Dr.

Dini Sri Damayanti,MKes

PHYSIOLOGY OF CIRCULATION SYSTEM

The Blood Vessels

The cardiovascular system has three types

of blood vessels: Arteries (and arterioles) carry blood away from the heart Capillaries where nutrient and gas exchange occur Veins (and venules) carry blood toward the heart.

Blood vessels

The Arteries
Arteries and arterioles take blood away

from the heart. The largest artery is the aorta. The middle layer of an artery wall consists of smooth muscle that can constrict to regulate blood flow and blood pressure. Arterioles can constrict or dilate, changing blood pressure.

The Capillaries
Capillaries have walls only one cell thick to allow

exchange of gases and nutrients with tissue fluid. Capillary beds are present in all regions of the body but not all capillary beds are open at the same time. Contraction of a sphincter muscle closes off a bed and blood can flow through an arteriovenous shunt that bypasses the capillary bed.

Anatomy of a capillary bed

The Veins
Venules drain blood from capillaries,

then join to form veins that take blood to the heart. Veins have much less smooth muscle and connective tissue than arteries. Veins often have valves that prevent the backward flow of blood when closed. Veins carry about 70% of the bodys blood and act as a reservoir during hemorrhage.

The Vascular Pathways

The cardiovascular system includes two

circuits: 1) Pulmonary circuit which circulates blood through the lungs, and 2) Systemic circuit which circulates blood to the rest of the body. 3) Both circuits are vital to homeostasis.

Cardiovascular system diagram

The Pulmonary Circuit

The pulmonary circuit begins with the

pulmonary trunk from the right ventricle which branches into two pulmonary arteries that take oxygen-poor blood to the lungs. In the lungs, oxygen diffuses into the blood, and carbon dioxide diffuses out of the blood to be expelled by the lungs. Four pulmonary veins return oxygen-rich blood to the left atrium.

The Systemic Circuit

The systemic circuit starts with the aorta

carrying O2-rich blood from the left ventricle. The aorta branches with an artery going to each specific organ. Generally, an artery divides into arterioles and capillaries which then lead to venules.

 The vein that takes blood to the vena cava often

has the same name as the artery that delivered blood to the organ. In the adult systemic circuit, arteries carry blood that is relatively high in oxygen and relatively low in carbon dioxide, and veins carry blood that is relatively low in oxygen and relatively high in carbon dioxide. This is the reverse of the pulmonary circuit.

Blood Flow
The beating of the heart is necessary to

homeostasis because it creates pressure that propels blood in arteries and the arterioles. Arterioles lead to the capillaries where nutrient and gas exchange with tissue fluid takes place.

Blood Flow in Arteries

Blood pressure due to the pumping of the

heart accounts for the flow of blood in the arteries. Systolic pressure is high when the heart expels the blood. Diastolic pressure occurs when the heart ventricles are relaxing. Both pressures decrease with distance from the left ventricle because blood enters more and more arterioles and arteries.

Cross-sectional area as it relates to blood pressure and velocity

Blood Flow in Capillaries

Blood moves slowly in capillaries

because there are more capillaries than arterioles. This allows time for substances to be exchanged between the blood and tissues.

Blood Flow in Veins

1) 2) 3)

Venous blood flow is dependent upon: skeletal muscle contraction, presence of valves in veins, and respiratory movements. Compression of veins causes blood to move forward past a valve that then prevents it from returning backward.

Blood Flow in Veins

1) 2) 3)

Venous blood flow is dependent upon: skeletal muscle contraction, presence of valves in veins, and respiratory movements. Compression of veins causes blood to move forward past a valve that then prevents it from returning backward.

 Changes in thoracic and abdominal pressure

that occur with breathing also assist in the return of blood. Varicose veins develop when the valves of veins become weak. Hemorrhoids (piles) are due to varicose veins in the rectum. Phlebitis is inflammation of a vein and can lead to a blood clot and possible death if the clot is dislodged and is carried to a pulmonary vessel.

Blood pressure (BP)

A constant flow of blood is necessary to transport oxygen to the cells of the body
The arteries maintain an average blood

pressure of around 90 mmHg This helps push the blood from the arteries into the capillaries
In the capillaries, oxygen transfers from the

blood to the cells

Systole and Diastole

The arteries fluctuate between a state of systole and diastole
In systole, the pressure in the arteries

increases as the heart pumps blood into the arterial system

As the pressure increases, the elastic walls of

the arteries stretch

This can be felt as a pulse in certain arteries

Systole and Diastole

In diastole, the recoil of the elastic arteries forces blood out of the arterial system into the capillaries
The pressure in the arteries falls as blood

leaves the system

Minimum diastolic pressure is typically 70-80

mmHg
Maximum systolic pressure is typically 110-

120 mmHg

Factors affecting ABP:

Sex M > F due to hormones/ equal at menopause. Age Elderly > children due to atherosclerosis. Emotions due to secretion of adrenaline & noradrenaline. Exercise due to venous return. Hormones (e.g. Adrenaline, noradrenaline, thyroid H). Gravity Lower limbs > upper limbs.

Race Orientals > Westerns ? dietry factors, or weather. Sleep due to venous return. Pregnancy due to metabolism.

Factors determining ABP:

Blood Pressure = Cardiac Output X Peripheral Resistance
(BP) (CO) Flow (PR) Diameter of arterioles

BP depends on:

1. Cardiac output CO = SV X HR. 2. Peripheral resistance. 3. Blood volume.

More cells

constriction of blood vessel walls

Regulation of ABP:
Maintaining B.P. is important to ensure a steady blood

flow (perfusion) to tissues.

B.P. is regulated neurally through centers in medulla

oblongata:
1. Vasomotor Center (V.M.C.), or (pressor area): Sympathetic fibers. 2. Cardiac Inhibitory Center (C.I.C.), or (depressor area): Parasympathetic fibers (vagus).

Regulation of ABP

(continued)

cardiac control centers in medulla oblongata

1. Cardiacaccelerator center (V.M.C)
Sympathetic n. fibers

2. Cardiacinhibitory center (C.I.C)

Parasympathetic n. fibers

Regulatory mechanisms depend on:

a. Fast acting reflexes: b. Long-term mechanism:

Concerned by controlling CO (SV, HR), & PR. Concerned mainly by regulating the blood volume.

Regulation of CO:
A fast acting mechanism. CO regulation depends on the regulation of:
a. Stroke volume, & b. Heart rate

Regulation Of COP
COP = SV X HR
HR : Sympatic /parasympatic SV : Venous return, Contractility

Regulation of Peripheral Resistance (PR):

A fast acting mechanism. Controlled by 3 mechanisms:
1. Intrinsic. 2. Extrinsic. 3. Paracrine.

Extrinsic mechanism is controlled through several reflex mechanisms, most important:

1. Baroreceptors reflex. 2. Chemoreceptors reflex.

Baroreceptors
How does the body know that there has been a fall in blood pressure?
Baroreceptors on the aorta and carotid artery

respond to falls in BP

They send signals to the cardiovascular

centre in the brain stem medulla

The medulla sends signals along the sympathetic nerves to the arterioles and heart, increasing SVR and cardiac output

1. Baroreceptors reflex:
Baroreceptors are receptors found in carotid sinus & aortic arch. Are stimulated by changes in BP.
BP + Baroreceptors

= V.M.C
= Sympathetic Vasodilatation & TPR

++ C.I.C
+ Parasympathetic Slowing of SA node ( HR) & CO

2. Chemoreceptors reflex:
Chemoreceptors are receptors found in carotid &

aortic bodies. Are stimulated by chemical changes in blood mainly hypoxia ( O2), hypercapnia ( CO2), & pH changes.
Haemorrhage

BP
Hypoxia

++ V.M.C
+ Adrenal medulla + Sympathetic Vasoconstriction & TPR

+ Chemoreceptors

= C.I.C
= Parasympathetic
HR

3. Other Vasomotor Reflexes:

1. Atrial stretch receptor reflex:
Venous Return ++ atrial stretch receptors reflex vasodilatation & BP.

2. Thermoreceptors: (in skin/or hypothalamus)

Exposure to heat vasodilatation. Exposure to cold vasoconstriction.

3. Pulmonary receptors:
Lung inflation vasoconstriction.

4. Hormonal Agents:
NA vasoconstriction. A vasoconstriction (except in sk. ms.). Angiotensin II vasoconstriction. Vasopressin vasoconstriction.

REGULATION OF ARTERIAL BLOOD PRESSURE of Blood Volume B. Regulation

Regulation of Blood Volume:

A long-term regulatory mechanism. Mainly renal:
1. Renin-Angiotensin System. 2. Anti-diuretic hormone (ADH), or vasopressin. 3. Low-pressure volume receptors.

1. Renin-Angiotensin System:
Most important mechanism for Na+ retention in order to maintain the blood volume. Any drop of renal blood flow &/or Na+, will stimulate volume receptors found in juxtaglomerular apparatus of the kidneys to secrete Renin which will act on the Angiotensin System leading to production of aldosterone.

 Renin-Angiotensin System:
renal blood flow &/or Na+ ++ Juxtaglomerular apparatus of kidneys (considered volume receptors) Renin Angiotensinogen Angiotensin I
(Lungs) Converting enzymes

Angiotensin III
(powerful vasoconstrictor)

(powerful vasoconstrictor) Adrenal cortex

Angiotensin II

Aldosterone N.B. Aldosterone is the main regulator of Na+ retention.

Corticosterone

2. Anti-diuretic hormone (ADH), or vasopressin:

Hypovolemia & dehydration will stimulate the osmoreceptors in the hypothalamus, which will lead to release of ADH from posterior pituitary gland. ADH will cause water reabsorption at kidney tubules.

3. Low-pressure volume receptors:

Atrial natriuritic peptide (ANP) hormone, is secreted from the wall of right atrium to regulate Na+ excretion in order to maintain blood volume.