Guyton:
• Venous return (blood returning to the heart) is essential for maintaining cardiac output.
• The amount of blood returned to the heart affects how much blood the heart pumps out
Blood Flow into Right Atrium:
Blood from all the systemic veins flows into the right atrium of the heart.
Therefore, pressure in the right atrium is referred to as the central venous pressure.
Regulation of Right Atrial Pressure:
Right atrial pressure is regulated by the balance between:
1. The ability of the heart to pump blood out of the right atrium and ventricle into the lungs.
2. The tendency of blood flow from peripheral veins into the right atrium.
Strong pumping: When the right side of the heart pumps blood strongly, it reduces the pressure in the right
atrium.
Conversely
Weak Pumping: if the right side of the heart is not pumping effectively (weakness), it allows the pressure in the
right atrium to increase.
Rapid Blood Inflow: If a lot of blood rushes quickly into the right atrium from the body's veins, it raises
the pressure.
RAPID INFLOW AND WEAK PUMPING causes increase pressure, while strong pumping reduces pressure in the
right atrium
Factors increasing venous return and right atrial pressure:
1. Increased Blood Volume:
If there's more blood in your body (increased blood volume), it naturally increases the pressure in the right
atrium.
Think of a balloon getting fuller; as it fills up with more air (blood), it expands and the pressure inside rises.
2. Increased Large Vessel Tone:
When the larger blood vessels in your body tighten, it puts more pressure on the veins.
Imagine squeezing a water hose; the tighter you squeeze, the harder it is for water (blood) to flow, and
pressure builds up.
3. Arteriolar Dilation:
If the (arterioles) widen, it lowers the resistance to blood flow in the peripheral vessels.
The things that control the pressure in the right atrium also play a role in managing how much blood the heart
pumps. And so with that, Cardiac output is how much blood the heart pumps in a given time.
It depends on two main things:
1. Heart’s Pumping Ability: How strong the heart is in pushing blood out.
2. Blood Flow into the Heart: The tendency for blood to enter the heart from the body's vessels.
So how does the pressure in the right atrium affect Cardiac Output
1. If the heart pumps well (strong pumping) and blood flows smoothly into the heart cardiac output is
generally good.
2. On the other hand, if the heart is weak or there are problems with blood flow into the heart, cardiac output
may be affected.
Increased cardiac output may lead to a decrease in atrial pressure due to enhanced blood flow and reduced blood
accumulation in the atria.
Weak pumping is more likely to decrease cardiac output and may lead to increased atrial pressure due to insufficient
ejection of blood.
Normal and Abnormal Right atrial pressures
Normal Right Atrial Pressure:
In a healthy situation, the pressure in the right atrium is around 0 mm Hg, which is the same as the
atmospheric pressure around us.
Abnormal Increase in Right Atrial Pressure:
Sometimes, due to certain problems like serious heart failure or a large amount of blood transfused into the
body, the right atrial pressure can shoot up to 20-30 mm Hg.
Lower Limit in Special Cases:
In some cases, during vigorous heart pumping or after severe bleeding (hemorrhage), the right atrial pressure
can approach -3 to -5 mm Hg below atmospheric pressure.
Substances that can cross the capillary wall and the mechanisms
Capillary Membrane and Diffusion:
The capillary membrane is important for transferring substances between plasma (liquid component of blood)
and interstitial fluid (fluid surrounding cells).
it's like a tiny exchange system happening in the capillaries, where water and small particles move between
the blood and the fluid around our cells, making sure everything gets mixed up nicely.
1. Substances Easily Diffusing:
Electrolytes, nutrients, and waste products of metabolism can easily diffuse through the capillary membrane.
However, proteins are an exception; they do not readily pass through the capillary membrane.
2. Lipid-Soluble Substances:
Lipid-soluble substances, like oxygen and carbon dioxide, can directly diffuse through the cell membranes of
the capillary endothelium.
This direct diffusion is faster compared to lipid-insoluble substances, which can only go through pores in the
membrane.
2. Water-Soluble, Non-Lipid-Soluble Substances:
Water-soluble substances, such as water molecules, sodium ions, chloride ions, and glucose, cannot pass
through the lipid membranes of endothelial cells.
These substances diffuse through intercellular pores in the capillary membrane,
lipid-soluble substances pass through more easily than water-soluble substances has to do with the nature
of the cell membranes of the capillary endothelium being made up of lipids
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Lymph Channels in the Body
Almost every part of the body has special channels called lymph channels that help drain extra fluid from
spaces between cells.
Exceptions
Some parts like the outer skin, central nervous system, muscles' endomysium, and bones don't have these
channels directly. However, there are tiny channels called prelymphatics. These allow fluid to flow, and
eventually, it joins the lymphatic vessels.
Drainage into Thoracic Duct
Lymph vessels from the lower part of the body all join together into a big duct called the thoracic duct.
This duct then connects to the blood system at a point where the left internal jugular vein and left subclavian
vein meet.
Lymph from Different Areas
Lymph from the left side of the head, left arm, and parts of the chest go into the thoracic duct before entering
the veins.
Lymph from the right side of the neck and head, right arm, and parts of the right chest enter the right lymph
duct (smaller than the thoracic duct). This duct joins the blood system where the right subclavian vein and
internal jugular vein meet.
Fluid Movement in Capillaries:
1. MAJORITY: reabsorbed back into the venous ends of blood capillaries.
2. one-tenth of this fluid: enters lymphatic capillaries instead and eventually returns to the blood via lymphatic
system.
Importance of Lymphatic System:
The fluid returning through the lymphatic system is called lymph. It only amounts to 2 to 3 liters per day.
The lymph This carries important substances, especially proteins, which are of high molecular weight and
cannot be absorbed by regular blood capillaries.
Special Structure of Lymphatic Capillaries:
Lymphatic capillaries have a unique structure.
imagine the cells of these capillaries like tiny doors.
This valve opens when fluid from between cells (interstitial fluid) pushes against it, allowing the fluid to flow
into the lymphatic capillary.
Challenges of Fluid Leaving the Capillary:
Once the fluid is inside the lymphatic capillary, it has difficulty leaving because any attempt at backflow closes
the valve. This ensures a one-way flow.
Valves in the Lymphatic System:
The lymphatic system has valves not only at the tips of the smallest lymphatic capillaries and larger vessels,
preventing backflow.
These valves persist up to the point where the lymphatic vessels empty into the blood circulation.
these valves as checkpoints along a one-way road for the lymph fluid. They make sure the fluid keeps moving
forward, helping it reach its final destination where it rejoins the blood circulation.
