Digital Pulsewave Analysis (DPA)

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Cardiovascular disease is the leading cause of death is the U.S. Loads of resources have been poured into figuring out the root causes and what we need to do in order to prevent it.

Revolution Health & Wellness Clinic focuses on a preventive approach to your health and we seek tests that help us better evaluate your physiology so that we can make accurate assessments of your risks. Early identification of cardiovascular disease is critical. The earlier we are able to identify a problem the earlier we are able to intervene.

It is always easier to treat a mole hill than it is a mountain!

In order to try to decrease the risk of cardiovascular disease each patient needs to have a thorough and comprehensive historical and comprehensive historical and physiologic assessment.

Some of the known risk factors for cardiovascular disease are:

  • Hyperlipidemia
  • High blood pressure
  • Smoking
  • Diabetes
  • Endothelial Dysfunction

And there are more. We want to make sure that we are as thorough as possible in evaluating each patient’s risk for cardiovascular disease.

Enter the DPA…

The DPA is one such test that provides valuable data about the health of your arteries.[1] The DPA uses infrared light sent to the fingertip and obtains pulse wave information with the light absorbing characteristics of Hemoglobin (the HbO2 of arterial blood). The medical terminology for this measurement method is Plethysmogram (PTG).

The DPA is absolutely painless and takes less than 5 minutes to perform. We perform this test while you are ‘resting’ in preparation for having your blood pressure checked in accordance with JNC-VII guidelines. Our DPA device is FDA cleared and simple to perform. The finger probe evaluates the changes in pressure, velocity, blood flow, and profile through the duration of the entire pulse wave.

Aging and disease states associated with an increase in cardiovascular events alter the physical characteristics of blood vessel walls and impair the pulsatile function of arteries.

The pulsatile flow is defined as that portion of the cardiac cycle controlled by the Autonomic Nervous System which is the part of the nervous system that does not require the brain’s involvement in order to function.

Impaired pulsatile function of arteries provides important predictive and therapeutic information beyond that provided by traditional blood pressure measurements.

Accelerated Plethysmogram (APG) Waveform – The second derivative of PTG – an excellent method to evaluate the biological age of arteries.

In short, the DPA measures the overall health of the arteries. It doesn’t tell you if you have plaques in your arteries but it can help us determine your overall risk for developing them.

So, what is this pulse wave?

As the heart beats, pressure and flow pulse waves travel away from the heart and are reflected back toward the heart from various locations in the arterial system. Arterial stiffness occurs at varying rates in different people.

A study of 3,075 older, healthy patients revealed a 3 fold increased risk of death due to cardiovascular disease in those patients with the highest pulse wave velocity (NIH/NIA/USDHHS).

It is becoming more apparent that changes in the aging circulatory system, even those without outward symptoms, precede and predict a higher risk of developing cardiovascular diseases.

The photoplethysmograph detects the volume of blood in or through a tissue by using an optical detector.

The arterial pulse waveform results from the ejection of blood from the left ventricle and moves with a velocity that is much greater that the velocity of the flow of the blood itself. The stiffer the arteries the quicker the blood and waveform pass along.

The timing of the wave reflections is how we can non-invasively measure arterial stiffness. Epidemiological studies using these measures have determined that high aortic pulse wave velocity (aPWV) is an independent predictor of arterial stiffness and cardiovascular disease and death.

What does my ‘waveform’ mean?

There are 7 different waveforms which help ‘grade’ the overall health of your arteries.

Type 1

DPA Level 1 Waveform Tulsa Revolution Cardiovascular Health

The ‘Type 1’ waveform is optimal and indicates excellent arterial wall compliance and elasticity. This waveform is our goal.

Type 2

DPA Type 2 waveform

The ‘Type 2’ waveform shows that blood circulation and artery state is good but a slight buildup is beginning to occur. There are a number of factors that can cause the waveform to deteriorate from a Type 1 to a Type 2 waveform. We may consider instituting therapy at this point.

 

Type 3 & 4

DPA Type 3 Type 4 waveforms

The ‘Type 3’ and ‘Type 4’ waveforms differ in the amplitude of the upward deflection at the bottom of the graph. In patients with these waveforms, blood circulation and artery state is becoming poor and buildup is starting. We will most certainly begin therapy in patients with these types of waveforms.

 

Type 5

DPA Level 5 waveform

The ‘Type 5’ waveform shows that blood circulation and artery state is bad and buildup is increasing. We will begin to fairly aggressive with these patients in order to maximize cardiovascular function as well as decrease cardiovascular disease risk.

Type 6 & 7

DPA Level 6 Level 7 waveforms

The ‘Type 6’ and ‘Type 7’ waveforms show that the blood circulation and artery state is very bad and buildup is becoming serious!

 

 

 

Treatment (What to do about it):

The key to improvement of arterial function is improving endothelial function.

  • Vitamin C & E – there is some evidence that they may improve endothelial function.
  • Omega Health – ensure an Omega-3 Index is above 8%. We measure this on all of our patients in their blood labs.
  • B Vitamins
  • Exercise
  • Proper nutrition
  • L-Arginine – L-Arginine helps stimulate the production of Nitric Oxide. Our preferred source of L-arginine is one of 2 supplements: Giddy’up and N.O. Max. N.O. Max is also in Mitochondrial Revolution.

 

 

 

 

References:

  1. http://www.ncbi.nlm.nih.gov/pubmed/18034848
  2. http://en.wikipedia.org/wiki/Endothelial_dysfunction
  3. http://circ.ahajournals.org/content/108/9/1059.full
  4. http://care.diabetesjournals.org/content/32/suppl_2/S314.full
  5. http://circ.ahajournals.org/content/109/23_suppl_1/III-27.full