Blood Flow: Review

In order to grasp the concepts of measuring and interpreting hemodynamic values, it is important to understand how blood flowing through the heart is related to the cardiac cycle.

Diastole:

  1. The heart is at rest and the myocardium is relaxed.
  2. The atria and ventricles passively fill. AV valves allow blood to pass
  3. The aortic and pulmonary artery semilunar valves are closed because the blood in those vessels is at a higher pressure than the ventricles.
  4. Blood continues to fill atria and ventricles, stretching the compliant heart cells.

Systole:

  1. The atria contract and eject the final amount of blood into the ventricles. At rest, the atrial contraction contributes only about 10% to the total ventricular volume. If the heart rate is high and the ventricles don't have time to fill completely, atrial systole can contibute as much as 40%.
  2. Atria relaxation causes atrial pressure to be lower than ventricular pressure.
  3. High ventricular pressure relative to the atria causes the AV valves to close, preventing backflow while the ventricles contract.
  4. The ventricles continue to contract, ejecting blood through the semilunar valves out to the lungs and rest of the body.


Fluid flows from high pressure to lower pressure.
Blood within the cardiovascular system adheres to this rule. This is evidenced by the direction of blood flow. The higher pressure generated by the left heart produces a gradient which moves blood from the left heart, through the body and into the right side of the heart.

When the left ventricle (LV) contracts, it generates a systolic blood pressure of 100-140 millimeters of Hg (mm Hg).

  1. The aortic diastolic pressure is usually 60-90 mm Hg. The LV/aortic pressure gradient causes blood to pass through the aortic valve.
  2. Blood flowing from the LV to the aorta raises the aortic pressure to equal the LV pressure.
  3. A momentary aortic systolic pressure of 100-140 mm Hg is then dissipated across the capillary beds.
  4. Capillary pressure exceeds that of the venuoles. The capillary/venuole gradient causes blood to flow into the low pressure venous system.
  5. Low pressure venous blood is returned to the right atrium, aided by skeletal muscle compression, negative intra-thoracic pressure and a multitude of one-way valves that advance the blood toward the vena cavae.

The pressure of blood within the right atrium is the central venous pressure (CVP). The blood pressure of the vena cavae is similar to the CVP because there are no valves or flow obstructions between the vena cavae (VC) and the RA. The VC and heart's right side can be viewed as one chamber with a contractile portion at the distal end. The CVP averages between 2-6 millimeters of mercury (mm Hg).

During right ventricular (RV) diastole, the pressure within the RV is between 0-5 mm Hg. Elasticity and compliance of the ventricular myocardium help generate a lower intraventricular pressure. Lower intraventricular pressure, aided by atrial systole, causes blood to flow across the open atrioventricular AV valve.

Right ventricular systolic pressure is usually from 20-30 mm Hg. This exceed the right atrial pressure. The pressure gradient applies greater pressure to the ventricular side of the AV valve, which causes it to close.

The pulmonary artery (PA) pressure, prior to systole, is normally 8-12 mm Hg. During RV systole the PA pressure will rise to equal the RV pressure, usually 20-30 mm Hg. The systolic PA pressure of 20-30 Hg is quickly dissepated by the compliance of the pulmonary vascular bed to a diastolic pressure of 8-12 Hg.

Blood leaves the pulmonary vasculature at about 4-12 mm Hg, passively entering the pulmonary veins. The pulmonary veins empty directly into the left atrium. Elasticity and compliance of the ventricular myocardium help generate a slightly lower intraventricular filling pressure. Lower intraventricular pressure, aided by atrial systole, causes blood to flow across the open atrioventricular AV valve.

LV systole generates 100-140 mm Hg. Aortic diastolic pressure is usually 60-90mm Hg. The pressure gradient of 100-140/60-90 mm Hg drives blood into the aorta and onward to the rest of the body. The cycle is complete.


Instant Feedback:

What causes the AV valve to close.

low atrial pressurel/high ventricular pressure
high atrial pressure/low ventricular pressure