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Blood Pressure and Sound

Blood Pressure and Sound

What i s pressure? P= F/A - Measured in Pascal -1 Pa = 1 Newton/ 1

What is pressure?

What i s pressure? P= F/A - Measured in Pascal -1 Pa = 1 Newton/ 1
What i s pressure? P= F/A - Measured in Pascal -1 Pa = 1 Newton/ 1

P=F/A

-Measured in Pascal -1 Pa = 1 Newton/ 1 m 2 -Sectioned view of a syringe – pressure exerted by plunger is

distributed to all parts of the fluid

Measurement of Pressure

Measurement of Pressure -1 Atmosphere = force needed to raise the mercur y in column about
Measurement of Pressure -1 Atmosphere = force needed to raise the mercur y in column about

-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?

W h y we measure pressure? • Pressure i s t h e driving f orce

• 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.

l

h

B ood Pressure around t e Heart

SP: Systolic Blood Pressure DP: Diastolic Blood Pressure

l h B ood Pressure around t e Heart SP: Systolic Blood Pressure DP: Diastolic Blood
l h B ood Pressure around t e Heart SP: Systolic Blood Pressure DP: Diastolic Blood

Blood pressure reading as essential

of every clinical visit

Blood pressure reading as essential of every clinical visit
Blood pressure reading as essential of every clinical visit

Arterial blood pressure

Arter i a l b l ood pressure
Arter i a l b l ood pressure
Very direct measurement of blood pressure
Very direct measurement of blood pressure

Very direct measurement of blood pressure

Direct measurements

• Extra-vascular sensors:

D i rect measurements • Extra-vascular sensors: – Catheter filled with saline-heparin solution connected to a

– 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, and semiconductor devices

Direct – Extra Vascular Measurement of Blood p ressure - Sa line is more friendly with

Direct Extra Vascular Measurement of Blood pressure

Direct – Extra Vascular Measurement of Blood p ressure - Sa line is more friendly with

-Saline is more friendly with body than sensor -Time Delay for pressure to reach sensor through saline

-Saline must be flushed every minute to avoid blood clotting at tip of catheter

Flush solution under pressure

Roller clamp Sample and transducer zero stopcock
Roller clamp
Sample and transducer
zero stopcock
Direct – Extra Vascular Measurement of Blood p ressure - Sa line is more friendly with

Sensing

port

Electrical connector

Disposable pressure transducer with an integral flush device

Insertion of catheter:

Seldinger-technique

Insertion of catheter: Seldinger-technique
Insertion of catheter: Seldinger-technique

An arterial monitoring set-up

An arterial monitorin g set - up Extra-vascular blood pressure measurement
Extra-vascular blood pressure measurement
Extra-vascular blood pressure measurement

Direct measurements

• Intravascular sensors:

D i rect measurements • Intravascular sensors: – Sensors a ti p of catheter – Has

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, opteo- electronics, and semiconductor devices

Old Generation Pressure Sensor

O l d Generat i on Pressure Sensor  i (b) c R 2 R 1

i

(b)

c R 2 R 1 R x a R y R 3 R 4 d 
c
R 2
R 1
R x
a
R y
R 3
R 4
d
  o
R i

b

Wheatstone bridge for

the pressure sensor (four

active elements)

Diaphragm A B Armature C D (a) Strain-gage wires Di ap ragm coup e h l
Diaphragm
A
B
Armature
C
D
(a)
Strain-gage wires
Di
ap ragm coup e
h
l
d
w t
i h
stra n
i

gage, when P increases strain

B &C increases and strain on

A&D decreases

Fiber Optics based Pressure Sensor

F i ber Opt i cs based Pressure Sensor -Operate in linear range of response -Pressure
F i ber Opt i cs based Pressure Sensor -Operate in linear range of response -Pressure

-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

Disposable Pressure Sensor

Disposable Pressure Sensor • Connect diaphra g m to a piezo-electric cr y stal • Pressure

• Connect diaphragm to a piezo-electric crystal Pressure moves diaphragmcrystal movesvoltage is generated • Reduce cross-patients contamination

• Can connect diaphragm to variable resistor to measure diaphragm displacement and related to pressure

Harmonic analysis of BP waveform

Harmonic analysis of BP waveform • A Pressure waveform can be decomposed into infinite number of
Harmonic analysis of BP waveform • A Pressure waveform can be decomposed into infinite number of

• A Pressure waveform

can be decomposed into

infinite number of sine

waves with different

amplitudes and phases

• Adding the first six

harmonics almost

reconstructs the signal

Required bandwidth for measuring

Requ i red bandwidth f or measuring • Up to 10 h armon ics if interest

• Up to 10 th harmonics if interest is in the amplitude of the signal

• Up to 20 th harmonics if interest is in the slope of the signal (d/dt information)

• Catheter + transducer system must have sufficient bandwidth

• Catheter + transducer system must have suitable dynamic properties

Bandwidth requirements

Bandw i dt h requ i rements • For BP waveform: harmonics hi g her than

• For BP waveform: harmonics higher than the 10 th are ignored

– BP BW for HR of 120 bpm is 20 Hz Derivative of BP may require BW up to frequency of the 20 th harmonic.

Modeling the catheter-sensor

system

Modeling the catheter-sensor system • We have three components (diaphra g m, sensor and the li

• We have three components (diaphragm, sensor and the liquid catheter) • Each component has

– Inertial resistance to motion – Friction touching other material – ElasticityAbility to change shape with pressure

The catheter-sensor system No-bubble

Th e ca th e t er - sensor system N o - bubble Catheter Catheter
Catheter Catheter liquid inertia li qu id res stance i Sensor Diaphragm compliance
Catheter
Catheter
liquid inertia
li
qu
id
res stance
i
Sensor
Diaphragm
compliance

• Resistance due to friction between molecules moving in catheter

R= ΔP/F= ΔP/μA

Where ΔP i

s pressure

diff

t i

erence across a segmen

n

P

a,

F i

s

fl

3

ow ra e, m /s, μ

t

is the average velocity m/s, and A is the cross sectional area m 2

• Inertia or inertance L c is given by

L c = ΔP/(dF/dt) = ΔP/aA=ρL/A

• Where a= acceleration of fluid m/s 2, , L =Length of catheter, ρ is density of fluid

kg/m 3

• Compliance C =ΔV/ ΔP = 1/E d

Where E d is the modulus of elasticity for the diaphragm

The catheter-sensor system No-bubble

T h e cat h eter - sensor system No - bubble - Solving the second

-Solving the second order system

dv t

( )

  • I o

t

dt

  • c C

( )

KVL

( )

  • v L

t

dI t

c

( )

  • i dt

( )

I t R

c

v

o

  • v i )

(

t

LC

2

d v

o

( )

t

  • 2

dt

RC

dv t

o

( )

dt

( )

v t

o

For a laminar flow

f n

r

P

2  L  V
2 
L
 V

Resonance Frequency

4

r

3

L (  V /  P ) 
L
(
V
/
P
)


Damping Ratio (η= viscosity)

Normalized step responses (2 nd

order system)

Normalized step responses (2 order system)
Normalized step responses (2 order system)

Effect of bubble in system

Effect of bubble in system L c R c L cd R cd  (t) C
L c R c L cd R cd  (t) C C  (t) i o
L c
R c
L cd
R cd
 (t)
C
C
(t)
i
o
b
d

i (t)

(b) Effect of Bubble L c R c C C b d (c)
(b)
Effect of Bubble
L c
R c
C
C b
d
(c)
  • o (t)

Two parts, one before the bubble and the other is after the bubble, can ignore some elements

Transfer function with and without air bubble = 91 Hz f n  = 0.033 10

Transfer function with and without air bubble

= 91 Hz f n  = 0.033 10 = 22 Hz f n  =
= 91 Hz
f n
 = 0.033
10
= 22 Hz
f n
 = 0.137
1 0
.
No bubble
Bubble
0 1
.
0.0
1
0.01
0.02
0.04 0.06
0.1
0.22
0.4
0.6
1
2
4
6
8 10
 o (j)
 i (j)

f/f

n

0.91

Bubble reduces cut-off frequency For proper BP measurement, need to get 20 harmonics

~40Hz

BP terms and concepts

BP terms and concepts • Heart Rate (HR): Rate at which the heart is pumping bloo

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)=P dias +1/3(P sys -P dias )

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

Modeling the BR

Modeling t h e BR • Blood flow can be modeled usin g Ohms law where

• Blood flow can be modeled using Ohms law where pressure resembles voltage, flow resembles current and resistance of vessels is impedance (resistive + capacitive)

• Many models are there to measure cardiac output using MAP

R (vessels resistance, L length, r is radius, and P is pressure)

( R )

L

r

4

F

Pr

4

L

BR waveform

BR waveform • Systolic pressure (P )  ventricle ejects into aorta • As ventricle relaxes
BR waveform • Systolic pressure (P )  ventricle ejects into aorta • As ventricle relaxes

• Systolic pressure (P systolic ) ventricle ejects into aorta

• As ventricle relaxes, pressure drops • The "dicrotic notch,“ occurs with aortic valve closes • Lowest value before blood ejection is P diastolic

P ressure i n and around the heart
P ressure i n and around the heart

Pressure in and around the heart

System step response

System step response Step response by the bulb Surgical Three- Measure output glove way stopcock Match
Step response by the bulb Surgical Three- Measure output glove way stopcock Match O-ring Ai r
Step response by the bulb
Surgical
Three-
Measure output
glove
way
stopcock
Match
O-ring
Ai r
Saline
Rubber
washer
Sphygmomanometer
bulb

Step response

Step response  ln    y  n n  1 1 y 
 ln    y  n n  1 1 y   
ln    y
n
n  1
1
y
  
n
2
T
1 
2
2
4
n
π 
ln
y   
y
   
n 1 

Sinusoidal Response (frequency)

Sinusoidal Response (frequency) Pressure sensor Frequency response Ideal sensor com p ares readin g " Ideal

Pressure sensor

Frequency response

Ideal sensor compares reading

"Ideal

sensor

Underwater

speaker

Sinusoidal Response (frequency) Pressure sensor Frequency response Ideal sensor com p ares readin g " Ideal
Sinusoidal Response (frequency) Pressure sensor Frequency response Ideal sensor com p ares readin g " Ideal

Catheter

Sinusoidal Response (frequency) Pressure sensor Frequency response Ideal sensor com p ares readin g " Ideal
Sinusoidal Response (frequency) Pressure sensor Frequency response Ideal sensor com p ares readin g " Ideal

Saline

Low-frequency

sine generator

Waveform distortion

Wave f orm d i stort i on
Wave f orm d i stort i on

Waveform distortion

Wave f orm d i stort i on
Wave f orm d i stort i on

Heart sounds

Heart sounds • Sounds: due to acceleration and deceleration of the blood. • Murmurs: due to

• Sounds: due to acceleration and deceleration of the blood.

• Murmurs: due to blood turbulence

Heart sounds: 1st: closing mitral and tricuspid valves 2nd: closing of aortic valve (end of ECG
Heart sounds: 1st: closing mitral and tricuspid valves 2nd: closing of aortic valve (end of ECG

Heart sounds:

1st: closing mitral

and tricuspid valves

2nd: closing of aortic

valve (end of ECG T)

3rd: end ventricular

filling

4th: contraction of

atria and propelling

blood into ventricles

Normal/Abnormalities

Normal/Abnormalities • Normal murmurs durin g earl y sy stolic phase in children. • Abnormal ones

• Normal murmurs during early systolic phase in children.

• Abnormal ones due to stenoses and leaks at different valves (aortic, mitral, pulmonary).

• Measurement of time duration between murmurs, relation to heart cycle may determine the abnormality in the heart

Auscultation techniques to

measure heart sound

Auscultation techniques to measure heart sound • BW of heart sounds (0.1-2000 Hz)
Auscultation techniques to measure heart sound • BW of heart sounds (0.1-2000 Hz)

• BW of heart sounds (0.1-2000 Hz)

Stethoscopes

Stethoscopes • Transfer heart sound through tube to ears • Electronic stethoscopes ( micro phones) ,

• Transfer heart sound through tube to ears

• Electronic stethoscopes (microphones), not accepted by many doctors since sound is different

Stethoscopes • Transfer heart sound through tube to ears • Electronic stethoscopes ( micro phones) ,

Indirect measurements of BP

Sphygmomanometer

Indirect measurements of BP Sphygmomanometer • Non-invasive • Reduce cuff pressure  blood flows  hear
Indirect measurements of BP Sphygmomanometer • Non-invasive • Reduce cuff pressure  blood flows  hear

Non-invasive

Reduce cuff pressure blood flowshear the sound in the scope

Korotkoff sounds (20-300 Hz) are heart with a stethoscope

Manometer reading at first sound is systolic pressure

Sounds stop at diastolic pressure (why?)

Automatic systems are also available.

Less accurate for infants and hypertensive patients

Not effective in noisy area

Automatic Detection of pressure

Automatic Detect i on o f pressure • Automaticall y inflate the cuff with known p

• Automatically inflate the cuff with known pressure

• Replace stethoscope with a microphone

When the first Kortkoff sound detected, record pressure inside the cuff

• When sounds are no longer present, record cuff pressure,

U l trason i c determination o f BP • Doppler sensor detect vessel wall motion.

Ultrasonic determination of BP

U l trason i c determination o f BP • Doppler sensor detect vessel wall motion.

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

Oscillometric

O sc ill ome tri c 1 • MAP  DP + (1/3)(SP – DP) 200
  • 1 • MAP DP + (1/3)(SP – DP)

200 160 2 systolic and diastolic pressures 120 80 40 0 Cuff pre ssure mm Hg
200
160
2
systolic and diastolic pressures
120
80
40
0
Cuff pre ssure mm
Hg

• Start and end of oscillation indicates

Cuff pressure oscillations

Block diagram of oscillometric type External Internal Cuff pressure Pressure A u o-zero t sensor valve

Block diagram of oscillometric type

External Internal Cuff pressure Pressure A u o-zero t sensor valve Multiplexer Cuff pressure and analog
External
Internal
Cuff pressure
Pressure
A
u o-zero
t
sensor
valve
Multiplexer
Cuff pressure
and analog
BP cuff
oscillations
to digital
converter
Inflation
system
Deflate valve
Microcomputer
with memory
Dump
and I/O
valve
Over-
Pressure
switch
MAP
SYS
HR
DYS

References

• Webster (Medical Instrumentation) Dr Baha and Dr Haithams class notes www.Wikipedia.com www.Cvphysiology.com

References • Webster (Medical Instrumentation) • Dr Baha and Dr Haitham ’ s class notes •