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The Heart

The function of the heart is to circulate blood around the body. The heart comprises of four
chambers:

 Right Atrium
 Left Atrium
 Right Ventricle
 Left Ventricle

Functionally the heart comprises of two pumps:

 The right atrium receives blood from the body (de-oxygenated blood) and the right
ventricle pumps it into the lungs for aeration (removal of carbon dioxide and to add
oxygen).
 The left atrium receives the oxygenated blood from the lungs and the left ventricle
pumps it around the body.

Blood Pressure

Blood pressure represents the force (pressure) exerted by blood against the arterial walls
during a cardiac cycle (heart beat) which consists of heart muscle contraction (systole) and
heart muscle relaxation (diastole).
Systolic blood pressure, the higher of the two pressure measurements, occurs as the heart
muscles contract pumping blood into the aorta. Heart muscles then relax allowing the heart
to refill with blood and the lowest pressure reached represents the diastolic blood pressure.

Normal systolic blood pressure in an adult varies between 110 and 140 mm Hg, and
diastolic pressure varies between 60 and 90 mm Hg.

Blood Pressure Classification

The following table is the NICE[4] classification of blood pressure levels. (Note: "mm Hg"
means millimeters of mercury)

Systolic(mm Hg) Diastolic(mm Hg) Classification


<130 <85 Normal
130-139 85-89 High Normal
140-159 90-99 Hypertension (stage 1)
160-179 100-109 Moderate Hypertension (stage 2)
>180 >110 Severe Hypertension (stage 3)

Resting Heart Rate


The resting heart rate for the average person is between 70 and 90 beats per minute
(bpm). The term tachycardia is applied to a rapid heart rate (over 100 bpm) and the term
bradycardia indicates a slow heart rate (less than 50 bpm). Endurance athletes may have a
resting heart rate of less than 50 bpm.

Cardiac Output

This is the amount of blood pumped from your heart and is calculated by multiplying heart
rate by stroke volume (the amount of blood ejected by the heart in each beat). An
endurance athlete will have a lower resting heart rate and a larger stroke volume than a
non-athlete. The cardiac output for an endurance athlete is approx. 35 litres while that for
the non-athlete is 22 litres.

Starling's Law of the Heart

Starling's law of the heart states that the stroke volume of the heart increases in response
to an increase in the volume of blood filling the heart. A paper by Solaro (2007)[3] examines
the mecahnism of Starling's Law.

Blood Pressure daily variations

Research by Millar-Craig et al. (1978)[1] found that blood pressure was lowest at 3-am and
began to rise again during the early hours of the morning before waking.

Classification of the Hypertensive Disorders of Pregnancy

Higgins et al. (2001)[2] defines the clasifications as:

 Chronic hypertension - hypertension (>140 mm Hg systolic or >90 mm Hg


diastolic) that is present and observable before pregnancy or that is diagnosed
before the 20th week of gestation
 Pre-eclampsia-eclampsia - usually occurs after 20 weeks of gestation
 Pre-eclampsia superimposed upon chronic hypertension - with hypertension
and no proteinuria early in pregnancy <20 weeks, new-onset proteinuria (urinary
excretion of 0.3 g Protein or greater in a 24-hour specimen)
 Gestational hypertension - blood pressure elevation detected for the first time
after mid pregnancy, without proteinuria
How the Heart Functions

The "SA Node" (see diagram) is the


heart's pacemaker which sends out an
electrical signal causing the Atrium to
contract and to pump blood into the
ventricle.

The electrical impulse is conducted to


the ventricle via the "AV Node" causing
the muscle to contract and to pump
blood out.

Oxygen enriched blood from the lungs


enters the left atrium and the left
ventricle pumps it out to the body.

Blood from the body, which contains


carbon dioxide (CO2), enters the right
atrium and the right ventricle then
pumps the blood out to the lungs to
have the CO2 removed and replenished
with oxygen.
Simplified Normal ECG Trace
Normal Heart ECG Trace

The diagram opposite reflects a


simplified normal heart
electrocardiogram (ECG).

The "P Wave" represents the electrical


activity of the SA Node and atrium.

The "QRS Interval" represents the


electrical activity of the ventricle.

The "T Wave" represents the ventricle


relaxing ready for the next electrical
impulse - known as repolorisation.

"Q-T Interval" is the measurement of


repolorisation.