4 The systemic arterial blood pressure Flashcards

1
Q

Define systolic pressure

A

The BP in mmHg in an innate muscular artery during systole (brachial)

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2
Q

Define diastolic pressure

A

the BP in mmHg in an innate muscular artery during diastole (brachial)

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3
Q

Define pulse pressure

A

Difference in pressure

Systolic - Diastolic pressure

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4
Q

Describe mean arterial pressure

A

Mean arterial pressure (MAP)
- can be worked out using:
MAP = Diastolic pressure + [(SBP)/(DBP)]3

So, MAP is closer to the diastolic value
- as diastole lasts longer than systole at rest
- At high heart rates, however, MAP is closer to the arithmetic average of systolic and diastolic pressure (almost 100mmHg)
> This is due to the change in the shape of the arterial pressure pulse (narrower)

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5
Q

Describe the effects of decreased aortic distensibility on BP

A

A decrease in aortic distensibility leads to an increase in Systolic BP
- normally, the elastic aorta takes up KE from blood during systole + dampens the rise in pressure
- Inelastic aorta can cause systolic hypertension in the elderly
> Hard arteries reduce the baroceptor response

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6
Q

Describe the effects of increased heart rate on BP

A
  • SVR = (MAP - CVP)/CO
    or, rearranged MAP = (CO*SVR) + CVP

SO, an increase in HR will increase mean arterial pressure (due to lack of runoff)

  • so, lower heart rate = increased runoff (lower BP)
  • higher heart rate = decreased runoff (less time to go to diastolic pressure)
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7
Q

Describe the effects of systemic vascular resistance on BP

A

As SVR increases, MAP increases
- the resistance vessels are innervated by SNS nerve terminals, that cause vasoconstriction when active
- The SVR increase account for 80% of the compensatory response to a fall in the MAP under resting conditions
(so cardiac component contributes around 20%)

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8
Q

Describe ways in which the cardiovascular system monitors + maintains the arterial pressure

A

The C-V system includes 2 distinct pathways for monitoring + maintaining arterial pressure:

  1. Baroreceptor reflex - fast activating and helps compensate for short-term pressure changes
  2. Slow-activating system - manipulates mean arterial pressure through changes in circulating blood volume by modifying renal function
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9
Q

Describe the 2 baroreceptor groups

A

2 groups providing the ‘integrator’
- which is located in the medulla with information about pressure and flow in the C-V system

  1. High-pressure baroreceptors in carotid sinus + aortic arch
  2. Low-pressure cardiopulmonary receptors
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10
Q

Describe the carotid and aortic baroreceptors

A

They are the primary means of detecting changes in MAP
- They monitor pressure indirectly by responding to arterial wall stretch
- They are bare sensory receptors buried in the elastic layers of the aorta, carotid sinus
- Information from the sinus travels back to the brain (afferent limb)
o Via the glossopharyngeal nerve (CN IX)
- Information from the aortic arch travels back on CN X – the vagus nerve

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11
Q

Describe the function of baroreceptors (and how they carry this out)

A

In the absence of stretch, baroceptors are inactive
- As MAP increases, nerve endings are stretched – leading to a graded potential
> if deformation (stretch) is high = ACTION POTENTIAL triggers

The higher the pressure the higher the frequency.
(This level then drops during diastole when pressure is lower)

To enable a more nuanced response, stretch sensitivity varies from one nerve ending to the next, thereby allowing for responsiveness over a wide pressure range.
o The carotid baroreceptors have a response threshold of around 50mmHg and saturate at 180mmHg
o The aortic baroreceptors operate over a range of 100 – 300mmHg, meaning they are usually inactive under resting conditions.

SO, carotid baroreceptors bear the brunt of responses to moment-by-moment changes in BP

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12
Q

Describe cardiopulmonary baroreceptors

A

They are found in lower pressure regions of the cardiovascular system.
- They provide CNS with info about ‘fullness’ of the cardiovascular system (role is hence about modulating renal function)

  • However, because fullness correlates with ventricular preload, they also have a role in maintaining MAP
    o Preload is load applied to a myocyte + establishes muscle length before contraction.
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13
Q

Describe the structure of cardiopulmonary baroreceptors,

as well as where they are found,

and how information is conveyed back to the CNS

A

Anatomically they are similar to the high-pressure ones – also free nerve endings
- They are found in the vena cava, pulmonary arteries and veins + atria
o Info is conveyed back to CNS on Vagal afferents (X cranial nerve)

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14
Q

Describe the central integrator as an integration centre

in the medulla

A

These afferents converge (nerves from baroreceptors) converge on the medulla

  • where the information is ‘compared’ to preset values
  • and a decision is made about the nature of the compensatory response

The medulla is composed of a collection of nuclei that comprise the cardiovascular centre.

  • Arterial pressure = CO x SVR
  • and the control centres adjust both parameters simultaneously
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15
Q

Describe the 3 different control centres that are in the central integration centre in the medulla

A

3 control centres, which are interlinked extensively so as to generate a unified response to changes in arterial pressure:

  • Vasomotor centre - cells in that area that cause vasoconstriction
  • Cardioacceleratory centre - increases HR and myocardial inotropy (force of contraction)
  • Cardioinhibitory centre - slows HR when active
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16
Q

Describe the other inputs to the Cardiovascular system from other regions of the brain and periphery (which help to monitor and regulate BP)

A

Hypothalmic control centres
- help coordinate vascular responses to changes in external and internal body temperatures

Cortical control centres

  • account for changes in cardiovascular performance induced by emotions
  • (e.g. fainting or anticipatory changes associated with exercise)

Pain centres
- can also precipitate profound changes in blood pressure by manipulating cardiovascular centre output

The brainstem also contains a respiratory centre that controls breathing
- the resp. centre monitors arterial O2 and CO2 using peripheral and central chemoreceptors

17
Q

Describe what the effector pathway is

A

The cardiovascular centres adjust cardiac and vascular function via the Autonomic Nervous System (ANS)

The cardioinhibitory centre depresses HR.

  • It acts via parasympathetic fibres travelling in the Vagus nerve
  • that target the sinoatrial (SA) and atrioventricular (AV) nodes.

The cardioacceleratory and vasomotor centres
- act via sympathetic nerves.
o The cardioacceleratory centre increases HR by manipulating SA and AV node excitability + increasing myocardial contractility
o The vasomotor centre controls resistance vessels, veins and adrenal glands

18
Q

Describe why the BP decreases when someone moves to stand from sitting/supine position

A
  • When a person stands, 600-800mL of blood is forced down under the influence of gravity + begins to pool in the legs + feet
  • Venous return and CVP fall as a consequence

More blood in lower limbs means:
- venous pressure and volume increases in lower limbs
SO
- volume of blood in the thorax and pressure is reduced in the thorax
- this decreases RV filling pressure + volume - Decrease in Stroke Volume
- This also decreases LV stroke volume due to reduced pulmonary return

HENCE

  • BP falls
  • MAP = (decreased CO x SVR) + decreased CVP
19
Q

Describe what happens when BP falls > 20mmHg

when standing

A

This is known as orthostatic/postural hypotension

BP falls > 20mmHg

20
Q

Describe the effector pathway mechanism that takes place when the BP falls due to standing up (postural hypotension)

A

Baroreceptors are activated
- Initially, as stroke volume decreases, there is an increase in Heart Rate
(baroreceptor-mediate tachycardia) to maintain CO and hence BP

  • This increase in SNS tone also leads to an increase in SVR and an increase in venous tone (decreased compliance) - venoconstriction
  • this also prevents pooling and oedema forming in lower limb
    (though the pressure is raised in feet on standing)
  • and increased preload by increasing venous return (EDV increases)

Once this happens

  • heart rate can reduce
  • as can SVR
21
Q

Describe other mechanisms that act as compensatory mechanisms to maintain BP (when it reduces), aside from baroreceptor reflexes - effector response

A
  • Valves - prevent backflow
  • Muscle pump
  • Abdominothoracic pump

These work to increase venous return, increase preload (EDV) and increase the cardiac output once again