Lecture 14 Part 2

Question 1

What is pulse pressure?

Answer 1

Systolic pressure - diastolic pressure

Question 2

What is mean arterial pressure?

Answer 2

Diastolic pressure + (1/3) x pulse pressure

Question 3

What is incisura?

Answer 3

A diacritic notch, at end of ventricular ejection, due to valve closure

Question 4

How many components of the arterial pulse are there?

Answer 4

There are normally 2, a forward wave and a reflected wave

Question 5

Describe the forward wave

Answer 5

Generated when the heart (ventricles) contracts during systole. The wave travels down the large aorta from the heart and gets reflected at the bifurcation

Question 6

What is the reflected wave?

Answer 6

It is the diastolic phase, after the closure of the aorta valves

Question 7

What is important with the reflected wave?

Answer 7

The velocity at which the wave returns, the stiffer arteries are the faster it returns

Question 8

What are pulse pressure waves like in a younger person?

Answer 8

Arterial pulse propagates slowly and there are changes in pulse pressure amplitude and contour

Question 9

What are pulse pressure waves like in older people?

Answer 9

Arterial pulse propagates more rapidly and wave is relatively unchanged along tree due to less wave reflection

Question 10

Why in older people to the pressure waves travel faster?

Answer 10

Because the artery walls are stiffer which means the pressure wave travels faster - could be in hypertensive patients

Question 11

What is the risk of pressure waves traveling fast?

Answer 11

Systolic hypertension, strokes

Question 12

What does pulse pressure increase with?

Answer 12

Age - pulse pressure can double with age

Question 13

What is an increase in systolic pressure due to?

Answer 13

Reduced compliance of elastic vessels

Question 14

What does mean BP increase due to?

Answer 14

Resistance vessel changes (increase TPR)

Question 15

How does systolic pressure increase more than mean pressure?

Answer 15

Because systolic pressure is affected by the compliance of the large, elastic arteries

Question 16

What happens to the elastic vessels with ageing?

Answer 16

They have a lower compliance (arteriosclerosis)

Question 17

What happens to aortic compliance with age?

Answer 17

It is reduced, caused by progressive changes in collagen and elastin content of arterial walls

Question 18

What is arteriosclerosis?

Answer 18

Reduction in elasticity of elastic arteries

Question 19

What does fragmentation and loss of elastic lamellae in tunica media =

Answer 19

Weakening of wall and structural dilation

Question 20

Increase in collagen content =

Answer 20

Vessel walls becomes stiffer

Question 21

What does remodelling =

Answer 21

Results in increased systolic pressure primarily and increased pulse pressure

Question 22

What are the physiological adaptions in ageing?

Answer 22

Increased pulse pressure
Reduce compliance - arteriosclerosis
Increased blood pressure - hypertension
Reduced barorecepor sensitivity
Impaired cardiac performance during exercise

Question 23

What is hypertension?

Answer 23

Increased blood pressure - increases risk of strokes, myocardial infarctions, heart failure, and renal failure

Question 24

What is an example of increased blood pressure resulting in hypertension?

Answer 24

140/90mmHg in a person below 50 years

Question 25

Describe essential hypertension (primary hypertension)

Answer 25

No obvious known cause Benign = symptomless, detected at a check up due to serious consequences like a stroke, heart disease Malignant = rare, rapid increase in blood pressure leading to cardiac failure, oedema, renal damage

Question 26

Describe secondary hypertension

Answer 26

Identifiable, pathological cause e.g. primary hyperaldosteronsim, renal artery stenosis

Question 27

What are some characters of hypertension?

Answer 27

Increase in pulse pressure, increase in mean pressure, increase in systolic wave due to reduced compliance and early return of reflected wave

Question 28

What is suggested to be altered in certain hypertensive conditions?

Answer 28

Coupling between ca2+ speaks and BKca channels

Question 29

What happens to baroreceptors in hypertension?

Answer 29

They reset to operate at higher blood pressures

Question 30

What does an increase in pressure at the baroreceptors result in?

Answer 30

A fall in systemic BP

Question 31

What are the cardiovascular adaptions in pregnancy?

Answer 31

Increase in cardiac output, stroke volume and heart rate and decrease in peripheral vascular resistance

Question 32

What happens to eNOS in pregnancy?

Answer 32

Upregulation of eNOS causes reduction in peripheral vascular resistance

Question 33

What is pre-eclampsia?

Answer 33

Hypertension and proteinuria in pregnancy - impaired NO bioavailability, possible role for increased enothelin production

Question 34

What can eclampsia cause?

Answer 34

Cerebral oedema (swelling of the brain) and seizures

Question 35

Describe atherosclerosis

Answer 35

Progressive inflammatory disease of large and medium arteries, accumulation of cholesterol deposits (plaques), stenosis

Question 36

What is atherosclerosis associated with?

Answer 36

Age, gender, genetics and diet

Question 37

What does atheroma reduce?

Answer 37

NO levels

Question 38

What do mutations in key smooth muscle myofilament related proteins increase?

Answer 38

The risk of aortic aneurysms and cerebral vasoconstriction in early adult life

Question 39

What gene is associated with thoracic aortic aneurysms?

Answer 39

ACTA2