Circulation:

Blood vessels:
 Arteries:
 Arterioles:
 Capillaries:
 Venules & veins:

Blood flow:
Blood flow = pressure/resistance
Normal flow is laminar
Measured by Fick principle
Shock:
Is circulatory failure --> result in inadequate tissue perfusion.

Features:
• The skin is cool, pale and sweaty.
• tachycardia and vasoconstriction.
• Restlessness.
• Thirst.
• Low urine volume.
• lactic acidosis.
Types of shock:
① Hypovolemic shock:
Causes:
- Blood loss.
- Plasma loss (massive burn).
- Dehydration.
②Distributive shock (vasogenic or low-resistance shock):
• Because the size of the vascular system is increased by vasodilation.
Causes:
- Sepicemia.
- Sever allergy (anaphlaxis).
- Neurogenic (damage of CNS).
- Adrenal cortical failure.
③Cardiogenic shock:
• Caused by inadequate pumping action of the heart as a
result of myocardial abnormalities --> low C.O.P.

④Obstructive shock:
• inadequate cardiac output as a result of obstruction of
blood flow in the lungs or heart.
Treatment:
 is aimed at correcting the cause and helping the
physiologic compensatory mechanisms to restore an
adequate level of tissue perfusion.
 treat the primary cause of the shock

* If not treated:
- result in multiorgan failure --> death
Hemorrhage:
- Blood loss.
- Acute blood loss or chronic.

Acute blood loss:

- Is serious because it leads to sudden drop in blood volume
--> Decrease venous return --> Decrease EDV --> Decrease C.O.P
--> Decrease BP.
- Loss of RBCs.
 if blood Loss < 20% of the blood volume (< 1L):
- Adjusted by compensatory mechanism
- Rapid
- Less rapid
- Prolong: restore volume (with in ds).
- Hypoxia stimulate erythropoietin --> to form RBCs ( takes 4 – 8 Ws).

 if blood Loss > 20% of the blood volume (> 1L):

- compensatory mechanism not enough.
- Require blood transfusion.
Circulation Through Special Regions:
1) Coronary circulation:
Blood supply to the heart:
 Right coronary artery: supply -> most of right ventricle + posterior
wall of left ventricle.
 Left coronary artery: supply -> most of left ventricle + part of
anterior surface of right ventricle.

- SA node --> by both

- AV node --> by Right coronary artery.

o About 80% of coronary blood flow

takes place during diastole.
Regulation of coronary blood flow:
1. Autoregulation:
- Mainly by metabolic autoregulation.
- By chemical factors:
1. PO2
• The degree of coronary dilatation is proportional to myocardial O2
consumption.
• Cardiac muscle has high O2 consumption:
- Resive 250 ml blood/min.
- Extract 30 ml of O2 /min.
• Hypoxia = low PO2 is potent vasodilator.
• it release adenosine from ATP -> increase coronary blood flow 5 fold.
Other chemical factors:
• PCO2.
• Hydrogen ion.
• Potassium ion.
• Adrenaline.
• PG.

2. Neural: play small role.

- Parasympathetic --> produce vasodilation.
- Sympathetic --> Produce mild vasoconstriction via α1.
- However increase of HR & contractility -> O2
uptake.
- The net result --> vasodilation (by metabolic -).
Coronary Artery Disease:
 Atherosclerosis: narrowing of coronary artery.
- Result in insufficient myocardial flow = myocardial ischemia.
- cause severe chest pain = Angina pectoris.
Coronary Artery Disease:
- If the myocardial ischemia is severe and prolonged, irreversible
changes occur in the muscle, and the result is myocardial infarction.
Treatment
aims to restore flow to the affected area as rapidly as possible.
 Nitroglycerin:
- sublingual.
- cause coronary vasodilation.
 Surgical treatment:
- include balloon angioplasty to hold the vessels open.
- or grafting of coronary vessels to bypass blocked segments.
Cerebral circulation:
 Brain blood supply:
- Internal carotid arteries
- Vertebral arteries
Communicate through circle of Willis.
The brain resives about 15% of COP.

 Regulation:
1. Autoregulation:
a) myogenic autoregulation.
b) metabolic autoregulation.
a) myogenic autoregulation:
- Arteries dilate when BP decreases & constrict when the BP is high.
- This effect take place over wide range of mean BP (50- 150 mmHg).

b) metabolic autoregulation:
Arterioles are sensitive to:
- PCO2:
normal PCO2 = 40 mmHg
Rise of PCO2 --> vasodilation --> increase blood flow
fall of PCO2 --> vasoconstriction --> decrease blood flow
- Low pH.
- PO2 = hypoxia --> little vasodilation.
2. neural:
Sympathetic & parasympathetic --> play minor role.

Increase of intracranial pressure:

Causes:
- Meningitis
- Brain tumor
- Hydrocephalus
o compression of intracranial blood vessels
o decreases cerebral blood flow -> Hypoxia and hypercapnia
(i) stimulate vasomotor area –> increase BP –> increase blood flow.
(ii) cause vasodilation --> increase blood flow.
*Increasing arterial BP stimulate baroreceptor-> reflex bradycardia =
(Cushing's reflex).
Heart failure