Introduction to the Circulation

Bio-Med 3662
August 2019
Douglas Burtt, MD, FACC

Functions of the Cardiovascular System

Deliver oxygen-carrying
blood to the tissues
Provide nutrients to the
cells
Remove waste products
from cells

Arteries, Veins & Capillaries

Arteries carry blood from
the heart to the tissues
Veins carry blood from
tissues back to the heart
Thin-walled capillaries,
interposed between
arteries & veins allow
exchange of nutrients,
wastes and fluid

Arteries, Veins & Capillaries

Arteries carry blood from

the heart to the tissues

Veins carry blood from
tissues back to the heart
Thin-walled capillaries,
interposed between
arteries & veins allow
exchange of nutrients,
wastes and fluid

Other Cardiovascular functions

Homeostatic functions
Regulation of blood pressure
Regulation of body temperature
Facilitates adjustments to altered physiologic states
Exercise
Change in posture
Hemorrhage

Delivery of endocrine hormones to sites of action in

tissues

The Circuitry of the Cardiovascular System

The Circuitry of the Cardiovascular System

Path of blood flow through Heart and Lungs

Cardiac Blood Flow

Cardiac Blood Flow

Cardiac Blood Flow

Cardiac Blood Flow

Cardiac Blood Flow

Cardiac Blood Flow

Cardiac Blood Flow

Cardiac Blood Flow:

Right vs. Left Heart

Cardiac Blood Flow:

Right vs. Left Heart

Cardiac Blood Flow:

Right vs. Left Heart

Cardiac Blood Flow:

Right vs. Left Heart

Cardiac Blood Flow:

Entire Heart

Cardiac Blood Flow:

Entire Heart

Circulation through the body: Circuitry

Circulation through the body: Circuitry

Cardiac output distributed to organs in parallel

Distribution is variable, regulated by arterioles
Approximate distribution:

15% brain
5% heart
25% kidneys
25% GI
25% muscle
5% skin

Circulation through the body: Arteries and

Veins

Circulation through the body: Arteries and

Veins
Arteries
Thick-walled
High-pressure system
Become progressively
smaller, branching into
arterioles
Site of arteriolar
resistance
Alpha-1 and Beta-2
receptors

Veins

Thin-walled
Low-pressure system
Large capacitance
Small branches are
called venules
Also innervated by
sympathetic nervous
system

Circulation through the body: Arteries and

Veins

Circulation through the body:

Capillaries
Capillaries:
Lined with a single layer of endothelial cells
Surrounded by basal lamina
Are the site of exchange of:

Nutrients
Gases
Water
Solutes

The microcirculation: arterioles through

venules

Circulation through the body:

Capillaries

Microcirculation:
Capillaries
Most common capillary

Intestines
Glomeruli

Microcirculation:
Capillaries
Capillaries:
Lipid-soluble substances (e.g. oxygen and CO2) cross
the endothelial cell membranes
Water-soluble substances (e.g. ions) cross either
through:
Water-filled clefts between cells
Large pores in walls of fenestrated capillaries
Pinocytotic vesicles via transcytosis

Microcirculation:
Capillaries

Not all capillaries are perfused at all times (e.g.

during exercise)
Perfusion is governed by dilation or constriction of
arterioles and pre-capillary sphincters
Regulated by sympathetic innervation of blood
vessels and vasoactive metabolites which act
locally (at tissue level)

Area and Volume of blood vessels

The physics of blood flow

Sir Isaac Newton:

Formulator of law of gravitation
Inventor of Calculus

Established study of optics

Father of physics

Velocity of Blood Flow

Velocity = rate of displacement of blood per unit time
Defined as: v = Q/A
where

v = velocity in cm/sec
Q = flow in mL/sec
A = cross sectional area (cm2)

Velocity of Blood Flow

Velocity of Blood Flow

Where is velocity of
blood flow highest?
A: Where area is
lowest..

Velocity of Blood Flow

Conversely, velocity of
blood flow is lowest in
the
Capillary bed allowing for more
time for exchange of nutrients, etc.
Velocity in aorta ~
800 x velocity in
capillaries

Area and Volume

of the
Cardiovascular
System

Regulation of Blood flow:

Relationship of Pressure, Flow and Resistance

Blood flow through a vessel is determined by:

Pressure difference at each end of the vessel
Resistance of the vessel to blood flow

This is a re-formulation of Ohms Law

(where V = i x R)

Relationship of Pressure, Flow and

Resistance

In a blood vessel:
P = Q x R
Where: Q = flow (mL/min)
P = Pressure difference (mm Hg)
R = Resistance (mm Hg/mL/min)

Relationship of Pressure, Flow and

Resistance
Likewise, resistance can be calculated, if one knows
the change in pressure and the blood flow (using the
equation: R = P / Q)
Resistance can be calculated in an organ, or in a
system of organs
The resistance of the entire systemic vasculature is
called the Total Peripheral Resistance (TPR) or the
Systemic Vascular Resistance (SVR)

Relationship of Pressure, Flow and

Resistance

Relationship of Pressure, Flow and

Resistance
Example 1:
The blood flow to the left kidney is measured at 500 mL/min
The pressure in the renal artery is 100 mm Hg
The pressure in the renal vein is 10 mm Hg
The vascular resistance of the left kidney is:
R = P / Q
or
R = (100 10) / 500 = 0.18 mm Hg/mL/min

Relationship of Pressure, Flow and

Resistance
Question 2: What pressure drop
would one measure to calculate
the systemic vascular resistance
(SVR)?
Answer:
mean arterial pressure
minus
mean right atrial pressure

Relationship of Pressure, Flow and

Resistance
Question 2: What pressure

drop would one measure to

calculate the pulmonary
vascular resistance (PVR)?

Answer:
mean pulmonary arterial pressure
minus
mean left atrial pressure

Determinants of Vascular Resistance

Determinants of vascular resistance include:
Blood vessel diameter and length
Viscosity of the blood
As described by the Poiseuille equation:
R = 8l / r4
Where = blood viscosity
l = length of blood vessel
r = vessel radius

Vascular Resistance
Since
R = 8l / r4
Where = blood viscosity

l = length of blood vessel

r = vessel radius

Therefore:
Resistance increases as viscosity increases
Resistance increases as length increases
Resistance increases as radius decreases
to the fourth power

Resistance in Series and in Parallel

Series resistance is calculated by simple additon of

each segments resistance
Rtotal = R1 + R2 + R3

Parallel resistance is calculated as follows:

Rtotal = 1/R1 + 1/R2 + 1/R3

Resistance in Series and in Parallel

Series Resistance:
e.g. arrangement of blood vessels within an organ

As blood flows through the series

pressure decreases
Where is the resistance the highest?

Laminar Flow

Ideally, blood flow in the

cardiovascular system is laminar
Laminar flow implies a parabolic
profile of velocity
Irregularities in the vessel cause
turbulent flow

Turbulent flow

In turbulent flow, streams are

propelled radially and axially
More energy is required
Turbulent flow in the heart can cause
a murmur
Turbulent flow in blood vessels can
cause a bruit

Reynolds number
Reynolds number is a dimensionless number used to predict whether
blood flow is laminar or turbulent

NR < 2000
Predicts laminar flow
NR > 2000
Predicts turbulent flow

Reynolds number
Major influences on
Reynolds number:
Blood viscosity
(decreased viscosity
increases turbulence
e.g. anemia)
Velocity of flow
(increased velocity
increases turbulence)

How does blood vessel

narrowing affect
turbulence?
Decreased radius occurs, but
velocity increases by square
of radius
Therefore, narrower vessels
(or stenotic vessels) have
higher turbulence

Compliance of Blood vessels

Compliance in a blood vessel is similar to
compliance of the heart:
Compliance is proportional to V / P
Compliance of veins is high (veins can hold large
volume of blood at low pressure)
Compliance of arteries is lower (they hold a
lower volume at a higher pressure)
Older arteries are least compliant

Compliance of blood vessels

Pressures in the Cardiovascular System

There is a progressive
drop in mean pressure
as blood flows from:
The aorta: to the arteries, to
the arterioles, to the
capillaries, to the venules and
to the great veins
The largest pressure drop
occurs at the arteriolar level

Pressures in the Cardiovascular System

Arterial pressure is pulsatile, due to the
cardiac cycle
Systolic pressure represents the highest pressure
in the pressure tracing
Diastolic pressure represents the lowest pressure
in the pressure tracing
Mean pressure is the driving pressure, and is
calulcated as: Diastolic pressure + 1/3 of the pulse
pressure

Pressures in the Cardiovascular System

Mean pressures:

Aorta: 90 - 100 mm Hg
Arterioles: 50 mm Hg
Capillaries: 20 mm Hg
Vena Cava: 4 mm Hg

Pressures in the Cardiovascular System

Examples of Learning Objectives
What happens to blood pressure with:

The aging process?

Stenosis of the subclavian artery?
Aortic stenosis?
Aortic insufficiency (regurgitation)?