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Blood vessels are more than simple pipes, passively enabling blood to pass through them. Their form and function are dynamic, changing with both aging and disease. This process involves a feedback loop wherein changes to the shape of a blood vessel affect the hemodynamics, causing yet more structural adaptation. This feedback loop is driven in part by the hemodynamic forces generated by the blood flow, and the distribution and strength of these forces appear to play a role in the initiation, progression, severity, and the outcome of vascular diseases. Magnetic Resonance Imaging (MRI) offers a unique platform for investigating both the form and function of the vascular system. The form of the vascular system can be examined using MR-based angiography, to generate detailed geometric analyses, or through quantitative techniques for measuring the composition of the vessel wall and atherosclerotic plaques. To complement these analyses, 4D Flow MRI can be used to quantify the functional aspect of the vascular system, by generating a full time-resolved three-dimensional velocity field that represents the blood flow. This thesis aims to develop and evaluate new methods for assessing vascular disease using novel hemodynamic markers generated from 4D Flow MRI and quantitative MRI data towards the larger goal of a more comprehensive non-invasive examination oriented towards vascular disease. In Paper I, we developed and evaluated techniques to quantify flow stasis in abdominal aortic aneurysms to measure this under-explored aspect of aneurysmal hemodynamics. In Paper II, the distribution and intensity of turbulence in the aorta was quantified in both younger and older men to understand how aging changes this aspect of hemodynamics. A method to quantify the stresses generated by turbulence that act on the vessel wall was developed and evaluated using simulated flow data in Paper III, and in Paper V this method was utilized to examine the wall stresses of the carotid artery. The hemodynamics of vascular disease cannot be uncoupled from the anatomical changes the vessel wall undergoes, and therefore Paper IV developed and evaluated a semi-automatic method for quantifying several aspects of vessel wall composition. These developments, taken together, help generate more valuable information from imaging data, and can be pooled together with other methods to form a more comprehensive non-invasive examination for vascular disease.
Elias Hanna and D. Luke Glancy provide an in-depth understanding of waveforms and tracings seen in varous disease states as well as pathophysiology behind those findings. Practical issues that are rarely discussed or focused upon in textbooks are highlighted in this book with detailed waveform analysis. Caveats in the hemodynamic assessment of valvular diseases, constriciion, tamponade, pulmonary hypertension, shunt pathology, and right and left ventricular failure are provided. This book also provides case-based and tracing-based quizzes. The reader wil learn to identify disease states and waveform subtleties from single tracings or from case studies. The reader will take the initiative to interpret tracings, understand notches, artifacts, and formulate a diagnosis. This book will feature: Complete presentation of basic and advanced hemodynamics. Numerous case studies allow the reader to learn real-life application of hemodynamic data in clinical decision-making. Quizzes and explanations provides the reader with self-assessment and problem solving skills Over 300 illustrations with detailed discussion.
Here's a source of guidance on the analysis of the hemodynamic waveforms generated in the cardiac catheterization lab. It progresses from a review of basic monitoring principles and normal waveforms through an assessment of the waveform data associated with the full range of individual coronary diseases, providing the assistance needed to accurately interpret any findings encountered in practice. Its extremely clinically oriented approach makes it an ideal hands-on tool for any clinician involved in diagnosing cardiac problems using interventional cardiology.
This book, part of the European Society of Intensive Care Medicine textbook series, teaches readers how to use hemodynamic monitoring, an essential skill for today’s intensivists. It offers a valuable guide for beginners, as well as for experienced intensivists who want to hone their skills, helping both groups detect an inadequacy of perfusion and make the right choices to achieve the main goal of hemodynamic monitoring in the critically ill, i.e., to correctly assess the cardiovascular system and its response to tissue oxygen demands. The book is divided into distinguished sections: from physiology to pathophysiology; clinical assessment and measurements; and clinical practice achievements including techniques, the basic goals in clinical practice as well as the more appropriate hemodynamic therapy to be applied in different conditions. All chapters use a learning-oriented style, with practical examples, key points and take home messages, helping readers quickly absorb the content and, at the same time, apply what they have learned in the clinical setting. The European Society of Intensive Care Medicine has developed the Lessons from the ICU series with the vision of providing focused and state-of-the-art overviews of central topics in Intensive Care and optimal resources for clinicians working in Intensive Care.
Hypertension is a condition which affects millions of peopleworldwide and its treatment greatly reduces the risk of strokes andheart attacks. This fully revised and updated edition of the ABCof Hypertension is an established guide providing all thenon-specialist needs to know about the measurement of bloodpressure and the investigation and management of hypertensivepatients. This new edition provides comprehensively updated andrevised information on how and whom to treat. The ABC of Hypertension will prove invaluable to generalpractitioners who may be screening large numbers of patients forhypertension, as well as nurse practitioners, midwives and otherhealthcare professionals.
Hemodynamics makes it possible to characterize in a quantitative way, the function of the heart and arterial system, thereby producing information about what genetic and molecular processes are of importance for cardiovascular function. Snapshots of Hemodynamics: An Aid for Clinical Research and Graduate Education by Nico Westerhof, Nikos Stergiopulos and Mark I. M. Noble is a quick reference guide designed to help basic and clinical researchers as well as graduate students to understand hemodynamics. The layout of the book provides short and independent chapters that provide teaching diagrams as well as clear descriptions of the essentials of basic and applied principles of hemodynamics. References are provided at the end of each chapter for further reading and reference.
This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology.
Structural and functional abnormalities of arteries and veinsmanifest clinically in a broad spectrum of disorders, includinganeurysmal disease, atherosclerosis, vasculitis, venousinsufficiency, microvascular complications, thrombo-embolism andlower limb ulceration. Many of these are common and/orchronic conditions which present for initial assessment by primaryhealth care workers. This new edition is a practical guide to the most commonlypresenting disorders, and provides a structured approach toclinical assessment, investigations and management. The lastfew years have seen major changes in the use of non-invasive orminimally-invasive techniques, e.g wider use of CT and MRangiography, and increasing use of percutaneous interventions forcarotid, lower limb and reno-vascular disease. The ABC of Arterial and Venous Disease (Second Edition)explains the underlying technology and the applications of newminimally-invasive methods, especially CT and MRI, and provides anup-dated, evidence-based guide to the modern day management ofpatients with common, life-threatening diseases involving differentparts of the circulation. This authoritative, full-colour, illustrated ABC is anideal reference for the primary care, non-specialist practitionerto base effective management and prevention programmes.
New updated edition first published with Cambridge University Press. This new edition includes 29 chapters on topics as diverse as pathophysiology of atherosclerosis, vascular haemodynamics, haemostasis, thrombophilia and post-amputation pain syndromes.
The essential resource on cardiac hemodynamics—now in a new edition Hemodynamic Rounds, Fourth Edition is intended to help cardiologists, cardiovascular fellowship trainees, residents and other members of the medical community enhance their understanding of cardiac physiology and its associated hemodynamic presentations in health and disease. This includes the basic principles of flow and pressure measurements, systemic as well as coronary hemodynamics in normal and diseased states, and changes in hemodynamics following interventional procedures ranging from TAVI and valvuloplasty to stent placement. Like its popular predecessors, this new edition draws on case studies to illustrate characteristic cardiac hemodynamic findings and discusses the essential methods used in interpreting pressure waveforms as a diagnostic and monitoring tool. The text is organized into chapters on specific areas of the heart, common cardiac pathophysiologic conditions, and hemodynamic situations resulting from different therapeutic procedures. It includes discussions of both normal and abnormal pressure waveforms. This new edition has been revised throughout to include brand new content on aortic and mitral valve stenosis and regurgitation as well as TAVI and mitral clip hemodynamics. Highlights include: Essential and easy to understand resource for those required to interpret cardiac blood flow and blood pressure tracings Covers hemodynamic assessment by cardiac disorder, plus the bedside applications of hemodynamics Revised throughout and includes brand new content on valve stenosis and regurgitation and TAVI and mitral clip hemodynamics Hemodynamic Rounds: Interpretation of Cardiac Pathophysiology from Pressure Waveform Analysis, Fourth Edition is an indispensable tool for all physicians, nurses, and students responsible for measuring and interpreting cardiac waveforms in cardiac diagnosis and monitoring.