SPECIAL CIRCULATIONS

Dr. Mariano J. Rey

1. To understand the physiological determinants and regulators of coronary blood flow.

2. To be able to describe the factors that influence diffusion exchange across capillaries.

3. To learn the role of the venous system and the lymphatic system in the overall circu lation.

1. Historical Background
• A. Starling - balance of hydrostatic and osmotic forces (1896)
2. The Coronary Circulation
• A. Functional anatomy
• B. Collaterals
• C. Flow During Cardiac Cycle
• D. Neurohumoral Regulation
• E. Metabolic Regulation
3. Cerebral Circulation
• A. Blood-Brain Barrier
• B. Regional Blood Flow
• C. O2 and CO2 Effects
4. The Microcirculation
• A. The Starling Hypothesis
• B. Hydrostatic and Osmotic forces
• D. Transcapillary Exchange
• E. Capillary Filtration Coefficient
5. The Venous Circulation
6. The Lymphatic System

Define or Explain
• nutritional vs. shunt flow
• flow vs. diffusion limitation
• osmotic vs. hydrostatic forces
• resistance vs. capacitance vessels
• Donan Effect on colloid osmotic pressures
• filtration coefficient vs. reflection coefficient
Case Studies
Consider the case in Chapter 28 (pages 53-54) - Mitral Stenosis with Congestive Heart Failure. The case discussion (pages 159-161) uses the setting of heart failure to explain the venous and lymphatic circulations.

The case: Coronary Artery Disease (pages 59-60) in Chapter 31 and the discussion (pages 167-169) result in a review of the special circulations: coronaries, brain, skin, skeletal muscles, and others.

Computer Module
Work through Section 10 of the A.D.A.M. Cardiovascular Module. This section, Autoregulation and Capillary Dynamics will be of help in understanding the physiology of the special circulations.