VENOUS PRESSURE

O.T. OYEBANJO (Ph.D)

 VENOUS PRESSURE
• Venous pressure is the pressure exerted on the wall
of the veins by the blood flowing through them

• It is usually reduced in the parts of the body above

the level of the heart and it is increased in parts
below the level of the heart

• Peripheral venous pressure: 8 - 10 mmHg

• Central venous pressure: 0 - 6 mmHg

 VARIATIONS

Pathological Variations
Physiological Variations
Low Cardiac output
From standing to supine postion
Congestive heart failure
Tilting the body
Venous obstruction
Valsalva maneuver
Renal faiulure
Contraction of abdominal and limb
muscles
Hermorrhage
Excitement
Surgical Shock
 FACTORS AFFECTING VENOUS PRESSURE
• Left ventricular contraction (vis a tergo):
– directly proportional to venous pressure.
– Forces blood from arteries, capillaries and veins into the right
atrium

• Volume of venous blood: directly proportional to

venous pressure

• Gravity and Posture: Pressure increases more below the

level of the heart than above
 FACTORS AFFECTING VENOUS PRESSURE
• Resistance offered to blood through veins (vis a latre). This is
directly proportional to venous pressure. It occurs due to venous
tone and extravascular factor such as:
– Compression of arm vein
– Compression of neck veins
– Compression of abdominal veins
– Compression of skeletal muscle veins

• Peripheral Resistance:
– inversely proportional due to vasoconstriction of arterioles

• Right atrial pressure (vis a fronte):

– also called central venous pressure
– regulates peripheral venous pressure
– It is 0mmHg
 EFFECTS OF RESPIRATION ON VENOUS
PRESSURE
• During quiet breathing central venous pressure is altered in
accordance with intrathoracic pressure
– Decreases with inspiration
– Increases with expiration.

• It is best expresses in two forms

• Valsalva Maneuver
• Mueller Maneuver
 VALSALVA MANEUVER (expiration).

• This is a forced expiratory effect with closed glottis

• There is high intra-thoracic pressure which causes:

 Compression of central vein in thorax
 Decrease in venous return to right atrium
 Increase in peripheral venous pressure due to accumulation
of blood in peripheral
veins such as veins of neck, face and limbs
 Decrease in central venous pressure.
MÜELLER MANEUVER (inspiration)
There is reduction in the intrathoracic pressure which
causes:
 Dilation of the central vein because of the reduction
in the intrathoracic pressure
 Increase in venous return to the right atrium by
emptying of blood from peripheral veins into the
central veins
 Decrease in peripheral venous pressure
 Increase in central venous pressure.
CAPILLARY PRESSURE
Capillary Pressure

• Is the pressure exerted by the blood contained in

capillary; it is also called capillary hydrostatic
pressure.

• Normal Values –
– 30 to 32 mm Hg in the arterial end

– 15 mmHg in the venous end.

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• The regional variation in capillary pressure is in
relation to the physiological activities of the
particular region.
• Capillary pressure remarkably varies in kidneys and
lungs.

• Capillary Pressure in Kidneys

– glomerular capillary pressure is high (60 mm Hg)
– this is responsible for glomerular filtration.

• Capillary Pressure in Lungs

– pulmonary capillary pressure is low (7 mm Hg)
– favors exchange of gases between blood & alveoli.
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REGULATION OF CAPILLARY PRESSURE
Arterial Pulse
• Defined as the pressure changes transmitted in the
form of waves
• Pulse rate is the accurate measure of heart rate

Transmission of Pulse
• Formation and transmission of pulse wave depends
upon the elasticity of blood vessels.
• When the walls of the arteries are more distensible,
the pressure rise is less and so the transmission of
pulse is less.

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• When the arterial wall loses its elastic property and
becomes rigid as in old age, the pressure rise is more
and the transmission of pulse is also more

• Pulse is not transmitted to capillaries because

capillaries are devoid of elastic tissues.

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 VENOUS PULSE
• This is the pressure changes transmitted in the form of waves
from right atrium to veins near heart.

• It is observed in larger veins near the heart e.g. jugular vein.

• It is of significant importance in physical examination as it reflects

both pressure changes and hemodynamic activities of the right
atrium .

• Venous pulse is examined via the inspection of the jugular vein

• Recording of jugular venous pulse is called phlebogram

 IMPORTANCE OF VENOUS PULSE
• Its recording is used to determine the rate of atrial contraction.

• Its tracing is used to recognise or determine the phases of cardiac

cycle.

• Its tracing is the most accurate methos to measure the duration

of different phases in diastole.

• Venous pulse is also used to show the atrial pressure changes

during cardia cycle.
 CLINICAL CORRELATES
• Elevated Jugular venous pulse:
– It indicates the rise in right ventricular pressure
– It occurs in bradycardia, pericardial effusion and pulmonary
hypertension.

• Kussmaul sign
– An increase in venous distention and venous pressure.
– Occurs frequently during inspiration