This in vitro model elucidates the fluid dynamics of Korotkoff sound generation, demonstrating how a steep wave front forms in a fully collapsed compliant tube.
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Elucidates wave dynamics underlying Korotkoff sounds; leaves open in vivo validation for blood pressure measurement accuracy.
In order to model the fluid dynamics of Korotkoff sound generation when the artery under the cuff is fully collapsed during most of the heart cycle, the characteristics of pressure-wave propagation in a long silicone-rubber tube were studied experimentally. The central portion of this tube was designed to collapse to zero cross-sectional area as a result of high negative transmural pressure, thus simulating a collapsed artery. Propagation of a single half-sinusoidal pressure wave in and around this segment was studied in detail by pressure, velocity and tube-longitudinal-shape measurements. A very steep wave front (shock wave) capable of producing a short tapping sound was formed by an overtaking phenomenon in the fully collapsed tube segment and it propagated into the inflated tube distal to the collapsed segment. An empirical equation relating the flow rate penetrating into the collapsed segment, the incident-wave pressure and the external pressure P c over the collapsed segment was obtained. This equation predicts that the pressure-wave propagation in a fully collapsed segment depends only on the flow rate into the collapsed segment. The initial internal pressure of the tube distal to the collapsed segment P d is one independent variable in the high-cuff-pressure condition. The amplitude of the steep wave front and the shape of the pressure wave in the inflated tube distal to the collapsed segment are governed by P c – P d and the flow rate penetrating the collapsed segment. For the same flow rate, if P c – P d is lower than a critical value, the amplitude of the pressure in the distal tube decreases with increasing P d because of positive pressure-wave reflection at the exit of the collapsed segment. On the other had, if P c – P d is higher than that value, no wave reflection occurs and the amplitude of the pressure wave is independent of P d . In the latter case a severe constriction exists near the distal end of the collapsed segment, and flow occurs as two thin high-speed jets.
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Masashi Shimizu (1985) studied this question.
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