A 

ventilator is a machine that moves air through a person's lungs. It is attached to a trach tube in the person's
throat. It blows air or air with extra oxygen in to the lungs. t has many settings and alarms. Each person's
ventilator will use different settings that are determined by the doctor. Some people need a ventilator all of the
time while others only use it part of the time. It depends on the person’s needs and the doctor’s orders.

Why is a ventilator necessary?

Because the spinal cord and its nerves help control breathing, people with a spinal cord injury in the neck area
may require a ventilator. The ventilator assists with breathing by helping the diaphragm, abdominal and rib
muscles move to allow air in and out of the lungs. Helping these muscles also provides the body with the ability
to cough and move mucous out of the lungs and throat.

The nature of a person’s breathing problems will depend on the level of injury, the person’s general physical
condition and whether the person was a heavy smoker.

People with a C1 or C2 injury will require a ventilator all of the time because the injury is so high in the cord
that it cannot send any messages to the diaphragm, rib or abdominal muscles.

People with C3 injuries may need a ventilator all of the time or part of the time.

People with C4 - C8 injuries may not need a ventilator at all, but are still at high risk for breathing problems.

What do the controls do?

 On/Off Switch: This switch is located at far left of the bottom row on the machine pictured. The gray
square box must be pressed to turn machine on or off. If you have two portable ventilators at home,
keep one plugged into an electrical outlet at the bedside. The second portable ventilator should be
hooked up to your power chair and connected to the chair battery.
  Mode of Ventilation: The doctor will determine which method of ventilation will best benefit the patient’s
respiratory system. The doctor will order either the Assist / Control or the SIMV / CPAP mode.

 Breath Rate: This controls how many breaths are given each minute. The number of breaths will also
be ordered by your doctor. It is important to always check the rate to make sure enough breaths are
being given.

 Tidal Volume: This controls how much air is given in each breath. The setting is ordered by your doctor.
It is important to know the tidal volume setting when doing routine ventilator checks.

 Inspiratory Time: This controls how fast to deliver the set tidal volume during inhalation. The respiratory
therapist will set the time.

 Pressure Support: The Pressure Support control can only be used in the SIMV / CPAP mode,
to help wean the patient off the ventilator. This control supports each spontaneous breath the
patient takes by providing extra pressure, reducing the amount of work needed by the patient to
breathe. This setting is ordered by the doctor.

 Oxygen: This control will read 21% oxygen, unless the patient is receiving extra oxygen in the hospital
setting.

 Sensitivity: This allows the ventilator to be set according to the person's breathing effort. The ventilator
can provide 100% of the breathing work or it can be set to "assist" a person who has some breathing
ability. This setting will be set by the respiratory therapist.

 LOCK will lock the settings. This control will safeguard against children changing ventilator settings in
the home.

What do the alarms do?

Alarms are indicators that will let you know if something is wrong with the ventilator. When an alarms
sounds, it is important that you respond to it immediately.

Here are some immediate actions you can take:

Check the person to make sure they are not in distress. If they are, take them off the ventilator and use the
Ambu Bag to breathe for the person. Bag the person until you find the problem. If the ventilator tubing has
popped off the trach tube, simply re-attach it. If it is not something obvious, continue bagging the person and
begin checking the tubing, starting where it connects to the person, and examine the tubing all the way back to
the machine. If tubing has become disconnected, re-connect it.

Check the trach cuff as you were taught. If it is low, insert a little more air and see if this stops the alarm. If you
still cannot find the problem, keep bagging and call 911 for help. You will also need to call your homecare
company and respiratory therapist after the emergency situation is over.     

 High Pressure Limit: This alarm tells you that there has been an increase in air pressure delivered to
the lungs. It could mean that the person has too much mucous in the lungs and needs to be suctioned.
It can also mean that the ventilator tubing has become kinked.

 Low Pressure: This alarm tells you that there has been a drop in air pressure delivered to the lungs. It
could mean that the ventilator tubing has popped off the trach tube, that there is a leak or that a piece
of tubing has become disconnected. It may signal that there is a problem with the trach cuff. While this
is not a ventilator problem, the alarm will still sound because there is not enough air pressure being
given to the person.
  Low Min. Vol: This setting will be set by the respiratory therapist. When this alarm sounds, it indicates
that the lung volume has dropped. Check the trach cuff pressure and examine the ventilator tubing for a
leak.

 Silence / Reset: This control performs two functions: 

o Silence: When pressed to silence a ringing alarm, it will do so for 60 seconds. Silence should
only be pressed after a problem has been fixed.
o Reset is pressed to return the ventilator back to patient’s usual settings.

 Set Value dial: This is the large gray dial below the alarm section. When any of the settings on the
control panel needs to be changed, the gray square box under the setting must be pressed, and then
the Set Value dial is used to reduce or increase the setting. During this process, the setting number will
be highlighted and the rest of the numbers on the panel will be dimmed. Once the desired number is
set, press the gray square box again. To prevent unintended changes to the settings, the CONTROL
LOCK can be pressed to lock the settings. This control will safeguard against children changing
ventilator settings in the home.

The Low Pressure number and Low Minute Volume numbers will blink when there is a disconnection
or leak. If this happens, check connection at the trach and all tubing connections. Check the cuff pressure of
the trach tube. It might need more air. Move the vent tubing to make sure it is lying on the patient's chest. The
high pressure alarm will beep when a patient needs to be suctioned.

An increase in the PIP level above its normal level also means that the patient needs to be suctioned.

Airway Pressure Display: This is the long, rectangular window that, when “Select” is pressed, will display
several pieces of information. For example, the three most important homecare readings are PIP, for airway
pressure, exhaled tidal volume and breath rate. An increase or decrease in airway pressure (PIP) can
indicate that the patient needs suctioning or has an airway leak. The exhale tidal volume might need to be
monitored if the patient is weaning off the ventilator.                                                                             

Power Indicator (upper right hand corner on front of ventilator)

 During the daytime hours while the converter box is on, the EXTERNAL POWER LIGHT should be ON
and GREEN.
 During the nighttime hours while the ventilator is being charged, the CHARGE STATUS light will blink
until it is fully charged, then it will become a STEADY AMBER LIGHT.

If the person is using oxygen, please note the following:

 Never smoke while oxygen is in use.

 Never place oxygen equipment near heat, electrical appliances (battery shavers are OK) or the furnace.
 Never use petroleum jelly products (like Vaseline) on oxygen equipment or the person.

What is resting ventilation?

A normal minute volume while resting is about 5–8 liters per minute in humans. Minute volume generally
decreases when at rest, and increases with exercise. ... Minute ventilation during moderate exercise may be
between 40 and 60 litres per minute.

Types of contractions
When we think of a muscle contracting normally, we tend to think of the muscle shortening as it generates
force. While it's true that this is a way of muscle contracting, there are many different ways that a muscle can
generate force, as seen in Figure 1 below.

Figure 1: A demonstration of the difference in force responses for between lengthening and non-lengthening
active
contractions
(isometric vs.
eccentric), and
between active
lengthening
(eccentric) vs.
non-active
lengthening
(passive
stretch).
Concentric
Contractions—
Muscle Actively Shortening

When a muscle is activated and required to lift a load which is less than the maximum tetanic tension it can
generate, the muscle begins to shorten. Contractions that permit the muscle to shorten are referred to as
concentric contractions. An example of a concentric contraction in the raising of a weight during a bicep curl.

In concentric contractions, the force generated by the muscle is always less than the muscle's maximum (Po).
As the load the muscle is required to lift decreases, contraction velocity increases. This occurs until the muscle
finally reaches its maximum contraction velocity, Vmax. By performing a series of constant velocity shortening
contractions, a force-velocity relationship can be determined.

Eccentric Contractions—Muscle Actively Lengthening

During normal activity, muscles are often active while they are lengthening. Classic examples of this are
walking, when the quadriceps (knee extensors) are active just after heel strike while the knee flexes, or setting
an object down gently (the arm flexors must be active to control the fall of the object).

As the load on the muscle increases, it finally reaches a point where the external force on the muscle is greater
than the force that the muscle can generate. Thus even though the muscle may be fully activated, it is forced to
lengthen due to the high external load. This is referred to as an eccentric contraction (please remember that
contraction in this context does not necessarily imply shortening). There are two main features to note
regarding eccentric contractions. First, the absolute tensions achieved are very high relative to the muscle's
maximum tetanic tension generating capacity (you can set down a much heavier object than you can lift).
Second, the absolute tension is relatively independent of lengthening velocity. This suggests that skeletal
muscles are very resistant to lengthening. The basic mechanics of eccentric contractions are still a source of
debate since the cross-bridge theory that so nicely describes concentric contractions is not as successful in
describing eccentric contractions.

Eccentric contractions are currently a very popular area of study for three main reasons: First, much of a
muscle's normal activity occurs while it is actively lengthening, so that eccentric contractions are
physiologically common (Goslow et al. 1973; Hoffer et al. 1989) Second, muscle injury and soreness are
selectively associated with eccentric contraction (Figure 2, Fridén et al. 1984; Evans et al. 1985; Fridén and
Lieber, 1992). Finally, muscle strengthening may be greatest using exercises that involve eccentric
contractions. Therefore, there are some very fundamental structure-function questions that can be addressed
using the eccentric contraction model and eccentric contractions have very important applications
therapeutically to strengthen muscle.

Figure 2: Plot demonstrating maximal tetanic force prior

to and immediately following an exercise bout. While
passive stretch causes negligible force decrement,
isometric causes a moderate loss and eccentric
causes a significant loss of force.

The Virtual Hospital has a more clinical look at this and other forms of muscle injury.

Isometric Contraction—Muscle Actively Held at a Fixed Length

A third type of muscle contraction, isometric contraction, is one in which the muscle is activated, but instead of
being allowed to lengthen or shorten, it is held at a constant length. An example of an isometric contraction
would be carrying an object in front of you. The weight of the object would be pulling downward, but your
hands and arms would be opposing the motion with equal force going upwards. Since your arms are neither
raising or lowering, your biceps will be isometrically contracting.

The force generated during an isometric contraction is wholly dependant on the length of the muscle while
contracting. Maximal isometric tension (Po) is produced at the muscle's optimum length, where the length of
the muscle's sarcomeres are on the plateau of the length-tension curve.

Figure 3: A series of isometric

contractions performed at varying
muscle lengths (from -40% (slack) to
+40% (stretched). The maximum force
is produced at optimum length (Lo). Note
that as the muscle is stretched, the
baseline of the force record is raised
due to passive tension (PT) in the
muscle and contributes more to
overall force than the active tension (AT).

Passive Stretch—Muscle Passively

Lengthening
There is a fourth type of muscle "contraction" known as passive stretch. As the name implies, the muscle is
being lengthened while in a passive state (i.e. not being stimulated to contract). An example of this would be
the pull one feels in their hamstrings while touching their toes.

The structure(s) responsible for passive tension are outside of the cross-bridge itself since muscle activation is
not required. Several recent studies have shed light on what has turned out to be a fascinating and huge
protein with skeletal muscle—aptly named, “titin.” A seminal study performed by Magid and Law, demonstrated
convincingly that the origin of passive muscle tension is actually within the myofibrils themselves. This is
extremely significant because, prior to this study, most had assumed that extracellular connective tissue in
striated muscle caused the majority of its passive properties. However, Magid and Law measured passive
tension in whole muscle, single fibers and single fibers with membranes removed and showed that each
relationship scaled to the size of the specimen. In other words, the source for passive force bearing in muscle
was within the normal myofibrillar structure, not extracellular as had previously been supposed.

Isometric contraction occurs when muscle length remains relatively constant as tension is produced. For
example, during a biceps curl, holding the dumbbell in a constant/static position rather than actively raising or
lowering it is an example of isometric contraction.21,22 Although the forces generated during isometric
contractions are potentially greater than during concentric contractions, muscles are seldom injured during this
type of contraction. Isometric exercises are often used during the early phases of rehabilitating a
musculotendinous injury because the intensity of contraction and the muscle length at which it contracts can be
controlled.

An isometric contraction is a muscle

contraction without motion. Isometric contractions are used to stabilize a joint, such as when a weight is held at
waist level neither raising nor lowering it. Dynamic contractions are muscle contractions with a fixed amount of
weight. They are divided into concentric and eccentric contractions. A concentric contraction occurs when the
muscle length is shortened during a contraction, e.g., a biceps curl. An eccentric contraction occurs when the
muscle length is increased during the contraction, i.e., the “negative” contraction. Eccentric contractions are
used for decelerating or controlling motions. Isokinetic contractions are activated at a constant velocity and are
artificially created by types of exercise equipment. Measurements of these contractions are often used in
research settings but little relevance has been proven under real conditions. Plyometrics refers to a contraction
sequence when a rapid eccentric contraction precedes a concentric contraction such as during a jump. An
example is a jumper lowering the body and eccentrically loading the gluteal muscles prior to the jump which
then requires concentric gluteal muscle contraction. Plyometric training can be especially useful in sport-
specific rehabilitation. Strength is the maximal force generated during a single contraction while power is the
amount of force generated per unit time. Power may be more important to emphasize for a person to return to
maximal function. The amount of force generated by muscle contraction type from highest to lowest is:
eccentric > isometric > concentric.
An isometric exercise is a form of exercise involving the static contraction of a muscle without any visible
movement in the angle of the joint. The term "isometric" combines the Greek words "Isos" (equal) and "metria"
(measuring), meaning that in these exercises the length of the muscle and the angle of the joint do not change,
though contraction strength may be varied.[1] This is in contrast to isotonic contractions, in which the
contraction strength does not change, though the muscle length and joint angle do.
The three main types of isometric exercise are isometric presses, pulls, and holds. They may be included in a
strength training regime in order to improve the body’s ability to apply power from a static position or, in the
case of isometric holds, improve the body’s ability to maintain a position for a period of time. Considered as an
action, isometric presses are also of fundamental importance to the body’s ability to prepare itself to perform
immediately subsequent power movements. Such preparation is also known as isometric preload.

Cardiovascular Physiology

(Summary from Silverthorn, Human Physiology)

This page outlines information on the cardiovascular system. Separate pages describe the types and
structures of arteries, characteristics of blood flow, and information on lipoproteins .

The human cardiovascular system is composed of a heart which pumps blood through a closed system of
blood vessels. The heart is composed mostly of cardiac muscle, or myocardium. Its primary function is to
transport nutrients, water, gases, wastes, and chemical signals throughout the body. More information on the
heart as a pump, blood flow and control of blood pressure, and components of blood will be discussed in
related pages.

The cardiovascular system transports materials throughout the body:

1. Materials entering the body, such as oxygen via the lungs and nutrients and water via the intestinal tract, are
carried to all cells.
2. Materials moved from cell to cell (intercellular communication) including:
a) wastes products from some cell cells to the liver for processing;
b) immune cells that are present in the blood continuously for other cells,
c) hormones from endocrine cells to their target cells
d) stored nutrients from liver and adipose tissue to all cells.
3. Materials that are expelled from the body, such as metabolic wastes, heat, and carbon dioxide that are
removed via the kidneys, skin, and lungs, respectively.

As a general overview, the cardiovascular system is composed of the heart, the blood vessels (or vasculature),
and the cells and plasma of the blood.
1. Arteries are blood vessels that carry blood away from the heart and veins return the blood to the heart. A
system of valves in the heart and veins ensures that the blood flows in one direction.
2. The heart is anatomically divided into two halves by a central wall, or septum, into left and right halves. Each
half is composed of an atrium which receives blood returning to the heart and a ventricle that pumps the blood
out into the blood vessels that serve the body. The atria and ventricles and exiting blood vessels are separated
by closable valves. Functionally, the heart serves as a pump in series that generates pressure to propel the
blood through the system.
3. The lungs are were oxygen is picked up and carbon dioxide is expelled. The pulmonary circulation goes
from the right side of the heart (deoxygenated blood) and returns it to the left side of the heart, with oxygenated
blood.
4. The systemic circulation consists of the vessels that go from the left side of the heart to the tissues and back
to the right side of the heart.

The systemic circulation and the pulmonary circulation can be traced together:
Deoxygenated blood returning from body enters the heart in the right atrium. From the right atrium the blood
passes through the tricuspid valves to enter the right ventricle. The blood is then pumped into the pulmonary
arteries, passing the pulmonic valves, where it goes to the lungs. After becoming oxygenated in the lung's
capillaries, the blood is carried by the pulmonary veins to the left atrium. It then passes through the bicuspid or
mitral valves into the left ventricle, where it is pumped into the aorta through the aortic valves. The aorta
branches into smaller and smaller arteries that finally lead to capillary beds in the tissue. Here oxygen is
exchanged for carbon dioxide and returned via veins which join into the inferior vena cava (veins coming from
the lower body) and superior vena cava (from the upper body). The IVC and the SVC empty into the right
atrium.

Functions of the cardiovascular system

Blood circulates through a network of vessels throughout the body to provide individual cells with oxygen and
nutrients and helps dispose of metabolic wastes. The heart pumps the blood around the blood vessels.

Functions of blood and circulation:

 Circulates OXYGEN and removes Carbon Dioxide.

 Provides cells with NUTRIENTS.
 Removes the waste products of metabolism to the excretory organs for disposal.
 Protects the body against disease and infection.
 Clotting stops bleeding after injury.
 Transports HORMONES to target cells and organs.
 Helps regulate body temperature.

Blood

Blood is made up of about 45% solids (cells) and 55% fluids (plasma). The plasma is largely water, containing
proteins, nutrients, hormones, antibodies, and dissolved waste products.

General types of blood cells: (each has many different sub-types)

ERYTHROCYTES
(red cells) are small red disk shaped cells. They contain HAEMOGLOBIN, which combines with oxygen
in the lungs and is then transported to the body's cells. The haemoglobin then returns carbon dioxide
waste to the lungs. Erythrocytes are formed in the bone marrow in the knobby ends of bones.
LEUKOCYTES
(white cells) help the body fight bacteria and infection. When a tissue is damaged or has an infection
the number of leukocytes increases. Leukocytes are formed in the small ends of bones. Leukocytes
can be classed as granular or non granular. There are three types of granular leukocytes (eosinophils,
neutrophils, and basophils), and three types of non-granular (monocytes, T-cell lymphocytes, and B-cell
lymphocytes). See also the lymphatic system.
THROMBOCYTES
(platelets) aid the formation of blood CLOTS by releasing various protein substances. When the body is
injured thrombocytes disintegrate and cause a chemical reaction with the proteins found in plasma,
which eventually create a thread like substance called FIBRIN. The fibrin then "catches" other blood
cells which form the clot, preventing further loss of blood and forms the basis of healing.
carry oxygenated blood away from the heart. They are thick hollow tubes which are highly ELASTIC
which allows them to DILATE (widen) and constrict (narrow) as blood is forced down them by the heart.
Arteries branch and re-branch, becoming smaller until they become small ARTERIOLES which are
even more elastic. Arterioles feed oxygenated blood to the capillaries. The AORTA is the largest artery
in the body, taking blood from the heart, branching into other arteries that send oxygenated blood to the
rest of the body.
CAPILLARIES
distribute the nutrients and oxygen to the body's tissues and remove deoxygenated blood and waste.
They are extremely thin, the walls are only one cell thick and connect the arterioles with the venules
(very small veins).
VENULES
(very small veins) merge into VEINS which carry blood back to the heart. The vein walls are similar to
arteries but thinner and less elastic. Veins carry deoxygenated blood towards the lungs where oxygen
is received via the pulmonary capillaries. The PULMONARY Veins then carries this oxygenated blood
back to the heart.

The heart

The heart is a hollow muscular organ which beats over 100,000 times a day to pump blood around the body's
60,000 miles of blood vessels. The right side of the heart receives blood and sends it to the lungs to be
oxygenated, while the left side receives oxygenated blood from the lungs and sends it out to the tissues of the
body. The Heart has three layers; the ENDOCARDIUM (inner layer), the EPICARDIUM (middle layer), and
MYOCARDIUM (outer layer). The heart is protected by the PERICARDIUM which is the protective membrane
surrounding it.

The heart has FOUR CHAMBERS, in the lower heart the right and left Ventricles, and in the upper heart the
right and left Atria. In a normal heart beat the atria contract while the ventricles relax, then the ventricles
contract while the atria relax. There are VALVES through which blood passes between ventricle and atrium,
these close in such a way that blood does not backwash during the pauses between ventricular contractions.
The right and left ventricles are divided by a thick wall (the VENTRICULAR SEPTUM), babies born with "hole
in the heart" have a small gap here, which is a problem since oxygenated and deoxygenated can blood mix.
The walls of the left ventricle are thicker as it has to pump blood to all the tissues, compared to the right
ventricle which only pumps blood as far as the lungs.

Cardiovascular function has particular significance during fetal life because delivery of oxygen and many
substrates to developing fetal organs is accomplished by high blood flow rates which counteract low arterial
concentrations. This chapter reviews the performance and the physiological control of the fetal heart and
circulation. Growth and maturation of the cardiovascular system continues throughout development in utero
and after birth, and although the progression of events in the development of the fetal circulation is similar in
different species, the relative maturation at any stage of development varies considerably. Therefore
gestational variations and important species differences are presented where data are available. Most of the
present concepts of fetal cardiovascular regulation are based on physiological studies of chronically
instrumented sheep studied in the last third of gestation, and there is a paucity of information relating to
early fetal development. 

The spleen
 This is a large flat oval organ located below the diaphragm, it's main function is to STORE BLOOD. The size of
the spleen can vary, for example it may enlarge when the body is fighting infection also it's size tends to
decrease with age. It is a non-vital organ and it is possible to survive after removal of the spleen.

Perinicious anaemia is a Vitamin B12 deficiency resulting in a reduction in number of erythrocytes.

Aplastic anemia is a failure of the bone marrow to produce the enough red blood cells.

Septicaemia - bacterial toxins in blood.

The vessels of the cardiovascular system are

the h
eart, arteries, capillaries, and veins.

This is a transport system, within which the blood is propelled by the heart in a closed circuit through
vessels.

This continual circulation of fluid throughout the body serves:

 As a means of delivery and removal of substances;

 It provides all the living cells of the organism with the materials required for their normal
functions (e.g., O2 and nutrients)
 It carries away the products of cell metabolism (CO2 and other metabolites).
 These substances do not enter and leave the bloodstream directly; their passage is indirect, by way
of the interstitial (extracellular) fluid [1].

The regulation of the cardiovascular system occurs via an innumerable number of stimuli, including
changing blood volume, hormones, electrolytes, osmolarity, medications, adrenal glands, kidneys, and
much more. The parasympathetic and sympathetic nervous systems also play a key role in the regulation
of the cardiovascular system

Heart

The organ that pumps the blood through the vessels. It pumps blood directly into arteries, more
specifically the aorta or the pulmonary artery.
 The heart pumps oxygenated blood out of the left ventricle and into the aorta to begin systemic
circulation.
 After the blood has supplied cells throughout the body with oxygen and nutrients, it returns deoxygenated
blood to the right atrium of the heart.
 The deoxygenated blood flows down from the right atrium to the right ventricle.
 The heart then pumps it out of the right ventricle and into the pulmonary arteries to begin pulmonary
circulation.
 The blood moves to the lungs, exchanges carbon dioxide for oxygen, and returns to the left atrium.
 The oxygenated blood shoots from the left atrium to the left ventricle below, to begin systemic circulation
again.

Arteries

Arteries supply the body with oxygenated blood –

with the exception of the pulmonary arteries from the

heart; these carry deoxygenated blood to the lungs , and
the umbilical artery, which carries deoxygenated blood
from the foetus to the placenta. Blood travels from the
arteries to the arterioles and on to the capillaries,
where gaseous exchange takes place.
The largest artery is the aorta, which extends from the
left ventricle down the left side of the body. It divides
into four major regions, the ascending aorta, aortic
arch, thoracic aorta, and abdominal aorta.

Arteries can be divided into elastic arteries, muscular

arteries, and arterioles

1. Elastic arteries are the largest (1-2.5cm in

diameter) and comprise large amounts of elastin as
well as smooth muscle. They have a large lumen with a
low resistance to blood flow and can expand and recoil
to accommodate changes in blood volume.
2. Muscular arteries regulate local blood flow and deliver blood to individual organs. They measure
0.3mm-1cm in diameter and possess more smooth muscle but less elastin than elastic arteries.
3. Arterioles are the smallest arteries (0.01-0.3mm in diameter). In certain areas, they have all three
vascular layers (tunica intima, media, and externa). When they are close to the capillaries they comprise a
single smooth muscle layer overlying endothelial cells [4].

Capillaries

The capillaries can be compared to the smallest branches of a tree and connect arterioles to venules. This
thin layer allows for the exchange of nutrients, gases, and waste with tissues and organs.
 Blood flow into the capillaries is determined by the diameter of the arterioles and can be increased
through vasodilation.
 Capillaries act as a semipermeable membrane allowing the diffusion of gases and the transfer of
nutrients and waste products.
 The single layer of flattened endothelial cells of the capillaries facilitates the exchange of
substances between capillaries and tissues.
 Gases, such as O2 and CO2, metabolic waste products, lactate, glucose, and other nutrients are
transferred across the walls of the capillaries through small slits in the endothelial cells known as pores or
fenestrations.
 To prevent capillaries from losing vital substances such as plasma proteins, the slits in the
endothelial cells are smaller than these proteins [4].

Veins

Transport blood back to the heart, contain valves to prevent the backflow of blood [2]. Veins are:

 Thin, elastic vessels that act as a reservoir of blood

 Do not need large amounts of elastin and smooth muscle as they transport low-pressure blood
back to the heart
 Have a large lumen, as well as valves that ensure a one-way flow of blood to the heart.

Structure

 Venules measure 8-100µ in diameter and the largest ones possess a thin tunica externa and a
tunica media comprising two or three layers of smooth muscle cells.
 The venules join to form veins, in which the tunica externa, consisting of thick collagenous
bundles, is the largest layer.
 The largest veins – the superior and inferior venae cavae – have a large tunica externa further
thickened by smooth muscle bands
 The venous system is an irregular network that tends to follow the course of the arteries [4].

CARDIOVASCULAR ADJUSTMENT IN HEAT OR COLD

How does heat affect the cardiovascular system?

As long as the air around you is cooler than your body, you radiate heat to the air. But this transfer
stops when the air temperature approaches body temperature. Radiation requires rerouting blood
flow so more of it goes to the skin. This makes the heart beat faster and pump harder.