1. Blood Flow and Pressure Exchange

2. Outline Overview of circulation Components of the Vascular system Medical physics of blood flow Vascular distensibility and compliance Arterial damping of pressure pulses Veins as reservoirs of blood Capillary exchange

3. Learning Objectives Know each component of the vascular system. Understand blood flow using Ohm’s and Poiseuille’s laws. Know how vascular distensibility allows arteries to dampen pressure pulses and veins to act as reservoirs. Know how hydrostatic and colloid osmotic forces determine the flow of fluid in the capillaries.

4. Components of the Vascular System - Blood Vessels Closed circulatory system Arteries Arterioles Capillaries Venules Veins 3 tunics Lumen Tunica interna – Endothelium – Connective tissue Tunica media – Smooth muscle – Elastin – Vasoconstriction – Vasodilation Tunica externa – Collagen fibers – Nerve fibers – Lymphatic vessels – Elastin fibers

5. Comparison of Veins and Arteries Arteries:Veins:

7. Histological Structure of Blood Vessels

8. Arteries Away from the heart Thick, muscular walls Very elastic Arterioles Diameter varies in response to neural stimuli and local chemical influences. Capillaries Consist of a single tunica interna Gas, nutrient, and waste exchange Brain capillaries Blood-brain barrier Capillary beds Precapillary sphincter Shunting of blood Digestion

9. Venous System Toward the heart Venules—porous—free movement of fluids and white blood cells. Veins 3 tunics—but thin Venous valves Varicose veins Incompetent valves hemorrhoids Maintenance of Blood Pressure – Neural control Shunting and vasoconstriction. – Vasomotor center – Baroreceptors Carotid and aorta – Chemoreceptors – Higher brain centers – Hormones Catecholoamines Atrial natrietic peptide ADH – Alcohol – Histamine—other vasodilators

10. Hypertension 30% of people over 50 Damages arteries Causes heart failure, vascular disease, renal failure, stroke, and blindness. Enlargement falled by hypertrophy of the myocardium Contributing factors: – Diet (sodium, saturated fat, cholesterol) – Obesity – Age – Race – Heredity – Stress – Smoking—nicotine is a vasoconstrictor.

11. Atherosclerosis Damage to the tunica interna – Viral – Bacterial – Hypertension Reinjury Inflammation LDLs—”bad cholesterol” Foam cells Fatty streak stage Arteriosclerosis Hypertension Stroke Heart attack Coronary bypass Angioplasty tPA—tissue plasminogen activator Clot buster HDL—removes cholesterol from vessel walls.

12. Arteries Aorta—largest artery – Ascending – Descending – Right and left coronary arteries – Common carotid arteries—branch to form internal and external carotids External—supply tissues of the head except the brain and orbits. Internal—supply the orbits and most of the cerebrum. – Vertebral arteries—branch to the cervical spinal cord, neck, cerebellum, pons, and inner ear.

15. Arteries to Know Know the arteries on the proceeding chart plus: – Arteries of the arm—brachial, radial, ulnar – Arteries of the leg—femoral, popliteal, anterior tibial, posterior tibial – Be able to identify these arteries on a diagram. Also know the locations served by these arteries.

16. Veins Dural sinuses—veins of the brain drain into these enlarged chambers and drain to the internal jugular veins. External jugular veins—superficial head structures. Vertebral veins—cervical vertebrae and neck muscles. Brachiocephalic—mammary glands and first 2 or 3 intercostal spaces.

19. Veins to Know Know the veins on the preceding chart plus: – The veins of the arms—cephalic, axillary, brachial, radial, ulnar. – The veins of the legs—external iliac, femoral, popliteal, anterior tibial, posterior tibial, great saphenous vein, hepatic portal vein. – The great saphenous vein is a superficial vein. Connect with many of the deep veins of the legs and thighs. – Be able to identify these veins on a diagram. Also know the locations served by these arteries.

21. Overview of Circulatory System: Arteries + Veins and Everything in Between Function of Circulatory System: To carry nutrients and hormones to tissues and wastes products away from tissues.

22. Basic Circulatory Function Rate of blood flow to tissues changes based on need. - e.g., during exercise, blood flow to skeletal muscle increases. - In most tissues, blood flow increases in proportion to the metabolism of that tissue. Cardiac output is mainly controlled by venous return. Generally, arterial pressure is controlled independently of local blood flow or cardiac output control.

23. Parts of the Vasculature Aorta receives blood from left ventricle. Arteries transport under high pressure, strong vascular walls. Arterioles control conduits, last branch of arterial system, strong muscular walls that can strongly constrict or dilate. Capillaries exchange substances through pores. Venules collect blood from capillaries. Veins low pressure, transport blood back to the heart, controllable reservoir of extra blood.

24. Blood Volume and Vasculature Cross-Sectional Area Cross-sectional area (cm 2 ) Aorta 2.5 Small Arteries 20 Arterioles 40 Capillaries 2500 Venules 250 Small Veins 80 Venae Cavae 8

25. Normal Blood Pressures in Vasculature

26. Ohm’s Law Applied to Blood Flow

27. Blood Pressure BP is the force exerted by the blood against the vessel wall. - Typically measured as mm Hg. - E.g., 100 mm Hg is the force needed to push a column of Hg to a level of 100 mm.

28. Resistance Resistance is the impediment to blood flow. Not measured directly, but determined from pressure and flow measurements. - If ΔP = 1 mm Hg and F = 1 ml/sec, then R = 1 PRU (peripheral resistance unit). - In the adult systemic circulatory system, ΔP = 100 mm Hg, and F = 100 ml/sec; so R = 1 PRU. - In the pulmonary system, ΔP = 14 mm Hg and F = 100 ml/sec; so R = 0.14 PRU.

29. Conductance Conductance is the opposite of resistance: Conductance = 1/resistance Conductance may be easier to conceptualize than resistance and is sometimes easier to use in calculating the total resistance of parallel vessels.

30. Vessel Diameter and Blood Flow – Changes in Resistance

31. Laminar Flow

32. Poiseuille’s Law

33. Turbulant Flow

34. Adding Resistance in Series and Parallel

35. Effect of Viscosity on Resistance and Blood Flow

36. Summary of Blood Flow Physics

37. Vascular Distensibility Vascular distensibility is the ability of the vascular system to expand with increased pressure, which - Increases blood blow as pressure increases. - In arteries, averages out pulses. - Allows veins to act as reservoirs

38. Calculate Distensibility Fractional increase in volume per rise in pressure: Vascular = Increase in Volume DistensibilityIncr in P x orig Vol If 1mm Hg increases a vessel from 10mm to 11mm, the distensibility would be 0.1 per mm Hg or 10% per mm Hg.

39. Distensibility of Arteries and Veins Artery walls are much stronger than those of veins and thus, much less distensible. The larger distensibility of veins allows them to act as blood reservoirs.

40. Vascular Compliance The quantity of blood that can be stored in a particular portion of the vasculature for a rise in pressure: Vascular compliance = Increase in volume Increase in pressure Compliance = distensibility x vol

41. Arterial and Venous Volume-Pressure Curves

42. Damping of Pulse Pressure in Arterial System

43. Athersclerosis – Arteries become less Compliant

44. Veins Can distend to hold large amounts of blood. Contraction of skeletal muscles can constrict the veins and propel blood to the heart and increase cardiac output. The contraction- induced constriction and the valves prevent the venous pressure from building up on the feet of standing adults.

45. Veins as Blood Reservoirs > 60% of blood in the circulatory system is in the veins. When blood is lost, sympathetic stimulation causes veins to constrict and make up for the lost blood. Conversely, veins can distend to hold excess blood if too much is given during a transfusion.

46. The Distribution of Blood

47. Blood Volume Distribution of H 2 O within the body: Intracellular compartment: – 2/3 of total body H 2 O within the cells. Extracellular compartment: – 1/3 total body H 2 O. 80% interstitial fluid. 20% blood plasma. Maintained by constant balance between H 2 O loss and gain.

48. Capillaries Exchange nutrients and waste with tissues. ~ 10 billion capillaries with 500 – 700 m 2 total surface area in whole body.

49. Capillaries are Porous The exchange of water- soluble nutrients and waste between bloo d plasma and interstitial fluid occurs by di ffusion through pores in the capillary walls. Lipid- soluble substances pass directly through th e capillary wall (e.g., O 2 and CO 2 ).

50. Capillary Structure

51. Capillary Exchange Diffusion: Filtration: Reabsorption:

52. Capillary Exchange

53. Molecular Weight and Capillary Porosity

54. Colloid Osmotic Pressure Starling force=(P c +  if ) - (P if +  p ) P c – Hydrostatic pressure in the capillary.  if – Colloid osmotic pressure of the interstitial fluid. P if – Hydrostatic pressure in the interstitial fluid.  p – Colloid osmotic pressure of the blood plasma.

55. Volume of blood pumped/min. by each ventricle. – Pumping ability of the heart is a function of the beats/ min. and the volume of blood ejected per beat. CO = SV x HR – Total blood volume = about 5.5 liters. Each ventricle pumps the equivalent of the total blood volume/ min. Cardiac Output (CO) Recall the Frank-Starling Mechanism?

56. Forces Determining the Flow of Substances in the Capillary

57. Forces at Arterial End of Capillary

58. Forces at Venous End of Capillary

59. Mean Capillary Forces