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Where is the majority of blood during circulation?
in the venous side
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3 things that determine cardiac output
- preload
- afterload
- contractility
-
preload
- 'the pool'
- amount of stretch created by the volume
-
afterload
- 'the pipes'
- resistance to outflow
- blood pressure
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-
starlings law
force of contraction is determined by stretch
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Autonomic Control:
Reflex activation of __________
Vasomotor Center
Baroreceptors
- reflex= SNS and PNS
- V.C= Medulla Oblongata => heart rate; last resort attempt to sustain life
- B= Aortic Arch
- = Carotid Artieries
- = Vena Cava
- => these 3 use vessel size to control BP
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humoral control list
1-4
- Catecholamines:
- -NE
- -Epi
- Aldosterone
- Renin-Angiotensin-Aldosterone
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aldosterone saves h2o and Na+
but kicks out K+
aldosterone saves h2o and Na+
but kicks out K+
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Angiotensin II is a strong vasoconstrictor and signals release of Aldosterone
Angiotensin II is a strong vasoconstrictor and signals release of Aldosterone
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Problems with the pump:
valve problems
wall problems
V= stenotic or regurgitant
- W= structural (congenital or acquired)
- = Post MI (akinetic)
-
-
dysrhythmias
- Bad electricity
- Bad pumping
- Bad perfusion
-
acute coronary syndrome
- chest pain - 1st from blockage
- SOB
- Diaphoresis
- N/V
- ECG- Elevated ST segment is classic sign of ischemia
-
blood pressure regulation
- baroreceptors
- RAAS
- Renal regulation
- Natriuretic peptides
-
Natriutretic peptides
- A-atrial
- B-brain
- =Both reduce blood volume, decreasing preload
- =Vasodilate
- C-vascular endothelium
- =vasodilation
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BP:
normal
pre-HTN
HTN stage 1
HTN stage 2
- nl= 120/80
- pre= 120-139 or 80-89
- HTN 1= 140-159 or 90-99
- HTN 2= >160 or >100
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Renin-Angiotensin-Aldosterone
Renin produced by_________in response to_____&______
Renin coverts Angiotensinogen to ________
A1 + ACE =A2
A2 causes______ and releases____
- Renin produced by Kidneys in response to decreased BP& flow
- Renin coverts Angiotensinogen to Angiotensin I
- A1 + ACE =A2
- A2 causes vasoconstriction and releases aldosterone
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ACE Inhibitors
- -PRILS
- given orally (except Vasotec IV)
- can be given with food (except Captopril)
- Pro-drugs= not activated until metab in Liver (except Lisinopril)
- Excreted by the Kidney
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Captopril / Capoten
- 1st ever ACE inhibitor
- MANY Problems
- given orally, BUT not with food
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Lisinopril / Prinivil
- 2nd generation ACE Inhibitor
- given orally with food
- NOT A Pro-Drug
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actions of ACE inhibitor
- Prevent Angiotensin II
- Vasodilation= Dec. BP
- Loss of Na+ and h2o and INCREASE K+= dec. bld volume
- Prevent and reverse cardiac remodeling
- A2 and Aldosterone
-
4 therapeutic uses of ACE Inhibitors
- HTN
- HF- from acute MI and Left Vent. dysfunction
- Diabetic and non-D nephropathy= Delay onset / slow progression of renal failure b/c of decrease in Kidney remodeling
- Prevent MI, stroke, death in pt's at high risk for CV events
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Renal Artery Stenosis
- #1 problem w/ ACE Inhibitors
- low bld flow in kidney
- high production of Agio II
- - support renal blood flow by:
- = elevated renal pressures
- = constriction of Efferent (out) arterioles
- ACE Inhibitor dilates efferent arteriole:
- = Angio II mechanisms to overcome the stenotic process fails
Severe renal failure occurs
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Bradykinin causes...
- arteriolar vasodilation (pulmonary)
- capillary permeability
-
ACE / Kinase II
Kinase is ACE II when it interacts with bradykinin
Quickly breaks down Bradykinin
-
If we inhibit ACE/Kinase II...
promote the metabolic effects of Bradykinin (vasodilation and inc. permeability):
-
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adverse effects of ACE inhibs
- 1st dose HypoTN
- angiodema
- cough
- hyperkalemia
- renal failure
- fetal injury
-
"-sartan"s
- Angio II Receptor blockers (ARB's)
- improvement on ACE inhibs
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ARB's
uses:
- block receptors for Angio II
- Action blocks all angio II
- - ACE/Kinase II not involved
- - cough not a problem
- - Angiodema still there
Uses: MI, HF, HTN, DM nephropathy
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adverse effects of ARB's
- angiodema
- renal failure (stenosis), Fetal harm
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Losartan / Cozaarr
Angio II Receptor Blocker
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Vaksartan / Diovan
Angio II Receptor Blocker
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Direct Renin Inhibitor
- Aliskiren / Tektura
- Binds w/ renin and stops creation of Angio I from Angiotensinogen --> no Angio II or Aldosterone
- ONLY for HTN
- rare SE's
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Aldosterone Antagonists:
Aldosterone ______
- Aldosterone - save Na+, decrease K+
- - very effective in lowering BP
- - Hyperkalemia ONLY adverse effect
- - steroid (sex hormones) suppressed
-
Spironolactone / Aldactone
- Aldosterone Antagonist
- NON-SELECTIVE
-
Eplarenone / Inspra
- Aldosterone Antagonist
- SELECTIVE aldosterone receptor blocker
- - getting rid of fluid w/o SE and w/o hormone problems
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