BLOOD PRESSURE, CIRCULATION

AND ITS MEASUREMENT

Govind Rajesh & Adhish Srinivasan

BLOOD PRESSURE
o Force exerted by blood per unit area of the vessel wall or Heart
o Relative to atmospheric pressure
1 atm = 760 mmHg
1mmHg = 1.36 cmH20
o Absolute Blood Pressure= Patm + Pblood
SYSTOLIC AND
DIASTOLIC PRESSURE
o Systolic blood pressure – the maximum pressure achieved during contraction of the heart
o Affected by inotropy of heart o Hypotension < 90mmHg
o Normal (At Rest): 90 – 120mmHg o Hypertension > 140mmHg

o Diastolic blood pressure – the minimum pressure achieved during relaxation of the heart
o Affected by blood volume in vessels and resistance of vessels
o Normal (At Rest): 60 – 80mmHg
 BLOOD FLOW
o Works based on a pressure difference
o Velocity of blood flow: 𝐴𝑣=𝑄
o Blood Flow 𝑄(ml/min) = Δ𝑃 (mmHg) / 𝑅
(mmHg/ml/min)
o This is analogous to OHM’s Law for Current

o Blood Flow or Cardiac Output is the Volume of blood pumped

into the circulatory system by the heart in unit time
(usually given as L/Min)
VELOCITY, BLOOD
FLOW AND CROSS-
SECTIONAL AREA
RESISTANCE
o Calculated by Poiseuille equation which gives factors that change the resistance of
blood vessels
o Directly proportional to viscosity of blood and length of vessel
o Inversely proportional to the fourth power of the vessel radius
LAMINAR VS TURBULENT
BLOOD FLOW
o Laminar flow is streamlined
o Korotkoff sounds are caused by turbulent blood flow
o Reynolds Number- predicts whether flow will be laminar or
turbulent


o Re > 2000 is turbulent

COMPLIANCE
o Distensibility of the vessels
o C = ΔV / ΔP
o Volume of blood that can be stored in a vessel at a given pressure
o Change in volume during a change in pressure
o Pulmonary arteries > Systemic arteries
o Veins have greater compliance than arteries
o (thus more blood is contained in the veins)
 CARDIAC OUTPUT, STROKE
VOLUME AND VENOUS
o
RETURN
Heart Rate – the number of heart beats (cardiac cycles) per unit time
o 60-90 bpm

o Stroke Volume – the amount of blood pumped from the heart per beat
o EDV – ESV = SV
o 125ml – 50ml = 75ml

o Cardiac Output – the amount of blood pumped from the heart per unit time
o CO = HR x SV
o 4-6 L/min

o Venous Return – the amount of blood returning to the heart from the venous circulation per unit
time
o VR = CO

Ejection Fraction – the percentage of blood ejected from the ventricles at each contraction
o EF = SV / EDV
o 55-70%
LENGTH-TENSION
RELATIONSHIP
o Preload – the initial stretching of the cardiomyocytes before contraction
oClosely related to EDV

o Afterload – the pressure the heart must work against to eject blood during systole
o Frank-Starling Law: Stroke volume of the heart depends on Ventricular End
Diastolic Volume (VEDV), or Preload increases due to additional venous return.
o↑ Preload → ↑ number of cross-bridges formed → stronger contraction → ↑
stroke volume
o As the cardiac wall stretches, less part is overlapped, leading to optimal contraction
and ejections of blood
 Too much –heart failure (more effort from heart)
 Too little (insufficient blood flow)
HOW DOES BLOOD
CIRCULATE IN
OUR BODY?
Via the systemic and pulmonary
circulation
HOW TO LOOK
AT
CIRCULATION
Functional arrangement of the
circulatory system:
1. The energetic segment - Heart
2. The conveying segment –
Arterial system
 The compliant part – Large
arteries
 The resistive part – Arterioles
3. The diffusing segment –
Capillaries
4. The collecting segment –
Venous system
CARDIAC
CYCLE AND
PV LOOP
1. Ventricular Filling
2. Isovolumetric Contraction
3. Ejection
4. Isovolumetric Relaxation
ARTERIAL PULSE
PRESSURE AND MAP
• Pulse Pressure = Systolic Pressure – Diastolic Pressure
• Pulse Pressure = Stroke Volume / Arterial Compliance

• Mean Arterial Pressure (MAP) – the average pressure in

the arteries during a single cardiac cycle

= Diastolic Pressure + Pulse Pressure/3

Or
= Systolic BP + 2 x Diastolic BP
3
= Cardiac output x Total peripheral resistance

≈ 93 mmHg*
FACTORS AFFECTING PULSE
PRESSURE
o Stroke volume and the Compliance of the arterial system
o High Pulse pressure (>60mmHg) due to high BP or Atherosclerosis
o Low Pulse Pressure (<25% of Systolic pressure) due to Low LV Stroke Volume
BLOOD PRESSURES IN THE BODY
ALWAYS EXPRESS AS A RANGE!

Left ventricle = Aorta & arteries Arterioles = 25- Capillaries = 15- Venules = 10-15
0-120 mmHg = 80-120 mmHg 35 mmHg 35 mmHg mmHg

Right atrium
Veins = 5-10 Vena cavae = 0-5 Right ventricle = Pulmonary artery
(CVP) = 0-5
mmHg mmHg 0-30 mmHg = 8-25 mmHg
mmHg

Pulmonary
Pulmonary vein = Left atrium = 5-
capillaries = avg.
5-10 mmHg 10 mmHg
around 7 mmHg
CONTROL OF
BLOOD
PRESSURE
1. Myogenic
2. Neural (Short Term)
3. Humoral (Long Term)
AUTOREGULATION
o Local Tissue BP is maintained between 70mmHg -170mmHg
o Increased arterial pressure -> Increased vascular resistance
o Mechanisms
• Sympathetic stimulation
• Endocrine (norepinephrine, angiotensin II, vasopressin)
• Autacoid (NO, endothelin)
• Myogenic contraction
o Heart, Brain and Kidney
STARLING HYPOTHESIS

Fluid movement =
Kf x (capillary hydrostatic pressure +
interstitial fluid oncotic pressure) - (interstitial fluid hydrostatic
pressure + plasma protein oncotic pressure)
 PRESSURE
PROFILE
THROUGHO
UT THE
BODY
How will gravity affect out pressure
profile?
GRAVITY AND BP

For every 1cm away from the heart

BP changes by 0.77 mm Hg, this is
the equivalent to 1cm water.

Can you predict the blood pressure

recorded in the carotid artery and the
femoral artery, in an individual with a
pressure of 120/80 in their brachial
artery (at the level of the heart)?
HOW DO WE
MEASURE BP?
Classification?
CLASSIFICATION
Indirect / Noninvasive
 Palpation
 Oscilometry Measured in millimeters of
mercury (or kPa, torr.), within
 Auscultation
the major arterial system of the
Direct / Invasive body.
 Arterial Catheter

How do we decide which one to use?

AUSCULTATIO
N
Equipment- Sphygmomanometer +
Stethoscope

Why do the sounds disappear?

PALPATION
-Without sound
-Only systolic pressure can be
measured
OSCILLOM
ETRY
Equipment- Either
Sphygmomanometer or
electronic equivalent
Unlike auscultation,
oscillometry requires
mathematical interpretation of
the raw data to get a value for
diastolic pressure as well as
systolic
IS ONE MEASUREMENT
ENOUGH TO DIAGNOSE
HYPERTENSION?

According to the WHO at least 2-3 consecutive

readings must be hypertensive before it can be
diagnosed
Pseudohypertension also known as “White Coat
Syndrome” can also cause elevated BP
 HOLTER
MONITORING
A Holter monitor is a type of
ambulatory electrocardiography
device
It is a portable device
for monitoring of the electrical
activity of the cardiovascular
system for at least 24 to 72
hours
INVASIVE/ DIRECT
METHODS

- Using an arterial catheter/ arterial line

-Reserved for the care of critically ill/

hospitalized patients

 -Advantages
 -Provides constant monitoring of patient’s
BP
 -Measures Bp throughout the entirety of
the cardiac cycle, rather than just systolic
and diastolic

 -Disadvantages
 -Uncomfortable for the patient
 -Requires training and special equipment-
can only be done in hospitals
CENTRAL
VENOUS
CATHETER
o Inserted into large vein
(jugular, subclavian, axillary or
femoral)
o Measures BP in Right Atrium
and Venae cavae
o Used to monitor CVP and
changes in blood volume
o Also used to administer
medication
SWAN-GANZ
CATHETER
o Large Vein -> RA -> RV ->
Pulmonary Artery
o Used to measure Pulmonary
Wedge Pressure to monitor
lungs, left atrium and right
heart
o Diagnostic tool for Heart
Failure and Pulmonary
Hypertension
WHAT IS CENTRAL VENOUS
PRESSURE?

WHY IS IT HOW CAN WE HOW CAN WE

USEFUL? ESTIMATE IT? MEASURE IT?
ESTIMATE
MEASURE
 HOW DO WE
WILLINGLY
CONTROL CVP?
QUESTIONS?
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