REGIONAL CIRCULATION

PHYG

KWAME ADU-BONSAFFOH
MBChB, MGCS, MPHIL

2/6/2020 1
 Lecture outline
• Regula on of peripheral blood flow
• Systems
– Coronary
– Cerebral
– Skeletal muscle
– skin
– Pulmonary
– Renal
• Clinical applica on
2/6/2020 2
2/6/2020 3
 Regula on of Peripheral Blood Flow
• Changes in blood flow to an individual organ are
achieved by altera on in arteriolar resistance
• Dual Control
– Extrinsic
• Primarily by the nervous system
• Humorally

– Intrinsic (Locally in the ssues)

• Controlled by the condi ons in the immediate vicinity of the
blood vessels

2/6/2020 4
• Local control of blood flow is the primary
mechanism u lized for matching blood flow to the
metabolic needs of a ssue. Local control is exerted
through the direct ac on of local metabolites on
arteriolar resistance

• Neural or hormonal control of blood flow includes

such mechanisms as the ac on of the sympathe c
nervous system on vascular smooth muscle and the
ac ons of vasoac ve substances such as histamine,
bradykinin, and prostaglandins.

2/6/2020 5
 Regula on of Peripheral Blood Flow

2/6/2020 6
 Pharmacologic S muli that Cause Contrac on or
Relaxa on of Vascular Smooth Muscle

VASOCONSTRICTORS VASODILATORS
• Catecholamines • Histamine
– Epinephrine • Adenosine
– Norepinephrine • Nitric Oxide (NO)
– Dopamine
• Carbon Dioxide
• Endothelin
• Potassium
• Serotonin
• Hydrogen Ion
• Angiotensin II
• Prostaglandins
• Vasopressin
• Acetylcholine
• Bradykinin

2/6/2020 7
Circula on Local Vasoac ve Sympathe c Mechanical
Metabolic Metabolites Control Effects
Control
Coronary Most important Hypoxia Least important Mechanical
mechanism mechanism compression during
Adenosine systole

Cerebral Most important CO2 Least important Increases in

mechanism mechanism intracranial pressure
H+ decrease cerebral
blood flow

Skeletal Most important Lactate Most important Muscular ac vity

mechanism during mechanism at rest (α1 compresses blood
Muscle exercise K+ receptors, vessels
Adenosine vasoconstric on; β2
receptors, vasodila on)

Skin Least important - Most important -

mechanism mechanism for
temperature regula on
(α1 receptors,
vasoconstric on)

pulmonary Most important Hypoxia Least important Lung infla on

mechanism mechanism
vasoconstricts
Renal Most important - Least important -
mechanism (myogenic; mechanism
tubuloglomerular
feedback)

2/6/2020 Control of Special Circula ons 8

 Intrinsic Control of Local Blood Flow:
Metabolic Factors

Acute Local Feedback Control of Blood Flow

Metarteriole

Precapillary Relaxation of smooth muscle

Sphincter

Lack of oxygen?
Capillary Formation of vasodilators?
Combination of both??

Increased Blood Flow

2/6/2020 9
 Examples of Metabolic Control of Local Blood flow

Ac ve Hyperemia
• Illustrates the concept that blood flow to an
organ is propor onal to its metabolic ac vity

Reac ve Hyperemia
• Is an increase in blood flow in response to or
reac ng to a prior period of decreased blood
flow
2/6/2020 10
 Autoregula on
• Intrinsic ability of an organ to maintain a constant
blood flow despite changes in perfusion pressure

• Autoregula on is the maintenance of a constant

blood flow to an organ in the face of changing
arterial pressure

• Possible explana ons for Autoregula on:

– Myogenic Mechanism
– Metabolic Mechanism

2/6/2020 11
 Cerebral Autoregula on

2/6/2020 12
 Ques ons

2/6/2020 13
 HEMODYNAMICS

KWAME ADU-BONSAFFOH

2/6/2020 14
 Hemodynamics

• The study of the physical principles

governing blood flow within the
cardiovascular system

2/6/2020 15
 Blood Circula on

Hemodynamic Modulators
• Heart -Inotropy
Chronotropy
• Blood Vessels-
Vasoac vity
• Blood- Intravascular
Volume

2/6/2020 16
 Vasculature
• Elaborate system of
pipes that runs through
the body

2/6/2020 17
2/6/2020 18
 Comparative structure of blood vessels

2/6/2020 19
2/6/2020 20
 Blood distribu on in the cardiovascular system

2/6/2020 21
 Pressure Gradients
• Systemic circuit
a) MAP = average pressure in the aorta
throughout the cardiac cycle
= ~90 mm Hg
b) Central Venous Pressure (CVP)
= pressure in the large veins (vena cava) in the
thoracic cavity leading to the right atrium
= ~2-8 mm Hg
List the Factors increasing CVP……… CO, blood vol,
venoconstric on, supine posi on, arterial
dilata on, forced expira on (valsava), muscel
contrac on

2/6/2020 22
 Pressure Gradients
• Pulmonary circuit
- Difference between the pressure in the
pulmonary arteries and pressure in
the pulmonary veins
- During cardiac cycle:
pulmonary arterial pressure = ~15 mmHg
pulmonary venous pressure = ~0 mmHg

2/6/2020 23
 Resistance
• The resistance of fluid flowing smoothly
through a cylindrical tube
R = 8Lη / πr4

L = length of the tube

η = viscosity of fluid
r = internal radius of the tube

2/6/2020 24
 Arrangements of blood vessels in series and in parallel

2/6/2020 25
 Effect of aging on compliance of the arteries

• Characteris cs of the arterial walls change

with increasing age
• The walls become s ffer, less distensible, and
less compliant. At a given arterial pressure,
the arteries can hold less blood.
• Arterial pressures are increased in the elderly
due to decreased arterial compliance.

2/6/2020 26
 Capacitance of veins and arteries

2/6/2020 27
 Velocity of the Bloodstream
• Velocity = Q/A
Q = flow (volume of fluid displaced)
A = cross-sec onal area

capillaries – largest cross-sec onal area

slowest blood velocity

2/6/2020 28
2/6/2020 29
 Laminar and Turbulent Flow

• Streamlined
Rapid radial mixing
flow
• Greater
Velocity pressure
at centerrequired
of streamtoisforce
maximal
a given
and 2x
the mean
flow of fluid
velocity
so heart
of flow
doesacross
more work
the cross
sec on

2/6/2020 30
 Reynold’s number NR
• Dimensionless number
• Predicts whether tubular or laminar flow will
exist in a tube under given condi ons
• Represents the ra o of iner al to viscous
forces
• NR <2000 = laminar flow
2000-3000 = transi onal
>3000 = turbulent flow
2/6/2020 31
 Reynold’s number NR
For a fluid flowing through a cylindrical tube:
NR = ρDv/η

ρ = fluid density v = Q/A or

v = Q/πr2
D = tube diameter
v = mean velocity
η = viscosity
1. ANAEMIA
2. THROMBI
2/6/2020 32
 QUESTIONS

2/6/2020 33
 MICROCIRCULATION
OBJECTIVES
1. Recognize the structural components of the microcirculation.
2. Describe the ultrastructure of a capillary and how it relates to function.
3. Explain oncotic pressure and the reflection coefficient.
4. Explain the four Starling forces that govern transcapillary exchange.
5. Explain how net filtration pressure and the filtration coefficient regulate
filtration flow.

2/6/2020 34
 MICROCIRCULATION
• Microcircula on refers to the func ons of the
smallest blood vessels, the capillaries and the
neighboring lympha c vessels
• Delivery of blood to and from the capillaries is
cri cally important because the capillaries are
the site of exchange of nutrients and waste
products in the ssues, as well as the site of
fluid exchange between the vascular and
inters al compartments

2/6/2020 35
 Structure of the Microcircula on

Smooth
muscle
Endothelial
cells Arteriole

Precapillary
sphincters

Capillary

Metarteriole
Venule
2/6/2020 36
 Microcircula on

Figure 16-1;
2/6/2020 Guyton and Hall 37
2/6/2020 38
2/6/2020 39
2/6/2020 40
 Starling pressures across the capillary wall

2/6/2020 41
2/6/2020 42
2/6/2020 43
2/6/2020 44
 Lympha c System

2/6/2020 45
2/6/2020 46
 Causes and Examples of Edema Forma on
Cause
↑ Pc (capillary hydrosta c pressure)
↓ πc (capillary onco c pressure)
↑ Kf (hydraulic conductance)
Impaired lympha c drainage
2/6/2020
Examples
Arteriolar dila on
Venous constric on
Increased venous pressure
Heart failure
Extracellular fluid volume expansion
Decreased plasma protein concentra on
Severe liver failure (failure to synthesize
protein)
Protein malnutri on
Nephro c syndrome (loss of protein in urine)
Burn
Inflamma on (release of histamine;
cytokines)
Standing (lack of skeletal muscle
compression of lympha cs)
Removal or irradia on of lymph nodes
Parasi c infec on of lymph nodes
47
 QUESTIONS

2/6/2020 48