Hemodynamics

5/14/15
Cardiovascular Physiology
BENG 230C

Velocity and Flow

The terms "velocity" and "ow" can someGmes
be confused and thought of as being
interchangeable, but they are not.
Velocity is the distance an object (solid, liquid or
gas) moves with respect to Gme (i.e., the distance
traveled per unit of Gme) and is expressed in the
units of cm/sec.

Flow, Q, Qdot or is the volume of a liquid or gas
that is moving per unit of Gme, and is expressed
in units of mL/sec

Review: Flow and Cross SecGonal Area

0

20

Aorta
23
(mean)

Vena cava
15

0
1000
100
10

Vena cava
7
Aorta
4

Veins

Venules

Capillaries

Resistance
vessels

Large
arteries

40

Left
ventricle

V=velocity
Q=ow
A=cross secGonal area

Total cross-section area (cm2)

Q=V x A

Blood velocity (cm/sec)

Major Principle
Flow depends on
Pressure Drop: For overall system, pressure drop:
PA-PV
Resistance

Darcys Law:
Pressure and Resistance Determine Flow
Pressure P1

Flow Q

Pressure P2

For laminar flow, Q is proportional to P1 - P2

Putting in a proportionality factor K, called conductance:
Q = K ( P 1 - P2 )
This is called Darcys law of flow.
Since resistance (R) is defined as
1/conductance:
Q = ( P 1 - P2 )
R
(analogous to Ohms law, I=V/R)

5 Engineer,
Henry Darcy, Civil
Dijon, France

Example: use of Darcys to understand

increased local flow through an individual
exercising muscle

Q (local flow) = (PA PV)

Local R
Every tissue has the same perfusion pressures (PA PV)
Therefore flow in an individual active muscle must be
due to in its local vascular resistance R
A 20x fall in R within an individual exercising muscle
(e.g. quadriceps, skiing) increases its blood flow 20x
6

PA T T E RN S O F
BL O O D F L O W

L aminar

Turbulent

There are
3 different patterns of
blood flow
Most
arteries,
arterioles
venules
and veins

Most arteries,
arterioles,
venules, veins
Ventricles.
Sometimes aorta,
e.g. in pregnancy.
Atheroma (bruit)

Ventricles.
Sometimes
aorta,
e.g. in
pregnancy

Capillaries

Bolus

Capillaries
7

Laminar vs Turbulent Flow

Turbulent flow
e.g. aorta at
peak ejection
in pregnancy
in some women,
espec. if anemic
benign systolic
murmur of
pregnancy

Flow

Laminar
flow

Re = 2000

Shape of basic pressureflow relation

Sir
Osbourne
Reynolds

Pressure

Reynolds number Re = velocity x diameter x density / viscosity (anemia)

Understanding Darcys law: Pressure

governs blood ow, Qdot = P/R
Pressure dierence across circulaGon
depends upon:

Arterial blood pressure

Venous blood pressure

Resistance depends upon uid viscosity and

the conduit (to be covered later in lecture --
Poiseuilles law).

Arterial Pressure: 3 relaGonships (1)

1. Pulse pressure: dierence between systolic
and diastolic pressures.
Systolic pressure = 120 mmHg

Incisura

Diastolic pressure = 80 mmHg

Pulse pressure = Systolic pressure Diastolic pressure

Arterial Pressure: 3 relaGonships (2)

2. Compliance:
Pulse pressure = ~stroke volume/compliance

Because arteries harden with aging (arteriosclerosis), this reduces

compliance, so pulse pressure can double with aging.

Pulse pressure increases with age,

due to arteriosclerosis of big elastic vessels.. Bigger
oscillations around the mean.
Mean BP increases due to resistance vessel changes.
200

Systolic

Brachial artery pressure (mmHg)

180
160
140

Mean
120
100
80

Diastolic

60
40
20
0
0

10

20

30

40

50

60

Age in years

70

80

90

13

Arterial compliance curve is not

linear

120

Compliance =
volume/pressure
Pulse
pressure

Arterial pressure

160

80
Stroke
volume

Volume of blood in elastic arteries

14

Arterial compliance curve is not

linear
Compliance =
volume/pressure

Bigger pulse pressure

when stroke volume raised

120

Pulse
pressure

Arterial pressure

160

Exercise

80
Stroke
volume

Volume of blood in elastic arteries

15

Hydraulic Filtering Creates Uniform

Flow Over Time

Figure 7-1 (your text)
When the arteries are
normally compliant, blood
ows through the capillaries
throughout the cardiac
cycle. When the arteries are
rigid, blood ows through
the capillaries during
systole, but ow ceases
during diastole.

Also reduces work

At steady state, W = P x V; where W=work,
P=pressure, V=volume
Consider pumping 100 ml for 1s in a hypotheGcal
rigid system (A and B):
If conGnuous, lets say 100 mmHg: 100mmHg
* 100 ml/s = 10^4 mmHg*ml/s
However, if intermihent, need to pump 200
ml/s for the 0.5 s acGvity and 0 ml/s for the 0.5
s of inacGvity. Because P=Q*R, pressure is
therefore 200 mmHg during acGvity:
200 mmHg * 200 ml/0.5 s = 2*10^4 mmHg
ml/ 0.5s acGvity
Therefore, intermihent pumping requires more
work than conGnuous.

Compliance compensates for intermiEent ow
delivered by the heart, creaLng a nearly perfect
ltering of the intermiEent ow. Therefore,
W=100mmHg * 100ml/s = 10^4mmHg/ml/s

Reflected Wave

Point of reecGon
e.g. bifurcaGon

Model Descending Aorta

The reflected wave in the human aorta

varies with age and mean pressure

Hodder Arnold / An
IntroducGon to Cardiovascular
Physiology 2010 J. Rodney
Levick

Why Does the Reected Wave Maher?

In young people, the reecGve wave returns slowly (system is
more compliant)
The slow return increases diastolic pressure, increasing
coronary artery perfusion (good)
In contrast, faster return in hypertension and elderly
increases systolic pressure. This increases aPerload, hence
cardiac work and O2 demand.

Arterial Pressure: 3 relaGonships (3)

3. Mean Blood Pressure:
120

Brachial
artery
pressure
(mmHg)

2/3rd
Mean pressure P
A = 93.3
Mean

Pulse
pressure

1/3rd

80

Time, t

Mean BP = diastolic pressure + 1/3[pulse pressure]

What determines Mean Blood

Pressure?

Applying Darcys law to whole systemic circulaLon, of

total peripheral resistance TPR:
Flow = Cardiac output C.O. = (PA-PV) / TPR
Since venous pressure (PV) is negligible compared with PA

C.O. PA / TPR

Therefore, Mean BP (PA) governed largely by CO & TPR

So, what determines PA is

cardiac output, e.g. exercise

total peripheral resistance
e.g. clinical hypertension
22

Understanding Darcys law: Pressure

governs blood ow, Qdot = P/R
Pressure dierence across circulaGon
depends upon:

Arterial blood pressure

Venous blood pressure

Resistance depends upon uid viscosity (to

be covered later in lecture -- Poiseuilles law)

and the conduit (also covered later).

The pressurevolume curve of veins

Volume (ml)

Relaxed

Typical venous pressures

(mmHg)
Limb vein, heart level 810
Central venous pressure 0-7
Foot vein, standing

Stimulated by sympathetic
venoconstrictor nerves shifts blood
centrally, supporting central venous
pressure CVP
24
Venous pressure (cmH2O)

90

1 cm blood
=1.06 cmH2O
= 0.78 mmHg

Vascular
pressures
during
standing

60 mmHg

-35 mmHg

h= 122 cm blood

h=45 cm

(58)

95 mmHg

mmHg
0-50-6
mmHg

95 mmHg

Heart level
Bloodfilled
manometer

Arteries

Veins

h=115 cm

Heart

Hg-filled
manometer
mmHg
90 90
mmHg

185 mmHg

185 mmHg

(183)

25

High local venous

pressure in
upright position
is reduced by
calf muscle pump

PV

Low Pv increases local

pressure gradient Pa-Pv, so flow
Displaced blood raises CVP,
hence stroke volume (Starling LOH)
Low Pv reduces leg capillary pressure
avoiding oedema formation

Central venous pressure

Hodder Arnold / An
IntroducGon to Cardiovascular
Physiology 2010 J. Rodney
Levick

27

Understanding Darcys law: Pressure

governs blood ow, Qdot = P/R
Pressure dierence across circulaGon
depends upon:

Arterial blood pressure

Venous blood pressure

Resistance depends upon (Poiseuilles law):

uid viscosity
the conduit

Poiseuilles law tells us that 3

factors govern resistance
Length of tube
Radius of tube
Viscosity of liquid

Poiseuilles law denes R in Darcys law (Q = (PA-PV)/R)

29

Poiseuilles law: what governs resistance?

Length L
Flow

Radius r

Q
Viscosity

For laminar flow down a tube of radius r,

= (P1P2) r 4
8 L

Since flow equals pressure drop (P1P2) divided by resistance,

Resistance R =

8 L
r 4

Resistance depends on:

radius r 4
viscosity

length L

30

Radius of arterioles is therefore a hugely powerful

regulator of peripheral resistance (r4 eect)
Arterioles & the smallest arteries
are the
main site of resistance to blood flow.

Proof? the biggest pressure drop occurs between the

conduit arteries and the arterial end of the capillaries.

Local arteriole radius therefore controls local blood flow

in a given tissue. Doubling r increases flow 16x!
Arteriole radius in the whole circulation controls TPR,
and therefore mean arterial blood pressure.
Hypertension is caused by narrowing of the resistance
vessels. Remember the r4 effect!
The majority of the total peripheral resistance is situated in the microcirculaGon, more
specically, in the arterioles, which are arterial vessels with diameters from 150 to 10
m. In the resGng condiGon, total peripheral resistance is primarily regulated at this level
by the myogenic response, sympatheGc tone, paracrine factors (e.g., local metabolites),
31
and humoral factors (e.g., ANG II) NEXT LECTURE

How arteriole radius affects both flow & BP

(for a given cardiac work)
Heart

Artery

Resistance
vessels

BP

Capillaries

flow
resistance

Hodder Arnold / An
IntroducGon to Cardiovascular
Physiology 2010 J. Rodney
Levick

33

How arteriole radius affects both flow & BP

(for a fixed level of cardiac work)
Heart

Artery

Resistance
vessels

BP

Capillaries

flow
resistance

flow

BP
Hodder Arnold / An
IntroducGon to Cardiovascular
Physiology 2010 J. Rodney
Levick

resistance
34

PA T T E RN S O F
BL O O D F L O W

L aminar

Turbulent

There are
3 different patterns of
blood flow
Most
arteries,
arterioles
venules
and veins

Most arteries,
arterioles,
venules, veins
Ventricles.
Sometimes aorta,
e.g. in pregnancy.
Atheroma (bruit)

Ventricles.
Sometimes
aorta,
e.g. in
pregnancy

Capillaries

Bolus

Capillaries
35

Blood Rheology
(Shear Thinning: Apparent viscosity
decreases with increased stress)

Figure 6-17
Decrease in the viscosity of blood (in cenGpoise) at increasing rates of shear. The
shear rate refers to the velocity of one layer of uid relaGve to that of the adjacent
layers and is direcGonally related to the rate of ow. (Redrawn from Amin TM, Sirs JA:
The blood rheology of man and various animal species. Q J Exp Physiol 70:37, 1985.)

Relative apparent viscosity of whole blood perfused through glass capillary tubes of varying
diameters (the Fhraeus-Lindqvist effect).

Effective viscosity
of blood in the
circulation diameter
is that of arterioles

Linea Natalie Toksvang, and Ronan M. G. Berg Advan in

Physiol Edu 2013;37:129-133
2013 by American Physiological Society

Human red blood cells flowing through glass capillary tubes with different inner diameters.

Linea Natalie Toksvang, and Ronan M. G. Berg Advan in

Physiol Edu 2013;37:129-133
2013 by American Physiological Society

Blood viscosity falls in narrow tubes!

the Fhraeus-Lindqvist effect
When you get unexpected results you should be darn happy! If you always get the
results you anGcipate you can never hope to discover anything new!
Poiseuille's law, which describes the steady,
4

laminar volume ow of a Newtonian uid

through a uniform and rigid cylindrical,
provides a useful starGng point:

r
Q = P
8L

Q is the volume ow through the tube, P is the pressure drop along the tube, L is
the length of the tube, r is the tube radius, and is the viscosity of the uid.

However, viscosity is not constant but is progressively reduced when the tube
diameter decreases below 0.3 mm, therefore, Poiseuille's law does not apply to the
ow of blood through tubes with a diameter of <0.3 mm. This roughly corresponds
to the onset of the microcirculaGon in vivo.

Bolus flow in capillaries.

Plasma columns are trapped between the red cells;
the cells move like pistons along the capillary.
Two factors that underline the Fahraeus-Lindqvist effect:
(1) Axial streaming - migration of RBC to the middle of the stream, thus leaving cell-free plasma
near the vessel wall, reducing friction.
(2) Bolus flow - reduction in viscosity due to RBC moving in single file w/ some plasma between
them, thus eliminates most of velocity profile, velocity shear and internal friction. The RBCs
traverse the vessel at a higher velocity than the slower flowing marginal plasma stream. The
consequent dilution of the blood at a given tube diameter furthermore reduces41
its viscous
resistance, that is, the apparent viscosity of the flowing blood (the Fhraeus-Lindqvist effect)

Blood viscosity & disease

Viscosity depends on:
Hematocrit (4045%)
typical tube is 4-5
mPA

Clinical aspects:
Polycythemia (high )
Anemia (low )

Tube diameter
(FhraeusLindqvist
effect)
Red cell deformability
Velocity of blood (shear
thinning)

Sickle cell anemia crises

Slow venous flow in
immobile legs
42

Jean Lonard Marie Poiseuille

(1779-1869)
Au revoir, mes enfants.
Le fin!

Hodder Arnold / An
IntroducGon to Cardiovascular
Physiology 2010 J. Rodney
Levick

43

Extra slides

Putting it all together:

pressureflow relation in circulations in vivo
Saline

Blood

Blood
+ noradrenaline

Flow

Autoregulation: protects flow

against pressure fluctuations
brain, myocardium, kidneys
0
Hodder Arnold / An
IntroducGon to Cardiovascular
Physiology 2010 J. Rodney
Levick

100
Blood pressure (mmHg)

200
45

Baylisss myogenic response of arterioles is

cause of autoregulation
Cross-sections of arteriole; resistance proportional to 1/r4

Flow

Pressure

46