Guyton Hall PHYSIOLOGY Chapter 15 PDF

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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

VASCULAR DISTENSIBILITY 400mL of blood, the pressure falls to zero.


▪ Expressed as: Fractional increase in volume for each mmHg rise o Entire systemic venous system:
in pressure ▪ Volume normally ranges from 2000-3500mL; change of
o 1mm Hg = 10mL of blood  its volume by 1mL--- the several hundred mL in volume is required to change the
distensibility would be 0.1 per mm Hg, or 10% per mm venous pressure only 3-5 mm Hg.
Hg. ▪ This mainly explains why as much as 1/2 L of blood
▪ Arteries can be transfused into a healthy person in only a few
▪ Accommodate the pulsatile output of the heart minutes without greatly altering function of the circulation.
▪ Average out the pressure pulsations ▪ Effects on volume-pressure curves:
▪ Provides smooth, continuous flow through very small blood o Sympathetic stimulation
vessels. ▪  vascular smooth muscle tone ( cardiac output)
▪ Veins ▪  pressure at each volume of the arteries or veins.
▪ Most distensible--- reservoir function o Sympathetic inhibition
▪ Slight  venous pressure cause veins to store 0.5-1.0 L of ▪  pressure at each volume
extra blood. o Sympathetic control of vascular capacitance
▪ Systemic Arteries: Walls are far stronger ▪ Highly important during hemorrhage
▪ Systemic Veins: Walls are considerably strong; 8x more ▪ Enhancement of sympathetic tone, especially to the veins,
distensible;  pressure = 8x  blood in a vein reduces the vessel sizes enough that the circulation
▪ Pulmonary vein: Distensibilities are similar to systemic continues to operate almost normally even when as much
circulation. as 25% of the total blood volume has been lost.
▪ Pulmonary arteries: operate under pressures about 1/6 of those in
the systemic arterial system; 6x more distensible than systemic ARTERIAL PRESSURE PULSATIONS
arteries. ▪ Heart beat means new surge of blood that fills arteries.
▪ Arterial compliance normally  pressure pulsations to almost
VASCULAR COMPLIANCE (VASCULAR CAPACITANCE) no pulsations by the time the blood reaches the capillaries;
▪ Total quantity of blood that can be stored in a given portion therefore, tissue blood flow is continuous with very little
of the circulation for each mm Hg pressure rise. pulsation.
▪ Compliance and Distensibility are quite different ▪ Pressure pulsations (root of the aorta):
o A highly distensible vessel that has a slight volume may o Top of each pulse (systolic pressure): 120 mm Hg.
have far less compliance than a much less distensible o Lowest point of each pulse (diastolic pressure): 80 mm Hg.
vessel that has a large volume because compliance is o Difference: 40 mm Hg (pulse pressure)
equal to distensibility x volume. ▪ Factors affecting/determining pulse pressure:
o Compliance of systemic vein is 24x that of its o Stroke volume output of the heart
corresponding artery because it is 8x as distensible and it o Compliance (total distensibility) of the arterial tree.
has a volume 3x as great (8 × 3 = 24). o Character of ejection from the heart during systole
▪ Delayed Compliance (Stress-Relaxation) Of Vessels ▪  stroke volume output =  amount of blood that must be
o Vessel exposed to  volume initially  pressure; but accommodated in arterial tree per heartbeat =  pulse
progressive returns to normal. pressure
o Stress-relaxation. ▪  compliance of arterial system - rise in pressure for
o  Blood volume causes immediate elastic distention of stroke volume of blood pumped into the arteries.
the vein, but then the smooth muscle fibers of the vein ▪ Pulse pressure (elderly) rises to as much as 2x normal,
begin to “creep” to longer lengths, and their tensions because arteries have become hardened with arteriosclerosis
correspondingly . (relatively noncompliant).
o Allows circulation to accommodate extra blood when
necessary (blood transfusion). ABNORMAL PRESSURE PULSE CONTOURS
o Reverse direction ▪ Causes of abnormal contours of the pressure pulse wave:
o circulation automatically adjusts itself over a period of o Aortic valve stenosis
minutes or hours to diminished blood volume after serious ▪ Diameter of aortic valve opening is reduced significantly,
hemorrhage. and aortic pressure pulse is  significantly because of
diminished blood flow outward through the stenotic valve.
VOLUME-PRESSURE CURVES o Ductus arteriosus
▪ Volume-pressure curve ▪ 1/2 or more of blood pumped into the aorta by the left
o Relation of pressure to volume in a vessel or in any ventricle flows immediately backward into the pulmonary
portion of the circulation. artery and lung blood vessels, thus allowing the diastolic
o Normal systemic arterial system and venous system: pressure to fall very low before the next heartbeat.
▪ When the arterial system of the average adult person is o Aortic regurgitation
filled with about 700mL of blood--- the mean arterial ▪ Aortic valve is absent or will not close completely.
pressure is 100 mm Hg, but when it is filled with only Therefore, after each heartbeat, blood pumped into the

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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.

EFFECT OF GRAVITATIONAL PRESSURE ON VENOUS BLOOD RESERVOIR FUNCTION OF THE VEINS


PRESSURE ▪ Blood - more than 60% located in veins
▪ Body of water that is exposed to air: ▪ Compliant- serves as blood reservoir for the circulation
o Pressure at the surface of the water = atmospheric ▪ Blood loss → arterial pressure  →nervous signals are
pressure. elicited from carotid sinuses and other pressure-sensitive areas
o For each 13.6 mL of distance below the surface: pressure of the circulation → elicit nerve signals from brain and spinal
rises 1 mm Hg---- pressure results from the weight of the cord (sympathetic nerves) to the veins → constriction.
water and therefore is called gravitational pressure or Specific Blood Reservoirs
hydrostatic pressure. ▪ Certain portions of the circulatory system that are so
▪ Gravitational pressure extensive and/or so compliant.

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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 Spleen - can  in size to release as much as 100 mL


of blood
o Liver- sinuses can release several hundred mL of blood
o Large abdominal veins - can contribute as much as 300 mL
o Venous plexus beneath the skin - can contribute several
hundred mL.
▪ Heart and Lungs
o Heart shrinks during sympathetic stimulation and can
contribute some 50-100 mL of blood.
o Lungs can contribute another 100- 200 mL when the
pulmonary pressures decrease to low values.

THE SPLEEN AS A RESERVOIR FOR STORING RED BLOOD


CELLS
▪ Areas for storing blood:
o Venous sinuses - can swell and store whole blood
o White pulp
o Red Pulp- capillaries are so permeable that whole blood,
including RBCs, oozes through capillary walls into a
trabecular mesh.
▪ Special reservoir that contains large quantities of
concentrated RBCs expelled into the general circulation
when sympathetic nervous system becomes excited and
causes its vessels to contract.
▪ As much as 50 mL of concentrated RBCs can be
released into the circulation, raising the hematocrit 1-2%.

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