I.U.I.C Physiology- B Ms.

Iter PHARM 318

Circulation
Part 1
 Course content  The Heart
o Anatomy of circulatory system - Arteries, Arterioles,
 Plasma, Capillaries, veins
 The Blood o Heartbeat coordination,
o Blood Cell,  Mechanical Events of the Cardiac Cycle,
o Blood Pressure,  The Cardiac output,
o Blood Flow and resistance,  Measurement of Cardiac Function,
o Blood volume & Long term regulation of  Other Cardiovascular Reflexes and Responses,
arterial pressure  Disease Physiology (Pathophysiology)
o Formation of Platelet Plug o Hemorrhage and Other Causes of Hypotension,
o Blood Coagulation o Hypertension,
 Clot formation o Heart Failure,
 Anticlotting systems o Coronary Artery Disease and
 Anticlotting drugs o Heart Attacks,
 The Lymphatic System o Formation of Platelet Plug,
 Baroreceptor  The Upright Posture,
 Reflexes
 Exercise
 Organs of Circulatory System
The human circulatory system comprises 4 main organs that have specific roles and functions. The

vital circulatory system organs include:

1. Heart

2. Blood (technically, blood is considered a tissue and not an organ)

3. Blood Vessels

4. Lymphatic system
 The function of the circulation is to serve the needs of the body tissues—

• to transport nutrients to the body tissues,

• to transport waste products away,

• to transport hormones from one part of the body to another

• to maintain an appropriate environment in all the tissue fluids of the body for survival and optimal

function of the cells.

Hemodynamics
 The Blood

Parts of Blood;
• Plasma
• Red blood cells
• White blood cells
• Platelets
 Plasma
• When separated from the rest of the blood, plasma is a light yellow liquid.
Plasma contains 90 per cent water with dissolved substances such as glucose
(blood sugar), hormones, enzymes, and also waste products such as urea and
lactic acid.
• Plasma also contains proteins such as albumin, fibrinogen (important in clotting),
and globular proteins or globulins.
• The main role of plasma is to take nutrients, hormones, and proteins to the parts
of the body that need it. Cells also put their waste products into the plasma. The
plasma then helps remove this waste from the body.
• Blood plasma also carries all parts of the blood through your circulatory system.
 Red Blood Cells
• Erythrocytes (known as Red Blood Cells (RBCs) are biconcave cells.
• RBCs lack a nucleus, contain haemoglobin (the red iron-rich protein that carries O2) and are surrounded by a membrane
of lipids and proteins.
• It forms 44% of the total blood volume
• They are produced by red bone marrow via a process called erythropoiesis.

Functions of Erythrocytes
• A single Erythrocyte cell lives only for 120 days and in that duration, it performs successive roles.
1. Oxygen delivery from the lungs to the peripheral tissues.
2. Collect CO2 from peripheral cells and return it to the lungs.
• RBCs contain hemoglobin with ferrous heme (Fe) which has an affinity for oxygen. When it arrives at deoxygenated
cells the Fe looses its affinity for O2 (due to decreased partial pressure of O2 and low PH).
 White Blood Cells (Leukocytes)
• Leucocytes are the cellular component of the blood that are also known as white blood cells (WBCs).
• WBCs have a nucleus and lack hemoglobin.
• WBCs form 1% of the total blood volume in healthy adults.
• They are considered to be an important part of the immune system.
• The leucocytes are produced in the bone marrow in a process called Hematopoiesis and normal WBCs count ranged
between 4,000 and 10,000 cells/MCL18.

Pathophysiology of Leucocytes
• Elevated WBCs counts can indicate a variety of conditions.
• Infection, inflammation, trauma, pregnancy, asthma, allergy, cancers such as leukaemia and even aggressive exercises
can result in elevated WBCs.
• On the other hand, low WBCs counts can indicate severe infections, bone marrow damage, autoimmune diseases (e.g.
Systemic Lupus Erythematosus SLE) and splenic sequestration.
 Platelets
• Platelets are only about 20% of the diameter of red blood cells.

• The normal platelet count is 150,000-350,000 per microliter of blood, but since platelets are so small, they make up

just a tiny fraction of the blood volume.

• Have an average lifespan of 7 to 10 days in humans.

• The principal function of platelets is to prevent bleeding.

• Platelets are also crucial in inflammation, tissue growth, and the immune response. These processes are under the

mediation of the release of compounds from the alpha and dense granules which are inside the platelet.
 Blood Pressure
• In general, an individual’s “blood pressure" (systemic arterial pressure) refers to the pressure measured within large

arteries in the systemic circulation. This number splits into systolic blood pressure and diastolic blood pressure.

• Blood pressure is traditionally measured using auscultation with a mercury-tube sphygmomanometer. It is measured in

millimeters of mercury and expressed in terms of systolic pressure over diastolic pressure.

• Systolic pressure refers to the maximum pressure within the large arteries when the heart muscle contracts to propel

blood through the body.

• Diastolic pressure describes the lowest pressure within the large arteries during heart muscle relaxation between beating.

• Blood pressure is one of the most commonly measured clinical parameters and blood pressure values are major

determinants of therapeutic decisions.

 Maintaining Blood Pressure
Hypertension ranges

• A blood pressure between 140/80 mmHg to 159/99 mmHg is classified to as stage 1 hypertension.

• Stage 2 hypertension is a pressure between 160/100 mmHg to 179/109 mmHg.

• Hypertensive urgency describes a blood pressure greater than 180/110 mmHg.

• Hypertensive emergency refers to a very high blood pressure that results in potentially life-threatening symptoms and

end-organ damage.

• Hypotension, on the other hand, is a blood pressure less than 90/60 mmHg.

• It is crucial for the body to be able to adjust to acute changes in blood pressure and for the patient to receive medical

treatment or lifestyle adjustments for chronic variations.

Mechanism of maintaining normal Blood
Pressure

1.Baroreceptors

2.Antidiuretic Hormone

3.Aldosterone System (RAAS)

 1. Baroreceptors
• In response to acute changes in blood pressure, the body responds through the baroreceptors located within blood vessels.

• Baroreceptors are a form of mechanoreceptor that become activated by the stretching of the vessel.
• This sensory information is conveyed to the central nervous system and used to influence peripheral vascular resistance and
cardiac output.

There are two forms of baroreceptors.

1. High-Pressure Baroreceptors: Two baroreceptors are located within the high-pressure arterial system:

o The carotid baroreceptor responds to both increases and decreases in blood pressure and sends afferent signals via the

glossopharyngeal nerve (CN IX).

o The aortic arch baroreceptor responds only to increases in blood pressure, sending its signals through the vagus nerve

(CN X).

2. Low-Pressure Baroreceptors
 2. Antidiuretic Hormone
• Antidiuretic hormone (ADH) is a hormone synthesized in the hypothalamus. ADH is synthesized and released in response

to multiple triggers which are:

1. High serum osmolality, which acts on osmoreceptors in the hypothalamus
2. Low blood volume causes a decreased stretch in the low-pressure baroreceptors, leading to the production of ADH
3. Decreased blood pressure causes decreased stretch in the high-pressure baroreceptors, also leading to the
production of ADH
4. Angiotensin II

ADH mainly functions to increase free water reabsorption in

the collecting duct of the nephrons within the kidney, causing
an increase in plasma volume and arterial pressure. ADH in
high concentrations also causes moderate vasoconstriction,
increasing peripheral resistance, and arterial pressure.
 3. Renin-Angiotensin-Aldosterone System
•
(RAAS)
The renin-angiotensin-aldosterone system (RAAS) is a critical regulator of blood volume and systemic vascular resistance.
o While the baroreceptor reflex responds in a short-term manner to decreased arterial pressure, the RAAS is responsible
for more chronic alterations (Hormone mediated).
o It does this by increasing sodium reabsorption, water reabsorption, and vascular tone.
o It is composed of three major compounds: renin, angiotensin II, and aldosterone.
o These three act to elevate arterial pressure in response to decreased renal blood pressure, decreased salt delivery to the
distal convoluted tubule, and/or beta-agonism.
• Through these mechanisms, the body can elevate the blood pressure in a prolonged manner (as shown in image)
• Though the RAAS serves a critical function, it can be activated inappropriately in several conditions that may then lead to
the development of hypertension.
• For example, renal artery stenosis results in a decreased volume of blood reaching one (or both) kidneys resulting in the
juxtaglomerular cells sensing a decrease in blood volume, activating the RAAS. This can lead to an inappropriate elevation
of circulating blood volume and arteriolar tone due to poor renal perfusion.
 3. Renin-Angiotensin-Aldosterone System
•
(RAAS)
The renin-angiotensin-aldosterone system (RAAS) is a critical regulator of blood volume and systemic vascular resistance.
o While the baroreceptor reflex responds in a short-term manner to decreased arterial pressure, the RAAS is responsible
for more chronic alterations (Hormone mediated).
o It does this by increasing sodium reabsorption, water reabsorption, and vascular tone.
o It is composed of three major compounds: renin, angiotensin II, and aldosterone.
o These three act to elevate arterial pressure in response to decreased renal blood pressure, decreased salt delivery to the
distal convoluted tubule, and/or beta-agonism.
• Through these mechanisms, the body can elevate the blood pressure in a prolonged manner (as shown in image)
• Though the RAAS serves a critical function, it can be activated inappropriately in several conditions that may then lead to
the development of hypertension.
• For example, renal artery stenosis results in a decreased volume of blood reaching one (or both) kidneys resulting in the
juxtaglomerular cells sensing a decrease in blood volume, activating the RAAS. This can lead to an inappropriate elevation
of circulating blood volume and arteriolar tone due to poor renal perfusion.
 Factors controlling Blood Pressure

• Factors Controlling Arterial Blood Pressure.

1. Pumping Action of heart.
2. Cardiac Out put.
3. Peripheral Resistance.
i. Velocity of blood,
ii. viscosity of blood,
iii. Elasticity,
iv. Lumen of the vessel,
v. Blood volume.
 Factors Affecting Blood Pressure
1. Pumping Action of heart.
Effectual contraction of heart is the main factor for controlling cardiac out-put, blood pressure and flow within the blood
vessel. Because in each effectual contraction of the ventricle certain amount of blood is ejected out into the aorta. The
driving force of blood is mainly created by pumping action of heart.
2. Cardiac Out-Put
Any change in cardiac out-put will change blood pressure directly, if increases the cardiac out-put, increases the blood
pressure and vice versa. Cardiac out-put increases in muscular exercise, emotional condition, etc. So in these conditions
the systolic pressure is increased. In myocardial infarction the cardiac out-put decreases resulting in fall in systolic
pressure. Cardiac out-put depends upon venous return, force and frequency of heart beat.

Cardiac out-put = stroke volume * heart rate.

 Factors Affecting Blood Pressure
3. Peripheral Resistance
It is the resistance which blood has to over come while passing through the periphery. The chief seat of peripheral
resistance is the arterioles and to smaller extent the capillaries.

Peripheral resistance depends upon following factors.

i. Velocity of Blood
Rapid velocity of blood stream will cause more resistance than slower one. As velocity of blood is high in aorta
than capillaries, so pressure in aorta is also high as compare to capillaries
ii. Viscosity of Blood
Arterial blood pressure is directly proportional to the viscosity of blood. When viscosity of blood increases , the
frictional resistance is increased and this increases the pressure. Increased amount of plasma proteins, the viscosity
of blood is increased causing increase in blood pressure. In anemia, the viscosity of blood is less, this decreases the
blood pressure.
 Factors Affecting Blood Pressure
iii. Lumen of the vessel.

Peripheral resistance is inversely proportional to the lumen of the vessel. In other wards, smeller the lumen, higher will

be the resistance and increased the blood pressure and vice versa. According to this blood pressure in capillaries should

be more than aorta, but it does not happens, b/c the velocity (more dependent factor of B.P) of blood in aorta is increased

as compare to capillaries. The seat of peripheral resistance is found to be chiefly in arterioles, where velocity is increases

and lumen is narrow.

iv. Blood Volume

Increased volume of blood with raise both the systolic and diastolic blood pressure, b/c if there is more blood in arterial

system, there will be greater stretching of the arterial walls and hence the blood pressure would be increased.
Thankyou
This is only Part 1
(to be continued)