Physiology of circulation II

Pavlina Buckova M.D.

5/2014
Hemodynamic
Blood pressure
Pulse pressure
Mean arterial pressure
Blood flow
 (ARTERIAL) BLOOD PRESSURE
pressure exerted by circulating blood upon the walls
of blood vessels
due to the pumping action of the heart

maximum = systolic pressure

minimum = diastolic pressure
Measurement
Blood pressure values are generally reported
in millimetres of mercury (mmHg)
1. Invasive
2. Noninvasive
Palpation
Auscultatory
Oscilometric
(arterial) Blood pressure

physical factors that influence arterial pressure:

P = Q. R
volume of fluid (blood volume)
resistance

mean blood pressure drops over the whole circulation (although most of the
fall occurs along the small arteries and arterioles, because total cross
sectional area increase = resistance decrease)
How Does Increased Fluid Volume Elevate the
Arterial Pressure?
Extracellular fluid
volume

Blood Volume

Mean circulatory
Filling pressure

Venous return

Cardiac output

Arterial pressure
Resistance
resistance to flow that must be overcome to
push blood through the circulatory system
systemic vascular resistance (SVR) = total peripheral resistance
pulmonary vascular resistance(PVR)

determinants of resistance:
viscosity of the blood
small arterioles
pre-capillary arterioles
the vessel diameter controls resistance:
vasoconstriction increases SVR
vasodilation decreases SVR
Regulation of arterial pressure
is not completely understood

the following mechanisms of regulating arterial

pressure have been well-characterized:
Baroreceptors in the high pressure receptor zones
Baroreceptors in low pressure receptor zone
RAAS
1. Baroreceptors in the high pressure receptor zones
in the left and right carotid sinuses and in the aortic
arch
detect changes in arterial pressure

send signals ultimately to the brain stem

by autonomic nervous system adjusts the mean
arterial pressure by altering:
both the force and speed of the heart's contractions
total peripheral resistance
2. Baroreceptors in low pressure receptor zones
in the venae cavae, pulmonary veins, atria
result in feedback by regulating the secretion
of ADH, renin and aldosterone

increase in blood volume

increased cardiac output by the FrankStarling law

of the heart

increasing arterial blood pressure

3. Renin-angiotensin - aldosteron system:
long-term adjustment of arterial pressure

activates an endogenous vasoconstrictor - angiotensin II

releases aldosteron in response to angiotensin II

aldosterone stimulates sodium retention and potassium

excretion by the kidneys
sodium determines the amount of fluid in vessels by osmosis

increase fluid retention indirectly arterial pressure

Reaction to stress
Cortex

Formatio retikularis

VMC (vasomotor center)

Sympathetic activation of heart

Elevated heart rate and stroke volume

High blood pressure
 PULSE PRESSURE
the pressure difference between the systolic and
diastolic pressures
pressure that is felt when feeling the pulse
proportional to stroke volume
inversely proportional to the compliance of the aorta

(120 80 = 40 mmHg)

Low (Narrow) Pulse Pressure

High (Wide) Pulse Pressure
 MEAN ARTERIAL PRESSURE
the average arterial pressure during a single cardiac
cycle

the perfusion pressure seen by organs

normally between 70 to 110 mmHg
greater than 60 mmHg is enough to sustain the
organs
below this number for an appreciable time, vital organs will not get enough oxygen
perfusion, and will become ischemic
 BLOOD FLOW
Volume of fluid movement per unit time

F= v.A
.F= flow, v= velocity, A= area

Velocity of blood decrases as blood flows to smaller vessels , because

total cross sectional area increase
As blood continues toward bigger veins, velocity increase again
 BLOOD FLOW
Relationship between flow and pressure:
Difference in blood pressure are responsible for blood flow
Pressure of blood decrases as blood flows to smaller vessels , because total cross sectional
area increase = resistance decrease

F, Q = flow P = pressure R= resistance

HagenPoiseuille equation
Local Regulation of Blood Flow
tissues and organs are able to regulate their own blood
supply in order to meet their metabolic and functional
needs
local regulatory mechanisms act independently
of extrinsic (neural, hormonal) control mechanisms

main factor of local regulation is metabolic mechanism

Others: myogenic and endothelial mechanisms

balance between local regulatory mechanisms and

extrinsic factors in vivo
Local Regulation of Blood Flow
Different organs display varying degrees of
autoregulatory behavior:
The renal, cerebral, coronary circulations - excellent
autoregulation
skeletal muscle and splanchnic circulations - moderate
autoregulation
cutaneous circulation - little or no autoregulatory
capacity
Circulation in brain
Relies on continuous blood flow interruption of
flow for 5-10s causes loss of consciousnes
Cerebral autoregulation is very effective
Flow is determined by factors in brain itself
Flow remains constant in wide range of systemic pressure
Vasculature is very sensitive to changes in CO2 (increase
CO2 vasodilatation)
Circulation in lungs
Blood flow is controled locally by alveolar gas
tension
O2 and CO2 in alveoli vasoconstriction

Low pressure, low resistance circulation

Circulation in skin
Skin has small nutrient requirements supply of
nutrients is not chief factor in blood flow regulation
The primary function of cutaneous blood flow
regulation maitnance of constant body
temperature

Two types of resistance vessels:

Arterioles
Arteriovenous anastomoses
Circulation in skin
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ATTENTION