REGIONAL CIRCULATION

CORONARY CIRCULATION

ARTERIAL SUPPLY

RIGHT CORONARY ARTERY SUPPLIES

z Right atrium
z Major portion of right ventricle
z Interventricular septum (posterior part)
z Most of the conducting system of the heart

LEFT CORONARY ARTERY

TWO BRANCHES
• ANTERIOR DESCENDING ARTERY
Runs in interventricular groove
• LEFT CIRCUMFLEX ARTERY
Runs in A-V groove

SUPPLY
z Whole left atrium
z Most of left ventricle.
z Interventricular septum, (anterior part).
z Small part of right ventricle near anterior interventricular septum.
z Part of left branch of bundle of his

NOTE- In 50% individuals predominant supply is by right coronary artery.

30% individuals balanced
20% individuals, supply is by left coronary artery.

VENOUS DRAINAGE OF THE HEART

• Coronary sinus
• Great cardiac veins
• Anterior cardiac veins
MEASUREMENT OF CORONARY BLOOD FLOW

z Nitrous oxide technique

z Radionuclide technique
z Coronary angiography

POINTS TO REMEMBER
z Normal coronary blood flow is 250 ml /min.
z O2 consumption of myocardium at rest is 25ml/min.
z 80% coronary blood flow occurs during diastole whereas only 20% CBF
occurs during systole.

PRESSURE (mm Hg) Pressure difference

AORTA LV RV LV RV
SYSTOLE 120 122 25 -1 95

DIASTOLE 80 0 0 80 80

NOTE
1. Pressure difference between aorta and left ventricle is very small during systole,
therefore there is no blood flow in subendocardial portion of LV during systole.
2. 80% blood flow occurs during diastole
3. Subendocardial portion of LV is prone to MI.
4. All conditions that leads to high LV pressure leads to more chances of MI, as
coronary perfusion is severely compressed during systole.
5. CCF, increase in venous pressure? Decrease aortic diastolic pressure, effective
coronary perfusion pressure decreases.

REGULATION OF CORONARY BLOOD FLOW

Myocardium has high O2 consumption during rest. Coronary blood flow is

increased during exercise. Coronary blood flow is maintained by
autoregulation.
Factors affecting autoregulation

CHEMICAL FACTORS

• Hypoxia leads to formation of adenosine, a potent vasodilator. It increase

coronary blood flow and myocardial hypoxia is relieved.
• Other vasodilator metabolites are CO2 , H ,K LACTIC ACID ,PG,ATP,
ADP.

NEURAL FACTORS
• Alpha- adrenergic receptors----vasoconstriction
• Beta- adrenergic receptors----vasodilatation

FACTORS AFFECTING CORONARY BLOOD FLOW

z Exercise – CBF increase during exercise by sympathetic activity.

z Hypotension Reflex increase in non adrenergic discharge causing increased
CBF
z Stress, emotional excitement increase sympathetic activity.
z Hormones – a. Thyroid – hyperthyroidism increases metabolism and
increase CBF
b. Epinephrine and nor-epinephrine acts through beta
receptors and increase CBF.
z Temperature – Increased body temperature increases CBF.

CEREBRAL CIRCULATION

BLOOD SUPPLY

Arterial supply

Two main arteries

z Two internal carotid artery
z Two vertebral arteries
Vertebral arteries join to form basilar artery
Venous drainage
z Jugular veins
z Vertebral venous plexus

Cerebral blood flow is 750ml min

Cerebral O 2 consumption 45ml min
Brain is very sensitive to hypoxia; therefore if blood supply is stopped for 10 secs,
person may get unconsciousness.

METHOD FOR MEASUREMNT CEREBRAL BLOOD FLOW

1. Nitrous oxide technique

2. Xe Clearance curve technique

REGULATION OF CEREBRAL BLOOD FLOW

FACTORS AFFECTING CEREBRAL BLOOD FLOW

z Fall in pO2 causes vasodilatation increasing cerebral blood flow. If hypoxia is

severe then vasoconstriction occurs.
z Rise in PCO2 causes vasodilatation, increase in cerebral blood flow.
z Anesthetic drugs decrease CBF.
z Rise in Intra cranial pressure decrease effective perfusion pressure further
decreasing CBF.

MECHANISM OF CEREBRAL AUTOREGULATION

z Mild decrease in perfusion pressure leads to vasodilation.

z Marked decrease in perfusion pressure leads to hypoxia.

CEREBROSPINAL FLUID (CSF)

z Clear, colorless
z Specific gravity 1005- 1008
 z Protein – 20-30 mg%
z Lymphocytes – 0-4
z Glucose less than plasma
z Volume 150 ml
z Normal CSF pressure 130 mm Hg H2O

CSF PLASMA
Na 146 150
K 3.0 4.6
Ca 2.2 4.7
HCO3 25 24.8

PROTEIN 20-32 6000

GLUCOSE 50-80 100
pH 7.33 7.4
OSMOLALITY 290 290

Formation and absorption of CSF

CSF is formed by choroid plexus in ventricles and blood vessels of meningeal and
ependymeal lining of ventricles. Absorbed by arachnoid villi into dural sinuses and
spinal veins.

CSF TRAVELS VIA

LATERAL VENTRCILES
↓ FORAMEN OF MONRO

THIRD VENTRICLE
↓ AQUDUCT OF SYLVIUS

CISTERNA MAGNA
↓
SUBARACHNOID SPACE
FUNCTIONS OF CSF
• Supports the delicate brain.
• Acts as buffer.
• Removal of waste product from brain.

BLOOD BRAIN BARRIER

It is defined as barrier between blood and brain tissue.

Formed between
1. Choroids plexus and CSF fluid interface
2. CSF and brain capillaries

FUNCTION OF BBB

z Protects brain from toxins in the blood.

z Prevents electro chemical fluctuations in the CNS.

NOTE
z Highly permeable to water, O2,CO2 SULPHA DRUGS
z Slightly permeable to H, Na, K HCO3 Mg
z Impermeable to gold, urea, bile salts

NOTE
Four areas where substances in the blood can act and cause changes in brain
functions without entering BBB are :
1. The posterior pituitary
2. The area postrema
3. The organosum vasculosum
4. Subfornical organs

PULMONARY CIRCULATION

FEATURES
It consists of
1. Pulmonary trunk
2. Pulmonary arterioles
3. Pulmonary capillaries
 4. Pulmonary venules and veins

Pulmonary trunk

Divided into
Right pulmonary artery
Left pulmonary artery

Pulmonary arterioles

Divided into capillaries

Pulmonary capillaries surround the alveoli

Pulmonary venules and veins

a) Receives oxygenated blood from the capillaries

b) Join to form four main veins
c) Finally open into the right atrium.

Mean Pulmonary Artery Pressure 10 – 15 mm Hg

Systolic Blood Pressure 20 – 25 mm Hg

Diastolic Blood Pressure 8 – 12 mm Hg
Pulmonary capillary pressure 8 – 10 mm Hg

NOTE - Pulmonary blood volume is more in recumbent position and it decreases on

standing.

Pulmonary artery is
1. Very distensible
2. Low pressure system
3. Resistance to blood flow is low. Therefore work done by right ventricle to
pump blood is less than that of left ventricle.

Nerve supply

Sympathetic nerve supply to lung vessels.

On stimulation, increases the pulmonary vascular resistance.

Vascular Reflexes

Baroreceptor reflex - Stimulation cause reflex dilation of pulmonary vessels.

Chemoreceptor reflex – Stimulation cause pulmonary vasoconstriction via
sympathetic nerves.
Vagal mechanoreceptor present in
a) Pulmonary trunk – Rise in pressure in pulmonary artery causes reflex bradycardia
and hypotension.
b) Junction of pulmonary vein and left atrium – Stimulation causes reflex tachycardia
and diuresis.
c) Effect of chemical changes on the lung vessels

HYPOXIA

Acute Hypoxia – Stimulates chemoreceptor causing reflex sympathetic

stimulation leading to pulmonary vasoconstriction.
Chronic Hypoxia – Causes Pulmonary Hypertension, marked increase in
pulmonary arterial pressure that results in right ventricular failure and
pulmonary oedema.

HYPERCAPNIA – No effect on pulmonary flow and resistance

SPLANCHNIC CIRCULATION

Drainage of blood from liver, GIT, spleen and pancreas. The blood from GIT, spleen
and pancreas drains via portal veins to the liver (Portal circulation) and from the
liver via hepatic veins to the inferior vena cava.

INTESTINAL CIRCULATION

Intestine receives blood from

Superior mesenteric artery
Inferior mesenteric artery
Blood flow to intestine increases during metabolic activity.
There exists a counter current system of villous blood vessels in the small intestine
ROLE – Slows down the entrance of rapidly absorbed solutes into the blood.

Splanchic nerve stimulation causes rise in arterial blood pressure due to

a) Vasoconstriction caused by stimulation of splanchnic nerves.
b) Release of adrenaline from the adrenal medulla.

There exists an Autoregulation mechanism in intestine

HEPATIC CIRCULATION
80% of blood supply to the liver is through the portal vein.
20% of blood supply to the liver is through the hepatic artery.

NERVE SUPPLY
Innervated by vasoconstrictor sympathetic nerves.

Fall in Arterial BP
↓
Stimulation of sympathetic nerves
↓
Constriction of hepatic, mesenteric arterioles and venules
↓
Capacitance vessels constricts
↓
Blood flow is directed towards the heart

NOTE – Splanchnic constriction can pump approximately 1Litre of blood into

arterial circulation in less than 1 minute. Therefore it is called Reservoir Function of
the Splanchnic circulation.
Hepatic Artery Blood Flow
1. Contributes 20% of the hepatic blood flow.
2. Pressure is 100 mm Hg
3. Autoregulation of blood flow due to
a) Myogenic arterial tone
b) Local vasodilator metabolites
4. When portal blood flow decreases, then hepatic artery blood flow increases.
Thus keeps the total hepatic blood flow constant.

Hepatic Portal Vein Blood Flow

1. Contributes 20% of hepatic blood flow.
2. Portal venous pressure is 7-12 mm Hg
3. No mechanism of autoregulation exists.
4. Increases after meals.