HEMODINAMIKA

HEMODINAMIKA
Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera
Utara
Dr. Poland Room 3-007, Sanger Hall, Phone: 828-9557
E-mail: [email protected]
HEMODINAMICA
Introduction
The blood vessels are a closed system
of conduits that carry blood from the
heart to the tissues and back to the
heart.
All of the blood flows through the
lungs, but the systemic circulation is
made up of numerous different circuits
in parallel, arrangement that permits
wide variations in regional blood flow
without changing total systemic flow.
Diagram of the circulation in

the adult.
Struktur Pembuluh darah

Tunica intima endothelium
-EDRF (NO)
-angiotensin II
-norepinephrin
- endothelin
- adrenergic receptor
- Thromboxane AII
Tunica media sel otot polos, elastin, kolagen

Tunica adventitia kolagen, fibroblast, otot <<
Characteristics of various types

of blood vessels in humans
Vessel Size and Composition
Arterioles: flow control to capillary beds

Arterioles and capillaries are less elastic
and more rigid; limited capacity to expand
passively
Arterioles contribute to peripheral
resistance; hence blood pressure (BP)
Smooth muscle constriction/dilation
changes in diameter changes in BP
General
anatomy of
vessels
Arteries
a. distribution of blood from heart
b. high pressure ( > 100 mm Hg)
a.
b.
c.
d.
Endothelium: Lining, specialized exchange cells

Elastic Tissue: Allows stretch, elastin
Smooth Muscle: Circular wrapping, contractile
Fibrous Tissue: Prevents blowouts, collagen
Arterioles: small (5-100 m).circular smooth muscle
a. General distribution along arterioles
Controls arteriole diameter
vasoconstriction:contractiontoreducediameter
vasodilation:relaxationtoenlargediameter
b. Concentration at entry to capillary beds

Precapillary sphincters
allow control of flow into
capillaries
Smooth muscle activity
controlled by Autonomic NS
Critical for blood pressure
regulation
The total area of all the

capillary walls in the
body exceeds 6300
m2 in the adult.
Capillaries
Blood-ECF Exchange Site. All cells are
1-3 cells away from a capillary
a. Anatomy
b. Mechanisms of blood-ECF
exchange of solutes
(1) Diffusion across capillary wall
(a) via pores easy for small molecules
such as water, ions
(b) across membranes ,e.g., lipids, gases
(c) facilitated diffusion across , endothelial
cell membranes e.g., insulin, glucose
(2) Filtration
(a) Due to two types of pressure:
Hydrostatic Pressure (pHy)
physical force blood exerts on the
walls of vessels due to mechanical
compression
Osmotic Pressure (pOs)
chemical force due to presence of
dissolved solutes
Draws fluid into vessels
Cross-sections of capillaries
Left: Continuous type of

capillary found in muscle.
Right: Fenestrated type of

capillary
Hydraulic conductivity of capillaries in various

parts of the body.1
Outline of the Circulation
Venous Valves
Valves create one way flow.
Venous valves prevent
blood flow away from the
heart.
Venous valves combine
with skeletal muscle to
assist pumping of venous
blood.
BIOPHYSICAL
CONSIDERATIONS
Flow, Pressure, & Resistance

Blood always flows, of course, from
areas of high pressure to areas of low
pressure, except in certain situations
when momentum transiently sustains
flow.
The relationship between mean flow,
mean pressure, and resistance in the
blood vessels is
Haemodynamics of
Pressure and Flow
Flow(Q ) is the volume that passes
through a region in a unit time.
Flow through the vascular system is
produced by the arterio-venous
pressure difference and is proportional
to the pressure difference.
Q = Q
t
P
R
Factors affecting resistance
Vascular resistance (largest

impact)
friction between blood and
vessel walls
related to blood vessel

diameter (and length)
The narrow arterioles

(and capillaries)
generate the largest
vasoconstriction:contractiontoreducediameter
vasodilation:relaxationtoenlargediameter
vascular resistance
Turbulence
Blood flow is laminar
Faster flow at centre, slowest near
vessel wall
Increased turbulent flow occurs at
very high flow rates or as a result of
vascular disease
Occurs normally during blood flow
between chambers (characteristic
sound)
Higher turbulent flow increases
resistance (and elevated BP required to
maintain flow can further damage
walls)
Laminar Flow
The flow of blood in straight blood vessels,
like the flow of liquids in narrow rigid
tubes, is normally laminar (streamline).
Laminar flow occurs at velocities up to a

certain critical velocity. At or above this
velocity, flow is turbulent. Streamline flow
is silent, but turbulent flow creates sounds.
The probability of turbulence is also

related to the diameter of the vessel and
the viscosity of the blood. This probability
can be expressed by the ratio of inertial
to viscous forces as follows:
R = Re = Reynolds
= densitas
cairan
D = diameter
pebuluh
V= kecepatan
aliran
= viskositas
cairan
Re < 2000 -> tidak terjadi turbulen

Re > 3000 -> turbulen
Top: Effect of constriction (C) on the

profile of velocities in a blood vessel.
Bottom: Range of velocities at each
point along the vessel.
Flow Through the

Circulation
Pulmonary perfusion
(blood flow) is equal
to the cardiac output.
Total perfusion
through all systemic
vascular beds is equal
to cardiac out put.
The resistance of the
parallel systemic
vascular beds
determines the
distribution of blood
flow through organs.
If cardiac output is
constant, changes in
resistance of any
vascular bed will alter
perfusion through all
parallel organs.

Viscosity
The thicker the liquid the more
resistance it creates
Blood is thicker than water therefore
has higher resistance (presence of
cells, proteins)
Resistance is Dependent on Diameter

Resistance falls with increasing radius of the blood vessel, and
increase with increasing blood viscosity.
Under ideal conditions the resistance of a tube is described by
Poiseuilles law.
l
R 4
r
Where R= resistance
= viscosity
r= radius
l= length
Halving the radius of an arteriole

increases resistance by 16 fold.
Resistance
Along the
Vascular
System
Resistance is
greatest in
arterioles.
Total resistance is
controlled by arteriolar
resistance.
Arterioles control
perfusion through
organs and the
distribution of cardiac
output.
Viscosity of Blood
The viscosity of whole
blood is dependent on the
haematocrit.
Anaemia can reduce blood
viscosity.
Polycythaemia increases
the haematocrit, blood
viscosity and resistance.
Velocity and Area

in the Vascular
System
Total crosssectional area of
the vascular
system is greatest
in the capillaries
and lowest in the
large vessels.
Because flow is
constant the blood
velocity is fastest
in the large vessels
and slowest in
capillaries.
A erythrocyte
spends 0.5 to 1
Pressure and
Volume in the
Circulation
Pressure is pulsatile
in the arteries but
steady in the
capillaries and veins.
Pressure falls along
the circuit with the
greatest fall across
arterioles.
Volume is greatest in
the venous system.
At any time most of
the blood is in veins
Effect of Gravity
The pressure in any vessel below heart
level is increased and that in any vessel
above heart level is decreased by the
effect of gravity.
The magnitude of the gravitational effect
the product of the density of the blood,
the acceleration due to gravity (980
cm/s/s), and the vertical distance above or
below the heartis 0.77 mm Hg/cm at the
density of normal blood.
Blood Pressure
200
180
160
140
120
100
120
110
100
90
80
70
Blood pressure is the force that

blood exerts against blood vessel
walls.
Pengukuran Tekanan Darah

Harus diketahui syarat pengukuran TD !
Casual BP measurement (pengukuran TD di
praktek)
Home blood pressure measurement (pengukuran
TD di rumah)
ABMP (Ambulatory blood pressure monitoring,
pemantauan TD 24 jam)
Pulse pressure = TD sistolik - TD diastolik
Mean arterial pressure = TD diastolik + 1/3 (TDS TDD)
Determinacin de la presin arterial

esttica
Cuff inflated to occlude
blood flow - no sound can
be heard through
stethoscope placed over
the brachial artery
Korotkoff sounds are

created by turbulent
pulsatile blood flow
through the compressed
artery - systolic pressure
Blood flow is silent when

the artery is no longer
compressed - diastolic
pressure
Blood pressure and flow

Blood pressure (BP) is a product of volume, flow and
peripheral resistance (PR)
BP = CO x PR
CO =
cardiac output: amount of blood pumped

out by each ventricle in 1 minute
CO = stroke volume (SV) x heart rate (HR)

CO = HR (75b/m) x SV (70ml/beat) = 5250ml/min
CO is related to demand: regulated by changes in HR
and SV
Blood Pressure (BP)

Pulse pressure (PP)
= (SP DP)
Mean arterial pressure
= DP + 1/3(SP DP)
BP expressed as SP/DPmmHg
eg 125/75mmHg
NB: this is not a division sum!!!
MAP is pressure driving

blood into tissue, averaged
over the whole cardiac
cycle
Tekanan darah normal
ESC 2003
(WHO, ISH 1999, JNC VI 1997 pada usia >= 18 th)
Kategori
Sistolik
(mmHg)
Optimal
<120
Normal
<130
High Normal 130-139
Diastolik
(mmHg)
dan <80
dan <85
atau 85-89
JNC
JNC 77
2003
2003
Table 1. Classification and Management of Blood

Pressure for adults aged 18 years or older
BP
Classificatio
n
Normal
Prehyperten
sion
Stage 1
hypertension
Stage`2
hypertensi
on
Systolic BP,
Diastolic BP,
mmHg*
mmHg*
<`120
and
< 80
120-139
or
80-89
140-159
or
90-99
160
or
100
JAMA.2003;289:(DOI10.1001/jama.289.19.2560).
Let it
beat!

HEMODINAMIKA

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HEMODINAMIKA

Diagram of the circulation in

Struktur Pembuluh darah

Tunica media sel otot polos, elastin, kolagen

Characteristics of various types

Vessel Size and Composition

Arterioles: flow control to capillary beds

Endothelium: Lining, specialized exchange cells

b. Concentration at entry to capillary beds

The total area of all the

Left: Continuous type of

Right: Fenestrated type of

Hydraulic conductivity of capillaries in various

Outline of the Circulation

Flow, Pressure, & Resistance

Factors affecting resistance

Vascular resistance (largest

related to blood vessel

The narrow arterioles

Factors affecting resistance

Laminar flow occurs at velocities up to a

The probability of turbulence is also

Re < 2000 -> tidak terjadi turbulen

Top: Effect of constriction (C) on the

Flow Through the

Factors affecting resistance

Resistance is Dependent on Diameter

Halving the radius of an arteriole

Velocity and Area

Blood pressure is the force that

Pengukuran Tekanan Darah

Determinacin de la presin arterial

Korotkoff sounds are

Blood flow is silent when

Blood pressure and flow

cardiac output: amount of blood pumped

CO = stroke volume (SV) x heart rate (HR)

Blood Pressure (BP)

MAP is pressure driving

Tekanan darah normal

(WHO, ISH 1999, JNC VI 1997 pada usia >= 18 th)

Table 1. Classification and Management of Blood

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