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Cardiovascular Physiology Concepts

Richard E. Klabunde, PhD


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Reactive Hyperemia

Reactive hyperemia is the transient increase in organ blood flow that occurs following a brief period of ischemia (e.g., arterial occlusion). Reactive hyperemia occurs following the removal of a tourniquet, unclamping an artery during surgery, or restoring flow to a coronary artery after recanalization (reopening a closed artery using an angioplasty balloon or clot dissolving drug).In general, the ability of an organ to display reactive hyperemia is similar to its ability to display autoregulation.

In the following figure, the left panel shows the effects of a 2 min arterial occlusion on blood flow. In this example, blood flow goes to zero during arterial occlusion. When the occlusion is released, blood flow rapidly increases (i.e., hyperemia occurs) that lasts for several minutes. The hyperemia occurs because during the period of occlusion, tissue hypoxia and a build up of vasodilator metabolites (e.g., adenosine) dilate arterioles and decrease vascular resistance. Then when perfusion pressure is restored (i.e., occlusion released), flow becomes elevated because of the reduced vascular resistance. During the hyperemia, the tissue becomes reoxygenated and vasodilator metabolites are washed out of the tissue.  This causes the resistance vessels to regain their normal vascular tone, thereby returning flow to control. The longer the period of occlusion, the greater the metabolic stimulus for vasodilation leading to increases in peak reactive hyperemia and duration of hyperemia.  Depending upon the organ, maximal vasodilation as indicated by peak flow, may occur following less than one minute (e.g., coronary circulation) of complete arterial occlusion, or may require several minutes of occlusion (gastrointestinal circulation).  Myogenic mechanisms may also contribute to reactive hyperemia in some tissues. By this mechanism, arterial occlusion results in a decrease in pressure downstream in arterioles, which can lead to myogenic-mediated vasodilation.

reactive hyperemia in skeletal muscle

RK Revised 03/29/2007

DISCLAIMER: These materials are for educational purposes only, and are not a source of medical decision-making advice.