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Q. Draw both aortic root and a radial artery pressure wave forms on the sameaxes. Explain the differences between them
Aorta pressure-time curve
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X axis;
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Y axis; Radial artery pressure-time curve
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X axis;
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Y axis;OverviewCauses of radial pulse
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Pressure transmission
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Wave & flowRecording
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Occlusion & waveMechanism of radial waves
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mechanical activity
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electrical activity
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absenceDifference1. Delay in onset
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Onset & pressure rise
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Reason2. Systolic peak
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Height
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Effect to systolic pressure
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Shape
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Causes3. Presence of dicrotic notch
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presence
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Aortic curve & notch
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Causes4. Shape
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Distorted shape
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Causes4. Presence of diastolic hump
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presence;
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Causes5. Pulse pressure
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Comparison
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Mean pressure
8. Duration
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Relative durationEfffect of age on radial artery pressure contourPhysiological changes in elderly
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Decrease compliance of the aorta; due to aortic atheroscerosis & loss of aortic fibre
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Decrease myocardial performanceChanges in arterial contourAortic curve shape
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Slower upstroke than young ptnAortic curve height
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Higher peak ; due to low aortic complianceClinical significant
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Note; if this systolic peak is persistently elevated then; ptn has systolic hypertensionSummary;
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The low aortic compliance causes the pressure wave to travel faster and lessdistorted from the contour of aortic curve
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Ie sama jer bentuknyeDifferences with young
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Changes in elderly ; difference in pressure curve found in young patient
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The difference between aortic and radial curves in the elderly are less than found inyoung ptn.Causes of difference
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The differences between the waves are due to the decreased compliance which gaverise to the steeper upstroke in the radial wave form.
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The higher systolic radial arterial pressure is due to reflection and summation,tapering and faster transmission of pressure waves.
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Whilst damping in the radial wave causes the loss of anacrotic and dicrotic notches;
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whereas reflection and resonance lead to a diastolic hump on the radial wave form.
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In elderly patients, pulse wave may be transmitted unchanged from the ascendingaorta to the periphery because of the less compliant vesselsShort answer questionOverviewAorta pressure-time curve Radial artery pressure-time curveOverviewCauses of radial pulse
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Transmission of pressure wave peripherally
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The pressure wave travel faster than flow of bloodRecording
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The wave can be measured eventhough there is occlusion at distal partMechanism of radial waves
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Heart is pumping ---mechanical activity
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Heart is generating electricity --- has electrical activity
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If absence ---no radial waveDifference1. Delay in onset
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Radial artery has---- delay in the time of onset of the initial pressure rise
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This is due to--- time taken to travel distally2. Systolic peak
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Radial artery curve is taller
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Effect ---higher systolic pressure
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Narrower peak
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Due to higher velocity of higher pressure peak 3. Presence of dicrotic notch
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Radial aretry doesnt has diacrotic notch as aortic wave
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Reason--its high pressure components is dampened
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Dicrotic notch---which at aortic arch is the incisura
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due to closing of the aortic valve) becomes delayed and slurred4. Presence of diastolic hump
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Radial artery pressure -time traces--has diastolic hump;
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this is due to reflection and resonance5. Pulse pressure
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The radial pulse pressure is higher than aortic pressure,
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But the mean pressure ; not much difference from the mean pressure recordedcentrally
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peak and pulse pressures of the radial artery pressure wave to be greater than theaortic root pressure wave.8. Duration
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the radial wave pressure should show a steeper upstroke and a shorter duration thanthe aortic traceEfffect of age on radial artery pressure contourPhysiological changes in elderly
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Decrease compliance of the aorta; due to aortic atheroscerosis & loss of aortic fibre
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Decrease myocardial performanceChanges in arterial contour
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