Beat-to-Beat Alterations in Relationship of Simultaneously Recorded Central and Peripheral Arterial Pressure Pulses During Valsalva Maneuver and Prolonged Expiration in Man

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Abstract
Simultaneous recordings of central and multiple peripheral pressure pulses were obtained in 5 healthy male subjects during performance of Valsalva maneuvers in the 40-degree head-up tilt position and prolonged expiration maneuvers. Striking beat-to-beat changes in the contour of central and peripheral pressure pulses were obtained and especially in the relationship between central and peripheral pulses generated by the same heart beat. Peripheral pulse pressures more than double aortic pulse pressures were obtained, peripheral dicrotic pressures dipping down to below end-diastolic pressures so that the general contour of the pulse resembled a simple sine wave. These changes in amplitude and form are in harmony with Frank''s suggestion that the peripheral arterial system may resonate with the aortic pulse. The aortic pulse consists of two forcing impulses: a positive, the ascending limb; and a negative, the incisura. The distance between the two impulses is related to systolic time. The optimal systolic time for resonance during the Valsalva maneuver could be determined (for any particular subject) by plotting systolic time against percentage increase in amplitude of the peripheral pulse, as in a classic frequency-amplitude response curve. As systolic time decreased from 300 to 200 milliseconds, peripheral amplification of the pulse pressure in the radial and brachial arteries increased from 130 to more than 200% with decreasing amplification thereafter.