Arteries stiffen as a consequence of age and arteriosclerosis. Age related stiffness occurs when the elastic fibres within the arterial wall (elastin) begin to fray due to mechanical stress, free radical oxidation, and deposition of cholesterol plaque.

The two leading causes of death in the developed world, myocardial infarction and stroke, are both a direct consequence of atherosclerosis. Increased arterial stiffness is associated with an increased risk of cardiovascular events.

Assessment of the pulse character is one of the earliest recorded medical skills, but objective recordings of the pulse waveform--sphygmography--emerged only in the nineteenth century. This technique fell into disuse with the advent of the sphygmomanometer (blood pressure cuff), but interest has recently been rekindled with the introduction of computer technology and applanation tonometry. Pulse wave analysis (PWA) is a highly reproducible technique and easy to apply.
Together with ECG assessment, PWA, these measures provide important information about arterial stiffness. If they fall into the age related profile, you should make effort to put them on vitamins, anti-oxidants, and lecithin to reduce the cholesterol.

Increased stiffness is associated with most cardiovascular risk factors and established atherosclerosis. However, increased stiffness may be more than a marker for occult atheroma. It may be involved in the pathogenesis of cardiovascular disease by a number of mechanisms. Assessment of stiffness using PWA may therefore provide better risk assessment and allow treatment to be targeted to those most in need.


The graph of aortic pressure throughout the cardiac cycle displays a small dip (the "incisure" or "dicrotic notch") which coincides with the aortic valve closure.

The dip in the graph is the snap-back wave of the blood caused by aortic valve closure which is immediately followed by a brief rise (the "dicrotic wave") then gradual decline. Just as the ventricles enter into diastole, the brief reversal of flow from the aorta back into the left ventricle causes the aortic valves to snap shut. This results in the slight increase in aortic pressure caused by the elastic recoil of the semilunar valves and aorta. The notch represents the ability of the arteries to expand, i.e. arterial elasticity.

Now, you don't need a $14,000 pulse wave machine to read the importance of the notch. It's all in the notch!

According to pulse wave data in this research, pulse wave is relatively stable under all testing conditions: subject sitting in a quiet environment and keeping calm. The pulse wave analysis result is highly consistent in this condition. The similarity of pulse waveforms doesn’t change much under similar cardiovascular health condition even the heart rate and pulse strength changes, so waveform analysis can be applied in different clinical or field scenarios.

The classifications focus on the lack of the notch of the waveform which is considered as the indicator of arterial stiffness.

Class 1, a distinct notch is seen on the downward slope of the pulse wave; should be seen in all young individuals.
Class 2, a slight notch develops and the line of descent becomes horizontal;
Class 3, no notch develops but there is a well-defined change in the angle of the descent;
Class 4, no notch develops or no change in angle of descent occurs.

They found class 1 to be prevalent in younger individuals and class 4 present in older participants and in individuals with established coronary artery disease. The less distinct the notch, the great probability of coronary heart disease. Only 50% of males by age 45-54 will have a normal dicrotic notch of Class 2. In men aged 65–74, the prevalence of myocardial infarction was approximately fourfold greater in participants with a class 4 waveform compared with a class 1 waveform.

For you pulse fans, if you want to get more precise information from the waveform, researchers take the traditional pulse diagnosis of classical medicine as the reference and map the characteristics of pulse diagnosis with the pattern of waveform itself which appears on this Handy Device. This can be used to detect certain cardiovascular risks as well as determine the classification. For example, acute anterior myocardial infarction will have a sharp systolic component and very small diastolic component which suggests poor blood supply based on this pulse wave analysis model.


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