**6. Summary and conclusions**

Although the diagnostic sciences have been advanced significantly during the last eight decades [32–40], until the theoretical discovery of the Sanal flow choking, the real occurrence of acute-heart-failure was poorly understood, largely for the reason that it was an under diagnosis condition [2]. Now the real cause of an acute-heart-failure comes to the foreground [1, 2]. All the findings reported in this chapter are complementing with the clinical data causing asymptomatic cardiovascular diseases. Analytical models, *in vitro* and *in silico* results presented herein corroborated that a vaccination or a single drug could reduce the risk of hemorrhagic stroke and acute heart failure [1, 2]. It could be achieved by increasing the BHCR and/or decreasing the BPR. We recognized through this comprehensive review that the internal flow choking, leading to the shock-wave generation and the transient pressure spike in a blood vessel, is the fundamental cause of asymptomatic cardiovascular diseases including hemorrhagic stroke and acute heart failure. Now the precipitating factor for the plaque rupture has come to the foreground. We concluded that the boundary-layer-blockage persuaded Sanal flow choking could occur anywhere in the circulatory circuit with gas embolism when BPR reaches LCHI. The boundary-layer-blockage-factor depends on the BHCR, flow Mach number, biofluid viscosity and turbulence, which could alter due to seasonal changes, variations in lipoprotein and other contributing factors. The greater the reduction in low-density lipoprotein (LDL) cholesterol, the lower the risk of stroke. The shock wave due to the Sanal flow choking could disrupt an atherosclerotic plaque or coronary artery wall. In a nutshell, the discovery of the biofluid/Sanal flow choking is a paradigm shift in the diagnostic sciences of coronary artery disease (CAD) and peripheral artery disease (PAD).

In vitro study shows that nitrogen (N2), oxygen (O2), carbon dioxide (CO2), and argon (Ar) gases are predominant in fresh blood samples of healthy subjects at a temperature range of 37 – 40 °C (98.6 – 104 °F), which enhances the chances of internal flow choking (with or without any coronary artery stent) leading to pressure-overshoot and acute heart failure. This physical situation is more dangerous in Covid-19 patients, which could lead to cardiac epidemic. We observed through *in vitro* study that (**Figure 4**), CO2, the gas with the lowest heat capacity ratio (HCR), is relatively and consistently higher in the healthy males than the healthy male *Guinea pig* of four weeks old. It reveals that as a preventive measure for all subjects with a low BHCR, including patients who are taking blood-thinning medication must maintain their BPR always less than 1.82, as dictated by Eq. (4), for reducing the risk of asymptomatic CVD.

We concluded that a single anticoagulant drug capable to suppress the turbulence level and enhance the BHCR or a companion medicine along with the traditional blood-thinning medications is predestined for meeting the conflicting requirements (i.e., decrease viscosity and turbulence simultaneously) of all the subjects for reducing the risk of asymptomatic hemorrhage (AH) and acute heart failure (AHF). In high risk subjects, (i.e., BPR is very close to the LCHI), a slight oscillation in the BPR predisposes to the choking and the unchoking phenomena, which could lead to arrhythmia and memory effect. Briefly, this study sheds light for exploring new avenues in biological science for discovering new blood-thinning drugs for reducing the risk of internal flow choking causing asymptomatic cardiovascular diseases [1, 2]. The cardiovascular treatment should be targeted based on blood pressure ratio (BPR), instead of blood pressure levels alone, in chronic heart failure patients. We concluded that the risk of internal flow choking heading to asymptomatic cardiovascular diseases could be decreased by concurrently reducing blood viscosity and turbulence by enhancing the BHCR and/or reducing the BPR.

**333**

*Internal Flow Choking in Cardiovascular System: A Radical Theory in the Risk Assessment…*

The discovery of the Sanal flow choking phenomena calls for continuous ambulatory blood pressure (BP) and thermal level monitoring in high risk patients in the diagnosis and preventive management of asymptomatic cardiovascular diseases. The continuous blood pressure and thermal level measurement could be done in a more pragmatic way by using a wearable BP monitor with the temperature sensor in the modern form of a wristwatch. Analytical methods such as machine learning could definitely enhance the accuracy and advance daily wearable devicebased diagnoses [41–49]. Recent studies on heart failure management in gravity and microgravity environment (during the long human spaceflight) corroborate that the physical situation of the Sanal flow choking phenomena calls for continuous ambulatory BP and thermal-level monitoring in astronauts'/cosmonauts [6, 41–50]. Note that the Sanal flow choking is more susceptible at microgravity condition due to altered variations of blood viscosity, turbulence and the BPR. Microgravity environment decreases plasma volume and increases the hematocrit compared with the situation on the earth surface, which increases the relative viscosity of blood. We concluded that for a healthy-life all subjects (human being/animals) in the earth and in the outer space with high BPR necessarily have high BHCR. We also concluded that for reducing the cardiovascular risk, all the astronauts/cosmonauts should maintain the BPR lower than the lower critical hemorrhage index (LCHI) as dictated by the lowest heat capacity ratio (HCR) of the gas generating from the biofluid/blood for prohibiting the internal flow choking during the space travel. We recommend all astronauts/cosmonauts should wear ambulatory blood pressure and thermal level monitoring devices similar to a wristwatch throughout the space travel for the diagnosis, prognosis and prevention of internal flow choking leading to asymptomatic cardiovascular diseases. The scientific objective of this study and review was to discover the correlation between the thermal tolerance level in terms of BHCR, the BPR, blood viscosity, ejection fraction (EF) and the cardiovascular risk leading to AH and AHF, which we could achieve herein. We concluded that designing the precise blood thinning regimen is vital for attaining the desired therapeutic efficacy and negating undesirable flow choking leading to acute-heart failure. For a healthy-life all subjects with high-BPR inevitably have high-BHCR for reducing the risk of the internal flow choking (biofluid/Sanal flow choking) triggering the AHF due to the shock wave generation. We corroborated that, the acute-heart-failure (AHF) is a transient episode and not an illness. In a nutshell, a single drug capable to increase BHCR and/or decrease the BPR could reduce the risk

of asymptomatic cardiovascular diseases without any prejudice.

*DOI: http://dx.doi.org/10.5772/intechopen.96987*

#### *Internal Flow Choking in Cardiovascular System: A Radical Theory in the Risk Assessment… DOI: http://dx.doi.org/10.5772/intechopen.96987*

The discovery of the Sanal flow choking phenomena calls for continuous ambulatory blood pressure (BP) and thermal level monitoring in high risk patients in the diagnosis and preventive management of asymptomatic cardiovascular diseases. The continuous blood pressure and thermal level measurement could be done in a more pragmatic way by using a wearable BP monitor with the temperature sensor in the modern form of a wristwatch. Analytical methods such as machine learning could definitely enhance the accuracy and advance daily wearable devicebased diagnoses [41–49]. Recent studies on heart failure management in gravity and microgravity environment (during the long human spaceflight) corroborate that the physical situation of the Sanal flow choking phenomena calls for continuous ambulatory BP and thermal-level monitoring in astronauts'/cosmonauts [6, 41–50]. Note that the Sanal flow choking is more susceptible at microgravity condition due to altered variations of blood viscosity, turbulence and the BPR. Microgravity environment decreases plasma volume and increases the hematocrit compared with the situation on the earth surface, which increases the relative viscosity of blood. We concluded that for a healthy-life all subjects (human being/animals) in the earth and in the outer space with high BPR necessarily have high BHCR. We also concluded that for reducing the cardiovascular risk, all the astronauts/cosmonauts should maintain the BPR lower than the lower critical hemorrhage index (LCHI) as dictated by the lowest heat capacity ratio (HCR) of the gas generating from the biofluid/blood for prohibiting the internal flow choking during the space travel. We recommend all astronauts/cosmonauts should wear ambulatory blood pressure and thermal level monitoring devices similar to a wristwatch throughout the space travel for the diagnosis, prognosis and prevention of internal flow choking leading to asymptomatic cardiovascular diseases. The scientific objective of this study and review was to discover the correlation between the thermal tolerance level in terms of BHCR, the BPR, blood viscosity, ejection fraction (EF) and the cardiovascular risk leading to AH and AHF, which we could achieve herein. We concluded that designing the precise blood thinning regimen is vital for attaining the desired therapeutic efficacy and negating undesirable flow choking leading to acute-heart failure. For a healthy-life all subjects with high-BPR inevitably have high-BHCR for reducing the risk of the internal flow choking (biofluid/Sanal flow choking) triggering the AHF due to the shock wave generation. We corroborated that, the acute-heart-failure (AHF) is a transient episode and not an illness. In a nutshell, a single drug capable to increase BHCR and/or decrease the BPR could reduce the risk of asymptomatic cardiovascular diseases without any prejudice.

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

Although the diagnostic sciences have been advanced significantly during the last eight decades [32–40], until the theoretical discovery of the Sanal flow choking, the real occurrence of acute-heart-failure was poorly understood, largely for the reason that it was an under diagnosis condition [2]. Now the real cause of an acute-heart-failure comes to the foreground [1, 2]. All the findings reported in this chapter are complementing with the clinical data causing asymptomatic cardiovascular diseases. Analytical models, *in vitro* and *in silico* results presented herein corroborated that a vaccination or a single drug could reduce the risk of hemorrhagic stroke and acute heart failure [1, 2]. It could be achieved by increasing the BHCR and/or decreasing the BPR. We recognized through this comprehensive review that the internal flow choking, leading to the shock-wave generation and the transient pressure spike in a blood vessel, is the fundamental cause of asymptomatic cardiovascular diseases including hemorrhagic stroke and acute heart failure. Now the precipitating factor for the plaque rupture has come to the foreground. We concluded that the boundary-layer-blockage persuaded Sanal flow choking could occur anywhere in the circulatory circuit with gas embolism when BPR reaches LCHI. The boundary-layer-blockage-factor depends on the BHCR, flow Mach number, biofluid viscosity and turbulence, which could alter due to seasonal changes, variations in lipoprotein and other contributing factors. The greater the reduction in low-density lipoprotein (LDL) cholesterol, the lower the risk of stroke. The shock wave due to the Sanal flow choking could disrupt an atherosclerotic plaque or coronary artery wall. In a nutshell, the discovery of the biofluid/Sanal flow choking is a paradigm shift in the diagnostic sciences of coronary artery disease (CAD) and peripheral

In vitro study shows that nitrogen (N2), oxygen (O2), carbon dioxide (CO2), and argon (Ar) gases are predominant in fresh blood samples of healthy subjects at a temperature range of 37 – 40 °C (98.6 – 104 °F), which enhances the chances of internal flow choking (with or without any coronary artery stent) leading to pressure-overshoot and acute heart failure. This physical situation is more dangerous in Covid-19 patients, which could lead to cardiac epidemic. We observed through *in vitro* study that (**Figure 4**), CO2, the gas with the lowest heat capacity ratio (HCR), is relatively and consistently higher in the healthy males than the healthy male *Guinea pig* of four weeks old. It reveals that as a preventive measure for all subjects with a low BHCR, including patients who are taking blood-thinning medication must maintain their BPR always less than 1.82, as dictated by Eq. (4),

We concluded that a single anticoagulant drug capable to suppress the turbulence level and enhance the BHCR or a companion medicine along with the traditional blood-thinning medications is predestined for meeting the conflicting requirements (i.e., decrease viscosity and turbulence simultaneously) of all the subjects for reducing the risk of asymptomatic hemorrhage (AH) and acute heart failure (AHF). In high risk subjects, (i.e., BPR is very close to the LCHI), a slight oscillation in the BPR predisposes to the choking and the unchoking phenomena, which could lead to arrhythmia and memory effect. Briefly, this study sheds light for exploring new avenues in biological science for discovering new blood-thinning drugs for reducing the risk of internal flow choking causing asymptomatic cardiovascular diseases [1, 2]. The cardiovascular treatment should be targeted based on blood pressure ratio (BPR), instead of blood pressure levels alone, in chronic heart failure patients. We concluded that the risk of internal flow choking heading to asymptomatic cardiovascular diseases could be decreased by concurrently reducing blood viscosity and turbulence by enhancing the BHCR and/or reducing the BPR.

**6. Summary and conclusions**

artery disease (PAD).

for reducing the risk of asymptomatic CVD.

**332**
