PHSC415 Exam 1

blood pressure increases

- cardiac output increases and resistance in the arterioles remains unchanged (flow in is greater than flow out) OR - cardiac output remains unchanged and resistance in the arterioles increases then pressure would increase (flow out decreased and blood will accumulate in the arteries) --> main cause of hypertension - distribution of blood in systemic circulation - constriction of veins

ischemic stroke

- caused by a blood clot that cuts off blood supply to the brain

Hemmorrhagic stroke

- caused by bleeding in the brain

signs and symptoms of MI

- chest pain shortness of breath left arm or shoulder pain (referred pain) - nausea and abdominal pain - sweating

Statins

- decrease cholesterol synthesis in the liver (HMG-CoA Reductase inhibitors) - increases LDL uptake - used as both primary and secondary prevention

metabolic acidosis

- decreased pH in blood and body tissues as a result of an upset in metabolism - can lead to coma or death

Metformin

- decreases blood glucose levels largely due to reducing glucose production and release by the liver - promotes weight loss - can have cardioprotective effects

secondary hypertension

- due to a known cause, usually an underlying pathology (ex. endocrine disorder that causes fluid retention --> total blood volume is increased)

characteristics of atherosclerosis

- fatty deposits form inside arterial blood vessels

what causes the blood clot in a ischemic stroke

- formation of a thrombus in a vessel in the brain - embolism: clot forms elsewhere and then travels to the brain

fat (triglycerides)

- have higher energy content per gram - little water is required for storage - energy from this is harder/slower to access - stored in adipocytes

glucagon secretion leads to

- increased glycogenolysis - gluconeogenesis - ketogenesis

hypertension

- increased pressure on blood vessel walls - may cause weakened areas to rupture and bleed into tissues

treatments for T2DM

- lose weight - exercise - metformin - management of hyperglycemia with meds

hypotension

- low blood pressure - Driving force for blood flow is unable to overcome opposition by gravity - Blood flow and O2 supply to the brain is impaired --> a person may feel dizzy or faint

prevention of atherosclerosis

- management of cholesterol levels - lifestyle interventions

hyperglycemia can lead to:

- microvascular complications - retinopathy - nephropathy - neuropathy - slow wound healing

number of participants in the SPRINT Trial

- more than 9,300 participants age 50 and older - recruited from about 100 medical centers and clinical practices throughout the United States and Puerto Rico.

essential (primary) hypertension

- no clear cut cause - more than 90% of cases

Type 1 Diabetes

- primarily caused by the auto-immune mediated destruction of pancreatic B-cells - reliant on exogenous administration of insulin to avoid ketoacidosis - most common cause of chronic disease in children (juvenile diabetes)

tips for treating strokes

- quick treatment is important - effective IV treatment with tissue plasminogen activator (tPa) can help to dissolve clots in ischemic stroke and minimize damage

untreated hypertension

- risk factor for atherosclerosis - heart muscle hypertrophies

lipoproteins

- synthesized by the liver and get released into the bloodstream - vary in composition and density - the more proteins a complex contains, the heavier it is

treatment for type 1 diabetes

- taking insulin (injections or long term pump) - carb counting - frequent blood sugar monitoring - eating healthy foods - exercising regularly and maintaining a healthy weight

structure of the heart

- the heart is composed of mostly of myocardium - the heart valves ensure one-way flow

Result of a thrombus?

- triggers clot formation which can cut off blood supply - cause of MI and ischemic stroke

what compounds do we digest our food into?

- triglycerides - monosaccharides - amino acids

what happens during a MI

- unusually high Ca+2 concentration in the cytosol closes gap junctions in the damaged cells. - Closure electrically isolates the damaged cells so that they no longer contract - forces action potentials to find an alternate route from cell to cell.

cardiac catherization (CC)

- used to diagnose and treat heart conditions - passage of a catheter into the heart through a vein or artery to provide a comprehensive evaluation of the heart

total blood volume

- usually constant - varies with ingestion of food and liquid but usually adjusted by kidneys (excretion of excess volume in the urine)

cause of bleeding in brain for hemmorhagic strokes

- weakened blood vessels can rupture and pooled blood can put pressure on the brain - aneurysms are enlarged and weakened blood vessels that are at increased risk of rupture

Bile Acid Sequestrants

- work in the intestinal tract to block the absorption of bile acids - since bile acids are synthesized in the liver from cholesterol, this lowers cholesterol levels by increasing the production of bile acids

energy

all living systems require an ongoing supply of this which has the capacity to cause specific chemical or physical changes

aerobic respiration

consumes organic molecules and O2 and yield ATP (catabolic)

thrombus

blood clot

what does liver glycogen regulate?

blood glucose

Pressure throughout the systemic circulation

blood pressure is highest in the arteries and decreases continuously as it flows through the circulatory system

Glycogenolysis

breakdown of glycogen to glucose

chemical work

building molecules, including synthesis of energy storage molecules (short term storage (ATP) and long term energy storage (glycogen, fat))

how are chylomicrons metabolized?

by lipoprotein lipase (lpl) to release free fatty acids and glycerol for use by muscle and adipose tissue

how are chylomicron remnants absorbed and metabolized?

by the liver

ventricular contraction

contraction of the ventricles pushes blood into the elastic arteries, causing them to stretch 1. ventricle contracts 2. semilunar valve opens. Blood ejected from ventricles flows into the arteries 3. aorta and arteries expand and store pressure in the elastic walls

what do fatty deposits in blood vessels do?

decrease blood flow and pose a serious risk of rupture over time

type 2 diabetes mellitus

diabetes caused by either a lack of insulin or the body's inability to use insulin efficiently; usually develops in middle-aged or older adults, and patients usually do not require insulin replacement therapy to control the disorder

type 1 diabetes mellitus

diabetes in which no beta-cell production of insulin occurs and the patient is dependent on insulin for survival

embolus

A clot that breaks lose and travels through the bloodstream.

how many days on average do people have of stored glycogen?

1-2 days

1 kilocalorie = x calories

1000 cal, 1 Kcal

hypertension and obesity

Being overweight or obese also contributes to this process as it increases inflammation and the inflammatory response in tissues

DASH diet

Dietary Approaches to Stop Hypertension

what type of process does glucagon promote?

catabolism

diabetes mellitus

insulin is not secreted adequately or tissues are resistant to its effects

LDL that infiltrates the arteries retains and builds up where?

intima

nephropathy

kidney damage, renal failure

subcutaneous fat

layer of fat cells beneath the skin that helps conserve body heat

Where does cholesterol come from?

liver

two chemical forms of energy storage

liver and muscle glycogen

Oxidation

loss of electrons

LDL

low density

what does muscle glycogen regulate?

muscle contraction

mechanical work

muscle contractions

neuropathy

nerve damage that can lead to numbness, weakness, and pain; especially in the hands and feet

when does a rapid blood pressure chance occur?

occurs when the left ventricle pushes blood into the aorta can be felt as a pulse or pressure wave

during cellular respiration what is oxidized and reduced?

oxidized: glucose reduced: O2

how does HDL promote the health of blood vessels

prevents the oxidation of cholesterol and decreasing the inflammatory response that contributes to plaque formation

beta oxidation of fatty acids

produce acetyl CoA (precursor of acetoacetate)

glucostatic theory

proposes that blood glucose levels ultimately control the feeding and satiety centers

lipostatic theory

proposes that the level of body fat regulates the feeding and satiety centers - Recent discovery of several peptides (especially leptin and neuropeptide Y) seems to support this theory

directionality

reactions have this and they can only proceed spontaneously in one direction

where does cholesterol (HDL-c) that is released from chylomicrons go?

received by the liver and packaged into lipoproteins or excess can be converted to bile salts and excreted.

Niacin (Vitamin B3)

reduces LDL and raises HDL levels

how does HDL help decrease accumulation of plaque

removes LDL-c from bloodstream decreasing its chances of accumulating in plaques

Mean Arterial Pressure (MAP) formula

diastolic pressure + 1/3 pulse pressure

pulse pressure

difference between systolic and diastolic pressure

Protein

digested into amino acids to be used for building needed body proteins

fats

digested into glycerol (used in glycolysis) and fatty acids (used in generating acetyl CoA)

indirect calorimetry

estimates metabolic rate as a measure of energy use - oxygen consumption - carbon dioxide production - ratio of CO2 to )2 (RQ)

polyphagia

excessive hunger/increased apetite - a result of more glucose

hyperglycemia

excessive sugar in the blood

post-absorptive phase

fasted state (catabolic)

visceral fat

fat located around major organs; also called intra-abdominal fat

Absoptive state

fed state (anabolic)

excess amino acids

feed glycolysis or the citric acid cycle and are converted into glucose or fatty acids by the liver.

long term energy storage

glycogen and fat

Atherosclerosis

hardening of the arteries

Hypertension

high blood pressure

Essential benign hypertension

high blood pressure that doesn't have a known secondary cause. It's also referred to as primary hypertension

hyperglycemia

high blood sugar

HDL

high density

Fed state

high levels of plasma glucose and amino acids leading to secretion of insulin

HDL

high-density lipoprotein

low glucagon

high: - glycogenolysis - gluconeogenesis - ketogenesis

low insulin

high: - glucose oxidation - glycogen synthesis - fat synthesis - protein synthesis

Glycogen

highly branched polymer of glucose that when stored can bind water and is found in liver/muscle

mellitus means?

honey sweet

structural properties of fats

hydrophobic and insoluble

second law of thermodynamics (law of thermodynamic spontaneity)

in every physical or chemical change, the universe tends towards greater disorder or randomness (entropy)

homeostatic control of metabolism: glucagon

in the fasting state. low plasma glucose results in the secretion of glucagon

Calorie

the amount of energy required to raise one gram of water by one degree centigrade at one atmosphere of pressure

large damage to myocardium can cause

the disruption can lead to an irregular heartbeat (arrhythmia) and potentially result in cardiac arrest or death.

how do lipoproteins enter a cell?

through receptor-mediated endocytosis. -Apoproteins mediate this process (ApoB and ApoA).

goal of fasted state metabolism

to maintain blood glucose levels within an acceptable range so the brain and neurons have adequate fuel.

True or false? High LDL-c levels increase heart disease risk

true

true or false? 95% of all cases of diabetes are type 2

true

true or false? High LDL-c increase risk of atherosclerosis

true

true or false? Low HDL is also associated with increased risk

true

true or false? hemorrhagic strokes are less common (~13%)

true

true or false? ischemic stroke accounts for 87% of all strokes

true

true or false? ~70% of Type 2 Diabetics die from cardiovascular disease

true

true or false? If a clot blocks blood flow to the heart muscle, a heart attack, or myocardial infarction

true

true or false? About every 34 seconds, someone in the United States has a myocardial infarction (heart attack)

true

true or false? blood flows down pressure gradient in systemic circulation

true

true or false? The more proteins a complex contains, the heavier it is (more dense)

true

true or false? insulin promotes anabolism

true - increased glucose transport into most insulin-sensitive cells - enhances cellular utilization of amino acids - promotes fat synthesis

true or false? glucagon promotes catabolism

true - glucagon is antagonistic to most actions of insulin, resulting in a catabolic state in the body

true or false? Increased sodium intake can cause fluid retention in most individuals

true - Some are affected more than others - Salt sensitivity is found in 73% of all African American hypertensive patients

true or false? sodium intake is out of control in Western (American) diet

true - most likely a result of increased process foods and meals prepared in restaurants

cellular respiration

includes both aerobic and anaerobic respiration but is often used to refer to aerobic respiration (catabolic)

blood pressure control

includes rapid responses from the cardiovascular system and slower responses by the kidneys

insulin leads to what processes?

increase in - glucose oxidation - glycogen synthesis - fat synthesis - protein synthesis

calories

units for quantifying the energy changes during chemical reactions

vLDL

very low density

BMI formula

weight (kg) / height (m^2)

what does LDL-c do?

takes cholesterol from the liver and transports it to most cells

Arteries versus veins

- arteries are low in volume and hold about 11% of total blood volume - veins are high volume and hold about 60% of total blood volume

cerebral hemorrhage

- bleeding in the brain - a main cause of stroke

risk factors of T2DM

- bmi > 25 - increased adiposity (body fat %) - sedentary lifestyle - tobacco smoking - genetics - poor diet

lifestyle interventions of atherosclerosis

- Dietary increases in plant sterols and stanols can displace cholesterol in lipoproteins and decrease absorption (Nuts, seeds, plant oils) - Dietary restriction of saturated fat intake

hypertension risk factors

- First pharmacological treatments weren't available until the 1950s - National Heart, Lung, and Blood Institute initiated the National High Blood Pressure Education Program in 1971 to bring awareness to both physicians and patients about the risks of unmanaged hypertension

hypertension and atherosclerosis

- High blood pressure puts stress on the arteries which promotes atherosclerosis - promotes Inflammatory process - Both increases plaque formation and plaque destabilization

contributing factors to atherosclerosis

- High cholesterol (LDL-C) - hypertension - inflammation

anabolism

- Increases glucose transport into most, but not all, insulin-sensitive cells - Enhances cellular utilization and storage of glucose - Enhances utilization of amino acids - Promotes fat synthesis

Systole blood pressure

- Maximum blood pressure during contraction of the left ventricle of the heart. - reaches average high of 120 mmHg

diastole blood pressure

- Minimum blood pressure during ventricle relaxation - reaches a low of 80 mmHg during diastole

fats stored in chylomicrons

- To move through the blood stream, ingested fats are broken down and then packaged into transport vessels called chylomicrons in the intestines. - Contain a mixture of cholesterol and triglycerides in a phosopholipid monolayer - Have apoproteins embedded on the exterior that facilitate delivery through specific binding

Joint National Committee

-Panel of experts that make evidence-based recommendations on the management of high blood pressure. -First report in 1977, when diastolic pressure was still thought to be the basis for the diagnosis and treatment of hypertension.

arterial plaque formation steps

1. LDL accumulates and becomes oxidized 2. macrophages ingest cholesterol and become foam cells 3. Smooth muscle cells begin to proliferate and take up cholesterol 4. Lipid core accumulates beneath the endothelium 5. Fibrous scar tissue forms to wall off lipid core 6. Smooth muscle cells continue to proliferate, increasing the size of the plaque. 7. Calcifications deposit in plaque and fibrous collagen cap forms. [Plaque Rupture] 8. Macrophages may release enzymes that dissolve collagen and can destabilize the plaque. 9. Platelets that are exposed to collagen activate and initiate a blood clot.

six factors affecting metabolic rate

1. age and gender 2. amount of lean muscle mass 3. Activity level 4. energy intake & output - diet induced thermogenesis 5. Hormones 6. Genetics

Leptin

A hormone produced by adipose (fat) cells that acts as a satiety factor in regulating appetite.

Insulin

A hormone produced by the pancreas or taken as a medication by many diabetics

Ghrelin

A hunger-arousing hormone secreted by an empty stomach

Glucagon

A protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

Cholesterol

A type of fat made by the body from saturated fat; a minor part of fat in foods.

short term energy storage

ATP

ischemia

Blocked blood flow in a coronary artery cuts off the oxygen supply to myocardial cells supplied by that artery

cellular respiration equation

C6H12O6+6O2---> 6CO2+6H2O+ATP

Joint National Committee (JNC-8)

Change of recommendations this past year. Again based on evidence that treatment of prehypertension might be too aggressive and not achieve desired result.

satiety

Condition of being too full or too satisfied

retinopathy

Damage to retinal blood vessels. The two most common causes are diabetes and hypertension.

myocardial infarction (MI)

Death of cardiac muscle due to ischemia

first law of thermodynamics (law of conservation of energy)

Energy can be transferred and transformed, but it cannot be created or destroyed.

discovery of insulin

Frederick Grant Banting and John James Rickard Macleod - first administered in 1922 to a 14 year old boy with severe metabolic acidosis

DASH eating plan

Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts

Framingham Heart Study (1948)

Longitudinal cohort study designed to identify risk factors associated with cardiovascular disease -Term "risk factor" was popularized after repeated use in this study

anabolic pathways

Metabolic pathways that consume energy to build complicated molecules from simpler ones.

catabolic pathways

Metabolic pathways that release energy by breaking down complex molecules into simpler compounds.

cholesterol

Precursor of a number of important steroid hormones (progesterone, estrogen, testosterone)

Metabolic Rate (MR)

Rate at which an animal consumes energy (rate at which energy is converted to heat and external work or force.

consequences of blocked blood flow

The oxygen-starved cells produce less ATP and are unable to pump Ca+ out of the cell. (Essential for cardiac cell contraction)

Thermodynamics

The study of energy transformations that occur in a collection of matter.

bomb calorimeter

a device for measuring the heat evolved in the combustion of a substance under constant-volume conditions

Chylomicrons

a droplet of fat present in the blood or lymph after absorption from the small intestine.

body mass index

a measure of body weight relative to height

Double labeled water technique

a method for measuring energy expenditure based on measuring the disappearance of isotopes of hydrogen and oxygen in body fluids after consumption of a defined amount of water labeled with both isotopes

BMI (body mass index)

a person's weight in kilograms divided by the square of height in meters

membrane transport

action potentials

what type of process does insulin promote?

anabolism

Bioenergetics

applies principles of thermodynamics to the biological world

where does energy primarily exist? In what form?

chemical bonds

Lipoproteins

clusters of lipids associated with proteins that serve as transport vehicles for lipids in the lymph and blood

what can the catheter help with?

dye can be injected to visualize blood flow in the coronary arteries and minor surgery can be performed (i.e. placement of stents to fix a blockage).

ventricular relaxation

elastic recoil in the arteries maintains driving pressure during ventricular diastole 1. isovolumic ventricular relaxation 2. semilunar valve shuts, preventing flow back into ventricle 3. elastic recoil of arteries sends blood forward into rest of circulatory system

homeostatic control of metabolism: insulin

endocrine pancreas secretes hormones insulin and glucagon to control blood sugar

the key to weight control

energy input= energy output OR energy output = work + heat

glucogenesis

formation of glucose

Glycogenesis

formation of glycogen from glucose

mean arterial pressure

function of cardiac output and resistance in the arterioles

reduction

gain of electrons

hyperglycemic state

glucagon levels are too high

hyperglycemia can lead to

macro vascular complications - atherosclerosis - increases risk of hypertension

thermodynamic spontaneity

measure of whether or not a reaction or process can occur

calculating metabolic rate

measure oxygen consumption by number of kilocalories metabolized per liter of oxygen consumed: metabolic rate (kCal/day) = L O2 consumed/day x kCal/L O2

direct calorimetry

measures the energy content of food fat = 9 Kcal/g protein & carbs= 4kcal/g

metabolism push-pull control

metabolic balance can shift when enzyme activity is controlled

Phospholipids

structural components of cell plasma membranes

importance of SPRINT trial

the largest study of its kind to date to examine how maintaining systolic blood pressure at a lower than currently recommended level will impact cardiovascular and kidney diseases -NIH stopped the blood pressure intervention earlier than originally planned in order to quickly disseminate the significant preliminary results.

Lipogenesis

the metabolic formation of fat

blood pressure

the pressure that is exerted by the blood against the walls of blood vessels (in mmHg)

appetite

the psychological desire for food

basal metabolic rate (BMR)

the rate at which the body burns energy when the organism is resting

Total Energy Expenditure (TEE)

the sum of the energy used for basal metabolism, activity, processing food, deposition of new tissue, and production of milk

redox reactions (oxidation-reduction reactions)

the transfer of electrons during chemical reactions releases energy in organic molecules which is ultimately used to synthesize ATP Oterm-15IL RIG

work

the use of energy to drive a process other than heat flow

SPRINT trial

•Preliminary results were just released on 9/11/15 for a clinical trial sponsored by the National Institutes of Health called the Systolic Blood Pressure Intervention Trial (SPRINT) •Recruited those at high-risk for hypertension with systolic BP ≥ 130 mm hg

hypertension warning

•The risk of developing cardiovascular disease doubles with each 20/10 mm Hg increase in blood pressure

treatment groups in SPRINT trial

•Two treatment groups •Target of 120 mm Hg Target of 140 mm Hg