PULSE AND BLOOD PRESSURE

Rhythmic expansion and recoil of an arterial wall can be felt as a pulse in an artery close to the bodys surface. Blood pressure is the pressure of blood against the wall of a blood vessel (The
force exerted by the blood against the blood vessels wall with unit area (in mmHg))

P [1mm Hg] = 133,3 Pa

MAP and pulse pressure decrease with distance from heart Blood pressure decreases with friction Pulse pressure decreases due to elastic rebound

Highest pressure, systolic pressure, is reached when blood ejects from the heart.

Lowest pressure, diastolic pressure is reached when the ventricles are relaxing.
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Pulse Pressure & Mean Arterial Pressure

HEMODYNAMICS
Blood pressure = Cardiac output x Peripheral resistance

1 Pa Pd + ( Ps - Pd ) 3
Pulse Pressure: the difference between systolic and diastolic pressure (40 mmHg) Mean arterial pressure: the arterial pressure averaged over the cardiac cycle (90-95 mmHg)
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BP = CO x PR
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Cardiac output
Cardiac output (CO) is the amount of blood pumped by each ventricle per minute

CO is the product of heart rate (HR = number of heart beats per minute) times the stroke volume (SV= amount of blood pumped out by a ventricle with each beat) CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat) CO = 5250 ml/min (5.25 L/min)

BP = HR x SV x PR
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Stroke Volume (SV)

Volume of blood pumped per contraction (per heart beat) SV = EDV ESV End-diastolic volume (EDV) volume of blood in ventricle before contraction End-systolic volume (ESV) volume of blood in ventricle after contraction Normal Value 60-70 mL

Ejection Fraction (EF)

A parameter related to SV is Ejection Fraction (EF)
EF is the fraction of blood ejected by the Left Ventricle (LV) during the contraction or ejection phase of the cardiac cycle

Ejection Fraction (EF) = (SV / EDV) 100%

Normal range 60-75% of EDV

Cardiovascular disease can be associated with increased Q as occurs during infection and sepsis, or decreased Q, as in cardiomyopathy and heart failure

Cardiac Output (CO) = SV HR

Preload
Definition Volume in ventricle at the end of diastole. OR Pressure exerted on walls of ventricle at the end of diastole. Represents fluid returning to heart Also known as filling pressure

Right ventricle preload CVP

(Central Venous Pressure)

Left ventricle preload PAOP

(Pulmonary Artery Occlusion Pressure)
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Afterload
Definition Amount of pressure the ventricle must work against during systole to open the valve. Factors that increase afterload: Vasoconstriction Valvular stenosis blood volume Factors that decrease afterload Vasodilation
Right ventricle afterload PVR (Pulmonary Vascular Resistance) Left ventricle afterload SVR (Systemic Vascular Resistance)
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Systemic Vascular Resistance (SVR)

Definition The resistance the left ventricle must pump against to eject its volume This resistance is created by the systemic arteries and arterioles SVR => Cardiac Output SVR => Cardiac Output Systemic Vascular Resistance (SVR) - Causes: Vasoconstriction Catacholamine release Hypertension Cardiogenic shock Cardiac tamponade
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Systemic Vascular Resistance (SVR)

Systemic Vascular Resistance (SVR) Causes: Vasodilation Vasodilator therapy Septic shock (hyperdynamic)

Contractility
Definition The hearts contractile force or muscle strength Factors that influence contractility: Starlings Law Sympathetic nervous system Pharmacologic agents

Pulmonary Vascular Resistance (PVR)

Definition The resistance the right ventricle must pump against to eject its volume This resistance is created by the pulmonary arteries and arterioles Causes of PVR Pulmonary vessel constriction due to PaO2 PaCO2 Pulmonary embolus
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Contractility
Starlings Law The force of ventricular ejection is related to: The volume in the ventricle at enddiastolic (preload). The amount of myocardial stretch placed on the ventricle.

Sympathetic Nervous System

SNS fibers are found throughout the atria and ventricles The most important regulatory factor for myocardial contractility
Cardiac plexuses: innervate heart Vagus nerves (X): carry parasympathetic preganglionic fibers to small ganglia in cardiac plexus

Cardiac centers monitor: baroreceptors (blood pressure) chemoreceptors (arterial oxygen and carbon dioxide levels)
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Cardiac centers of medulla oblongata: cardioacceleratory center: controls sympathetic neurons (increase heart rate) cardioinhibitory center: controls parasympathetic neurons (slow heart rate)

Baroreceptor reflexes
-Carotid sinus reflex Receptors in carotid artery wall Sensory input to cardiovascular center in medulla Maintains normal BP in the brain -Aortic reflex Receptors in wall of ascending aorta Sensory input to cardiovascular center in medulla Maintains general systemic BP

Factors Involved in Regulation of Cardiac Output

(Blood pressure)

Chemoreceptor reflexes
Carotid bodies and aortic bodies Detect changes in blood levels of O2, CO2, and H+ (hypoxia, hypercapnia or acidosis ) Causes stimulation of cardiovascular center Increases sympathetic stimulation to heart & vessels Cardiac output and increase in blood pressure Also change breathing rates
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Factors Affecting Stroke Volume

Changes in EDV or ESV
SV = EDV ESV

Venous pressure and venous return

Venous pressure is very low and can not account for return of blood to heart Factors that aid in venous return
- Contraction of skeletal muscles squeeze Veins and push blood toward heart - Breathing squeeze pulmonary vessels - Venous valves prevent backflow of blood once it is squeezed past them

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Peripheral Resistance
Amount of friction blood encounters through vessels (all vascular resistance within the systemic circulation)

Peripheral Resistance
Resistance directly proportional to length of vessel and to the viscosity of the blood Inversely proportional to 4th power of the radius of the vessel

Poiseulles Law

R=

8L r4

Depends on:

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Peripheral Resistance
Poiseulles Law R= 8L r4
Adult vessel length is constant Vessel diameter varies by vasodilation and vasoconstriction

RESISTANCE TO FLOW IN THE CARDIOVASCULAR SYSTEM

Rt = R1 + R2 + R3. SERIES RESISTANCE 1/Rt = 1/R1 + 1/R2 + 1/R3 PARALLEL RES.

Advantages of Parallel Circuitry Independence of local flow control increase/decrease flow to tissues independently Minimizes total peripheral resistance (TPR) Oxygen rich blood supply to every tissue

R1

R2

R3
R1 R2 R3

LOWER R

HIGHER R

LOWER R

Total peripheral resistance is mainly determined by arterioles (6070%) Resistance and arterial blood pressure affect blood flow of organs
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ARTERY

ARTERIOLES

CAPILLARIES

Greatest R is in arterioles... 24 ...peripheral resistance

Blood Flow & Resistance

Blood flow (Q)amount of blood flowing through organ, tissue per given time (ml/min)

Blood Flow & Poiseuilles Law

describe blood flow in arteries

Blood flow = P/resistance = Pr4 8L But vessel length (L) and blood viscosity () do not vary significantly Viscosity
Viscosity reflects a resistance to flow caused by the internal friction between layers of a fluid.

Q = Volume / Time
Combination of pressure & resistance

V analogy with Ohms law I = R

The greater the viscosity, the greater the stress required to get the layers of the liquid to slide past each other and the slower the liquid will move. Whole blood viscosity is about 4 times that of water
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Increased resistance decreases blood flow

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Systemic circuit blood flow

Aortafastest flow due to Large blood volume and close to pressure source Capillaries low velocity flow due to Blood traveled great distance and friction slowed it down Smaller diameter increased resistance More vessels going into larger area away from the heart (fast river, flows into lake) Small artery and arteriole - resistance vessels are regulated by neurohumoral factors Veinshigh velocity Large diameter with less resistance Many capillaries converge on a vein (lake into stream) Never reach artery pressure
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Compliance
is the ability of a vessel to stretch and hold volume Compliance = Volume / Pressure

In systemic arteries a small volume is associated with a large pressure In systemic veins a large volume is associated with a small pressure

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Cardiovascular Physiology

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Hypertension - Definition
Hypertension can be defined as the level of blood pressure at which there is risk to the organs or vasculature.

Primary Hypertension - Definition

The category of hypertension when the cause is unknown. There are probably several different genetic causes as well as a complex interplay of polygenetic and environmental factors.

Category optimal normal high-normal Hypertension stage 1 stage 2 stage 3

Systolic (mmHg) <120 < 130 130-139 140-159 160-179 _ > 180

Diastolic (mm Hg) < 80 < 85 85-89 90-99 100-109 _ >110

Includes approximately 90% of cases. Also referred to as essential hypertension. Approximately 20% of all adults are affected. Even though the underlying cause usually is not known, hypertension can usually be very effectively treated.

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Secondary Hypertension - Definition

The category of hypertension when the cause is secondary to renal, endocrine, anatomic disorders etc. Includes approximately 10% of cases.

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Factors that influence mean arterial pressure

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