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Vascular resistance
Vascular resistance is a term used to define the resistance to flow that must be overcome to push blood through the circulatory system. The resistance offered by the peripheral circulation is known as the systemic vascular resistance (SVR), while the resistance offered by the vasculature of the lungs is known as the pulmonary vascular resistance (PVR). The systemic vascular resistance may also be referred to as the total peripheral resistance. Vasoconstriction (i.e., decrease in blood vessel diameter) increases SVR, whereas vasodilation (increase in diameter) decreases SVR. Units for measuring vascular resistance are dynscm5, pascal seconds per cubic metre (Pas/m) or, for ease of deriving it by pressure (measured in mmHg) and cardiac output (measured in l/min), it can be given in mmHgmin/l. This is numerically equivalent to hybrid reference units (HRU), also known as Wood units, frequently used by pediatric cardiologists. To convert from Wood units to MPas/m3 you must multiply by 8, or to dynscm5 you must multiply by 80.[1]
Measurement dyns/cm5 Systemic vascular resistance [2] Reference Range MPas/m3 mmHgmin/l or HRU/Wood units
7001600
70160 213
Calculation of resistance
The basic tenet of calculating resistance is that flow is equal to driving pressure divided by resistance. The systemic vascular resistance can therefore be calculated in units of dynscm5 as
where mean arterial pressure is 2/3 of diastolic blood pressure plus 1/3 of systolic blood pressure. The pulmonary vascular resistance can therefore be calculated in units of dynscm5 as
where the pressures are measured in units of millimetres of mercury (mmHg) and the cardiac output is measured in units of litres per minute (L/min). The pulmonary artery wedged pressure (also called pulmonary artery occlusion pressure or PAOP) is a measurement in which one of the pulmonary arteries is occluded, and the pressure downstream from the occlusion is measured in order to approximately sample the left atrial pressure.[4] Therefore the numerator of the above equation is the pressure difference between the input to the pulmonary blood circuit (where the heart's right ventricle connects to the pulmonary trunk) and the output of the circuit (which is the input to the left atrium of the heart). The above equation contains a numerical constant to compensate for the units used, but is conceptually equivalent to the following:
where R is the pulmonary vascular resistance (fluid resistance), P is the pressure difference across the pulmonary circuit, and Q is the rate of blood flow through it. As an example: If Systolic pressure: 120 mmHg, Diastolic pressure: 80 mmHg, Right atrial mean pressure: 3 mmHg, Cardiac output: 5 l/min, Then Mean Arterial Pressure would be : (2 Diastolic pressure + Systolic pressure)/3 = 93.3 mmHg, and Systemic vascular resistance: (93 - 3) / 5 =18 Wood Units. or Systemic vascular resistance: 18 x 80 = 1440 dyns/cm5 These values are in the normal limits.
Vascular resistance
Role of adenosine
Adenosine probably doesn't play a role in maintaining the vascular resistance in the resting state. However, it causes vasodilation and decreased vascular resistance during hypoxia. Adenosine is formed in the myocardial cells during hypoxia, ischemia, or vigorous work, due to the breakdown of high-energy phosphate compounds (e.g., adenosine monophosphate, AMP). Most of the adenosine that is produced leaves the cell and acts as a direct vasodilator on the vascular wall. Because adenosine acts as a direct vasodilator, it is not dependent on an intact endothelium to cause vasodilation. Adenosine causes vasodilation in the small and medium sized resistance arterioles (less than 100m in diameter). When adenosine is administered it can cause a coronary steal phenomenon, where the vessels in healthy tissue dilate as much as the ischemic tissue and more blood is shunted away from the ischemic tissue that needs it most. This is the principle behind adenosine stress testing. Adenosine is quickly broken down by adenosine deaminase, which is present in red cells and the vessel wall.
Vascular resistance
References
[1] Fuster, V.; Alexander, R.W.; O'Rourke, R.A. (2004) Hurst's the heart, book 1. 11th Edition, McGraw-Hill Professional, Medical Pub. Division. Page 513. ISBN 978-0-07-143224-5. [2] Table 30-1 in: [3] Derived from values in dyns/cm5 [4] University of Virginia Health System. "The Physiology: Pulmonary Artery Catheters" (http:/ / www. healthsystem. virginia. edu/ internet/ anesthesiology-elective/ cardiac/ pacphys. cfm)
Literature
1. Grossman W, Baim D. Grossman's Cardiac Catheterization, Angiography, and Intervention, Sixth Edition. Page 172, Tabe 8.1 ISBN 0-683-30741-X 2. Heart information: Systemic vascular resistance (http://booktine.com/systemic-vascularresistance)
License
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