Cardiovascular

Biomechanics
Taken from College Note of Z. Mardina, S.T, M.Sc (IULI)

Alfian Pramudita Putra

BIOMEDICAL ENGINEERING
FACULTY OF SCIENCE AND TECHNOLOGY
UNIVERSITAS AIRLANGGA
 Knowledge of the biomechanics of
the heart is useful for :

Understanding the causes and

consequences of cardiac diseases
Evaluate cardiac function
Creating the diagnostic and
therapeutic tools for various heart
problems 18/12/20
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The Application

 Angiography

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 The Application
• Cardiac Ultrasound

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Pacemaker, Prosthetics Valve, Vascular Graft, and Stent

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Trans-Esophageal Echocardiogram
Catheter inserted through esophagus. The end tip of
the catheter is attached to an ultrasound transducer

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The Systemic Circulation

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Cardiac Function

 Observed from the left ventricle, as the main pump

 Ability to pump : Depends on myocardial contraction,
valve condition, ventricular size and shape, and loading
condition
 When left ventricle is unable to meet the requirement
-> heart failure

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Cardiac Function

Some Parameters for Determining Cardiac

Function
1. Ventricular Pressure-Volume Relationship

2. Stroke Volume & Ejection Fraction

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Ventricular Pressure-Volume Relationship
Ejection Mechanism
Mitral Blood Filling Followed By
Leads to Mitral Valve
Valve of Left
Close
Open Ventricle

Left Leads to
Ventricular Followed By
P LV > P Leads to Iso-Volumic
Myocardial
Aorta Contraction
Contraction
Leads to
Opening Leads to Followed By Closing of End of
Blood
of Aorta Aorta
Ejection Systole
Valve Valve
Iso-
Volumic Decrease
Relaxation Pressure of LV
Ventricular Pressure-Volume Relationship

Filling Mechanism
Filling of
P of LV fall Mitral valve
blood from
below LA opens
LA to LV

Contraction
Mitral
of LA to
Valve empty the
Close blood
End of
Diastole

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Ventricular Pressure-Volume Relationship

Summary of Ejection-Filling
Mechanism
Ventricular Pressure-Volume Relationship
Ventricular Pressure-Volume Relationship

 EDV : volume of blood in the right and/or left

ventricle at end load or filling in (diastole) or the
amount of blood in the ventricles just before ejection
(systole)
 ESV : volume of blood left in the ventricle for a given
aortic blood pressure-> more aortic pressure, less
blood will be able to escape the ventricle
 Both EDV and ESV influence Cardiac Output & Stroke
Volume

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Stroke Volume & Ejection Fraction

-Stroke Volume: represents how much blood the heart

pumps per beat
-Ejection fraction (EF) is often used to describe heart
function
-Normal EF = 50%-80%, below -> heart failure

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Ventricular Pressure-Volume Relationship

 Cardiac output is defined as the volume of blood a heart

pumps per minute.
 Why bother measuring stroke volume and cardiac output?
 Abnormal trend patterns in SV during exercise are proven
signs of cardiac function impairment (e.g. coronary artery
disease).
 CO is important in the diagnosis of pathologic conditions
such as hypertension
 Very unfortunately CO has so far been underused because
of the invasive, cumbersome and inaccurate nature of the
available measurement techniques. Their cost has also
been a limiting factor.
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Measuring Cardiac Function

 Non Invasive Devices:

 Echocardiography Allows for the calculation of LV
volumes and wall thicknesses.
 CT scans may give added resolution as compared to
echocardiography. However, they come with added
expense and radiation dose to the patient.
 MRIs can offer very detailed geometries of the LV, but
due to imaging times, as well as costs may not be the
best choice
A Multi Gated Acquisition Scan (MUGA), radioactive
tracer is injected into the blood stream and the LV is
imaged with a gamma camera that detects the gamma
particles emitted by the tracer
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 Measuring Cardiac Function

Some Parameters

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 Measuring Cardiac Function
 Swan-Ganz Catheter/Pulmonary artery catheter -> monitor
critically ill patient

Gives us information of :
1. Vascular capacity
2. Blood Volume
3. Pump Effectiveness
4. Tissue Perfusion

How much pressure that coming from the

body, and being pushed into the lung
 Measuring Cardiac Function
 Swan-Ganz Catheter/Pulmonary artery catheter -> monitor
critically ill patient

Never inflates the balloon > 1,5 ml of air, and never longer than 15
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Ventricular Pressure-Volume Relationship

 Stroke Volume is influenced by many other factors : Pre-

load, after-load and contractility
 Pre-load : it is the initial stretching of
the cardiomyocytes prior to contraction; therefore, it is
related to the sarcomere length at the end of diastole
 After load : the stress in the wall of the left
ventricle during ejection.
 Increased preload can cause serial addition of
sarcomeres, lengthening of myocytes and dilation of the
left ventricular wall, resulting in eccentric hypertrophy
 Increase afterload can be caused by systemic
hypertension or artery stenosis
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 Heart Valve

-Main task : Allow blood

flow and prevent
backflow
-The opening and closing
of the valves is
controlled by the relative
pressures between the
various compartments.
https://upload.wikimedia.org/wikipedia/commons/1
/12/CG_Heart.gif
 Bicuspid (Mitral)
 Tricuspid
 Pulmonary valve
 Aorta valve

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Common Biomechanics Problems with Heart Valve

 Stenosis : a heart valve that doesn’t open properly.

http://www.ultrasoundregistryreview.com/3AVstenosis.ht
ml

https://www.youtube.com/watch?v=3t1n5szXriQ
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 Common Biomechanics Problems
with Heart Valve
Degree of Stenosis

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Common Biomechanics Problems with Heart
Valve

 Regurgitation : Valve can not close properly

 https://medmovie.com/library_id/13727/topic/cvml
_0075a/

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HEMODYNAMIC
MONITORING
Sequence of Events During the Cardiac Cycle

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Important Parameters for Hemodynamic Monitoring

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 Important Parameters in Hemodynamic Monitoring

Relationship Among Parameters

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 Important Parameters in Hemodynamic Monitoring

Measurement of Cardiac Output

 MAP (Mean Arterial Pressure) : P Aorta

 CVP (Central Venous Pressure) : P Right Atrium
 CO (Cardiac Output) : Volume of blood pumped/minute
 SVR (Systemic Vascular Resistance) : Total resistance of blood vessels for the
systemic circulation

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 Important Parameters in Hemodynamic Monitoring
Measurement of Cardiac Output

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 Measurement of Cardiac Output
• Swan-Ganz Catheter/Pulmonary artery
catheter -> monitor critically ill patient
https://www.youtube.com/watch?time_continue=101&v=7putxZN7ij4

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Measurement of Cardiac Output
Components
• Swan-Ganz
:
Catheter/Pulmonary
-Monitored by Trans Esophageal
artery catheter
Echocardiography (TEE)
-Heparin coated catheter
-Syringe to fill 0.5 – 1.5 cc of air to
inflate the balloon
-Balloon : inflatable, deflate-able
(locking mechanism) -> was Similar to a
sailboat which is able to move even in
the slightest breeze
-Pressure transducer (also for tracking
https://rk.md/2017/pulmonar location by seeing transducer waveform)
y-artery-catheter-structure- if no TEE is used
waveforms/ -Thermistor (thermodilution method)
-Deflate the balloon when withdraw the
catheter
 Measurement of Cardiac Output

• Swan-Ganz Catheter/Pulmonary artery catheter

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 Measurement of Cardiac Output

• Swan-Ganz Catheter/Pulmonary artery catheter

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Measurement of Cardiac Output

• Doppler Cardiography

 CO = SV x HR
 HR is easily measured
 SV is determined by the volume of blood that goes
through valve in one cycle

-SV = sum of all the dVs during one stroke

-d is the diameter of the valve (determined by
echocardiography)
- v is the velocity of blood determined by use of Doppler
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echocardiography 19
 Important Parameters in Hemodynamic Monitoring

Cardiac Index

 Cardiac index (CI) : a hemodynamic measure that relates

the cardiac output (CO) to body surface area (BSA).
 Relates heart performance to the size of the individual

 The unit : (L/min/m2)

 The normal range of cardiac index (CI) at rest is 2.6-4.2
L/min per square meter.
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 Important Parameters in Hemodynamic Monitoring

Determinants of Stroke Volume

 Preload : Stretch of ventricular wall. Usually related

to volume. (how full is the tank?)
 Afterload : resistance the blood in the ventricle must
overcome to force the valves open and eject
contents to circulation.
 Contractility : How well does the ventricular walls
move? How good is the pump?

 Normal SV : 500-100 mL/beat

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