Cardiovascular Response to

Change in Posture
From supine to standing
 Cardiovascular readjustments accompany
changes in body position
• Significant cardiovascular readjustments
accompany changes in body position because
gravity has an effect on pressures within the
cardiovascular system.
• In a standing individual, additional
cardiovascular pressure differences exist
between the heart and regions that are not at
heart level. This is most important in the lower
legs and feet of a standing individual.
 Effects of the increased pressure in the
lower extremities
• There are two major direct effects of the
increased pressure in the lower extremities
(1) the increase in venous transmural pressure
distends the compliant peripheral veins and
greatly increases peripheral venous volume
by as much as 500 mL in a normal adult
(2) the increase in capillary transmural
hydrostatic pressure causes a tremendously
high transcapillary filtration rate.
 Consequences of standing
The immediate consequence of standing is an increase in both
arterial and venous pressure in the lower extremities. The
latter causes a major redistribution of blood volume out of
the central venous pool.
This primary disturbances influence the cardiovascular centers
by lessening the normal input from both the arterial and the
cardiopulmonary baroreceptors.
The result of a decreased baroreceptor input to the
cardiovascular centers will be reflex adjustments appropriate
to increase blood pressure ie, decreased cardiac
parasympathetic nerve activity and increased sympathetic
activity.
Heart rate and cardiac contractility will increase, as will arteriolar
and venous constriction in most systemic organs (brain and
heart excepted)
• The kidney is especially susceptible to changes in
sympathetic nerve activity, and consequently, in , every
reflex alteration in sympathetic activity has influences
on fluid balance that become important in the long
term.
• Standing, which is associated with an increase in
sympathetic tone, ultimately results in an increase in
fluid volume. The ultimate benefit of this is that an
increase in blood volume generally reduces the
magnitude of the reflex alterations required to tolerate
upright posture.
 ROLE OF SKELETAL MUSCLE PUMP IN
• The normal cardiovascular reflex mechanisms
alone are incapable of dealing with upright
posture without the aid of the "skeletal muscle
pump."
• A person who remained upright without
intermittent contraction of the skeletal muscles
in the legs would lose consciousness in 10–20
minutes because of the decreased brain blood
flow that would stem from diminished central
blood volume, stroke volume, cardiac output,
and arterial pressure.
• The compression of vessels during skeletal
muscle contraction expels both venous blood
and lymphatic fluid from the lower extremities
• Immediately after a skeletal muscle
contraction, both veins and lymphatic vessels
are relatively empty because their one-way
valves prevent the back flow of previously
expelled fluid
• Most important, the weight of the venous and
lymphatic fluid columns is temporarily supported
by the closed one-way valve leaflets.
• Consequently, venous pressure is drastically
lowered immediately after skeletal muscle
contraction and rises only gradually as veins refill
with blood from the capillaries. Thus capillary
pressure and transcapillary fluid filtration rate are
dramatically reduced for some period after a
skeletal muscle contraction.
• This, in combination with an increased
pressure drop across vasoconstricted
arterioles, prevents capillary pressures from
rising to intolerable levels in the lower
extremities.