INTEGRATIVE FUNCTIONS OF THE

CARDIOVASCULAR SYSTEM

MICHAEL F. HILL, Ph.D.

 LECTURE OBJECTIVES
1) Identify a variety of situations that alter normal cardiovascular
homeostasis.
2) Understand the general mechanisms involved in the
cardiovascular responses to:
i) Exercise
ii) Hemorrhage
iii) Change in Posture
3) Indicate what immediate reflex compensatory changes will
occur in basic cardiovascular variables such as heart rate,
cardiac contractility, C.O., TPR, CVP, and blood flow through
any major organ in response to the above mentioned
physiological stresses.
4) List the therapeutic interventions that may be required to
augment compensatory cardiovascular reflex responses.
 INTEGRATIVE FUNCTIONS OF THE
CARDIOVASCULAR SYSTEM

• The cardiovascular system ALWAYS

operates in an integrated manner!

INTEGRATIVE FUNCTIONS OF THE
CARDIOVASCULAR SYSTEM

Cardiovascular System Responses to:

1) Exercise
2) Hemorrhage
3) Changes in Posture
 RESPONSES TO EXERCISE

• Involves a combination of the central nervous

system (CNS) and local mechanisms (metabolites)
Fig. 4.35 Cardiovascular responses to exercise.
 RESPONSES TO HEMORRHAGE

• When a person loses a large quantity of

blood, Pa falls rapidly
Fig. 4.36 Effect of hemorrhage on mean arterial pressure (Pa).
Fig. 4.37 Cardiovascular responses to hemorrhage.
 RESPONSES TO HEMORRHAGE
• In some people, the compensatory responses fail

Pa falls irreversibly

Death (Irreversible Shock)

RESPONSES TO CHANGES IN POSTURE

• Supine (lying) position to a standing position

Fig. 4.38 Cardiovascular responses in a person moving from a supine to a
standing position.
 SUMMARY OF KEY CONCEPTS

• Pa is carefully monitored and maintained

at a normal value of 100 mm Hg

• The baroreceptor reflex is a fast, neurally

mediated mechanism that detects changes
in Pa and directs changes in sympathetic
and parasympathetic outflow to the heart
and blood vessels to restore Pa back to
normal
 SUMMARY OF KEY CONCEPTS

• The renin-angiotensin II-aldosterone

system is a slower, hormonally-mediated
mechanism that detects changes in Pa, and
via aldosterone, restores Pa back to
normal through changes in blood volume
10. The figure below shows pressure-volume loops for two situations.

CLINICAL PHYSIOLOGY CASE

Which of the following would be helpful to hemorrhagic shock

victims?

A) Keep them on their feet

B) Warm them up
C) Give them fluids to drink
D) Maintain their blood pressure with vasodilator-type drugs
E) Maintain their blood pressure with diuretic therapy
10. The figure below shows pressure-volume loops for two situations.

CLINICAL PHYSIOLOGY CASE

A 32-year-old woman is recovering from a bout of “intestinal flu.” She has
been unable to eat or drink for the past 36 hours. Feeling slightly better after
a good night's sleep, she decides that it's time to return to work. Realizing
that she has slept through her alarm, she jumps out of bed, feels light-
headed, and fears that she might faint. She has the sensation that her heart is
racing. Wisely, she returns to bed and decides to allow herself one more day
of recovery. Which of the following is the most likely explanation for this
patient's condition?

A) The decrease in her Pa is exaggerated because of volume depletion secondary

to gastrointestinal fluid losses
B) Her sensation of a racing heart results stems from increased parasympathetic
outflow
C) The decrease in her blood volume caused increased stretch on the
baroreceptors and increased firing rate in the afferent nerves
D) The decrease in her blood volume caused increased secretion of ANP
RELEVANCE TO ORO-FACIAL CARE

ORTHOSTATIC HYPOTENSION IS
AMONG THE LEADING CAUSES OF
SYNCOPE IN DENTAL SETTINGS!
PRECIPITATING FACTORS FOR ORTHOSTATIC
HYPOTENSION IN THE DENTAL OFFICE

• Administration of drugs (e.g. sedatives,

ganglionic-blocking agents)

• Prolonged period of recumbency (supine or

semi-supine during long procedures)
 DENTAL THERAPY CONSIDERATIONS FOR
PROPHYLAXIS OF ORTHOSTATIC HYPOTENSION

• Slowly reposition patients upright

• Stand alongside the patient until they are

able to stand freely without feeling dizzy