600 8. Cardiovascular System 8.4.4 Windkessel Model This simplified model of the arterial pulse is also known as the Windkessel Model [8], which was the first real model of blood flow, In this model blood flows from the left ventricle at a rate Qiq(1) into an elastic chamber of compliance C (‘e., the larger arteries) of volume V (f) and leaves it at a rate Qou(t) to enter a resistive element of resistance Ry (peripheral resistance of the arterioles and capillaries). It assumes that all pressure changes in the arteries occur at the same time, Because conservation of volume for an incompressible fluid gives av Qin(t) = oo + Qou(t), (8.108) with C = dV (t)/4P (0) (8.57) and Qour(t) = P(0)/Rp (8.68), (8.108) becomes P(t) dt Pw) Re Qin(t) = (8.109) The formal solution to this is P(t) = exp(—(t/1)) (ro +of exp(t'/7) Qin(t')dt 0 ) . (8.110) where tT = RC. This can be shown to be the solution by substitution and by the method shown in Appendix C. Still itis simple and instructive to examine what happens after ventricular ejection, starting at r= 0 when Qia(t) = 0 and P = PO), until the next cycle starts at (= 7, Then dP) dt Po 0 ford<1 £ Fig. 8.56. Electrical analogs of the a classic or elastic Windkessel Model (W2), b three-element (or improved) Windkessel Model (W3), and ¢ viscoelastic Windkessel Model (VW). The electrical resistances represent flow resistances and the electrical capacitances represent flow compliances (See Appendix D) elements sum to zero (Kirchhoff’s 2nd Law, Chap. 12), so FRetect + 4/Cetect = 0. Because [ = dg/dt, we have (dq/dt)Retect + 4/Cetect = 0 or with Vetece = 4/Cetect Vetect Vetecs dt RetectCelect 0. (8.113) The two-element Windkessel Model can be refined by adding more elements to the clectrical analog. The three-element Windkessel Model shown in Fig. 8.56b predicts a more realistic arterial pulse. The vascular resistance R, of the aorta is added in series, and the value of the resistance in parallel is now Ry, which equals Ry— Ry. The viscoelastic Windkessel Model (Fig. 8.56c) represents a different type of improvement of the two-element Wiridkessel Model. The compliant arterial systems are represented by a capacitance (in the electrical analog of flow compliance) that is in series with a resistor Ra, which represents the viscous wall motion to more fully represent the viscoelasticity of the aorta. 84.5 Modeling the Malfunctioning Heart ‘There are many reasons and ways a heart can malfunction [46]. For example, single mutations that truncate the sarcomere protein titin (Chap. 5) can lead to changes in heart size, shape and function (which is also known as cardiac remodeling), and can cause early heart failure and death, including by dilated cardiomyopathy [33]. These conditions can be characterized quantitatively and, in principle, can be included in our models of the heart and circulation, Cardiac performance can be characterized by several parameters, such as the stroke volume Vsyoke and cardiac output Qy F’Veqoke, described earlier. Figure 8.57 shows cardiac performance as a function of the conditions at the end of diastole in the left ventricle. The middle curve describes the operation of that person’s heart, and point a represents that normal person at rest. In systolic heart failure, such as after a myocardial infarction, the curve shifts down due to lessened