Is the Origin of Korotkoff Sounds Rooted in the Resonance of the Arterial Wall?

In summary: BP.In summary, the "official" thinking today about the origin of Korotkoff sounds is that they are caused by a stretched arterial wall acting as a resonant system. There have been critiques of this hypothesis, but it is still considered to be the prevailing theory.
  • #1
Swamp Thing
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What is the "official" thinking today about the origin of Korotkoff sounds?

Has this 2015 paper found general acceptance?
https://www.sciencedirect.com/science/article/pii/S1933171115007068

The idea IIUC is that the stretched arterial wall acts as a resonant system, and what we hear are transient excitations of this resonator.

Have there been critiques of this hypothesis?
 
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  • #3
jim mcnamara said:
Um, why is this of interest....?
It might be related to their recent thread asking about taking BP measurements:

Swamp Thing said:
Is it ok to gently squeeze the bulb just after crossing the systolic or diastolic threshold, just to make sure of the exact value?
 
  • #4
Oooh. Not a good assumption. BP mensuration results are a snapshot of a changing system. It is not a fixed unchanging declaration of a static system, more like a sample.

Its is a hydrostatic pressure measurement at a moment in time:
From the text above:
The pressure in a liquid at a given depth is called the hydrostatic pressure. This can be calculated using the hydrostatic equation: P = rho * g * d, where P is the pressure, rho is the density of the liquid, g is gravity (9.8 m/s^2) and d is the depth (or height) of the liquid.

During measurement if the patient raises an arm it changes the result. Changes in hormone levels like cortisol can really mess up readings - e.g., a kid getting a BP who is petrified of the whole process. So the result is not necessarily indicative of other pathologies. Clinicians know this and have to deal with the uncertainty - maybe by getting a series of readings or giving the kid a lollipop. Or treating the result as a sample of a population of these readings, and have, through experience, generated a working idea of true outliers caused by medical problems. And otherwise just go with the result as frightened kid "normal"
 
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What are Korotkoff sounds and when are they heard?

Korotkoff sounds are the sounds that a medical professional listens for when they are taking a blood pressure reading using a sphygmomanometer (blood pressure cuff) and a stethoscope. These sounds are heard when the cuff is slowly deflated. They start when the blood begins to flow back into the artery as the pressure in the cuff is released, which is known as the systolic blood pressure, and they disappear when the cuff pressure fully releases, indicating the diastolic blood pressure.

What is the origin of Korotkoff sounds?

The origin of Korotkoff sounds is generally attributed to the complex dynamics of blood flow near the partially occluded site of the artery under the cuff. As the cuff pressure is lowered, blood starts to flow through the compressed artery, causing vibrations in the arterial wall and turbulent blood flow. These vibrations and turbulent flows are what produce the audible Korotkoff sounds.

Is the resonance of the arterial wall responsible for Korotkoff sounds?

While the resonance of the arterial wall contributes to the characteristics of Korotkoff sounds, it is not the sole cause. The primary mechanism involves the turbulent flow of blood as it passes through the constricted section of the artery and the resulting vibrations in the artery wall. The resonance may amplify these sounds, but the initial generation of these sounds is more directly related to blood flow dynamics and arterial wall movements.

How does the resonance of the arterial wall affect the measurement of blood pressure?

The resonance of the arterial wall can potentially affect the clarity and quality of the Korotkoff sounds, thereby influencing the accuracy of the blood pressure measurement. If the resonance significantly amplifies or dampens the sounds, it might lead to misinterpretation of when the sounds start and stop, which are critical for determining systolic and diastolic pressures. However, this effect is typically minor compared to other factors like cuff size and placement, and the technique of the observer.

Are there any new technologies that improve the detection or interpretation of Korotkoff sounds?

Yes, there have been advancements in technology aimed at improving the detection and interpretation of Korotkoff sounds. Digital stethoscopes and automated blood pressure monitors use advanced signal processing technologies to enhance the detection of these sounds and reduce human error in interpretation. These devices can provide more consistent and reliable blood pressure readings, and some are capable of filtering out ambient noise, which further improves accuracy.

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