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28/cardiovascular system BLOOD FLOWS IN A CIRCLE. At first glance, the ‘anatomy of the circulation js a mess! its basic functional simplicity is obscured by the fact that the heart appears to be a single anatomical organ, when it is actually composed of two separate, functionally distinct, pumps. The right heart pumps blood to the lungs, where blood takes up oxygen and gives up car- bon dioxide; the left heart pumps blood to tissues, where just the reverse happens. Further, although the lungs appear to be two organs (right and let), both Jungs do exactly the same thing; they are really just one organ, We can use these ideas to untangle the circul- ation. Begin by separating the heart into iis two tunc- tional units by an imaginary slice through the thiok sep- tum (wall) that divides the heart into right and teft pumps. Pull these pumps apar, and place all vessels entering or leaving each heart in neat parallel arrays This can be accomplished without really compromising the functionel pathway taken by the blood. Finally. re- present the lungs as a single organ, and you will arrive atthe simple circle shown in the ilustration in the upper right comer. Here, all pulmonary arteries (.., arteries that leave the right Neart and go to the lungs) are co!- lected into a single functional path, as are all pulmonary veins (veins that leave the lungs and enter the left heart). Similarly, all systemic arteries (ve. those thet leave the left heart bound for all non-lung tissues of the body) are collected, as are all systemic veins (veins leaving the non-Iung tissues anc emptying into the right heart). As illustrated inthe functional diagram, the northern hemicircle (between right and left heart) sup- plying the lungs is called the pulmonary circulation. The ‘southern hemicircle (between left anc right heart) sup- plies the rest of the body tissues; itis called the sys- temic circulation. The eastern hemicircle contains oxy- ‘gers-tich blood, In the western hemicircle the blood is ‘oxygen poor Follow the diagrems on the opposite page that ‘show important properties of blood flow through this Circular pat: 1. Steady state blood flow is the same through any total cross-section of the circulation. During each min- tte, the amount of blood flowing out of the right heart equals the amount flowing into the left heart; if tis were nt true, blood would be piling up continuously in the lungs. Momentarily, some fluid shifts could occur, but UTRODUCTION TO Ths CARDIOVASCULAR SYSTEM on average, over a substantial period of time our Conclusion is Correct, and the same argument can be applied fo any section of the diagram. When the aver- age adult is at rest, this low amounts to about 5000 mL per min, 2. Blood flow = blood velocity x cross-sectional area Blood velocity represents the speed of a blood particle" in the stream, ie., how far the particle moves in one minute. Blood flow represents how many part- cles {more precisely, the volume of these “particies") pass a given cross-section in one minute; iis measured in mL/min, The diagram illustrates the. ‘lationship betwaen these wo quantities. 3. Toia! cross-sectional area of the vascuter tree is greatest in the capilaries. By total cross-sectional area, ‘we mean the sum of the cross-sections of all branches of a similar type, e.g, major arteries, minor arteries, capillaries, major veins, etc. Beginning in the aorta and progressing toward the tissue, the total cross-section of the vascular tree gets larger and larger unti it becomes ‘maximal in the capillaries, Although each branch is. smaller than its parent, the number of branches in- creases so rapicly that it more than compensates for the reduction in size of any individual branch, Pro- {ressing from capillaries to venules to veins and back {o the hear, the reverse occurs. 4, Blood velocity is slowest in the capillaries. This {ollows because the blood flow is constant throughout the vascular tree; and the total cross-sectional area is largest in the capilaries, The equation total blood flow = blood velocity * total cross-sectional area shows that as cross-sectional area increases, blood velocity ‘decreases, so thal the product of the two does nat change. (The same argument applies to a river, where ‘a widening of the river bed is accompanied by a slowing ‘of the stream) it follows that the velocity will ‘be smallest where the area is largest (in the capillarios) This is important because capillaries are very short (approximately 0.1 em), and ifthe blood didn't slow ‘down, there wouldn't be enough time for exchange (e.g, of 02) between blood and tissues to occur. For ‘example, blood normally spends about 1 sec. in a capil. lary; fittraveled at the same speed as it does in the aorta, this time would be reduced to only 0.001 sec., a 1000-fold reduction, CGN: Use blue or 8, purple for C, and ced (or D. 1. Begin with the anatomical description ol blood flow. Foliow the numbered sequence staring with + inthe right arm (marked by an asterisk) 2. Color the functional description of biood flow, Starting again win the right heart 3. Color the diagrams describing the relationship between flow, area and velocity 4. Color the chart in the tower night comer demon sirating these physical principles as they eccur in the body, LIVOCARDIAD: FLOM: PONCTIOUAL: IDEOK,GEVATEDIEGOODN ro (Pi YRS, SYSVERUC PULMOMARY AAUEHASS: GUEDE CAPILLARIES. Gen J OXLMSEMATED FLOOD: SYSUELUC ARTERMES, POMOWDE UE0NS> PLOW: AUATORNCAL. BEAD, TRUM ANG: exTRMITES. ‘The steady sate Blood ow tcogh ach fa cross-section ofthe orcwlaton is equal During each minut, the amount of ged fwing out of height et egUs1 ne ameurt owing in the it Rea fs were not rue en bod woud be ‘ling up carncousiy nthe ngs, Momentary, some fale ‘Shils woul occu, buon average, over 2 substantia ped of time our eenesuson is careck Tho sare aoumen’ can ba fanpled te any secon of the gure. tres vison amounts fe abavt 3000-m. permin. 39 avora9e edu VARIDTIOUWS 000 VELOCITY, 150 arteries oe | YSLOCITH Blood veloc represen he speed fa bond “paris” fe stream Le. now for he parle moves in ‘ane min. Blood Now reoresenis Pow ‘many parices (more precisely ine volun of ase "paicies) pass | ghon cress scton mane minute itis measureo mum BWAREA: tag CCOG2. Doni. Beginning nite sorta anc progestin towarc ne su the toil crass sector o! he vasa ve ges lager ane arger nth oecomes maximal inte cagitanes. Aoxgn 9ach -raneh is sailor han sparen the rurmbor of ragctes in creazes 20 rap tha! more han compensa fie e- Sect in ize of any incl branch Progressing tom Caples to venules fo veins apd hack o ha Par, he 1 eree aocurs Because area is fargest ne capita, and G fe is the sae in 3 Secor, Fefows that ara You can vey sn he spaca’ ut equa ne number passing tout Frecpderyie area la peta (ie eth oor Case spown above, The al cress see- plane of B inane min. (=4 nour a7y- Seer) Ao et tion are ofthe tubing at B is tice tat at ple) Fortis to accus, the elements at A ee ee ee ee ‘A sotnat a given length of ubirg rear B must have passed the pin ane minute Seles 009 eee ee hols twice as many cuDC elements as 8 ago while tose a1 6 passed te pon ve ve iTravele tine same speed as does Pe aaa, is te ar fengn near A Wn constart fom, Dung Pe same minuto, ose 9A have Arsmia P4 eee see) tien ee fra number ube faa ements travels hice he dence 33 tose 3 . iaeeh ‘ ‘Bessrg rough the pare 2 none min. ther velooay is wice as gre. cardiovascular system COUTROL & MEASUREMEUT OF GARDIAG OUTRUT ‘The cardiovascular system is intricate and complex, yet its function is simple: it moves blood, The most important index of cardiovascular performance, the bottom line, is; "How much blood is moved to the tissues during each minute?" This quantity is called the cardiac ouput. Cardiac output ‘equals the amount of blood expelled from one ventricle: during a single beat (stroke volume) times the number of beats por minute (cardiac output = stroke volume x hear! reie), In a steady state, the cardiac output of the left heart ‘equals that of the right heart flows in the systemic and pulmonary circulations are equal), In an average sized person at rest, the cardiac output is about 5 L per minute. However, this figure fluctuates: itrises with activity, reaching as high as 25 L per minute during heavy exercise, and even higher in athletes. Cardiac output can change by alterations in either stroke volume or heart rate. During exercise, for example, the stroke volume may show a moderate increase while the heart rate rises about three times, These changes in stroke volume and heart rate are brought about by intracardiac mechanisms (response of the contractile machinery to stretch) and to extracardiac mechanisms (action of sympathetic and parasympathetic nerves). INTRACARDIAC MECHANISM, As in skeletal muscle con- traction, the strength of contraction of heart muscle depends on its length Under normal resting conditions, the length of an average heart muscle fiber may be only about 20% of its optimum length for maximal force. Stretching the fiver beyond its norm reveals a reserve of additional power for forceful contractions. This response to stretch, called the Frank- Starting mechanism, has important implications. more blood is returned to the heart, the walls of the ventricles are stretched, and the Frank-Starling mechanism ensures that the heart can develop the extra strength required to empty its. I arterial pressure suddenly rises, the stroke volume will decrease because the ventricle will not have sufficient farce to overcome the increased arterial pressure. The extra blood that remains in the heart (the residual volume) just following the beat will Increase, and this increased blood will help stretch the walls prior to the next beat, Consequentiy, the force of the next beat will increase, helping the heart moet the increased load imposed by increased arterial pressure, This will increase the stroke volume back toward normal The Frank-Starling mechanism is particularly important in adjusting the output of the right and lott hearts. if, for example, your right heart output was just 1 ml/min. greater than your lett, then affer about 15 min. some 1000 mL of fluid would accumulate in the pulmonary circulation. The increased pressure would force fluid out of the capillaries into the lungs, and you would drown! EXTRACARDIAC MECHANISM. The action of the autonomic cardiac nerves has been considered in plate 30. The para- sympathetic nerves to the heart are carried in the vagus nerve. The vagus nerve is generally active, discharging @ continuous barrage of impulses at the SA and AV nodes and slowing the basic heart rate. When the parasympathetic herve supply to the hear is interrupted, the heart speeds up. GN: Use red for 8 and blue for 4, Begin wah the upper panel 2. Color the heart rate panel Increasing the frequency of parasympathetic impulses siows the heart; decreasing the trequency speeds it The sympathetic nerves to the heart are also continually active, but heir effect on rate is opposite ta that of the para- sympathetic nerves, Sympathetic impuises increase the heart rate, and when this nerve supply is interrupted, the heart slows. Increasing the frequency of sympathetic impuises speeds the heart; decreasing the frequency slows it Generally, the activilies of these two opposing sets of nerves are coordinated: when the sympathetic nerves are excited. the parasympathetic are inhibited, and vice versa. In aaiition, sympathetic impulses increase stroke volume by increasing the force of contraction of the ventricuiar muscle, Thus, there are two independant mechanisms for changing stroke volume; (1) changing the intial length of the cardiac fibers (ie., changing the end diastolic volume) and (2) increasing the barrage of sympathetic impulses to the ventricular musculature (or, similarly, by releasing ca- techolamine hormones from the adrenal medulla) THE FICK PRINCIPAL — MEASUREMENT OF CARDIAC QUTPUT. Blood flow through any organ can be measured by a simple application of the conservation of matter known as the Fick principle. Applying this 10 O2 consumption, this prin- ciple relies on the following facts, which hold whenever the ‘organ is in the steady state, During each minute’ 1. (O2/min.) = amount of oxygen consumed oxygen delivered by biood 2. oxygen delivered by blood = amount carried in by artery = amount carried away by veins 8. amount carried in by artery = L of blood flowing in (F) x the amount in each L (02) art. F [Op] ven. 4, amount carried out by veins = L of blood flowingout(F) x amount in each L [O2) =F [02] von. Putting steps 1, 2, 9, and 4 together: (Ozimin) = Fx {Oz} art. F * [O2} ven. Solving for F F = (Qp/min)/({O9] art. - [Oe] ven.) ‘To measure cerdiac outpul, simply measure the blood tlow through the lungs. (This is the flow out ofthe right heart which equals the flow into and out of the left heart} In this Case, the Oz temoved trom the biood is obtained by measuring the difference between the Op content in the inspired air and the Op content in the expired ait. The measurement also requires analysis of [Oa] in blood samples from the pulmonary artery and vein. A sample representing pulmonary venous blood can be obtained from any systemic artery, Pulmonary veins and systemic arteries have the same 2 content because blood has ne opportunity to exchange ‘Op unti it reaches the systemic capillaries via the left heart and systemic arteries. Obtaining a sample of pulmonary arterial blood is much more dificult. I requires passing a catheter (a narrow. flexible, hollow tube) into a vein and carefully threading @ through the right heart and into the pulmonary artery, @ nontrivial routine! 3. Color the stroke volume panel 4. Color the elements of cardiac content mea ‘surement below. Note cavetuly the iter labels. Cardiac ouput equals the amount of tnod expeleg om one vonvicle during @ sngte beat (svoke volume) tes the numer of ‘esis ear minute Resing cariac output averages abou ters ‘mn. rises 8 high a8 30 ltes/mn dung exercise, f area STROKES _ CARDIAC || gene, * VOCOMs.- QurRUE SE = Skat. VEQTRICGULAR FILLINE PRESSURE: | Sane nTOSTIG OUPRUBNIER. PARASYMPATHETIC WERUES, ( Dy Aacuamauemae erating te requancy of api (rbot masses NY Stor oro eocvang we regareywests Went gn tesa ere Spay rtd nee seets ws. ea hace meine are on esate ae ope asia te tec) spate as ote har Grong a fosaney (cig ones) sore . ‘e Trove ae wo ndeenctet mechan or nersasig ove © dats waa Pn (FFP)! sotirn + Steen em na ng one cota hoes eg. G | Caar vacant casos teed : hea and 2 Iorease he borage o sympathetic mises fhe tenireuer muscusture, Tre pet shows pow te sre lume Incase win ncrnsedeoricuar ng waco, wher he renee aa ren encore oobig eeabe eerie reese and anew (ume uve) is oBaned BERSURINS CARDING OUTPUT dete oa ness encoun COIS PIC CRNOCIFLE) eee ae ee ei 60 bu 909 oneionung cove & cies a Pee, Sepancy ol 2 for every Herta ws How many ts mst UTER. CRBYEEM, tow to acount fx te amount (10 icles entering vie he ings Gora e8en mee? 56 (etang NPS) yar our on P(cecrepancy prey fe CORDIME Wh> : 1 OUD gopape 2 alo (l= Ae Sle/onin.