Lecture 13: Control of Blood Flow II

Question 1

What are the characteristics of hypertension?

Answer 1

increased cardiac output
increased sympathetic nerve activity
increase in angiotensin II and aldosterone levels
impairment of renal pressure natriuresis mechanism
inadequate secretion of salt and water

Question 2

what is primary hypertension? major factors?

Answer 2

unknown origin

major factors: weigh gain, sedentary lifestyle

Question 3

What is secondary hypertension?

Answer 3

hypertension second to some other cause such as:
tumor affecting renin secreting juxtaglomerular cells
renal artery constriction
coarctation of the aorta
preeclampsia
neurogenic hypertension
genetic causes

Question 4

What are the contributing factors to hypertension?

Answer 4

genetic factors
single gene disorder that alters sodium reabsorption by the kidneys 
genetic variants in the renin angiotensin system 
stress
obesity
smoking
physical inactivity 
heavy consumption of salt

Question 5

What are the Factors resulting in decreased peripheral resistance (vessel dilation) leading to decreased blood pressure?

Answer 5

Increased production of nitric oxide
• Increased release of prostacyclin
• Increased release of kinins
• Increase in atrionatriuretic peptide (ANP)
• Decreased neural factors (β-adrenergic)

Question 6

What factors result in decreased cardiac output leading to decreased blood pressure?

Answer 6

• Decreased blood volume
• Decreased heart rate
• Decreased contractility

Question 7

Factors resulting in increased cardiac output leading to increased blood pressure:

Answer 7

• Increased heart rate
• Increased contraction
• Increased blood volume (due to aldosterone)

Question 8

Factors resulting in increased peripheral resistance leading to increased blood pressure:

Answer 8

• Increased angiotensin II
• Increased catecholamines
• Increased thromboxane
• Increased neural factors (α-adrenergic)

Question 9

What are humoral vasoconstrictors?

Answer 9

• Angiotensin II
• Catecholamines
• Endothelin

Question 10

What are humoral vasodilators?

Answer 10

• Kinins
• Prostaglandins
• Nitric oxide

Question 11

What are the renal causes of hypertension?

Answer 11

• Chronic renal disease
• Renal artery stenosis
• Renin-producing tumors
• Acute glomerulonephritis
• Polycystic disease
• Renal vasculitis

Question 12

What are the endocrine causes of hypertension?

Answer 12

• Cushing syndrome (adrenocortical hyperfunction)
• Exogenous hormones (i.e., glucocorticoids, estrogen)
• Pheochromocytoma
• Acromegaly
• Hypothyroidism (myxedema)
• Hyperthyroidism (thyrotoxicosis) • Pregnancy induced

Question 13

What are the cardiovascular causes of hypertension?

Answer 13

• Coarctation of the aorta
• Polyarteritis nodosa
• Increased intravascular volume
• Rigidity of the aorta
• Increased cardiac output

Question 14

What are the neurological causes of hypertension?

Answer 14

• Psychogenic
• Increased intracranial pressure
• Sleep apnea
• Acute stress

Question 15

What are the lethal effects of chronic hypertension?

Answer 15

• Early heart failure and coronary artery disease
• Cerebral infarct
• Kidney failure

Question 16

What is atherosclerosis?

Answer 16

type of arteriosclerosis “hardening of the arteries”

presence of lesions within the intimate of the vessel wall that protrude not the vessel lumen

Question 17

What are the non modifiable risk factors of atherosclerosis?

Answer 17

age
gender
genetics

Question 18

What are the modifiable risk factors of atherosclerosis?

Answer 18

hyperlipidemia
hypertension
cigarette smoking
diabetes

Question 19

What are other risk factors of hypertension?

Answer 19

inflammation
hyperhomocystinemia 
metabolic syndrome
Lipoprotein (a)
Factors affecting hemostasis Life style:
• Lack of exercise
• Competitive, stressful life style:
• Obesity

Question 20

What is hyperhomocystenima?

Answer 20

inborn error of metabolism

Question 21

What is metabolic syndrome?

Answer 21

associated with insulin resistance

Question 22

What is the pathogenesis of atherosclerosis?

Answer 22

endothelial injury or dysfunction of any kind leading to intimal thickening and may lead to formation of atheroma in presence of hyperlipidemia

Question 23

What does the accumulation of lipoproteins the result of?

Answer 23

chronic hyperlipidemia

Question 24

What is an atheroma?

Answer 24

a cap of smooth muscle cells, macrophages, foam cells (converted macrophages), and other extracellular components, overlying a necrotic center composed of cell debris, cholesterol, foam cells, and calcium.

Question 25

What happens in the developmental stage of atherosclerosis?

Answer 25

• earliest lesions are fatty streaks
• plaques appear white or yellow
• plaques enlarge due to cell death and degeneration synthesis/degradation of extracellular matrix
• plaque may undergo calcification
• plaque may rupture, ulcerate, or erode

Question 26

What the the most common arterial sties (most involved to least)?

Answer 26

• Lower abdominal aorta
• Coronary arteries
• Popliteal arteries
• Internal carotid arteries
• Circle of Willis

Question 27

Short term control of arterial pressure via _____

Answer 27

sympathetic nervous system effects on:

• Total peripheral vascular resistance and capacitance
• Cardiac pumping ability

Question 28

Long term control of arterial pressure via _____

Answer 28

Via multiple nervous and hormonal controls
Via local controls in kidney that regulate:
-Salt and water excretion

Question 29

Return of the arterial pressure always back to the equilibrium point = _______

Answer 29

near infinite feedback gain principle

Question 30

What is chronic hypertension?

Answer 30

one’s mean arterial pressure is greater than the upper range of the accepted normal measure

Question 31

What is normal blood pressure?

Answer 31

90 mm Hg (110/70)

Question 32

What is hypertensive blood pressure?

Answer 32

110 mmHg (135/90)

Question 33

What is severe hypertension?

Answer 33

150/170 mmHg (250/130)

Question 34

What are the lethal effects of chronic hypertension?

Answer 34

early heart failure
coronary heart disease
heart attack
cerebral infarct
destruction of areas of kidney--kidney failure ---uremia--death