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4/22/16

Cardiovascular Physiology Case Studies

Case 13:
1. During exercise, the demand for oxygen transport to the muscle tissue increases,
prompting a cardiovascular response. The ultimate purpose of theses
cardiovascular responses is to deliver oxygen to these tissues. The net result of
this is an increased heart rate and constriction of blood vessels, which allow for
an increased blood delivery to the muscles. Regarding the autonomic nervous
system, this increased activity prompts the cerebral cortex to trigger an increase
heart rate, while the muscular and sympathetic vasocontraction of the blood
vessels, increasing venous return. Altogether, this produces an increased cardiac
output. Regarding local control, blood flow is increased as a result of the release
of the chemical byproducts of exercise, causing a decrease in vascular diameter
and therefore a decreased resistance to the local blood flow.
2. Mean arterial pressure is calculated from pulse pressure, so we calculate this first.
Since pulse pressure is the difference of systolic and diastolic pressure,
Cassandras pulse pressure was 40mmHg initially and 85mmHg following
exercise. Further, her mean arterial pressures are 83mmHg initially, then
88mmHg following exercise.
3. Cassandras cardiac output is 6L per minute initially, then 14300mL per minute
during exercise. It would seem that heart rate made a greater contribution to
Cassandras cardiac output, since this increased more than stroke volume.
4. Cassandras increase in pule pressure would suggest that there is a greater
difference between the systolic and diastolic pressures, meaning that there was a
greater amount of blood ejected from the heart than filled.

5. Systolic pressure is increased during exercise due to the larger volume of blood
ejected from the heart. Diastolic pressure decreased as a result of increased local
vessel diameter, decreased resistance, increased vascular distensibility.
6. Propranolol would block specific receptors that cause increases sympathetic
responses, by what was explained in question 1, this would have resulted in a
decreased cardiac output and inhibited oxygen delivery. Taking this drug would
have a decreased exercise tolerance.
7. The change in skin temperature is the result of the vasocontraction of the vessels
just beneath the skin and an immediate redirection of blood flow (and therefore
heat) away from the skin. At the peak of exercise, the resulting local vasodilation
and increased blood flow causes the skin becomes warmer and flushed.
8. The venous P02 decrease was the result of the increased rate of consumption of
oxygen by the muscle tissues, while the the arterial P02 remained the same
because the pressure difference must be maintained to attain this increased blood
flow.

Case 14:
1. The occlusion of Mr. Hannas left renal artery cased an overall decrease in
pressure, prompting more renin to be secreted in to the blood, causing an
increase in plasma renin activity.
2. The increase in renin led to an increase in the sodium uptake, which led to an
increase in fluid and blood volume and increased peripheral resistance, and
therefore an increased arterial blood pressure.
3. The renin secretion increase in the left kidney was caused by a decreased left
renal pressure, which was the result of a narrowing of the left renal artery. The

decreased renin secretion in the right kidney was the homeostatic response to the
increase in left.
4. The narrowing of the artery caused the renal blood flow to become more
turbulent as the result of the following: the diameter length of a vessel is inversely
proportional to the velocity of the blood, the turbulent flow increases with
velocity, therefore the narrowing would lead to more turbulent flow.
5. The balloon angioplasty might have failed because it would not affect the
increased plasma renin activity, which may have been caused by increases in
angiotensin. ACE inhibitors are indented inhibit the angiotensin activity, thereby
lowering arterial pressure.

Case 15:
1. Circulatory shock is the condition marked by a decreased blood flow, perfusion,
and oxygen delivery. The major causes of shock include improper functioning of
the heart, decreases in blood flow, or loss of circulating blood.

2. After gastrointestinal blood loss, wed expect Mrs. Byrne to experience a decrease
in of venous blood volume, decreased venous return, and decreased filling,
decreased cardiac output, thus leading to decreased arterial pressure.

3. Her arterial pressure was lower when she was upright because more of the blood
was allowed to be delivered to the veins, but the pooling of this blood would lead
to a decreased venous return, which again decreases arterial pressure.

4. When Mrs. Byrne was supine, the inadequate pressure would be detected by the
baroreceptors which prompt an increased heart rate and increased cardiac output
to in an attempt to restore arterial pressure. When she was upright her blood
pressure was lower (as mentioned in question 3), which would prompt the
baroreceptors to increase heart rate more than previously.

5. Since the supply to the vena cava eventually feeds into the right atria and the
pulmonary artery eventually feeds into the left atrial, and a pressure gradient
must be maintained, wed expect that the central venous and pulmonary capillary
wedge pressures should have decreased as a result of the decrease in arterial
pressure.

6. Hematocrit is the proportion of red blood cells in a given volume of blood. Mrs.
Byrnes hematocrit was decreased because of the large quantities of blood lost
internally, which prompted an increase of fluid in the blood to compensate for
this loss, leading to an overall decreased proportion of red blood cells. This
decrease is dangerous because it compromises her bloods oxygen delivering
ability.

7. Her skin was pale because of her bodys response to blood loss, which stimulated
baroreceptors to promote the release of vasoconstrictors to redirect blood flow
(and therefore warmth) centrally, away from the skin.

8. Mrs. Byrnes sodium ion excretion is likely to be affected by the decrease in

arterial pressure, which would have triggered an increased reabsorption of
sodium ions to allow for an increased blood volume, and therefore increased
arterial pressure. Due to this reabsorption, we expect to find a lower sodium ion
concentration in the urine.

9. Saline infusion would increase Mrs. Byrnes blood volume because of the
resulting increase in reabsorption.

10. Physicians measured her urine output to determine whether the increasing
vasocontraction is compromising renal absorption. Prostaglandins produces
vasodilators to balance the effects of the vasocontraction caused by the blood
loss. Aspirin is potentially dangerous because it blocks prostaglandins
production. If the vasocontraction is not regulated, this may result in kidney
failure.

11.

Dopamine would assist in the treatment of hypovolemic shock because it

can dilate the blood vessels delivering blood to specific organs, including the
kidneys.