Vascular Hemodynamics: Deep-Rooted Misconceptions and Misnomers

Abstract

Erroneous concepts about vascular hemodynamics are widespread, notably as regards the effect of gravity on blood flow. Vascular pressure at any point is equal to the sum of two pressures of entirely different origins: (1) pressure caused by the pumping action of the heart (‘cardiodynamic’ pressure which is vital for circulation) and (2) pressure due to gravity acting on the blood (‘gravitational’ or hydrostatic pressure which plays no direct role in blood flow). Gravity neither helps nor hinders circulation because of the U tube or siphon principle. The gravitational energy of the column of blood in arteries is balanced exactly by the gravitational energy of the column in veins and vice versa. Thus, contrary to common belief, gravity does not hinder blood flow to the head in the upright position, nor does it hinder venous return from the dependent parts of the body. For this reason, in Poiseuille’s equation, perfusion pressure should exclude gravitational pressure. Postural effects on circulation result from the distension of vessels (particulary veins) subsequent to changes in gravitational pressure of blood.