406
Chapter 12
infl ow and outfl ow is reached. In other words, at any given pump
input, a change in total outfl ow resistance must produce changes
in the volume and, thus, the height (pressure) in the reservoir.
This analysis can be applied to the cardiovascular sys-
tem by again equating the pump with the heart, the reservoir
with the arteries, and the outfl ow tubes with various arteriolar
beds. As described earlier, small arteries and capillaries offer
some resistance to fl ow, but the major site of resistance in the
systemic blood vessels is the arterioles. Moreover, changes in
total resistance are normally due to changes in the resistance
of arterioles. Therefore, in our discussions we equate total
peripheral resistance with total arteriolar resistance.
A physiological analogy to opening outfl ow tube 1 is
exercise: during exercise, the skeletal muscle arterioles dilate,
thereby decreasing resistance. If the cardiac output and the
arteriolar diameters of all other vascular beds were to remain
unchanged, the increased runoff through the skeletal muscle
arterioles would cause a decrease in systemic arterial pressure.
We must reemphasize that it is the total arteriolar resis-
tance that infl
uences systemic arterial blood pressure. The
distribution of resistances among organs is irrelevant in this
regard.
Figure 12–50
illustrates this point. On the right,
outfl ow tube 1 has been opened, as in the previous exam-
ple, while tubes 2 to 4 have been simultaneously constricted.
The increased resistance in tubes 2 to 4 compensates for the
decreased resistance in tube 1; therefore total resistance remains
unchanged, and the reservoir pressure is unchanged. Total
outfl ow remains 1 L/min, although the distribution of fl ows
is such that fl ow through tube 1 increases, fl ow through tubes
2 to 4 decreases, and fl ow through tube 5 is unchanged.
Applied to the systemic circulation, this process is anal-
ogous to altering the distribution of systemic vascular resis-
tances. When the skeletal muscle arterioles (tube 1) dilate
during exercise, the total resistance of the systemic circulation
can still be maintained if arterioles constrict in other organs,
such as the kidneys and gastrointestinal organs (tubes 2 to 4).
In contrast, the brain arterioles (tube 5) remain unchanged,
ensuring constant brain blood supply.
This type of resistance juggling can maintain total resis-
tance only within limits, however. Obviously, if tube 1 opens
very wide, even complete closure of the other tubes cannot
prevent total outfl ow resistance from falling. In that situation,
cardiac output must be increased to maintain pressure in the
arteries. We will see that this is actually the case during exercise.
We have thus far explained in an intuitive way why car-
diac output (CO) and total peripheral resistance (TPR) are the
two variables that determine mean systemic arterial pressure.
This intuitive approach, however, does not explain specifi cally
why MAP is the arithmetic product of CO and TPR. This
relationship can be derived formally from the basic equation
relating fl ow, pressure, and resistance:
F
=
P
/
R
Rearranging terms algebraically, we have
P
=
F
×
R
Because the systemic vascular system is a continuous
series of tubes, this equation holds for the entire system—that
is, from the arteries to the right atrium. Therefore, the
P
term is mean systemic arterial pressure (MAP) minus the pres-
sure in the right atrium,
F
is the cardiac output (CO), and
R
is
the total peripheral resistance (TPR).
MAP – Right atrial pressure = CO
×
TPR
Because the pressure in the right atrium is very close
to 0 mmHg, we can drop this term and we are left with the
equation presented earlier:
MAP = CO
×
TPR
This equation is the fundamental equation of cardiovas-
cular physiology. An analogous equation can also be applied
to the pulmonary circulation:
Mean pulmonary
Total pulmonary
arterial pressure
= CO
×
vascular resistance
These equations provide a way to integrate almost all the
information presented in this chapter. For example, we can
now explain why mean pulmonary arterial pressure is much
lower than mean systemic arterial pressure. The cardiac output
through the pulmonary and systemic arteries is of course the
same. Therefore, the pressures can differ only if the resistances
differ. Thus, we can deduce that the pulmonary vessels offer
much less resistance to fl
ow than do the systemic vessels. In
other words, the total pulmonary vascular resistance is lower
than the total peripheral resistance.
Figure 12–51
presents the grand scheme of factors
that determine mean systemic arterial pressure. None of this
1 L/min
P
200 ml
P
1 L/min
12345
12345
700 ml
200 ml
Figure 12–50
Compensation for dilation in one bed by constriction in others.
When outfl ow tube 1 is opened, outfl ow tubes 2 to 4 are
simultaneously tightened so that total outfl ow resistance, total
runoff rate, and reservoir pressure all remain constant.
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