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- | *continued here from [[Lecture 6 Transcapillary Exchange]] on 01/27/11 at around 8:37 ish.
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- | ==Neural Control==
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- | ===Objectives===
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- | *Book Chapter 18, Problems 19 and 20 page 337
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- | *How do the sympathetic and parasympathetic nervous systems change each of the following: Heart rate, Cardiac Contractility, Arterial Resistance, and venous constriction
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- | *As the mean arterial pressure is increased, how does the arterial baroreceptor activity (firing rate) change? If the artery containing the baroreceptor sensors could not expand as the pressure is increased, how would baroreceptor activity change?
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- | *What are atrial and ventricular baroreceptors? During which phases of the heart cycle are they active? When excessively active, what general types of modifications of neural and hormonal control occur?
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- | *At a conceptual level, there are four centers in the brain stem which interact to regulate the sympathetic and parasympathetic nervous systems. What are the four centers and what major functions does each have?
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- | *Compare the effects of pleasurable emotions versus fear versus anger on neural control of the cardiovascular system.
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- | *Complete loss of neural cardiovascular control would result in a very low arterial blood pressure, a heart rate of about 100-110 beats/min (no vagal control), and low cardiac output. Why do these problems occur?
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- | *How does an increase in the intracranial pressure progressively cause decreased brain blood flow even if the arterial blood pressure is elevated?
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- | ===Overview of Neural Vascular Regulation===
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- | ====Without regulatory system====
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- | 1. Mean pressure ~50 mmHg
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- | 2. Standing difficult, walking very difficult
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- | ====Range of Activity====
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- | 1. Sleep ~ 80% of waking control 2. Exercise -500-1000% increase in metabolism
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- | ====Must adapt to life span of >80 years====
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- | 1. 12-25 fold increase in body size 2. Birth to old age arterial pressure increases ~ 25 mmHg
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- | ====Set Point Pressure====
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- | - the average resting pressure defended at all costs Examples of set point pressures variations Sleep ~80 mmHg Awake ~90 mmHg Walking ~ 95 mmHg Moderate Exercise ~ 105 mmHg Maximum exercise ~ 140-150 mmHg
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- | cardiovascular tree Richardson
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- | ====E. Regulated variables====
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- | 1. Cardiac Function a. Heart Rate (1) Sedentary Life Style Resting 75-85 bpm Sleeping 70-80 bpm Stairs 100-110 (2) Athletic Life Style Enlarged heart, larger Stroke Volume Cardiac Output = Heart Rate X Stroke Volume Resting 50-70 bpm Sleeping 50-65 bpm Exercise ?? Maxed out? b. Contractility - Changes follow heart rate responses 2. Vascular Function a. Arterial resistance Tends to be inversely changed with heart rate - mostly reflects skeletal muscle vascular regulation b. Venous constriction follows directional changes in heart rate
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- | Sleep
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- | 3. Blood Volume
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- | a. Exercise training
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- | 1. Expand volume in about 1 week by
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- | 10%
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- | 2. Initial responses are plasma expansion but hematocrit catches up in about 1 month
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- | b. Temperature during the seasons
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- | 1. Lowest volumes in cold weather
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- | 2. Highest volumes in hot weather
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- | 3. Can be manipulated by clothes worn in cold weather to limit decline in blood volume
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- | ===Short Term Sensor Systems for Neural Regulation===
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- | ====Peripheral Arterial Baroreceptors====
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- | Arch of aorta and bifurcation area of common carotid arteries
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- | 1. Monitor stretch of vessel walls
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- | a. Vessel wall must deform to
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- | generate signal
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- | b. Firing rate proportional to stretch caused by pressure
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- | c. Carotid baroreceptor
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- | (1) glossopharyngeal nerve
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- | (2) Works at pressures of 50- 200 mmHg
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- | d. Aortic baroreceptor
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- | (1) Uses vagus nerve
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- | (2) Works at pressures of 100-200 mmHg
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- | BARORPTR
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- | Diameter of Baroreceptor Vessel
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- | F I R R A I T N E G
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- | 2.
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- | How Might a Baroreceptor Work at the cellular level? a. Mechanosensitive Receptor 1. Sodium channel allows Na+ ions to enter and partially depolarizes neuron 2. Likely a calcium channel is opened to allow calcium channels to enter and both depolarize membrane and excite other channels b. Near the stretch sensitive site, the local depolarization initiates an action potential that is then propagated.
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- | Likely Modifiers of Function 1.
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- | Prostacyclin – increased firing
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- | 2.
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- | Nitric Oxide – increased firing
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- | 3.
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- | Lipid Abnormality – less firing
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- | 4.
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- | Activated platelets – less firing
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- | Ventricular and atrial Baroreceptors
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- | ====Low pressure baroreceptors====
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- | 1. Atria baroreceptors
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- | (a). Atrial Type A - atrial contraction
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- | (b) Atrial Type B – atrial filling during ventricular systole!!
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- | (c) if overactive, suppress antidiuretic hormone release (water loss), decrease sympathetic activity
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- | 2. Ventricular centers monitor both stretch of ventricle during diastole and somehow monitor pressure developed. Hyperactivity suppresses sympathetic nervous system
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- | Ventricular and atrial Baroreceptors
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- | ===Integration of Input and Output Neural Signals in the Medulla Excitatory Centers===
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- | ====Pressor Center - sympathetic nervous system to blood vessels====
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- | 1. Tonically active but depressed by baroreceptor input 2. Causes increased arterial resistance and venous constriction
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- | Neural control centers and cvtree
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- | ====Cardiac Excitatory Center - sympathetic nervous system to heart====
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- | 1. Tonically active - but depressed by baroreceptor input 2. Increases heart rate and contractility
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- | Neural control centers and cvtree
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- | Inhibitory Centers
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- | A. Depressor Center - suppresses activity of the sympathetic nervous system to blood vessels
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- | 1. Activated by the baroreceptor input
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- | 2. Does not send neurons to blood vessels
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- | B. Cardiac Inhibitory Center
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- | 1. Activated by the baroreceptor input
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- | 2. Vagal activity to the heart to slow the heart rate
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- | Neural control centers and cvtree
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- | Baroreceptor and sympathetic activity
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- | The overall outcome of the baroreceptor and central nervous system interaction is 1. As baroreceptor activity is increased, the medulla will reflexively decrease the sympathetic nervous system activity 2. Vagal activity usually changes in the opposite direction of sympathetic activity. The cardiovascular system without sympathetic or parasympathetic activity: Heart rate about 100-110 beats/min, Arterial pressure 65/40 mmHg, Cardiac output about 70% of normal, Vasculatures very dilated, Skin warm, mucus membranes flushed, very little tolerance to sitting or standing The Full Neural Control System: Heart rate should be 70-80 beats.min, arterial pressure 120/70 mmHg, cardiac output 70 ml/min per kg, skin cool and mucus membranes pink, able to perform to the maximum ability of the skeletal muscle system.
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- | ===Modifications of Neural Control By Higher Brain Centers===
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- | ====Emotion====
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- | 1. Pleasurable sensations Lowers sympathetic activity Raises vagal activity Heart rate and pressure fall
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- | P1010003
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- | FIRST DINNER PRAYER
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- | 2. Anger or rage: One of the most potent excitatory mechanisms for sympathetic activity a. Acts in brain – higher conscious centers increase firing rate of sympathetic neurons, suppress parasympathetic neurons b. Decreased sensitivity of baroreceptors due to their contraction?
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- | picrdata
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- | 3. Fear and depression: Inhibits sympathetic activity
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- | a. Works from conscious centers in brain – some how depresses the medulla
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- | b. Sympathetic system depressed, parasympathetic system activated - slow heart rate and low vascular resistance
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- | cobra
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- | John and Diane's home
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- | ====Pain====
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- | 1. Sharp pain - activate sympathetic system 2. Visceral pain - suppress sympathetic system C. Exercise 1. Activate sympathetic nervous system 2. Emotional connotation greatly impacts degree of activation
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- | runner
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- | m3a
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- | ===Consequences of Loss of Neural Vascular Control===
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- | ====Loss of baroreceptor Input====
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- | Mean arterial pressure normal but wide range of variation each day Has been duplicated in humans with similar results 1. Seen when aorta and carotid arteries are stiffened with age 2. Limits cardiovascular responses to body position and temperature changes
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- | neural control SAD Dog
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- | ====Loss of all neural control====
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- | 1. Spinal anesthesia or damage 2. Partial recovery from chronic injury associated with increased sensitivity to norepinephrine
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- | Neural control full loss on arterial pressure
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- | ===The Brain as a Baroreceptor===
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- | ====Inadequate perfusion of the brain====
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- | 1. Possible causes
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- | a. Arterial pressure too low for autoregulation to be fully protective
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- | b. Compromise of the carotid arteries
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- | c. Increased intracranial pressure collapsing first venules then arterioles (edema and low perfusion)
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- | cerebral baroreceptor flowchart
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- | 2. Consequences of inadequate perfusion a. Oxygen availability decreases in tissue b. Carbon dioxide accumulates c. Tissue becomes acidotic B. Responses: Sympathetic activity increased dramatically in an attempt to raise pressure adequately to perfuse the brain vessels
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- | cerebral baroreceptor flowchart
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- | ===Long Term Regulation of Arterial Blood Pressure===
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- | ====Intake of NaCl equals Renal loss of NaCl over a matter of a few days====
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- | 1. Increased NaCl does increase MAP but body compensates by greater excretion of NaCl to lower blood volume 2. Generally assumed that major MAP effect of NaCl is blood volume effect on central venous pressure and CO.
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- | Increase NaCl Intake
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- | However, there are negative effects on endothelial and vascular smooth muscle mainly due to increased generation of oxygen radicals
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- | ====If arterial pressure increases and baroreceptors work, less sympathetic nerve activity to kidney allows increased loss of NaCl====
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- | ====If intake of NaCl can not be properly excreted, arterial pressure will increase====
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- | Common problem in many forms of renal disease.
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- | ===Clinical Example===
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- | While camping in Florida, a 24 year old medical student went for a vigorous bicycle ride on a very warm day. When he returned several hours later, he collapsed in his tent. His classmates tried to have him drink water, but he was too unresponsive to swallow properly. At the Emergency Department of a local hospital, the vital signs were as follows:
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- | Heart rate: 127 beats/ min
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- | Arterial blood pressure: 80/50 mmHg
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- | Neck veins and arm veins lying: flattened
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- | Facial and body skin : Sweating profusely
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- | Vascular refill in fingers: 6 seconds
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- | Patient: Unresponsive to name, but both pupils react rapidly to light, reacts sluggishly to sternal pain stimulus
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- | What is the primary underlying problem in the student's collapse?
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- | A. Intravascular clotting
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- | B. Failure of sympathetic nervous system
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- | C. Elevated peripheral vascular resistance
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- | D. Inadequate cardiac output
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- | E. Decreased blood volume
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- | cardiovascular tree Richardson
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