Chapter 21: Cardiovascular Physiology

Blood Flow Purpose of cardiovascular regulation is maintenance of adequate blood flow through capillaries in peripheral tissues and organs Actual volume of blood flowing through a vessel, an organ, or the entire circulation in a given period: Is measured in per min Is equivalent to (CO), considering the entire vascular system Is relatively constant when at rest Varies widely through individual organs, according to immediate needs Is determined by the interplay between (P) and (R) Blood Flow, Blood Pressure, and Resistance Blood flow (F) is proportional to the difference in blood pressure (P) between two points in circulation If P increases, blood flow . If P decreases, blood flow . Blood flow is proportional to resistance (R) If R increases, blood flow . If R decreases, blood flow . is more important than in influencing local blood pressure In summary, Flow (F) = . Resistance Resistance force that opposes blood flow Measure of amount of blood encounters as it passes through vessels Referred to as resistance (PR) The three important sources of resistance are: Blood - thickness of blood Normally stable but disorders that affect change viscosity and thus PR Increase viscosity resistance Total blood vessel . Normally constant but may increase with . Increase vessel length resistance Blood vessel . Most important factor affecting resistance Decrease diameter resistance More blood in contact with walls of vessel Vessel Diameter and Resistance Vessel diameter determines how much blood flows through a tissue or organ decreases resistance, increases blood flow increases resistance, decreases blood flow Relationship between resistance and vessel diameter is expressed as: R= . Fatty plaques from atherosclerosis Cause blood flow Dramatically resistance due to turbulence Velocity of Blood Flow Blood velocity: Changes as it travels through the systemic circulation Is proportional to the cross-sectional area

Slow capillary flow allows adequate time for

between blood and tissues

Flow at Different Points From aorta to capillaries, flow for 3 reasons greater distance, more to flow smaller of arterioles and capillaries farther from heart, total cross sectional area From capillaries to vena cava, flow again Closer to heart, cross sectional area never regains velocity of large arteries Capillary Exchange Only occurs across capillary walls between blood and surrounding tissues 3 routes across endothelial cells clefts through . Mechanisms involved diffusion, transcytosis, filtration and reabsorption Diffusion Most important mechanism -soluble substances steroid hormones, O2 and CO2 diffuse easily Lipid-insoluble substances and must pass through channels, fenestrations or intercellular clefts Large particles , held back Transcytosis transport vesicles across cell . Important for fatty acids, albumin and some hormones (insulin) Filtration and reabsorption Opposing forces : movement of fluid and solutes out of blood blood ( ) pressure drives fluid out of capillary physical force exerted against walls by blood high on end of capillary, low on end : movement of fluid and solutes into blood pressure (COP) draws fluid into capillary results from plasma (albumin) increasing osmolarity of blood net COP = blood COP (BCOP) - intersitial COP (ICOP)

Edema Edema due to build-up of tissue fluid Capillary filtration ( capillary or ) poor return congestive heart failure edema insufficient activity failure (water retention, hypertension) makes capillaries more permeable Capillary reabsorption ( BCOP) - cirrhosis, famine, burns, kidney disease Obstructed drainage Normally drains fluid not reabsorbed by capillaries Consequences of Edema Tissue . oxygen delivery and waste removal impaired Pulmonary edema . edema headaches, nausea, seizures and coma shock excess fluid in tissue spaces causes low blood volume and low BP Tissue Perfusion Refers to blood flow through tissues Factors that affect tissue perfusion include: Regulatory mechanisms used to control perfusion mechanisms mechanisms Autoregulation of Blood Flow Maintains fairly constant blood flow despite BP variation Involves 2 different mechanisms 1. control mechanisms: vascular smooth muscle contracts when stretched & relaxes when not stretched E.g. decreased arterial pressure causes cerebral vessels to dilate & vice versa 2. control mechanism matches blood flow to local tissue needs Low (acidity due to lactic acid) or high CO2 (hypercapnia), or K+ from high , low metabolism cause vasodilation which increases blood flow ( ) Regulation of Blood Flow Endothelium produces several regulators that promote relaxation: (NO) NO is involved in setting resting tone of vessels Levels are by parasympathetic activity Vasodilator drugs such as nitroglycerin or Viagra act thru NO Sympathetic activation causes increased & increased in periphery & viscera Blood flow to muscles is increased arterioles dilate in response to epinephrine Thus blood is shunted viscera & skin to muscles

Hormonal Regulation of Tissue Perfusion hormone released in response to blood volume Increases water retention by kidneys released in response to a in blood pressure Causes . released if BP falls or O2 levels are abnormally low Stimulates production of . peptides released in response to excessive right stretch Causes . Circulatory Pressure Circulatory pressure is divided into three components pressure (BP) pressure, reported in mm Hg Range from about 100 at entrance to aorta to about 35 at start of capillary network pressure (CHP) Pressure within capillary beds (35 mm Hg at start18 at end) pressure Pressure within the venous system ; pressure gradient from venules to right atrium is about .18 mm Hg P across the entire systemic circuit is called the . Averages about 100 mm Hg For circulation to occur, this pressure must be sufficient to overcome resistance of entire cardiovascular system

Blood Pressure Force that blood exerts against a vessel wall Measured at brachial artery of arm pressure: BP during ventricular systole pressure: BP during ventricular diastole Normal value, young adult: < mm Hg Pulse pressure: systolic - diastolic important measure of stress exerted on small arteries Mean arterial pressure (MAP): diastolic pressure + (1/3 of pulse pressure) Perfusion pressure of organs > mmHg adequate to sustain organs Importance of arterial elasticity expansion and recoil maintains steady flow of blood throughout cardiac cycle, smoothes out pressure fluctuations and stress on small arteries BP with age: arteries less distensible BP determined by , blood and . Abnormalities of Blood Pressure . chronic resting BP > 140/90 Consequences: can weaken small arteries and cause . low resting BP < 90/60 caused by , Consequences: Inadequate tissue

, anemia, excessive vasodilation .