PRINSIP HEMODINAMIK

Rahmatina B. Herman
Bagian Fisiologi
Fakultas Kedokteran - Unand

Cardiovascular System
Closed circulatory system:
Heart
Atrium

Ventricle
Arterial system

Venous system

Capillary system

SIRKULASI
(CIRCULATION)

Introduction
In general, the function of cardiovascular system
is to maintain appropriate environment in all
tissue fluids optimal survival and function of the
cells homeostasis
The function of the circulation is to service the
needs of body tissues as a transport system of:
-

Essential materials to tissues: nutrients and O2

Waste products away to excretory system
Humoral communication throughout the body
(including hormones and electrolytes)
Body temperature

Introduction..
The rate of blood flow through tissues is controlled in
response to tissue need for nutrients and O2
The heart and circulation in turn are controlled to
provide necessary cardiac output (COP) and arterial
pressure to cause the needed tissue blood flow
COP is the quantity of blood pumped into the aorta
each minute by heart the quantity of blood that
flows through circulation

COP = stroke volume (SV) X heart rate (HR)

Physical Characteristics of Circulation

The Circulation is divided into:
- Systemic circulation
- Pulmonary circulation
Because systemic circulation supplies blood flow to all
tissues of the body , it is also called:
- Greater circulation or
- Peripheral circulation

Systemic Circulation
Left atrium

Left A-V valve

Left semilunar valve

Right atrium

Vena Cava

Left ventricle

Throughout body
Capillary

Aorta

Pulmonary Circulation

Right atrium

Right A-V valve

Atrium kiri

Pulmonary
vein

Right ventricle
Right semilunar valve

Lung
Capillary

Pulmonary
trunk

Distribution of blood in different parts of circulatory system

The Function of Parts of Circulation

Arteries:
To transport blood under high pressure to the tissues
Have strong vascular walls
Blood flows at a high velocity
Arterioles:
The last small branches of arterial system
Acts as control blood released into capillaries
Have strong muscular wall that can close
(constriction) the arteriole completely and also can
dilate (relaxation) several folds in response to the
need of tissue

The Function of Parts of Circulation..

Capillaries:
To exchange fluid and substances between the blood
and the interstitial fluid:
Transfer tissue needs to interstitial fluids
Uptake tissue waste products from interstitial fluids

The capillary walls:

are very thin (only a single layer of endothelial)
have numerous minute capillary pores permeable to
water and other small molecular substances

The Function of Parts of Circulation..

Venules:
To collect blood from capillaries and gradually coalesce
into progressively larger veins
Veins:
Blood transport from venules back to the heart
the pressure is very low (lower than in capillary)
the walls are thin
even so muscular enough to contract or expand

Acts as controllable reservoir for the extra blood

depending on the needs of circulation
Serve as major reservoir of extra blood

Cross-Sectional Areas of Vessels

Cross-Sectional Areas of Vessels..

Note particularly: the much larger cross-sectional areas
of veins than of arteries, averaging 4 times large
storage of blood in venous system
The same volume of blood must flow through each
segment per minute blood flow velocity is inversely
proportional to vascular cross-sectional area
Under resting conditions, the average velocity in:
Aorta: 33 m/sec
Capillaries: 0.3 m/sec (1/1000 as in aorta)
The capillary length: 0.3-1 mm blood remains in
capillary for only 1-3 sec rapidly exchanging process

Pressure in Portions of Circulation

Systemic Circulation
Aorta:
Heart pumping is pulsatile pressure alternates
between 120 mmHg (systolic) & 80 mmHg (diastolic)
Capillaries:
In systemic capillaries varies:
35 mmHg near arteriolar ends
17 mmHg in most vascular beds
10 mmHg near venous ends
Venous:
Mean pressure falls progressively to 0 mmHg when
blood empty into right atrium

Pressure in Portions of Circulation..

Pulmonary Circulation
Pulmonary artery:
Heart pumping is also pulsatile pressure alternates
between 25 mmHg (systolic) & 8 mmHg (diastolic)
Capillaries:
Average 7 mmHg
Venous:
Total blood flow through the lung each minutes =
through systemic, in accord with the lung needs all
that is required to expose the blood in pulmonary
capillaries to O2 and other gases in alveoli

Pressure in Portions of Circulation..

Diagram of the changes in pressure and velocity as blood flows

through systemic circulation

Basic Theory of Circulatory Function

3 basic principles that underlie all functions of system:
1. Rate of blood flow to each tissue is almost always
precisely controlled in relation to the tissue need
When tissues are active the need increased
occasionally 20-30 x resting level
Heart only can increase COP 4-7 x resting level

Microvessels dilating or constricting to control

local blood flow precisely to the level required
Central nervous system provides additional help
in controlling tissue blood flow

Basic Theory of Circulatory Function..

2. COP is controlled mainly by the sum of all local tissue
flows.
When blood flows from tissues immediately
returns to the heart (venous return) the heart
responds automatically (acts as automation:
Frank-Starling mechanism) pumping force
increased SV increased COP increased
Central nervous system provides additional help
to make it pump the required amounts of blood
flow

Basic Theory of Circulatory Function..

3. Arterial pressure is controlled independently of either
local blood flow control or COP control.
When pressure falls < normal within seconds
nervous reflexes elicits a series of circulatory
changes to raise pressure back toward normal:
a. Increase the force of heart pumping
b. Contraction of large venous more blood to the heart
c. Generalized constriction of most arterioles throughout
body more blood accumulates in large arteries to
increase arterial pressure

Over more prolonged periods (hours days), kidney

play additional major role:
a. Secreting pressure- controlling hormones
b. Regulating blood volume

Biophysical of Circulatory Physiology..

Interrelationship among pressure, flow, and
resistance
Blood flow through a blood vessel is determined by
two factors:
1. Pressure difference of the blood between the two
ends of the vessel, sometimes called pressure
gradient
2. The impediment to blood flow through the vessel,
called vascular resistance

Biophysical of Circulatory Physiology..

Ohms law:

Q=

P
R

Q = flow
P = pressure difference
R
= resistance

Biophysical of Circulatory Physiology..

Blood flow
- Blood flow means the quantity of blood that

passes a given point in the circulation in a given

period of time
- The overall blood flow in total circulation of an
adult person at rest is 5000 ml/min.
It is the amount of blood pumped into aorta by
heart each minute or cardiac output

Methods for Measuring Blood Flow

Using flowmeter
Electromagnetic flowmeter:

Methods for Measuring Blood Flow

Using flowmeter
Ultrasonic Doppler flowmeter:

Blood Flow in Vessels

Laminar flow
When blood flows at a steady state rate in smooth
blood vessel flows streamline or laminar flow:
- each layer of blood remaining the same distance
from the vessel wall
- the central most portion of the blood stays in the
center of blood vessel
Turbulent flow
- the opposite of streamline flow
- blood flowing in all direction in the vessel and
continually mixing within the vessel

Blood Flow in Vessels..

Parabolic velocity profile during laminar flow,
due to:
- The fluid molecules touching the wall barely move
because of adherence to the wall vessel wall.
- The next layer of molecules slips over these
- The third layer over the second, the fourth layer
over the third, and so forth
Thus, each layer toward the center flows progressively
more rapidly than the outer layers

Blood Flow in Vessels..

Diagram of velocities of concentric laminas of a viscous fluid

flowing in a tube, illustrating parabolic distribution of velocities
(Laminar flow)

Blood Flow in Vessels..

Blood Flow in Vessels..

Turbulent flow means:
- The blood flows crosswise in the vessel as well as
along the vessel
- Usually forming whorls in the blood, called eddy
currents, similar to the whirlpools that frequently
see in a rapidly flowing river at a point of obstruction
Turbulent flow under conditions:
- when rate of flow becomes too great and
> passes by an obstruction makes a sharp turn
> or passes over a rough surface

Blood Flow in Vessels..

Effect of constriction on velocities profile

Blood Flow in Vessels..

Probability of turbulence:
Re
v
d
p

: Reynolds number
: velocity
: diameter
: density of fluid
: viscosity of fluid

When Re rises above 200-400, turbulent will occur at

some branches of vessels but will die out along the
smooth portions of vessels
Flow is usually not turbulent if Re is less than 2000
Flow is almost always present if Re is more than 3000

Blood Flow in Vessels..

Conditions that appropriate for turbulence:
1. high velocity
2. pulsatile nature of flow
3. sudden change in vessel diameter
4. large vessel diameter
In small vessels, Re is almost never enough to
cause turbulence

Average Velocity
Velocity (V) is proportional to flow (Q) divided by area
of the conduit (A):

If flow constant, velocity increase in direct proportion

to any decrease in A
The average velocity of fluid movement is inversely to
the total cross sectional area the average velocity of
blood is high in aorta, declines steadily in smaller
vessels, and lowest in capillaries, then increase again
as the blood enters the vein

Resistance to Blood Flow

Resistance is the impediment to blood flow in a vessel
Resistance must be calculated from measurements of
blood flow and pressure difference between two
points in the vessel.
The unit used to express resistance is peripheral
resistance unit (PRU)
The rate of blood flow through entire circulatory
system is equal to COP = 100 ml/sec
The pressure difference from systemic arteries to
systemic veins is 100 mmHg
So, the total peripheral resistance is 100/100 = 1 PRU

Viscosity and Resistance

The resistance of blood flow is determined by:
- radius of blood vessels
- viscosity of blood

Plasma is 1.8 times as viscous as water and whole

blood is 3-4 times as viscous as water viscosity
depends on hematocrit
In large vessels, hematocrit viscosity ,
but in vessel < 100 m in diameter (arterioles,
capillaries, venules) viscosity change per unit change in
hematocrit is much less than it is in large vessels
hematocrit changes have relatively little effect on
peripheral resistance, except the changes are large

Viscosity and Resistance..

In severe polycythemia, resistance the
work of heart
In marked anemia, peripheral resistance is
decreased, because of decline in viscosity
blood flow
The decrease in Hb decreased the O2carrying ability, but the increased blood flow
partially compensates for this

Effect of changes in hematocrit on relative viscosity of blood

measured in a glass viscometer and in hind leg of a dog

Critical Closing Pressure

In rigid tubes, the relationship between pressure and flow
of homogenous fluid is linear
But in vivo, in thin-walled blood vessels: when pressure
a point is reached at which no blood flows, even though
the pressure is not zero, because vessels are surrounded by
tissues that exert small but definite pressure on them
intraluminal pressure below the tissue pressure the
vessels collapse
In inactive tissues, the pressure in many capillaries is low,
because precapillary sphincters and metarterioles are
constricted many of the capillaries are collapsed
The pressure at which flow ceases is called the critical
closing pressure

Conductance
Conductance is a measure of blood flow
through a vessel for a given pressure difference
Conductance =

1
Resistance

Very slight changes in diameter of a vessel can

change its conductance tremendously

Law of Laplace
This law states that tension in the wall of cylinder (T) is
equal to the product of the transmural pressure (P)
and the radius (r) divided by the wall thickness (w)
T= Pr/w
The transmural pressure = pressure inside cylinder
pressure outside cylinder
But tissue pressure in body is low, it can be generally
ignored and P = pressure inside the viscus
In a thin-walled viscus, w is very small and can be
ignored, but it becomes significant factor in arteries

Relationship between distending pressures (P) and wall tension (T)

Law of Laplace..
So, in thin-walled viscus: P=T divided by the two
principal radii of curvature of the viscus

In a cylinder such as blood vessel, one radius is infinite,

so
Consequently, the smaller the radius of blood vessel,
the lower the tension in the wall necessary to balance
the distending pressure
In aorta the tension at normal pressure is 170,000
dynes/cm, in vena cava 21,000, in capillaries 16

Law of Laplace..
The law of Laplace makes clear a disadvantage faced
by dilated hearts
When radius of heart chamber is increased a greater
tension must be developed in myocardium to produce
any given pressure a dilated heart must do more
work than a non-dilated heart
In the lungs, the radii of curvature of alveoli become
smaller during expiration tend to collapse because
of the pull of surface tension if the tension were not
reduced by the surface-tension-lowering agent,
surfactant

Resistance and Capacitance Vessels

The vena is called capacitance vessels, because
a large amount of blood can be added to the
venous system before the veins become
distended to the point where further
increments in volume produce a large rise in
venous pressure
The small arteries and arterioles are referred to
as resistance vessels, because they are the
principal site of peripheral resistance

Resistance and Capacitance Vessels

At rest, at least 50% of circulating blood volume is in
systemic veins, 12% in heart cavities, 18% in
pulmonary circulation; only 2% in aorta, 8% in arteries,
1% in arterioles, and 5% in capillaries
When extra blood is administered by transfusion,
- < 1% of it is distributed in the arterial system (the
high-pressure system), and
- all rest is found in systemic veins, pulmonary
circulation, and heart chambers other than the left
ventricle (the low-pressure system)