Haemodynamics Notes
Pressure is a force over an area, Blood pressure, is force that the blood exerts
on the surface area of the walls of the blood vessels. Differences in blood
pressure throughout the body keep blood flowing from high-pressure areas, like
the arteries, to low-pressure areas, like the veins. “Blood flow,” refers to the
volume of blood that flows through a vessel or an organ over some period of
time.
The amount of blood flow from one end of a blood vessel to another is affected
by the blood pressure, and by the resistance, which comes from the vessels
themselves.
Vasoconstriction, where the vessels constrict, decreases blood flow, and
vasodilation, where the blood vessels expand, increases blood flow.
Blood flow is not the same thing as the velocity of blood.
Blood flow is the volume of blood that moves by a point over some period of
time.
Eg: chunk of blood has a volume of 83 cm^3, and it took 1 second for this
much to flow past the blue circle—this is the blood flow, represented by the
variable capital Q.
velocity on the other hand, is the distance travelled in a certain amount of time.
So maybe in the same one second, a red blood cell at the very edge traveled a
distance of 27 cm, then it’d be moving 27 cm/s, represented by lowercase v.
Even though these aren’t equal, they are related, and the last piece is area,
specifically the cross-sectional area of the blood vessel, which in reality is the
same as the blood cross section like this. So, based on units, since area’s going
to be expressed in cm^2,
flow rate = area Xvelocity!
Problem :calculate blood velocity, for the cardiac output of 5L/min, which
is average for an adult, and the diameter of their aorta, which is 2cm.
Answer: 26 cm per second! 1 km / hr!
Mathematical equation representing Blood pressure, blood flow, and resistance
is
Blood pressure is usually highest in a large artery like the brachial artery, which
is where blood pressure is usually measured, That’s because at that point the
blood still needs to be able to push through the smaller arterioles and capillaries,
which means lots of resistance. In an average adult, blood pressure is about
120/80 mmHg or millimeters of mercury..
The first number, 120, is the systolic pressure, which is the force that the blood
exerts on the walls of the arteries during systole, when the heart contracts to
pump blood through the body, and the second number, 80, is the diastolic
pressure, which is the pressure on the walls of the arteries during diastole, when
the heart relaxes and refills with blood between heartbeats..
The mean arterial pressure, or MAP, is the average pressure on the arteries
during a complete cardiac cycle, including the systolic and diastolic pressures. It
can be calculated a couple ways. The first is the quickest: assuming that about
⅓ of the cardiac cycle is spent in systole and about ⅔ of the cardiac cycle is
spent in diastole
MAP = ⅓ (systolic blood pressure) + ⅔ (diastolic blood pressure).
Another measurement is the pulse pressure, which is the difference between the
systolic pressure and the diastolic pressure,
Relationship between blood pressure, blood flow, and resistance with reference
to MAP .
The aorta, the biggest of the arteries coming right from the heart itself. That
artery goes to arterioles and capillaries, representing the whole human body,
and then the venous blood returns to the right atrium of the heart.
So, the initial pressure here is pressure in the arteries, in other words—the mean
arterial pressure, and the final pressure over here is we have the central venous
pressure, or CVP, in the vena cavae right before they enter the right atrium.
Based on equation, Pi - Pf = Q x R, blood flow is the total blood flow through
all of the blood vessels and organs, which is called the cardiac output and is
measured in L/min. Pi is MAP and Pf is CVP, and finally, the combined
resistance of all of the blood vessels of systemic circulation would be
the systemic vascular resistance, called SVR,.
So the equation is MAP - CVP = CO x SVR.
CVP is usually a small number, so it’s usually ignored and the equation is
simplified to MAP = CO x SVR.
Based on this relationship, an increase in resistance, which is mostly caused by
arteriole vasoconstriction, will cause the blood pressure to rise.
Pressures in Cardio vascular system
. Pressures in different parts of the cardiovascular system aren’t equal and these
differences in pressures keep the blood moving from high pressure areas leaving
the heart like the arteries to low pressure areas like the veins.
The pressure curve looks a little more like this, and fluctuates in the arteries
depending on part of the cardiac cycle it’s in, the peaks being systole, and the
low points being diastole - original line is the average of these fluctuations, or
the mean arterial pressure. since systole takes up about a third of a
single cardiac cycle, and diastole takes up the remaining 2/3 of the cycle, we
can calculate the mean arterial pressure at any time by the equation:
MAP = (⅓) SBP + (⅔) DBP
Which after distributing we get:
MAP = DBP + (⅓) PP
Now, looking at these fluctuations on the arterial side, there’s a couple
important things to notice.
First of all, on the downswing of the curve, there’s a sharp sharp pressure drop
followed by a rise again forming what’s called the dicrotic notch or incisura. As
blood is ejected out into the aorta, pressure rises quickly, and then as a tiny
amount of blood flows back into the ventricle, and causes the valve to snap shut
and the pressure to fall. That snapping shut of the valve causes it to recoil back,
which causes a brief increase in pressure of aorta, and then finally the
pressure falls as the aorta settles and the heart relaxes.
A second thing to notice is that the pulse pressure in the large arteries
downstream of the aorta is larger than those in the aorta themselves!That’s
because the pressure from blood travels a bit faster than blood itself. To
understand that idea - think of the molecules and cells in the blood like
Newton’s cradle, and while they move together, they bump into each other and
transmit that pressure wave faster than the group can move as a whole, meaning
that the pressure wave actually increases the pressure downstream. Also, the
pressure waves bounce off the branch points in the arteries, which causes them
to reflect back and increase the pressure in the arteries even more.
so it should seem a little weird that both systolic pressure and pulse pressure are
higher in the downstream arteries, since we know that blood wants to move
from a high pressure area to a low pressure area, but one thing to remember is
that in the large arteries the diastolic pressure is lower, and remember that it’s
the mean arterial pressure that drives blood flow, which this is mostly affected
by diastolic pressure, which is highest in the aorta.
As an example, let’s say the aorta’s SBP is 115 and DBP is 85, meaning PP is
30. That said, the MAP is 95 mmHg.
Now, if the large arteries’ SBP is 120 and DBP is 80, with a PP of 40, the MAP
ends up being 93, which is lower than in the aorta
we move out from the arterial tree, the pressure gets lower and lower as the
arteries branch out into smaller and smaller arteries and then arterioles and
then capillaries. As the blood move across the arterioles the pressure falls from
about 80 mmHg to 30 mmHg. As the vessels branch into smaller and smaller
arterioles, resistance goes up, and since resistance goes up, and according to the
equation flow rate equals change in pressure or pressure initial minus pressure
final, divided by resistance, with increased resistance, the pressure final or
downstream pressure must decreases, which increases the change in pressure
and keeps flow rate constant. Across the capillaries, the pressure drops from 30
mmHg down to about 10 mmHg. So the pressure drop is greater across the
arterioles then the capillaries, even though capillaries are even smaller, which
means even more resistance. The pressure drop is less, though, because there
are so many capillaries that run in parallel to one another, that it helps to reduce
total resistance, since total resistance for vessels in parallel is less than the
resistance in any individual vessel.
After the capillaries, blood goes into the venules and then the larger veins. At
this point, the pressure drops aren’t great because the blood vessels have a
larger and larger radius and have a high compliance and can expand to hold
more blood.
Finally blood makes it to the vena cavae, and pressure is roughly 4 mmHg and
right atrial pressure is around 2 mmHg. Even though there are only small
differences in pressure, it’s enough to move blood back to the heart, even when
it’s going against gravity.
Various clinical situations can cause pressures in the system to go up or down,
and that affects all of the downstream pressures as well.
As an example,
. The first is arteriosclerosis, which is a chronic condition where the arteries
become stiff and less compliant, a bit like a rubber hose turning into a lead pipe
over time.
The baseline diastolic pressure usually doesn’t change, but the extra volume of
blood that exerts pressure on the walls during systole, results in enormous
increases in systolic pressure because the walls are so stiff.
The high systolic pressure with the unchanged diastolic pressure means that
there is also an increased pulse pressure and therefore an increased mean arterial
pressure.
The second example is aortic stenosis - a narrowing of the aortic valve which
increases it’s resistance. With increased resistance, the change in pressure must
increase, which means there’s a decrease in pressure after the valve.
The diastolic pressure remains unchanged, but there’s a decrease systolic
pressure, decreased pulse pressure, and decreased mean arterial pressure.
Laminar and Turbulent flow
Laminar means smooth, and so laminar blood flow is blood that’s flowing
smoothly through the vessels.
Turbulent flow, , is when the blood’s not flowing smoothly, and we can figure
out if blood is likely to be laminar or turbulent by finding its Reynolds
number or Re, which is named after Osborne Reynolds, a Victorian scientist
who not only studied fluid dynamics, but is a man that knows how to rock a
beard and bowtie.
If everything’s moving like it should and the blood flow is laminar, the linear
velocity of the blood -- how fast it’s moving in a straight line -- is greatest in the
center of the blood vessel, and lowest near the walls of the vessel, dropping to
zero at the wall.
Sometimes, though, blood flow is disrupted, like in atherosclerotic plaque
along the wall, which reduces the diameter of the blood vessel at that point and
causes turbulence.
There are a number of factors help predict turbulence,
they include the density of the blood, usually denoted by the greek letter rho,
the viscosity denoted by the greek letter nu.
fluid’s viscosity as it’s thickness,
velocity of blood flow (v), and the diameter of the blood vessel (d)
If the Reynolds number is low - below 2000, then blood flow will be laminar -
think “low” and “laminar”, and if the Reynolds number is above 3000 it’ll be
turbulent. A Reynolds number between 2000 and 3000 is somewhere in
between.
Example, a person with anemia has a low red blood cell count, and in general
has a lower hematocrit, the ratio of red blood cells to total blood volume. This
essentially means the blood’s less thick or viscous, which means based on our
equation, if viscosity decreases, reynolds number increases.
Also, these individuals often have an increased cardiac output, which means
increased blood velocity and therefore increased reynolds number.
Another example would be a person with a thrombus, or blood clot, which just
like the atherosclerotic plaque would narrow or decrease the diameter of the
blood vessel...
Shear is related with viscosity, because the higher the shear, the lower the
viscosity of the blood. This is because shear helps to pull the elements in the
blood apart decreasing it's stickiness, or viscosity, making blood less viscous at
the vessel walls and more viscous in the middle of the vessel.
Resistance to Blood Flow
Blood flow refers to the volume of blood travelling through a blood vessel, an
organ, or the entire body over a period of time, and it can be measured as liters
per minute. As blood flows, it encounters various factors that resist flow and
movement of blood, known as the vascular resistance.
In serial resistance total resistance is sum of individual resistanc
Sources
1. "Medical Physiology" Elsevier (2016)
2. "Physiology" Elsevier (2017)
3. "Human Anatomy & Physiology" Pearson (2018)
4. "Principles of Anatomy and Physiology" Wiley (2014)