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Cardiac Physiology II-b, Vasoconstriction-0.1% -pheochromocytoma -ad. medulla tumor -too much epi, NE -surgical removal Combination Renal HTN -lowered renal perfusion P ->fluid retention, renin secretion ->vasoconstriction -rising BP, normal CO ->but TPR still high, BP high 5-10% cases -stenosis of renal artery, Renin-Angiotensin System ⇓Na, β2 receptor (SNS)activation, BP⇓ ->kidney JG cells secrete renin ->cleaves angiotensinogen to a'tensin I ->converted to II by ACE (lung) ->vasoconstrictor, renal Na retention -water retained w/ Na, ⇑ blood volume, BP in BP rises, renin secretion ⇓ Renin-shift curve right directly or thru aldosterone (adrenal medulla) -both cause kidney to retain Na ???? Renal Fcn Curve -shows natriuresis/diuresis vs. perfusion pressure -more pee, Na w/ high P ->can increase BP w/ fcn curve shift, or more salt, H2O intake, Mechanisms ???? Vasoconstriction-0.1% -pheochromocytoma -ad. medulla tumor -too much epi, NE -surgical removal, Mechanisms ???? Volume loading -reduction of renal tissue &water, salt loading-> ->increase BP ->start w/ ⇑CO ->TPR⇑ next few days -normal kidneys would ⇓vol ->CO normalizes, but TPR high -still have HTN, Cardiac Physiology II-b BP regulation Hormonal Control, Neural Control ???? CNS Ischemic response-BPឬ ->decreased blood flow to brain ->VERY STRONG SNS STIM -effect of CO2 on neurons Cushing rxn-raise CSF pressure -compress blood vessels ->decrease flow ->CNS ischemic response ->BP high enough to resume flow ->baroreceptors decrease HR, Hormonal Control Renen Renin-Angiotensin System ⇓Na, β2 receptor (SNS)activation, BP⇓ ->kidney JG cells secrete renin ->cleaves angiotensinogen to a'tensin I ->converted to II by ACE (lung) ->vasoconstrictor, renal Na retention -water retained w/ Na, ⇑ blood volume, BP in BP rises, renin secretion ⇓ Renin-shift curve right directly or thru aldosterone (adrenal medulla) -both cause kidney to retain Na, Autoregulation of flow -vasc. resistance changes perf pressure increase-> -vasculature moderates P Long-term Autoregulation angiogenesis vs. atrophy Myogenic Mech Small resistance aa. -intrinsic vasoconstrictor tone BP falls->sm. mm. relaxes BP increases->constricts -to keep tension in check (La Place T=rP) -thus changes blood flow, Autoregulation of flow -vasc. resistance changes perf pressure increase-> -vasculature moderates P Long-term Autoregulation angiogenesis vs. atrophy Metabolic Mech vasodilator metabolites ->released by surr. tissue (ex. lactate,CO2, H+, K) -buildup causes vasodil. ->increase blood flow -dissipate, then constriction ->need-based blood flow, Cardiac Physiology II-b BP regulation <math xmlns="http://www.w3.org/1998/Math/MathML"> <mtext> TPR=ΔP/Cardiac Output ⇑extracell. fluid vol-> ⇑blood volume, filling P ⇑venous return to heart ⇑CO, aa'oles contrict-> ⇑TPR ⇑blood pressure </mtext> </math>