(Hypertension. 1995;26:2-9.)
© 1995 American Heart Association, Inc.
Articles |
Mechanical Principles in Arterial Disease
From the University of New South Wales, St Vincent's Hospital, Sydney, New South Wales, Australia.
Correspondence to Michael O'Rourke, MD, University of New South Wales, St Vincent's Hospital, Victoria St, Darlinghurst, New South Wales 2010, Australia.
Key Words: arteriosclerosis • compliance • atherosclerosis • wave reflection
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Introduction |
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Arterial disease and degeneration are the major causes of cardiovascular death and disability, including myocardial and cerebral infarction, cerebral hemorrhage, and hypertensive left ventricular failure. Recent research has concentrated on chemical and molecular mechanisms: on thrombogenesis and thrombolysis, vasoactive chemicals produced by endothelial cells, and the chemical control of cardiac and vascular remodeling. There has been far less concern with details of physical factors and their relevance to atherogenesis, plaque rupture, aortic medial degeneration, and altered left ventricular hydraulic load. This is a serious anomaly, since the functions of the heart and arteries are mechanical rather than chemical: those of the heart is to contract and to generate flow; those of the arteries is to transmit blood and to cushion pulsations. Their diseases and resultant complications are mechanical as well, comprising arterial obstruction, arterial rupture, and failure of the heart as a mechanical pump. A logical approach to therapy requires consideration of mechanics and physical principles in sufficient detail to explain observed phenomena. Such an approach to arterial disease is not the role of the surgeon alone but should be taken by contemporary internists, cardiologists, and specialists in hypertensive disease. Practicing physicians need to look beyond simplistic mechanical notions and beyond simple instruments such as the cuff sphygmomanometer, which still dominates clinical practice as it has for the past 100 years. It is appropriate that they consider those recent advances in mechanical science that are as important and as far-reaching as those in chemical and molecular science but that have
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