CARDIOVASCULAR

(CVS) MEASUREMENTS

Blood circulation
THE CIRCULATORY SYSTEM
Pulmonary Circulation: oxygen
depleted blood (impure blood) taken from
the heart to the lungs
Systemic Circulation: oxygenated
blood from heart to rest of the body and
depleted blood back to the heart.
Coronary Circulation: blood supply to
the heart

Cardiovascular
circulation

The hearts pumping cycle

Two major parts: Systole and Diastole.
Systole: Defined as the period of
contraction of the heart muscles,
specifically the ventricular muscles, at
which time the blood is pumped into the
pulmonary artery and aorta.
Diastole: the period of dilation of the heart
cavities as they fill with blood.

Blood pressure variations as a

The blood pressure variations as a function of time

Figure shows systole and diastole in detailed

phases of operation. The blood pressure waves
of aorta, left atrium and left ventricle are drawn
to show time and magnitude relationships. Also
correlated electrical events are shown in ECG.
Observing aortic wave, it is seen that during
systole, ejection of blood from the left ventricle
is rapid at first. As the rate of pressure change
decreases, rounded maximum curve of the
waveform is obtained.
The peak aortic blood pressure during systole, is
a function of left ventricular stroke volume, peak

 When the systolic period is completed, the aortic valve is closed,

by the back pressure of the blood against the valve. This effect is
seen as dicrotic notch. Now the arterial pressure gradually
decreases as blood pours into countless vascular networks.
The rate at which the pressure falls depends on pressure achieved
during systolic interval, the rate of outflow, and diastolic interval.
The form of arterial pressure pulse changes as it passes through
the arteries. The mean pressure in some arteries can be as much
as 20mm higher than that in aorta.
As the blood flows into smaller arteries and arterioles, the
pressure decreases, which can vary from 60mm of Hg down to 30
mm of Hg.
As the blood enters the venous system, the pressure is down to
15mm of Hg. In the venous system, the pressure in the venules
decreases to approximately 8 mm of Hg, in veins 5 mm of Hg. In
the vena cava, 2mm of Hg.

Characteristics of blood flow

Blood
flow at any point in the circulatory system is the

volume of blood that passes that point during a unit of

time.
Unit is millilitres per minute or litres per minute.
Highest blood flow (cardiac output) is highest at
pulmonary artery and aorta: 3.5 to litres /min.

Stroke volume is defined as the amount of blood ejected

during each heart beat.
Mean velocity of the blood

 Blood flow is a function of blood pressure and flow

resistance of the blood vessels.
The velocity of the blood flowing through a vessel is not
constant throughout the cross section of the vessel.
It is a function of the distance from the wall of the
vessel.
Highest velocity occurs at the center of the vessel and
decreases towards the walls of the vessel.

Heart sounds
Auscultations: The technique of listening to sounds
produced by the organs and the vessels of the body.
Auscultation is subjective.
The heart sounds heard through the stethoscope occur at
the time of closure of major valves in the heart.
With each heart beat, the normal heart produces two
distinct sounds lub-dub.
The lub: the first heart sound is caused by the closing
of the atrioventricular valves, which permit blood flow from
atria to ventricles and prevent blood flow in the reverse
direction. It occurs approximately at the time of QRS
complex of the ECG and just before the ventricular systole.

 the dub: second heart sound-caused by closing of

the semilunar valves, which release blood into the
pulmonary and systemic circulation systems. These
valves close at the end of the systole, just before the
atrioventricular valves reopen. The second heart sounds
occurs about the time of the end of the T wave of ECG.
A third heart sound is sometimes heard in young
adults, occurs from 0.1 sec to 0.2 sec. after the second
heart sound, attributed to the rush of blood from the
atria into the ventricles, which causes turbulence and
some vibration of the ventricular walls.(this sound
precedes atrial contraction).
An atrial heart sound, (low amplitude/low
frequency) (cannot be heard) occurs when atria

 In abnormal heart, murmurs are heard between the

normal heart sounds. (improper opening and closing of
valves).
Phonocardiogram: Graphical representation of heart
sounds.
Pulse: can be felt with the fingertips at certain points
on major arteries.
Korotkoff sounds: When an artery is partially
occluded so that the blood velocity through the
constriction is increased sufficiently, identifiable sounds
can be heard downstream through a stethoscope.

Relationship of heart sounds to functions of the

Measurement of blood pressure

1. Indirect Methods : Non invasive
2. Direct methods: Invasive

Indirect method of blood pressure measurements

Sphygmomanometer (Sphygmos=pulse)
Advantages: Easy to use, can be automated.
Limitations:
It does not provide a continuous recording of pressure
variations
Practical repetition rate is limited.
Only systolic and diastolic arterial pressure readings can be
obtained, no indication of the details of the pressure
waveform.
Subjective
Fails when the blood pressure is very low. (shock)

Direct method of blood pressure measurements

Advantage:
They provide continuous recording of the blood pressure
waveform.
More accurate than indirect methods.
Used when high accuracy, dynamic response and continuous
monitoring is required.
Measures pressure in deep regions inaccessible by indirect
methods.
Limitations:
The blood vessel should be punctured to introduce the sensor.

Indirect method
Uses sphygmomanometer and a stethoscope
Method uses cuff over the limb containing the artery
Determines systole and diastole pressure
The sphygmomanometer consists of an inflatable pressure cuff
and a mercury or aneroid manometer to measure pressure in
the cuff. The cuff consists of a rubber bladder inside an inelastic
fabric covering that can be wrapped around the upper arm and
fastened with hooks or Velcro fastener.
The cuff is normally inflated manually with a rubber bulb and
deflated slowly through a needle valve.
Principle: When the cuff is placed on the upper arm and
inflated , arterial blood can flow past the cuff only when
the arterial pressure exceeds the pressure in the cuff.

Sphygmomanometer

 When the cuff is inflated to a pressure where it only partially

occludes the artery, turbulence is generated in the blood. The
sounds produced by turbulence, Korotkoff sounds, can be heard
using stethoscope placed over the artery downstream.
Method: Initially pressure in the cuff is raised well above the
systolic pressure, so that the blood flow is completely stopped.
Then pressure is released at the particular rate.
When it reaches a level, below the systole pressure, brief flow
occurs.
Korotkoff sounds begin to be heard through the stethoscope.
The pressure of the cuff that is indicated on the manometer when
the first korotkoff sound is heard is SYSTOLIC BLOOD PRESSURE.
If the cuff pressure is allowed to fall further, just below the
diastole pressure, flow becomes normal.

 As the pressure in the cuff continues to fall, korotkoff

sounds continue until the cuff pressure is no longer
sufficient to occlude the artery.
The pressure of the cuff that is indicated on the
manometer when the korotkoff sound disappears is
DIASTOLIC BLOOD PRESSURE.
This
method
is
auscultatory
method
of
sphygmomanometry.
In palpatory method, physician identifies the flow of the
blood by feeling the pulse of the patient.

Figure: Principle of blood pressure measurement

using Korotkoff sounds

Direct methods of blood pressure

measurements
Used when high accuracy, dynamic response and continuous
monitoring is required.
Measures pressure in deep regions inaccessible by indirect methods.
A catheter or a needle type probe is inserted through a vein or artery.
Two types of probes:
Catheter tip probe- Here sensor is mounted on the tip of the probe
and pressure exerted on it are converted to electrical signal. They
provide maximum dynamic response and avoid acceleration artefacts.
Fluid filled catheter type-transmits pressure exerted on its fluid
filled column to an external transducer which converts it to electrical
signal.

Typical set up for pressure monitoring

using direct method

 Three methods of direct blood pressure measurement:

1. Percutaneous insertion
2. Catheterization
3. Implantation of a transducer in a vessel in the heart
1. Percutaneous insertion: A local anesthetic is injected near the
site of invasion. The vessel is occluded and a hollow needle is
inserted at a slight angle toward the vessel. When the needle is in
place, a catheter is fed through the hollow needle, with the help of a
guide. When the catheter is secured in place, the needle and guide
are withdrawn.
For some measurements, the type of needle attached to an airtight
tube is used, so that the needle can be left in the vessel, and blood
pressure sensed directly by attaching the transducer to the tube.
Other types have transducer attached to the catheter.

2. Catheterization
Methods used to obtain blood pressure from heart chambers
and vessels, also used to take blood samples, for oxygen
content analysis. Catheter is a long tube inserted into the
heart or major vessels, by way of superficial vein or artery.
Methods:
1. Introduce sterile saline solution into the catheter, so that,
fluid pressure is transmitted to a transducer outside the body.
2. Transducer is introduced into the catheter and pushed to a
point where the pressure is measured. Or the transducer is
mounted at the tip of the catheter.-catheter tip BP transducer.
3. Implantation techniques: involve major surgery:
advantage: keeping the transducer fixed in place in the vessel
for long periods of time.