Chapter 21

Lecture Outline*
RodR.Seeley

IdahoStateUniversity

TrentD.Stephens
IdahoStateUniversity

PhilipTate

PhoenixCollege

*See PowerPoint Image Slides for all

figures and tables pre-inserted into
PowerPoint without notes.

CopyrightTheMcGrawHillCompanies,Inc.Permissionrequiredforreproductionordisplay.

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Chapter 21

The Cardiovascular System

Peripheral Circulation and Regulation

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Functions of the Peripheral

Circulation
1. Carry blood
2. Exchange nutrients, waste products, and gases
3. Transport of hormones, components of the
immune system, molecules required for
coagulation, enzymes, nutrients, gases, waste
products, etc.
4. Regulate blood pressure
5. Direct blood flow
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Types of Blood Vessels

Arteries
Elastic
Muscular
Arterioles

Capillaries: site of exchange with tissues

Veins: thinner walls than arteries, contain less elastic
tissue and fewer smooth muscle cells
Venules
Small veins
Medium or large veins

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Capillaries
Capillary wall consists of endothelial cells (simple squamous
epithelium), basement membrane and a delicate layer of loose C.T.
Scattered pericapillary cells that are fibroblasts, macrophages or
undifferentiated smooth muscle cells.
Substances move through capillaries by diffusion through
Lipid-soluble and small water-soluble molecules through plasma
membrane
Larger water-soluble molecules pass through fenestrae or gaps
between endothelial cells.

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Types of Capillaries
Continuous. No gaps between endothelial cells. No
fenestrae. Less permeable to large molecules than other
capillary types. E.g., muscle, nervous tissue.
Fenestrated. Have pores. Endothelial cells have numerous
fenestrae. Fenestrae are areas where cytoplasm is absent
and plasma membrane is made of a thin, porous
diaphragm. Highly permeable. E.g., intestinal villi, ciliary
process of eye, choroid plexus, glomeruli of kidney
Sinusoidal. Large diameter with large fenestrae. Less
basement membrane. E.g., endocrine glands (large
molecules cross their walls).
Sinusoids. Large diameter sinusoidal capillaries. Sparse
basement membrane. E.g., liver, bone marrow.Venous
sinuses are similar in structure but even larger. E.g., spleen
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Structure of Capillary Walls

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Capillary Network
Blood flows from
arterioles through
metarterioles, then
through capillary network
Flow through
thoroughfare channel
fairly consistent while
flow through arterial
capillaries is intermittent
Smooth muscle in
arterioles, metarterioles,
precapillary sphincters
regulates blood flow

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Structure of Arteries and Veins

Tunica intima
Endothelium
Basement membrane
Lamina propria (C.T. layer)
Internal elastic membrane. Fenestrated
layer of elastic fibers.
Tunica media: smooth muscle cells
arranged circularly around the blood
vessel.
Vasoconstriction: smooth muscles
contract, decrease in blood flow
Vasodilation: smooth muscles relax,
increase in blood flow
Tunica externa (adventitia): connective
tissue, varies from dense regular near the
vessel to loose that merges with the
surrounding C.T.

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Photomicrograph of Artery and Vein

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Elastic Artery
Elastic or conducting arteries
Largest diameters, pressure high and fluctuates between
systolic and diastolic. More elastic tissue than muscle.
Relatively thick tunica intima, thin tunica intima

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Muscular Artery
Muscular or medium arteries
Smooth muscle allows vessels to regulate blood supply by constricting or
dilating
Most of the smaller unnamed arteries
Thick walls due to 25-40 layers of smooth muscle.
Also called distributing arteries because smooth muscle allows vessels to
partially regulate blood supply to different regions of the body.

Smaller muscular arteries

Adapted for vasodilation and vasoconstriction .

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Arterioles
Transport blood from small arteries to
capillaries
Smallest arteries where the three tunics
can be differentiated
Like small arteries, capable of
vasoconstriction and dilation

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Venules and Small Veins

Venules drain capillary network.
Endothelial cells and basement membrane
with a few smooth muscle cells. As
diameter of venules increases, amount of
smooth muscle increases.
Small veins. Smooth muscle cells form a
continuous layer. Addition of tunica
adventitia made of collagenous connective
tissue
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Medium and Large Veins

Medium veins. Go-between between small veins and large
veins.
Large veins. Tunica intima is thin: endothelial cells, relatively
thin layer of C.T and a few scattered elastic fibers. Tunica media
has circularly arranged smooth muscle cells. Adventitia is
predominant layer.

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Valves
Valves found in all veins greater than 2 mm in diameter.
Folds in intima form two flaps that overlap.
More valves in veins of lower extremities than in veins
of upper extremities.

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Other Vessel Types

Vasa vasorum: blood vessels that supply the walls of
arteries and veins. Penetrate vessel walls from the exterior.
Branches of arteries.
Arteriovenous anastomoses. Vessels allow blood to flow
from arterioles to small veins without going through
capillaries. If arranged in a convoluted fashion and
surrounded by collagenous connective tissue, referred to as
a glomus.
Portal veins: veins that begin in a primary capillary
network, extend some distance and end in a secondary
capillary network without a pumping mechanism, such as
the heart, between.

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Nerve Supply
Unmyelinated sympathetic nerve fibers form plexi
in tunica adventitia: vasoconstriction
Small arteries and arterioles innervated to greatest
extent
Vessels of penis and clitoris innervated by
parasympathetic
Some blood vessels innervated by myelinated
fibers and act as baroreceptors that monitor stretch
and detect changes in blood pressure
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Aging of the Arteries

Arteriosclerosis:
general term for
degeneration changes
in arteries making
them less elastic
Atherosclerosis:
deposition of plaque
on walls
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Pulmonary Circulation
From right ventricle into pulmonary
trunk
Pulmonary trunk divides into left and
right pulmonary arteries.
Two pulmonary veins exit each lung
and enter left atrium
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Systemic Circulation
Aorta: exits left ventricle and is divided into three
parts
Ascending aorta: right and left coronary arteries branch
from here
Aortic arch: arching posteriorly and to the left and has
three branches
Brachiocephalic artery
Left common carotid
Left subclavian artery

Descending aorta
Thoracic aorta: portion in thorax
Abdominal aorta: inferior to diaphragm. Ends as two common
iliac arteries

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Branches of the Aorta

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Major Arteries

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Head and Neck Arteries

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Major Arteries of the Head and

Thorax

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Arteries of Upper Limb and

Shoulder

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Arteries of Abdomen

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Arteries of Abdomen and Pelvis

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Arteries of Pelvis and Lower Limb

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Arteries of Lower Limb

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Systemic Circulation: Veins

Return blood from body to right atrium
Major veins
Coronary sinus (heart)
Superior vena cava (head, neck, thorax, upper
limbs)
Inferior vena cava (abdomen, pelvis, lower
limbs)

Types of veins
Superficial, deep, sinuses
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Major Veins

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Venous Sinuses Associated with

the Brain

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21-40

Veins of Head and Neck

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Head and Thorax Veins

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Veins of Shoulder and Upper Limb

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21-45

Veins of Thorax

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Inferior Vena Cava and Its

Tributaries

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21-49

Hepatic Portal System

Portal system: vascular system that
begins and ends at a capillary bed with
no pumping mechanism in between.
Hepatic portal- liver; renal portalkidney; hypothalamohypophyseal
portal between hypothalamus and
pituitary.
Blood entering the hepatic portal vein
is rich with nutrients collected from the
intestines, but may also contain toxic
substances. Both nutrients and toxic
substances will be regulated by the
liver

Nutrients: either taken up and stored or modified chemically and

used by other parts of the body
Biotransformation: Toxic substances can be broken down by
hepatocytes or can be made water soluble. To be transported in
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blood and excreted by the kidneys.

21-51

Veins of Abdomen and Pelvis

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Veins of Pelvis and Lower Limb

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Veins of Lower Limb

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Dynamics of Blood Circulation

Interrelationships between
Pressure
Flow
Resistance
Control mechanisms that regulate
blood pressure and blood flow
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Laminar and Turbulent Flow

Laminar flow
Streamlined; interior of blood vessel is smooth and of
equal diameter along its length
Outermost layer moving slowest and center moving
fastest

Turbulent flow

Interrupted
Rate of flow exceeds critical velocity
Fluid passes a constriction, sharp turn, rough surface
Partially responsible for heart sounds
Sounds due to turbulence not normal in arteries and is
probably due to some constriction; increases the
probability of thrombosis
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Blood Pressure
Measure of force exerted by blood against the wall
Blood moves through vessels because of blood pressure
Measured by listening for Korotkoff sounds produced by
turbulent flow in arteries as pressure released from blood
pressure cuff

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Blood Flow
Rate of flow through a tube is expressed as the
volume that passes a specific point per unit of
time. E.g.; cardiac output at rest is 5L/min, thus
blood flow through the aorta is 5L/min
Flow = (P1 P2/R)
P1 and P2 are pressures in the vessel at points one
and two; R is the resistance to flow
Directly proportional to pressure differences,
inversely proportional to resistance
Resistance = 8vl/r4
v is viscosity, l = length of the vessel, r is the
radius of the vessel
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Poiseuilles Law
Flow decreases when resistance increases and vice
versa. Since resistance is proportional to blood
vessel diameter, constriction of a blood vessel
increases resistance and thus decreases flow
Flow =(P1 P2)/R - (P1 P2)r4/8vl
During exercise, heart beats with greater force
increasing pressure in the aorta. Capillaries to
skeletal muscle increase in diameter decreasing
resistance and increasing flow. Increased flow in
aorta can go from 5L/min to 5 times that amount

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Viscosity
Measure of resistance of liquid to flow
Resistance proportionate to flow
As viscosity increases, pressure required to
flow increases
Viscosity influenced largely by hematocrit
(percentage of the total blood volume
composed of red blood cells).
Dehydration and/or uncontrolled production
of RBCs can lead to increased viscosity
which increases the workload on the heart.
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Critical Closing Pressure,

Laplaces Law and Compliance
Critical closing pressure:
Pressure at which a blood
vessel collapses and blood
flow stops
Laplaces Law
Force acting on blood vessel
wall is proportional to diameter
of the vessel times blood
pressure
F= D X P; thus as diameter of a
vessel increases, force on the
wall increases. Weakened part
of a vessel wall bulges out and
is an aneurysm.

Vascular compliance:
Tendency for blood
vessel volume to
increase as blood
pressure increases
Compliance = increase
in volume/Increase in
pressure

More easily the vessel

wall stretches, the greater
its compliance
Venous system has a large
compliance (24 times
greater than that of
arteries) and acts as a
blood reservoir

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Physiology of Systemic
Circulation
Determined by
Anatomy of circulatory system
Dynamics of blood flow
Regulatory mechanisms that control heart and
blood vessels

Blood volume
Most in the veins (greater compliance)
Smaller volumes in arteries and capillaries
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Cross-Sectional Area
As diameter of vessels
decreases, the total crosssectional area increases and
velocity of blood flow
decreases. Only one aorta
with a cross-sectional area of
5 cm2. Total cross-sectional
area of the millions of
capillaries is 2500 cm2.
Much like a stream that
flows rapidly through a
narrow gorge but flows
slowly through a broad plane

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Pressure and Resistance

Blood pressure averages 100 mm

Hg in aorta and drops to 0 mm Hg
by the time the blood gets to the
right atrium. Due to decreased
resistance to flow as crosssectional area increases.
Greatest drop in pressure occurs in
arterioles which regulate blood
flow through tissues
No large fluctuations in capillaries
and veins
Muscular arteries and arterioles are
capable of constricting or dilating
in response to autonomic and
hormonal stimulation. Muscular
arteries regulate flow into a region
of the body; arterioles regulate
flow into a specific tissue.

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Pulse Pressure
Difference between systolic and
diastolic pressures
Increases when stroke volume
increases or vascular compliance
decreases. Compliance tends to
decrease with age
(arteriosclerosis) and pressure
rises.
Pulse pressure can be used to take
a pulse to determine heart rate and
rhythmicity
Most frequent site used to measure
pulse rate is in the carpus with the
radial artery- the radial pulse.
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Capillary Exchange and Regulation

of Interstitial Fluid Volume
Capillary exchange: the movement of substances into and
out of capillaries
Most important means of exchange: diffusion.
Lipid soluble cross capillary walls diffusing through plasma
membrane. E.g., O2, CO2, steroid hormones, fatty acids.
Water soluble diffuse through intercellular spaces or through
fenestrations of capillaries. E.g., glucose, amino acids.

Blood pressure, capillary permeability, and osmosis affect

movement of fluid from capillaries
Fluid moves out of capillaries at arterial end and most but
not all returns to capillaries at venous end. That which
remains in tissues is picked up by the lymphatic system
then returned to venous circulation.
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Fluid Exchange Across

Capillary Walls
Net filtration pressure (NFP)- force responsible for
moving fluid across capillary walls. Two forces affect
pressure
Hydrostatic pressure: physical pressure of blood flowing
through the vessels or of fluid in interstitial spaces
Osmotic pressure: movement of solutes (plasma or tissue
fluid) through a membrane (plasma membrane) in the presence
of a non-diffusible solute (large proteins). Large proteins do
not freely pass through the capillary walls and the difference
in protein concentrations between the blood and interstitial
fluid is responsible for osmosis
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Pressures Involved
NFP = Net hydrostatic pressure minus net osmotic
pressure
Net hydrostatic pressure = BP-IFP
Net osmotic pressure = BCOP-ICOP where
BP = blood pressure
IFP = interstitial fluid pressure= (lymphatic vessels are
pulling in tissue fluid)
BCOP = blood colloid osmotic pressure
ICOP = interstitial fluid colloid osmotic pressure

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Fluid Exchange Across the Walls of Capillaries

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Edema and Capillary Exchange

If capillaries become more permeable, proteins can
leak into the interstitial fluid increasing ICOP. More
fluid moves from the capillaries into the interstitial
fluid: edema.
Chemicals of inflammation increase permeability
Decreases in plasma concentration of protein reduces
BCOP; more fluid moves into interstitial fluid
Liver disease resulting in fewer plasma proteins
Loss of plasma proteins through the kidneys
Protein starvation

Blockage of veins increases capillary BP; reduced

venous return due to gravity
Blockage or removal of lymphatic vessels (blockage:
elephantiasis; removal: cancer)

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Characteristics of Veins
Venous return to heart increases due to
increase in blood volume, venous tone, and
arteriole dilation
Venous tone: continual state of partial
contraction of the veins as a result of
sympathetic stimulation

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Effect of Gravity on Blood Pressure

In a standing position, hydrostatic pressure
caused by gravity increases blood pressure
below the heart and decreases pressure
above the heart.
Muscular movement improves venous
return.

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Control of Blood Flow in Tissues

Local control: in most tissues, blood flow is
proportional to metabolic needs of tissues
Nervous System: responsible for routing
blood flow and maintaining blood pressure
Hormonal Control: sympathetic action
potentials stimulate epinephrine and
norepinephrine
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Local Control of
Blood Flow by Tissues

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Local Control of Blood Flow

Blood flow can increase 7-8 times as a result of
vasodilation of metarterioles and precapillary
sphincters in response to increased rate of
metabolism
Vasomotion: periodic contraction and relaxation
of precapillary sphincters. Autoregulation.
Long-term local control: capillaries become more
dense in a region that regularly has an increased
metabolic rate.
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Nervous Regulation of Blood Vessels

Important in minute-to-minute regulation of
local circulation
Provides a means by which blood can be shunted
from one large area of the peripheral circulatory
system to another area by increasing resistance
Sympathetic division most important. Innervates
all vessels except capillaries, precapillary
sphincters, and most metarterioles.
Vasomotor center in lower pons and upper
medulla oblongata.
Excitatory part is tonically active. Causes
vasomotor tone. Norepinephrine
Inhibitory part can cause vasodilation by
decreasing sympathetic output

Sympathetic stimulation of adrenal medulla causes output of

norepinephrine and epinephrine into circulation. Causes vasoconstriction
in vessels (-adrenergic receptors) except in skeletal muscle where
vasodilation takes place (-adrenergic receptors)
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Regulation of
Mean Arterial Pressure
Mechanisms that maintain arterial blood pressure within a
normal range of values
Mean arterial pressure (MAP): slightly less than the average
of systolic and diastolic pressures because diastole lasts
longer than systole.
70 mmHg at birth, 100 mmHg from adolescence to middle
age, 110 mmHg in healthy older individuals.
MAP = CO(PR), MAP = HR(SV)(PR)
MAP HR, SV, and PR. If any of these go up, so does MAP.
Two systems to regulate pressure: short-term and long-term

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Short-Term Regulation of
Blood Pressure
Baroreceptor reflexes: change peripheral

resistance, heart rate, and stroke volume in

response to changes in blood pressure
Chemoreceptor reflexes: sensory receptors
sensitive to oxygen, carbon dioxide, and pH levels
of blood

Central nervous system ischemic

response: results from high carbon dioxide or

low pH levels in medulla and increases peripheral

resistance
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Baroreceptor Reflex Control

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Adrenal Medullary Mechanism

Activated when stimuli
result in a substantial
increase in sympathetic
stimulation of heart and
blood vessels (large decrease
in blood pressure, sudden
and substantial increase in
physical activity, stress)
Adrenal releases epinephrine
and norepinephrine
Hormones mimic
sympathetic stimulation of
heart and blood vessels.
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Baroreceptor Effects

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Chemoreceptor Reflex Control

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Effects of pH and Gases

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CNS Ischemic Response

Elevation of BP in response to a lack of blood
flow to the medulla oblongata.
Functions in response to emergency situations and
BP falls below 50 mmHg
Neurons of vasomotor center strongly stimulated;
increases blood flow to brain if vessels are intact
but at the same time, decreases oxygenation of
blood because blood does not go to lungs.
Lack of oxygen causes vasomotor center to
become inactive; extensive vasodilation follows
with concomitant drop in BP. Death if CNS
ischemic response lasts longer than a few minutes.
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Long-Term Regulation
of Blood Pressure

Renin-angiotensin-aldosterone mechanism
Vasopressin (ADH) mechanism
Atrial natriuretic mechanism
Fluid shift mechanism
Stress-relaxation response

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Renin-Angiotensin-Aldosterone Mechanism

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Vasopressin (ADH) Mechanism

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Long-Term Control of Blood Pressure

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Long-term Mechanisms
Atrial natriuretic hormone: released from cardiac
muscle cells when atrial blood pressure increases,
simulating an increase in urinary production, causing
a decrease in blood volume and blood pressure
Fluid shift: movement of fluid from interstitial
spaces into capillaries in response to decrease in
blood pressure to maintain blood volume and vice
versa.
Stress-relaxation response: adjustment of blood
vessel smooth muscle to respond to change in blood
volume. When blood volume suddenly declines and
pressure drops, smooth muscles contract and vice
versa.
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