PULSE WAVE
EVIDENCE-BASED
CARDIOVASCULAR HEALTH
CENTER FOR
HE      RTS
 
 

The arterial pulse waveform is a contour wave generated by the heart when it contracts, and it travels along the arterial walls of the arterial tree. Generally, there are 2 main components of this wave: forward moving wave and a reflected wave. The forward wave is generated when the heart (ventricles) contracts during systole. This wave travels down the large aorta from the heart and gets reflected at the bifurcation or the “cross-road” of the aorta into 2 iliac vessels. In a normal healthy person, the reflected wave usually returns in the diastolic phase, after the closure of the aorta valves. The returned wave give a notch and it also helps in the perfusion of the heart through the coronary vessels as it pushes the blood through the coronaries. Therefore the velocity at which the reflected returns becomes very important: the stiffer the arteries are, the faster it returns. This may then enter into the systolic phase and augment final blood pressure reading.


Diagram shows a typical healthy arterial pulse waveform.
























Physiology of Pulse Waveform


Pulse Waveform of a 25 year old person

For a normal young person, where the arteries are generally compliant, the slow travelling reflected wave from the peripheral occurs during diastole, thus enhancing perfusion of the coronary arteries.



Pulse Waveform of a 47 year old person

With age, the arteries stiffen. Pulse wave velocity increases and the reflected wave now travels faster and gives rise to a “shouldering” at the primary wave, and occurs during systole. This effect prolongs the systolic cycle increasing the workload and oxygen requirement of the heart muscles. The poor notch also compromises the flow of the coronaries.



Pulse Waveform of a 80 year old person

In the elderly, further arterial stiffening cause the reflected wave to return much faster and gives rise to a “shouldering” at the primary wave; and coincide very close to the systolic peak, resulting in an augmented wave. The heart now needs to contract even harder (to overcome the oncoming reflected wave) and for a longer period. At the same time, coronary artery perfusion is further compromised.














 

Features of the Pulse Waveform

Pulse Wave


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Benefits of Non-invasive Pulse Wave Analysis

Cardiovascular specialists spend considerable effort on evaluating heart function, including electrocardiograms (ECGs), echocardiograms and stress tests, but are limited in their ability to assess the functional and structural abnormality of the arteries prior to the late phase of arterial obstruction. 
Subtle changes in arterial elasticity introduce changes in the arterial system that are reflected in the arterial blood pressure waveform. Research suggests that these changes in the function and structure of the arterial wall precede the development of diseases such as hypertension and diabetes.






By assessing the elasticity of the arterial system, clinical investigators have been able to identify a reduction in arterial elasticity in patients without evidence of traditional risk factors, suggesting the early presence of vascular disease. Furthermore, clinical research data has demonstrated that individuals with heart failure, coronary artery disease, hypertension and diabetes typically exhibit a loss of arterial elasticity. 

These abnormal blood vessel changes often appear to precede overt signs of cardiovascular disease and the occurrence of a heart attack or stroke by many years. Clinical investigators have also demonstrated an age-related loss of elasticity of both the large and small arteries suggesting that premature stiffening of an individual’s arteries is an apparent marker for the early onset of cardiovascular disease.
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©  2010 Center for Hearts, LLC.

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