)1( ‫الكترونيات حيوية و قياسات‬

Bioinstrumentation I
Chapter 7 –Blood Pressure and sound

‫ نعمان النجار‬.‫إعداد د‬
Dr.Eng. Noman AL Najjar- PhD in biomedical engineering
Department of Biomedical Engineering UST-Sana’a
noman_qaed@yahoo.com
Dr.Noman
 Dr.Noman 2

NOTE -This chapter taken from different resources

internet and modified by dr.Noman AL najjar

in
John G. Webster (Editor)
Medical Instrumentation: Application and Design
John Wiley & Sons, 1998

ISBN 0-471-15368-0
 Blood Pressure and sound
3 Outline
 Concept of pressure
 Measurement of Pressure
 Blood Pressure around the Heart
 Classification of blood pressure
 Direct blood pressure measurement
 Blood Pressure Transducers
 Strain gage w/ Wheatstone Bridge
 Intravascular Sensors
 Fiber O ptics based Pressure Sensor
 Dynamic Properties of the Measurement System
 Bandwidth Requirements
 Heart Sounds
 Indirect blood pressure measurement
 AuscultatoryMethod
 Ultrasonic determination of blood pressure
 Oscillometric Automated BP Monitors
 Practical part Dr.Noman
 Blood Pressure and sound
4

 What is pressure?
 P=F/A

 -Measured in Pascal

 -1 Pa = 1 Newton/ 1 m2

 -Sectioned view of a syringe –pressure exerted

by plunger is distributed to all parts of the fluid

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 Blood Pressure and sound
5

Measurement of Pressure
1 Atmosphere = force needed to raise the mercury
in column about 760 mm high
-Blood pressure is measured in terms of mm Hg
 Why we measure pressure?
 • Pressure is the driving force of the dynamics of
the human body
 • Pressure is generated by the heart (constant
volume or a constant pressure pump?)
 • Changes of the pressure inside heart chambers
cause acceleration and deceleration of the
blood that generate sounds.

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 Blood Pressure and sound
6

 Figure 7.1 The left

ventricle ejects blood into
the systemic circulatory
system. The right ventricle
ejects blood into the
pulmonary circulatory
system.

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 Blood Pressure and sound-Blood Pressure around the Heart
7

Figure 7.2 Typical values of circulatory pressures SP is the systolic

pressure, DP the diastolic pressure, and MP the mean pressure. The wedge
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pressure is defined in Section 7.13.
 Blood Pressure and sound- Classification of blood pressure
8

Classification of blood pressure levels for adults 18 years and older. Systolic
pressure, the higher number of a blood pressure reading, is the pressure as the
heart pumps; diastolic pressure is the pressure when the heart relaxes between
beats
CATEGORY SYSTOLIC (mm Hg) DIASTOLIC (mm Hg)
Normal* <130 < 85
High normal 130-139 85-89
Hypertension
STAGE 1 (Mild) 140-159 90-99
STAGE 2 (Moderate) 160-179 100-109
STAGE 3 (Severe) 180-209 110-119
STAGE 4 (Very Severe) >209 >119

Optimal blood pressure is less than 120/80 mm Hg. Unusually low readings should
be evaluated by a physician.
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 Blood Pressure and sound- Classification of blood pressure
9

Invasive measurements –two major techniques:

Couple vascular pressure to an external sensor via a liquid-filled catheter
(extravascularpressure sensor)
Place the sensor on the catheter tip which is directly inserted into the vessel of interest
(intravascular pressure sensor).
Direct measurements
• Extra-vascular sensors:
– Catheter filled with saline -heparin solution connected to a sensor.
– Connected to the vessel through surgical cut-down or percutaneous insertion
• Sensors used can be:
– Strain gage, piezo-electric crystals, LVDT,
variable inductance, variable capacitance, opteo-electronics,
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and semiconductor devices
 Blood Pressure and sound- Classification of blood pressure
10

Direct – Extra Vascular Measurement of Blood pressure

-Saline is more friendly with body than sensor
Time Delay for pressure to reach sensor through saline Flush solution under pressure
-Saline must be flushed every minute to avoid
blood clotting at tip of catheter

Sensing
port
Sample and transducer Roller clamp
zero stopcock

Electrical connector
Disposable pressure transducer with an integral flush device

Figure 7.3 Extravascular pressure-sensor system A catheter couples a flush

solution (heparinized saline) through a disposable pressure sensor with an integral
flush device to the sensing port. The three-way stopcock is used to take blood samples
and zero the pressure sensor. Dr.Noman
 Blood Pressure and sound- Classification of blood pressure
11

Direct – Extra Vascular Measurement of Blood

pressure
Extravascular Sensors
Catheter connected to a pressure sensor
through 3-way stopcock
System is filled with saline-heparin solution
(anticoagulant agent), must be flushed every
few minutes
Catheter inserted through surgical cut down
or percutaneousinsertion
BP info is transmitted via the catheter fluid to the
sensor diaphragm (why use water, but not air?)

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Blood Pressure and sound- Blood Pressure Transducers
12

•A thin flexible metal diaphragm is stretched

across the opening of the transducer top.

•The diaphragm is connected to an inductive

bridge (or resistive Wheatstone bridge) strain
gauge which flexes the strain gauge an amount
proportional to the applied pressure.

•A clear plastic dome, filled with fluid sits atop

the diaphragm and provides the hydraulic
coupling / connection to the catheter. Electrical
connector typically houses the bridge circuit

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Blood Pressure and sound- Blood Pressure Transducers
13

Direct measurements
• Intravascular sensors:
– Sensors a tip of catheter
– Has higher frequency response and less time delay
– More expensive, may break after a few uses
• Sensors used can be:
– Strain gage, piezo-electric crystals, LVDT,
variable inductance, variable capacitance, opteoelectronics,
and semiconductor devices

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Blood Pressure and sound- Strain gage w/ Wheatstone Bridge
14

Diaphragm with straincoupled

gage, when P increases
strain
Wheatstone bridge for B &C increases and strain on
the pressure sensor (four active A&D decreases
elements)
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Blood Pressure and sound- Intravascular Sensors
15

Disadvantage of the previous system: The frequency response of the system is limited
by the hydraulic properties, in particular the low pass filter effect of the tubing system

Using an intravascular system eliminates the entire plumming system, by making the
measurement at the site!
•Eliminates the time delay introduced by the tubing system
•Allows high fidelity measurement of the high frequency components of the BP
signal
Typical sensors used:
•Strain gages bonded onto a flexible diaphragm at the catheter tip
•Fiber optic systems where the displacement measurement of the diaphragm is
made optically

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Blood Pressure and sound- Fiber Optics based Pressure Sensor
16

-Operate in linear range of response

-Pressure causes membrane deflection
-Deflection causes change in angle of
reflected light
-Reflected light is picked up by Photo-detector
-The amount of reflection is proportional to the
membrane motion which is proportional to the
blood pressure

Figure 7.4 (a) Schematic diagram of an intravascular fiber-optic pressure sensor. Pressure causes deflection in a thin
metal membrane that modulates the coupling between the source and detector fibers. (b) Characteristic curve for the
fiber-optic pressure sensor. Dr.Noman
Blood Pressure and sound- Fiber Optics based Pressure Sensor
17

Figure 7.5 Fiber-optic pressure sensor for intracranial pressure measurements in the

newborn. The sensor membrane is placed in contact with the anterior fontanel of the

newborn.

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Blood Pressure and sound- Dynamic Properties of the Measurement System
18
Sensor

Errors in measurement of
dynamic pressure can lead to
(a) P Diaphragm
significant consequences, Liquid Catheter
Incremental
underdamped system - D
length
V
Overestimated BP.
The liquid filled catheter-sensor
Rc Lc Rc Lc Rc Lc Rs Ls
is a hydraulic system that can be (b)

best modeled by distributed Cc Cc Cc Cd =DV

Cs DP
parameters. Figure 7.7 (a) Physical model of a catheter-sensor system.
(b) Analogous electric system for this catheter-sensor system.
Each segment of the catheter has its own resistance Rc, inertance Lc, and
compliance Cc. In addition, the sensor has resistor Rs, inertance, Ls, and
compliance Cs. The compliance of the diaphragm is Cd.
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Blood Pressure and sound- Dynamic Properties of the Measurement System
19

Figure 7.8 (a) Simplified analogous circuit.

Compliance of the sensor diaphragm is larger than
compliance of catheter or sensor cavity for a bubble-
free, noncompliant catheter. The resistance and
inertance of the catheter are larger than those of the
sensor, because the catheter has longer length and
smaller diameter.

(b) Analogous circuit for catheter-sensor system with a

bubble in the catheter. Catheter properties proximal to
the bubble are inertance Lc and resistance Rc. Catheter
properties distal to the bubble are Lcd and Rcd.
Compliance of the diaphragm is Cd; Compliance of the
bubble is Cb.

(c) Simplified analogous circuit for catheter-sensor

system with a bubble in the catheter, assuming that Lcd
and Rcd are negligible with respect to Rc and Lc.
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Blood Pressure and sound- Bandwidth Requirements
20

10 harmonics would clearly be adequate to accurately represent the BP signal.

Considering that the fundamental frequency should be around 1 ~ 2 Hz, a 0 ~ 20 Hz
bandwidth should be sufficient for a bioamplifierused to condition BP signals.
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Blood Pressure and sound- Bandwidth Requirements
21

Distortion will be seen on all signals acquired by a system that does not possess
the appropriate frequency response.

(Air bubble / blood clot)

(a) Recording of an undistorted left-ventricular pressure waveform via a pressure

sensor with bandwidth dc to 100 Hz. (b) Underdampedresponse, peak value is
increased. A time delay is also evident (c) Overdampedresponse showing a significant
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time delay and an attenuated response.
Blood Pressure and sound- Bandwidth Requirements
22

Modeling the catheter-sensor system

• We have three components (diaphragm, sensor and the liquid catheter)
• Each component has
– Inertial resistance to motion
– Friction  touching other material
– Elasticity Ability to change shape with pressure

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Blood Pressure and sound- Bandwidth Requirements
23

The catheter-sensor system No-bubble Catheter

• Resistance due to friction between molecules moving in catheter R= ΔP/F= ΔP/μA

• Where ΔP is pressure difference across a segment in Pa, F is flow rate, m3/s, μ

is the average velocity m/s, and A is the cross sectional area m2

• Inertia or inertance Lc is given by Lc= ΔP/(dF/dt) = ΔP/aA=ρL/A

• Where a= acceleration of fluid m/s2, , L =Length of catheter, ρ is density of fluid

kg/m3
• Compliance C =ΔV/ ΔP = 1/Ed
• Where Ed is the modulus of elasticity forDr.Noman
the diaphragm
Blood Pressure and sound- Bandwidth Requirements
24

The catheter-sensor system No-bubble Catheter

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Blood Pressure and sound- Bandwidth Requirements
25

The catheter-sensor system No-bubble Catheter

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Blood Pressure and sound- Bandwidth Requirements
26

Effect of bubble in system

Two parts, one before the bubble and the

other is after the bubble, can ignore some
elements

Transfer function with and without air bubble

For proper BP measurement, need to get 20

harmonics
~40Hz
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Bubble reduces cut-off frequency
Blood Pressure and sound- BP terms and concepts
27

BP terms and concepts

• Heart Rate (HR): Rate at which the heart is pumping blood
• Stroke Volume (SV): volume of blood pumped in one cycle
• Cardiac output (CO): Volume of blood pumped by the heart = HR x SV
• Mean Arterial Pressure (MAP)=Pdias+1/3(Psys-Pdias)
• Resistance of vessels (capillaries), required cardiac output, and thickness of blood affect
blood pressure
• Exercise  more blood is needed increase CO
• Vessels obstructed resistance is high increase BP to force the flow

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Blood Pressure and sound- Heart Sounds
28

Heart sounds: Vibrations or sounds due to acceleration or decelarationof blood

Heart murmurs: Vibrations or sounds due to blood turbulance
Listening to the sounds made by the heart for diagnostic purposes is known as
auscultation. The temporal relationship of these sounds and the mechanical /
electrical events of the cardiac cycle provide significant diagnostic information
phonocardiaography

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Blood Pressure and sound- Heart Sounds
29

Figure 7.15 Correlation of the four heart sounds with electric and
mechanical events of the cardiac cycle.
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Blood Pressure and sound- Heart Sounds
30

S1: Movement of blood during the ventricular systole, asynchronous closure

of the tricuspid/mitral valves

S2: Closure of semilunar valves causing the deceleration and reversal of flow
in the aorta and pulmonary artery

S3: Termination of rapid filling of the ventricles from the atria

S4 (non-audible, but noticeable on phonocardiogram contraction of atria and
propelling of blood into the ventricles

Murmurs: typically due to stenosis (constriction / blockage) or insufficiencies

(leakages) of the heart valves
Typical frequencies of HS and murmurs: 0.1 ~ 2000 Hz.

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Blood Pressure and sound- Heart Sounds
31

Auscultation techniques to measure heart sound

• BW of heart sounds
(0.1-2000 Hz)

Figure 7.16 Auscultatory areas on the chest A, aortic; P, pulmonary; T,

tricuspid; and M, mitral areas.

(From A. C Burton, Physiology and Biophysics of the Circulation, 2nd ed. Copyright © 1972 by
Year Book Medical Publishers, Inc., Chicago. Used by permission.)
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Blood Pressure and sound- Indirect Measurements AuscultatoryMethod
32

•Most commonly used technique for

listening sounds and/or indirectly (non-
invasively) measuring blood pressure is
the auscultatorymethod

•For NIBP, one listens to the

Korotkoffsounds

•Typically less then 200 Hz, where

human hearing is not very acute, time
consuming, but remarkably accurate

Figure 7.20 Typical indirect blood-pressure measurement system The sphygmomanometer cuff is inflated by a hand
bulb to pressures above the systolic level. Pressure is then slowly released, and blood flow under the cuff is monitored
by a microphone or stethoscope placed over a downstream artery. The first Korotkoff sound detected indicates systolic
pressure, whereas the transition from muffling to silence brackets diastolic pressure .
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(From R. F. Rushmer, Cardiovascular Dynamics, 3rd ed., 1970. Philadelphia: W. B. Saunders Co. Used with permission.)
Blood Pressure and sound-Indirect Measurements Ultrasonic determination of
33
BP
Figure 7.21 Ultrasonic determination of
blood pressure A compression cuff is
placed over the transmitting (8 MHz) and
receiving (8 MHz ±D ƒ) crystals. The
opening and closing of the blood vessel are
detected as the applied cuff pressure is
varied.

•Doppler sensor detect vessel wall motion.

•• Inflate cuff with known pressure
•• Start deflating, when motion is detected,
record pressure
•• When motion no longer detected, record
pressure
•• Good for infants and hypertensive patients

From H. F. Stegall, M. B. Karedon, and W. T. Kemmerer, "Indirect Measurement

Dr.Noman of Arterial Blood Pressure by Doppler
Ultrasonic Sphygmomanometry, "J. Appl. Physiol., 1968,25,793-798. Used with permission.)
Blood Pressure and sound- Oscillometric Automated BP Monitors

Cuff pressure mm Hg
34
1
Oscillometric 200
MAP = DP + (1/3)(SP – 160 2
DP)
120
• Start and end of
oscillation indicates 80
systolic and diastolic 40
pressures 0

Cuff pressure oscillations

Figure 7.22 The oscillometric method A compression cuff is inflated above
systolic pressure and slowly deflated. Systolic pressure is detected (Point 1)
where there is a transition from small amplitude oscillations (above systolic
pressure) to increasing cuff-pressure amplitude. The cuff-pressure
oscillations increase to a maximum (Point 2) at the mean arterial pressure.
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Blood Pressure and sound- Oscillometric Automated BP Monitors
35

Figure 7.23 Block diagram of the major components and subsystems of an

oscillometric blood-pressure monitoring device, based on the Dinamapunit, I/O
= input/output; MAP = mean arterial pressure; HR = heart rate; SYS= systolic
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pressure; DYS = diastolic pressure. From Ramsey M III
36

Practical part , read and

understand electrical equivalents of
pressure parameters

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 IBP ( Invasive BP ) measurement
37

diaphragm
Blood catheter
Pi cable
vessel Po
pill up with
some liquid strain gages
(ex.saline)
Pi

If we choose sticky and dense liquid,

We can’t get the signal of Pi just like the graph.
t To get the signal, We should concern with
Po distance, diameter of a catheter and liquid, air-
bubble inside a catheter.

t Dr.Noman
 IBP ( Invasive BP ) measurement
38

# Equivalent Circuit Model Of Catheter-Sensor System

L
(1) Resistance A 

V L
Electrical resistance : V  Ri , R  
 A
resistivity

P1 F  ( P1  P2)
R
P2 Liquid resistance : op  R  F

L
R  
A
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 IBP ( Invasive BP ) measurement
39

(2) Capacitance or Compliance

dv A dp
i C , C  f C D
C  Y  Young' s modulus
dt x dt

(3) Inductance or Inertance

di df m
V L PL , L
dt dt A2

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 IBP ( Invasive BP ) measurement
40

multi
physics Electric Circuit Fluid Mechanics
voltage pressure
current flow
charge volume

R
V L
[ ] (   )
 Pa  s 8L
R [ 3 ] ( )
I A F m r 4

L
V P L
dI L ( 2 )
dt dF r
dt
I C  Young' s modulus
C
dV
dt
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 Equivalent Circuit Model of IBP
41

Rc Lc
Po diaphragm
catheter cable +
Pi Vi i Vo Cd
-
liquid strain gages Compliance of
diaphragm
di dV0
Vi  Rc  i  Lc  V0 i  Cd
dt dt
dV0 d 2V0
Vi  V0  RcCd  Lc Cd 2
: 2nd order ODE
dt dt
D d
Rc Cd
D : operator K  1,  
dt 2 Lc
D 2 2D 1
damping

[ 2  1] Vo (t )  KVi (t ) Wn 
ratio

Wn Wn Lc Cd
natural
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frequency
 Equivalent Circuit Model of IBP
42

(1) Frequency Transfer Function

Vo ( jw) 1 1
H ( jw)   
Vi ( jw) ( jw ) 2  2 jw  1 1  ( w ) 2  j 2 w
Wn Wn Wn Wn
w
2
1 Wn
 H ( jw)    tan 1 ( )
w 2 2 2 w 2
w
[1  ( ) ]  4 ( ) 1  ( ) 2

Wn Wn Wn
1 2
  tan 1 ( )
w w w Wn
[1  ( ) 2 ]2  4 2 ( ) 2 
Wn Wn Wn w
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 Equivalent Circuit Model of IBP
43

|H|   0.5 (underdamped)

  1 (critically damped)

  2 (overdamped)

Wn w

∠H w
  0.5 (underdamped)

-π/2   1 (critically damped)

  2 (overdamped)

-π

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 Equivalent Circuit Model of IBP
44

Methods to solve 2nd order ODE d 2V0 dV

LC 2  RC 0  Vo  Vi
dt dt
(1) LCD 2Vo  RCDVo  Vo  Vi
d D
( LCD  RCD  1)Vo  Vi 
2
D
dt
Vo 1
H ( D)   : operational transfer function
Vi LCD 2  RCD  1

(2) LC ( jw) 2 Vo  RCjwV o  Vo  Vi

Vo 1
H ( jw)  
Vi LC ( jw) 2  RC ( jw)  1
 H ( D) D  jw
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 Steady State Freq. Response
45

|H| ∠H f1 f2
K -4/π

0.5
-1.8π
f1 f2 f

Vi (t )  A sin(2f1t ) Vi (t )  A sin(2f 2t )
 Vo (t )  0.5 A sin(2f 2t  1.8 )
Vo (t )  KA sin(2f1t  )
4

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 Unit Step Response
46

In reality, We need a unit step function for a starting point.

For example, Vi (t )  A sin(2f1t ) should be Vi (t )  A sin(2f1t )  u(t )

underdamping

input signal

overdamping

critical damping

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 Transient Step Response
47

Po

balloon

P
bulb

saline

overdamping

critical damping

underdamping

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 Example
48

(7.1) A 5mm-long air bubble has formed in the rigid-walled catheter to

a Statham P23Dd sensor. The catheter is 1m long, 6 French diameter,
and filled with water at 20 ℃. Plot the frequency-response curve of the
system with and without the bubble.

r 1 DP 12
fn  ( )  91Hz
2 L DL
4 L DV 12
  3( )  0.033
r  DP

f n,bub  22 Hz
 bub  0.137
1.34 1.95 log f

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 Example
49

(7.2) By changing only the radius of the catheter, redesign the (no-bubble)
catheter of Figure 7.9 to achieve the damping ratio ζ=1.
Calculate the resulting natiral frequency fn.

r 3 r0    0
3

r 3  0.0032
r  0.147
f n f n 0  r r0
f n  29 Hz 1.46 log f

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50

Thank you.

Dr.Noman
 Dr.Noman 51

References
• main text book “)Medical Instrumentation( Webster”
• Dr Baha and Dr Haitham’s class notes at KAU BME
•Lectures of Dr Noman AL Najjar at UST –BME
•http//engineering.roman.edu
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