CVP Second exam

admin / February 1, 2018
Question Answer What is the main function of systemic circulation? (delivers 2, Removes 2) To deliver adequate oxygen and nutrients AND to remove CO2 and waste The systemic circulation also serves as a conduct for what? Hormones Blood flow is regulated by what? Metabolic demand of the tissue 5 functional parts of systemic circulation? 1. Systemic arteris 2. Arterioles and precapillary phincters 3. Caps 4. Venules 5. systemic veins Designed to carry blood under increased pressure out to tissue beds Systemic arteries Act as control valves to regulate local flow Arterioles and precapillary spincters Provvides exchange between tissues and blood Caps (on cell thick) Collects blood from caps Venules Returns blood to the heart and does dynamic storage Systemic veins Blood flow is directly proportional to what? Metabolic demand Cardiac output is controlled by what? Local systemic tissue flow Arterial pressure is independant of what? (2) Local flow and Cardiac output 4 components of all blood vessels 1. Endothelium 2. Elastic Tissue 3. Smooth muscle 4. Fibrous tissue What part of systemic circulation only posses an endothelial wall? Caps 1. Relative composition of aorta 2. Typical artery? 3. Typical vein? 1. Elastic tissue > Fibrous tissue > Smooth muscle 2. Smooth muscle > Elastic tissue > Fibrous tissue 3. Everything is equal Flow (Q) = ? Volume time Delta P = ? Delata P = QR (Q= flow R= resistance) Blood is how much thicker that water? 3 times!!! 1. Flow ____ pressure gradient 2. Flow ____ resistance 3. Viscosity ____ resistance 1. Directly proportional 2. Indirectly proportional 3. Directly proportional 1. Lenght ___ resistance 2. Cross-sectional area ____ resistance 1. Directly proportional 2. Indrectly proportional Volume of blood that passes a certain point per unit time Flow 1. At any given flow, the velocity is inversly proportional to what? 2. Write an equation to illustrate this 1. Total cross-sectional area 2. Q = Velocity x cross sectional area 1. Flow ___ Delta P Directly proportional How is flow related to resistance? Indirectly proportional Increase in Delta P makes for what kind of resistance? Increases!! At a given Q, the greater the drop in P, the greater the what? Resistance 2 variables you need to figure out resistance? Flow and Delta P The systemic circulation is what kind of circulation?? A parallel circuit with NESTED SERIES What is true about total resistance in a parallel circuit? Total resistance is always less that the lowest single resistance What kind of resistance is benificial for a blocked vessel? 2. Why? 1. Parallel circuit 2. If one leg is blocked, it can get there from another 3 advantages of a parallel circuit 1. Independant of local flows 2. Minimizes TPR 3. Oxygen rich blood to every tissue What is the relationship between viscosity and sheer rate (velocity)? Indirectly proportional (slopping curve tho) 1. Blood has a viscosity of what? 2. Plasma? 3. Water? 1. 3 2. 1.5 3. 1 1. In small vessels (microvasculature), what can happen to viscosity as elements stick together or at constriction points? 2. What can offset this? 1. Increased velocity 2. Cells lining up in small vessels would decrease velocity (Fahaeus-Lindquist) Viscosity of small vessels wouldn't increase until the vessel reaches what size? 0.3 mm in diameter 1. What is hematocrit? 2. Hematocrit is primarily composed of what? Why? 1. The percentage of packed cell volume 2. RBCs because they are denser 1. Normal range of hematocrit? 2. What would the hematocrit be in EOP users? 1. 38-45% 2. Much higher What kind of flow: 1. Streamline, silent and telescoping effect, most efficient 2. Cross mixing, vibrational noise, least efficient, bruit 1. Laminar 2. Turbulent Blood passing in a vessel packed with arthersclerosis, what do you think happens to velocity? Increases! Artery disease that turbulent flow is associated with? Arthersclerosis What is a bruit? The noise a blocked vessel makes under a stethoscope The bigger the Reynold's number, the greater the probability for what? Turbulent flow 1. Reynolds # of what usually represents laminar flow? 2. R # of what represents turbulent flow? 1. < 2000 2. > 3000 T or F: If R# is 1500, flow is laminar False! It MAY be lamiar…the sneeky little… People with anemia have higher risk for what? Flow murmer The doppler ultrasound is used to determin what? Velocity of flow To measure flow with doppler, we would still need what variable? Trr2 — cross-sectional area In the doppler ultrasound meter, the angle that the transmitter makes with the vessel should be what? Less that 30 degrees 1. In Doppler ultrasounding, what is associated with turbulent flow? 2. With laminar flow? 1. Broad band 2. Narrow band 1. 2 ways to determine cardiac output. 2. 3 ways to determine vessel flow 1. Fick principle and indicator dilution 2. Venous occlusion plesthymography AND Doppler ultrasound flow meter AND Vascular flow cuffs 1. Determinant of blood flow to a tissue or organ 2. 3 peices of information needed 1. Fick principle 2. Input blood concentration, output blood concentration , Addition or removal of substance from tissue Indicator dilution: Cardiac output ___ duration of curve Indirectly proportional Indicator dilution measures what what? Vol Time (CO is indirectly proportional to duration of curve) 1. Define distensibility 2. Define compliance 1. The ability of a vessel to strech 2. Ability of a vessel to stretch and hold volume 1. What is more distendible: the average artery or the average vein? 2. Therefor it is also more ____ 1. Average vein 2. Complient Does compliance = distendibility? Hell no! But they are proportional A diffrence in volume is ___ to a diffrence in pressure Directly proportional What is the relationship between a diffrence in volume and a diffrence in pressure in systemic arteries and in systemic veins? Arteries = Small diffrence in volume is associates with a large diffrence in pressureVein = Large diffrence in volume is associated with a small diffrence in pressure 1. A small diffrence in volume is denoted as what? 2. A large diffrence in volume is as what? 1. 750 ml 2. 2500ml Veins are about ___ more distensible and ___ more compliant than systemic arteries. 8 times more distensible and 24 times more compliant Wall tone is ___ to compliance and distensibility? Indirectly proportional As volume increases, pressure increases extremely more in arteries or veins? Arteries Control of blood flow: 1. Short term control 2. Long-term control 1. Vasodilation or Vasoconstriction 2. Formation or dissolution of vessels (VEGF, Angiotensin) As long as pressure stays constant, what effect will constriction and dilation have on flow? Dilation will increase flow while contriction will decrease flow Vasoconstriction or Vasodilation: 1. SNS 2. NO 3. CO 4. Angiotensin II 5. ADH 6. Adenosine 1. D 2. D 3. D 4. C 5. C 6. Potent D 1. What is the Bayliss reaction? 2. What is a potent vasodilator? 1. Increase in BP will cause constriction response 2. Adenosine What kind of receptors do arterioles that are richly innervates by SNS fibers have? Alpha receptors 1. In the local, short term control of flow, describe the local vasodilator theory 2. Fun time!! List 9 local vasodilators 1. Active tissues release local vasodilator metabolites, which relaxes smooth endothelial muscle. 2. Adenosine, CO2, Adenosine Phosphate, PGE and PGI, NO, Histaime!, K+, H+, CO 1. What is an older, screwy theory of local control of flow? 2. Why is it screwy? 1. It;s an O2 demand theory… as O2 in consumes by tissues, vascular smooth muscl can't maintain contraction 2. O2 is always present in arteries Define autoregulation The ability to keep flow (Q) constant as arterial pressure changes T or F : Most tissues show some degree of autoregulation True Q is ___ to metabolic demand Directly proportional In the kidney, both ___ and ___ are autoregulated Renal Q and Glomerular filtration rate (GFR) Long term control of flow invlves what? (2) Ongoing day to day reconstruction of vascular system and angiogenesis What is ateriogenisis associated with? Sheer stress caused by enhanced blood flow velocity associated with partial occulsion 1. Small peptide that stimulates growth of new vessels 2. Example 1. Angiogenic factors 2. VEGF Endothelium under stress up-regulates the expression of what protein? Monocyte cheoattractant protein-1 (MCP-1) 1. What does MCP-1 protein do ? (2) 2. What up-regulates its expression? 1. Attracks monocytes that invade arteriols and acts with other growth factors in the inflammatory processs to kill cells and potentially create new collateral vessels 2. Stress activated endothelium How can the SNS impair and augment blood flow? Impairs = Vasoconstriction Augments = NPY 1. Hypoxia causes release of what? 2. What will this do? 1. VEGF 2. Increase capillary proliferation and therefor increase collateral arterial generation NPY is ___ Angiogenic Who wins in a fist fight : Vasodilation or vasoconstriction? Vasodilation 4 things endothelium can release? Prostacylin, NO, Endothelin, Endothelial derived contractig factor Function of Prostacyclin (PGI2) (2) 1. Inhibits platelet aggregation 2. Relaxes vascular smooth muscle 1. Function of NO 2. NO releases in increased by what 2 things? 1. Relaxes vascular smooth muscle 2. Shear stress associated with increase flow and AcH binding to endothelium 1. 2 things released by endothelium that causes constriction 2. 2 things that cause vasodilation 1. Endothelin and endothelial devrived contracting factor 2. PGI2 and NO Lets say you have 2 blood vessels, one has the endothelium in tact and the other has it removed. AcH binds to both vessels. What happens? why? The vessel with the endothelium will undergo vasodilation via NO and the vessel with no endothelium will undergo vasoconstriction 1. Where does the bulk of exchange in O2 occur? 2. What is the functional unit of circulation? 1. in microcirculation (caps) 2. Capillary What is functional flow? It's the blood traveling through capillary beds Functional or non-functional flow? 1. If O2 levels drop 2. If O2 levels don't drop 1. Functional 2. Non-functional 3 mechanisms of O2 exchange Diffusion, ultrafiltration, vesicular transport What is blood doing if you're experiencing non-functional flow? (non-nutritive) It is shunting though somewhere In ultrafiltration, bulk of flow is through a ____. 2. What acts as a filter? 1. Filter 2. The cap wall 1. 2 strarling forces involved in ultrafiltration 2. Function of each? 1. Hydrostatic P = pushes fluid out 2. Colloid osmotic P = pulls fluid in When is vesicular transport used in capillary exchange? When you have larger mollecular weight non lipid soluble substances 1. Starling force favoring filtration 2. Starling force favoring reabsorption 1. Hydrostatic pressure gradient 2. Colloid osmotic pressure gradient 1. Total hydrostatic pressure forcing fluid out of vessels 2. Capillar and interstitial HP averages that make the above HP. 1. 20 mmHg 2, Capillary HP average of 17mmHg and interstial HP average of -3 mmHg (therefor 20 total) 1. Capillary osmotic pressure average 2. Interstial osmotic pressure average 1. 28 mmHg 2. 9 mmHg Net filtration pressure = what? ** Net filtration P = (CHP – IHP)-(CCOP – ICOP) What is greater: filtration or reabsorption? Filtration (20) > Reabsorption (19) 1. Filtration = Reabsorption + _____ 2. What would = edema? 1. Lymph drainage 2. Filtration > Reabsoprtion + LD = EDEMA!!! Increase in filtration is offset by what? Increase in LD! 1. What determins colliod osmotic pressure ? 2. What is the dominant protein? 1. Plasma protein concentration 2. Albumin (75%) Globulins (25%) Fibrinogen (<1%) 1. Combined colliod effect in vessel? 2. Actual colliod value in vessel? 3. What is this discrepency due to? 1. 19 mmHg 2. 28 mmHg 3. The freaken donnan effect Describe how the donnan effect increases osmotic effect by about 50%? (19 mmHg to 28 mmHg) Large molecular weight plasma proteins (albumin) carries a negative charge which attracts positive ions (NA++) therefor increasing solutes in vessel and therefor increasing osmotic effect in vessel. Osmotic pressure reflects concentrations of H2O and NA Explain the effects of the ultrastructure of capillary wall on colliod osmotic pressure Capillary walls that have filtration slits allow some proteins through… only the proteins that can't cross the wall can have an effect on the osmotic pressure T or F : all caps possess filtration slits? False, some have tight junctions What does the relfection coefficient tell you? How readily a protein can cross a cap wall Greater than half of TPR (outflow) is at the level of what? Systemic arterioles What is peripheral runoff? Rate at which blood exits the arterioole tree Peripheral runoff ___ TPR (outfloow) Directly proportional 1. During systole, the left ventricle output is greater than what? 2. Therefor, total blood volume rises which causes arteriole BP to do what? 1. Peripheral runoff 2. Increases to a peak During systole (BP rising to a peak) the arteries are ____ Distended 1. During diastole when the left ventricle is filling, what are the arteries doing? 2. This serves to maintain what? 1. The arteries recoil 2. This serves to maintain perfusion to the tissue beds 1. During diastole, total blood volume is ___ which causes arterial BP to fall to a ___ ____ 2. This is known as what? 1. Decreasing, Minimum value 2. Diastole BP 1. When does systolic BP happen? 2. Diastolic? 1. As total blood volume rises which causes arterial BP to peak 2. Total blood volume falls causing arterial BP to fall to a minimum What is hydrolic filtering? It's the stretch from SYSTOLE and the recoil from DIASTOLE of the arteriole tree that normally occurs during the cardiac cycle What is the advantage of hydraulic filtering? It converts an intermittent out by the heart to a steady delivery at the tissue beds therefor saves the heart work T or F : Hydrolic filtering increases the work load on the heart? False 1. What happens to the distendibility of the arterial tree as we age? 2. What effect will this have on hydraulic filtering? 1. Decreases 2. Reduces hydraulic filtering thus increasing work load of the heart T or F: The mean arterial pressue (MAP) is the arithmetical mean between systole and diastole? Ha! that's funny! …uhhh… no! 1. The MAP is determined by calculating the area under the ___ and dividing it into equal ____ 2. What is an equation for MAP? 1. Area under the curve and dividing it into equal areas 2. MAP = one third pulse pressure + DBP 1. MAP is usually closer to what pressure? 2. In MAP = 0.333 + DBP, how do you determine pulse pressure? 1. Diastole 2. Pulse pressure = S-D S of 120 mmHg, D of 80 mmHg, what is the mean arterial pressure (MAP)? MAP = 0.333 pulse pressure + DBP… 0.333(120-80) +80 = 93.3 1. Most postganglionic SNS terminals realse what? 2. What is the predominant receptor type? (SNS) 1. Norepi 2. Alpha What is the response of vessels when alpha receptors are activated? Constriction Stimulation of alpha receptors : 1. Constriction of arterioles does what? 2. Constriction of arteries does what? 3. Contriction of veins do what? 1. Decrease blood floow 2. Increase arterial BP 3. Increase venous return What happens to blood volume when we exercise? Redistribution of blood volume to where we need it 1. How much blood can be redistributed when we exercise? 2. The blood that gets redistributed during exercise is from where? 1. 1 L 2. The splanchnic system Sympathetic stimulation causes widespread vasconstriction causing a decrease in bloood flow with what 3 exceptions? 1. Brain 2. Heart 3. Lungs 1. In the brain and lungs, why don't they vasocontric under SNS control? 2. What about the heart? 1. Both are weakly innervated by SNS 2. Vasoconstriction effects are over-ridden by SNS induced increases in cardial activity and this increases release of local vasodilators Critical closing pressure is required for what? Required to keep arteries from closing completely CCP ___ vascular tone Directly proportional 1. Increase SNS will do what to CCP? To tone? 2. How about a drecrease in SNS? 1. Increase SNS — Increase CCP — increase Tone 2. Decrease SNS — Decrease CCP — Decrease tone What would happen to arterioles and venous pressure is CO is stopped? Arteriole pressure will fall and venous pressure will rise What exactly is the mean circulatory filling pressure? It's an equilibration pressure where arteriole BP = Venous BP Equilibration pressure (MCFP) may be prevented by what? Closure of the arterioles (CCP) MCFP is responsible for the pressure gradient driving what? Peripheral venous return MCFP is attained whene what equals what? AP = VP 1. With a shunt, is you stop the heart, arterial pressure will fall until you reach what? 2. Without a shunt? (EXAM!) 1. MCFP 2. CCP In a vascular function curve, at a given MCFP as CVP increases, what happens to venous return? Decreases At the operating point, what = what? Venous return = cardiac output When do you have a venous return of zero? When MCFP = CVP What is central venous pressure anyway? 2. CVP = what? 1. Pressure of central veins (sup and inf vena cava) as the enter the right atrium 2. CVP = right atrial pressure Increase in pressure in right chambers of the heart tells you what? Tells you have an increase in CVP 1. What happens to CO as an artery dialates? 2. What happewns to venous return? 1. CO increases 2. VR Increases! What happens to CO as MCFP increases? CO will increase and VR too As CVP increases, what happens to cardiac output? Due to what? CO increases due to both intrinsic and extrinsic effects What will increase in hypereffectiveness do to CO and CVP? Increase Co and Decrease CVP The vasomotor center is a collection of neurons in the ___ and ___ Medulla and pons 4 major regions in vasomotor center 1. Pressor center 2. Depressor center 3. Sensory area 4. Cardioinhibitory area Functions of: 1. Pressor center 2. Depressor center 3. Sensory area 4. Cardioinhibitory area 1. Increase BP via increase SNS 2. Decrease BP via decrease SNS 3. Mediates baroreceptor reflex 4. Stimulates CN 10 Vasoconstriction center aka what? (2) Pressor center and C1 1. Where is the pressor center located? 2. What kinf of projections to where? 1. Anterior portion of upper medulla 2. Norepi projections to IML cells 3 effects of pressor center 1. Vasoconstriction 2. Stimulate cardiac activity 3. SNS tonic outflow Depressor center aka what? (2) A1 or Vasodilator area 1. Location of depressor center 2. Fibers project where and do what? 1. Anterolateral lower MO 2. Fibers project to and inhibit pressor center 2 effects of depressor center 1. Vasodilation 2. Decrease cardiac activity 1. Location of pressor center 2. Location of depressor center 1. Upper MO 2. Lower MO Sensory area aka what? A2 1. Location of sensory area 2. In the nucleus ___ ____ 1. Posterolateral portions of pons and medulla 2. NTS Sensory area receives info from what 2 cranial nerves? CN9 and CN 10 Sensory area sends projections to where? (2) Pressor center and depressor center 1. Sensory area mediates ____ relflexes 2. 2 functions of sensory area? 1. Baroreceptor 2. Decrease pressor center and decrease BP Cardioihibitory area: 1. Location 2. Transmits impulses where? 3. What does it do to heart activity? 1. Medially next to DMNV 2. DMNV (Dorsal vagal N. ala cinerea) 3. Inhibits Catastrophic stroke is a stroke where? Brainstem Sympathetic vasoconstriction tone maintains normal ____ Arterial BP When wall is stretched (Systole), what happens to : 1. Baroreceptors 2. SNS 1. Activated 2. Inhibited What happens to 1. Baroreceptors and 2. SNS when wall recoils? (diastole) 1. Inhibited 2. Activated 1. If you remove baroreptor innveration, ___ ___ increases 2. Also highs are ___ and lows are ____ 1. Pulse pressure 2. Highs are higher and lows are lower 2 things pressure is dependant on? Which maintains pressure long-term and short term? 1. Volume — long term 2. Tone of wall — short term Control of BP: Short-term or long-term? 1. Vascular smooth muscle 2. Kidneys 1. Short term 2. Long term Control of BP is accomplished by either affecting ___ or ____ 1. Vascular tone (container) 2. Blood volume (sat_flash_1s) Baroreceptors have what type of nerve endings in vessel walls? Spray type 2 places where barorecptors are especially found 1. Carotid sinus (CN 9) 2. Arch of aorta (CN 10) 1. When baroreceptors are stimulated (strech) what do they inhibit? 2. Inhibits this area via ___, ___ or ___ 1. Pressor center 2. Via 9, 10, NTS Net effects of baroreceptor stimulation (2) Vasocontriction and decrease cardiac output The carotid sinus reflex is more sensitive to ___ pressure than ____ pressure Changing pressure, static pressure The carotid sinus relflex provides buffering systems in what 2 situations? (in reguards to maintaining BP) During normal cardiac cycle in change in volume and chance in body position Lying down, standing or walking: which 2 have similar BPs? Lying down and walking Lying down, walking or standing: which has higher BP in lower extremities? Standing Low pressure baroreceptors are located where? Atrial walls and pulmonary arteries LP baroreceptors augment ___ baroreceptors Arterial Low pressure baroreceptors minimizes ___ pressure changes in response to ____ changes 1, Arterial 2. Bloood pressure Whata is more effective in maintaining arterial BP: arterial baroreceptors or low pressure baroreceptors? Low pressure baroreceptors are twice as effective Stretch on atrial wall… .1. What will baroreceptors do to HR and urine production? how? 2. What will brainbridge do to HR? 1. Decrease HR and increase urine production by decreasing SNS in renal nerves and decreasing ADH 2. Increase HR 1. Strech on atrial wall will cause release of what hormone? 2. This hormone has what functions? 1. ANP 2. Diruretic, Natriretic and Vasodilator 1. Increase in EFC will cause ___ ___ to rise 2. In response, what do the kidneys do? 1. Atrial pressure 2. kidneys will excrete excess ECF 1. Increase intake will increase what 3 other things? 2. Decrease fluid intake will cause decrease in 3 other things 1. ECF, BV, BP 2. ECF, BV, BP When fluid intake is increased by alot, what is the response? Decrease Aldosterone, SNS, Renin, ANG II, ADH, Increase ANP Increase Aldosterone, SNS, Renin, ANG II, ADH, Decrease ANP… what happend to fluid intake to produce this response? Decrease fluid as well as decrease EFC, BV and BP In the renal-body fluid system, who is the odd man out? ANP… of everything else rises, ANP falls 1. What will decrease BP and ECF do to thirst reponse? 2. What will this do to kidney reabsorption and urine production? Decrease fluid intake: decrease BP: decrease ECF and increase thirst therfore increase kidney reabsorption and decrease urine production What curve demonstrates only perfusion of kidney alone? Acute renal output curve Does arterial BP increase when we intake a lot of fluid? why? Nope! think chronic renal output curve What hormone increases drinking behavior of the brain? Angiotensin II Afferent arterioles supply what? Glomerular caps 1. What drains glomerular caps? 2. These give rise to ___ ____ which is where reabsorption takes place 1. Efferent arterioles 2. Peritubular caps Where in the kidney does reabsorption take place? Peritubular caps Specialized pertitbular caps associated with juxtamedullary nephrons Vasa recti 1. Gain = ? 2. Kidney had what kind of gain? 1. Compensation / remaining error 2. Infinite gain 1. In gain, what is better, a higher or lower number? 2. What will this kind of number do? 1. Higher 2. Brings things back to normal Most autoregulation of both blood flow and glomerular filtration takes place where? At the afferent arteriole (upstream) T or F: Both renal blood flow and glomerular filtration are autoregulated? True What has greater autoregulation? RBF or GFR? GFR In kidneys, constriction of afferent arteriole in decrease what? (2) Renal flow and GFR Constriction of efferent arterioles will do what to RBF and GFR? Decrease RBF and Increase GFR (by creating back pressure) In the face of increased BP, contriction of what will autoregulate both flow and GFR? Afferent arterioles When ___ increases, ____ increases ECF and arterial BP 1. Acute renal output curve measures effects effect of arterial BP alone. 2. Chronic curve measures what? Art BP + SNS… this zigs : renin/angiotensin system, aldosterone, ADH and this zags : ANP 4 hormones that decrease renal blood flow NE, Epi, Ang II, ADH (vassopressin) What increases RBF? Prostaglandins (e and I) Tubuloglomerular feedback monitors what? NACL in macula densa of distal tubules Decrease in NaCl in macula densa stimulates relase of what from where? Renin from juxtaglomerular cells Increase in renin will increase what? Ang II and Efferent arteriole resistance Decrease NaCl in macula densa causes dilation of what? Afferent arterioles Primary source of renin? Smooth muscle cells in afferent arterioles 4 things stimulate renin release Decrease in perfusion pressure, SNS, decrease in NaCl delivery to macula densa (distal tubual) and hormones 2 hormones that increase renin release Thyroid hormone and growth hormone Renin catalyzes the formation of __ from ___ Ang I from angiotensin Where does angiotensin I go to Ang II? Lung (ACE) Ang II stimulates what 3 things? STIMULATES adrenal cortex to secrete aldosterone, ADH (vassopressin) and Kidney Net effect of Ang II is to decrease ___ and ___ excretion and increase ___ 1. Decrease Na and H2O 2. Increase BP

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