PULSE

Blood Pressure

Low: < 90mmHg systolic over < 60mmHg diastolic (more info)
Normal: 90-120 mmHg systolic over 60-80mmHg diastolic (more info)
High: >120mmHg systolic, >80mmHg diastolic (more info)

Resting Heart Rate

Normal: 60-100 beats per minute (more info)

Recovery Rate

Good: 23-40 beats per minute decrease in heart rate, 1 minute after peak exercise (more info)

Heart Rate During Aerobic Exercise

Normal (suggested): 50-85% of maximum heart rate (more info)

Orthostatic Adaptation or Orthostatic Tolerance

Normal: “Rule of 20-10-20″ (more info)

Pulse Pressure

Normal: 40-59mmHg (more info)

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EKG/ECG - ELECTROCARDIOGRAM

PVCs Per Minute

Normal: less than 6 per minute (more info)

QT Interval

Short QT: .34 seconds and shorter (QTc) (more info)
Normal: .35 - .44 seconds (when corrected for heart rate, or QTc) (more info)
Long QT: .45 seconds and longer (QTc) (more info)

PR Segment

Normal: Along Baseline (more info)

PR Interval

Normal: .12-.20 seconds in duration (more info)

QRSd

Normal: .06 - .10 seconds (more info)

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ECHOCARDIOGRAM

Because the left ventricle has the more difficult task of pumping blood through the entire body, and because the presence of heart disease affects the left ventricle more than it affects the right, most data and studies that are available focus on the left ventricle. We will do the same.

Left Ventricle Mass

Male aged 20-50 - Average: 193 grams (more info)
Female aged 20-50 - Average: 141 grams (more info)

Left Ventricle End Diastolic Volume

Males 20-50- Average: 163 ml (more info)
Females 20-50 - Average: 118 ml (more info)

Left Ventricle End Systolic Volume

Males 20-50 - Average: 65ml (more info)
Females 20-50 - Average: 42ml (more info)

Ejection Fraction

Normal: 50-70% (more info)

Left Ventricle Septum and Wall Thickness

Normal: 10mm (± 1mm) (more info)

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BLOOD

Normal Electrolyte Levels

Sodium (Na+): 136-144 mmol/l (more info)
Potassium (K+): 3.5-5.0 mmol/l (3.7-5.2mmol/l reported as normal by NIH) (more info)
Magnesium (Mg2+): 1.7 - 2.2 mg/dl (more info)
Calcium (Ca2+): 8.4-10.2 mg/dl (more info)
Chloride (Cl-): 96-106 mmol/l (more info)

INR Value

Normal: 0.9 - 1.7 (more info)

eGFR/GFR

Normal: >90 ml/min/1.73m(sq) (more info)

TSH Level

Normal: .40-4.70 uIU/ml (more info)

BNP

Normal: less than 100pg/ml (more info)

PULSE - More Information

Blood Pressure

Normal Blood Pressure: 90-120mmHg (millimeters of mercury) systolic over 60-80mmHg diastolic. The systolic and diastolic values of your blood pressure are simple measures of the amount of pressure in your veins and arteries, not unlike the pressure in the tires on your car (except that your tire’s pressure doesn’t change from moment to moment). The higher number, your systolic pressure, is a measure of the pressure your blood is exerting on your veins just after your heart contracts, which is the highest pressure of the cardiac (heart beat) cycle. The lower number, your diastolic pressure, is a measure of the pressure in your veins just before the next contraction, when pressure is lowest in the cardiac cycle.

The definition of what “normal blood pressure” is has been consistently revised downward over the years in response to lengthy studies showing a connection between what used to be considered mildly high blood pressure and cardiovascular complications. Currently, normal blood pressure is considered to be between 120-80 over 90-60.[1] (back)

Low Blood Pressure: < 90mmHg (millimeters of mercury) systolic over < 60mmHg diastolic. However, it is possible for a person to have blood pressure of 90/50, for example, and not be hypotensive (the characteristic of having low blood pressure). It all depends on the symptoms that person experiences. If the person normally has 90/50 blood pressure and does not experience any ill effects from that blood pressure, then that person is not considered to have low blood pressure.(back)

High Blood Pressure: >120mmHg (millimeters of mercury) systolic, >80mmHg diastolic. Between 120/80 and 139/89 is considered pre-hypertension and may be treated by your doctor, depending on the doctor’s evaluation of your lifestyle and risk factors. Blood pressure of 140/90 and above is considered high blood pressure.[2]

A useful blood pressure reference can be found at Vaughns 1 Pagers.(back)

Normal Resting Heart Rate: 60-100 beats per minute. It’s important to note a few things about your resting heart rate. While it’s practical for the general population to have defined parameters for what is considered a “normal” resting heart rate, it’s also possible that the “normal”, healthy rate for you falls outside of this range. Doctors just use that rate as a guide in determining overall cardiac health. For example, Lance Armstrong, seven time Tour de France winner, has been reported as having a resting heart rate as low as 32 beats per minute. And even resting heart rates over 100 can be considered normal, or at least not something that requires treatment (so long as that resting rate is of shorter duration, such as during a period of anxiety, stress or physical pain). If you are experiencing symptoms that accompany your resting heart rate, such as lightheadedness, dizziness, nausea or vomiting, reporting your symptoms to your physician would be a reasonable precaution. [3][4] (back)

Exercise Recovery Rate - Good: 23-40 beats per minute decrease in heart rate, 1 minute after peak exercise. This value was difficult to quantify because 1) several studies defined “normal” heart rate recovery (HRR) differently, and 2) we did not have access to the raw data from each study, making comparison between studies impossible. Therefore we are unable to define a “normal” heart recovery rate. The range we propose (23-40) seems to accommodate the defined normal ranges of most relevant studies. [5][6][7][8] (back)

Normal or Suggested Heart Rate During Aerobic Exercise: 50-85% of maximum heart rate. This range is calculated by first finding your theoretical maximum heart rate by subtracting your age from 220, then multiplying that number by .50 and .85, giving you a BPM range to maintain in order to receive cardiovascular benefits from the exercise.

For example, a 30 year old would have a theoretical max heart rate of (220-30) 190bpm, and her target heart rate should be (190 x .50) 95bpm to (190 x .85) 162bpm. A heart rate that is higher or lower than this range may still be healthy, but you should discuss it with your physician.[9] (back)

Normal Orthostatic Adaptation or Orthostatic Tolerance: “Rule of 20-10-20.” Defined as your body’s adaptation of heart rate and blood pressure to meet changes in cardiovascular demands when changing position (from laying to sitting, sitting to standing, for example). It’s expected that when you go from a supine (laying down) position to standing, there should be a decrease in systolic (higher number) blood pressure of up to 20mmHg (millimeters of mercury), an increase in diastolic pressure of 10mmHg and an increase in heart rate of 20 bpm. [10][11][12] (back)

Normal Pulse Pressure: 40-59mmHg (millimeters of mercury)Pulse pressure is the difference between your systolic (higher, first number) and diastolic (lower, second number) pressures. In mechanical terms, if you were to connect a fire hose to a hydrant and turn the water on and off, pulse pressure measures how much more pressure is in the hose when the water is on compared to when it’s off. It’s calculated by simply subtracting your diastolic pressure from your systolic pressure. Pulse pressure less than 40 can be a sign of blood loss (such as with a serious injury), or possibly congestive heart failure, where the volume of blood pumped with each contraction is diminished. Pulse pressure that is 60 or greater is considered abnormal and research suggests that it is a predictor of future heart problems. The most common cause of high pulse pressure is loss of elasticity or stiffness in the aorta, the largest artery in your body. Long-term high blood pressure and fatty deposits on artery walls can make the aorta less elastic, as can hyperthyroidism and severe anemia.

Treatments for high pulse pressure are the same for that of high blood pressure, and the reduction of blood pressure usually results in lower pulse pressure, too.[13][14] (back)

EKG/ECG - ELECTROCARDIOGRAM - More Information

Normal PVCs Per Minute: less than 6 per minute. Technically PVCs are not called normal, but are called rare, isolated or occasional when they occur at a rate of less than 6 per minute. Some authors consider anything less than 10 PVCs per minute to be occasional or rare. In general, further testing of your PVCs is warranted if

  • You recently had a myocardial infarction (heart attack) and are experiencing an increase in PVCs
  • You are experiencing additional symptoms during your PVC episodes, including light-headedness, dizzyness, blurry vision, confusion or syncope.
  • You are experiencing 6 or more PVCs per minute and this represents an increase in PVC frequency for you.

[15][16][17] (back)

QT Interval

highlighted ecg of a normal heartbeatNormal QT Interval: .35 - .44 seconds (when corrected for heart rate, or QTc). The QT interval can vary with an individual depending on the person’s heart rate at the time of the ECG. To more accurately measure QT interval then, formulas were created to account for the variance in heart rate, so that a “normal” range could be defined for the general population. Bazett’s Formula, named for physiologist Henry Cuthbert Bazett, is the most often used of the formulae. It states that the corrected QT interval (QTc) is equal to the mean of the measured QT intervals (more than one QT interval should be measured) divided by the square root of the RR interval (which is the interval between the onset of one QRS complex and the onset of the next QRS complex). [18] (back)

Short QT Interval: .34 seconds and shorter (when corrected for heart rate, or QTc). Though there are respected websites that indicate that this is a potentially dangerous condition, a substantial study (10,822 patients) was conducted by Finland’s Department of Medicine over the span of 29 years, and found no difference in mortality between those with a short QT interval (”Short QT Syndrome”) and those with a normal QT interval. Short QT Syndrome is inherited and is autosomal dominant. [19][20][21] (back)

Long QT Interval: .45 seconds and longer (when corrected for heart rate, or QTc). Long QT Syndrome, like Short QT Syndrome, can be dangerous and causes approximately 4,000 deaths in the United States each year. (To understand the relative risks, more than 40,000 people have died each year in motor vehicle accidents in the United States since 1975. [a]) Having a long QT interval is considered more dangerous than a short one and is genetic (passed from parents to children), but can also be acquired. If you have unexplained episodes of loss of consciousness during physical exertion, emotional excitement or after taking a new medication, you should see your physician. [22][23][24][25] (back)

Normal PR Segment: Along Baseline. The PR segment is the portion of the cardiac cycle seen between the end of the P wave and start of the QRS complex. This segment is typically straight and horizontal, along the baseline of the ECG. Abnormalities seen in the PR segment include segment elevation, where the horizontal tracing of the PR segment is above the ECG baseline, or segment depression, where the tracing falls below the baseline. PR segment depression greater than .8mm on an ECG can be a sign of a cardiovascular problem, while PR segment elevation is usually a sign of a poor baseline related to ECG equipment issues and not heart health. [26] (back)

Normal PR Interval: .12-.20 seconds. Though their names are similar, the PR interval and the PR segment are different and provide different diagnostic information. The PR interval is the measure from the start of the P wave to the start of the QRS complex, where the PR segment measures the flatline/baseline space between the P wave and the QRS complex. PR intervals that are less than .12 seconds mean that the electrical signal from the SA node is being transmitted extremely quickly to the ventricles, which may be caused by the presence of an alternate or extra electrical pathway from the atria to the ventricles, such as with Wolff-Parkinson-White (WPW) syndrome. PR intervals that are longer than .20 seconds indicate a delay in electrical conduction and are a sign of AV block. [27][28] (back)

Normal QRSd: .06 - .10 seconds in duration. QRSd is the measure of the duration of the QRS complex, which is the depolarization (electrical activation) of the ventricles, initiating their contraction. A QRSd that is .10 - .12 seconds indicates slower progression through the ventricles than is expected, and a QRSd greater than .12 seconds is a sign of complete bundle branch block. “Poor R wave progression” is often a notation on ECGs showing a longer than normal QRSd.[29] (back)

ECHOCARDIOGRAM - More Information

Left Ventricle Mass, Male aged 20-50 - Average: 193 grams, Female aged 20-50 - Average: 141 grams. Left ventricle mass estimations can be useful in helping determine if ventricular hypertrophy (abnormal enlargement of ventricle) is present.[30] (back)

normal and diseased left ventriclesLeft Ventricle End Diastolic Volume, Males 20-50 - Average: 163 ml, Females 20-50 - Average: 118 ml. End diastolic volume is the measure of the size of the ventricular cavity when it is completely filled with blood, just before the initiation of contraction. An end diastolic volume that is far above the average can be a sign of dilated cardiomyopathy, an abnormal increase in the cavity size of the left ventricle. When the diastolic volume is far below the average, it can be a sign of hypertrophic cardiomyopathy, where the increased muscle mass of the left ventricle makes the ventricular cavity smaller, reducing the amount of blood pumped per cardiac cycle (heartbeat). (see image comparing normal left ventricle (above) to hypertrophied left ventricle (below)) Both types of cardiomyopathy can lead to heart failure and arrhythmias.[31][32] (back)

Left Ventricle End Systolic Volume, Males 20-50 - Average: 65ml, Females 20-50 - Average: 42ml. End systolic volume is the measure of the size of the ventricular cavity when it has just completed a full contraction (not when it’s empty - your ventricles will never be completely emptied). The end systolic and end diastolic volumes are used to calculate the stroke volume, or volume of blood pumped with each heartbeat. [32] (back)

Normal Ejection Fraction: 50-70%. This number, reported as a percentage, is the amount of blood ejected from the ventricle during contraction compared to the amount of blood in the ventricle when it’s full. Left ventricle ejection fraction (LVEF) is what’s most often reported, and is calculated as follows:

Ejection Fraction = 100 * (1-(Left Ventricle End Systolic Volume / Left Ventricle End Diastolic Volume))

Ejection fractions below 50% can indicate heart failure. Thankfully, many forms of heart failure can be treated and ejection fractions improved. (See Shelby’s story)[33][34][32] (back)

Normal Left Ventricle Wall Thickness: 10mm (± 1mm). Along with ejection fraction data, being able to measure the thickness of the septum that separates the ventricles, as well as the free wall of the left ventricle help doctors to recognize heart disease processes that are underway. Left ventricle hypertrophy (LVH) is a condition where the muscle walls have thickened. This can occur because of long-standing high blood pressure; the left ventricle has to work against the added pressure in the arteries and veins in order to pump blood throughout your body, and just like any other muscle, when it works harder, it gets larger. The problem with hypertrophy of your heart muscle is that the muscle almost never grows outward. Instead it grows inward, filling the space the blood is supposed to occupy before it gets pumped out. As you can imagine, this reduces the amount of blood that can be pumped with each cardiac cycle (heartbeat), which means the heart now has to beat faster to do the same job. This cycle results in the heart muscle actually getting weaker, not stronger, and can lead to heart failure.[35][36] (back)

BLOOD - More Information

Normal Electrolyte Levels

Normal Sodium (Na+): 136-144 mmol/l (millimoles per liter) While sodium plays an important part in the transmission of electrical signals in the heart, given the salty diets of most people in developed countries it would appear at the surface that it is unlikely your diet would suffer from lack of sodium. [37] (back)

Normal Potassium (K+): 3.5-5.0 mmol/l (3.7-5.2mmol/l reported as normal by NIH) Low levels of potassium cause an increase in heart muscle activity which can result in an irregular heartbeat; high levels cause a decrease in heart muscle activity, which also has the potential to be dangerous.[38] (back)

Normal Magnesium (Mg2+): 1.7 - 2.2 mg/dl (milligrams per deciliter) Magnesium helps control muscle function, including your heart muscle. [39] (back)

Normal Calcium (Ca2+): 8.4-10.2 mg/dl (milligrams per deciliter). Like sodium, calcium also plays a large role in the transmission of electrical signals in the heart. When sodium ions enter a cell, calcium ions are released which cause another electrochemical reaction to occur that results in your heart muscle contracting. [40][41] (back)

Normal Chloride (Cl-): 96-106 mmol/l (millimoles per liter). Chloride helps your body maintain the appropriate fluid levels.[42] (back)

Normal INR Value: 0.9 - 1.7INR stands for International Normalized Ratio and is a measure of the time it takes for your blood to clot. While the lower end of this range does represent a normal result, most often those interested in measuring INR levels are those who are receiving some sort of anticoagulation therapy. Specific to this site, it’s going to be people who may be receiving prophylactic treatment for an arrhythmia that has the potential to cause blood clots, such as atrial fibrillation. In that case, the target INR is more likely to be 2.0-3.0.

That being said, your physician should be the one to give you your target INR values, as only your physician is familiar enough with your medical history to make informed decisions about your treatments.[43][44] (back)

Normal eGFR: >90 ml/min/1.73m(sq). eGFR or GFR is your Glomular Filtration Rate, and is a measure of how effectively your kidneys are functioning. For this test, the larger the number, the better. A larger number means your kidneys are filtering out contaminants at a faster rate. While the overall filtration rate is important, the rate of decline in kidney function is also important. For example, a person with a slightly low but unchanging eGFR (as measured by multiple blood tests over a year or more) may be in less jeopardy of kidney failure than someone who has a normal eGFR that has been declining rapidly.

If your kidney function is impaired it can’t adequately filter out potassium, one of the electrolytes important in the electrochemical processes of your heart. The electrolytic balance in your body is very delicate and complex, and the condition of having too much potassium, hyperkalemia, can cause arrhythmias.[45][46] (back)

Normal TSH Levels: 0.40-4.70 uIU/ml (1 millionth of an International Unit per milliliter). TSH is an acronym for Thyroid-Stimulating Hormone, which is probably the more common name used for thyrotropin. The function of thyrotropin/TSH is to stimulate the thyroid to create and secrete two other hormones, T3 (triiodothyronine) and T4 (thyroxine).

In the case of hyperthyroidism, too much TSH is being created by the pituitary gland. This overabundance of TSH can result in excess thyroid hormones (T3 and T4) acting on the cardiac and nervous systems, causing palpitations and other arrhythmia (as well as other symptoms). [47][48][49] (back)

Normal BNP: < 100pg/ml (picograms per milliliter). BNP stands for Brain Natriuretic Peptide. It’s name is a misnomer because it has little to do with the brain, but because it was discovered in the brain and presumably scientists didn’t know why it was manufactured or what it’s function was, it’s name was forever tied to the brain. But BNP is very specific in it’s origin - it’s created and stored in the heart’s ventricles, and released when the ventricles have experienced ongoing diastolic pressure increase. In other words, when the ventricles are consistently stretched more than they should be by blood volume overload in between contractions (possibly because of congestive heart failure) over an extended period of time, the ventricles release BNP. A simple blood test can determine whether your BNP levels are elevated. Because congestive heart failure (CHF) can cause palpitations and arrhythmia, if your physician thinks you may be suffering from CHF, a BNP test may be in order.[50][51][52] (back)

References

  1. ^ MedicineNet.com: Low Blood Pressure (Hypotension)
  2. ^ MedicineNet.com: High Blood Pressure (Hypertension)
  3. ^ WebMD.com: Pulse Measurement (page 2)
  4. ^ MayoClinic.com: Heart Rate: What’s Normal?
  5. ^ PubMed.gov: Heart rate recovery predicts mortality and cardiovascular events in patients with type 2 diabetes.
  6. ^ ChestJournal.org: Heart Rate Recovery After 6-Minute Walk Test Predicts Survival in Patients With Idiopathic Pulmonary Fibrosis
  7. ^ Annals of Internal Medicine: Heart Rate Recovery after Submaximal Exercise Testing as a Predictor of Mortality in a Cardiovascularly Healthy Cohort
  8. ^ Journal of the American College of Cardiology: Heart rate recovery after exercise is apredictor of mortality, independent of the angiographic severity of coronary disease
  9. ^ American Heart Association: Target Heart Rates
  10. ^ Emergency Nursing World: Orthostatic Measurement
  11. ^ EMSResponder.com: The Vital Signs, Part 2: Pulse
  12. ^ First Responders: Orthostatics Protocol
  13. ^ MayoClinic.com: What’s the significance of the spread between systolic and diastolic blood pressure readings?
  14. ^ Cardiovascular Physiology Concepts: Arterial Pulse Pressure
  15. ^ European Journal of Heart Failure: ‘Frequent’ ventricular bigeminy – A reversible cause of dilated cardiomyopathy. How frequent is ‘frequent’?
  16. ^ British Medical Journal | Heart: Ventricular Ectopic Beats: Not So Benign
  17. ^ p 172, Guide to ECG analysis By Joseph T. Catalano
  18. ^ MedScape Today: QT Interval: How to Measure It and What Is “Normal”: Normal Values of the QT Interval (12-Lead ECG)
  19. ^ ShortQTSyndrome.com: What is a QT?
  20. ^ DoctorsLounge.com: Short QT Syndrome
  21. ^ PubMed.gov: Prevalence and prognostic significance of short QT interval in a middle-aged Finnish population.
  22. ^ MayoClinic.com: Long QT Syndrome: When to seek medical advice
  23. ^ Texas Heart Institute: Long Q-T Syndrome
  24. ^ eMedicine Specialties | Cardiology | Arrhythmias: Long QT Syndrome
  25. ^ Wikipedia.org: List of motor vehicle deaths in U.S. by year
  26. ^ nursCE.com: Basics of ECG Reading: Part I
  27. ^ University of Utah School of Medicine : IV. Abnormalities in the ECG Measurements
  28. ^ ECGLibrary.com: A normal adult 12-lead ECG
  29. ^ SkippingHearts.com: What Is a Normal QRSd?
  30. ^ PubMed Central: Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study
  31. ^ American Heart Association: Cardiomyopathy
  32. ^ PubMed Central: BMC Med Imaging. 2009; 9: 2. Table 2
  33. ^ MayoClinic.com: Ejection fraction: What does it measure?
  34. ^ IrishHealth.com: Heart Palpitations Revisited ceomment by George(NIV39780), posted 05/01/2006
  35. ^ ClevelandClinic.org: Understanding Your Ejection Fraction
  36. ^ CHFPatients.com: Echocardiogram
  37. ^ MedLine Plus: Sodium - blood
  38. ^ MedLine Plus: Potassium Test
  39. ^ MedLine Plus: Serum magnesium - test
  40. ^ MedLine Plus: Serum calcium
  41. ^ SkippingHearts.com: Anatomy of a Heartbeat
  42. ^ MedLine Plus: Chloride test - blood
  43. ^ University of Virginia Health System: Reference Range for Prothrombin Time-Coumadin
  44. ^ ClinLab Navigator: Prothrombin Time and INR
  45. ^ National Kidney Foundation: Kidney Early Evaluation Program (KEEP) Reference Ranges
  46. ^ MedicineNet.com: Kidney Failure (contd.) | What are the symptoms of kidney failure?
  47. ^ MedicineNet: Definition of Thyrotropin
  48. ^ endocrineweb: Hyperthyroidism: Overactivity of the Thyroid Gland | Part 1: Introduction to hyperthyroidism
  49. ^ endocrineweb: Hyperthyroidism: Overactivity of the Thyroid Gland | Part 4: Treatment Options for Hyperthyroidism
  50. ^ Journal of Postgraduate Medicine: Brain natriuretic peptide in diagnosis and treatment of heart failure.
  51. ^ pp 280-1, Cardiac Nursing by Susan L. Woods
  52. ^ WebMD.com: Brain Natriuretic Peptide (BNP) Test

Images of cross-sections of left ventricles courtesy of Echo in Context
Image of echocardiogram of ejection fraction courtesy of Heart and Metabolism