University of Jordan 1 Cardiovascular system- L6 Faisal I. Mohammed, MD, PhD

The peripheral resistance:  It is the resistance to blood flow through a vessel caused by friction between the moving fluid and the vascular wall.  Most of the resistance to blood flow occurs in arterioles ( 50%) and capillaries ( 25%) so it is called peripheral.

Velocity of Blood Flow is Greatest in the Aorta Velocity of Blood Flow = Blood Flow Cross sectional area Aorta >Arterioles> Small veins >Capillaries

Hemodynamic laws  Ohm’s law: F =∆P/R F = Flow, ∆P = Change in Pressure, R = Resistance CO = cardiac output, MAP = mean arterial pressure, TPR = total peripheral resistance. Since Rt. Atrial pressure = 0 then

Hemodynamic laws… cont  Poiseuille’s law F =  ∆Pr 4 / 8  L F = flow, ∆P = change in pressure r = radius of the vessel  (eta) = viscosity L = length of the vessel Then Resistance, R = 8  L /  r 4

P= 100 mm Hg

How Would a Decrease in Vascular Resistance Affect Blood Flow? FLOW =  P RESISTANCE FLOW =  P RESISTANCE Conversely,

Poiseuille’s law …cont

10 Blood Pressure Regulation

11 Sphygmomanometry

12 Measurement of Systolic and Diastolic Pressures  Auscultatory method is the most commonly used method for measuring systolic and diastolic pressures.  When cuff pressure reaches systolic pressure, one begins to hear tapping sounds in the antecubital artery; as the cuff pressure reaches diastolic pressure, one hears muffled sounds and then Korotkoff sounds disappear.  Mean arterial pressure can be estimated by adding 40% of systolic pressure to 60% of diastolic pressure.

13 Blood Pressure Regulation  Mean Arterial Pressure (MAP) = 1/3 systolic pressure + 2/3 diastolic pressure  MAP= Diastolic Pressure+1/3 Pulse Pressure

14 Mean Arterial Pressure

Sympathetic Innervation of Blood Vessels  Sympathetic nerve fibers innervate all vessels except capillaries and precapillary sphincters and some metarterioles.  Innervation of small arteries and arterioles allow sympathetic nerves to increase vascular resistance.  Large veins and the heart are also sympathetically innervated.  Parasympathetic nervous system is mainly important in control of heart rate via the vagus nerve.

16 Short term regulation of BP 1.Baroreceptors or pressoreceptos (High pressure ) Carotid and Aortic Baroreceptors

17 Short term regulation of BP cont… 1. Baroreceptors or pressoreceptos (High pressure)

The Vasomotor Center (VMC)  The VMC transmits impulses downward through the cord to almost all blood vessels.  VMC is located bilaterally in the reticular substance of the medulla and the lower third of the pons.  The VMC is composed of a vasoconstrictor area, vasodilator area, and sensory area.

Arterial Baroreceptor Reflex  Important in short term regulation of arterial pressure.  Reflex is initiated by stretch receptors called baroreceptors or pressoreceptors located in the walls of the large systemic arteries.  A rise in pressure stretches baroreceptors and causes them to transmit signals to the vasomotor center (VMC) and feedback signals are sent via the automonic nervous system to the circulation to reduce arterial blood pressure back to normal. Blood Pressure Arterial Baroreceptors Vasomotor Center

20 Baroreceptor mechanism

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22 Effect of Parasympathetic and Sympathetic Nervous Systems on Factors that Influence the Mean Arterial Pressure

23 Short term regulation of BP cont… Chemoreceptors

Carotid and Aortic Chemoreceptors  Chemoreceptors are chemosensitive cells sensitive to oxygen lack, CO2 excess, or H ion excess.  Chemoreceptors are located in carotid bodies near the carotid bifurcation and on the arch of the aorta.  Activation of chemosensitive receptors results in excitation of the vasomotor center. Sympathetic activity ChemoreceptorsVMC O2 CO2 pH BP

25 Nervous Control of the Heart

University of Jordan 26

University of Jordan 27 Cardiovascular system- L7 Faisal I. Mohammed, MD, PhD

28 Blood Pressure Regulation  Mean Arterial Pressure (MAP) = 1/3 systolic pressure + 2/3 diastolic pressure

29 Intermediate / Long term Regulation of BP 1. Epinephrine – Adrenal medulla system works as intermediate term needs  10 min. to work causes vasoconstriction 2. ADH (vasopressin) system needs  30 min to work causes vasocnstriction

30 Long term Regulation of BP…cont 3. Renin-Angiotensin-Aldosterone system  1 hour to be effective Angiotensinogen (14 a.a peptide) converted into Angiotensin I (10 a.a peptide) by Renin that come from afferent arteriolar cell, the angiotensin I is converted into angiotensin II (8 a.a peptide) by Angiotensin converting enzyme mainly in the lungs. Angiotensin II (A II) is very potent vasoconstrictor. AII also stimulates aldosterone synthesis and secretion from the adrenal coretx (Zona glomerulosa), aldosterone increases Na + reabsorption from the renal nephrone and so water. AII is also a positive inotropic agent

Renin-Angiotensin System  Renin is synthesized and stored in modified smooth muscle cells in afferent arterioles of the kidney.  Renin is released in response to a fall in pressure.  Renin acts on a substance called angiotensinogen to form a peptide called angiotensin I.  AI is converted to AII by a converting enzyme located in the endothelial cells in the pulmonary circulation.

32 Long term Regulation of BP …cont 4. Atrail Natriuretic peptide (ANP): An 28 a.a peptide released mainly from the Rt. Atrium in response to stretch. It causes increase in GFR so increase Na + and water. Its concentration decreases when BP is low and its concentration increases if BP is high, mainly due volume overload

33 Determinants of Mean Arterial BP

34 Negative Feedback Cycle of Elevated BP

35 Cardiac Output and Venous return

36 Effect of Venous Valves

37 Effect Of Gravity on Venous return

38 Effect of Venous Valves

39 Factors that Facilitate Venous Return

40 Thank You