Download Comparison of Simultaneously Recorded Central and Peripheral

Comparison of Simultaneously Recorded
Central and Peripheral Arterial Pressure
Pulses During Rest, Exercise and
Tilted Position in Man
By
EDWIN J. KKOEKER, M.D.
AND EARL H. WOOD, M.D.,
PH.D.
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Central (aortic or subclavian), brachial, radial and femoral pressure pulses were recorded simultaneously in 12 healthy subjects during conditions of rest, exercise and 70 degree head-up tilt. Peripheral systolic pressure at rest uniformly exceeded the central systolic pressure generated by the same
heartbeat. The average radial pulse pressure was 146, 146 and 165 per cent of central pulse pressure
during rest, exercise and tilt while radial mean pressures were 94, 93 and 9S per cent of central
mean pressures respectively. Summation of the incident pulse wave with reflected waves from the
periphery and i-esonance effects in the peripheral arterial systems may produce these changes in
pressure and contour.
ton and co-workers4 in 1936. Aortic and radial
arterial pressure pulses were recorded simultaneously by Fuller and associates6 in 1952
during an operation for coarctation of the aorta.
Using the technic of arterial catheterization,
Schnabel and co-workers8 in 1952 reported
measurements of the central pressure pulse
in the intact human.
The present investigation was initiated for
the purpose of establishing normal pressurepulse data in man by the simultaneous recording of central and multiple peripheral arterial pressure pulses during conditions of rest,
exercise and 70-degree head-up tilt.
ALTHOUGH measurements of blood
/ % pressure in man by direct needle puncJL A . ture are now commonplace, actually,
determinations of arterial pressure by this
technic, are of relatively recent origin. The
average and range of values encountered in
man, especially in regard to central arterial
pressure pulses, have not as yet been well
documented.
Direct arterial blood pressure was first
recorded in man during limb amputations.
Thus, Faivre 1 in 1856 repoi^ted the blood
pressure in the femoral artery of man as
being 120 mm. of mercury. Merke and Mviller,2 in 1925, surgically exposed a brachial
artery in each of two critically ill patients and
inserted T tubes for the recording of pressures.
Brachial arterial pressures were obtained by
needle puncture in 1931 by Wolf and von BonsdorfP in a series of normal subjects and of
patients with cardiovascular disease. Hypodermic-type manometers were used to record
simultaneous pressure pulses in the axillary,
femoral and dorsalis pedis arteries by Hamil-
METHODS
The studies included 14 arterial catheterizations
of 12 healthy male physicians whose average age
was 32 years (range: 27 to 41), average height was
70 inches (range: 66 to 74) and average weight was
175 pounds (range: 150 to 205) (table 1). Subjects
were supine during rest and exercise; however, during exercise the left foot was in the pedal of a
bicycle ergometer, while the right leg, with an
indwelling needle in the femoral artery in the right
groin, remained at rest. The subject maintained
exercise at a rate of approximately 45 r.p.m. with
his left leg by watching a tachometer leading from
the bicycle ergometer.7 Arterial pressure pulses at
multiple sites were recorded at rest, after 3 to 6
minutes of exercise and after at least 10 minutes
in the 70-degree head-up tilt position. Respiration
and the electrocardiogram were registered simultaneously. Cardiac output was measured by the
From the Section of Physiology, Mayo Clinic and
Mnyo Foundation, Rochester, Minn.
Abridgment of a portion of the thesis submitted
by Dr. Kroeker to the Faculty of the Graduate
School, University of Minnesota, in partial fulfillment
of the requirements of a degreo of Master of Science
in Medicine.
Received for publication June 28, 1955.
623
CirciJallon RftrarcA, Volume III, jVoremfter 1MI
024
CENTRAL AND PERIPHERAL PRESSURE PULSES IN MAN
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direct Fick technic or by the dye-dilution technic,
under all three conditions just before or after the
recordings of aiterial pressures.
Central arterial pressure pulses were obtained
via a Petei-son-type aiterial catheter advanced up
to the arch of the aorta or to the left subclavian
artery through an IST-gage needle inserted into
the femoral artery at the groin or into the left
braehial artery in the antecubital fossa respectively.
The catheter was 80 cm. in length, 1.0 mm. in
external diameter and 0.5 mm. in internal diameter.
The final position of the catheter tip as measured
on the roentgenogram with correction for x-ray tube
distortion was an average of 5.5 cm. (range: 1.5 to
9.3) from a point at the top of the aortic arch at
the midsternal line. The catheter was inserted an
average distance of 51.5 cm. (4S.5 to 54.5) in the
five femoral aiterial catheterizations and 42.5 cm.
(40 to 45) in the nine brachial aiterial catheterizations. The average distance from the third interspace at the sternum to the femoral-needle puncture
site was 50 cm. (45 to 53), and from the brachialneedle puncture site 42.5 cm. (40 to 46) respectively
in these subjects.
The catheter-manometer system permitted immediately interchangeable recording with a capacitance* or strain-gage manometer. Both straingauge and capacitance manometer-catheter systems
were optimally damped. The response of the straingauge manometer-catheter system to sine-wave
pressure variations of increasing frequencies was
within 10 per cent of static sensitivity out to 12
c.p.s., while the capacitance manometer-catheter
system had a uniform response out to 60 cycles
per second. It has been found that catheter-manometer systems with these characteristics are adequate
to reproduce the practically important components
of peripheral8 and central* pressure pulses in man.
Peripheral arterial pressure pulses were recorded
by means of a hypodermic strain-gauge manometer
system described previously1"1" with a uniform
response to sine-wave pressure variations up to 25
cycles per second. Dynamic response characteristics
of all manometer systems to sine-wave and squarewave pressure variations were determined immediately following each procedure.10
Photokymographic recording was at paper speeds
ninging from 75 to 150 mm. per second. The manometers were calibrated frequently during the
course of a procedure, known pressures being
projected into all the manometer systems simultaneously. The zero reference point for both the supine
and the tilt position was taken as the midpoint of
the anteroposterior diameter of the chest at the level
of the third interspace at the sternum. Mean pres• A commercial version of the Lilly manometer
manufactured by the Tochnitrol Engineering Company, Philadelphia, Pn.
sures were obtained by planimetry of the photographic record. Only simultaneously recorded pulses
were measured. Simultaneous recordings of central
and radial pressure pulses were obtained in all 12
subjects. In addition simultaneous brachial pressure
pulses were obtained in eight and simultaneous
femoral pressure pulses in nine of these 12 subjects.
RESULTS
The values for the 12 subjects as regards age,
height, surface area, metabolic rate, heart
rate, cardiac indexes, and central and radial
arterial pressures are shown in table I.
Table 2 compares central arterial pressures
recorded in different conditions in healthy
men. The average increase in oxygen consumption produced by the exercise was 2.50
(200 to 320) per cent as compared to an increase of 69 (46 to 97) per cent in the cardiac
output (table 1).
Table 3 shows the relationship of peripheral
arterial pressures to the pressures generated
by the same heartbeat in the central arteries
in healthy men. AVhen the men were resting,
in the supine position, there was a uniform
increase of systolic pressure toward the periphery. The diastolic, dicrotic and mean pressures
showed a smaller but uniform decrease to the
periphery.
During exercise the pressure changes from
the central to the peripheral arteries were
similar to the changes at rest except for a
greater decrement in dicrotic pressure to the
brachial and radial arteries and an absence of
the increase in systolic pressure at the femoral
artery.
During the 70-degree head-up tilt the
average percentage increase of systolic pressure
was larger and the decrement in mean pressure
toward the periphery was smaller than in the
resting state.
Table 4 is a comparison of pulse pressures
recorded from the aorta and from the femoral,
brachial and radial arteries in healthy men.
At rest, central pulse pressure was 45 mm. of
mercury, but it increased to 57 mm. during
exercise and decreased to 33 mm. at the 70
degree head-up tilt. At rest, brachial pulse
pressure was 131 per cent, femoral ]39 per
cent and radial 146 per cent of aortic pulse
pressure. During exercise there was a striking
625
E. J. KROEKER AND E. H. WOOD
TARI.K 1.— Vikd Statistics awl Simultaneous Central and Radial Arterial Pressures in IS Healthy
White Men at Resl in Supine Position*
Age, Years
Cardiac Index,
Heart
Metabolic Rate at
L./min./M
Height, Surface
Area,
Rate,
Rest,
Inches
Win.
Rest Exercise Tilt
40
69
69
66
71
71
68
2.12
1.95
1.95
1.90
2.02
2.10
2.11
2.15
1.86
1.93
1.7S
2.06
2.07
1.81
Avcrune 32
70
1.9S
40
31
2S
28
2<J
30
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29
28
27
31
41
70
70
68^
71
72
74
+2
-7
-3
-2
0
+2
+5
+1
+32
-3
-2
-8
+ 10
+2
+3
Standard deviation
Arterial Pressure (mm. Hg) During Supine Rest
Systolic
66
4.1
3.1
3.7
3.3
5.6
3.0
6.5
5.7
—
4.S
8.6
5.9
2.7
—
2.6
—
2.9
—
114
US
114
115
12S
121
133
113
137
120
131
119
136
146
64
3.8
6.3
2.S
S
O.S
1.1
0.2
60
58
59
64
63
72
3.2
60
5S
54
66
62
63
88
5.5
2.4
A Q
7 ^
q i
—
—
3.3
3.S
5.3
7.3
2.7
q o
a c
q 0
—
Right radial artery
Central artery
(A)
(A)
(A)
(A)
(S)
(S)
(A)
(S)
(S)
(S)
(S)
(S)
(S)
(S)
Diastolic
71
73
73
76
7S
7S
S4
Diastolic
Mean
116
139
136
12S
15S
144
65
72
6S
72
74
75
77
64
75
75
S2
76
78
S3
S3
91
88
91
97
96
100
SI
100
96
106
94
104
107
Mean Systolic
92
93
91
94
101
99
SS
00
113
113
149
US
146
144
142
12S
147
153
126
SI
102
140
75
96
10
6
7
12
5
7
72
80
S4
S5
86
104
92
105
104
110
103
* Arranged in order of increasing central arterial diastolic pressure.
S •= Pressure recorded from left subclavian artery by catheter inserted via bracliial artery.
A = Pressure recorded from aorta by catheter inserted via femoral artery.
TABLE 2.—Central* Arterial Pressures Recorded During Different Coiulitions in Healthy Men
Condition
Rest
Kxercisc
Tilt
Subjects
12
12
S
Constant
Average
Range
Average
Range
Average
Range
Heart Rate,
Beats per
Minute
Pressure, ram. Hg
Systolic
Diastolic
Dicrotic
Mean
64
126
SI
10S
102
54-SS
99
71-125
113-140
71-90
96-124
91-113
144
S7
109
112
116-187
69-101
87-125
92-133
9S
S9-105
S9
116
S3
102
69-113
104-122
75-S9
90-110
* Aorta or subclavian artery near aorta.
decrease in the degree of amplification of the
pulse pressure in the femoral artery, femoral
pulse pressure being only 114 per cent of aortic
pulse pressure, while brachial and radial
pulse pressures relative to aortic pulse pressure
showed little change from the resting condition. During the 70-degree head-up tilt the
absolute aortic pulse pressure was reduced
but the amplification of peripheral pulse pressure in relation to aortic pulse pressure was
increased at all the sites studied to levels of
14G per cent in the brachial, 159 per cent in the
femoral and 165 per cent in the radial artery.
These differences in pressure levels between
peripheral and central pressure pulses are
associated with the characteristic differences
in contour of these pulses. Figure 1 shows a
series of simultaneously recorded pulses in a
31 year old healthy subject. There is a gradual
increase in the time interval between the peak
of the R wave in the electrocardiogram and
the onset of the pulse wave and a gradual
increase in pulse pressure, especially the systolic peaks, toward the periphery. The anaerotic shoulder is present in the aortic pulse
but barely visible in the femoral pulse. There
626
CENTRAL AND PERIPHERAL PRESSURE PULSES IX MAN
TABI^E 3.—Peripheral Arterial Pressures* as Percentages of Central Arterial Pressure Recorded
Simultaneously in Healthy Men
% of Central Pressure
Pressure Pulse
Constant
Systolic
Diastolic
Dicrotic
Mean
98
92-101
94
SS-9S
96
93-99
At rest
Brachial
Radial
Femoral
8
12
9
Averuge
Range
Average
Range
Average
Range
109
96
92
101-llS
90-100
89-96
SS
83-95
94
SS-99
112
93
102-123
SS-99
110
94
104-119
90-97
During exercise
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Brachial
Radial
Femoral
S
12
S
Average
Range
Average
Range
Average
Range
111
97
89
97
101-122
90-101
93
86-99
88-93
83
73-SS
92-101
113
9S-12S
93
S9-100
101
95
97
97
95-107
S7-100
S3-104
92-101
9S
96-102
95
92-9S
98
96-101
93
8S-9S
89
84-95
95
93-97
99
96-103
9S
92-101
100
9S-102
During 70 degree lead-up tilt
Brachial
Radial
Femoral
S
S
3
Average
Range
Average
Range
Average
Range
111
105-1IS
115
103-121
123
112-139
* The average and range of distances from the needle puncture site to the midsternum at the third interspace were 50 (45-53), 42 (40—15) and 68 (60-72) cm. for the femoral, brachial and radial arterial puncture sites
respectively.
TABLE 4.—Relationship of Pulse Pressures Recorded Simultaneously From Different Arteries in
Healthy Men
Condition
Rest
Exercise
Tilt
Constant
Subjects
Average
Range
Subjects
Average
Range
Subjects
Average
Range
Aortic Pulse
Pressure,
mm. Hg
12
45
33-57
12
57
46-86
12
33
25-40
is a secondary wave following the primary
peak but preceding the dicrotic notch in the
brachial-radial system and there is an absence
of this wave in the femoral-dorsalis pedis system. The incisura, sharp and short in the
(Peripheral Pulse Pressure/Aortic) X 100
Femoral
Brachial
Radial
9
139
118-170
8
131
104-156
S
127
103-147
S
146
119-16S
12
146
119-192
12
146
106-191
S
165
122-1SS
s
114
95-136
3
159
142-177
aortic pulse, is lost during transmission of
the pulse wave peripherally. The dicrotic
notch, which is drawn out and deep in the
brachial-radial system, is practically nonexistent in the femoral and so drawn out and
E. J. KROEKER AND E. H. WOOD
027
RIGHT :
RADIAL
d
LEFT F
LEFT
BRACHIAL ~-
AORTIC
LJ
£
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RIGHT
FEMORAL -
RIGHT
DORSALIS
L_
PEDIS
ECG
FIG. 1. Comparison of central and various peripheral arterial pulses (as labeled) from a normal
male. Discussion in toxt.
deep in the dorsalis pedis pulse that it approaches end diastolic pressures.
Figure 2 shows the transformation of the
subclavian type of pulse to the brachial-radial
type at graded distances from the subclavian
artery near the aorta. The records have been
mounted so that the R waves of the electrocardiogram are superimposed. On the left are
pulses recorded by the strain-gauge manometer system and on the right those recorded by
the higher-frequency capacitance manometer.
Note the similarity of the pulses recorded by
these two widely different manometer systems.
There is an increase in the interval from the
R wave of the electrocardiogram to the onset
of the pulse toward the periphery; the systolic
peaks, however, tend to be stationary for the
first 20 cm. There is a gradual increase in
amplitude, with higher systolic peaks. The
anacrotic shoulder is present and similar in
both systems but disappears after the 10 cm.
withdrawal. In this subject preoscillations
were recorded in the central pulse only by the
faster capacitance manometer system and
were absent after the 10 cm. withdrawal.
In the subclavian artery the ineisura is fol-
lowed by a second negative deflection. On
withdrawal these two merge and the dicrotic
notch becomes progressively deeper.
Central pulse preoscillations have been
classically described in the horse by Chaveau
and Marey12 and in the dog by Frank." The
first preoscillation occurring in the latter part
of diastole consists of a broad positive pressure
wave and was attributed by the foregoing
authors to atrial systole. The second preoscillation is a short positive pressure wave occurring immediately preceding the onset of the
aortic pulse. Between the two waves there is a
negative deflection with a sharp peak, somewhat resembling the ineisura. The genesis of
these waves is still in dispute. However, Laszt
and Miiller," in simultaneous recording of
left ventricular and aortic pressure pulses in
dogs, found the lowest dip of the negative
deflection to coincide with the rapid increase
in left ventricular pressure during isometric
contraction.
Preoscillations were seen in eight of the 12
healthy subjects investigated in the present
study and were more clearly demarcated in
recordings by the faster manometer systems
628
CENTRAL AXU PERIPHERAL PRESSURE PULSES IN MAN
STRAIN GAUGE MANOMETER I CAPACITANCE MANOMETER
POSITION:
PROXIMAL
SUBCLAVIAN ARTERY
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RADIAL ARTERY
AT WRIST
Fio. 2. Curves showing transformation of central to peripheral pulses at graded distances from
subclavian artery near aorta. Discussion in text.
than in recordings by the slower systems. The
first preosoillation recorded in animal studies
could not, however, be discerned in the records
obtained. The negative V-shaped dip was
most easily recognized and was usually followed by a short positive wave, which would be
analogous to the second preoscillation obtained
in animal studies. Preoscillations were less
readily recognized during exercise than at
rest but, when seen, the V-shaped dip was
closer to the central pulse and the ascending
limb of the pressure pulse seemed to arise
from the onset of the second preoscillation.
The preoscillations were most often and most
clearly seen in the 70 degree head-up tilt position and then were a greater interval in advance of the ascending limb of the aortic
pulse. Preoscillations were seldom seen beyond
10 cm. from the aortic arch, midsternal line.
Table 5 shows the relationship of the onset
of the central pressure pulse to the peak of the
R wave of the electrocardiogram and to the
anacrotic shoulder on the ascending limb of
the pressure pulse in different conditions in
healthy men. The interval from the peak of
the R wave to the onset of pulse was shortest
during exercise (64 msec), longest during the
70 degree head-up tilt (108 msec), the resting
value occupying an intermediate position of
88 milliseconds.
The anacrotic wave was present in the
central pulse in all subjects at rest and exercise. In two subjects the anacrotic wave became the point of maximal pressure after the
70 degree head-up tilt and by definition could
no longer be called an anacrotic wave. The
TABLE 5.—Relationship of the Onset of the Central
Pressure Pulse to the Peak of the R Wave of the Electrocardiogram and to the Anacrotic Wave*
Condition
Rest
Exercise
Tilt
Constant
Interval from
Peak of R
Wave to Onset of Central
Pulse, Milliseconds
Average
Range
Average
Range
Average
Range
SS
73-103
64
52-91
10S
97-1IS
Interval
Heart
from Onset
of Pulse to
Rote,
Annr.ro tic Beat* per
Wave,Milli- Minute
seconds
73
51-96
60
4S-S0
5S
46-87
64
54-SS
02
71-100
S9
69-113
* Data from 10 arterial catheterizations of eight
healthy men.
E. J. KROEKER AND E. H. WOOD
TABLE
G29
8.—Trayismission Times of Pressure Pulses Recorded Simultaneously From Different Arteries
in Healthy Men
Transmission Time*
Constant
Condition
| lit
II [J
160
12
77
8.8
183
S
75
It
Rest
Exercise
Tilt
Subjects
Average
Range
Subjects
Average
Range
Subjects
Average
Range
Brachial
Radial
I
11
Femora
ill
I
8
Brachial to radial
II
ill
59
7.2
170
9
75
6.3
8
57
7.4
172
3
63
6.5
11
III
S
20.6
12.5
144-186 65-105 6 .6-13 8 126-160 47-83 5 4-S.5 151-lSS 64-100 4.7-10.4 12-28 0 3-22 5
9
12
8
s
7.7
129
140
75
8.9
119
55
61
7.8
23
11.0
102-169 52-95 7 .2-13 8 100-143 37-69 6 2-11.6 91-142 41-71 5.4-12.4 16-28 9 6-16 9
168-195 62-95
147
7
S
14.1
.3-10 5 147-179 46-75 5 3-9.4 157-178 55-72 5.7-7.3 15-23 10 0-16 9
165
8.8
IS
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* Tho time interval from the peak of the R wave to the onset of the central pulse is shown in table 5.
I I — msec, from peak of R wave of electrocardiogram to onset of pulse wave.
J II = msec, from onset of central pulse to onset of peripheral pulse.
§ I I I = calculated pulse-wave velocity from central to peripheral recording site, meters per second.
TABLE 7.—Buildup Times of Pressure Pulses Recorded Simultaneously From Different Arteries
of Healthy Men
Interval from On&et of Pulse to Maximal Pressure, msec.
Condition
Constant
Radial
Brachial
166
12
102
109
118-214
92-112
94-131
13S
117-160
12
96
S
102
9
114
82-120
74-131
92-139
8
93
S
94
3
91
85-100
S6-100
77-106
Central
Rest
Exercise
Tilt
Subjects
Average
Range
Subjects
Average
Range
Subjects
Average
Range
12
•
anacrotic time, the time interval from the
onset of the pulse wave to the point of maximal convexity of the anacrotic wave, showed
little change during the physiologic conditions
studied.
Table 6 illustrates the transmission times
of pressure pulses recorded simultaneously
from different arteries in healthy men. The
measurement from the peak of the R wave to
the onset of the peripheral pulse is an absolute
reference point for all pulses. It includes the
possible latent period between the beginning
of electric and the beginning of mechanical
left ventricular systole, the period of isometric
cardiac contraction and the transmission time
of the impulse from the semilunar valves to the
catheter tip and the peripheral arterial needle.
12
121
94-157
8
109
59-164
s
Femoral
9
By and large, these results with subjects
supine and at rest are similar to the values
recorded in the literature and obtained by
sphygmographic means.16'16 The pulse-wave
velocity to the radial artery averaged 8.8
meters per second, to the brachial artery 7.2
meters per second and to the femoral artery
6.3 meters per second. Pulse-wave velocity
from the brachial artery at the antecubita)
fossa to the radial artery at the wrist averaged
12.5 meters per second.
There was little change in the transmission
time to the radial and brachial arteries during
exercise and tilt. However, the average pulsewave velocity to the femoral artery increased
by 1.5 meters per second during exercise, and
the pulse-wave velocity from the brachial to
630
CENTRAL AND PERIPHERAL PRESSURE PULSES IN MAN
TABLE 8.—Systolic Times of Pressure Pulses Recorded Simultaneously From Different Arteries of
Healthy Men
Interval from Onset of Pulse Wave to Dicrotic Notch, msec.
Condition
Rest
Exercise
Tilt
Constant
Subjects
Average
Range
Subjects
Average
Range
Subjects
Average
Range
Central
Radial
Brachial
Femoral
12
311
296-321
12
271
228-298
8
231
210-244
12
330
310-344
12
296
244-326
8
242
211-272
8
320
300-339
8
299
27S-317
S
237
213-267
9
336
306-365
9
291
227-325
3
234
214-263
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the radial artery increased by an average of
1.6 meters per second during the tilt.
Table 7 gives the buildup times of pressure
pulses recorded simultaneously in healthy
men. The average buildup time (onset of pulse
to maximal pressure) of the central pulse was
longest at rest (166 msec), shorter during
exercise (121 msec.) and shortest during the
tilt (109 msec). The buildup times of the
peripheral pulses were uniformly shorter than
the buildup times of the central pulses generated by the same heart beats. At rest, the
average buildup time of radial pulses was 102
msec, of brachial pulses 109 msec, and of femoral pulses 138 msec. During exercise and the
70-degree head-up tilt, shortening of the
buildup time peripherally persisted but to a
lesser degree.
Table 8 shows systolic times of pressure
pulses recorded simultaneously from different
arteries of healthy men during conditions of
rest, exercise and 70 degree head-up tilt. All
times were measured from the onset of the
pulse wave to the lowest dip in pressure of the
incisura or dicrotic notch. In the femoral
pulses, in which the dicrotic notch is poorly
defined, the descending limb of the primary
peak was extended to meet the extension of a
Line from the ascending slope of the undulation
following the primary peak.
Central systolic time was longest at rest (311
msec), shorter during exercise (271 msec.)
and shortest during the 70 degree tilt (231
msec). The shortening of the systolic time
during the tilt did not seem to be related
merely to the heart rate, for the heart rate
Heart Rate,
Beats/min.
12
64
54-SS
12
99
71-125
S
89
69-113
was more rapid during exercise than in the
tilt position. At rest, the peripheral systolic
time was uniformly prolonged beyond that of
the central pulse, brachial-artery values being
closest to those of the central pulse and femoral-artery values deviating the most.
COMMENT
In 1890 Hiirthle17 noted a higher systolic
and wider pulse pressure in the crural than
in the carotid artery of the dog. Frank11 considered the increase in pulse pressure and the
absolute increase in systolic pressure of the
peripheral over the central pulse as its most
prominent features and this led him to doubt
the hypothesis of simple transmission of the
pulse wave as in an endless elastic tube. These
amplitude changes have been noted in man by
Hamilton and co-workers4 and by Schnabel
and co-workeis.8 These investigators found
that, although there was an increase of systolic pressure peripherally, the diastolic and
mean pressures remained relatively constant.
Wood and co-workers13 demonstrated that in
addition to the increase in systolic pressure
peripherally there was a small but significant
drop in diastolic and mean pressures. These
latter findings have been confirmed by our
present studies.
The hypotheses of the transformation of the
central to the peripheral pulse have been summarized by Hamilton and Dow.19 Our findings
are best explained by the hypothesis that the
increase in amplitude and change of contour
in passage from the central to the peripheral
pulse is due to the summation of the incident
E. J. KROEKER AND E. H. WOOD
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wave with the reflected wave from the periphery. Resonance effects in the peripheral arterial
systems probably also play a role, especially
under conditions of cardiovascular stress such
as the Valsalva maneuver.20 The increase in
central pulse pressure amplification to the
radial artery in the tilt above that seen at rest
and exercise (table 4) may at least partially
be attributed to compensatory vasoconstriction in this condition. The peripheral resistance would be increased and there would
lie an increase of positive wave reflection.
The smaller drop in mean pressure in this
condition as compared to rest and exercise
would lie compatible with reduced flow secondary to the vasoconstriction.
The decrease in amplification of central
pulse pressure at the femoral artery during
exercise was marked as compared to the rest
and tilt conditions (table 4). As the exercise
consisted of pedalling with the opposite leg, a
decrease in peripheral resistance would be
expected secondary to vasodilatation in the
vascular bed supplied by the femoral arteries;
a decrease in positive wave reflection would
result and therefore a decrease in amplification of pulse pressure. I t is probable that the
character of the systolic ejection from the left
ventricle also affects the degree of peripheral
amplification of the pulse pressure. In severe
aortic stenosis, for instance, the increase in
systolic pressure peripherally is small or an
actual decrease occurs, while in contrast the
amplification of the pressure pulse peripherally
is exaggerated in patients with severe aortic
insufficiency (unpublished).
SUMMABY AND CONCLUSIONS
Central (aortic or subclavian), brachial,
radial, and femoral pressure pulses were recorded simultaneously by means of intraarterial needles and catheters in 14 studies on
12 healthy subjects during conditions of rest,
exercise and 70 degree head-up tilt.
The average central arterial pressure was
126 (113-146) mm. Hg systolic and 81 (71 to
90) diastolic. Preoscillations and anacrotic
oscillations were evident. As this pulse wave
was transmitted peripherally, striking changes
in contour occurred, along with a small pro-
631
gressive decrease in diastolic and mean pressure and a larger progressive increase in systolic pressure. Peripheral systolic pressure at
rest uniformly exceeded the central systolic
pressure generated by the same heartbeat;
brachial was 109 per cent, radial 112 per cent
and femoral 110 per cent of central systolic
pressure. The average radial pulse pressure
was 146, 146 and 165 per cent of central
pulse pressure during rest, exercise and tilt
respectively, while radial mean pressures were
94, 93 and 98 per cent of central mean pressures respectively. Femoral pulse amplitude
was similar to that of the radial except during
exercise of the opposite leg when femoral pulse
presure was only 114 per cent of central pulse
pressure.
The velocity of the pulse wave was increased
toward the periphery, the buildup time was
shortened while the systolic time was prolonged. The contour of the pulse wave was
uniformly strikingly different in the braehialradial and femoral-dorsalis pedis system. A
double systolic wave developed in the pressure
pulse during transmission peripherally from
the subclavian artery. The primary systolic
wave increased in amplitude, the secondary
systolic wave usually decreased and the dicrotic dip was exaggerated during transmission
down the arm. In contrast, the pressure pulse
at the femoral artery consisted of a single
systolic wave followed by a poorly defined or
absent dicrotic dip. These time relations and
changes in contour, in conjunction with corresponding pressure alterations, best describe
the changes that the pulse wave undergoes
in transit to the periphery.
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EDWIN J. KROEKER and EARL H. WOOD
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Circ Res. 1955;3:623-632
doi: 10.1161/01.RES.3.6.623
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