CIRCULATION THROUGH SPECIAL

REGION
Circulation of blood occurs through the following special region:
1. Coronary circulation
2. Cerebral circulation
3. Splanchnic circulation
4. Capillary circulation
5. Fetal circulation
6. Cutaneous circulation
7. Circulation through skeletal muscles
1. CORONARY CIRCULATION
Coronary arteries

Heart muscle is supplied by two coronary arteries, namely right and left
coronary arteries, which are the first branches of aorta. Arteries encircle the
heart in the manner of a crown, hence the name coronary arteries (Latin word
corona = crown).

Right and Left Coronary Arteries

Right coronary artery supplies whole of the right ventricle and posterior
portion of left ventricle. Left coronary artery supplies mainly the anterior and
lateral parts of left ventricle. There are many variations in diameter of coronary
arteries.
Variations in Coronary Arteries

1. In 50% to 60% of human beings, the right coronary artery is larger (right

dominant) and supplies more blood to heart than left coronary artery

2. In 15% to 20% of human beings, the left coronary artery is larger (left

dominant)

3. In 20% to 30% of human beings, both arteries supply almost equal amount

of blood.
Branches of Coronary Arteries

Coronary arteries divide and subdivide into smaller branches, which run all

along the surface of the heart.

Smaller branches are called epicardiac arteries and give rise to further

smaller branches known as final arteries or intramural vessels. Final

arteries run at right angles through the heart muscle, near the inner aspect

of wall of the heart.

VENOUS DRAINAGE
Venous drainage from heart muscle is by three types of vessels.
1. Coronary Sinus
Coronary sinus is the larger vein draining 75% of total coronary flow. It
drains blood from left side of the heart and opens into right atrium near
tricuspid valve.
2. Anterior Coronary Veins
Anterior coronary veins drain blood from right side of the heart and open
directly into right atrium.
3. Thebesian Veins
Thebesian veins drain deoxygenated blood from myocardium, directly into
the concerned chamber of the heart.
Physiological shunt

Physiological shunt is the diverted route (diversion), through which the

venous (deoxygenated) blood is mixed with arterial blood. Deoxygenated
blood flowing from thebesian veins into cardiac chambers makes up the part
of normal physiological shunt. Other component of physiological shunt is the
drainage of deoxygenated blood from bronchial circulation into pulmonary
vein, without being oxygenated.

Normal coronary blood flow

Normal blood flow through coronary circulation is about 200 mL/minute. It

forms 4% of cardiac output. It is about 65 to 70 mL/minute/100 g of cardiac
muscle.
Phasic changes in coronary blood flow

Blood flow through coronary arteries is not constant. It decreases during systole

and increases during diastole.

Intramural vessels or final arteries supplying myocardium are perpendicular to the

cardiac muscles.

So, during systole, the intramural vessels are compressed and blood flow is

reduced. During diastole, the compression is released and the blood vessels are

distended. So, the blood flow increases.

Factors regulating coronary blood flow

Autoregulation
Like any other organ, heart also has the capacity to regulate its own blood
flow by autoregulation. Coronary blood flow is not affected when mean
arterial pressure varies between 60 and 150 mm Hg. Several factors are
involved in the autoregulation mechanism. Coronary blood flow is regulated
mainly by local vascular response to the needs of cardiac muscle.
Factors regulating coronary blood flow:
1. Need for oxygen
2. Metabolic factors
3. Coronary perfusion pressure
4. Nervous factors.
1. Need for oxygen
Oxygen is the most important factor maintaining blood flow through the
coronary blood vessels. Amount of blood passing through coronary
circulation is directly proportional to the consumption of oxygen by cardiac
muscle.

Even in resting condition, a large amount of oxygen, i.e. 70% to 80% is

consumed from the blood by heart muscle than by any other tissues. In
conditions associated with increased cardiac activity, the need for oxygen
increases enormously.

Thus, the need for oxygen, i.e. hypoxia immediately causes coronary
vasodilatation and increases the blood flow to heart.
2. Metabolic factors
Coronary vasodilatation during hypoxic conditions occurs because of some
metabolic products, which increase the coronary blood flow by
vasodilatation.
Reactive Hyperemia
Reactive hyperemia is the increase in blood flow due to the vasodilator
effects of metabolites.
Metabolic products that increase coronary circulation
i. Potassium
ii. Hydrogen
iii. Carbon dioxide
iv. Adenosine phosphate compounds
v. Adenosine
3. Coronary perfusion pressure
Perfusion pressure is the balance between mean arterial pressure and
venous pressure.
Thus, coronary perfusion pressure is the balance between mean arterial
pressure in aorta and the right atrial pressure. Since right aterial pressure is
low, the mean arterial pressure becomes the major factor that maintains the
coronary blood flow.
4. Nervous factors
Coronary blood vessels are innervated both by parasympathetic and
sympathetic divisions of autonomic nervous system. It is not known whether
the autonomic nerves have direct effect on blood flow in various conditions.
However, these nerves influence the coronary blood flow indirectly by acting
on the musculature of heart.
CEREBRAL CIRCULATION
Brain tissues need adequate blood supply continuously. Stoppage of blood
flow to brain for 5 seconds leads to unconsciousness and for 5 minutes
leads to irrepairable damage to the brain cells.

Cerebral vessels and normal cerebral blood flow

Brain receives blood from the basilar artery and internal carotid artery.
Branches of these arteries form circle of Willis. Venous drainage is by
sinuses, which open into internal jugular vein.

Normally, brain receives 750 to 800 mL of blood per minute. It is about 15%
to 16% of total cardiac output and about 50 to 55 mL/100 g of brain tissue
per minute.
Regulation of cerebral blood flow

Cerebral circulation is regulated by three factors:

1. Autoregulation

2. Chemical factors

3. Neural factors.
SPLANCHNIC CIRCULATION

Splanchnic or visceral circulation constitutes three portions:

1. Mesenteric circulation supplying blood to GI tract

2. Splenic circulation supplying blood to spleen

3. Hepatic circulation supplying blood to liver.

Unique feature of splanchnic circulation is that the blood from mesenteric bed

and spleen forms a major amount of blood flowing to liver. Blood flows to liver

from GI tract and spleen through portal system.

1. Mesenteric circulation
Distribution of blood flow
Stomach : 35 mL/100 g/minute
Intestine : 50 mL/100 g/minute
Pancreas : 80 mL/100 g/minute.

2. Splenic circulation
Importance of splenic circulation

Spleen is the main reservoir for blood. Due to the dilatation of blood vessels, a
large amount of blood is stored in spleen. And the constriction of blood vessels
by sympathetic stimulation releases blood into circulation.
Storage of blood
In spleen, two structures are involved in storage of blood, namely splenic
venous sinuses and splenic pulp.
Small arteries and arterioles open directly into the venous sinuses. When
spleen distends, sinuses swell and large quantity of blood is stored.
Capillaries of splenic pulp are highly permeable. So, most of the blood cells
pass through capillary membrane and are stored in the pulp. Venous
sinuses and the pulp are lined with reticuloendothelial cells.
3. Hepatic circulation
Blood vessels
Liver receives blood from two sources:
1. Hepatic artery
2. Portal vein.
Normal blood flow
Liver receives maximum amount of blood as compared to any other organ in
the body since, most of the metabolic activities are carried out in the liver.
Blood flow to liver is 1,500 mL/minute, which forms 30% of the cardiac
output. It is about 100 mL/100 g of tissue/minute.

Normally, about 1,100 mL of blood flows through portal vein and remaining
400 mL of blood flows through hepatic artery. However, portal vein carries
only about 25% of oxygen to liver. It is because it carries the blood, which
has already passed through the blood vessels of GI tract, where oxygen
might have been used. Hepatic artery transports 75% of oxygen to the liver.
CAPILLARY CIRCULATION
Microcirculation
Microcirculation refers to flow of blood through the minute blood vessels
such as arterioles, capillaries and venules. Capillary circulation forms the
major part of microcirculation. Human body contains about 10 billion
capillaries.
Features of capillaries
1. Capillaries arise from arterioles and form the actual functional area of
circulatory system, i.e. exchange of materials between blood and tissues.
2. Structurally, capillaries are very narrow and short. However, quantitatively,
these vessels outnumber the other blood vessels. About 10 billion capillaries
are present in the body.
3. Each capillary lies in a very close proximity to the cells of the tissues at a
distance of about 20 to 30 mm. This enables easy and rapid exchange of
substances between blood and the tissues through interstitial fluid.
FUNCTIONS OF CAPILLARIES

Most important function of capillaries is the exchange of substances

between blood and tissues. Oxygen, nutrients and other essential
substances enter the tissues from capillary blood; carbon dioxide,
metabolites and other unwanted substances are removed from the tissues
by capillary blood. Exchange of materials across the capillary endothelium
occurs by the following processes:
1. Diffusion
2. Filtration
3. Pinocytosis.
ARCHITECTURE OF CUTANEOUS BLOOD VESSELS
Architecture of cutaneous blood vessels is formed in the following manner:
1. Arterioles arising from the smaller arteries reach the base of papillae of
dermis
2. Then, these arterioles turn horizontally and give rise to meta-arterioles
3. From meta-arterioles, hairpin-shaped capillary loops arise. Arterial limb
of the loop ascends vertically in the papillae and turns to form a venous limb,
which descends down.
4. After reaching the base of papillae, few venous limbs of neighboring
papillae unite to form the collecting venule
5. Collecting venules anastomose with one another to form the subpapillary
venous plexus
6. Subpapillary plexus runs horizontally beneath the bases of papillae and
drain into deeper veins.
Cutaneous blood flow performs two functions:

1. Supply of nutrition to skin

2. Regulation of body temperature by heat loss.

Normal blood flow to skin

Under normal conditions, the blood flow to skin is about 250 mL/square
meter/minute. When the body temperature increases, cutaneous blood flow
increases up to 2,800 mL/square meter/minute because of cutaneous
vasodilatation.
Regulation of cutaneous blood flow

Cutaneous blood flow is regulated mainly by body temperature. Hypothalamus plays

an important role in regulating cutaneous blood flow. When body temperature

increases, the hypothalamus is activated. Hypothalamus in turn causes cutaneous

vasodilatation by acting through medullary vasomotor center. Now, blood flow

increases in skin. Increase in cutaneous blood flow causes the loss of heat from the

body through sweat. When body temperature is low, vasoconstriction occurs in the

skin. Therefore, the blood flow to skin decreases and prevents the heat loss from skin.
FETAL CIRCULATION
Fetal circulation is different from that of adults because of the presence of
placenta. Since fetal lungs are nonfunctioning, placenta is responsible for
exchange of gases between fetal blood and mother’s blood. So, the blood
from right ventricle is diverted to placenta.
Development of heart is completed at 4th week of intrauterine life and it
starts beating at the rate of 65 per minute. Along with heart, the blood
vessels also develop. Heart rate gradually increases and reaches the
maximum rate of about 140 beats per minute just before birth.
Fetus is connected with the mother through placenta. Fetal blood passes to
placenta through umbilical vessels and the maternal blood runs through
uterine vessels. These two sets of blood vessels lie in close proximity in the
placenta through which exchange of substances takes place between
mother’s blood and fetal blood. However, there is no direct admixture of
maternal and fetal blood.
Blood vessels in fetus
As fetal lungs are non-functioning, there is no necessity of large amount
of blood to be pumped into lungs. Instead, the fetal heart pumps large
quantity of blood into the placenta for exchange of substances. From
placenta, the umbilical veins collect the blood, which has more oxygen and
nutrients. Umbilical vein passes through liver. Some amount of blood is
supplied to liver from umbilical vein. However, a large quantity of blood is
diverted from umbilical vein into the inferior vena cava through ductus
venosus. Liver receives blood from portal vein also. In liver, the oxygenated
blood mixes slightly with deoxygenated blood and enters the right atrium via
inferior vena cava. From right atrium, major portion of blood is diverted into
left atrium via foramen ovale.
Foramen ovale is an opening in intra-atrial septum. Blood from upper part of
the body enters the right atrium through superior vena cava. From right
atrium, blood enters right ventricle.
From here, blood is pumped into pulmonary artery. From pulmonary artery,
blood enters the systemic aorta through ductus arteriosus. Only a small
quantity of blood is supplied to fetal lungs. Blood from left ventricle is
pumped into aorta. Fifty percent of blood from aorta reaches the placenta
through umbilical arteries.
CIRCULATION THROUGH SKELETAL MUSCLE
During resting condition, blood flow to skeletal muscle is 4 to 7 mL/100
g/minute. During exercise, it increases to about 100 mL/100 g/minute.

Factors regulating blood flow to skeletal muscle

Blood flow through skeletal muscle is regulated by three factors:

1. Mechanical factors

2. Chemical factors

3. Nervous factors.
Mechanical factors
During contraction of the muscle, blood vessels are compressed and the blood
flow decreases. And during relaxation of the muscle, compression of blood
vessels is relieved and the blood flow increases. In severe muscular exercise,
blood flow increases in between the muscular contractions.
Chemical factors
Important chemical factors, which regulate the blood flow through skeletal
muscles, are lack of oxygen, excess of carbon dioxide and increased hydrogen
ion concentration. All these chemical factors increase the blood flow to muscle
by causing vasodilatation.
Nervous factors
Blood vessels of the skeletal muscles are mostly innervated by sympathetic
nerve fibers and few parasympathetic nerve fibers are also seen. Special
feature of sympathetic nerve fibers supplying the skeletal muscles is that these
nerve fibers are vasodilators and not constrictors. Since the sympathetic nerve
fibers cause dilatation of blood vessels in muscle by secreting acetylcholine,
these nerve fibers are called sympathetic vasodilator fibers or sympathetic
cholinergic fibers.