1. Cardiovascular System L-5 Special Circulations, hemorrhage and shock
Dr Than Kyaw
March 2012

2. (Coronary, Pulmonary, and Cerebral circulations)
Special circulation
(Coronary, Pulmonary, and Cerebral circulations)
Introduction
Special attention to circulation in coronary, pulmonary and brain
Differences in mechanisms to other systems
Their importance
Coronary circulation is discussed in the previous lecture [(L-3 (b)]

3. Pulmonary circulation
Separate circulation
Low pressure (right ventricle) than systemic (left ventricle)
Deoxygenated venous blood from whole body pass through the lung to re-oxygenate

4. Right
ventricle
Lung alveoli
Gas exchange
Right
Artery
Right
lung
Extensive
capillary bed
Pulmonary
trunk
Left
lung
Left
Artery
Extensive
capillary bed
Venules
Pulmonary
vein
Left
atrium

5. Trachea
bronchi
bronchiole
Smaller branches
Alveoli
Capillaries

7. Alveolar type I cells. Squamous cells, as thin as 0
Alveolar type I cells. Squamous cells, as thin as 0.05 m; 95% of the alveolar epithelial surface.
Alveolar type II cells. Irregular, cuboidal shaped; cytoplasm contains a large number of granules (cytosomes) which secrete pulmonary surfactant (a mixture of proteins and phospholipids which reduce the surface tension of the alveoli, and prevent their collapse during exhalation, and act as a bactericide)

8. Diffusion of respiratory gases
Respiratory gases diffuse readily throughout the body tissues
CO2 - greater lipid solubility, diffuse about 20 times than O2 through the membranes
Diffusion rate decreases in diseases like pulmonary edema

9. Oxygen-Hb dissociation curve

10. Direction of diffusion of O2 and CO2

11. Circulation to the Brain
The inner surfaces of capillaries in the brain are lined by the single layer of endothelial cells.
Unlike other organs, endothelial cells of the capillaries in the brain have tight junctions.
So, most substances in the blood cannot readily enter the cells of CNS.
This limitation is k/s Blood-brain-barrier.
Lipid soluble substances like O2 and CO2 can readily diffuse.
Some molecules, such as glucose, needs special methods (active transport)
Transport for most substances is provided by astrocytes which are interposed between the CNS cells and capillaries.
The BBB is not permeable to hydrogen ions

15. Functions and properties of the BBB
The BBB has several important functions:
Protects the brain from "foreign substances" in the blood that may injure the brain.
Protects the brain from hormones and neurotransmitters in the rest of the body.
Maintains a constant environment for the brain.

16. Functions and properties of the BBB
General Properties of the BBB
Large molecules do not pass through the BBB easily.
Low lipid (fat) soluble molecules do not penetrate into the brain. However, lipid soluble molecules rapidly cross the BBB into the brain.
Molecules that have a high electrical charge to them are slowed.

17. Blood requirement by the brain
Need continuous supply of the blood for normal functioning
Other tissues can deprived of a blood supply for extended periods and recover to normal function when blood supply resumes.
5 to 10 min of little or no blood to the brain injure brain cells (cerebrum) no recovery
Respiratory and cardiovascular centers (medulla oblongata)
more resistant to hypoxia revival after 10 min
Adult brain less resistant to hypoxia than new born brain

18. Hemorrhage and shock

19. Hemorrhage and shock Hemorrhage (Bleed causing loss of blood)
From injuries –
External
Internal
Traumatic
Non-Traumatic
Anatomical Type
Arterial
Venous
Capillary
Timing – Acute/Chronic

20. Hemorrhage
May cause:
Inadequate peripheral perfusion leading to failure of tissue oxygenation
may lead to anaerobic metabolism
oxydative phosphorylation can’t occur without oxygen
glycolysis can occur without oxygen
cellular death leads to tissue and organ death
can occur even after return of perfusion
 organ or organism death

21. Effect of anaerobic metabolism
Inadequate cellular O2 delivery
Inadequate energy production
anaerobic metabolism
Lactic acid production
Metabolic failure
Cellular death
Metabolic acidosis

22. Maintaining perfusion requires
Volume (normal cardiac out put, normal flow)
Pump ( normal heart action, pressure)
Vessels (normal transport and diffusion of substances)
Failue of one or more of above causes shock
excessive hemorrhage affects these factors

23. Shock Different types of shock Hypovolumic shock (low volume)
Most common cause of shock
Traumatic blood loss (intraperitoneal, intrathoracic)
Non traumatic blood loss
vomiting
diarrhoea
Burns
GI (melena)
Sweating
Cardiogenic shock (Pump failure)
when the heart is damaged or injured

24. Shock
- Inadequate delivery of oxygen and nutrients to maintain normal tissue and cellular function
3 stages:
(1) Compensatory: body try to maintain normal function
(2) Progressive stage: body mechanism used up and blood started shuntting blood from extremities to vital organs
(3) Irreversible stage- blood shunted from blood vessels and unable to sustain the pressure need to feed the heart and brain.

25. Progressive Shock Low Cardiac Output
Decreases arterial pressure and reduces transport of nutrients to tissues
Blood pH decreases because of lactic & carbonic acid buildup.
Waste products lead to blood agglutination. Smaller vessels may become blocked, further decreasing nutrient transport

26. Shock may be observed by
Cool clammy extremities
tachycardia,
weak or absent peripheral pulses
hypotension
Such apparent clinical shock results from at least 25 to 30% loss of the blood volume.
However, substantial volumes of blood may be lost before the classic clinical signs of shock are evident.
When a patient is significantly tachycardiac or hypotensive, this represents both significant blood loss and physiologic decompensation

27. Immediate treatment necessary
Fluid replacement (N/S; Ringer’s lactate solution)
Coloids and Blood products (plasma, red cells)
END OF LECTURE

28. Assignment II Test I Title: Role of pancreas in digestion
Submission date: 26 March 2012
Test I
Date and time: 12/3/ :00 AM to 11:00 AM
Time allowed: 1 hour
Question types: Multiple choice and short questions
Reading: Both theory and practical