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CV Final Material > Hypertension I: Cowley > Flashcards

Hypertension I: Cowley Flashcards

1
Q

Four ways to increase Arterial Pressure

A

• Constricting most arterioles of the body–> increases total peripheral resistance.
• Increasing blood volume –> increases
venous return and CO
• Constricting large vessels of the circulation,
–> increases venous return and CO
• Directly increasing CO by increasing HR and contractility.

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2
Q

Constricting most arterioles of the body–> increases

A

total peripheral resistance.

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3
Q

• Increasing blood volume –> increases

A

venous return and CO

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4
Q

• Constricting large vessels of the circulation

–> increases

A

venous return and CO

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5
Q

We can directly increase CO by increasing

A

HR and contractility.

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6
Q

In short term BP regulation, vasodialators can decreased vascular tone which will decrease _________ which then lowers BP

A

Peripheral resisitance

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7
Q

What to receptors when activated will increase vascular tone?

A

alpha 1 and AT1

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8
Q

What Neural controls will act on vascular smooth muscle?

A

Vasoconstictors; SNS nerves

Vasodialators: Neurons releasing NO

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9
Q

What local controls act on the arterial smooth muscle?

A

Vasocnx; myogenic response

Vasodialtors: PO2 reduction/K+,CO2/H+, osmolality, NO, adenosine (based on metabolizm)

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10
Q

What Humoral controls will act on arterial smooth muscles?

A

Vasocnx: Nepi, Ang II, Vasopressin, endothelin, thrombaxanes
VasoD: Epi, ANP, Bradykinin, Histamine, PGEs

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11
Q

How is Ca++ concentration in vascular smooth muscle modulated?

A

via signal transduction mechanisms; NE/AII, ET-1 will bind to their GCPR which activates PLC–>make IP3 and DAG–> get IP3 going to SR to release a bunch of Ca++

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12
Q

How does nervous regulation affect circulation?

A
  1. Redistribution of blood flow to different areas.
  2. Affects HR and pumping activity of the heart.
  3. Essential for the very rapid control of arterial pressure.
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13
Q

Reticular substance has a key role in circulation

  • lateral and superior portions ~
  • medial and inferior portions ~
A
  • lateral and superior portions ~ excitation

- medial and inferior portions ~ inhibition

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14
Q

Hypothalamus has key roles in circulation regulation:

  • posterior-lateral portions cause mainly
  • anterior portion can cause
A

excitation

mild excitation or inhibition.

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15
Q

Motor cortex has key roles in circualtion regulation:

A
  • excitation or inhibition depending on region stimulated
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16
Q

Located bilaterally in the reticular substance of

the medulla and lower third of the pons.

A

Vasomotor center

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17
Q

Vasoconstrictor area “C-1” located in:

role is:

A

anterolateral upper medulla

sympathetic discharge

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18
Q

What area inhibits C-1 area (C1 key for sympathetic discharge)

A

Vasodilator area “A-1” anterolateral lower medulla:

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19
Q

Sensory area “A-2” bilateral in :

what is it’s role:

A

nucleus tractus solitarii

receive sensory signals from vagus and glossopharyngeal from baroreceptors. Control C-1 and A-1 areas.

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20
Q

Control C-1 and A-1 areas.

A

Sensory A2 bilateral in nucleus tractus solitarii

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21
Q

Sympathetic nerve fibers innervate all vessels except

A

capillaries and precapillary sphincters and some meta arterioles.

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22
Q

Innervation of small arteries and arterioles allow sympathetic nerves to

A

increase vascular resistance.

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23
Q

Large veins and the heart are also_______ innervated.

A

sympathetically

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24
Q

• Parasympathetic nervous system is mainly important in control of

A

heart rate via the vagus nerve.

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25
Q

Effect of total spinal anesthesia on the arterial pressure

Sympathetics responsible for

A

“vasomotor tone”

*when you remove SNS, arterial pressure drops ( you can increase it with Nepi injection, but will go back down once that wears off (baseline is around 100)

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26
Q

In vascular smooth muscle, alpha 1 R, when bound by Nepi from the Sympathetic neuron, causes

A

vasocontriction

27
Q

What is the role of the alpha 2 adrenergic receptor?

A

It’s located on the sympathetic neuron that releases the Nepi… when bound, will inhibit Nepi release via negative feedback

28
Q

alpha 1 is located on in the ______ while Beta 2 is located on the ______; both bind Nepi from the SNS

A 
vascular smooth muscle (vasocnx)
myocardium muscle (increase HR and contractility)
29
Q

What happens when a B2 receptor is bound by Nepi in the myocardium

A

increase in HR and contractility

30
Q

• Baroreceptors are spray type nerve

endings located in what two places?

A

walls of the carotid bifurcation= the carotid

sinus and in the walls of the aortic arch.

31
Q

Signals from the carotid sinus are

transmitted by the Hering’s nerve to the _________nerves and then to the ______of the medulla

A

glossopharyngeal

NTS

32
Q

How are signals from the arch of the aorta transmistted into the NTS?

A

through the vagus

33
Q

Baroreceptor pressure control system is based on a

A

negative feedback control system

34
Q

Feeback gain represents the:

A

strength of the feedback

35
Q

what is the equation for feedback gain?

A

G = correction of error signal/ Error (abnormality still remaining)

36
Q

Arterial pressure is sitting happy at 100mmHg… if you clamp the carotids you will decrease the pressure at teh carotid sinuses… this results in:

A

increased arterial pressure. once the clamps are released, you go back to normal

37
Q

Which will cause more firing of the carotid sinus nerve: an arterial pressure of 50 or an arterial pressure of 200?

A

Arterial pressure of 200 results in much more firing of the carotid sinus nerve… higher the Pa… the more the firing

38
Q

Carotid sinus baroreceptors respond to pressures between

A

60 and 180 mmHg.

39
Q

Baroreceptors respond to______ in arterial pressure.

• Baroreceptor reflex is most sensitive at a pressure of ______

A

CHANGES

100mmHg

40
Q

As pressure increases the number of impulses from carotid sinus increases which results in:

1) inhibition of the_______
2) activation of the _________

A

vasoconstrictor

vagal center

41
Q

When carotid distending pressure is low (around 50-70 mmHg) you will have high or low firing of SNS nerves?

A

very HIGH firing

42
Q

When carotid distending pressure is higher (around 125 to 200 mmHg) you will have high or low firing of SNS nerves?

A

very LOW firing

43
Q

When carotid distending pressure is low (around 50-70 mmHg) what happens to the R-R interval?

A

you have a lower rate, or shorter R-R interval (at this time the SNS firing is HIGH)

44
Q

When carotid distending pressure is higher (around 125 to 200 mmHg) what happens to the R-R interval?

A

you have a higher rate, or increased R-R interval (at this time the SNS firing is LOW)

45
Q

In the experiment when we denervated the dog’s baroreceptors, what happened to the arterial pressure? How did the average of arterial pressure over a day change?

A

From second to second the dog couldn’t normalize the Pa… it went up and down… but over the course of a day, it averages out to normal.

46
Q

“Resetting” of baroreceptor has been thought to prevent

the_______ from functioning as a control system for changes in pressure that last more than a day.

A

reflex

recent data shows that this resetting may not be complete

47
Q

angiotensinogen –> Ang I via

A

renin, from the kidney, splits btwn Leu-Val

48
Q

Ang I–> AngII via

A

ACE in lung splits between Phe-His

–ACE is vasoactive and works to increase smooth musl contraction

49
Q

Once Ang II has been made, it will act on AT1 and causes:

A

vasocnx, fibrotic rxn, inflmammation and antinaturietic activation

50
Q

ACE converts Ang I –> Ang II which causes:

ACE converts Bradykinin to its active or inactive form?

A

causes vasocnx and aldosterone release = Na+ retention

Bradykinin to INactive form; no more NO release or vasodilation

51
Q

Shit below happens as result of HTN
NO–> ONOO- causes:
O2–>O2- and then H2o2 cause:

A

endothelial dysfunction

medial wall hypertrophy

52
Q

Bad “ROS” as a result of HTN

A

increased GSSG/H2O2/O2-
lipid peroxidation
increased Ang II and aldosterone
–Affects most systems in the body, we get remodeling, fiborsis, vasocnx, ex

53
Q

Essential HTN affects 26% of world population, 67 million americans and is only controlled in _____ of US population

A

1/2

54
Q

What age and ethnicity is mostly affected by HTN

A

60 and over and african americans

is found younger and in other races

55
Q

How is HTN defined?

A

by mortality risks as RATIOS of actual to expected deaths from cardiovascular and renal disease among insured individuals

56
Q

Classification for
Normal BP
Pre-HTN
HTN

A

normal <80 diastolic
pre-HTN 120-139 and 80-89 for systolic
HTN 140-159 and 90-99 for systolic
anything higher is higher stage of HTN

57
Q

The operational definition of hypertension is:

A

level at which the benefits of action exceed those of inaction

58
Q

There is no dividing line (between normal and high BP).

The relationship between arterial pressure and mortality is quantitative;

A

the higher the pressure, the worse the prognosis

59
Q

Difference between Platt and Pickering’s hypothesis

A

Platt said there are 2 groups of individuals with different distributions of BPs
Pickering said it was a continous curve, which is the case

60
Q

Measure blood pressure twice and take the average because:

A

The running average is more important than individual readings.

61
Q

Hypertension is diagnosed if the average of at least_____readings per visit obtained at ____
separate visits each _____to ___weeks apart is
140 mm Hg or greater systolic and 90 mm Hg or greater diastolic.

A

2 readings per visit
3 seperate visits
2 to 4

62
Q

Hypertenion is diagnosed when systolic is greater then ____ and diastolic is greater then _____

A

140

90

63
Q

Systolic and Diastolic pressure increase as we get older, what age do we start to see a greater rise and which is more affected, systolic or diastolic?

A

see more increase around 40-50 and systolic is more affected then diastolic

64
Q

What two factors would increase your risk for IHD?

A

raise in systolic or diastolic BP
risk increases as you age
if you have high BP and you are older, even more risk

CV Final Material (16 decks)

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