Western Visayas Medical Center

Department of Anesthesiology

CIRCULATORY PHYSIOLOGY
Presenters
Dr. Ricky Jaleco
Dr. Charmaine Ann Maranan
Dr. Caryll Jane Canarejo

Preceptors:
Dr. Agnes Bravo-Cortes
Dr. Mary Ann Arenga
Dr. Michael Toledo

Topics
1. Blood Vessel structure & function
2. Arterial & venous systems
3. Control of circulation, other special circulation

Arteries and veins are composed of three tunics:

 tunica interna
 tunica media
 tunica externa

Capillaries are composed of endothelium with sparse basal

lamina

Lumen – central blood-containing space surrounded by

tunics

1. Tunica Intima
 The inner layer (tunica intima) is the thinnest layer,
formed from a single continuous layer of endothelial cells and supported by a
subendothelial layer of connective tissue

 the tunica intima is surrounded by a thin membrane comprised of elastic fibers running
parallel to the vessel.

 Capillaries consist only of the thin endothelial layer of cells with an associated thin layer of
connective tissue. and supportive cells.
2. Tunica Media
 Surrounding the tunica intima is the tunica
media, comprised of smooth muscle cells and
elastic and connective tissues arranged
circularly around the vessel.

 This layer is much thicker in arteries than in

veins.

 Fiber composition also differs; veins contain

fewer elastic fibers and function to control
caliber of the arteries, a key step in
maintaining blood pressure.

3. Tunica Externa (Adventitia)

 The outermost layer is the tunica externa or tunica adventitia, composed entirely of
connective fibers and surrounded by an external elastic lamina which functions to anchor
vessels with surrounding tissues.

 The tunica externa is often thicker in veins to prevent collapse of the blood vessel and
provide protection from damage since veins may be superficially located.

VALVES Function
 A major structural difference between arteries and veins is the presence of valves.

 In arteries, the blood is pumped under pressure from the heart, so backflow cannot occur.
However, passing through the capillary network results in a decrease in blood pressure,
meaning that backflow of blood is possible in veins.

 To counteract this, veins contain numerous one-direction valves that prevent backflow.

Blood Vessel Function

 Blood vessels carry nutrients and oxygen throughout the body and aid in gas exchange

 The circulatory system can be split into two sections, systemic and pulmonary.

 In the systemic circulatory system, highly oxygenated blood (95-100%) is pumped from the
left ventricle of the heart and into the arteries of the body.

 The capillaries merge into venules and then veins, carrying the deoxygenated blood (~75%)
back to the right atrium of the heart at the end of the systemic circulatory system.

 Blood Vessel Function

 Blood vessels also facilitate the rapid distribution and efficient transport of factors such as
glucose, amino acids, or lipids into the tissues and the removal of waste products for
processing elsewhere, such as lactic acid to the liver or urea to the kidneys

 Arteries: blood from heart

 Strong & Elastic
 Conduct blood to capillaries
 Sphincters

 Capillaries:
 exchange with cells

 Veins
 Return blood to heart
 valves

Arteries
 Arteries are blood vessels that carry blood away from the heart under pressure. This blood is
usually oxygenated,

 with the exception of that in the pulmonary artery, which carries deoxygenated blood to the
lungs.

 Arterial pressure varies between the peak pressure during heart contraction, called the
systolic pressure, and the minimum or diastolic pressure between contractions, when the
heart expands and refills. 

Elastic Arteries:
 Elastic arteries include the largest arteries in the body, those closest to the heart. They give
rise to medium-sized vessels known as muscular, or distributing, arteries.

 Elastic arteries differ from muscular arteries both in size and in the relative amount of elastic
tissue contained within the tunica media.

 Arterial elasticity gives rise to the Windkessel effect, which helps to maintain a relatively
constant pressure in the arteries despite the pulsating nature of blood flow.

Muscular arteries
 Distributing arteries are medium-sized arteries that draw blood from an elastic artery and
branch into resistance vessels.

 In contrast to the mechanism elastic arteries use to store energy generated by the heart ‘s
contraction, distributing arteries contain layers of smooth muscle.
 major area of vasoconstriction & dilation to regulate blood flow

Arterioles
 smallest arteries; lead to capillary beds
 Control flow into capillary beds via vasodilation and constriction

VENULES
 Are formed when capillary beds unite
 small blood vessels in the microcirculation that connect capillary beds to veins.

POSTCAPILLARY VENULES
 smallest venules, composed of endothelium and a few pericytes

LARGE VENULES
 have one or two layers of smooth
 muscle (tunica media)

Veins
 Veins are blood vessels that carry blood from tissues and organs back to the heart; they have
thin walls and one-way valves

 Veins are also called capacitance vessels because they contain 60% of the body’s blood
volume.

 Veins contain a series of one-way valves, and they are squeezed, blood is pushed through the
valves, which then close to prevent backflow.

Veins - Mechanisms to Return Blood

 The return of blood to the heart is assisted by the action of the skeletal-muscle pump and by
the thoracic pump action of breathing during respiration.

 Standing or sitting for prolonged periods can cause low venous return from venous pooling.
In venous pooling, the smooth muscles surrounding the veins become slack and the veins fill
with the majority of the blood in the body, keeping blood away from the brain, which can
cause unconsciousness.

Capillaries
 A capillary wall is very thin and composed of (endothelium only) single layer of cells as it
does not have to withstand high internal pressure.

 A capillary wall is often highly permeable, partly because its very thin and partly because of
holes in and between cells in some capillaries (particularly those with high demand of
exchange e.g endocrine glands)

 Capillaries are the smallest blood vessels

 Walls consisting of a thin tunica interna, one cell thick

 Allow only a single RBC to pass at a time

 Pericytes on the outer surface stabilize their walls

 Capillaries
 There are three structural types of capillaries:
 continuous, fenestrated, and sinusoids

 Continuous Capillaries
 are abundant in the skin and muscles, and have:
 Endothelial cells provide an uninterrupted lining, only allowing small molecules like water
and ions to diffuse through tight junctions. This leave gaps of unjoined membrane called
intercellular clefts.

Continuous Capillaries
 Continuous capillaries of the brain:
 Have tight junctions completely around the endothelium
 Constitute the blood-brain barrier

Fenestrated Capillaries
 Found wherever active capillary absorption or filtrate formation occurs (e.g., small intestines,
endocrine glands, and kidneys)

 have pores in the endothelial cells (60-80 nanometers in diameter) that are spanned by a
diaphragm of radially-oriented fibrils. They allow small molecules and limited amounts of
protein to diffuse.

 Sinusoids
 Highly modified, leaky, fenestrated capillaries with large lumens

 Found in the liver, bone marrow, lymphoid tissue, and in some endocrine organs
 Allow large molecules (proteins and blood cells) to pass between the blood and surrounding
tissues

 Blood flows sluggishly, allowing for modification in various ways

Basic Principles of Circulatory Function

1. Blood flow to most tissues is controlled according to the tissue needs

2. Cardiac output is the sum of all the local tissue flows.

3. Arterial pressure regulation is generally independent of either local blood flow control or
cardiac output control.

 The pulmonary circulatory system circulates deoxygenated blood from the heart to the lungs
via the pulmonary artery and returns it to the heart via the pulmonary vein.

 The systemic circulatory system circulates oxygenated blood from the heart around the body
into the tissues before returning deoxygenated blood to the heart.

 resistance to flow must be overcome to push blood through the circulatory system. If
resistance increases, either pressure must increase to maintain flow, or flow rate must reduce
to maintain pressure
Resistance
 The resistance offered by peripheral circulation is known as systemic vascular resistance
(SVR)
 while the resistance offered by the vasculature of the lungs is known as pulmonary vascular
resistance (PVR).

Blood Pressure
 The pressure originates in the contraction of the heart, which forces blood out of the heart
and into the blood vessels.

 If flow is impaired through increased resistance then blood pressure must increase, so blood
pressure is often used as a test for circulatory health. Blood pressure can be modulated
through altering cardiac activity, vasoconstriction, or vasodilation.

Blood Flow
 A relatively constant flow is required by the body’s tissues, so pressure and resistance are
altered to maintain this consistency.

 A too-high flow can damage blood vessels and tissue, while flow that’s too low means tissues
served by the blood vessel may not receive sufficient oxygen to function.

Mechanisms of Blood Flow Control

 Acute control is achieved by rapid changes in local vasodilation or vasoconstriction of the
arterioles, metarterioles, and precapillary sphincters that occur within seconds to minutes to
provide rapid maintenance of appropriate local tissue blood flow.

 Long-term control means slow, controlled changes in flow over a period of days, weeks, or
even months. In general, these long-term changes provide even better control of the flow in
proportion to the needs of the tissues.

Short-Term Chemical Control

 Constriction or dilation of blood vessels alters resistance, increasing or decreasing blood
pressure respectively.

 Generalized vasoconstriction usually results in an increase in systemic blood pressure, but it

may also occur in specific tissues, causing a localized reduction in blood flow.

 Vasoconstriction results from increased concentration of calcium (Ca2+) ions within vascular
smooth muscle.

 When blood vessels dilate, the flow of blood is increased due to a decrease in vascular
resistance. Therefore, dilation of arterial blood vessels (mainly the arterioles) causes a
decrease in blood pressure.

 Localized tissues increase blood flow in multiple ways, including releasing vasodilators,
primarily adenosine, into the local interstitial fluid, which diffuses to capillary beds
provoking local vasodilation.

Long-Term Renal Regulation

 When blood volume is low, renin, excreted by the kidneys, stimulates production of
angiotensin I, which is converted into angiotensin II. This substance has many effects,
including increase in blood pressure due to its vasoconstrictive properties.

 The cells that excrete renin are called juxtaglomerular cells. When blood volume is low,
juxtaglomerular cells in the kidneys secrete renin directly into circulation. Plasma renin then
carries out the conversion of angiotensinogen released by the liver to angiotensin I.

 Aldosterone secretion from the adrenal cortex is induced by angiotensin II and causes the
tubules of the kidneys to increase the reabsorption of sodium and water into the blood,
thereby increasing blood volume and blood pressure.

 Humoral control of the circulation means control by substances secreted or absorbed into the
body fluids, such as hormones and locally produced factors. Some of these substances are
formed by special glands and transported in the blood throughout the entire body
 VASOCONSTRICTORS
- Norepinephrine and Epinephrine
- Angiotensin II
- Vasopressin
 VASODILATORS
- Bradykinin
- Histamine

Humoral Control of the Circulation

VASCULAR CONTROL BY IONS AND OTHER CHEMICAL FACTORS
 An increase in intracellular calcium ion concentration causes vasoconstriction because of the
general effect of calcium to stimulate smooth muscle contraction

 An increase in potassium ion concentration, within the physiological range, causes

vasodilation. This effect results from the ability of potassium ions to inhibit smooth muscle
contraction.

 An increase in magnesium ion concentration causes powerful vasodilation because

magnesium ions inhibit smooth muscle contraction.

Reference:
Guyton and Hall. Textbook of Medical Physiology. 14th ed