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Introduction: Detection of a pulse is crucial to decision-making in the care of patients who are in cardiac arrest, however, the current standard of manual pulse palpation is unreliable. An emerging alternative is the use of point-of-care ultrasound (POCUS) for direct assessment of the carotid pulse. The primary objective of this study is to determine the interobserver reliability for physician interpretation of pre-recorded point-of-care ultrasound pulse-check clips for patients who are in cardiac arrest. Methods: We conducted a web-based survey of residents and physicians working in an academic center. Participants were shown a tutorial demonstrating POCUS detection of the carotid pulse and then asked to interpret 15 carotid pulse ultrasound clips from patients who were in cardiac arrest. The primary outcome was interobserver reliability for carotid pulse assessment. Secondary outcomes included interobserver reliability stratified by physician role and POCUS experience, median tutorial and median pulse assessment duration. Interobserver reliability was determined by Krippendorff's ⍺. Results: 68 participants completed the study, with a response rate of 75%. There was high interobserver reliability for pulse assessment amongst all study participants (⍺ = 0.874, 95% CI 0.869 to 0.879). All sub-groups had ⍺ greater than 0.8. Median tutorial duration was 35 s (IQR 29). Median pulse assessment duration was 6 s (IQR 5) with 76% of assessments completed within 10 s. Conclusion: Interpretation of the carotid pulse by POCUS showed high interobserver reliability. Further work must be done to determine the performance of POCUS pulse assessment in real-time for patients who are in cardiac arrest.

The need to understand and control intracranial pressure (ICP) is required for treatments in various clinical situations. The ICP value can only be measured by direct intracranial catheter or sensor placement, and a non-invasive ICP prediction method has not yet been established. We focused on the natural resonance frequency (NRF) of the brain to predict the ICP value. The ICP value, pulse waveform of intracranial pressure (PWICP) and cervical carotid pressure waveform (CCPW) were simultaneously collected from patients who had undergone ventricular drainage or ICP sensor placement for medical treatment in our institute. A total of 43 data were obtained from 27 patients, age ranged 14-48 (mean: 54) years, body height 137-187 (mean 163) cm and body weight 32-103 (mean 61) kg. The total measured time was 29,653 seconds and the measured mean ICP value in each data ranged from 3.82 to 69.39 (mean 25.9) hPa. Consecutive data was cut into 10.24 seconds, which was called a "column". To decrease respiratory modulation, the largest positive peak of cardiac pulsation of CCPW was picked up in each column, as well as one ICP pulse waveform. The picked-up CCPW and PWICP were averaged by the weighted average method. The transfer characteristics from CCPW to PWICP were calculated by the transfer function method. The first initial negative peak of transfer characteristics was judged as the NRF of the brain. The relationship between the ICP value and the NRF of the brain was presented on the quadratic functions graph (ICP = 0.0329(NRF)2 + 0.0842NRF). These parameters were strongly correlated to each other (R2= 0.9952 coefficient of determination). The individual NRF, which was calculated by the transfer function method, only depends on the measured ICP value and their relationship can be presented in the simple quadratic functions. Funding: This research was funded by Japan Science and Technology Agency (JST) A-STEP feasibility study in 2012, and by Japan's New Energy and Industrial Technology Development Organization (NEDO) in 2013, and by Grants-in-Aid for scientific research in Ministry of Education, Culture, Sports, Science and Technology-Japan from 2015 to 2017 and 2018 to 2020. Receiver: Kenji Furihata. Declaration of Interest: Although the authors (T.G., K.F. and K.H.) have some patents of non-invasive intracranial pressure monitoring apparatus, the claim of the patents belong to affiliated university not to individuals. All of authors had already opened their COI disclosure in Japanese Neurosurgical Society. The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described. Our proposing theory is a quite new concept. We strongly believe that there is nothing to competing interest declaration. Ethical Approval: The simultaneous measurement of intracranial pressure and cervical carotid artery pressure waveform was approved by Ethical Committee of Shinshu University School of Medicine. “Development of non-invasive intracranial pressure monitoring” approved number 2343.

Purpose: To evaluate the early changes in carotid artery elasticity in patients with non-alcoholic fatty liver disease (NAFLD) by measuring carotid ultrafast pulse wave velocity (UFPWV). Methods: Data of 89 patients with NAFLD (observation group) and 155 healthy people (control group) were collected. The clinical and laboratory indices, carotid intima-media thickness (IMT), and PWV at the beginning of systole (PWV-BS), and the end of systole (PWV-ES) were compared and statistically analyzed. Results: Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) levels, IMT, PWV-BS, and PWV-ES in the NAFLD group were higher than those in the control group (P < 0.05), while the high-density lipoprotein cholesterol (HDL-C) level was lower than that in the control group (P < 0.05). Moreover, IMT, PWV-BS, and PWV-ES values increased with the increasing severity of NAFLD (P < 0.05). Pearson correlation analysis demonstrated that PWV-BS and PWV-ES were positively correlated with age, BMI, fasting plasma glucose (FPG), SBP, DBP, TC, TG, and LDL-C (P < 0.05), and negatively correlated with HDL-C (P < 0.05). Stepwise multiple linear regression analysis indicated that the factors influencing PWV-BS included BMI, FPG, TG, HDL-C, and LDL-C (P < 0.05), whereas the factors influencing PWV-ES included BMI, FPG, SBP, TG, HDL-C, and LDL-C (P < 0.05). Conclusion: UFPWV measurement can detect the significant increase in PWV-BS and PWV-ES in patients with NAFLD. This can provide a theoretical basis for early intervention in carotid atherosclerosis.

Background Basic life support (BLS) performed by general population improves outcomes in cardiorespiratory collapse. This community-based study aims to measure the general population's eagerness in learning BLS, knowledge regarding early recognition, and use an automated external defibrillator. Methods This was a cross-sectional community-based study in Jakarta using questionnaire. Numerous questions asked through a questionnaire in order to evaluate the general population's eagerness and knowledge about basic life support. Results There were 303 respondents in this study. Most respondents stated that knowledge about BLS is important and was eager to learn; however, only 39.6% of respondents have ever done BLS training. 59.4% of respondents have ever looked for information or read about BLS. 63.6% of respondents chose to call an ambulance for the first reaction, while 36,5% of respondents preferred to look for a pulse. Most of the respondents know to check the carotid pulse in the neck. 77.4% of respondents know that chest compression was done on mid-chest. 81.5% of respondents agreed that CPR was preferably done repeatedly in a specific rhythm, but giving one despite the method is better than none. Only 49.5% of respondents wanted to give mouth-to-mouth ventilation. Most respondents thought that they are not allowed to use AED, and only a small proportion had seen AED in public. Conclusion Most of the respondents agreed that BLS is important. Respondents have satisfying knowledge about how to react while encountering an unconscious person. Most respondents have not seen AED and most likely didn't know how to use it.

Continuous hemodynamic monitoring is important for long-term cardiovascular healthcare, especially in hypertension. The impedance plethysmography (IPG) based carotid pulse sensing is a non-invasive diagnosis technique for measuring pulse signals and further evaluating the arterial conditions of the patient such as continuous blood pressure (BP) monitoring. To reach the high-resolution IPG-based carotid pulse detection for cardiovascular applications, this study provides an optimized measurement parameter in response to obvious pulsation from the carotid artery. The influence of the frequency of excitation current, electrode cross-sectional area, electrode arrangements, and physiological site of carotid arteries on IPG measurement resolution was thoroughly investigated for optimized parameters. In this study, the IPG system was implemented and installed on the subject’s neck above the carotid artery to evaluate the measurement parameters. The measurement results within 6 subjects obtained the arterial impedance variation of 2137 mΩ using the optimized measurement conditions, including excitation frequency of 50 kHz, a smaller area of 2 cm2, electrode spacing of 4 cm and 1.7 cm for excitation and sensing functions, and location on the left side of the neck. The significance of this study demonstrates an optimized measurement methodology of IPG-based carotid pulse sensing that greatly improves the measurement quality in cardiovascular monitoring.

Flexible sensors are required to be lightweight, compatible with the skin, sufficiently sensitive, and easily integrated to extract various kinds of body vital signs during continuous healthcare monitoring in daily life. For this, a simple and low-cost flexible temperature and force sensor that uses only two carbon fiber beams as the sensing layer is reported in this work. This simple, flexible sensor can not only monitor skin temperature changes in real time but can also extract most pulse waves, including venous waves, from most parts of the human body. A pulse diagnostic glove containing three such flexible sensors was designed to simulate pulse diagnostic methods used in traditional Chinese medicine. Wearable equipment was also designed in which four flexible sensors were fixed onto different body parts (neck, chest, armpit, and fingertip) to simultaneously monitor body temperature, carotid pulse, fingertip artery pulse, and respiratory rate. Four important physiological indicators—body temperature (BT), blood pressure (BP), heart rate (HR), and respiratory rate (RR)—were extracted by the wearable equipment and analyzed to identify exercise, excited, tired, angry, and frightened body states.

OBJECTIVES: To investigate the effects of menaquinone on the progression of arteriosclerosis in maintenance hemodialysis patients, and to provide evidence for the clinical prevention strategy of cardiovascular diseases in maintenance hemodialysis patients. METHODS: In this perspective, randomized, placebo-controlled trial, 107 MHD patients were randomized into Vitamin K2 group (VK2, n = 60) that received vitamin K2(menaquinone) at a dose of 270 μg/d and control group (n = 47). The following measurements were taken at baseline and after 9 months: carotid pulse wave velocity (cPWV) was measured with ultrasound, dephosphorylated-uncarboxylated matrix Gla protein (dp-ucMGP) was tested with enzyme-linked immunosorbent assay. RESULTS: After 9 months follow-up, 40 patients from the VK2 group and 38 patients from the control group were included in the analysis. The cPWV values of MHD patients was positively correlated with age (r = 0.293, P = 0.01) and hypertension complication (r = 0.495, P = 0.00). The baseline cPWV values of VK2 group and the control group did not show a significant difference (7.53 ± 1.47 vs. 7.28 ± 1.18 m/s, P = 0.24). After 9 months of intervention, cPWV values in VK2 group were lower than baseline, but not significant (7.60 ± 1.50 vs. 7.53 ± 1.47 m/s, P = 0.90). The cPWV values of the control group at 6 months were increased when compared with the baseline (7.21 ± 1.18 vs. 7.86 ± 1.14 m/s, P = 0.04) . The increment rate of cPWV(△cPWV) from VK2 group was significantly lower than the control group (1.32 ± 12.53% vs 10.40 ± 16.85%, P = 0.00) 3. Baseline dp-ucMGP level of VK2 group and the control group showed no significant difference (1802.30 ± 552.88 vs. 1698.15 ± 488.06 nmol/L, P = 0.67) . After 9 months, the dp-ucMGP level in VK2 group was significantly decreased (1802.30 ± 552.88 vs 1448.42 ± 456.08 nmol/L, P = 0.01) , and significantly lower than control group (1448.42 ± 456.08 vs 1705.42 ± 424.48 nmol/L, P = 0.03). CONCLUSIONS: Menaquinone supplementation induced a marked reduction of inactive MGP, and may retard the progression of arteriosclerosis in maintenance hemodialysis patients. This trial was registered at the Chinese Clinical Trial Registry as ChiCTR1900028459. FUNDING SOURCES: None.

Obesity is a risk factor for cardiovascular events and is associated with increased arterial stiffness [1,2]. However, the effect of drastic changes in Body Mass Index (BMI) on arterial mechanics has not been fully investigated. Our study aimed at evaluating changes in local carotid PWV (cPWV) in obese patients before and 6 months after bariatric surgery. N = 20 obese subjects free of cardiovascular events and diabetes (44 ± 9 years, 5 men, BMI = 48.8 ± 7.5 kg/m2) undergoing bariatric surgery were recruited in the Pisa University Hospital (Italy). Flow and diameter waveforms were acquired by ultrasound scanner (Aloka Alpha10, Hitachi Group, Japan) (1 kHz) at the right common carotid artery at baseline, after a 32.4 ± 7.6 days diet period, and 6.5 ± 2.7 months post-intervention. The lnDU-loop method was used for the estimation of cPWV [3]. Basal cPWV was 6.05 ± 1.21 m/s. The 1-month diet period produced a 2 kg/m2 reduction in BMI, while cPWV decreased by approx. 0.6 m/s. 6–7 months after bariatric surgery, BMI dropped to 35.3 ± 6.5 kg/m2 and cPWV furtherly decreased of approx. 0.9 m/s reaching a mean value of 4.57 ± 1.02 m/s (76% of the basal value) (Figure 1). Bariatric surgery and the consequent intensive weight loss produced a significant decrease of arterial stiffness and restored cPWV to physiological values of age-matched healthy subjects [4]. The fast reversal of increased arterial stiffness suggests a functional mechanism possibly related to a reduced haemodynamic load. Moreover, while having a small effect on the BMI, 1-month diet regulation effectively decreased cPWV by 10%, possibly indicating the short-term positive effects of a healthy lifestyle on haemodynamics. Figure 1

Background: Local carotid pulse wave velocity (PWV) estimation is challenging due to a complex anatomy and associated wave reflections [1]. Wave interference is both blood pressure (BP) and position dependent, hence causing nonlinearity in the spatiotemporal PWV estimation [2]. In lack of beat-to-beat quality assessment [3], we propose a method to quantify this nonlinearity and thereby introduce a quality indicator (QI) for reliable PWV estimation. Methodology: Carotid artery ultrasound (Vantage64, VerasonicsInc., USA) was acquired from 10 subjects (38 ± 10 years) in six repeated measurements. Simultaneously, ECG (ECG100C, BIOPACInc., USA) and noninvasive BP (NOVA, FinapresMedicalSystems B.V., NL) were recorded. Signals were processed into distension waveforms to extract systolic foot (SF) and dicrotic notch (DN) fiducials [4]. Beat-to-beat PWV estimates at SF (PWVSF) and DN (PWVDN) were obtained via spatiotemporal fitting of respective fiducial timings against transducer element distances. The proposed nonlinearity QI was quantified as standard deviation of the error between full-length PWV estimate and piecewise PWV estimates from the proximal, middle and distal subset of transducer elements. Linear regression was performed between independent pulse pressure (PP, in 2 [mmHg] intervals) and dependent PWV (means of all estimates) to validate QI according to Bramwell-Hill [5]. Results: When qualifying PWV estimates with QI ≤1 [m/s] we observed a significant R2 increase for both PWVSF (0.22 to 0.41, with decreased RMSE from 0.47 to 0.42 [m/s]) and PWVDN (0.21 to 0.53, although with constant RMSE of 0.32 [m/s]) as shown in annexed figure. Conclusion: The proposed beat-to-beat QI accounts for significant variability in the PWV-PP relation, albeit at substantial data reduction. Therefore, the QI may facilitate real-time quality assessment towards reliable local PWV estimation. The unexplained variability remainder requires further investigations for confounding variables.

Background/Aims: Elderly patients with normal systemic arterial blood pressure associated with femoral carotid pulse velocity (cf-PWV) less than 7.6 m/s and without associated comorbidities are considered to have good vascular health. The aim of the current study was to verify the probability that elderly patients with good vascular health have at least one blood pressure measurement above the different thresholds for systolic blood pressure (120, 130 and 140 mmHg) during two years of follow–up. Methods: We selected 72 normotensive patients (< 140/90 mmHg) without comorbidities and divided them into group A, with cf-PWV < 7.6 m/s (n = 27; 65 ± 4 years), and group B, with cf-PWV ≥ 7.6 m/s (n = 45; 66± 8 years). These patients were followed for two years and were observed in 3 outpatient visits (0, 12 and 24 months). At each visit, the brachial pressures were indirectly measured in triplicate, and applanation tonometry was performed. Results: When group A and group B were compared, the odds ratio (OR) of having a systolic pressure measurement ≥ 140 mmHg in two years of follow-up was 0.22 (P < 0.0001); ≥ 130 mmHg, the OR was 0.49 (P < 0.0007), and ≥ 120 mmHg, the OR was 0.54 (P < 0.001). Group A and group B showed increased values of cf-PWV during the two years of follow-up (P < 0.05). Changes in the average systolic brachial pressure were not significant during the two years in groups A or B. Conclusion: Vascular health in elderly individuals seems to protect against occasional elevations in systemic arterial pressure.

BACKGROUD AND PURPOSE Wall-to-lumen ratio of retinal arterioles (W/L ratio) might serve as an in-vivo parameter of microvascular damage. No study has investigated the relationship between carotid stiffness and W/L ratio of retinal arteries. Therefore, the aim of the current study was to assess the correlation between local carotid stiffness, as assessed by echotracking technique, and W/L ratio of retinal arterioles, as assessed by noninvasive flowmetry in normotensive patients and in patients with primary hypertension. METHODS Two hundred and twenty-seven patients underwent renal arteries W/L ratio and local carotid-pulse wave velocity (carotid PWV) measurement. One hundred and fifteen patients had a diagnosis of primary hypertension, whereas 112 were normotensive patients. RESULTS W/L ratio and carotid PWV were both related with clinic SBP (r = 0.17, P

Introduction: Detection of a pulse is crucial to decision-making in the care of patients who are in cardiac arrest, however, the current standard of manual pulse palpation is unreliable. An emerging alternative is the use of point-of-care ultrasound (POCUS) for direct assessment of the carotid pulse. The primary objective of this study is to determine the inter-observer reliability for healthcare provider interpretation of the carotid pulse by POCUS in patients who are peri-arrest or in cardiac arrest. Methods: We conducted a web-based survey of healthcare providers. Participants were shown a tutorial demonstrating POCUS detection of the carotid pulse and then asked to interpret 15 carotid pulse ultrasound clips from patients who were peri-arrest or in cardiac arrest. The primary outcome was inter-observer reliability for carotid pulse assessment. Secondary outcomes included inter-observer reliability stratified by healthcare provider role and POCUS experience, mean tutorial duration, mean pulse assessment duration, rate of pulse assessments < 10 seconds, and change in participant confidence before and after the study. Inter-observer reliability was determined by Krippendorff's α. Change in participant confidence was determined by Wilcoxon signed-rank test. Results: 68 participants completed our study, with a response rate of 75% (68/91). There was near perfect inter-observer reliability for pulse assessment amongst all study participants (α=0.874, 95% CI 0.869, 0.879). Senior residents (n = 24) and POCUS experts (n = 6) demonstrated the highest rates of inter-observer reliability, α=0.902 (95% CI 0.888, 0.914) and α=0.925 (95% CI 0.869, 0.972), respectively. All sub-groups had α greater than 0.8. Mean tutorial duration was 31 seconds (SD = 17.5) with maximum duration of 55 seconds. Mean pulse assessment duration was 7.7 seconds (SD = 5.2) with 76% of assessments completed within 10 seconds. Participant confidence before and after the study significantly increased from a median of 2 to a median of 4 on a 5-point Likert-type scale (z = 6.3, p Conclusion: Interpretation of the carotid pulse by POCUS showed near perfect inter-observer reliability for patients who were peri-arrest or in cardiac arrest. Participants required minimal training and indicated improved POCUS pulse assessment confidence after the study. Further work must be done to determine the impact of POCUS pulse assessment on the resuscitation of patients in cardiac arrest.

Checking responsiveness is the mainstay in cardiopulmonary resuscitation (CPR). It is rare in the clinical situation when the patient requires resuscitation despite the presence of wakefulness. We report a case in which the patient presented with flat arterial line and absence carotid pulse while he was awake. A thorough literature review will also be discussed. How to cite this article Asghar A, Salim B, Tahir S, Islam F, Khan MF. Awareness during Cardiopulmonary Resuscitation. Indian J Crit Care Med 2020;24(2):136–137.

A recent guideline on hypertension of the European Society of Cardiology recommends assessment of hypertensive organ damage. One of these aspects is the measurement of pulse wave velocity as an index of arterial stiffness and underlying atherosclerosis. Pulse wave velocity measurement provides valuable predictive information added to standard risk factors such as blood pressure, lipids, and blood glucose in cardiovascular risk assessment. The recently introduced ultrasound echo-tracking technique is considered a modern aspect in measuring local arterial siffness in clinical practice. The carotid artery is of particular interest because of its easy accessibility and the data obtained from numerous studies on the predictive value of the carotid pulse wave velocity for cardiovascular events.

Background: The clinical significance of pressure-dependent intra-beat changes in local pulse-wave velocity (C) has recently come to light [1]. While reported methods require arterial pressure and diameter measurements from a single site to assess intra-beat changes in C, we present an image-free fast ultrasound device that performs this by capturing diameter waveforms from two proximal locations on an artery.. Methods: The functionality was assessed on eight normotensive participants (26 ± 4 years). By perturbing blood pressure through a short duration moderate lower body negative pressure intervention [2], CD and CF pulse wave velocities corresponding to diastolic and 80% of peak pressure were measured from the carotid artery. Human NIBP system (ADInstruments, India) was used for monitoring continuous pressure. Results: The device captured dual-diameter waveforms and evaluated CD and CF, with a beat-to-beat variation 0.6, p < 0.001) of CD and CF with the diastolic and systolic pressures for each individual was preserved even after adjusting for heart-rate. Conclusions: The device demonstrated its functionality and reliably measured the incremental nature of C. Its pressure-dependent intra-beat variations and inter-beat dynamics during the intervention concurred with literature. Further studies are underway to demonstrate the potential use of the device in vascular research and clinical applications.

Pulse detection during out-of-hospital cardiac arrest is necessary to identify cardiac arrest and detect return of spontaneous circulation. Currently, carotid pulse checking and checking for signs of life are the most widespread procedures for pulse detection, but both have been proven inaccurate and time consuming. Automatic methods that could be integrated in Automated External Defibrillators (AEDs) are needed. In this study we propose a deep neural network classifier to detect pulse using exclusively the ECG. We extracted 3914 segments of 4s from 279 patients, all of them with an organized rhythm. They were annotated as pulsed rhythm or pulseless rhythm based on clinical information. A total of 2372 pulsed rhythms and 1542 pulseless rhythms were included in the study. To train and test the model 3038 (223 patients) and 876 segments (56 patients) were used, respectively. The model was evaluated in terms of Sensitivity (Se) and Specificity (Sp) for pulse detection. The network showed a Se/Sp of 89.4%/97.2% during training process and 91.7%/92.5% for the test set.

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease associated with accelerated atherosclerosis and increased cardiovascular morbidity and mortality. Objectives: To assess the local arterial stiffness in carotid artery in subjects with AS compared with controls evaluated by carotid artery pulse wave velocity (carPWV). Methods: Ultrasound examinations were conducted with a Mylab One color Doppler ultrasound diagnostic system (Esaote, Firenze, Italy), the right common carotid artery (RCCA) was scanned, using a 5-12 MHz vascular probe with built-in quality arterial stiffness (QAS) which calculate carPWV. Results: Forty-seven male subjects (20 with Ankylosing Spondylitis and 27 controls) aged between 20 and 75 (mean age 41.17 ± 11) were evaluated. AS patients have not Hypertension, history of cardiovascular risk factors or smoking). Higher carPWV was observed in patients with AS (6.27 ± 0.72 vs 5.56 ± 1.02 m/s; p = 0.0123) compared with controls, respectively. Conclusions: AS subjects showed higher carPWV compared with controls, this novel assessment for local arterial stiffness could be useful in the future to calculate cardiovascular risk, more studies should be developed with this method in this pathology in our population.

Pulse wave analysis (PWA) over the carotid artery is one of the available methodological options to obtain central arterial pressures and other important hemodynamic parameters. However, limited data exist relating the PWA estimates of one carotid artery over the contralateral one as the majority of the available data rely on measures over the right carotid artery.To evaluate the agreement of the PWA estimates between the right carotid artery and the left carotid artery.A cross-sectional study of 38 patients, with a mean age of 28.85±1.70 years, was carried out. Brachial blood pressure was evaluated using a sphygmomanometer. Subsequently, PWA was obtained randomly over the left or the right carotid arteries with the Complior Analyse. All the evaluations were performed by the same experienced operator.The overall mean differences observed by comparing the obtained parameters in each carotid territory were -1.50±8.06 mmHg for central systolic blood pressure (SBP), -1.63±7.98 mmHg for central pulse pressure, -3.37±27.80% for the augmentation index, and 1.50±8.06 mmHg for the SBP amplification, and were not statistically significant for all the parameters. The Bland-Altman analysis showed distinct correlations and concordance levels for different parameters: central SBP and central pulse pressure showed a very strong agreement (intraclass correlation of 0.926 and 0.886, respectively). In contrast, the concordance for the augmentation index and the SBP amplification was moderate (intraclass correlations between 0.5 and 0.8).PWA provides similar measures of central blood pressure, whether measured over the right or the left carotid arteries, even though the morphological features of the pulse waves showed moderate agreement. The advantages of PWA over each arterial territory and the requirements that should mediate the choice of one of the both sides require further investigation.

Cardiovascular diseases are one of the major causes of death. Regular checkups and preventive actions can drastically help reducing fatal incidences. This can be achieved by monitoring the carotid artery or rather the carotid pulse signal. Commonly, ultrasound devices are used for that purpose. However, these devices are costly, mostly stationary and their usage requires training and experience. $\mathbf{This}$ paper investigates the possible usage of radar systems as a contactless and low-cost alternative for carotid pulse measurements. Theoretical investigations reveal a linear relationship between the measurands of both devices and synchronous recordings from three test persons further confirm the feasibility of using radar systems as a potential device for monitoring cardiovascular diseases.

OBJECTIVES Central pulse pressure (PP) has been suggested a better predictor of cardiovascular risk than brachial PP, and its routine noninvasive assessment can be useful for risk stratification. The present study evaluated the capability of a radiofrequency-based carotid wall tracking to estimate central PP from distension curves, comparing the values of carotid PP as obtained by wall tracking with those provided by applanation tonometry. Furthermore, the associations of carotid PP with intermediate markers of cardiovascular risk, like carotid intima-media thickness (IMT) and left ventricular mass (LVM), were assessed. METHODS Carotid PP was measured by wall tracking and applanation tonometry during the same session in 346 individuals (healthy controls, patients with hypertension and diabetes). IMT was measured in all individuals and LVM was measured in 253. RESULTS Carotid PP values as measured by wall tracking and applanation tonometry were highly correlated [r = 0.87; slope 0.90 (0.85-0.95); P

Aim To evaluate the effect of a necktie on heart rate HR , blood pressure BP and ankle brachial index ABI Methods In a cross sectional study, a total of 56 clients were enrolled of age group 25 35 years group A and 36 45 years group B wearing necktie for more than 1 year. Heart rate carotid pulse , blood pressure and ABI of the clients were measured by Oscillometric Sphygmomanometer. Results There was a significant difference in HR of group A as compared to group B, no significant difference was seen in systolic blood pressure SBP of group A but some significant difference was demonstrated in group B. For diastolic blood pressure DBP , there was much significant difference seen in group B as compared to group A. There was no significant change seen for ABI in any of the groups. Conclusion A necktie may increase heart rate and decreases blood pressure in both the age groups but have no effect on ABI. Dr. Sohajpreet Kaur (PT) | Dr. Reecha Bedi (PT) | Dr. Suresh Mani (PT) "Effect of Necktie on Heart Rate, Blood Pressure and Ankle Brachial Index among Male Office Workers" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-2 , February 2018, URL: https://www.ijtsrd.com/papers/ijtsrd9599.pdf

Japanese emergency medical services (EMS) personnel providing advance life support confirm the absence of a carotid pulse before initiating chest compressions (CCs) in adult out-of-hospital cardiac arrest (OHCA). This study aims to investigate the efficacy of a new protocol facilitating early CCs before definitive cardiac arrest in enhancing the outcomes of OHCA.The 2011 new protocol facilitated EMS to initiate CCs when the carotid pulse was weak and/or50/min in comatose adult patients with respiratory arrest (apnoea or agonal breathing) and loss of the radial pulse. During 2008-2015, we compared the neurologically favourable 1-year survival rate of EMS-witnessed OHCA and EMS-confirmed out-of-hospital respiratory arrest (OHRA) in adults before (N = 257 and 34, respectively) and after (N = 255 and 54, respectively) the implementation of the new protocol.After the new protocol, EMS initiated CCs1.5 min before definitive cardiac arrest in 31% (80/255) and 33% (18/54) of EMS-witnessed OHCA and EMS-confirmed OHRA, respectively. While the new protocol was not significantly associated with survival of EMS-confirmed OHRA, it was significantly associated with survival of EMS-witnessed OHCA: 9.0% and 14.9%, before and after, P by univariate analysis0.03; adjusted OR (95% CI) by multivariable logistic regression analysis, 2.01 (1.04-3.90). Neither early start of CCs nor the new protocol was associated with the progression to cardiac arrest in 212 cases with impending cardiac arrest.A new EMS protocol facilitating early CCs before definitive cardiac arrest was associated with higher survival of EMS-witnessed OHCA.

Klasifikasi sinyal Carotid Pulse sangat penting untuk mengetahui proses terjadinya tekanan darah dalam mengalirkan darah melewati katup-katup jantung menuju ruang-ruang jantung dan paru-paru serta mendukung analisa suara jantung yang ada untuk mendeteksi murmur, mengklasifikasikan suara jantung normal dan tidak normal, serta untuk menjelaskan dinamika jantung, oleh sebab itu pada penelitian ini dilakukan beberapa pekerjaan pendahuluan pada pembuatan instrumentasi pendeteksian sinyal tekanan darah (Carotid Pulse).Pada penelitian ini dihasilkan informas Low Pass Filter Analog Orde 4 dengan frekuensi cutoff 100 Hz penguatan -3 dB terjadi di area frekuensi 120 Hz. Hasil uji Notch Filter dihasilkan tegangan output terkecil di frekuensi 50 Hz dengan besar Vout (0.14 ± 0.00) volt dengan Quality factor (Q) sebesar 6.28. Analisa sinyal Carotid Pulse dengan DFT memberikan informasi bahwa pada tekanan darah, area frekuensinya di antara 1 Hz sampai 20 Hz. Sinyal Carotid Pulse untuk siklus pertama Frekuensi tertingginya (6.81 ± 0.41) Hz dan merupakan gelombang P yang menggambarkan kenaikan Carotid Pulse secara tiba-tiba dari pemompaan darah pada ventrikel kiri menuju aorta hinggga mencapai puncak. Analisa dengan menggunakan CWT menghasilkan data keterangan waktu yang menunjukkan waktu terjadinya frekuensi tertinggi sinyal Carotid Pulse. Penelitian ini selanjutnya akan dikembangkan pada Multimodal Cardiac Analysis untuk mendapatkan informasi anatomi dan fisiologi jantung yang lebih kompleks.

Background: Heart rate variability (HRV), pulse pressure amplification, and obesity represent risk factors for cardiovascular events. The aims of the present study are (1) to explore the impact of HRV on pulse pressure amplification and (2) to investigate whether the association between HRV and pulse pressure amplification differs in obese and lean subjects. Methods: A total of 342 patients (age 61 ± 11 years) were enrolled. HRV was analyzed concerning both the frequency and time domain as well as concerning the HRV triangular index. Pulse pressure amplification was estimated as the ratio between brachial and carotid pulse pressure, the latter measured with SphygmoCor. Results: Time domain HRV indices were directly correlated with pulse pressure amplification (the lower the HRV indices, the lower the pulse pressure amplification). This association was stronger in obese than in lean subjects after controlling for age and sex. Conclusion: Larger controlled studies are needed to provide a more detailed insight into the relation between HRV and pulse pressure amplification and to determine which pathways are differentially activated in lean and obese subjects.

Neurally mediated syncope (NMS) is a disorder of the autonomic regulation of postural tone. These patients suffer from blood-pressure regulation failure resulting in hypo-perfusion of the brain, which might lead to significant injuries due to falls. Detection of the onset of blood-pressure regulation failure enables the patient to start counter-measures and, hence, avoid hypo-perfusion of the brain. Monitoring of blood-pressure (BP) changes is key to develop an early alert solution. Several setups have been tested for this purpose using vascular unloading and pulse arrival time (PAT). The aim of this study was to do an initial investigation of using the electrocardiography (ECG) signal and accelerometry (ACC) signals acquired from the carotid to reliably infer pulse presence and pulse absence. A classifier using a correlation feature derived from the ECG and the ACC signals was conceptualized and implemented. The algorithm performance was tested with data acquired during scheduled head-up tilt table tests of 8 syncope patients. This is an essential step towards PAT inference as a BP surrogate.

OBJECTIVE To compare intraosseous pentobarbital treatment (IPT) and thoracic compression (TC) on time to circulatory arrest and an isoelectric electroencephalogram (EEG) in anesthetized passerine birds. ANIMALS 30 wild-caught adult birds (17 house sparrows [Passer domesticus] and 13 European starlings [Sturnus vulgaris]). PROCEDURES Birds were assigned to receive IPT or TC (n = 6/species/group). Birds were anesthetized, and carotid arterial pulses were monitored by Doppler methodology. Five subdermal braided-wire electrodes were used for EEG. Anesthetic depth was adjusted until a continuous EEG pattern was maintained, then euthanasia was performed. Times from initiation of euthanasia to cessation of carotid pulse and irreversible isoelectric EEG (indicators of death) were measured. Data (medians and first to third quartiles) were summarized and compared between groups within species. Necropsies were performed for all birds included in experiments and for another 6 birds euthanized under anesthesia by TC (4 sparrows and 1 starling) or IPT (1 sparrow). RESULTS Median time to isoelectric EEG did not differ significantly between treatment groups for sparrows (19.0 and 6.0 seconds for TC and IPT, respectively) or starlings (88.5 and 77.5 seconds for TC and IPT, respectively). Median times to cessation of pulse were significantly shorter for TC than for IPT in sparrows (0.0 vs 18.5 seconds) and starlings (9.5 vs 151.0 seconds). On necropsy, most (14/17) birds that underwent TC had grossly visible coelomic, pericardial, or perihepatic hemorrhage. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that TC might be an efficient euthanasia method for small birds. Digital pressure directly over the heart during TC obstructed venous return, causing rapid circulatory arrest, with rupture of the atria or vena cava in several birds. The authors propose that cardiac compression is a more accurate description than TC for this procedure.

The purpose of this work is to study the effect of long term alterations of ballistocardiography during 12 years time recorded in sitting position by using EMFi (Electromechanical Film) sensors. ECG, BCG, ankle pulse signal and carotid pulse (CP) signal from the neck near the carotid artery were recorded from a single person and duration of the signal components according to R spike of the ECG and amplitudes of the signals were studied.

A 25-year-old man was bitten in the neck by an aggressive camel, causing three small puncture wounds. The left carotid pulse of the patient was weakly palpated. Angiography showed irregular dissection of the distal part of the left common carotid artery. Neck exploration confirmed the findings. An interposition autogenous saphenous vein graft was performed successfully. The patient was discharged home in good condition. We have systematically reviewed the literature on this topic, and only four other similar cases were reported previously. Although camel bite wounds are small, they may penetrate deeply, causing serious injuries to the neck structures including the major vessels. Care should be taken when approaching male camels during the rutting season. Language: en

Arrhythmias in tetralogy of Fallot (ToF) and transposition of the great arteries (TGA) could be the consequence of reduced baroreflex-sensitivity (BRS). Hypoxia until the first surgical correction in these patients may impair BRS. We aimed to compare the BRS of ToF, TGA and control subjects and test the effect of the timing of operation on BRS. 19 patients with ToF, 22 patients with TGA and 19 healthy controls were enrolled. Carotid pulse pressure (PPc) was similar in ToF and TGA patients but lower in controls. BRS was lower in the ToF group compared to the control or to the TGA groups. The first operation was performed later in patients with ToF than in patients with TGA. Adjustment for PPc attenuated the difference in BRS between ToF and control subjects. Adjustment for age at corrective surgery abolished the difference in BRS between the ToF and the TGA groups. In ToF patients, reduced BRS could be explained by the stiffening of central arteries and the later corrective surgery. Earlier surgical correction may prevent irreversible deterioration of baroreflex-function and arrhythmia development in ToF patients.

Introduction: Pulse check by manual palpation (MP) is an unreliable skill even in the hands of healthcare professionals. In the context of cardiac arrest, this may translate into inappropriate chest compressions when a pulse is present, or conversely omitting chest compressions when one is absent. To date, no study has assessed the utility of B-mode ultrasound (US) for the detection of a carotid pulse. The primary objective of this study is to assess the time required to detect a carotid pulse in live subjects using US compared to the standard MP method. Methods: This is a prospective randomized controlled cross-over non-inferiority trial. Health care professionals from various backgrounds were invited to participate. They attended a 15 minute focused US workshop on identification of the carotid pulse. Following a washout period, they were randomized to detect a pulse in live subjects either by MP first or by US first. Both pulse check methods were timed for each participant on 2 different subjects. The primary outcome measure was time to carotid pulse detection in seconds. Secondary outcome measures included comfort levels of carotid pulse detection measured on a 100mm visual analog scale (VAS), and rates of prolonged pulse checks (greater than 5 or 10 seconds) for each technique. Mean pulse detection times were compared using Students t-test. The study was powered to determine whether US was not slower than MP by greater than 2 seconds. Results: A total of 93 participants completed the study. Time to detect pulse was 4.2 (SD=3.4) seconds by US compared with 4.7 (SD=6.5) seconds by MP (P=0.43). Seventeen (18%) participants took >5 seconds to identify the carotid pulse using US compared to 19 (20%) by MP (P=0.74). Eight (9%) candidates took >10 seconds to identify the pulse using US compared to 9 (10%) by MP (P=0.81). Prior to training, participants had a higher comfort level using MP than US pulse checks (67 vs 26 mm, PConclusion: Carotid pulse detection in live subjects was not slower using US as compared to MP in this study. A brief teaching session was sufficient to improve confidence of carotid pulse identification even in those with little to no previous US training. The preliminary results from this study provide the groundwork for larger studies to evaluate this pulse check method for patients in actual cardiac arrest.

Objective:Ankylosing spondylitis (AS) is an autoimmune inflammatory disease and a prototype form of the spondyloarthropathies1. The precise etiology of AS is not fully understood, but inflammation has a critical role in the pathogenesis of the disease affecting the axial skeleton and extra skeletal

Background and Objectives : Maximum Oxygen uptake (VO 2 max) is a good predictor of cardiopulmonary and muscle fitness. Maximum oxygen uptake is defined as the highest rate at which oxygen can be taken up and utilize by body during severe exercise. The present study aims to find out the level of VO 2 max using Mc Ardle equation and to compare obtained values from Chatterjee’s equation in Nepalese population. Methodology: Maximum oxygen uptake was determined by using the Queen’s college step-stool of 16.25 inches and popular Mc Ardle equation. Stepping was done for a total duration of 3 minutes at the rate of 24 cycles per minute for males and 22 cycles per minute for females. After completion of the exercise, subjects remained standing while the carotid pulse rate was taken as heart rate. Maximum oxygen uptake was calculated using obtained heart rate. Results: Queen’s college step test (QCT) was used as a submaximal exercise and the estimated VO 2 max in boys and girls was 48.8± 7.3 ml/kg/min and 37.4± 2.7 ml/kg/min respectively with Mc Ardle equation and the value was higher when compared with Chatterjee’s equations. The value of VO 2 max was observed and found to be less in smokers and sedentary individuals. Conclusion: As the values of VO 2 max obtained from different equations are different, this research strongly argues the need of developing a prediction equation specifically for the Nepalese population. DOI: http://dx.doi.org/10.3126/jmcjms.v1i1.7879 Janaki Medical College Journal of Medical Sciences (2013) Vol. 1 (1):3-8

The study aimed to assess the utility of ultrafast ultrasound imaging for evaluation of carotid pulse wave velocity (PWV) in newly diagnosed hypertension patients. This prospective non-randomized study enrolled 90 hypertensive patients in our hospital from September to December 2013 as a hypertension group. An age- and sex-matched cohort of 50 healthy adults in our hospital from September to December 2013 was also included in the study as a control group. Carotid PWV at the beginning and at the end of systole (PWV-BS and PWV-ES, respectively) and intima-media thickness (IMT) were measured by ultrafast ultrasound imaging technology. The associations of PWV-BS, PWV-ES, and IMT with hypertension stage were evaluated by Spearman correlation analysis. PWV-BS and PWV-ES in the hypertension group were significantly elevated compared with those in control group. Different hypertension stages significantly differed in PWV-BS and PWV-ES. PWV-BS and PWV-ES appeared to increase with the hypertension stage. Moreover, IMT, PWV-BS, and PWV-ES were positively correlated with the hypertension stage in hypertensive patients. Ultrafast ultrasound imaging was a valid and convenient method for the measurement of carotid PWV in hypertensive patients. Ultrafast ultrasound imaging might be recommended as a promising alternative method for early detection of arterial abnormality in clinical practice.

The external blood pressure pulse, recorded on a non-contact basis using the method of laser Doppler vibrometry (LDV), has been shown to be a rich source of information regarding cardiac and vascular dynamics. Considerable attention has been directed specifically to the pulse from the neck, overlying the carotid artery, which is of special interest because the carotid pulse is highly similar to the central aortic pressure pulse. The findings presented here are consistent with an interpretation of the signal at the neck as originating in the carotid artery. A detailed mapping study involving a 35 point matrix over the right neck disclosed a focal zone of maximal signal amplitude, with a course consistent with the tract of the underlying carotid. Appreciable individual differences in the 22 examinees were disclosed, particularly at lower sites. In addition to confirming a local source for the LDV carotid pulse, the data highlight the importance of accurate targeting considerations.

Objectives The study was to explore whether the brachial/carotid pulse pressure (B/C-PP) ratio selectively predicts the sex difference in age-related cardiovascular (CV) death. Background Hypertension and CV complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the B/C-PP ratio is a physiological marker of PP amplification between B and C arteries that tends toward 1.0 with age. Methods The study involved 72,437 men (ages 41.0 ± 11.1 years) and 52,714 women (39.5 ± 11.6 years). C-PP was calculated for each sex by a multiple regression analysis including B-PP, age, height and risk factors, and a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3,028 men and 969 women died. Results In the total population, the adjusted hazard ratios (HR) (95% confidence interval [CI]) of B/C-PP ratio were: 1) for all-cause mortality: men, HR: 1.51 (95% CI: 1.47 to 1.56), women; HR: 2.46 (95% CI: 2.27 to 2.67) (p Conclusions PP amplification is highly predictive of differences in CV risk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in CV risk.

Objectives: The aim of this study is to investigate the perception of professionals from a Family Health Team on cardiopulmonary arrest. Material and Methods: This an exploratory and descriptive study, with quantitative and qualitative approaches, performed in a Family Health Unit in Joao Pessoa - PB. The study followed the ethical observances of 196/96 Resolution of the National Health Council, and data collection was conducted in January 2010. For database analysis, tables and charts were built descriptively in Microsoft Excel 2007. Results: Data showed that 80% of respondents said that the first signs revealing a cardiopulmonary arrest are apnea, unconsciousness, and absence of carotid pulse. 60% reported that the right order was mouth-to-mouth resuscitation / artificial circulation by external thoracic compression / and early defibrillation by use of automatic defibrillators. 60% of respondents reported that the correct support sequence in cardiopulmonary resuscitation maneuvers are 5 cycles of 30 compressions to 2 breaths, and 40% of professionals interviewed have never had an experience with patients in cardiac arrest. Conclusion: Although these professionals have technical and scientific knowledge, there is a lack of skills required when facing a situation of cardiac arrest. DESCRIPTORS: Cardiac Arrest. Family Health. Nursing.