Plethysmography System to Monitor the Jugular Venous Pulse: A Feasibility Study

Cerebral venous outflow is investigated in the diagnosis of heart failure through the monitoring of jugular venous pulse, an indicator to assess cardiovascular diseases. The jugular venous pulse is a weak signal stemming from the lying internal jugular vein and often invasive methodologies requiring surgery are mandatory to detect it. Jugular venous pulse can also be extrapolated via the ultrasound technique, but it requires a qualified healthcare operator to perform the examination. In this work, a wireless, user-friendly, wearable device for plethysmography is developed to investigate the possibility of monitoring the jugular venous pulse non-invasively. The proposed device can monitor the jugular venous pulse and the electrocardiogram synchronously. To study the feasibility of using the proposed device to detect physiological variables, several measurements were carried out on healthy subjects by considering three different postures: supine, sitting, and upright. Data acquired in the experiment were properly filtered to highlight the cardiac oscillation and remove the breathing contribution, which causes a considerable shift in the amplitude of signals. To evaluate the proper functioning of the wearable device for plethysmography, a comparison with the ultrasound technique was carried out. As a satisfactory result, the acquired signals resemble the typical jugular venous pulse waveforms found in literature.

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Coupling between arterial and venous cerebral blood flow during postural change

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00325.2016 ◽

2016 ◽

Vol 311 (6) ◽

pp. R1255-R1261 ◽

Cited By ~ 9

Author(s):

Shigehiko Ogoh ◽

Takuro Washio ◽

Hiroyuki Sasaki ◽

Lonnie G. Petersen ◽

Niels H. Secher ◽

...

Keyword(s):

Blood Flow ◽

Healthy Subjects ◽

Internal Carotid ◽

Jugular Vein ◽

Venous Drainage ◽

Postural Change ◽

Venous Outflow ◽

Venous Flow ◽

End Tidal ◽

The Brain

In supine humans the main drainage from the brain is through the internal jugular vein (IJV), but the vertebral veins (VV) become important during orthostatic stress because the IJV is partially collapsed. To identify the effect of this shift in venous drainage from the brain on the cerebral circulation, this study addressed both arterial and venous flow responses in the “anterior” and “posterior” parts of the brain when nine healthy subjects (5 men) were seated and flow was manipulated by hyperventilation and inhalation of 6% carbon dioxide (CO2). From a supine to a seated position, both internal carotid artery (ICA) and IJV blood flow decreased ( P = 0.004 and P = 0.002), while vertebral artery (VA) flow did not change ( P = 0.348) and VV flow increased ( P = 0.024). In both supine and seated positions the ICA response to manipulation of end-tidal CO2 tension was reflected in IJV ( r = 0.645 and r = 0.790, P < 0.001) and VV blood flow ( r = 0.771 and r = 0.828, P < 0.001). When seated, the decrease in ICA blood flow did not affect venous outflow, but the decrease in IJV blood flow was associated with the increase in VV blood flow ( r = 0.479, P = 0.044). In addition, the increase in VV blood flow when seated was reflected in VA blood flow ( r = 0.649, P = 0.004), and the two flows were coupled during manipulation of the end-tidal CO2 tension (supine, r = 0.551, P = 0.004; seated, r = 0.612, P < 0001). These results support that VV compensates for the reduction in IJV blood flow when seated and that VV may influence VA blood flow.

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Assessing Acute Decompensated Heart Failure – Strategies and Tools

European Cardiology Review ◽

10.15420/ecr.2012.8.2.128 ◽

2012 ◽

Vol 8 (2) ◽

pp. 128

Author(s):

Ali Vazir ◽

Martin R Cowie ◽

◽

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Pulse Contour Analysis ◽

Decompensated Heart Failure ◽

Rapid Onset ◽

Clinical Syndrome ◽

Response To Therapy ◽

Contour Analysis ◽

Physiological Variables ◽

Co Morbidity

Acute heart failure – the rapid onset of, or change in, signs and/or symptoms of heart failure requiring urgent treatment – is a serious clinical syndrome, associated with high mortality and healthcare costs. History, physical examination and early 2D and Doppler echocardiography are crucial to the proper assessment of patients, and will help determine the appropriate monitoring and management strategy. Most patients are elderly and have considerable co-morbidity. Clinical assessment is key to monitoring progress, but a number of clinical techniques – including simple Doppler and echocardiographic tools, pulse contour analysis and impedance cardiography – can help assess the response to therapy. A pulmonary artery catheter is not a routine monitoring tool, but can be very useful in patients with complex physiology, in those who fail to respond to therapy as would be anticipated, or in those being considered for mechanical intervention. As yet, the serial measurement of plasma natriuretic peptides is of limited value, but it does have a role in diagnosis and prognostication. Increasingly, the remote monitoring of physiological variables by completely implanted devices is possible, but the place of such technology in clinical practice is yet to be clearly established.

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Remote monitoring of patients with heart failure during the first national lockdown for COVID-19 in France

European Heart Journal - Digital Health ◽

10.1093/ehjdh/ztab044 ◽

2021 ◽

Author(s):

Sylvain Ploux ◽

Marc Strik ◽

Saer Abu-Alrub ◽

F Daniel Ramirez ◽

Samuel Buliard ◽

...

Keyword(s):

Heart Failure ◽

Health Care ◽

Heart Rate ◽

Remote Monitoring ◽

Marked Decrease ◽

Clinical Status ◽

Health Care Use ◽

Physiological Variables ◽

Patients With Heart Failure ◽

Vital Parameters

Abstract Background Multiparametric remote monitoring of patients with heart failure (HF) has the potential to mitigate the health risks of lockdowns for COVID-19. Aims To compare health care use, physiological variables, and HF decompensations during one month before and during the first month of the first French national lockdown for COVID-19 among patients undergoing remote monitoring. Methods Transmitted vital parameters and data from cardiac implantable electronic devices were analyzed in 51 patients. Medical contact was defined as the sum of visits and days of hospitalization. Results The lockdown was associated with a marked decrease in cardiology medical contact (118 days before vs 26 days during, -77%, p = 0.003) and overall medical contact (180 days before vs 79 days during, -58%, p = 0.005). Patient adherence with remote monitoring was 84±21% before and 87±19% during lockdown. The lockdown was not associated with significant changes in various parameters, including physical activity (2±1 to 2±1 h/day), weight (83±16 to 83±16 kg), systolic blood pressure (121±19 to 121±18 mmHg), heart rate (68±10 to 67±10 bpm), heart rate variability (89±44 to 78±46 ms, p = 0.05), atrial fibrillation burden (84±146 vs 86±146 h/month), or thoracic impedance (66±8 to 66±9 Ω). Seven cases of HF decompensations were observed before lockdown, all but one of which required hospitalization, versus six during lockdown, all but one of which were managed remotely. Conclusions The lockdown restrictions caused a marked decrease in health care use but no significant change in the clinical status of HF patients under multiparametric remote monitoring. lay summary The first French COVID-19 lockdown had a huge detrimental impact on conventional health care use (-78% in cardiology medical contact). However the lockdown had little impact over the short-term, if any, on vital parameters and the clinical status of patients with heart failure who were adherent to multiparametric remote monitoring. This remote monitoring strategy allowed early identification and home management of most of the heart failure decompensations during the lockdown.

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Evaluation of renal and cardiovascular protection mechanisms of SGLT2 inhibitors: model-based analysis of clinical data

AJP Renal Physiology ◽

10.1152/ajprenal.00202.2018 ◽

2018 ◽

Vol 315 (5) ◽

pp. F1295-F1306 ◽

Cited By ~ 15

Author(s):

K. Melissa Hallow ◽

Peter J. Greasley ◽

Gabriel Helmlinger ◽

Lulu Chu ◽

Hiddo J. Heerspink ◽

...

Keyword(s):

Renal Impairment ◽

Clinical Data ◽

Healthy Subjects ◽

Interstitial Fluid ◽

Sglt2 Inhibitors ◽

Fluid Volume ◽

Diabetic Patients ◽

Pressure Reduction ◽

Physiological Variables ◽

Interstitial Fluid Volume

The mechanisms of cardiovascular and renal protection observed in clinical trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) are incompletely understood and likely multifactorial, including natriuretic, diuretic, and antihypertensive effects, glomerular pressure reduction, and lowering of plasma and interstitial fluid volume. To quantitatively evaluate the contribution of proposed SGLT2i mechanisms of action on changes in renal hemodynamics and volume status, we coupled a mathematical model of renal function and volume homeostasis with clinical data in healthy subjects administered 10 mg of dapagliflozin once daily. The minimum set of mechanisms necessary to reproduce observed clinical responses (urinary sodium and water excretion, serum creatinine and sodium) was determined, and important unobserved physiological variables (glomerular pressure, blood and interstitial fluid volume) were then simulated. We further simulated the response to SGLT2i in diabetic virtual patients with and without renal impairment. Multiple mechanisms were required to explain the observed response: 1) direct inhibition of sodium and glucose reabsorption through SGLT2, 2) SGLT2-driven inhibition of Na+/H+ exchanger 3 sodium reabsorption, and 3) osmotic diuresis coupled with peripheral sodium storage. The model also showed that the consequences of these mechanisms include lowering of glomerular pressure, reduction of blood and interstitial fluid volume, and mild blood pressure reduction, in agreement with clinical observations. The simulations suggest that these effects are more significant in diabetic patients than healthy subjects and that while glucose excretion may diminish with renal impairment, improvements in glomerular pressure and blood volume are not diminished at lower glomerular filtration rate, suggesting that cardiorenal benefits of SGLT2i may be sustained in renally impaired patients.

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Influential Factors in Remote Monitoring of Heart Failure Patients: A Review of the Literature and Direction for Future Research

Sensors ◽

10.3390/s21113575 ◽

2021 ◽

Vol 21 (11) ◽

pp. 3575

Author(s):

Sashini Senarath ◽

Geoff Fernie ◽

Atena Roshan Fekr

Keyword(s):

Heart Failure ◽

Remote Monitoring ◽

Influential Factors ◽

Future Research ◽

False Alarms ◽

Cardiac Events ◽

Readmission Rates ◽

Daily Monitoring ◽

Multiple Parameters ◽

Physiological Variables

With new advances in technology, remote monitoring of heart failure (HF) patients has become increasingly prevalent and has the potential to greatly enhance the outcome of care. Many studies have focused on implementing systems for the management of HF by analyzing physiological signals for the early detection of HF decompensation. This paper reviews recent literature exploring significant physiological variables, compares their reliability in predicting HF-related events, and examines the findings according to the monitored variables used such as body weight, bio-impedance, blood pressure, heart rate, and respiration rate. The reviewed studies identified correlations between the monitored variables and the number of alarms, HF-related events, and/or readmission rates. It was observed that the most promising results came from studies that used a combination of multiple parameters, compared to using an individual variable. The main challenges discussed include inaccurate data collection leading to contradictory outcomes from different studies, compliance with daily monitoring, and consideration of additional factors such as physical activity and diet. The findings demonstrate the need for a shared remote monitoring platform which can lead to a significant reduction of false alarms and help in collecting reliable data from the patients for clinical use especially for the prevention of cardiac events.

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Optical Flow Analysis of Left Ventricle Wall Motion with Real-Time Cardiac Magnetic Resonance Imaging in Healthy Subjects and Heart Failure Patients

Annals of Biomedical Engineering ◽

10.1007/s10439-022-02907-2 ◽

2022 ◽

Author(s):

Yu Y. Li ◽

Jason Craft ◽

Yang Cheng ◽

William Schapiro ◽

Kathleen Gliganic ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Heart Failure ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Left Ventricle ◽

Healthy Subjects ◽

Wall Motion ◽

Flow Analysis ◽

Resonance Imaging ◽

Heart Failure Patients

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Internal Jugular Vein Cross-Sectional Area and Cerebrospinal Fluid Pulsatility in the Aqueduct of Sylvius: A Comparative Study between Healthy Subjects and Multiple Sclerosis Patients

PLoS ONE ◽

10.1371/journal.pone.0153960 ◽

2016 ◽

Vol 11 (5) ◽

pp. e0153960 ◽

Cited By ~ 9

Author(s):

Clive B. Beggs ◽

Christopher Magnano ◽

Pavel Belov ◽

Jacqueline Krawiecki ◽

Deepa P. Ramasamy ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Comparative Study ◽

Internal Jugular Vein ◽

Healthy Subjects ◽

Jugular Vein ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Multiple Sclerosis Patients

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Excess fluid volume: clinical validation in patients with decompensated heart failure

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692011000300013 ◽

2011 ◽

Vol 19 (3) ◽

pp. 540-547 ◽

Cited By ~ 9

Author(s):

Quenia Camille Soares Martins ◽

Graziella Badin Aliti ◽

Joelza Chisté Linhares ◽

Eneida Rejane Rabelo

Keyword(s):

Heart Failure ◽

Jugular Vein ◽

Venous Pressure ◽

Decompensated Heart Failure ◽

Cross Sectional Study ◽

Fluid Volume ◽

University Hospital ◽

Central Venous ◽

Cross Sectional ◽

Nursing Diagnosis

This cross-sectional study aimed to clinically validate the defining characteristics of the Nursing Diagnosis Excess Fluid Volume in patients with decompensated heart failure. The validation model used follows the model of Fehring. The subjects were 32 patients at a university hospital in Rio Grande do Sul. The average age was 60.5 ± 14.3 years old. The defining characteristics with higher reliability index (R): R ≥ 0.80 were: dyspnea, orthopnea, edema, positive hepatojugular reflex, paroxysmal nocturnal dyspnea, pulmonary congestion and elevated central venous pressure, and minor or secondary, R> 0.50 to 0.79: weight gain, hepatomegaly, jugular vein distention, crackles, oliguria, decreased hematocrit and hemoglobin. This study indicates that the defining characteristics with R> 0.50 and 1 were validated for the diagnosis Excess Fluid Volume.

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