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Chapter: Medical Physiology: Overview of the Circulation; Medical Physics of Pressure, Flow, and Resistance

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Basic Theory of Circulatory Function

Although the details of circulatory function are complex, there are three basic principles that underlie all functions of the system.

Basic Theory of Circulatory Function

Although the details of circulatory function are complex, there are three basic principles that underlie all functions of the system.

The rate of blood flow to each tissue of the body is almost always precisely controlled in relation to the tissue need. When tissues are active, they needgreatly increased supply of nutrients and therefore much more blood flow than when at rest—occasionally as much as 20 to 30 times the resting level. Yet the heart normally cannot increase its cardiac output more than four to seven times greater than resting levels. Therefore, it is not possible simply to increase blood flow everywhere in the body when a particular tissue demands increased flow. Instead, the microvessels of each tissue continuously monitor tissue needs, such as the availability of oxygen and other nutrients and the accumulation of carbon dioxide and other tissue waste products, and these in turn act directly on the local blood vessels, dilating or constricting them, to control local blood flow precisely to that level required for the tissue activity. Also, nervous control of the circulation from the central nervous system provides additional help in controlling tissue blood flow.

  

The cardiac output is controlled mainly by the sum of all the local tissue flows. When blood flows through a tissue, it immediately returns by way of the veins to the heart. The heart responds automatically to this increased inflow of blood by pumping it immediately into the arteries from whence it had originally come. Thus, the heart acts as an automaton, responding to the demands of the tissues. The heart, however, often needs help in the form of special nerve signals to make it pump the required amounts of blood flow.

In general the arterial pressure is controlled independently of either local blood flow control or cardiac output control. The circulatorysystem is provided with an extensive system for controlling the arterial blood pressure.

For instance, if at any time the pressure falls significantly below the normal level of about 100 mm Hg, within seconds a barrage of nervous reflexes elicits a series of circulatory changes to raise the pressure back toward normal. The nervous signals especially (a) increase the force of heart pumping, (b) cause contraction of the large venous reservoirs to provide more blood to the heart, and (c) cause generalized constriction of most of the arterioles throughout the body so that more blood accumulates in the large arteries to increase the arterial pressure. Then, over more prolonged periods, hours and days, the kidneys play an additional major role in pressure control both by secreting pressure-controlling hormones and by regulating the blood volume.

Thus, in summary, the needs of the individual tissues are served specifically by the circulation.

 

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