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
