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CVS > Session 5 > Flashcards

Session 5 Flashcards

1
Q

Mean Arterial BP is equal to…

A

MABP = CO x TPR

Flow x Resistance

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2
Q

CO is equal to…

A

CO = SV x HR

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3
Q

The short term control of mean arterial blood pressure is controlled by the…

A

Baroreceptor reflex

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4
Q

How does the baroreceptor reflex affect CO?

A

Adjusts sympathetic/parasympathetic inputs to the heart

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5
Q

How does the baroreceptor reflex affect TPR?

A

Adjust sympathetic input to peripheral resistance vessels

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6
Q

Where are the nerve endings of the baroreceptor reflex found?

A

Aortic arch

Carotid sinus

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7
Q

The nerve endings of the baroreceptor reflex are sensitive to…

A

Stretch

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8
Q

How does an…

I) increased arterial pressure
II) decreased arterial pressure

affect the nerve endings of the baroreceptor reflex?

A

Stretches more —> Fires more

Stretches less —> Fires less

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9
Q

Feedback of the baroreceptor reflex is via ___________ pathways to which part of the brain?

A

Afferent

Medulla oblongata

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10
Q

Why is the baroreceptor reflex only helpful in the short term control of mean arterial blood pressure?

A

Cannot control sustained increases because the threshold for baroreceptor firing resets

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11
Q

The medium and long term controls of blood pressure are directed at…

A

Controlling sodium balance and therefore extracellular fluid volume

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12
Q

Which 4 parallel neurohormonal pathways work for the medium/long term control of blood pressure?

A

RAAS
Sympathetic NS
ADH
ANP

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13
Q

Where is the RAAS based in the body?

A

In the renal system (kidneys)

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14
Q

The RAAS involves the release of ________

A

Renin

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15
Q

Where is renin released from in the kidney?

A

The granular cells of the juxtaglomerular apparatus within the kidney

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16
Q

What is the juxtaglomerular apparatus consisted of?

A

Macula densa
Granular cells
Surrounding mesangial cells

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17
Q

Name three factors that stimulate renin release from the granular cells of the JGA?

A

Reduced NaCl delivery to distal tubule
Reduced perfusion pressure in the kidney
Sympathetic stimulation to JGA

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18
Q

What detects renal perfusion pressure in the kidneys?

A

Baroreceptors in afferent arterioles of the kidney

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19
Q

Renin catalyses which reaction?

A

Angiotensinogen —> Angiotensin I

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20
Q

What is angiotensin I converted to in the RAAS?

A

Angiotensin II

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21
Q

Angiotensin I is converted to angiotensin II via the action of which enzyme?

A

ACE - angiotensin converting enzyme

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22
Q

Name three effects that angiotensin II can have in the control of blood pressure

A

Vasoconstriction

Increased Na+ reabsorption at the kidneys

Increased aldosterone

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23
Q

Where is aldosterone released from?

A

The adrenal cortex

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24
Q

What type of receptors does angiotensin II work on?

A

GPCRs

AT1 & AT2

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25
Q

What effect can angiotensin II have on the sympathetic nervous system?

What effect can angiotensin II have on the hypothalamus?

A

Increased release of NA

Increased thirst sensation (ADH release)

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26
Q

Which cells of the kidney does aldosterone work on?

A

Principal cells of collecting ducts

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27
Q

What effect does aldosterone have on the kidneys?

A

Increased Na+ (and therefore water) reabsorption

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28
Q

How does aldosterone increase reabsorption of Na+ at the kidneys?

A

Activates the ENaC (epithelial Na+ channel)

Increases basolateral extrusion via Na/K/ATPase

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29
Q

As well as converting angiotensin I to angiotensin II what other effects can ACE have?

A

Catalyses the breakdown of bradykinin into peptide fragments in the lungs

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30
Q

Bradykinin has what effects in the lung?

A

Vasodilation

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31
Q

The breakdown of bradykinin into peptide fragments in the lung will have what effect?

A

Less vasodilation

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32
Q

Name two ACE inhibitors

A

Captopril

Ramipril

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33
Q

What are ACE inhibitors used to treat?

A

Hypertension by blocking the action of ACE

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34
Q

What effects can ACE inhibitors have with regards to bradykinin?

A

Block its breakdown causing a dry cough

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35
Q

What effect will high levels of sympathetic stimulation have on the arterioles supplying the kidneys and renal blood flow?

A

Vasoconstriction

Reduced renal blood flow

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36
Q

What effect does the sympathetic stimulation have on the Na+ channels in the kidney?

What part of the kidney does it directly effect?

A

Activates the apical NHE and basolateral Na/ATPase

Proximal tubule

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37
Q

What effect does the sympathetic nervous system have on renin release?

A

Increases renin release —> Increased Na+ reabsorption

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38
Q

What is diuresis?

A

Loss of fluid/salts from the kidneys

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39
Q

ADH helps in the formation of ________________ urine

A

Concentrated

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40
Q

What effect does ADH have on water reabsorption?

A

Increases water reabsorption in the distal nephron

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41
Q

Name two factors stimulating ADH release

A

Plasma osmolarity

Severe hypovolaemia

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42
Q

How does ADH affect Na+ reabsorption?

What part of the kidney does it act on to do this? How?

A

Increases Na+ reabsorption

Thick ascending limb - stimulates apical Na/K/Cl- cotransporter

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43
Q

ANP promotes Na+ ___________

A

Excretion

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44
Q

Where is ANP synthesised and stored? What causes their release?

A

Atrial myocytes

Stretch (high BP)

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45
Q

Reduced effective circulating volume ___________ release of ANP

A

Inhibits

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46
Q

What effects does ANP have on the kidneys? (2)

A

Vasodilation of afferent arterioles

Inhibits Na+ reabsorption along nephron

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47
Q

Why is ANP not typically given to patients to reduce their blood pressure?

A

It is short-lived

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48
Q

Do prostaglandins work locally or systemically in affecting blood pressure?

A

Locally

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49
Q

Prostaglandins act as local ___________________ in the control of blood pressure

A

Vasodilators

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50
Q

As well as acting as vasodilators what effect do prostaglandins have in the kidneys?

A

Enhance glomerular filtration

Reduce Na+ reabsorption

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51
Q

Prostaglandins act as a buffer to…

A

Excessive vasoconstriction

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52
Q

Where is dopamine produced and has its effect in the control of blood pressure?

A

In the kidney

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53
Q

What effect does dopamine have on renal blood flow and absorption of NaCl?

A

Vasodilation and increased renal blood flow

Reduced NaCl reabsorption

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54
Q

What channels does dopamine inhibit to reduce Na+ reabsorption in the kidneys?

A

NHE and Na/K ATPase

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55
Q

If dopamine is given to people with Parkinson’s what effect can it have?

A

Hypotension

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56
Q

Define hypertension

A

A sustained increase in blood pressure

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57
Q

What blood pressure is classified as stage 1 hypertension (mild)?

A

> 140/90 mmHg

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58
Q

What blood pressure is classified as stage 2 (moderate) hypertension?

A

> 160/100 mmHg

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59
Q

What blood pressure is classified as severe hypertension?

A

> 180 systolic

> 110 diastolic

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60
Q

Blood pressure measured at home or 24/7 is generally slightly __________ than blood pressure measure in a clinic

A

Lower

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61
Q

What is primary hypertension?

A

Where the cause is unknown

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62
Q

What is secondary hypertension?

A

Where the cause can be defined

63
Q

What is more common - primary or secondary hypertension?

A

Primary hypertension much more common (~95%)

64
Q

Name two diseases that cause hypertension

A

Renovascular disease
Chronic renal disease
Hyperaldosteronism

65
Q

In secondary hypertension it is important to treat the…

A

Primary cause

66
Q

What are some factors that have been associated with primary hypertension?

A

Genetic factors
Environmental factors
Arterioles stiffen over time

67
Q

What happens in renovascular disease?

A

There is an occlusion of the renal artery causing a fall in perfusion pressure and activation of RAAS resulting in vasoconstriction and Na+ retention

68
Q

How does renovascular disease affect perfusion pressure in the kidneys?

A

Decreases perfusion pressure

69
Q

What happens in chronic kidney disease? How does it affect blood pressure?

A

Na+ and water retention due to inadequate glomerular filtration —> Increased plasma volume —> Increased BP

70
Q

What effect can chronic kidney disease have on the size of the kidneys?

A

Leads to small kidneys as they become scarred over time

71
Q

Conny’s syndrome is a result of…

A

An aldosterone secreting adenoma (benign tumour)

72
Q

Cushing’s syndrome is as a result of…

A

Excess secretion of the glucocorticoid, cortisol

73
Q

How does Cushing’s syndrome affect BP?

A

Acts on aldosterone receptors at high concentrations resulting in Na+/Water retention

74
Q

What is the name given to a tumour of the adrenal medulla? How can this affect BP?

A

Phaeochromocytoma

Secretes NA, DA and adrenaline

75
Q

Hypertension is often __________________ with regards to symptoms

A

Asymptomatic

76
Q

A rise in both systolic and diastolic pressures is associated with an increase in…

A

Mortality

77
Q

What is afterload?

A

The pressure against which the heart beats

78
Q

What affect does hypertension have on afterload?

A

Increases afterload

79
Q

What effect can increased afterload as a result of hypertension have on the heart?

A

LV hypertrophy

Increased oxygen demand of the heart

80
Q

What affect does hypertension have on arteries?

A

Damages them causing atherosclerosis or weakened vessels (e.g. Aneurysms)

81
Q

Name 5 parts of the body particularly targeted by hypertension

A 
Brain 
Eyes
Heart 
Arteries
Kidneys
82
Q

What is the treatment for secondary hypertension?

A

Treatment of the primary cause

83
Q

Name some non-pharmacological approaches to the treatment of hypertension

A

Diet
Exercise
Reduced salt intake
Reduced alcohol intake

84
Q

Smoking has no strong link with hypertension but is associated strongly with…

A

Cardiovascular disease

85
Q

As well as ACE inhibitors (e.g. Captopril/Ramipril) what other medication targets the RAAS for the treatment of hypertension?

A

Ang II receptor antagonists

86
Q

Name two types of vasodilators that can be given in the treatment of hypertension

A

L-type Ca channel blockers

a1-receptor blockers

87
Q

How do L-type Ca channel blockers help in the treatment of hypertension?

A

Cause relaxation of vascular smooth muscle —> vasodilation

88
Q

How do a1 receptor blockers help in the treatment of hypertension?

A

Reduce sympathetic tone —> relaxation of vascular smooth muscle —> vasodilation

89
Q

What is a side effect of vasodilators?

A

Can cause postural hypotension —> falling

90
Q

What effect will aldosterone antagonists have on blood pressure?

Give an example of an aldosterone antagonist

A

Lower BP

Spironolactone

91
Q

How do thiazide diuretics work in the treatment of hypertension?

A

Reduce the circulating volume and inhibit the Na/CL cotransporter in the distal tubule

92
Q

Are beta blockers commonly used in the treatment of hypertension?

When are they used?

A

No

When there is not just hypertension alone - e.g. Previous MI

93
Q

How do beta blockers work in the treatment of hypertension?

A

Block b1-receptors reducing the effects of the sympathetic output

94
Q

Give two other equations for maBP in addition to…

maBP = CO x TPR

A

maBP = SV x HR x TPR

maBP = diastolic pressure + 1/3 pulse pressure

95
Q

What is haemodynamic shock?

A

Acute condition of inadequate blood flow throughout the body

96
Q

Shock can be either as a result of a fall in…

A

Cardiac output

TPR

97
Q

A catastrophic fall in maBP can result in…

A

Shock

98
Q

Name three types of shock due to fall in cardiac output

A

Cardiogenic shock
Mechanical shock
Hypovolaemic shock

99
Q

By which mechanism does a fall in peripheral resistance cause shock?

A

Excessive vasodilation results in catastrophic fall in maBP

100
Q

What is the cause of cardiogenic shock?

A

Pump failure - ventricle fails to empty properly

101
Q

What is the difference between cardiogenic shock and heart failure?

A

Cardiogenic shock - acute failure and acutely life threatening

Heart failure - chronic failure and not acutely life threatening

102
Q

What are some potential causes of cardiogenic shock?

A

Damage to LV following MI
Serious arrhythmias
Worsening of heart failure

103
Q

What will happen to the central venous pressure in cardiogenic shock?

A

May be raised as blood flows back into the veins

104
Q

Cardiogenic shock causes a dramatic _______ in arterial BP resulting in…

A

Fall

Poorly perfused tissues

105
Q

What is cardiac arrest?

A

Unresponsiveness associated with lack of pulse

106
Q

In cardiac arrest the heart has…

A

Stoped

107
Q

Cardiac arrest may be as a result of… (3)

A

Asystole

Pulseless electrical activity

Ventricular fibrillation

108
Q

What is asystole?

A

Heart stops beating due to loss of electrical and mechanical activity

109
Q

What can cause pulseless electrical activity? What happens with regards to electrical/mechanical activity in PEA?

A

Acidosis

Electrical activity but no mechanical activity

110
Q

What is ventricular fibrillation?

A

Uncoordinated electrical activity

111
Q

What is the most common form of cardiac arrest?

A

As a result of ventricular fibrillation

112
Q

What happens in mechanical shock?

A

There is an obstruction resulting in the ventricle not being able to fill properly

113
Q

What two things commonly cause mechanical shock?

A

Cardiac tamponade

Pulmonary embolism

114
Q

What is cardiac tamponade? How does it affect the heart with regards to shock?

A

Where fluid builds up in the pericardial sac

Restricts the filling of the heart causing mechanical shock

115
Q

How does cardiac tamponade affect central venous pressure and arterial blood pressure?

A

High central venous pressure

Low arterial blood pressure

116
Q

What is a pulmonary embolism? How does it affect pulmonary artery pressure?

A

Embolus occluding a large pulmonary artery

High pulmonary artery pressure

117
Q

How does high pulmonary artery pressure as a result of a pulmonary embolus cause shock?

A

RV is not able to empty
Leading to a high CVP and reduced return of blood to the left heart
Low atrial pressure —> Low arterial blood pressure —> shock

118
Q

Pulmonary embolism is typically due to…

A

DVT

119
Q

How does an embolus reach the lungs?

A

Portion of thrombus (e.g. In the legs) breaks off
Travels in the venous system to the right side of the heart
Pumped out via the pulmonary artery and lodges

120
Q

In hypovolaemic shock there is ____________ blood volume

A

Reduced

121
Q

Hypovolaemic shock is commonly due to ______________

A

Haemorrhage

122
Q

The severity of hypovolaemic shock depends on which two factors?

A

The amount and speed of blood loss

123
Q

What % blood loss is unlikely to cause shock?

A

Less than 20%

124
Q

At what % blood loss is there a serious shock response?

A

30-40%

125
Q

What happens to…

I) Venous pressure
II) Cardiac output
III) Arterial pressure

in a haemorrhage?

A

Falls
Falls
Falls

126
Q

Describe the compensatory response of baroreceptors in a haemorrhage?

A 
Results in increased sympathetic stimulation 
Tachycardia 
Increased force of contraction 
Peripheral vasoconstriction
Venoconstriction
127
Q

Normally at the capillaries you get a small movement of fluid ________ the tissues.

This returns to the venous system via the…

A

Into

Lymphatic system

128
Q

What happens to fluid movement in the capillaries during hypovolaemic shock?

A

There is reduced capillary hydrostatic pressure resulting in fluid movement into capillaries

129
Q

Name 4 symptoms of someone with hypovolaemic shock

A

Tachycardia
Weak pulse
Pale skin
Cold clammy extremities

130
Q

What causes the pale skin seen in hypovolaemic shock?

A

Peripheral vasoconstriction

131
Q

What causes the cold clammy extremities seen in hypovolaemic shock?

A

Activation of sweat gland by sympathetic stimulation

132
Q

What else can cause hypovolaemic shock apart from haemorrhage?

A

Severe burns
Severe diarrhoea
Severe vomiting

133
Q

What is danger of decompensation? What can it result from?

A

Where peripheral vasoconstriction impairs tissue perfusion

Hypovolaemic shock

134
Q

Distributive shock is due to…

A

Profound peripheral vasodilation, resulting in a lower TPR

135
Q

Is distributive shock as a result of a fall in CO or a fall in TPR?

A

TPR

136
Q

Name two types of distributive shock

A

Toxic shock

Anaphylactic shock

137
Q

What can cause toxic shock?

A

Sepsis

138
Q

What is another name for toxic shock?

A

Septic shock

139
Q

Define toxic (septic) shock

A

Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation

140
Q

How does sepsis lead to septic shock?

A

Endotoxins are released by circulating bacteria, inflammatory response leads to…

Vasodilation, reduced TPR, reduced arterial pressure and impaired perfusion

141
Q

How can toxic shock affect capillaries?

A

Can cause them to be leaky resulting in reduced blood volume

142
Q

Patients with toxic shock will present with… (2)

A

Tachycardia

Warm, red extremities

143
Q

What does basic life support for a cardiac arrest involve?

A

Chest compressions and external ventilation

144
Q

What does advanced life support for cardiac arrest involve?

A

Defibrillation

145
Q

How does defibrillation work in the treatment of cardiac arrest?

A

Depolarises cells, puts into refractory period allowing coordinated electrical activity to restart

146
Q

How does adrenaline help in the treatment of cardiac arrest?

A

Enhances myocardial function and increases peripheral resistance

147
Q

Anaphylactic shock is as a result of…

A

Severe allergic reaction

148
Q

What happens in the severe allergic reaction that causes anaphylactic shock?

A 
Release of histamine from mast cells
Vasodilation 
Fall in TPR
Fall in arterial pressure 
Impaired perfusion
149
Q

Patients with anaphylactic shock will present with… (4)

A

Difficulty breathing
Collapse
Tachycardia
Red/warm extremities

150
Q

Anaphylactic shock is acutely life threatening. How is it treated? How does this work?

A

With adrenaline to cause vasoconstriction via a1-adrenoreceptors

151
Q

Name two things that can cause distributive shock.

Does this primarily reduce TPR or CO?

A

Sepsis (toxic)

Anaphylaxis

152
Q

Name two things that can cause hypovolaemic shock.

Does this primarily reduce TPR or CO?

A

Haemorrhage
Severe burns

CO

153
Q

Name two things that cause cardiogenic shock.

Does this primarily reduce TPR or CO?

A

MI
Heart failure

CO

154
Q

Name two things that cause mechanical shock.

Does this primarily reduce TPR or CO?

A

PE

Cardiac tamponade

CVS (8 decks)

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