High Yield RelationshipsSlide # 1

Q=

P
R

P R
L
R 4
r

Flow =

MAP = CO X TPR

V
C=
P

CO = HR X SV
T Pr
(LaPlace)
Uptake of O2

PP =

SV
C

A V O2 difference

Reynolds # = (velocity) (diameter) (density) / viscosity

Cardiac Index = CO/ body surface area (BSA)
Pulse pressure (PP) = systolic - diastolic
MAP = 1/3 PP + diastolic pressure

EF = SV/EDV X 100

P = height X density X gravity

Velocity = Q/CSA

Whole Body CV RegulationSlide # 2

MAP = CO X TPR
4 factors determine
1. HR ( CO exercise; CO
with tachyarrhythmias)
2. Contractility (direct)
3. Afterload (inverse)
4. Preload (direct)

Tone of arterioles
Sympathetic (alpha)
AII
AVP
Epi (alpha/beta-2)
Metabolism
NO

Directly related to venous return

Blood volume (direct)
Venous compliance (inverse)

Pharm integration

Short/Long Term MAP RegSlide # 3

Heart rate
M2

Contractility

Autonomic
drugs
Stroke volume
F-S

Venoconstriction

VR
Preload
VR

Cardiac
output

Shock

TPR

Mean Arterial
Pressure
Anti-hypertensive
drugs
Baroreceptor activity

Blood volume
Urine volume

Renin

A II

Stimulates

Parasympathetic
activity
Inhibits

Sympathetic
activity

Aldo

PV Loops: Systolic/Diastolic Dysfunction

Systolic dysfunction:
decreased contractility
results in elevated volumes

Slide #4

Pressure (mmHg)

120

Diastolic dysfunction:
decreased compliance
causes increased
pressure

80

40

50

100

Volume (ml)

150

Passive
tension

IPPPulmonary Blood FlowSlide # 5

Increased output delays
closing of pulmonic valve
(physiologic splitting of S2)

Inspiration

RA in chest expands
pressure so Q (VR)

MAP = CO X TPR

Increases pulmonary
vascular resistance
Flow to LH
Becomes
more
negative

PTM for
pulmonary
vessels; their
volume increases

PTM = 0 -5 = 5
Veins here are
unaffected
Inspiration decreases vagal outflow
to the heart, thus HR increases
(respiratory sinus arrhythmia)

Pg 143

Differential for Causes of HypoxemiaSlide # 6

Low PaO2
(hypoxemia)
PAO2: calculate using
alveolar air equation or
use end-tidal PO2

A a gradient

Elevated

Normal

Cause is
PAO2

Increase FIO2
Corrects
PaO2

Doesnt
correct PaO2

FIO2 corrects
PaCO2 likely
elevated

Diffusion
impairment

VA/Q
mismatch

Cause is rightto-left shunts

Relationships/Equations for RenalSlide # 7

FF =

GFR
RPF

FF impacts Pc!!!

Transport = excretion filtered load

Filtered load = GFR X PX
Rate of excretion = UX X V

UPAH X V
Renal
UX X V
clearance =
PX

CPAH = ERPF =

Renal blood flow =

PPAH

ERPF
1- Hct

Factors Affecting GFR and FFSlide # 8

Glomerular
cap
pressure

Peritubular
cap
pressure

Nephron
plasma
flow

GFR

FF

Constrict efferent

Dilate efferent

Constrict afferent

Dilate afferent

Properties of ReceptorsSlide # 9
E + S (ES) E + P

H + R (HR) response
stimulus response

Michaelis-Menten
100
Vmax: determined
by [E] & [S]

50
[S] is
limiting

% Response

Velocity (% of max)

100

[R] is one
factor
50
[H] is
limiting

Km
0

[S]

[H]

Properties of ReceptorsSlide # 10
H + R (HR) response
stimulus response

A + R (AR) response
stimulus response
100

[R] is one
factor
50
[H] is
limiting

% Response

% Response

100

50
[H] is
limiting
EC50

[H]

Log [A]

Overview of AVP PathophysiologySlide # 11

Plasma osmolality

High

Low

Note: AVP=ADH

Plasma AVP

Plasma AVP

High

Low

High

Low

Primary Polydipsia (2O)

*Nephro DI
(1O)

Dehydration

Neuro DI*

SIADH

(2O)

(1O)

(1O)

UOSM
POSM

>> 1

UOSM
POSM

<< 1

UOSM
POSM

>> 1

UOSM
POSM

<< 1

MetabolismCortisolSlide # 12
Glycogen
Gly
synthase

Gly
phos

Cortisol
FA

Glucokinase
FA
Glucose
Glucose
synthase
6-P
PFK-1 (via
G6-phos
PFK-2)
Malonyl CoA
Fructose 1,6AA
Pyruvate
bisphosphatase
(alanine)
kinase
Acetyl CoA
PEPCK
PDH
carboxylase
OAA
(thiamine)
Pyruvate
Acetyl CoA
Pyruvate
carboxylase
Cortisol
LDH
(biotin)
TCA
Ketones
Lactate

InsulinGlucagonSlide # 13
Glycogen
Gly
synthase

Insulin stimulates
Glucagon stimulates

Gly
phos

FA

Glucokinase
FA
Glucose
Glucose
Urea synthase
6-P
PFK-1 (via
G6-phos
PFK-2)
Malonyl CoA
Fructose 1,6AA
Pyruvate
bisphosphatase
(alanine)
kinase
Acetyl CoA
PEPCK
PDH
carboxylase
OAA
(thiamine)
Pyruvate
Acetyl CoA
Pyruvate
carboxylase
(biotin)
TCA
Ketones

Bone RemodelingSlide # 14

RANK-L promotes resorption

OPG reduces resorption
High glucocorticoids:

RANK-L;

OPG

Sexual DifferentiationSlide # 15
MIH = Mllerian inhibiting
hormone

Ovaries

T = Testosterone
SRY = sex determining
region of Y

Undifferentiated
gonad
XXno
SRY

XY has
SRY

Testes

MIH
Mllerian
ducts

Fallopian
tubes,
uterus,
inner vagina

Wolffian
ducts

Mllerian
ducts

Regress

Regress

Epididymis,
vas
deferens,
seminal
vesicles

Fallopian
tubes,
uterus, inner
vagina

T
Wolffian
ducts

Epididymis,
vas
deferens,
seminal
vesicles

Sexual DifferentiationSlide # 16
Testosterone

5 alpha-reductase

dihydrotestosterone (DHT)
Testes

Ovaries
No
DHT

DHT
Undifferentiated
organs

Clitoris, outer
vagina, labia

Penis,
scrotum, &
prostate

MenopauseSlide # 17
ACTH

FSH/LH

Choles

Tumor
Growth

DHEA

Test/A
aromatase

A
Adrenal cortex

Choles

17-Estradiol

Blood
Ovary
Anastrozole

Tamoxifen

Letrozole

Raloxifene
aromatase
DHEA

A
Adipose tissue

Estrone

Polycystic Ovarian SyndromeSlide # 18

PCOS
Hirsutism; irregular menstrual bleeding; chronic anovulation; obesity;
insulin resistance; infertility
Oral contraceptives
Clomiphene: FSH
LH
to LH
FSH
Adipose
estrone

aromatase

Pituitary

Estradiol
anovulation

Follicle
maturation

Adipose
insulin

Thecal
hormone
production

Ovaries
Androgens

Thiazolidinediones;
Metformin
SHBG

Androgens Dexamethasone

Adrenal