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An Overview . . .
Measurement of blood pressure

Cardiac output
Cardiac rate
Heart sound

Respiratory rate
Gas volume
Flow rate of Co2, o2 in exhaust air

pH of blood,
ESR, GSR measurements
Plethysmography.
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Cardiac Output

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It is the amount of blood delivered by the heart to the aorta per minute
For normal adults it is 4 -6 litres / minute

Any decrease may be due to

Low Blood Pressure
Reduced Tissue Oxygenation
Poor Renal Function
Shock
Acidosis
Methods of cardiac output measurements
Ficks Method
Indicator Dilution Method
Measurement of Cardiac Output by Impedance Change

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Ficks Method :
Based on analysis of gas - keeping of the organism
Cardiac output can be calculated by continuously
infusing oxygen into the blood or removing it from the
blood and measuring the amount of oxygen in the blood
before and after its passage

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Ficks Method for Cardiac Output Measurement

Oxygen uptake
by Ventilation

Q2

Heart Catheter

Vena
Cava

Mixed Venous Blood

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Aorta
Q
Heart
and
Lungs

Arterial Blood

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Let I be the amount of infused or removed oxygen per unit time

It is equal to the difference between the amounts in the blood arriving at and
departing from the site of measurement
I = CAQ CVQ
Q=

I
CA CV

where

Q cardiac output in litres / minute

CA - Concentration of oxygen in the arterial blood in millilitres
of oxygen per litre of blood
CV - Concentration of oxygen in the mixed venous blood in
millilitres of oxygen per litre of blood
I - Volume of oxygen uptake by ventilation in millilitres of
blood
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Indicator Dilution Method

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Principle
A known amount of dye or radioisotope is introduced as an indicator in the
blood circulation
The concentration of the indicator is measured with respect to time and the
volume of blood flow is estimated
Let M mg of an indicator be injected into a large vein or preferably into the

right heart itself

After passing through the right heart, lungs and the left heart, the indicator
appears in the arterial circulation
The presence of the indicator in the peripheral artery is detected by a
detector
The output of the detector is directly proportional to the concentration of
the indicator
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Let an increment volume dV pass through the sampling site in time dt

Let the mass of the indicator in dV = dM

Therefore the concentration of the indicator, c = dv

dt
Now

dM
dt

= c dV
dt

But

dV
dt

= Q

Therefore

dM

= Q c dt

Integrating over the time of the experiment,

t

M
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Q c dt

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Considering the flow as constant,

t

Q c dt
0

(or)

M
t
0

c dt

Here concentration of the indicator c is a function of time

By drawing a curve between concentration and time, the area of the

curve gives directly the value of the denominator in the above equation
Thus
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M
Area of the curve

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Block Diagram of the Thermo Dilution System

Timer/Control

Linearity
Amplifier

Integrator

Linearising
Amplifier

Microcomputer

Thermistor for
Blood Temperature

Thermistor for
Thermoindicator
Temperature
Preset Adjustment
Control

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Cardiac
Output
Display

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A bolus of about 10 millilitres of 5% Dextrose in water at room

temperature is injected as a thermal indicator into the right atrium
After mixing it is detected in the pulmonary artery by means of a
thermistor mounted at the tip of a miniature catheter probe
The temperature difference between the injectate temperature and
the circulating temperature in the pulmonary artery is measured
The reduction in temperature is integrated with respect to time
After applying proper corrections, a meter reads the cardiac output

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Cardiac Output Measurement by Impedance Method

Potential Electrodes

A1

Oscillator
f = 100kHz

Amplifier and
Demodulator

Current
Electrodes

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A2

Differentiator

 Electrodes 1 and 4 are used as current electrodes

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Electrodes 2 and 3 are used to pick up the voltage across the thorax

If

p - resistivity of the patients haematocrit

A - cross sectional area of the thorax
L - separation between the potential electrode 2 and 3

Then the resistance of the thorax is given by

R =

(or)
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V =

pL

A
pL2
R

pL2
AL

pL2
V

(V volume of the thorax)

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During ejection of stroke volume, the change in volume is dV and

the corresponding decreasing in resistances is dR
Differentiating the above expression,
dV =

- pL2
R2

dR

Since a.c. excitation is used, R should be replaced by impedance Z

Therefore

dV =

Taking

dZ = t

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- pL2
Z2
dZ
dt

dZ

max

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where,
dZ
dt

- corresponds to the peak negative value of

max

(dZ/dt) found during systole and

t - corresponds to the interval between (dZ/dt) = 0 and
the second heart sound

Thus

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dV =

- pL2
Z2

t.

dZ
dt

max

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The voltage signal due to changes in impedance is amplified and

demodulated to obtain impedance Z of the thorax
The value of (dZ/dt) is calculated using a differentiator and its
output is recorded on a recorder
From that (dZ/dt)max can be noted
By determining dV, the cardiac output can be measured by
multiplying dV with heart rate per minute

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Spirometer

Linkage
o

VOL

VBB

kR

+
r

VOUT
-

Patient
air into
Bellows

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Spirometer

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Used for respiratory volume measurements

All lung volumes and capacities can be measured

Consists of light weight bellows

These bellows are mechanically articulated to a biased potentiometer such that the wiper voltage is proportional
to volume of the bellows

The maximum volume of the bellows is given by

VOLmax = L(Pi)r2

If k is the proportionality constant giving the fractional position of the wiper arm on the potentiometer R such
that

k = Vout = VOL
VBB

Therefore

VOLmax

VOL = Vout (VOLmax)

VBB

Better Linearity can be obtained in measuring respiratory volumes

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Gas Analysers
Used to
Determine the quantitative composition of inspired and expired gas
Assess the lung function
Types
Infrared Gas Analyser based on infrared absorption of carbon dioxide
Paramagnetic Oxygen Analyser - based on paramagnetic behaviour of
oxygen
Thermal Conductivity Gas Analyser based on thermal conductivity of
carbon dioxide

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Block Diagram of Infrared CO2 Analyzer

Mirror

Infra red
Source

Mirror

Sample Tube

Reference Tube

Motor

Sample
Cell
Detector Unit
Diaphragm
Amplifier

Panel Meter

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Recorder

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By means of mirror assembly two infrared beams with same intensity are produced

A high speed rotating chopping disc is present which occludes each beam twice per motion

The chopped lights pass through the reference and sample tubes

When the opaque portions of the choppers are not in the way, the beam falls on the balanced
condenser microphone detector after passing the gas

The sample beam falling on the detector will be weaker than the reference beam since there is
absorption in the sample cell by the component of interest

The heating of the gas in the detector situated in the reference beam side will cause rise in
pressure

The diaphragm vibrates at the chopping frequency

The diaphragm forms one half of the capacitor

Thus, the change in position of the diaphragm produces a periodic change in the capacity of the

capacitor

This change is amplified and demodulated and the output is displayed on a meter or a recorder
in terms of concentration of the wanted component

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Simplified Block Diagram of Oxygen Analyzer

SCALE

MIRROR

DUMB CELL

O2

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There is a small glass dumb cell shaped assembly containing a

weakly diamagnetic gas such as nitrogen

It is suspended from a platinum iridium thread between the poles

of a powerful permanent magnet

The pole pieces are wedge shaped in order to produce a non linear
field

If the gas surrounding the dumb shell is also nitrogen there will be
no force acting on the dumb shell
If oxygen is added to the gas, the oxygen molecules experience a
force, displacing the diamagnetic dumb shell
The resulting rotation of the suspension turns a small mirror and
deflects a small beam of light over a scale calibrated in percentages
by volume of oxygen or partial pressure of oxygen

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Hot Wire Cell Thermal Conductivity Analyzer

Sample Gas
Flow

Reference Gas
Flow
S1

R1

uA

S2

R2

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 There are four platinum filaments as heat sensing elements

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Each of these is placed in a brass black

These are maintained at constant temperature and form the four arms of a bridge
Two filaments R1 and R2 act as reference gas arms
S1 and S2 act as sample gas arms
Initially reference gas is made to flow through all the filament cells and the
bridge is balanced
When the sample gas flows through the sample gas filament cells, the
temperature of the filaments in those cells are changed
If the thermal conductivity of the sample gas is more, then cooling of the

filaments takes place

This changes the resistances of the filaments
The bridge becomes unbalanced and a current flows through the meter which is
calibrated in terms of concentration of CO2 gas

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Digital pH Meter

-Er

( From Reference )

+
EIN

( From Solution )
Reference
Electrode
Electrical
Conductor

Buffer Solution

o
YT
-10 mV / oC
From
Temperature
Sensor

Glass Membrane
VOUT = Er EIN - YT
Analyzed
Solution

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VOUT

Digital
Voltmeter

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Used to measure pH at a given temperature and also at different

temperature
Consists of a glass electrode terminal and reference terminal

The calomel or silver silver chloride in potassium chloride electrolyte acts

as the reference terminal
A salt bridge consisting of a fiber wick saturated with KCl is at the tip of the
reference electrode
This keeps the reference terminal potential the same regardless of the
solution under test
The active terminal is sealed with common glass except for the tip
The tip is made of sensitive glass consisting of hydrated gelatinous glass
layer
Its membrane potential is proportional to the pH of the solution under test
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The electronic circuitry is adopted to increase the sensitivity and

accuracy
It consists of an external reference voltage to compensate the various
errors
To determine the pH at different temperatures , a voltage from the
temperature regulator circuit corresponding to a given temperature

is also added with the output from pH electrode

The operational amplifiers amplify these voltages in the required
manner

The final output is given to a digital voltmeter

In the digital voltmeter the display is obtained in terms of pH as
discrete numerals
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Plethysmography

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Used to measure the volume changes in any part of the body that result from the
pulsations of blood occurring with each heart beat

Used to measure Total Lung Capacity (TLC)

Consists of a rigid cup or chamber placed over any part of the body in which the
volume changes are to be measured

The cup is tightly sealed

The changes in the volume reflect the pressure changes of air inside the chamber

The pressure change is measured at constant volume or vice versa

Types based on nature of sensor

Capacitance Plethysmograph

Impedance Plethysmograph

Photoelectric Pltehysmograph

Mercury Strain Gauge Plethysmograph

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Measurement of Total Lung Capacity

The principle operation is the Boyles Law which states that at a

Kelvin Temperature, the pressure of a given mass of gas is inversely
proportional to its volume
i.e. P * (VOL) = k1T
where k1 is a constant

Since the patient is made to sit inside an air tight chamber whose
temperature is constant,
P * (VOL) = constant
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Partially Differentiating the above equation

d (P VOL)

(or)

(PVOL)

VOL dP

+
dP

dVOL

dP

P dVOL

= -

(PVOL)

VOL
=

dVOL

P
VOL

Now the door of the air tight chamber is sealed with the patient
inside and the valve on the mouthpiece is closed
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The patient cannot breathe with the valve closed, so the air
pressure in the mouthpiece is equal to the lung pressure PT
d TLC

In the body,

where

d PT

PT

TLC = Thorax Volume

PT

In the chamber,

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= -

TLC

= Thorax Pressure

d (VOLC)
d PC

= -

VOLC
PC

where

VOLC = Chamber Volume

PC

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= Chamber Pressure

Since the chamber is closed, any increase in the thoracic volume

causes a decrease in the chamber volume of air ,
i.e. d (VOLC)
TLC
PT

d PT

= - d (TLC)

= -

VOLC
PC

d PC

Since the changes in pressure induced by breathing motions are

small when the patient is sitting normally, PC = PT
Therefore
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TLC

= - VOLC

d PC

d PT

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Procedure

First mouthpiece valve is closed when the patient is sitting inside

the sealed chamber

Now the patient is asked to make breathing motions

The change in pressure reading in the pressure gauge 1 is noted
down, this gives dPT

The change in pressure reading in the pressure gauge 1 is noted

down, this gives dPC
Thus knowing the value of VOLC, the TLC can be calculated using

the formula,
TLC
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VOLC

d PC
d PT

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Blood Pressure
Blood pressure (BP) is a force exerted by circulating blood on the walls

of blood vessels
The term blood pressure usually refers to the pressure measured at a
person's upper arm.
For each heartbeat, BP varies between systolic and diastolic pressures.
Systolic pressure is peak pressure in the arteries, which occurs near the end
of the cardiac cycle when the ventricles are contracting.
Diastolic pressure is minimum pressure in the arteries, which occurs near

the beginning of the cardiac cycle when the ventricles are filled with blood.
A person's BP is usually expressed in terms of the systolic pressure and
diastolic pressure, for example 120/80 millimetres of mercury (mmHG)
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Measurement
Noninvasive measurement
Palpation method
Auscultatory method
Oscillometric method
White-coat hypertension
Home monitoring
Invasive measurement
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Auscultatory method

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Uses a stethoscope and a sphygmomanometer

Comprises an inflatable (Riva-Rocci) cuff placed around the upper armat roughly the
same vertical height as the heart, attached to a mercury or aneroid manometer

The mercury manometer measures the height of a column of mercury giving an

absolute result

A cuff of appropriate size is fitted smoothly and snugly, then inflated manually by

repeatedly squeezing a rubber bulb until the artery is completely occluded.

Listening with the stethoscope to the brachial artery at the elbow, the examiner
slowly releases the pressure in the cuff

When blood just starts to flow in the artery, the turbulent flow creates a "whooshing"

or pounding (first Korotkoff sound).

The pressure at which this sound is first heard is the systolic BP.

The cuff pressure is further released until no sound can be heard (fifth Korotkoff
sound), at the diastolic arterial pressure.

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Auscultatory method aneroid sphygmomanometer with stethoscope

Mercury manometer

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Invasive measurement
Arterial blood pressure (BP) is most accurately measured invasively

through an arterial line.

Involves direct measurement of arterial pressure by placing a cannula
needle in an artery (usually radial, femoral,dorsalis pedis or brachial)
The cannula must be connected to a sterile, fluid-filled system, which is
connected to an electronic pressure transducer
The advantage of this system is that pressure is constantly monitored beatby-beat, and a waveform (a graph of pressure against time) can be

displayed
Regularly employed in human and veterinary intensive care
medicine, anesthesiology, and for research purposes
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Classification of blood pressure for adults

Category

systolic, mmHg

Hypotension

< 90

< 60

Normal

90 120

and 60 80

Prehypertension

121 139

or 81 89

Stage 1 Hypertension

140 159

or 90 99

Stage 2 Hypertension

160

or 100

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diastolic, mmHg

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Heart sounds

The heart sounds are the noises (sound) generated by the beatingheart and the
resultant flow of blood through it.

In healthy adults, there are two normal heart sounds often described as a lub and
a dub (or dup), that occur in sequence with each heart beat. These are produced by
the closing of the AV valves and semilunar valves respectively

In addition to these normal sounds, a variety of other sounds may be present

including heart murmurs,adventitious sounds, and gallop rhythms

Heart murmurs are generated by turbulent flow of blood, which may occur inside or
outside the heart.

Abnormal murmurs can be caused by stenosis restricting the opening of a heart

valve, resulting in turbulence as blood flows through it.

Abnormal murmurs may also occur with valvular insufficiency which allows
backflow of blood when the incompetent valve closes with only partial effectiveness

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