.
After the cuff is placed snugly over the arm, the radial artery is palpated
while the pressure is increased until the pulse can no longer be felt, then
30 mm Hg. more. As the pressure is released the artery is palpated until
the pulse is felt again. This palpatory method will detect systolic
pressure only.
The auscultatory method detects diastolic as well as systolic pressure.
The sound heard when a stethoscope bell (or diaphragm) is applied to the
region below the cuff were described by Korotkow in 1905 and are called
Korotkow's sounds.
The artery is compressed by pressure and as the pressure is released the
first sound heard is a sharp thud which becomes first softer and then
louder again. It suddenly becomes muffled and later disappears. Most
people register the first sound as Systolic, the muffled sound as the first
diastolic and the place where it disappears as the second diastolic. It
requires practice to distinguish the first diastolic, so, for our
laboratory, we will record only the first sound (systolic) and the
disappearance of the sound (second diastolic). These will not be difficult
to elicit, and a little practice will enable you to get the same reading on
a fellow student three times in succession.
A defective air release valve or porous rubber tubing connections make it
difficult to control the inflation and deflation of the cuff. The
aneroid manometer gauge tube should be clean.
If an aneroid manometer is used, its accuracy must be checked regularly
against a standard manometer. The needle should indicate zero when the
cuff is fully deflated.
The lab is divided into 4 sections, the first 3 of which you should do in
parallel in the usual paired groups. Half the class should start with the
blood pressure measurements while the other half starts with the ECG
measurements. For the final section, please form groups of 4-7 as this
exercise needs more people to carry out.
The subject lies down with both arms resting comfortably at his sides or
sits quietly with arm hanging down, elbow slightly bent-the goal is to
have the arm at the same level as the heart. Wrap the sphygmomanometer
cuff about the arm so that it is at heart level. The air bag inside the
cuff should overlay the anterior portion of the arm about an inch above the
antecubital fossa--the depression on the inside of the elbow joint. Note
the ``Artery'' label and the arrow that should sit over the center of the
inside of the elbow. The cuff should be wrapped snugly about the arm.
Palpate the radial pulse with the index and middle fingers near the base of
the thumb on the anterior surface of the wrist. While palpating the radial
pulse, rapidly inflate the cuff until the blood pressure manometer reads
200 mm Hg pressure. Set the valve on the rubber bulb so that the pressure
leaks out slowly (about 5 mm per second). Continue palpating the radial
pulse, and watch the manometer while air leaks out of the cuff. Note the
pressure at which the pulse reappears.
Record the pressure: mm Hg.
Elevate the pressure in the cuff 20 mm Hg higher than the pressure at which
the radial pulse reappeared in A. Apply the stethoscope bell lightly
against the skin in the antecubital fossa over the brachial artery. There
will be no sounds heard if the cuff pressure is higher than the systolic
blood pressure because no blood will flow through the artery beyond the
cuff. As the cuff is slowly deflated, blood flow is turbulent beneath the
stethoscope. It is this turbulent flow that produces Korotkow's sounds.
Laminar flow is silent. Thus when the cuff is deflated completely, no
sounds are heard at the antecubital fossa. Deflate the cuff completely and
allow the subject to rest for a few minutes. DO NOT REMOVE THE CUFF
Palpate the radial artery, and elevate the pressure in the cuff to 20
mm Hg. Higher than that at which the radial pulse reappeared. Apply the
stethoscope to the skin over the brachial artery, and allow pressure to
leak slowly from the cuff. Note the pressures:
The pressure at which the sound was first heard is recorded as systolic
blood pressure. Allow the pressure to continue to fall. The Korotkow's
sounds grow more and more intense as the pressure is reduced. Then they
suddenly acquire a muffled tone and finally disappear.
The pressure observed at the first muffled tone is the first Diastolic
pressure.
The pressure observed when the sound disappears is the second diastolic
pressure. Record this pressure as the diastolic pressure for this
laboratory. (Note: In practice you should record both diastolic
pressures.)
Repeat the blood pressure determination at least three times, or until
sufficient proficiency is acquired that agreement is obtained between
consecutive readings. Blood pressure is recorded with the systolic
pressure reading first,
e.g., 120/80 means Systolic 120 mm Hg; Diastolic 80 mm Hg.
Pulse Pressure is the difference between Systolic and Diastolic blood
pressure.
How do the measurements from these two methods compare? Which do
you think was more accurate and why? Try and explain any differences in
results.
One can measure the approximate venous pressure by noting how much above
the level of the heart an extremity must be so that hydrostatic and venous
pressures are equal. At that point, there is barely enough venous pressure
to lift blood against the hydrostatic pressure of the elevate limb.
With the subject sitting quietly next to a bench, with one arm lying on the
bench-top, observe the veins on the back of the relaxed hand1. While the subject is reclining, passively raise
and lower the subject's arm and observe for filling and collapsing of the
veins of the back of the hand. Measure the distance in millimeters from
the position where the veins are just barely collapsed to the level of the
heart (in the sitting subject approximately at mid-thorax. This will give
the venous pressure in mm of blood.
Venous pressure in mm of blood =
The specific gravity of blood is 1.056.
mm of blood *
Sp.Gr. of blood = mm of mercury *
Sp.Gr. of mercury
Venous pressure in mm Hg. =
The ``limb leads'' are part of the legacy of Wilhems Einthoven, developer
of the string galvanometer and winner of the 1926 Nobel Prize for his
advances in electrocardiography. The idea was to capture the projection of
the cardiac dipole in the frontal plane based on an equilateral triangle
coordinate system. The underlying formalism of the limb lead (and the
Frank lead) system is the lead field, a function that projects a current
dipole source to any point on the body surface as shown in
Figure 2. The lead field vector
is specific to
a set of electrode locations and when multiplied by the current dipole
vector
, the result is a scalar value equal to the potential
difference between the electrodes of the lead.
The goal of this part of the lab is just to learn the basics of measuring
an ECG. Figure 3 illustrates the limb lead ECG, with
three electrodes forming three difference measurements or ``leads''. We
will use the remaining electrode as the reference in each case and record
the lead from the other two electrodes. Note the polarity of each of the
limb leads and try to mimic them in your measurements.
The steps in setting up this basic ECG measurement are as follows:
You can check that you have proper polarity by comparing the measured
signals to the sample in Figure 5 below.
Now ensure that you have a good signal on the oscilloscope, make
adjustments as necessary, and then:
The goal of this part of the lab is to record the response of a test
subject to moderate exercise. For this, each team needs 4-6 people
organized as follows (See Figure 6):
There are two protocols for these experiments, but before beginning, let
the subject warm up and make sure he/she is comfortable on the bike and has
selected a comfortable gear and resistance setting to be able to complete
8-10 minutes of pedaling with moderate exertion.
For this part of the protocol, use the same ECG setup as above, recording
all 3 limb leads simultaneously on the computer and monitoring at least 1
of them on the oscilloscope.
To ensure a constant or controlled load, we will use a metronome to
determine the pedaling cadence (rate) of the subject. Make the
own metronome from a signal generator, as follows:
Some additional technical aspects to note:
The goal for this protocol is to apply a graded stress to the subject and
observe the response. For this, have the subject select a gear that he/she
can maintain over a cadence range of about 60-90 rpm. The subject will
spend 2 minutes at each cadence, then stop for measurements, then continue
at an increased cadence for 2 minutes, and so on.
Work out beforehand a sequence of cadences and associated periods that will
span at least 60-90 rpm in 4 steps.
As with the previous report, concentrate on presenting the results and
discussion of them rather than the methods and background sections. You
may choose to include the discussion with the results or have separate
results and discussion sessions. It is up to you.
Include results and discussion for the following parts of the lab:
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ECG, Blood Pressure, and Exercise Lab
1 Purpose and Background
Purpose:
Background
1.1 Blood Pressure measurement
1.2 Sources or error in blood pressure measurement
1.2.1 Faulty Technique
1.2.2 Defective Apparatus
2 Procedure
2.1 Arterial blood pressure measurement
2.1.0.1 Palpatory method:
This is Systolic pressure
as detected by palpation. Allow the pressure to continue to decrease,
noticing the changes in the strength of the radial pulse.
2.1.0.2 Auscultatory method:
2.1.0.3 Palpatory and Auscultatory methods simultaneously:
(1) At which the radial pulse is first felt: mm Hg.
(2) At which the sound is first heard with the stethoscope:
mm Hg.
2.2 Venous blood pressure
2.2.1 Estimation of Venous Pressure
The specific gravity of mercury is 13.6.
Compute the venous pressure in mm Hg using the equation
2.3 ECG Measurement
2.4 Response to exercise
2.4.1 ECG measurement
2.4.2 Setting exercise workload with the metronome
2.5 Tips
2.5.1 Constant load protocol
2.5.2 Graded load protocol
3 Lab Report
About this document ...
ECG, Blood Pressure, and Exercise Lab
Copyright © 1997, 1998, 1999,
Ross Moore,
Mathematics Department, Macquarie University, Sydney.
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Rob Macleod
2006-03-31