Regional Circulation

Prof. K. Sivapalan
 Regional blood flow.
• Every organ has specific functions to perform.
• The blood flow to each organ will vary
depending on the functional state of the organ,
metabolic requirements and general conditions.
• Blood flow to each organ can be measured by
– Fic principle using substances released into or
removed from blood.
– Plathysmography.
– Flow meters.

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 Pulmonary circulation.
• Pressure: 25 / 10 mm Hg.
• Thickness of the wall of Pulmonary artery is only
30 % compared to aorta and arterioles also contain
less muscles.
• 1000 ml of blood in pulmonary vessels when erect.
• When erect, base of the lungs are at the level of the
heart.
• When lying, most of the lungs are below heart level.
• When lying 400 ml more accumulates.

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 Pulmonary circulation ctd.
• Bronchial vein opens into the pulmonary vein resulting in
2 % deoxygenated blood mixing with oxygenated blood.
• Capillaries form baskets around alveoli and their
diameter is 8μ.
• Abundant lymphatics.
• No tissue fluid formation in alveoli:
– Pressure less than oncotic pressure.
– Surfactant.
• Function – gas exchange, filtration of clots, etc.
• Ventilation perfusion ratio:
– Alveolar ventilation / cardiac output
= 4.2 / 5.5 = 0.8
– Varies within regions of lung due to gravity.

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 Regulation of Pulmonary
circulation.
• All cardiac output goes through lungs.
• Inspiration increases venous return to right atrium and
reduces to left atrium.
• Expiration reverses the inequality resulting in differences
in stroke volume
• Local metabolites:
– Hypoxia, hypercapnoea and acid → arteriolar constriction
[different from other areas].
• Arteriolar constriction by,
– Sympathetics, catecholamines, angeotension II,
thromboxans,PGF2
• Arteriolar dilatation by,
– Acetylcholine, PGI2, histamine.

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 Splancnic circulation.
• Blood flow through liver [1500 ml per min.].
• From portal vein [1L] and hepatic artery to hepatic vein through
sinosoids.
• Sympathetic: vasoconstriction
• Reduces during heavy exercise and hemorrhage.
• Dogs: spleen reservoir for red cells.
• Parasympathetic: vasodialatation.
• Vasoactive intestinal peptide from intestine dialates.
• Blood flow doubles after meals.
• Congestive cardiac failure: enlarged liver, necrosis around
central vein.
• Cirrhosis of the liver [fibrosis]: acytis due to portal
hypertension.

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 Cerebral circulation.
• Two internal carotid and two vertebral arteries supply
blood to brain.
• Arteries anastomose at the circle of Willis but mixing
blood is minimal under normal conditions.
• Precapillary anastomosis between arteries are minimal
and not effective and so arteries in brain are known as
end arteries.
• If they are occluded, the area supplied by them will result
in ischemia and infraction.
• Deep veins empty into Venus sinuses in dura and
internal carotid vein.
• Blood from eye and nose also drain into internal carotid
vein.

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Exchange of substances in cerebral
vessels.
• Blood brain barrier: tight junctions in
endothelium & pia mater [choroid
epithelium] or end feet of astrocytes
applied to endothelium.
• No fenestrations in capillaries.
• Only water, CO2 and O2 cross BBB.
• Cerebrospinal fluid formed in choroid
plexus.
• Astrocytes feed neurons.

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 Cerebral blood flow.
• Cranium contains brain [1400 g.], blood
[75 ml], CSF [75 ml, 550 ml/d].
• Flow: 750 ml/min. [54 ml/100 g.]
• Kept constant by,
– Cranium.
– Auto regulation [negligible VMC effect].
– Cushing reflex- ↑ ICP → ↓ blood flow →
ischemia → + VMC, +CIC, ↑BP
• Regional flow within the brain is affected
by metabolites.
• Serious reduction of systemic blood
pressure reduces blood flow.
• No blood for 1 minute – faint, 5 minutes:
serious damage to cortical areas. Further
ischemia – death.

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 Coronary circulation.
• Coronary arteries arise from
sinuses behind two cusps of
aortic valves.
• Veins →coronary sinus →right
atrium.
• Interior parts of ventricles
drain directly into chambers,
into left heart as well.
• Arteries anastomose to a
certain extent. It can be
improved by exercise.

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 Coronary flow.
• At rest: 250 ml/min. (84
ml/100g/min.) oxygen
extraction 70 – 80 %.
• Left ventricle is responsible
for ejection resulting in
higher tissue pressure than
the aortic pressure in systole.
• Flow in left coronary artery is
highest during diastole.

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 Regulation of coronary flow.
• Mechanical factors.
– Left ventricle- during systole intra muscular tension
compresses arteries and therefore blood flows only
during diastole.
• Metabolites:
– Hypoxia, hypercapnoea, acidity, potassium ions, lactic
acid, adenine nucleotides, adenosine- vaso dilators.
• Neural:
– α constriction. [ in muscle, ↑force, metabolites →
dilatation]
– β dilatation

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 Abnormalities of coronary flow.
• Atherosclerosis is deposition of fatty material
below intima, calcification, damage to intima, etc.
• This narrows the lumen and prevents dilatation
and promotes thrombosis which can block
completely.
• When this occur in coronary arteries, angina
pectoris and myocardial infarction can occur.
• Risk factors: over eating, diabetes, smoking, lack
of exercise, stress.
• Alcohol – dilator but promotes
atherosclerosis. ? benefit to heart.
• Aspirin 150 mg daily, glyceryl trinitrin and other
drugs better care.

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 Cutaneous circulation.
• Function of skin: heat loss and protection.
• Flow 1 to 150 ml/min/100g.
• Cutaneous vaso dilatation in hot and
constriction in cold under
thermoregulatory center.
• Extreme cold, arterio-venus anastomosis
shunt blood in fingers, toes, palm and ear
lobes.
• Prolong exposure to cold – exhaustion of
smooth muscles, vaso dilatation and
bleeding [frost bite]
• Subdermal venous plexus- reservoir of
blood.

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 Control of flow.
• Vasomotor tone – constriction.
• Circulating catacholamines- constriction.
• Thermoregulatory influence over rides
baro receptor influences. [blanket and
shock]
• Local metabolites – dilatation.
• Reactive hyperaemia- after occlution.
• Dilatation caused by alcohol.
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 Response to injury.
• Mild stroke-
– white reaction.
– [Mechanical stimulation to
pre capillary sphincters.]
• Deeper stroke- triple
response:
– Red reaction [ cap.
Dilatation.]
– Wheal [cap. Permeability]
– Flare. [art. Dilatation]
• Axon reflex.
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 Capillary circulation.
• Contain 5 % of the blood.
• Active blood [exchange].
• Transition time – 1 -2 sec.
– Pre capillary sphincters-
controlled by local metabolites.
• Fluid exchange.
• Pulse pressure from 5 → 0.
[pulsatile → non pulsatile]

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 Special capillaries.
Liver – sinusoids.
Brain – BBB.
Kidney – glomerular tuft and vasa recta.

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 Uterus.
• 8 x 5 x 3 cm, 70
grams.
• Pregnancy – well
developed uterus and
fetus.
• Uterine artery
develops and blood
flow increases more
than 20 times.

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 Placental circulation.
• The placenta has to provide
oxygen and nutrients to and
remove wastes from the fetus.
• Umbilical vein and artery form villi
covered with chorion.
• Inter villus space is filled with
maternal blood.
• Arterioles open into and venules
drain the blood from this space.
[no capillaries]
• This increases cardiac output but
reduces peripheral resistance.
• Pulse pressure increases.

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 Fetal respiration.
• Gas exchange through placenta.
• Fetal Hb % = 18 g/100 ml.
• Fetal hemoglobin attaches to oxygen at
lower partial pressure than adult Hb.

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 Fetal circulation.
• Umbilical vein: 80 % saturated.
• Venous blood from lower body: 26 %
saturated.
• IVC: 67 % saturated.
• Left atrium gets IVC blood through
foramen ovale.
• Upper body gets this blood through
aorta.
• SVC [60 % saturated] drains into right
ventricle through the atrium and goes to
lower body and placenta through ductus
arteriosus [lung high resistance]
• Pressure in pulmonary artery is higher
than in aorta.
• 55% of cardiac out put goes to placenta.

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 Change at birth.
• Placental circulation
cut.
• Foramen ovale is
closed [left atrial
pressure rises,
umbilical vein closed]
• Ductus arteriosus is
closed as lungs
expand and draw
blood in.

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