1. بـسـم الله الرحـمن الرحـيم

2. Cardiovascular Physiology Arterial Blood Pressure

3. Arterial Blood Pressure (BP) = The lateral pressure force generated by the pumping action of the heart on the wall of aorta & arterial blood vessels per unit area. OR = Pressure inside big arteries (aorta & big vessels). ■ Measured in (mmHg), & sometimes in (cmH 2 O), where 1 mmHg = 1.36 cmH 2 O. ■ Of 2 components: systolic … (= max press reached) = 110-130 mmHg. diastolic … (= min press reached) = 70-90 mmHg. In normal adult  120/80 mmHg.

4. Arterial Blood Pressure (continued) ■ Diastolic pressure is more important, because diastolic period is longer than the systolic period in the cardiac cycle. ■ Pulse pressure = Systolic BP – Diastolic BP. ■ Mean arterial pressure = Diastolic BP + 1/3 Pulse press. In normal adult  120/80 mmHg.

5. Factors affecting ABP: ■ Sex … M > F …due to hormones/ equal at menopause. ■ Age … Elderly > children …due to atherosclerosis. ■ Emotions …  due to secretion of adrenaline & noradrenaline. ■ Exercise …  due to  venous return. ■ Hormones …  ( e.g. Adrenaline, noradrenaline, thyroid H). ■ Gravity …  Lower limbs > upper limbs. ■ Race … Orientals > Westerns … ? dietry factors, or weather. ■ Sleep …  due to  venous return. ■ Pregnancy …  due to  metabolism.

6. Factors determining ABP: Blood Pressure = Cardiac Output X Peripheral Resistance (BP) (CO) Flow (PR) Diameter of arterioles ■ BP depends on: 1. Cardiac output  CO = SV X HR. 2. Peripheral resistance. 3. Blood volume.

7. Regulation of Arterial Blood Pressure

8. Regulation of ABP: ■ Maintaining B.P. is important to ensure a steady blood flow (perfusion) to tissues. ■ B.P. is regulated neurally through centers in medulla oblongata: 1. Vasomotor Center (V.M.C.), or (pressor area):  Sympathetic fibers. 2. Cardiac Inhibitory Center (C.I.C.), or (depressor area):  Parasympathetic fibers (vagus).

9. cardiac control centers in medulla oblongata Regulation of ABP (continued) 1. Cardiacaccelerator center (V.M.C) 2. Cardiacinhibitory center (C.I.C) Sympathetic n. fibersParasympathetic n. fibers Regulatory mechanisms depend on: a. Fast acting reflexes: Concerned by controlling CO (SV, HR), & PR. b. Long-term mechanism: Concerned mainly by regulating the blood volume.

10. Regulation of Arterial Blood Pressure A. Regulation of Cardiac Output

11. Regulation of CO: ■ A fast acting mechanism. ■ CO regulation depends on the regulation of: a. Stroke volume, & b. Heart rate

12. Mean arterial pressure Cardiac output = Stroke volume X Heart rate End Contraction diastolic strength volume (EDV) Stretch Sympathetic n Parasympathetic n Frank - Starling Regulation of the CO:

13. Regulation of Arterial Blood Pressure B. Regulation of Peripheral Resistance

14. Regulation of Peripheral Resistance (PR): ■ A fast acting mechanism. ■ Controlled by 3 mechanisms: 1. Intrinsic. 2. Extrinsic. 3. Paracrine. ■ Extrinsic mechanism is controlled through several reflex mechanisms, most important: 1. Baroreceptors reflex. 2. Chemoreceptors reflex.

15. 1. Baroreceptors reflex: ■ Baroreceptors are receptors found in carotid sinus & aortic arch. ■ Are stimulated by changes in BP.  BP + Baroreceptors = V.M.C++ C.I.C = Sympathetic Vasodilatation &  TPR + Parasympathetic Slowing of SA node (  HR) &  CO

16. 2. Chemoreceptors reflex: ■ Chemoreceptors are receptors found in carotid & aortic bodies. ■ Are stimulated by chemical changes in blood mainly hypoxia (  O 2 ), hypercapnia (  CO 2 ), & pH changes.  BP + Chemoreceptors ++ V.M.C = C.I.C + Sympathetic Vasoconstriction &  TPR = Parasympathetic  HR Haemorrhage Hypoxia + Adrenal medulla

17. 3. Other Vasomotor Reflexes: 1. Atrial stretch receptor reflex:  Venous Return  ++ atrial stretch receptors  reflex vasodilatation &  BP. 2. Thermoreceptors: (in skin/or hypothalamus)  Exposure to heat  vasodilatation.  Exposure to cold  vasoconstriction. 3. Pulmonary receptors: Lung inflation  vasoconstriction.

18. 4. Hormonal Agents: ■ NA  vasoconstriction. ■ A  vasoconstriction (except in sk. ms.). ■ Angiotensin II  vasoconstriction. ■ Vasopressin  vasoconstriction.

19. Regulation of Arterial Blood Pressure B. Regulation of Blood Volume

20. Regulation of Blood Volume: ■ A long-term regulatory mechanism. ■ Mainly renal: 1. Renin-Angiotensin System. 2. Anti-diuretic hormone (ADH), or vasopressin. 3. Low-pressure volume receptors.

21. 1. Renin-Angiotensin System: ■ Most important mechanism for Na + retention in order to maintain the blood volume. ■ Any drop of renal blood flow &/or  Na +, will stimulate volume receptors found in juxtaglomerular apparatus of the kidneys to secrete Renin which will act on the Angiotensin System leading to production of aldosterone.

22. Renin Aldosterone Adrenal cortex Corticosterone Angiotensinogen (Lungs)  renal blood flow &/or  Na + ++ Juxtaglomerular apparatus of kidneys (considered volume receptors) Angiotensin I Converting enzymes Angiotensin II (powerful vasoconstrictor) Angiotensin III (powerful vasoconstrictor) Renin-Angiotensin System:  N.B. Aldosterone is the main regulator of Na + retention.

23. 2. Anti-diuretic hormone (ADH), or vasopressin: ■ Hypovolemia & dehydration will stimulate the osmoreceptors in the hypothalamus, which will lead to release of ADH from posterior pituitary gland. ■ ADH will cause water reabsorption at kidney tubules.

24. 3. Low-pressure volume receptors: ■ Atrial natriuritic peptide (ANP) hormone, is secreted from the wall of right atrium to regulate Na + excretion in order to maintain blood volume.