Pulse wave analysis.

PULSE WAVE ANALYSIS IN HISTORICAL TIMES: Interpretation of the arterial pulse has been an important part of the medical examination from ancient times. Graphic methods for clinical pulse wave recording were introduced by Marey in Paris and by Mahomed in London last century. Mahomed showed how such recordings could be used to detect asymptomatic hypertension, and used them to chart the natural history of essential hypertension and to distinguish between this condition and chronic nephritis. Interest in arterial pulse analysis, as applied by Mahomed, lapsed with the introduction of the cuff sphygmomanometer 100 years ago. MODERN PULSE WAVE ANALYSIS: Analysis of the arterial pulse is now regaining favour as limitations of the cuff sphygmomanometer are better recognized (including the ability only to measure extremes of the pulse in the brachial artery). In addition, high-fidelity tonometers have been introduced for very accurate, non-invasive measurement of arterial pulse contour, and there is now a better understanding of arterial hemodynamics, and appreciation of disease and aging effects in humans. It is now possible to record the pulse wave accurately in the radial or carotid artery, to synthesize the ascending aortic pulse waveform, to identify systolic and diastolic periods and to generate indices of ventricular-vascular interaction previously only possible with invasive arterial catheterization. Pressure pulse wave analysis now permits more accurate diagnosis and more logical therapy than was ever possible in the past.

Pressure wave propagation in a multibranched model of the human upper limb.

The influence of the large arteries and the peripheral load on pressure wave propagation in the human upper limb was investigated in an anatomically realistic multibranched model based on linear transmission theory. To mimic vascular changes seen in life, the viscoelastic properties of large arteries and the peripheral load properties (represented as modified windkessels) were altered as follows: Young's modulus (from 10.9 x 10(6) to 15.3 x 10(6) dyn/cm2) and phase (from 0 to 15 degrees) of the complex elastance, windkessel time constant (from 0 to 0.6 s), and peripheral reflection coefficient (from 0 to 0.95). The relationship between the central aortic and peripheral radial pressure waveforms was analyzed in the time and the frequency domain. Results indicate that the large arterial properties have less influence (peak systolic pressure changed by 3% and peak of transfer function changed by 29%) than the properties of the peripheral load (systolic pressure changed by 14% and peak of transfer function changed by 74%) on the pressure wave propagation in the upper limb.

Functional origin of reflected pressure waves in a multibranched model of the human arterial system.

The effects of wave travel and wave reflection were simulated in a mathematical model of the whole arterial tree consisting of 142 uniform transmission line segments. The arterial model was partitioned into three separate segments: upper limbs, trunk, and lower limbs. Aging was simulated by increasing average pulse wave velocities of these segments (10.9-12.9, 8.0-11.7, and 9.0-11.3 m/s for upper limbs, trunk, and lower limbs, respectively). Reflection coefficients at the terminal elements were altered to simulate vasodilation (0.0) and vasoconstriction (0.95). The impedance patterns and spatial distribution of pressure waveforms generated by the model simulating aging and vasoconstriction were similar to in vivo measurements by other investigators. Reflected pressure waves from each segment reached the ascending aorta and contributed differently to the late systolic peak on the aortic pressure wave. Aging does not alter the origin of these reflected pressure waves in the trunk. Aortic impedance and pressure wave changes induced by simulation of dilation of splanchnic bed were similar to those observed experimentally with nitroglycerin.

Interaction of depression and bereavement on mental health in the elderly.

Three hundred ninety-three elderly adults aged 55 and older were divided into 1 of 9 subgroups in a 3 (bereavement group: survivors of spouses who died by natural death or by suicide and nonbereaved control Ss) x 3 (depression group: none, mild, and moderate-severe) design over 4 times of measurement--1 month, 6 months, 1 year, and 2.5 years after death of spouse. Significant Bereavement x Depression Group effects were obtained on Brief Symptom Inventory scores. The moderate-severe depression/suicide subgroup had the greatest psychiatric complications with bereavement. Results indicated that elderly persons with significant clinical depression at the time of a spouse's death were at significant risk for psychological complications during the bereavement process, and survivors of spouses who had committed suicide were even more at risk within the greatest depression group.

Effectiveness of psychotherapy for both endogenous and nonendogenous depression in older adult outpatients.

This study explored the effectiveness of brief psychotherapies for treatment of elderly depressed outpatients. All were in a current episode of major depressive disorder, but half the sample (n = 15) presented with endogenous symptomatology as well. Patients were assigned to either behavioral, cognitive, or insight-oriented psychotherapy for 16 sessions over a 12-week period. Evaluation occurred before and after therapy, and at four times during a 1-year follow-up interval. Nonendogenous patients responded more favorably to psychotherapy; this differential effect persisted throughout follow-up. Significant improvement, however, was made by some endogenous patients. One-third were not depressed by termination of therapy, and seven others were notably improved. Eight of 15 had not relapsed at 1-year follow-up.

Effects of bereavement on indicators of mental health in elderly widows and widowers.

The effects of bereavement on self-report measures of psychological distress were evaluated in widows and widowers at approximately 2 months after the death of a spouse. These data represent the first time of measurement in an ongoing longitudinal study of conjugal bereavement in elders. Responses of 95 male and 104 female elderly bereaved on measures of grief, depression, global severity of psychological distress, and general mental health functioning were compared with those of 79 male and female elderly individuals who were not currently suffering from the loss of a spouse. In general, means for the bereaved group were not in ranges consistent with the presence of serious psychopathology. Women in both groups reported greater distress than men, and significant sex-by-bereavement-status interactions on mental health measures were not observed.

Psychosocial factors affecting adaptation to bereavement in the elderly.

A spouse's death requires more readjustment on the part of the bereaved than any other stressful life event. This finding holds across the many age groups and cultural backgrounds that have been studied. Although it is unclear as to whether the stress of bereavement is greater for women than for men, for the young than for the old, for one socioeconomic level or for another, a critical review of the literatures suggests the following: 1) Negative changes in physical health, mortality rate and mental health status usually accompany widowhood; 2) Complex social-psychological variables such as the individual's characteristic ways of coping with stress (coping strength), the adequacy of the social network - plus other factors such as income and religious commitment - may attenuate widowhood's negative impact. Suggestions for further research include studies exploring differential adaptation to widowhood across age groups and in elderly men and women, and longitudinal studies tracing the process of recovery from acute grief.