Blood Vessel s Wall. heart. arteries. veins. all vessels in body = CONDUITS only! They 1. TUNICA. the heart. 2. TUNICA. of the lumen). 3.

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1 Blood Vessels, Perfusion & Capillary Dynamics 1 CARDIOVASCULAR SYSTEM: Blood Vessels Vessel Structure, Cardiovascular Dynamics, Perfusion & Capillary Dynamics I. OVERVIEW - Path of BLOOD FLOW: heart arteries capillaries veins heart * Arteries gradually get smaller by branching or splitting into arterioles, which then split into capillaries. Capillaries then merge into larger vesselss called venules, which the merge into veins. * If added up lengths of all vessels in body = 100,000 km (60,000 mi)! - ARTERIES & VEINS - blood CONDUITS only! They have very thick walls. - CAPILLARIES = chemical exchangee w/ body tissue or lungs. VERY thin walls to facilitate diffusion! A) Generalized Structure of a Blood Vessel s Wall - LUMEN - central space. Surrounded by 3 layers: 1. TUNICA INTIMA or INTERNA - Diffusion layer. Inner-most layer. Single layer of squamosal epithelium (= ENDOTHELIUM). continuous w/ endocardium of the heart. Endothelium covers inside of entire cardiovascular system. 2. TUNICA MEDIA Regulation layer. Middle layer. Controls blood pressure by controlling size of lumen. Smooth muscle, regulated by vasomotor nerve fibers of the sympathetic nervous system which can cause VASOCONSTRICTIONN (decrease in size of lumen) or VASODIALATION (increase in size of the lumen). 3. TUNICA ADVENTITIA or EXTERNA - Support layer. Outer-most layer. Collagen fibers, nerve fibers and lymph vessels.

2 Anatomy & Physiology II Note Series CJ Shuster 2 - The 3 vessels differ in the relative width and importancee of these 3 layers, as per their role in the body: Image by Kelvin Song (Own work) [CC-BY-SA-3.0 ( sa/3.0)], via Wikimedia Commons B) Arteries - Take blood away from heart. NOTE: definition does not include oxygenated blood (= common mistake!). - In general, thick T. Media around endothelium; not much T. adventitiaa (relatively). Compare later to vein.

3 Blood Vessels, Perfusion & Capillary Dynamics 3-3 types of arteries: 1) ELASTIC ( CONDUCTING ) - large, thick arteries near heart. - Lots of elastin in T. Media; expand under pressure and then squeeze the blood, thereby keeping blood under constant pressure (and therefore, constant blood flow) THROUGHOUT THE CARDIAC CYCLE. The pulmonary trunk and aorta, as well as their major arterial branches (the pulmonary, common carotid, subclavian, and common iliac arteries) aree elastic arteries. They keep blood pumping while the ventricles relax. 2) MUSCULAR ( DISTRIBUTING ) - bring blood to the organs. Pencil-thick. Thickest T. Media of all the vessels with lots of smooth muscle = lots off vasoconstriction/dilation. Most common large artery. Most of the arteries feeding thee limbs and organs. 3) ARTERIOLES - microscopicc structures taking blood to the tissues. Al 3 tunics present, but T. Media is only a few cells thick. Eventually, arterioles usually feed blood to the capillaries (see next section). C) Capillaries - Microscopic ( little hairs ). T. Intima ONLY; sometimes just 1 cell thick. * Lumen diameter = 8-10 Um = 1 blood cell thick. * Supplies almost all body tissue with VASCULAR SUPPLY, performing NUTRIENT & WASTE EXCHANGE with the tissues (gases, nutrients, metabolic acids, hormones, etc.). EXCEPTIONS (places without a lot of capillaries): epithelial & cartilage = AVASCULAR; eye receives nutrients from AQUEOUS HUMOR; tendons & ligaments = poorly vascularized.

4 Anatomy & Physiology II Note Series - Types: 1) CONTINUOUS - most common. Continuous referring to uninterrupted endothelium (no holes). - Cells held together through incompletee tight junctions; leaving gaps in between them for nutrients to pass through = INTRACELLULAR CLEFTS. * Exception = brain capillaries = BLOOD-BRAIN BARRIER. 2) FENESTRATED - Window-like pores, covered by a delicate membrane. Found in areas of high absorption/filtration (sm. intestines, endocrine organs, kidneys. CJ Shuster 4 3) SINUSOIDAL - leaky - highly modified, w/ large lumens and fenestrations w/ loose tight junctions = areas where large molecules need to pass (liver removes large molecules from blood, remove bacteria, etc.). - Capillaries usually found in CAPILLARY BEDS = network of vessels. 2 special vessels in a capillary bed: 1) VASCULAR SHUNT - Consists of METARTERIOL E (arterial portion) & THOUROUGHFARE CHANNEL (venule portion). 2) TRUE CAPILLARIES - Brings blood close to tissue cells; entrance into the capillaries controlled by PRE-CAPILLARY SPHINCTERS. Tissues with low metabolic activity = close sphincter = shut off capillaries in that area. Anastomosis: a direct capillary, withoutt a bed. Portal system: 2 capillary beds merge via a vein. Example: hepatic portal system.

5 Blood Vessels, Perfusion & Capillary Dynamics 5 D) Veins - Bring blood back to heart. Thinner T. media & a thick (relatively) T.. adventitia. - Types: 1) VENULES - Thin; receive blood from the capillaries. See image previous page. 2) VEINS - Very different from arteries: large lumen & thinner walls; usually opened & filled with blood. * Little smooth muscle or elastin in T. media. an increase in connective tissue. T. adventitia = thicker, with On slide, they are collapsed because they can t stay open without blood in them. * Large lumen + thin walls = hold more blood volume than arteries. 65% of all blood is in veins at any time (= BLOOD RESERVOIRS ). * Also, lg. lumen = lower pressure than in arteries. This is important for maintaining blood flow (see next section Physiology of Circulation ) 3) VENOUS SINUSES - Specializations in areas that need addedd protection. No muscular coat. Blood pools up, allowing more time for moving nutrients/wastes in & out. In areas with a Blood Barrier (among others). * 2 important ones: CORONARY SINUS and DURAL SINUS OF THE BRAIN (contains cerebrospinal fluid). Large flattened cells that form a large open space.

6 Anatomy & Physiology II Note Series CJ Shuster 6 II. PHYSIOLOGY OF CIRCULATION A) INTRODUCTION TO BLOOD FLOW, BLOOD PRESSURE AND RESISTANCE. - Some important concepts from Physics: 1) FLOW (of a fluid): Hydrodynamics = the study of liquids in motion. There are many properties, especially when dealing with fluid flow in a tube (like, blood in a blood vessel). Many things affect flow. We will look at 3: (i) Amount of pressure that is pushing the fluid. (ii) Diameter of the tube it is flowing through, and length of the tube. (iii) Viscosity of the fluid (friction). BLOOD FLOW - volume of blood flowing through vessel (measured in ml / minute). * If measure for entire system = Cardiac Output. 2) PRESSURE (P) - of a fluid: the force that anything puts on its surroundings. In our case, blood pressing on the vessel wall. - Two things about pressure: 1. Pressure and volume have an INVERSE relationship: * When volume goes down, pressure goes up. * When volume goes up, pressure goes down. 2. You can have pressure gradients just like concentration gradients! Substances move down a pressure gradient (similar to a concentrationn gradient). * Therefore, they will always move into an area with a greater volume (all things being equal).

7 Blood Vessels, Perfusion & Capillary Dynamics 7 - To measure pressure, we use mercury (Hg) as an arbitrary standard. * The amount of force the mercury is exerting (measured by its weight) determines how high the column is. * Therefore, the height of the column is a measure of the force being exerted. * Measured as millimeters of mercury (mmhg), although we no longer use mercury. - Many things affect pressure of a fluid. We will look at three of them (same three that affected flow!): (i) Volume of the fluid. (ii) Amount of pressure that is pushing the fluid. (iii) Diameter of the tube it is flowing through, and how long is the tube. BLOOD PRESSURE (BP) - force blood is exerting on walls of vessels; measured in mmhg (millimeters of mercury). * Unless otherwise stated, BP = pressure in arteries near heart, but changes through system. See later. 3) RESISTANCE - opposition to flow due to friction of the surface it touches. - What affects resistance? For us, 2 main variables (from many): (i) Longer the tube, the more resistance there is. * Weight gain leads to an increased blood pressure as adipose is highly vascular. Therefore, there is a much longer tube to push blood through, and much more resistance! (ii) There is a lot more friction in a narrow tube than a wide tube. This is due to the increase in surface are (SA) as the tube gets smaller.

8 Anatomy & Physiology II Note Series CJ Shuster 8 - Vasodilation and Vasoconstriction Changing the width of a blood vessel in order to control blood flow. It also affects blood pressure! * dilate: open a tube, make it wider. * constrict: close a tube, make it narrower. B) CARDIOVASCULAR DYNAMICS: SYSTEMIC BLOOD PRESSURE AND FLOW 1) GENERAL (SYSTEMIC) BP Since most resistance in circulatory system occurs in the capillaries, we refer to the resistance in circulatory system as PERIPHREAL RESISTANCE. 3 things affect PR: (i) BLOOD VISCOSITY - Internal resistance due to stickinesss of fluid due to elements in blood. (ii) BLOOD VESSEL LENGTH - Increase friction. (iii) BLOOD VESSEL DIAMETER - Vasodilation: If narrower = more friction. Decreased diameter = increased surface areaa (SA). - But, can resistance get so high that is stops blood flow? Unlikely! * REMEMBERR - pressure gradient works like a [ ] gradient; you always flow from high to low. As long as veins have lower P than arteries, blood will flow through capillaries to get there!! It can be a serious problem if proper pressure gradients are not maintained. Let s follow these pressuress as we move through the system.

9 Blood Vessels, Perfusion & Capillary Dynamics 9 Pressure changes through system with respect to resistance: While looking at the image, NOTE THE FOLLOWING: 1. Theree are 2 pressures in the arteries (diastole & systole); but not in rest of system. Arteries are PULSATILE. See section ARTERIAL BP. 2. Highest drop in BP is in arterioles; but general decline throughout system. Blood always move from high P low P 3. Blood flow in veins is low due to high resistance and low pressure gradient. Veins need special adaptions to get blood back to heart. Seee section VENOUS BP. 4. By time get to rt. atrium, BP = 0mmHg; so, don t put pressure back on pump and valves. Hypertension can lead to damaged heart valves. 5. Huge change in P between arterioles & venules keeps blood moving through capillaries. IMPORTANT: The slope of the graph here is very important, as it determines the speed of BF. The speed that blood moves past tissues is extremely important; itt cannot be too fast or too slow. See later sections on CAPILLARY BLOOD PRESSURE and PERFUSION.

10 Anatomy & Physiology II Note Series CJ Shuster 10 2) ARTERIAL BP - BP in artery reflects 2 things: how much blood is forced into them & how elastic are their walls (more elastin = lower pressure). * PULSATILE - amount blood is changing with pumping of heart. Left ventricle puts kinetic energy into aorta; stretches. Highest pressuree = SYSTOLIC PRESSURE of ventricle ~ 120 mmhg. Then, during diastole, SL valves closes, walls of aorta recoils acts like a bellows, maintaining constant pressure in aorta; P slowly drops in aorta to ~ mmhg. (= DIASTOLIC PRESSURE) Arteriosclerosi s refers to a thickening and hardening of arterial walls in the arteries. Arteriosclerosis is a general term describing any hardening (and loss of elasticity) of medium or large arteries. Atherosclerosis (also known as arteriosclerotic vascular disease or ASVD) is a specific form of arteriosclerosis in which an artery wall thickens as a result of the accumulation of calcium and fatty materials such as cholesterol. It reduces the elasticity of the artery walls and therefore allows less blood to travel through. This also increases blood pressure. ASVD a chronic inflammatory response in the walls of arteries, caused largely by the accumulation of macrophages and white blood cells and promoted by low-density We had a Just for your education box in the heart chapter on the relationship between arteriosclerosis s, cholesterol, and heart attacks in the heart lipoproteins (LDL, plasma proteins that carry cholesterol and triglyceride). chapter.

11 Blood Vessels,, Perfusion & Capillary Dynamics 11 Pulse pressure is the difference between the systolic and diastolic pressure readings. It is measured in i millimeters of mercury (mmhg). It represents the force that the heart generates each time it contracts. If resting blood pressure is 120/ /80 mmhg, pulse pressure is 40. Mean arterial pressure (MAP) is a term used to describe an average blood pressure in an individual. It is defined as the average arterial pressure during a single cardiac cycle. Do not worry about how to figure MAP pressure for this series. But, it is the number we use in the rest of this chapter while talking about the pressure of blood as it enters the arterioles & capillaries. 3) Capillary BLOOD PRESSURE - PR greatly reduces BP. necessary for 3 reasons: This loss of pressure is (i) Flow slow to give time for nutrient exchange. (ii) High resistance due to high surface area, that is necessary for efficient nutrient exchange. (iii) Lower BP means walls can be thinner, to facilitate exchange. - Hypertension or hypotension leads to a multitude of problems which we will talk about as the semester continues. * In General: Tissues cannot come in direct contact with the blood, or the cells die due to waste buildup and changes in ph (among other things). An increase in BP puts stress on the capillary wall, putting it in danger of bursting. Stroke, heart attack and kidney damage may result, among other things. A decreased BP allows wastess to build up, killing the cells.

12 Anatomy & Physiology II Note Series CJ Shuster 12 4) VENOUS BP - Not pulsatile; steady during cardiac cycle. * Entire gradient only about 20 mmhg, due to PR. flow back to the heart! Too low a pressure gradient to maintain blood - How get blood back to heart, especially since blood is moving against gravity? Several adaptions: 1. Large diameter lumens, with low pressure, so they are always filling with blood as it moves down its pressure gradient. Lower blood pushes up higher blood in circuit. 2. MUSCULAR PUMP - During normal contractions, skeletal muscless are milking veins towards heart. 3. VENOUS VALVES - One-way valves built into the vein s walls prevent back-flow towards the feet. * VARICOSE VEINS (VARICOSITIES) The valves break down; blood pools on lower valves, causing veins to bulge out. Especially prevalent during after pregnancy, or men with pot bellies (increase blood flow to increased amount of adipose tissue). 4. RESPIRATORY PUMP Intrathoracic pressure decreases during inspiration and abdominal pressure increase, squeezing local abdominal veins, allowing thoracic veins to expand and squeezes veins = increases flow to right atrium.

13 Blood Vessels,, Perfusion & Capillary Dynamics 13 C) REGULATION OF BP & BF Regulation of Blood Flow & Capillary Perfusion Locally & Systemically - Cardiovascular Regulation - must maintain flow to organs, despite constant changes in pressuree (EG: standing up could lower BP to brain enough for fainting). Systemic blood pressure must be maintained. - Perfusion is the processs of the body delivering blood to a capillary bed; that is, blood flow to the tissues must be maintained. Blood flow is absolutely dependent on BP. We can affect BP and Blood flow via the following: * Perfusion is dependent on the same variables as systemicc BP: a. CO (HR & SV) b. Peripheral resistance short-term, this is vasodilation & vasoconstriction. * Long-term: angiogenesiss (add blood vessels), but we won t talk much about this here. c. Blood volume - BP - Cardiovascular Regulation is a complicated series of feedback loops. Also, there are 2 (sometimes conflicting) needs: The local needs of the tissues and the need to maintain the vital organs. 1. Locally, tissues have needs to control water flow, and nutrient, electrolyte and waste levels. This need changes from minute-to-minute e. If wastes build up, the tissues die. Also, can t let pressure go up or down. 2. The body controls blood flow to all the organs. However, some organs have priority; these are the VITAL ORGANS (those which, if they stopped functioning properly, would kill you immediately). Heart, Brain, Kidneys, Liver, and Lungs. MAP is considered to be the perfusion pressure seen by organs in the body. It is believed that a MAP that is greater than 60 mmhg is enough to sustain the organs of the average person. MAP is normally between 70 to 110 mmhg. If the MAP falls too low for an appreciable time, vital organss will not get enough oxygen perfusion, wastes will build up, and the tissue will become ischemic. The brain is especially sensitive to ph and blood pressure. needs steady, adequate blood flow, or else you faint. Brain 1. A drop in BP leads to general vasoconstriction in order too keep the vital organs functioning. Decrease BP to brain increased sympathetic output & decreased parasympathetic output to heart general vasoconstriction higher MAP. This is why the person becomes pale and clammy lessened BF to the skin. 2. An increase in i BP to the brain or any change in ph causes systemic vasodilation, so waste removal can continue: Increase BP to brain decrease sympathetic output & increased parasympathetic output to heart general vasodilation lower MAP. In fact, systemic vasodilation can be so extreme that it can lead to fainting (SYNCOPE) if MAP falls below 60mmHg. See Side Note Box on the Vasovagal Response and Syncope. * Why fainting? This puts your brain at the same level as your heart, so the cardiovascular system does not have to work against gravity.

14 Anatomy & Physiology II Note Series CJ Shuster 14 - Looking at the (sometimes conflicting) FEEDBACK LOOPS: 1. Systemic Regulation * The Systemic Control Center: The brain has many homeostatic control centers, including one for blood flow in the medulla oblongata. Via the vasocontrol or vasomotor center (area of brain controlling diameter of the vessels), the brain can affect the entire systemic circuit, making sure the vital organs do not shut down. * Systemic Stimuli and receptors: Theree are many stimuli thatt will cause a reaction: blood pressure, ph, electrolyte levels, core body temperature. * Many receptors. Carotid and Aortic bodies looking at BP. Other stretch receptors throughout system. Peripheral Chemoreceptors scattered throughout. Cold sensors on skin. * NOTE: body is using [fluid chemicals] as an indicator of BP. CO2 levels are often used to monitor ph. * E.g. of a stimulus to vitals affecting systemic perfusion frostbite is a case where perfusion to the periphery is shut down to maintain the vital organs. * Systemic Effectors: We ll talk about the heart, blood vessels, kidney (via hormonal control of water volume) & adrenal glands (hormonal control of CO & PR). * As seen, blood flow and pressure depend on CO (HR & SV), blood volume & PR. * See the images for the effects * NOTE: vasoconstriction/vasodilation centers only seem to have sympathetic output. No parasympathetic. Why? Possibly, if there isn t a systemic need, the body lets the tissuess control things locally (next section).

15 Blood Vessels,, Perfusion & Capillary Dynamics Local Regulation * The Local Control, the sensory receptors, AND the effectors are the cellss and blood vessels themselves. The cells have receptors on their PM for nutrient, electrolyte, and waste levels (among other things). Also, the Blood Vessels control themselves by responding to their own blood pressure ( myogenic response ). The BVs control their own vasodilation and vasoconstrictionn (the myogenic response). The cells release several paracrines that affect vasodilation & vasoconstrictio on. NOTE: all local control is PR (increasing it or decreasing it) ). In general, these mechanisms do not directly affect CO or blood volume. However, this will lead us to thee possible conflict later (see later section in Blood Vessel chapter on Vascular Shock )

16 Anatomy & Physiology II Note Series CJ Shuster 16 Vasovagall Response and Syncope. A vagal episode or vasovagal response or vasovagal attack ( also called neurocardiogenic syncope) is "general bad feeling" mediated by the vagus nerve. When it leads to syncope or "fainting", it is called a vasovagal syncope, which is the most common type of fainting. There are different syncope syndromes whichh all fall under the umbrella of vasovagal syncope. The common element among these conditions is the central mechanism leading to loss of consciousness. The differences among them are in the factors that trigger this mechanism. There are MANY, for example: Prolonged standing or upright sitting After or during urination (micturition syncope) Standing up very quickly (orthostatic hypotension) Stress Any painful or unpleasant stimuli, such as: Trauma (such as hitting one's funny bone), watching or experiencing medical procedures (such as venipuncture or injection) High pressure on or around the chest area after heavy exercise Sensitivity to pain Arousal or stimulants, e.g. sex, tickling Sudden onset of extreme emotions Lack of sleep Dehydration Hunger Pressing upon certain places on the throat, sinuses, and eyes (alsoo known as vagal reflex stimulation when performed clinically) Use of certain drugs that affect blood pressure, such as cocaine, alcohol, marijuana, inhalants, and opiates Swallowing Low blood sugar (Less commonly) Vasovagal syncope is most commonly discovered in adolescents and in younger adults. It may be a clinical condition called Postural orthostatic tachycardia syndrome (POTS). Multiple chronic episodes are experienced daily byy many patients diagnosed with this syndrome. Episodes are most commonly manifested upon standing up. Several underlying causes, not well understood. In older people, most common is orthostatic hypotension.

17 Blood Vessels,, Perfusion & Capillary Dynamics 17 - The following section summarizes these controls: local control by the tissues, systemic control of BP via the nervous system, and systemic control via the endocrine system. NOTE TO STUDENT: Be careful! It is easy to confuse the following 2 main points: 1) Perfusion (blood flow through capillaries) and its relationshipp to local BP and 2) SYSTEM-WIDE control of blood pressure. - These 2 are often in conflict! Certain types of Vascular Shock occur when these 2 needs (perfusion of tissues versus systemic blood pressure) are in conflict. This leads to a positive feedback loop that results in death (seee end of section). - We are only going to deal with the Systemic Circuit in this section. Perfusion of Pulmonary capillaries will be covered in the Respiratory Chapter. - Summary of Events: (The first 2 below deal with Perfusion control, while #3 deals with control of system-wide BP) i. Locally, if blood pressure goes up, vasoconstriction will occur. This stops capillaries from popping. This is due to those local intrinsic controls I will talk aboutt below (myogenic, chemical). ii. Locally, if blood pressure goes down, vasodilation will occur, making sure the tissues get fed. This is due to those local intrinsic controls I will talk about below (myogenic, chemical). iii. Systemically, if your blood pressure goes up, systemic vasodilation occurs, and vice versa. This is because your body wants to make sure that you don t have a stroke or a heart attack by popping a blood vessel. This is controlled by the nervous and endocrine systems.

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