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Cardio > Control of arterial BP part 2 > Flashcards

Control of arterial BP part 2 Flashcards

1
Q

What percentage of the body weight is water?

A

60%

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2
Q

Total body fluid equation?

A

Intracelullar (2/3) + extracellular fluid - normally 1/3 of the total

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3
Q

Extracellular Body fluid volume equation?

A 
ECFV= Plasma volume + Interstitial fluid volume 
ECFV= PV + IFV
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4
Q

What is ECFV?

A

The fluid that bathes the cells and acts as the go between for the blood and the body cells

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5
Q

What happens if plasma falls?

A

Compensatory mechanisms shift fluid from interstitial compartment to plasma compartment

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6
Q

What else is controlled if ECFV is controlled?

A

MAP

Blood volume

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7
Q

20% of body weight is?

A

Extracellular fluid

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8
Q

40% of body weight is?

A

Intracellular fluid

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9
Q

Components of extracellular fluid?

A

3/14th plasma

11/14th Interstitial fluid

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10
Q

What 2 main factors affect our bodies extracellular fluid volume ECFV?

A

Water excess or deficit

Na+ excess or deficit

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11
Q

How do our bodies control the factors that affect our extracellular fluid volume?

A

Hormones act as effectors to regulate the ECFV by regulating the water and salt balance in our bodies
Healthy= water input=water output

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12
Q

Hormones which regulate the extracellular fluid volume?

A 
The renin-angiotensin - aldosterone system (RAAS)
Natriuretic Peptides (NPs)
Antidiuretic hormone (Arginine Vasopressin) - ADH
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13
Q

Role of RAAS?

A

Important role in plasma volume regulation and SVR - hence the regulation of MAP

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14
Q

3 components of RAAS?

A

Renin
Angiotensin
Aldosterone

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15
Q

What is renin?

A

Renin is released from the kidneys and stimulates formation of angiotensin 1 in the blood from angiotensinogen (produced by liver)

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16
Q

Angiotensin 1 conversion?

A

Converted to angiotensin 2 by angiotensin converting enzyme- ACE

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17
Q

Where is angiotensin converting enzyme produced?

A

Mainly by pulmonary vascular endothelium

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18
Q

What does angiotensin 2 do?

A

-Stimulate the release of aldosterone from the adrenal cortex
- Causes systemic vasoconstriction -which increase SVR
- Also stimulates thirst and ADH release
Contributes to increasing plasma volume mainly by aldosterone

19
Q

What does aldosterone do?

A

A steroid hormone which acts on kidneys to increase sodium and water retention- increase plasma volume

20
Q

What is the rate limiting step for RAAS?

A

Renin secretion

21
Q

What is the renin angiotensin aldosterone system regulated by?

A

Mechanisms which stimulate renin release from the juxtaglomerular apparatus in the kidney.

22
Q

What does the mechanism that regulates RAAS involve?

A

1) Renal artery hypotension- caused by systemic hypotension (decreases blood pressure)
2) Stimulation of renal sympathetic nerves
3) Decreased [Na+] in renal tubular fluid - sensed by macula densa (specialized cells of kidney tubules)

23
Q

What are natriuretic peptides?

A

Peptide hormones synthesized by heart (also brain and other organs)

24
Q

When are natriuretic peptides released?

A

In response to cardiac distension or neurohormonal stimuli

25
Q

What do NPs do?

A
  • They cause excretion of salt and water in the kidneys thereby reducing blood volume and blood pressure.
  • Decrease renin release- decrease BP
  • Act as vasodilators; decrease SVR and BP
  • Provide a counter regulatory system for the RAAS
26
Q

How many types of natriuretic peptides are released by the heart?

A

2

27
Q

The NPs released by the heart?

A

1) Atrial natriuretic pepide (ANP)

2) Brian-type natriuretic peptide (BNP)

28
Q

What is ANP and when is it released?

A

28 amino acid peptide synthesized and stored by atrial
myocytes (Atrial muscle cells)
-Released in response to atrial distension (Hypervolemic states)

29
Q

What is Brian-type natriuretic peptide?

A

32 amino acid peptide synthesized by heart, ventricles, brain and other organs

30
Q

How is BNP first synthesized?

A

First synthesized as prepro-BNP (
then cleaved to Pro-BNP (108)
Then finally BNP (32)

31
Q

What can be measured in patients with suspected heart failure?

A

Serum BNP

N-terminal piece of pro-BNP (NT- proBnp)

32
Q

Where is ADH synthesized and stored?

A

Hypothalamus and stored in posterior pituitary

33
Q

What is secretion stimulated by?

A

1) Reduced extracellular fluid volume

2) Increased ECF osmolality (main)

34
Q

What does plasma osmolality indicate?

A

Relative solute-water balance

35
Q

What is osmolality monitored by?

A

Osmoreceptors in brain in close proximity to the hypothalamus

36
Q

What is ADH release stimulated by?

A

Increased plasma osmolality?

37
Q

What does ADH do?

A

Acts in the kidney tubules to increase water reabsorption(conserves water) antidiuresis (concentrating urine

38
Q

What does antidiuresis cause?

A

increased ECFV and plasma volume hence cardiac output and BP

39
Q

How does ADH act on blood vessels?

A

Causes vasoconstriction which increases SVR and blood pressure- this effect is small in normal people but for people in hypovolaemic shock it becomes important (haemmorhaging people)

40
Q

How is short term moment to moment control of MAP carried out?

A

Baroreceptor reflex (rapid)

41
Q

Long term regulation of MAP is achieved by?

A

Control of Blood volume by hormones

42
Q

Summary of what ADH does?

A

Regulates ECF including plasma volume and osmolality to deal with fluid loads/deficits

43
Q

Role of Renin angiotensin aldosterone system?

A

Important role in long term regulation of MAP

44
Q

Role of natriuretic peptides?

A

Act as counter-regulatory to RAAS

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