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Fisiologia Cardiovascular

Circulaciones Especiales

AGUSTIN IZA STOLL


Hemicardio derecho Hemicardio Izquierdo

Pulmones
Aurícula Derecha Aurícula Izquierda
100%
V Tricúspide V. Mitral
Ventrículo Derecho Ventrículo Izquierdo
Válvula Pulmonar
15% 100%
Cerebral
100% 5%
Coronaria
Vena Cava 25%
Arteria Aorta
Renal

Digestiva 25
%
Músculo 25
Esqueletico %

Venas Piel 5% Arterias


Integra las velocidades de todos los
anillos concéntricos. Velocidad de fluido
reales.
Q = velocidad del flujo sanguíneo

Q =  (Pi –Pf) r4
8 n l
FLUJO SANGUINEO

• Depende de las necesidades:


Hígado 95ml/minuto/100gr
Riñón 360ml/minuto/100gr
Músculo en reposo 4ml/min/100gr.
80ml/m/100gr
El cerebro constituye el 2% del total del
peso corporal y recibe 15% del gasto
cardiaco.
El flujo sanguíneo cerebral, O2 y glucosa
tienen una alta demanda comparada con
otros órganos, excepto el corazón
Falta de flujo cerebral solo puede ser
tolerado por pocos segundos sin perdida de
conciencia y solo 3-4 minutes sin daño
cerebral permanente a temperatura normal.
Cerebral circulation
Unique features:
– contained within rigid structure  inflow/outflow
dysbalances  pressure
• Cushing’s phenomenon:  systemic BP with  intracranial pressure
(e.g. tumor) - by ischemic stimulation of vasopressor center in medulla
(helps maintain brain flow)
– Absolute requirement for adequate flow
• tissue least tolerant to ischemia
– 5 sec ischemia  loss of consciousness
• glucose-dependent
• no contribution to total PVR regulation

03:08 PM Organ vascular beds 25


Brain flow autoregulation
• Excelente entre 60 y 160 mmHg

• Menor a 60 mmHg: sincope

• Mayor a 160 mmHg: edema cerebral

03:08 PM Organ vascular beds 26


Neural regulation of brain
vessels
• Minimal importance (local mechanisms
predominate)

• SNS (along carotid & vertebral arteries) - weak


vasoconstriction

• Parasympathetic fibers from facial nerve - weak


vasodilation

03:08 PM Organ vascular beds 27


Local regulation of brain vessels
• Hypoxia
• Very sensitive to CO2 (vasodilation via changed
pH)
• H+ cannot cross blood-brain barrier
 cerebral vasodilation by:
– local CO2/pH changes
– blood CO2
– not blood pH (if = CO2)

03:08 PM Organ vascular beds 28


Intestinal circulation
• Countercurrent O2
exchange (shortcut for O2
from arteries to veins)
• Flow needed to carry away
nutrients, not to bring O2
• Necrosis of villi with severe
flow reduction (
bacteremia)

03:08 PM 31
GIT flow regulation
• Neural:
– prominent (blood shunted away when needed elsewhere)
– SNS (NE,  vasoconstriction;
 receptors much less expressed)
• Autoregulation less developed
– functional hyperemia (after meal)
– gastrin & cholecystokinin  GIT blood flow
– vasodilation by digestion products (glucose, FFA)

03:08 PM Organ vascular beds 32


Hepatic circulation
• Hepatic blood flow ~ 25% CO
– 3/4 of that via portal vein
• little O2
• mean pressure ~10 mmHg  small driving pressure
gradient
–  hepatic (and central) venous pressure easily transmit upstream
 liver edema  transudation to peritoneal cavity (ascites)
(also with  portal resistance due to fibrosis in cirrhosis)

03:08 PM Organ vascular beds 33


Regulation of liver circulation
• Autoregulation
– not in portal system
– hepatic arterioles autoregulate
• SNS
– constriction of resistance vessels in portal venous & hepatic
arterial systems
– constriction of capacitance vessels more important (blood
reservoir)
• liver contains ~ 15% of all blood
• 50% of that can be rapidly expelled by SNS

03:08 PM Organ vascular beds 34


FLUJO SANGUINEO CUTANEO
EN REPOSO EN AMBIENTES
TERMONEUTRALES =
250 ml/min;
disipacion de calor de 80 – 90 kcal/h

En exposicion a calor o en ejercicio,


el aumento de la T* corporal produce
Vasodilatacion y sudoracion
Cutaneous circulation
• Low metabolism

• Blood flow serves mainly thermoregulatory


role

03:08 PM Organ vascular beds 38


Numerous AV anastomoses

• Thick muscular layer


• Rich nerve supply
• No basal tone (can constrict maximally)
• No metabolic autoregulation
• Exclusively under SNS control (can close
completely)  thermoregulation

03:08 PM Organ vascular beds 39


Countercurrent heat exchange
• Major skin arteries run alongside veins
• In cold: heat taken up from arteries by cooled blood in
veins before it reaches surface  heat conservation
• In heat: heat taken up by blood in the surface is given
from veins to colder arterial blood  heat not taken up
(+  temperature difference from skin to environment
 heat dissipation)

03:08 PM Organ vascular beds 40


Other skin arterioles
• Some basal tone
• Dual control:
– SNS (more important)
• adrenaline & NA only vasoconstriction
• but sweat gland activation (controlled by ACh SNS
terminals)  skin vasodilation (bradykinin released from
tissue fluid proteins by enzyme in sweat)
– local metabolic & myogenic autoregulation
– no parasympathetic nerves

03:08 PM Organ vascular beds 41


Regulacion Neural
• Centros nerviosos superiores  SNS:
– Enrojecimiento con la verguenza o colera
– Palidez con la ira o el miedo

03:08 PM Organ vascular beds 42


Raynaud’s disease
• Vasoconstrictor hypersensitivity of fingers (&
sometimes toes) to cold
• Finger ischemia in cold
(tingling, numbness, pain)
• Blanching (no blood)  cyanosis (ischemia) 
redness (spasm subsides)
• Idiopathic (mostly young women)

03:08 PM Organ vascular beds 43


Rosy color in cold

• Cold vasodilation (relieving cold


vasoconstriction)
• Reduced O2 uptake of cold skin (high Hb
saturation)
• Cold-induced shift to the left
of the Hb dissociation curve

03:08 PM Organ vascular beds 44


HIPOTALAMO
Transferencia de calor central al periferico, aumento del G.C. y vasoconstriccion esplacnica
Circulacion cutanea es unica porque esta controlada
por 2 poblaciones de nervios simpaticos:
•Nervios adrenergicos vasoconstrictores
•Nervios simpaticos vasodilatadores

Nervios vasoconstrictores y vasodilatadores inervan areas


con vellos

Areas sin vellos (palmas, plantas y labios :


Inervados solo por nervios vasoconstrictores
Abundantes anastomosis arteriovenosas (paredes gruesas,
baja resistencia, alto flujo desde arteriolas a venulas)
Apertura o cierre de las anastomosis producen grandes
variaciones de flujo.
Temperatura interna
Temperatura corporal

+ -

Vasodilatacion simpatica Vasoconstriccion simpatica


ARTERIOLA Norepinefrina, Neuropeptido Y
Oxido
CUTANEA
nitrico

Nervios sensoriales
+ _
(CGRP,SP,NKA)

Temperatura local
MECANISMOS EN EL CONTROL DE CIRCULACIONES
% del G.C. Control Metabolitos Control simpatico Efectos
metabolico local vasoactivos mecanicos

Coronaria mas importante Hipoxia menos importante Compresion


Autoregulacion Adenosina mecanica en sistole
(5%)
Hiperhemia reactiva
Cerebral mas importante C02 menos importante Aumento en P.
Autoregulacion H+ intracraneal
(15%)
Hiperhemia reactiva disminuye flujo
cerebral
Musculo mas importante Lactato mas importante en Actividad muscular
Autoregulacion, K+ reposo (receptor comprime venas
(20%)
hiperhemia reactiva Adenosina alfa=vasoconstriccio
Receptor
beta=vasodilatacion

Piel menos importante mas importante


Regulacion
(5%)
temperatura

Pulmonar mas importante Hipoxia: menos importante Inflacion pulmonar


vasoconstriccion
(100%)