Physiology of the vasculature 2

Question 1

Characteristics of hypertension

Answer 1

Abnormally raised blood pressure
symptoms: breathlessness, fatigue, fluid retention
left untreated= increases your risk of heart attack or stroke
causes: most commonly secondary to atherosclerosis

Question 2

Characteristics of heart failure

Answer 2

Disease of the heart itself- reduced CO

often secondary to coronary artery disease and heart attack

Question 3

Characteristics of angina

Answer 3

Oxygen supply to the heart isnt efficient
chest pain
stable angina- condition doesn’t worsen and only occurs upon exercise

Question 4

Characteristics of pulmonary hypertension

Answer 4

Rarer disease
narrowing of the pulmonary arteries-increased pressure on the right side of the heart
poor gas exchange in lungs
life expectance- usually 1-3 years after diagnosis

Question 5

Characteristics of Raynaud disease

Answer 5

Inappropriate vasoconstriction of smaller arteries/ arterioles supplying the periphery
white/blue fingers- goes red when warm again
severe effects: ulceration and gangrene

Question 6

What vascular effects does smoking have?

Answer 6

Damages glycocalyx
reduced bioavailability of NO
stops eNOS attachment to membrane

Question 7

What vascular effects does hyperlipidaemia have?

Answer 7

reduced eNOS function
fatty plaques separate connection between EC and VSMCs
increased endothelin production from the endothelium

Question 8

What vascular effects does hyperglycaemia have?

Answer 8

excessive insulin dampens AKT effect on eNOS activity
damages glycocalyx
increased endothelin production

Question 9

What vascular effects does ageing have?

Answer 9

loss of elastin/ loss of stretch and compliance of the arteries

Question 10

What vascular effects does sodium have?

Answer 10

reduced NO
damages the glycocalyx
increases endothelin production

Question 11

How do we target prostanoids to treat vascular diseases?

Answer 11

Want to reduce thromboxin A2, but increase IP-R pathway

Question 12

What channels do directly acting therapies target?

Answer 12

ATPase sensitive potassium channels
potassium channels- nicorandil
calcium channels

Question 13

Why do you need to be careful when taking sildenafil?

Answer 13

Viagra

dont use with nitric oxide- can cause dangerously low hypotension

Question 14

What are hypertension treatments and what are their main actions?

Answer 14

Sodium nitroprusside- nitric oxide donor
ACE inhibitors- prevents synthesis of angiotensin 2
Nifedipine, verapamil, diltiazem- blocks PM calcium channels in VSMCs
Sartans- ARBs at VSMCs
Minoxidil, diazoxide- Katp channel activators in VSMCs

Question 15

What are heart failure treatments and how do they work?

Answer 15

ACE inhibitors- prevents the synthesis of AGT2

Verapamil- blocks PM Ca channels in VSMCs

Question 16

What are angina treatments and how do they work?

Answer 16

Nicorandil- Katp channel activators in VSMCs and nitric oxide donors
Nitroglycerine- nitric oxide donor
Diltiazem- blocks PM calcium channels in VSMCs

Question 17

What are pulmonary hypertension treatments and how do they work?

Answer 17

Sildenafil- PDE5 inhibitor
Bosentan- ETa/ETb endothelin antagonist- blocks IP3 mediated calcium release in VSMCs
Iloprost- prostacyclin analogue increasing cAMP
Inhaled nitric oxide- NO acting directly on VSMCs (cGMP production)

Question 18

What are Raynauds treatments are how do they work?

Answer 18

Iloprost- prostacyclin analogue
Sildenafil- PDE5 inhibitor
Nifedipine- blocks PM calcium channels