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Human Systems and Anatomy > Control of Blood Pressure > Flashcards

Control of Blood Pressure Flashcards

1
Q

what is the mean arterial blood pressure

A

driving force for blood flow through organs apart from the lungs

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2
Q

why is maintenance of blood flow essential

A

for ensuring adequate blood flow to the organ systems

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3
Q

what is arterial blood pressure usually maintained around

A

120/80 mmhg

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4
Q

when must there be variations in blood flow to different organs

A

when demand arises to ensure adequate prefusion

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5
Q

what can arterial blood pressure provide good insight into

A

patient’s cardiovascular health

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6
Q

what is blood pressure

A

the measure of force to push the blood around the body

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7
Q

how is blood pressure determined

A

the systolic blood pressure over the diastolic blood pressure

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8
Q

when is blood pressure highest

A

on waking

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9
Q

when is blood pressure the lowest

A

during sleep

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10
Q

when does blood pressure increase

A

exercise, stress, sensory stimuli

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11
Q

why should health professionals be aware of potential variability when measuring BP

A

it is a variable haemodynamic phenomenon

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12
Q

what is the systolic blood pressure

A

the pressure in the arteries (aorta) during myocardial contraction

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13
Q

what is the diastolic blood pressure

A

the pressure in arteries (aorta) during myocardial relaxation ie when the ventricles are refilling

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14
Q

how do you determine pulse pressure

A

minus the diastolic blood pressure from the systolic

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15
Q

how do you determine the mean arterial pressure

A

the diastolic blood pressure plus one third of the pulse pressure

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16
Q

how is blood pressure measured

A

using a sphygmomanomater

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17
Q

how does a sphygmomanomater measure blood pressure

A

occludes the artery of an extremity like the arm with an inflatable cuff and by auscilation for detection of korotkoff sounds

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18
Q

what is cardiac output a product of

A

the stroke volume and the heart rate

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19
Q

what is the mean systemic arterial pressure a product of

A

cardiac output and total peripheral resistance

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20
Q

what is peripheral resistance created by

A

the system artery

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21
Q

how do you determine the mean arterial pressure

A

the diastolic blood pressure plus one third of the pulse pressure

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22
Q

should there be sounds coming from an occluded artery

A

no, you must release some air from the cuff to allow the blood flow to reduce occlusion. this creates turbulence as the artery is not fully open, and this creates the sounds

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23
Q

when in the cardiac cycle is the blood pressure highest

A

when the blood enters the aorta on contraction of the left ventricle

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24
Q

what are the two mechanisms that control and regulation of blood pressure occur by

A

rapid regulation and long term regulation

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25
Q

how does rapid regulation of blood pressure occur

A

through nerves and hormones

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26
Q

what is rapid control of blood pressure initially detected by

A

baroreceptors

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27
Q

what are baroreceptors

A

mechanoreceptors that detect the degree of stretch of blood vessel walls and monitor blood pressure

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28
Q

where are baroreceptors detected

A

the carotid sinus and the aortic arch

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29
Q

what do baroreceptors sense

A

difference in the stretch of the vascular wall

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30
Q

what is stretch in the arterial walls directly related to

A

blood pressure

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31
Q

where in the heart are baroreceptors most abundant

A

the carotid sinus because any increases or decreases can have a big impact when it is going to the head and neck. it is also sensitive to the rate of change, not just change in stretch

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32
Q

where is the aortic arch

A

between the ascending and descending aorta

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33
Q

between the carotid sinus and the aortic arch, which baroreceptors must be more sensitive to changes

A

the ones in the carotid arch

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34
Q

what innervates the carotid sinus baroreceptors

A

the sinus nerve of hering

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35
Q

which arteries supply the head and neck

A

the carotid arteries

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36
Q

how do the carotid arteries divide

A

into two smaller arteries each - internal and external on either side

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37
Q

what is the carotid sinus

A

the area of the artery wall which is thin and contains a large number of branching nerve endings that occurs as a bulge just before they split to become internal and external carotid arteries

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38
Q

what innervates the aortic arch baroreceptors

A

aortic nerve which combines with the vagus nerve

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39
Q

why are the aortic arch baroreceptors less sensitive than the carotid sinus baroreceptors

A

they have a higher threshold pressure

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40
Q

describe the series of events if baroreceptors detect a decrease in arterial pressure

A
  • reduced action potential fires from the baroreceptors
  • stimulation travels along afferent neurons
  • medullary cardiovascular center is located in the medulla oblongata
  • increased stimulation of the sympathetic neurons to the heart, arterioles and veins
  • decreased stimulation of the parasympathetic neurons from the vagus nerve to the heart
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41
Q

describe the series of events that follows if the baroreceptors detect an increase in arterial pressure

A
  • increased action potential firing from the baroreceptors
    -stimulation travels along the afferent neurons
  • medullary cardiovascular centre is located in the medulla oblongata
  • decreased stimulation of sympathetic neurons to the heart arterioles and veins
  • increased stimulation of the parasympathetic neurons to the heart, arterioles and veins
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42
Q

what structure innervates the carotid sinus

A

sinus nerve of hering, a branch of the glossopharyngeal nerve

43
Q

what is the valsalva manoeuvre

A

an attempt to expire against a close glottis and is associated with exhaling when the mouth and nose are closed or when lifting heavy weights

44
Q

what is the physiological response from the valsalva manoeuvre

A
  • increased intrathoracic pressure
  • raising blood pressure, normal left ventricle contraction and an increased baroreceptor firing
  • heart rate falls transiently, impeding venous return of blood to the heart
  • fall in cardiac output and mean arterial pressure
  • as the mean arterial pressure decreases, the heart rate rises and stabilises the blood pressure
45
Q

what is the physiological response once the glottis has been reopened

A
  • the intrathoracic pressure will fall
  • the blood pressure will fall initially
  • the venous return is rapidly restored
  • the end diastolic volume and cardiac output increase, raising the blood pressure
  • increased blood pressure is sensed by the baroreceptors and results in reflx bradycardia
46
Q

what happens to baroreceptor activity when the arterial blood pressure is elevated for prolonged periods

A

the threshold for the activity rises to a higher value

47
Q

what increases at the same level as the baroreceptor activity

A

heart rate

48
Q

are baroreceptors effective at monitoring the absolute pressure of blood in the carotid arteries to the brain

A

no as the heart rate increases at the same level as their activity

49
Q

are baroreceptors good regulators of blood pressure

A

only in short term regulation

50
Q

what does the baroreceptor sensitivty reset during exercise allow for

A

the cardiac output to be maintained as the heart rate does not fall in response to the increase in blood pressure in accompanying exercise

51
Q

how do baroreceptors have a role to play in hypertension

A

aids buffering of acute fluctuations in blood pressure at new higher blood pressure level

52
Q

what is the major influence for long term regulation of blood pressure

A

blood volume

53
Q

what does blood volume influence

A

venous pressure
venous return
end diastolic volume
stroke volume
cardiac output

54
Q

what does an increase in blood volume also increase

A

arterial pressure

55
Q

what does an increased arterial pressure cause

A

reduced blood plasma volume due to the increasing renal excretion of salt and water

56
Q

what are arteries

A

small diameter muscular walled blood vessels. small changes in the arteriolar radius control blood pressure in response to locally circulating substances.

57
Q

what causes a decrease in arteriolar radius

A

sympathetic nerves - noradrenaline leading to constriction

58
Q

what causes an increase in arteriolar radius

A

sympathetic cholinergic nerves - acetylcholine which binds to muscarinic receptors, plasma like adrenaline and local controls like an increase in potassium adenosine
overall leads to dilation

59
Q

what does local control of blood pressure modulate

A

blood pressure and blood flow

60
Q

what is blood pressure modified by

A

local changes in systemic vascular resistance - total peripheral resistance

61
Q

what does change in blood pressure occur in response to

A

factors like metabolites, blood gases endothelium derived factors

62
Q

what causes capillary fluid shift

A

venous dilators which are caused by reduced proximal capillary hydrostatic pressure

63
Q

what vessels do most vasodilators have effects on

A

arteries and veins

64
Q

how do mechanisms that locally regulate long term blood pressure originate

A
  • the RAAS system
    (renin angiotensin aldosterone system)
  • blood vessels
  • maintenance of constant blood flow
  • blood volume and fluid regulation
65
Q

how does blood pressure change with age

A

it increases

66
Q

does hypertension have symptoms

A

not unless very severe

67
Q

how is risk of hypertension increased

A

age
cigarette smoking
high salt intake
lack of exercise
being overweight
regularly drinking large amounts of alcohol
stress
genetic predisposition
family history

68
Q

which system of the body is most vulnerable to chronic hypertension

A

the renal system

69
Q

how often is it the case that hypertension is a result of an underlying health condition

A

one in twenty cases

70
Q

what are the health conditions that raise the risk of hypertension

A

kidney conditions such as
- chronic kidney disease
- renal hypertension (narrowing of the arteries that supply blood to the kidneys)
- long term kidney infections
- glomerulonephritis (damage to glomeruli filters in the kidney)

also diabetes, obstructive sleep apnoea and hormone problems like an over active thyroid

71
Q

what are therapeutics that can increase hypertension risk

A

contraceptive pill
non steroidal antiinflammatory drugs
recreational drugs like cocaine

72
Q

what are some clinical consequences of damage caused by prolonged hypertension

A

aneurysms in cerebral arteries
left ventriclar hypertrophy
thickening of arteries
atherosceloris
these can then lead to
renal disease
heart failure due to myocardial adaptation
malignant hypertension
myocardial infection or angina (cardiac ischaemia)
stroke

73
Q

why is it important to consider hypertension in dentistry

A

many hypertensive drugs have drug -drug interactions with local anaesthetics and analgesics which may lead to local anaesthetic intoxity

74
Q

how does dentistry and blood pressure correlate

A

dental treatment is stressful for many patients and any increase in blood pressure may lead to acute complications like myocardial infarction or stroke

75
Q

why do patients with cardiovascular disease have a higher risk of complications

A

due to release of endogenous catecholamines due to pain or stress

76
Q

what is postural hypotension

A

abnormal drop in blood pressure when individuals stand up after sitting or lying down

77
Q

what are symptoms of hypotension

A

dizziness, fainting, headedness when standing up after being stationary

78
Q

can hypotension lack symptoms

A

yes

79
Q

when is hypotension more common

A

older people and those with certain underlying conditions that affect the SNS or PNS like parkinsons or diabetes

80
Q

what can cause hypotension

A

dehydration or certain medicines like anti hypertensives

81
Q

how is blood pressure calculated

A

cardiac output multiplied by the total peripheral resistance

82
Q

how to calculate cardiac output

A

equal to heart rate multiplied by stroke volume

83
Q

what can affect heart rate

A

parasymapthetic nervous system
sympathetic nervous system
hormones
ions

84
Q

what is the main thing to think about regarding preload

A

anytime there is an increase in blood volume, this increases end diastolic volume. this increases the preload, or the stretch, of the heart and increases the stroke volume

84
Q

what three components can stroke volume be broken down into

A

preload, contractility, afterload

84
Q

what is an afterload

A

the amount of pressure you have to overcome to push blood from the ventricles to the arteries

84
Q

what does an increase in contractility mean for stroke volume

A

it will increase

84
Q

what is the end diastolic volume

A

the volume in the heart before ejection

84
Q

what is contractility dependent on

A

the sympathetic nervous system, which increases contractility using adrenaline and noradrenaline. could also be affected by glucagon and thyroxine

84
Q

how is heart rate measured

A

in beats per minute

84
Q

how is stroke volume measured

A

in ml per beat

85
Q

what is flow defined as

A

the volume of blood

85
Q

what can hypertension increase

A

the afterload

85
Q

what can peripheral resistance increase

A

the afterload

85
Q

how is cardiac output measured

A

in ml per minute

85
Q

how does diameter (cross sectional area) affect the velocity of blood flow

A

a decrease in cross sectional area increases the velocity of the blood flow

85
Q

what is velocity equal to

A

flow over the area of blood vessels

85
Q

how does increasing flow affect velocity

A

increases i

85
Q

what could an increase in cardiac output also be described as

A

an increase in blood flow

85
Q

how is the cross sectional area of the aorta

A

small

86
Q

describe the branching of blood vessels

A

aorta gives off arteries which give off arterial branches which give off capillary branches which then drain to become venules which become veins which join at the vena cava

86
Q

why is it important for flow of blood to be slow at the capillaries

A

to allow good exchange of the nutrients and substances from the capillaries to the tissues

86
Q

what can increase the afterload

A

hypertension and peripheral resistance

Human Systems and Anatomy (54 decks)

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