CARDIOVASCULAR CONTROL

Marinette Rumusud-Jambaro,MD
Diplomate in Internal Medicine
 Control of blood volume
Aim: ensures that all the organs receive
sufficient amount of blood
Mechanisms:
1. Neural
2. Endocrine
3. Renal
Nervous Regulation of the
Arterial Pressure
more global functions,
such as;
redistributing blood flow
to different areas of the
body
increasing or decreasing
pumping activity by the
heart,
especially, providing very
rapid control of systemic
arterial pressure.
 Nervous Regulation of the Circulation
Autonomic Nervous
System
1. Symphathetic NS
- control circulation
2. Parasymphathetic NS
- Regulation of heart
function
 Nervous Regulation of the Circulation
Transmit parasympa
impulses through the
vagus n. to the heart
Sympa impulses
through the cord and
peipheral sympa nerves
to almost all blood
vessels of the body
 Nervous Regulation of the Circulation
Symphathetic NS Parasymphathetic NS
- Inc heart rate - Dec in heart rate
- Inc contractility of the - Dec pumping
heart contractility of the
heart
 Nervous Regulation of the Circulation
Autonomic Nervous
System
1. Symphathetic NS
- control circulation
Sympathetic Vasoconstrictor System and
Its Control by the Central Nervous System
Tremendous vasoconstrictor nerve fibers
Few vasodilator fibers
Thus, vasoconstriction or vasodilation is
produced by increasing or decreasing
sympathetic activity
 Vasomotor Centers of the Brain
Located bilaterally
mainly in the reticular
substance of the
medulla and of the
lower third of the pons
 Vasomotor Centers of the Brain
1. A vasoconstrictor area
- located bilaterally in the anterolateral
portions of the upper medulla.
- The neurons originating in this area
distribute their fibers to all levels of the
spinal cord, where they excite
preganglionic vasoconstrictor neurons
of the sympathetic nervous system.
2. A vasodilator area
- located bilaterally in the anterolateral
portions of the lower half of the
medulla.
- The fibers from these neurons project
upward to the vasoconstrictor area
- they inhibit the vasoconstrictor activity
of this area, thus causing vasodilation.
 Vasomotor Centers of the Brain
.
3. A sensory area
- located bilaterally in the tractus
solitarius in the posterolateral portions
of the medulla and lower pons.
- The neurons of this area receive
sensory nerve signals from the
circulatory system mainly through the
vagus and glossopharyngeal nerves,
and output signals from this sensory
area then help to control activities of
both the vasoconstrictor and
vasodilator areas
- thus providing reflex control of many
circulatory functions.
- An example is the baroreceptor reflex
for controlling arterial pressure.
Continuous Partial Constriction of the Blood Vessels

Is Normally Caused by
Sympathetic Vasoconstrictor
Tone.
Maintains a partial state of
contraction of the blood vessel
vasomotor tone

Effect of total spinal anesthesia on the arterial

pressure, showing marked decrease in pressure
resulting from loss of vasomotor tone
Norepinephrine (NE)
Neurotransmitter of the sympathetic nervous
system
Secreted at the endings of vasoconstrictor
nerves
Acts directly on -adrenergic receptor of
vascular smooth muscle to cause
vasoconstriction
NE and E
Released from adrenal medulla during
sympathetic stimulation
adrenergic vasoconstriction (NE,E)
- adrenergic vasodilation (E)
Vasomotor System influenced by Higher
Nervous Centers
1. Reticular substance
(pons,mesencephalon,diencephalon)
- Cardioaccelerator /cardioinhibitor
2. Hypothalamus
- Temperature changes
- Vessel of skin constrict (heat conservation)
- Dilate(heat dissipation)
Emotional stress- influence HR & BP
- Stimulate or inhibit medullary centers
Vasomotor System influenced by Higher
Nervous Centers
3. Cerebral cortex
- Stimulation causes various motor responses
- Fight or flight response- complex response
- inc HR, inc CO, inc BP in anticipation of
flight or physical activity
Vasomotor System influenced by Higher
Nervous Centers
Emotional FaintingVasovagal Syncope.
In this case, the muscle vasodilator system becomes
activated, and at the same time, the vagal cardioinhibitory
center transmits strong signals to the heart to slow the
heart rate markedly.
The arterial pressure falls rapidly, which reduces blood flow
to the brain and causes the person to lose consciousnesS
Emotional fainting begins with disturbing thoughts in the
cerebral cortex.
The pathway probably then goes to the vasodilatory center
of the anterior hypothalamus next to the vagal centers of
the medulla, to the heart through the vagus nerve.
Role of the Nervous System in the Rapid
Control of Arterial Pressure
1. Most arterioles throughout the body are
constricted inc TPR---inc BP
2. The veins and larger vessels of the circulation
are constricted displacing blood from the
peripheral vessels towards the heart----inc
pumping force of the heart inc arterial P
3. The heart is directly stimulated by autonomic
nervous system enhanced cardiac pumping
 Autonomic Nervous System
Increased arterial Pressure
1. During exercise
- muscle require inc blood flow
- motor areas of NS activated to cause
exercise most of the RAS in the brain is also
activated----cardio accelerator
2. alarm reaction inc arterial P to immediately
supply blood to muscles that might need to
respond instantly to flee from perceived danger
 Reflex Mechanism for Maintaining
Arterial Pressure
there are multiple subconscious special
nervous control mechanisms that operate all
the time
to maintain the arterial pressure at or near
normal.
Almost all of these are negative feedback
reflex mechanisms
 Reflex Mechanism for Maintaining
Arterial Pressure
A rise in arterial pressure
stretches the
baroreceptors and causes
them to transmit signals
into the central nervous
system.
Feedback signals are
then sent back through
the autonomic nervous
system to the circulation
to reduce arterial
pressure downward
toward the normal level.
 Reflex Mechanism for Maintaining
Arterial Pressure
Arterial Baroreceptor
Reflex Control System
- Initiated by stretch
receptors
(baroreceptors)
- Walls of large systemic
arteries (carotid sinus &
aortic arch)
 Reflex Mechanism for Maintaining
Arterial Pressure
Baroreceptor is located in adventitia of
carotid sinus and aortic arch
Characteristics:
a. Response to stretch, not to pressure
itself
b. Activity is directly related to BP level
c. More sensitive to pulsatile pressure
than nonpulsatile pressure.
Reflex Mechanism for Maintaining
Arterial Pressure
inc BP

Carotid &aortic (inc. impulse firing)

receptors

NTS
vagal center cardiac vagus HR

cardiac symp TPR

CVLM RVLM CO

inh vasoconstrictor PR
dec BP
Inhibition of symphathetic
and stimulation of
parasympathetic activity
1. Vasodilation of veins and
arterioles
2. Dec. HR
3. Dec. strength of
contraction
--- dec in arterial P due to
dec in peripheral resistance,
dec CO----
 Baroreceptors as a Buffer
Maintains arterial Pressure during:
1. Changes in body posture
- supine- upright = P in head and upper parts
fall --- reduction in P dec. signals sent to
vasomotor centers --- strong sympa act
--non- functional baroreceptors dec cerebral
blood flow ---LOC
 Baroreceptors as a Buffer
Maintains arterial Pressure during:
2. Daily activities (eating, excitement,defacation)
--inc P
primary purpose:
To reduce daily variation in arterial Pressure.
Baroreceptors buffer
 Control of Arterial Pressure:
Chemoreceptor
O2 lack
CO2 excess
H+ excess

-----carotid bodies
----- aortic bodies
Significances of chemoreceptor reflex
Under normal condition chemoreflex
plays a litte role in control of
cardiovascular activity, but in an
emergency (asphyxia, hypoxia, acidosis,
severe hypotension) blood pressure is
maintained by this reflex.
Kidneys in the Long-term control of
Arterial Pressure
- Closely linked to control
of body fluid volume by
the kidneys
- renal-body fluid
feedback system
- renal sodium
excretion/reabsorption
- Water
excretion/reabsorption
- Slow mechanism but
most potent for long term
BP regulation
 Renal output of salt and water

- Effect of arterial P on urine output

- Pressure diuresis( inc output volume)
- Pressure natriuresis (Na)
- Balance bet renal output and intake of salt
and water
 Renal output of salt and water
2 factors determining
long-term arterial P
1. Renal output curve for
salt and water
2. The level of salt and
water intake
--so long as these 2 factors
remains constant, arterial
P also remains exactly at
normal level of 100mmHg.
Renin-Angiotensin-Aldosterone System
 JG cells
Renin is synthesized and
stored in
juxtaglomerular cells
(JG cells) of the kidneys.
JG cells are modified
smooth muscle cells
located in the walls of
the afferent arteriole
 RAA syatem
Angiotensin II
1. Constricts efferent
arterioles

2.salt and water retention

---inc bld volume ---inc BP

 RAA syatem
Angiotensin II
3.Stimulates adrenal
glands
- Secrete aldosterone
- inc salt and water
reabsorption by the
epithelial cells of renal
tubules.
--- inc blood volume--- inc
BP
Volume loading and hypertension
Artificial kidneys
Tumor of adrenal glands
--excessive aldosterone
 Causes of hypertension
Impaired renal circulation
1. Constriction of the
afferent arterioles
2. Stenosis of renal
arteries
3. Dec. GFR
 Causes of hypertension
4. one-kidney Goldblatt
hypertension
5. two-kidney Goldblatt
hypertension
6. Coarctation of the aorta
7. Pathcy ischemia of one
or both kidneys
 Causes of hypertension
8. Toxemia of pregnancy
-- impaired renal
natriuresis
- Thickening of
glomerular membranes
9. primary/essential
hypertension
-90%
Thank you..
 Regulators of the Heart:
Factors Influencing Stroke Volume

Figure 14-31: Factors that affect cardiac output