Mean Systemic Filling Pressure By Medical Physiology

— Strong sympathetic stimulation

— Normal circulatory system

— Complete sympathetic inhibition

• Normal volume

-0 1000 2000 3000 4000 5000 6000 7000 Volume (ml)

Figure 20-10

Effect of changes in total blood volume on the mean circulatory filling pressure (i.e., "volume-pressure curves" for the entire circulatory system). These curves also show the effects of strong sympathetic stimulation and complete sympathetic inhibition.

Effect of Sympathetic Nervous Stimulation of the Circulation on Mean Circulatory Filling Pressure. The green curve and blue curve in Figure 20-10 show the effects, respectively, of high and low levels of sympathetic nervous activity on the mean circulatory filling pressure. Strong sympathetic stimulation constricts all the systemic blood vessels as well as the larger pulmonary blood vessels and even the chambers of the heart. Therefore, the capacity of the system decreases, so that at each level of blood volume, the mean circulatory filling pressure is increased. At normal blood volume, maximal sympathetic stimulation increases the mean circulatory filling pressure from 7 mm Hg to about 2.5 times that value, or about 17 mm Hg.

Conversely, complete inhibition of the sympathetic nervous system relaxes both the blood vessels and the heart, decreasing the mean circulatory filling pressure from the normal value of 7 mm Hg down to about 4 mm Hg. Before leaving Figure 20-10, note specifically how steep the curves are. This means that even slight changes in blood volume or slight changes in the capacity of the system caused by various levels of sympathetic activity can have large effects on the mean circulatory filling pressure.

Mean Systemic Filling Pressure and Its Relation to Mean Circulatory Filling Pressure. The mean systemic filling pressure, Psf, is slightly different from the mean circulatory filling pressure. It is the pressure measured everywhere in the systemic circulation after blood flow has been stopped by clamping the large blood vessels at the heart, so that the pressures in the systemic circulation can be measured independently from those in the pulmonary circulation. The mean systemic pressure, although almost impossible to measure in the living animal, is the important pressure for determining venous return. The mean systemic filling pressure, however, is almost always nearly equal to the mean circulatory filling pressure because the pulmonary circulation has less than one eighth as much capacitance as the systemic circulation and only about one tenth as much blood volume.

Effect on the Venous Return Curve of Changes in Mean Systemic Filling Pressure. Figure 20-11 shows the effects on the venous return curve caused by increasing or decreasing the mean systemic filling pressure (Psf). Note in Figure 20-11 that the normal mean systemic filling pressure is 7 mm Hg. Then, for the uppermost curve in the figure, the mean systemic filling pressure has been increased to 14 mm Hg, and for the lowermost curve, has been decreased to 3.5 mm Hg.These curves demonstrate that the greater the mean systemic filling pressure (which also means the greater the "tightness" with which the circulatory system is filled with blood) the more the venous return curve shifts upward and to the right.

Mean Circulatory Filing Pressure

Figure 20-11

Conversely, the lower the mean systemic filling pressure, the more the curve shifts downward and to the left.

To express this another way, the greater the system is filled, the easier it is for blood to flow into the heart. The less the filling, the more difficult it is for blood to flow into the heart.

"Pressure Gradient for Venous Return"—When This Is Zero, There Is No Venous Return. When the right atrial pressure rises to equal the mean systemic filling pressure, there is no longer any pressure difference between the peripheral vessels and the right atrium. Consequently, there can no longer be any blood flow from any peripheral vessels back to the right atrium. However, when the right atrial pressure falls progressively lower than the mean systemic filling pressure, the flow to the heart increases proportionately, as one can see by studying any of the venous return curves in Figure 20-11.That is, the greater the difference between the mean systemic filling pressure and the right atrial pressure, the greater becomes the venous return. Therefore, the difference between these two pressures is called the pressure gradient for venous return.

Resistance to Venous Return

In the same way that mean systemic filling pressure represents a pressure pushing venous blood from the periphery toward the heart, there is also resistance to this venous flow of blood. It is called the resistance to venous return. Most of the resistance to venous return occurs in the veins, although some occurs in the arteri-oles and small arteries as well.

Why is venous resistance so important in determining the resistance to venous return? The answer is that when the resistance in the veins increases, blood begins to be dammed up, mainly in the veins themselves. But the venous pressure rises very little because the veins are highly distensible. Therefore, this rise in venous pressure is not very effective in overcoming the resistance, and blood flow into the right atrium decreases drastically. Conversely, when arteriolar and small artery resistances increase, blood accumulates in the arteries, which have a capacitance only 1/30 as great as that of the veins. Therefore, even slight accumulation of blood in the arteries raises the pressure greatly—30 times as much as in the veins—and this high pressure does overcome much of the increased resistance. Mathematically, it turns out that about two thirds of the so-called "resistance to venous return" is determined by venous resistance, and about one third by the arteriolar and small artery resistance.

Venous return can be calculated by the following formula:

Figure 20-11

Venous return curves showing the normal curve when the mean systemic filling pressure (Psf) is 7 mm Hg, and showing the effect of altering the Psf to either 3.5 or 14 mmHg. (Redrawn from Guyton AC, Jones CE, Coleman TB: Circulatory Physiology: Cardiac Output and Its Regulation. 2nd ed. Philadelphia: WB Saunders Co, 1973.)

in which VR is venous return, Psf is mean systemic filling pressure, PRA is right atrial pressure, and RVR is resistance to venous return. In the healthy human adult, the values for these are as follows: venous return equals 5 L/min, mean systemic filling pressure equals 7 mm Hg, right atrial pressure equals 0 mm Hg, and resistance to venous return equals 1.4 mm Hg per liter of blood flow.

Guyton Curve
Right atrial pressure (mm Hg)

Figure 20-12

Venous return curves depicting the effect of altering the "resistance to venous return." Psf, mean systemic filling pressure. (Redrawn from Guyton AC, Jones CE, Coleman TB: Circulatory Physiology: Cardiac Output and Its Regulation. 2nd ed. Philadelphia: WB Saunders Co, 1973.)

Effect of Resistance to Venous Return on the Venous Return Curve. Figure 20-12 demonstrates the effect of different levels of resistance to venous return on the venous return curve, showing that a decrease in this resistance to one-half normal allows twice as much flow of blood and, therefore, rotates the curve upward to twice as great a slope. Conversely, an increase in resistance to twice normal rotates the curve downward to one-half as great a slope.

Note also that when the right atrial pressure rises to equal the mean systemic filling pressure, venous return becomes zero at all levels of resistance to venous return because when there is no pressure gradient to cause flow of blood, it makes no difference what the resistance is in the circulation; the flow is still zero. Therefore, the highest level to which the right atrial pressure can rise, regardless of how much the heart might fail, is equal to the mean systemic filling pressure.

Combinations of Venous Return Curve Patterns. Figure 20-13 shows effects on the venous return curve caused by simultaneous changes in mean systemic pressure (Psf) and resistance to venous return, demonstrating that both these factors can operate simultaneously.

Analysis of Cardiac Output and Right Atrial Pressure, Using Simultaneous Cardiac Output and Venous Return Curves

In the complete circulation, the heart and the systemic circulation must operate together. This means that (1) the venous return from the systemic circulation must

Right atrial pressure (mm Hg)

Figure 20-13

Combinations of the major patterns of venous return curves, showing the effects of simultaneous changes in mean systemic filling pressure (Psf) and in "resistance to venous return." (Redrawn from Guyton AC, Jones CE, Coleman TB: Circulatory Physiology: Cardiac Output and Its Regulation. 2nd ed. Philadelphia: WB Saunders Co, 1973.)

equal the cardiac output from the heart and (2) the right atrial pressure is the same for both the heart and the systemic circulation.

Therefore, one can predict the cardiac output and right atrial pressure in the following way: (1) Determine the momentary pumping ability of the heart and depict this in the form of a cardiac output curve; (2) determine the momentary state of flow from the systemic circulation into the heart and depict this in the form of a venous return curve; and (3) "equate" these curves against each other, as shown in Figure 20-14.

Two curves in the figure depict the normal cardiac output curve (red line) and the normal venous return curve (blue line). There is only one point on the graph, point A, at which the venous return equals the cardiac output and at which the right atrial pressure is the same for both the heart and the systemic circulation. Therefore, in the normal circulation, the right atrial pressure, cardiac output, and venous return are all depicted by point A, called the equilibrium point, giving a normal value for cardiac output of 5 liters per minute and a right atrial pressure of 0 mm Hg .

Effect of Increased Blood Volume on Cardiac Output. A sudden increase in blood volume of about 20 per cent increases the cardiac output to about 2.5 to 3 times normal. An analysis of this effect is shown in Figure 20-14. Immediately on infusing the large quantity of extra blood, the increased filling of the system causes the mean systemic filling pressure (Psf) to increase to 16 mm Hg, which shifts the venous return curve to the right. At the same time, the increased blood volume distends the blood vessels, thus reducing their resistance and thereby reducing the resistance to venous return, which rotates the curve upward. As a result of these two effects, the venous return curve of Figure 20-14 is shifted to the c

Figure 20-14

The two solid curves demonstrate an analysis of cardiac output and right atrial pressure when the cardiac output (red line) and venous return (blue line) curves are normal. Transfusion of blood equal to 20 per cent of the blood volume causes the venous return curve to become the dashed curve; as a result, the cardiac output and right atrial pressure shift from point A to point B. Psf, mean systemic filling pressure.

right. This new curve equates with the cardiac output curve at point B, showing that the cardiac output and venous return increase 2.5 to 3 times, and that the right atrial pressure rises to about +8 mm Hg.

Further Compensatory Effects Initiated in Response to Increased

Blood Volume. The greatly increased cardiac output caused by increased blood volume lasts for only a few minutes because several compensatory effects immediately begin to occur: (1) The increased cardiac output increases the capillary pressure so that fluid begins to transude out of the capillaries into the tissues, thereby returning the blood volume toward normal. (2) The increased pressure in the veins causes the veins to continue distending gradually by the mechanism called stress-relaxation, especially causing the venous blood reservoirs, such as the liver and spleen, to distend, thus reducing the mean systemic pressure. (3) The excess blood flow through the peripheral tissues causes autoregulatory increase in the peripheral resistance, thus increasing the resistance to venous return. These factors cause the mean systemic filling pressure to return back toward normal and the resistance vessels of the systemic circulation to constrict. Therefore, gradually, over a period of 10 to 40 minutes, the cardiac output returns almost to normal.

Effect of Sympathetic Stimulation on Cardiac Output. Sympathetic stimulation affects both the heart and the systemic circulation: (1) It makes the heart a stronger pump. (2) In the systemic circulation, it increases the mean systemic filling pressure because of contraction of the peripheral vessels—especially the veins—and it increases the resistance to venous return.

In Figure 20-15, the normal cardiac output and venous return curves are depicted; these equate with

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Responses

  • bilcuzal
    What is the difference between mean circulatory pressure and mean systemic filling pressure?
    3 years ago
  • Abelina Arcuri
    What determines mean systemic filling pressure?
    7 months ago

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