BM3501 Cardiovascular Physiology

& Pharmacology

Special Circulations

Derek Scott
 Special Circulations - Introduction
• Each tissue in the body has its own circulation with its
own characteristics.
• During this lecture, we will review 5 of these special
circulations:
– Heart (coronary), skeletal muscle, skin (cutaneous),
brain (cerebral) and lung (pulmonary).
• Other major circulations which exist, but will not be
covered here include:
– Renal, hepatic, splenic and gastrointestinal.
 Coronary Circulation
• Flow during basal cardiac output = 70-80ml min-1 100g-1
• Flow during maximal work = 300-400ml min-1 100g-1
• Arterial blood comes from aorta
• 95% venous blood drains via coronary sinus into right
atrium, whilst rest drains into chambers via anterior
coronary and Thebesian veins.
• Shortest circulation in body: blood transit time = 6-8secs
Coronary Circulation Anatomy
Special Tasks & Structural Adaptations
• Delivers oxygen at high rate to keep up with cardiac
demand
• 20 x greater demand for oxygen than resting skeletal
muscle
• In exercise, CO increases 5 x, so oxygen supply must
increase accordingly
• High density of myocardial capillaries: 3000-5000/mm2
• Means 1 capillary per myocyte
• Produces efficient delivery of O2 and nutrients via:
• Increased surface area of endothelium
• Decreases diffusion distance to only 9µ m (myocyte is
~18µ m wide)
• Oxygen transport enhanced by myoglobin in myocytes
 Functional Adaptations
• High basal flow and high oxygen extraction
• Myocardium extracts 65-75% of O2 from coronary blood,
whereas other tissues may only take 25%
• NO produced continuously by the endothelium, helping
to maintain basal flow.
• If you block NO production via L-arginine analogues, you
decrease myocardial blood flow by 60%
 Maintenance of Blood Supply
• Extra O2 supplied by increased flow during exercise
• Build-up of metabolites causes vasodilatation =
METABOLIC HYPERAEMIA
• Autoregulation also occurs in the coronary circulation
• This means you can maintain tissue perfusion
independently of nervous control
• Resistance vessels (arterioles) respond directly to
changes in arterial blood pressure
∀ ↑ Pressure > vasoconstrict arterioles > ↑ Resistance
∀ ↓ Pressure > vasodilate arterioles > ↓ Resistance
• Helps to maintain constant flow
• Sudden obstruction (clots) or mechanical obstruction
during systole may disrupt normal function
 Skeletal Muscle Circulation
• Flow in postural muscle = ~15ml min-1 100g-1
• Resting phasic muscle = 3-5ml min-1 100g-1
• Max flow in exercise = >100-200ml min-1 100g-1
Special Tasks & Structural Adaptations

• During exercise, circulation delivers O2 and glucose to

muscle fibres at increased rate, whilst removing waste
and heat at increased rate
• Regulation of arterial pressure – skeletal muscle forms
40% of adult body mass.
• Resistance of this large vascular bed can affect BP
• Most human muscle fibres are phasic white fibres (twitch
fibres) – forearm, gastrocnemius
• 15% are tonic, red fibres (slow) that predominate in
postural muscles – soleus
• These are continuously active to maintain posture, so
have greater blood flow and capillary density than phasic
fibres
 Functional Adaptations
• Sympathetic vasoconstrictor innervation of arterioles
• Nerve activity controlled reflexly by BP receptors in the
thorax and neck
• Severe haemorrhage causes massive sympathetic
discharge
• This reduces perfusion to minimal levels, saving blood
for essential core functions
• Metabolic vasodilatation during exercise increases blood
flow x 20
• Skeletal muscle receives 80-90% cardiac output during
strenuous exercise
• Muscle hyperaemia may occur due to build-up of
metabolites (K+, phosphate, pH, hypoxia), washing them
away
• At rest, skeletal muscle extracts 25-30% of O2 from blood
• During severe exercise, this increases to 80-90% (via
actions of myoglobin)
• Build-up of lactic acid stimulates nociceptive C fibres and
increases [K+] between cells
• This results in pain, stopping you from exercising

• Skeletal muscle pump also exists - contraction

massages veins, squeezing blood back to heart, aiding
venous return

• Problems can occur with skeletal muscle circulation:

• Mechanical interference – 30-70% maximal muscle
contraction can squeeze intramuscular blood vessels
• Causes hypoxia and build-up of lactic acid
• Results in pain and fatigue
 Cutaneous (Skin) Circulation
• Flow in thermoneutral environment (27oC) = 10-20ml min-1 100g-1
• Minimal flow = 1ml min-1 100g-1
• Maximal flow = 150-250ml min-1 100g-1
• Special tasks include thermoregulation and response to trauma
 Structural Adaptations
• Arteriovenous anastomoses in extremities
 Functional Adaptations & Special
Problems
• Sympathetic control is dominant and regulated by core
temperature receptors
• Vessel tone directly sensitive to local temperature
• Dependent vasoconstriction by local mechanisms
• Reflex vaso- and venoconstriction in response to
hypotensive shock
• Triple response to cutaneous trauma - local redness, flare
and swelling
• Compression when weight-bearing = Bed sores
• Hot weather causes swelling and venodilatation,
aggravating postural hypotension
Cerebral Circulation
• Average flow (whole brain) =
55ml min-1 100g-1
• Basal flow to grey matter =
100ml min-1 100g-1
• Receives 14% resting cardiac
output, but only forms 2%
body mass!
• Special tasks include:
– Maintenance of oxygen
supply to hypoxia-intolerant
grey matter
– Adaptation of local
perfusion to local brain
activity
 Structural Adaptation - Circle of Willis
Preserves cerebral perfusion
even when one carotid artery
becomes obstructed - more
useful in younger patients.
Ultrasound below shows it has
developed even in the 2nd
trimester of development

Brain also has high capillary

density (similar to myocardium)
to give large nutrient/waste
exchange surface area, and tight
endothelial junctions (blood-brain
barrier)
 Functional Adaptations
• High basal blood flow
• Brain controls heart and peripheral resistance to maintain
its perfusion pressure
• Cerebral vessels “excused” from baroreflex
vasoconstriction
• Good autoregulation in face of pressure changes;
sensitive to PCO2.
• Local metabolic hyperaemia in response to local cortical
activity
• Blood-brain barrier provides highly stable neuronal
environment
 Special Problems - Cerebral
• Postural syncope (fainting) occurs if your baroreflexes
are impaired
• Space-occupying lesions (e.g. tumours, haemorrhages)
can squeeze the brainstem against the rigid skull. This
can impair brain function
Pulmonary Circulation
• Special tasks include:
– Respiratory gas
exchange
– Metabolic
conversion/removal of
circulating vasoactive
substances by
endothelium (Ang I, 5-
HT, PGE)
– Capacitance function
since vessels have
high compliance
Structural & Functional Adaptations
• Very high capillary density and
short diffusion distance
• Low vascular resistance so only
small rises in pressure when
pulmonary flow increases
• Hypoxic vasoconstriction allows
you to match regional perfusion
to regional ventilation
 Special Problems - Pulmonary
• Since pulmonary pressure is low, apices (top parts) of
lungs are poorly perfused when you are upright
• At extreme cardiac output (athletes) blood stays in
capillaries for 0.3sec or less
• Chronic hypoxic vasoconstriction may cause right-sided
cardiac failure due to generation of higher pressures
• Thin capillary-alveolar barrier can become leaky, causing
mitral stenosis (valve becomes obstructed) - oedema +
pulmonary haemorrhage