Guyton Hall PHYSIOLOGY Chapter 15 PDF
Guyton Hall PHYSIOLOGY Chapter 15 PDF
Guyton Hall PHYSIOLOGY Chapter 15 PDF
Systems
Reference: Guyton & Hall Textbook of Medical Physiology
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TRANS Chapter Title: Circulation: Vascular Distensibility and Functions of the Arterial and Venous
Systems
Reference: Guyton & Hall Textbook of Medical Physiology
aorta flows immediately backward into the left ventricle. o caused by blood jetting through partly occluded vessel and
▪ Aortic pressure can fall all the way to zero between by vibrations of the vessel wall.
heartbeats. o The jet causes turbulence in the vessel beyond the cuff,
▪ There is no incisura in the aortic pulse contour because and this sets up the vibrations heard through the
there is no aortic valve to close. stethoscope.
▪ Auscultatory method:
TRANSMISSION OF PRESSURE PULSES TO THE PERIPHERAL o Determine systolic and diastolic arterial pressures; not
ARTERIES accurate.
▪ Systole (heart ejects blood into the aorta): o Pressure is elevated well above arterial systolic pressure
o Proximal portion of aorta becomes distended---- because the (brachial artery collapses) ---no blood jets into the lower
inertia of blood prevents sudden blood movement all the artery; no Korotkoff sounds.
way to the periphery. o Pressure falls below systolic pressure---- blood begins to
o The rising pressure in proximal aorta rapidly overcomes slip through the artery during peak of systolic pressure----
inertia, and the wave front of distention spreads farther and begin to hear tapping sounds (antecubital artery) =
farther along the aorta. SYSTOLIC PRESSURE
▪ Velocity of pressure pulse transmission: o Pressure in the cuff is lowered ---- Korotkoff sounds change
o Normal aorta: 3-5m/sec in quality (less tapping and more rhythmical and harsher
o Large arterial branches: 7-10m/sec quality).
o Small arteries: 15-35m/sec o Pressure in the cuff falls near DIASTOLIC PRESSURE,
▪ The greater the compliance of each vascular segment, the slower sounds suddenly change to a muffled quality.
the velocity--- explains the slow transmission in the aorta and
the much faster transmission in the much less compliant small NORMAL ARTERIAL PRESSURES
distal arteries. in pressure with age is due to aging on the blood pressure
▪ Aorta: velocity transmission of pressure pulse is 15x or more control mechanisms.
of the velocity of blood flow--- pressure pulse is simply a ▪ Kidneys: primarily responsible for long-term regulation
moving wave of pressure that involves little forward total ▪ Slight extra increase in systolic pressure usually occurs
movement of blood volume. beyond the age of 60 years ---- resulting from distensibility,
or “hardening,” of arteries (atherosclerosis)
DAMPING OF THE PRESSURE PULSES IN THE SMALLER ▪ Mean Arterial Pressure:
ARTERIES, ARTERIOLES, AND CAPILLARIES o The average arterial pressures measured millisecond by
▪ Typical changes in contours of the pressure pulse as the millisecond over a period of time.
pulse travels into the peripheral vessels. o Not equal to the average of systolic and diastolic pressure
o Intensity of pulsation in smaller arteries, arterioles, and, --- rather 60% diastolic pressure and 40% systolic pressure.
especially, the capillaries.
o Only when the aortic pulsations are extremely large or the VEINS AND THEIR FUNCTIONS
arterioles are greatly dilated can pulsations be observed in ▪ Blood reservoir
the capillaries. ▪ Venous pump (propel blood forward and help to regulate
▪ Damping: cardiac output)
o Progressive diminution of pulsations in the periphery is Venous Pressures:
called damping of the pressure pulses. ▪ Right Atrial Pressure (Central Venous Pressure) - pressure in the
o Degree of damping is almost directly proportional to the right atrium
product of resistance x compliance. o Regulated by a balance between:
o Cause is two-fold: ▪ The ability of the heart to pump blood out of the right
▪ Resistance to blood movement in the vessels atrium and ventricle into the lungs.
o The resistance damps the pulsations because a small ▪ Right heart pumping = right atrial pressure
amount of blood must flow forward at the pulse wave ▪ Weakness of the heart = right atrial pressure
front to distend the next segment of the vessel o The tendency for blood to flow from the peripheral veins
o The greater the resistance, the more difficult it is for into the right atrium.
this to occur. ▪ Peripheral Venous Pressures
▪ Compliance of the vessels o Rapid inflow of blood into the right atrium from peripheral
o The compliance damps the pulsations because the more veins elevates right atrial pressure.
compliant a vessel, the greater the quantity of blood o Factors that increases venous return (right atrial pressure)
required at the pulse wave front to cause an increase are:
in pressure. ▪ blood volume
CLINICAL METHODS FOR MEASURING SYSTOLIC AND ▪ large vessel tone ( peripheral venous pressures)
DIASTOLIC PRESSURES ▪ Dilatation of arterioles ( peripheral resistance; allows
▪ Korotkoff sounds rapid blood flow from arteries to veins)
o Nikolai Korotkoff (1905) ▪ Normal right atrial pressure:
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TRANS Chapter Title: Circulation: Vascular Distensibility and Functions of the Arterial and Venous
Systems
Reference: Guyton & Hall Textbook of Medical Physiology
o Normal: 0 mm Hg (equal to atmospheric pressure) o Occurs in vascular system because of the weight of the
o Increases to 20-30mm Hg under very abnormal conditions: blood in vessels.
▪ Serious heart failure o Person standing: right atrium pressure remains 0mm Hg
▪ Massive transfusion---- total blood volume; causes (heart pumps excess blood that accumulates into arteries)
blood flow to the heart from peripheral vessels. o Person standing absolutely still: pressure in veins of the feet
o Lower limit: −3 to −5 mm Hg below atmospheric pressure--- is +90 mm Hg (gravitational weight of blood in veins
heart pumps with exceptional vigor or when blood flow into between the heart and feet)
the heart from peripheral vessels is greatly depressed o Venous pressures at other levels of the body are
(severe hemorrhage) proportionately between 0 mm Hg- 90 mm Hg.
▪ Arm veins:
VENOUS RESISTANCE AND PERIPHERAL VENOUS PRESSURE o Pressure at the level of the top rib: +6 mm Hg (compression of
▪ Large veins--- generally little resistance when distended (almost subclavian vein)
zero resistance) o Length of the arm: pressure is determined by the distance
▪ However, large veins do offer some resistance to blood flow--- below the level of this rib.
pressure in peripheral small veins in a person lying down is o Thus, if the gravitational difference between the level of the
usually +4 to +6 mm Hg greater than the right atrial rib and the hand is +29 mm Hg, this gravitational pressure
pressure. is added to +6 mm Hg pressure, making a total of +35 mm
o Veins in the thorax - compressed at many points by Hg pressure in the veins of the hand.
surrounding tissues impeding blood flow. ▪ Neck veins of a person standing upright:
o Veins from the arms- compressed by sharp angulations over o Collapses almost completely because of atmospheric
the first rib. pressure outside the neck---- causes pressure in veins to
o Neck veins - pressure falls so low that atmospheric remain at zero along their entire extent.
pressure on the outside of the neck causes veins to ▪ pressure →opens the veins and allows the pressure
collapse. to fall back to zero because of flow of the blood.
o Veins coursing the abdomen - often compressed by different ▪ pressure → collapses the veins more, which further
organs and by intra- abdominal pressure; usually are at resistance and again returns the pressure back to
least partially collapsed to an ovoid or slitlike state. zero.
▪ Veins inside the skull:
EFFECT OF HIGH RIGHT ATRIAL PRESSURE ON PERIPHERAL o Located in a noncollapsible chamber (the skull cavity) so
VENOUS PRESSURE that they cannot collapse.
▪ right atrial pressure rises → blood begins to back up in o Consequently, negative pressure can exist in the dural
the large veins→ veins enlarges→ collapse points in veins sinuses of the head.
open up when right atrial pressure rises above +4 - +6mm Hg. o Standing position: venous pressure in the sagittal sinus at
▪ right atrial pressure → additional increase causes a the top of the brain is about −10 mm Hg (hydrostatic
corresponding peripheral venous pressure. “suction” between the top and the base of the skull)
o Therefore, if the sagittal sinus is opened during surgery, air
EFFECT OF INTRA-ABDOMINAL PRESSURE ON VENOUS can be sucked immediately into the venous system; the air
PRESSURES OF THE LEG may even pass downward to cause air embolism in the
▪ Pressure in the abdominal cavity of a recumbent person: heart, and death can ensue.
o Average: +6 mm Hg
o Increases: +15 to +30mm Hg --- pregnancy, large tumors, EFFECT OF THE GRAVITATIONAL FACTOR ON ARTERIAL AND
abdominal obesity, or excessive fluid (called “ascites”) OTHER PRESSURES
o intra-abdominal pressure = pressure in veins of the legs ▪ Gravitational factor affects pressures in peripheral arteries,
must above abdominal pressure before abdominal veins capillaries, and veins.
open and allow blood to flow from the legs to the heart. ▪ Standing person:
o Thus, if the intra-abdominal pressure is +20mm Hg, the lowest o Mean arterial pressure (heart level) : 100 mm Hg
possible pressure in the femoral veins is also about +20 mm Hg. o Mean arterial pressure (feet): 190 mm Hg.
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https://www.coursehero.com/file/117913252/Guyton-Hall-PHYSIOLOGY-Chapter-15pdf/
TRANS Chapter Title: Circulation: Vascular Distensibility and Functions of the Arterial and Venous
Systems
Reference: Guyton & Hall Textbook of Medical Physiology
This study source was downloaded by 100000836080595 from CourseHero.com on 03-20-2023 21:24:28 GMT -05:00 4
https://www.coursehero.com/file/117913252/Guyton-Hall-PHYSIOLOGY-Chapter-15pdf/
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