Regulation of organ perfusion

Autoregulation
• Myogenic autoregulation: Myocytes in the walls of arteries and arterioles react to
changes in blood pressure to maintain constant blood flow in the blood vessels.
o Sites of action: almost all organs (especially the kidneys and brain)
except the lungs
• Local metabolites
o Mechanism of action: the release of vasoactive substances
▪ Nitric oxide (NO)
▪ Produced in endothelium by NO-
synthase from arginine → vasodilation
▪ NO production is triggered by:
▪ Increased BP
▪ Activation of endothelial receptors by
binding of vasoactive substances
(e.g., serotonin, bradykinin) → increased
release of NO
▪ Other substances: kinin, histamine, serotonin, prostaglandins,
thromboxane
Central regulation
• Differing effects of catecholamines
o Epinephrine: acts on both receptor types but has a greater affinity
for beta-2 receptors
▪ Low concentrations: stronger effect on beta-2
receptors → vasodilation
▪ High concentrations: stronger effect on alpha-1
receptors → vasoconstriction
o Norepinephrine: mainly acts on alpha-1 receptors → vasoconstriction
Autoregulation of specific organs
• Heart
o Local metabolic autoregulation: Adenosine and NO
cause vasodilation of the coronary arteries to increase blood flow
and oxygen delivery to the myocardium.
 o Has the highest arteriovenous O2 difference of all organs
(O2 extraction at rest ∼ 60–80%)
o During exercise, there is limited capacity to
increase myocardial oxygen extraction (small coronary flow reserve).
• Lungs
o Adjustment of vascular perfusion to ventilation
o Hypoventilation (hypoxia) causes vasoconstriction (Euler-Liljestrand
mechanism).
• Kidneys
o Myogenic autoregulation
o Tubuloglomerular feedback
• Brain
o Local metabolic autoregulation (CO2, pH) → vasodilation
o Myogenic autoregulation
• Skeletal muscle
o At rest: sympathetic innervation
o During exercise: local metabolic and chemical autoregulation due to an
increase in H+, lactate, CO2, adenosine, and K+
o Blood flow can be increased (20–30 times) during exercise
▪ Local metabolic and chemical autoregulation due to an
increase in H+, lactate, CO2, adenosine, and K+
• Skin
o Mainly sympathetic innervation (vasoconstriction)

The lungs are the only organs in which hypoxia causes vasoconstriction. This is to ensure
that perfusion only occurs in areas that are well ventilated. In all other
organs, hypoxia leads to vasodilation to improve perfusion and maintain oxygen supply.
To remember the local metabolites used in autoregulation of skeletal muscle, consider to
“CAll HuLK”: CO2, Adenosine, H+, Lactate, K+.