[2] Lecture 13: CO And Blood Flow In Muscle Tissues Flashcards
Quantity of blood pumped into the aorta each minute but the heart.
Quantity of blood that flows through the circulation
Sum of all the blood flows to all of the tissues of the body
Cardiac output
Cardiac output per sq. Meter of body surface
Cardiac index
Calc norm cardiac index
70 kg
Body surface area: 1.7 sq. m
CO: 5L
5L /1.7 =3L min/m^2
Through life, cardiac index increases til about age _____ and decreases from there on
- Indicative of declining muscle mass and/ or activity w/ age
Increasing levels of execise:
Increase oxygen consumption and CO and CI
Used to calc blood flow through an organ
Flick principle of blood flow
Flick principle formula:
CO= O2 consumption / [O2] pul.vein - [O2] pul.artery
Patient has a resting O2 consumption of 250 mL/min
Systemic arterial O2 content of 0.20 mL O2 /mL of blood Systemic mixed venous O2 content of 0.15 mL O2 /mL of blood Heart rate of 72 beats/min
CO?
SV?
5L;
70 ml
Determining factor controlling how much heart pumps out?
Based on ‘demand’
Pumps out what is pumped in
Amt. blood returning to heart determines how much is pumped out
CV system:
2 pumps and 2 circuits
What are the 2 CV pumps?
L and r side of heart
What’re the 2 circuits of CV system?
Pulmonary and systemic circuits
The CV circuits are connected in :
Series
2 things same and 1 different in pul. And systemic Circuits of CV system:
Flow and CO is equal
Pressures are different…higher in systemic
Chemical composition of Paul. Venous blood and systemic arterial is
Similar,
Same venous blood entering r atrium is same as Pul. Arterial blood
Factors affecting CO (4):
Basic level of metabolism
Whether person is exercising
Age
Size of body
WNL CO values:
Young healthy men: 5.6 L/min
Women: 4.9L/min
Resting adult: 5L/min
Heart automatically pumps whatever amt. of blood that flows into R atrium
Frank-starling law
What initiates bainbridge reflex?
Stretched R atrium
Strecthing heart causes:
Heart to pump faster
Most important factors in controlling heart:
Peripheral system factors primarily control CO
Anytime a long-term level of TPR changes CO changes quantitatively in exactly the oppo direction
Ohm’s law
MOst important controller of CO:
Peripheral factors
2 reflexes that control heart rate
Bainbridge and baroreceptor reflexes
Responds to changes in blood volume as detected by stretch receptors in R atrium
Bainbridge reflex
Respond to changes in arterial pressure
Baroreceptors
After birth, what happens to mother who recently delivered baby:
Tachycardia, b/c of blood return form uteroplacental return that activates bainbridge reflex
Is bainbridge considered detrimental to humans?
No, its not significant in humans
Formula for CO:
CO = Art. Pressure / TPR
Factors casing hypereffective heart:
Nervous stimulation
Hypertrophy
Exercise via the NS
Hyper effective heart:
Too effective
Exercise effect on CV:
Increase in metabolism=arterioles relax;
Allows more blood into these arterioles;
Brain sends motor signals to the muscles and ANS centers of the brain to excite circulatory activity;
Causes large vein constriction;
Leads to increased HR and contractility
Factors to hypoeffective heart:
Increased arterial pressure; Inhibition of NS excitation; Pathological factors causing abnormal HR; CAD blockage; Valvular heart Dz; Congenital heart Dz; Cardiac hypoxia
As ventricles fill in response to higher atrial pressures,e ach ventricular volume and stretch of cardiac muscle contraction also increases in CO….what is this called?
Ex of frank-starling mechanism
Factors decreasing CO
Severe vessel blockage- MI Severe valvular Dz Myocarditis Cardiac tamponade Cardiac metabolic arrangements
Non-cardiac factors leading to decreased CO
Decreased blood volume Acute venous dilation Obstruction of large veins Decreased tissue mass (muscle mass) Decreased metabolic rate of tissues
what is req’d to maintain CO?
Nervous control/maintenance
Factors that affect venous return to heart from systemic circulation:
Right atrial pressure
Degree of filing of systemic circulation
Resistance to blood flow
When venous return is 0 (mean systemic filling pressure)
This is when right atrial pressure =+7 mm Hg
Pressures everywhere in the body become equal
Mean circulatory filling pressure
The greater the difference btw the mean systemic filling pressure and right atrial pressure:
The greater the venous return
The difference between the mean systemic filling pressure and the right atrial pressure
Pressure gradient for venous return
Mean systemic filing pressure - R atrial pressure
/
Resistance to venous return
=
Venous return
2/3 of resistance to venous return is determined by venous resistance b/c of
Vein distensibility. There is little rise in venous return
About 1/3 of the resistance to venous return is determined by arteriolar and small artery resistance d/t
Accumulation of blood overcomes Munich of the resistance
Impedes flow of blood from veins into r atrium
R atrial pressure
Forces systemic blood toward heart
Pressure when atrial and venous pressure come to equilibrium and systemic circulation flow comes to a stop (=7mm Hg)
Mean systemic filling pressure
Thiamine deficiency. Reduced peripheral resistance
This causes heart failure by means of high cardiac output
Beriberi
fusion of artery and vein leads to a lowering in peripheral resistance….causes increased CO
Atriovenous fistula
Elevated levels of hormone induces vasodilation of circulatory beds supplying muscle and skin.
Reduced peripheral resistance
This leads to an increase in CO
Hyperthyroidism
This decrease causes a lowered afterload effect
Reduced peripheral resistance
This increases CO
Anemia
The loss of this tissue req’s less circulation b/c there is less tissue
This decreases CO
Decreased skeletal muscle mass
This condition req’s less nutrient transportation to tissues leading to decrease in CO
Decreased metabolic rate
Where R atrial pressure = mean systemic filling pressure, venous return =
0
What does the plateau of venous return graph signify?
Caused by collapse of large veins entering chest when R atrial pressure < ATM pressure
This is good b/c it is maximizing CO @ approx. -2 mm Hg
What constricts all the systemic and pulmonary blood vessels and the chambers of the heart and leads to increased mean circulatory filling pressures?
What kind of shift is this?
Strong sympathetic stimulation
This is a shift to the left?
What relaxes all the systemic and pulmonary blood vessels and the chambers of the heart and leads to decreased mean circulatory filling pressures.
Complete sympathetic INHIBITION
This causes a shift to the Right
What happens to venous return when R arterial pressure increases?
Venous return decreases
What happens w/ blood flow (venous return) when resistance decreases?
More venous return
What is the highest level to which the R atrial pressure can rise is
Equal to the mean systemic filling pressure
As resistance decreases= venous return __________
Increases
What function is shown as the cardiac output curve?
Ventricular function
What does the point at which venous return curve and CO curve insect signify?
The amount of blood pumped is = the amt. of blood returned.
Measured when the heart is stopped experimentally
R atrial pressure when there is “no flow” in the CV system
CO and venous return= 0
Pressure is equal throughout the CV system
Mean systemic filling pressure
what effect does increased blood volume have on mean systemic pressure ?
What shift happens on vascular function curve?
What does this do to CO and R atrial pressure?
Increases
Shifts to the right
Increases CO and R atrial pressure
A decrease in blood volume has what effect on mean systemic pressure?
What type of shift in vascular function curve?
What is the effect on CO and R atrial pressure?
Decreases mean systemic pressure
Shifts the vascular function curve to the left
Decreases CO and R atrial pressure
How to increase vascular volume:
Infusion
Activation of renin-aldosterone system
Ways to decrease venous compliance (3):
Sympathetic stimulation
Muscle pump exercise
Lying down
What could cause decrease in vascular volume:
Hemorrhage
Burn trauma
Vomiting
Diarrhea
Ways to increase venous compliance:
Inhibit sympathetic
Alpha block
Venodilator
Standing upright
What vascular event would increase filling of the ventricles?
Decrease filling of ventricles?
Increase mean systemic filling pressure
Decreasing would decrease filling of ventricles
Equilibrium shifts to a higher CO and a correspondingly lower R atrial pressure.
R atrial pressure decreases b/c there’s increased SV
Positive inotropic effect
Equilibrium shifts to a lower CO and a correspondingly higher R atrial pressure
Negative inotropic effect
Large blood flow during skeletal muscle activity is d/t mainly chemicals that act directly on muscle arterioles to dilate them
Local controls
Ex of local controls
Reduction in oxygen Adenosine K+ ion ATP lactic acid CO2
Controls that affect blood flow through skeletal muscles:
Local controls
Nervous controls
Nervous controls in blood flow regulation:
Sympathetic
Adrenal medullae
Secrete norepinephrine
Can decrease blood flow through resting muscles to as little as 1/2 to 1/3 normal
Sympathetic vasoconstrictor nerves
Secretes norepinephrine and epinephrine
Epinephrine also has slight vasodilator effect
Adrenal medulla
3 effects of mass discharge of sympathetic nervous system:
- HR increases
- most peripheral arteries are strongly contracted except: those in active muscles, coronary arteries and cerebral arteries
- muscle walls of veins are contracted: increases mean systemic filling pressure
How does sympathetic stimulation increase arterial pressure
Vasoconstriction of arterioles and small arteries in most tissues
Increased pumping activity in heart
Increase in mean filing pressure caused mainly by venous contraction
Effects of muscle exercise on blood flow in the calf:
C=blood flow increases and decreases between contractions
Exercise has what effect on CO and venous return?
Increases
coronary arteries:
RCA, LAD, Left circumflex
Coronary blood flow in the left ventricle falls to a low value during:
Systole
Coronary blood flow is _______ to flow in vascular beds elsewhere in body
Opposite
The cardiac muscle relaxes and no longer obstructs blood flow the rough the left ventricular capillaries during:
Diastole
Coronary arteries are perfused during which cardiac cycle?
Diastole
Coronary arteries show
Inverse phasic changes
What is primary controller of coronary flow?
Local muscle metabolism
Coroconary flow increases in direct proportion to:
additional metabolic consumption of O2 by heart
Direct ANS stimulation acts on:
Indirect acts on:
blood vessels themselves
Cardiac muscle stissue and indirectly on the coronary vessels via local control mechanisms
Causes of death after acute coronary occlusion:
- Decreased CO
- Damming of blood in pulmonary blood vessels and death resulting from pulmonary edema
- fibrillation of heart
- rupture of heart
Areas of ischemic myocardium are at risk of
Systolic stretch