Circulation of Blood

Chapter 30

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 Learning Objectives
Lesson 30.1: Principles of Blood
Pressure and Blood Flow
1. Discuss the physical principles that
govern fluid flow and circulation.
2. Discuss how arterial blood pressure is
influenced by cardiac output, stroke
volume, peripheral resistance,
vasomotor pressoreflex, and
chemoreflex control mechanisms.

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 Introduction

 The cardiovascular system’s vital role in

maintaining homeostasis depends on the
continuous, controlled movement of
blood through the capillaries
 Numerous control mechanisms help

regulate and integrate the diverse

functions and components of the
cardiovascular system (CVS); as a result,
the blood supply meets the specific
needs of different areas of the body

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 Hemodynamics

 Hemodynamics: A collection of
mechanisms that influence the dynamic
(active and changing) circulation of
blood
 Circulation of different volumes of blood

per minute is essential for healthy

survival
 Circulation control mechanisms must

accomplish two functions:

 Maintain circulation
 Vary the volume and distribution of the
blood circulated
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Hemodynamics Experiment

From Harvey W: The anatomical exercises, London, 1995, Dover Publishing.

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 Primary Principle of Circulation

 Blood flows because a pressure gradient

exists between different parts of its
volume; based on Newton’s first and
second laws of motion
 For example, blood circulates from left
ventricle to right atrium of heart because a
blood pressure gradient exists between these
two structures
 P1–P2 is the symbol used to represent a
pressure gradient; P1 represents the
higher pressure and P2 the lower pressure
 A perfusion pressure (PP) gradient is
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Pressure Gradient

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 Arterial Blood Pressure

 The primary determinant of arterial

blood pressure is the volume of blood in
the arteries; a direct relationship exists
between arterial blood pressure and
arterial blood volume
 Cardiac output (CO) is the volume of

blood pumped out of the heart per unit

of time (ml/min or L/min)

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Arterial Blood Volume
and Blood Pressure

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Cardiac Output
(Slide 1 of 2)

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 Cardiac Output
(Slide 2 of 2)

 CO is determined by the stroke volume

(SV) and heart rate (HR)
 SV is the volume pumped per heartbeat
 CO (volume/min) = SV (volume/beat) × HR
(beats/min)
 In practice, CO is computed by Fick’s
formula
 Because HR and SV determine CO,
anything that changes either factor also
tends to change CO, arterial blood volume,
and blood pressure in the same direction
 The cardiac reserve is the amount the CO
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 Factors That Affect Stroke
Volume
(Slide 1 of 3)

 Starling’s law of the heart (Frank-

Starling mechanism)
 Within limits, the longer, or more stretched,
the heart fibers are at the beginning of
contraction, the stronger the contraction
 The amount of blood in the heart at the end
of diastole determines the amount of stretch
or preload placed on the heart fibers
 Unlike mechanical pumps, the myocardium
contracts with enough strength to match its
pumping load (within certain limits) with
each stroke
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Starling’s Law of the Heart

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 Factors That Affect Stroke
Volume
(Slide 2 of 3)

 Contractility (strength of contraction)

can also be influenced by chemical
factors:
 Neural: Norepinephrine
 Endocrine: Epinephrine
 Triggered by stress, exercise
 The ejection fraction (EF) is the ratio of
SV to end-diastolic volume (EDV)
 Usually expressed as a percentage:
EF = (SV ÷ EDV) × 100
 In a healthy adult, the EF is at least 55%
 The EF decreases as the myocardium fails
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 Stroke Volume
(Slide 1 of 2)

From Rhoades R, Pflanzer R: Human physiology, ed 3, Philadelphia, 1995, Perennial.

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 Stroke Volume
(Slide 2 of 2)

From Rhoades R, Pflanzer R: Human physiology, ed 3, Philadelphia, 1995, Perennial.

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 Factors That Affect Stroke
Volume
(Slide 3 of 3)

 Afterload is the pumping work the heart

must do to push blood into the arteries
 The harder it is to push blood out of the
ventricles, the lower the stroke volume
 Abnormally high afterload from flow
resistance in the arteries can cause heart
failure

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 Cardiac Pressoreflexes

 Aortic baroreceptors and carotid

baroreceptors are located in the aorta
and carotid sinus
 They are extremely important because

they affect the autonomic cardiac

control center, and therefore
parasympathetic and sympathetic
outflow, to aid in control of blood
pressure

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Cardiac Baroreceptors

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Aortic and Carotid Sinus

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 Carotid Sinus Reflex

 Located at the beginning of the internal

carotid artery
 Sensory fibers from carotid sinus

baroreceptors run through the carotid

sinus nerve and the glossopharyngeal
nerve to the cardiac control center
 Parasympathetic impulses leave the

cardiac control center and travel

through the vagus nerve to reach the
SA node

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 Aortic Reflex

 Sensory fibers extend from

baroreceptors in the wall of the aortic
arch through the aortic nerve and
through the vagus nerve to terminate in
the cardiac control center
 Stimulation causes the cardiac control

center to increase vagal inhibition, thus

slowing the heart

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Other Reflexes That Influence Heart
Rate
 Emotions produce changes in the heart
rate through the influence of impulses
from the cerebrum by way of the
hypothalamus
 Anxiety, fear, and anger often increase the
heart rate
 Grief tends to decrease the heart rate
 Exercise normally increases the heart
rate
 Increased blood temperature or

stimulation of skin heat receptors

increases the heart rate
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 Peripheral Resistance

 Resistance to blood flow imposed by the

force of friction between blood and the
walls of its vessels
 Factors that influence peripheral

resistance:
 Blood viscosity: The thickness of blood as a
fluid
 Diameter of arterioles

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 Blood Viscosity

Adapted from Guyton A, Hall J: Textbook of medical physiology, ed 11, Philadelphia, 2006,
Saunders.
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Vessel Diameter

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 How Resistance Influences
Blood Pressure
 Arterial blood pressure tends to vary
directly with peripheral resistance
 Friction is caused by viscosity and small

diameter of arterioles and capillaries

 Arterioles have a muscular coat that

allows them to constrict or dilate and

change the amount of resistance to
blood flow

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Vasomotor Effects on Blood Pressure

Adapted from Boron W, Boulpaep E: Medical physiology, updated version, ed 1, Philadelphia, 2005, Saunders.

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 Vasomotor Control Mechanism

 Controls changes in the diameter of

arterioles; it plays a role in maintenance
of general blood pressure and in
distribution of blood to areas of special
need
 Vasomotor pressoreflexes
 Sudden increase in arterial blood pressure
stimulates aortic and carotid baroreceptors,
resulting in dilation of the arterioles and
venules of the blood reservoirs
 Decrease in arterial blood pressure results
in stimulation of vasoconstrictor centers,
causing vascular smooth muscle to constrict
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Relative Blood Volumes

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Changes in Local Blood
Flow During Exercise

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Vasomotor Pressoreflexes

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 Vasomotor Control Mechanism
(Slide 1 of 2)

 Vasomotor chemoreflexes involve

chemoreceptors in the aortic and
carotid bodies; these are sensitive to
hypercapnia, hypoxia, and decreased
arterial blood pH
 The medullary ischemic reflex acts

during emergency situations involving

decreased blood flow to the medulla;
this reflex causes marked arteriole and
venous constriction

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 Vasomotor Control Mechanism
(Slide 2 of 2)

 In vasomotor control by higher brain

centers, impulses from centers in the
cerebral cortex and hypothalamus are
transmitted to vasomotor centers in the
medulla to help control vasoconstriction
and dilation

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Vasomotor Chemoreflexes

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 Local Control of Arterioles

 Several local mechanisms produce

vasodilation in localized areas; this is
referred to as reactive hyperemia

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 Venous Return to the Heart

 Venous return is the amount of blood

returned to the heart by the veins
 The stress-relaxation effect occurs when

a change in blood pressure causes a

change in vessel diameter (because of
elasticity) that accommodates the new
pressure and thereby keeps blood
flowing (works only within certain limits)
 The pull of gravity on venous blood

while sitting or standing tends to cause

a decrease in venous return (orthostatic
effect) Copyright © 2019, Elsevier Inc. All Rights Reserved. 37
Gravity and Blood Distribution

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 Learning Objectives
Lesson 30.2: Blood Flow,
Volume, and Velocity and
Identifying Pulse
(Slide 1 of 2)
3. Identify and discuss the most important
factors influencing venous return to the
heart.
4. Discuss measurement of the arterial
blood pressure.
5. Explain how the blood pressure gradient
and peripheral resistance are related to
the minute volume of blood.
6. Describe how the velocity of blood flow is
governed.
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 Learning Objectives
Lesson 30.2: Blood Flow,
Volume, and Velocity and
Identifying Pulse
7. Define pulse and(Slide 2 of 2)
identify the factors most
responsible for its existence.
8. Identify the body areas where the pulse
can be felt, and the areas where pressure
may be applied to stop arterial bleeding.
9. Discuss the types of circulatory shock,
hypertension, and hypotension.

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 Venous Pumps

 Blood-pumping action of respirations

and skeletal muscle contractions
facilitates venous return by increasing
the pressure gradient between the
peripheral veins and the venae cavae
(central veins)
 Respirations: Inspiration increases the
pressure gradient between peripheral and
central veins by decreasing central venous
pressure and also by increasing peripheral
venous pressure
 Skeletal muscle contractions promote
venous return by squeezing veins through a
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Venous Pumping Mechanisms
(Slide 1 of 2)

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Venous Pumping Mechanisms
(Slide 2 of 2)

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Venous Valves

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 Total Blood Volume
(Slide 1 of 2)

 Changes in total blood volume change

the amount of blood returned to the
heart
 At the arterial end of a capillary,

outward hydrostatic pressure is the

strongest force; it moves fluid out of the
plasma and into the interstitial fluid (IF)
 At the venous end of a capillary, inward

osmotic pressure is the strongest force;

it moves fluid into the plasma from the
IF; 90% of fluid lost by plasma at the
arterial end is recovered
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 Total Blood Volume
(Slide 2 of 2)

 The lymphatic system recovers the fluid

not recovered by the capillary and
returns it to the venous blood before it
is returned to the heart

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Starling’s Law of the Capillaries

From Patton KT, Thibodeau G: Human body in health & disease, ed 7, St. Louis, 2018, Mosby.

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 Changes in Total Blood Volume

 Mechanisms that change total blood

volume most quickly are those that
cause water to quickly move into or out
of the plasma
 The antidiuretic hormone (ADH)

mechanism reduces the amount of

water lost by the body by increasing the
amount of water the kidneys resorb
from urine before the urine is excreted
from the body; this mechanism is
triggered by input from baroreceptors
and osmoreceptors
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Influences on Total Plasma
Volume

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 Renin-Angiotensin-Aldosterone
System (RAAS)
 Renin is released when blood pressure
in the kidneys is low; this leads to
increased secretion of aldosterone,
which stimulates retention of sodium,
causing increased retention of water
and an increase in blood volume
 Angiotensin II is an intermediate

compound that causes vasoconstriction;

this complements the volume-
increasing effects of renin and promotes
an increase in overall blood flow
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 Atrial Natriuretic Hormone
(ANH) Mechanism
 Adjusts venous return from an
abnormally high level by promoting the
loss of water from plasma, thereby
causing a decrease in blood volume
 Increases urine sodium loss

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Feedback Responses of Various
Arterial Pressure Mechanisms

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 Arterial Blood Pressure

 Measured with the aid of a

sphygmomanometer and stethoscope;
listen for Korotkoff sounds as the pressure
in the cuff gradually decreases
 Systolic blood pressure: Force of blood

pushing against artery walls as ventricles

contract
 Diastolic blood pressure: Force of the

blood pushing against artery walls when

ventricles are relaxed and during
isovolumetric ventricular contraction
 Pulse pressure: Difference between the
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Sphygmomanometer

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 Blood Pressure and Bleeding

 During arterial bleeding, blood escapes

from the artery in spurts because of the
alternating increase and decrease of
arterial blood pressure
 During venous bleeding, blood flows

slowly and steadily as a result of low

and practically constant pressure

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 Minute Volume of Blood

 The minute volume of blood is

determined by the magnitude of the
blood pressure gradient and peripheral
resistance
 Poiseuille’s law: Minute volume =

Pressure gradient ÷ Resistance

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Factors That Influence Blood Flow

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 Velocity of Blood Flow

 Governed by this physical principle:

When a liquid flows from an area of one
cross-sectional size to an area of larger
size, its velocity decreases in the area
with the larger cross-section
 Blood flows more slowly through
arterioles than arteries because the total
cross-sectional area of arterioles is
greater than that of arteries, and
capillary blood flow is slower than
arteriole blood flow
 The venule cross-sectional area is smaller
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 Cross-Sectional Area
and Blood Flow Velocity
(Slide 1 of 2)

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 Cross-Sectional Area
and Blood Flow Velocity
(Slide 2 of 2)

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 Pulse Mechanism

 Clinical significance: Reveals important

information about the cardiovascular
system, blood vessels, and circulation
 Physiological significance: Expansion

stores energy released during recoil,

conserving energy generated by the
heart and maintaining relatively
constant blood flow
 Existence of pulse is due to two factors:
 Alternating increase and decrease of
pressure in the vessel
 Elasticity of arterial walls allows them to
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Normal Carotid Pulse Wave

Adapted from Canobbio MM: Cardiovascular disorders, St Louis, 1990, Mosby.

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Functional Role of the Pulse
Wave

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 Pulse Wave

 Each pulse starts with ventricular

contraction and proceeds as a wave of
expansion throughout the arteries
 It gradually dissipates as it travels,

disappearing in the capillaries

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 Where the Pulse Can Be
Felt and Venous Pulse
 The pulse can be felt wherever an
artery lies near the surface and over a
bone or other firm background
 Venous pulse: Detectable pulse exists

only in large veins, most prominently

near the heart; this pulse is not
clinically important

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 Where the Pulse Can Be Felt

 Radial artery: At the wrist

 Temporal artery: In front of the ear or on

the outer side of the eye

 Common carotid: Anterior edge of the

sternocleidomastoid muscle
 Facial artery: Lower margin of the lower

jawbone
 Brachial artery: Bend of the elbow,

along inner margin of the biceps muscle

 Femoral artery: Middle of the groin
 Popliteal artery: Behind the knee

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 Stopping Arterial Bleeding

 Six important pressure points:

 Temporal artery: In front of the ear
 Facial artery: Same place pulse is taken
 Common carotid artery: Where pulse is
taken, with pressure back against spinal
column
 Subclavian artery: Behind medial third of
the clavicle, pressing against first rib
 Brachial artery: Few inches above the elbow,
on the inside of the arm, pressing against
the humerus
 Femoral artery: Middle of the groin, where
the artery passes over the pelvic bone
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Pulse Points

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 Circulatory Shock

 Cardiogenic shock: Results from any

type of heart failure
 Hypovolemic shock: Results from loss of

blood volume in the blood vessels

 Neurogenic shock: Caused by

widespread dilation of blood vessels

 Anaphylactic shock: Results from

anaphylaxis
 Septic shock: Results from septicemia

complications

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Hypertension and Hypotension

 Hypertension (HTN): High blood pressure

 Occurs when force exerted by the arterial
blood vessel exceeds 140/90 mm Hg
 Classified in stages, according to severity
 Genetic factors play a significant role
 Hypotension: Lower than normal blood
pressure
 Acute or chronic
• Essential hypotension is chronic and results from
heart disease or genetic factors

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Questions?

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