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Hypertension
Arrhythmia
Heart failure
Reduced vascular blood flow
I. Background to Hypertension -
Regulation of Blood Pressure
Arterial blood pressure due to combination
of cardiac output (CO) and total peripheral
resistance (TPR)
CO – regulated by heart rate and stroke
volume (CO = HR x SV)
TPR function of
– Viscosity of blood (hematocrit)
– Length of blood vessels
– Blood vessel luminal diameter (especially
precapillary arterioles)
Cardiac Output
Heart rate
– Function of
sympathetic, vagal nervous activity
Neuro-hormonal substances
– 1° angiotensin II
– 2º vasopression (anti-diuretic hormone = ADH)
Stroke volume
– Function of
Venous return (function of venous tone [contractile state]
and circulating blood (vascular) volume)
– Venous tone function of sympathetic activity (α1, α2
receptors)
– Vascular volume depends on
Intake of fluids (thirst)
Output of fluids (urine, sweat, etc)
Distribution of fluids (Starling’s law)
Myocardial contractility (MC proportional to sympathetic
tone [β1 receptors])
Characteristics of some adrenoceptors
Tissues (sympathetic nerves)
and effects receptors
α1 α2 β1 β2
Smooth
muscle
Arteries/ constrict constrict/ dilate
veins dilate
Skeletal dilate
muscle
Heart
Rate (increase)
Force of increase
contraction
Beat-to-Beat Modulation of Blood
Pressure
Controlled by baroreceptor reflex arch
– Fast acting
Autonomic Regulation of Blood Pressure
Heart Rate
– Parasympathetic input via vagus nerve
causes decrease in HR (dominates)
– Sympathetic input to sino-atrial node
causes increase in HR (usually minor)
Heart contractility
– Increased by sympathetic activity
causing release of epinephrine,
norepinephrine from adrenal gland
II. Background to Arrhythmia -
Rhythm of the Heart
Human heart is four-
chambered
Above controlled
electrically (Purkinje fibers
allow rapid, organized
spread of activation)
Regulation of Heart Rate
– Primarily accomplished by sinoatrial node (SA)
Located on right atrium
Receives autonomic input
When stimulated, SA signals atrial contractile fibers
atria depolarization and contraction (primes
ventricles with blood)
– Depolarization picked up by atrioventricular
node (AV node) depolarizes ventricles
blood discharged to pulmonary artery and
dorsal aorta eventually rest of body
Sequential Discharge of SA and AV nodes
III. Background to Congestive Heart Failure
Maintenance of Normal Heart Function
Normal cardiac output needed to adequately perfuse
peripheral organs
– Provide O2, nutrients, etc
– Remove CO2, metabolic wastes, etc
– Maintain fluid flow from capillaries into interstitium and back
into venous system if flow reduced or pressure increased in
venous system build up of interstitial fluid = edema
Because CO is a function of
– Heart Rate – determined by pacemaker cells in the sinoatrial
node
– Stroke volume – determined by fill rate and contractile force
– Atrial/ventricular/valvular coordination
Capillaries
– Tiny but contain greatest cross-sectional area to allow high exchange
rate
– Contain precapillary sphincters to regulate blood flow
– 5% of blood volume
0.063
0.5
Relationship between blood pressure,
velocity and total area of vasculature
Humeral Regulation of Blood Pressure:
Renin-Angiotensin-Aldosterone System
Renin: secreted by the kidney in response to reduced blood pressure
or blood volume
Angiotensin II:
– Actions:
I’m outta’
here!