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An exact non-invasive approximation of mean arterial

pressure (MAP) is of significant in the appraisal of circulatory function and diagnosis of various cardiovascular
illnesses. MAP estimation technique based on the depending on pulse transit time (PTT) of cuff pressure (CP).

Sebuah tepat non - invasif perkiraan rata-rata arteri tekanan ( MAP ) adalah signifikan dalam penilaian fungsi
peredaran darah dan diagnosis berbagai kardiovaskular penyakit . Teknik estimasi MAP berdasarkan tergantung
pada waktu transit pulsa ( PTT ) dari tekanan cuff ( CP )

The human heart is a muscular organ and its function is exemplified by alternating intervals of contraction and
relaxation. Throughout the contraction stage (systole), blood is driven out from the both of the left and right
ventricles and impelled into the organised circulation and pulmonary circulation, relevantly. Throughout the
relaxation stage of the heart (diastole), the ventricles are filled up with the blood in organising for subsequent
contraction phase. Although systolic and diastolic arterial blood pressure values are significant measurements
and contain tremendous diagnostic value, it is the mean arterial pressure (MAP) that drives blood all the way
through the vasculature from arteries to arterioles, capillaries, venules, veins, and then back to heart.

Hati manusia adalah organ berotot dan fungsinya dicontohkan oleh bolak interval kontraksi dan
relaksasi. Sepanjang tahap kontraksi ( sistol ), darah diusir dari kedua ventrikel kiri dan kanan
dan terdorong ke dalam sirkulasi terorganisir dan sirkulasi paru-paru , relevan . Sepanjang tahap relaksasi
jantung ( diastole ) , ventrikel diisi dengan darah dalam mengorganisir untuk fase kontraksi berikutnya .
Meskipun sistolik dan tekanan darah arteri diastolik nilai-nilai pengukuran yang signifikan dan mengandung
luar biasa diagnostik nilai , itu adalah mean tekanan arteri ( MAP ) yang mendorong darah semua jalan melalui
pembuluh darah dari arteri ke arteriol , kapiler , venula , vena , dan kemudian kembali ke jantung .

Mean Arterial Pressure is estimated for the instance-subjective average of blood pressure values in large system
arteries throughout the cardiac phase. The mean arterial pressure corresponds to the average arterial pressure
throughout the cardiac cycle, in addition to it is the force that constrains the blood all the way through the
vasculature. Mean arterial pressure is the instance-weighted arithmetic mean of pressure values in bulky arteries
through the cardiac phase.

Rata Tekanan arteri diperkirakan untuk rata-rata contoh - subjektif dari nilai tekanan darah
pada arteri sistem besar seluruh fase jantung . Tekanan arteri rata-rata sesuai dengan
tekanan arteri rata-rata di seluruh siklus jantung , selain itu adalah kekuatan yang
membatasi darah semua jalan melalui pembuluh darah . berarti arteri Tekanan adalah mean
aritmatika contoh - tertimbang dari nilai tekanan di arteri besar melalui fase jantung .

The function of Mean arterial pressure is (1) The rate of heart pumping the blood into bulky arteries, (2) the rate
of flow of blood out from large arteries to get into the smaller arteries and arterioles (3) Compliance of the
arterial wall. A precise non-invasive approximation of mean arterial pressure (MAP) has an immense
significance in the analysis of circulatory purpose and prognosis of various cardiovascular diseases.

Itu fungsi dari tekanan arteri mean adalah ( 1 ) Tingkat jantung memompa darah ke dalam arteri besar , ( 2 )
tingkat aliran darah keluar dari pembuluh darah besar untuk masuk ke dalam arteri yang lebih kecil dan arteriol (
3 ) Kepatuhan dinding arteri . Sebuah pendekatan non - invasif yang tepat dari rata-rata tekanan arteri ( MAP )
memiliki makna besar dalam analisis tujuan peredaran darah dan prognosis dari berbagai penyakit
kardiovaskular .

Blood pressure is one among the principle parameter used to measure in medical practice that provides
important
information regarding the physiological state of the patients and their heart performance. Systolic Blood
Pressure (SBP)
and Diastolic Blood Pressure (DBP) shown in Fig 1 are the values approximated in the blood pressure
measurement.
Physiologically, SBP occur in the starting of the cardiac phase (systole phase) while heart contracts, that raises
the pressure among the arteries surrounding the heart to the highest level pushing the blood from the left
ventricle to the vessels of the heart. Conversely, DBP occurs in the end of cardiac phase (diastole phase) while
the heart relaxes, due to which the pressure fall of the arteries to the low level and fills the blood in chambers of
heart. Blood pressure approximation would be either Invasive (direct) or Non-invasive (indirect)
Fig

Tekanan darah adalah salah satu di antara parameter prinsip yang digunakan untuk mengukur dalam praktek
medis yang menyediakan penting informasi mengenai kondisi fisiologis pasien dan kinerja hati mereka . Sistolik
Tekanan Darah ( SBP ) dan diastolik tekanan darah ( DBP ) ditunjukkan pada Gambar 1 adalah nilai-nilai
didekati dalam pengukuran tekanan darah . Secara fisiologis , SBP terjadi pada awal fase jantung ( fase sistol )
sementara jantung berkontraksi , yang menimbulkan tekanan antara arteri yang mengelilingi jantung ke tingkat
tertinggi mendorong darah dari ventrikel kiri ke pembuluh jantung . Sebaliknya , DBP terjadi pada akhir fase
jantung ( fase diastole ) sementara jantung berelaksasi , karena dimana tekanan jatuhnya arteri ke tingkat rendah
dan mengisi darah di ruang jantung . Tekanan darah pendekatan akan baik Invasif ( langsung) atau Non - invasif
( tidak langsung )

Fig 1: The Cardiac Cycle. Definition of Systole and Diastole. Opening And Closure of the Aortic and Mitral
Valves

MAP Estimation
The cuff pressure of the calculated PTT signals maximum is determined [1]. The detected maximum of PTT
signal is
the estimated MAP
Validation
For the validation purpose the values for the reference MAP are calculated from the huge dataset and the same is
considered as reference MAP values. Thus here the MAP reference values are calculated using SBP and DBP
values
using the three different validation formulae [1].
1). 33% Formula
The principle for determining MAP using the measured SBP and DBP Values depends on addition of 33% of
the pulse
pressure to the DBP which is as shown below
Mean Arterial Pressure= DP+ 0.33*Y (1)
Where DP= diastolic pressure
SP=Systolic pressure
Y= DP-SP (2)

2). 40% Formula


The uses of conventional formula of 33% under rate the MAP values. Thus as the part of correction the 33%
coefficient is replaced by the 40% co-efficient which is shown as follows
Mean arterial pressure=DP+0.40* Y (3)

3) Heart Rate-Dependent Formula:


Both the above used 33% as well as 40% formulae do not consider the effect of heart rate. Thus the new formula
is proposed for calculation of MAP which uses the heart rate and obtains more accurate results. The heart rate
dependent formula is as shown below

Mean Arterial Pressure =DBP + [0.33+0.0012 R]*Y (4)


Where HR represents the heart rate

Prospective Evaluation of a Method for Estimating


Ascending Aortic Pressure From the Radial Artery
Pressure Waveform
Pressure wave reflection in the upper limb causes amplification of the arterial pulse so that radial
systolic and pulse pressures are greater than in the ascending aorta.

refleksi tekanan gelombang di ekstremitas atas menyebabkan amplifikasi pulsa arteri


sehingga sistolik radial dan tekanan nadi lebih besar dari pada aorta menaik.

Wave transmission properties in the upper limbs (in contrast to


the descending aorta and lower limbs) change little with age, disease, and drug therapy in adult humans. Such
consistency has led to use of a generalized transfer function to synthesize the ascending aortic pressure pulse
from the radial pulse. Validity of this approach was tested for estimation of aortic systolic, diastolic, pulse, and
mean pressures from the radial pressure waveform.

sifat transmisi gelombang di tungkai atas ( berbeda dengan yang turun aorta dan tungkai
bawah ) berubah sedikit dengan usia , penyakit , dan terapi obat pada manusia dewasa .
Seperti itu konsistensi telah menyebabkan penggunaan fungsi transfer umum untuk
mensintesis naik pulsa tekanan aorta dari pulsa radial . Validitas dari pendekatan ini diuji
untuk estimasi sistolik aorta , diastolik , denyut nadi , dan tekanan berarti dari gelombang
tekanan radial .

Exercise and Blood


Flow
The changes in blood flow that
occur during exercise provide an
excellent illustration of intrinsic and
extrinsic control of arteriolar radius.
The vascular tone of arterioles found
in skeletal muscle is relatively high,
consequently blood flow to resting
muscles is low (20-25% of total
blood flow). However, during heavy
exercise, blood flow to the skeletal
muscles increases significantly (up
to 80-85% of total blood flow). The
increase in blood flow to skeletal
muscles during exercise is mediated
by three factors: (1) an increase in
cardiac output, (2) vasodilation of
skeletal muscle arterioles, (3)
vasoconstriction of arterioles in the
viscera and skin.

1. An increase in cardiac
output. Exercise activates
the sympathetic nervous
system. Increased
sympathetic output to the
heart causes an increase in
heart rate and stroke volume.
Heavy exercise increases
venous return of blood to the
heart via the skeletal muscle
pump and the respiratory
pump. An increase in venous
return leads to an increase in
end-diastolic volume (EDV),
which in turn, causes an
increase in stroke volume.
2. Vasodilation of skeletal
muscle arterioles. The most
important factor governing
flow of blood to exercising
muscles is local metabolic
control (active hyperemia).
As muscular activity
increases, metabolites build
up and directly induce the
vasodilation of local
arterioles. Additionally,
beta-adrenergic stimulation
by epinephrine causes
vasodilation of arterioles in
skeletal muscle.
3. Vasoconstriction of
arterioles in the viscera
and skin. As a result of
alpha-adrenergic
sympathetic stimulation,
arterioles in the viscera and
skin vasoconstrict during
exercise. However, as
exercise progresses and body
temperature rises, cutaneous
arterioles dilate in order to
radiate heat and reduce body
temperature.

Summary of Factors that Effect Blood


Flow during Exercise