COLLEGE OF MEDICINE AND HEALTH
SCIENCES
DEPARTMENT OFDELIVERY
LECTURE HUMAN PHYSIOLOGY
GUIDE
Course Code: PIO 223
Course Title: Cardiovascular Physiology
Developer: ONWUKA Osah Martins
Phone: +2348164098951
Email
CIRCULATION THROUGH SPECIAL AREAS
Learning Outcomes/Objectives:
1. Coronary Circulation 5. Others
2. Cerebral Circulation
3. Fetal Circulation
4. Cutaneous Circulation 1
CORONARY CIRCULATION
• Coronary circulation refers to the
circulation of blood in the blood
vessels of the heart muscle
(myocardium).
• Normal blood flow through
coronary circulation = about 200
mL/minute. It forms 4% of cardiac
output. It is about 65 to 70
mL/minute/100 g of cardiac muscle.
• Blood flow through coronary
arteries decreases during systole and
increases during diastole.
• The coronary circulation consists of
coronary arteries and coronary veins
2
Coronary Arteries:
• There are two main coronary arteries: the left coronary artery and
the right coronary artery.
• The right coronary artery: supplies blood to the right atrium, right
ventricle, and the inferior part of the left ventricle.
• The left coronary artery further divides into the left anterior
descending artery and the left circumflex artery.
• The left coronary artery supplies blood to the left atrium, left
ventricle, and most of the interventricular septum.
3
Coronary Veins:
• After blood has supplied oxygen and nutrients to the heart muscle,
it is collected by coronary veins.
• The coronary veins drain the deoxygenated blood from the
myocardium and return it to the right atrium of the heart.
• The coronary sinus, situated on the posterior aspect of the heart,
serves as the primary coronary vein, draining 75% of total
coronary flow from smaller coronary veins on the left side and
ultimately opening into the right atrium near the tricuspid valve.
• Anterior coronary veins drain blood from right side of the heart
and open directly into right atrium.
• Thebesian veins drain deoxygenated blood from myocardium,
directly into the concerned chamber of the heart. 4
MEASUREMENT OF CORONARY BLOOD FLOW
• Directly - electromagnetic flowmeter placed around any coronary
artery
• Indirectly - By Fick principle
Amount of N2O taken up/minute
Blood flow =
Arteriovenous difference of N2O content
Others:
• By using Doppler flowmeter
• By videodensitometry
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Regulating Factors of coronary blood flow:
1. Need for oxygen
2. Metabolic factors
• Reactive Hyperemia - Adenosine (potent vasodilator), i. Potassium,
ii. Hydrogen iii. Carbon dioxide iv. Adenosine phosphate
compounds.
3. Coronary perfusion pressure
• coronary perfusion pressure = balance between mean arterial
pressure in aorta and the right atrial pressure.
4. Nervous factors
• Parasympathetic and sympathetic
• Neurotransmitters (adrenaline etc.)
6
PATHOPHYSIOLOGY
Coronary Artery Disease (CAD):
• Coronary artery disease occurs when the coronary arteries become
narrowed or blocked, usually due to the accumulation of cholesterol
and other substances, leading to reduced blood flow to the heart.
Mediating factors:
1. Coronary occlusion: atherosclerosis induced
• Myocardial ischemia and necrosis
• Myocardial infarction – heart attack
• Common symptoms
Cardiac pain – angina pectoris,
Palpitations
Difficulty in breathing etc
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• Venous drainage is by
sinuses, which open into
internal jugular vein.
• Brain receives 750 to 800
mL of blood per minute.
about 15% to 16% of total
cardiac output and about 50
to 55 mL/100 g of brain
tissue per minute.
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REGULATION OF CEREBRAL CIRCULATION
1. Autoregulation
• Effective perfusion pressure: mean arterial pressure within (60-
140 mmHg) makes autoregulation possible.
• Cerebral vascular resistance: intracranial pressure, cerebrospinal
fluid pressure and viscosity of blood.
• Cushing reflex: activation of vasomotor center, resulting in
peripheral vasoconstriction and rise in the arterial pressure.
2. Chemical factors
i). Decreased oxygen tension (ii). Increased carbon dioxide tension
iii. Increased hydrogen ion concentration.
3. Neural factors
the sympathetic nerves cause constriction of cerebral blood vessels,
leading to reduction in blood flow. It prevents cerebral vascular
hemorrhage and cerebral stroke. 9
PATHOPHYSIOLOGY – STROKE
Cardiovascular accident (CVA) or brain attack.
• Stroke = sudden death of neurons = inadequate blood supply.
• It is characterized by reversible or irreversible paralysis with
other symptoms.
Types
Stroke is classified into two types:
1. Ischemic stroke = interruption of blood flow to a part of
brain
2. Hemorrhagic stroke = rupture of a blood vessel in the brain
and spilling of blood into the surrounding areas.
Causes: Heart disease, Hypertension, High cholesterol in blood,
High blood sugar (diabetes mellitus), Heavy smoking, Heavy
alcohol consumption. 10
Ductus Venosus:
Fetal Circulation Blood from the placenta bypass the
fetal liver and flow directly into the
inferior vena cava.
Foramen Ovale:
between the right and left atria.
Blood flows from the right atrium to
the left atrium, bypassing the non-
functioning fetal lungs.
Ductus Arteriosus:
between the pulmonary artery and the
aorta.
Blood bypass the non-functional fetal
lungs, directed from the pulmonary
artery to the aorta.
Umbilical Arteries and Vein:
The umbilical arteries carry
deoxygenated blood from the fetus to
the placenta.
The umbilical vein carries oxygenated
blood from the placenta to the fetus.
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Pulmonary vascular resistance
Major factor that induces diversion of blood from lungs
CHANGES IN CIRCULATION AND RESPIRATION AFTER
BIRTH – NEONATAL CIRCULATION AND RESPIRATION
1. First breath of the child
• sudden hypoxia and hypercapnia
• respiratory center is strongly stimulated
• Gasping occurs, then normal respiration
2. Flow of blood to lungs
• Lungs expand during the first breath
• reduction in the pulmonary vascular resistance, blood flow to lungs
3. Closure of foramen ovale
4. Reversal of blood flow in ductus arteriosus
5. Closure of ductus venosus
6. Closure of ductus arteriosus
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Cutaneous Circulation • blood flow Skin
• Thermoregulation
Hypothalamus
cutaneous vasodilatation
via medullary vasomotor
center.
• nutrient supply,
• waste removal
• immune response
Vascular responses of
skin To mechanical
stimuli
White reaction
Lewis triple response
1. Red reaction
2. Flare
3. Wheal 13
Others
Splanchnic
Circulation:
• Mesenteric
circulation
supplying blood to
GI tract
• Splenic circulation
supplying blood to
spleen
• Hepatic circulation
supplying blood to
liver.
Renal circulation
Circulation through
Skeletal Muscle
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