PHYSIOLOGY of BLOOD CIRCULATION

Lecturer:dr HERMAN MULIJADI, MS, SpKP

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Learning Objective
 Describe the Circulatory routes of Systemic and Pulmonal
circulation.

Describe the fetal and adult. circulation

Describe the differences between fetal and adult blood
circulation.
Blood circulations
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Blood circulations
The circulation of the blood within the cardiovascular system can be distinguished as :

Pulmonary circulation: Systemic circulation:.

Left ventricle  aorta / arteries 

Right ventricle  pulmonary
arteries  lungs  pulmonary arterioles  capillaries  venules 
veins  left atrium veins/Vena Cava  right atrium
Gas, nutrient, and waste exchange
occur across the capillary walls.
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Portal circulation: Lymphatic circulation

• Driven by factors similar to venous

circulation:
- muscle activity
Veins from gastrointestinal tract 
portal vein  liver  hepatic veins - valves
 IVC - respiration
• Lymph = plasma-proteins
• Lymphatic circulation collects fluid not
reabsorbed by the capillaries
• Lymph is filtered in nodes before return
to blood circulation
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Pulmonary Circulation

• Pulmonary trunk branches

– Right and left pulmonary arteries
– Division into lobar arteries
• 3 on right
• 2 on left
– Smaller and smaller arterioles,
into capillaries surrounding
alveoli
• Gas exchange
• Pulmonary system pressure is only
1/6 of systemic blood pressure
•After gas exchange blood enters
venules
•Larger and larger into Superior and
Inferior Pulmonary veins
•Four Pulmonary Veins empty into left
atrium
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Blood Flow Through Alveoli

• cells of alveolar wall are tightly joined together
• the high osmotic pressure of the interstitial fluid draws water out of them

CO2
O2
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Systemic circulation:.
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Physiology of Systemic Circulation

• Determined by
 Anatomy of circulatory system
 Dynamics of blood flow
 Regulatory mechanisms that control heart
Cardiac out put and Blood vessels (peripheral resistance)

Blood pressure
 Blood volume
 Most in the veins
Smaller volumes in arteries and capillaries

HRxSV
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Dynamics of Blood Circulation

Interrelationships between
– Pressure (Control mechanisms that regulate
blood pressure  Local, Hormonal, Neural)
– Blood flow through vessels (Blood volume &
viscosity)
– Resistance vascular

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Factors That Influence Blood Circulation

Autonomic Venous
innervations return

Neural Heart rate

Strokes Volume
control

Cardiac out put Blood

volume
Blood in vessels
Circulation
Blood
Peripheral resistance viscosity
in vessels

Local control
Neural control
Hormonal control
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Systemic Circulation ( Cardiac out put)
• Oxygenated blood to body
• Leaves LV through Ascending Aorta
– Only branches are the 2 coronary arteries to the heart
• Aortic Arch has three arteries branching from it:
1. Brachiocephalic trunk, has 2 branches:
a. Right common carotid a.
b. Right subclavian a.
2. Left common carotid a.
3. Left subclavian a.
1a 3
1b

2
1
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Systemic Circulation (venous return)

• 3 major vessels enter Right

Atrium:
– SVC (superior vena cava)
– IVC (inferior vena cava)
– Coronary sinus
• Many veins are very
superficial (unlike arteries)
• Venous plexuses (networks of
anastomoses and parallel
veins) are very common
• Head and hepatic portal
systems are unusual

Right subclavian V
Right brachiocephalic V
Right jugular vein
VCS
Left subclavian V
Left brachiocephalic V
Left jugular vein

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Head
•Common carotids branch just
lateral to trachea : At larynx divides
into internal & external
–Internal carotids. Enters skull
through carotid canal. Supply orbits
and most of cerebrum
–Gives off:
• Ophthalmic artery
–Then divides into anterior and
middle cerebral arteries
–together they supply 80% of cerebrum

–External carotids supplies head

external to brain and orbit
–Feel superficial temporal a.
–Middle meningeal: vulnerable
•Subclavian: 3 (branch of maxillary
branches
–Vertebral arteries
–Thyrocerical trunk
–Costocervical trunk
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Head

• Internal jugular veins

– Drain most of blood from brain
– Run lateral to internal then common carotid
– At base of neck joins subclavian v. to form
brachiocephalic v.
• External jugulars – drain some of scalp & face

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Upper limb
•Subclavian runs laterally onto 1st rib,
under clavicle
•Enters axilla as axillary artery
–Sends branches
•Continues as brachial artery in upper arm
–Splits into radial & ulnar arteries
–See hand supply
Feel brachial & radial pulses
• Deep veins of upper limbs follow
arteries, most of them double to
one artery
• Superficial veins: see pic
• Blood drawn from median cubital
vein in antecubital fossa
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•Descending aorta
–Thoracic aorta
•at T12 becomes abdominal aorta
–Abdominal aorta
•ends at L4 branching into:
•R & L common iliac arteries
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Thorax Azygos system drains the thorax:

• Anterior intercostals branch

off Internal thoracic*
(branch of subclavian)
• Posterior intercostals branch
off Thoracic aorta
Intercostal arteries, veins and
nerves run just UNDER the ribs
Small bronchial arteries supply the
lung structures 18
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Arteries to the Abdomen

• Arise from the abdominal aorta

• At rest, ½ arterial blood is here!
• Three single midline branches supply the digestive tube
1. Celiac trunk divides into 3 right away: left gastric, splenic & common hepatic (see pic;
the latter is the only which goes off to the right)
2. Superior mesenteric artery supplies most of intestines
3. Inferior mesenteric artery supplies distal half of large intestine
Paired branches off the abdominal aorta supply adrenal glands, kidneys, gonads
and abdominal body wall
 Vein of Abdomen

 Superior mesenteric and splenic veins join to form hepatic portal

vein, which goes up into liver
 Inferior mesenteric empties into the splenic vein
• Tributaries of IVC: note asymmetry
– Left gonadal and suprarenal veins drain into left renal vein
– On right they drain directly into IVC
– Right and left hepatic veins enter superior part of IVC
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Lower limb
• Abdominal aorta branches into
Common iliacs at L4; these
branch into
– Internal iliacs to pelvic
organs, perineum, buttocks,
medial thighs
– External iliacs: to rest of
lower limbs

• External iliac passes under

inguinal ligament becoming
Femoral artery
• At back of knee femoral
becomes popliteal artery,
and branches

Feel dorslis pedis & posterior

tibial
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Lower limb
Leg veins
• Names similar to
arteries
• Femoral becomes
external iliac after
crossing under inguinal
ligament

_________used for grafting in coronary

artery bypass grafts: is the
longest vein in the body

• External iliac joins with

internal iliac to form
common iliac vein

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• Hepatic portal system
– Two capillary beds Hepatic Portal System
– Carries Venous Blood From Capillaries in Digestive Organs  Capillaries in Liver
– Picks up digested nutrients from stomach & intestines and delivers them to liver for
processing and storage
• Storage of nutrients
• Converts
• Detoxification of toxins, drugs, etc.
– Route: artery to capillaries of gut to hepatic portal vein  liver’s capillaries  hepatic
vein  IVC
– Liver also Receives Arterial Blood from Hepatic
Fig. 13.19
Artery

Don’t confuse hepatic vein with

hepatic portal vein
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FETAL CIRCULATION - General
Differs from Adult
“Non-functional” Lungs &
Digestive Tract
Primary Functions Carried
out by Mom’s Systems
Exchange Between Fetal
Blood & Maternal Blood
Occurs at Placenta

• The one umbilical vein (Branches

Below Liver; 1st Branch Joins Portal
Vein) brings blood which has been to
the placenta for oxygenation (by gas
diffusion from mom’s blood) Returns
O2 Rich Blood from Placenta to Fetus

• The pair of umbilical arteries

(branches from baby’s internal iliac
arteries) carry blood to placenta to pick
up oxygen and nutrients
• Fetal heart starts beating at 21 days
post conception
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FETAL CIRCULATION - Fetal Vessels

• Ductus Venosus
– Branch of Umbilical Vein (O2 Rich)
– Bypasses Liver; Empties into Inferior
Vena Cava
• Foramen Ovale
– Interatrial Opening
– Bypasses Pulmonary Circ. Connect
Right atrium left atrium
• Ductus Arteriosus
– Connects Pulmonary Trunk & Aorta
– Bypasses Pulmonary Circ. Pulmonary A
 aorta descendens

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The blood from the Special Circuits: Fetal Circulation

superior vena cava  the
right atrium  directed
downward through the
tricuspid valve  the right
ventricle. (deoxygenated 12%
blood from the head Pulmonary trunk
the right ventricle
region of the fetus) pumped  the
superior Lungs
Ductus pulmonary trunk
vena arteriosus
blood from the inferior cava
Right
through the
vena cava  the right ventricl Pulmonary veins
e ductus
atrium is  a straight arteriosus  the
Right Foramen Left Left
pathway through the Aorta descending aorta,
atrium ovale atrium ventricle
foramen ovale
directly into the left
Inferior Systemic
atrium circulation
vena
cava
bypassing Liver
Ductus Venosus: the liver.
55%
Branch of Umbilical Vein Ductus
(O2 Rich)  Bypasses venosus
Liver;  Empties into
Inferior Vena Cava
Umbilical vein Placenta Umbilical arteries
the lungs are mainly nonfunctional
during fetal life the fetal heart must
the liver is only partially functional, pump large quantities
it is not necessary for the fetal heart to of blood through the
pump placenta.
Primary Changes in Pulmonary and Systemic Vascular Resistances at Birth .
 First, loss of the tremendous blood flow through the placenta  approximately
doubles the systemic vascular resistance at birth.  increases the aortic pressure
as well as the pressures in the left ventricle and left atrium.
 Second, expansion of the lungs.  greatly decreases the pulmonary vascular
resistance
 Third, in fetal life, the hypoxia of the lungs tonic vasoconstriction of the lung
blood vessels aeration of the lungs eliminates the hypoxia.  vasodilation
 All these changes together reduce the resistance to blood flow through the lungs
 reduces the pulmonary arterial pressure, right ventricular pressure, and right
atrial pressure.
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Closure of the Foramen Ovale

 increases the aortic pressure as well

as the pressures in the left ventricle and
left atrium.
 reduces right ventricular pressure,
 reduces right atrial pressure

Blood now to attempt to flow

backward through the foramen ovale
from the left atrium into the right
atrium;

the small valve that lies over the

foramen ovale on the left side of
the atrial septum  closes over
this opening.

Foramen Ovale  Fossa Ovalis

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Closure of the Ductus Venosus In fetal life,.
 Immediately after birth, blood flow through
the umbilical vein ceases,
 But most of the portal blood still flows through
the ductus venosus, with only a small amount
passing through the channels of the liver.

Within 1 to 3 hours the muscle wall of

the ductus venosus contracts strongly
and closes this avenue of flow. .

The portal venous pressure rises

from near 0 to 6 to 10 mm Hg,
Although the ductus venosus rarely
fails to close, we know almost nothing
force portal venous blood flow through about what causes the closure.
the liver sinuses.
Ductus Venosus  Ligamentum
Venosum
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Closure of the Ductus Arteriosus
 First, the increased systemic resistance 
elevates the aortic pressure
 Second, the decreased pulmonary resistance
 reduces the pulmonary arterial pressure

Blood begins to flow backward from the

aorta into the pulmonary artery through the
ductus arteriosus

relates to the increased oxygenation of

the blood flowing through the ductus.

In fetal life the PO2 15 to 20 mm Hg,  about

100 mm Hg within a few hours after birth.

• Ductus Arteriosus
contraction of the smooth muscle in the
ductus wall • Ligamentum Arteriosum
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Review

Fate of Fetal Vessels

• Umbilical Arteries 
Medial Umbilical
Ligaments
• Umbilical Vein 
RoundLigaments /
Ligament Teres
• Ductus Venosus 
Ligamentum Venosum
• Foramen Ovale 
Fossa Ovalis
• Ductus Arteriosus 
Ligamentum Arteriosum
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Thanks for your attention

Any Question?
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Reference
Lauralee Sherwood: Human Physiology;. Department of Physiology and
Pharmacology School of Medicine West Virginia University. rooks/Cole
10 Davis Drive Belm
Arthur C. Guyton, M.D., John E. Hall, Ph.D:Text Book of Medical Physiology;.
Department of Physiology and Biophysics University of Mississippi Medical
Center Jackson, Mississippi, 11th ed. Philadelphia, Saunders.
Vander et al's : Human Physiology: The Mechanisms of Body Function,
9th ed , the McGraw-Hill Publishing

W.F.: Ganong MD: Review of Medical Physiology, 12th ed , Lange

Medical Publications

Mc Naught C. Illustrated Physiology 5th Ed Churchill Livingstone,1990

Other sources,

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