CARDIOVASCULAR

HEMODYNAMIC

Mukhammad Dema Prakasa

Outline
• Oxygen Delivery
• Cardiac Output and its Control
• Hemodynamic Concept
 Oxygen Delivery
• The transport of oxygen is fundamental to aerobic respiration
• Global oxygen delivery describes the amount of oxygen delivered to the
tissues in each minute and is a product of the cardiac output and
arterial oxygen content

J-OC Dunn. MG Mythen. MP Grocott. Physiology of oxygen transport. BJA Education, 16 (10): 341–348 (2016)
 Cardiac Output
Cardiac Output (CO) is the volume of blood pumped
by each ventricle per minute (not the total amount of
blood pumped by the heart)

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed. 2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016
FACTORS AFFECTING HEART RATE & STROKE VOLUME

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016
Autonomic Control of SA Node
Activity & Heart Rate

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016

STROKE VOLUME
Stroke volume are the amount of
blood pumped out by each
ventricle during each beat

Factors influence SV
• Intrinsic control related to the
extent of venous return (Pre
Load)
• Extrinsic control related to the
extent of sympathetic
stimulation of the heart
(Contractility)
• The Afterload

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016

VENOUS RETURN

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016

Intrinsic Factor of STROKE VOLUME
End-Diastolic Volume (EDV)
• At the end of diastole, the ventricles are filled to
their End-Diastolic Volume (EDV). The LV EDV
(typically about 120 mL)

End-Systolic Volume (ESV)

• In a normal ventricle, about 60% or more of the
EDV is ejected. The residual volume of blood that
remains in a ventricle after ejection is called the
End-Systolic volume (ESV). For the LV,
(approximately about 50 mL)

Stroke Volume (SV)

• The difference between the EDV (120 mL) and the
ESV (50 mL) represents the Stroke Volume (SV) of
the ventricle, (about 70 mL)

Ejection Fraction (EF)

• The SV (EDV –ESV) divided by the EDV is called the
Ejection Fraction (EF) of the ventricle, which
normally is >0.55 (or 55%)

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed. 2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016
 Preload
• Preload is the initial stretching of the cardiac myocytes prior to contraction; therefore, it is related to the
sarcomere length at the end of diastole.
• The extent of filling is referred to as the preload because it is the workload imposed on the heart before
contraction begins.

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016

 Extrinsic Factor of STROKE VOLUME

Contractility
• Extrinsic control are factors originating outside the heart,
actions of the cardiac sympathetic nerves and epinephrine
• Sympathetic stimulation and epinephrine enhance the
heart’s contractility, which is the strength of contraction at
any given EDV.
• On sympathetic stimulation, the heart contracts more
forcefully and squeezes out a greater percentage of the blood
it contains, leading to more complete ejection
Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.. 2012
Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016
Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 Afterload
• When the ventricles contract, to force open the
semilunar valves they must generate sufficient
pressure to exceed the blood pressure in the major
arteries. The arterial blood pressure is called the
afterload.
• If arterial blood pressure exit valve is stenotic is
chronically elevated (high BP) or if the, the ventricle
must generate more pressure to eject blood

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed. 2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed. 2016
 HEMODYNAMICS
(FLOW, PRESSURE & RESISTANCE)
The term hemodynamics describes the physical factors governing
blood flow within the circulatory system.

(F) : The flow rate is the volume of blood passing

through per unit of time)

(P) : The pressure gradient is the difference in

pressure between the beginning and the end of a vessel

(R) : The resistance, which is a measure of the

hindrance to blood flow through the vessel,

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012.

 RESISTANCE
Resistance is a measure of the hindrance or opposition to blood flow
through the vessel, caused by friction between the moving fluid and the
stationary vascular walls.

Factors determine the RESISTANCE

(R)
• Viscosity ()
• Length (L)
• Diameter (radius) of the vessel.

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 RESISTANCE

Factors determine the RESISTANCE

(R)
• Viscosity ()
• Length (L)
• Diameter (radius) of the vessel.
Viscosity
• Refers to the friction developed between the molecules of a fluid as they slide
over each other during flow of the fluid
• The thicker a liquid is, the greater its viscosity, the greater the resistance
• Determined primarily by the number of circulating RBC
• Relatively constant and not important in controlling resistance

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 RESISTANCE

Factors determine the RESISTANCE

(R)
• Viscosity ()
• Length (L)
• Diameter (radius) of the vessel.
• Vessel’s length remain constant, the major
determinant of resistance to flow is the
vessel’s radius.
• Fluid passes more readily through a large
vessel because blood comes into contact with
more of the surface area of a small-radius
vessel resulting in greater resistance
• A slight change in the radius of a vessel
brings about a substantial change in flow

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 Vascular Tone

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016

Systemic Vascular Resistance /
Total Peripheral Resistant
Resistance to blood flow offered by all of the
systemic vasculature, excluding the
pulmonary vasculature

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012
Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 Poiseuille’s Equation

FLOW

(F) : The flow rate is the volume of blood passing RESISTANCE

through per unit of time)
Factors determine the RESISTANCE
(P) : The pressure gradient is the difference in (R)
pressure between the beginning and the end of a vessel • Viscosity ()
• Length (L)
(R) : The resistance, which is a measure of the • Diameter (radius) of the vessel.
hindrance to blood flow through the vessel,
Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012
Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 PRESSURE
• Pressure within Cardiac Chambers & Great Vessels
• Pulse Pressure
• Mean Arterial Pressure

• The pressure gradient is the difference in

pressure between the beginning and the
end of a vessel.
• Blood flows from an area of higher
pressure to an area of lower pressure
down a pressure gradient.
• Contraction of the heart imparts pressure
to the blood, which is the main driving
force for flow through a vessel

Klabunde, RE. Cardovascular Physology Concepts 2 nd Ed.2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
Normal Pressure within Cardiac Chambers
& Great Vessels

1. Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

Systolic, Diastolic & Pulse Pressure

• Systolic Pressure. The maximum

pressure exerted in the arteries when
blood is ejected into them during
systole, averages 120 mmHg.
• Diastolic Pressure. The minimum
pressure within the arteries when
blood is draining off into the rest of
vessels during systole, averages 80
mmHg
• Pulse Pressure. The difference
between the systolic and diastolic
pressures is the aortic.

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016
 Mean Arterial Pressure

• At normal resting heart rates, mean aortic (or arterial) pressure (MAP)
can be estimated from the diastolic (Pdias) and systolic (Psys) pressures

Factors determining Mean Arterial Pressure (MAP)

• Cardiac Output (CO)
• Systemic Vascular Resistance (SVR)
Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.
Sherwood, L. Human Physiology from Cells to Systems 9th Ed
ARTERIAL BLOOD PRESSURE

.Sherwood, L. Human Physiology from Cells to Systems 9th Ed.2016

VENOUS BLOOD PRESSURE
• Venous pressure is a general term that represents the
average blood pressure within the venous compartment
• A more specific term, central venous pressure (CVP),
describes the blood pressure in the thoracic vena cava near
the right atrium.
• This pressure is important because it determines the filling
pressure of the right ventricle, and thereby determines
ventricular stroke volume through the Frank−Starling
mechanism

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

 Central Venous Pressure

Factors influence CVP:

• Cardiac Output
• Respiratory Activity
• Contraction of skeletal muscles
(particularly leg & abdominal muscles)
• Sympathetic vasoconstrictor tone
• Gravitational forces

Klabunde, RE. Cardovascular Physology Concepts 2nd Ed.2012

THANK YOU