CRS 5 Flashcards
Describe the cellular signalling mechanism of nitric oxide
- NO potent vasodilator
- Inhibits platelet aggregation and elevates cGMP
- Role in blood thinning
- Gas produced by endothelium from amino acids by nitric acid synthases
- NO passes from endothelium to VSMC via gap junctions
- ACh, bradykinin and serotonin act as 1st messengers in endothelial cells due to increased NO
- cGMP is 2nd messenger
- Ca2+ 3rd in VSMCs
- ACh released by nerve terminals in blood vessel wall activate NO synthase in endothelial cells lining blood vessels
- Endothelial cells produce NO
- NO diffuses out of endothelial cells and into underlying smoth muscle cells
- Binds to and activates guanylyl cyclase to produce cGMP
- cGMP tiggers response that causes smooth muscle cells to relax
- Enhances blood flow through vessels
- Occurs because cGP activates Ca2+ pump on membrane of intracellular stores
- Then pump Ca2+ out of intracellular environment
- Decreases concentration
- Reduction in Ca2+ causes contractile filaments in VSMC to slide apart and muscle cells relax
Give examples of water vs lipid soluble signalling
- Steroids are lipid soluble while peptides are water soluble
Describe the regulation of nitric oxide
- Different isoforms of NO synthase
- eNOS, nNOs, iNOS
- eNOS: found in cardiac cells, osteoclast and osteoblasts, platelets and endothelial cells
- iNOS: found in inflammatory cells, fibroblasts, endothelial cells and vascular smooth muscle
- Each of these have different metabolites
Describe what happens during gram negative sepsis in relation to NO
- Massive activation of iNOS
- Excessive vasodilation
- Hypotension and vascular leakage
- Organ failure occurs
- Can be treated with the use of an NO blocker
Explain why vasoconstriction is necessary
- Used to boost systemic pressure
- Not about reducing flow
- Blood vessels made narrower by VSMC contraction
- Increases vascular resistance
- Vasoconstriction is titrable (mild/moderate/severe) and can be increased by disease, drugs and short or long term physiological responses
- Smooth muscle cells are linked by gap junctions to underlying VSMCs forming functional syncytium
Describe the receptors of blood pressure
- Detected by baroreceptors
- Sit on carotid sinus and aortic arch
- Sensory neurons with free sensory endings in walls of particular arteries
- Sensitive to stretch
- Detect changes in pressure within the artery
- Information collected by baroreceptors integrated in medulla oblongata
- ANS makes appropriate changes to cardiac function and degree of vasoconstriction
Describe th autonomic pathways that regulat blood pressure
- SNS: vasoconstriction, increase heart rate and contractility, occurs when BP low
- PSNS: reduces heart rate and contracility, vasodilation, decrease high BP
Differentiate between dehydration and hypovolaemia
- Dehydration is loss of fluid from ECF and ICF
- Hypovolaemia is loss of lfuid from vaculature
- In acute hypovolaemia, dehydration is unlikely to occur so skin tenting and altererd PCV will not be seen
Describe the effect of hypovolaemia on cardiac function
- Preload decreases
- Stroke volume decreases
- MAP decreases
- Viscosity of blood unchanged
- Tissue oxygen decreased
- RAAS activated
- Heart rate increases to increase cardiac output and blood pressure
Describe the paracrine, endocrine and autonomic responses to hypovolaemis
- Symapthetic tone increases, noradrenaline reelased
- Acts on beta1 receptors in heart
- Positive chronotropic and iontropic effect
- Sympathetic system stimulates adrenal galnd
- Release adrenaline
- Also acts on beta1 as agonist - increase HR and contractility further
- Increased sympathetic tone also stimulates vasoconstriction
- Indirect endocrine effects include: ADH released from pituitary in response to reduced blood volume, cause vasoconstrictioin and retention fo circulation volume through kidneys
- Angiotensin II in change of blood vessel tone
Describe the difference between systolic and diastolic pressure
- Systolic pressure is highest pressure reached during ejection phase
- Diastolic pressure is lowest pressure reached during ventricular filling stage
Explain what is meant by mean arterial pressure and its importance
- MAP is the average pressure over the whole cardiac cycle
- Drives tissue perfusion with blood result of discharge of volume of blood from heart
- Is not half way between systolic and diastolic pressure, 2/3 of cardiac cycle is diastole
- MAP = ((2xdiastolic)+systolic)/3
- MAP of 60mmHg is needed to perfuse the brain, normal range is 70-110mmHg
- Dependent on cardiac output, total peripheral resistance and blood volume
- Pressure = cardiac output x TPR
- Systolic ejection of blood creastes pressure waveform as blood passes from LV to aorta
- Arterial pulse walve in aorta is asymmetrical, transmitted to rest of arterial tree
- Pressure - time wave form also asymmetrical
- Peak of waveform is systolic pressuer (120mmHg) and base is diastolic pressure
- MAO is average effetive pressure forcing blood through circulatory system
Describe the vascular responses to hypoxia other than the pulmonary vessels
- Vasodilate in response to hypoxemia
- Improve oxygen supply to the tissues
- Mediated by release of adenosine from hypoxic muscles or tissues
- Local acidosis leading to increased lactage
- Hyperpolarises cell membrane due to increased K+ reducing Ca2+ channel opening potential
- Release of NO from endothelium
Describe the pulmonary vascular responses to hypoxia
- Vasoconstriction
- Mediated by fall in SaO2
- Response very fast but also patchy
- Dependent on individual
- Pulmonary vasoconstriction occur to maintain ventilation:perfusion relationships
- Mediated by vessel’s endothelium
- Adenosine or angiotensin
- Increases the resistance within pulmonary vasculature
- Tunica media of arterioles hypertrophies
- Hypertrophy of right ventricular myocardium in response to increased pressure within
List the clinical manifestations of high altitude disease
- Fluid in the lungs
- Increased PCV
- Cerebral dysfunction
- Pulmonary hypertension
- Pulmonary oedema, RV hypertrophy, right sided heart failure, cerebral oedema,erythrocytosis, prevention of maturation of the foetal to adult circualtion, neurological signs, soft wet cough, shallow fast breathing
Explain why fluid in the lungs occurs with high altitude disease
- Increased pressure within pulmonary arterioles and vasoconstriction of pulmonary veins
- Leakage of fluid from vessels into alveoli due to pulmonary capillary over distension
- Hydrostatic pressure within capillaries greater than that in alveoli
- Fluid floods alveoli (wet cough)
- Fluid contains protein and red cells
- Harder for alveolar macrophages and lymphatics to clear
- Shallow fast breathing
Explain why increased OCV occurs with high altitude disease
- Erythrocytosis
- Erythropoeitin produced by interstitial capillary bed of kidneys
- In response to hypoxemia
- Released into circulation, triggers development of red cell precursors in the bone marrow
- Release of mature and immature RBCs
- Increased PCV and erythrocytosis
Explain why cerebral dysfunction occurs with high altitude disease
- Low PaO2
- Vasodilation in the brain leading to cerebral oedema
- INcreased pressure = leakage of fluid from vessels ino cerebral tissues
- Can appear similar to BSE/ Pb toxicity/hypomagnaemic cows in mid to late stages
- Irritability, headaches, disorientation, ataxia, dysphoria, aggression, coma and death
Describe the agricultural importance of high altitude disease in animals
- High altitude for animals as will be poor for crops
- Mainly cows
- European breeds badly affected (pigs, turkeys, horses, human)
- Sheep, goats, rabbits, guinea pigs, dogs, cats and South American camelids resistance
- Much greater losses when farming at high altitude
- Young do not adapt and are worse affected
- Susceptibility is also hereditary
Define hypoxia
A deficiency in the amount of oxygen reaching the tissues
Define hypoxemia
An abnormally low concentration of oxygen in the blood
Give an explanation of what high altitude disease is
- Cor pulmonale/Mountain sickness/Brisket disease
- Primarily vascular disease seen at high altitudes
- Hypoxia
- Made worse by cold and exposure
- Can also be seen with lung disease
- Defined as right sided heart failure due to increased cardiac work secondary to pulmonary hypretension
Describe the main ultrastructural features of a vascular smooth msucle cell
- State of constant tone
- Form a functional syncitium
- Internal elastic lamina between VSMC layer and endothelial cell layer of blood vessel
- Main elements of VSMC are actin filaments, gap junctions, elastic elements and a sarcoplasmic reticulum
State the roles of NO ion cahnnels in governing VSMC tone
- NO is a vasodilator
- Released from vascular endothelium of small muscular arteries and larger arterioles
- Released in response to shear stress but also ACh, polypeptides and kinins
State the role of endothelin ion cahnnels governing VSMC tone
- Family of peptides
- Different actions depending on organ/tissue
- e.g. in brain elicits initial vasodilation followed by potent, sustained vasoconstriction
Describe how metabolic factors operate loally to regulate arteries and veins
- Rate of blood flow infleunces local metabolic acitivity
- Shear stess
- O2 primary controlled - decreased O2 supply => vasodilation, continued demand stimulates angiogenesis
- Adenosine, phosphate ions, pCO2, lactate, K+ and osmolarity also regulate arteries and veins
- Functional hyperemia (functional demands i.e. if only legs working then more blood to legs) and reactive hyperemia (reaction to clear accumulated metabolites after ischemia) also affect arteria and veins
Describe how neural factors operate to regulate arteires and veins
- Arteries, arterioles, veins, muscular venules and arteriovenous anastomoses innervated by sympathetic fibres
- Resting sympathetic tone dominant through constant stimulation of alpha-adrenoceptors
- Leads to vasoconstrction (norepinephrine)
- Beta2-adrenoceptors cause vasodilation
Describe how alpha blockers work
- Block norepinephrine generation
- Less circulating IP3
- Less contraction of vessels and vasodilation occure
- Arterioles and venules sympathetically innervateed
- Some dilation will occur in both with an alpha blockade
Describe how hormonal factors regulate arteries and veins
- Vasoconstrictors: epinephrine, norepinephrine, prostaglandins, angiotensin II, vasopressin (at low concentrations called ADH)
- Vasodilators: bradykinin, histamine, prostaglandins
- Prostaglandins can be constrictors or dilators depending on species, concentration and local sensitivity but mainly constrictors
- Dilators can be beta and alpha blockers, sodium channel blockers, chlorine channel agonists
- Constrictors can be: sodium channel agonists, chlorine channel blockers, alpha and beta agonists
Describe how mechanical facotrs regulate arteries and veins
- Sudden rise in arterial pressure leads to an increase in blood flow
- Quickly restored to a normal value
- Myogenic autoregulation from direct response of VSMC to stretching and relaxation
- Endothelium forms bioactive interface
- Constant exposure of ECs to shear stess maintains vascular tone
- Mediated in part through regulation of eNOS
- Shear stress can be either atheroprotective or atheroprone
- Steady pulsatile flow in straight parts of arterial tree is atheroprotective (increases eNOS derived NO availability and exerts anti-inflammatory and antioxidative effects)
- In bends and bifurcations, distured flow patterns induce expression of molecules involved in atherogenesis
- Elevate level of reactive oxygen species in ECs
Describe how arteriolar flow is regulated
- Controlled centrally and locally
- Centrally is controlled by brain’s cardiovascular centre
- Acts indirectly through baro- and chemoreceptor reflex arches
- Peripherally controlled by vascular beds and local fine tuning
- Acted directly upon through metabolic, mechanical and pharmacological stimuli
List the mecahnisms that maintain vasomotor tone
- Metabolic
- Neural
- Hormonal
- Mechanical
- Endothelial factors
- RAAS
- Intracellular calcium
Briefly outline the RAAS
- Renin angiotensin aldosterone system
- High concentration leads to vasoconstriction
- High blood pressure supresses RAAS, low stimulates it
- Angiotensin II ver vasoactive
- Increases blood pressure
- Short half life and is very potent
Explain how calcium ion concentration is kept low for signalling
- Calcium complexes insoluble
- Ca kept low by Ca transporters
- Means there is a steep concentratin gradient
- Offers potential to rapidly increase intracellular Ca and control VSMC contractility
- Calcium complexes of phosphorylated and carboxylated compounds often insoluble
- Intracellular levels of Ca2+ kept low
- Prevent precipitation of these compounds
- In eukaryotic cells 2 transport system
- Ca2+ ATPase pump and Na+/Ca2+ antiporter
- Steep concentration gradient, able to rapidly increase cystolic Ca2+ by opening Ca2+ channels in plasma membrane of in intracellular membrane
Explain the term EC50
The concentration of a drug that will give the half-maximal response
Explain the term Emax
The efficacy of a drug and refers to the maximum response achievable from a drug
Describe techniques used to investage receptor expression in arterial and vascular systems
- Administration of different drugs and combinations of drugs
- Measuring effect on blood pressure, heart rate, contractility etc
- If know what action drug has on a receptor, the know if response occurs and if the drug is antagonistic or agonistic
Explain the different causes of heart failure
- Usually chronic
- Acute can be vascular and AMI
- Chronic usually degenerative
- Fall in cardiac pressure detected as fall in blood pressure by baroreceptors
- In all cases, cardiac output falls
- Sympathetic activation, RAAS stimulation and cardiac enlargement
Compare concentric and eccentric cardiac hypertrophy and their causes and effects
- Concentric caused by pressure loading (hypertension, aortic pulmonary stress)
- Leads to stiff non-compliant heart due to thickening of the heart wall
- Eccentric caused by volume loading (valvular disease allowing regurgitation of blood back in to tha atria or ventricles)
- Leads to thin heart wall, overall increase in internal and external diameters of the heart
List the pathophysiological responses which occur in cases of cardiac failure
- Increased heart rate and contractility
- Vasoconstrction
- Salt and water retention
- Cardiac enlargement
- Backwards failure (congestion) more likely to occur than forwards failure (poor perfusion) as whole system is designed to maintain perfusion pressure