Topic 4 Blood vessels & Hemodynamics

Joanna Komorowski, PH.D.

Lecture objectives Marieb Chapter 19: pages 706- 721

Express blood pressure in terms of cardiac output and peripheral resistance Describe the short-term neural and chemical mechanisms for the regulation of blood pressure Describe the role of the kidneys in the long-term regulation of blood pressure Define and explain the mechanisms of autoregulation with regard to local blood flow Explain the forces that act to influence capillary exchange Identify the principal arteries and veins of the cardiovascular system:

You will be responsible for arteries and veins up to the level of the wrist and ankle, to each organ and to the brain (to and including the circle of Willis). If you begin early and review often, then you will find it is not as daunting as it looks. However, there will be little learning time during the lectures, so it will be up to you to put in the time.

Regulation of blood pressure

Central regulation (CVC) Autorgulaion (local factors)

Cardiovascular Control Center (CVC)

The neural center that oversees changes in blood vessels diameter is the vasomotor center
Pressor area - increases BP via vasoconstriction Depressor area - decreases BP by inhibiting nerves causing vasoconstriction

Vasomotor center in medulla

Cardioaccleration center Increases HR (is activated when the pressor area is stimulated)

Cardioinhibitory center depresses heart activity(is associated with vagus nerve)

Vasomotor activity is regulated mainly by:

Local factors: blood levels of H+, O2, CO2

Baroreceptors (pressuresensitive mechanoreceptors) monitor chronic and acute BP changes; respond to arterial BP changes, stretch, mechanical deformation
Baroreceptors -located in carotid sinus and aortic arch and in the walls of arteries, veins, and right atrium

Body temperature

Regulation of blood pressure

Neural control centers Muscle afferents

Regulation of Blood Pressure and Tissue Circulation

Local tissue metabolism

Hormonal control

Regulation of blood pressure

Short term regulation 1. Neural controls changes in peripheral resistance 2. Hormonal controls changes in peripheral resistance Long term regulation 1. Hormonal control changes in blood volume 2. Renal control changes in blood volume

Short-term mechanism: Neural controls

BP = CO x TPR

Moment-to moment BP regulation

Neural control 2 main goals: 1) Maintaining adequate MAP by regulating blood vessel diameter 2) Altering blood distribution to respond to specific demands of various organs Most of neural control operates via: baroreceptors and associated afferent fibres the vasomotor center of the medulla vasomotor fibres innervate vascular smooth muscle, (mainly smooth muscles of the arterioles are controlled)

CO

TPR

Neural Control
Blood flow is tightly coupled to oxygen demand Sympathetic stimuli result in: Vasodilation of blood vessels in the heart and skeletal muscles, thus, increased blood flow to these organs Vasoconstriction of blood vessels in the skin and abdominal organs Vasoconstriction of veins

Neural regulation of contraction

Different autonomic nerves serving smooth muscle release different neurotransmitters The effect of a specific neurotransmitter depends on the type of receptors Some smooth muscle cells do not have nerve supply!!!! They respond to other stimuli such as hypoxia, low pH, etc.

 Most postganglionic sympathetic neurons release norepinephrine (noradrenaline) which combines with -adrenergic receptors on smooth muscle in blood vessel walls, causing vasoconstriction What would this do to blood pressure? Blood vessels of the heart and skeletal muscle contain -adrenergic receptors; sympathetic stimulation of these receptors causes vasodilation This control system ensures that the heart and the active skeletal muscles receive adequate blood flow during stress

Neural Control of Blood Flow

Parasympathetic stimuli Cause vasodilation of blood vessels in the digestive tract and reproductive organs, by releasing acetylcholine, which inhibits smooth muscle contraction Some sympathetic neurons are cholinergic (release acetylcholine) and cause vasodilation of blood vessels in skeletal muscle

Barororeceptor reflexes that help maintain BP

Figure 19.8 top

Barororeceptor reflexes that help maintain BP

Figure 19.8 bottom

The Autonomic Nervous System and Cardiovascular Function

Sympathetic HR (1 receptors) Cardiac contractility (1 receptors) Vasodilation of coronary arteries (2 receptors) and skeletal muscle arteries Mild vasodilation of pulmonary vessels (2) Vasoconstriction in abdomen, kidneys and skin blood vessels muscle () Vasodilation in muscle and skin (cholinergic)

Symbols
- vasoconstriction

2 - vasodilation 1- vasoconstiction

The Autonomic Nervous System and Cardiovascular Function Parasympathetic HR strength of atrial contraction (vagal innervation of atria but not ventricles)

modest vasodilation of coronary arteries

Chemoreceptors (chemical sensors)

Located close to aortic and carotid barorecepetors in aortic and carotid bodies Monitor blood-borne substances (O2, CO2, [H+]) Increase respiration in order to increase CO2 output and O2 intake Increase BP by sending afferent signals via glossopharyngeal (IX) and vagus (X) nerves to the cardiovascular acceleratory center in response to [O2] or [CO2] or [H+]

Regulation of blood pressure

Short term regulation 1. Neural controls changes in peripheral resistance 2. Hormonal controls changes in peripheral resistance Long term regulation 1. Hormonal control changes in blood volume 2. Renal control changes in blood volume

Short-term mechanism: Hormonal Controls

Vasoconstrictors:
Catecholamines (norepinephrine and epinephrine) from adrenal medulla -vasoconstriction at -adrenergic receptors

Vasopressin (ADH) - produced by hypothalamus, stored in posterior pituitary

Renin - Angiotensin II system angiotensin II Serotonin, released in response to blood vessel injury, causes arteriolar constriction

Short-term mechanism: Hormonal Control of BP Vasodilators:

Histamine, released by eosinophils and mast cells in most tissues Atrial Naturetic Peptide (ANP) produced by the heart Bradykinin, vasodilator in tissues such as blood Catecholamines, vasodilators at 2adrenergic receptors Prostacyclin, vasodilator in several vascular beds

Long term regulation of BP Hormonal Control

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

Hormones: Renin-angiotensin system aldosterone

Vasopressin (ADH) Epinephrine and norepinephrine from the adrenal medulla ( CO but not volume per se) ANF (Atrial Naturetic Factor) = ANP (peptide)

Table 19.2

Angiotensinogen

Renin
Thirst

Angiotensin I

ACE*

Angiotensin II

* ACE - angiotensin converting enzymes

Sites of Thirst and ADH Release in Hypothalamus

Small changes in plasma osmolality are more effective than small changes in blood pressure and volume in stimulating ADH release

Thirst = the conscious desire for water

The release of AVP occurs before the sensation of thirst!!!

ADH involvement in BP Control: volume effect

The Role of ANP in the Regulation of Blood Pressure

ANP: generalized vasodilation antagonizes aldosterone and ADH actions antagonizes epinephrine sodium and water loss from the body RAP = Right Atrial Pressure

UNaV = Urine sodium Excretion (Natriuresis)

HCT = Hematocrit UV = Urine volume (Diuresis)

Long-term mechanism:
Renal regulation of Blood Pressure
An increase in blood volume is followed by a rise in BP and stimulates kidneys to eliminate water via: direct mechanism independent of hormones indirect mechanism hormone-dependent
Figure 19.9

Activity of muscular pump and respiratory pump

Release of ANP

Fluid loss from Crisis stressors: hemorrhage, exercise, trauma, excessive body sweating temperature

Bloodborne Dehydration, chemicals: high hematocrit epinephrine, NE, ADH, angiotensin II; ANP release

Body size

Conservation of Na+ and water by kidney

Blood volume Blood pressure

Blood pH, O2, CO2

Blood volume

Baroreceptors

Chemoreceptors

Venous return

Activation of vasomotor and cardiac acceleration centers in brain stem

Stroke volume

Heart rate

Diameter of blood vessels

Blood viscosity

Blood vessel length

Cardiac output
Initial stimulus
Physiological response Result

Peripheral resistance

Mean systemic arterial blood pressure Figure 19.11

Measuring Pulse Rate and Arterial BP

Arterial Pulse Produced when the left ventricle forces blood against the wall of the aorta. The impact creates a pressure wave along the branches of the aorta and the rest of the arterial walls Corresponds to the beating of the heart All arteries have a pulse, but you can palpate a pulse at certain landmarks better than others The radial artery is the most common site to take a pulse - use the middle fingers!!!!

Taking a pulse
Pressure wave due to alternating expansion & recoil of elastic arteries Pressure points (push surface artery against firm tissue, usually radial artery)

sln.fi.edu/biosci2/ monitor/inline/pulse.gif

Fig. 19.11

The Procedure of Taking the Radial Pulse (a) and the Carotid Pulse (b)

 Tachycardia - pulse rate > 100 bpm Bradycardia - pulse rate < 60 bpm Pulse rate after severe blood loss, exercise, or eating----WHY? Venous Pulse Only occurs in the largest veins It is a reflected pulse produced by the changes in pressure that accompany atrial contractions

Diastolic BP
The lowest force with which blood pushes against arterial walls as a result of ventricular relaxation Provides information about systemic vascular resistance

Blood pressure is expressed as systolic/diastolic (in mmHg

Systolic BP
The highest force with which blood pushes against arterial walls as a result of ventricular contraction Systolic pressure reflects the force of ventricular contraction

Measuring BP
Auscultatory method using sphygmomanometer (brachial artery)

Cuff fully inflated (artery fully collapsed no flow) Cuff pressure lowered to < peak systolic pressure (momentary high velocity spurt) record cuff pressure as systolic BP Cuff pressure lowered to < diastolic pressure (continuous flow - sounds disappear) record cuff pressure as diastolic pressure

Measurement of Arterial BP

Blood Pressure mm Hg
Normal BP = 120/80 mm Hg High normal = 130-139/85-89 Mild hypertension (high BP) = 140-159/90-99 Moderate hypertension = 160-179/100-109 Severe hypertension = 180-209/110-119 Very severe (morbid) hypertension = >209/120 Hypotension <90/40 Shock <80/40 Prevalence of hypertension increases with age (4% at 18-20 y, 44% at 50-59y, 65% at 80+ y)

Factors influencing BP

BP is influenced by age, gender, weight, race, stress, nutrition, mood, posture, fitness level, etc..

Blood Pressure During Exercise

Systemic BP is affected mostly by increased CO There is a linear in systolic BP with levels of exercise (Max systolic BP should not > 260 mm Hg) Diastolic BP either remains unchanged or slightly* Pulse pressure usually with the intensity of exercise BP reaches a steady-state during sub-maximal steadystate exercise With prolonged exercise systolic BP will start decreasing, diastolic will remain constant ( in systolic BP reflects dilation of vessels) Resistance exercise BP, it may temporarily reach 480/350 mm Hg!!!!!

Distribution of blood flow during exercise

Figure 19.12

Autoregulation: Local regulation of blood flow

Autoregulation = Local adjustment of blood flow to a given tissue metabolism 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, cAMP, cGMP, K+, heat, inflammatory chemicals and nitric oxide (NO)

Autoregulation: Local regulation of blood flow cont.

Response to accumulation of local metobiltes: immediate vasodilation in needy tissues (relaxation of precapillary sphincters) active or reactive hyperemia Long-Term Autoregulation: Eg: increases in number/ diameters of tissue blood vessels, e.g., when coronary vessels become occluded, in response to regular exercise or living at high altitude

Myogenic Controls (Local!): vascular smooth muscle responds to increased stretch with increased tone stretch is resisted vasoconstriction decreased stretch results in vasodilation

result: tissue perfusion homeostasis so cells not deprived/capillaries not damaged

Myogenic control
Both physical (myogenic) and chemical (metabolic) factors determine final autoregulatory response in tissues

Active Hyperemia - Chemical

Myogenic Autoregulation Physical

Fig. 19-10 (R&P)

Summary of control of arteriolar smooth muscle in the systemic circulation

Dilate Constrict

Figure 19.14

Exchange of nutrients, wastes and gasses

Mechanisms for exchange

Diffusion (a passive process) Vesciular transport (endocytosis and exocytosis) Bulk flow (filtration and absorption) - a movement of a fluid (liquid or gas) from region of higher pressure to one of lower pressure (a passive process)

Capillary transport mechanism

Routes of exchange: Diffusion or active transport of some small molecules through endothelial membranes Diffusion through intercellular clefts (pores);most substances including water, small hydrophilic molecules Passage of large molecules through endothelial fenestrations (little windows) Passage of some larger molecules through endothelial tissue via pinocytic vesicles

Figure 19.15

Capillary Exchange Mechanisms: examples

Vesicle Transport: for relatively large, lipid-insoluble molecules (e.g., insulin) shuttling via endocytosis, then exocytosis also antibody molecules from maternal to fetal circulation

http://www.skcc.org/n_im ages/transcytosis.jpg

Diffusion: primary mechanism for dissolved solutes & gases; eg: O2, CO2, glucose follow gradients heat moves via convection down a thermal gradient water-filled pores (Na+. K+, Cl-, glucose) or through bilayer (O2, CO2, urea) pores <1% capillary SA; lipid-soluble substances have 100X more SA
J. Carnegie, UofO

Fluid exchange

~ 20 L of fluid are filtered out of capillaries each day before returning to blood

Fluid exchange
As blood flows through a capillary, the blood hydrostatic pressure (BHP = HP) tends to push fluid out through the capillary pores The blood colloid osmotic pressure (BCOP = OP) tends to pull water from the interstitial fluid into the capillary There is a very small interstitial fluid osmotic pressure (IFOP) that tends to move fluid out of the capillaries into the interstitial fluid NEF = the difference between BHP and BCOP Net filtration pressure (NFP) shows direction of fluid movement

Fluid exchange
The formula for calculating NFP: NFP = [HPC Hpif] [OPC OPif]
Example: when HPC = 35 mmHg at the arterial end of capillary and 17 mmHg at the venous end; OPC=26mmHg and OPif =1 mmHg; unlike HP, OP does not vary from one end of capillary to the other Thus, net osmotic pressure that pulls fluid back to capillary is OPC Opif =
= 26 mmHg 1mmHg = 25 mmHg

NFP = (35 - 0) (26 1) = 10 mmHg The net force at the arterial end = 10 mm Hg forcing plasma out of capillary by a process called filtration The net force at the venous end is equal to (17-0)-(26-1) = -8 mmHg, pulling water back into the capillary by osmosis
As a result of this exchange, a constant flow of interstitial fluid washes over the tissue cells, supplying O2 and nutrients and carrying away CO2 and wastes

Fluid flows at capillaries

HP = hydrostatic pressure NFP = Net Filtration Pressure

OP = colloid osmotic pressure

Figure 19.17

Paths of Circulation
A. Pulmonary Circuit = the vessels that carry blood from the right ventricle to the lungs, and the vessels that return blood to the right atrium (i) pulmonary trunk (ii) Right and left pulmonary artery (iii) Capillaries in the lungs (iv) Right and left pulmonary veins

B. Systemic Circuit = the vessels that carry blood from the heart to body cells and back to the heart 1. Arterial System 2. Venous System

The Coronary Arteries

Interarterial anastomosis a connection between arteries that provides collateral circulation to different areas of the myocardium

Coronary arteries originate behind aortic semilunar valve: fill during ventricular diastole

Note the anastomoses between the coronary arteries. This is an interarterial anastomosis which provides collateral circulation to different parts of the myocardium. The fact that the coronary arteries fill during ventricular diastole allows them to overcome the resistance which would be too great during ventricular systole.

Major Arteries of the Systemic Circulation

Left side of head & left upper limb Aortic arch right side of head & right upper limb

Descending aorta

Thoracic aorta
Bronchial artery Pericardial artery Esophageal artery Mediastinal artery Posterior intercostal artery

Abdominal aorta
Celiac artery Phrenic artery Superior mesentric artery Supra renal artery Renal artery Gonadal artery Inferior mesenteric artery Lumbar artery Middle sacral artery Common iliac artery

Fig. 19.4b

Arteries of the head, neck and brain

The Circle of Willis

- provides collateral circulation to the brain

Fig 19.5d

Arteries of the Upper limb and Thorax

Arteries of the Abdomen

organs of upper digestive tract

Arteries of the pelvis and lower limb

The Aorta and Its Principal Branches

Portion of Aorta Major Branch General Regions/ organs supplied Portion of Major Branch Aorta Abdominal aorta Celiac artery Phrenic artery rt upper limb, rt side of head Lt side of the head lt upper limb Superior mesentric artery Supra renal artery Renal artery Gonadal artery Bronchi Pericardium Esophagus Mediastinum Common iliac artery Thoracic wall Lower abdominal wall, pelvic organs & lower limbs Inferior mesenteric artery Lumbar artery General Regions/ organs supplied Organs of upper digestive tract Diaphram Portions of small & large intestine Adrenal gland kidney Ovaries & testis Lower portions of large intestine Posterior abdominal wall

Ascending aorta
Arch of aorta

Rt & lt coronary artery

Brachiocephalic artery

Heart

Lt common coratid artery

Lt subclavian artery Descending aorta Thoracic aorta Bronchial artery Pericardial artery Esophageal artery Mediastinal artery Posterior intercostal artery

Middle sacral artery

Sacrum and coccyx

Venous System
Veins that return blood to the heart after gas, nutrient and waste exchange, usually follow pathways that are parallel to the arteries. Some exceptions: (i) Jugular veins (head) -external jugular (face and scalp) -internal jugular (brain)

(ii) Median cubital vein (venipuncture site)

(iii) Subclavian vein + jugular = brachiocephalic veins on each side (iv) Superior vena cava: union of brachiocephalic veins (head and upper limbs)

(v) Coronary sinus (cardiac veins) (vi) Cardiac veins (caps of the myocardium)
(vii) Hepatic Veins (drain the Hepatic Portal System) (viii) Great Saphenous vein= longest vein in the body, extends from the medial ankle to the external iliac vein (ix) Inferior vena cava (drain from the abdominal & lower limb)

The Coronary Veins

To right atrium

All coronary veins empty into the coronary sinus, which enters the right atrium directly, without going through either the inferior or superior vena cave. This is the only systemic venous drainage which does this. Note the anastomosis of these veins as well

Major Veins of the Systemic Circulation

Veins of the head and Neck

Veins of the upper limb and thorax

Veins of the Abdomen

Hepatic Portal System takes blood from the spleen , stomach, small and large intestine to the liver before it enter general circulatiom

Spleen

Hepatic artery
Large Intestine

Small Intestine

Veins of the Pelvis and Lower Limbs