Screen results explained

pulse-curve-v2.jpg

On the pulse curve:

The aortic valve opens at T0 and closes at T4. An average pulse in a healthy person starts at T0 will and rapidly rise to a peak called T1, the Systolic pressure. In a healthy person, the pressure falls rapidly from the Systolic pressure with a small bump at T3. This bump is the effect of the reflected [pressure] wave adding to the pressure from the heart. At T4 the heart valve closes and the pressure drops down to the lowest pressure called the diastolic pressure before the process is repeated with the next pulse from the heart. The reflected pressure wave can arrive sooner and louder in people with stiffer arteries and then T3 will move left and up and can result in the pressure at T3 exceeding T1 and then this becomes the Systolic pressure. The heart is working against this pressure and must pump harder to overcome the increased vascular resistance of the stiff arteries. 

When the arteries become stiff, the larger reflected waves arrive earlier in the pulse and increase the pressure the heart has to overcome. It means that the heart has to pump harder and also longer with less resting time at each pulse. This causes the heart muscle to increase in size, it gets worn out and eventually gives up.

Looking after your heart is important.

The example pulse curve (red line) illustrates the ideal pressure curve the heart should follow.

How is this curve affected?

When blood is pumped, a wave moves away from the heart. Where arteries split in two, a wave is formed moving back at the heart (much like the ripple when you throw a pebble in a pond). When arteries are healthy and flexible, the wave disappears, and the heart is not affected, in fact the heart experiences a positive flow of oxygen rich blood into the heart muscle. 

When the arteries become stiff, theses waves have to go back at the heart. Now the heart has to overcome this back-pressure. It means that the heart has to pump harder and also longer with less resting time at each pulse. This causes the heart muscle to increase in size, it gets worn out and eventually gives up. We want the heart muscle to have as easy a time as possible. 

Pulse rate

It is the rate at which your heart pumps. A slower rate indicates a level of fitness or the effect of medication. Normal rates are between 60 and 80 beats per minute. Below is everything you need to know about your upper arm blood pressures numbers as per NICE guidelines.

How is central blood pressure different from conventional blood pressure?

Conventional BP is measured in the upper arm, which is a ‘peripheral’ artery. Peripheral BP is usually higher than central BP as it includes the increased pressure associated with more and smaller arteries in the arm.

central-blood-pressure.jpg

What is central blood pressure

Central BP is the pressure at the heart and differs from the pressure in your arm or wrist. The pressure at your heart is important as it is the pressure that your brain, kidneys and other vital organs and arteries experience. A safe central systolic pressure is less than 130, however less than 110 is ideal.

Why is central BP important?

Central BP helps us to accurately monitor the effects of medication or lifestyle changes. Central BP has been shown to more strongly relate to vascular disease and outcome than traditional upper arm blood pressure. It also can distinguish between the effects of different hypertension medications when upper arm blood pressure and pulse wave velocity do not. Non-invasive measurement of central BP using a cuff significantly increases the available information to make better informed clinical decisions that are specific to each person. 

What is arterial stiffness (AI)?

Augmentation index (AI) is an indicator of arterial status. Smooth muscle in the artery responds to regulate the flow of blood in the artery. Arterial elasticity is an important requirement for normal arterial function and blood volume control.

The muscles in a normal artery is compliant and changes diameter freely, however if the artery narrows then the BP rises. This contributes to hypertension and requires specific medication for successful treatment.

Why is arterial stiffness important?

Arterial stiffness in the large arteries has been shown to predict the likelihood of future cardiovascular events, such as heart attacks, heart failure and strokes, which may lead to death. Additionally, arterial stiffness has been shown to be a better predictor of these complications than other commonly measured parameters such as conventional upper arm BP.

How is arterial stiffness related to BP?

When the large arteries become stiff (and narrow), resistance and BP increases and so does cardiovascular risk. Conversely, when arteries are compliant and elastic, the heart does not need to work so hard to deliver blood to the rest of the body.

What can be done about high arterial stiffness?

  • Exercise helps to prevent arteries from becoming stiff and can reduce levels of stiffness.

  • Some (but not all) hypertension drugs reduce arterial stiffness by relaxing the muscles in the artery wall.

  • New drugs are being developed to target the arterial stiffness.

  • Your doctor can advise about the best treatment and management for vascular health.

What is the Rhythm strip?

It is a 10 second snap shot of the pump action of your heart. It is highly sensitive technology that tells us if there are any irregularities in your pulse rhythm. The Pulse Rate Variability confirms irregularities. If any irregularities are noticed, you may be referred to your doctor for further investigation to rule out Atrial Fibrillation.

Rhythm-strip.jpg

Looking after your heart is important.

Understanding the health of your arteries and heart can help you to make choices to keep your heart healthy. Ask your health team for advice and how they can help you monitor achievements. 10mmHg reduction in systolic pressure reduces the chance of a cardiovascular event by 20%

Common forms of heart disease are:

  • Coronary heart disease where the flow of blood to the heart becomes restricted causing heart attacks and angina

  • Peripheral vascular disease which causes a narrowing of the arteries in the legs

  • A stroke which is caused by a lack of oxygen reaching the brain due to either a burst or blocked artery

By checking heart health and cholesterol, risks are identified early and preventative actions can be taken.

You are at risk if:

  • you’re  over 40 years old

  • you’re of South Asian or African-Caribbean descent

  • you have any immediate family members under the age of 55 if male and 65 if female who have or had heart disease or high blood pressure

  • you have high blood pressure or a family history of high cholesterol levels

  • you are a smoker, are overweight or lead an inactive life

  • you have more than 2-3 units of alcohol a day

  • you have a high salt diet or little fruit and vegetables a day

  • you are overweight and don’t do much exercise

What causes heart disease?

Heart disease, also known as cardiovascular disease, covers a range of conditions affecting the heart and arteries. Healthy arteries are supple and make your heart happy. They are less likely to have cholesterol build-up as they are also smoother on the inside. Stiffer and narrowed arteries make your heart work harder, allowing less time for oxygen rich blood to reach the heart muscle. Your heart gets worn out and heart disease follows. Age, smoking, lack of exercise, weight, stress, diabetes, cholesterol or your genes are some of the factors affecting arterial health.