11.12.08(a): systemic stress response
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Slideshow is from the University of Michigan Medical School's M1 Cardiovascular / Respiratory sequence View additional course materials on Open.Michigan: openmi.ch/med-M1CardioTRANSCRIPT
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Author(s): Louis D’Alecy, 2009
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Systemic Stress Response
M1 – Cardiovascular/Respiratory Sequence
Louis D’Alecy, Ph.D.
Fall 2008
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Wednesday 11/12/08, 9:00Systemic Stress Response
(After Baroreceptor Reflex)34 slides, 50 minutes
1. Reflex response to hemorrhagic stress
2. What happens next? 3. Starling forces and fluid shifts
4. Lymph flow
5. Vasoconstriction & absorption
6. VR and CO in hemorrhage
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Arterial Baroreceptor Reflex(s)
-minimize changes in arterial blood pressure
- tend to restore MAP to initial value
- moves pressure opposite disturbance
- utilizes (controls) HR, SV, TPR, “other” changes
- can be over ridden by other reflexes and controls
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6Fig 9.1
ArterialBaroreceptors
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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No
carotid
baroreceptors
Intact baroreceptor reflexes minimize the response to hemorrhage
involving 20% loss of blood.
No
aortic
baroreceptors
“No”
baroreceptors
Source Undetermined
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Partial restoration Of
MAP McGraw-Hill
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HEMORRHAGE
blood volume
arterial blood pressure
baroreceptor
mediated
arteriolar vasoconstriction
capillary blood pressure Pc
absorption of interstitial fluid
partial
restoration
of blood volume
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Hematocrit* 46 46 37
Erythropoiesis *Hematocrit = % of blood volume occupied by red blood cells
Source Undetermined
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colloid osmotic
pressure
STARLING FORCES
colloid osmotic
pressure
McGraw-Hill
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CAUSES OF DECREASED PLAMSA
COLLOID OSMOTIC PRESSURE
1. Synthesis of albumen by liver
A. protein malnutrition - decreased amino
acid availability
B. liver disease - decreased formation of
plasma proteins
2. Loss of albumen across capillary walls
A. burns
B. kidney disease C. GI disease
3. Iatrogenic (excess IV salt solutions, hemodilution)
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LYMPHATIC SYSTEM
veins
capillaries
One-way valves
lymphatic capillaries
permeable to proteins
filtration absorption
20 17 L per day
3 L per day
D Alecy
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valves
collecting lymphatic
pores
lymphatic
capillaries
endothelial cells
anchoring filaments Source Undetermined
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LYMPH FLOW
Bulk fluid flow into lymphatic capillaries
Hydrostatic pressure gradient
1. Increased interstitial fluid volume increases Pisf
2. Decreased pressure in lymphatic capillaries
Bulk fluid flow along lymphatic network
1. Rhythmic contractions of lymphatic smooth muscle
(one way flow due to valves in lymphatics)
2. Tissue compression - skeletal muscle pump
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Lymph vessel
Lymphflows toward
thoracic duct.
Similar to venousblood flow but lower pressure and lower volume.
Contracted muscles=closed valve
Please see: http://www.vhlab.umn.edu/atlas/phystutorial/graphics/fig3.jpg
Image of skeletal muscle pump
removed
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LYMPH vs. PLASMA
Flow: Lymph Plasma
3 L / day 4320 L / day
2 mL / min 3000 mL / min
Lymph
Volume 4 L (35% of 11 L of interstitial fluid)
Composition No RBC, some WBC
Small molecular composition equal to venous plasma
Protein composition equal to interstitial fluid
protein g / L
plasma 73 muscle lymph 20
intestinal lymph 40
liver lymph 50
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Back Into the
Plasma
Compartment
How does this happen?
McGraw-Hill
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What determines capillary
hydrostatic pressure Pc ?
• Arterial pressure Pc
• Venous volume (pressure) Pc ** •Closure of arteriole Pc
•Closure of a venule Pc
• Local arteriolar vasoconstriction Pc
•Local venoconstriction Pc
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Localized arteriolar
Source Undetermined
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Normal Balance
Source Undetermined
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Hydro - Osmo = ?
(35-0) - (28-3) =10 fil
Hydro - Osmo = ? (15-0) - (28-3) = -10 abs
Venous end Arterial end
Then Constrict Arterioles &
decrease capillary pressure
Hydro - Osmo = ?
(25-0) - (28-3) = 0
Hydro - Osmo = ? (5-0) - (28-3) = -20 abs
Venous end Arterial end
Reduced filtration Interstitial Absorption
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Increased Capillary
Hydrostatic Pc
Decreased
Hydrostatic Pc
6-7 MH
6-7
If localizedvasoconstriction
orvasodilation
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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Increased Systemic
Pressure
6-7 MH
If generalizedvasoconstriction
orvasodilationDecreased Systemic
Pressure
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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Arterial Baroreceptor Reflex(s)
-minimize changes in arterial blood pressure
- tend to restore MAP to initial value
- moves pressure opposite disturbance
- utilizes (controls) HR, SV, TPR, “other” changes
- can be over ridden by other reflexes and controls
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But
OTHER
VOLUME
LOSSES
McGraw-Hill
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OTHER FLUID LOSS - diarrhea or sweating
fluid loss
extracellular fluid volume
plasma volume
Pc COPp
absorption of interstitial fluid
partial restoration of plasma volume
due to loss of
plasma water
plasma
plasma
protein
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SWELLING AT SITES OF TISSUE INJURY
tissue damage
release of local chemical agents (paracrines)
e.g. histamine
arteriolar
dilation
Pc
ultrafiltration
capillary permeability
to plasma proteins
COPisf
fluid absorption
tissue swelling
edema Plasma volume
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net filtration
interstitial fluid
Pisf COPifs
ultrafiltration lymph flow osmotic
absorption
INTERSTITIAL FACTORS OPPOSING EDEMA
(& PLASMA LOSS)
Initial cause of Edema
By diluting
interstitium
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M&H 11-1
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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Generalized
Localized
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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328.5 MH
Cardiac output curve
Venous return curve
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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338.6 MH
Normal cardiac output curve
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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Some Hemorrhage Responses
A
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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Hemorrhage on VR and CO curves 1
CVP VR CO
A 2 mmHg 5L /min 5L /min Original curves
Hemorrhage shifts to new “hemorrhage” VR curve and momentarily unbalances system.
A’ 2 mmHg 2L /min 5L /min Unstable
(imaginary)
central pool emptying and lowering
CVP from 2 to 1 mmHg on
“Hem “ VR curve brings you to B
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Hemorrhage on VR and CO curves 2
CVP VR CO B 1mmHg 3 L/min 3 L/min new stable state
WITHOUT reflex compensations.
The reduced CO lowers MAP, triggers arterial baroreceptor
reflex and first step (illustrated) is positive inotropic and
chronotropic effects on heart. This shifts you to a new CO
function curve and further empties CV pool.
You move along the VR curve from B to C
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Hemorrhage on VR and CO curves 3
CVP VR CO C 0.3mmHg 4 L /min 4L /min
Compensation further lowers CVP increasing VR and partially restores CO with SV and HR increases.
D 0.5mmHg 4.5L /min 4.5L /min
Venoconstriction shifts to a new VR curve and new stable point.
Even with near immediate baroreceptor reflex compensations the
system still has not fully compensated. The heart is being
autonomically (sympathetic and parasympathetic) driven, peripheral vessels are constricted and this is a temporary “fix”.
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Slide 6: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
Slide 7: Source Undetermined
Slide 8: McGraw-Hill
Slide 10: McGraw-Hill
Slide 11: Source Undetermined
Slide 13: D’Alecy
Slide 14: Source Undetermined
Slide 16: Please see: http://www.vhlab.umn.edu/atlas/phystutorial/graphics/fig3.jpg
Slide 18: McGraw-Hill
Slide 20: Source Undetermined
Slide 21: Source Undetermined
Slide 23: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
Slide 24: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
Slide 26: McGraw-Hill
Slide 30: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
Slide 31: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
Slide 32: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
Slide 33: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
Slide 34: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
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