High Yield Relationships—Slide # 1

P MAP = CO X TPR V SV
Q= C= PP =
R CO = HR X SV P C
L P ∝ R
R∝ 4 T ∝ Pr
r Uptake of O2 (Vo2)
Fick Flow = (LaPlace)
equation A – V O2 difference
Extraction
of O2
Uptake of O2 (Vo2) = Flow X A – V O2 difference

Reynold’s # = (velocity) (diameter) (density) / viscosity

Cardiac Index = CO/ body surface area (BSA)
Pulse pressure (PP) = systolic - diastolic
MAP = 1/3 PP + diastolic pressure EF = SV/EDV X 100
P = height X density X gravity Velocity = Q/CSA
© LBW
 Short/Long Term MAP Reg—Slide # 2
 Contractility Veno-
Heart rate  constriction
Autonomic
drugs   VR
M2 Stroke volume
F-S Preload
 VR
Cardiac Shock TPR
output  Blood volume

Mean Arterial Urine volume

Pressure
Anti-hypertensive
drugs Renin
Baroreceptor activity

Ang II
Parasympathetic Sympathetic
activity Aldo
activity
Stimulates Inhibits © LBW
 Whole Body CV Regulation—Slide # 3

MAP = CO X TPR

4 factors determine
Tone of arterioles
1. HR ( CO exercise;  CO
• Sympathetic (alpha)
with tachyarrhythmias)
• Ang II
2. Contractility (direct)
• AVP (ADH)
3. Afterload (inverse)
• Epi (alpha/beta-2)
4. Preload (direct)
• Metabolism
• NO
Directly related to venous return • Pharm integration
• Blood volume (direct)
• Venous compliance (inverse)
© LBW
 PV Loops: Systolic/Diastolic Dysfunction
Systolic dysfunction:
Slide #4 decreased contractility
results in elevated volumes
120
Pressure (mmHg)

Diastolic dysfunction:
80 decreased compliance
causes increased
pressure

40

Passive
50 100 150 tension
Volume (ml)
© LBW
 Differential for Causes of Hypoxemia
PAO2: calculate using
alveolar air equation or
use end-tidal PO2
Normal
Note PaCO2 (may avoid
Low PaO2
calculation step):
(hypoxemia)
If low, then NOT low
PAO2 (exception is high
A – a O2 altitude), thus go straight
gradient to elevated gradient.
Elevated

Cause is Increase
PAO2 FIO2

Corrects Doesn’t
PaO2 correct PaO2
FIO2 corrects
PaCO2 likely
elevated Diffusion VA/Q Cause is right-
impairment mismatch to-left shunts
© LBW Handout slide #5
 Relationships/Equations for Renal—Slide # 6

GFR Transport = excretion – filtered load

FF =
RPF Filtered load = GFR X PX
FF impacts Pc!!! Rate of excretion = UX X V

UPAH X V
Renal CPAH = ERPF =
UX X V PPAH
clearance =
PX

ERPF
Renal blood flow =
1- Hct

© LBW
 Factors Affecting GFR and FF—Slide # 7

Glomerular Peritubular Nephron GFR FF

cap cap plasma
pressure pressure flow
Constrict efferent
    
Dilate efferent
    
Constrict afferent
    
Dilate afferent
    

© LBW
 Properties of Receptors—Slide # 8

E + S  (ES)  E + P H + R  (HR)  response

Michaelis-Menten stimulus  response

100 100

Vmax: determined
Velocity (% of max)

% Response
by [E] & [S] [R] is one
factor

50 50
[S] is [H] is
limiting limiting
Km

0 0
[S] [H]
© LBW
 Properties of Receptors—Slide # 9

H + R  (HR)  response A + R  (AR)  response

stimulus  response stimulus  response
100 100

% Response
% Response

[R] is one
factor

50 50
[H] is [H] is
limiting limiting

EC50

0 0
[H] Log [A]
© LBW
Overview of ADH Pathophysiology—Slide # 10
High Plasma osmolality Low

Note: ADH=AVP

Plasma ADH Plasma ADH

High Low High Low

*Nephro DI
(1O)

Dehydration Neuro DI* SIADH Primary Poly-

(2O) (1O) (1O) dipsia (2O)

Uosm >> 300 Uosm << 300 Uosm >> 300 Uosm << 300

© LBW
 Metabolism—Cortisol—Slide # 11

Glycogen
Gly Cortisol
synthase Gly
FA
Glucokinase phos
Glucose FA
Glucose synthase
6-P
G6-phos PFK-1 (via
PFK-2) Malonyl CoA
Fructose 1,6- AA
Pyruvate
bisphosphatase (alanine)
kinase Acetyl CoA
PEPCK PDH carboxylase
OAA
(thiamine)
Pyruvate Acetyl CoA
Pyruvate
Cortisol carboxylase
(biotin) LDH

Lactate TCA Ketones

© LBW
 Insulin—Glucagon—Slide # 12
Insulin stimulates+
Glycogen
Gly Glucagon stimulates*
synthase+ Gly
FA
Glucokinase+ phos*
Glucose FA
Glucose synthase
6-P Urea
G6-phos* PFK-1 (via 1*
PFK-2+) Malonyl CoA
Fructose 1,6- AA
Pyruvate
bisphosphatase* (alanine)
kinase+ Acetyl CoA
PEPCK* PDH carboxylase+
OAA
(thiamine)
Pyruvate Acetyl CoA
Pyruvate
carboxylase
(biotin)*
TCA Ketones
1 = N-acetylglutamate

© LBW
 Sexual Differentiation—Slide # 13
MIH = Müllerian inhibiting T = Testosterone
Undifferentiated
hormone gonad SRY = sex determining
region of Y

XX—no XY has
Ovaries SRY SRY Testes

MIH T

Müllerian Wolffian Müllerian Wolffian

ducts ducts ducts ducts

Regress Regress

Fallopian Epididymis, Fallopian Epididymis,

tubes, vas tubes, vas
uterus, deferens, uterus, inner deferens,
inner vagina seminal vagina seminal
vesicles vesicles © LBW
 Sexual Differentiation—Slide # 14
5 alpha-reductase
Testosterone dihydrotestosterone (DHT)

Ovaries Testes

No DHT
DHT
Undifferentiated
organs

Clitoris, outer Penis,

vagina, labia scrotum, &
prostate

© LBW
 Menopause—Slide # 15
ACTH FSH/LH

Choles Tumor Choles

Growth
DHEA Test/A
aromatase
A 17-Estradiol
Blood
Adrenal cortex Ovary
Anastrozole
Tamoxifen
Letrozole
Raloxifene

aromatase
DHEA A Estrone

Adipose tissue © LBW

 Polycystic Ovarian Syndrome—Slide # 16
PCOS
Hirsutism; irregular menstrual bleeding; chronic anovulation; obesity;
insulin resistance; infertility
Clomiphene:  FSH Oral contraceptives
 LH to  LH
 FSH

 Adipose Pituitary
 estrone

 Thecal
aromatase
 Estradiol  Follicle hormone
anovulation maturation production
Adipose
Ovaries
 insulin
 Androgens

Thiazolidinediones;  Androgens Dexamethasone

 SHBG Metformin
Adrenal © LBW