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FM1020 Physiology > Haemorrhage, Fainting, Exercise > Flashcards

Haemorrhage, Fainting, Exercise Flashcards

1
Q

What is haemorrhage?

A

Severe blood loss

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2
Q

What does haemorrhage cause?

A

Hypovolaemia

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3
Q

What happens in hypovolaemia?

A

Reduction in venous return
Reduction in cardiac output
Reduction in MAP
Reduction in prefusion of regional circulations (circulatory shock)

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4
Q

What kind of shock is present if there is a pressure greater than 45mmHg?

A

Nonprogressive/compensatory shock

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5
Q

What happens during compensatory shock?

A

Bodily compensatory mechanism alone cause full recovery

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6
Q

What happens if pressure drops below 45mmHg?

A

Progressive shock which worsens until death without therapy

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7
Q

What will trigger sympathetic reflexes initiated by arterial baroreceptors and other vascular stretch receptors?

A

Initial haemorrhage and drop in MAP

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8
Q

What happens as a result of baroreceptor and vascular reflexes?

A

General systemic arteriolar constriction increases total peripheral resistance
Veins and venous reservoirs constrict; helps to maintain adequate venous return despite diminished blood volume
Heart rate increases to ~180bpm

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9
Q

When does the intensity of baroreceptor reflex plateau?

A

MAP<60mmHg

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10
Q

What will inadequate blood flow stimulate?

A

Strongly stimulates peripheral chemoreceptors

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11
Q

What does the chemoreceptor reflex do?

A

Increases rate and depth of respiration promoting venous return by reducing intrathoracic pressure

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12
Q

When does MAP plateau for a 2nd time?

A

~50mmHg

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13
Q

What causes the second plateau in MAP?

A

Activation of CNS ischaemic response resulting from increased PCO2 and decreased PO2

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14
Q

What does the CNS ischaemic response cause?

A

Extreme stimulation of the SNS which results in pronounced vasoconstriction and increased cardiac contractility

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15
Q

What decreases capillary hydrostatic pressure?

A

Reduced MAP
Increased TPR
Reduced venous pressure

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16
Q

What does decreased capillary hydrostatic pressure promote?

A

Reabsorption of large quantities of interstitial fluid

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17
Q

Why does colloid osmotic pressure of plasma decrease?

A

Dilution of blood by tissue fluid

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18
Q

When does the concentration of adrenaline in plasma increase greatly?

A

MAP of ~40mmHg

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19
Q

What is a potent vasoconstrictor?

A

Vasopressin/ADH

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20
Q

What stimulates the release of vasopressin?

A

Sensory input from baroreceptors and other vascular stretch receptors

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21
Q

What stimulates the release of vasopressin?

A

Sensory input from baroreceptors and other vascular stretch receptors

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22
Q

What does a reduction in MAP cause renally?

A

Reduces renal glomerular filtration rate
Increases renal sympathetic nerve activity
ADH promotes renal water reabsorption

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23
Q

What does increased renal sympathetic nerve activity do?

A

Increased production of angiotensin II stimulating the release of aldosterone
Increases salt and water reabsorption in the nephrons

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24
Q

How long after haemorrhage are sympathetic reflexes maximally activated?

A

30-60 sec after haemorrhage

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25
Q

What do the reflexes allow in regard to suvival?

A

Full recovery from blood loss of ~30-40%

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26
Q

How long does it take for angiotensin and vasopressin mechanisms to fully respond?

A

10-60 minutes

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27
Q

How long does the readjustment of blood volume by absorption of interstitial fluid take?

A

1hr to 48hrs

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28
Q

What is progressive shock?

A

Positive feedback mechanisms that further reduce cardiac output - decompensatory mechanisms

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29
Q

What dictates the outcome of a patient in progressive shock?

A

Relative strength of compensatory/decompensatory mechanisms

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30
Q

Describe the vicious cycle of cardiac failure.

A

Reduction in ventricular function leads to
Reduction in cardiac output leads to
Reduction in coronary blood flow resulting in
Reduction in ventricular function

31
Q

Describe the vicious cycle of increased tissue hypoxia.

A

Decreased tissue blood supply leads to
Increased tissue hypoxia leads to
Increased vasodilatory metabolites leads to
Reduction in total peripheral resistance leads to
Decreased MAP which
Reduces tissue blood supply

32
Q

How does acidosis work?

A

Reduced O2 delivery increases cellular production of lactate and impaired kidney function slows excretion of protons
Further metabolic acidosis further depresses cardiac function and reduces vasoconstriction by decreasing sensitivity to noradrenaline

33
Q

How does CNS depression work?

A

Reduction in cerebral perfusion depresses activity of cardiovascular control centres
Further reduction in sympathetic outflow

34
Q

What causes blood agglutination?

A

Acidosis

35
Q

What does blood agglutination result in?

A

Minute blood clots leading to very small plugs in small vessels (sludged blood)

36
Q

What can acidosis do once blood agglutination has began?

A

Cause cellular release of thromboxane A which promotes further platelet aggregation

37
Q

What is endotoxin release?

A

The phagocytic activity of macrophages which usually detoxify endotoxins in the liver is depressed by shock and thereby increases endotoxins level in blood
This can lead to widespread vasodilation (septic shock) and depress cardiac function

38
Q

What is syncope?

A

Sudden loss of consciousness caused by insufficient supply of O2 to neuronal cells in brain

39
Q

What are most synoptic episodes caused by?

A

Hypoxia or rapid hypotension (MAP not sufficient to perfuse cerebral circulation)

40
Q

What is the most common form of syncope and what is it caused by?

A

Vasovagal syncope
Triggers that stimulate the NTS resulting in activation of the vagal centre which reduces heart rate
Inhibition of spinal sympathetic nerves reducing vasoconstrictor tone
Rapid fall in MAP reducing blood flow to brain

41
Q

What are some triggers of vasovagal syncope?

A

Heat exposure
Sight of blood/having blood drawn
Intense fear or emotional shock

42
Q

Where do the triggers usually originate in?

A

Cerebral cortex

43
Q

What is orthostatic hypotension?

A

Sudden, but transient drop, in MAP caused by rapid movement from supine to standing position - caused by gravity

44
Q

What happens during orthostatic hypotension?

A

Decreased venous return leads to a reduction in cardiac output which results in a lower MAP

45
Q

When might syncope happen with orthostatic hypotension?

A

Chronic hypotension
Hypovolaemia
Medication - alpha 1 blockers

46
Q

What usually restores the normal MAP?

A

Baroreceptor reflex

47
Q

Where do cardiovascular and respiratory control centres receive input from?

A

Muscular mechanoreceptors
Baroreceptors
Vascular and muscular chemoreceptors

48
Q

What does anticipation/initiation of exercise do?

A

Inhibits vagal impulses to the heart and decreases sympathetic discharge
Results in increases in myocardial contractility and cardiac output, and tachycardia

49
Q

What does functional sympatholysis do?

A

Prevents constriction in cerebral and coronary circulations

50
Q

What is there an increased concentration of in circulation?

A

Increased catecholamines enhancing effects of SN stimulation

51
Q

What is active hyperaemia?

A

Increased blood flow due to increased tissue activity

52
Q

How does CO increase during exercise?

A

Tachycardia

53
Q

Why does Stroke volume only increase a little during exercise?

A

Tachycardia reduces filling time and decreases EDV

54
Q

What effect does exercise have on venous return and what causes this?

A

Increased venous return due to:
SNS induced vasoconstriction of venules
Contracting skeletal/respiratory muscles pumps blood
Increased depth/rate of ventilation decreases intrathoracic pressure, increasing blood flow into thoracic cavity (increased delta P)

55
Q

What effect does intense exercise using few muscles have on TPR?

A

Large increase in TPR as only the working muscles are vasodilated

56
Q

What effect does a whole-body exercise have on TPR?

A

TPR decreases during exercise as there is vasodilation in large masses of active muscle

57
Q

Is MAP increased during exercise?

A

Greatly increased in weightlifting
Slight increase in whole-body exercise as CO still predominates

58
Q

What does an increase in MAP increase?

A

Perfusion pressure into skeletal muscle
Blood vessel diameters

59
Q

Does exercise cause a greater increase in systolic or diastolic pressure?

A

Systolic as there is an increased SV

60
Q

What happens when the exercise is finished?

A

HR and CO are quickly reduced
Accumulation of vasodilatory metabolites keeps TPR low
MAP may fall briefly but is corrected by baroreceptor reflex

61
Q

What is VO2?

A

Volume of O2 consumed by the body per minute during exercise

62
Q

What is the equation for VO2?

A

VO2 = HR x SV x Arteriovenous O2 difference (PaO2 - PvO2)

63
Q

What name is given to O2 consumption at maximum exercise intensity?

A

VO2 Max

64
Q

What is the resting VO2?

A

3.5ml/min/Kg

65
Q

What falls as additional O2 is consumed by contracting muscle?

A

PO2 levels

66
Q

What is unloading of O2 facilitated by?

A

Right shift of oxyHgb curve
Increase in temperature
Increase in [2,3 DPG]
Increase in PCO2
Decrease in pH

67
Q

What stops an increase in exercise intensity?

A

Maximum pumping capacity of heart is attained -determines VO2 max in fit individuals

68
Q

What happens once the VO2 max has been attained and what is this called?

A

Anaerobic respiration increases
Acidosis
Stimulates high rate of ventilation by chemoreceptors
Anaerobic threshold

69
Q

What determines exercise tolerance?

A

Anaerobic threshold
Acidosis
Muscle pain
Subjective feeling of exhaustion

70
Q

What happens as a result of regular exercise?

A

Improved capacity to deliver O2 to active muscles
Improved utilisation of O2 by muscles
Results in progressive increase in VO2 max

71
Q

What increases exercise fitness in the cardiovascular system?

A

Lower HR
Increased SV (ventricular filling)
Decreased TPR
Improved extraction of O2 from blood (Increased arteriovenous O2 difference)

72
Q

What causes a lower HR and higher SV in fit individuals?

A

Higher vagal tone and lower sympathetic tone

73
Q

What causes a decreased TPR in fit individuals?

A

Capillary density in muscles increases, improved endothelial function - increasing NO production

74
Q

What improves the extraction of O2 from blood in fit individuals?

A

Increased size and number of mitochondria

FM1020 Physiology (12 decks)

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