Cardiology Lectures 4-6: Blood Pressure Flashcards
What is blood pressure?
Blood Pressure is “the outwards (hydrostatic) pressure exerted by the blood on blood vessel walls”
What is the upper limit of systolic blood pressure?
140
What is the upper limit for diastolic BP?
90
What is the term for normal blood flow?
Laminar
What is the first Korotkoff sound?
Systolic BP
What is the fifth Korotkoff sound?
Diastolic Pressure is Recorded at the Fifth Korotkoff Sound (point at which sound disappears
What is the main driving force of the venous return to the heart?
MAP
What is MAP?
The average arterial blood pressure during a single cardiac cycle which involves contraction and relaxation of the heart
How do you calculate MAP?
(Diastolic x 2 + Systolic) divided by 3
What is the other way to calculate MAP?
BDP + 1/3 Pulse pressure
What is the normal range for MAP?
70-105
What is the lowest MAP that allows perfusion of coronary arteries, brain and kidney?
at least 60
What determines MAP?
CO and total peripheral resistance
What is total peripheral resistance?
Sum of resistance of all peripheral vasculature in the systemic circulation
What are the major resistance vessels?
Arterioles
Where are you baroreceptors?
Aortic arch
Carotid sinus
Which nerve signals to the medulla from the carotid sinus?
CN IX
Which nerve signals to the medulla from the aortic baroreceptors?
CN X
Why are baroreceptors important?
Short term BP regulations ie postural changes
What is postural hypotension?
Results from failure of Baroreceptor responses to gravitational shifts in blood, when moving from horizontal to vertical position
How is MAP controlled long term?
By hormones which control blood volume.
What two main factors control extracellular fluid volume?
Water
Sodium
What three mechanisms control long term blood pressure?
Rennin-Angiotensin-Aldosterone- System
Atrial Natriuretic Peptide
Antidiuretic hormone
Where is rennin released?
Kidneys
What does rennin do?
Stimulates the formation of angiotensin I
What converts angiotensin I to angiotensin II?
ACE
What does angiotensin II do?
- Stimulates the release of aldosterone form the adrenal cortex
- Vasocontriction
- Stimulates thirst and the release of ADH
What does aldosterone do?
Increased sodium and water retention therefore increasing plasma volume
What cells release rennin?
Granular cells
What makes up the juxtaglomerular region?
Macula densa
Extraglomerular mesangial cells
Granular cells
What three things stimulate rennin release?
Hypotension in the renal artery
Stimulation of renal sympathetic nerves
Decreased sodium in the renal tubular fluid (sensed by the macula densa)
When is ANP released?
Released in response to atrial distention
What does ANP do?
Causes the excretion of salt and water therefore reducing the blood volume and pressure.
Acts as a vasodilator.
Decreases rennin release
What is another name for ADH?
Vasopressin
Where is ADH synthesized?
HYpothalamus
Where is ADH stored?
Pituitary gland
What stimulates secretion of ADH?
Reduced extracellular fluid volume
Increase extracellular fluid osmolarity
How is plasma osmolarity monitored?
Osmoreceptors
How does ADH increase BP?
Acts on the kidney tubules to increase the reabsorption of water
This increases extracellular output and blood pressure
What affect does ADH have on blood vessels?
Vasocontriction
What is the relationship between blood viscosity and length of blood vessel?
Directly proportional to the power of 4
What is the relationship between blood viscosity and radius of the blood vessel?
Inversely proportional tot eh power of 4
Which adrenoceptor acts on vascular smooth muscle?
alpha
What is the vasomotor tone?
Blood vessels are partially constricted at rest
What causes the vasomotor tone?
Tonic discharge of sympathetic nerves resulting in continuous release of noradrenaline
What will increase the vasomotor tone?
Sympathetic stimulation
What adrenoceptor causes vasodilation when acted on by noradrenaline?
beta
Where are the alpha receptors situated?
Skin, gut, kidney arterioles
Where are the beta receptors located?
Cardiac and skeletal smooth muscle
True or false: Intrinsic controls of vasculature can over-ride extrinsic ones?
True
What vessels contain most of the blood volume under resting conditions?
Capacitance vessels eg the veins
What local metabolites cause vasodilation?
Decreased PO2 Decreased CO2 Decreased pH Increased extra cellular K Increased ECF osmolarity Adenosine release
What physical factors cause vasodilation
Warmth
Decreased MAP (myogenic)
Sheer stress
What is the myogenic affect?
If the MAP rises- vasoconstirction occurs to limit flow and vice versa
What humoral agents cause vasodilation
Histamine
Prostoglandin
Bradykinin
Nitric oxide
Where is NO produced
Endothelium
What humoral agents cause vasoconstriction
Seratonin
Thromboxane A2
Leukotrienes
Endothelin
What physical factors cause vasocontriction
Cold
Increase MAP
What amino acid is NO produced from
L-argenine
Which enzyme catalyses the formation of nitric oxide
NOS
What is the relatioship between sheer stress and NO production
Sheer stress increases calcium release which activates NOS and results in increase NO
What is the consequence of an increased venomotor tone?
increased venous return to the heart
What is the acute CVS response to exercise?
Increased sympathetic tone Increased HR and SV Vasodilation to smooth mucles and cardiac Vasocontriction to gut and kidney etc Increase SBP but decreased TPR and DBP Post exercise hypotension
What is the chronic CVS response to exercise?
Reduced BP