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Ch. 12 D&E

MAP =...F =..>... CO x P/R > CO = MAP / TPR > MAP = CO x TPR
if you change the CO or TPR you... change MAP
changing the CO can happen through ^ HR, ^ EDV (venous return), ^ Ejection fraction (all three of these ^ CO and MAP), ^ afterload (decrease CO and MAP)
changing the TPR (tpr stands for..?) happens through dilating arterioles (decrease resistance to decrease map) or constric arterioles (^ resistance and ^ MAP)
systemic MAP...but... > pulmonary MAP...systemic CO = pulmonary CO (must pump equal volumes)
systemic TPR > pulmonary TPR (pulmonary arterioles have less resistance)
CO and TPR are directly related to MAP
regulation of MAP primarly through arterial baroreceptors
arterial baroreceptors are located in the aortic arch (immediate measurement of pressure) and carotid sinuses (enough pressure to get blood to the brain)
action of baroreceptors ^ MAP > ^ barorecedptor firing, ^ pulse pressure > ^ baroreceptor firing
other baroreceptors are located in the heart, pulmonary vessels and large systemic veins
what recieves signals from baroreceptors? and what is its function? medulla...basic body functions
arterial baroreceptor reflex performs short-term regulation (lie down and then stand up = dizzy = receptors don't receive pressure drop right away)
arterial baroreceptor reflex: ^ baroreceptor firing > decreases symp output> ^ parasymp
arterial baroreceptor reflex: decrease baroreceptor firing > ^ symp output > decrease parasymp
effects of hemorrhage in arterial baroreceptor reflex the problem is that the hemorhhage means you lose blood which decreases pressure (look at fig) and the solution is to increase symp and dec. parasymp
the baroreceptor reflex can be considered neg feedback
blood volume is directly related blood pressure
blood vol. - blood pressure relationship is a...and it performs... neg feedback system...long term regulation (modify plasma or blood volume)
blood vol - blood pressure: ^ vol > ^ pressure > dec volume through regulation in the kidney
regulation in the kidney means you either do salt/water retention (^ vol and pressure) or salt/water excretion (dec vol and pressure)
other reflexes and responses to regulate MAP include arterial O2 & CO2 concentrations, blood flow to the brain, body position and mood
arterial O2 and CO2 concentrations are monitored through...and the predicted effects if dec O2 and ^ CO2? systemic arterial blood...symp works faster > ^ MAP
blood flow to the brain: predicted effects if dec flow to brain symp takes over to ^ pressure
body position: predicted effects if ^ effects of gravity dec pressure initially, then ^ it
mood: predicted effects w/ symp activation? parasymp? excitation, fear, stress or relaxed
hypotension is low blood pressure related to body size/cardio fitness/ genetics (no set #s)
hypotension can be caused by hemorrhage, excess salt/water loss, weakened heart, anaphylactic shock, vasovagal syncope
hemorrhage immediate effects include dec SV, dec CO(due to dec SV), dec MAP(due to dec SV and measured directly through baroreceptors)
hemorrhages trigger the baroreceptor reflex (dec firing > ^ symp stimulation)
baroreceptor reflex causes ^ SV (bec ^ contractility), ^ HR (sa can get to threshod faster), ^CO, ^ TPR(vasoconstriction), ^ MAP
additional compensation for hemorrhage include autotransfusion and kidney function
autotransfusion increases interstitial fluid return to blood stream > ^ blood volume
kidney function is a ...that involves... longer term fix to keep plasma volume high...angiotensin II(salt/water retention) and vasopressin (water retention)
blood cell replacement also helps during...through... hemorrhage...erythropoiesis and the production of erythropoietin
excess salt and water loss (cause of hypotension) through.. fluid loss...sweating, burns, GI tract disorders
weakened heart can't develop contractilitiy and pressure
anaphylactic shock involves allergies and IgE which activates basophils and ^ histamine so there is a whole body inflammatory response
vasovagal snycope is a...resulting in... strong emotion...fainting (dec BP)
shock is... another cause of hypotension that is the inability to get blood to organs > organ damage > could lead to problems in other systems
shock decreases blood flow and resulting damage to organs
3 types of shock hypovolemic (dec blood fluid vol), low-resistance shock (dec TPR - anaphylactic shock) and cardiogenic shock (innefective heart/dec cardiac function)
hypertension is high blood pressure
what defines pre hypertension and hypertension 120/80-129/89...140/90+
problems associated with hypertension left ventricle hypertrophy, atherosclerosis, heart attack, cerebral hemorrhage and stroke, kidney disease
left ventricle hypertrophy means that...and there is ^ the muscle enlarges but the tissue is non-productive...afterload > ^ workload of left vent
atherosclerosis means the laying down of fatty plaque (directly related to hypertension)
heart attack means heart needs to work harder - can you provide enough O2 to the heart
cerebral hemorrhage and stroke ^ pressure in vessels > ^ chance of rupturing vessels and clot in the brain
primary hypertension is also called...and the cause is... idiopathic...unknown (inherent to the person)
treatment for primary hypertension (same as if you do know the cause), dec NA intake to reduce plasma vol
another treatment for primary hyper. is to take diuretics which ^ excretion of water in the kidney
treatment for primary hypertension also includes...which... calcium channels blockers (reduce ability of arterioles to vasoconstrict)...dec Ca2 influx to smooth muscles of vessels
the calcium channel blockers may be linked to increased risk of heart attacks
last treatment for primary hypertension is beta-adrenergic receptor blockers that respond to symp system and they dec effect of NE on heart > dec CO
renal hypertension is when there is a problem with kidney, secretes too much renin and angiotensin II
excess renin and angiotensin II > vasoconstriction > effects TPR > effects CO
treatment for renal hypertension include ACE inhibitors: angiotensin-converting enzyme inhibitor
congestive heart failure is inadequate cardiac ouput
congestive heart failure can either be diastolic dysfuncion or systolic
diastolic dysfunction is a problem filling the heart
diastolic dysfunction decreases ventricular compliance > dec vent filling > dec EDV
diastolic dysfunction is often associated with hypertension and leads to ventricular hypertrophy
diastolic dysfunction: ventricular hypertrophy changes characteristics of the myocardium (the tissue is not effective at contracting)
systolic dysfunction is a problem...and it dec... contracting...contractility > dec SV
systolic dysfunction results in ventricular damage but no hypertrophy
serious consequences of diastolic and systolic dysfunction hypertension and progressive heart failure and edema
hypertension and progressive heart failure result from a dec response of the baroreceptors (sensory receptor adaptation) > ^ symp system activity > 4 different things
dec response of baroreceptors > ^ symp system activity >... ^ vasoconstriction > ^ blood pressure
dec response of baroreceptors > ^ symp system activity which ^... angiotensin II and vasopressin > ^ vasoconstriction and blood pressure
dec response of the baroreceptor also leads to... ^ fluid retention > ^ blood plasma volume > ^ blood pressure
lastly, dec reponse of the baroreceptors > ^ symp system activity > ^ blood plasma vol > ^ EDV > ^ frank-starling mechanism > initially ^ then dec heart contractility
edema -esp...- is a problem with pulmonary edema...left ventricle
edema increases salt and water retention in the kidney > ^ blood volume and pressure > ^ bulk flow loss to interstitial fluids (tissues)
edema is failure of the left ventricle > dec output of left ventricle > ^pressure in pulmonary vessels > ^ bulk flow loss in lungs
edema means there is a possibility that there is uneven CO between left and right ventricles (blood stays in the pulmonary tissues which accumulates in the lungs - causes pneumonia)
treatment for congestive heart failure includ3 diuretics, cardiac ionotropic drugs (digitalis), vasodilator drugs and beta-adrenergic receptor blockers
diuretics get rid pressure...dec afterload and edema
cardiac ionotropic drugs, also called...increase digitalis...cytostolic ca concentraction to ^ contractility
cardiac ionotropic drugs only treat the symptoms
vasodilator drugs dec afterload and TPR
vasodilator drugs include ACE inhibitors or inhibit symp system input
ACE inhibitors keep angiotensin out so there is less vasoconstriction and retention in the kidneys)
beta-adrenergic receptor blockers may block excessive release of ca in the heart which could cause myocardial cell death
coronary artery disease is ischemia (low blood flow) in the heart
symptoms of coronary artery disease include angina (chest pain from little oxygen supply)
cause of coronary artery disease include atherosclerosis
atherosclerosis involves fatty streak deposits (cholesterol in coronary arteries), collection of macrophages (clean up fatty streaks), thickening of the artery wall with smooth muscle and CT (stop inflammatory response of macrophages) counterintuitive
effects of coronary artery dieases reduced blood flow (ischemia), excess production of endothelial vasoconstrictors, may cause coronary thrombus
reduced blood flow(ischemia) increases resistance to flow
coronary artery disease may cause coronary thrombus which is the total occlusion of vessel > heart attack
risk factors associated with coronary artery disease and heart attack high cholesterol, high levels of amino acid homocysteine, obesity, sedentary lifestyle, smoking, menopause for women
high cholesterol involves... high level of LDL ( < 100) and low level of HDL (> 60) and ratio
LDL gets...and HDL facilitates.. cholesterol into blood...cholesterol out of blood
high levels of amino acid homocysteine damages the endothelium of blood vessels - inappropriate inflammatory response
obesity and a sedentary lifestyle involves what risks heart health, blood pressure, diabetes and cholesterol
smoking increases...bec of BP...heart health, blood pressure, toxins(impact endothelial cells)
menopause for women is a risk factor for coronary artery disease and heart attack bec reduced blood hormones
treatment for coronary artery disease and heart attacks include dieting, drugs, vitamins, control obesity, have an active lifestyle and stop smoking
diets control cholesterol (lower level of LDL and raise level of HDL - weight control
drugs (cholesterol) - ...reduce the ability of the... statins...liver to produce cholesterol
drugs (cholesterol) - ...prevent.... bile acid sequesterants...bile from aiding in fat digestion and absorption
vitamins include folate (folic acid, B vitamin) that reduce levels of the amino acid homocysteine and also vintamin E which is an antioxidant
drugs that treat coronary artery disease and heart attacks include vasodilators, beta blockers, clot disrupting drugs
vasodilators would be things like...and are used when... nitroglycerin...blood flow is the issue
beta blockers block... beta-adrenergic receptors (symp system)
beta blockers dec blood pressure and cardiac output
clot disrupting drugs are things like aspirin (cox inhibitors that block platelet thromboxane formation) and tPA - tissue plasminogen activator (plasmin breaks down fibrin)
angioplasticity is the insertion of a balloon in the artery to relieve coronary artery disease
coronary stents are sleeves that keep the artery open
the last form of treatment for the coronary artery disease is to perform coronary bypass
heart attacks are caused by total occlusion (coronary arterial disease - can progress from this) and can be caused from an embolism
symptoms of heart attack include pain (jaw, neck, back, shoulders, right arm), weakness, shortness of breath, vomitting and sweating
during a heart attack there is increased...from... plasma concentration of myocardial creatine kinse and troponin...damaged cells
another symptom of heart attack is ventricular fibrillation
treatment for heart attack include CPR & defibrillation to restore regular heartbeat and also clot busting drugs like tPA
changes in blood flow and distribution during exercise goes from...and the major changes include 5 L/min resting > 35 L/m max...skeletal muscle (73%), skin 11 %, heart 4 %
changes in cardiovascular functions during exercise increase symp activity
increases in cardiovascular functions include ^ HR & SV > ^ CO, ^ SV & ejection speed > ^ pulse pressure
decreases in cardiovascular functions include ^ vasodilation > dec TPR > more blood flow to muscles
increases and decreases in cardiovascular functions happen as a result of symp activity
body wide mechanisms during exercise include arterial baroreceptors and medullary cardiovascular center
arterial baroreceptors reset homeostatic set point
medullary cardiovascular center monitors...and keeps... body activity...set point high
during exercise at maximal consumption o2...(vo2 max)
factors determing VO2 max co = hr x sv (bec blood has to get to cells - how well the heart can circulate blood)
avg resting CO = 72 bpm x 0.07 L/beat = 5.0 L/min
the trained athlete has a more effecient heart beat (dec HR resting, ^ SV)
the trained athlete has increases in blood vol, vessels to skeletal muscle, musculature of ventricles(productive), EDV(^return and stretch) and ejection fraction
endurance in the trained athelete has an increase in efficiency of muscle metabolism because they can utilize o2 better, ^ mitochondria, ^ capillaries for more access to o2 and removal of waste products, ^ ability to deliver o2
Created by: handrzej



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