HYDRODYNAMIC PRINCIPLES

ARTERIAL & VENOUS HYPEREMIA

ISCHEMIA

Ketevan Gambashidze MD., Ph.D., D.Sc.

Associa
te
Profess
or
 Large-diameter arteries - Aorta and its main branches have a high
elastic fiber content, which allows them to accommodate cardiac stroke
volume and convert the intermittent flow of blood to a more, even
steady flow.

They are distensible thus, allowing them to accommodate

large volume of blood.

Blood flow during systole is the result of cardiac contraction

and blood flow during diastole is the result of the elastic
recoil of the arteries as they discharge the blood that had
caused their distention during systole.
 The Arteries arise from the aorta and its main branches, that supply various
organs are called as resistant vessels, because they have muscular walls and rich
sympathetic nerve supply that permits adjustment of luminal size and changes the
resistance to blood flow.
They regulate volume and pressure in the arterial system and blood flow to the
capillary bed.

The Venules are formed as capillary network coalesces and the venules
converge to form veins of progressively larger diameters. Veins have valves to
prevent reflux and the action of the muscles exert helps venous return.

The veins are called as capacitance vessels, because approximately 75% of the
total blood volume can be stored within them.

Muscular tissue in the venules and small veins which is innervated by

sympathetic fibers can through constriction cause the return the large amounts
of "stored" blood to the circulating blood volume.
 Capillaries are the exchange vessels.

They have neither muscular nor elastic fibers and are presented by ultrastructure,
which is composed of a unicellular layer of endothelial cells and surrounded by a
basement membrane on the outside.

The capillaries are extremely thin structures, the microscopic and minute vessels.
Their main function is to provide (supply) tissues by nutrients and simultaneously to
remove the cellular excreta (waste products).

Metabolically active tissues such s skeletal tissue have a relatively greater

concentration of capillaries than metabolically inactive tissue such as cartilage.

Some capillary beds have arterio-venous connections that allow blood to pass
directly the arterial and venous systems. This mechanism allows heat exchange
from the vessels.

Changes in capillary diameter are passive and caused by changes in precapillary

and postcapillary resistance, also by the state of surrounding tissue.
Branching in a typical microcirculation, that of the smooth muscle and
submucosa of the intestine
r, radius.
Regulation of blood flow in
capillaries
 Blood vessels Artery Arteriole Capillaries Venule Vena
Diameter in mm

Wall thickness
in mm

Endothelial l.
Elastic fibers
Muscular layer
Fibrous layer

Scheme
of
blood
vessels
Hemo- and Hydrodynamic
Principles

Equation of continuity
Bernoulli's principle
 According to the equation of continuity

V= q v =const

V volumetric speed of blood flow

q diameter of blood vessel

v liner speed of blood flow

distance
 Bernoulli's Principle

Bernoulli's Principle is a physical phenomenon that was named after the

Swiss scientist Daniel Bernoulli who lived during the eighteenth century.

Bernoulli studied the relationship of the speed of a fluid and pressure.

The principle states that "the pressure of a fluid [liquid or gas] decreases as
the speed of the fluid increases. High-speed flow is associated with low
pressure, and low-speed flow is associated with high pressure.
Very interesting things can happen when fluids move with respect to objects.
Consider fluid flowing in a pipe: There are different types of energy to
consider.

First there is the kinetic energy (v2/2) of the fluid itself.

Next, if the height of the pipe is changing, the changes in gravitational

potential energy (Z) must be accounted for.

Finally, there is work done by pressure forces P/

(potential energy)

The statement that the total energy must be conserved at each point in the
pipe is called Bernoulli's Principle.

Note that, if the density of the fluid remains constant, Where the speed of a
fluid increases, the internal pressure in the fluid decreases.
According to Bernoulli's principle the total energy must be conserved.
In the other words, the sum of kinetic and potential energies (when
density of the fluid remains constant) at each point in the pipe is
constant.

It means that when kinetic energy increases potential energy decreases

and vice versa.

(potential Z and P/, and kinetic v2/2)

Z + P/ + v2/2 = const
 LOCATION ENERGY Z (potential energy)

The pressure in any vessel below heart level is increased and that in any vessel
above heart level is decreased by the effect of gravity.

The magnitude of the gravitational effect - the product of the density of the blood,
the acceleration due to gravity (980 cm/s/s), and the vertical distance above or
below the heart is 0,77 mm Hg/cm at the density of normal blood.

Thus, in an adult human in the upright position, when the mean arterial pressure at
heart level is 100 mm Hg, the mean pressure in a large artery in the head (50 cm
above the heart) is 62 mm Hg (100- [0,77 x 50]) and the pressure in a large artery in
the foot (105 cm below the heart) is 180 mm Hg (100+ [0,77 x 105]). The effect of
gravity on venous pressure is similar.

So, the energy dependent on location of blood vessel (is it above-, below- or at the
heart level) is known as Location energy (Z).
 PRESSURE FORCES P/

(Pressure energy, pressure exerted on blood vessel walls potential

energy)

The pressure that would be exerted by the fluid on the walls of the

tubes is - P and the viscosity of the fluid is - .

P/ is called as Pressure energy.

Both, Z and P/ are potential energies.

SPEED DEPENDENT EXERTION - v2/2 (kinetic energy)

v2/2
where V is the speed of fluid motion and is the viscosity.
 Bernoulli's principle also has a significant application in pathology.
According to the principle, the greater the velocity of flow on vessel,
the lower is the lateral pressure distending its walls.

When a vessel is narrowed, the velocity of flow in the narrowed portion

increases and the distending pressure decreases.

Therefore, when a vessel is narrowed by a pathologic process such as

an atherosclerotic plaque, the lateral pressure at the constriction is
decreased and narrowing tends to maintain itself.

When fluid flows through the narrow portion of the tube, the kinetic energy of
flow is increased as the velocity increases, and the potential energy is
reduced.

Consequently, the measured pressure (P) is lower than it would have been at
that point if the tube had not been narrowed.

The line (Fig. N1) indicates what the pressure drop due to frictional forces would
have been if the tube had been of uniform diameter.
Fig. N1. Examples of Bernoulli's Principle in the circulation. Interconversion of pressure
(potential) energy and velocity (kinetic) energy
How Bernoulli's Principle Works

P P
P

V V V
 The arterial pressure in humans is routinely measured by the auscultatory
method. An inflatable cuff (Riva-Rocci cuff) attached to a mercury manometer
(sphygmomanometer) is wrapped around the arm and a stethoscope is placed
over the brachial artery at the elbow.

The cuff is rapidly inflated until the pressure in it is well above the expected
systolic pressure in the brachial artery. The artery is occluded by the cuff and no
sound is heard with the stethoscope (velocity of blood flow and consequently
V2/2g=0, and kinetic energy is converted to potential energy. At the same time
Location energy Z is ignored as well, because hand with cuff is placed at the hart
level. Therefore, we measure only a pure P or arterial pressure).

The pressure in the cuff is then lowered slowly. At the point at which systolic
pressure in the artery just exceeds the cuff pressure, a spurt of blood passes
through with each beat, a tapping sound is heard below the cuff. The cuff
pressure at which the sounds are first heard is the systolic pressure. As the cuff
pressure is lowered further, the sounds become lauder, then dull and muffled.
Last sound corresponds to diastolic pressure. These are the sounds of Korotcoff.
 Disorders of Local Hemocirculation -
Arterial Hyperemia

HYPEREMIA is an increase in local blood flow or a localized increase in the

volume of blood in capillaries and small vessels due to local or general
relaxation (dilatation) of arterioles.

There are:

Physiologic and
Pathologic Hyperemia
 Physiologic hyperemia involves:

Functional hyperemia It is ability of tissues to increase blood flow in situations of increased

activity, such as exercise.

Hyperemia "Pudency" develops on the basis of emotional excitements

Physiologic hyperemia develops after exposure to heat sources.

Reactive hyperemia When the blood supply to an area has been occluded and then restored,
local blood flow through the tissues increases within seconds to restore the metabolic equilibrium of the
tissues. It is also known as Postischemic hyperemia.

Inflammatory hyperemia

Neuro-paralytic hyperemia
Artificial hyperemia - develops at traditional Chinese Cupping therapy.

Hyperemia after disorder of vasoconstrictors (traumas, toxins, mediators,

pharmacological remedies).

Hyperemia due to increased tonus of vasodilators (toxins, mediators,

pharmacological remedies).
 Arterial hyperemia is characterized by:

Redness

Increased metabolism

Increased heat production

Increased pressure in affected vessels

Increased production of tissue fluid

 V = q x v

The diameter of blood vessel

Linear speed of blood flow

Volumetric speed of blood flow

In case of arterial hyperemia pressure in dilated area increases as
a result of decreased resistance.

Increased pressure in turn increases process of exudation and

tissue fluid formation increases as well.

The increased heat of skin is due to the entry of a large amount

of blood at body core temperature into the normally cooler
skin.

When hyperemia occurs internally where tissue is normally at

body core temperature no increase in heat is apparent.
 Venous Hyperemia

Venous or passive hyperemia or congestion results from obstructed venous return

or increased back pressure from congestive heart failure.

Local reasons of venous hyperemia are: thrombus, emboli, tumor, inflamed organ

General reasons are: shock and heart failure leading to decreased venous return
and thereby venous congestion.
 V = q x v

Tissue nutrition and heat production are decreased.

Pressure is increased which is reflected on the process of filtration.

Plasma passage is increased extremely and formation of interstitial fluid

is exaggerated leading to edema formation.

Color of the skin is cyanotic, because under the thin layer of epidermis,
reduced hemoglobin is shown as blue, and skin is of blue color with
cyanotic tinged.

In long-standing venous congestion, fibrosis of interstitium develops.

 Ischemia
Ischemia is the deficiency (insufficiency) of blood in a part, usually
due to functional constriction or actual obstruction of a blood vessel.

However, sometimes ischemia develops in the absence of vascular

constriction or obstruction, so, when blood vessel is intact.

In such case, the reason of ischemia is disparity between the

demand and blood supply of tissue, when blood supply is unable to
meet increased demand of organ or tissue.
 COMPRESSIVE NEUROPARALYTIC
Compression of arteries or arterioles Block of vasodilatators or
(scaring, tumor, etc.) reduced tonus

ISCHEMIA

OBSTRUCTIVE NEUROTONIC
Arterial occlusion by thrombus, emboli,
Arterial spasm
obstruction due to arterial wall pathology

REFLEX
INCREASED SENSITIVITY OF
ARTERIAL MIOCYTES to factors (In response to pain,

emotions, cold and etc.)

stimulating their contraction
Cardiac ischemia
 Obstructed or constricted blood vessel is unable to provide adequate
oxygen supply and tissue nutrition leading to hypoxia.

Hypoxia in turn supports anaerobic metabolism.

Accumulation of end products of anaerobic metabolism (lactic acid,

pyruvic acid) excites nerve endings therefore ischemia usually is
accompanied by pain.

Ischemia of myocardium is known as stenocardia or angina

pectoris, another manifestations of ischemia are Hemicrania,
Raynaud's disease, endarterites.
 MICROCIRCULATION AT ISCHEMIA

Reduced cross section of supplying blood vessels

Increased resistance in arteries

Decreased pressure gradient Decreased blood pressure Decreased concentration of

in capillaries in pre-capillary arteries RBC in micro blood vessels

Decreased lineal speed of blood flow Conversion of active capillaries in

in micro blood vessels passive non-functioning capillaries

Decreased blood pressure in

capillaries

REDUCED INTENSITY OF MICRCIRCULATION,

CAPILLARY INSUFFICIENCY
 Hemicrania

Hemicrania is the unilateral headache.

It is the one sided headache (resembling a claster headache but) occureing in

paroxysms of half an hour or less, several times a day, sometimes for years.

The reason of vasoconstriction is not clear. Vasoconstriction is than followed

by vasodilatation.
 Raynaud's disease
Intermittent spasm of the arterioles (exaggerated vasoconstriction of digital arteries
and arterioles) is the underling pathologic defect in Reynaud's disease.

The etiology of this disorder is unknown.

The disease mainly affects women and onset usually occur before the age of 40.

The tips of finger, toes, ears and the nose are most commonly affected by
paroxysmal pallor or cyanosis.

Clinical manifestations include intermittent attacks of numbness and tingling. Severe

pain may also occur.

Characteristically, the involved digits show red, white, and blue color changes from
most proximal to most distal, correlating with proximal vasodilation, central
vasoconstriction, and more distal cyanosis.

At first the affected part will appear pale and feel cold. Pallor is followed by
cyanosis.

The affected part may become black and gangrenous.

Raynaud phenomenon may be a primary disease entity or be secondary to a variety

of conditions.
 Primary Raynaud phenomenon (previously called Raynaud disease) reflects an
exaggeration of central and local vasomotor responses to cold or emotion, with
a prevalence in the general population of 3% to 5% and a predilection for
young women.

Structural changes in the arterial walls are absent except late in the course,
when intimal thickening can appear.

The course of primary Raynaud phenomenon is usually benign, but long-

standing, chronic cases can result in atrophy of the skin, subcutaneous tissues,
and muscles. Ulceration and ischemic gangrene are rare.

In contrast, secondary Raynaud phenomenon refers to vascular insufficiency of

the extremities in the context of arterial disease caused by other entities
including SLE, scleroderma, Buerger disease, or even atherosclerosis.
 Clinical manifestations are precipitated by exposure to cold.

The stress response, which causes peripheral vasoconstriction, exacerbates this

disorder.

Treatment includes prevention of attacks by avoidance of cold and careful attention to

protective clothing (including the wearing of gloves), avoidance of trauma, smoking,
vasoconstricting drags.

Drags can be used to promote vascular relaxation and decrease pain.

During an attack they first become white and dead looking then bluish and
cold burning. There may be considerable pain, numbness or tingling.
 Endarteritis
Endarteritis - or intermittent claudication or pain in lags with exercise, a
condition referred to as arterial insufficiency.
Endarteritis in fact is the inflammation of the innermost coat of artery
(tunica intima).

Inflammation usually results in narrowing of arterial lumen .

Due to it affected arterias are unable to provide appropriate organs or
tissues by blood.
There is not adequate blood supply of organs and tissues,
especially when this last performs the function (functioning
organ demands more blood).
The disease mainly affects men.
 Manifestations of an arterial occlusive
process are:

The absence of palpable pulses

Coldness to the touch

A chalk-white pallor alternating with cyanosis

Anesthesia or paresthesia

The pain in the legs with exercise is the characteristic for

endarteritis
 Appeared pain indicates arterial insufficiency and is described as cramping, aching,
burning or squeezing.

As the disease process worsens, the pain may even be experienced at rest.

Placing the extremity in a dependent position will help restore blood flow and relieve the
pain.

Burning or shocking pain can be result of ischemic neuropathy.

The patient may also complain of feeling cold in the feet and toes.
Because of the decrease supply of nutrients and oxygen, trophic changes of the tissues
occur
- Loss of hair on the affected extremity
- Nail deformities
- Atrophy of tissue

The development of gangrene is a particular danger.

Shiny, hairless skin, dystrophic nail changes and dependent rubor associated with
peripheral arterial occlusive disease of the patient's right foot.