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Control of the circulation depends on a variety of mechanisms that are directly related to the specific functions that the circulation performs.
Special cases:
Skin for cooling in hot weather.
Methods of Regulation
Vasodilator: Lack of oxygen produces lactic acid, adenosine (degradation of ATP) which directly affect vascular tone. Oxygen demand: Lack of oxygen prevents SMC from sustaining contraction. (But smc can remain contracted with extremely low oxygen).
Hyperemia
Active Hyperemia: As a result of exercise.
Can increase blood up to 20-fold.
Acute
250 mm Hg
Arterial Pressure
NO and Bacteria
NO is a primitive immune response. Does not so much kill bacteria as maintain them in stasis so that they will not proliferate and grow. Produced during wound healing as a first line of defense.
NO and Viagra
Viagra stimulates the production of NO.
Vasoconstrictors
Angiotensin: 1 micro gram can cause 50 mm Hg increase in pressure. Acts on all arterioles Vasopression: Made in hypothalamus released to pituitary from which it is distributed to the body. Highly potent. Controls flow in renal tubules
Vasoconstrictors (contd)
Endothelin Effective in nanogram quantitites. Probably major mechanism for preventing bleeding from large arterioles (up to 0.5 mm). Constricts the umbilical artery of a neonate. Especially effective on coronary, renal, mesenteric and cerebral arteries.
Vasodilators
Bradykinin: Causes arteriole dilation and increased capillary permeability. Kallerikin -> Kallikrein* (acts on) alpha2-globulin (releases) kallidin -> bradykinin (inactivated by) carboxypeptidase (or) converting enzyme
Vasodilators (continued)
Serotonin (5-hydroxytryptamine or 5HT):
Found in platelets (potentiator of platelet activation). Neurotransmitter. May be vasoconstrictor or vasodilator. Role in circulation control not fully understood.
Vasodilators (continued)
Histamine:
Released by damaged tissue. Vasodilator and increases capillary porosity. May induce edema. Major part of allergic reactions.
Prostaglandins:
Most are vasodilators, some are vasoconstrictors. Pattern of function not yet understood.
Other Ions
Calcium: Vasoconstrictor (smc contraction) Potassium: Vasodilator (inhibit smc contraction) Magnesium: Vasodilator (inhibit smc contraction) Sodium: Mild dilatation caused by change in osmolality. Increased osmolality causes dilitation. Acetate and Citrate: Mild vasodilators. Increased CO2/pH: Vasodilation
CARDIAC OUTPUT
Cardiac Output
Generally proportional to body surface area. Cardiac Index (CI): Approximately 3 liters/min/m2 of body surface area. CI varies with age, peaking at around 8 years.
Frank-Starling Law
What goes into the heart comes out. Increased heart volume stretches muscles and causes stronger contraction. Stretch increases heart rate as well. Direct effect on sino-atrial node Bainbridge reflex (through the brain)
Cardiac Output
Depends on venous return, which, in turn, depends on the rate of flow to the tissues. Rate of flow to tissues depends on tissue needs (i.e. it depends on Total Peripheral Resistance). Therefore, cardiac output is proportional to the energy requirements of the tissues.
Hypereffective Heart
Effected by: 1. Nervous excitation. 2. Cardiac Hypertrophy
Exercise Marathon runners may get 30 to 40 L/min Aortic Valve Stenosis
Hypoeffective Heart
Valvular disease Increased output pressure Congential heart disease Myocarditis Cardiac anoxia Toxicity
tamponade 15 L/min CO
Generally shift the cardiac output curve in proportion to pressure change (breathing, Valsalva maneuver). Cardiac Tamponade (filling of pericardial sac with fluid) lowers rate of change of CO with right atrial pressure
Resistance to Flow Pressure change is slight. Thus, small increase in RA Pressure causes dramatic reduction in venous return. (mean systemic filling pressure).
-4
0
Mean systemic filling pressure ~ 7 mm Hg
Filling Pressure
Mean Circulatory: The pressure within the circulatory system when all flow is stopped (e.g. by stopping the heart). Mean Systemic: Pressure when flow is stopped by clamping large veins. The two are close numerically.
- Reduced CO
5 L/min VR (CO) -4 0
Effects of AV Fistula
1. Decreased VR resistance. 2. Slight increased CO because of reduced peripheral resistance. After restoration of pressure (sympathetic) 1. Further CO increase. 2. Increased filling pressure. 3. Decreased kidney output (leads to higher fluid volume and more increase in CO). 4. Cardiac hypertrophy (caused by increased workload).
Measurement of CO
Electromagnetic/ultrasonic (transit time) flow meter. Oxygen Fick method: CO = (Rate of O2 absorbed by lungs) [O2]la - [O2]rv Indicator dilution method: Inject cold saline (or dye) into RA, measure temperature (or concentration) in aorta.