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Blood Flow Mechanics (Medicalstudyzone - Com)

This document discusses blood flow mechanics including equations for flow, resistance, compliance, and pulse pressure. It explains how vessel properties like stiffness and distensability affect resistance and compliance. Types of blood vessels are described along with how they determine total peripheral resistance. The document also covers hypertrophy, wall tension, preload and afterload.

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Lordoc Doctorsaab
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57 views31 pages

Blood Flow Mechanics (Medicalstudyzone - Com)

This document discusses blood flow mechanics including equations for flow, resistance, compliance, and pulse pressure. It explains how vessel properties like stiffness and distensability affect resistance and compliance. Types of blood vessels are described along with how they determine total peripheral resistance. The document also covers hypertrophy, wall tension, preload and afterload.

Uploaded by

Lordoc Doctorsaab
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Blood Flow

Mechanics
Jason Ryan, MD, MPH
Flow Equations

Ohm’s Law V = I R
For fluids: ΔP = Q X R
CO = Q for body
TPR = total peripheral resistance
ΔP = CO * TPR
Flow Equations

Velocity
Area

Velocity * Area = Flow


(m/s) * (m2) = (m3/s)
Resistance and Compliance

Resistance = resistance to flow


Compliance = distensability of vessels

Stiff Vessels Stretchy Vessels


↑ resistance ↓ resistance
↓ compliance ↑ compliance

High resistance = low compliance (vice versa)


Pulse Pressure
• Systolic BP – diastolic BP
• Normal = 120 – 80 = 40mmHg
• Older patients = ↑ pulse pressure
• Hypertensive patients = ↑ pulse pressure
• Related to vessel compliance
• ↓ compliance = ↑ pulse pressure
Pulse Pressure
• Compliance = Δ volume / Δ pressure
• Stiff vessel → ↓ compliance → ↑ pulse pressure
• Small change in volume for given pressure applied to walls
• Stretchy vessel → ↑ compliance → ↓ pulse pressure
• Large change in volume for given pressure applied to walls

C = ΔV / ΔP

ΔP = ΔV / C
Pulse Pressure
• Pulse pressure varies with vessel compliance
• Stiff vessels → ↓ compliance

Distensible Stiff
Vessel Vessel
120/80 170/100
Flow Equation
Total Peripheral Resistance

ΔP = CO * TPR

↑ resistance = ↑ pressure to maintain flow


↑ pressure = ↑ cardiac work
Total Peripheral Resistance
• Easy to push blood out of heart → less O2 required
• Resistance to flow → more work for heart
• What resists forward flow out of heart?
1. Types of vessels (i.e. pipes/tubes)
2. Thickness of blood (viscosity)
Types of Vessels
• Aorta: SBP 100mmHg
• Large arteries: Falls few mmHg
• Small arteries: 10-20mmHg
• Arterioles: 35mmHg
• Capillaries: 25mmHg
Types of Vessels
• Arterioles = “resistance vessels”
• Major determinant of total peripheral resistance
• Large pressure drop
• Vasoconstriction = ↑ TPR
• Vasodilation = ↓ TPR
Viscosity
• Thickness of blood
• Low viscosity
• Anemia
• High viscosity
• Polycythemia
• Multiple myeloma
• Spherocytosis
Poiseuille's Law
• ΔP= QXR
ΔP 8 η (viscosity) L (length)
R = =
Q Π r (radius) 4

Changes in radius → large change in resistance


Series and Parallel Circuits

Human organs arranged in parallel


Resistances add up differently in series than in parallel
1 1 1
= + Rtotal = R1 + R2
Rtotal R1 R2

Parallel Series
Series and Parallel Circuits

For two resistances (2 and 2), what is total R?

1 1 1
= + Rtotal = R1 + R2
Rtotal R1 R2
Rtotal = 2 + 2 = 4
1 1 1
= +
Rtotal 2 2

Rtotal = 1
Flow Equation ΔP = Q * R

• Used to calculate resistance, CO, or ΔP


• Often applied to body and lungs
• For both systems Q = Cardiac Output (CO)
Flow Equation ΔP = Q * R

• Body
• ΔP = Arterial pressure – right atrial pressure
• R = Total peripheral resistance (TPR)
• R = Systemic vascular resistance (SVR)
• Lungs
• ΔP = Pulmonary artery pressure – left atrial pressure
• R = Pulmonary vascular resistance (PVR)
Mean Arterial Pressure
• Diastolic plus 1/3 (Systolic – Diastolic)
• Total body
• Arterial blood pressure = 120/80 mmHg
• Mean arterial pressure = 80 + 1/3 (40) = 93 mmHg
• Lungs
• Pulmonary artery pressure = 40/20 mmHg
• Mean pulmonary artery pressure = 20 + 1/3 (20) = 27 mmHg
Total Body
ΔP = CO * TPR
• R = TPR
• ΔP = MAP – RAP
• MAP = mean arterial pressure
• RAP = right atrial pressure
• CO of 5L/min; BP 155/80 (MAP 105), RA 5

TPR = ΔP = MAP – RAP = 105 – 5 = 20


CO 5 5
Lungs
ΔP = CO * TPR
• R = PVR
• ΔP = PA – LAP
• PA = mean pulmonary artery pressure
• LAP = left atrial pressure
• CO of 5L/min; PA 40/10 (MAP 20), LA 5

PVR = ΔP = PA – LAP = 20 – 5 = 3
CO 5 5
Lung and Body Flow Variables

Lung Body
Flow CO CO
Resistance PVR TPR
Start Pressure PA AoP
End Pressure LA RA
ΔP PA – LA Ao - RA
Velocity and Area
• Flow = Velocity * Area
• Changes as blood moves through vessels
• Aorta → arterioles → capillaries → veins
• Cardiac output moves through system (same flow)
• Different vessels → different area, velocity
• Area ↑↑, velocity ↓↓

Velocity
Area

Flow = Velocity * Area


(m3/s) = (m/s) * (m2)
Flow Properties of
Blood Vessels
Property Highest Lowest
Flow -- --
Area Capillaries Large arteries
Velocity Large Arteries Capillaries
Resistance Arterioles Veins
ΔP Arterioles Veins

Flow = Vel * Area


ΔP= QXR
Law of Laplace
• Wall tension or wall stress
• Applies to vessels and cardiac chambers
• ↑ tension → ↑ O2 demand → ischemia/angina

P*r
Tension α
2h
Wall Tension
• Afterload: Increases pressure in left ventricle
• Hypertension, aortic stenosis
• Will increase wall tension
• “Pressure overload”

P*r
Tension α
2h
Wall Tension
• Preload: Increases radius of left ventricle
• Chronic valvular disease (aortic/mitral regurgitation)
• Will increase wall tension
• “Volume overload”

P*r
Tension α
2h
Wall Tension
• Hypertrophy: Compensatory mechanism
• Will decrease wall tension
• Force distributed over more mass
• Occurs with chronic pressure/volume overload

P*r
Tension α
2h
Eccentric Hypertrophy
• Longer myocytes
• Sarcomeres added in series
• Left ventricular mass increased
• Wall thickness NOT increased

Normal
LV Size Dilated LV Increased myocyte size
Sarcomeres in series
Normal wall thickness
Eccentric Hypertrophy
• Volume overload of left ventricle
• Aortic regurgitation
• Mitral regurgitation
• Cardiomyopathy
• Ischemic and non-ischemic
Concentric Hypertrophy
• Pressure overload
• Chronic ↑↑ pressure in ventricle
• Sarcomeres added in parallel
• Left ventricular mass increased
• Wall thickness increased

Normal Increased myocyte size


LV Size ↓ LV Size
Sarcomeres in parallel
Increased wall thickness
Concentric Hypertrophy
• Classic causes: Hypertension, Aortic stenosis
• Both raise pressure in LV cavity
• Decreased compliance (stiff ventricle)
• Often seen in diastolic heart failure

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