Page 60 - Clinical Pearls in Cardiology

48 Clinical Pearls in Cardiology

27. What can you do to increase the audibility of the
Korotkoff sounds?
The low frequency Korotkoff sounds are sometimes
inaudible in some people. In such individuals, the
intensity of the Korotkoff sounds can be increased by
adopting any of the following maneuvers:
• By asking the person to open and clench his fist
several times before taking BP
• By inflating the cuff very quickly
• By elevating the person’s arm before inflating the cuff
• By using the bell of the stethoscope to auscultate.
28. What precautions should be taken while recording
blood pressure in those with cardiac arrhythmias and
in pregnant women?
Certain clinical conditions may complicate blood
pressure measurement. In the case of arrhythmias (e.g.
atrial fibrillation), irregularity in the timing of Korotkoff
sounds can decrease the accuracy of a single blood
pressure value. Accuracy can be improved by decreasing
the rate of deflation of cuff and by taking the average
of at least three blood pressure recordings in the same
limb (Fig. 10).
Atherosclerotic vascular disease can result in the
persistence of audible Korotkoff sounds despite deflation
of the cuff to zero mm Hg (i.e. prolonged Korotkoff phase
4 or absence of Korotkoff phase 5). This is called as
persistent systole and may occur in older patients, during
pregnancy, and in conditions like aortic regurgitation.
In these situations, diastolic blood pressure should be
estimated by noting the appearance of the fourth phase
(i.e. muffling) of the Korotkoff sounds.