UNIT II

BIOFLUID MECHANICS

Fluid mechanics is the study of the effects of forces and energy on liquids and gases. Like other branches of
classical mechanics, the subject subdivides into statics (often called hydrostatics) and dynamics (fluid
dynamics, hydrodynamics, or aerodynamics). Hydrostatics is a comparatively elementary subject with a few
classical results of importance but little scope for further development. Fluid dynamics, in contrast, is a
highly developed branch of science that has been the subject of continuous and expanding research activity
since about 1840.
Fluid dynamics is studied both theoretically and experimentally, and the results are described both
mathematically and physically. The phenomena of fluid motion are governed by known laws of physics-
conservation of mass, the laws of classical mechanics (Newton's laws of motion), and the laws of
thermodynamics. These can be formulated as a set of nonlinear partial differential equations, and in principle
one might hope to infer all the phenomena from these. In practice, this has not been possible; the
mathematical theory is often difficult, and sometimes the equations have more than one solution, so that
subtle considerations arise in deciding which one will actually apply. As a result, observations of fluid
motion both in the laboratory and in nature are also essential for understanding the motion of fluids.

Fluid statics:
Fluid statics or hydrostatics is the branch of fluid mechanics that studies fluids at rest. It embraces the study
of the conditions under which fluids are at rest in stable equilibrium; and is contrasted with fluid dynamics,
the study of fluids in motion. Hydrostatics offers physical explanations for many phenomena of everyday
life, such as why atmospheric pressure changes with altitude, why wood and oil float on water, and why the
surface of water is always level whatever the shape of its container. Hydrostatics is fundamental to
hydraulics, the engineering of equipment for storing, transporting and using fluids.

Fluid dynamics:
Fluid dynamics is a subdiscipline of fluid mechanics that deals with fluid flow—the science of liquids and
gases in motion. Fluid dynamics offers a systematic structure—which underlies these practical disciplines—
that embraces empirical and semi-empirical laws derived from flow measurement and used to solve practical
problems. The solution to a fluid dynamics problem typically involves calculating various properties of the
fluid, such as velocity, pressure, density, and temperature, as functions of space and time.

Shear stress:
Shear stress is most commonly applied to solids. Shear forces acting tangentially to a surface of a solid body
cause deformation. In contrast to solids that can resist deformation, liquids lack this ability, and flow under
the action of the force. When the fluid is in motion, shear stresses are developed due to the particles in the
fluid moving relative to one another.
For a fluid flowing in a pipe, fluid velocity will be zero at the pipe wall. Velocity will increase while moving
towards the center of the pipe. Shear forces are normally present because adjacent layers of the fluid move
with different velocities compared to each other.

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Fig. Fluid velocity profile in a pipe.
By considering the velocity of this relative motion, shear rate, , can be calculated. Shear rate is defined as
a measure of the extent or rate of relative motion between adjacent layers of the moving fluid. Shear rate for
the fluid flowing between two parallel plates, one moving at a constant speed and one is stationary, is
determined by:

(1)

Where

is velocity gradient (can be written in differential form ).

Shear rate is normally expressed in units of reciprocal seconds (sec -1). For Newtonian fluids in laminar flow,
shear stress is proportional to shear rate where viscosity is the proportionality coefficient. This is known as
Newton’s law of viscosity.

(2)

Where
µ is dynamic viscosity of the fluid.

Fluid as continuum:
We know very well that all matter is made up of molecules, which are in random motion. Any fluid we
consider has molecules bombarding each other and the boundaries, i.e. the walls of the container. There is no
guarantee whatever that molecules are present at that point at a given instant of time. we can say that we
define density or velocity at point in an average sense. That is as an average of velocities (or densities) of the
molecules that pass through a small volume surrounding that point. The size of this small volume has to meet
with certain criteria. It must be smaller than the physical dimensions of the region under consideration like
the wing of an aircraft or the pipe in a hydraulic system. At the same time it must be sufficiently large to
accommodate a large number of molecules to make any averaging meaningful. It seems that there is a lower
limit to the size of this volume.

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The existence of this limit is established by considering the definition of density as mass per unit volume
( ). Consider a small volume around the point P within the region of interest, R. Let us
calculate density at P by considering different sizes of . Values of density so calculated are plotted. It is
clear that the size has an enormous influence on the calculated value of density. Too small a , the
value of calculated density fluctuates because the number of molecules within is varying significantly
with time. Too big a might mean that density itself is varying significantly within the region of interest.

As seemed before it is clear that there is a limit below which molecular variations assume importance
and above which one finds a macroscopic variation of density within the region. Therefore it appears that
density is best defined as a limit

Properties of Fluids:

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Fluid Statics:

Types of Fluids:

Viscosity:
Viscosity is a measure of a fluid's resistance to flow. It describes the internal friction of a moving fluid. A
fluidwith large viscosity resists motion because its molecular makeup gives it a lot of internal friction. A
fluid with low viscosity flows easily because its molecular makeup results in very little friction when it is in
motion.
Viscosity is defined as the measure of the resistance of a fluid to gradual deformation by shear or tensile
stress. In other words, viscosity describes a fluid’s resistance to flow. Simply put, we can say that honey is
thicker than water; in turn, honey is more viscous than water.
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The definition of viscosity can be written as:
The viscosity of a fluid is a measure of its resistance to deformation at a given rate.

Example: Syrup has a higher viscosity than water.

Viscosity Formula
Viscosity is measured in terms of a ratio of shearing stress to the velocity gradient in a fluid. If a sphere is
dropped into a fluid, the viscosity can be determined using the following formula:

Where,

 ∆ρ is the density difference between fluid and sphere tested

 a is the radius of the sphere
 g is the acceleration due to gravity
 v is the velocity of the sphere
Where,

 v = distance travelled by sphere/ time it takes to travel that distance

Viscosity is measured in Pascal seconds (Pa s). As you can see in this equation, if the speed of the sphere is
less, the viscosity will be more. The more viscous a fluid is, the more resistance it offers to any object
moving inside it. Although all liquids have a certain value of viscosity, the for liquids is generally considered
as high or low, keeping the viscosity of water as a benchmark.
Newtonian fluid:
A Newtonian fluid is a fluid in which the viscous stresses arising from its flow, at every point, are linearly[1]
correlated to the local strain rate—the rate of change of its deformation over time.[2][3][4] That is equivalent
to saying those forces are proportional to the rates of change of the fluid's velocity vector as one moves away
from the point in question in various directions.

A Newtonian fluid's viscosity remains constant, no matter the amount of shear applied for a constant
temperature.. These fluids have a linear relationship between viscosity and shear stress.
Examples:
• Water
• Mineral oil

• Gasoline
• Alcohol

Non-Newtonian Fluids:
Non-Newtonian fluids are the opposite of Newtonian fluids. When shear is applied to non-Newtonian fluids,
the viscosity of the fluid changes. A non-Newtonian fluid is a fluid that does not follow Newton's law of
viscosity, i.e., constant viscosity independent of stress. In non-Newtonian fluids, viscosity can change when
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under force to either more liquid or more solid. Ketchup, for example, becomes runnier when shaken and is
thus a non-Newtonian fluid. Many salt solutions and molten polymers are non-Newtonian fluids, as are many
commonly found substances such as custard,[1] honey,[1] toothpaste, starch suspensions, corn starch, paint,
blood, melted butter, and shampoo.
Most commonly, the viscosity (the gradual deformation by shear or tensile stresses) of non-Newtonian fluids
is dependent on shear rate or shear rate history.

The behavior of the fluid:

When shear is applied to non-Newtonian fluids, the viscosity of the fluid changes. The behavior of the fluid
can be described one of four ways:
Dilatant - Viscosity of the fluid increases when shear is applied. For example:
o Quicksand
o Cornflour and water
o Silly putty

Pseudoplastic - Pseudoplastic is the opposite of dilatant; the more shear applied, the less viscous it becomes.
For example:
 Ketchup

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 Rheopectic - Rheopectic is very similar to dilatant in that when shear is applied, viscosity increases. The
difference here, is that viscosity increase is time-dependent. For example:
o Gypsum paste
o Cream

 Thixotropic - Fluids with thixotropic properties decrease in viscosity when shear is applied. This is a time
dependent property as well. For example:
o Paint
o Cosmetics
o Asphalt
o Glue

Viscoelastic:
Elasticity:

Elasticity is the tendency of solid materials to return to their original shape after forces are applied on them.
When the forces are removed, the object will return to its initial shape and size if the material is elastic.

Viscosity:

Viscosity is a measure of a fluid’s resistance to flow. A fluid with large viscosity resists motion. A fluid with
low viscosity flows. For example, water flows more easily than syrup because it has a lower viscosity. High
viscosity materials might include honey, syrups, or gels – generally things that resist flow. Water is a low
viscosity material, as it flows readily. Viscous materials are thick or sticky or adhesive. Since heating reduces
viscosity, these materials don't flow easily. For example, warm syrup flows more easily than cold.

Viscoelasticity:

Viscoelasticity is the property of materials that exhibit both viscous and elastic characteristics when
undergoing deformation. Synthetic polymers, wood, and human tissue, as well as metals at high temperature,
display significant viscoelastic effects. In some applications, even a small viscoelastic response can be
significant.

Elastic behavior versus viscoelastic behavior:

The difference between elastic materials and viscoelastic materials is that viscoelastic materials have a
viscosity factor and the elastic ones don’t. Because viscoelastic materials have the viscosity factor, they have
a strain rate dependent on time. Purely elastic materials do not dissipate energy (heat) when a load is applied,
then removed; however, a viscoelastic substance does.

Uses of a viscoelastic material:

Viscoelastic materials are used for isolating vibration, dampening noise, and absorbing shock. They give off
the energy absorbed as heat.

Good viscoelastic material:

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Sorbothane is recognized worldwide as the ultimate material for absorbing shock, isolating vibration and
damping noise. No synthetic rubber or polymer can dissipate energy as effectively. Sorbothane is a highly
damped, visco-elastic polymeric solid that flows like a liquid under load. Sorbothane is used in many
applications because not only can it reduce vibration as it is intended, it can do so without being impacted by
extreme temperatures. It is also resilient to a number of harmful chemicals. It can be cut and shaped to a
specific application, which makes custom fitting a machine possible. Whether it is a commercial or private
use, this might be the only vibration reduction material that you need to consider.

Sorbothane has a wide range of damping material properties. It allows excessive noise and heat to be safely
dissipated before it reaches the human operators. It prevents vibrational creep, which is the action of a
machine moving out of place due to the vibrations during operation. It can also absorb some of the vibrations
where two machines connect. New designs, especially those that use newer, composite materials, may need
to use different types of bonding agents, which makes the pieces stronger but also eliminates one of the
methods of damping. Sorbothane restores that ability without changing the strength or design of the machine
and without impacting user safety.

Elastic versus viscoelastic behavior:

Stress–strain curves for a purely elastic material (a) and a viscoelastic material (b). The red area is a
hysteresis loop and shows the amount of energy lost (as heat) in a loading and unloading cycle. It is equal to,
where is stress and is strain.

Unlike purely elastic substances, a viscoelastic substance has an elastic component and a viscous component.
The viscosity of a viscoelastic substance gives the substance a strain rate dependence on time. Purely elastic
materials do not dissipate energy (heat) when a load is applied, then removed. However, a viscoelastic
substance dissipates energy when a load is applied, then removed. Hysteresis is observed in the stress–strain
curve, with the area of the loop being equal to the energy lost during the loading cycle.

Viscoelasticity:

When a body is suddenly strained and then the strain is maintained constant afterward, the corresponding
stresses induced in the body decrease with time. This phenomena is called stress relaxation, or relaxation for
short. If the body is suddenly stressed and then the stress is maintained constant afterward, the body
continues to deform, and the phenomenon is called creep. If the body is subjected to a cyclic loading, the
stress-strain relationship in the loading process is usually somewhat different from that in the unloading
process, and the phenomenon is called hysteresis.
The features of hysteresis, relaxation, and creep are found in many materials. Collectively, they are called
features of viscoelasticity. Mechanical models are often used to discuss the viscoelastic behavior of
materials.

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Maxwell model

The Maxwell model can be represented by a purely viscous damper and a purely elastic spring connected in
series, as shown in the diagram. The model can be represented by the following equation:

Under this model, if the material is put under a constant strain, the stresses gradually relax. When a material
is put under a constant stress, the strain has two components. First, an elastic component occurs
instantaneously, corresponding to the spring, and relaxes immediately upon release of the stress. The second
is a viscous component that grows with time as long as the stress is applied. The Maxwell model predicts that
stress decays exponentially with time, which is accurate for most polymers. One limitation of this model is
that it does not predict creep accurately. The Maxwell model for creep or constant-stress conditions
postulates that strain will increase linearly with time. However, polymers for the most part show the strain
rate to be decreasing with time.[2]
Applications to soft solids: thermoplastic polymers in the vicinity of their melting temperature, fresh concrete
(neglecting its aging), numerous metals at a temperature close to their melting point.

Kelvin–Voigt model

The Kelvin–Voigt model, also known as the Voigt model, consists of a Newtonian damper and Hookean
elastic spring connected in parallel, as shown in the picture. It is used to explain the creep behaviour of
polymers. The constitutive relation is expressed as a linear first-order differential equation:

This model represents a solid undergoing reversible, viscoelastic strain. Upon application of a constant stress,
the material deforms at a decreasing rate, asymptotically approaching the steady-state strain. When the stress
is released, the material gradually relaxes to its undeformed state. At constant stress (creep), the model is
quite realistic as it predicts strain to tend to σ/E as time continues to infinity. Similar to the Maxwell model,
the Kelvin–Voigt model also has limitations. The model is extremely good with modelling creep in materials,
but with regards to relaxation the model is much less accurate. [5]
Applications: organic polymers, rubber, wood when the load is not too high.

Standard linear solid model:

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The standard linear solid model, also known as the Zener model, consists of two springs and a dashpot. It is
the simplest model that describes both the creep and stress relaxation behaviors of a viscoelastic material
properly.

Under a constant stress, the modeled material will instantaneously deform to some strain, which is the
instantaneous elastic portion of the strain. After that it will continue to deform and asymptotically approach a
steady-state strain, which is the retarded elastic portion of the strain. Although the Standard Linear Solid
Model is more accurate than the Maxwell and Kelvin–Voigt models in predicting material responses,
mathematically it returns inaccurate results for strain under specific loading conditions.

Vascular tree:

A healthy body has a perfect balance of arteries, capillaries and veins that allow the blood to reach every cell
in the body and that form what is called the “vascular tree”. New blood vessels are formed by endothelial
cells, which normally coat the inside of blood vessels and which organise themselves into tubes and mature,
along with other cells, into arteries, capillaries or veins.

Throughout a person’s life, the vascular tree has to adapt its branches to the changing needs of body tissue,
such as during growth, muscle building or wound healing. However, there are diseases that affect the
endothelial cells in a way that throws the vascular tree out of balance, which exacerbates the disease and
often causes haemorrhaging. In cancer, for example, it is known that the vessels leak and direct shunts form
between arteries and veins, preventing drugs from reaching the tumour.

Fluid movement between capillaries and tissues:

According to the Starling principle (named after physiologist Ernest Starling who described it in 1896), fluid
movement through the capillary walls is governed by hydrostatic pressure and oncotic pressure. Like any
fluid pushed through a confined space, blood in a capillary exerts pressure on the wall of the vessel because
of the pressure exerted upstream by the blood coming from the arteriole. The blood pressure (BP) generates
hydrostatic pressure, which expels fluid from the pores of the capillary into the interstitial compartment. The
size of the pores in the capillary dictates whether particular nutrients are delivered to particular tissues.
Hydrostatic pressure is highest at the arterial end, and lowest at the venous end, of the capillary.

The other influencing force is oncotic pressure, which is underpinned by the principle of osmosis; this is the
passive movement of water through a semipermeable membrane from a region of low solute concentration to
one of high solute concentration, with the aim of achieving equilibrium. In blood, plasma proteins – which
cannot easily pass through the capillary walls – exert an osmotic pressure that tends to pull fluid from the

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surrounding tissue (which has a higher water concentration) into the capillary (which has a lower water
concentration). This is referred to as oncotic pressure.

Fig illustrates the interplay between hydrostatic and oncotic pressure. At the arterial end of the capillary,
hydrostatic pressure exceeds oncotic pressure, so fluid moves out of the capillary into the interstitial
compartment. At the venous end of the capillary, the two forces are reversed, so fluid moves back from the
tissue into the capillary.

Flow properties of Blood:

Tissue perfusion

Velocity of a blood flow is directly related to a minute blood flow in a specific system, and inversely related
to a cross-sectional area:

v=F/S

1) Minute blood flow value that applies to the entire circulation (5 l/min)

2) Cross-sectional area of the aorta is about 2.5 square centimeters

3) Cross sectional area of the capillaries is up to 2500 square centimeters

Blood Circulation:

Introduction:
The body requires oxygen and nutrients and needs to eliminate waste products to maintain metabolic
stability. The vascular system has a crucial role in bringing oxygen and nutrients to every organ and tissue,

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 and removing waste products, via a series of blood vessels. In conjunction with the heart, which acts as a
pump, it forms the cardiovascular system. Arteries leaving the heart with oxygenated blood provide oxygen,
nutrients, hormones and other substances throughout the body. Veins leaving the organs and tissues return to
the heart carrying metabolic waste.

1. Rheological properties of blood:

Five classes of blood vessels

There are five classes of blood vessels: arteries and arterioles (the arterial system), veins and venules (the
venous system), and capillaries (the smallest bloods vessels, linking arterioles and venules through networks
within organs and tissues). Arteries are described as ‘branching’ or ‘bifurcating’ vessels, as great arteries
(such as the aorta) branch off into smaller arteries and arterioles. Veins are described as ‘converging’ or
‘joining’ vessels, as venules and veins join to return blood to the heart through the largest veins. Capillaries
are in intimate contact with the tissues, providing nutrients and removing waste products through their thin
walls at a cellular level. Table details the functions of the five blood vessel types.

Anatomy of the vasculature

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Rheology is a scientific discipline that examines a mechanical properties of continuous media. This
discipline is also called mechanics of a continuum. From the medical point of view it focuses on the physical
properties of a blood.

To achieve a detailed understanding of the physiological processes in the cardiovascular system, it is

necessary to understand both the biophysical properties of a blood and its interaction with the systems of
blood vessels.

Vascular system can be divided in functional systems of arteries, arterioles, capillaries, venules and veins.

Arteries
Arteries distribute blood under a high pressure throughout the entire body. They are morphologically adapted
to suit this purpose. Arteries have thick muscle-rich walls. There is about 13 % of a total blood volume in
the arteries.

Arterioles
Arterioles are the smallest branches of the arteries. They role consist in controlling the flow of blood into the
capillary system. This is achieved by an action of muscle cells in their walls. In particular, they attenuate
fluctuating changes in a blood pressure, thus making its value constant. Action of the arterioles prevents
damaging the microcirculation.

Arterioles and small arteries are known as resistance vessels, because they form a main portion of a
peripheral resistance value.

Capillaries
Exchange of nutrients, electrolytes and respiratory gases takes place in the capillaries. This exchange is based
on a Starling’s forces. There is only a 7 % of total blood volume in capillaries, but this portion is sufficient
enough to provide nutrition to an entire organism.

Venules
Venules collect the blood from capillaries and then merge into large veins.

Veins
System of veins is often called a low pressure system or a capacitance system, due to its function as a blood
reservoir. Apart from its blood reservoir function, blood flows back to the heart through veins. There is about
50 % of total blood volume in the veins.

2. Blood pressure (BP) and its measurement

Blood flow is a value indicating a degree of a motion in the blood vessel. It is expressed as a unit of volume
per unit of time – most commonly liters per minute (l/min). Concept of the blood flow is similar to a concept
of electric current. Electric current indicates the degree of movement of electrically charged particles in the
conductor. Although the similarity, there is a few differences:

Pressure gradient:
Pressure gradient is a difference between the pressures at the beginning and at the end of the vessel. It is the
major cause of a blood flow in the entire body. In general, liquids move from an area with high pressure
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value to an area with low pressure value. Thus the main function of the heart is to generate a pressure
gradient.

The same principle underlines the electric current. There is an electric voltage instead of a pressure gradient.
In fact, voltage is nothing else than a difference between the electric potential at beginning and at the end of a
wire.

Vascular resistance
As it is true for electric current, the blood flow is inversely proportional to the resistance. Resistance of blood
vessels depends on a number of factors, which will be discussed later.

Thus we can apply Ohm’s law in a case of a blood vessel as well as in case of an electric wire:

 F = ΔP / R
where:
F = blood flow
ΔP = pressure gradient (P1-P2)
R = resistance of a vascular system

3. Blood flow in different organs

The movement of blood in the vessel can be expressed as a flux. Flux is a purely quantitative value
indicating a volume of blood passing through a vessel per a unit of time. Flux is a scalar. Another point of
view is to describe blood flow qualitatively. Flow can be either laminar or turbulent.

Laminar flow
Laminar flow occurs in the straight parts of arteries with intact endothelium. For every two points in the
flowing volume of blood, there is a flow line. Flow lines are curves, which lie in parallel with the blood flow
vector. According to the definition flow lines never crosses. Thus there are neither whirls nor vortices in
laminar flow.

Laminar flow is characterized by parabolic velocity profile. This means that, there are the fastest molecules
flowing in the centre of a vessel. Values of velocity decrease in a direction to a vessel surface (from centre to
walls). Explanation of this phenomenon is quite simple, there is a friction of vessel wall. Molecules slowed
by a contact with the endothelium are in turn slowing those flowing next to them.

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Turbulent flow
Turbulent flow occurs whenever the velocity of the flowing blood is too high, the vessel is narrowed or there
is an obstacle in the lumen of a vessel. There are whirls and vortices in the stream of flowing blood. If the
flow become turbulent, there is a significant increase in vascular resistance and a value of blood flow
decreases.

An exact way to calculate a value for which the flow become turbulent does not exist. But we can determine
a probability of turbulent flow occurrence. Rate of probability is called Reynolds number.

Re = (v . d . ϱ ) / η

where:

Re = Reynolds number

v = velocity of blood flow

d = diameter of blood vessels

ρ (rho) = density of blood

η (eta) = viscosity

Re acquires following values:

1) Re < 200: Low probability of turbulent flow occurrence

2) 200 < Re < 2000: Turbulent flow is likely to occur in narrowed parts of vessels

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3) Re> 2000: High probability of turbulent flow occurrence anywhere in the vessels

4. Regulation of blood flow

Cerebral blood flow
15 % of the cardiac output enters the brain, because of high oxygen demand. Although brain represents only
2 % of total body weight, it requires up to 20 % of the total oxygen supply. Oxygen is utilized, particularly in
its the gray matter.

Oxygenated blood enters the brain through two internal carotid arteries and two vertebral arteries. Vertebral
arteries merge forming a basilar artery. Basilar artery and internal carotid arteries connect to each other
forming a Circle of Willis. Six great arteries arises from the Circle of Willis. These supply the brain cortex,
providing oxygenated blood. Deoxygenated blood is collected by deep veins that enters internal jugular
veins.

Regulation of cerebral blood flow

Cerebral blood flow is strictly regulated. It must be maintained whatever it takes during all variable
conditions. It is affected by the arterial and venous pressure as well as the blood viscosity and the degree of
constriction of the brain arterioles.

Degree of arteriolar constriction is regulated by metabolic rate of nervous tissue. The most important factor is
the rise in pCO2 (hypercapnia), which causes vasodilatation. Vasodilatation increases blood flow, thus excess
CO2 is removed. Therefore fainting may occur in hypocapnia. Decrease in pCO 2 causes vasoconstriction.
Diminished cerebral blood flow finally results in fainting. This can be seen during hyperventilation from
various causes. High plasma levels of potassium, high osmolarity or adenosine induce vasodilation as well.
Local decrease in pO2 also increases cerebral blood flow. But many physiologically vasoactive substances
have no effect in cerebral arterioles.
Neurogenic control is not too significant. Sympathetic noradrenergic fibers arising from the superior cervical
ganglion are worth mentioning. They posses a significant vasoconstrictor effect. Parasympaticus with its
mediator acetylcholine has no physiological regulatory role.

Intracranial pressure is determined by the sum of following pressures: pressure of the brain tissue,
cerebrospinal fluid pressure, and the blood pressure in the brain vasculature. Enlargement of any
compartment (brain tissue, cerebrospinal fluid or blood) cause significant increase in intracranial pressure.
Elevated intracranial pressure compress arteries, diminishing the cerebral blood flow as well as perfusion of
the nervous tissue. This phenomenon can be potentially fatal.

Cerebral blood flow autoregulation mainly involves process, where an increase in the systemic pressure
causes compensatory vasoconstriction in the CNS. On the other hand, a decrease in the systemic blood
pressure is compensated by the vasodilatation, which sustains sufficient cerebral blood flow.

Coronary blood flow

Coronary blood flow hear is about 250 ml/min at resting conditions. Myocardium is supplied by two
coronary arteries. They arise from aorta just above the aortic valve. Left coronary artery supplies the front
portion of the septum, the conduction system and the major portion of the left ventricle. The right coronary
artery supplies majority of right ventricle, a portion of the septum and the posterior wall of the left ventricle.

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Large subepicardial branches enter the myocardium. They ends subendocardially as capillaries. Only a thin
layer of cardiac muscle just beneath the endocardium is oxygenated directly by diffusion of oxygen from the
blood within the chambers of the heart.

Pulmonary blood flow

100 % of cardiac output flows through the low-pressure pulmonary circulation. The pulmonary circulation is
anatomically unique at the level of the microcirculation. Arterioles and venules are shorter, but have a larger
diameter and richly anastomose. Mean pressure in a pulmonary artery is about 15 mmHg. Thus pressure in
the pulmonary circulation is significantly lower than blood pressure in systemic circulation.

Renal blood flow

About 25 % of the cardiac output passes through the kidneys. Most of the blood (90 %) flows through the
renal cortex. Each kidney is supplied by a renal artery. This artery arises from the aorta. It divides into 2-3
branches before entering the renal cortex. One branch supplies the upper portion of a kidney, another the
middle portion and the last one the lower portion. Furthermore, these branches divides into the interlobular
arteries, which give rise to an afferent arterioles. Blood flows to glomerulus through the afferent arterioles.
Blood is collected by interlobular veins, then passes to the arcuate veins, from those continue to the
interlobar veins, which finally merge into the renal vein.

Skin blood flow

Skin is one of the most important organ in thermoregulation, that human body possess. About 5 % of cardiac
output passes through skin. Only sympathetic nervous system innervates skin vessels. Both adrenalin and
noradrenalin cause vasoconstriction. Despite this fact vessel of the skin dilate during heavy exercise. This
phenomenon is a response to an increase of body temperature. A reflex that is controlled by hypothalamic
thermoregulatory centers. Local vasodilator agents include histamine and bradykinin. On the other hand
serotonin and substance P are potent vasoconstrictors.

5. Microcirculation
The capillaries are designed for an exchange of nutrients, respiratory gasses and a fluid. High value of total
surface area and their thin permeable walls contribute to their functionality. In fact capillaries are nothing
more than a thin membrane composed of endothelial cells and their basal membranes. In some cases,
capillaries posses pores with diameter smaller than the size of albumin is. There are several ways how the
substances pass through the capillary wall – through interconnections between endothelial cells, pores,
vesicle transport, diffusion or filtration. The main factor that determines the capillary blood flow is a value of
pO2, which controls a tone of precapillary sphincter.
About 20 l of a fluid is filtered daily through the capillary wall. About 18 liters of filtered fluid is reabsorbed.
The remainder is drained off through the lymphatic circulation. The main transport process in capillaries is a
simple diffusion. Oxygen and carbon dioxide pass directly through the capillary wall, while ions, glucose and
water pass through its pores.

Movement across the capillary membrane is determined by Starling forces:

1) The capillary hydrostatic pressure – outwards from the capillary

2) Interstitial fluid pressure – its value depends on the particular organ – it is positive in the kidneys, liver
and brain, negative in the skin

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3) Capillary oncotic pressure – inside to the capillary

4) Interstitial oncotic pressure – outward from the capillary

6. Lymphatic circulation
About 20 l of a fluid is filtered daily through the capillary wall. About 90 % of the filtered fluid volume is
reabsorbed. The remainder is drained off through the lymphatic vessels. Lymph is rich in proteins (including
clotting factors), fats absorbed from the lymphatic system of the gut and immune cells. The flow of lymph is
caused by a voluntary movement of skeletal muscles, valves of the lymphatic vessel, negative intrathoracic
pressure during the inspiration and the suction effect of a bloodstream in the large veins. Pulsation of the
smooth muscle in the walls of greater lymphatic ducts also contribute to some extent.

7. Venous return
Blood returns from organs to the heart through the venous system. Venous return is defined as the volume of
a blood that returns to the right atrium in one minute. The venous return equals cardiac output under the
physiological conditions,.

The venous return is determined by:

1) The residual pressure gradient – pressure difference between venules and right atrium. It acquires low
values under the physiological conditions.

2) Negative heart pressure – negative pressure originating in the right atrium during the diastole – the suction
effect of the heart.

3) Muscle pump – a contraction of skeletal muscles compress the veins.

4) Intrathoracic negative pressure – inhalation further decreases the negative pressure in the thoracic cavity.
This leads to dilatation of blood vessels in the chest. Resulting in suction of the blood into the large veins.

5) Positive pressure in the abdominal cavity during inspiration – due to contraction of diaphragm.

6) Venous valves assure one way flow of blood.

Blood vessels in the lower extremities are affected by an increased hydrostatic pressure of the blood column,
while an individual stands. Increase in hydrostatic pressure leads to a dilatation of the blood vessels. Thus the
circulating blood volume reduces by about 0.4 l. Decrease in circulating blood volume leads to a decrease in
venous return and cardiac output. Pathological phenomenon called an orthostatic collapse may occur. This
can be prevented by an activation of orthostatic reflex. Low pressure stimulates baroreceptors, which in turn
increase sympathetic tone. Increased sympathetic activity raises cardiac output and causes vasoconstriction,
thus normalize a blood pressure value.

Central venous pressure (CVP) is a mean pressure in the superior vena cava (which is identical with the
pressure in the right atrium). It reflects the pressure in the right ventricle at the end of diastole. CVP depends

20 | k r i p a ’ s n o t e s . .
primarily on the volume of blood and its normal value is about 0-9 mmHg. The increase in CVP may
indicate heart failure.

8. Fetal circulation
_
Correct function of the placenta is essential for the fetus. Placenta provides fetal tissues with oxygen and
nutrients as well as provide disposal of metabolites and CO 2 .
Oxygenated blood from the placenta flows through the umbilical veins. It passes through venous duct to the
inferior vena cava. Then blood continue to the right heart, passes through opened oval foramen to left heart
and then to the aorta. Blood from the upper half of the body partially mixes with blood from the lower half of
the body in the right atrium. The blood from the upper half of the body flows from the superior vena cava
through the right atrium to the right ventricle and then to the pulmonary artery. From pulmonary artery it
flows through the arterial duct into the aorta. Arterial duct merges with aorta past the great aortic branches
for the head and upper extremities. Thus the brain and the arms are supplied by oxygen rich blood. The
mixed blood then enters umbilical arteries as well as lower half of a body.

After birth, umbilical vessels are interrupted. Level of pCO 2 rises and stimulates first inspiratory movement.
Inspiratory movement causes a negative pressure in the chest cavity, leading to a suction of the blood from
the umbilical vein and the placenta. With the inflation of the lungs, the pulmonary circulation resistance
significantly decreases. This changes the direction of blood flow in the arterial duct. Blood flows into the
vasculature of the lungs causing sudden increase in left atrial pressure, therefore closing the oval foramen.
The arterial duct, venous duct and oval foramen obliterates after the birth (up to two weeks).

Physical Characteristics of Blood:

Blood contains plasma and blood cells, some of which have hemoglobin that makes blood red. The average
blood volume in adult is five liters.
 erythrocyte: An anucleate cell in the blood involved with the transport of oxygen. Also called a red
blood cell because of the red coloring of hemoglobin.
 hemoglobin: The iron-containing substance in red blood cells that transports oxygen from the lungs to
the rest of the body. It consists of a protein (globulin) and haem (a porphyrin ring with an atom of
iron at its center).
 tissue perfusion: The amount of blood that can reach the tissues to supply them with oxygen and
glucose.

Blood is a specialized bodily fluid in animals that delivers necessary substances, such as nutrients and
oxygen, to the cells and transports metabolic waste products away from those same cells. Blood plays many
roles in sustaining life and has physical characteristics that distinguish it from other body tissues.

Physical Characteristics

Blood is a fluid that is technically considered a connective tissue. It is an extracellular matrix in which blood
cells are suspended in plasma. It normally has a pH of about 7.4 and is slightly denser and more viscous than

21 | k r i p a ’ s n o t e s . .
water. Blood contains red blood cells (RBCs), white blood cells (WBCs), platelets, and other cell fragments,
molecules, and debris. Albumin is the main protein found in plasma, and it functions to regulate the colloidal
osmotic pressure of blood.

Blood appears red because of the high amount of hemoglobin, a molecule found on RBCs. Each hemoglobin
molecule has four heme groups that interact with various molecules, which alters the exact color. In
oxygenated blood found in arterial circulation, hemoglobin-bound oxygen creates a distinctive red color.

Deoxygenated blood is a darker shade of red. It is present in veins and can be seen during blood donation or
lab tests. Carbon monoxide poisoning causes bright red blood due to the formation of carboxyhemoglobin. In
cyanide poisoning, venous blood remains oxygenated, increasing the redness. Under normal conditions,
blood can never truly be blue, although most visible veins appear blue because only blue light can can
penetrate deeply enough to illuminate veins beneath the skin.

Blood Volume

Blood generally accounts for 8% of the human body weight. The average adult has a blood volume of
roughly five liters (1.3 gal). By volume, red blood cells constitute about 45% of whole blood, plasma about
54.3%, and white cells about 0.7%, with platelets making up less than 1%.

Blood volume is a regulated variable that is directly proportional to blood pressure through the output of the
heart. In order to maintain homeostasis, blood volume and blood pressure must be high enough that blood
can reach all of the body’s tissues, a process called tissue perfusion. Most tissues can survive without
perfusion for a short amount of time, but the brain needs a continuous supply of oxygen and glucose to stay
alive.

Many mechanisms exist to regulate blood volume and tissue perfusion, including renal water excretion in the
kidney, the pumping activity of the heart, and the abilities of the arteries to constrict or dilate. When blood
volume becomes too low, such as from an injury, dehydration, or internal bleeding, the body will enter into a
state of hypovolemic shock, in which tissue perfusion decreases too much. A healthy adult can lose almost
20% of blood volume (1 L) before the first symptom, restlessness, begins, and 40% of volume (2 L) before
hypovolemic shock sets in. Conversely, higher than normal blood volume may cause hypertension, heart
failure, and aneurysms.

Neuronal regulatory mechanisms:

Neural regulation of blood flow is mediated through sympathetic portion of autonomic nervous system.
Noradrenaline is the main vasoactive substance, acting through α1-receptor. Sympathetic system is
distinguished by a tone of a certain frequency which can be modified according to the needs of organism.
Thus the degree of constriction depends on the current sympathetic tone – by decreasing the sympathetic tone
vasodilatation is induced and vice versa. An unique exceptions to the rule of sympathetic dominance are
genital blood vessels and vasculature of sweat and salivary glands. Those are under the control of the
parasympathetic innervation. Acetylcholine induce NO synthesis, thus acting as vasodilator agent.
Vasoactive centre is located in the brain stem. It receive information directly from from the chemoreceptors
and baroreceptors in the aorta and carotid arteries.

Chemoreceptors:

22 | k r i p a ’ s n o t e s . .
Chemoreceptors are located in the carotid glomus and aortic arch. They have a high oxygen demand and are
very sensitive to decrease in pO2. Changes in pH or pCO2 are also considered to be adequate modalities for
stimulating the chemoreceptors. But if compared to the decrease in pO 2, the chemoreceptor response is much
weaker. If stimulated, chemoreceptors increase sympathetic tone, through the direct afferents into the
vasoactive centre of the brain stem. Thus increasing the blood pressure.
On the other hand, central chemoreceptors of medulla and brain stem respond to changes in pCO 2 and pH.
pO2 is not likely to induce any response at all. Increase in pCO 2 or decrease in pH greatly stimulates central
chemoreceptors, which in turn increase sympathetic tone. Both cardiac output and peripheral vascular
resistance increase.
Baroreceptors

Baroreceptors:

Baroreceptors are mechanoreceptors, that are stimulated by a change in a blood pressure value. Receptor
located in the carotid sinus is sensitive to a pressures around 180 mmHg. Receptor in the aortic arch reacts at
even higher pressures. Activation of baroreceptors by high blood pressure value induces a decrease in
sympathetic tone. Thus baroreceptor reflex is a mechanism involved in acute regulation of blood pressure.
Vasoactive centre constantly regulates the sympathetic tone, thus determining actual degree of peripheral
resistance.

Extracorporeal:

An extracorporeal is a medical procedure which is performed outside the body.

Blood is taken from a patient's circulation to have a process applied to it before it is returned to the
circulation. All of the apparatus carrying the blood outside the body is termed the extracorporeal circuit.

1. Aapheresis
Apheresis is a medical procedure that involves removing whole blood from a donor or patient and separating
the blood into individual components so that one particular component can be removed. The remaining blood
components then are re-introduced back into the bloodstream of the patient or donor.
Apheresis is used for the collection of donor blood components (such a platelets or plasma) as well as for the
treatment for certain medical conditions in which a part of the blood that contains disease-provoking
elements is removed.
Apheresis is also called pheresis or hemapheresis. The terminology used may also reflect the
component of blood that is being removed, such as:
• Plasma (plasmapheresis)
• Platelets (plateletpheresis)
• Leukocytes (leukapheresis or leukopheresis)
• Lymphocytes (lymphopheresis or lymphapheresis)
• Red blood cells (erythropheresis)
23 | k r i p a ’ s n o t e s . .
Total plasma exchange (removal of plasma and replacement with fresh frozen plasma) can also be performed
using the apheresis procedure. It is also used for the collection of stem cells from the peripheral blood.

2.Cardiopulmonary bypass:

Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the
heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient's
body. The CPB pump itself is often referred to as a heart–lung machine or "the pump". Cardiopulmonary
bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal
membrane oxygenation is generally used for longer-term treatment.

CPB mechanically circulates and oxygenates blood for the body while bypassing the heart and lungs. It uses
a heart–lung machine to maintain perfusion to other body organs and tissues while the surgeon works in a
bloodless surgical field. The surgeon places a cannula in the right atrium, vena cava, or femoral vein to
withdraw blood from the body. Venous blood is removed from the body by the cannula and then filtered,
cooled or warmed, and oxygenated before it is returned to the body by a mechanical pump. The cannula used
to return oxygenated blood is usually inserted in the ascending aorta, but it may be inserted in the femoral
artery, axillary artery, or brachiocephalic artery (among others).

The patient is administered heparin to prevent clotting, and protamine sulfate is given after to reverse effects
of heparin. During the procedure, hypothermia may be maintained; body temperature is usually kept at 28 °C
to 32 °C (82.4–89.6 °F). The blood is cooled during CPB and returned to the body. The cooled blood slows
the body's basal metabolic rate, decreasing its demand for oxygen. Cooled blood usually has a higher
viscosity, but the crystalloid solution used to prime the bypass tubing dilutes the blood.

Surgical procedures in which cardiopulmonary bypass is used[edit]

• Coronary artery bypass surgery
• Cardiac valve repair and/or replacement (aortic valve, mitral valve, tricuspid valve, pulmonic valve)
• Repair of large septal defects (atrial septal defect, ventricular septal defect, atrioventricular septal defect)
• Repair and/or palliation of congenital heart defects (Tetralogy of Fallot, transposition of the great vessels)
• Transplantation (heart transplantation, lung transplantation, heart–lung transplantation, liver
transplantation)
• Repair of some large aneurysms (aortic aneurysms, cerebral aneurysms)
• Pulmonary thromboendarterectomy
• Pulmonary thrombectomy
• Isolated Limb perfusion
Hemodialysis:
Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were
healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium,
and calcium, in your blood.
Hemodialysis can help you feel better and live longer, but it’s not a cure for kidney failure.

24 | k r i p a ’ s n o t e s . .
During hemodialysis, your blood goes through a filter, called a dialyzer, outside your body. A dialyzer is
sometimes called an “artificial kidney.”
At the start of a hemodialysis treatment, a dialysis nurse or technician places two needles into your arm. You may
prefer to put in your own needles after you’re trained by your health care team. A numbing cream or spray can be
used if placing the needles bothers you. Each needle is attached to a soft tube connected to the dialysis machine.
During hemodialysis, your blood is pumped through a filter, called a dialyzer.
The dialysis machine pumps blood through the filter and returns the blood to your body. During the process, the
dialysis machine checks your blood pressure and controls how quickly
• blood flows through the filter
• fluid is removed from your body
Autotransfusion:
Autotransfusion is a process wherein a person receives their own blood for a transfusion, instead of banked
allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously "pre-
donated" (termed so despite "donation" not typically referring to giving to one's self) before a surgery, or
alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device.
Medical uses
Autotransfusion is intended for use in situations characterized by the loss of one or more units of blood and may
be particularly advantageous for use in cases involving rare blood groups, risk of infectious disease transmission,
restricted homologous blood supply or other medical situations for which the use of homologous blood is
contraindicated. Autotransfusion is commonly used intraoperatively and postoperatively. Intraoperative
autotransfusion refers to recovery of blood lost during surgery or the concentration of fluid in an extracorporeal
circuit. Postoperative autotransfusion refers to the recovery of blood in the extracorporeal circuit at the end of
surgery or from aspirated drainage. Further clinical research in the form of randomized controlled trials is
required to determine the effectiveness and safety of this procedure due abdominal or thoracic trauma surgery.
Advantages

25 | k r i p a ’ s n o t e s . .
• High levels of 2,3-DPG
• Normothermic
• pH relatively normal
• Lower risk of infectious diseases
• Functionally superior cells
• Lower potassium (compared to stored blood)
• Quickly available
• May reduce the need for allogeneic red cell transfusion during certain surgeries, such as, adult elective
cardiac and orthopaedic surgery.
Substances washed out
• Plasma
• Platelets
• White cells
• Anticoagulant solution
• Plasma free hemoglobin
• Cellular stroma
• Activated clotting factors
• Intracellular enzymes
• Potassium
• Plasma bound antibiotics

Plasmapheresis:
Plasmapheresis is the removal, treatment, and return or exchange of blood plasma or components thereof
from and to the blood circulation. It is thus an extracorporeal therapy (a medical procedure performed outside
the body).
Medical uses
During plasmapheresis, blood (which consists of blood cells and a clear liquid called plasma) is initially
taken out of the body through a needle or previously implanted catheter. Plasma is then removed from the
blood by a cell separator. Three procedures are commonly used to separate the plasma from the blood cells,
with each method having its own advantages and disadvantages:
• Discontinuous flow centrifugation: One venous catheter line is required. Typically, a 300 ml batch of
blood is removed at a time and centrifuged to separate plasma from blood cells.

26 | k r i p a ’ s n o t e s . .
• Continuous flow centrifugation: Two venous lines are used. This method requires slightly less blood
volume out of the body at any one time, as it is able to continuously spin out plasma.
• Plasma filtration: Two venous lines are used. The plasma is filtered using standard hemodialysis
equipment. This continuous process requires that less than 100 ml of blood be outside the body at one time.

After plasma separation, the blood cells are returned to the person undergoing treatment, while the plasma,
which contains the antibodies, is first treated and then returned to the patient in traditional plasmapheresis.
Rarely, other replacement fluids, such as hydroxyethyl starch, may be used in individuals who object to
blood transfusion but these are rarely used due to severe side-effects. Medication to keep the blood from
clotting (an anticoagulant) is given to the patient during the procedure.

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