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Year 1 HLB > Blood Pressure - Physiology and Pathology > Flashcards

Blood Pressure - Physiology and Pathology Flashcards

1
Q

What is systolic BP?

A
  • heart contracts
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2
Q

What is diastolic BP?

A
  • heart relaxes
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3
Q

How do we calculate mean BP?

A
  • SBP + 2xDBP / 3
  • 120/80 mmHg = normal BP
  • (120 + 160) / 3 = 93.3 mmHg
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4
Q

What is the blood flow type in arterial and venous blood vessels?

A
  • arterial = pulsatile
  • venous = laminar (continuous smooth blood flow)
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5
Q

What can a BP that is too low cause?

A
  • fainting (vaso-vagal attack) over active parasympathetic
  • shock (causes tissue acidosis)
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6
Q

What can a BP that is too high cause?

A
  • tissue damage
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7
Q

What are the 2 main factors that contribute to blood pressure?

A
  • cardiac output
  • vascular resistance
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8
Q

How do we calculate blood pressure?

A
  • cardiac output x systemic vascular resistance
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9
Q

Where is blood pressure highest in the body?

A
  • at aorta
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10
Q

Why is the compliance and elastic recoil of arteries important for energy in systole?

A
  • stretch and elastic recoil provide potential energy
  • useful in maintaining blood flow in diastole
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11
Q

As we age what happens to the compliance and elastic recoil in our blood vessels?

A
  • both reduce
  • ⬆️ systolic pressure
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12
Q

How can an increased blood viscosity increase blood pressure?

A
  • increases resistance
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13
Q

Does blood with a high protein count and cell count have a high or low viscosity?

A
  • high viscosity
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14
Q

What does inotropic mean?

A
  • force of contraction
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15
Q

What does preload mean?

A
  • degree of stretch in heart at the end of diastolic
  • specifically left ventricular end diastolic pressure
  • degree of stretch is proportional to ventricle filling
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16
Q

How do we calculate cardiac output?

A
  • SV x HR
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17
Q

When trying to apply Starlings law clinically, why do we use end diastolic pressure instead of end diastolic volume?

A
  • end diastolic volume is difficult to measure
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18
Q

Why does stroke volume plateau in the Starling curves?

A
  • due to heart size
  • ventricle can only stretch so much
  • only able to pump so much fluid out
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19
Q

In Starlings law the cardiac structure is relatively fixed, however another factor that contributes to cardiac output is preload, why is preload not fixed?

A
  • preload is affected by venous return
  • myriad of factors affect preload
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20
Q

What are 2 common causes of a decrease in blood volume that can reduce venous return and therefore preload?

A

1 - dehydration

2 - major blood loss

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21
Q

How can an over blood transfusion effect cardiac output?

A
  • ⬆️ venous return
  • ⬆️ preload
  • causes heart to work harder and ⬆️ blood in lungs
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22
Q

How do the 2 sides of the autonomic system affect venous tone and ultimately affect venous return and preload?

A
  • sympathetic ⬆️ venous tone
  • para sympathetic ⬇️ venous tone
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23
Q

How does the circulating vasoconstrictors, such as catecholamines of the sympathetic nervous system affect venous tone and ultimately affect venous return and preload?

A
  • adrenalin can ⬆️ venous tone
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24
Q

How can the local vasoactive substance affect venous tone and ultimately affect venous return and preload?

A
  • ⬇️ venous tone due to vasodilation
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25
Q

What are some common vasoactive substances that can act locally?

A
  • nitric oxide
  • prostacyclin
  • endothelin (most potent vasoconstrictor in the body)
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26
Q

What is blood plasma mainly composed of?

A
  • proteins
  • H2O
  • salts (Na+, K+, Cl-, HCO3-)
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27
Q

What is aldosterone?

A
  • mineralocorticoid steroid hormone
  • produced by the zona glomerulosa of the adrenal cortex in the adrenal gland
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28
Q

How does aldosterone affect blood pressure?

A
  • acts on distal convoluted tubes
  • stimulates Na+ retention
  • H2O follows Na+
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29
Q

What is anti-diuretic hormone (ADH) and where is it produced and store?

A
  • anti-diuretic
  • produced by hypothalamus
  • stored and secreted by pituitary gland
  • angiotensin II signals its release
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30
Q

What is the role of anti-diuretic hormone (ADH)?

A
  • acts on distal convoluted tubes
  • if needs ⬆️ in BP it stimulates H2O retention and thirst
  • if needs ⬇️ in BP it stiumulates increased urine passing
  • ADH aims to maintain osmolarity
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31
Q

What is the intrinsic control of heart rate?

A
  • sinus node
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32
Q

What is the autonomic control of heart rate?

A
  • sympathetic act on B1 receptors = ⬆️ HR
  • para-sympathetic act on M2 receptors = ⬇️ HR
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33
Q

How does a circulating substance such as adrenaline influence HR?

A
  • activation of B1 receptors
  • activation of a1 receptors
34
Q

Roughly what % of blood in the body is fixed in the larger arteries?

A
  • 15%
35
Q

85% of blood pressure and systemic vascular resistance in the arterioles is controlled by what?

A
  • local and systemic mediators
36
Q

What is the main role of the renin-angiotensin-aldosterone system (RAAS)?

A
  • regulating blood volume
  • regulate systemic vascular resistance
  • influence cardiac output
  • influence arterial pressure
37
Q

Does the renin-angiotensin-aldosterone system (RAAS) work locally or systemically to the whole body?

A
  • whole body
38
Q

What is renin?

A
  • a protease (breaks down protein)
  • enzyme that catalyses proteolysis
39
Q

When is renin released from the kidney?

A
  • when blood flow is low to kidneys
40
Q

What is the most potent vasoconstrictor in the body?

A
  • endothelin
41
Q

What is the second most potent vasoconstrictor in the body?

A
  • angiotensin 2
42
Q

In addition to initiating vasoconstriction, what 2 other functions does angiotensin have?

A

1 - stimulate aldosterone release from adrenal cortex

2 - stimulates ADH secretion from pituitary gland

43
Q

How to correctly pronounce renin?

A
  • ree-nuhn
44
Q

If O2 is low or CO2 is high in the arterioles, what 2 substances can be secreted locally causing dilation in an attempt to increase blood flow and O2?

A
  • nitric oxide
  • prostacyclin
45
Q

What substance is secreted locally at arterioles to initiate vasoconstriction?

A
  • endothelin
46
Q

In addition to secreting aldosterone, what 2 other catecholamines is the adrenal gland able to produce?

A
  • adrenaline
  • noradrenaline
47
Q

Are the 2 catecholamines (adrenaline and noradrenaline) secreted from the adrenal gland able to initiate an acute or chronic effect on the body?

A
  • acute sustained changes
48
Q

What alpha and beta receptors to adrenaline and noradrenaline generally act on?

A
  • noradrenaline predominantly an alpha agonist
  • adrenaline is an agonist and alpha and beta receptors
49
Q

What does an agonist of the adrenergic receptors such as adrenaline and noradrenaline do to alpha receptors in relation to systemic arterioles?

A
  • vasoconstriction
  • re-directs blood away from unessential organs
  • skin and bowels for example
50
Q

What does an agonist of the adrenergic receptors such as adrenaline do to beta receptors in relation to systemic arterioles?

A
  • vasodilation in skeletal muscles
  • ⬆️ blood flow to muscles
51
Q

What does an agonist of the adrenergic receptors such as adrenaline do to beta receptors in relation to the heart?

A
  • ⬆️ HR
  • ⬆️ force of contraction
52
Q

Where are baroreceptors located?

A
  • aortic arch
  • carotid bodies
53
Q

Which 2 nerves are generally responsible for sending signals to the brain about blood pressure?

A
  • vagus nerve
  • glossopharyngeal nerve
54
Q

What are the 3 control centres in the medualla of the brainstem that act in response to blood pressure requirements?

A

1 - cardio-accelerator centre

2 - cardio-inhibitor centre

3 - vasomotor centre (peripheral blood vessels)

55
Q

What is the overall arching aim of the control centres in the medulla of the brainstem, cardio-accelerator centre, cardio-inhibitor centre and vasomotor centre (peripheral blood vessels)?

A
  • integrate sympathetic and parasympathetic responses to blood pressure
56
Q

What is one of the most common medical cause of high BP?

A
  • chronic kidney disease
57
Q

What are 2 structural causes in the body that can affect kidney function and thus increase blood pressure?

A
  • renal artery stenosis
  • aortic coarctation (narrowing of abdominal aorta)
58
Q

If a patient has renal artery stenosis or aortic coarctation what will the kidney increase the production of in an attempt to increase blood flow?

A
  • renin
59
Q

What are some common endocrine causes of high blood pressure?

A
  • ⬆️ aldosterone (retains salts)
  • ⬆️ catecholamines (⬆️ HR and BP)
  • ⬆️ cortisol (stress hormone)
  • ⬆️ growth hormones
60
Q

What is essential hypertension?

A
  • no specific known cause - majority of people have this
61
Q

What are some of the factors that contribute to essential hypertension?

A
  • genetics (poly)
  • ⬆️ salt intake
  • obesity
  • ⬆️ alcohol intake
  • ethnicity
62
Q

How does chronic hypertension cause heart failure?

A
  • ⬆️ afterload (SVR)
  • heart chronically working heart
63
Q

What is an aneurysm?

A
  • stretching and rupture of a blood vessel
64
Q

How can chronic hypertension cause an aortic aneurysm?

A
  • ⬆️ pressure on weakened on blood vessels
  • blood vessels compliance may decline with disease and age
  • eventually cause rupture
65
Q

What is a cerebrovascular disease, commonly called a stoke?

A

1 - ischaemic (narrowing of blood vessels)

2 - ruptute of blood vessels

  • both cause a lack of blood to the brain and tissue dies
66
Q

How can cerebrovascular disease, commonly called a stoke be caused by chronic hypertension?

A
  • ⬆️ narrowing of blood vessels
  • ⬆️ risk of becoming blocked or ⬇️ blood flow
67
Q

How can chronic hypertension cause coronary artery disease?

A
  • ⬆️ pressure damages coronary arteries
  • plaque can block coronary arteries
68
Q

How can chronic hypertension cause peripheral vascular disease?

A
  • ⬆️ pressure damages peripheral arteries
  • plaque can build up and block arteries
69
Q

What are some common problems caused by kidney dysfunction in patients with chronic hypertension?

A
  • brain dysfunction
  • exacerbations of other co-morbidities such as eyes, diabetes and peripheral nerves
70
Q

Severe hypertension can present and can cause damage to tissues. Acute dissection can occur, what is this?

A
  • tear in the aorta
  • causes severe chest pain
  • often misdiagnosed
71
Q

Severe hypertension can present and can cause damage tissues. Acute heart failure can occur, what is this?

A
  • ⬆️ resistance placed on heart
  • ⬆️ afterload
  • heart unable to manage and fails to maintain cardiac output
72
Q

Severe hypertension can present and can cause damage tissues. Encephalopathy (confusion) and cerebral haemorrhage can occur, what is this?

A
  • swelling on the brain
  • may cause a rupture and bleed on the brain
73
Q

Severe hypertension can present and can cause damage tissues. Retinal haemorrhage can occur, what is this?

A
  • bleeding in the eyes
74
Q

What is a vaso-vagal episode, also referred to as fainting?

A
  • abnormal response to shock
  • parasympathetic system is over activate
  • ⬇️ in BP and HR
75
Q

What does syncope mean?

A
  • black out
76
Q

Shock can cause a significant reduction in BP that is persistently low, generally <90 mmHg for systolic BP. What are come common causes of this?

A
  • cardiogenic shock (inability to pump blood - MI)
  • sepsis
  • anaphylaxis
  • ⬇️ blood volume (bleeding)
77
Q

During a shock that causes a significant reduction in BP that is persistently low, generally <90 mmHg for systolic BP what does the sympathetic system do, and what are the consequences of this on other organs/tissues?

A
  • redistributes blood to heart/brain
  • other organs become hypoxic
  • acidosis
78
Q

Most circulation in the body receive blood during systole. However, the coronary arteries receive their blood during diastole, how?

A
  • during systole heart compresses coronary arteries
  • compressed coronary arteries means no blood flow
  • during diastole coronary arteries are able to fill
79
Q

The lungs have a different response to the general system circulation in response to low O2 and high CO2. What is the normal response to low O2 and high CO2 in the systemic arterioles?

A
  • vasodilation to ⬆️ blood flow
  • ⬆️ blood flow brings O2 and removes CO2
80
Q

The lungs have a different response to the general system circulation in response to low O2 and high CO2. What is the response to low O2 and high CO2 in the pulmonary arterioles?

A
  • vasoconstriction
  • minimise blood flow to non perfusing lung tissue
  • maximise blood flow to perfusing blood tissue
81
Q

The lungs are extremely sensitive to vasoactive stimuli in relation to systemic arterioles. What are 2 vasoactive chemicals that are classed as vasoactive?

A
  • endothelin
  • prostacyclin

Year 1 HLB (25 decks)

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