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beat deviation including hypothyroidism. Other than that, it can also be influenced by medication that can lower down the heart
rate. In contrast, the heart rate is increased by exercise, stress, caffeine and alcohol. The automated system shown in Figure
4.5 clearly shows that an elderly individual who lives alone can be monitored from time to time. This form of monitoring is very
easy to install as it consists of a small pulse counter that is placed behind a wrist watch that can continuously monitor us-
ers heart rate when worn. If the heart rate reaches certain level, it will send an alert to the corresponding centre to request for
immediate medical attention. Before the medical team approach the users location, they will first try to telephone the user to
check whether the user is carrying out his or her routine activi- ties. An unanswered call definitely needs immediate attention. It
is vital to ensure that the threshold set has sufficient capabilities to reduce the chances of a false alarm, while at the same time
ensuring that any serious problem will not be left undetected. Nevertheless, it is difficult to detect a weak pulse. A weak pulse
can be due to a blood clot or heart disease which may lead to fatal. Therefore, it is very important to develop more method to
measure heart beat for detecting palpitations. Besides that, the ECGEEG that discussed in section 4.2 can be utilized to
measure heart beat which can provide precise measurement and indication of the rhythm which co-relates to pattern and the
strength. This information is useful when we use it to detect symptom of heart disease and abnormal blood vessels. Howev-
er, just counting the number of beats per minute is not enough to determine whether there is a blockage of blood vessels. Palpi-
tations might be unending or intense with shifting outcomes and each of them has diverse prerequisites for detection. Therefore,
more advanced methods of analyzing heart beats are required.
Sometimes, the medical history of a patient can reveal a forth- coming problem. Additionally, in some circumstances a chemi-
cal analysis might be included for example when recognizing
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ingestions identified with reasons for palpitation. A laboratory diagnosis is required to detect the substance that may influence
the changes of heart beat. Before a diagnosis is done no adjust- ments can be made. Both circumstances oblige interfacing the
testing to a particular division of the hospital with a specific goal of accommodating outpatient observation of palpitation. It
may even be important for the patient to use embedded mecha- nisms underneath the skin when continuous observation for cer-
tain conditions is needed.
Figure 4.5 Automated devices to assist the elderly
FONG et al 2011
4.1.3 Pressure of Blood Normal systolic pressure range: 100-140 mmHg
Blood pressure is a measurement of the pressure that exerted onto the wall of arteries. It is responsible for ensuring blood cir-
culation throughout the body to deliver oxygen and nutrients to all organs. Plotting the blood pressure variation of an individual
on a normal day will probably result in an untidy diagram that has little significance. Generally, the blood pressure of a person
is usually higher when awake than asleep. Nevertheless, we cannot take this as a correct assumption for all case scenarios. A
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perfectly healthy adult will have a mean systolic maximum pressure around 120mmHg but it can fluctuate within a range of
20 mmHg above or below the mean systolic pressure while car- rying out normal activities. The diastolic minimum blood
pressure of a person is generally over half of the highest pres- sure in the arteries which is within a range of 80 to 90 mmHg. A
spot measurement of an immediate reading cannot be used here due to the irregular variation experienced throughout the day.
When we visit a doctor a sphygmomanometer is used to meas- ure our blood pressure. This device will bind our arm tightly in
a cuff and a reading is obtained by pumping the device. This refers to the most conventional method that does not involve
any technology. Before we go in the technology aspect, we should understand the whole concept of blood pressure meas-
urement first. Blood pressure is the measurement of the pressure which is exerted inside a blood vessel when our heart is beating
and pumping blood throughout our body via arteries. This kind of measurement also can be called as systolic pressure, where
this can be done anywhere that has of artery near the skin. Apart from that, the diastolic pressure is also important for us to
measure as it is the pressure where the heart rest in between two consecutive beats. Hypertension is indicated when either of the-
se parameters exceeded certain level. When measuring these parameters, the sphygmomanometer is used together with the
stethoscope to listen to the heart beat so that the reading can be obtained at proper times; a pulse is for systolic pressure while
the absence of a pulse refers to diastolic pressure. This method involves taking the reading corresponding to hearing. Therefore,
this will definitely introduce errors. Moreover, this form of spot reading is inappropriate for ambulatory blood pressure monitor-
ing ABPM as it is only taken at a particular time instead of a continuous reading. ABPM requires a wearable monitor which
can retrieve blood pressure readings throughout the day. The data is then relayed to an external device so that the supporting
medical team can run an analysis. ABPM is normally used to monitor abnormal blood pressure for patients having abnormal-
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ly high blood pressure caused by prescribed drugs or for pa- tients who are undergoing prolonged anxiety psychological
treatment. Here, technology provides patients with a wearable device for increased comfort .It is very useful for patients with
hypertension and are resistant to pharmacotherapy. The whole process of blood pressure reading involves reading, scanning
and analysis of the data obtained. There are different ways to perform ABPM whereby the measuring device can be remotely
connected to the hospital to offer off-site measurement. This is useful when it necessary to obtain accurate measurements dur-
ing normal daily activities while monitoring cardiovascular pa- tients. In many cases, patients get nervous during a doctor visit
which would lead to the recording of an unintentional rise in blood pressure. Here, the remote measurement technology will
not face this kind of problem so accurate measurement can be taken. Different types of automated blood pressure meters are
readily available in the market whereby measurements can be taken at various parts of the body.
Figure 4.6 Blood pressure meter FONG et al 2011
Measurements can also be obtained from the leg, wrist, and fin- ger, apart from the arm. An example of the small monitor is in
Figure 4.6. There are tons of similar devices that can be found in the market for just below RM299. The device adopts a design
in which air is pumped into an inflatable wrap that acts similar
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as the manually inflated cuff of a sphygmomanometer. High and low reading which are based on the systolic and diastolic
pressure respectively is recorded through a quick series of read- ing on the pressure exerted on the switch. With a built in clock,
the time of reading can be stored for further analysis. Telemedi- cine technology grants much more than remote controlling and
periodic blood pressure monitoring. It will alert the medical team when certain procedures which are not suitable to be per-
formed on patients with special needs arise. For instance using a sphygmomanometer on a patient who is suffering from sickle
cell anemia is not recommended as excessive pressure applied to the patient can cause intravascular sickling which may lead to
tissue necrosis, intravascular thrombi and haemolysis. In order to avoid such consequences, checking the medical history of the
patient can be done electronically prior to performing any treatment to the patient. As we have discussed briefly on the
methods which technology can assist in the monitoring and measurement of blood pressure, we will proceed to the next vi-
tal sign which is the respiration rate.
4.1.4 Rate of Respiratory Normal Range: 12–24 breaths per minute
Respiratory rate is the most challenging aspect of measurement amid all the body vital signs because of its significant change
over a very short lapse of time. The respiratory rate is most likely intertwined with heart beat since the level of intensity of
activity would influence both parameters. Taking a deep breath might increase the duration of breath cycle and therefore cause
the reduction of respiratory rate. On the other hand, heart beat would be less affected. The breathing rate of a healthy adult is
12-24 times per minutes, which is much lower than heart rate.
