The Arterial Circulation: Physical Principles and Clinical Applications

277 Pages·2000·5.758 MB·English

by  Dr. John K.-J. Li PhD (auth.)

THE ARTERIAL CIRCULATION
THE
ARTERIAL CIRCULATION
Physical Principles and Clinical Applications
JOHN K-J. LI,
PHD
Department of Biomedical Engineering
Rutgers University, Piscataway, NJ
SPRINGER-SCIENCE+BUSINESS
MEDIA,LLC
© 2000 Springer Science+Business Media New York
Originally published by Humana Press Inc. in 2000
Softcover reprint of the hardcover 1 st edition 2000
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new research, changes in government regulations, and knowledge from clinical experience relating
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10 9 8 7 6 5 4 3 2
ISBN 978-1-61737-106-6 ISBN 978-1-59259-034-6 (eBook)
DOI 10.1007/978-1-59259-034-6
To my parents, Dr. George Tien-Fu Li, MD, and Yin-Chu Pan, RN,
for always being content with my accomplishments.
To my sons, Michael ofJ ohns Hopkins,
and Christopher ofH arvard, who have made me ever so proud.
PREFACE
After yet another decade of leaming, experimenting, and inves
tigating since my first book, Arterial System Dynamics, the many new
medical breakthroughs and technological advances have inspired me to
write this book to bridge the gap between basic research and clinical
applications. The application of physical principles and quantitative
approaches to the understanding of the arterial circulation and its
interactions with the heart in normal and diseased conditions form the
basis of The Arterial Circulation. Knowledge of the physiology and
rheology of arteries, as well as all of their structural-functional corre
lates, is a necessary prerequisite to the proper hemodynamic interpretatiqn
of pressure-flow relations and the pulsatile transmis sion characteristics
in different arteries. The natural coupling and interactions of the heart,
the coronary circulation, and the arterial system necessitate analysis of
alterations to global functioning. Modeling provides a tool for isolating
and predicting parameter changes and is employed throughout the book.
Experimental data are provided for model validations, and also for more
realistic interpretations. Techniques and new methods for clinical hemo
dynamic measurement and diagnosis are included to help the reader un
derstand the physical principles underlying such abnormal cardiovascular
functions as hypertension, stenosis, and myocardial ischemia. The
progressive changes in vascular properties during aging are also discussed.
Modem approaches utilizing computer mode ling and allomery are
presented with selected examples, such as combined hypertension and
aortic valve stenosis, and ventricular hypertrophy. The overall treatment
is based on physical principles, with physiological relevance and
clinical applications in mind. The Arterial Circulation is written
for students, physiologists, biomedical engineers, pharmacologists,
cardiologists, and other clinicians with a common interest in overall
cardiovascular function.
Finally, 1 would like to thank all those who have contributed to
the completion of this book.
John K-J. Li, PHD
VII
CONTENTS
Preface .......................................................................................................... vii
About the Author ...................•......................................................•......•....... xi
1 INTRODUCTION ............................................................................... 1
1.1 Historica1 View of Arteria1 Circulation ....................................... 1
1.2 Recent Developments ................................................................... 6
1.3 Book Content ................................................................................ 8
References ................................................................................... 12
2 PHYSIOLOGY AND RHEOLOGY OF ARTERIES ................... 13
2.1 Anatomica1 and Structural Organization ................................... 13
2.2 Material Properties ofthe Arterial Wall:
Elastin, Collagen, and Smooth Muscle Cells ............................ 19
2.3 Viscoelastic Properties of Blood Vessels .................................. 24
References ................................................................................... 30
3 THEORIES AND MODELS
OF ARTERIAL CIRCULATION ........................................... 33
3.1 Simple Windkessel Model ofthe Arterial System .................... 33
3.2 Oscillatory Blood Flow in Arteries ............................................ 37
3.3 Linear Theories of Blood Flow in Arteries ............................... 41
3.4 Analogy of Arterial Blood Flow to Transmission Line ............ 46
3.5 Distributed and Reduced Arterial Tree Models ........................ 49
3.6 Nonlinear Aspects and Pressure-Dependent
Arterial Compliance ................................................................... 53
References ................................................................................... 64
4 ARTERIAL PULSE TRANSMISSION .
CHARACTERISTICS ................•.................•.................•......... 69
4.1 Pressure and Flow Waveforms in Large and Small Arteries .... 69
4.2 Vascular Impedance to Blood Flow ........................................... 78
4.3 Pulse Propagation, Wave Velocity, and Damping .................... 85
4.4 Pu1se Wave Reflections and Reflection Sites ............................ 95
4.5 Pu1se Transmission at Vascular Branching ............................. 112
4.6 Pulse Transmission to Vascular Beds ...................................... 116
References ................................................................................. 122
ix
x CONTENTS
5 HEMODYNAMIC MEASUREMENTS
AND CLINICAL MONITORING ....................................... 129
5.1 Invasive Blood Pressure Measurements .................................. 129
5.2 Noninvasive B100d Pressure Measurements ........................... 139
5.3 Blood Flow Measurements ...................................................... 146
5.4 ThermodiJution Measurement of Cardiac Output ................... 148
5.5 Vascular Ultrasound Dimension Measurement.. .................... 153
References ................................................................................. 155
6 ARTERIAL CIRCULAT ION AND THE HEART ..................... 159
6.1 Coupling of Heart and Arterial System ................................... 159
6.2 Dynamic Heart-Arterial System Interactions and
the Concept of Dynamic Arterial Compliance ....................... 164
6.3 Coronary Arterial Circulation .................................................. 169
6.4 Hemodynamics and Modeling of Coronary Circulation ......... 179
6.5 Myocardial Function and Arteria1 System Load ..................... 188
References ................................................................................. 194
7 NEW APPROACHES
TO CLINICAL EVALUATIONS ......................................... 201
7.1 Hypertension, Vascular Stiffness, and Arterial
Compliance ............................................................................... 201
7.2 Vascular Hemodynamics of Aging
and Iso1ated Systolic Hypertension ......................................... 219
7.3 Aortic Va1ve Stenosis and Arterial System Afterload
on Left Ventricu1ar Hypertrophy ............................................. 228
7.4 Allometry and Its Diagnostic App1ications ............................. 236
References ................................................................................. 250
INDEX .............................................................................................. 257
ABOUT THE AUTHOR
Dr. Li is a Professor II (distinguished) and Director of Cardiovascular
Research in the Department of Biomedical Engineering at Rutgers, The
State University, Piscataway, NJ. Re is a Fellow ofthe American College
of Cardiology, a Fellow of the American College of Angiology, and a
Fellow ofthe American Institute of Medical and Biological Engineering.
xi
1
INTRODUCTION
1.1. Historical View of Arterial Circulation
The heart and the arterial system are such c10se functional complements
that the eirculatory system cannot be effectively described by either one
alone. Only by virtue of the distributing arterial trees can oxygen, humoral
agents, and nutrients be transported to the vital parts of the body, while the
heart provides the necessary energy.
The observation that humans must inspire air to sustain life led aneient
seientists and philosophers to toy with the idea that arteries contained air
rather than blood. This notion was originally attributed to Erasistratus in
the third century BC, following the teaching of Aristotle. That arteries
contract and relax had been known in Aristotle's time. Galen later (130-
200 AD) described the ebb and flow ofblood in arteries, which, though it
lasted for centuries, was grossly inaccurate. Additionally, in the Galenic
view, blood was passed from the right side of the heart to the left side
through pores, which was later shown to be incorrect, because they do not
exist within the interventricular septum. This open-eircuit interpretation
does not accurately describe the eirculation ofblood. Galileo (1564-1642)
in his Dialogue oft he Two Sciences, which appeared in 1637, suggested the
circulation of blood in a c10sed system. Today, the idea of the circulation
of blood is credited to William Harvey (1578-1657), a contemporary of
Galileo, in his now famous De M otu Cordis and De Circulatione Sanguinis
(1628). Re described in his Anatomical Exercises explained that "blood
does continually passes through the heart" and that "blood flows continually
out the arteries and into the veins." Ris work was completed before
Malphighi, who worked with the aid of a microscope, and discovered the
capillaries in 1661, which linked the arterial eirculation to the venous circu
lation. Rarvey's work indicated the pulsatile nature of blood as a conse
quence of intermittent inflow, during roughly one-third of the heart cyc1e,
now known as systole, in combination with essentially steady outflow
through the periphery during the remaining cardiac period, the diastole.
Fascinated by the anatomic structure of the vascular tree, Leonardo da
Vinei (1452-1519) made many detailed drawings ofthe constituent parts
of the circulatory system. Re apparently already knew that both contrac-
From: Arterial Circulation: Physical Principles and Clinical Applications
By: J. K-J. Li © Humana Press Inc., Totowa, NJ
1
2 Li I The Arterial Circulation
Fig. 1-1. Drawings of the human heart, heart valves, and the great vessels by the artist
Leonardo da Vinei. Shape and size are shown in good geometric proportions. Coronary
arteries and their major branehes, as well as leaflets of the valves are well illustrated.
tion and resting periods are necessary for the heart to function with a
normal rhythm. His anatomic drawings of the heart and the perfusing
arteries are amazingly accurate: Figure 1-1 illustrates one such drawing, in