HEMODYNAMICS

Dr. MUNDUNI SAMUEL

Dr. KAKANDE PATRICK

Dr. AMRAN AHMED YALAHON

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Definition

• Branch of physiology concerned with the physical principles governing

pressure, flow, resistance, volume, and compliance as they relate to
the cardiovascular system

• These principles are used to explain the performance of each part of

the cardiovascular system

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Definition

• Principles that govern the blood flow in the cardiovascular system

• Study of forces involved in blood circulation

• Study general principles regarding blood flow, physics of blood flow,

role of blood vessels, then blood pressure regulation

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Distribution of blood

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Poiseuille’s law

• The volume of fluid flowing through a rigid tube per unit time (Q) is proportional
to the pressure difference (P) between the ends of the tube and inversely
proportional to the resistance to flow (R) Q =∆P/R

• The flow of fluid through rigid tubes is governed by the pressure gradient and
resistance to flow. Resistance depends on the radius and length of the tube as
well as the viscosity of the fluid

• Poiseuille’s law is useful in understanding blood flow.

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Poiseuille’s law

• Poiseuille found that the following factors determine resistance to steady,

streamlined flow of fluid through a rigid, cylindrical tube

where
r is the radius of the tube

L is its length

∩ is the viscosity of the fluid

8 and ∏ are geometrical constants

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Poiseuille’s law after incorporating all of the
factors influencing flow

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Blood flow
• Flow rate through a vessel( volume of blood passing through per unit
of time)
• Directly proportional to the pressure gradient
• Inversely proportional to vascular resistance
• F=∆P/R
F=flow rate of blood through a vessel
∆P=pressure gradient
R=resistance of blood vessel

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Pressure gradient

• Pressure is force applied over a surface, such as the force applied to the
cross-sectional surface of a fluid at each end of a rigid tube

• The height of a column of fluid is often used as a measure of pressure

• The height of a column of mercury is frequently used for this purpose

because it is dense (approximately 13 times more dense than water), and a
relatively small column height can be used to measure physiological
pressures
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Pressure expressed as height of mercury

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Pressure gradient

• Difference in pressure between the beginning and the end of vessel

• Blood flows from area of high pressure to an area of low pressure,

down the pressure gradient

• When the heart contracts, it gives pressure to the blood, which is the
main driving force for flow through a vessel

• Due to resistance in the vessel, the pressure drops as blood flows

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Demonstrates pressure gradient

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Resistance

• Measure of hindrance or opposition to blood flow through a vessel,

caused by friction between the blood in the vessel wall

• If the resistance to flow increases, it is difficult for blood to pass

through a vessel, therefore, the flow rate decreases

• When resistance increases, the pressure gradient must increase to

maintain the same flow rate
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applied

• If vessel offer more resistance to flow eg increased peripheral

resistance, which occurs in high blood pressure then heart must work
harder to maintain adequate circulation

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Factors affecting resistance

• Resistance to blood flow depends on three factors

1. Viscosity of flow

2. Vessel length

3. Radius of the vessel-most important

• The resistance to blood flow increases proportionately with increases in

fluid viscosity or tube length and inversely proportional to the fourth
power of the radius
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Viscosity of blood flow(∩)

• Friction which is developed between the molecules of fluid as they slide over each
other during flow

• The viscosity of normal blood is about three times as great as the viscosity of water

• Greater the viscosity, greater the resistance to flow

• Blood viscosity only rarely changes enough to have a significant effect on resistance

• Blood viscosity is determined by the number of RBC and protein concerntration

• Hence increased in polycythemia and decreased in anemia

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Vessel length

• When blood flows through a vessel, blood rubs against the vessel wall

• The greater the vessel surface area in contact with the blood, the
greater will be resistance to the flow

• Length does not change

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Radius of the vessel

• Fluid passes more readily through large vessels

• Slight changes in radius of vessel brings great change to flow

• Resistance is inversely proportional to the fourth power of the

radius(multiplying the radius by itself four times

• R

• Doubling the radius reduces resistance to 1/16 and there for increases blood
flow through the vessel 16folds
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Radius of vessel cont

• In the body, changes in radius are usually responsible for variations in blood flow

• Numerous control systems exist for the sole purpose of maintaining the arterial

pressure relatively constant so there is a steady force to drive blood through the

cardiovascular system

• Small changes in arteriolar radius can cause large changes in flow to a tissue or

organ because flow is related to the fourth power of the radius

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Applied

• Clinically radius of arterioles can be regulated

• This is the most important factor in controlling resistance to blood

flow throughout the vascular system

• Factors include: atherosclerosis, fibromusclular dysplasia, blunt

trauma, clotting abnormalities, inflammation

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Conditions in the Cardiovascular System Deviate
From the Assumptions of Poiseuille’s Law
• The cardiovascular system does not strictly meet the criteria necessary to apply the
law
1. The cardiovascular system is composed of tapering, branching, elastic tubes, rather than rigid
tubes of constant diameter

2. Poiseuille’s law requires that flow be steady rather than pulsatile, yet the contractions of the
heart cause cyclical alterations in both pressure and flow.

3. Poiseuille’s law is that flow be streamlined

4. Finally, blood is not a strict newtonian fluid, a fluid that exhibits a constant viscosity
regardless of flow velocity
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Streamline (laminar) flow

• Describes the movement of fluid through a tube in concentric layers

that slip past each other

• The layers at the center have the fastest velocity and those at the
edge of the tube have the slowest

• This is the most efficient pattern of flow velocities, in that the fluid
exerts the least resistance to flow in this configuration

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Turbulent flow

• Has crosscurrents and eddies, and the fastest velocities are not
necessarily in the middle of the stream

• Several factors contribute to the tendency for turbulence: high flow

velocity, large tube diameter, high fluid density, and low viscosity

• All of these factors can be combined to calculate Reynolds number

(NR), which quantifies the tendency for turbulence
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Reynolds number (NR)

• Where

v is the mean velocity,

d is the tube diameter,

P is the fluid density, and

∩ is the fluid viscosity.

• Turbulent flow occurs when NR exceeds a critical value. This value is hardly ever exceeded in a normal
cardiovascular system, but high flow velocity is the most common cause of turbulence in pathological state
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Turbulent flow cont
• Once turbulence occurs, a given increase in pressure gradient causes less increase in flow
because the turbulence dissipates energy that would otherwise drive flow

• Under normal circumstances, turbulent flow is found only in the aorta (just beyond the aortic
valve) and in certain localized areas of the peripheral system, such as the carotid sinus

• Pathological changes in the cardiac valves or a narrowing of arteries that raise flow velocity
often induce turbulent flow

• Turbulent flow generates vibrations that are transmitted to the surface of the body; these
vibrations, known as murmurs and bruits, can be heard with a stethoscope
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streamline flow vs turbulent flow).

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Blood is not a strict newtonian fluid
• Newtonian fluid is a fluid that exhibits a constant viscosity regardless of flow velocity

• When measured in vitro, the viscosity of blood decreases as the flow rate increases

• This is because red cells tend to collect in the center of the lumen of a vessel as flow
velocity increases, an arrangement known as axial streaming

• Axial streaming reduces the viscosity and, therefore, resistance to flow

• Because this is a minor effect in the range of flow velocities in most blood vessels, we
usually assume that the viscosity of blood (which is 3 to 4 times that of water) is
independent of velocity
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Axial streaming

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Bulk Flow

• Blood circulation is an example of transport by bulk flow

• Hemodynamic pressure gradient dives bulk flow

• This is an efficient means of transport over long distances, such as

those between the legs and the lungs

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Diffusion

• The random movement of individual molecules and is an effective transport

mechanism over short distances

• Diffusion occurs at the level of the capillaries, where the distances between
blood and the surrounding tissue are short.

• The net transport of molecules by diffusion can occur within hundredths of a

second or less when the distances involved are no more than a few microns.

• Concentration gradient drives diffusion

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Effects of Pressure on Vascular Resistance
and Tissue Blood Flow
• An increase in arterial pressure cause a increase in blood flow through the various tissues of the body.

• Increases the force that pushes blood through the vessels

• Distends the vessels at the same time, which decreases vascular resistance

• changes in blood flow are caused sympathetic nerve stimulation of the peripheral blood vessels.

• Thus, inhibition of sympathetic activity greatly dilates the vessels and can increase the blood flow twofold or

more.

• Conversely, very strong sympathetic stimulation can constrict the vessels so much that blood flow

occasionally decreases to as low as zero for a few seconds despite high arterial pressure

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Venous blood flow
• The venous system completes the circulatory circuit.
• Blood leaving the capillary beds enters the venous system for transport back to the heart
.Veins serve as a blood reservoir and as passage ways to the heart.

• Veins have a large radius, so they offer little resistance to flow.

• Systemic veins also serve as blood reservoirs and hence they are also called capacitance vessels.
• The venous smooth muscle has little inherent myogenic tone.
• Because of these features, veins are highly distensible, or stretchable,and have little elastic recoil.

• They easily distend to accommodate additional volumes of blood with only a small increase in venous
pressure

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Venous return
• Venous return refers to the volume of blood entering each atrium from the veins.
• The magnitude of flow through a vessel is directly proportional to the pressure gradient.
• Much driving pressure imparted to the blood by cardiac contraction has been lost by the time the blood
• reaches the venous system .
• This is because of frictional losses along the way, especially during passage through the high-resistance
arterioles.

• By the time the blood enters the venous system, blood pressure averages only 17 mm Hg

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Factors that enhance venous return
• Sympathetically induced venous vasoconstriction
• Skeletal muscle pump
• Venous valves
• Respiratory pump
• Cardiac suction

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Factors facilitating venous return

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• 1 sympathetically induced venous vasoconstriction
• venous vasoconstriction immediately increases flow through the vessels because of their decreased capacity
• (Narrowing of veins squeezes out more of the blood already in the veins, increasing blood flow through these
vessels)

• In addition to mobilizing the stored blood, venous vasoconstriction sustains increased venous return.

• With the filling capacity of the veins reduced, less blood draining from the capillaries remains in the veins but
continues to flow instead toward the heart.

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• 2.skeletal muscle pump
• Many large veins in the extremities lie between skeletal muscles, so muscle contraction compresses the veins.

• This external compression decreases venous capacity and increases

• venous pressure, in effect squeezing blood in the veins forward towards the heart.

• This pumping action is known as the skeletal muscle pump.

• it counters the effect of gravity on the venous system.

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• 3.Venous valves
• Blood can only be driven forward because the large veins are equipped with one-way valves spaced at 2- to 4-
cm intervals;
• These valves let blood move forward toward the heart but keep it from moving back toward the tissues.

• They also play a role in counteracting the gravitational effects of upright posture by minimizing the
• backflow of blood that tends to occur when a person stands up
• They temporarily support portions of the column of blood when the skeletal muscles are relaxed.

• Varicose veins occur when the venous valves become incompetent and can no longer support the column of
• blood above them.

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• 4.Respiratory activity
• The pressure within the chest cavity averages 5 mm Hg less than atmospheric pressure.
• As the venous system returns blood to the heart from the lower
• regions of the body, it travels through the chest cavity, where it is exposed to this sub atmospheric pressure.

• Because the venous system in the limbs and abdomen is subject to normal atmospheric
• pressure, an externally applied pressure gradient exists between the lower veins and the chest veins

• This pressure difference pushes blood from the lower veins to the chest veins,promoting increased venous
return

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• 5.cardiac suction
• During ventricular contraction, the AV valves are drawn downward, enlarging the atrial cavities

• As a result, atrial pressure transiently drops below 0 mm Hg, thus increasing the vein-to-atria pressure
gradient so that venous return is enhanced.

• The rapid expansion of the ventricular chambers during ventricular relaxation creates a
• transient negative pressure in the ventricles so that blood is
• “sucked in” from the atria and veins—that is,

• The negative ventricular pressure increases the vein-to-atria-to-ventricle pressure gradient ,enhancing venous
return.

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References
• Human physiology by Lauralee Sherwood, seventh edition
• Text book physiology by Guyton and Hall, 11th edition
• Text book of physiology by Linda . S. Constanzo, third edition
• Internet, Wikipedia

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