Fisiologi

Sistem Kardiovaskuler
Hardian
Bagian Fisiologi FK UNDIP

Blood Vessels: The Vascular System

Taking blood to the tissues and back

Arteries
Arterioles
Capillaries
Venules
Veins

The Vascular System

Figure 11.8b

Vasculature

Blood Vessels: Anatomy

Three layers (tunics)
Tunic intima
Endothelium
Tunic media
Smooth muscle
Controlled by sympathetic nervous system
Tunic externa
Mostly fibrous connective tissue

Differences Between Blood Vessel Types

Walls of arteries are the thickest

Lumens of veins are larger
Skeletal muscle milks blood in veins toward the
heart
Walls of capillaries are only one cell layer thick to
allow for exchanges between blood and tissue

Movement of Blood Through Vessels

Most arterial blood is

pumped by the heart
Veins use the milking
action of muscles to help
move blood

Figure 11.9

Capillary Beds

Capillary beds consist of

two types of vessels
Vascular shunt
directly connects an
arteriole to a venule

Figure 11.10

Capillary Beds
True capillaries
exchange vessels
Oxygen and
nutrients cross to
cells
Carbon dioxide and
metabolic waste
products cross into
blood
Figure 11.10

Functional properties of different blood vessels

Artery:
Aorta and large artery Pressure reservoir vessels
Middle artery:
Carry blood to arterioles distribution vessels
Small artery and arteriole:
Resistance vessels are regulated by neurohumoral
factors Control of capillary blood flow

Elastic reservoir vessels

Systole: store of energy

Elastic fiber elasticity

Stretched
Distensibility

Distole: release of energy

recoil maintain distolickinetic energy

elastic reservoir pressure
intermittent flow continuous flow

 Capillary vessels: exchange vessels

Exchange of substances between blood and
interstitial fluid.
Precapillary sphincter.
Control of inflow of capillaries

A-V shunt (anastomosis)

Blood flow from arteriole to venules by
passing capillary.

Venous Vessels
Capacitance vessels: large vein, vena cava
Blood reservoir
Big compliance, low mean venous pressure, low
resistance vessels
Venous valve; venule.

Blood flow

Blood volume passing a given section in the cardiovascular system per unit time (ml/s).

P1-P2
(1). F =
R

(2). Poiseulles law for laminar

flow.
pr4
F =
8L

Laminar flow

Velocity of different layers is different

Parabolic

No vibration

No sound

Turbulent flow

Blood flow is in direct proportion to square root of

pressure difference
Vibration
Sound (murmur)
Wasteful energy

Empirical equation: Reynolds number:

NR=DV/
(rho): density of fluid.
D: diameter of the tube.
V: velocity of flow.
NR< 2000

laminar flow

NR< 3000

turbulent flow

Resistance to blood flow:

P1-P2
F =
R

81
R =
r4

Resistance comes from external friction (L, r), internal

friction ().
Total peripheral resistance is mainly determined by
arterioles (60 70%).
Resistance and arterial blood pressure affect blood flow
of organ and redistribution of blood flow of organs

Physical laws governing blood flow and blood

pressure
Flow of blood through out
body = pressure gradient
within vessels X resistance to
flow
- Pressure gradient: aortic
pressure central venous
pressure
- Resistance:
-- vessel radius
-- vessel length
-- blood viscosity

Factors promoting total peripheral resistance

(TPR)
Total peripheral
resistance = TPR
-- combined resistance of
all vessels
-- vasodilation
resistance decreases
-- vasoconstriction
resistance increases

Blood pressure.

Two requirements for blood pressure formation:

Blood filling in cardiovascular system.
Heart work

Arteries and blood pressure

Pressure reservoir
Arterial walls are able to
expand and recoil
because of the pressure of
elastic fibers in the
arterial wall
Systolic pressure:
maximum pressure
occurring during systole
Diastolic pressure:
pressure during diastole

Arterial blood pressure

Figure 14.8

Blood pressure values

Pulse pressure:
PP = SP-DP
Mean arterial blood pressure
= MABP
MABP = SBP + (2XDBP)
3
CO = MABP = SV x HR
TPR

 Blood flow within each

organ changes with body
activities

Reminder: The ANS

controls blood flow to the
various organs

 Blood filling in cardiovascular system

Mean circulatory filing pressure
blood volume
= 7mmHg
vascular volume
Affect venous return to heart.

Heart work
Pressure energy + Kinetic energy
Pressure (systole)

Diastolic
pressure

forward flow

Arterial Blood Pressure

Normal value
Systolic Pressure:100 120mmHg
Diastolic Pressure: 60 80mmHg
Pulse Pressure: 30 40mmHg.
Mean arterial pressure (MAP) =
(2 DP + SP) 1/3
Fall of blood pressure is in direct proportion to
resistance to blood flow

Determinants of arterial blood pressure

Arterial blood volume

Arterial compliance Volume/pressure

If we assume that arterial compliance remains constant,

arterial blood pressure will depend on arterial blood
volume and vascular volume

Blood volume
BP
vascular volume

If a vascular volume does not change

Arterial blood volume arterial BP

 Arterial blood volume is determined by the rate of inflow

and outflow of arterial system.
Rate of inflow cardiac output
Rate of outflow: resistance and BP.
AP = F R = HRSVR
Inflow outflow arterial blood
AP
volume
>

<

Factors affecting arterial pressure

(1) stroke volume

(2) heart rate
(3) peripheral resistance
(4) aorta large artery
(5) circulatory blood flow

Venous pressure and venous return

1. Central venous pressure 4 12 cm H2O
Affect factors
(1) Heart pump action
(2) Venous return velocity
An index of cardiovascular function
2. Peripheral venous pressure

Effect of gravity on venous pressure

Venous return and affecting factors

(1) Mean circulatory filling pressure

(2) Cardiac contractility
(3) Sympathetic nerve
(4) Muscle pump
(5) Thoracic pump

Tekanan darah
Tekanan darah = Curah jantung X tahanan perifer
BP

= COP

X PR

Cardiac output = curah jantung volume darah yang

dipompa oleh jantung dalam 1 menit
COP = stroke volume X heart rate
Stroke volume = isi sekuncup volume darah yang
dipompa dalam 1 kali denyutan
Tahanan perifer diameter pembuluh darah tepi (di
kulit)
Vasokontriksi tahanan perifer naik
Vasodilatasi tahanan perifer turun

Blood pressure measurement

Figure 11.18

Factors affecting blood pressure

Nerve factors
Autonomic nerve system sympatic
Renal factors
Blood volume
Renin

Water & Sodium Balance in Blood Pressure Homeostasis

Mechanisms & consequences of ANP release.

Factors affecting blood pressure

Temperature
Hot vasodilatation
Cool vasoconstriction
Chemical substance
Increase adrenalin
Decrease vasodilator agent
Food: caffeine

JNC 7 Blood pressure classification

Types Of Cardiovascular Disease

Atherosclerosis
Coronary heart disease (CHD)
Chest pain (angina pectoris)
Irregular heartbeat (arrhythmia)
Congestive heart failure (CHF)
Congenital and rheumatic heart disease
Stroke

Artherosclerosis

Characterized by deposits of fatty substances,

cholesterol, cellular waste products, calcium, and
fibrin in the inner lining of the artery
Hyperlipidemia abnormally high blood lipid level
Plaque the buildup of deposits in the arteries

Coronary Heart Disease

Myocardial infarction (MI) or heart attack blood

supplying the heart is disrupted
Coronary thrombosis blood clot in the artery
Embolus when the blood clot is dislodged and
moves through the circulatory system
Collateral circulation - if blockage to the heart is
minor, an alternative blood flow is selected

Angina Pectoris

Ischemia reduction of the hearts blood and

oxygen supply
The more serious the oxygen deprivation the more
severe the pain
Nitroglycerin drug used to relax (dilate) the veins
Beta blockers control potential overactivity of the
heart muscle

Arrythmias

An irregularity in heart rhythm

Tachycardia racing heart in the absence of exercise
or anxiety
Bradycardia abnormally slow heartbeat
Fibrillation heart beat is sporadic, quivering
pattern

Congestive Heart Failure (CHF)

Damaged or overworked heart muscle is unable to

keep blood circulating normally
Affects over 5 million Americans
Damage to heart muscle may result from: rheumatic
fever, pneumonia, heart attack, or other
cardiovascular problem
Lack of proper circulation may allow blood to
accumulate in the vessels of the legs, ankles, or lungs
Diuretics relieve fluid accumulation

Congenital And Rheumatic Heart Disease

Congenital heart disease affects 1 out of 125

children born
May be due to hereditary factors, maternal diseases,
or chemical intake (alcohol) during fetal
development
Rheumatic heart disease results from rheumatic
fever which affects connective tissue

Stroke

Occurs when the blood supply to the brain is

interrupted
Thrombus blood clot
Embolus free flowing clot
Aneurysm bulging or burst blood vessel
Transient ischemic attack (TIA) brief interruptions
that cause temporary impairment

Arterial disorders

Sustained high arterial pressure increases the effects of

injury and disease
Effects of arterial disease causes
Tissue ischemia death of tissue
Severity of symptoms is dependent upon metabolic rate
& tissue needs
Surgery may re-establish circulation

Common Blood Vessel Disorders

Figure 15.6

Arterial disorders

Arterial system problems can be controlled by

modifying risk factors:
Smoking
Diet
Glucose control
Activity level
Hyperlipidemia
Bp (doubles risk)

When arteries become occluded

Healthy arteries are blood vessels which are

flexible,Strong & elastic
Their inside lining is smooth so blood can flow
without restriction
Risk factors cause arteries to become occluded.

Progression of Occlusion

PLAQUE DEPOSIT
Original diameter

Common diagnostic vascular tests

Non-invasive techniques
Segmented arterial pressure monitoring
Measures pressure difference between extremities at
different levels
Uses b/p monitor & doppler

Ankle/brachial index
Example:
Brachial pressure =120 mmHg
Ankle pressure = 96 mmHg
Abi = 96 / 120 = 0.8
Normal

0.9 - 1.2

Risk is low

Vascular
disease

0.6 0.9

Moderate
Risk exists

Severe disease

< 0.5

Very high risk

exists

Angioplasty

Balloon angioplasty
catheter
Inserted through an
artery
Balloon is inflated
and compresses
lesion

Used for
insertion of
stents

Angioplasty

Arterial diseases

BUERGERS DISEASE
(aka: Thromboangiitis Obliterans / TAO)

Disease is linked directly to smoking

Possible immunopathogenesis

Inflammation produces critical limb ischemia

Disease can progress proximally

Raynauds Disease

Vasospastic disorders:

Blood vessels (fingers & toes) go into spasm

Extreme sensitivity to temp changes (especially

cold)

More common female > male

Color changes are red/white/blue

RAYNAUDS

Classified:
1. Raynauds disease = when symptoms are the only
presenting factor
2. Raynauds phenomenon = when symptoms are
secondary to another condition
Ex: RA, scleroderma, lupus, carpal tunnel
sydrome, thoracic outlet syndrome

RAYNAUDS
Dx:
1. Bilateral
2. Occurs x 2 years
3. No other cause

Prevention:
1. Protect from cold exposure
2. Avoid excessive emotional stress
3. Do not use vibrating tools

ANEURYSM

ANEURYSM = An
localized abnormal
dilation of a blood
vessel
High risk in
marfans
syndrome