Dynamics of Blood Flow

Departemen Fisiologi
Fakultas Kedokteran Universitas Sumatera Utara

Introduction

blood vessels are a closed system of conduits that carry blood from heart to tissues and back to heart.

FUNCTIONAL MORPHOLOGY

Vessel Size and Composition

Arteries & Arterioles

Walls ; outer layer (adventitia) : connective tissue middle layer (media) : smooth muscle inner layer (intima) : endothelium & underlying connective tissue

 Aorta and other large arteries contain relatively large amount of elastic tissue, arterioles contain less elastic tissue but much more smooth muscle.

Arterioles are major site of resistance to blood flow, and small changes in their caliber cause large changes in the total peripheral resistance.

Capillaries

Active & Inactive Capillaries

In active tissues, metarterioles and precapillary sphincters dilate, is due to action of vasodilator metabolites formed in active tissue and a decrease activity of sympathetic vasoconstrictor nerves In resting tissues, most of capillaries are collapsed, and blood flows through the thoroughfare vessels from the arterioles to the venules

 total area of all capillary walls in body exceeds 6300 m2 in adult walls, which are about 1 um thick, are made up of a single layer of endothelial cells

Left: Continuous type of capillary, found in muscle. : 10 nm

Right: Fenestrated type of capillary, found in endocrine glands, intestinal villi, and parts of kidneys, : 20 100 nm

 Pericytes, cells found in capillaries and postcapillary venule, contractile and release vasoactive agents synthesize and release constituents of basement membrane and extracellular matrix regulate of flow through junctions between endothelial cells, particularly in inflammation

Arteriovenous (A V) Anastomoses or Shunt

short channels that connect arterioles to venules, by passing capillaries In fingers, palms, and ear lobes of humans and paws, ears have thick, muscular walls and are abundantly innervated, presumably by vasoconstrictor nerve fibers

Venules & Veins

walls are only slightly thicker than capillaries. walls are also thin and easily distended relatively little smooth muscle, venoconstriction is produced by activity noradrenergic nerves to veins and by circulating vasoconstrictors such as endothelins intima of limb veins is folded at intervals to form venous valves that prevent retrograde flow

VENOUS CIRCULATION
Venous flow is aided by heartbeat, increase in negative intrathoracic pressure during each inspiration, and contractions of skeletal muscles that compress the veins (muscle pump) Heartbeat, during systole contribute venous return especially at rapid heartbeat Thoracic Pump, during inspiration intrapleural pressure falls from -2.5 to -6 mm Hg, drop in venous pressure during inspiration aids venous return

 Muscle Pump, Rhythmic contractions of the leg muscles while the person is standing serve to lower the venous pressure in the legs to less than 30 mm Hg by propelling blood toward the heart. In patients with varicose veins because their valves are incompetent, may develop stasis and ankle edema

Angiogenesis
formation of new blood vessels, important during fetal life and growth to adulthood. many factors are involved in angiogenesis; protein growth factor vascular endothelial growth factor (VEGF).

Haemodynamics of Pressure and Flow

) is the volume that passes Flow(Q through a region in a unit time.
Flow through the vascular system is produced by the arterio-venous pressure difference and is proportional to the pressure difference.

Q Q= t

P P a v Q= R

Resistance is Dependent on Diameter

Resistance falls with increasing radius of the blood vessel, and increase with increasing blood viscosity. Under ideal conditions the resistance of a tube is described by Poiseuilles law. Resistance to blood flow is determined not only by radius of the blood vessels (vascular hindrance) but also by viscosity of the blood. Where R= resistance = viscosity r= radius 4 l= length

l
r

Halving the radius of an arteriole increases resistance by 16 fold.

Factors affecting resistance

Vascular resistance (largest impact) friction between blood and vessel walls

related to blood vessel diameter (and length)

The narrow arterioles (and capillaries) generate the largest

vasoconstriction: contraction to reduce diameter vasodilation: relaxation to enlarge diameter

vascular resistance

Factors affecting resistance

Viscosity
The thicker the liquid the more resistance it creates Blood is thicker than water therefore has

higher resistance (presence of cells,

proteins) Plasma is about 1.8 times as viscous as water, whereas whole blood is 3-4 times as viscous as water.

Viscosity of Blood
The viscosity of whole blood is dependent on the haematocrit. Anaemia can reduce blood viscosity.

Polycythaemia increases the haematocrit, blood viscosity and resistance.

viscosity increases are seen in diseases in plasma proteins such as the immunoglobulins and in hereditary spherocytosis (red blood cells are abnormally rigid)

Factors affecting resistance

Turbulence
Blood flow is laminar

Faster flow at centre, slowest near vessel wall

Increased turbulent flow occurs at very high flow rates or as a result of

vascular disease
Occurs normally during blood flow between chambers (characteristic sound)

Higher turbulent flow increases resistance (and elevated BP required to maintain flow can further damage walls)

 Turbulence is also related to the diameter of the vessel and the viscosity of the blood.
R = Re = Reynolds = densitas cairan D = diameter pebuluh V= kecepatan aliran = viskositas cairan

Re < 2000 -> tidak terjadi turbulen Re > 3000 -> turbulen

Resistance Along the Vascular System

Resistance is greatest in arterioles.

Total resistance is controlled by arteriolar resistance. Arterioles control perfusion through organs and the distribution of cardiac output.

Pressure and Volume in the Circulation

Pressure is pulsatile in the arteries but steady in the capillaries and veins. Pressure falls along the circuit with the greatest fall across arterioles. Volume is greatest in the venous system. At any time most of the blood is in veins

Laminar Flow
flow of blood in straight blood vessels, like flow of liquids in narrow rigid tubes, is normally laminar (streamline).

Laminar flow occurs at velocities up to a certain critical velocity. At or above this velocity, flow is turbulent. Streamline flow is silent, but turbulent flow creates sounds.

Average velocity
Velocity : displacement per unit time (eg, cm/s), Flow : volume per unit time (eg, cm3/s) Velocity (v) is proportionate to flow (Q) divided by the area of the conduit (A) if flow stays constant, velocity increases in direct proportion to any decrease in A

 Top: Effect of constriction (C) on the profile of velocities in a blood vessel. Bottom: Range of velocities at each point along the vessel.

Velocity and Area in the Vascular System Total cross-sectional area of the vascular system is greatest in the capillaries and lowest in the large vessels. Because flow is constant the blood velocity is fastest in the large vessels and slowest in capillaries. A erythrocyte spends 0.5 to 1 second in the capillaries.

Law of Laplace
tension in the wall of a cylinder (T) is equal to the product of the transmural pressure (P) and the radius (r) divided by the wall thickness (w). T =Pr/w

Arterial Pressure
Pulse pressure, the difference between the systolic and diastolic pressures (SP DP), is normally about 50 mm Hg (120 80 mmHg) Mean pressure is the average pressure throughout the cardiac cycle, equals diastolic pressure plus one-third of the pulse pressure = DP + 1/3 (PP)

Effect of Gravity
Pressure in any vessel below heart level is increased and in any vessel above heart level is decreased by the effect of gravity. Besarnya efek gravitasi-hasil kali densitas darah, akselerasi akibat gravitasi, dan jarak vertikal di atas atau di bawah jantung 0,77 mmHg/cm pada densitas darah normal.

Methods of Measuring Blood Pressure Auscultatory Method Palpation Method

Measuring Venous Pressure

Central venous pressure can be measured directly by inserting a catheter into the thoracic great veins. Peripheral venous pressure correlates well with central venous pressure in most conditions Perkiraan tekanan vena sentral, dengan mengukur distensi vena jugularis eksterna pada waktu pasien berbaring dengan kepala sedikit di atas jantung. Jarak vertikal antara atrium kanan dan tempat vena yg kolaps (tempat dgn besar tekanan nol) adalah tekanan vena dalam mm darah.

Let it beat!