L-Arginine infusion has no effect on systemic haemodynamics in
|
|
- Owen Ramsey
- 6 years ago
- Views:
Transcription
1 Br J clin Pharmac 1993; 36: L-Arginine infusion has no effect on systemic haemodynamics in normal volunteers, or systemic and pulmonary haemodynamics in patients with elevated pulmonary vascular resistance S. V. BAUDOUIN', P. BATH2, J. F. MARTIN2, R. DU BOIS' & T. W. EVANS1 'The Intensive Care Unit and Department of Thoracic Medicine, The National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, 2The Department of Medicine, King's College School of Medicine and Dentistry, Bessemer Road, London SE5 9PJ and 3The Department of Rheumatology, Royal Free Hospital, Pond Street, London NW3 2QG 1 The evidence that the infusion of L-arginine, the precursor of endothelium-derived relaxing factor (EDRF)/nitric oxide (NO), may reduce systemic blood pressure, via the generation of intracellular cyclic guanosine-3,5-monophosphate(cgmp), in normotensive volunteers is controversial. In the first part of the study we investigated the effect of an L-arginine infusion on systemic blood pressure and plasma cgmp in healthy volunteers. 2 Patients with systemic sclerosis have widespread endothelial damage which, by reducing the release of NO, could contribute to the raised pulmonary vascular resistance (PVR) often found in this condition. We hypothesised that if there were a failure of NO synthesis this might be overcome by infusing L-arginine into the pulmonary artery, thereby lowering PVR. In the second part of the study we investigated the effect of L-arginine infusion on systemic and pulmonary haemodynamics, and on plasma cgmp levels in patients with pulmonary hypertension and systemic sclerosis. 3 L-arginine (500 mg kg-1) was infused over 30 min into five normotensive volunteers and five patients with systemic sclerosis and pulmonary hypertension. Blood pressure, heart rate and skin temperature were measured non-invasively in the volunteers and systemic and pulmonary haemodynamics recorded via radial artery cannulae and balloon-tipped, flow directed, pulmonary artery catheters in the patients with systemic sclerosis. 4 L-arginine had no significant effect on blood pressure, heart rate or skin temperature in the normotensive volunteers nor on systemic or pulmonary haemodynamics in the systemic sclerotic group. Cyclic-GMP levels did not significantly change in either group. 5 In both normotensive volunteers and patients with pulmonary hypertension and systemic sclerosis, EDRF/NO release is unlikely to be substrate-limited by the availability of L-arginine. Keywords L-arginine vasodilation endothelium-derived relaxing factor pulmonary hypertension systemic sclerosis systemic blood pressure haemodynamics Introduction Nitric oxide (NO), which accounts for the biological essential amino acid, L-arginine [3] and relaxes smooth activity of endothelium-derived relaxing factor (EDRF) muscle by stimulating soluble guanylate cyclase and [1], is released by endothelial cells lining blood vessels thereby raising intracellular cyclic guanosine-3,5- and causes relaxation of vascular smooth muscle cells monophosphate (cgmp) concentrations [4]. [2]. NO is synthesised by NO synthase from the semi- Evidence now suggests that NO contributes to the Correspondence: Dr T. W. Evans, The Royal Brompton National Heart and Lung Hospital, Sydney Street, London SW3 6LY 45
2 46 S. V. Baudouin et al. regulation of basal blood pressure and flow through its inhibitory effect on vascular smooth muscle cell tone. NO synthesis may be inhibited using the competitive antagonist of L-arginine, NG-monomethyl-L-arginine (L-NMMA), which increases blood pressure in anaesthetized rabbits [5]. Similarly, L-NMMA infused locally into human forearm arteries [6] results in vasoconstriction and reduced blood flow. NO-dependent dilatation is known to be reduced in systemic and pulmonary hypertension [7-10], hypercholesterolaemia [11, 12] and atherosclerosis [12, 13], both in experimental animals and man suggesting that attenuated EDRF/NO function may be a general finding in vascular disease. Intravenous infusions of L-arginine have been reported to lower blood pressure acutely in man [14, 15] and in some laboratory studies [16], but not in others [5, 17]. Similarly, the endothelial dysfunction present in the coronary micro-circulation of hypercholesterolaemic patients may be corrected with the intra-coronary infusion of L-arginine [18]. Evidence that these effects are mediated by the conversion of L-arginine to NO, and thence the stimulation of vascular soluble guanylate cyclase and intracellular cgmp concentrations, is suggested by a small rise in both plasma cgmp and L-citrulline levels (a by-product of the conversion of L-arginine to EDRF/NO) [15, 19] and urinary nitrite/ nitrate concentrations [15]. However, others have challenged this interpretation suggesting that L-arginine does not lower blood pressure by this mechanism since D-arginine (which does not form EDRF/NO) also modulated blood flow [20]. Widespread endothelial damage occurs in patients with systemic sclerosis [21-23], a condition frequently complicated by increased pulmonary vascular resistance (PVR) [24]. We hypothesised that EDRF/NO synthesis and release might be impaired in such patients and that L-arginine, by increasing substrate availability, might increase EDRF release and lower vascular resistance. To investigate the effect of L-arginine on systemic blood pressure we performed a study infusing L-arginine intravenously into normal volunteers. Secondly, L-arginine was infused into the pulmonary artery of patients with systemic sclerosis and pulmonary hypertension and its effects on haemodynamics measured. In both studies the effects of L-arginine on plasma cgmp concentrations was also assessed. Methods Normal volunteers Five healthy male volunteers (age range years) who were not taking any medication were studied in the Intensive Care Unit. Peripheral, venous cannulae (Abbocath 20G, Abbott Ireland Ltd, Sligo, Ireland) were inserted under sterile conditions into both antecubital fossae. Supine blood pressure was measured non-invasively and automatically (Hewlett Packard Careview 9000, Hewlett Packard CA, USA) and heart rate, electrocardiography (lead II), and skin temperature were recorded. At 4 min intervals throughout the study systolic, diastolic and mean arterial pressures, heart rate and skin temperature were recorded. L-arginine monochloride (Guy's Hospital, London, UK) was infused into the left antecubital vein to give a total dose of 500 mg kg-' [19] over a 30 min period. Venous blood samples were taken 15 min before the start of the infusion and then at 20 min into the infusion period. These samples were assayed for cyclic 3'- 5 '-guanosine monophosphate levels (see below). Measurements were made for 30 min following the end of the infusion. Patients with systemic sclerosis and pulmonary hypertension Five patients with systemic sclerosis (all meeting the American Rheumatology Association criteria for diagnosis) who were undergoing right heart catheterization for the diagnosis or management of pulmonary hypertension were studied. Systemic supine blood pressure was monitored by a radial arterial line (Abbocath 20G, Abbott Ireland Ltd, Sligo, Ireland). A balloontipped, flow-directed, thermodilution pulmonary artery catheter (Arrow Thermodilution catheter, AH H, Arrow International, Pennsylvania, USA) was introduced by an internal jugular venous approach. Systemic and pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output (Hewlett Packard 66S, Hewlett Packard CA, USA) and arterial and mixed venous oxygen saturations were measured at 10 min intervals for 30 min before the start of the L-arginine infusion and at 10 min intervals throughout the study. Cardiac output was measured by thermodilution. L-arginine monochloride (Guy's Hospital, London, UK) was infused into the pulmonary artery at a total body dose of 500 mg kg-' over a 30 min period. Cardiac index, systemic and pulmonary vascular resistances were calculated. Venous blood samples were taken 15 min prior to the start of the infusion and at 20 min into the infusion period for the assay of 3'- 5'-guanosine monophosphate concentrations. Measurements continued to be made for 30 min following the end of the infusion. The study protocols were approved by the Ethics Committee of the Royal Brompton National Heart and Lung Hospital and informed, written consent was obtained from all subjects and patients studied. Cyclic GMP assay Venous blood was taken onto edetic acid and centrifuged at 400 C. The separated plasma aliquots were frozen at -70 C prior to assay. cgmp concentrations were measured by radioimmunoassay (Amersham, Aylesbury, UK) according to the manufacturer's instructions; plasma samples were acetylated before analysis [25]. Statistics Mean (s.d.) values are presented for each set of data. Two-way analysis of variance (ANOVA) was performed for the haemodynamic data for both volunteers and patients for the five time points studied; multiple comparisons were not undertaken since the ANOVA did not reveal any significant differences at any time-point.
3 L-arginine and haemodynamics 47 Baseline and 20 min cgmp concentrations were compared by paired t-test. Probability values of P < 0.05 were considered significant. Results Normal volunteers The mean values for all the measured haemodynamic parameters are shown in Table 1. There were no significant changes recorded in pulse rate (F = 0.99, P = 0.44), mean systemic systolic (F = 0.67, P = 0.62) or diastolic blood pressure (F = 2.12, P = 0.13) or skin temperature (F = 0.17, P = 0.95) during the infusion of L-arginine. Similarly, basal and peri-infusion (20 min) cyclic GMP concentrations were not significantly different (Table 2, P = 0.99). Systemic sclerosis Haemodynamic data are shown in Table 3. Pulmonary artery pressure and vascular resistance were raised in all patients. There were no significant changes in any of the parameters measured including heart rate (F = 0.31, P = 0.87), mean systemic systolic (F = 1.21, P = 0.38) or diastolic arterial pressure (F = 2.41, P = 0.13), mean pulmonary systolic (F = 1.17, P = 0.39) or diastolic artery pressure (F = 2.95, P = 0.09), cardiac output (F = 0.05, P = 0.99), systemic vascular resistance (F = 0.08, P 0.99), pulmonary vascular resistance (F = 0.05, P = 1.00) or mixed venous oxygen saturation (F = 0.17, P = 0.95). Plasma cgmp concentrations did Table 1 Mean (s.d.) pulse rate, systolic and diastolic arterial pressure and skin temperature during L-arginine infusion in the five volunteers. Comparison by two-way analysis of variance Systolic Diastolic Skin Time Pulse rate pressure pressure temperature (min) (beats min-') (mm Hg) (mm Hg) (OC) Pre-infusion 71 (6) 121 (9) 63 (2) 30.5 (1.6) 0 72 (7) 120 (6) 61 (6) 29.9 (1.5) (6) 119 (7) 58 (6) 30.0 (1.8) (5) 120 (7) 59 (1) 30.0 (1.2) Post-infusion 75 (10) 119 (6) 61 (4) 29.8 (1.1) F value P value Table 2 Mean (s.d.) cyclic GMP concentrations (nm) in plasma before, and during L-arginine infusion, in the control subjects and patients with systemic sclerosis. Comparison by paired t-test Controls Patients Plasma [cgmp] (0.33) (0.10) (1.51) (0.81) P value not change during the infusion of L-arginine (Table 2, P = 0.63). Discussion Infusion of L-arginine into healthy volunteers did not produce any significant change in systemic haemodynamics as assessed by non-invasive methods. This finding contradicts previous reports that L-arginine infusion reduces blood pressure in healthy normotensive subjects [14, 15], but is similar to studies suggesting that L-arginine has no effect on blood pressure in some animal species [5, 17]. L-arginine is a precursor of EDRF/NO and could increase the synthesis and release of NO if this reaction is substrate-limited at physiological concentrations of L-arginine. Intra-arterial infusions into the forearm of both L-arginine and D-arginine only increase blood flow at high concentrations [9, 20] and since D-arginine is not a substrate for EDRF/NO synthesis it is likely that vasodilation was not mediated by increased release of EDRF/NO. In addition, results from both animal and in vitro studies suggest that the supply of L-arginine is not normally the rate-limiting step for EDRF/NO synthesis in endothelial cells [26, 27]. Abnormalities of EDRF/NO release have been reported in secondary pulmonary hypertension in both experimental studies and in pulmonary vascular rings from patients undergoing lung transplantation [10]. The loss of intrinsic vasodilation could then contribute to the rise in pulmonary vascular resistance. Pulmonary hypertension is relatively common in patients with systemic sclerosis [24]. Endothelial damage occurs in both the systemic and pulmonary circulations in systemic sclerosis [21, 23] and we hypothesised that this could also lead to the loss of EDRF/NO release. Although the synthesis of NO is unlikely to be limited by lack of L-arginine in normal endothelial cells, a relative lack of substrate could reduce NO production in damaged cells. However, infusion of L-arginine did not significantly alter either pulmonary or systemic haemodynamics in our patients. Equally important, cgmp levels did not change suggesting that intracellular second messenger activity is not inducible by L-arginine. Limitation of L-arginine is therefore unlikely to contribute to the pulmonary hypertension of systemic sclerosis. The discrepancies between the previously published results showing that L-arginine lowers blood pressure in man [14, 15] and our present findings are difficult to explain since similar protocols (including quantity and form of L-arginine) were followed. Firstly, it could be argued that our results do not exclude an effect of L-arginine on blood pressure, and perhaps NO synthesis, in view of the relatively small number of subjects studied (a type II statistical error). However, our sample size is similar to that used in the studies that originally showed the hypotensive effect of infused L-arginine [14, 15]. Secondly, despite the identical infusion rates of L-arginine used in both studies it is possible that the blood levels of L-arginine achieved were higher in the volunteers in Nakaki's study and produced vasodilation by non-specific mechanisms, as reported by Calver in the forearm [9, 20] and others in isolated vessels in vitro [27].
4 48 S. V. Baudouin et al. Table 3 Mean (s.d.) heart rate (HR), mean systolic (MSAP) and diastolic (MDAP) systemic arterial pressures, mean systolic (MSPAP) and diastolic (MDPAP) pulmonary artery (MPAP) pressures, cardiac output (CO), systemic (SVR) and pulmonary (PVR) vascular resistance and mixed venous oxygen saturations (MvSaO2) during L-arginine infusion in the five patients with systemic sclerosis. Comparison by two-way analysis of variance HR SVR PVR Time (beats MSAP MDAP MSPAP MDPAP (dyn s- (dyn s- MvSaO2 (min) min-) (mmhg) (mmhg) (mmhg) (mmhg) CO(lmin-) cm-5) cm-5) (%) Preinfusion 91 (3) 139 (20) 72 (6) 58 (28) 22 (13) 4.7 (0.6) 1427 (50) 530 (341) 72 (1) (2) 136 (12) 66 (5) 59 (30) 22 (12) 5.1 (1.3) 1366 (182) 470 (318) (4) 134 (18) 66 (7) 60 (32) 23 (13) 5.1 (1.6) 1379 (285) 518 (363) (3) 136 (7) 64 (4) 56 (30) 25 (14) 5.1 (1.8) (305) (404) Postinfusion 88 (5) 145 (10) 66 (5) 58 (32) 24 (14) 5.2 (1.6) 1297 (257) 472 (317) 72 (1) F value P value Finally, it is noteworthy that the positive and negative studies were performed in Japanese and Caucasian subjects respectively. This raises the possibility that racial differences exist in blood pressure sensitivity to L-arginine, perhaps related to genetic differences in NO synthase [28]. Dr P. Bath was supported by a Medical Research Council grant, Professor J. F. Martin is British Heart Foundation Professor of Cardiovascular Science. The authors gratefully acknowledge the technical assistance of Dr E. Nava. References 1 Palmer RMJ, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature 1987; 327: Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980; 288: Palmer RMJ, Ashton DS, Moncada S. Vascular endothelial cells synthesize nitric oxide from L-arginine. Nature 1988; 333: Rapoport RM, Draznin MB, Murad F. Endotheliumdependent relaxation in rat aorta may be mediated through cyclic GMP-dependent protein phosphorylation. Nature 1983; 306: Rees DD, Palmer RMJ, Moncada S. Role of endotheliumderived nitric oxide in the regulation of blood pressure. Proc Natl Acad Sci 1989; 86: Vallance P, Collier J, Moncada S. Effects of endotheliumderived nitric oxide on peripheral arteriolar tone in man. Lancet 1989; ii: Linder L, Kiowski W, Buhler FR, Luscher TF. Indirect evidence for release of endothelium-derived relaxing factor in human forearm circulation in vivo. Blunted response in essential hypertension. Circulation 1990; 81: Panza JA, Quyyumi AA, Brush JE, Epstein SE. Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. New Engl J Med 1990; 323: Calver A, Collier J, Vallance P. Dilator actions of arginine in human peripheral vasculature. Clin Sci 1991; 81: Cremona G, Dinh-Xuan AT, Higenbottam TW. Endothelium-derived relaxing factor and the pulmonary circulation. Lung 1991; 169: Creager MA, Cooke JP, Mendelsohn ME et al. Impaired vasodilation of forearm resistance vessels in hypercholesterolemic humans. J clin Invest 1990; 86: Shimokawa H, Vanhoutte PM. Impaired endotheliumdependent relaxation to aggregating platelets and related vasoactive substances in porcine coronary arteries in hypercholesterolemia and atherosclerosis. Circ Res 1989; 64: Jayakody L, Kappagoda T, Senaratne MPJ, Thomson ABR. Impairment of endothelium-dependent relaxation: an early marker for atherosclerosis in the rabbit. Br J Pharmac 1988; 94: Nakaki T, Hishikawa K, Suzuki H, Saruta T, Kato R. L-arginine-induced hypotension. Lancet 1990; 336: Hishikawa K, Nakaki T, Tsudu M et al. Effect of systemic L-arginine administration on hemodynamics and nitric oxide release in man. Jap Heart J 1992; 33: Cernadas MR, Riesco A, Gallego MJ et al. L-arginineinduced hypotension. Lancet 1990; 336: Murakami M, Suzuki H, Ichihara A, Naitoh M, Nakamoto H, Saruta T. Effects of L-arginine on systemic and renal haemodynamics in conscious dogs. Clin Sci 1990; 81: Drexler H, Zeiher AM, Meinzer K, Just H. Correction of endothelial dysfunction in coronary microcirculation of hypercholesterolaemic patients by L-arginine. Lancet 1991; 338: Hishikawa K, Nakaki T, Suzuki H, Saruta T, Kato R. L-arginine-induced hypotension. Lancet 1991; 337: Calver A, Collier J, Vallance P. L-arginine-induced hypotension. Lancet 1990; 336: Harrison NK, Myers AR, Corrin B et al. Structural features
5 L-arginine and haemodynamics 49 of interstitial lung disease in systemic sclerosis. Am Rev resp Dis 1991; 144: Loscalzo J. Endothelial dysfunction in pulmonary hypertension. New Engl J Med 1992; 327: Christman BW, McPherson CD, Newman JH et al. An imbalance between the excretion of thromboxane and prostacyclin metabolites in pulmonary hyptertension. New Engl J Med 1992; 327: Ungerer RG, Tashkin DP, Furst D, Clements PJ, Gong H, Bein M, Smith JW, Roberts N, Cabeen W. Prevalence and clinical correlates of pulmonary arterial hypertension in progressive systemic sclerosis. Am J Med 1983; 75: Schulz R, Nava E, Moncada S. Induction and potential biological relevance of a Ca2+-independent nitric oxide synthase in the myocardium. Br J Pharmac 1992; 105: Gold ME, Bush PA, Ignarro LJ. Depletion of arterial L-arginine causes reversible tolerance to endotheliumdependent relaxation. Biochem Biophys Res Comm 1989; 164: Schmidt HHHW, Baeblich SE, Zernikow BC, Klein MM, Bohme E. L-arginine and arginine analogues: effects on isolated blood vessels and cultured endothelial cells. Br J Pharmac 1990; 101: Rees DD, Cellek S, Palmer RMJ, Moncada S. Dexamethasone prevents the induction by endotoxin of a nitric oxide synthase and the associated effects on vascular tone: an insight into endotoxic shock. Biochem Biophys Res Comm 1990; 173: (Received 30 July 1992, accepted 31 March 1993)
PCTH 400. Endothelial dysfunction and cardiovascular diseases. Blood vessel LAST LECTURE. Endothelium. High blood pressure
PCTH 400 LAST LECTURE Endothelial dysfunction and cardiovascular diseases. Classic Vascular pharmacology -chronic -systemic Local Vascular pharmacology -acute -targeted High blood pressure Blood pressure
More informationEndothelium. A typical endothelial cell is about 30mm long, Accounts for 1% or less of the arterial weight
Endothelium Discovered in 1845 A typical endothelial cell is about 30mm long, 10mm wide, and 0.2 3 mm thick Accounts for 1% or less of the arterial weight As recently as the late 1960s it was thought of
More informationEffects of angiotensin converting enzyme inhibition on endothelial vasodilator function in primary human hypertension
European Heart Journal (1993) 14 (Supplement C), 5-9 Effects of angiotensin converting enzyme inhibition on endothelial vasodilator function in primary human hypertension W. KlOWSKI*, L. LlNDERt, R- NUESCHt
More informationImpaired vasodilation of peripheral response to acetylcholine in human with abdominal aortic aneurysm
Impaired vasodilation of peripheral response to acetylcholine in human with abdominal aortic aneurysm arteries beings in Kimihiro Komori, MD, PhD, Kyoutaro Mawatari, MD, Hiroyuki Itoh, MD, and Keizo Sugimachi,
More informationEffects of L-Arginine on Forearm Vessels and Responses to Acetylcholine
511 Effects of on Forearm Vessels and Responses to Acetylcholine Tsutomu Imaizumi, Yoshitaka Hirooka, Hiroyuki Masaki, Seiki Harada, Michiko Momohara, Tatsuya Tagawa, and Akira Takeshita This study was
More informationPulmonary Hypertension. Murali Chakinala, M.D. Washington University School of Medicine
Pulmonary Hypertension Murali Chakinala, M.D. Washington University School of Medicine Pulmonary Circulation Alveolar Capillary relationship Pulmonary Circulation High flow, low resistance PVR ~1/15 of
More informationThe dynamic regulation of blood vessel caliber
INVITED BASIC SCIENCE REVIEW The dynamic regulation of blood vessel caliber Colleen M. Brophy, MD, Augusta, Ga BACKGROUND The flow of blood to organs is regulated by changes in the diameter of the blood
More informationRole of Endothelial Nitric Oxide in Shear Stress Induced Vasodilation of Human Microvasculature
Role of Endothelial Nitric Oxide in Shear Stress Induced Vasodilation of Human Microvasculature Diminished Activity in Hypertensive and Hypercholesterolemic Patients Oscar A. Paniagua, MD; Melissa B. Bryant,
More informationRegular Aerobic Exercise Augments Endothelium- Dependent Vascular Relaxation in Normotensive As Well As Hypertensive Subjects
Regular Aerobic Exercise Augments Endothelium- Dependent Vascular Relaxation in Normotensive As Well As Hypertensive Subjects Role of Endothelium-Derived Nitric Oxide Yukihito Higashi, MD, PhD; Shota Sasaki,
More informationTreatment of Acute Pulmonary Hypertension With Inhaled Nitric Oxide
Treatment of Acute Pulmonary Hypertension With Inhaled Nitric Oxide Martin Tonz, MD, Ludwig K. von Segesser, MD, Julian Schilling, MD, Thomas F. Luscher, MD, Georg Noll, MD, Boris Leskosek, BA, and Marko
More informationEndothelial cells play a key role in the local regulation
929 Vasodilation to Acetylcholine in Primary and Secondary Forms of Human Hypertension Stefano Taddei, Agostino Virdis, Paola Mattei, and Antonio Salvetti Endothelium-dependent vasodilatation to acetylcholine
More informationEndothelial regulation of vascular tone
Postgrad Med J (1992) 68, 697-701 i) The Fellowship of Postgraduate Medicine, 1992 Leading Article Endothelial regulation of vascular tone Patrick Vallance Department ofpharmacology & Clinical Pharmacology,
More informationFAILURE IN PATIENTS WITH MYOCARDIAL INFARCTION
Br. J. clin. Pharmac. (1982), 14, 187S-19lS BENEFICIAL EFFECTS OF CAPTOPRIL IN LEFT VENTRICULAR FAILURE IN PATIENTS WITH MYOCARDIAL INFARCTION J.P. BOUNHOURE, J.G. KAYANAKIS, J.M. FAUVEL & J. PUEL Departments
More informationAcute Vascular Effects of Estrogen
786 Acute Vascular Effects of Estrogen in Postmenopausal Women David M. Gilligan, MD; Diane M. Badar, RN; Julio A. Panza, MD; Arshed A. Quyyumi, MD; Richard. Cannon III, MD Downloaded from http://ahajournals.org
More informationIntroduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring
Introduction Invasive Hemodynamic Monitoring Audis Bethea, Pharm.D. Assistant Professor Therapeutics IV January 21, 2004 Hemodynamic monitoring is necessary to assess and manage shock Information obtained
More informationDoes Acute Improvement of Endothelial Dysfunction in Coronary Artery Disease Improve Myocardial Ischemia?
904 JACC Vol. 32, No. 4 MYOCARDIAL ISCHEMIA Does Acute Improvement of Endothelial Dysfunction in Coronary Artery Disease Improve Myocardial Ischemia? A Double-Blind Comparison of Parenteral D- and L-Arginine
More informationTopics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow
Topics to be Covered MODULE F HEMODYNAMIC MONITORING Cardiac Output Determinants of Stroke Volume Hemodynamic Measurements Pulmonary Artery Catheterization Control of Blood Pressure Heart Failure Cardiac
More informationThe Study of Endothelial Function in CKD and ESRD
The Study of Endothelial Function in CKD and ESRD Endothelial Diversity in the Human Body Aird WC. Circ Res 2007 Endothelial Diversity in the Human Body The endothelium should be viewed for what it is:
More informationEffect of L-Arginine on Human Coronary Endothelium-Dependent and Physiologic Vasodilation
1220 JACC Vol. 30, No. 5 Effect of L-Arginine on Human Coronary Endothelium-Dependent and Physiologic Vasodilation ARSHED A. QUYYUMI, MD, FACC, NADER DAKAK, MD, JEAN G. DIODATI, MD, FACC, DAVID M. GILLIGAN,
More informationAging is a well-documented cardiovascular risk factor.
Physical Activity Prevents Age-Related Impairment in Nitric Oxide Availability in Elderly Athletes Stefano Taddei, MD; Fabio Galetta, MD; Agostino Virdis, MD; Lorenzo Ghiadoni, MD; Guido Salvetti, MD;
More informationIncreased forearm vascular resistance after dopamine blockade
Br. J. clin. Pharnac. (1984), 17, 373-378 Increased forearm vascular resistance after dopamine blockade D. MANNERING, E.D. BENNE7T, N. MEHTA & F. KEMP Department of Medicine 1, St George's Hospital Medical
More informationHemodynamic Monitoring and Circulatory Assist Devices
Hemodynamic Monitoring and Circulatory Assist Devices Speaker: Jana Ogden Learning Unit 2: Hemodynamic Monitoring and Circulatory Assist Devices Hemodynamic monitoring refers to the measurement of pressure,
More informationReversal by L-arginine of a dysfunctional arginine/nitric oxide pathway in the endothelium of the genetic diabetic BB rat
Diabetologia (1997) : 91 915 Springer-Verlag 1997 Reversal by L-arginine of a dysfunctional arginine/nitric oxide pathway in the endothelium of the genetic diabetic BB rat G.M. Pieper, W. Siebeneich, G.
More informationA. HOLiiCYOVA, J. TOROK, I. BERNATOVA, O. PECHANOVA
Physiol. Res. 45: 317-321, 1996 Restriction of Nitric Oxide Rather than Elevated Blood Pressure is Responsible for Alterations of Vascular Responses in Nitric Oxide-Deficient Hypertension A. HOLiiCYOVA,
More informationDisclosures. Objectives 6/16/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension
A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension Susan P. D Anna MSN, APN-BC, CHFN June 24, 2016 Disclosures Objectives Differentiate structure and function of RV and LV
More informationChapter 14 Blood Vessels, Blood Flow and Pressure Exam Study Questions
Chapter 14 Blood Vessels, Blood Flow and Pressure Exam Study Questions 14.1 Physical Law Governing Blood Flow and Blood Pressure 1. How do you calculate flow rate? 2. What is the driving force of blood
More informationvascular smooth muscle and platelet aggregation
Br. J. Pharmacol. (1989), 98, 1275-1280 Interactions of iloprost and sodium nitroprusside on vascular smooth muscle and platelet aggregation 1 Paul S. Lidbury, 2Edson Antunes, 2Gilberto de Nucci & John
More informationTechnique. Technique. Technique. Monitoring 1. Local anesthetic? Aseptic technique Hyper-extend (if radial)
Critical Care Monitoring Hemodynamic Monitoring Arterial Blood Pressure Cannulate artery Uses 2 Technique Sites Locate artery, prep 3 1 Technique Local anesthetic? Aseptic technique Hyper-extend (if radial)
More informationEVects of L- and D-arginine on the basal tone of human diseased coronary arteries and their responses to substance P
Heart 1999;81:55 511 55 Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece D Tousoulis C Tentolouris G Katsimaglis C Stefanadis P Toutouzas Cardiology Unit, Imperial
More informationChapter 9. Body Fluid Compartments. Body Fluid Compartments. Blood Volume. Blood Volume. Viscosity. Circulatory Adaptations to Exercise Part 4
Body Fluid Compartments Chapter 9 Circulatory Adaptations to Exercise Part 4 Total body fluids (40 L) Intracellular fluid (ICF) 25 L Fluid of each cell (75 trillion) Constituents inside cell vary Extracellular
More information27 part 2. Laith Abu Shekha. Mamoon Al-qatameen
27 part 2 Laith Abu Shekha Mamoon Al-qatameen Ebaa Alzayadneh In this sheet we will continue talking about second messengers for hormone that can t cross PM. D. Ca +2 as a second messenger: Another second
More informationINTRODUCTION. Regulation of blood flow to skeletal muscles during exercise
INTRODUCTION The human body is a multi-cell organism in which all cells require delivery of oxygen (O2) and nutrients as well as removal of byproducts of metabolism. The cardiovascular system facilitates
More informationRelationship between serum glutathione peroxidase-1activity with endothelial dysfunction level in patients with coronary artery diseases
Relationship between serum glutathione peroxidase-1activity with endothelial dysfunction level in patients with coronary artery diseases Introduction Reactive oxygen species (ROS),such as superoxide and
More informationImpairment of the Nitric Oxide Mediated Vasodilator Response to Mental Stress in Hypertensive But Not in Hypercholesterolemic Patients
1207 Impairment of the Nitric Oxide Mediated Vasodilator Response to Mental Stress in But Not in CARMINE CARDILLO, MD, CRESCENCE M. KILCOYNE, RN, MS, RICHARD O. CANNON, III, MD, JULIO A. PANZA, MD Bethesda,
More informationThe Role of Massage in Blood Circulation, Pain Relief, and the Recovery Process: Implications of Existing Research
The Role of Massage in Blood Circulation, Pain Relief, and the Recovery Process: Implications of Existing Research I. Basic Physiology of Circulation A. The Vascular Endothelium The endothelium is a complex
More informationThe Hemodynamics of PH Interpreting the numbers
The Hemodynamics of PH Interpreting the numbers Todd M Bull MD Associate Professor of Medicine Division of Pulmonary Sciences and Critical Care Medicine Pulmonary Hypertension Center University of Colorado
More informationTreatment of T Angina reatment of By Ali Alalawi
Treatment of Angina By Ali Alalawi Determinants of Oxygen Demand Need to improve ratio of: Coronary blood flow / cardiac work Or Cardiac O2 Supply / Cardiac Requirement Coronary Circulation vs Other Circulation
More informationP or bradykinin is specifically inhibited by the L- (Rees et al., 1989b). In the present study in the anaesthetized rat, the
Br. J. Pharmacol. (1989), 98, 646-652 Modulation of the vasodepressor actions of acetylcholine, bradykinin, substance P and endothelin in the rat by a specific inhibitor of nitric oxide formation 1B.J.R.
More informationSHOCK AETIOLOGY OF SHOCK (1) Inadequate circulating blood volume ) Loss of Autonomic control of the vasculature (3) Impaired cardiac function
SHOCK Shock is a condition in which the metabolic needs of the body are not met because of an inadequate cardiac output. If tissue perfusion can be restored in an expeditious fashion, cellular injury may
More informationPharmacology. Drugs affecting the Cardiovascular system (Antianginal Drugs)
Lecture 7 (year3) Dr Noor Al-Hasani Pharmacology University of Baghdad College of dentistry Drugs affecting the Cardiovascular system (Antianginal Drugs) Atherosclerotic disease of the coronary arteries,
More informationImpedance Cardiography (ICG) Method, Technology and Validity
Method, Technology and Validity Hemodynamic Basics Cardiovascular System Cardiac Output (CO) Mean arterial pressure (MAP) Variable resistance (SVR) Aortic valve Left ventricle Elastic arteries / Aorta
More informationSCVMC RESPIRATORY CARE PROCEDURE
Page 1 of 7 New: 12/08 R: 4/11 R NC: 7/11, 7/12 B7180-63 Definitions: Inhaled nitric oxide (i) is a medical gas with selective pulmonary vasodilator properties. Vaso-reactivity is the evidence of acute
More informationCircadian Variation of Blood Pressure and Endothelial Function in Patients With Essential Hypertension: A Comparison of Dippers and Non-Dippers
Journal of the American College of Cardiology Vol. 40, No. 11, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)02535-4
More informationSynthesis of calcitonin gene-related peptide (CGRP) by rat arterial endothelial cells
Histol Histopathol (2001) 16: 1073-1 079 http://www.ehu.es/histol-histopathol Histology and Histopathology Cellular and Molecular Biology Synthesis of calcitonin gene-related peptide (CGRP) by rat arterial
More informationREGULATION OF CARDIOVASCULAR SYSTEM
REGULATION OF CARDIOVASCULAR SYSTEM Jonas Addae Medical Sciences, UWI REGULATION OF CARDIOVASCULAR SYSTEM Intrinsic Coupling of cardiac and vascular functions - Autoregulation of vessel diameter Extrinsic
More informationDiabetologia 9 Springer-Verlag 1993
Diabetologia (1993) 36:33-38 Diabetologia 9 Springer-Verlag 1993 Dietary fish oil augments nitric oxide production or release in patients with Type 2 (non-insulin-dependent) diabetes mellitus 1 1 1 1 1
More informationino in neonates with cardiac disorders
ino in neonates with cardiac disorders Duncan Macrae Paediatric Critical Care Terminology PAP Pulmonary artery pressure PVR Pulmonary vascular resistance PHT Pulmonary hypertension - PAP > 25, PVR >3,
More informationConduit Artery Constriction Mediated by Low Flow
Journal of the American College of Cardiology Vol. 51, No. 20, 2008 2008 by the American College of Cardiology Foundation ISSN 0735-1097/08/$34.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.01.049
More informationEndogenous nitric oxide: physiology, pathology and clinical relevance
European Journal of Clinical Investigation (1991) 21, 361-374 ADONIS 001 429729 1000522 REVIEW Endogenous nitric oxide: physiology, pathology and clinical relevance S. MONCADA & E. A. HIGGS, The Wellcome
More informationSupplemental Figure I
Supplemental Figure I Kl ( mmol/l)-induced Force orta M (mn) 1 (mn) 1 Supplemental Figure I. Kl-induced contractions. and, Kl ( mmol/l)-induced contractions of the aorta () and those of mesenteric arteries
More informationDisclosures. Objectives. RV vs LV. Structure and Function 9/25/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension
Disclosures A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension No financial relationships Susan P. D Anna MSN, APN BC, CHFN September 29, 2016 Objectives RV vs LV Differentiate
More informationPulmonary Hypertension Perioperative Management
Pulmonary Hypertension Perioperative Management Bruce J Leone, MD Professor of Anesthesiology Chief, Neuroanesthesiology Vice Chair for Academic Affairs Mayo Clinic Jacksonville, Florida Introduction Definition
More informationPharmacology - Problem Drill 11: Vasoactive Agents
Pharmacology - Problem Drill 11: Vasoactive Agents Question No. 1 of 10 1. Vascular smooth muscle contraction is triggered by a rise in. Question #01 (A) Luminal calcium (B) Extracellular calcium (C) Intracellular
More informationGadolinium Effect of Experimental Orthostatic Hypotension
[Index FAC] [FVCC Index] Otras Unidades Temáticas /Other Thematics Units Gadolinium Effect of Experimental Orthostatic Hypotension Zarco Olvera G., Pastelín Hernández G. Departamento de Farmacología, Instituto
More informationRevision. General functions of hormones. Hormone receptors. Hormone derived from steroids Small polypeptide Hormone
االله الرحمن الرحيم بسم Revision General functions of hormones. Hormone receptors Classification according to chemical nature Classification according to mechanism of action Compare and contrast between
More informationNothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
More informationWhen fed a high salt diet, the Dahl salt-sensitive
290 Reduced Influence of Nitric Oxide on Arteriolar Tone in Hypertensive Dahl Rats Matthew A. Boegehold The aim of this study was to evaluate the influence of endogenous nitric oxide on resting microvascular
More informationExam KEY. NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 23, 2015 Total POINTS: % of grade in class
NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 23, 2015 Total POINTS: 100 20% of grade in class 1) Arterial and venous blood samples are taken, and other physiological measures are obtained, from a
More informationMagnesium is a key ionic modulator of blood vessel
Hypomagnesemia Inhibits Nitric Oxide Release From Coronary Endothelium: Protective Role of Magnesium Infusion After Cardiac Operations Paul J. Pearson, MD, PhD, Paulo R. B. Evora, MD, PhD, John F. Seccombe,
More informationThe mechanisms through which diabetic hyperglycemia
AJH 2001; 14:126S 131S Arterial Pressure Control at the Onset of Type I Diabetes: The Role of Nitric Oxide and the Renin-Angiotensin System Michael W. Brands and Sharyn M. Fitzgerald Little is known about
More informationBlood Pressure. a change in any of these could cause a corresponding change in blood pressure
Blood Pressure measured as mmhg Main factors affecting blood pressure: 1. cardiac output 2. peripheral resistance 3. blood volume a change in any of these could cause a corresponding change in blood pressure
More informationEuropean Heart Journal (1999) 20, Article No. euhj , available online at on
European Heart Journal (1999) 20, 1676 1680 Article No. euhj.1999.1689, available online at http://www.idealibrary.com on Vitamin C improves endothelial function of epicardial coronary arteries in patients
More informationGeorgios C. Bompotis Cardiologist, Director of Cardiological Department, Papageorgiou Hospital,
Georgios C. Bompotis Cardiologist, Director of Cardiological Department, Papageorgiou Hospital, Disclosure Statement of Financial Interest I, Georgios Bompotis DO NOT have a financial interest/arrangement
More informationRole of Nitric Oxide in Reactive Hyperemia in Human Forearm Vessels
2285 Role of Nitric Oxide in in Human Forearm Vessels Tatsuya Tagawa, MD; Tsutomu Imaizumi, MD; Toyonari Endo, MD; Masanari Shiramoto, MD; Yasuhiko Harasawa, MD; Akira Takeshita, MD Background The role
More informationCentral haemodynamics during spontaneous angina pectoris
British Heart Journal, I974, 36, I0-I09I Central haemodynamics during spontaneous angina pectoris From the Department of Clinical Physiology, Malmo General Hospital, S-214 OI Malmo, Sweden. Central pressures
More informationPulmonary Vasodilator Treatments in the ICU Setting
Pulmonary Vasodilator Treatments in the ICU Setting Lara Shekerdemian Circulation 1979 Ann Thorac Surg 27 Anesth Analg 211 1 Factors in the ICU Management of Pulmonary Hypertension After Cardiopulmonary
More informationFluid bolus of 20% Albumin in post-cardiac surgical patient: a prospective observational study of effect duration
Fluid bolus of 20% Albumin in post-cardiac surgical patient: a prospective observational study of effect duration Investigators: Salvatore Cutuli, Eduardo Osawa, Rinaldo Bellomo Affiliations: 1. Department
More informationFUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART
FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART CINDY BITHER, MSN, ANP, ANP, AACC, CHFN CHIEF NP, ADV HF PROGRAM MEDSTAR WASHINGTON HOSPITAL CENTER CONFLICTS OF INTEREST NONE
More informationDIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE
DIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE Mefri Yanni, MD Bagian Kardiologi dan Kedokteran Vaskular RS.DR.M.Djamil Padang The 3rd Symcard Padang, Mei 2013 Outline Diagnosis Diagnosis Treatment options
More informationBlood pressure. Formation of the blood pressure: Blood pressure. Formation of the blood pressure 5/1/12
Blood pressure Blood pressure Dr Badri Paudel www.badripaudel.com Ø Blood pressure means the force exerted by the blood against the vessel wall Ø ( or the force exerted by the blood against any unit area
More informationSeptic Acute Kidney Injury (AKI) Rinaldo Bellomo Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) Melbourne Australia
Septic Acute Kidney Injury (AKI) Rinaldo Bellomo Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) Melbourne Australia Things we really, honestly know about septic AKI AKI is common
More informationCOMPARISON OF SUFENTANIL-OXYGEN AND FENTANYL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY BYPASS GRAFTING
Br. J. Anaesth. (1988), 60, 530-535 COMPARISON OF SUFENTANIL-OXYGEN AND FENTANYL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY BYPASS GRAFTING H. M. L. MATHEWS, G. FURNESS, I. W. CARSON, I. A. ORR, S. M. LYONS
More informationFlow-mediated dilation (FMD), the vasodilation of the
Blood Vessels Flow-Mediated Dilation of the Radial Artery Is Offset by Flow-Induced Reduction in Transmural Pressure Benyu Jiang, Mike Seddon, Henry Fok, Ann Donald, Phil Chowienczyk See Editorial Commentary,
More informationInhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction
Inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction 4th Annual Pulmonary Hypertension Drug Discovery and Development Symposium July -, 7 Berlin,
More informationTargeting intracellular arginine / asymmetric dimethylarginine (ADMA).
Targeting intracellular arginine / asymmetric dimethylarginine (ADMA). From bench to practice: Novel anti-atherogenic strategies to improve endothelial function Rainer H. Böger, M.D. Institute of Clinical
More informationTitle: Rg3-enriched Korean Red Ginseng enhances blood pressure stability in spontaneously hypertensive rats
Title: Rg3-enriched Korean Red Ginseng enhances blood pressure stability in spontaneously hypertensive rats Author: Harsha Nagar Sujeong Choi Jung Saet-byel Byeong Hwa Jeon Kim Cuk-Seong PII: S2213-4220(16)30047-6
More informationImpedance Cardiography (ICG) Application of ICG for Hypertension Management
Application of ICG for Hypertension Management 1mA @ 100 khz Impedance Cardiography (ICG) Non-invasive Beat-to-beat Hemodynamic Monitoring Diastole Systole Aortic valve is closed No blood flow in the aorta
More informationTreatment with Hydralazine and Nitrates Uri Elkayam, MD
Treatment with Hydralazine and Nitrates Uri Elkayam, MD Professor of Medicine University of Southern California School of Medicine Los Angeles, California elkayam@usc.edu Hydralazine and Isosorbide Dinitrate
More informationEicosapentaenoic Acid and Docosahexaenoic Acid: Are They Different?
Eicosapentaenoic Acid and Docosahexaenoic Acid: Are They Different? Trevor A Mori, Ph.D., Professor, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth,
More informationEndothelium-derived relaxing and contracting factors: Perspectives in nephrology
Kidney International, Vol. 39 (1991), pp. 575 590 EDITORIAL REVIEW Endothelium-derived relaxing and contracting factors: Perspectives in nephrology The fact that the endothelium can profoundly affect the
More informationComparative effects of glyceryl trinitrate and amyl nitrite on pulse wave reflection and augmentation index
et al. DOI:1.1111/j.1365-2125.24.2334.x British Journal of Clinical Pharmacology Comparative effects of glyceryl trinitrate and amyl nitrite on pulse wave reflection and augmentation index Lynn D. Greig,
More informationCardiovascular Physiology V.
Cardiovascular Physiology V. 46. The regulation of local blood flow. 47. Factors determining cardiac output, the Guyton diagram. Ferenc Domoki, November 20 2017. Control of circulation Systemic control
More informationCardiovascular Responses to Exercise
CARDIOVASCULAR PHYSIOLOGY 69 Case 13 Cardiovascular Responses to Exercise Cassandra Farias is a 34-year-old dietician at an academic medical center. She believes in the importance of a healthy lifestyle
More informationHaemodynamics. Milan Chovanec Department of Physiology 2.LF UK
Haemodynamics Milan Chovanec Department of Physiology 2.LF UK Major types of blood vessels Blood flow: 50cm/s 0.05cm/s Flow, pressure, resistance Flow, pressure, resistance ΔU = I x R Blood and vessels
More informationPhysiology Unit 3 CARDIOVASCULAR PHYSIOLOGY: THE VASCULAR SYSTEM
Physiology Unit 3 CARDIOVASCULAR PHYSIOLOGY: THE VASCULAR SYSTEM In Physiology Today Hemodynamics F = ΔP/R Blood flow (F) High to low pressure Rate = L/min Pressure (P) Hydrostatic pressure Pressure exerted
More informationSpecial circulations, Coronary, Pulmonary. Faisal I. Mohammed, MD,PhD
Special circulations, Coronary, Pulmonary Faisal I. Mohammed, MD,PhD 1 Objectives Describe the control of blood flow to different circulations (Skeletal muscles, pulmonary and coronary) Point out special
More informationREGULATION OF CARDIOVASCULAR FUNCTIONS DURING ACUTE BLOOD LOSS
Indian J Physiol Pharmacol 2005; 49 (2) : 213 219 REGULATION OF CARDIOVASCULAR FUNCTIONS DURING ACUTE BLOOD LOSS RAJINDER K. GUPTA* AND MOHAMMAD FAHIM Department of Physiology, Vallabhbhai Patel Chest
More informationDiversity of endothelium-derived vasocontracting factors arachidonic acid metabolites 1
1065 2003, Acta Pharmacologica Sinica Chinese Pharmacological Society Shanghai Institute of Materia Medica Chinese Academy of Sciences http://www.chinaphar.com Review Diversity of endothelium-derived vasocontracting
More informationBlood flows away from the heart in arteries, to the capillaries and back to the heart in the veins
Cardiovascular System Summary Notes The cardiovascular system includes: The heart, a muscular pump The blood, a fluid connective tissue The blood vessels, arteries, veins and capillaries Blood flows away
More informationChanges in Conduit Artery Blood Flow and Diameter Post Blood Flow Restriction. Erin Rachel Mandel. A thesis. presented in the University of Waterloo
Changes in Conduit Artery Blood Flow and Diameter Post Blood Flow Restriction by Erin Rachel Mandel A thesis presented in the University of Waterloo in fulfillment of the thesis requirement for the degree
More informationAbundance of endothelial nitric oxide synthase in
Archives of Disease in Childhood 1995; 73: F17-F21 Developmental Vascular Biology and Pharmacology Unit, Institute of Child Health, 30 Guilford Street, London WCIN leh A A Hislop S G Haworth Department
More informationManagement of Cardiogenic Shock. Dr Stephen Pettit, Consultant Cardiologist
Dr Stephen Pettit, Consultant Cardiologist Cardiogenic shock Management of Cardiogenic Shock Outline Definition, INTERMACS classification Medical management of cardiogenic shock PA catheters and haemodynamic
More informationDefinition: HPS is a disease process with a triad of: 1- Liver disease. 2- Widespread intrapulmonary vasodilatation. 3- Gas exchange abnormality prese
Hepatopulmonary syndrome (HPS) By Alaa Haseeb, MS.c Definition: HPS is a disease process with a triad of: 1- Liver disease. 2- Widespread intrapulmonary vasodilatation. 3- Gas exchange abnormality presenting
More informationCardiovascular Physiology
Cardiovascular Physiology Introduction The cardiovascular system consists of the heart and two vascular systems, the systemic and pulmonary circulations. The heart pumps blood through two vascular systems
More informationDietary L-Arginine Supplementation Normalizes Platelet Aggregation in Hypercholesterolemic Humans
479 Dietary L-Arginine Supplementation Normalizes Platelet Aggregation in Hypercholesterolemic Humans ANDREAS WOLF, MD, CHRISTOFF ZALPOUR, MD, GREGOR THEILMEIER, MD, BING-YIN WANG, MD, PHD, ADRIAN MA,
More informationWhat is the mechanism of the audible carotid bruit? How does one calculate the velocity of blood flow?
CASE 8 A 65-year-old man with a history of hypertension and coronary artery disease presents to the emergency center with complaints of left-sided facial numbness and weakness. His blood pressure is normal,
More informationCirculatory System Review
Circulatory System Review 1. Know the diagrams of the heart, internal and external. a) What is the pericardium? What is myocardium? What is the septum? b) Explain the 4 valves of the heart. What is their
More informationThe Cardiovascular System
The Cardiovascular System The Cardiovascular System A closed system of the heart and blood vessels The heart pumps blood Blood vessels allow blood to circulate to all parts of the body The function of
More informationDOSE-RESPONSE RELATIONSHIP FOR INHALED NITRIC OXIDE IN EXPERIMENTAL PULMONARY HYPERTENSION IN SHEEP
British Journal of Anaesthesia 1993; 71: 702-708 DOSE-RESPONSE RELATIONSHIP FOR INHALED NITRIC OXIDE IN EXPERIMENTAL PULMONARY HYPERTENSION IN SHEEP O. DYAR, J. D. YOUNG, L. XIONG, S. HOWELL AND E. JOHNS
More informationCardiovascular System. Biology 105 Lecture 15 Chapter 12
Cardiovascular System Biology 105 Lecture 15 Chapter 12 Outline I. Functions of cardiovascular system II. Components of the cardiovascular system: I. Blood vessels II. Heart III. Regulation of the heartbeat
More information