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Cardiology > Long Term control of Blood Pressure > Flashcards

Long Term control of Blood Pressure Flashcards

1
Q

Basically, how do the kidneys regulate plasma volume?

A

They control how much water is lost in the urine and how much you reabsorb

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2
Q

In what way do the kidneys control water reabsorption?

A

By altering the osmotic gradient between the collecting duct and the arterioles. And the ducts permeability to water

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3
Q

How is the osmotic gradient controlled?

A

By altering the amount of Na+ pumped out the duct into the arterioles

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4
Q

What do we call the system by which the kidneys regulate plasma volume?

A

The renal counter-current system

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5
Q

What do we call it when very little water is reabsorped and you have loads of dilute urine?

A

Diuresis

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6
Q

What 3 hormone systems regulate the renal counter-current system?

A
  • The renin-angiotensin-aldosterone system
  • Antidiuretic factor (ADH, vasopressin)
  • Atrial/Brain Natriuretic Peptide (ANP/BNP)
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7
Q

What cells produce renin?

A

juxtaglomerular (granule) cells of the kidney

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8
Q

Where are juxtaglomerular cells found?

A

Around the afferent & efferent arteriole clsoe to the glomerulus

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9
Q

What do we call the capsule of the glomerulus?

A

Bowman’s Capsule

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10
Q

What 3 things signal the juxtaglomerular cells to release renin?

A

Symp. innervation signals a lower MAP
Decreased distension in the afferent arteriole signals lower MAP
The macula densa signal a reduced MAP

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11
Q

How do the macula densa detect a lower MAP?

A

Macula Densa is/are a set of eithelial cells in the ascending loop of henle that border on the juxtaglomerular cells on the outside.

They detect a lower flow of Na+ and Cl- ions through the ascending loop of henle.

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12
Q

What does renin do?

A

Converts angiotensinogen to angiotensin I

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13
Q

How does angiotensin I become angiotensin II?

A

By Angiotensin converting enzyme

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14
Q

What does angiotensin II do?

A

Increases ADH release from the pituitary gland
Causes vasconstriction -> TPR increase -> MAP increase
Increases aldosterone release form adrenal cortex

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15
Q

Whats the function of Anti-diuretic hormone?

A

Increases the water permeability of the collecting duct so more is reabsorped and plasma volume increases

It also increases thirst

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16
Q

What does aldosterone do to increase MAP?

A

Increases Na+ reabsorption in the loop of Henle.

  • > increased osmotic gradient
  • > increased water reabsorption
  • > increased plasma volume
17
Q

Summarize the renin-angiotensin-aldosterone system:

A

A negative Feedback System
Multiple mechanisms detect MAP dropping
-> Stimulates Relase of Renin
-> Multiple mechanisms increase MAP

18
Q

Where is ADH produced?

A

ADH is made in the hypothalalmus but released from the posterior pituitary

19
Q

When is ADH released?

A
  • Circulating angiotensin II
  • Blood volume decreases

(detected by cardiopulmoanry baroreceptors & relayed by medullary baroreceptors…
…also detected by osmoreceptors in hypothalamus which sense increase ISF osmolarity.)

20
Q

Where are atrial & brain natriuretic peptide produced?

A

The myocardial cells of the atria and ventricles respectively

21
Q

When are ANP/BNP released?

A

When theres increased distension of atria & ventricles, a sign of abnormally high MAP

22
Q

What do ANP & BNP do?

A
  • decrease Na+ reabsorption leading to deceased water reabsorption (natriuresis)
  • Inhibits renin release (inhibiting the renin-angiotensin-aldosterone system)
  • Acts on the medullary CV centres to reduce MAP
23
Q

Summarize the ANP/BNP function:

A

A negative feedback system

  • > 2 mechanisms detect a MAP drop
  • > ANP & BNP released
  • > 3 mechanisms act to decrease MAP
24
Q

How many cases of hypertension are secondary (i.e. explained)?

A

5-10%

25
Q

What do we call unexplained cases of hypertension?

A

Primary or essential

26
Q

Name 5 treatments for hypertension?

A
  • Ca2+ channel antagonists
  • B-adrenoceptor antagonists
  • Thiazide diuretics
  • angiotensin converting enzyme inhibitors
  • angiotensin II antagonists
27
Q

How do B-adrenoceptor antagonists work?

A

They block B1 receptors in the heart causing a lowered HR & contractility -> lowers CO -> lowers MAP

28
Q

How do thiazide diuretics work?

A

They increase water excretion to lower MAP

29
Q

What do angiotensin converting enzyme inhibitors and angiotensin II antagonists do?

A

They both block the production or function of angiotensin II, lowering MAP

30
Q

How do Ca2+ channel antagonists treat hypertension?

A

They block calcium channels in the cardiac muscle, reducing the force of contraction and so SV, therefore CO and MAP are reduced.

31
Q

In summary what three hormones act on the kidney to control blood pressure?

A
  • Renin-Angiotensin-Aldosterone system
  • Antidiuretic Hormone (ADH, vasopressin)
  • Atrial/Brain Natriuretic Peptide (ANP/BNP, Atriopeptin)

Cardiology (29 decks)

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