Vasodilation. Autoregulation ป จจ ยท ควบค มขนาดของหลอดเล อด. CO 2, H +, K +, lactate, adenosine osmolarity, temperature O 2
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1 Regulation in cardiovascular system Local control/autoregulation of organs (brain and heart have higher priority) To provide adequate blood flow to tissue Central regulation To provide optimal blood pressure to the whole body 1 ป จจ ยท ควบค มขนาดของหลอดเล อด Local vasodilating substance histamine, substance P WBC Platelets (serotonin, TXA 2 ) Tissue (CO 2, H +, K +, lactate, adenosine, osmolarity, temperature) Vascular smooth muscle Endothelium Endothelium-derived factors Neural Hormonal 2 Vasodilation Hyperemia = ภาวะท ม blood flow ไปย งเน อเย อเพ มข น CO 2, H +, K +, lactate, adenosine osmolarity, temperature O Autoregulation ค อการท เน อเย อสามารถควบค ม ปร มาณเล อดท มาเล ยงต วม นได เอง เด นใน สมอง และห วใจ ท ไต ก พบได แต ไม ค อยเด น 5 6
2 กลไก Autoregulation Myogenic theory Metabolic theory 7 8 Endothelium-derived relaxing factor ACh, BK, Substance P, VIP, Thrombin Relaxation Ca 2+ NO synthase cgmp Blood flow, shear stress L-arginine NO+ L-citrulline Guanylate Cyclase 9 Endothelium-derived substances Prostacyclin (PGI 2 ) ขยายหลอดเล อด และย บย ง aggregation ของเกร ดเล อด Endothelin หล งออกมาในขณะถ กด งย ด ท าให vasoconstriction (บางแห งเป น vasodilation) Smooth muscle proliferation 10 Neural control Sympathetic control > Parasympathetic control vasoconstriction sympathetic tone a 1 -adrenergic receptors Increase whole-body sympathetic tone arteriolar vasoconstriction decrease capillary hydrostatic pressure venoconstriction, followed by increase in Vasodilation Neural control decrease sympathetic tone (inhibit vasomotor center) b 2 -adrenergic receptors in muscle sympathetic cholinergic vasodilation during exercise parasympathetic vasodilation at brain, heart, salivary gland, and sex organ venous return 11 12
3 Hormonal control Circulating vasodilator Atrial natriuretic peptide vasoactive intestinal peptide (VIP) kinin Circulating vasoconstrictor vasopressin angiotensin II Central Regulation 2 types of central regulation short-term regulations (reflexes) long-term regulations (blood volume change) noradrenaline and adrenaline Regulating centers Centers in medulla and pons Cardioinhibitory center (C-I center) nucleus ambiguus and dorsal nucleus of N. X decreases heart rate Vasomotor center Short-tem regulation Intrinsic Cardiovascular reflex Baroreceptor reflex Chemoreceptor reflex Cardiopulmonary reflex Atrial and vena caval reflex Ventricular receptor Pulmonary receptor Extrinsic Pain Cold Limb chemoreceptor and stretch receptor special somatic reflex Pressor and depressor area Higher center influence Baroreceptor reflex Baroreceptor reflex 17 18
4 Pressor response Increase in sympathetic activity and decrease in parasympathetic activity to heart Increase in sympathetic activity to Arteries and arterioles Veins Depressor response Increase in parasympathetic activity and decrease in sympathetic activity to heart Decrease in sympathetic activity to Arteries and arterioles Veins 19 Pressor response Heart Increases heart rate, SV and CO Arteries and arterioles Vasoconstriction, thus increases TPR Decreases capillary hydrostatic pressure Vein Venoconstriction, thus raises venous return 20 Depressor response Respond in the opposite way ANS Neural control of blood vessels Only sympathetic nerve supply Vasoconstriction by a 1 -adrenergic receptors stimulation Results Increases whole-body sympathetic tone arteriolar vasoconstriction decreases capillary hydrostatic pressure venoconstriction, followed by an increase in venous return 23 Neural control of blood vessels Vasodilation Decreases sympathetic tone (inhibits vasomotor center) b 2 -adrenergic receptors in muscle Sympathetic cholinergic vasodilation during exercise Cholinergic vasodilation at muscle, heart, kidney, lung and uterus 24
5 Extrinsic reflex Pain mild to moderate pain increases HR and BP severe pain decreases HR and BP Cold mild cold causes vasoconstriction severe cold causes pain and increases sympathetic tone 25 Extrinsic reflex Chemoreceptor and stretch receptors in limb muscles stimulated during exercise (muscle stretching and local metabolites) controlled by hypothalamus responses increase in CO 26 Extrinsic reflex Special somatic reflex Diving reflex cold immersion of face causes apnea, hypoxia and hypercapnia chemoreceptor stimulation causes vasoconstiction (except brain and heart) and vagal bradycardia Oculocardiac reflex pressure to eye balls causes bradycardia and hypotension 27 Higher center influence CNS ischemic response Cushing reflex due to pressor area stimulation Hypothalamus 28 Long-term regulations Angiotensinogen Renin Angiotensin I Renin-angiotensinaldosterone system (RAAS) ADH Atrial natriuretic peptide 29 Angiotensin converting enzyme Angiotensin II กระต นการหล ง aldosterone vasoconstriction กระต นการหล ง ADH และกระต นกระหาย 30
6 Renin-angiotensin-aldosterone JG cell ถ กกระต นโดย การลด renal blood flow การลดลงของ Na+ ในน ากรองท ผ าน distal tubule การกระต น sympathetic ท เล ยง JG cell Stimulated by ADH release Increased plasma osmolarity Angiotensin II Hypovolemia (atrial stretch receptor) Atrial Natriuretic peptide Atrial stretching ANP release ฤทธ ของ ANP ข บ Na + ทางไต ย บย งการหล ง renin และ aldosterone ย บย ง vasoconstriction และ venoconstriction (จากฤทธ AII และ NE) vasodilate หลอดเล อดใหญ ๆ 33
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