BLOOD PRESSURE

• Blood pressure is the force or pressure of the blood against the walls of the blood
vessels
• Arterial blood pressure is a measure of the pressure exerted by the blood as it
flows through the arteries.
• It is the result of ejection of blood from left ventricle to aorta,
• Measured with Sphygmomanometer
• BP is recorded as a fraction of systolic pressure over diastolic pressure and
expressed in millimeters of mercury
Direct Measurement
• For direct measurement, a catheter or a needle type probe is inserted through a vein or
artery to the area of interest.
• Two types of probes can be used.
One type is the catheter tip probe in which the sensor is mounted on the tip of the
probe and the pressures exerted on it are converted to the proportional electrical signals.
The other is the fluid-filled catheter type, which transmits the pressure exerted on
its fluid-filled column to an external transducer. This transducer converts the exerted
pressure to electrical signals. The electrical signals can then be amplified and displayed
or recorded.
Catheter tip probes provide the maximum dynamic response and avoid acceleration
artefacts whereas the fluid-filled catheter type systems require careful adjustment
• Pressure transducers presently available incorporate a continuous flush arrangement.
• The source of fluid for the flushing system (Fig. 6.21) is a plastic bag (600 ml),
which is filled with normal saline and kept at a pressure of 300 mmHg.
• The high pressure fluid then flows through a Millipore filter (0.22m) which is
essential to prevent clogging of the fine bore resistance element and which also
serves to filter any bacteria found in the solution.
• Continuous flush is achieved by using a large resistive element to convert the
pressure source to a flow source.
• It is found that large flow rates can cause significant error when using the small
diameter catheter.
• To initially fill the transducer and catheter, a fast flush feature is needed. This is
done by using a rubber valve in the system which when operated permits a fast
flush, fills the transducer,and purges the air bubbles from the flush system.
Indirect Measurement
• The classical method of making an indirect measurement of blood pressure is by
the use of a cuff over the limb containing the artery.
• This technique was introduced by Riva-Rocci for the determination of systolic and
diastolic pressures.
• Initially, the pressure in the cuff is raised to a level well above the systolic
pressure so that the flow of blood is completely terminated.
• Pressure in the cuff is then released at a particular rate. When it reaches a level,
which is below the systolic,pressure, a brief flow occurs.
• If the cuff pressure is allowed to fall further, just below the diastolic pressure
value, the flow becomes normal and uninterrupted.
KOROTKOFF s METHOD
•.
• The principle behind the generation of the Korotkoff sound is the
turbulence of blood flowing through a partially occluded area in the
artery.
• Korotkoff sounds, named after Dr.
Nikolai Korotkoff, a physician who
described them in 1905, are sounds
that physicians listen for when they
are taking blood pressure.
• Korotkoff sounds are pulsatile
circulatory sounds heard upon
auscultation of the brachial artery.
• The method consists in putting a cuff around the upper part of the
patient’s arm and applying a microphone over the brachial artery.
• The compressed air required for inflating the cuff is provided by a
pumping system incorporated in the apparatus.
• Usually the inflating is done to a preset pressure level, well beyond the
systolic value at the rate of approximately 30 mmHg/s.
• The pressure in the cuff is then decreased at a relatively slow pace at the
rate of 3–5 mmHg/s. The cuff is to be applied in such a way that the
veins are not occluded.
• While air is allowed to leak from the cuff, the Korotkoff sounds are
picked up by a special piezoelectric microphone.
• The corresponding electrical signals are fed to a preamplifier. The amplified
signals are then passed on to a bandpass filter having a bandwidth of 25 to 125
Hz.
• With this passband, a good signaI-to-noise ratio is achieved when recording
Korotkoff sounds from the brachial artery beneath the lower edge of the cuff.
• The system is so designed that the appearance of the first Korotkoff sound
switches in the systolic manometer and locks the reading on the indicating meter.
• In a similar way, the diastolic value is fixed by the last Korotkoff sound.
• The cuff is completely deflated, automatically, after an interval of 2–5 s after the
determination of the diastolic value
Rhegographic Method
• In this method, a set of three electrodes
(Fig. 6.27), which are attached to the
cuff, are placed in contact with the skin.
• A good contact is essential to reduce the
skin electrode contact impedance.
• Electrode B which acts as a common
electrode is positioned slightly distal
from the mid-line of the cuff.
• Electrodes A and C are placed at a
certain distance from the electrode B,
one distally and the other proximally.
Rhegographic Method
• A high frequency current source
operating at 100 kHz is connected to the
electrodes A and C.
• When we measure the impedance
between any two electrodes before
pressurizing the cuffs, it shows
modulation in accordance with the blood
flow pulsations in the artery.
• Therefore, arterial pulses can be detected
by the demodulation and amplification
of this modulation.
Differential auscultatory technique
• The “differential auscultatory technique” is a non-invasive method for accurately
measuring blood pressure.
• A special cuff-mounted sensor consisting of a pair of pressure sensitive elements,
isolates the signal created each time the artery is forced open.
Oscillometric method
• The oscillometric technique operates on the principle that as an occluding cuff
deflates from a level above the systolic pressure
• The artery walls begin to vibrate or oscillate as the blood flows turbulently
through the partially occluded artery and these vibrations will be sensed in the
transducer system monitoring cuff pressure.
• As the pressure in the cuff further decrease, the oscillations increase to a
maximum amplitude and then decrease until the cuff fully deflates and blood flow
returns to normal.
• The oscillometric method is based on oscillometric pulses (pressure pulses)
generated in the cuff during inflation or deflation.
ULTRASONIC DOPPLER SHIFT METHOD
• Instruments making use of ultrasonic Doppler-shift principle for the measurement
of blood flow are based on the detection of the frequency shift ascribed to back
scattering from moving blood particles.
• The blood pressure instrument filters out these higher frequency reflections and
senses the lower frequency refractions originating from the movement of the
relatively slow moving arterial wall.
• In principle, the instrument consists of four major subsystems (Fig. 6.34).
• The power supply block converts incoming ac line voltage to several filtered and
regulated dc voltages required for the pneumatic subsystem in order to inflate the
occlusive cuff around the patient’s arm.
• Control subsystem signals gate-on the transmitter in the RF and audio subsystem,
thereby generating a 2 MHz carrier, which is given to the transducer located in the
cuff.
• The transducer converts the RF energy into ultrasonic vibrations, which pass into
the patient’s arm.
• The cuff pressure is monitored by the control subsystem and when the pressure
reaches the preset level, further cuff inflation stops.
• At this time, audio circuits in the RF and audio subsystems are enabled by control
subsystem signals, and the audio signals representative of any Doppler frequency
shift are thus able to enter the control subsystem logic.
• The control subsystem signals the pneumatic subsystem to bleed off the cuff
pressure at a rate determined by the preset bleed rate.
• As air bleeds from the cuff, the frequency of the returned RF is not appreciably
different from the transmitted frequency as long as the brachial artery remains
occluded. Till then, there are no audio signals entering the control subsystem.
• At the systolic pressure, the occluded artery snaps open and the arterial blood flow
starts. This artery motion results in a Doppler shift in the returning ultrasonic
• An occlusive cuff is placed on the arm (Fig. 6.35) in the usual manner, with an
ultrasonic transducer on the arm over the brachial artery.
• The cuff is inflated first to above systolic pressure and then deflated at a specified
rate.
• A low energy ultrasonic beam (less than 50 mw/cm2 ) at a frequency of 2 MHz is
transmitted into the arm.
• The portion of the ultrasound that is reflected by the arterial wall shifts in
frequency when the wall of the artery moves.
• Above systolic, the vessel remains closed due to the pressure of the occluding
cuff, and the monitor signals are not received.
As the cuff pressure falls to the point where it is just overcome by the brachial
artery pressure, the artery wall snaps open.
This opening wall movement, corresponding to the occurrence of the first Korotkoff
sound, produces a Doppler-shift which is interpreted by logic in the instrument as
systolic and displayed.
The instrument notes the sudden diminution in the amplitude of the Doppler shift
and cuff pressure at this point is displayed as diastolic pressure.
Special electronic circuits used in the instrument help to discriminate against
extraneous motion artefacts