The Cardiovascular System

Blood pressure

The heart

The Cardiovascular System

The Cardiovascular System

The right heart, the lungs, left heart, and systemic vasculature are arranged in series Thus, the volume of blood flowing through any of these four regions per unit of time must be equal At steady-state, cardiac output and venous return are always equal.

Blood Vessels
Arteries.
Arterioles.
Capillaries.

Venules.

Veins.

Cardiac Cycle
Cardiac Cycle = All of the events associated with one heartbeat

Cardiac cycle = Systole + Diastole

Each cardiac cycle during rest takes about 0.8 sec.

Systole and diastole

Systole = The period of ventricular contraction systolic pressure reflects the force of ventricular contraction

Diastole = The period of ventricular relaxation

Provides information about systemic vascular resistance

Summary of events occurring in the heart during the cardiac cycle

Heart Rate
Heart rate = The number of times the heart beats in one minute

Heart responses are sensitive to: Age Body position Fitness level Type of activity The presence of heart disease

Factors affecting Heart Rate

Medications Blood volume Temperature Humidity

Factors Controlling Heart Rate

Sympathetic nerves
Sympathetic stimulation increases HR and contractility

Parasympathetic nerves
Parasympathetic stimulation decreases HR

Heart Rate Responses to Exercise

HR may increase with anticipation for the exercise HR increases in a linear fashion with increase in exercise intensity and increase oxygen uptake Increase in HR occurs primarily at the cost of diastole (filling time) rather than systole Near the point of exhaustion HR begins to level-off (maximal HR) Steady-state HR is a valid predictor of heart efficiency: a lower HR a more efficient heart

Stroke Volume

SV = EDV - ESV
Stroke volume End diastolic vol. End systolic vol. At rest: SV = 70ml, EDV = 135ml, ESV = 65ml

Stroke volume
SV is determined by four factors: The volume of venous blood return Ventricular distensibility Ventricular contraction Aortic (or pulmonary) artery pressure/distensibility

EDV
EDV dependent upon venous return. Factors affecting venous return: -constriction of large veins. -pumps (skeletal & respiratory). -valves.

PRELOAD :Degree of ventricular stretching -critical factor affecting SV.

Stroke Volume
Stretching increases actinactin-myosin crosscross-bridge formation. -increased force of contraction.

ESV
ESV affected by Afterload . Afterload. ESV affected by contractility. Degree of calcium release in response to sympathetic stimulation & hormones.

AFTERLOAD: factors that the heart must pump against

Cardiac Output CO = SV x HR
CO: cardiac output. SV: stroke volume HR: heart rate
Cardiac output (CO) = The volume of blood pumped by each ventricle per minute CO (liters/minute) = SV (liters/beat) x HR (beats/min) CO about 5 liters/minute at rest

Cardiac output
Depends on 3 main factors: 1. The pressure gradient for venous return: 2. Resistance to blood flow: 3. Venous pumps a) Skeletal venous pump

b) Respiratory pump

SKELETAL MUSCLE PUMP AND VALVES

Stroke Volume and Exercise

SV is higher in supine than in an upright position SV can double during an upright exercise (from about 60-70 ml to 120-140 ml), however during swimming it increases only about 2040%

SV increases to about 40-60% of VO2max (exception highly trained endurance athletes)

Principles of Blood Flow

Blood Flow = The volume of blood flowing through a vessel or a group of vessels during a specific period of time

Basic unit = ml/min

4.8% % of cardiac output 4.4% 13.6% 5.2%

Hepatosplanchnic

0.60 0.55 1.70 0.65 0.55

Q (L/min)

4.4%

27% 20% 9% 13% 3% 15% 13%

1.35 1.00 0.45 0.65 0.15 0.75 0.65

Renal Skin Brain Heart Skeletal muscle Bone; other

64%

8.00

Resting CO=5 L/min

Moderate Exercise CO=12.5 L/min

3.6% 0.45

Pulse pressures
PP = Systemic Blood Pressure (SBP) Diastolic Blood Pressure (DBP) Systolic pressure diastolic pressure Determined by three factors: 1. Arterial distensibility 2. Stroke volume 3. Speed of ejection from left ventricle

Blood Pressure (BP)

BP = The force with which blood is pushed against the walls of blood vessels Basic unit = mmHg Blood flows down a pressure gradient, from higher (P1) to lower (P2) gradient Blood flow is dependent on this pressure gradient Blood pressure is expressed as systolic/diastolic (in mm Hg)

Blood Pressure
In the arteries and arterioles the blood pressure rises and falls with each heartbeat, causing a pulsing (irregular) flow of blood

Example: 120 80 = 40 mm Hg

Mean Arterial Blood Pressure (MAP) is the pressure driving blood into the tissues throughout the cardiac cycle

Mean arterial blood pressure (MAP)

The average pressure that drives the blood through the systemic circulatory system Determined by 2 factors 1. CO 2. Rate at which blood drains from the arteries (arterial drainage is controlled by the vascular resistance to blood flow) therefore MAP = CO x TPR Since diastole lasts longer than systole MAP = DP + 1/3(SP-DP) Normally around 90 mm Hg MAP = DBP + 1/3 PP

Main factors influencing blood pressure

Cardiac output, depends on: -venous return -Myocardium contractility -Afterload -Sympathetic and parasympathetic stimulation Blood volume Peripheral resistance

Blood Flow Peripheral Resistance

Blood flow is impeded by friction The friction offered by the entire system of blood vessels is termed Total Peripheral Resistance (TPR)

TPR depends on: 1) The length of blood vessels (increases in obesity) 2) The radius of the blood vessels (The most important and most variable) 3) The viscosity of the blood Flow = P1-P2 Resistance

Flow = MAP/Resistance

Interrelationship of pressure, flow and resistance

Blood flow (F) = (P1 P2)/R Resistance (R) = vessel length x viscosity of blood/ vessel radius4 Cardiac output (CO) = (P1-P2)/TPR CO = mean arterial pressure (MAP)/TPR Mean arterial pressure (MAP) = CO x TPR

Factors Affecting Resistance

The lumen of a blood vessel is regulated by: 1) Neural mechanism 2) Hormonal mechanisms 3) Auto-regulatory mechanisms All of these factors affect smooth muscle in the walls of arterioles and precapillary sphincters!!

Neural Control of Resistance

Sympathetic stimuli result in: Ex epinephrine
Vasodilation of blood vessels in the heart and skeletal muscles, Vasoconstriction of blood vessels in the skin and abdominal organs Vasoconstriction of veins

Parasympathetic stimuli: Ex acetylcholine

Cause vasodilation of blood vessels in the digestive tract and reproductive organs Smooth sympathetic neurons are cholinergic

Hormonal Control of Resistance

Vasoconstrictors: Catecholamines (norepinephrine and epinephrine) from adrenal medulla -- vasoconstriction at -adrenergic receptors Vasopressin (ADH) from hypothalamus Angiotensin II blood born Vasodilators: Histamine, released by eosinophils and mast cells in most tissues Atrial Natriuretic Peptide (ANP) produced by the heart Bradykinin, in tissues such as blood Catecholamines, vasodilate at -adrenergic receptors

Autoregulation of Resistance
Autoregulation = Local adjustment of blood flow to a given tissue due primarily to chemical (metabolic) and physical factors in that area Local factors causing vasodilation include: Decreases in O2 or nutrient levels Increases in CO2 levels in that area Decrease in pH Increases in adenosine, lactic acid, and nitric oxide (NO)

Physical factors influencing the autoregulation of blood flow

Heat causes local vasodilation and increases in blood flow Cold causes vasoconstriction and decreases in blood flow Arteriole smooth muscle responds to passive stretching by increasing its tone.

Neural regulation of blood pressure - baroreceptors

Hemostatic receptors Baroreceptors Chemoreceptors

Baroreceptors (pressure sensors) constantly monitor changes in arterial pressure.

Chemoreceptors and BP regulation

Located close to aortic and carotid baroreceptors in aortic and carotid bodies Monitor blood-borne substances (O2, CO2, [H+]) Increase respiration in order to increase O2 intake and CO2 output

Other factors influencing BP control

1. Left atrial volume receptors and hypothalamic osmoreceptors: Help regulate salt and water balance Control BP through blood volume

2. Hormones: Renin-angoitensin system Vasopressin epinephrine and norepnephrine ANF (atrial naturetic factor)

3. The kidneys Regulate blood volume Increase in arterial BP = increase in blood filtration = increase in urine excretion

4. Blood viscosity 5. Capillary fluid shift 6. Higher brain centers and emotions

MEASURING BLOOD PRESSURE

MEASURING BLOOD PRESSURE WHEN BLOOD PRESSURE IS 120/80 Cuff pressure >greater than 120 mm Hg The brachial artery is compressed No blood flows through the artery No sound is heard

MEASURING BLOOD PRESSURE (continued) Cuff pressure is between 120 and 80 mm Hg Whenever blood pressure exceeds cuff pressure blood will force the artery to open Blood flow through the vessel is turbulent Intermittent sounds are heard throughout the cardiac cycle

MEASURING BLOOD PRESSURE (continued)

Cuff pressure is < 80 mm Hg Blood pressure is always greater than 80 mm Hg so the artery is always open Blood flows through the artery in a smooth fashion No sound is heard

Korotkoff sounds
Phase I: Clear tapping/thud sound, marks SBP Phase II: Murmuring or swishing sound Phase III: Crisper sounds, increasing in intensity Phase IV: Sound becomes muffled Phase V: Sound disappears, Marks DBP

Blood pressure and exercise

Systemic BP is affected most by increased CO There is a linear increase in systolic BP with increased levels of exercise (max 260 mmHg) Diastolic BP either remains unchanged or decreases slightly Pulse pressure usually increases with the intensity of exercise BP reaches a steady-state during sub-maximal steady-state exercise With prolonged exercise, systolic BP will start decreasing, diastolic will remain constant (decrease in systolic BP indicates dilation of vessels) Resistance exercise increase BP, it may temporarily reach 480/350mmHg

Exercise BP warning signs

Exercise testing should be terminated immediately in persons demonstrating exertional hypotension possible myocardial ischemia and risk of a cardiac event Systolic BP (SBP) decreasing by 20 mmHg or more after an initial rise SBP at the end of exercise dropping below resting levels Exercise should also be stopped immediately with diastolic BP increasing by 15 mmHg or more

Blood pressure- mm Hg
Normal BP = 120/80 mm Hg High normal = 130-139/85-89 mm Hg Mild hypertension = 140-159/90-99 mm Hg Moderate hypertension = 160-179/11-109 mm Hg Severe hypertension = 180-209/110-119 mm Hg Very severe hypertension = >209/120 mm Hg Hypotension < 90/40 mm Hg Shock < 80/40 Prevalence of hypertension increases with age

Hypertension
Preliminary exercise testing is strongly recommended prior to vigorous exercise in persons with a history of hypertension Although persons with hypertension generally exhibit above-normal systolic and diastolic BP, most studies report no difference in relative blood pressure increase between mildly hypertensive and normotensive subjects. Some patients with hypertension normalize their BP during exercise to resting values (transient) Regular aerobic exercise significantly decreases BP Excessive response of BP to dynamic exercise in nomotensive subjects may be predictive of future hypertension