Hemodynamics (or haemodynamics in British English), meaning literally "blood movement" is the study of blood flow or the circulation. All animal cells require oxygen (O2) for the conversion of carbohydrates, fats and proteins into carbon dioxide (CO2), water and energy in a process known as aerobic respiration.
The circulatory system functions to transport the blood to deliver O2, nutrients and chemicals to the cells of the body to ensure their health and proper function, and to remove the cellular waste products. The circulatory system is a connected series of tubes, which includes the heart, the arteries, the microcirculation, and the veins.
The heart is the driver of the circulatory system generating cardiac output (CO) by rhythmically contracting and relaxing. This creates changes in regional pressures, and, combined with a complex valvular system in the heart and the veins, ensures that the blood moves around the circulatory system in one direction. The "beating" of the heart generates pulsatile blood flow which is conducted into the arteries, across the micro-circulation and eventually, back via the venous system to the heart. The aorta, the main artery, leaves the left heart and proceeds to divide into smaller and smaller arteries until they become arterioles, and eventually capillaries, where oxygen transfer occurs. The capillaries connect to venules, into which the deoxygenated blood passes from the cells back into the blood, and the blood then travels back through the network of veins to the right heart. The micro-circulation-the arterioles, capillaries, and venules-constitutes most of the area of the vascular system and is the site of the transfer of O2, glucose, and enzyme substrates into the cells. The venous system returns the de-oxygenated blood to the right heart where it is pumped into the lungs to become oxygenated and CO2 and other gaseous wastes exchanged and expelled during breathing. Blood then returns to the left side of the heart where it begins the process again. Clearly the heart, vessels and lungs are all actively involved in maintaining healthy cells and organs, and all influence haemodynamics.
Haemodynamics can be defined as the physical factors that govern blood flow. These are the same physical factors that govern the flow of any fluid, and are based on a fundamental law of physics, namely Ohm's Law, which states that current (I) equals the voltage difference (ΔV) divided by resistance (R). In relating Ohm's Law to fluid flow, the voltage difference is the pressure difference (ΔP; sometimes called driving pressure, perfusion pressure, or pressure gradient), the resistance is the resistance to flow (R) offered by the blood vessel and its interactions with the flowing blood, and the current is the blood flow (F). This hemodynamic relationship can be summarized by:
For the flow of blood in a blood vessel, the ΔP is the pressure difference between any two points along a given length of the vessel. When describing the flow of blood for an organ, the pressure difference is generally expressed as the difference between the arterial pressure (PA) and venous pressure (PV). For example, the blood flow for the kidney is determined by the renal artery pressure, renal vein pressure, and renal vascular resistance.
The blood flow across a heart valve follows the same relationship as for a blood vessel; however, the pressure difference is the two pressures on either side of the valve. For example, the pressure difference across the aortic valve that drives flow across that valve during ventricular ejection is the intraventricular pressure (PIV) minus the aortic pressure (PAo). The resistance (R) is the resistance to flow that is related in large part to the size of the valve opening. Therefore, the relationship describing the flow across the aortic valve is:
Under ideal laminar flow conditions, in which vascular resistance is independent of flow and pressure, the relationship between pressure, flow and resistance can be depicted as shown in the figure to the right. Because flow and resistance are reciprocally related, an increase in resistance decreases flow at any given ΔP. Also, at any given flow along a blood vessel or across a heart valve, an increase in resistance increases the ΔP.
Changes in resistance are the primary means by which blood flow is regulated within organs because control mechanisms in the body generally maintain arterial and venous blood pressures within a narrow range. However, changes in perfusion pressure, when they occur, will affect flow.
The above relationship also indicates that there is a linear and proportionate relationship between flow and perfusion pressure. This linear relationship, however, is not followed when pathological conditions lead to turbulent flow, because turbulence decreases the flow at any given perfusion pressure. Furthermore, the pulsatile nature of flow in large arteries also alters this relationship so that greater pressures are required for a given flow. In other words, pulsatility, like turbulence, increases resistance to flow.
Edited by John Sandham