The direct and crossed components of the reflex vasoconstriction in the hind limbs of the dog following stimulation of the carotid body chemoreceptors.
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Biomedical subjects
Publications and source records attributed to A Ungar.
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1. The reflex effects of alterations in lung volume on systemic vascular resistance have been studied in anaesthetized dogs under conditions in which the systemic circulation was perfused at constant blood flow. The pressures in the isolated perfused carotid sinuses and aortic arch, and the arterial blood P(O2) and P(CO2) were maintained constant.2. A maintained inflation of the lungs produced by injection of air into the trachea caused a fall in systemic arterial perfusion pressure, indicating vasodilatation. The size of the systemic vasodilator response varied directly with the pressure and volume of gas used to inflate the lungs. A similar effect was observed when the tidal volume of lungs ventilated by an intermittent positive pressure was increased.3. Collapse of the lungs by creating a pneumothorax in closed-chest spontaneously breathing animals evoked a systemic vasoconstrictor response which was reversed when the lungs were re-expanded.4. These vasodilator responses were abolished by dividing the pulmonary branches of the thoracic vagosympathetic nerves. Evidence is presented that the afferent fibres run in the cervical vagosympathetic nerves and through the stellate ganglia.5. The responses were unaffected by atropine, but were abolished by hexamethonium, guanethidine and by bretylium tosylate, indicating that they are mediated via the sympathetic nervous system.6. Evidence is presented that the lungs are a constant course of afferent impulses inhibiting the ;vasomotor centre', and that the lung inflation-systemic vasodilator reflex is a potential mechanism operating in eupnoeic breathing.
1. In dogs under chloralose and urethane anaesthesia, the carotid and aortic bodies were isolated from the circulation and separately perfused with blood, the composition of which could be controlled at will. The remainder of the systemic circulation was perfused at constant blood flow, thereby enabling the reflex vascular responses to be determined. The systemic venous blood was oxygenated in the isolated perfused lungs of a second dog and the P(O2) and P(CO2) of the systemic arterial blood was maintained constant.2. Using hypoxic hypercapnic blood to stimulate the arterial chemoreceptors, carotid body excitation in spontaneously breathing animals caused an increase in respiratory minute volume approximately seven times larger than that evoked by stimulation of the aortic bodies. Whereas the hyperpnoea of carotid body origin is due to an increase in rate and depth of breathing, that from the aortic bodies is due predominantly to an increase in respiratory frequency.3. Stimulation of the carotid bodies in spontaneously breathing animals caused small variable changes in systemic vascular resistance, whereas stimulation of the aortic bodies invariably increased the vascular resistance.4. When pulmonary ventilation was maintained constant, the vascular response to stimulation of the carotid bodies was considerably modified in that constriction invariably occurred; that from the aortic bodies, however, was little affected. There was now no significant difference in the size of responses from the two groups of chemoreceptors. These constrictor responses represent the primary vascular effects.5. A similar modification of the carotid body vascular response occurred in the spontaneously breathing animal after denervation of the lungs, and is due to abolition of a lung-inflation vasodilator reflex.6. The size of the primary vasoconstrictor responses from the carotid and aortic bodies is reduced by lowering the arterial blood P(CO2).7. The results indicate that there is a fundamental difference in the functions of the carotid and aortic bodies. They exert a quantitatively similar primary control of the ;vasomotor centre' which is in striking contrast to the relatively more powerful influence on respiration by the carotid bodies. In the spontaneously breathing animal, however, the primary vasoconstrictor response from the carotid bodies is offset to a varying degree by the lung-inflation vasodilator reflex initiated by the concomitant hyperpnoea. This is not evident with the aortic bodies because of the relatively weaker respiratory response they evoke.
Although many cases of beta-adrenoceptor antagonist (beta-blocker) poisoning are uneventful, a proportion develop serious and sometimes fatal cardiovascular system depression with severe hypotension. As beta-adrenergic tone is not essential for cardiovascular function in health, there is no physiological reason why total beta-adrenoceptor blockade should have serious consequences in the resting individual. The toxic actions of beta-blockers appear to be related to properties such as membrane depressant activity and possibly due to actions on beta-adrenoceptors distinct from those in the cardiovascular system. Most reports of serious adverse effects following overdosage concern beta-blockers with significant membrane depressant activity, and in particular propranolol and oxprenolol, with which progressive heart block and bradycardia are features. Sotalol toxicity, with its unique electrophysiological action, is a special case. Animal experiments confirm that beta-blockers with membrane depressant activity are more toxic than the newer more selective ones, such as atenolol and nadolol. However, experimental models also reveal that artificial ventilation markedly reduces the toxicity of all beta-blockers tested, suggesting a respiratory depressant action with very high doses. Treatment of serious overdosage in man should include maintenance of adequate ventilation. High dose intravenous glucagon is recommended, because its inotropic action depends on direct stimulation of adenylate cyclase. beta-Agonists such as isoprenaline (isoproterenol) or prenalterol may be effective, but the nature of agonist-competitive antagonist interactions may necessitate the use of unrealistically large doses to overcome very high tissue beta-blocker concentrations.
BACKGROUND: In the aging kidney renal blood flow and glomerular filtration rate are reduced due to glomerulosclerosis. On this regard, hypertension has synergistic effects and may lead to end-stage renal disease in a significant proportion of cases. MATERIAL AND METHODS: To study the effects of antihypertensive drugs in an acute setting, we expressly designed an acute experiment to assess the renal response to mental stress (MS). In healthy elderly, the response was characterized by a prolonged and pronounced renal vasoconstriction, due to a reduction in renal autacoid modulatory capacity, particularly of prostaglandins. In older patients with isolated systolic hypertension, the response to MS was impaired, being characterized by a passive vasodilation with hyperfiltration. The effects of antihypertensive drugs were evaluated twice in adults patients with mild to moderate essential hypertension: after two weeks of pharmacological wash-out and after two weeks of treatment with the ACE-inhibitor trandolapril (4 mg), or the non-dihydropyridinic Ca2+ channel blocker verapamil (240 mg), or both (2 mg + 180 mg). RESULTS: While the three antihypertensive regimens reduced blood pressure to a similar extent, their effects on the renal response to MS were different. Each regimen re-established a renal vasoconstrictive response to adrenergic activation. However, with trandolapril, renal vasoconstriction was limited, as it occurs physiologically, to the period of blood pressure rise, while verapamil, or the combination of the two drugs, were associated with more prolonged vasoconstriction. CONCLUSIONS: Further studies are needed to confirm the nephroprotective effects of these drugs, particularly of ACE-inhibitors. These data may be a pathophysiological basis for future clinical trials.