ABSTRACT
The first edition of Blood Flow in Arteries contained separate chapters on arterial flow waves and arterial pressure waves. These were excluded from the second edition on the basis that there was general agreement on the contour of, and mechanisms responsible for, pressure and flow waves in different arteries of experimental animals. This is basically true. However, there has been, over the past 40 years, increasing interest in the contour of pressure and flow waves in human arteries under different conditions, and thus more need to know what is responsible for determining the contour of the pulse in central arteries and its modification in transit to peripheral vessels (Fig. 10.1) (Oparil and Izzo, 2006). Over this period, it has become routine practice to monitor the arterial pressure pulse contour in operating rooms and in the intensive care units, as well as to record it in the cardiovascular diagnostic laboratory. New sphygmographs, utilizing high-fidelity pressure sensors and the principle of applanation tonometry, are now available commercially (see Chapters 26 and 30). These permit accurate registration of arterial pressure waves in central (carotid) and peripheral arteries of humans (see Chapter 9) (Avolio et al., 1988; Kelly et al., 1989a; Kelly et al., 1989b; Kelly et al., 1990a; Kemmotsu et al., 1991a; Kemmotsu et al., 1991b; O’Rourke et al., 1992a; O’Rourke et al., 1992b; O’Rourke et al., 1992c; O’Rourke et al., 1993a; Sato et al., 1993; Chen et al., 1996; Chen et al., 1997; Wilkinson et al., 1998; Fetics et al., 1999; Siebenhofer et al., 1999; Filipovsky et al., 2000; Avolio et al., 2001; Brooks et al., 2001; Pauca et al., 2001; Nichols and Singh, 2002; Jankowski et al., 2004; Mitchell, 2009a; Mitchell, 2009b). Their use has led to re-exploration of the
relationship between central and peripheral pressure in humans and questioning of sphygmomanometric values of arterial pressure (Smulyan et al., 2003; Smulyan et al., 2008; Zuo et al., 2010). With the application of ultrasound to diagnostic studies, flow pulses can be recorded noninvasively from the great vessels of the chest and abdomen and from peripheral arteries in humans, and even from the cerebral blood vessels of humans and the umbilical arteries of the fetus (Perlman et al., 1983; Fleischer et al., 1985; Trudinger et al., 1985; Shimamoto and Shimamoto, 1995) (see Chapter 6). Disease is being diagnosed and the effects of therapy monitored and altered on the basis of interpretation of pressure and flow wave characteristics. This sixth edition of Blood Flow in Arteries cannot be a text for such interpretations, but it can provide a background for these. Accordingly, this chapter will describe normal features and basic mechanisms relevant to the pulse in experimental animals and humans, while Chapters 19, 20, 21, 22, 23, 24, 25, and 26 deal with effects of aging in humans, specific disease, and the influence of therapies. Chapter 30 deals specifically with non-invasive pressure recording and its value and potential in humans.
