1. Arterial System & Hemodynamics Arterial system Pressures in the circulation Arterial pressure during diastole Pulse pressure and work of the heart Hemodynamics is the study of the physical principles that govern blood flow in the cardiovascular system. Factors affecting resistance to flow Laminar & turbulent flow Tension, pressure and radius

2. Arterial system The arterial system consists of: Elastic arteries: major distribution vessels with a large component of elastic tissue and low resistance: aorta, brachiocephalic, common carotid, subclavian and pulmonary arteries. Muscular arteries: distributing branches with more muscular tissue and less elastic tissue: radial, femoral, coronary and cerebral arteries. Arterioles: terminal branches that supply the capillaries.

3. = MAP Mean & pulse pressures in the circulation Systolic pressure 80 100 120 60 40 20 L ventricle Arteries Capillaries Arterioles ArteriesRt atriumRt ventricle VeinsCapillaries Veins L atriumL ventricle Venules PulmonarySystemic Pulse pressure Pressure, mm Hg Shaded area = systolic pressure - diastolic = pulse pressure Diastolic pressure

4. Pulse pressure depends on stroke volume and aortic compliance Peak systolic pressure & pulse pressure are determined by stroke volume & aortic compliance. Compliance depends on the elastic tissue of the aorta. Pulse pressure = peak systolic minus diastolic pressure. A decrease in aortic compliance will result in a higher peak systolic pressure & pulse pressure (assuming stroke volume is unchanged). Stroke volume Pulse pressure Mean arterial pressure Aortic compliance Aortic valve closure

5. Arterial pressure is maintained during diastole by recoil of the aorta The stroke volume is ejected during the rapid ejection period & is accommodated by expansion of the aorta. Aortic pressure is maintained during diastole by recoil of the aorta as blood flows to the periphery. Because of the elasticity of the aorta and large arteries, the pulsatile pressure signal is gradually dampened so that flow is steady (not pulsatile) in the venules. During diastole the aortic valve is closed and recoil of the elastic aorta drives blood to the periphery systole diastole Left Ventricle Aorta pressure

6. Central and peripheral aortic pressures Simultaneously recorded pressures from the aortic root (Ao) and femoral artery (FA) demonstrate delayed transmission and a higher systolic pressure in the femoral artery. Although peak pressure is higher in the femoral artery than the aorta, average driving pressure (MAP) is higher in the aorta than the femoral artery. There is smoothing of the pressure waveform and loss of the dicrotic notch between the aorta and femoral artery. UpToDate®

7. The work of the heart consists of pumping volume against pressure Work = force (f) operating over distance (dl): W = (f)( dl) For work done by a piston with area A moving against pressure P, For the left ventricle: P = afterload = arterial pressure when the aortic valve is open & V = stroke volume, so cardiac work = stroke volume x afterload A dl P

8. Age Arterial pressure 100 150 50 2040 60 80 mean diastolic systolic Systolic and pulse pressures increase with age Determinants of pulse pressure: Stroke volume Aortic compliance Aging & atherosclerosis  aortic compliance  systolic pressure & pulse pressure  cardiac work due to  systolic pressure

9. A decrease in aortic compliance or an increase in afterload increase cardiac work Cardiac work = stroke volume x afterload. Cardiac work  stroke volume x systolic BP. Increasing systolic pressure increases cardiac work. Compliance of the aorta minimizes peak systolic pressure & cardiac work. Cardiac work increases with age, & in hypertension, aortic stenosis or coarctation. % increase in volume 10060140180 Pressure, mm Hg 22 years old 75 years old C =  V/  P 150 200 250 100 50 Difference in aortic compliance in young versus old subjects

10. Arterial, arteriolar & capillary resistance The resistance of an individual vessel is inversely proportional to radius so R artery < R arteriole < R capillary The total resistance of a category of vessels is determined by the total cross sectional area of all the vessels and the radius of the individual vessels. Comparing arteries & arterioles supplying an organ, the total resistance of the arterioles is greater than the resistance of the arteries. Comparing arterioles & capillaries, the total cross sectional area of the capillaries is so much greater than the area of the arterioles that the total resistance of the capillaries is less than the resistance of the arterioles. The greatest pressure drop in the circulation is across the arterioles.

11. Series & parallel resistances Resistances in series are additive; total resistance equals the sum of individual resistances. Resistances in parallel add as the inverse sum, like parallel electrical circuits: Most vessels of a given category are arranged in parallel. Conductance is the inverse of resistance. For Parallel circuits conductances are additive C total = C 1 + C 2 + C 3 Series and parallel resistance

12. Parallel resistances in the systemic circulation Aorta Arteries to stomach, spleen, pancreas, gut Arteries to CNS Hepatic artery Arteries to limbs & trunk Renal arteries Coronary arteries Arterial beds are arranged in parallel Venous pressure is small compared to arterial pressure. Blood pressure is nearly the same in all large arteries, so  P is the same in all vascular beds:  P = MAP – VP  MAP and MAP = CO X TPR The resistance of each arterial bed is set by its own arteriolar tone TPR is less than the resistance of any single arterial bed. For example: TPR = MAP/CO Renal resistance = MAP/renal flow And renal flow < CO so Renal resistance > TPR There are multiple parallel paths for blood flow so total peripheral resistance is less than resistance in any one bed.

13. Laminar & turbulent flow Normal flow in the circulation is laminar. Laminar (or streamlined) flow exhibits maximal velocity at the center of the vessel, and concentric thin layers of plasma with gradually decreasing velocity toward the walls of the vessel. Laminar flow is silent. Plasma flowing closest to the vessel wall exerts a drag on the wall (shear stress) that influences endothelial function. Turbulent flow exhibits irregular radial mixing of blood as overall flow occurs in the longitudinal direction. Turbulent flow usually causes vibrations that are audible with the stethoscope as murmurs or bruits. The pressure gradient required to drive turbulent flow is greater than that required to drive laminar flow so turbulence increases cardiac work. Turbulent Laminar

14. Causes of turbulent flow Examples of turbulent flow: Flow across an obstruction (aortic stenosis, coarctation) Abnormally high flow velocity (high CO & reduced viscosity in severe anemia) Regurgitant flow across an incompetent heart valve Abnormal shunt from a high to low pressure chamber (ventricular septal defect) Presence of turbulent flow increases the likelihood of development of blood clots Flow in the vascular system is normally laminar. Turbulence occurs if Reynold’s number (N R ) exceeds 3000: Factors predisposing to development of turbulence in flowing fluid include: Greater density (  ) larger vessel diameter (D) High velocity (v) Low viscosity (  ) In addition, turbulence is likely in the presence of abrupt changes in vessel diameter or irregularities in vessel walls as may occur with atherosclerosis or other pathology.

15. Viscosity and hematocrit Viscosity of a fluid is its resistance to flow resulting from molecular cohesion. Blood is a complex mixture of fluid and cells; blood viscosity increases with hematocrit. Resistance to blood flow is proportional to viscosity (  ): 10305070 Hematocrit Normal hematocrit viscosity anemia polycythemia Viscosity of whole blood (solid line) relative to plasma (dashed line) as a function of hematocrit

16. Vessel diameter and viscosity of blood 0.10.20.30.40.5 Relative viscosity Vessel diameter, mm Blood viscosity decreases in vessels with diameter < 0.3 mm (300  m) Mechanism is complicated but the effect reduces resistance to blood flow. Most of the resistance in the systemic circulation is from arterioles with small diameters. Lower resistance reduces the work of the heart. Viscosity increases at low temperature, & may reduce blood flow in the extremities & contribute to frost bite.

17. Law of Laplace The law of Laplace states that tension (T) in the wall of a blood vessel equals the product of transmural pressure (P) and radius (r): Tension is a force acting tangential to the surface of a cylinder. P is transmural pressure (internal pressure minus external) Transmural pressure equals blood pressure minus tissue pressure. Extravascular tissue pressure is small & can be ignored so P T

18. Law of Laplace and tension in blood vessel walls T = Pr The amount of elastic tissue in the vessel wall correlates with the wall tension. Elastic tissue maintains wall integrity against the outward force of the pressure. The table shows that a very small tension in the wall of the capillaries suffices to withstand the intraluminal pressure. For comparison, the breaking strength of a strip of Kleenex one cm wide is about 50,000 dynes per cm, over 3000 times as great as the tension required to maintain a capillary wall.

19. Compliance of the aorta as an example of an elastic artery In this figure smooth muscle is relaxed pharmacologically so the vessel’s compliance is due primarily to the compliance of the elastic tissue. Compliance of elastic arteries is nearly constant over the physiological range of pressure. Relative volume, % Pressure, mm Hg 200 300 400 100 150200100 50 Compliance decreases slightly at higher pressures Slope = Compliance =  V/  P

20. Compliance in the vena cava as an example of a large vein In this figure smooth muscle is relaxed; the compliance is due primarily to the changes vessel geometry. Slope = Compliance =  V/  P Maximal physiological pressure Relative volume, % Pressure, mm Hg 200 300 400 100 15010050 Compliance decreases as cross section becomes circular

21. Contribution of collagen & elastic fibers to passive tension development Tension, dynes/cm x 10 3 Relative radius, % 80 120 160 40 Collagen fibers only 140160120100180 T= Pr elastic fibers only Intact artery Passive tension development (smooth muscle relaxed) with increasing radius in an intact artery or an artery with only collagen fibers (elastic fibers digested) or only elastic fibers (collagen fibers digested). Arterial segment studied in vitro by injecting fluid & measuring radius & tension. Collagen fibers are least compliant, develop greatest tension for a given radius.

22. Wall tension and pathological changes T = Pr Arteries: If weakening of the wall causes dilatation (aneurism), as the radius increases the tension required to maintain wall integrity increases. If the wall is too weak to maintain the tension, it will rupture. The heart: Pathological dilation of the heart as occurs in heart failure increases the radius of the ventricles. As a result, more tension must be generated to create a given pressure, increasing the work of the heart & causing progression of heart failure.