Invited review: aging and the cardiovascular system.

Aging is associated with complex and diversified changes of cardiovascular structure and function. The heart becomes slightly hypertrophic and hyporesponsive to sympathetic (but not parasympathetic) stimuli, so that the exercise-induced increases in heart rate and myocardial contractility are blunted in older hearts. The aorta and major elastic arteries become elongated and stiffer, with increased pulse wave velocity, evidence of endothelial dysfunction, and biochemical patterns resembling early atherosclerosis. The arterial baroreflex is sizably altered in aging, but different components are differentially affected: there is a definite impairment of arterial baroreceptor control of the heart but much better preserved baroreceptor control of peripheral vascular resistance. Alterations at the afferent, central neural, efferent, and effector organ portions of the reflex arch have been claimed to account for age-related baroreflex changes, but no conclusive evidence is available on this mechanistic aspect. Reflexes arising from cardiopulmonary vagal afferents are also blunted in aged individuals. The cardiovascular and reflex changes brought about by aging may have significant implications for circulatory homeostasis in health and disease.     

Chronophysiology of the cardiovascular system

The development of ambulatory blood pressure monitoring devices and the beat-by-beat measurement of heart rate have enabled it to be established that there are circadian rhythms in heart rate and blood pressure in subjects living normally. Investigations of these variables have led to quantification of their fall at night, and rapid rise on awakening and becoming active in the morning. These changes are of particular interest insofar as abnormalities in them are associated with cardiovascular problems and morbidity in patients and also act as risk factors in otherwise healthy individuals. It has also been shown that there are many other variables of the cardiovascular system. The causes of the circadian rhythms in heart rate and blood pressure are outlined, with particular stress upon the role of the autonomic nervous system, as assessed from low- and high-frequency components of the variation in heart rate measured beat-by-beat. Activity increases blood pressure, but there is evidence that this “reactivity” varies with time of day, and this also might be related to cardiovascular morbidity. Based upon data from several sources, including night work, resting subjects and bed-ridden patients, it is concluded that the contribution of the “body clock” to producing the circadian rhythm in heart rate and blood pressure is relatively small. A bias towards an exogenous cause applies also to most other circadian rhythms in the cardiovascular system. Knowledge of circadian rhythmicity in cardiovascular system, together with an understanding of its causes, provides a rationale for advice to reduce cardiovascular risk and to assess the efficacy of therapies.     

Melatonin and the cardiovascular system

Melatonin concentrations in serum, as well as urinary levels of its main metabolite, 6-sulphatoxymelatonin, decrease with age. In the course of aging, the frequency of heart diseases, both acute and chronic, systematically increases. The evidence from the last 10 years suggests that melatonin influences the cardiovascular system. The presence of vascular melatoninergic receptors/binding sites has been demonstrated; these receptors are functionally linked with vasoconstrictor or vasodilatory effects of melatonin. Melatonin can contribute in cardioprotection of the rat heart, following myocardial ischemia. It has been shown that patients with coronary heart disease have a low melatonin production rate, especially those with higher risk of cardiac infarction and/or sudden death. There are clinical data reporting some alterations of melatonin in human stroke and coronary heart disease. The suprachiasmatic nucleus and, possibly, the melatoninergic system may also modulate cardiovascular rhythmicity. Hypercholesterolemia and hypertension are the other age-related symptoms. People with high levels of LDL-cholesterol have low levels of melatonin. It has been shown that melatonin suppresses the formation of cholesterol by 38% and reduces LDL accumulation by 42%. A 10-20% reduction of cholesterol concentration in women using the B-oval pill has been observed. It is a very important because, even a 10-15% reduction in blood cholesterol concentration has bee shown to result in a 20 to 30% decrease in the risk of coronary heart disease. People with hypertension have lower melatonin levels than those with normal blood pressure. The administration of the hormone in question declines blood pressure to normal range. It has been observed that melatonin, even in a dose 1 mg, reduced blood pressure and decreased catecholamine level after 90 min in human subjects. Melatonin may reduce blood pressure via the following mechanisms: 1) by a direct effect on the hypothalamus; 2) as an antioxidant which lowers blood pressure; 3) by decreasing the level of catecholamines, or 4) by relaxing the smooth muscle in the aorta wall.     

Lysophospholipids and the cardiovascular system

The lysophospholipids sphingosine-1-phosphate (S1P) and lysophosphatidic acid (LPA) have varied effects on the cardiovascular system. S1P is necessary for normal vascular development and may play an important role in angiogenesis. These molecules may exert potentially detrimental effects. Both S1P and LPA are released from activated platelets and can in turn stimulate platelet aggregation. These thrombogenic effects would further enhance ischemia in acute coronary syndromes and myocardial infarction. LPA is a major component of the lipid core of human atherosclerotic plaques and can stimulate vascular smooth muscle proliferation. Both LPA and S1P cause cardiac myocyte hypertrophy in vitro. Beneficial effects include cardioprotection both in vitro and during ischemia/reperfusion in an ex vivo whole heart mouse model. Understanding both the acute and the chronic physiologic and pathophysiologic roles of the lysophospholipids and their cognate receptors and signaling pathways in the cardiovascular system, which are likely to be species-, tissue-, and cell-specific, may allow the development of molecules that can be targeted to stimulate or inhibit a specific function.     

Mechanical simulator of the cardiovascular system

To devise and to build a mechanical simulator of the cardiovascular system of increasing complexity is a fascinating experience for a medical Physicist. We did it, and the effort to match the solutions with the objectives forced us to deepen the knowledge of the physiological aspects, to devise different solutions and to compare their results. This paper describes the final solution and shows the results, discussing the theoretical and practical aspects of the different choices.The ventricle is simulated by a pumping syringe with an external pulsing chamber to accomplish the Frank–Starling mechanism; the coronary circulation by a nonlinear hydraulic resistance device; the aorta by different wall thickness rubber tubes; the arterial vascular resistance by a thin, variable length tube; the venous reservoir by a variable volume chamber connected to a reservoir simulating the atrium.The simulator was mainly devoted to teaching purposes, but the possibility to modify the mechanical characteristics of the single components moved it to be used also for research, with an unexpected satisfaction.     

Numerical simulation of the cardiovascular system

In this article, we aim at giving a non-technical overview of some mathematical models currently used in the numerical simulation of the cardiovascular system. A hierarchy of models for blood flows in large arteries is briefly described as well as an electromechanical model for the heart. We discuss some possible applications of the numerical simulations of such models, for example the optimization of prostheses. We also address the issue of the data assimilation for the calibration of the models.     

Structural modelling of the cardiovascular system

Computational modelling of the cardiovascular system offers much promise, but represents a truly interdisciplinary challenge, requiring knowledge of physiology, mechanics of materials, fluid dynamics and biochemistry. This paper aims to provide a summary of the recent advances in cardiovascular structural modelling, including the numerical methods, main constitutive models and modelling procedures developed to represent cardiovascular structures and pathologies across a broad range of length and timescales; serving as an accessible point of reference to newcomers to the field. The class of so-called hyperelastic materials provides the theoretical foundation for the modelling of how these materials deform under load, and so an overview of these models is provided; comparing classical to application-specific phenomenological models. The physiology is split into components and pathologies of the cardiovascular system and linked back to constitutive modelling developments, identifying current state of the art in modelling procedures from both clinical and engineering sources. Models which have originally been derived for one application and scale are shown to be used for an increasing range and for similar applications. The trend for such approaches is discussed in the context of increasing availability of high performance computing resources, where in some cases computer hardware can impact the choice of modelling approach used.     

On the theory of the cardiovascular system

Most theoretical studies of the circulation have focussed on the transmission line properties of arteries. Only a small number of papers have dealt with the circulation as a closed (lumped) system with two pumps connected by the lesser and greater circulation (Beneken, inCirculatory Analog Computers, No. Holland Publ. Co., Amsterdam, 1963; Defares,et al., inCirculatory Analog Computers, No. Holland Publ. Co., Amsterdam, 1963; Grodins,Quart. Rev. of Biology,34, 93, 1959; Guyton,Cardiac Output and its Regulation, Saunders Publ. Co., New York, 1963). F. W. Cope's recent studies in this journal (Bull. Math. Biophysics,22, 19, 1960;23, 337, 1961;24, 137, 1962) deal with essentially the same questions, although here the circuit is not “closed”. We have attempted to extend the analysis of the areflex (closed) circulation. The complete study is reported elsewhere (Defares,et al., Acta Physiol, et Parmac. Neerl., 1963).     

Simulation of the cardiovascular system using equivalent electronic system

This paper describes simulation of the cardiovascular system using a complex electronic circuit. In this study we have taken a slightly different approach to the modeling of the system and tried to advance existing electrical models by increasing more segments and parameters. The model consists of 42 segments representing the arterial system. Anatomical and physiological data for circuit parameters have been extracted from medical articles and textbooks. The frequency of heart is 1 Hz and the system operates in steady state condition. Each artery is modeled by one capacitor, resistor and inductor. The left and right ventricles are modeled using AC power suppliers and diodes. The results of the simulation including pressure and volume graphs exhibit operation of the cardiovascular system under normal condition. The results of the simulation have been compared with the relevant experimental observation and are in good agreement with them.