1. Physiology of the Circulatory System.

( BERATO, NAVARRO)

The general function of the our circulatory system is to maintain an appropriate environment in
all the tissue fluids of the body for survival and optimal function of the cells. 

The circulation is divided into the systemic circulation and pulmonary circulation.
Cross-sectional areas (total) of various blood pathways (cm )
2

cm 2
AORTA 2.5
SMALL ARTERIES 20
ARTERIOLES 40
CAPILLARIES 2500
VENULES 250
SMALL VEINS 80
VENA CAVA 8

Velocity of Blood Flow

Functional parts of the Circulation 

 Functions:
- Deliver needed materials such as oxygen and glucose to the cells of the body.
- Remove waste products such as carbon dioxide from the cells
- Fighting diseases by transporting white blood cells throughout the body.

 Arteries
o Are thick walled and muscular vessels
o To transport blood under high pressure to the tissues. 
o Moves rich oxygen away from the heart
  Arterioles
o The small branches of arteries that lead to capillaries.
o Comparatively thinner walls
o Regulates blood pressure and blood flow.
o They have strong muscular walls that can close the arterioles or can dilate the
vessels several fold, thus having the capability of vastly altering blood flow in
each tissue in response to its needs.

 Capillaries
o Are only one cell thick and have very flexible walls
o Capillary walls are thin and have many minute pores to serve its purpose.
o It connects to arteries (arterioles) to veins (venules) and allowas, gas, nutrient
and waste exchange.

 Venules
o Receive blood from the capillaries and gradually deliver them into progressively
larger veins

 Veins
o Conduits for transport of blood from venules back to the heart
o Major reservoir of extra blood because the pressure in the venous system is very
low and venous walls are thin.

Pressures in the Various Portions of the Circulation 

Basic Principles of Circulatory Function

 The rate of blood flow to each tissue of the body is

almost always precisely controlled in relation to
the tissue need.

 The cardiac output is controlled mainly by the sum of

all the local tissue flows.

 Arterial pressure regulation is generally independent

of either local blood flow control or cardiac
output control.
PATHOPHYSIOLOGY OF HYPERTENSION
Can be:
1. PRIMARY “ESSENTIAL” – 95%
2. SECONDARY – 5%

NORMAL
ELEVATED

BASIC CONCEPT:

ESSENTIAL HYPERTENSION

- Hemodynamic effect of hormonal, neural and renal dysregulation of blood

pressure.
- Pathogenesis is probably a slow and gradual process
 - No single or specific cause
- Initiating Factors may no longer be apparent when hypertension is developed,
since they have been normalized by the compensatory interactions
1. Initial phase: Increase Cardiac Output
2. Late phase: Increase peripheral arteriolar resistance , cardiac output is
normalized.

MECHANISM OF ESSENTIAL HYPERTENSION

- Increase activity of Renin- Angiotensin Aldosterone

- Hyperfunction of sympathetic system
- Vasoactive substances – endothelial function
- Insulin resistance – obesity
- Arteriolar hypertrophy
- Renal defect to excrete sodium
HYPERFUNCTION OF SYMPATHETIC SYSTEM

- Primary increase activity of vasomotor neurons

 - Angiotensin 11 and endothelin increases activity of vasomotor neurons
- Noepinephrine potentiates renin releasing.

VASOACTIVE SUBSTANCE
- Influence on vascular tone and sodium transport
1. Endothelin
2. Digitalis (ouabain) – like substance
3. Natriuretic peptides

SODIUM TRANSPORT ACROSS VASCULAR SMOOTH MUSCLE CELL MEMBRANE

1. Sodium retention – activation of natriuretic mechanisms

2. Digitalis – like inhibitor of Na, K, ATP-ase.
HYPERTROPHY OF ARTERIOLAR WALL
ROLE OF KIDNEYS

1st phase: Normal kidneys and sodium excretion , sympathetic hyperactivity, R-A stimulation.
= RENAL VASOCONSTRICTION
2nd phase: Tubular ischemia – interstitial inflammation – decrease ultrafiltration and increase Na
reabsorption
= INCREASE BLOOD PRESSURE

3rd phase: Elimination of tubular ischemia; sodium excretion is normal

= BLOOD PRESSURE IS MORE INCREASED AFTER ENHANCED SALT INTAKE