Pulse Pressure and Mortality in Older People

Total Page:16

File Type:pdf, Size:1020Kb

Pulse Pressure and Mortality in Older People ORIGINAL INVESTIGATION Pulse Pressure and Mortality in Older People Robert J. Glynn, ScD; Claudia U. Chae, MD; Jack M. Guralnik, MD, PhD; James O. Taylor, MD; Charles H. Hennekens, MD, DrPH Background: In older people, observational data are un- sure 80 to 89 mm Hg; relative to this group, the highest clear concerning the relationships of systolic and dias- death rate occurred in those with systolic pressure of tolic blood pressure with cardiovascular and total mor- 160 mm Hg or more and diastolic pressure less than 70 tality. We examined which combinations of systolic, mm Hg (relative risk, 1.90; 95% confidence interval, diastolic, pulse, and mean arterial pressure best predict 1.47-2.46). Both low diastolic pressure and elevated sys- total and cardiovascular mortality in older adults. tolic pressure independently predicted increases in car- diovascular (P,.001) and total (P,.001) mortality. Pulse Methods: In 1981, the National Institute on Aging ini- pressure correlated strongly with systolic pressure tiated its population-based Established Populations for (R=0.82) but was a slightly stronger predictor of both Epidemiologic Studies of the Elderly in 3 communities. cardiovascular and total mortality. In a model contain- At baseline, 9431 participants, aged 65 to 102 years, had ing pulse pressure and other potentially confounding vari- blood pressure measurements, along with measures of ables, diastolic pressure (P=.88) and mean arterial pres- medical history, use of medications, disability, and physi- sure (P=.11) had no significant association with mortality. cal function. During an average follow-up of 10.6 years among survivors, 4528 participants died, 2304 of car- Conclusions: Pulse pressure appears to be the best single diovascular causes. measure of blood pressure in predicting mortality in older people and helps explain apparently discrepant results Results: In age- and sex-adjusted survival analyses, the for low diastolic blood pressure. lowest overall death rate occurred among those with sys- tolic pressure less than 130 mm Hg and diastolic pres- Arch Intern Med. 2000;160:2765-2772 N MIDDLE-AGED populations, both pulse pressure and a diminished associa- From the Division of Preventive systolic and diastolic blood pres- tion between systolic and diastolic pres- 21 Medicine, Department of sure have strong, linear relation- sure. This may lead to differing relation- Medicine, Brigham and ships with cardiovascular and to- ships of systolic and diastolic pressure with Women’s Hospital and Harvard tal mortality.1-5 Because of the mortality in older people. Medical School, Boston, Mass Ihigh correlation between systolic and di- It is also possible that pulse pressure (Drs Glynn and Chae); astolic pressure, studies examining car- is the measure of blood pressure most Department of Biostatistics, diovascular risk in this age group com- strongly related to cardiovascular risk in Harvard School of Public monly find that diastolic pressure provides older people, and that consideration of Health, Boston (Dr Glynn); little additional prognostic information af- pulse pressure may explain the apparent Cardiology Division, 1-4 Department of Medicine, ter consideration of systolic pressure. In increased risk associated with low dias- Massachusetts General older people, however, observational stud- tolic pressure. Several prospective stud- 6-13 Hospital, Boston (Dr Chae); ies have been less consistent and have ies have found that elevated pulse pres- Epidemiology, Demography, commonly found U- or J-shaped relation- sure, which reflects increased arterial and Biometry Program, ships of blood pressure with mortality, es- stiffness with age, is associated with risk National Institute on Aging, pecially for diastolic pressure. In some of myocardial infarction, congestive heart Bethesda, Md (Dr Guralnik); studies, individuals with the lowest blood failure, and cardiovascular and total mor- East Boston Neighborhood pressure had the highest mortality.14,15 tality.22-27 However, pulse pressure is Health Center, East Boston, Treatment implications of these relation- strongly correlated with systolic pres- Mass (Dr Taylor); and 16-20 Department of Medicine, ships remain controversial. With the sure, and it remains unclear whether it pro- Epidemiology, and Public loss of aortic compliance, systolic pres- vides independent prognostic informa- 28 Health, University of Miami sure rises with age in industrialized coun- tion or is useful in clarifying J-curves. School of Medicine, Miami, Fla tries, while diastolic pressure declines af- Using data from 3 population- (Dr Hennekens). ter about age 60 years, leading to increased based cohorts of the Established Popu- (REPRINTED) ARCH INTERN MED/ VOL 160, OCT 9, 2000 WWW.ARCHINTERNMED.COM 2765 ©2000 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 SUBJECTS AND METHODS to 1992, giving an average follow-up of 10.6 years (range, 9.1-11.1 years) among survivors. Of the 9431 partici- SUBJECTS AND MEASURES pants, 4528 died, and death certificates were obtained for 4494. A single trained nosologist coded the underlying cause In 1981, the National Institute on Aging initiated its Es- of death according to the International Classification of Dis- tablished Populations for Epidemiologic Studies of the El- eases, Ninth Revision.36 We used these codes to classify deaths derly studies of community-dwelling persons aged 65 years as being caused by cardiovascular disease including stroke and older in 3 locations: East Boston, Mass; Washington (codes 401-459) or other causes. and Iowa counties, Iowa; and New Haven, Conn. During 1982 and 1983, surveys were conducted in the entire popu- STATISTICAL ANALYSIS lations of persons aged 65 years and older in East Boston and Iowa and in a stratified sample of residents of New Ha- We first determined correlations among the measures of ven. To maximize participation, trained interviewers vis- blood pressure to quantify their interrelationships. To ited the homes of all eligible participants. Participation rates examine the joint association of systolic and diastolic ranged from 80% to 85%, with 3809 participants in East pressure with mortality, we classified participants Boston, 3673 participants in Iowa, and 2812 participants according to categories of both variables. Categories in New Haven, for a total population of 10294 community- used were the same as in a previous study of blood pres- dwelling elderly subjects. Because some individuals par- sure in one of these populations,12 except that a priori ticipated through a proxy, 9431 participants had baseline we grouped individuals with systolic pressure between blood pressure measurements, and they constitute the co- 140 and 159 mm Hg and also formed a single group hort for the current study. among those with diastolic pressure between 70 and 79 In East Boston and New Haven, the trained inter- mm Hg. Thus, we partitioned the population into 16 viewer took 3 blood pressure measurements at 30-second groups according to category of systolic pressure (,130, intervals by means of a standard mercury sphygmoma- 130-139, 140-159, or $160 mm Hg) and category of nometer, after the participant had been seated for at least diastolic pressure (,70, 70-79, 80-89, or $90 mm Hg). 5 minutes, according to the protocol used in the Hyper- We used proportional hazards analyses to compare age- tension Detection and Follow-up Program.29 Two mea- and sex-adjusted total and cardiovascular death rates surements were taken in Iowa. For this study, systolic across these 16 categories. pressure was the average of all systolic measures; dias- To examine whether simpler models might summa- tolic pressure was the average of all diastolic measures; rize these relationships, we compared the ability of both pulse pressure was systolic minus diastolic pressure; single measures and pairs of measures of blood pressure and mean arterial pressure was [systolic+(23diastolic to predict total and cardiovascular mortality. We catego- pressure)]/3. rized pulse pressure and mean arterial pressure accord- The interviewer also collected information about ing to approximate quartiles in the population. We com- other characteristics potentially related to both blood pared the ability of alternative models to predict pressure and mortality. Participants reported their height mortality by means of the R2 statistic for survival analy- and weight, present and past use of cigarettes and alcohol, sis and the likelihood ratio–based discrimination index and whether they were ever told by a physician that they D (defined as the model likelihood ratio x2−1 divided by had myocardial infarction, stroke, or cancer. Angina was the −2 log likelihood of the null model) described by identified by the Rose questionnaire.30 All medications Harrell and colleagues.37 We used likelihood ratio tests used in the 2 weeks before the interview were identified to determine whether adding variables to a model sig- by direct inspection. Disability was identified through nificantly improved the fit. Additional models included reports of problems with activities of daily living31 and other variables that may affect both blood pressure and problems with physical function by a 3-item scale.32 We risk of death, but were restricted to the 4054 deaths in classified participants as low in physical activity when 8715 participants with complete data on these potential they reported not exercising vigorously at least once a confounding variables. week,
Recommended publications
  • Effect of Isoproterenol, Phenylephrine, and Sodium Nitroprusside on Fundus Pulsations in Healthy Volunteers
    British Journal of Ophthalmology 1996; 80: 217-223 217 Effect of isoproterenol, phenylephrine, and sodium nitroprusside on fundus pulsations in Br J Ophthalmol: first published as 10.1136/bjo.80.3.217 on 1 March 1996. Downloaded from healthy volunteers Leopold Schmetterer, Michael Wolzt, Alex Salomon, Alexander Rheinberger, Christian Unfried, Gabriele Zanaschka, Adolf Friedrich Fercher Abstract have not yet been carried out and quantitative Aims/Background-Recently a laser inter- pressure flow relations in human choroidal ferometric method for topical measure- vessels are as yet unknown. Linear choroidal ment of fundus pulsations has been pressure flow relations have been obtained in developed. Fundus pulsations in the macu- animal experiments in different species.5-8 In lar region are caused by the inflow and out- the rabbit, the choroidal blood flow has been flow ofblood into the choroid. The purpose shown to be pressure independent when IOP ofthis work was to study the influence of a was less than 20-25 mm Hg.9 peripheral vasoconstricting (the a,x adreno- Blood vessels can be considered as cylin- ceptor agonist phenylephrine), a predomi- ders filled with fluid at a pressure greater than nantly positive inotropic (the non-specific that outside the cylinders. The pressure dif- I adrenoceptor agonist isoproterenol), and ference between the inside and the outside of a non-specific vasodilating (sodium nitro- a vessel is called the transmural pressure P. prusside) model drug on ocular fundus The corresponding tension T in the vessel pulsations to determine reproducibility wall can be calculated by Laplace's law and sensitivity ofthe method. P=T/R, where R is the radius of the cylinder.
    [Show full text]
  • Increased Pulse Pressure Is Associated with Reduced Baroreflex Sensitivity
    Journal of Human Hypertension (2004) 18, 247–252 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Increased pulse pressure is associated with reduced baroreflex sensitivity R Virtanen1, A Jula2, H Huikuri3, T Kuusela4, H Helenius5, A Ylitalo6, L-M Voipio-Pulkki1,7, H Kauma3,8, YA Kesa¨niemi3,8 and J Airaksinen1 1Department of Medicine, University of Turku, Turku, Finland; 2Research Department of the Social Insurance Institution, Turku, Finland; 3Department of Medicine, University of Oulu, Oulu, Finland; 4Department of Physics, University of Turku, Turku, Finland; 5Department of Biostatistics, University of Turku, Turku, Finland; 6Division of Cardiology, Satakunta Central Hospital, Pori, Finland; 7Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; 8Biocenter Oulu, University of Oulu, Oulu, Finland Although pulse pressure (PP), heart rate variability significant when 24-h ambulatory diastolic blood pres- (HRV) and baroreflex sensitivity (BRS) have been shown sure, body mass index, smoking and alcohol intake were to predict cardiovascular events and mortality in various added as covariates in the multivariate analysis. In- populations, their relationships have not been clarified. creased ambulatory PP was also associated with We examined these associations in two separate increased beat-to-beat systolic arterial pressure varia- population-based samples of healthy middle-aged sub- bility. Associations between ambulatory PP and HRV jects. In population 1, data were obtained from 149 were not significant after controlling for age and gender. subjects (71 men and 78 women) aged 35–64 (mean 47.7) Our results suggest that elevated PP does not affect years, and in population 2, from 214 subjects (88 men overall HRV, but it interferes with baroreflex-mediated and 126 women) aged 40–62 (mean 50.5) years.
    [Show full text]
  • Static and Dynamic Components of Right Ventricular Afterload Are Negatively Associated with Calf Survival at High Altitude1
    Published September 29, 2016 Static and dynamic components of right ventricular afterload are negatively associated with calf survival at high altitude1 J. M. Neary,*2 R. D. Brown,† T. N. Holt,‡ K. R. Stenmark,† R. M. Enns,§ M. G. Thomas,§ and F. B. Garry‡ *Department of Animal and Food Sciences, College of Agricultural Sciences and Natural Resources, Texas Tech University, Lubbock 79409-2141; †Division of Pediatric Critical Care, School of Medicine, University of Colorado Denver, Aurora 80045; ‡Integrated Livestock Management, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins 80523-1678; and, §Department of Animal Sciences, The College of Agricultural Sciences, Colorado State University, Fort Collins 80523-1171. ABSTRACT: The purposes of this study were to pulse pressures (P = 0.03) at 3 mo of age than calves evaluate mean, systolic, and diastolic pulmonary that survived to 7 mo. Calves presumed to have died arterial pressures; pulmonary arterial pulse pres- tended to have greater systemic oxygen extraction sures; and systemic oxygen extraction fraction as fractions at 3 mo of age than calves that survived (P risk factors for the survival of suckling calves on one = 0.13). Diastolic pressure was not associated with ranch located at an altitude of 2,730 m in Colorado, survival (P = 0.27). Mean pulmonary arterial pres- USA. A prospective cohort study of 58 calves was sure is predominantly determined by static resistance performed. Pulmonary arterial pressures and sys- attributable to distal pulmonary arterial remodeling. temic oxygen extraction were measured when calves Pulse pressure and systolic pulmonary arterial pres- were approximately 3 mo (86 ± 7 d) and 7 mo (197 sure represents the dynamic or oscillatory resistance ± 6 d) of age.
    [Show full text]
  • Pulse and Blood Pressure Procedures Manual
    NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY III CYCLE 2 PULSE AND BLOOD PRESSURE PROCEDURES FOR HOUSEHOLD INTERVIEWERS Prepared by: Westat, Inc. 1650 Research Boulevard Rockville, MD 20850 September 1989 Revised July 1993 TABLE OF CONTENTS Chapter Page 1 PULSE AND BLOOD PRESSURE PROCEDURES....................................... 1-1 1.1 Introduction to Pulse and Blood Pressure............................................. 1-1 1.2 Background on Pulse and Blood Pressure............................................ 1-1 1.2.1 The Circulatory System ........................................................... 1-1 1.2.2 Definition of Pulse ................................................................... 1-3 1.2.3 Definition of Blood Pressure................................................... 1-3 1.2.4 Meaning of Blood Pressure..................................................... 1-3 1.2.5 Method of Measuring Arterial Blood Pressure.......................................................................... 1-4 2 DESCRIPTION AND MAINTENANCE OF BLOOD PRESSURE EQUIPMENT ................................................................................. 2-1 2.1 Blood Pressure Equipment..................................................................... 2-1 2.1.1 Manometer................................................................................ 2-1 2.1.2 Inflation System........................................................................ 2-5 2.1.3 Stethoscope..............................................................................
    [Show full text]
  • Chapter 9 Monitoring of the Heart and Vascular System
    Chapter 9 Monitoring of the Heart and Vascular System David L. Reich, MD • Alexander J. Mittnacht, MD • Martin J. London, MD • Joel A. Kaplan, MD Hemodynamic Monitoring Cardiac Output Monitoring Arterial Pressure Monitoring Indicator Dilution Arterial Cannulation Sites Analysis and Interpretation Indications of Hemodynamic Data Insertion Techniques Systemic and Pulmonary Vascular Resistances Central Venous Pressure Monitoring Frank-Starling Relationships Indications Monitoring Coronary Perfusion Complications Electrocardiography Pulmonary Arterial Pressure Monitoring Lead Systems Placement of the Pulmonary Artery Catheter Detection of Myocardial Ischemia Indications Intraoperative Lead Systems Complications Arrhythmia and Pacemaker Detection Pacing Catheters Mixed Venous Oxygen Saturation Catheters Summary References HEMODYNAMIC MONITORING For patients with severe cardiovascular disease and those undergoing surgery associ- ated with rapid hemodynamic changes, adequate hemodynamic monitoring should be available at all times. With the ability to measure and record almost all vital physi- ologic parameters, the development of acute hemodynamic changes may be observed and corrective action may be taken in an attempt to correct adverse hemodynamics and improve outcome. Although outcome changes are difficult to prove, it is a rea- sonable assumption that appropriate hemodynamic monitoring should reduce the incidence of major cardiovascular complications. This is based on the presumption that the data obtained from these monitors are interpreted correctly and that thera- peutic decisions are implemented in a timely fashion. Many devices are available to monitor the cardiovascular system. These devices range from those that are completely noninvasive, such as the blood pressure (BP) cuff and ECG, to those that are extremely invasive, such as the pulmonary artery (PA) catheter. To make the best use of invasive monitors, the potential benefits to be gained from the information must outweigh the potential complications.
    [Show full text]
  • Monitoring of the Central Blood Pressure Waveform Via a Conformal Ultrasonic Device
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Nat Biomed Manuscript Author Eng. Author Manuscript Author manuscript; available in PMC 2019 March 21. Published in final edited form as: Nat Biomed Eng. 2018 September ; 2(9): 687–695. doi:10.1038/s41551-018-0287-x. Monitoring of the central blood pressure waveform via a conformal ultrasonic device Chonghe Wang#1, Xiaoshi Li#2, Hongjie Hu#2, Lin Zhang1, Zhenlong Huang1, Muyang Lin7, Zhuorui Zhang1, Zhenan Yin3, Brady Huang5, Hua Gong1, Shubha Bhaskaran3, Yue Gu2, Mitsutoshi Makihata6, Yuxuan Guo1, Yusheng Lei1, Yimu Chen1, Chunfeng Wang8, Yang Li1, Tianjiao Zhang1, Zeyu Chen4, Albert Pisano6, Liangfang Zhang1, Qifa Zhou4, and Sheng Xu1,2,3,9,* 1Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093-0448, USA. 2Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, 92093-0418, USA. 3Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093-0407, USA. 4Department of Ophthalmology and Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. 5Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, 92103, USA. 6Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, 92093-0411, USA. 7School of Precision Instrument and Optoelectronic Engineering, Tianjin University, Tianjin, 300072, China. 8The Key Laboratory of Materials Processing and Mold of Ministry of Education, School of Materials Science and Engineering, School of Physics & Engineering, Zhengzhou University, Zhengzhou, 450001, Henan, China. 9Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093-0412, USA.
    [Show full text]
  • Wide Pulse Pressure and Quincke's Pulse in High-Output Heart Failure
    Case report BMJ Case Rep: first published as 10.1136/bcr-2021-241654 on 22 July 2021. Downloaded from Wide pulse pressure and Quincke’s pulse in high- output heart failure Katie Lin Berry,1 Peter D Sullivan,2 André Martin Mansoor 2 1School of Medicine, Oregon SUMMARY progressive exertional dyspnoea and weight gain. The Health & Science University, A 74-year -old man with a history of chronic alcohol use patient reported drinking three to four glasses of wine Portland, Oregon, USA 2 presented with progressive exertional dyspnoea and daily for at least 10 years. Physical examination was Department of Medicine, weight gain. On physical examination, he was noted notable for a body mass index of 34.3 kg/m2, blood Oregon Health & Science to have wide pulse pressure, elevated jugular venous pressure of 177/56 mm Hg, dependent pitting periph- University, Portland, Oregon, pressure, and alternating flushing and blanching of eral oedema, jugular venous pressure of 18 cm H O USA 2 the nail beds in concert with the cardiac cycle, known with a normal waveform, unremarkable S1 and S2 Correspondence to as Quincke’s pulse. Transthoracic echocardiography without extra transient sounds or murmurs, and subun- Dr André Martin Mansoor; demonstrated normal biventricular systolic function gual capillary pulsations (Quincke’s pulse) (video 1). mansooan@ ohsu. edu and valvular function, but noted a dilated inferior vena cava. Right heart catheterisation revealed elevated Accepted 1 July 2021 filling pressures, high cardiac output and low systemic INVESTIGATIONS vascular resistance, consistent with high-output heart Laboratory data were notable for haemoglobin of failure.
    [Show full text]
  • Vascular Responses to Acute Intracranial Hypertension
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.34.5.587 on 1 October 1971. Downloaded from J. Neurol. Neurosurg. Psychiat., 1971, 34, 587-601 Vascular responses to acute intracranial hypertension S. S. HAYREH1 AND J. EDWARDS From the Department of Experimental Ophthalmology, Institute of Ophthalmology, University of London SUMMARY In 27 rhesus monkeys the cerebrospinal fluid pressure (CSFP) was raised by injections into the cisterna magna to about 40 to 50 mm Hg in steps of 5 mm Hg every five minutes. During the initial phase of the rise of the CSFP to about 15 mm Hg normal animals showed a significant fall in the systolic arterial blood pressure. With a further elevation of the CSFP the BP rose till the CSFP reached 30 to 40 mm Hg. If the CSFP were raised higher than that, a large number of the animals showed a significant fall in the BP. In animals which were shocked before the CSFP was raised there was no drop in the systolic BP during the initial phase. This study indicates that vascular decompensation occurs in the majority of animals when the CSFP goes higher than 30 to 40 mm guest. Protected by copyright. Hg; there is a significant rise in the pulse rate, superior sagittal sinus pressure (SSP), and internal jugular vein pressure (JVP). The JVP was related to the SSP, indicating that the JVP most probably reflected the pressure changes in the intracranial venous sinuses. Four animals suddenly collapsed at the highest CSFP. In the remaining 23 animals, on a sudden lowering of the CSFP to zero from the highest level, 13 monkeys died in less than half an hour and four in about an hour, while six animals stood this elevation of the CSFP well, with a good recovery.
    [Show full text]
  • Pulse, Blood Pressure and Jugular Venous Pulse
    CHAPTER Back to Bedside Basics - Pulse, Blood Pressure and Jugular Venous Pulse 195 Ruchit A Shah, BR Bansode INTRODUCTION peak is palpable. Percussion wave is more prominent than In the era of electrocardiogram and echocardiography, the tidal wave. Anacrotic notch, tidal wave, dicrotic notch clinical bedside examination is a forgotten art. However and dicrotic wave are not palpable. accurate these investigations may be, evaluation of As the pulse wave travels from aortic valve to the peripheral the patient is incomplete without a detailed physical arteries; i) the upstroke becomes steeper, ii) systolic peak examination. In this chapter we shall discuss the basic becomes high, iii) systolic upstroke time becomes shorter, bedside art and clinical relevance of examination of the iv) ejection time increases, v) systolic pressure increases, arterial pulse, blood pressure and jugular venous pulse. vi) pulse pressure increases, vii) diastolic pressure THE ARTERIAL PULSE decreases, viii) mean pressure decreases, ix) anacrotic shoulder disappears, x) sharp incisura is replaced by a Physiology - The arterial pulse begins with aortic valve smoother and latter dicrotic notch, followed by a dicrotic opening and ejection of blood from the left ventricle into wave. The carotid artery is a large artery close to the aortic the aorta. The nature of arterial pulse depends on left valve and its contour resembles that of central aortic pulse. ventricular stroke volume, ejection velocity, compliance, Hence the carotid pulse and not the peripheral pulse is distensiblity and capacity of arterial system. The pulse used to assess the volume and contour (Table 1). contour is a result of frequency waves produced by antegrade blood flow and reflection of the waves returning With aging, arteriosclerosis and hypertension, there is from the peripheral circulation.
    [Show full text]
  • Post-Extrasystolic Characteristics in the Arterial Blood Pressure Waveform Are Associated with Right Ventricular Dysfunction in Intensive Care Patients
    Journal of Clinical Monitoring and Computing (2019) 33:565–571 https://doi.org/10.1007/s10877-018-0216-2 ORIGINAL RESEARCH Post-extrasystolic characteristics in the arterial blood pressure waveform are associated with right ventricular dysfunction in intensive care patients Simon Tilma Vistisen1,2,3 · Benjamin Moody3 · Leo Anthony Celi3,4 · Christina Chen3,4 Received: 4 September 2018 / Accepted: 30 October 2018 / Published online: 8 November 2018 © Springer Nature B.V. 2018 Abstract Right ventricular dysfunction (RVD) is associated with end-organ dysfunction and mortality, but has been an overlooked condition in the ICU. We hypothesized that analysis of the arterial waveform in the presence of ventricular extrasystoles could differentiate patients with RVD from patients with a normally functioning right ventricle, because the 2nd and 3rd post-ectopic beat could reflect right ventricular state (pulmonary transit time) during the preceding ectopy. We retrospectively identified patients with echocardiographic evidence of moderate-to-severe RVD and patients with a normal functioning right ventricle (control) from the MIMIC database. We identified waveform records where ECG and arterial pressure were avail- able in combination, simultaneously with echocardiographic evaluation. Ventricular extrasystoles were visually confirmed and the median systolic blood pressure (SBP) of the 2nd and 3rd post-ectopic beats compared with the median SBP of the ten sinus beats preceding the extrasystole. We identified 34 patients in the control group and 24 patients in the RVD group with ventricular extrasystoles. The mean SBP reduction at the 2nd and 3rd beat was lower in the RVD group compared with the control group [− 1.7 (SD: 1.9) % vs.
    [Show full text]
  • Validity of Pulse Pressure Variation (PPV)
    Turk J Anaesthesiol Reanim 2017; 45: 210-7 DOI: 10.5152/TJAR.2017.04568 Validity of Pulse Pressure Variation (PPV) Compared with Stroke Volume Variation (SVV) in Predicting Fluid Responsiveness Sıvı Yanıtının Tahmin Edilmesinde Atım Hacmi Değişimi (SVV) ile Karşılaştırıldığında Nabız Basıncı Original Article Araştırma Original / Özgün Değişiminin (PPV) Geçerliliği Abhishek Rathore1, Shalendra Singh1, Ritesh Lamsal2, Priya Taank3, Debashish Paul1 1Department of Anaesthesiology, Army R&R Hospital Delhi Cantt, Delhi, India 2Department of Neuroanaesthesiology, All India Institute of Medical Science, New Delhi, India 3Department of Ophthalmology, Army R&R Hospital Delhi Cantt, Delhi, India Cite this article as: Rathore A, Singh S, Lamsal R, Taank P, Paul D. Validity of Pulse Pressure Variation (PPV) Compared with Stroke Volume Variation (SVV) in Predicting Fluid Responsiveness. Turk J Anaesthesiol Reanim 2017; 45: 210-7. Objective: Static monitors for assessing the fluid status during Amaç: Günümüzde anestezi pratiğinde, büyük ameliyatlarda ve ağır major surgeries and in critically ill patients have been gradually hastalarda sıvı durumunun değerlendirilmesi için kullanılan statik replaced by more accurate dynamic monitors in modern-day an- izlem yöntemlerinin yerini, daha doğru sonuçlar veren dinamik iz- aesthesia practice. Pulse pressure variation (PPV) and systolic pres- lemler almıştır. Nabız basıncı değişimi (PPV) ve sistolik basınç deği- sure variation (SPV) are the two commonly used dynamic indices şimi (SPV) sıvı yanıtını değerlendirmek amacıyla yaygın bir şekilde Abstract Abstract / Öz for assessing fluid responsiveness. kullanılan dinamik indekslerdir. Methods: In this prospective observational study, 50 patients Yöntemler: Bu prospektif gözlemsel çalışmada, major cerrahi geçire- undergoing major surgeries were monitored for PPV and SPV: cek 50 hastada anestezi indüksiyonundan ve 500 mL izotonik veril- after the induction of anaesthesia and after the administration of dikten sonra PPV ve SPV monitörize edildi.
    [Show full text]
  • BIOPAC Systems, Inc
    Physiology Lessons Lesson 16 for use with the Biopac Student Lab BLOOD PRESSURE ¾ Indirect measurement ¾ Ventricular Systole & Diastole ¾ Korotkoff sounds ¾ Mean Arterial pressure Manual Revision 3.7.3 061808 Richard Pflanzer, Ph.D. Associate Professor Indiana University School of Medicine Purdue University School of Science William McMullen Vice President BIOPAC Systems, Inc. BIOPAC® Systems, Inc. 42 Aero Camino, Goleta, CA 93117 (805) 685-0066, Fax (805) 685-0067 Email: [email protected] Web: www.biopac.com © BIOPAC Systems, Inc. Page 2 Biopac Student Lab I. INTRODUCTION In this lesson, you will record your blood pressure, which is comprised of two numbers: systolic pressure (the force of blood in your arteries as the heart contracts and pushes it out) and diastolic pressure (the force of your blood between heartbeats). Understanding circulation will help you understand and accurately measure your blood pressure. Circulating blood provides a transportation and communication system between the body’s cells and serves to maintain a relatively stable internal environment for optimum cellular activity. Blood circulates because the heart pumps it through a closed circuit of blood vessels (Fig. 16.1 and 16.2). Blood flow through the heart and the blood vessels is unidirectional, flowing into the heart from the pulmonary and systemic veins, and out of the heart into pulmonary and systemic arteries. Figure 16.2 Figure 16.1 Blood flow through the chambers of the heart is unidirectional because of the action of four valves inside the heart (see fig. 16.3) that normally prevent retrograde or backward flow during the cardiac cycle (one heartbeat).
    [Show full text]