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Education : UGM - MD
Academic Medical Center (AMC),University of
Amsterdam (Department of Cardiothoracic
surgery) - PhD
Other organs:
meets the basic metabolic needs
adjusted to activity level
can’t withstand << blood flow
Brain: 4min permanent
damage
Flow rate, pressure gradient,
vascular resistance
Flow rate (Q/F)
“volume darah yang melewati titik tertentu dalam pembuluh
darah pada waktu tertentu”
Q = ΔP/R
Q : blood flow (L/min; mil/min; ml/sec) 5L/min
ΔP : pressure gradient
R: resistance
Flow rate, pressure gradient,
vascular resistance
Blood pressure
Kekuatan darah melawan setiap luas dinding pembuluh
darah. Tekanan pemb.drh 50mmHg mampu mendorong
air raksa setinggi 50 mmHg.
Pressure gradient ( ΔP )
Δ pressure at the beginning and the end of blood vessel
heart contraction frictional losses on blood vessels ΔP
ΔP : forward flow of blood
Flow rate, pressure gradient,
vascular resistance
Resistance
hindering blood flow
friction of moving fluid &
vascular wall
η = viscosity,
L = vessel length,
r= vessel radius
Rtot
Seri: R1 + R2 + R3
Paralel: 1/R1 + 1/R2 + 1/R3
Flow rate, pressure gradient,
vascular resistance
Konduktansi
ukuran dari jumlah darah yang mengalir setiap
pemberian tekanan yang berbeda, dan dinyatakan
dalam ml/detik/mmHg. Secara singkat konduktans
merupakan kebalikan dari resistensi.
Konduktansi = 1/resistensi
Konduktansi = diameter 4 d=1 1 ml/mnt
d=2
P=100 mmHg 16 ml/mnt
Q =pr 4
8nl
p = tekanan
r 4 = Luas penampang
r = diameter
l = panjang
n = kekentalan/viscocity
Flow rate, pressure gradient,
vascular resistance
The vascular tree
Systemic:
LV aorta big arteries
small arteries (organs)
arterioles – capillaries –
venules – small veins big
veins v. cava RA
Pulmonary:
RV pulmonary a.
arterioles capillaries
venules pulm. v LA
Vascular tree
3 different types, all with different functions:
1. Distributing system : Aorta, arteri, and arteriole
Rapid-transit passageway
heart organs
Pressure fluctuates in
relation to ventricular
systole & diastole
Elastic recoil
Arteries
Mean arterial pressure (MAP)
The average pressure driving blood forward into
the tissues throughout the cardiac cycle
Chemical :
1. Local metabolic changes (exp: exercise)
Active hyperemia, reactive hyperemia
2. Histamine releases
Physical :
How much the vessels is stretched
Extent of shear stress
Heat/cold
Local controls (chemical)
1. Active hyperemia: respons thdp perubahan komposis
kimia lokal yg diakibatkan o/ perubahan aktv. metabolik
lokal
Chemical changes:
decreased O2, increased CO2, increased acid (carbonic acid
from CO2 & lactate acid), increased K+, increased osmolarity,
adenosine release (cardiac muscle) relaxation of smc
vasodilatation
Endothelial vasoactive paracrine:
Paracrine: secreted by EC and acted on SMC
Nitric oxide vasodilatation
Endothelin vasoconstriction
Local controls (Chemical)
2. Reactive hyperemia: respons for suppply-demand
imbalance due to cut of blood supply (metabolic activity
remain constant). c/ tourniquet
Chemical changes:
decreased O2,
increased CO2, acid and other metabolites
2. Shear stress
release of NO vasodilatation
3. Heat/cold
Heat vasodilatation
Cold vasoconstriction
Extrinsic control
Regulating blood flow; Sympathetic & hormonal.
1. Sympathetic innervation
Generalized vasoconstriction
Control center: Cardiovascular control center in medulla brain
stem
Total peripheral resistance (TPR) influence MAP
ΔP = Q x R MAP = CO x TPR
Norepinephrine
α1-adrenergic receptors on smc: vasoconstriction
Brain: no α1-adrenergic receptors. Cerebral arterioles (local control)
No parasympathetic innervation to arterioles; MAP increases
reflex reduction of sympathetic activity.
Extrinsic control
2. Hormones:
Sympt stim medulla adrenal
Norepinephrinie + α1 adrenergic vasoconstrinction
Epinephirine (more abundant of adrenal medullary hormones)
+ β2 receptors (heart & skeletal) : vasodilatation
Vasopressin: regulate water retention in the kidney
Angiotensin II : Renin – angiotensin – aldosterone salt
retention
Vasopressin & angiotensin II: potent vasoconstrictors
3. Others
Hypothalamus
Apart of temp. regulating system controls blood to the skin to
adjust heat loss
Capillaries
Capillaries
Site of materials exchange between blood and tissue
cells
Materials exchanges: mainly via diffusion
Factors that enhance diffusion:
1. Short distance: capillaries – cells
Capillaries: very thin walls, single layer of flat EC,
narrow
Extensive branching
2. Large surface area: 10-40 x 109 capillaries
3. Blood flow more slowly in capillaries
extensive branching
Allows exchange of nutrients & metabolic products
Capillaries pores
Brain: tight
junction, BBB
Skeletal muscle:
pores +
Liver cells: EC
discontinuous
(sinusoids)
protein can pass
Precapillary sphincters (PS)
Branching of cap
depending on the tissue
Directly from arterioles or
from metarteriole
(between arterioles and
venules)
Cells - IF.
Passive : diffusion down electrochemical gradient or carrier-
mediated facilitated diffusion
Active: carrier mediated active transport or vesicular transport
Capillary – tissue:
Passive diffusion down concentration gradient
(individual solutes)
Bulk flow determine distribution of ECF
Exchange of individual solutes
Capacitance vessels
Thinner SMC, more collagens, SMC less myogenic tone
Veins: highly distensible, little/no elastic recoil
Venous return:
Vol. of blood/minute entering atrium from veins
Influenced by:
1. Sympathetic induce vasoconstriction
2. Skeletal muscle pump
3. Venous valves
4. Respiratory pump
5. Cardiac suction
Venous return (VR)
1. Sympathetic stimulation
Veins SMC innervated with sympathetic nerves
Vasoconstriction elevates venous pressure increase
press gradient increase VR
2. Skeletal pump
Countering gravity of venous system
Large veins: btw skeletal muscle
Muscle contraction compress veins decrease venous
capacity, increase venous pressure
Venous return (VR)
3. Venous valve
One way valve blood move forward & prevent back flow
Varicose veins : incompetent valves; prolonged standing >>
4. Respiratory pump
Pressure in the chest 5 mmHg < atmospheric pressure
ΔP between lower veins & chest pressure: push blood forward
5. Cardiac suction
Ventricular contraction, AV valves drawn downward atrial
cavity >>, atrial pressure drops < 0 mmHg push blood from
vein RA
Thank you
d.pabitei@gmail.com