1
Table of Contents
1
Blood Pressure
Hypertension
Hypotension
Heart Rate
Target Heart Rate for Men
4
4
6
6
8
2
First Aid and Cardio Pulmonary Resuscitation
8
Techniques and Implementation of CPR
9
3
Cholesterol
11
Normal Value Cholesterol
11
4
Diabetes
Types of Diabetes
Blood Sugar Permissible Limits
12
13
14
5
References
18
2
Preface
The PE 101 course is offered in the first semester of the undergraduate
programme. The content of this course highlights the general health education,
safety and CPR. Cardiovascular diseases are the single most fatal diseases
globally in the present day. To keep up the recent trends, the course describes the
blood pressure, heart rate, cholesterol and diabetes, their causes, effects and
preventative measures. Another important life-saving aspect, CPR, is described
in detail with its practical implementation and the safety measures to be adopted
while administering it to save the life of a person.
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Blood Pressure
Blood Pressure (B.P.) is the pressure that the blood exerts on the walls of the blood
vessels while circulating. An optimal amount of blood pressure is essential for:
:
i)
The return of the blood to the heart
after making its way through more
than 60,000 miles of long blood
vessels in the body.
ii)
The exchange of nutrients and
waste products between the various
cells of the body and blood
capillaries.
iii)
The filtering and purification of the
blood in the kidneys and lungs.
Every time the heart beats, it pumps
around 70 ml of blood. It also flows
through three types of vessels; the
arteries, the capillaries and the veins
in this order, and returns to the heart
again.
Blood Pressure is usually measured in the Brachial artery of the arm using an
instrument known as sphygmomanometer.
Normal Values of Blood Pressure : Systolic B.P. For age 20 to 60 years: 120 +
1/5. For ages above 60: 135+1 for each year above 60. Diastolic B.P : At age 25
year: 80. For ages above 25 to year: 80+1 for every 5 years beyond the age of 25
years. Temporary conditions which lead to an increase in B.P. are;
i) Mental stress, ii) constipation, iii) cold weather, iv) after eating, v) after drinking
coffee, tea & alcohol, vi) bathing or showering, vii) exercising, viii) smoking, ix)
urinating.
Types of Blood Pressure: There are two types of Blood Pressure: i) Hypertension
(High blood pressure), ii) Hypotension (Low blood pressure).
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Hypertension (High blood pressure): It means a persistent systolic pressure of 140
mm of Hg or more or a persistent diastolic pressure of 90 mm of Hg. The H.B.P is
classified as follows:
Level of Severity
Mild Hypertension
Moderate Hypertension
Severe Hypertension
Systolic B.P.
140 - 160
160 - 200
Above 200
Diastolic B.P.
90 - 100
100 - 200
Above 120
When a person has got high B.P., it means that the heart has to exert greater force to
pump almost the same quantity of blood within the same time due to which B.P.
becomes more elevated than normal.
Causes of Hypertension: 1. Heredity 2. Mental Tension 3. Excess intake of salt 4.
Obesity 5. Sedentary life 6. Smoking 7. Alcohol 8. Diet having saturated fats 9. Use of
fried and too much oily foods 10. Excess intake of sugar 11. Tea, coffee and cold
drinks. Many of the above factors lead to the narrowing and hardening of the arteries
(atherosclerosis) because of the deposition of cholesterol in the walls of the arteries.
As old age approaches the artery walls harden and lose much of their elasticity.
Common Symptoms of Hypertension: 1. Lack of sleep 2. Headache, especially
throbbing pain, which is associated with anger and working under stress 3. Dizziness
4. Flushed face on exertion 5. Excessive craving for salt 6. Obesity 7. increased
irritability and tendency to become angry or violent 8. Hurry and impatience and
always racing against time. A rapid or sudden increase in B.P. to very high levels
(usually 240/130 mm of Hg or more) leads to severe headaches, blurring of vision,
drowsiness, vomiting and breathlessness. This requires emergency treatment.
Types of Hypertension: There are two types of hypertension: 1. Essential (or
Primary) Hypertension 2. Secondary hypertension.
Essential Hypertension: Essential hypertension is blood pressure that is consistently
higher than normal when no cause for the high blood pressure can be found. Many
experts think essential hypertension is genetic. Factors that can increase blood
pressure, such as the amount of blood pumped by the heart, size and condition of the
arteries, water and salt content of the body, condition of the kidneys, nervous system
or blood vessels, and hormone levels in the body. Other factors can include stress,
being overweight, smoking, alcohol use, a diet high in salt, heredity, gender, age and
race. What are the symptoms?: A mild headache, tiredness, shortness of breath,
confusion, dizziness, visual changes, nausea and vomiting, anxiety, perspiration, nose
bleeds, pale or red skin and an angina-like pain in the chest. Rarely, the first symptom
is a stroke.
Secondary Hypertension: This is caused by some disease or disorder in the body
like:
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1. Disease of the kidney and endocrine glands, especially the adrenal glands 2. Long
standing diabetes mellitus 3. Long term use of oral contraceptives containing estrogen
4. Use of steroids for many years (steroids are a group of drugs commonly used for
treatment of asthma, some skin disorders etc.) 5. Inborn defects of the “aorta”.
Risks associated with Hypertension : 1. Heart Attack (pain in the chest) 2.Stroke
(Brain hemorrhage) 3. Heart failure 4. Effect on kidneys (kidney failure) 5. Effect on
eyes.
Management or Control of Hypertension: 1.Weight reduction 2. Reduction of salt
intake 3. Aerobic exercise 4. Stretching exercises 5. Avoid saturated fats 6. Intake of
Calcium, potassium and magnesium in proper proportions 7. High intake of fibers
(soluble fibers ) 8. Consume Vitamin C , Vitamin B3 (Niacin) and Vitamin E for
lowering B.P. 9. Intake of food items like garlic, honey, lemon juice , onion to be
increased 10. Use of relaxation techniques for lowering B.P. 11. Intake of water in
large quantities especially in empty stomach in the morning 12. Adopt a positive
outlook towards life.
Hypotension
The term "hypotension" is usually used only when blood pressure has fallen so far that
enough blood can no longer reach the brain, causing dizziness and fainting.
Causes and symptoms: Postural hypotension is the most common type of low blood
pressure. In this condition, symptoms appear after a person sits up or stands quickly.
In normal people, the cardiovascular system must make a quick adjustment to raise
blood pressure slightly to account for the change in position. For those with postural
hypotension, the blood pressure adjustment is not adequate. It also happens to
diabetics when nerve damage has disrupted the reflexes that control blood pressure.
Many people have a chronic problem with low blood pressure that is not particularly
serious. This may include people who require certain medications.
Treatment
For those people with postural hypotension, a medication adjustment may help
prevent the problem. These individuals may find that rising more slowly, or getting out
of bed in slow stages, helps the problem. Low blood pressure with no other symptoms
does not need to be treated.
Heart Rate
Blood Flow /Cardiac Output =
Heart Rate is the number of heart beats per
unit time, usually per minute. The heart rate is
based on the number of contractions of the
ventricles (the lower chambers of the heart).
The heart rate may be too fast (tachycardia) or
too slow (bradycardia).
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Blood Flow / Cardiac Output = Heart Rate x Stroke Volume.
Heart rate for a human being at rest is about 70 beats per minute. During vigorous
exercise, heart rate can increase dramatically (the rule of thumb given for maximal
heart rate is 220 minus your age). This will result in an increase in blood flow.
Controllable Risk Factors of Heart rate : Coronary artery disease, heart attack,
diabetes, high cholesterol, high blood pressure, smoking,
drugs or alcohol abuse, excess weight,
high fat diet
sedentary, lifestyle, stress, certain medication (over-thecounter and prescription, including decongestants and diet
and herbal supplements), heart surgery (may also be a non –
controllable risk factor)
Non- Controllable Risk Factors: Family history of heart disease, congenital heart
disorders (heart problem present at birth, usually involving the heart chambers or
valves), advancing age, gender (males are more susceptible).
Factors affecting heart rate: 1.Anxiety 2. Dehydration 3. Ambient temperature 4.
Altitude 5. Elapsed time after meals can increase heart rate, sometimes markedly.
Heart Rate Reading: The heart rate is the pulse one feels at the periphery. When the
blood is pumped in the arteries they expand and the same pulse is felt throughout the
arteries. There are two suitable points through which one can check the pulse. 1. In
the radial artery at the thumb side. 2. at the carotid artery which is located in the neck,
at either side of the windpipe. Two fingers have to be placed at these points and the
count can be noted for 15 seconds or 30 seconds and can be multiplied by 4 or 2
respectively to get the heart rate for one minute.
Heart Rate and Fitness
In addition to following a healthy diet and incorporating important heart nutrients, you
must also exercise to maintain the health of your heart. Exercise can help you prevent
as well as reverse heart disease.
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Target Heart Rate Chart for
Men
.
The target heart rate chart below shows the target heart rate zones for men, by age
Recovery/Weight
Aerobic
Anaerobic
Maximum
Max
Loss
Age
Heart Rate
60% - 70%
60% - 70%
60% - 70%
60% - 70%
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202
121
141
141
162
162
162
162
202
19
201
121
141
141
161
161
161
161
201
20
200
120
140
140
160
160
160
160
200
21
199
119
139
139
159
159
159
159
199
22
198
119
139
139
158
158
158
158
198
23
197
118
138
138
158
158
158
158
197
24
196
118
137
137
157
157
157
157
196
25
195
117
137
137
156
156
156
156
195
26
194
116
136
136
155
155
155
155
194
27
193
116
135
135
154
154
154
154
193
28
192
115
134
134
154
154
154
154
192
29
191
115
134
134
153
153
153
153
191
30
190
114
133
133
152
152
152
152
190
Cardio - Pulmonary Resuscitation (CPR)
It is an emergency medical procedure for a victim of
cardiac arrest or, in some circumstances, respiratory
arrest. CPR can be utilised in many other emergency
situations and some of them are; 1. Heart attacks 2.
Strokes (when blood flow to a part of the brain has
suddenly stopped ) 3. Choking on something that blocks
the entire airway 4. Near drowning incidents (when
someone is under water for too long and the breathing
has stopped) 5. A very bad neck, head or back injury 6.
Severe electrical shocks (touching a live wire of high
intensity ) 7. Suffering from sickness of a serious nature
8. Excessive bleeding 9. Severe allergic reactions.
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CPR is performed in hospitals or in the community by laypersons or by emergency
response professionals.
CPR involves physical interventions to create artificial circulation through rhythmic
pressing on the patient's chest to manually pump blood through the heart, called chest
compressions, and usually also involves the rescuer exhaling into the patient (or using
a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called
artificial respiration. Its purpose is to maintain a flow of oxygenated blood to the brain
and the heart, thereby delaying tissue death and extending the brief window of
opportunity for a successful resuscitation without permanent brain damage.
Techniques of Implementation of CPR
For administering CPR, a primary assessment has to be made with regard to the
gravity of the condition of an ill or injured person using the ABCDS sequence as
shown below:
A stands for:
Assessment of the scene,
Alerting EMS (call first) &
opening the blocked airway.
B stands for:
Breathing Check & Rescue Breathing
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C stands for: Circulation Check & Chest Compression
D stands for: Defibrillation, either by EMS or by an Automated External
Defibrillator
5.
S stands for: Serious bleeding management, Shock management & Spinal injury
Management
The Emergency Medical Services of the local area have to be informed immediately of
the incident while continuing to monitor the patient’s condition with ABCDS and to
administer treatment to the emergency problems while waiting for the Emergency
Medical Services.
During the primary assessment of the patient the following procedure has to be
adopted:
It’s important to Look, Listen and Feel for Agonal Breathing. Individuals in cardiac
arrest do not breathe. Some may gasp irregularly, which seems as if the patient is
breathing. It’s important not to confuse agonal breaths with normal breathing. There
are several reasons why a person might to stop breathing: 1. Submersion and near
drowning 2. Stroke 3. Foreign body obstructing (choking ) the airway 4. Smoke
inhalation or suffocation 5. Drug overdose 6. Electrocution 7. Injuries 8. Heart attack or
sudden cardiac arrest 9. Lightening strike 10. coma.
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If the heart beat, breath and chest movement are not found, then begin the CPR.
PROCEDURE: The rescuer should put his mouth over the patient’s open mouth and
start blowing to force air into the lungs (actually, it is advisable for rescuer to use a
special mask so that the mouths actually do not touch) .This rescue breathing will aid
in the movement of oxygen into the lungs. In the rescue breathing the unused oxygen
from the breath can be used since the air contains 21% of oxygen and only 5% is
used for the breath. After about two breaths, use both hands (one placed over the
other) to press on the patient’s chest for a number of times in a row to move the blood
out of the heart that has stopped beating. This is termed chest compression and it
helps to supply oxygen to the vital organs especially the brain. The brain cells will die
if oxygen is not supplied to them soon. Continue the combination of rescue breathing
and manual chest compressions with the mouth and pressing on the chest. If the
patient has a heartbeat, the rescue breath can be continued for many hours.
This may improve the chances of reviving the heart. CPR can be learned by
undergoing special training which will be a boon for present day society as medical
emergencies have increased drastically.
CHOLESTEROL
Cholesterol is a soft, wax-like fatty substance
found in all parts of the body. It is a white
crystalline substance found in animal tissues
and various foods, normally synthesized by
the liver. Our body needs a little bit of
cholesterol to work properly. But too much
cholesterol can be harmful as it forms a fatty
plaque which can clog your arteries, reduce
their circumference and lead to heart
disease. Some cholesterol is considered
"good" and some is considered "bad”.
Cholesterol has to be transported through
the blood and the carriers are called
Lipoproteins.
There are two different types of lipoproteins 1. Low Density Lipoproteins (LDL) 2 High
Density Lipoproteins (HDL) . Lipoproteins are a combination of fat and proteins. LDL
has more fat, less proteins, is called bad cholesterol, forms plaque in the arteries and
is the cause of heart diseases. By contrast, HDL has more protein, less fat, is termed
good cholesterol, and it carries cholesterol to the liver and out of the body. HDL avoids
the formation of plaque and heart diseases. Different blood tests are needed to
individually measure each type of cholesterol.
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Normal Value: The normal values of cholesterol are Total Cholesterol: Desirable:
Under 200 milligrams per deciliter (mg/dL), Borderline high: 200 to 239 mg/dL , High
risk: 240 mg/dL and higher
Low Density Lipoproteins (LDL, bad cholesterol) Optimal: Less than 100 mg/dL,
Near/Above optimal: 100 mg/dL to 129 mg/d, Borderline high: 130 mg/dL to 159
mg/dL, High: 160 mg/dL to 189mg/dL, Very high: 190 mg/dL HighDensity
Lipoproteins (HDL, good cholesterol) Low: Less than 40mg/dL. High: Above 60
mg/dL (may lower the rate of Heart diseases) Women tend to have a higher HDL due
to Estrogen (needs to be over 50 mg/dL), Triglycerides: Normal: less than 150 mg/dL,
Border line high: 150 mg/dL to 199 mg/dL, High: above 200 mg/dL.
Abnormal results: In general, a total cholesterol value over 200 mg/dL may mean
you have a greater risk of heart disease. However, LDL levels are a better predictor of
heart disease, and they determine how your high cholesterol should be treated.
High Cholesterol levels may be caused by:
Biliary cirrhosis familial
hyperlipidemias, high fat diet, hypothyroidism, nephrotic syndrome & uncontrolled
diabetes.
Low cholesterol levels may be caused by: Hyperthyroidism, liver disease,
malabsorption (inadequate absorption of nutrients from the intestinal tract)
malnutrition. Experts recommend that you have a complete cholesterol and
triglycerides analysis every 5 years starting at age 20. The total cholesterol test is
usually done as part of a lipid profile, which also checks for LDL, HDL, and
triglycerides.
Risk Factors: Overweight and obesity, hypertension and diabetes (type II), family
inheritance excessive bleeding, hematoma and infection.
Special considerations
Any acute illness can raise or lower your total cholesterol number. If you have had an
acute illness in the 3 months before having this test, you should have it repeated in 2
or 3 months. Even a flare up of arthritis can affect your cholesterol level.
Other conditions associated with high cholesterol: Pregnancy & Removal of
ovaries.
Prevention of high cholesterol: Eating healthy diet, keep body weight under normal
range, maintain normal levels of hypertension and diabetes, do not smoke, exercise
every day for 30 minutes, monitor cholesterol levels regularly.
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DIABETES
Diabetes is caused by the non-functioning
of one of the organs in the body, the
pancreas. The pancreas is an elongated,
tapered organ located across the back of
the abdomen, behind the stomach. The
endocrine tissue of this organ secretes the
hormone insulin which regulates the level of
glucose in the blood, oxidizes it and
releases energy. The deficiency of insulin or
the inability of body cells to use the
available insulin causes the accumulation of
glucose in the blood causing the symptoms
of diabetes.
Mechanism of Diabetes:
After taking food, the concentration of glucose in the blood rises. Insulin prevents the
glucose concentration from rising above the normal or physiological limit. Thus, the
most important and obvious function of insulin is to control the concentration of
glucose in the blood.
If insulin is absent or inadequate, the glucose in the blood can’t enter various cells and
also can’t be converted into glycogen. Consequently, blood glucose level rises. When
this blood passes through the kidneys, excess sugar (beyond the capacity of the
kidneys to stop) spills into the urine.
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TYPES OF DIABETES
Most cases of diabetes are due to two major types, Insulin-dependent diabetes
Mellitus (IDDM) also known as Juvenile diabetes or Type I, and Non-insulindependent diabetes Mellitus (NIDDM) or Type II. Type I is due to the inability of body
cells to use available insulin. The differences are presented below:
IDDM (Type I) Diabetes
More common in childhood and young adulthood, Patients are underweight; Patients
are prone to frequent infection; Patients require lifelong insulin support. Complications
like diabetic coma are common if insulin is inadequate. Accounts for 3-7% of diabetic
cases.
NIDDM (Type II) Diabetes
More common in later life, generally after 40 years; Frequently associated with
obesity. Generally asymptomatic; Mostly Hereditary; Treated usually with diet control,
exercise and oral drugs when needed; Diabetic coma is rare; Accounts for about 9095% of diabetic cases.
SYMPTOMS OF DIABETES: Dryness of mouth and excessive thirst; Excessive
hunger; Excessive and frequent urination; Weight loss; Feeling of exhaustion and
weakness; Easy susceptibility to infections of skin, gums and respiratory system;
Wound infection and delayed healing; Lack of concentration and mental fatigue.
CAUSE OF DIABETES
1. HEREDITY: i) If both parents are diabetic, the chances of an individual developing
diabetes are almost 100%. ii) If one parent is diabetic, the chances of the offspring
developing diabetes are 50%. iii) If a close blood relative has diabetes, the risk of an
individual developing the disease is about 25%.
2. OBESITY AND OVER – NUTRITION: They are directly related to a higher risk of
developing diabetes. This is because it is found that obesity and higher fat intake
interfere with the proper function of insulin and fat people require a greater level of
insulin to achieve the same benefit.
3. LACK OF EXERCISE: The general physical inactivity termed as sedentary lifestyle
is also a factor for developing diabetes.
4. TENSION, ANXIETY AND STRESS: They can precipitate diabetes in those who
have a genetic predisposition to the disease.
5. SOME DRUGS: Drugs including those of the cortisone group can increase the
blood sugar and thus may reveal pre-existing diabetes.
6. INCORRECT DIETARY HABITS: The incidence of diabetes varies directly with the
consumption of processed, refined and junk foods, e.g. biscuits, bread, cake,
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chocolate, pudding and ice cream along with over eating. The body has to produce
more digestive juices and insulin to digest excessive food. Under the pressure of an
excessive work load, the pancreas glands weaken and ultimately break down leading
to diabetes.
7. HIGH ALCOHOL INTAKE 8. ETHNICITY 9. AGING AND HIGH BLOOD
PRESSURE 10. GESTATIONAL DIABETES OR GIVING BIRTH TO A BABY
WEIGHING MORE THAN 9 POUNDS
A diabetic may also become unconscious when the concentration of glucose in the
blood drops much below normal (Hypoglycemia). However, such unconsciousness
happens rapidly, while unconsciousness due to excessive glucose and ketosis is a
slowly developing condition: the patient experiences various symptoms of uneasiness
(e.g. acute thirst, dryness of mouth, weakness, headache, nausea, vomiting, profuse
urination etc.) before a diabetic coma due to hyperglycemia occurs.
Long- term complications of diabetes
In the long run, diabetes ruins almost every system of the body. Complications of the
nervous system give rise to distorted sensations and inefficiency of the urinary
bladder. Complications of the heart and blood vessels result in the hardening and
narrowing of the arteries (atherosclerosis), high B.P. and chronic heart disease. The
incidence of heart attacks is about 5-6 times higher than in healthy persons.
Diabetes damages the retina of the eyes. This results in gradual loss of vision.
Cataracts, too, occur at an early age in diabetes. Complications of the respiratory
system result in an increased susceptibility to infectious diseases of the lungs like T.B.
Diabetes has undesirable effects on the digestive system. Nausea/ vomiting, diarrhea
and gall stones are more common in diabetes.
Blood Sugar Permissible Limits:
Category
of Person
Normal
Early Diabetes
Established
Diabetes
Blood Glucose Concentration ( in mg% )
Fasting Value
Max Value
Less than 120
120 to 140
More than 140
Less than 160
160 to 180
200 or more
15
Value 2 Hours
after Consuming
Glucose
Less than 120
120 to 140
More than 140
TREATMENT OF
DIABETES
1.
Diet Control: Diet is the single most important factor for controlling diabetes. If
faulty dietary habits are not given up, drugs or any other treatment will be of little
value. In fact, for obese diabetics, dietary change assumes all the more
significance.
 Foods to be totally avoided: All concentrated sources of sugar such as
sugar, glucose, jam, chocolates, sweets, sweet drinks, sweetened milk,
canned fruits, sweet biscuits, cake, pie, pudding, peppermint and alcohol.
 Foods to be taken in limited quantity: cereals, pulses, potatoes, peas,
dry fruits, cheese, milk, butter, ghee, oil, meat, eggs, fish, curd, etc.
 Foods that can be taken freely: Most fruits, vegetables, drinks (tea,
coffee etc. sweetened with saccharine.)
 Special medicinal foods: Certain foods like bitter gourd, black berry,
fenugreek, garlic and neem are considered natural foods for controlling
diabetes, Hence patients of diabetes should consume them often.
 Fiber foods: Fibers lower the rate of glucose absorption from the gut and
thereby lowering glucose levels in the blood and aiding treatment of
diabetes. Fiber helps in reducing insulin dosage administered to the
diabetic patient. For fibers take whole grain cereals and pulses along with
fruits and vegetables.
2.
Exercise: Exercise helps diabetes in many ways. Exercise increases the
receptivity of muscles to insulin and so a greater amount of glucose will be
transferred from the blood stream to the muscles by the same amount of insulin.
Further during exercise, more oxygen is sent to the pancreas and thus the
pancreas is stimulated to function better. Physical activity will burn blood sugar
and lower its level. In the body, glucose can’t be metabolized without oxygen.
Exercise provides a lot of oxygen to metabolize the sugar. With consistent
physical activity, the ability of cells to respond to insulin gradually increases.
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3.
Medical: Two types of medicines are used in diabetes: I) Oral anti-diabetic drugs
ii) Insulin injections: The type and dosage of these medicines have to be
determined by an expert physician taking into account the condition of the patient.
4.
Acupressure: There are acupressure points in the palms and soles of the legs
corresponding to the pancreas. Pressing these points regularly and frequently will
activate the pancreas and gradually it will start functioning better. These
acupressure or reflex points are like switches or buttons. When you press them,
current or life energy starts running to that part.
Advice for Diabetic Patients:
The following practical suggestions will be useful for the diabetic patients.
1. Diabetics should take more smaller meals scattered over the day rather than taking
a few heavy concentrated meals so that the blood sugar level doesn’t shoot up
suddenly as the smaller amount of insulin (or that injected as a medicine) is
insufficient to metabolize large amount of blood sugar. 2. Diabetics should avoid
fasting and missing their meals to prevent low blood sugar. Even if you don’t have any
appetite, don’t abstain from food. Have light food at regular intervals. 3. While on a
tour, keep fruits like apples, oranges to prevent low blood sugar. 4. In sweetening
agent, saccharine is more preferable to sugar. Although it is sweeter than sugar, it has
no calorie content. 5. Maintain your meal timings properly to maintain blood sugar at
normal levels all the time. 6. Have variety in your food so that all necessary vitamins,
minerals and other nutrients reach body to keep it fit. Spices can be taken by a
diabetic as they possess no caloric value. However, restrict the use of salt. 7. The
diabetic should increase his awareness about the disease. 8. Exercise for at least 30
minutes per day like walking, jogging, cycling, etc. 9. Stop smoking.10. Total fat intake
should be less than 30% of the calories.
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Blood Pressure
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Heart Rate
Bohm, B., Rotting, N., Schwenk, W., Grebe, S., & Mansmann, U. (2001). A prospective randomized trial on heart
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By: PE Department 2009
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