BARORECEPTORS & CHEMORECEPTORS

RECEPTORS:

Aortic arch transmits via vagus nerve to solitary nucleus of medulla (responds to changes in
BP).
Carotid sinus (dilated region at carotid bifurcation) transmits via glossopharyngeal nerve to
solitary nucleus of medulla (responds to changes in BP).

BARO RECEPTORS:

Hypotension
Arterial pressure
Stretch
Afferent baroreceptor firing
Efferent sympathetic firing, efferent parasympathetic stimulation

Vasoconstriction
HR
contractility
BP

Important in the response to severe hemorrhage.

Carotid massage —
Pressure on carotid sinus
Stretch
Afferent baroreceptor firing
AV node refractory period
HR

Component of Cushing reflex —

(triad of HTN, bradycardia, respiratory depression)

Intracranial pressure constricts arterioles

Cerebral ischemia
pCO2, pH
Central reflex sympathetic in perfusion pressure (HTN)
Stretch
Peripheral reflex baroreceptor – induced bradycardia.

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CHEMO RECEPTORS:

Peripheral
Carotid and aortic bodies are stimulated by
PC02
pH of blood
PO2 (< 60 mm Hg)

Central
Become less responsive with chronically PCo2 (eg, COPD)
dependence on peripheral chemoreceptors to detect O2 to drive respiration.

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NORMAL CARDIAC PRESSURES

Pulmonary capillary wedge pressure is a good approximation of left atrial pressure.

(PCWP; in mm Hg)
In MS, PCWP > LV EDP
PCWP is measured with pulmonary artery catheter (Swan-Ganz catheter).

AUTO REGULATION

How blood flow to an organ remains constant over a wide range of perfusion pressures.

ORGAN FACTORS DETERMINING AUTO REGULATION

Heart Local metabolites (vasodilatory):
Adenosine, NO, CO2, O2
Brain Local metabolites (vasodilatory):
CO2 (pH)
Kidneys Myogenic & tubulo glomerular feedback
Lungs Hypoxia vasoconstriction
Skeletal Local metabolites during exercise:
Muscle CO2, H+, Adenosine, Lactate, K+ (CHALK)

At rest: sympathetic tone

Skin Sympathetic stimulation - temperature control
(Most Important Mechanism)

The pulmonary vasculature is unique in that alveolar hypoxia causes vasoconstriction so that
only well-ventilated areas are perfused.
In other organs, hypoxia causes vasodilation.

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CAPILLARY FLUID EXCHANGE
Starling forces determine fluid movement through capillary membranes:

Pc = capillary pressure - pushes fluid out of capillary

Pi = interstitial fluid pressure - pushes fluid into capillary

πc plasma colloid osmotic (oncotic) pressure - pulls fluid into capillary

πi interstitial fluid colloid osmotic pressure- pulls fluid out of capillary

Jv = net fluid flow Kf (Pc Pi) σ(πc πi)

Kf = capillary permeability to fluid

σ reflection coefficient (measure of capillary permeability to protein)

Edema - excess fluid outflow into interstitium commonly caused by:

Capillary pressure ( Pc: HF)

Capillary permeability ( Kf: toxins, infections, burns)

Interstitial fluid colloid osmotic pressure ( πi: lymphatic blockage)

Plasma proteins ( πc: nephrotic syndrome, liver failure, protein malnutrition)

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