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Circulatory and Respiratory Functions of the Blood

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The Heart and Circulation

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Abstract

The concept of mean circulatory pressure (MCP) is based on a manufactured phenomenon which fails to account for the movement of blood after cardiac arrest. Direct observations of microvascular beds in experimental animals confirm vestigial movement of the blood in direction of the heart up to 30 min following the cessation of heart’s contractions. Observations on patients and dogs in deep hypothermic arrest confirm persistent movement of blood against the pressure gradient. The phenomenon of spontaneous return of circulation (SROC) after cardiac arrest and “failed” resuscitation is well-described in the literature. Further discussed are: interstitial pressure (IP) as a marker of the rate of fluid movement across the capillary membrane; negative interstitial pressure and its importance in the maintenance of constant intravascular volume, normal organ function, and facilitation of wound healing; historical development of the concepts of vis á fronte (force from the front) and vis a tergo (force from behind) in relation to heart and capillary actions. The introduction of mechanical respiration gradually obscured the importance of pulmonary microvascular beds for left ventricular filling. It marks the transition from the “hemocentric” view of circulation, where microvascular beds are seen as the principal source of blood propulsion, to a “cardiocentric” view where this role is ascribed to the heart.

That is the essence of science: ask an impertinent question, and you are on the way to a pertinent answer.

Jacob Bronowski (1973)

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Notes

  1. 1.

    Distension of the right heart can be readily observed in patients after failed cardiopulmonary resuscitation with the aid of transthoracic or transesophageal echo probe.

  2. 2.

    The peak absorption of water from the intestine in humans is in the order of 1 L/h. In cat, rat, and rabbit, rapid water absorption is known to cause intravascular hemolysis in portal vein. A dehydrated camel can drink 30–33% of its body weight in 10 min [36].

  3. 3.

    Subatmospheric pressure is present throughout the thorax and plays an important role in maintaining the patency of the thin-walled, easily collapsible veins. Breaking of the vacuum by opening of the chest (pneumothorax) significantly reduces venous return. In light of our discussion, the common explanation that the negative intrapleural pressure is created by the tendency of the lungs to collapse and the recoil of the chest wall will have to be revised.

    Negative pressure extends also into the mediastinum and the esophagus, where it can be measured by means of an esophageal balloon-tipped manometer. Of interest, negative interstitial pressure is commonly used by anesthesia practitioners for the identification of the thoraco-lumbar epidural space by the “hanging drop” technique. A drop of saline placed at the hub of the advancing needle is sucked into the epidural space, confirming its proper placement.

  4. 4.

    Tracking of gas (carbon dioxide) into the tissues spaces of the neck and face can occasionally be seen after laparoscopic surgery. Extreme degrees of subcutaneous emphysema (air trapping) can occur in chest trauma patients with tension pneumothorax with air tracking through the tissues spaces of the entire body, i.e., the “Michelin man.”

  5. 5.

    In Galen’s system of medicine, air (aer) consists of (latent) heat and of pneuma (spiritus), the formative, life-giving principle. Heat or warmth was considered a separate element (quality), not only a secondary product of combustion. It pervaded the other three, namely earth, water, and air, and was the cause of their transformation [58].

  6. 6.

    Epicureanism, a system of philosophy founded by Epicurus (341–270 BCE), the follower of Democritus (460–370 BCE), attempted to explain the world exclusively upon natural (material) causes. According to epicurean view, the world consists of physically indivisible, indestructible atoms, of which there are as many types as the number of different substances.

  7. 7.

    Harvey completed the draft of this lesser known book (first published only in 1959) a year before the publication of De Motu Cordis. He investigated various sources and causes of living movement, including the self-motion in animals and humans, in the context of explanatory principles of Aristotelian pneumatic doctrine. Harvey concluded that vital spirit and “innate heat” are the active medium between the soul and body and the principal causes of voluntary as well as autonomous movements, and by extension, of the self-moving blood and of the beating heart [62].

  8. 8.

    Negative pressures in the xylem capillaries of the transpiring trees can be as low as −40 to −60 atmospheres [66].

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Authors and Affiliations

  1. Professor of Anesthesiology, Albany Medical College, Albany, NY, USA

    Branko Furst MD, FFARCSI

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  1. Branko Furst MD, FFARCSI
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Furst, B. (2020). Circulatory and Respiratory Functions of the Blood. In: The Heart and Circulation. Springer, Cham. https://doi.org/10.1007/978-3-030-25062-1_15

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  • DOI: https://doi.org/10.1007/978-3-030-25062-1_15

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