Which of the following is the maximum arterial pressure occurring during contraction of the left ventricle of the heart?

Roles of Capillaries

In addition to forming the connection between the arteries and veins, capillaries have a vital role in the exchange of gases, nutrients, and metabolic waste products between the blood and the tissue cells. Substances pass through the capillary wall by diffusion, filtration, and osmosis. Oxygen and carbon dioxide move across the capillary wall by diffusion. Fluid movement across a capillary wall is determined by a combination of hydrostatic and osmotic pressure. The net result of the capillary microcirculation created by hydrostatic and osmotic pressure is that substances leave the blood at one end of the capillary and return at the other end.

Blood Flow

Blood flow refers to the movement of blood through the vessels from arteries to the capillaries and then into the veins. Pressure is a measure of the force that the blood exerts against the vessel walls as it moves the blood through the vessels. Like all fluids, blood flows from a high pressure area to a region with lower pressure. Blood flows in the same direction as the decreasing pressure gradient: arteries to capillaries to veins.

The rate, or velocity, of blood flow varies inversely with the total cross-sectional area of the blood vessels. As the total cross-sectional area of the vessels increases, the velocity of flow decreases. Blood flow is slowest in the capillaries, which allows time for exchange of gases and nutrients.

Resistance is a force that opposes the flow of a fluid. In blood vessels, most of the resistance is due to vessel diameter. As vessel diameter decreases, the resistance increases and blood flow decreases.

Very little pressure remains by the time blood leaves the capillaries and enters the venules. Blood flow through the veins is not the direct result of ventricular contraction. Instead, venous return depends on skeletal muscle action, respiratory movements, and constriction of smooth muscle in venous walls.

Pulse and Blood Pressure

Pulse refers to the rhythmic expansion of an artery that is caused by ejection of blood from the ventricle. It can be felt where an artery is close to the surface and rests on something firm.

In common usage, the term blood pressure refers to arterial blood pressure, the pressure in the aorta and its branches. Systolic pressure is due to ventricular contraction. Diastolic pressure occurs during cardiac relaxation. Pulse pressure is the difference between systolic pressure and diastolic pressure. Blood pressure is measured with a sphygmomanometer and is recorded as the systolic pressure over the diastolic pressure. Four major factors interact to affect blood pressure: cardiac output, blood volume, peripheral resistance, and viscosity. When these factors increase, blood pressure also increases.

Arterial blood pressure is maintained within normal ranges by changes in cardiac output and peripheral resistance. Pressure receptors (barareceptors), located in the walls of the large arteries in the thorax and neck, are important for short-term blood pressure regulation.

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: The myocardium is relaxed. The atria and ventricles fill passively. AV valves allow blood to pass from the atria to the ventricles. The aortic and pulmonary artery semilunar valves are closed because the blood in those vessels is at a higher pressure than the ventricles. Blood continues to fill atria and ventricles, stretching the compliant heart cells. Systole: The atria contract and eject the final amount of blood into the ventricles. The atrial contraction contributes only about 10% to the total ventricular volume, while the patient is at rest. If the heart rate is high and the ventricles don't have time to fill completely, atrial systole can contibute as much as 40%. Atria relaxation causes atrial pressure to be lower than ventricular pressure. High ventricular pressure relative to the atria causes the AV valves to close, preventing backflow while the ventricles contract. The ventricles continue to contract, ejecting blood through the semilunar valves out to the lungs and rest of the body.

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

• The aortic diastolic pressure is usually 60-90 mm Hg. The LV/aortic pressure gradient causes blood to pass through the aortic valve.
• Blood flowing from the LV to the aorta raises the aortic pressure to equal the LV pressure.
• A momentary aortic systolic pressure of 100-140 mm Hg is then dissipated across the capillary beds.
• Capillary pressure exceeds that of the venuoles. The capillary/venuole gradient causes blood to flow into the low pressure venous system.
• 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.

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