ARTERIAL, CEREBROSPINAL AND VENOUS PRESSURES IN MAN DURING COUGH AND STRAIN

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Abstract
Differential pressure records are shown which separate the changes in arterial pressure due to simple propagation of intrathoracic pressure from those which are due to changes in blood flow. It is shown that increases due to the former, strain only the peripheral arteries whereas increases due to changes in blood flow or to changes in peripheral resistance strain also the vital arteries to the brain, spinal cord, and viscera. The nature of the cerebrospinal pressure pulsations is discussed. During the preliminary pressure rise of the cough people whose circulation is hypodynamic show arterial pressures which are no higher than simultaneous intrathoracic pressures. During brief intervals there is therefore no effective head of pressure to irrigate the coronary or other vital vascular beds. During the expulsive phase of the cough the arterial pressure may continue to rise while the intrathoracic pressure is going down or the arterial pressure may descend more slowly than the intrathoracic pressure. This signifies that the pressure distending the aorta is rising and, since it often occurs during diastole, it implies that during the expulsive phase of a cough blood is forced from the lungs through the relaxed left heart and into the aorta. The cough may force blood into the aorta in cases with hypodynamic circulation and in cases with congestive heart failure. This may occur in normal individuals but no evidence has been obtained to support the idea that it does.

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