Blood Pressure.

Blood pressure refers to the force exerted by circulating blood on the walls of blood vessels, ..
The pressure of the circulating blood decreases as blood moves through arteries, arterioles, capillaries, and veins; the term blood pressure generally refers to arterial pressure, i.e., the pressure in the larger arteries, the blood vessels that take blood away from the heart. .. blood pressure values are reported in millimetres of mercury (mmHg), ....

The systolic arterial pressure is defined as the peak pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are contracting; the diastolic arterial pressure is the lowest pressure during the resting phase of the cardiac cycle. The average pressure throughout the cardiac cycle is reported as mean arterial pressure; the pulse pressure reflects the difference between the maximum and minimum pressures measured.

Typical values for a resting, healthy adult human are approximately 120 mmHg systolic and 80 mmHg diastolic (written as 120/80 mmHg, and spoken as "one twenty over eighty") with large individual variations. These measures of arterial pressure are not static, but undergo natural variations from one heartbeat to another and throughout the day (in a circadian rhythm); they also change in response to stress, nutritional factors, drugs, or disease. Hypertension refers to arterial pressure being abnormally high, as opposed to hypotension, when it is abnormally low. Along with body temperature, blood pressure measurements are the most commonly measured physiological parameters.

In children the normal ranges are lower than for adults.
In the elderly, blood pressure tends to be higher than normal adult values, largely because of reduced flexibility of the arteries.

Factors ... influencing blood pressure values.

• age,
• gender,
• race,
• exercise,
• emotional reactions,
• sleep,
• digestion and
• time of the day.

High arterial pressure

.. Higher pressures increase heart workload and progression of unhealthy tissue growth (atheroma) that develops within the walls of arteries. The higher the pressure, the more stress that is present and the more atheroma tend to progress and the heart muscle tends to thicken, enlarge and become weaker over time.

Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure, arterial aneurysms, and is the leading cause of chronic renal failure. Even moderate elevation of arterial pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.

In the past, most attention was paid to diastolic pressure; but nowadays it is recognised that both high systolic pressure and high pulse pressure (the numerical difference between systolic and diastolic pressures) are also risk factors.

In some cases, it appears that a decrease in excessive diastolic pressure can actually increase risk, due probably to the increased difference between systolic and diastolic pressures ..

Low arterial pressure

Blood pressure that is too low is known as hypotension. .. perfusion of the brain (can) becomes critically decreased
(i.e., the blood supply is not sufficient), causing lightheadedness, dizziness, weakness and fainting. ...

However, people who function well, while maintaining low arterial pressures have lower rates of cardiovascular disease events than people with normal arterial pressures.

Influential factors

.. there are many physical factors that influence arterial pressure.
Each of these may in turn be influenced by physiological factors, such as diet, exercise, disease, drugs or alcohol, obesity, excess weight and ...

Some physical factors are:

Rate of pumping.
In the circulatory system, this rate is called heart rate, the rate at which blood (the fluid) is pumped by the heart.
The higher the heart rate, the higher (potentially, assuming no change in stroke volume) the arterial pressure.

Volume of fluid or blood volume,
the amount of blood that is present in the body.
The more blood present in the body, the higher the rate of blood return to the heart and the resulting cardiac output. There is some relationship between dietary salt intake and increased blood volume, potentially resulting in higher arterial pressure, though this varies with the individual and is highly dependent on autonomic nervous system response.

Resistance.
In the circulatory system, this is the resistance of the blood vessels.
The higher the resistance, the higher the arterial pressure. Resistance is related to size (the larger the blood vessel, the lower the resistance), as well as the smoothness of the blood vessel walls. Smoothness is reduced by the buildup of fatty deposits on the arterial walls. Substances called vasoconstrictors can reduce the size of blood vessels, thereby increasing blood pressure. Vasodilators (such as nitroglycerin) increase the size of blood vessels, thereby decreasing arterial pressure.

Viscosity, or thickness of the fluid.
If the blood gets thicker, the result is an increase in arterial pressure.
Certain medical conditions can change the viscosity of the blood. For instance, low red blood cell concentration, anemia, reduces viscosity, whereas increased red blood cell concentration increases viscosity. Viscosity also increases with blood sugar concentration—visualize pumping syrup. It had been thought that aspirin and related "blood thinner" drugs decreased the viscosity of blood, but studies found[27] that they act by reducing the tendency of the blood to clot instead.

Sometimes the arterial pressure drops significantly when a patient stands up from sitting.
This is known as orthostatic hypotension (postural hypotension); gravity reduces the rate of blood return from the body veins below the heart back to the heart, thus reducing stroke volume and cardiac output.

When people are healthy, the veins below their heart quickly constrict and the heart rate increases to minimize and compensate for the gravity effect. This is carried out involuntarily by the autonomic nervous system. The system usually requires a few seconds to fully adjust and if the compensations are too slow or inadequate, the individual will suffer reduced blood flow to the brain, dizziness and potential blackout. Increases in G-loading, such as routinely experienced by acrobatic jet pilots 'pulling Gs', greatly increases this effect. Repositioning the body perpendicular to gravity largely eliminates the problem.

Other causes of low arterial pressure include:
• Sepsis
• Hemorrhage - blood loss
• Toxins including toxic doses of blood pressure medicine
• Hormonal abnormalities, such as Addison's disease

Shock is a complex condition which leads to critically decreased perfusion.
The usual mechanisms are loss of blood volume, pooling of blood within the veins reducing adequate return to the heart and/or low effective heart pumping. Low arterial pressure, especially low pulse pressure, is a sign of shock and contributes to and reflects decreased perfusion.

If there is a significant difference in the pressure from one arm to the other, that may indicate a narrowing (for example, due to aortic coarctation, aortic dissection, thrombosis or embolism) of an artery. ...

  BP: The mechanism of blood pressure INDEX
http://en.wikipedia.org/wiki/Blood_presure
This page was last modified on 24 September 2008

Physiology.

The mean arterial pressure (MAP) is the average pressure measured over one complete cardiac cycle.

The up and down fluctuation of the arterial pressure results from the pulsatile nature of the cardiac output.
The pulse pressure is determined by the interaction of the stroke volume versus the resistance to flow in the arterial tree. ...

.. the vascular pressure wave (VPW).
This wave is created by the heart during the systole and originates in the ascending aorta.
Much faster than the stream of blood itself, it is then transported through the vessel walls to the peripheral arteries.
There the pressure wave can be palpated as the peripheral pulse.

As the wave is reflected at the peripheral veins it runs back in a centripetal fashion.
Where the crests of the reflected and the original wave meet, the pressure inside the vessel is higher than the true pressure in the aorta. This concept explains why the arterial pressure inside the peripheral arteries of the legs and arms is higher than the arterial pressure in the aorta, and in turn for the higher pressures seen at the ankle compared to the arm with normal ankle brachial pressure index values.

Regulation

The endogenous regulation of arterial pressure is not completely understood. ..

Baroreceptor reflex:
Baroreceptors detect changes in arterial pressure and send signals ultimately to the medulla of the brain stem.
The medulla, by way of the autonomic nervous system, adjusts the mean arterial pressure by altering both the force and speed of the heart's contractions, as well as the total peripheral resistance. The most important arterial baroreceptors are located in the left and right carotid sinuses and in the aortic arch.

Renin-angiotensin system (RAS):
This system is generally known for its long-term adjustment of arterial pressure.
This system allows the kidney to compensate for loss in blood volume or drops in arterial pressure by activating an endogenous vasoconstrictor known as angiotensin II.

Aldosterone release:
This steroid hormone is released from the adrenal cortex in response to angiotensin II or high serum potassium levels. Aldosterone stimulates sodium retention and potassium excretion by the kidneys. Since sodium is the main ion that determines the amount of fluid in the blood vessels by osmosis, aldosterone will increase fluid retention, and indirectly, arterial pressure.

These different mechanisms are not necessarily independent of each other, as indicated by the link between the RAS and aldosterone release. Currently, the RAS system is targeted pharmacologically by ACE inhibitors and angiotensin II receptor antagonists.

The aldosterone system is directly targeted by spironolactone, an aldosterone antagonist. The fluid retention may be targeted by diuretics; the antihypertensive effect of diuretics is due to its effect on blood volume. Generally, the baroreceptor reflex is not targeted in hypertension because if blocked, individuals may suffer from orthostatic hypotension and fainting.

  BP: Low Blood Pressure Linked to brain injury. INDEX
https://www.wellnessresources.com/news/low-blood-pressure-linked-with-brain-atrophy
June 2, 2014 --- Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

Hypertension, COPD, obstructive sleep apnea, poor cardiac function, and aorta stiffness are well known disorders linked with poor brain health and neurodegeneration. Hypertension in midlife has been associated with more brain atrophy in later life, but it is now understood that elderly with low blood pressure have more brain atrophy than those with hypertension. Recent research now shows that low diastolic blood pressure and/or orthostatic hypotension are associated with a greater progression of brain atrophy in the elderly with arterial disease than high blood pressure!

Researchers are expanding their research in cognitive impairments in the elderly.
They are looking at the brain’s microcirculation rather than only nerve synapses and large blood vessel flow.
In essence, researchers are looking at how well the brain’s own tree-like circulatory system is working and keeping the brain nourished. They are looking at the consistency of the amount and quality of nourishment going to the brain in both big and small vessel circulation, i.e. how healthy is the perfusion. When this tree-like circulation in the brain is diminished or has low output as in low diastolic blood pressure or hypotension, it is akin to having a garden hose turned on at a trickle or half pressure. If you are trying to water your garden at this pace, it takes a long time, the nourishment becomes hampered and the garden (may) begins to fail.

Avoiding high blood pressure or hypertension has historically been the focus for health, whereas low blood pressure has commonly been dismissed as being “normal”. Mayo Clinic defines a normal blood pressure as anything at or below 120/80, which leads to wide interpretation. Mayo Clinic also defines low blood pressure as 90 mm Hg systolic or 60 mm Hg diastolic. This means that if you have a blood pressure of 110/55 or 90/60, etc., you have low blood pressure.

While it is good to not have elevated blood pressure, far too often individuals who have low or borderline low blood pressure are dismissed or ignored. There is a bit of a dichotomy going on with blood pressure interpretation. If you were a patient in the ICU hooked up to all kinds of monitors and your BP was at 80/50, the alarms would be going off. Some type of intervention to support blood pressure would take place. Whereas individuals walking into their physician’s office complaining of fatigue, loss of stamina, or poor cognitive function and who have low blood pressure of 80/50 or 110/45 are often dismissed or worse, i.e. referred to the local psychologist and put on an antidepressant. Unless you are a patient who has fainting and dizziness with their low blood pressure, there just seems to be little support for the average person with low blood pressure.

With blood pressure, there are certainly a significant number of variables that affect the interpretation of the numbers. A healthy presentation may be one who has a BP of 110/65 and is an athlete or exercises regularly, non-smoker, normal body weight and does not have concerns of fatigue, brain fatigue, poor stamina, etc. An unhealthy presentation is someone who has a BP of 80/50, poor stamina, and feels mentally and physically exhausted. There are several variables to keep in mind that may need to be checked into with new onset of low blood pressure or symptomatic chronic low blood pressure.

These variables include
• anemia,
• dehydration,
• infections,
• pregnancy,
• some heart conditions,
• thyroid,
• adrenal,
• diabetes,
• low blood sugar,
• kidney problems, and
• others.

Many times, certain medications are the culprit.

These include
• diuretics,
• alpha blockers,
• beta blockers,
• certain antidepressants,

  drugs for

• male impotency,
• Parkinson’s disease and
• nitroglycerin.

Regardless of the cause, if you feel less than perky, and you have low blood pressure, don’t ignore it.
While the study reported in JAMA Neurology was focusing on the elderly, if you are having symptoms of brain fatigue and low blood pressure, you need to be proactive. This is your brain not getting enough blood flow and nourishment. That garden hose in your brain is not running well enough to provide nourishment to your garden. Examples of brain fatigue coupled with low blood pressure may include

• feeling spacey and near black out or
• blacking out with standing,
• falling asleep while reading material for work or pleasure,
• having better comprehension of material when reading lying down,
• easy forgetfulness,
• irritability,
• frequent yawning,
• craving caffeine or
• other stimulants,
• decreased mental energy for learning new material,
• feeling fatigued or drowsy when driving especially when on a road trip, or
• going back to school as an adult and feeling exhausted.

It may take years for research to trickle down to mainstream medicine on the impact of low blood pressure and brain health.
The fact that low diastolic (60 mm Hg or less) causes identifiable brain atrophy in the elderly should be a wake up call to the medical community. How many individuals have low blood pressure because of being overmedicated, or their physician’s goal is to have “good”, low numbers? How about the millions who have poor thyroid, adrenal, and blood sugar function with altered blood pressures contributing to poor cerebrovascular health? One is too many if it is your parent, your child or you.

As with any disorder, it is always best to identify what has caused the dysfunction if at all possible.
In general, there are a number of nutritional tools to help support healthy blood pressure regulation.

1. Stay hydrated.
Drink 6-8 twelve ounce glasses of water per day.
The more caffeine/coffee you drink, the more you need to pay attention to this.
At the same time, don’t forget about the elderly who often skimp on fluid intake for many reasons. Poor hydration challenges blood flow.

2. Address any concerns with anemia.
Consider using iron bisglycinate if you need iron support.
This is especially relevant to the young girls and women who have a vegetarian/low red meat intake lifestyle, athletic, and heavy periods.

3. Adrenal stress and fatigue is rampant in our society.
If you are running yourself into the ground, the more likely low blood pressure is present.

4. Low salt diets often contribute to low blood pressure.
Celtic or sea salt is not evil.

5. Certain nutrients like licorice root and tyrosine may help support significant concerns with adrenal fatigue. Work with a qualified health care professional for best results.

6. If there are concerns with autoimmune nervous system disorders, such as POTS, CFS, FM, work on reducing neurological stress and imbalances.

7. Improve blood viscosity to improve blood flow.

8. Try burst training, i.e. very brief periods of physical activity done several times throughout the day.
This may include one minute bursts of deep knee bends, push-ups, running up a flight of stairs, etc. Another method may include, brief exposure to cold showers to train the sympathetic nervous system to respond by improving blood pressure tone. For those who are less healthy, before getting up from a sitting or lying position, repetitively squeeze your thigh muscles for several seconds to a minute, and keep them squeezed as you are standing up. This can help push blood to the brain.

9. Above all, if you are on medications that are artificially lowering your blood pressure and de-energizing your brain, work on improving the health of the body. Presently there is no ability to calculate how many people developed brain atrophy while being on high blood pressure medications, and how their overmedication led to the development of Alzheimer’s disease and death. Don’t become a statistic thinking that low blood pressure is a sign of good health.

If you are dealing with low blood pressure, don’t ignore it.
By the time your medical provider is able to demonstrate brain atrophy on your MRI or CT scan due to low diastolic blood pressure, you already have major problems. If you have brain fatigue, brain fog, physical fatigue and low blood pressure now - get help. Figure out what the underlying issue is and do what you can to improve blood flow.

Common sense, says that if your blood pressure is low, especially with symptoms, you generally don’t have the same blood flow perfusion to the brain than you would if you had healthy blood pressure regulation.

  BP: Reflex Arc emergency response. INDEX
https://www.wisegeek.com/what-is-a-reflex-arc.htm
Originally Written By: Victoria Blackburn
Revised By: C. Mitchell
Edited By: Bronwyn Harris
Last Modified Date: 31 January 2019

LINK 2: http://www.emergencymedicalparamedic.com/what-is-a-reflex-arc/
Authors: Chris Cartwright and/or Ian Wells and/or Maria Co Paler and/or Joe Cartwright

LINK 3: https://www2.courses.vcu.edu/ptxed/m2/
powerpoint/download/Ishac%20Cardiovascular.PDF
Pharmacology of the Cardiovascular System
Edward JN Ishac, Ph.D.

LINK 4: https://en.wikipedia.org/wiki/Baroreflex
This page was last edited on 6 December 2018

LINK 5: https://www.sciencedirect.com/
topics/medicine-and-dentistry/cardiovascular-reflex
John C. Longhurst, Liang-Wu Fu,
in Primer on the Autonomic Nervous System (Third Edition), 2012

What is a Reflex Arc?
A reflex arc in human physiology refers to the physiological processes involving the afferent, interneuron and efferent neurons in response to an event that requires an immediate action. A reflex arc allows a immediate action to take place prior to the afferent neurons reaching the cerebral cortex (command center).

The simplest example of a reflex arc in practice is when a person stands on a sharp thumb tack, an afferent message will be sent from the foot to the spinal cord, where an interneuron will identify that a reflex arc is required and consequently an efferent message is sent directly to the foot to move, causing the person to jump.

A reflex arc is a nerve pathway in the body of humans and some animals that connects certain muscle groups to others, without involving the brain. These sorts of pathways primarily control involuntary movements in response to some sort of stimulus. Rapidly blinking the eyes in response to dust or dirt in the air is one example; coughing when food is lodged in the windpipe and kicking the leg out when whacked in the center of the knee are others. Reflex arcs are wholly independent of the pathways that most nervous impulses travel on. The messages carried over them are no less important, though, and problems with reflexes often signal bigger issues with nerve control and muscular support.

What is the Purpose of the Reflex Arc?
The purpose of the reflex arc is to avoid further damage to cells while the afferent messages are sent to the cerebral cortex.
By producing a reflex arc the interneurons are able to initiate the immediate reflex action required.

The key difference between a reflex action and any other nervous system action is the involvement of the brain. In the case of most nerve signals, stimulated cells send a message, called a nerve impulse, to the brain. The brain receives the message and then sends back another message in response to this initial stimulation that basically tells the body what action to take. This takes place very quickly, but it is not automatic like the response seen with reflexes.

Common Problems
Reflexes are an important part of muscular protection and communication.
People who have abnormal or unpredictable reflexes may also have other, larger problems with their nervous systems more generally, and should usually get evaluated by a medical provider. This is often particularly true of newborns and young infants. Babies often have a number of instinctive reflexes, often known as “primitive” reflexes, that help them adapt to the world around them. These include sucking and rooting, which are really important when it comes to feeding. Doctors often look for evidence of strong reflexes within the first few days of life, and scan for neurological disorders if these aren’t present. When caught early enough, disorders can often be solved or effectively treated with medication and lifestyle changes.

The baroreflex or baroreceptor reflex is one of the body's homeostatic mechanisms that helps to maintain blood pressure at nearly constant levels. The baroreflex provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes the heart rate to decrease and also causes blood pressure to decrease. Decreased blood pressure decreases baroreflex activation and causes heart rate to increase and to restore blood pressure levels. The baroreflex can begin to act in less than the duration of a cardiac cycle (fractions of a second) and thus baroreflex adjustments are key factors in dealing with postural hypotension, the tendency for blood pressure to decrease on standing due to gravity.

The system relies on specialized neurons, known as baroreceptors, in the aortic arch, carotid sinuses, and elsewhere to monitor changes in blood pressure and relay them to the Medulla. Baroreceptors are stretch receptors and respond to the pressure induced stretching of the blood vessel in which they are found. Baroreflex induced changes in blood pressure are mediated by both branches of the autonomic nervous system: the parasympathetic and sympathetic nerves. Baroreceptors are active even at normal blood pressures so that their activity informs the brain about both increases and decreases in blood pressure.

The body contains two other, slower acting systems to regulate blood pressure: the heart releases atrial natriuretic peptide when blood pressure is too high, and the kidneys sense and correct low blood pressure with the renin–angiotensin system.

Autonomic Reflex Responses to Visceral Afferent Activation
Cardiovascular reflex responses to visceral afferent stimulation are either excitatory or inhibitory.
In this respect, stimulation of vagal afferents causes reflex cardiovascular inhibition, including decreased heart rate, blood pressure, and myocardial contractility, consequent to reduced sympathetic outflow to the heart and blood vessels and increased vagal motor output to the heart. Conversely, stimulation of sympathetic afferents that project centrally through sympathetic nerves and spinal pathways evokes reflex cardiovascular excitation, including increases in heart rate, blood pressure and myocardial performance, through increased sympathetic motor activity and, possibly, withdrawal of parasympathetic tone to the heart.

Cardiovascular reflex responses originating from the heart consist of either reflex inhibitory or excitatory responses, or, more often, a combination of the two. Thus, stimulation of the posterior-inferior and inner regions of the wall of the left ventricle leads to reflex bradyarrhythmias and hypotension, while stimulation of the anterior and superficial regions of the wall of the left ventricle leads to reflex tachyarrhythmias and hypertensive responses. More commonly both vagal and sympathetic afferent pathways are stimulated concomitantly with a resulting reflex reflecting a mixed response consisting often of a small increase in blood pressure due to processing in the CNS, for example in the tractus solitarii and possibly the parabrachial nuclei.

  BP: Salt's effects on your body. INDEX
http://www.bloodpressureuk.org/microsites/salt/Home/Whysaltisbad/Saltseffects
Blood Pressure Association --- 2008

Salt works on your kidneys to make your body hold on to more water.
This extra stored water raises your blood pressure and puts strain on your kidneys, arteries, heart and brain.

S (Salt) Index
• Salt: Kidneys.
• Salt: Arteries.
• Salt: Heart.
• Salt: Brain.

Kidneys S Index

Your body removes unwanted fluid by filtering your blood through your kidneys.
Here any extra fluid is sucked out and put into your bladder to be removed as urine.

To do this, your kidneys use osmosis to draw the extra water out of your blood.
This process uses a delicate balance of sodium and potassium to pull the water across a wall of cells from the bloodstream into a collecting channel that leads to the bladder.

Eating salt raises the amount of sodium in your bloodstream and wrecks the delicate balance, reducing the ability of your kidneys to remove the water. The result is a higher blood pressure due to the extra fluid and extra strain on the delicate blood vessels leading to the kidneys. Over time, this extra strain can damage the kidneys - known as kidney disease. This reduces their ability to filter out unwanted and toxic waste products, which then start to build up in the body.

If kidney disease is left untreated and the blood pressure isn't lowered, the damage can lead to kidney failure.
This is when the kidneys are no longer able to be filter the blood and the body slowly becomes poisoned by its own toxic waste products. If you have high blood pressure and are being treated with a diuretic medication, this makes the kidneys remove more fluid from the bloodstream. Because the sodium in salt counteracts this effect, reducing your salt intake will make your blood pressure medicine more effective.

Arteries S Index

The extra blood pressure caused by eating too much salt puts extra strain on the insides of your arteries.

To cope with the extra strain, the tiny muscles in the artery walls become stronger and thicker.
Yet this only makes the space inside the arteries smaller and raises your blood pressure even higher.

This cycle of increasing blood pressure (which occurs slowly over a number of years) can ultimately lead to the arteries bursting or becoming so narrow that they then clog up entirely.

When this happens, the organs of the body that were receiving the blood from the arteries become starved of the oxygen and nutrients they need. This can result in the organs being damaged and can be fatal.

Heart S Index

The raised blood pressure caused by eating too much salt may damage the arteries leading to the heart.
At first, it may cause a slight reduction in the amount of blood reaching the heart.
This may lead to angina (sharp pains in the chest when being active).

With this condition the cells in the heart don't work as well as they should because they are not receiving enough oxygen and nutrients. However, lowering blood pressure may help to alleviate some of the problems and reduce the risk of greater damage.

If you continue to eat too much salt then, over time, the damage caused by the extra blood pressure may become so severe that the arteries burst or become completely clogged. If this happens, then the part of the heart that was receiving the blood no longer gets the oxygen and nutrients it needs and dies. The result is a heart attack.

The best way to prevent a heart attack is to stop the arteries becoming damaged.
And one of the best ways of doing this is keep your blood pressure down by eating less salt.

Brain S Index

The raised blood pressure caused by eating too much salt may damage the arteries leading to the brain.
At first, it may cause a slight reduction in the amount of blood reaching the brain.
This may lead to dementia (known as vascular dementia).

With this condition the cells in the brain don't work as well as they should because they are not receiving enough oxygen and nutrients. However, lowering blood pressure may help to alleviate some of the problems and reduce the risk of greater damage. If you continue to eat too much salt then, over time, the damage caused by the extra blood pressure may become so severe that the arteries burst or become completely clogged. If this happens, then the part of the brain that was receiving the blood no longer gets the oxygen and nutrients it needs and dies. The result is a stroke, where you lose the ability to do the things that part of the brain used to control.

The best way to prevent a stroke is to stop the arteries becoming damaged.
And one of the best ways of doing this is keep your blood pressure down by eating less salt.

  BP: Peripheral Heart Action Training with Dumbbells. INDEX
http://www.strengthcats.com/PHAtrainingdumbbells.htm

The "Peripheral Heart Action Training with Dumbbells" (PHAT-D) is a relatively short, but very intense circuit type workout. It is a great method for building stamina and work capacity in the major muscle groups. The PHAT-D workouts can be performed in 4 unique ways. Each way or option has its own degree of difficulty.