Cardiovascular 3
The Cardiovascular
System:
Blood Vessels and
Hemodynamics
By:
Prof. Dr. Hardi Darmawan, MPH&TM, FRSTM
1
Introduction
Hemodynamics is the means by which blood flow is
altered and distributed and by which blood pressure is
regulated.
The Cardiovascular System:
Blood Vessels and Hemodynamics
Structure and function of
blood vessels
Hemodynamics
forces involved in
circulating blood
Major circulatory routes
Structure and function of blood vessels
Angiogenesis: the growth of new blood
vessels
It is an important process in the fetus and in postnatal
processes
Malignant tumors secrete proteins called tumor
angiogenesis factors (TAFs) that stimulate blood vessel
growth to nature the tumor cells
Scientists are looking for chemicals that inhibit
angiogenesis to stop tumor growth and to
prevent the blindness associated with
diabetes.
Vessels
Blood vessels form a closed system of tubes that
carry blood away from the heart, transport it to the
tissues of the body, and then return it to the heart.
Arteries carry blood from the heart to the tissues.
Arterioles are small arteries that connect to capillaries.
Capillaries are the site of substance exchange between
the blood and body tissues.
Venules connect capillaries to larger veins.
Veins convey blood from the tissues back to the heart.
Vaso vasorum are small blood vessels that supply blood
to the cells of the walls of the arteries and veins.
Arteries
The wall of an artery consists of three
major layers.
Tunica interna (intima)
simple squamous epithelium known
as endothelium
basement membrane
internal elastic lamina
Tunica media
circular smooth muscle & elastic
fibers
Tunica externa
elastic & collagen fibers
6
Arteries
Arteries carry blood away from the heart to the
tissues.
The functional properties of arteries are elasticity
and contractility.
Elasticity, due to the elastic tissue in the tunica internal
and media, allows arteries to accept blood under great
pressure from the contraction of the ventricles and to
send it on through the system.
Contractility, due to the smooth muscle in the tunica
media, allows arteries to increase or decrease lumen
size and to limit bleeding from wounds.
Arteries
Muscular arteries
Tunica media contains more smooth muscle and fewer
elastic fibers than elastic arteries
Walls relatively thick
Capable of great vasoconstriction/ vasodilatation to
adjust rate of blood flow
Also called distributing arteries
Anastomoses
Union of the branches of 2 or more arteries supplying
the same body region
Provide alternate routes collateral circulation
Sympathetic Innervation
Vascular smooth muscle is innervated by sympathetic nervous
system
increase in stimulation causes muscle contraction or
vasoconstriction
decreases diameter of vessel
injury to artery or arteriole causes muscle contraction
reducing blood loss (vasospasm)
decrease in stimulation or presence of certain chemicals
causes vasodilation
increases diameter of vessel
nitric oxide, K+, H+ and lactic acid cause vasodilation
9
Elastic Arteries
Large arteries with more elastic fibers and less smooth muscle are called
elastic arteries and are able to receive blood under pressure and propel it
onward.
They are also called conducting arteries because they conduct blood
from the heart to medium sized muscular arteries.
They function as a pressure reservoir.
10
Elastic Arteries
Largest arteries
Largest diameter but walls
relatively thin
Function as pressure
reservoir
Help propel blood forward
while ventricles relaxing
Also known as conducting
arteries conduct blood to
medium-sized arteries
11
Muscular Arteries
Medium-sized arteries with more muscle than
elastic fibers in tunica media
Capable of greater vasoconstriction and
vasodilation to adjust rate of flow
walls are relatively thick
called distributing arteries because they direct
blood flow
12
Arteries
Muscular arteries
Tunica media contains more smooth muscle and fewer elastic
fibers than elastic arteries
Walls relatively thick
Capable of great vasoconstriction/ vasodilatation to adjust rate of
blood flow
Also called distributing arteries
Anastomoses
Union of the branches of 2 or more arteries supplying the same
body region
Provide alternate routes collateral circulation
13
Arterioles
Arterioles are very small, almost microscopic,
arteries that deliver blood to capillaries.
Through vasoconstriction (decrease in the
size of the lumen of a blood vessel) and
vasodilation (increase in the size of the lumen
of a blood vessel), arterioles assume a key
role in regulating blood flow from arteries into
capillaries and in altering arterial blood
pressure.
14
Arterioles
Abundant microscopic vessels
Metarteriole has precapillary sphincter which
monitors blood flow into capillary
Sympathetic innervation and local chemical
mediators can alter diameter and thus blood
flow and resistance
Resistance vessels resistance is opposition to
blood flow
Vasoconstriction can raise blood pressure
15
Arterioles
Small arteries delivering blood to
capillaries
tunica media containing few
layers of muscle
Metarterioles form branches into
capillary bed
to bypass capillary bed,
precapillary sphincters close &
blood flows out of bed in
thoroughfare channel
vasomotion is intermittent
contraction & relaxation of
sphincters that allow filling of
capillary bed 5-10 times/minute
16
Capillaries form Microcirculation
Microscopic vessels that connect arterioles to venules
Found near every cell in the body but more extensive in highly active
tissue (muscles, liver, kidneys & brain)
entire capillary bed fills with blood when tissue is active
lacking in epithelia, cornea and lens of eye & cartilage
Function is exchange of nutrients & wastes between blood and tissue
fluid
Capillary walls are composed of only a single layer of cells
(endothelium) and a basement membrane.
17
Capillaries
Capillaries
Smallest blood vessels connect arterial outflow and
venous return
Microcirculation flow from metarteriole through
capillaries and into postcapillary venule
Exchange vessels primary function is exchange
between blood and interstitial fluid
Lack tunica media and tunica externa
Substances pass through just one layer of endothelial cells
and basement membrane
Capillary beds arise from single metarteriole
Vasomotion intermittent contraction and relaxation
Throughfare channel bypasses capillary bed
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Arteries, Capillaries, and Venule
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Types of Capillaries
Continuous capillaries
intercellular clefts are gaps between neighboring
cells
skeletal & smooth, connective tissue and lungs
Fenestrated capillaries
plasma membranes have many holes
kidneys, small intestine, choroid plexuses, ciliary
process & endocrine glands
Sinusoids
very large fenestrations
incomplete basement membrane
liver, bone marrow, spleen, anterior pituitary, &
parathyroid gland
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Types of Capillaries
3 types:
1. Continuous
Endothelial cell
membranes from
continuous tube
2. Fenestrated
Have fenestrations or
pores
3. Sinusoids
Wider and more winding
Unusually large
fenestrations
21
Venules
Small veins collecting blood from capillaries
Tunica media contains only a few smooth
muscle cells & scattered fibroblasts
very porous endothelium allows for escape of
many phagocytic white blood cells
Venules that approach size of veins more
closely resemble structure of vein
22
Portal vein blood passes through second capillary
bed
Hepatic or hypophyseal
Venules
Thinner walls than arterial counterparts
Postcapillary venule smallest venule
Form part of microcirculatory exchange unit with
capillaries
Muscular venules have thicker walls with 1 or 2
layers of smooth muscle
23
Veins
Veins consist of the same three tunics as arteries but have
a thinner tunica interna and media and a thicker tunica
externa
less elastic tissue and smooth muscle
thinner-walled than arteries
contain valves to prevent the backflow of blood.
Vascular (venous) sinuses are veins with very thin walls
with no smooth muscle to alter their diameters. Examples
are the brains superior sagittal sinus and the coronary
sinus of the heart.
24
Veins
Structural changes not as distinct as in arteries
In general, very thin walls in relation to total
diameter
Same 3 layers
Tunica interna thinner than arteries
Tunica interna thinner with little smooth muscle
Tunica externa thickest layer
Not designed to withstand high pressure
Valves folds on tunica interna forming cusps
Aid in venous return by preventing backflow
25
Venous Valves
26
Veins
Proportionally thinner walls than
same diameter artery
tunica media less muscle
lack external & internal
elastic lamina
Still adaptable to variations
in volume & pressure
Valves are thin folds of
tunica interna designed to
prevent backflow
27
Varicose Veins
Twisted, dilated superficial veins
caused by leaky venous valves
congenital or mechanically stressed from prolonged standing
or pregnancy
allow backflow and pooling of blood
extra pressure forces fluids into surrounding tissues
nearby tissue is inflamed and tender
The most common sites for varicose veins are in the esophagus,
superficial veins of the lower limbs, and veins in the anal canal
(hemorrhoids). Deeper veins not susceptible because of support of
surrounding muscles
The treatments for varicose veins in the lower limbs include:
sclerotherapy, radiofrequency endovenous occlusion, laser
occlusion, and surgical stripping
28
Blood Distribution
60% of blood volume at rest is in systemic
veins and venules
function as blood reservoir
veins of skin & abdominal
organs (liver and spleen)
blood is diverted from it in
times of need
increased muscular activity
produces venoconstriction
hemorrhage causes
venoconstriction to help
maintain blood pressure
15% of blood volume in arteries & arterioles
29
Anastomoses
Union of 2 or more arteries supplying the same body region
blockage of only one pathway has no effect
circle of willis underneath brain
coronary circulation of heart
Alternate route of blood flow through an anastomosis is known as
collateral circulation
can occur in veins and venules as well
Arteries that do not anastomose are known as end arteries. Occlusion
of an end artery interrupts the blood supply to a whole segment of an
organ, producing necrosis (death) of that segment.
Alternate routes to a region can also be supplied by nonanastomosing
vessels.
30
Capillary Exchange
Movement of materials in & out of a capillary
diffusion (most important method)
Substances such as O2, CO2, glucose, amino acids, hormones,
and others diffuse down their concentration gradients.
all plasma solutes except large proteins pass freely across
through lipid bilayer, fenestrations or intercellular clefts
blood brain barrier does not allow diffusion of water-soluble
materials (nonfenestrated epithelium with tight junctions)
transcytosis
passage of material across endothelium in tiny vesicles by
endocytosis and exocytosis
large, lipid-insoluble molecules such as insulin or maternal
antibodies passing through placental circulation to fetus
bulk flow (see next slide)
31
Bulk Flow: Filtration & Reabsorption
Movement of large amount of dissolved or suspended material in same
direction
move in response to pressure
from area of high pressure to area of low
faster rate of movement than diffusion or osmosis
Most important for regulation of relative volumes of blood & interstitial fluid
filtration is movement of material into interstitial fluid
promoted by blood hydrostatic pressure & interstitial fluid osmotic
pressure
reabsorption is movement from interstitial fluid into capillaries
promoted by blood colloid osmotic pressure
balance of these pressures is net filtration pressure
32
Dynamics of Capillary Exchange
10
Starlings law of the
capillaries is that
the volume of fluid
& solutes
reabsorbed is
almost as large as
the volume filtered.
33
Capillary Exchange
Movement of substances between blood and
interstitial fluid
3 basic methods:
1.Diffusion
2.Transcytosis
3.Bulk flow
34
Diffusion
Most important method
Substances move down their concentration gradient
O2 and nutrients from blood to interstitial fluid to body
cells
CO2 and wastes move from body cells to interstitial fluid
to blood
Can cross capillary wall through intracellular clefts,
fenestrations or through endothelial cells
Most plasma proteins cannot cross
Except in sinusoids proteins and even blood cells leave
Blood-brain barrier tight junctions limit diffusion
35
Transcytosis
Small quantity of material
Substances in blood plasma become enclosed
within pinocytotic vessicles that enter endothelial
cells by endocytosis and leave by exocytosis
Important mainly for large, lipid-insoluble
molecules that cannot cross capillary walls any
other way
36
Bulk Flow
Passive process in which large numbers of ions,
molecules, or particles in a fluid move together in
the same direction
Based on pressure gradient
Diffusion is more important for solute exchange
Bulk flow more important for regulation of relative
volumes of blood and interstitial fluid
Filtration from capillaries into interstitial fluid
Reabsorption from interstitial fluid into
capillaries
37
NFP = (BHP + IFOP) (BCOP + IFHP)
Net filtration pressure (NFP) balance of 2 pressures
1. 2 pressures promote filtration
Blood hydrostatic pressure (BHP) generated by pumping
action of heart
Falls over capillary bed from 35 to 16 mmHg
Interstitial fluid osmotic pressure (IFOP)
1 mmHg
38
NFP = (BHP + IFOP) (BCOP + IFHP)
2. 2 pressures promote reabsorption
Blood colloid osmotic pressure (BCOP) promotes
reabsorption
Due to presence of blood plasma proteins to large to
cross walls
Averages 36 mmHg
Interstitial fluid hydrostatic pressure (IFHP)
Close to zero mmHg
39
Starlings Law
Nearly as much reabsorbed as filtered
At the arterial end, net outward pressure of 10
mmHg and fluid leaves capillary (filtration)
At the venous end, fluid moves in (reabsoprtion)
due to -9 mmHg
On average, about 85% of fluid filtered in
reabsorpbed
Excess enters lymphatic capillaries (about 3L/
day) to be eventually returned to blood
40
41
Net Filtration Pressure
Whether fluids leave or enter capillaries depends on
net balance of pressures
net outward pressure of 10 mm Hg at arterial end of
a capillary bed
net inward pressure of 9 mm Hg at venous end of a
capillary bed
About 85% of the filtered fluid is returned to the
capillary
escaping fluid and plasma proteins are collected by
lymphatic capillaries (3 liters/day)
42
Edema
An abnormal increase in interstitial fluid if filtration
exceeds reabsorption
result of excess filtration
increased blood pressure (hypertension)
increased permeability of capillaries allows plasma
proteins to escape
result of inadequate reabsorption
decreased concentration of plasma proteins lowers
blood colloid osmotic pressure
inadequate synthesis or loss from liver disease,
burns, malnutrition or kidney disease blockage of
lymphatic vessels postoperatively or due to
filarial worm infection
Often not noticeable until 30% above normal
43
Hemodynamics : Factors Affecting Blood
Flow
The distribution of cardiac output to various tissues
depends on the interplay of the pressure difference
that drives the blood flow and the resistance to
blood flow.
Blood pressure (BP) is the pressure exerted on the
walls of a blood vessel; in clinical use, BP refers to
pressure in arteries.
Cardiac output (CO) equals mean aortic blood
pressure (MABP) divided by total resistance (R).
44
Hemodynamics - Overview
Factors that affect blood pressure include cardiac output, blood volume,
viscosity, resistance, and elasticity of arteries.
As blood leaves the aorta and flows through systemic circulation, its
pressure progressively falls to 0 mm Hg by the time it reaches the right
atrium.
Resistance refers to the opposition to blood flow as a result of friction
between blood and the walls of the blood vessels.
Vascular resistance depends on the diameter of the blood vessel, blood
viscosity, and total blood vessel length.
Systemic vascular resistance (also known as total peripheral resistance)
refers to all of the vascular resistances offered by systemic blood
vessels; most resistance is in arterioles, capillaries, and venules due to
their small diameters.
45
Hemodynamics
Factors affecting circulation
pressure differences that drive the blood flow
velocity of blood flow
volume of blood flow
blood pressure
resistance to flow
venous return
An interplay of forces result in blood flow
46
Volume of Blood Flow
Cardiac output = stroke volume x heart rate
Other factors that influence cardiac output
blood pressure
resistance due to friction between blood cells
and blood vessel walls
blood flows from areas of higher pressure to
areas of lower pressure
47
Blood Pressure
Pressure exerted by blood on walls of a vessel
caused by contraction of the ventricles
highest in aorta
120 mm Hg during systole & 80
during diastole
If heart rate increases cardiac output, BP rises
Pressure falls steadily in systemic circulation
with distance from left ventricle
35 mm Hg entering the capillaries
0 mm Hg entering the right atrium
If decrease in blood volume is over 10%, BP
drops
Water retention increases blood pressure
48
Velocity of Blood Flow
The volume that flows through any tissue in a given period
of time is blood flow.
The velocity of blood flow is inversely related to the crosssectional area of blood vessels; blood flows most slowly
where cross-sectional area is greatest.
Blood flow decreases from the aorta to arteries to
capillaries and increases as it returns to the heart.
49
Velocity of Blood Flow
Speed of blood flow in cm/sec is
inversely related to cross-sectional area
blood flow is slower in the
arterial branches
flow in aorta is 40 cm/sec while
flow in capillaries is .1 cm/sec
slow rate in capillaries allows for
exchange
Blood flow becomes faster when vessels merge to form veins
Circulation time is time it takes a drop of blood to travel from right
atrium back to right atrium
50
Venous Return
Volume of blood flowing back to the heart from the systemic veins
depends on pressure difference
from venules (16 mm Hg) to right
atrium (0 mm Hg)
tricuspid valve leaky and buildup
of blood on venous side of circulation
Skeletal muscle pump
contraction of muscles &
presence of valves
Respiratory pump
decreased thoracic pressure and increased abdominal pressure
during inhalation, moves blood into thoracic veins and the right
atrium
51
Clinical Application
Syncope, or fainting, refers to a sudden,
temporary loss of consciousness followed
by spontaneous recovery. It is most
commonly due to cerebral ischemia but it
may occur for several other reasons
52
Factors that Increase Blood Pressure
53
Resistance
Friction between blood and the walls of vessels
average blood vessel radius
smaller vessels offer more resistance to blood flow
cause moment to moment fluctuations in pressure
blood viscosity (thickness)
ratio of red blood cells to plasma volume
increases in viscosity increase resistance
dehydration or polycythemia
total blood vessel length
the longer the vessel, the greater the resistance to flow
200 miles of blood vessels for every pound of fat
obesity causes high blood pressure
Systemic vascular resistance is the total of above
arterioles control BP by changing diameter
54
Control of Blood Pressure & Flow
Role of cardiovascular center
help regulate heart rate & stroke volume
specific neurons regulate blood vessel diameter
55
Cardiovascular Center - Overview
The cardiovascular center (CV) is a group of neurons in the
medulla that regulates heart rate, contractility, and blood
vessel diameter.
input from higher brain regions and sensory receptors (baroreceptors and
chemoreceptors)
output from the CV flows along sympathetic and parasympathetic fibers.
Sympathetic impulses along cardioaccelerator nerves increase heart rate
and contractility.
Parasympathetic impulses along vagus nerves decrease heart rate.
The sympathetic division also continually sends impulses to
smooth muscle in blood vessel walls via vasomotor nerves.
The result is a moderate state of tonic contraction or
vasoconstriction, called vasomotor tone.
56
Input to the Cardiovascular Center
Higher brain centers such as cerebral cortex,
limbic system & hypothalamus
anticipation of competition
increase in body temperature
Proprioceptors
input during physical activity
Baroreceptors
changes in pressure within blood vessels
Chemoreceptors
monitor concentration of chemicals in the blood
57
Outpout from the Cardiovascular Center
Heart
parasympathetic (vagus nerve)
decrease heart rate
sympathetic (cardiac accelerator nerves)
cause increase or decrease in contractility & rate
Blood vessels
sympathetic vasomotor nerves
continual stimulation to arterioles in skin & abdominal
viscera producing vasoconstriction (vasomotor tone)
increased stimulation produces constriction &
increased BP
58
Neural Regulation of Blood Pressure
Baroreceptors are important pressure-sensitive
sensory neurons that monitor stretching of the walls of
blood vessels and the atria.
The cardiac sinus reflex is concerned with maintaining
normal blood pressure in the brain and is initiated by
baroreceptors in the wall of the carotid sinus.
The aortic reflex is concerned with general systemic blood
pressure and is initiated by baroreceptors in the wall of the
arch of the aorta or attached to the arch.
If blood pressure falls, the baroreceptor reflexes
accelerate heart rate, increase force of contraction,
and promote vasoconstriction.
59
Neural Regulation of Blood Pressure
Baroreceptor reflexes
carotid sinus reflex
swellings in internal carotid artery wall
glossopharyngeal nerve to cardiovascular
center in medulla
maintains normal BP in the brain
aortic reflex
receptors in wall of ascending aorta
vagus nerve to cardiovascular center
maintains general systemic BP
If feedback is decreased, CV center reduces
parasympathetic & increases sympathetic
stimulation of the heart
60
Innervation of the Heart
Speed up the heart with sympathetic stimulation
Slow it down with parasympathetic stimulation (X)
Sensory information from baroreceptors (IX)
61
Carotid Sinus Massage & Syncope
Carotid sinus massage can slow heart rate in
paroxysmal superventricular tachycardia
Stimulation (careful neck massage) over the carotid
sinus lowers heart rate
paroxysmal superventricular tachycardia
tachycardia originating from the atria
Anything that puts pressure on carotid sinus
tight collar or hyperextension of the neck
may slow heart rate & cause carotid sinus syncope or fainting
62
Syncope
Fainting or a sudden, temporary loss of consciousness
not due to trauma
due to cerebral ischemia or lack of blood flow to the brain
Causes
vasodepressor syncope = sudden emotional stress
situational syncope = pressure stress of coughing,
defecation, or urination
drug-induced syncope = antihypertensives, diuretics,
vasodilators and tranquilizers
orthostatic hypotension = decrease in BP upon standing
63
Chemoreceptor Reflexes
Carotid bodies and aortic bodies
detect changes in blood levels of O2, CO2, and
H+ (hypoxia, hypercapnia or acidosis )
causes stimulation of cardiovascular center
increases sympathetic stimulation to arterioles &
veins
vasoconstriction and increase in blood pressure
Also changes breathing rates as well
64
Hormonal Regulation of Blood Pressure
Renin-angiotensin-aldosterone system
decrease in BP or decreased blood flow to kidney
release of renin / results in formation angiotensin II
systemic vasoconstriction
causes release aldosterone (H2O & Na+ reabsorption)
Epinephrine & norepinephrine
increases heart rate & force of contraction
causes vasoconstriction in skin & abdominal organs
vasodilation in cardiac & skeletal muscle
ADH causes vasoconstriction
ANP (atrial natriuretic peptide) lowers BP
causes vasodilation & loss of salt and water in the urine
65
Local Regulation of Blood Pressure
The ability of a tissue to automatically adjust its own blood flow to
match its metabolic demand for supply of O2 and nutrients and
removal of wastes is called autoregulation.
Local factors cause changes in each capillary bed
important for tissues that have major increases in activity (brain, cardiac &
skeletal muscle)
Local changes in response to physical changes
warming & decrease in vascular stretching promotes vasodilation
Vasoactive substances released from cells alter vessel diameter
(K+, H+, lactic acid, nitric oxide)
systemic vessels dilate in response to low levels of O2
pulmonary vessels constrict in response to low levels of O2
66
Evaluating Circulation
Pulse is a pressure wave
alternate expansion & recoil of elastic artery after each systole of the
left ventricle
pulse rate is normally between 70-80 beats/min
tachycardia is rate over 100 beats/min/bradycardia under 60
Measuring blood pressure with sphygmomanometer
Korotkoff sounds are heard while taking pressure
systolic blood pressure is recorded during ventricular contraction
diastolic blood pressure is recorded during ventricular contraction
provides information about systemic vascular resistance
pulse pressure is difference between systolic & diastolic
normal ratio is 3:2:1 -- systolic/diastolic/pulse pressure
67
Pulse Points
68
Evaluating Circulation
69
Blood Pressure
The normal blood pressure of a young adult male is
120/80 mm Hg (8-10 mm Hg less in a young adult
female). The range of average values varies with
many factors.
Pulse pressure is the difference between systolic
and diastolic pressure. It normally is about 40 mm
Hg and provides information about the condition of
the arteries.
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