Dynamics of

Blood Flow
Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera Utara

Introduction

blood vessels are a closed system of

conduits that carry blood from heart to
tissues and back to heart.

FUNCTIONAL
MORPHOLOGY

Vessel Size and Composition

Arterie
s
&
Arterio
les
Walls ; outer layer (adventitia) :
connective tissue
middle layer (media) : smooth muscle
inner layer (intima) : endothelium &
underlying connective tissue

 aorta and other large arteries contain

relatively large amount of elastic tissue,
arterioles contain less elastic tissue
but much more smooth muscle.
the muscle is innervated by
noradrenergic nerve fibers, which
function as constrictors, and in some
instances by cholinergic fibers, which
dilate the vessels
arterioles are major site of resistance
to blood flow, and small changes in
their caliber cause large changes in

Capillari
es

total area of all

capillary walls in
body exceeds
6300 m2 in adult
walls, which are
about 1 um thick,
are made up of a
single layer of
endothelial cells

 the junctions
between the
endothelial cells
permit the passage
of molecules up to
10 nm in diameter.
In most endocrine
glands, the
intestinal villi, and
parts of the
kidneys, the
cytoplasm of the
endothelial cells is
attenuated to form
gaps called
fenestrations,
are 20 to 100 nm
in diameter

 Capillaries and postcapillary venules have pericytes

around their endothelial cells.
have long processes that wrap around the vessels;
contractile and release a wide variety of vasoactive
agents.
Synthesize and release constituents of the basement
membrane and extracellular matrix.
Regulate flow through the junctions between endothelial

Arteriovenous (A V) Anastomoses
or Shunt

short channels that connect

arterioles to venules, bypassing
capillaries
in fingers, palms, and ear lobes of
humans and paws, ears
have thick, muscular walls and are
abundantly innervated, presumably
by vasoconstrictor nerve fibers

Venules & Veins

walls are only slightly thicker than capillaries,
and easily distended, relatively little smooth
muscle,
venoconstriction is produced by activity
noradrenergic nerves to veins and by
circulating vasoconstrictors such as
endothelins
intima of limb veins is folded at intervals to
form venous valves that prevent retrograde
flow
No valves are present in the very small
veins, great veins, or the veins from brain
and viscera

Angiogenesis
formation of new blood vessels,
important during fetal life and growth
to adulthood, wound healing,
formation of the corpus luteum after
ovulation, and formation of new
endometrium after menstruation.
many factors are involved in
angiogenesis; protein growth factor
vascular endothelial growth
factor (VEGF).

FLOW, PRESSURE,
& RESISTANCE

effective perfusion pressure is the

mean intra luminal pressure at the
arterial end minus the mean pressure
at the venous end
R units, which are obtained by
dividing pressure in mm Hg by
flow in mL/s
for example, when the mean aortic
pressure is 90 mm Hg and the left
ventricular output is 90 mL/s, the

Laminar Flow
flow of blood in straight blood vessels, like
flow of liquids in narrow rigid tubes, is
normally laminar (streamline).

Laminar flow occurs at velocities up to a

certain critical velocity. At or above this
velocity, flow is turbulent. Laminar flow is
silent, but turbulent flow creates sounds.

 Turbulence is also related to the diameter of

the vessel and the viscosity of the blood.
R = Re = Reynolds
= densitas cairan
D = diameter pebuluh
V= kecepatan aliran
= viskositas cairan

Re < 2000 -> tidak terjadi

turbulen
Re > 3000 -> turbulen

SHEAR STRESS & GENE

ACTIVATION

This shear stress

() is
proportionate to
viscosity () times
the shear rate
(dy/dr), which is the
rate at which the
axial velocity
increases from the
vessel wall toward
the lumen.

Average
velocity
Velocity : displacement per unit
time (eg, cm/s),
Flow : volume per unit time (eg,
cm3/s)
Velocity (v) is proportionate to
flow (Q) divided by the area of
the conduit (A)
if flow stays constant, velocity
increases in direct proportion to
any decrease in A

Resistance is Dependent on Diameter

Resistance falls with increasing radius of the blood vessel, and
increase with increasing blood viscosity.
Under ideal conditions the resistance of a tube is described by
Poiseuilles law.
Resistance to blood flow is determined not only by radius of
the blood vessels (vascular hindrance) but also by viscosity of
the blood.
Where R= resistance
= viscosity
r= radius
4
l= length

l
R
r

Halving the radius of an arteriole

increases resistance by 16 fold.

Factors affecting resistance

Vascular resistance (largest
impact)
friction between blood and
vessel walls

related to blood vessel

diameter (and length)

The narrow arterioles

vasoconstriction:contractiontoreducediameter
vasodilation:relaxationtoenlargediameter

(and capillaries)
generate the largest
vascular resistance

Factors affecting resistance

Viscosity
The thicker the liquid the more resistance
it creates
Blood is thicker than water therefore has
higher resistance (presence of cells,
proteins)
Plasma is about 1.8 times as viscous as
water, whereas whole blood is 3-4 times as
viscous as water.

Viscosity of Blood
The viscosity of whole
blood is dependent on the
haematocrit.
Anaemia can reduce blood
viscosity.
Polycythaemia increases
the haematocrit, blood
viscosity and resistance.
viscosity increases are
seen in diseases in plasma
proteins such as the
immunoglobulins and in
hereditary spherocytosis
(red blood cells are
abnormally rigid)

Factors affecting resistance

Turbulence
Blood flow is laminar
Faster flow at centre, slowest near
vessel wall
Increased turbulent flow occurs at
very high flow rates or as a result of
vascular disease
Occurs normally during blood flow
between chambers (characteristic
sound)
Higher turbulent flow increases
resistance (and elevated BP required to
maintain flow can further damage
walls)

Resistance
Along the
Vascular
System

Resistance is
greatest in
arterioles.
Total resistance is
controlled by arteriolar
resistance.
Arterioles control
perfusion through
organs and the
distribution of cardiac
output.

Pressure and
Volume in the
Circulation
Pressure is pulsatile
in the arteries but
steady in the
capillaries and veins.
Pressure falls along
the circuit with the
greatest fall across
arterioles.
Volume is greatest in
the venous system.
At any time most of
the blood is in veins

Velocity and Area

in the Vascular
System
Total crosssectional area of
the vascular
system is greatest
in the capillaries
and lowest in the
large vessels.
Because flow is
constant the blood
velocity is fastest
in the large vessels
and slowest in
capillaries.
A erythrocyte
spends 0.5 to 1

Law of Laplace
tension in the wall of a
cylinder (T) is equal to
the product of the
transmural pressure (P)
and the radius (r)
divided by the wall
thickness (w).
T =Pr/w

Arterial Pressure
Pulse pressure, the difference
between the systolic and diastolic
pressures (SP DP), is normally
about 50 mm Hg (120 80 mmHg)
Mean pressure is the average
pressure throughout the cardiac
cycle, equals diastolic pressure plus
one-third of the pulse pressure
= DP + 1/3 (PP)

Effect of Gravity
Pressure in any vessel below heart
level is increased and in any vessel
above heart level is decreased by the
effect of gravity.
Besarnya efek gravitasi-hasil kali
densitas darah, akselerasi akibat
gravitasi, dan jarak vertikal di atas
atau di bawah jantung 0,77
mmHg/cm pada densitas darah
normal.

Methods of Measuring Blood

Pressure

Auscultatory
Method
Palpation Method

Active & Inactive

Capillaries

In active tissues,
metarterioles and
precapillary sphincters
dilate, is due to action of
vasodilator metabolites
formed in active tissue and
a decrease activity of
sympathetic vasoconstrictor
nerves
In resting tissues, most of
capillaries are collapsed,
and blood flows through the
thoroughfare vessels from
the arterioles to the venules

VENOUS CIRCULATION
Venous flow is aided by heartbeat, increase in
negative intrathoracic pressure during each
inspiration, and contractions of skeletal
muscles that compress the veins (muscle
pump)
Heartbeat, during systole contribute venous
return especially at rapid heartbeat
Thoracic Pump, during inspiration intrapleural
pressure falls from -2.5 to -6 mm Hg, drop in
venous pressure during inspiration aids venous
return

 Muscle Pump, Rhythmic

contractions of the leg
muscles while the person is
standing serve to lower the
venous pressure in the legs
to less than 30 mm Hg by
propelling blood toward the
heart.
In patients with varicose
veins because their valves
are incompetent, may
develop stasis and ankle
edema

Measuring Venous
Pressure
Central venous pressure can be
measured directly by inserting a catheter
into the thoracic great veins.
Peripheral venous pressure correlates
well with central venous pressure in most
conditions
Perkiraan tekanan vena sentral, dengan
mengukur distensi vena jugularis
eksterna pada waktu pasien berbaring
dengan kepala sedikit di atas jantung.

Thank You

Let it
beat!