INNERRVATION OF BLOOD VESSELS AND HEART

Question 1

Integrated/ HMGO reductase inhibitors
Statins causes  Myopathy & muscle damage
→ renal failure in patient with 
renal dysfunction especially 
when combined with ?

Answer 1

Fibrates

or nicotinic acid

Question 2

Ө HMGO reductase enzyme →

Answer 2

↓CE in the liver → ↑LDL
receptors → ↑ uptake of LDL
in the liver → ↓ plasma LDLCE
• ↓ TG & ↑ HDL

Question 3

Bile acid sequestrates
Cholestyramine
Cholestipol
functions

Answer 3

Hypercholesterolemia
2. With statin (prevent ↑
endogenous CE synthesis)
or if statins are #

Question 4

sympathatic NORADRENERGIC FIBERS

Answer 4

Arise from vasomotor centre 
affect alpah receptor in small arterires and ARTERIOLES 
and veins 
CASUING VC 
CANT STIMULATE VENULES AND CAPILLARIES !

Question 5

SYMPATHATIC CHOINERGIC FIBERS ! From where they arise what are the functions ?

Answer 5

they areis from the hypothalamus and they are choinergic casuing release Ach CAUSING VD

WORK ON 4 ! 
1 - EXERCISE 
2-HYPERTENNSION 
3- FEAR 
4-CAROTID SINUS SSYNDROME##

Question 6

Parasympathatic cholinergic fibers areis function ?

Answer 6

They arise CRANIOSACRAL
the 37910 1973 !
cranial nerves to the heart and brain and git causing VD incresing the flow to these organs
while sacral 234 casuing erection of blood vessels of !

TIP : VD AT LOCAL TISSUE CAUSING INCREASING BLOOD SYPPLY TO IT !
VC AT BLOOD VESSELS CAUSING THE HIGH VELOCITY OF BLOOD TO REACH THE TISSUE
SO WE NEED VC IN BVS SYSTEMIC AND VD IN BLOOD VESSELS LOCAL TISSUE TO INCREAE ITS BLOOD FLOW AND SUPPLY
تخيل انك مضيق خرطوم ماء وبترش الماء في حوض
فضيق الخرطوم هو الوعاء الضيق اللي هيوصل للعضو
والحوض هو الاوعية الدموية بتاعت العضو كلما زادت مساحة الحوض بالاتساع زاد الانسياب الدموي وكلما قلت مساحة الحوض قل الانسياب الدموي

Question 7

Functions of arterioles ?

Answer 7

Reuglation of 2 !
the blood flow
the vasomotor tone 1

Question 8

GR/ the the aretrioles regulate the vasomotor tone ?

Answer 8

beccause they are under effect of ne sympathatic fibers from the VMC
CASUING VASOMOTOR TONE ON IT SYMAPATHCRI TONE !

Question 9

WHY BRAIN AND HEART HAVE LOWER VASMOTOR TONE?>

Answer 9

AS THEY ARE VITAL ORGANS SO THE BLOOD FLOW CANT DECRESR IN THEM

Question 10

THE SKIN AND GIT AND RESTING SKELETAL MUSCLES HAS HIGEST VMC TONE ?

Answer 10

Because they are at rest not needing blood as git and skeletal muscles
tip : no VMC IN THE VEINS

Question 11

In case of DEC BP THE VMC STIMULATED CAUSING arteriolar vasoconstriction the capillarirs increases abp how ?

Answer 11

Capillary flud shift resrve ! \
in case of aretriolar vc there ois high resitannce and the blood decrease in capillaries decrasing pressure so the fluid enter the capillary fronm ISF TO RAISE IT!

VMC + CASAUNG VENUOLCONSTRICTION VR INC INC COP INC ABP

Question 12

lOSS OF VMC TONE DUE TO CRUSH INJURY IS NOT THE END OF THE CONSTRICON OF ARTERIOLES ?

Answer 12

BECAUSE THER IS INTENAL MYOGENIC VASOCNSTRICTION TONE IN ARETRIOLE !

Question 13

Mention Cholestyramine mechanism

Answer 13

Bind with bile acid in the 
intestine → prevent its 
reabsorption to liver → ↓ bile 
acid in the liver → ↑ 
conversion of CE to bile → ↓ 
hepatic CE → ↑ LDL receptors 
→ ↓plasma LDL-CE

Question 14

1. Combined hyperlipidemia
2. Hypercholesterolemia
   are the indications of ?

Answer 14

HMGO reductase inhibitors
Statins
Sim, Ator, Flu vastatin

Question 15

the sympathatic NE outflow affect ?

Answer 15

samll arteris arteriole

capacitence vessel vein

Question 16

SKELETAL MUSCLES AND SKIN VESSEL THE MAJOR EFFECTOR ON THE RESISTTANCE PERIPHERAL NOT RECEVING CHOLINERGIC PARA SYMP
SO PARA NOT AFFECT ABPgonist →

Answer 16

TIP : THE CHOLINE SYMAP VD SKELETAL BLOOD VESSELS WITHOUT INCREASED OXYGEN CONSUPTION

Question 17

Lipoprotein lipase activators
Fibrates
Fenofibrate, Gimfibrozil قخمث

Answer 17

• PPAR-α receptor agonist →
↑activity of plasma 
lipoprotein lipase →
hydrolysis of VLDL & 
chylomicrons →↓ serum TG
• ↑ LDL uptake by the liver &
كذلك يزود مستقبلات LDL 
↑ HD

Question 18

in case of fall in the arterial blood pressure what is the compensatory mechanism ?

Answer 18

The VMC will be stimulated casuing
1-vc of the arterioles casuein increafin tpr hr vr abp
2- veno costriction casuing increasing vr decreasing vennous capacitenss of blood
3 -decrrease in capillary pressure casuing isf shift to capillarires increasing its preussre thus BP intermdeiate regulation

ALL THIS IS RESERVED IN FALL OF ABP
vmc has direct effect on the heart
+chrono ino tropics incresaing ABP

Question 19

What is the acute systemic nervous regulation of the blood flow ?

Answer 19

VC : sympathtaic NE fibers from VMC casuing VC of vessels lowering the blood flow to organs
VD : Inhibition of the VMC mentioned above !
the sympathtaic cholinergic fibers from the hypothalamus causing release ach causing VD Of blood vessles .
ecercise fear high bb baro carotid sinus syndrome
Sympathatic beta adrenergic affecting b2 receptor vd of skeletal and liver bv
the parasympathahtc cholinergic system casuing Vd
Antidromic vasodilator fibers injured skin is affected casuing stimulatoon fo afferent nerve fibers casuing vd of the bloods vessel ! ! ده الي بيحصل في الالتهاب؟ ؟

Question 20

Antidromic vasodilator fibers fucntion ?

Answer 20

injured skin is affected casuing stimulatoon fo afferent nerve fibers casuing vd of the bloods vessel ! ! ده الي بيحصل في الالتهاب؟ ؟

Question 21

the vascoconstrictor humoral mechanism of regulating the blood flow are ? مهم جدا

Answer 21

1- Angiotensin 2 thee most potent vasoconstrivcto?
Noreadrenaline on a receptora 
adrenaline high dose 
ADH high dose 
Serotoin 
TXA2 
ENDOTHELIN 1 
Ca of musclear  vessels constriciton 
أنس قاطن 
ANAS CaTEN  angiotensis adrenaline nor adrnaline adh serotoinnin txa2 ca endotelin

TIP TXA2 ANATAGOINZES PGE2

Question 22

The vasodilator systemic humoral regulation of the blood flow ? مهم جدا

Answer 22

the adrenalis in low dose b take the upper hand 
ANP 
bradykinin 
k
mg 
h
citrate 
co2
no 
PGE2

Question 23

acute Local regulation of blood flow

Answer 23

Auto regulation
ACTIVE HYPERMIA
REACTIVE HYEPRMIA

Question 24

Autoregulation method ?

Answer 24

intiricsic in vascular smooth muslce withou nervous or houmoral mechanisms

autoregulation mean that the blood flow remian constans in a wide range of abp 60- 160 mm Hg

Question 25

mention organs of higest and lowest autoregulation ?

Answer 25

highest : the brain the heart

lowest : skeletam muscles and skin under neurogeinc stimuli

Question 26

show the concept of autoreguation ?

Answer 26

If perfusion pressure to the heart is lowerded there will be autoregulatory vasodilating mechanism to iincreasit it bac k
if the opposite ! there will be vasoconstricting regulatory mechanism in smooth muscles of vessels to decrease blood flow to the heart !

Question 27

show Myogenic theory

Answer 27

the increased pressure inside the vessel
causes its (stretch )
and increased flow
causing the myogenic effect of muscles of blood vessels to appear vasoconstircting the blood vessel returining the blood flow to normal !

Question 28

Expain the metabolic theory

Answer 28

increasing tissue activity
increasing the CO2 K H LAVTIC ACID ADENOSIN
VASODILATION
INCREASING BLOOD FLOW !

Question 29

TISSUE PRESSURE THERORY

Answer 29

arrival of more blood to capillary with high pressure casuing more filtration to isf causing more pressure around the capillaries by this fluid filtrated vascoctriviton capiillaries and the flow dec to normal

Question 30

Expain active hypermia ?

Answer 30

it is similar to the metabolic theory of the autoregulation
when skeletal muscle work there is increase in tissue activity
and increasing co k h lactic acid and adenosine !
this will lead to vd of skeletal blood vessels
and increasing the blood flow washing out these metabolites
returning to vasconcstiction normalizeing the flow
TIP
WHEN TISSUE ACTIVITY INCREASES BLOOD FLOW TO IT MUST INCREAST TO MEET ITS DEMANDS !

Question 31

THE ROLE OF ACE IN PREVENTING COUGH /

Answer 31

It decreases the formation of bradykinin from kininogen

Question 32

Reactive hypermina illustrate !

Answer 32

the blood flow after a period of ( OCCLUSION )
THIS leads to increse co2 k h lactic acid adenosine
casuing vd of bloods vessel
and this is highest in
Heart brain
intermediate skeletal musclers
lowest skin LIVER LUNG

Question 33

Chronic regulation of blood flow

DESCRIBE .

Answer 33

Long term regulation of the blood flow in case of partially occluded blood vessel
the occulded segment will relase 3 sub = vascular endotheliah growh factor ,platelet derviced endothelidal growth factor and angioenen
will form collaterals to increase o2 supply to tissue
epecially heart brain and kideny
least the skin skeletal muscles

Question 34

Blood flow to 
brain 
heart 
kideny
liver 
skin 
skeletal muscle

Answer 34

Brain 53 ml/min/100gm 
heart 84 ml/min /100gm
kideny 420 ml/min/100mg
skin 12
liver 57

Question 35

heart and brain and kikdeny and liver
VMC TONE
AUTOREGULATION

Answer 35

THEY HAVE LOWEREST VMC TONE EXCEPT KIDENY IN Hge

THEY HAVE HIGHEST AUTOREGULATION

Question 36

skeletal muscles blood flow ?

Answer 36

2.7 m;/mmin/100gm
high VM TONE
LOW AUTOREGULATORY MECHANISMS

Question 37

TIPS

LIVER KIDENY DKLETEAL MUSCLES 2/3 BLOOD FLOW

Answer 37

TIPS
KIDENY LIVER HEART BRAIN HIGHEST BLOOD FLOW PER UNIT WEIGHT
LOW VM TONE AND VASCULAR RESISTANCE

Question 38

TIPS
SKIN SKELETAL MUSCLES OTHER TISSUE BONE CARTILAGE CT
HAS LOWER BLOOD FLOW PER UNIT TIMNE DEUR TO HIGH VM TONE AND HIGH VASCULAR RESISTANCE

Answer 38

The kidenys are the clearance organ so the high blood flow reaching it is non nutirictional but shar in urine formation`

Question 39

why in hge the kideny is conquered under the VMC

Answer 39

in attempt to decreasee blood floww to kideny by vasoconstriction of it blood vessel preventing urine frmation and keepin plasam volume !