vessels physiology - sinoe medical...

Vessels physiology Vessels physiology Danil Hammoudi.MDDanil Hammoudi.MD

Blood flowBlood flow

Blood Pressure = Cardiac Output x Total Peripheral Resistance or BP = CO x TPR

Actual volume of blood flowing through a ua o u o b ood o g oug avessel, an organ, or the entire circulation in a given period:◦ Is measured in ml per min.◦ Is equivalent to cardiac output (CO), equivalent to cardiac output (CO), considering the entire vascular systemconsidering the entire vascular systemconsidering the entire vascular systemconsidering the entire vascular system◦ Is relatively constant when at rest◦ Varies widely through individual organs

Blood FlowBlood FlowBlood FlowBlood Flow

Blood flow (F) is directly proportional Blood flow (F) is directly proportional to the difference in blood pressure to the difference in blood pressure to the difference in blood pressure to the difference in blood pressure ((ΔΔPP) between two points in the ) between two points in the circulationcirculation

f i bl d fl d if◦ If ΔP increases, blood flow speeds up; if ΔPdecreases, blood flow declines

Blood flow is inversely proportional to Blood flow is inversely proportional to i t (R)i t (R)resistance (R)resistance (R)

◦ If R increases, blood flow decreases R is more important than R is more important than ΔΔPP in in ppinfluencing local blood pressureinfluencing local blood pressure

Blood Flow, Blood Pressure, and Blood Flow, Blood Pressure, and Resistance Resistance Flow = Difference in pressure/resistanceFlow = Difference in pressure/resistanceResistance Resistance Flow = Difference in pressure/resistanceFlow = Difference in pressure/resistance

Flow rate through blood Flow rate through blood vessels•directly proportional to the pressure gradientp g•inversely proportional to vascular resistanceresistance

Arteries:act as pressure act as pressure reservoirs because the elastic walls collapse elastic walls collapse inward during ventricular diastole (when there is less blood in the arteries):

Resistance – opposition to flow s s a oppos o o o◦ Measure of the amount of friction blood encountersG ll t d i th t i ◦ Generally encountered in the systemic circulation◦ Referred to as peripheral resistance (PR)p p ( )The three important sources of resistance are blood viscosity, total blood vessel length, and blood vessel diameter

ResistanceResistanceResistanceResistance

Resistance factors that remain relatively constant are:constant are:◦ Blood viscosity – “stickiness” of the blood ◦ Blood vessel length – the longer the vessel, the g g ,greater the resistance encountered

Resistance Factors: Viscosity and Resistance Factors: Viscosity and Vessel LengthVessel LengthVessel LengthVessel Length

Changes in vessel diameter are frequent C a g s ss d a a quand significantly alter peripheral resistanceResistance varies inversely with the fourth power of vessel radius

F l if th di i d bl d th ◦ For example, if the radius is doubled, the resistance is 1/16 as much

Resistance Factors: Blood Vessel Resistance Factors: Blood Vessel DiameterDiameterDiameterDiameter

Small-diameter arterioles are the major S a d a a o s a ajodeterminants of peripheral resistanceFatty plaques from atherosclerosis: ◦ Cause turbulent blood flow◦ Dramatically increase resistance due to turbulenceturbulence

Resistance Factors: Blood Vessel Resistance Factors: Blood Vessel DiameterDiameterDiameterDiameter

Force per unit area exerted on the wall of o p u a a d o a oa blood vessel by its contained blood ◦ Expressed in millimeters of mercury (mm Hg)◦◦ Measured in reference to systemic arterial Measured in reference to systemic arterial BP in large arteries near the heartBP in large arteries near the heart

The differences in BP within the The differences in BP within the The differences in BP within the The differences in BP within the vascular system provide the driving vascular system provide the driving force that keeps blood moving from force that keeps blood moving from p gp ghigher to lower pressure areashigher to lower pressure areas

Blood Pressure (BP)Blood Pressure (BP)Blood Pressure (BP)Blood Pressure (BP)

shows the common sites where the pulse is felt.1. Temporal artery at the temple above and to th t id f th the outer side of the eye2. External maxillary (facial) artery at the point of crossing the mandible (lower jaw)3. Carotid artery on the side of the necky4. Brachial artery on the inner side of the biceps5. Radial artery on the radial bone side of the wristwrist6. Femoral artery in the groin7. Popliteal artery behind the knee8. Posterior tibial pulse behind the inner ankle9. Dorsalis pedis artery on the upper front part (anteriosuperior aspect) of the foot

Normal blood pressures are said to range from 100/60 mmHg to 150/90 H

A ( ) A ( ) S t li S t li Di t li Di t li

150/90 mmHg. Table 1. Some 'average' blood pressures relating to age

Age (years) Age (years) Systolic Systolic pressure pressure (mmHg) (mmHg)

Diastolic Diastolic pressure pressure (mmHg) (mmHg)

New-born 80 46

10 103 70 10 103 70

20 120 80

40 126 84

60 135 89 60 135 89

The pumping action of the heart generates The pumping action of the heart generates blood flow through the vessels along a pressure gradient, always moving from higher- to lower-pressure areasPressure results when flow is opposed by

i t

Systemic Blood PressureSystemic Blood Pressure

resistance

Systemic Blood PressureSystemic Blood Pressure

Systemic pressure:Systemic pressure:Sys e c p essu eSys e c p essu e◦ Is highest in the aorta◦ Declines throughout the length of the pathway◦◦ Is 0 mm Hg in the right atriumIs 0 mm Hg in the right atriumThe steepest change in blood The steepest change in blood pressure occurs in the arteriolespressure occurs in the arteriolespressure occurs in the arteriolespressure occurs in the arterioles

Systemic Blood PressureSystemic Blood PressureSystemic Blood PressureSystemic Blood Pressure

Systemic Blood PressureSystemic Blood PressureSystemic Blood PressureSystemic Blood Pressure

Figure 19.5

Arterial BP reflects two factors of the a s o a o s oarteries close to the heart◦ Their elasticity (compliance or distensibility)◦ The amount of blood forced into them at any given time

Blood pressure in elastic arteries near the Blood pressure in elastic arteries near the heart is pulsatile (BP rises and falls)

Arterial Blood PressureArterial Blood PressureArterial Blood PressureArterial Blood Pressure

Systolic pressure Systolic pressure – pressure exerted on i l ll d i i l arterial walls during ventricular

contraction Diastolic pressure Diastolic pressure – lowest level of arterial pppressure during a ventricular cyclePulse pressure – the difference between systolic and diastolic pressuresystolic and diastolic pressureMean arterial pressure (MAP) – pressure that propels the blood to the tissuesMAP diastolic p ess e + 1/3 p lse MAP = diastolic pressure + 1/3 pulse pressure[systolic]

Arterial Blood PressureArterial Blood PressureArterial Blood PressureArterial Blood Pressure

Capillary BP ranges from 20 to 40 mm Capillary BP ranges from 20 to 40 mm Cap a y a ges o 0 o 0Cap a y a ges o 0 o 0HgHgLow capillary pressure is desirable because high BP would rupture fragile, thin-walled capillariesL BP i ffi i t t f filt t t Low BP is sufficient to force filtrate out into interstitial space and distribute nutrients gases and hormones between nutrients, gases, and hormones between blood and tissues

Capillary Blood PressureCapillary Blood PressureCapillary Blood PressureCapillary Blood Pressure

Venous BP is steady and changes little ous s s ady a d a g sduring the cardiac cycleThe pressure gradient in the venous The pressure gradient in the venous system is only about 20 mm Hg system is only about 20 mm Hg A cut vein has even blood flow; a l t d t fl i tlacerated artery flows in spurts

Venous Blood PressureVenous Blood PressureVenous Blood PressureVenous Blood Pressure

Venous BP alone is too low to promote padequate blood return and is aided by the:◦ Respiratory “pump” pressure changes created ◦ Respiratory pump – pressure changes created during breathing suck blood toward the heart by squeezing local veins Muscular “pump” contraction of skeletal ◦ Muscular “pump” – contraction of skeletal muscles “milk” blood toward the heart

Valves prevent backflow during venous greturn

Factors Aiding Venous ReturnFactors Aiding Venous ReturnFactors Aiding Venous ReturnFactors Aiding Venous Return

F Aidi F Aidi Factors Aiding Factors Aiding Venous ReturnVenous Return

Figure 19.6

Maintaining blood pressure requires:a a g b ood p ssu qu s◦ Cooperation of the heart, blood vessels, and kidneysS i i f th b i◦ Supervision of the brain

Maintaining Blood PressureMaintaining Blood PressureMaintaining Blood PressureMaintaining Blood Pressure

The main factors influencing blood The main factors influencing blood e a ac o s ue c g oode a ac o s ue c g oodpressure arepressure are:◦◦ Cardiac output (CO)Cardiac output (CO)◦◦ Peripheral resistance (PR)Peripheral resistance (PR)◦◦ Blood volumeBlood volumeBlood pressure Blood pressure = CO x PRBlood pressure Blood pressure = CO x PRBlood pressure varies directly with CO, PR and blood volumePR, and blood volume

Maintaining Blood PressureMaintaining Blood PressureMaintaining Blood PressureMaintaining Blood Pressure

C di t t i d t i d b C di t t i d t i d b Cardiac output is determined by venous Cardiac output is determined by venous return and neural and hormonal controlsreturn and neural and hormonal controlsResting heart rate is controlled by the Resting heart rate is controlled by the Resting heart rate is controlled by the Resting heart rate is controlled by the cardioinhibitorycardioinhibitory center via the center via the vagusvagusnervesnerves◦ Stroke volume is controlled by venous return (end diastolic volume, or EDV)

Under stress, the Under stress, the cardioacceleratorycardioacceleratory

Cardiac Output (CO)Cardiac Output (CO)

Under stress, the Under stress, the cardioacceleratorycardioacceleratorycenter increases heart rate and stroke center increases heart rate and stroke volumevolume

The end s stolic ol me (ESV) dec eases and Cardiac Output (CO)Cardiac Output (CO)◦ The end systolic volume (ESV) decreases and MAP increases

Cardiac Output Cardiac Output (CO)(CO)

Figure 19.7

Short-term controls: S o e co o s◦◦ Are mediated by the nervous system and Are mediated by the nervous system and bloodbornebloodborne chemicalschemicalsC t t tC t t t tt t t ◦◦ Counteract momentCounteract moment--toto--moment moment fluctuations in blood pressure by altering fluctuations in blood pressure by altering peripheral resistanceperipheral resistancep pp p

Long-term controls regulate blood volume

Controls of Blood PressureControls of Blood PressureControls of Blood PressureControls of Blood Pressure

Neural controls of peripheral resistance:p p◦◦ Alter blood distribution in response to Alter blood distribution in response to demandsdemands◦◦ Maintain MAP by altering blood vessel Maintain MAP by altering blood vessel Maintain MAP by altering blood vessel Maintain MAP by altering blood vessel diameterdiameter

Neural controls operate via reflex arcs involving:involving:◦◦ BaroreceptorsBaroreceptors◦◦ Vasomotor centers and vasomotor fibersVasomotor centers and vasomotor fibers◦◦ Vascular smooth muscleVascular smooth muscle

ShortShort--Term Mechanisms: Neural Term Mechanisms: Neural ControlsControlsControlsControls

Vasomotor center Vasomotor center – a cluster of sympathetic neurons in the medulla that oversees changes in blood vessel diameter

M i t i bl d l t b i ti th ◦ Maintains blood vessel tone by innervating smooth muscles of blood vessels, especially arterioles

Cardiovascular center Cardiovascular center – vasomotor center plus the cardiac centers that integrate blood pressure control by altering cardiac output and blood vessel diameterand blood vessel diameter

ShortShort--Term Mechanisms: Term Mechanisms: Vasomotor CenterVasomotor CenterVasomotor CenterVasomotor Center

Sympathetic activity causes:Sympathetic activity causes:Sy pa e c ac y causesSy pa e c ac y causes◦ Vasoconstriction and a rise in BP if increased◦ BP to decline to basal levels if decreasedVasomotor activity is modified by:Vasomotor activity is modified by:◦ Baroreceptors (pressure-sensitive), chemoreceptors (O CO and H+ sensitive) chemoreceptors (O2, CO2, and H sensitive), higher brain centers, bloodborne chemicals, and hormones

ShortShort--Term Mechanisms: Term Mechanisms: Vasomotor ActivityVasomotor ActivityVasomotor ActivityVasomotor Activity

Increased blood pressure stimulates the Increased blood pressure stimulates the cardioinhibitory center to:◦ Increase vessel diameter◦ Decrease heart rate, cardiac output, peripheral resistance, and blood pressure

ShortShort--Term Mechanisms: Term Mechanisms: BaroreceptorBaroreceptor--Initiated ReflexesInitiated ReflexesBaroreceptorBaroreceptor Initiated ReflexesInitiated Reflexes

Declining blood pressure stimulates the cardioacceleratory center to:y◦ Increase cardiac output and peripheral resistance

L bl d l ti l t th Low blood pressure also stimulates the vasomotor center to constrict blood vesselsvessels

ShortShort--Term Mechanisms: Term Mechanisms: BaroreceptorBaroreceptor--Initiated ReflexesInitiated ReflexesBaroreceptorBaroreceptor Initiated ReflexesInitiated Reflexes

Impulse traveling alongafferent nerves frombaroreceptors:Stimulate cardio-inhibitory center(and inhibit cardio-acceleratory center)

Sympatheticimpulses toheart

Baroreceptorsin carotidsinuses and

acceleratory center) heart( HR and contractility)

COI hibitaortic archstimulated

Arterialblood pressurerises abovenormal range

Rate of vasomotorimpulses allowsvasodilation( vessel diameter)

R

CO

CO and Rreturn bloodpressure to

Inhibitvasomotor center

Stimulus:Rising bloodpressure

Stimulus:Declining

Homeostasis: Blood pressure in normal range

pHomeostaticrange

CO and Rreturn bloodpressure tohomeostaticrange

Cardiacoutput(CO)

Impulses frombaroreceptors:Stimulate cardio-acceleratory center(and inhibit cardio-inhibitory center)

Decliningblood pressure

Arterial blood pressurefalls below normal range

Baroreceptors incarotid sinuses

Vasomotor Sti l t

Peripheralresistance (R)

(CO)Sympathetic

impulses to heart( HR and contractility)

carotid sinusesand aortic archinhibited

Vasomotorfibersstimulatevasoconstriction

Stimulatevasomotorcenter

Figure 19.8

Impulse traveling alongafferent nerves frombaroreceptors:Stimulate cardio-inhibitory center(and inhibit cardio-acceleratory center)

Sympatheticimpulses toheart( HR and contractility)

Baroreceptorsin carotidsinuses andaortic arch COInhibitaortic archstimulated

Arterialblood pressure

Rate of vasomotorimpulses allowsvasodilation

R

CO and R

vasomotor center


blood pressurerises abovenormal range

vasodilation( vessel diameter)


pressure


Figure 19.8


CO and Rreturn blood

tImpulses fromb t

Stimulus:Decliningblood pressure

pressure tohomeostaticrange

Cardiacoutput(CO) Sympathetic

baroreceptors:Stimulate cardio-acceleratory center(and inhibit cardio-inhibitory center)



d ti h



and aortic archinhibited

VasomotorFibersstimulatevasoconstriction


vasoconstriction

Figure 19.8

Impulse traveling alongafferent nerves frombaroreceptors:Stimulate cardio-inhibitory center Sympathetic

Baroreceptorsin carotidsinuses and

inhibitory center(and inhibit cardio-acceleratory center)

yimpulses toheart( HR and contractility)

COI hibitaortic archstimulated

Arterialblood pressurerises abovenormal range

Rate of vasomotorimpulses allowsvasodilation( vessel diameter)

R

CO

CO and Rreturn bloodpressure to

Inhibitvasomotor center


Stimulus:Declining


pHomeostaticrange


Cardiacoutput(CO)

Impulses frombaroreceptors:Stimulate cardio-acceleratory center(and inhibit cardio-inhibitory center)

Decliningblood pressure



Vasomotor Sti l t


(CO)Sympathetic


carotid sinusesand aortic archinhibited

Vasomotorfibersstimulatevasoconstriction


Figure 19.8

Blood pressure is regulated by Blood pressure is regulated by ood p essu e s egu a ed yood p essu e s egu a ed ychemoreceptor chemoreceptor reflexes sensitive to oxygen and carbon dioxide◦ Prominent chemoreceptors are the carotid and aortic bodies◦ Reflexes that regulate BP are integrated in the ◦ Reflexes that regulate BP are integrated in the medulla◦ Higher brain centers (cortex and h h l ) d f lhypothalamus) can modify BP via relays to medullary centers

ShortShort--Term Mechanisms: Chemical Term Mechanisms: Chemical ControlsControlsControlsControls

Adrenal medulla hormones Adrenal medulla hormones –i h i d i h i i norepinephrine and epinephrine increase

blood pressureAntidiureticAntidiuretic hormone (ADH) hormone (ADH) – causes i t t i ti i f intense vasoconstriction in cases of extremely low BPAngiotensinAngiotensin II II – kidney release of renin

t i t i II hi h generates angiotensin II, which causes vasoconstrictionEndotheliumEndothelium--derived factors derived factors – endothelin

d l di d i d h f and prostaglandin-derived growth factor (PDGF) are both vasoconstrictors

Chemicals that Increase Blood Chemicals that Increase Blood PressurePressurePressurePressure

AtrialAtrial natriureticnatriuretic peptide (ANP) peptide (ANP) –p p ( )p p ( )causes blood volume and pressure to declineNitric oxide (NO) Nitric oxide (NO) is a brief but potent Nitric oxide (NO) Nitric oxide (NO) – is a brief but potent vasodilatorInflammatory chemicals Inflammatory chemicals – histamine, yy ,prostacyclin, and kinins are potent vasodilatorsAl h lAl h l BP t d b i hibiti AlcoholAlcohol – causes BP to drop by inhibiting ADH

Chemicals that Decrease Blood Chemicals that Decrease Blood PressurePressurePressurePressure

Long-term mechanisms control BP by o g a s s o o byaltering blood volumeBaroreceptorsBaroreceptors adapt to chronic high adapt to chronic high or low BPor low BP◦ Increased BP stimulates the kidneys to eliminate water thus reducing BPeliminate water, thus reducing BP◦ Decreased BP stimulates the kidneys to increase blood volume and BP

LongLong--Term Mechanisms: Renal Term Mechanisms: Renal RegulationRegulationRegulationRegulation

Kidneys act directly Kidneys act directly and indirectly to and indirectly to maintain longmaintain long--term term maintain longmaintain long term term blood pressureblood pressure◦ Direct renal mechanism

alters blood volume◦ Indirect renal

mechanism involves the

Kidney Action and Blood PressureKidney Action and Blood Pressure

renin-angiotensinmechanismKidney Action and Blood PressureKidney Action and Blood Pressure

◦◦ Declining BP causes the Declining BP causes the release of release of reninrenin, which , which triggers the release of triggers the release of ggggangiotensinangiotensin IIII◦◦ AngiotensinAngiotensin II is a potent II is a potent vasoconstrictor that vasoconstrictor that vasoconstrictor that vasoconstrictor that stimulates stimulates aldosteronealdosteronesecretionsecretion

Kidney Action and Blood PressureKidney Action and Blood Pressure

◦◦ AldosteroneAldosterone enhances renal enhances renal reabsorptionreabsorption and and stimulates ADH releasestimulates ADH releaseKidney Action and Blood PressureKidney Action and Blood Pressurestimulates ADH releasestimulates ADH release

Kidney Action Kidney Action and Blood and Blood and Blood and Blood PressurePressure

Figure 19.9

MAP IncreasesMAP IncreasesMAP IncreasesMAP Increases

Figure 19.10

Efficiency of the circulation can be d b ki l d bl d assessed by taking pulse and blood

pressure measurementsVital signs – pulse and blood pressure, g p p ,along with respiratory rate and body temperaturePulse – pressure wave caused by the Pulse pressure wave caused by the expansion and recoil of elastic arteries◦ Radial pulse (taken on the radial artery at the wrist) is routinely usedwrist) is routinely used◦ Varies with health, body position, and activity

Monitoring Circulatory EfficiencyMonitoring Circulatory EfficiencyMonitoring Circulatory EfficiencyMonitoring Circulatory Efficiency

Palpated PulsePalpated PulsePalpated PulsePalpated Pulse

Figure 19.11

Systemic arterial BP is measured Sys a a s asu dindirectly with the auscultatory method◦ A sphygmomanometer is placed on the arm

h lbsuperior to the elbow◦ Pressure is increased in the cuff until it is greater than systolic pressure in the brachial greater than systolic pressure in the brachial artery◦ Pressure is released slowly and the examiner listens ith a stethoscopelistens with a stethoscope

Measuring Blood PressureMeasuring Blood PressureMeasuring Blood PressureMeasuring Blood Pressure

◦ The first sound heard is recorded as the systolic pressure◦ The pressure when sound disappears is recorded as the diastolic pressurerecorded as the diastolic pressure

Measuring Blood PressureMeasuring Blood PressureMeasuring Blood PressureMeasuring Blood Pressure

Blood pressure cycles over a 24-hour ood p ssu y s o a ouperiodBP peaks in the morning due to waxing and waning levels of retinoic acidExtrinsic factors such as age, sex, weight,

d t i i race, mood, posture, socioeconomic status, and physical activity may also cause BP to varycause BP to vary

Variations in Blood PressureVariations in Blood PressureVariations in Blood PressureVariations in Blood Pressure

Hypotension – low BP in which systolic yp ypressure is below 100 mm HgHypertension – condition of sustained elevated arterial pressure of 140/90 or elevated arterial pressure of 140/90 or higher◦ Transient elevations are normal and can be caused by fever, physical exertion, and emotional upset◦ Chronic elevation is a major cause of heart jfailure, vascular disease, renal failure, and stroke

Alterations in Blood PressureAlterations in Blood PressureAlterations in Blood PressureAlterations in Blood Pressure

Orthostatic hypotension – temporary low yp p yBP and dizziness when suddenly rising from a sitting or reclining position Chronic hypotension hint of poor Chronic hypotension – hint of poor nutrition and warning sign for Addison’s diseaseAcute hypotension – important sign of circulatory shock

Threat to patients undergoing surgery and ◦ Threat to patients undergoing surgery and those in intensive care units

HypotensionHypotensionHypotensionHypotension

Hypertension maybe transient or yp ypersistentPrimary or essential hypertension – risk factors in primary hypertension include factors in primary hypertension include diet, obesity, age, race, heredity, stress, and smokinggSecondary hypertension – due to identifiable disorders, including excessive renin secretion arteriosclerosis and renin secretion, arteriosclerosis, and endocrine disorders

HypertensionHypertensionHypertensionHypertension

Blood flow, or tissue perfusion, is involved ood o , o ssu p us o , s o din:◦ Delivery of oxygen and nutrients to, and

l f f llremoval of wastes from, tissue cells ◦ Gas exchange in the lungs◦ Absorption of nutrients from the digestive tractAbsorption of nutrients from the digestive tract◦ Urine formation by the kidneysBlood flow is precisely the right amount to p y gprovide proper tissue function

Blood Flow Through TissuesBlood Flow Through TissuesBlood Flow Through TissuesBlood Flow Through Tissues

Blood velocity: ood o y◦ Changes as it travels through the systemic circulationI i l ti l t th ti l ◦ Is inversely proportional to the cross-sectional area

Slow capillary flow allows adequate time Slow capillary flow allows adequate time for exchange between blood and tissues

Velocity of Blood FlowVelocity of Blood FlowVelocity of Blood FlowVelocity of Blood Flow

Velocity of Blood FlowVelocity of Blood FlowFigure 19.13

Autoregulation – automatic adjustment of blood flow to each tissue in proportion to blood flow to each tissue in proportion to its requirements at any given point in timeBlood flow through an individual organ is Blood flow through an individual organ is intrinsically controlled by modifying the diameter of local arterioles feeding its gcapillariesMAP remains constant, while local

Autoregulation: Local Regulation Autoregulation: Local Regulation of Blood Flowof Blood Flow

demands regulate the amount of blood delivered to various areas according to needof Blood Flowof Blood Flowneed

Declining tissue nutrient and oxygen l l i li f l ilevels are stimuli for autoregulationHemoglobin delivers nitric oxide (NO) as well as oxygen to tissuesygNitric oxide induces vasodilation at the capillaries to help get oxygen to tissue cellscellsOther autoregulatory substances include: potassium and hydrogen ions, adenosine, lactic acid histamines kinins and lactic acid, histamines, kinins, and prostaglandins

Metabolic ControlsMetabolic ControlsMetabolic ControlsMetabolic Controls

Inadequate blood perfusion or excessively high arterial pressure:

A t l t ◦ Are autoregulatory ◦ Provoke myogenic responses – stimulation of vascular smooth muscle

Vascular muscle responds directly to:◦ Increased vascular pressure with increased tone, which causes vasoconstrictiontone, which causes vasoconstriction◦ Reduced stretch with vasodilation, which promotes increased blood flow to the tissue

Myogenic ControlsMyogenic ControlsMyogenic ControlsMyogenic Controls

Is evoked when short-term autoregulation cannot meet tissue nutrient requirementsMay evolve over weeks or months to enrich local blood flow

LongLong--Term AutoregulationTerm AutoregulationLongLong Term AutoregulationTerm Autoregulation

Angiogenesis takes place:g og s s a s p a◦ As the number of vessels to a region increases◦ When existing vessels enlarge◦ When a heart vessel becomes partly occluded ◦ Routinely in people in high altitudes, where oxygen content of the air is lowoxygen content of the air is low

LongLong--Term AutoregulationTerm AutoregulationLongLong Term AutoregulationTerm Autoregulation

Resting muscle blood flow is regulated by myogenic and general neural mechanisms in response to oxygen and carbon dioxide levelsWhen muscles become active hyperemia is When muscles become active, hyperemia is directly proportional to greater metabolic activity of the muscle (active or exercise hyperemia) hyperemia) Arterioles in muscles have cholinergic, and alpha (α) and beta (β) adrenergic receptorsα and β adrenergic receptors bind to epinephrine

Blood Flow: Skeletal MusclesBlood Flow: Skeletal MusclesBlood Flow: Skeletal MusclesBlood Flow: Skeletal Muscles

Muscle blood flow can increase tenfold or more during physical activity as vasodilation occurs ◦ Low levels of epinephrine bind to β receptors Cholinergic receptors are occupied◦ Cholinergic receptors are occupied

Blood Flow: Skeletal Muscle Blood Flow: Skeletal Muscle RegulationRegulationRegulationRegulation

Intense exercise or sympathetic nervous s s o sy pa oussystem activation results in high levels of epinephrine ◦ High levels of epinephrine bind to α receptors and cause vasoconstriction

This is a protective response to prevent muscle This is a protective response to prevent muscle oxygen demands from exceeding cardiac pumping ability

Blood Flow: Skeletal Muscle Blood Flow: Skeletal Muscle RegulationRegulationRegulationRegulation

Blood flow to the brain is constant, as neurons are intolerant of ischemiaM t b li t l b i ti i Metabolic controls – brain tissue is extremely sensitive to declines in pH, and increased carbon dioxide causes marked increased carbon dioxide causes marked vasodilationMyogenic controls protect the brain from d i h i bl d damaging changes in blood pressure◦ Decreases in MAP cause cerebral vessels to dilate to ensure adequate perfusion

Blood Flow: BrainBlood Flow: Brain

q p◦ Increases in MAP cause cerebral vessels to constrict

Blood Flow: BrainBlood Flow: Brain

The brain can regulate its own blood flow b a a gu a s o b ood oin certain circumstances, such as ischemia caused by a tumorThe brain is vulnerable under extreme systemic pressure changes

MAP b l 60 H ◦ MAP below 60mm Hg can cause syncope (fainting)◦ MAP above 160 can result in cerebral edema

Blood Flow: BrainBlood Flow: BrainBlood Flow: BrainBlood Flow: Brain

Blood flow through the skin:ood o oug s◦ Supplies nutrients to cells in response to oxygen needH l i t i b d t t ◦ Helps maintain body temperature ◦ Provides a blood reservoir

Blood Flow: SkinBlood Flow: SkinBlood Flow: SkinBlood Flow: Skin

Blood flow to venous plexuses below the ood o o ous p us s b oskin surface:◦ Varies from 50 ml/min to 2500 ml/min, d d b ddepending on body temperature◦ Is controlled by sympathetic nervous system reflexes initiated by temperature receptors and reflexes initiated by temperature receptors and the central nervous system

Blood Flow: SkinBlood Flow: SkinBlood Flow: SkinBlood Flow: Skin

As temperature rises (e.g., heat exposure, fever, vigorous exercise):

H th l i i l d t ◦ Hypothalamic signals reduce vasomotor stimulation of the skin vessels◦ Heat radiates from the skin Sweat also causes vasodilation via bradykinin in perspiration◦ Bradykinin stimulates the release of NO ◦ Bradykinin stimulates the release of NO As temperature decreases, blood is shunted to deeper, more vital organs

Temperature RegulationTemperature RegulationTemperature RegulationTemperature Regulation

Blood flow in the pulmonary circulation is ood o pu o a y u a o sunusual in that:◦ The pathway is short◦ Arteries/arterioles are more like veins/venules (thin-walled, with large lumens)◦ They have a much lower arterial pressure They have a much lower arterial pressure (24/8 mm Hg versus 120/80 mm Hg)

Blood Flow: LungsBlood Flow: LungsBlood Flow: LungsBlood Flow: Lungs

◦ The autoregulatory mechanism is exactly g y yopposite of that in most tissues

Low oxygen levels cause vasoconstriction; high levels promote vasodilationlevels promote vasodilationThis allows for proper oxygen loading in the lungs

Blood Flow: LungsBlood Flow: LungsBlood Flow: LungsBlood Flow: Lungs

Small vessel coronary circulation is influenced by:

A ti ◦ Aortic pressure◦ The pumping activity of the ventriclesDuring ventricular systole:g y◦ Coronary vessels compress◦ Myocardial blood flow ceases◦ Stored myoglobin supplies sufficient oxygen◦ Stored myoglobin supplies sufficient oxygenDuring ventricular diastole, oxygen and nutrients are carried to the heart

Blood Flow: HeartBlood Flow: HeartBlood Flow: HeartBlood Flow: Heart

Under resting conditions, blood flow U d s g o d o s, b ood othrough the heart may be controlled by a myogenic mechanismDuring strenuous exercise:◦ Coronary vessels dilate in response to local accumulation of carbon dioxideaccumulation of carbon dioxide◦ Blood flow may increase three to four times ◦ Blood flow remains constant despite wide pvariation in coronary perfusion pressure

Blood Flow: HeartBlood Flow: HeartBlood Flow: HeartBlood Flow: Heart

Oxygen, carbon dioxide, nutrients, and metabolic wastes diffuse between the metabolic wastes diffuse between the blood and interstitial fluid along concentration gradients◦ Oxygen and nutrients pass from the blood to tissues◦ Carbon dioxide and metabolic wastes pass from a bo d o d a d abo a pa otissues to the blood◦ Water-soluble solutes pass through clefts and fenestrationsfenestrations◦ Lipid-soluble molecules diffuse directly through endothelial membranes

Capillary Exchange of Respiratory Capillary Exchange of Respiratory Gases and NutrientsGases and NutrientsGases and NutrientsGases and Nutrients

Capillary Exchange of Respiratory Capillary Exchange of Respiratory Gases and NutrientsGases and Nutrients

Figure 19.15.1

Capillary Exchange of Respiratory Capillary Exchange of Respiratory d id iGases and NutrientsGases and Nutrients

Figure 19.15.2

Direction and amount of fluid flow depends upon the difference between:upon the difference between:◦ Capillary hydrostatic pressure (HPc)◦ Capillary colloid osmotic pressure (OPc) p y p ( c)HPc – pressure of blood against the capillary walls:

Tends to force fluids through the capillary walls ◦ Tends to force fluids through the capillary walls ◦ Is greater at the arterial end of a bed than at the venule end

OPc– created by nondiffusible plasma proteins, which draw water toward themselves

Capillary Exchange: Fluid Capillary Exchange: Fluid MovementsMovements

themselves

MovementsMovements

NFP – all the forces acting on a capillary a o s a g o a ap a ybedNFP = (HPc – HPif) – (OPc – OPif)At the arterial end of a bed, hydrostatic forces dominate (fluids flow out)

Net Filtration Pressure (NFP)Net Filtration Pressure (NFP)Net Filtration Pressure (NFP)Net Filtration Pressure (NFP)

At the venous end of a bed, osmotic ous d o a b d, os oforces dominate (fluids flow in)More fluids enter the tissue beds than return blood, and the excess fluid is returned to the blood via the lymphatic

tsystem



Figure 19.16

Circulatory shock – any condition in which C u a o y s o a y o d oblood vessels are inadequately filled and blood cannot circulate normally Results in inadequate blood flow to meet tissue needs

Circulatory ShockCirculatory ShockCirculatory ShockCirculatory Shock

Three types include:yp s ud◦ Hypovolemic shock – results from large-scale blood loss V l h k i l ti lti f ◦ Vascular shock – poor circulation resulting from extreme vasodilation◦ Cardiogenic shock – the heart cannot sustain gadequate circulation

Circulatory ShockCirculatory ShockCirculatory ShockCirculatory Shock

Figure 19.17

The vascular system has two distinct as u a sys as o d scirculations◦ Pulmonary circulation – short loop that runs f h h h l d b k hfrom the heart to the lungs and back to the heart◦ Systemic circulation – routes blood through a Systemic circulation routes blood through a long loop to all parts of the body and returns to the heart

Circulatory PathwaysCirculatory PathwaysCirculatory PathwaysCirculatory Pathways

The endothelial lining of blood vessels arises from mesodermal cells, which collect in blood islandscollect in blood islands◦ Blood islands form rudimentary vascular tubes through which the heart pumps blood by the fourth week of development

Fetal shunts (foramen ovale and ductus arteriosus) bypass nonfunctional lungsarteriosus) bypass nonfunctional lungsThe ductus venosus bypasses the liverThe umbilical vein and arteries circulate

Developmental AspectsDevelopmental Aspectsblood to and from the placenta

Developmental AspectsDevelopmental Aspects

Blood vessels are trouble-free during gyouthVessel formation occurs:

As needed to support body growth◦ As needed to support body growth◦ For wound healing◦ To rebuild vessels lost during menstrual cyclesWith aging, varicose veins, atherosclerosis, and increased blood pressure may arisepressure may arise

Developmental AspectsDevelopmental AspectsDevelopmental AspectsDevelopmental Aspects

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