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► Med Misc 01 > CVS S4 - Cellular and Molecular events + ANS innervation in the CVS > Flashcards

CVS S4 - Cellular and Molecular events + ANS innervation in the CVS Flashcards

1
Q

How is the resting potential of cardiac cells set up? What is the resting membrane potential of cardiomyocytes?

A

NOT Na+/K+ ATPase Resting permeability to K+ results in K+ efflux from the cell, causing depolarisation Small ‘leakage’ of Ca2+ and Na+ across the membrane means that resting potential is slightly higher than Ek -90mV

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2
Q

What does this picture show?

A

A sino-atrial node action potential

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3
Q

What does this picture show?

A

An action potential in the cardiac ventricle

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4
Q

Summarise the generation of the cardiac action potential

A

Initial depolarisation occurs to threshold

Main depolarisation due to opening of voltage gated Na+ channels - influx of Na+

Initial repolarisation due to opening of voltage gated K+ channels - efflux of K+

Plateu due to opening of voltage gated Ca2+ channels - influx of Ca2+ into cytoplasm (this balances K+ efflux)

Reuptake of Ca2+ into cellular stores or ejection from the cell

K+ efflux then repolarises the cell

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5
Q

How long is a cardiac action potential?

Why is it longer than normal?

A

280ms

Due to influx of Ca2+ into the cytoplasm

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6
Q

Why is there influx of Ca2+ into a cell during a cardiac action potential?

A

Ca2+ in the cytoplasm initiates contraction (i.e. the heartbeat)

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7
Q

For all cells but pacemeaker cells in the heart, how does the initial depolarisation to threshold come about?

A

Spread of electrical excitation from adjacent cells through ion movement through gap junctions

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8
Q

Summarise how the action potential is generated in a pacemeaker cell in the heart

A

During diastole the cells depolarise steadily of their own accord due to influx of Na+

This is referred to as the ‘funny current’ (If)

Once past threshold, voltage gated Ca2+ channels open and the cell will depolarise

The depolarisation stimulates voltage gated K+ channels to open, causing repolarisation (Ca2+ channels will close as the K+ channels open)

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9
Q

What channels are responsible for the funny current?

How are they activated?

A

HCN Channels (Hyperpolarisation-activated, Cyclic Nucleotie-gated)

Will activate when membrane potential is more negative than -50mV

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10
Q

How long does an SA node action potential last?

What heart rate would they set if they were not affected by other factors?

A

100ms

100bpm

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11
Q

Where are cardiac pacemaker cells in the heart found?

What rates do they all set?

A

SA node (primary) - 100bpm (not considering ANS innervation)

AV node - 40-60bpm

Bundle of His, Left and right bundle branches and purkinje fibres - 30-40bpm

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12
Q

What would happen if the SA node didn’t fire action potentials?

What would happen if both the SA and AV nodes didn’t fire APs?

A

SA node only:

  • AVN takes over as primary pacemaker at 40-60bpm

SA and AV nodes:

  • Bundle of His and downstream fibres take over as primary pacemaker at 30-40bpm
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13
Q

What are the major histological features of cardiac cells?

A

Striated
Branching
Centrally positioned nuclei
Intercalated disks between cells
Adherens and gap type junctions
T tubules inline with Z-disk

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14
Q

Describe in detail how cardiac cytosolic Ca2+ concentration is raised by an action potential

What percentages of Ca2+ influx into the cytoplasm come from which sources?

A

Depolarisation opens L-type Ca2+ channels in the T-tubules

Localised Ca2+ entry into cell cytoplasm (10-25% of overall)

Ca2+ binds to ryanodine receptors on the SR

Opens Calcium Induced Calcium Release (CICR) channels on the SR resulting in influx of Ca2+ into the cytoplasm (90-75% of overall)

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15
Q

How does Ca2+ influx into the cytoplasm of striated muscle initaite contraction?

A

Same as skeletal muscle

Ca2+ binds to troponin (TnC subunit)

Conformational change shifts tropomyosin to reveal myosin binding site on the actin filament

Contraction can begin (Sliding filament - REVISE IT)

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16
Q

How does relaxation of cardiac muscle occur?

A

Ca2+ is returned to resting levels

Msst is pumped back into SR by SERCA, which is stimulated by raised Ca2+ levels in cytoplasm

Some exits across cell membrane via:

  • Sarcolemmal Ca2+ ATPase
  • Na+/Ca2+ Exchanger
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17
Q

Describe the main mechanim for regulating smooth muscle contraction

How are these processes inhibited?

Why is this process necessary?

A

Ca2+ entry into the smooth muscle cells of the tunica media promotes constriction of the vessel

Ca2+ in cytoplasm binds to calmodulin (CaM) and activates myosin light chain kinase (MLCK)

MLCK will phosphorylate the myosin head and permit interaction with actin (contraction)

MLCK can be inhibited by PKA, inhibiting contraction

myosin light chain phosphatase (MLCP) will dephosporylate the myosin head, blocking it from binding to actin

Necessary as smooth muscle doesn’t contain Troponin complexes to block actin myosin interactions

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18
Q

What are the two major divisions of the ANS?

Describe the anatomical similarities of both divisions

A

Sympathetic and parasympathetic nervous systems

Both are made up of a series of 2 neurones, pre and post ganglionic

Pre ganglionic cell bodies in the CNS

Post ganglionic cell bodies in the ganglions of the PNS

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19
Q

The ANS exerts action on what types of effectors?

A

Smooth muscle

Viscera

Secretory glands

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20
Q

Describe the anatomical features of the ANS specific to the sympathetic nervous system

A

Nerve fibres have cell bodies from T1 - T12 and L1 - L2 (throracolumbar outflow)

Short preganglionic fibres and long post ganglionic fibres

Pre and post ganglionic neurones might synapse in 3 different locations:

  • Same level of origin (paravertebral origin)
  • Different level to origin (paravertebral origin)
  • Not in the paravertebral chain
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21
Q

What neurotransmitters are involved in the Sympathetic nervous system?

Where exactly are these transmitters found?

What receptor types do they bind to in the ANS?

A

Pre-ganglionic neurones:

  • Acetylcholine (Cholinergic)
  • Binds to nicotinic Ach receptors (ion channels) on the post-ganglionc neurone

Post-ganglionic:

  • Noradrenaline (Noradrenergic)
  • Alpha (1&2) and Beta (1&2) adrenoceptors (GPCRs) expressed by the effector
  • Exceptions are perspiration and ejaculation pathways, these are cholinergic
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22
Q

Describe the anatomical features of the ANS specific to the para-sympathetic nervous system

A

Fibres originalte from cranial nerves (3, 7, 9 and 10) and S2 - S4 (Craniosacral outflow)

Long preganglionic fibres and short postganglionic fibres

Tend to synapse close to the target structures

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23
Q

What neurotransmitters are involved in the parasympathetic nervous system?

What receptors might they bind to?

A

Only Acetylcholine

Post-ganglionic neurones express nicotinic Ach receptors (ion channels)

Effectors express muscarinic (M1, M2 and M3) Ach receptors (GPCRs)

24
Q

Where can you find chromaffin cells and what is their action?

How do they interact with the sympatheic nervous system?

A

Specialised cells of the adrenal medulla that release adrenaline into the bloodstream

Inervated by pre-ganglionic neurones, so act like specialised postganglionic neurones (with effector capabilities)

25
Q

When a tissue has both parasympathetic and sympathetic innervation how are the effects of the two related?

A

Tend to be opposing (eg. Relaxation and contraction)

26
Q

Under what general conditions do parasympathetic and sympathetic innervation predominate?

A

Parasympathetic dominant under basal conditions

Sympathetic activity increased when under stress

27
Q

Give the effects of the sympathetic innervation of the:

  • Heart
  • Airways
  • Pupil
  • Sweat glands

And include the receptor expressed for sympathetic innervation by each of these effectors

A

Heart:

  • Increase rate/force of contraction (Beta 1)

Airways:

  • Relaxation (Beta 2)

Pupil:

  • Dilation (Alpha 1)

Sweat glands:

  • Localised secretion (Alpha 1)
  • Generalised secretion (M3)
28
Q

Give the effects of the parasympathetic innervation of the:

  • Heart
  • Airways
  • Pupil
  • Sweat glands

And include the receptor for parasympathetic innervation expressed by each of these effectors

A

Heart:

  • Decrease rate (M2)

Airways:

  • Contract (M3)

Pupil:

  • Contract (M3)

Sweat glands:

  • No effect
29
Q

What effect does the increased output of the ANS to the vasculature have on vascular tone?

How does it exert this effect?

A

Vasoconstriction

Sympathetic innervation of the smmoth muscle in the walls of arteries, arterioles and veins

Increased sympathetic activity causes constriction via Alpha 1 receptors

Liver + Coronary and skeletal muscle vessels have Beta 2 receptors also, these cause vasodilation

30
Q

How are variations in vasomotor tone brought about by the sympathetic nervous system?

A

Sympathetic output to the vasculature is constant, holding vessels in vasomotor tone (a resting level of constriction)

A decrease in sympathetic output resuts in vasodilation

An increase results in vasoconstriction

Activation of B2 receptors in causes vasodilation

31
Q

What is the major mechanism by which vasomotor tone is reduced?

Why is an important counterbalance to sympathetic activity?

A

Vasomotor tone is reduced by the action of local vasodilatory metabolites, which act as sympathetic antagonists, reducing sympathetic output to the smooth muscle of the vascular system

The interplay between the action of vasodilatory sympathetic antagonists and sympahetic vasoconstriction is the principal means of controlling flow around the cardiovascular system

32
Q

Describe how vasomotor tone normally varies in the skin

Why does vascular tone of the skin need to be changed?

A

At rest, vasomotor tone is high

Arterioles, pre-capillary sphincters and arterio-venous anastomoses are generally shut down

Variations in sympathetic outflow then produce large changes in tone

This is neccessary for vascular thermoregulation

33
Q

What is the baseline vasomotor tone in skeletal muscle?

When does this change and how?

A

Baseline tone is high at rest

In exersize vasomotor tone is reduced (vasodilation) by local vasodilatory metabolites to increase blood flow

34
Q

How does vasomotor tone in the skin and skeletal muscle affect the CVS?

A

A mechanism for controlling total peripheral resistance

35
Q

How is vasomotor tone regulated in the gut?

A

High tone at rest

When a meal is consumed local vasodilators antagonise sympathetic activity, reducing vasomotor tone

36
Q

How is the vasculature of the brain affected by sympathetic innervation?

A

Virtually unaffected

37
Q

How is sympathetic output to the vasculature controlled?

A

Controlled by the ‘vasomotor’ centres of the medulla oblongata in the brainstem

38
Q

How does activating Alpha 1 receptors in the vasculature cause vasoconstriction?

A

Alpha 1 receptors are GPCRs

Activates Gq proteins which result in the increase of intracellular Ca2+ via effectors

This leads to contraction of the smooth muscle (vasoconstriction)

39
Q

How does activating Beta 2 receptors in the vasculature result in vasodilation?

A

B2 receptors are GPCRs

Activates Gs proteins which stimulate adenylyl cyclase and increase cellular cAMP concentration

Opens a type of K+ channel

This results in relaxation of the smooth muscle (vasodilation)

40
Q

Give some examples of local vasodilatory metabolites

A

K+

H+

Adenosine

Increasing PCO2

41
Q

What are the three major actions of the ANS on the CVS?

A

Control of:

  • Heart rate
  • Force of contraction
  • Peripheral resistance (Vasomotor tone)
42
Q

Describe the parasympathetic innervation of the heart

Hint: Structure and function

A

Preganglionic fibres originate from the 10th cranila nerve (Vagus nerve)

Synapse with post-ganglionic cells on the epicardial surface or at the SAN or AVN

Postganglionic cells release Ach

Acts on M2 receptors to:

  • Decrease heart rate (Negative chronotrophic effect)
  • Decrease AV node conduction velocity
43
Q

Describe the sympathetic innervation of the heart

Hint: Structure and function

A

POstganglionic fibres originate from the sympathetic trunk (throracolumbar outflow)

Innervate the SAN, AVN and myocardium

Noradrenergic

Acts of Beta 2 receptors to:

  • Increase heart rate (positive chronotropic effect)
  • Increases force of contraction (positive ionotropic effect)
44
Q

Describe how the sympathetic nervous system affects the pacemaker potentials in the heart

Hint: Start your explanation at the level of receptors

A

B1 receptors fire leading to increase in cAMP (via Gs proteins stimulating adenylyl cyclase)

This increases the gradient of the funny current slope, hence increasing frequency of pacemaker potentials

45
Q

Describe how the parasympathetic nervous system affects the pacemaker potentials in the heart

Hint: Start your explanation at the level of receptors

A

M2 receptor firing increases K+ conductance of the membrane (via Gi protein and K+ channels) and decrease cAMP

This decreases the gradient of the funny current slope hence decreasing the frequency of pacemaker potentials

46
Q

How does Noradrenaline affect the force of contraction in the heart?

A

Na acting on B1 receptors in the myocardium causes and increase in cAMP (via Gs and adenylyl cyclase) which in turn causes:

  • Phosphorylation of Ca2+ channels causes increased Ca2+ entry during APs
  • Increased uptake of Ca2+ into the sarcoplasmic reticulum
  • Increased sensitivity of contractile machinery to Ca2+

This leads to an increased force of contraction

47
Q

How are changes in blood pressure communicated to the brain?

A
  • Baroreceptors in the carotid sinus and aortic arch (high pressure side of the system)
  • Atrial volume (baro)receptors (low pressure side of the system)

Afferent nerves from these receptors communicate information about blood pressure to the medulla oblongata in the brainstem

48
Q

How do baroreceptors function?

A

These receptors are excited by stretching of the carotid sinus or aortic arch, as would occur when blood pressure raises

They then communicate this information to the medulla oblongata

49
Q

Describe how mean arterial pressure might be lowered after a rise

A

Baroreceptors excited by the stretch of the carotid sinus and aortic arch

They fire APs to the medulla oblongata

Medulla oblongata then increases parasympathetic output to the CVS

This results in bradycardia and vasodilation that counteract the rise in mean arterial pressure

50
Q

What classes of drugs acting on the CVS do we need to be aware of in Semester 2?

A

Sympathomimetics:

  • Alpha adrenoceptor agonists
  • Beta adrenoceptor agonists

Adrenoceptor antagonists

Cholinergics

  • Muscarinic agonists
  • Muscarinic antagonists
51
Q

Give two sympathomimetic drugs and their uses on the CVS

Include which receptors these drugs act on, and their action at those receptors

A

Adrenaline (general adrenoceptor agonist):

  • Administered to restore function in cardiac arrest
  • Can also be administered in anaphylactic shock

Dobutamine (B1 agonist):

  • Can be given in cardiogenic shock (pump failure)
52
Q

Give an example of a use of a sypathomimetic drug outside the CVS

Include it’s receptor type and action at that receptor

A

Salbutamol (B2 agonist):

  • Treatment of asthma (bronchodilation)
53
Q

Give an example of an alpha adrenoceptor antagonist and its function

A

Prazosin

Inhibits NA action on vascular smooth muscle A1 receptors causing vasodilation (anti-hypertensive agent)

54
Q

Give an 2 examples of a beta adrenoceptor antagonist and their function

Mention any important side effects

A

Propanolol:

  • Non selective B1 and B2 antagonist
  • Slows heart rate and reduces force of contraction
  • Also causes bronchoconstriction (B2 antagonism of bronchial smooth muscle)

Atenolol:

  • Selective B1 antagonist
  • Slows heart rate and reduces force of contraction
  • Less risk of bronchoconstriction
55
Q

Give an example of a drug that is a muscarinic agonist and include its function

A

Pilocarpine:

  • Used in the treatment of glaucoma (activates the constrictor pupillae muscle)
56
Q

Give an example of a drug that is a muscarinic antagonist and include its function

A

Atropine:

  • Increases heart rate
  • Increases bronchial dilation
  • Used to dilate the pupils to examine the eye
57
Q

What factors determine the magnitude of vasodilatory effect caused by local vasodilatory metabolites?

A

Rate they’re produced

Rate at which the blood stream washes them away

► Med Misc 01 (35 decks)

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