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Personalised Medicine - Cardiovascular > L8 - Physiology of the Vasculature II > Flashcards

L8 - Physiology of the Vasculature II Flashcards

1
Q

What 5 diseases are there where we target the vasculature to treat them?

A 
Hypertension
Heart Failure
Angina
Pulmonary Hypertension
Raynaud syndrome
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2
Q

How does smoking damage vascular function?

A

Damages endothelial glycocalyx –> adhesion molecules exposed –> monocytes/neutrophils bind to endothelial cells –> initiate atherosclerosis
Nicotine causes adrenaline release –> artery contraction
Causes eNOS uncoupling in endothelial cells –> less NO production

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3
Q

How does diabetes damage vascular function?

A

Impairs eNOS –> less NO production
Increased inflammation - ↑ endothelin/cytokine production
Net result - vasoconstriction

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4
Q

How does obesity damage vascular function?

A

Fatty plaque –> physical separation between endothelial cells and VSMCs
NO cannot reach smooth muscle –> no arterial relaxation

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5
Q

How does ageing damage vascular function?

A 
Increased BP 
Impaired arterial relaxation 
- Fibrosis 
- Calcification - stiffens arteries 
- VSMCs become senesce - can undergo apoptosis 
- Elastin fragmentation
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6
Q

How does infection damage vascular function?

A

Immune response –> activates endothelium –> recruitment of leukocytes to artery wall
Weakens atherosclerotic plaque - ↑ vulnerable to rupture
These stimuli generally activate pathways –> VSCM contraction

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7
Q

Does smoking, diabetes, obesity and ageing cause vasculature to be more contracted or relaxed?

A

Contracted –> hypertension

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8
Q

Hypertension overview

A

Affects around 30% of people in England
If left untreated, it increases a person’s risk of a heart attack or stroke
Commonly secondary to atherosclerosis

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9
Q

Symptoms of hypertension

A

Breathlessness
Fatigue
Fluid retention
Overall cardiac output is not adequate to meet metabolic demands

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10
Q

Heart failure overview

A

Inadequate cardiac output to meet metabolic demand

Disease of heart itself

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11
Q

Causes of heart failure

A

Secondary to Coronary Artery Disease and/or myocardial infarction
Viral infections causing inflammation of the heart tissue
Kidney failure
Sleep apnea

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12
Q

Angina overview

A

Oxygen supply to heart insufficient upon exertion
Leads to chest pain
Stable angina - if it does not worsen and only occurs upon exercise
Unstable – becomes progressively worse

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13
Q

Causes of angina

A

Due to coronary artery disease/atherosclerosis

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14
Q

Pulmonary hypertension overview

A

Narrowing of pulmonary arteries
Due to overgrowth of endothelial cells or VSMCs
↑ pressure on right side of heart → right heart failure
Life expectancy usually 1-3 years from diagnosis

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15
Q

What is Raynauds disease?

A

Over-activation of sympathetic nervous system –> inappropriate vasoconstriction of smaller arteries/arterioles

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16
Q

Symptoms of Raynauds disease

A

White then blue then redness on fingers/feet
- Reactive hyperaemia - return of blood flow
Severe cases - ulceration and gangrene
Spasm of arteries, leading to reduced blood flow

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17
Q

Treatments for Raynauds disease

A

Stop smoking
Avoid cold
Vasoactive therapies

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18
Q

Primary Raynauds

A

If idiopathic
May be somewhat hereditary
Increased risk in smokers

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19
Q

What is secondary Reynauds associated with?

A

Connective tissue disorders
Obstruction (atherosclerosis)
Some drug side effects (beta blockers, chemotherapy)

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20
Q

How do healthy endothelial cells relax?

A

Activated by high shear blood flow
Get activation of eNOS
Mediators (Ach, 5-HT) activate GPCRs –> IP3 –> increase Ca –> increased activation of eNOS –> relaxation

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21
Q

How do activated endothelial cells contract?

A

Activated by IL-1 and thrombin –> activate endothelin 1 and ROS –> increased exposure of adhesion molecules on cell surface – capture circulating leucokyctes –> link to atherosclerosis –> constriction

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22
Q

What are the two places Ca is stored and released from during VSMC contraction?

A

Plasma membrane

Sarcoplasmic reticulum

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23
Q

How do second messengers lead to the release of SR Ca during VSMC contraction?

A

Second messengers released through activating G proteins –> IP3 –> release of Ca for SR

24
Q

What are the 3 mediators regulating VSMC relaxation?

A

Guanylyl cyclase –> cGMP –> decreased Ca
Adenylyl cyclase –> cAMP –> decreased Ca
K channels –> hyperpolarisation –> opposes Ca influx
Overall prevents contraction response by preventing Ca release - muscle relaxation

25
Q

How does NO play a role in VSMC relaxation?

A

NO released from endothelial cells
Activates guanylyl cyclase –> cGMP
Activates PKG –> activates myosin phosphatase –> more inactive myosin

26
Q

How do Gs couples receptors play a role in VSMC relaxation?

A

Activate adenylyl cyclase –> cAMP

27
Q

How do PDE enzymes oppose VSMC relaxation?

A

Break down cGMP and cAMP

28
Q

What are the 3 examples of NO donors used as treatment?

A

Nitroglycerine
Sodium Nitroprusside
Inhaled NO

29
Q

What does nitroglycerine treat?

A

Angina - ↑ blood flow to ischaemic heart muscle
Nitroglycerine converted to NO by mitochondrial aldehyde dehydrogenase
Used sublingually or as oral spray – rapidly effect/conversion to NO

30
Q

What does sodium nitroprusside treat?

A

Emergency hypertension

31
Q

What does inhaled NO treat?

A

Pulmonary hypertension (severe)

32
Q

What are the 3 examples of prostanoids used as treatment?

A

Iloprost
Epoprostenol
Corticosteroids

33
Q

What does iloprost treat?

A

Prostacyclin stable analogue
Pulmonary hypertension
Raynaud syndrome

34
Q

What does epoprostenol treat?

A

IP receptor agonist

Some uses in Pulmonary Hypertension

35
Q

What do corticosteroids treat?

A

Suppress formation of prostaglandins
Prevents shock (hypotension)
Long term use not recommended – can suppress immune system broadly

36
Q

What are the 2 examples of endothelin inhibition used as treatment?

A

Phosphoramidon

Bosentan

37
Q

What does phosphoramidon treat?

A

Endothelin Converting Enzyme inhibitor

Experimental tool

38
Q

What does bosentan treat?

A

Pulmonary Hypertension

Blocks both endothelin A and B receptors

39
Q

What are the two approaches to target angiotensin II to get a relaxation response?

A

Target

  • Production of angiotensin II
  • Activation of angiotensin II at AT1 receptor
40
Q

What are the 5 examples of targeting angiotensin II used as treatment?

A 
AT1 receptor antagonists
- Sartans – Losartan and Valsartan
ACE inhibitors
- Captopril
- Enalapril and lisinopril
41
Q

What does losartan and valsartan treat?

A

Blood pressure reduction
Also inhibit production of angiotensin at Renin-Angiotensin-Aldosterone system
- Angiotensin I produced in the kidney

42
Q

What does captopril treat?

A

Hypertension, heart failure, after myocardial infarction

Blocks active site of enzyme

43
Q

What are the side effects of captopril?

A

Hypotension
Cough
Proteinuria
Taste

44
Q

What does enalapril and lisinopril treat?

A

Hypertension, heart failure, after myocardial infarction
Require conversion to active metabolite
Longer acting

45
Q

What are the 3 types of directly acting therapies?

A

Ca channel blockers
KATP channels activators
PDE inhibitors

46
Q

What are two examples of Ca channel blockers?

A

Nifedipine

Verapamil

47
Q

What are 3 examples of KATP channel activators?

A

Minoxidil
Diazoxide
Nicorandil (NO donor)

48
Q

What are 2 examples of PDE inhibitors?

A

Sildenafil = Viagra

Tadalafil

49
Q

What do minoxidil and diazoxide treat?

A

Severe hypertension

50
Q

What does nicorandil treat?

A

Refractory angina

51
Q

Which treatment type should not be taken in combination with NO donors?

A

PDE inhibitors

As they can cause a severe drop in blood pressure

52
Q

Why are many sympathetic nervous system-acting drugs effective in hypertension now rarely used?

A

Multiple or severe side-effects

53
Q

What are the 5 drugs used to treat hypertension?

A 
Sodium nitroprusside
ACE inhibitors 
Sartans 
Nifedipine, verapamil 
Minoxidil, diazoxide
54
Q

What are the 2 drugs used to treat heart failure?

A

ACE inhibitors

Verapamil

55
Q

What are the 3 drugs used to treat angina?

A

Nitroglycerine
Diltiazem
Nicrorandil

56
Q

What are the 4 drugs used to treat pulmonary hypertension?

A

Inhaled nitric oxide
Iloprost
Bosentan
Sildenafil and Tadalafil

57
Q

What are the 3 drugs used to treat Raynauds syndrome?

A

Iloprost
Nifedipine
Sildenafil

Personalised Medicine - Cardiovascular (11 decks)

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