From Big Medical Encyclopedia

SFIGMOGRAFIYA (Greek sphygmos pulse, a pulsation + grapho to write, represent) — graphic registration of pulse fluctuations of a wall of a blood vessel. The pulsation is perceived from a body surface over the studied vessel by means of the sensors imposed on area of a pulsation or beskontaktno, with use of remotely located sensors. The page is applied as an independent method of a research or is a part of other techniques (see. Mekhanokardiografiya , Polikardiografiya ). Villages use for assessment of a condition of the blood circulatory system and diagnosis of nek-ry diseases, in particular heart diseases.

The founder S. consider Firordt (To. Vierordt) which created the first model of a sphygmograph in 1855. For the first time received satisfactory sphygmograms (SFG) of arteries in 1860 Mr. E.Marey, and veins — N. Friedreich in 1865. Frank (O. of Frank) in 1905 developed technology of undistorted registration of arterial pulse and gave its detailed interpretation. J. Mackenzie gave interpretation of a venous pulse in 1902. In 1933 to Bremzer and the Wound (Ph. Vgoye-mser, O. Ranke), and in 1937 Vetsler and Beger (To. Wezler, A. Boger) used S. for calculation of a stroke output of heart.

The arterial sphygmogram reflects fluctuations of walls of the site of an artery as a result of changes of pressure in a vessel. The form of pulse fluctuations of the arteries registered on different sites of a big circle of blood circulation is various. It is connected with easing on length of an arterial bed of the main wave of pressure created by a systole of heart, and imposing on it the reflected waves arising owing to change of geometry of vessels (branchings, changes of caliber). Allocate the central pulse reflecting fluctuations of pressure in an aorta (SFG of carotid and subclavial arteries) and a peripheric pulse (SFG femoral, humeral, beam and other arteries).

Fig. 1. The sphygmogram of a carotid artery is normal: and — an atrial wave; in — with — an anacrotism; with — f — a catacrotism; d — a late systolic wave; e — f — g — an intsizura; g — a dicrotic wave; i \preanacrotic tooth; be — the period of exile; ef — a protodiastolic interval.

On SFG of a carotid artery (fig. 1) after low-amplitude waves and (reflects an auricular systole) and a tooth of i (arises in connection with the isometric tension of heart) the steep slope of the main wave of b — with — the anacrotism caused by opening of the aortal valve and transition of blood from a left ventricle in an aorta is observed. This rise is replaced in a point with the descending part of the main wave — the catacrotism forming as a result of dominance during this period in a vessel of outflow of blood over inflow. At the beginning of a catacrotism the late systolic wave of d is defined, for a cut the intsizura of efg follows. During ef (a protodiastolic interval) there is a zakhlopyvaniye of the aortal valve that is followed by the build-up of pressure in an aorta creating a dicrotic wave of g. The time slice presented by a piece e corresponds to the period of exile of blood from a left ventricle.

SFG of peripheral arteries differ from curves of a central pulse in more roundish outlines, lack of waves and and i, sometimes and the intsizura which was more expressed by a dicrotic wave is frequent emergence of the second diastolic wave. The interval between tops of the main and dicrotic waves of femoral pulse corresponds, according to Vetsler and Beger (1939), time of the main fluctuation of arterial pulse and is used for calculation of systolic volume of heart (see Blood circulation).

The analysis of SFG of arteries includes assessment of a form of curves, amplitudes and temporary ratios of separate components. At assessment of a form of curves attach significance to the steepness of increase of an anacrotism, the nature of its transition to a catacrotism, existence and an arrangement of additional teeth, expressiveness of a dicrotic wave. The form of curves of a central pulse considerably depends on peripheric resistance. At the low peripheric resistance of SFG of the central arteries have abruptly rising anacrotism, acute tops and deep intsizura; at the high peripheric resistance of change are opposite.

Absolute values of amplitudes of the SFG separate components usually are not estimated since the method C. has no calibration. For the diagnostic purposes correlate amplitudes of the SFG components to amplitude of the main wave. Similarly instead of assessment of absolute values of time frames of SFG use their ratio as a percentage with lasting a systolic wave; it allows to carry out the time analysis of SFG irrespective of heart rate.

There is other form of perception by sensors of a peripheric pulse which is the cornerstone of a volume sfigmografiya — a method of registration of pulse fluctuations of a krovenapolneniye of vessels of a certain segment of an extremity; as receivers of pulse in this case serve the rubber cuff or the strain gage imposed on perimeter on the explored site of an extremity (a shin, a hip, a finger etc.). The form of volume SFG is close to a form of the curves of a peripheric pulse received from the same sites. Volume S.'s dignity is reliability and convenience of fixing of the receiver of pulse.

Fig. 2. Sphygmograms at different forms of pathology: and — the sphygmogram of a carotid artery at a stenosis of the mouth of an aorta (the curve has an appearance of a cock crest); — the sphygmogram of a carotid artery at aortic incompetence (amplitude of a curve is increased, the intsizura is absent); in — the sphygmogram of a femoral artery at aortic incompetence (emergence of high-frequency fluctuations on an anacrotism); — the sphygmogram of a femoral artery at coarctation of an aorta (the curve has triangular shape — so-called triangular pulse); d — the volume sphygmogram of foot at an obliterating endarteritis (the curve has the dome-shaped form, the dicrotic wave is absent — so-called collateral pulse).

At a stenosis of the mouth of an aorta on an anacrotism of the central SFG there are jags (anacrotic pulse), the rise time of an anacrotism is extended, sometimes curves take a form of a cock crest (fig. 2, a). At a hypertrophic subaortal stenosis (see. Cardiomyopathy ) the rise time of an anacrotism is shortened, the ratio of a dlitelnosty anacrotism and exile decreases. Insufficiency of valves of an aorta is shown by sharp increase of amplitude of all waves, smoothing or disappearance of an intsizura on SFG of the central arteries (fig. 2, b), emergence of high-frequency oscillations on an anacrotism of femoral pulse (fig. 2, c) and on all volume SFG of the lower extremities. At coarctation of an aorta amplitude of the central SFG and volume SFG of upper extremities is increased, duration of an anacrotism of SFG of a carotid artery is shortened, the top of pulse wave is split; SFG of a femoral artery and volume SFG of the lower extremities are represented by low-amplitude dome-shaped waves, the deprived dimoles (triangular pulse, fig. 2, d).

Obliterirukyatsy and occlusal damages of peripheral arteries are shown on the volume SFG registered below the place of occlusion, decrease in amplitude of pulse waves (in hard cases the straight line is registered) and absence dimoles (monocrotic pulse). At defeat of a vessel of one extremity or an uneven obliteration of arteries in cases of their systemic lesion the difference of amplitudes and a form of curves of pulse on symmetric arteries takes place. Dominance of collateral blood supply is shown on volume SFG of extremities by flat dome-shaped waves of low amplitude without signs of a dicrotism (collateral pulse, fig. 2, e). At an aortic arch syndrome amplitude of pulse waves of peripheral arteries is reduced, their form is changed, SFG of a carotid artery keeps usually normal amplitude and a form.

Synchronously written down SFG of the central and peripheric pulse use for definition of rate of propagation of pulse wave on arteries; it is calculated as private from division of length of a way of a run of a wave into duration of an interval between the beginnings of anacrotisms of pulse of the studied arteries. Rate of propagation of pulse wave in an aorta (a vessel of elastic type) is calculated on SFG of sleepy and femoral arteries, in peripheral arteries (vessels of muscular type) — on the volume SFG registered on a shoulder and the lower third of a forearm or on a hip and the lower third of a shin. The relation of rate of propagation of pulse wave on vessels of muscular type to rate of propagation of pulse wave on vessels of elastic type at healthy people is in limits 1,1 — 1,3. Rate of propagation of pulse wave depends on the module of elasticity of an arterial wall; it increases at increase in tension of arterial walls or their consolidation and changes with age (from 4 m/s at children to 10 m/s and more at persons 65 years are more senior).

Fig. 3. Flebosfigmogramma is normal of a jugular vein: and — an atrial wave; b — the tooth reflecting the isometric tension of ventricles; with — a transfer wave of pulse of a carotid artery; d, d' — diastolic waves; x — a systolic collapse; at — a diastolic collapse.

Flebosfigmografiya, or wine pulsografiya. Because of small elasticity of walls of veins big fluctuations of volume of blood in them are followed by very small changes of pressure therefore the venous pulse unlike arterial is more caused by fluctuations of a krovenapolneniye of a vessel, than pressure in it. Flebosfigmogramma write down usually from jugular or femoral veins. Basic elements of SFG of a jugular vein are normal presented by positive waves and, with, to d and negative — H-, y-collapses (fig. 3). The wave and reflects a systole of the right auricle, the wave with is caused by impact on a jugular vein of a pulsation of a carotid artery. Before a wave e the tooth 6 matching on time the isometric tension of ventricles of heart sometimes comes to light. Formation - a collapse on a piece and ~ Kommersant is caused by an auricular diastole, on a piece x — bystry emptying of venas cava in the right auricle as a result of procrastination of an atrioventricular partition during a systole of a right ventricle, and also decrease in intrathoracic pressure owing to exile of blood in a ventral aorta down. The following positive wave of d is caused by filling of venas cava and the right auricle with blood at the closed tricuspid valve. After valve crack blood from the right auricle directs in a right ventricle that promotes emptying of venas cava — there comes the diastolic iZ-collapse. In process of filling of a right ventricle with blood the speed of emptying of an auricle decreases, pressure in it increases and the krovenapolneniye of veins approximately from the middle of a diastole of a ventricle increases again that is reflected emergence in a flebosfigmogramma of the second diastolic wave of d' (a congestive wave).

V. V. Larin and E. K. Lukyanov (1971) studying formation of a number of elements of a curve of a venous pulse believe that the piece and-b forms owing to stretching of the right auricle after its systole an elastic energy of lungs; the piece b-with is a consequence of passive inflow of blood from peripheral veins to the pericardiac venous pool and the right auricle at the closed tricuspid valve; the piece of d-y is formed due to bystry filling of a right ventricle at stretching by its falling diaphragm lifted in a sphygmic phase. It is offered to calculate on a flebosfigmogramma structure of a venous inflow to heart, changes a cut are characteristic of certain types of circulatory disturbances.

At difficulty of outflow of blood from the right auricle in a right ventricle (a stenosis of the right atrioventricular opening), from a right ventricle in a pulmonary artery (a stenosis of a pulmonary artery, pulmonary hypertensia) or at substantial increase of pressure in the left auricle amplitude of a wave and increases. At defect of an interatrial partition the wave and doubles, at a ciliary arrhythmia is absent. Increase in residual volume of blood in a right ventricle and development of venous stagnation are followed by deformation of a piece ah and reduction of depth of a ^-collapse;;;;;;;;;; absence of a ^-collapse and increase in a wave of d (with merge of waves with and d in one) designate as a positive venous pulse; it is observed at serious congestive conditions. At aortal insufficiency, arterial hypertension, an open botallovy channel, a stenosis of an isthmus of an aorta, insufficiency of the tricuspid valve amplitude of a wave with is increased, at small systolic emission of a left ventricle (insufficiency of a left ventricle, a stenosis of a mitral orifice) — is lowered. The stenosis of the right atrioventricular opening is followed by slow development of a ^-collapse and its Small depth. Amplitude of waves of dud' depends on a cardiac rhythm; at tachycardia the wave of d is reduced, the wave of d' is absent.

Sphygmographs — devices for registration of pulse fluctuations. In the first sphygmographs perception by sensors of pulse was carried out mechanically, by means of the pilot fastening on a body surface, or pneumatically, by means of a funnel, an elastic cylinder or a membrane imposed on the pulsing area; movements of the pilot or change of pressure in a pneumatic system were transmitted through levers to a feather, a cut reproduced them on paper. Expense of a part of energy of the pulsing body part for movement of a feather was a characteristic sign of this kind of sphygmographs that brought distortions in the registered process. Sovr. sfigmografiche-sky devices are deprived of this shortcoming since use external energy sources. Usually they represent sensors or prefixes to multichannel electrocardiographs and contain the receiver of a pulse signal, primary measuring converter, details of fastening of the receiver on a body inspected, auxiliary elements for forcing and deflation, indication of force of pressing of the receiver of pulse to a body, food, etc.

The receiver of pulse serves for transfer of a pulse signal from an organism on the device. Depending on the device of the receiver its mechanical interaction with an organism can be power, bessilovy or have intermediate character. At power interaction the pulsing vessel through surface fabrics creates contact pressure on the pilot of the sensor strengthened on an elastic element of big rigidity thanks to what its movement is insignificant a little. Such nature of interaction is used for registration of the arterial pulse which is followed by considerable fluctuations of pressure in a vessel. At bessilovy interaction the pulsation of a vessel is made freely, and the receiving device perceives movement of a vascular wall or adjacent structures beskontaktno, without counteraction from the outside; signal transmission is made in the electric or optical way. Almost bessilovy perception of pulse is carried out also during the use of the contact pilot on very soft suspension bracket. Bessilova renting of a pulse signal is applied when pressure in a vessel is not enough (in veins) or when the contact with a body is inadmissible (e.g., at an injury). Transfer of pulse fluctuations at intermediate interaction is carried out by means of the pilot of average rigidity, e.g. pneumoreceivers — air funnels, cuffs, cylinders; they are used for perception of arterial and fabric (volume) pulse.

The signal created in the receiving device is measured by primary converter as fluctuation of force or pressure (power interaction) or as movement (bessilovy interaction). The greatest distribution was gained by the piezoelectric and electro-capacity transducers which appeared the most convenient.

Registration of pulse fluctuations is carried out on a tape of the electrocardiograph usually synchronously with other cardiodynamic processes (an ECG, FKG, etc.).

The USSR produces the venopulsografichesky contactless Pulse — 10 prefix, a sfigmogra-fichesky prefix (model 064), the measuring converter for a sfigmoarteriografiya of the DOG in lots — 02.

The Pulse — 10 device intends for registration in the contactless way of venous (jugular) pulse. Operation of the device is based on the principle of continuous measurement of the electric capacity formed by the studied body part and the perceiving electrode remote from this site at distance of 3 — 5 mm. Notifiable process — movement of the pulsing surface of rather not movably strengthened perceiving electrode — creates change of functional capacity and subjects carries out input of a signal in the measuring scheme. The device is also used for registration of arterial pulse for what the area of renting of pulse fluctuations is limited to the ring shutter pressed to a body surface that interferes with penetration into this zone of a pulsation of adjacent veins. A functional part of the device is placed in two sensors strengthened on a special support where an operating controls, the power supply and sockets for connection of cables is located.

The Sfigmografichesky prefix (model 064) allows to register the pulse movements in various areas of a body. Perception of a signal is carried out by the pneumatic receivers connected by the rubber pipeline to the elekt-royemkostny manometrical converter. An exit of the converter is counted on connection to the electrocardiograph. For filling of receivers of balloon type with air the manometrical sensor is executed by differential; air-vessels on both sides of a sensitive element (membrane) are reported via the crane, at open situation to-rogo in a pneumatic system pressure is created (or it is taken off), at closed — pulse recording is carried out.

The DOG converter — 02 is intended for perception of arterial pulse. Its pneumatic receiving device represents the camera, on the one hand limited by the rubber membrane supplied with the pilot with another — a piesoceramic disk. The pilot imposed on a body surface accepts pulsations, to-rye in the form of fluctuations of pressure in the camera of the sensor influence a piezoelement, causing emergence on its plates of the EMF proportional to an entrance signal. For approval of output parameters of the piesoceramic converter of input parameters of registrar (electrocardiograph) the device is supplied with the analog converter (the coordinating amplifier) placed in a rupture of an output cable.

Pulse can be perceived not only as mechanical process (in the form of force or movement), but also in the form of other physical quantities: fluctuations of electric resistance of a body owing to pulse changes of a krovenapolneniye (see. Reografiya ), the optical density of body tissues (see. Pletizmografiya ), temperatures of fabrics, etc.

Bibliography: V. A marks. New technique of the analysis of a sfigmografichesky curve, Saturday. nauch. works of Nauch. - issled. in-that medical klimatol. and klimatoter., page 261, Yalta, 1958; Kayevitser I. M. Differential curves of carotid and yugulyarny pulse at healthy people and at some heart diseases, Cardiology, t. 8, No. 5, page 81, 1968; Karpman V. L. Sfigmografiya, in book: Sovr. methods issled. functions serd. - a vessel, a sist., under the editorship of E. B. Babsky and V. V. Parin, page 165, M., 1963; Paleev H. River and Kayevitser I. M. The first and second derivatives of curves of a central pulse at anemic methods of a research of force and speed of cordial reductions, Cardiology, t. 16, No. 6, page 105, 1976; Press m and L. P N. Clinical sfigmografiya, M., 1974, bibliogr.; Terekhova L. G. Practical questions of a sfigmografiya, L., 1968, bibliogr.; Bloch A., W about-surch of S. et DuchosalP. W. Le diagnostic des stenoses aortiques par le mesure du temps de of demi-mont£e sur le sphygmogramme carotidien, Ann. Cardiol. Angeiol., t. 22, p. 295, 1973; Carter W. H. a. o. Carotid pulse tracings in hypertrophic subaortic stenosis, Amer. Heart J., v. 82, p. 180, 1971; Davison R. Cannon R. Estimation of central venous pressure by examination of jugular veins, ibid., v. 87, p. 279, 1974; W a r e m-b o u r g H. e. a. La of deriv£e premiere du of pi£zogramme carotidien normal, Arch. Mai. Coeur, t. 62, p. 511, 1969.

V. P. Zhmurkin; E. K. Lukyanov, V. S. Salmanovich (tekhn.).