Cardiovascular Reflexes

Dr Katherine Howell

Learning Outcomes
To understand how MAP is regulated
To know the location and function of
arterial baroreceptors
To understand the baroreceptor reflex and
effects on MAP
To learn about hormonal control of MAP and
other cardiovascular regulatory processes
To know how the ANS can be assessed

Mean ARTERIAL PRESSURE

MAP = CO
Cardiac
Mean
arterial
TPR
output
pressure

HR
Heart
rate

Total peripheral
resistance

Stroke
SV
volume

Intrinsic Properties of the

Heart
Frank Starlings Mechanism
Extrinsic control (ANS + hormones)
Intrinsic
When venous return changes, the heart
automatically adjusts its output to match
inflow
EDV force of contraction SV CO

FRANK-Starlings
MECHANISM
EDV length of muscle fibres force
of contraction
Cardiac muscle has optimum length > resting
Stretching muscles fibres
affinity of troponin for Calcium
number of activated cross bridges

Starlings Law regulates

the size of heart
Prevents heart failure

Factors affecting Stroke

Volume
Sympathetic activity controlling
ventricular contractility
EDV
Affected by preload (end diastolic pressure)
CVP preload EDV SV

Afterload
Arterial pressure

Factors affecting SV

Venous
return
Enddiastolic
Volume

Sympathetic
activity or
Adrenaline
Ventricle
Contractility

Stroke Volume

Arterial
Pressure
(afterloa
d)

Regulation of Mean Arterial Pressure

MAP = HR * SV * TPR
Maintain adequate blood flow to all
organs
Short term regulation
Extrinsic/reflexes

Long term regulation

Sensory Receptors
Arterial baroreceptors
Low pressure baroreceptors
Chemoreceptors
Proprioreceptors
Cerebral cortex and hypothalamus

Firing pattern of baroreceptor in response to arterial

pressures of increasing magnitude

Arterial
Baroreceptors
Sensory receptor
neuron in blood vessels
Responds to changes in
pressure
Aortic arch
Carotid sinuses

Cardiovascular Control
Centre
Location: Medulla Oblongata
Sensory Input: from baroreceptors
Parasympathetic (vagus) to SAN and AVN
Sympathetic and parasympathetic to SAN
Sympathetic to ventricular myocardium
Sympathetic to Arterioles / resistance
vessels
Sympathetic to veins

Baroreceptor Reflex
Increase in pressure detected by arterial
baroreceptors
Increase in firing of baroreceptors
Decreased Sympathetic
Increased Parasympathetic
Decrease
HR
SV
Vascular resistance

BARORECEPTO
R REFLEX
Arterial pressure decreases
Baroreceptor firing decreases activity to
Medullary CV Centre
1.Increased HR ( symp para)
2.Increased contractility ( symp)
3.Arteriolar constriction ( symp)
4.Increased venous constriction (
symp)
Increased CO
Increased TPR
BP returned to normal
MAP = CO x TPR
CO = HR x SV

LONG TERM REGULATION OF

MAP
Quick fix
Variation of BP from normal for few days?
Hormonal control
Adrenaline

Sympathetic stimulation increases HR, SV and TPR

Vasopressin

Vasoconstriction increases TPR and MAP

Reduces urine output

Angiotensin II

Vasoconstriction increases TPR and MAP

Reduces urine output, causes vasoconstriction, thirst

Low Pressure Baroreceptors

Walls of large systemic veins
Wall of Right Atrium
Sensitive to changes in stretch
Detect changes in blood volume in veins
Increase sympathetic nerve activity
Stimulate vasopressin release

Respiratory Sinus
Arrhythmia
Rhythmic variation in HR associated
with breathing
Inspiration decreases
parasympathetic and HR increases
Expiration increases parasympathetic
and decreases
HR
Inspiration
Expiration

Autonomic testing
Respiratory sinus arrhythmia
Valsalva manoeuvre
Tilt table
Cold pressor test
Lower body negative pressure
Static Handgrip exercise
Power spectral analysis of heart rate
Muscle sympathetic nerve activity

Valsalva Manoeuvre

Valsalva Manoeuvre
1. Initial pressure rise
Increased pressure in chest forces pulmonary blood into left
atrium.
Blood pressure increases which is detected by baroreceptors

2. Reduced venous return and compensation:

Venous return impeded by elevated thoracic pressure
CO reduced therefore BP falls (5 to 14 secs)

3. Pressure release:
The pressure on the chest is released
Allows the pulmonary vessels and the aorta to re-expand
causing a further initial slight fall in pressure (20 to 23
seconds)
Venous return increases and cardiac output begins to
increase.

4. Return of cardiac output:

Significant venous return causes rapid increase in CO and BP

Upright tilt test

The normal
response

Orthostatic Hypotension
Defined by the
consensus group of
the American
Autonomic Society
as a sustained
decrease in blood
pressure exceeding
20 mmHg systolic or
10 mmHg diastolic
occurring within 3
minutes of upright
tilt.

Orthostatic hypotension
and lightheadedness
which lasts for more
than a minute is
probably abnormal.

Syncope

Symptom or finding

Diagnostic consideration

After sudden unexpected pain, unpleasant sight, sound, or

smell

Vasovagal syncope

During or immediately after micturition, cough, swallow, or

defecation

Situational syncope

With neuralgia (glossopharyngeal or trigeminal)

Bradycardia or vasodepressor reaction

Upon standing

Orthostatic hypotension

Prolonged standing at attention

Vasovagal

Well trained athlete after exertion

Vasovagal

Changing position (from sitting to lying, bending)

Atrial myxoma, thrombus

Syncope with exertion

Aortic stenosis, pulmonary hypertension, mitral

stenosis, IHSS, coronary artery disease

With head rotation, pressure on carotid sinus (as in tumors,

shaving, tight collars)

Carotid sinus syncope

Associated with vertigo, dysarthria, diplopia, and other motor

and sensory symptoms of brainstem ischemia

TIA, subclavian steal

With arm exercise

Subclavian steal

IHSS, Idiopathic hypertrophic subaortic stenosis;TIA,

transient ischemic attack.

Summary
Starlings Law
Increased venous return causes increased CO

MAP = HR * SV * TPR
MAP short and long term regulation
Arterial baroreceptors
Aortic arch
Carotid sinus
Respond to stretch
Increased pressure causes increased APs to medulla

Summary
Baroreceptor reflex
MAP
APs to CNS
parasympathetic and sympathetic
activity
SAN APs (HR)
ventricular contractility (SV)
venomotor control (EDV)
vasoconstriction (TPR)
MAP

Summary
Low pressure receptors
Respiratory Sinus Arrhythmia
Inspiration increases sympathetic (HR)
Expiration increases parasympathetic (HR)
Chemoreceptor reflexes
Detect changes in CO2
Increased CO2 HR TPR

ANS can be assessed using several

methods incluing Valsalva Manoeuvre and
change in posture (tilt table)