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CP1.06_Cardio_ZACHOW > Lecture 6 (RAAS and Hemodynamics) > Flashcards

Lecture 6 (RAAS and Hemodynamics) Flashcards

1
Q

Function of Renin:

A

necessary for angiotensin II synthesis

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2
Q

Function of Angiotensin II:

A
  • vasoconstrictor
  • stimulates aldosterone secretion from adrenal cortex
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3
Q

Function of Aldosterone:

A
  • promotes Na+ conservation by kidneys; H2O follows Na+
  • increases intravascular volume
  • vasoconstrictor
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4
Q

All angiotensin II bioactivity in vascular smooth muscle and cardiac muscle is mediated by what receptor?

A

AT1

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5
Q

Actions of angiotensin II that lead to increased blood pressure (4):

A
  1. vasoconstriction
  2. block in high pressure baroreceptor activity
  3. increased aldosterone levels
  4. stimulation of norepi release from post-ganglionic SNS fibers
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6
Q

Angiotensin II can block high pressure baroreceptor input. How does this cause an increase in BP?

A
  • endogenous counter-response to elevated BP is neutralized.
  • SNS not shut off in response to elevated BP.
  • SNS has free-reign to maintain increased BP.
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7
Q

Where are receptors for RAAS (angiotensin II and aldosterone) located?

A
  1. myocardium
  2. vascular smooth muscle
  3. kidney
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8
Q

Effect of RAAS (aldosterone and angiotensin II) on the heart:

A
  • contributes to left ventricular hypertrophy
  • increased wall stress and oxygen demand
  • reduced ejection fraction
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9
Q

Effect of RAAS (aldosterone and angiotensin II) on vascular smooth muscle:

A
  • leads to tunica intima and tunica media thickening
  • can cause vascular stenosis
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10
Q

Effect of RAAS (aldosterone and angiotensin II) on the kidney:

A
  • impairs normal renal function
  • can lead to renal failure.
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11
Q

Treatments for hypertension:

A
  1. ACE inhibitors (angiotensin II)
  2. ARBs (AT1 receptors)
  3. Diuretics (aldosterone)
  4. Calcium channel blockers (amlodipine)
  5. beta-blockers (SNS)
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12
Q

Function of verapamil and cardizem:

A
  • blocks Type L calcium channels in the heart.
  • help reduce heart rate by increasing AV nodal delay.
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13
Q

Function of amlodipine:

A
  • blocks Type L calcium channels in vascular smooth muscle.
  • prevents vasoconstriction.
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14
Q

Primary hypertension:

A
  • hypertension due to an unknown cause.
  • treatable with general hypertension protocol.
  • ACE inhibitors, ARBs, calcium channel blockers, etc.
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15
Q

Secondary hypertension:

A
  • hypertension due to another medical condition.
  • not treatable with general hypertension protocol.
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16
Q

How, specifically, does using a beta-blocker decrease blood pressure?

A
  • beta-blockers block SNS effects on the heart.
  • decrease HR and inotropy, and therefore CO.
  • CO = SV x HR.
  • MAP = CO X TPR.
17
Q

General primary hypertension treatment protocol:

A
  • First:
    • thiazide diuretic
  • Second:
    • thiazide diuretic + ACE inhibitor/ARB
  • Third:
    • thiazide diuretic + ACE inhibitor/ARB + Ca2+ channel antagonist
18
Q

The four body systems involved in hypertension, and drugs that target their function:

A
  • cardiac
    • calcium channel blockers, beta-blockers
  • renal
    • diuretics, ACE inhibitors, ARBs
  • vascular smooth muscle
    • calcium channel blockers, ACE inhibitors, ARBs, alpha-1 receptor blockers
  • ANS
    • beta-blockers
19
Q

Blood vessels with the highest velocity and lowest velocity of flow:

A
  • highest velocity: aorta
  • lowest velocity: capillaries
20
Q

Blood vessels with the highest and lowest total cross-sectional area:

A
  • highest: capillaries
  • lowest: aorta
21
Q

Blood vessels with the highest and lowest transmural (wall) pressure:

A
  • highest: aorta
  • lowest: vena cava
22
Q

Total peripheral resistance equation:

A
  • TPR = (Pa - Pv)/Qt.
    • Qt = cardiac output (CO = SV x HR).
  • Pa - Pv = CO x R
23
Q

60% of total peripheral resistance is due to:

A
  • arteriolar resistance
    • Arterioles can undergo 4x changes in lumen diameter, which leads to up to a 256x change in conductance.
24
Q

Which blood vessel has the greatest influence over total peripheral resistance?

A

arterioles

25
Q

Peak arterial pressure occurs at:

A
  • the end of decreased/slow systolic ejection phase, which is the end of the T wave.
26
Q

Lowest arterial pressure occurs at:

A
  • the end of isovolumetric contraction.
  • immediately before the aortic valve opens
27
Q

Draw ECG with arterial pressure graph underneath:

A
28
Q

Where does systolic pressure normalize with diastolic pressure?

A
  • right before entering the capillaries after traveling through the arterioles.
29
Q

How do arterioles maintain a relatively constant capillary pressure?

A
  • by adjusting resistance to flow with precapillary sphincters.
  • ΔP = Q x R
    • flow (Q) and capillary pressure remain relatively constant, so arterioles adjust arterial pressure going into capillaries via resistance.
30
Q

The four Starling forces governing capillary filtration/exchange with the interstitial fluid:

A
  1. Capillary hydrostatic pressure
  2. Capillary oncotic pressure
  3. Interstitial fluid hydrostatic pressure
  4. Interstitial fluid oncotic pressure
31
Q

What is oncotic pressure, and how does it affect capillary filtration?

A
  • The tendency for fluids to be pulled toward proteins.
  • Albumin generates about 70% of the oncotic pressure in capillaries, which decreases capillary filtration into interstitial fluid.
32
Q

On what end of capillaries is filtration the greatest?

A
  • arteriole
  • Pcap > Pif; filtration occurs
  • πif > πcap; filtration occurs
33
Q

Draw a capillary with starling force magnitudes:

A
34
Q

What carries capillary filtrate in the interstitial fluid back to the venous system?

A
  • lymphatic ducts
35
Q

Lymphatic function is compromised if the amount of capillary filtrate in the interstitial fluid is greatly increased. This causes edema. How can this occur?

A
  1. increased arterial pressure (increased Pcap)
  2. increased venous pressure (increased Pcap)
  3. a pathological increase in capillary permeability
36
Q

When does edema occur?

A
  • when there is increased capillary pressure that leads to increased filtration that overwhelms the lymphatic system.
37
Q

The two types of diffusion that occurs from capillaries to interstitial fluid:

A
  1. via pores:
    • water soluble molecules; rapid
  2. via plasma membrane:
    • lipid-soluble molecules (gases); very rapid
38
Q

The pressure drop across the arterial-venous tree is determined by what equation?

A

Pa - Pv = CO x R

  • R is determined by the arterial side, mostly by arterioles.

(TPR = (Pa - Pv)/QT)

CP1.06_Cardio_ZACHOW (10 decks)

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