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Flashcards in cardiovascular week 2 Deck (53):
1

What is the function of the arterial system?

to distribute blood from the heart to the capillary beds throughout the body

2

What are the three types of arteries?

elastic
muscular
arterioles

3

Describe elastic arteries

major distributing vessels including the aorta, brachiocephalic trunk, common carotid and subclavian arteries and most of the large pulmonary arterial vessels

4

Describe muscular arteries

main distributing branches of the arterial tree - radial, femoral, coronary and cerebral arteries

5

Descrive arterioles

the terminal branches of the arterial tree which supply the capillary beds

6

Describe the general trends in the structure of arteries

there is a gradual transition in structure and function between the three types of arterial vessel rather than an abrupt demarcation.
In general, the amount of plastic tissue decreases as the vessels become smaller and the smooth muscle component assumes relatively greater prominence

7

What is blood pressure?

the force exerted by the blood against any unit area of the vessel wall

8

What does blood pressure depend on?

cardiac output X total peripheral resistance

9

Describe the roll of the autonomic nervous system of controlling BP

the sympathetic is most important in controlling circulation
the parasympathetic contributes importantly to regulation of heart function

10

What does innervation of the small arteries and arterioles allow?

sympathetic stimulation to increase resistance to blood flow to the tissues

11

What does the innervation of the large vessels (particularly veins) allow?

sympathetic stimulation decreases the volume of the vessels. This can push more blood to the heart

12

what action does the sympathetic NS have on the heart?

increased heart rate and contractility

13

What action does the parasympathetic NS have on the heart?

decreased heart rate and contractility

14

Where is the vasomotor centre located?

bilaterally mainly in the reticular substance of the medulla and the lower third of the pons

15

Where are parasympathetic impulses carried?

Through the vagus nerve

16

Where are sympathetic impulses carried?

through the spinal cord and peripheral sympathetic nerves to virtually all arteries, arterioles and veins of the body

17

What is sympathetic vasoconstrictor tone?

continuous partial constriction of the blood vessels

18

What role does the hypothalamus have on regulating BP?

it can exert powerful excitrory or inhibitory effects on the vasomotor centre
Simulation of the motor cortex, for example, excites the vasomotor centre

19

What effect does sympathetic stimulation have on the adrenal medullae?

causes the medullae to secrete both adrenaline and noradrenaline into the circulating blood.

20

What are the actions of adrenaline and noradrenaline?

they act directly on all blood vessels, usually to cause vasoconstriction.
In a few types of tissue adrenaline causes vasodilation because it also has a beta adrenergic receptor stimulatory effect, which dilates rather than constricts certain vessels

21

How is blood pressure raised rapidly?

most arterioles of the systemic circulation are constricted, which greatly increases the TPR
The veins are especially strongly constricted to displace blood back to the heart, thus increasing the volume of blood in the heart chambers. the stretch of the heart then causes the heart to pump with increasing force and increases arterial pressure.
Strong sympathetic stimulation also increases heart rate and contractility of the heart, thereby increasing cardiac output and therefore increasing BP.

22

Where are the main baroreceptors located?

the carotid sinus and the aortic arch

23

What are some vasoconstrictor agents involved in the humoral control of BP?

noradrenaline
adrenaline
angiotensin II
ADH

24

Describe angiotensin II

powerful vasoconstrictor substance
powerfully constricts small arterioles and therefore increases TPR
Also decreases sodium and water excretion by the kidneys, thereby increasing arterial pressure

25

Where is ADH formed?

nerve cells in the hypothalamus and is transported down by nerve axons to the pituitary gland and from there is secreted into the blood

26

What are the major functions of ADH?

powerful vasoconstrictor
greatly increases water resorption from the renal tubules

27

What are some of the results of high blood pressure?

premature vascular disease leading to cerebrovascular events, iscahemic heart disease and peripheral vascular disease

28

How many people are affected by high BP?

20-30% of the population

29

What are some of the causes of hypertension?

genetic factors - runs in families
fetal factors - low birth weight
environmental factors - obesity
alcohol intake
sodium intake
stress - relationship with chronic stress uncertain

30

What happens to resistance vessels as result of hypertension?

structural changes
increased wall thickness
reduction in lumen diameter

31

What happens to the large vessels as a result of hypertension?

thickening of the media
increases in collagen and deposition of calcium
loss of arterial compliance

32

What effects does hypertension have on the heart?

increased peripheral resistance leads to increased ventricular load which may lead to left ventricular hypertrophy

33

What are the main ways that medications can lower blood pressure?

block effects of the sympathetic nervous system - reduces effect on heart B1, reduce effects on blood vessels a1 receptors, reduce renin release from kindney b1 blockers.
Kidney - reduce blood volume - diuretics
hormones - inhibit renin-angiotensin- aldosterone system (ACE inhibitors and angiotensin receptor blockers)
vasodilation of peripheral resistance arterioles (ca2+ channel blockers)

34

Give examples of beta blockers

propranolol (1 and 2)
atenolol (1 selective)

35

Describe the action of beta blockers

competitive reversible antagonists
lower BP by blockade of B1 sympathetic tone of heart and reduction of renin release from kidney
lowers heart rate and force of contraction
decreases CO

36

What are the adverse effects of beta blockers?

exacerbate asthma
intolerance to exercise
hypoglycaemia
vivid dreams

37

Give examples of alpha blockers?

phentolamine (1 and 2)
doxazosin, prozosin (1 selective)

38

Describe the action of alpha blockers

competitive reversible antagonists
lower BP via decrease in sympathetic tone in arterioles, decreases TPR

39

What are the adverse effects of alpha blockers?

postural hypotension
reflex tachycardia
increased closure of internal sphincter of the bladder

40

Give examples of ACE inhibitors

captopril
enelapril

41

Describe the mechanism of ACE inhibitors

lowers BP by reduced formation of angiotensin II, loss of stimulated release of aldosterone, reduction in renal resorption of sodium and water

42

What are the adverse effects of ACE inhibitors?

sudden hypotension on first dose
persistant irritant cough due to break down of bradykinin (a peptide that activates sensory neurons on the lungs)

43

Give examples of angiotensin II receptor blockers

losartan and candesartan

44

Describe the action of angiotensin II receptor blockers

mediates vasoconstriction and aldosterone releasing actions of angiotensin II

45

What is the advantage of angiotensin II receptor blockers?

No irritant cough as seen in ACE inhibitors

46

Give an example of a diuretic

bendroflumethiazide

47

Describe the action of diuretics

lower BP by reducing blood volume
mechanism through reduced renal resorption of sodium and water
additional vasodilator action may contribute

48

What are the adverse effects of diuretics?

decrease in plasma K+ concentration - can cause arrhythmia
reactions with other drugs

49

Give example of calcium channel blockers

verapamil (primary effect on cardiac muscle)
diltazem and nifedipine (primary effect on vascular smooth muscle)

50

Describe the action of calcium channel blockers

reduce Ca2+ into vascular smooth muscle by blocking L-type voltage operated calcium channels
either by open channel block, allosteric modulation (nifedipine)
reduces BP by reducing peripheral resistance / decreasing CO

51

What are the adverse effects of calcium channel blockers?

headaches
constipation
cardiac dysrythmias

52

What are the NICE guidelines for hypertension treatment?

Under 55 - ACE inhibitor or angiotensin II receptor blocker
Over 55 or African / caribbean origin - Ca2+ blockers
Then add ACE inhibitor or angiotensin II blocker and Ca2+ blocker
Then add diuretic
Then add alpha or beta blocker

53

What happens when a person stands up in relation to their blood pressure?

arterial pressure in the head and upper part of the body falls markedly
this could lead to unconsciousness
However, the falling pressure is detected by the baroreceptors and initiates an immediate reflex, resulting in strong sympathetic discharge throughout the body which minimises the decrease of pressure in the head and upper body