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The dicrotic notch analyzed by a numerical model.

María Teresa Politi1, Arthur Ghigo2, Juan Manuel Fernández1

  • 1Laboratorio de Biomembranas. Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO Houssay). Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121ABG Buenos Aires, Argentina.

Computers in Biology and Medicine
|March 27, 2016
PubMed
Summary

Reflected pressure waves, not just aortic valve closure, may cause the dicrotic notch. Clinical data and simulations show changes in peripheral vascular resistance alter the dicrotic notch, offering new insights for medical physiology education.

Keywords:
Dicrotic notchMedical physiologyNumerical modelReflection wave

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Area of Science:

  • Cardiovascular Physiology
  • Biomedical Engineering
  • Medical Education

Background:

  • The origin of the dicrotic notch in arterial pressure waveforms is commonly attributed solely to aortic valve closure in medical literature.
  • This traditional explanation is widely taught in medical physiology courses, potentially overlooking other contributing factors.

Purpose of the Study:

  • To investigate the role of reflected pressure waves in the formation of the dicrotic notch.
  • To challenge the conventional understanding of the dicrotic notch's origin.
  • To provide a more comprehensive explanation for medical physiology education.

Main Methods:

  • Continuous arterial pressure measurements were obtained from adult patients during vascular surgery.
  • Phenylephrine was administered intravenously to induce isolated changes in peripheral vascular resistance.
  • Numerical simulations using integrated axisymmetric Navier-Stokes equations were performed to model hemodynamic flow.

Main Results:

  • Administration of phenylephrine, altering peripheral vascular resistance, resulted in modifications to the dicrotic notch.
  • Numerical models demonstrated that changes in peripheral artery resistance influence the amplitude of the dicrotic notch by altering reflected pressure waves.
  • The findings suggest a significant contribution of reflected pressure waves to the dicrotic notch phenomenon.

Conclusions:

  • Reflected pressure waves are a contributing factor to the dicrotic notch, alongside aortic valve closure.
  • Modifications in peripheral vascular resistance can alter the dicrotic notch through their effect on reflected waves.
  • This study offers a valuable tool for enhancing the teaching of cardiovascular physiology.