Haemodynamics.

Understand the relationship between blood flow velocity and cross-sectional

areas in different sections of the vascular system.
The pressure gradient drives blood flow. By pumping blood into the arteries, the
heart increases the mean arterial pressure, which creates a difference in pressure
between the arteries and veins that drives the flow of blood.
Blood flow velocity is determined the distance it travels over time (cm/s).
Volume depends upon cross-sectional area of blood vessel. Therefore, flow =
velocity x area. Flow is constant in a rigid system and the wider is the cross-
sectional area, the slower is the blood flow. Velocity and cross-sectional area
variables change between each other to ensure that the flow is constant, where
a
1
v
1
= a
2
v
2.

However, blood does not flow faster in narrower vessels as evident because the
aorta is largest but the blood flow is very fast while the capillary is the most
narrow and blood vessel there is very slow. This is because if we add up all the
cross-sectional areas of the capillaries in contrast to only one cross section of the
aorta, it makes capillaries the largest.
However flow is opposed by the resistance provided by the blood vessels.


Know Poiseuiles Law and what it describes.
Poiseuilles Law describes laminar flow of homogeneous fluids through cylindrical
tubes in terms of flow, pressure, tube dimensions and viscosity of fluid.
Firstly, flow is directly proportional to the pressure gradient (the difference
between inflow pressure and outflow pressure). If there are 2 reservoirs and one is
filled up to h and the other is empty, then there is a certain flow rate. If the
reservoir is filled up to 2h while the other is still empty, the flow rate doubles. But,
if the reservoir is still at 2h while the other reservoir is at h, then the flow rate
would be halved again.

Flow is inversely proportional to the length of the conducting vessel. The longer is
the length of the conducting system, the less flow it is.

Flow also varies directly with the fourth power of the radius of the conducting
vessel. If there is a vessel with a certain radius, if it is doubled, then there is a 16-
fold increase in the flow rate. Radius of the conducting vessel is the most
influential determinant.

Flow is also inversely proportional to the viscosity of the fluid. The more viscous it
is, the slower is the flow rate. This is because friction (the sheering force) increases
when the fluid becomes more viscous, and more friction causes less flow.




Understand the concept of resistance to blood flow and the structure and
arrangement of blood vessels to counter it.
Resistance (R) to blood flow is the ratio of the pressure gradient to the flow.

Resistance to flow is greatest in arterioles relative to the cross-sectional area and
also due to constriction of arterioles.
Separate elements of circulation (artery, arteriole, capillary etc.) are arranged in
series while similar elements are arranged in parallel.


Resistance in series builds up and adds onto each other.
R
r
= R
1
+ R
2
+ R
3
+R
n
The reciprocal of resistance in parallel is the sum of reciprocal of individual
resistances. For any parallel arrangement, the total resistance is less than the
individual resistance of any segment.

Total peripheral resistance.
The total peripheral resistance is the resistance of the entire circulation. The kidney
has the highest resistance than any other organs.

Effect of pressure and vascular resistance on tissue blood flow.
Blood vessels are not rigid tubes.
The aorta is a conductance, and gets blood from the heart to the organs as soon as
possible. It is able to withstand high pressure, so it is quite fibrous. Its elasticity
also allows it to adapt to changes in the pressure. Compliance is the measure of
vessel elasticity. It can undergo elastic recoil after pumping blood to provide an
extra pump further that drives the blood forward.
Small arteries and arterioles are muscular, resistance and they alter their diameter
to control flow. When the muscle contracts, there is less blood flow due to a higher
resistance.
Capillaries are thin and have endothelial cells for gaseous exchange.
Venules have thin wall, little muscle and low resistance. They are capacitance
(reservoir) of blood. Most of the blood (~60%) is sitting in the veins. Venules have
thin wall (low resistance) and high compliance so that they can stretch a long way.























Appreciate the concepts of laminar and turbulent flow.
Blood flow that is constant has laminar flow. Due to friction with the vessel wall,
flow of blood and other fluid is at a constant velocity in a cylinder. There are
layers of blood and the layer closest to the wall is slowest as the friction in the
blood vessel slows it down. Meanwhile, at the centre, it is when flow is the fastest.
Increased velocity enhances the effect and there is axial streaming where cells
tend to line up in the centre of the vessel where it is fastest. Increased velocity also
increases shear stress of viscous drag on walls.


Irregular fluid motions within vessel cause turbulent flow. Greater pressure is
required to force turbulent flow through a tube.

Turbulent is more likely if the vessel has a large diameter, flow is faster and blood
viscosity is low.
Turbulent flow can be predicted in Reynolds number.