8/13/2019 4xunhuan2

1/155

SECTION 3 VASCULAR

PHYSIOLOGY

8/13/2019 4xunhuan2

2/155

8/13/2019 4xunhuan2

3/155

. Functional properties ofdifferent blood vessels

1. Artery:

Aorta and large artery

Pressure reservoir vessels

8/13/2019 4xunhuan2

4/155

1.Elastic reservoir vessels:

Systole: store of energy

Elastic fiber elasticity

Stretched

Distensibility Distole: release of energy

recoil maintain distolickinetic energy

elastic reservoir pressure

intermittent flowcontinuous flow

8/13/2019 4xunhuan2

5/155

8/13/2019 4xunhuan2

6/155

Middle artery:

carry blood to arteriolesdistribution vessels

Small artery and arteriole:resistance vessels areregulated

by neurohumoral factors

Control of capillary blood flow

8/13/2019 4xunhuan2

7/155

2. Capillary vessels: exchange vessels

Exchange of substances between

blood and interstitial fluid.

Precapillary sphincter.

Control of inflow of capillaries

8/13/2019 4xunhuan2

8/155

A-V shunt (anastomosis)

Blood flow from arteriole to

venules by passing capillary.

8/13/2019 4xunhuan2

9/155

3. Venous Vessels, capacitance

vessels: large vein, vena cava.

Blood reservoir

big compliance, low mean

venous pressure, low

resistance vessels

Venous valve; venule.

8/13/2019 4xunhuan2

10/155

8/13/2019 4xunhuan2

11/155

.Blood flow, resistance to bloodflow and pressure

Hemodynamics

1.Blood flow: Blood volume passing

a given section in the cardio-vascular system per unit time (ml/s).

8/13/2019 4xunhuan2

12/155

P1-P2(1). F =

R

(2). Poiseulles law for laminar

flow.pr4

F =8L

8/13/2019 4xunhuan2

13/155

8/13/2019 4xunhuan2

14/155

Laminar flow

Velocity of different layers

is different

parabolic

no vibration

no sound

8/13/2019 4xunhuan2

15/155

8/13/2019 4xunhuan2

16/155

Turbulent flow

blood flow is in direct proportion to

square root of pressure difference

Vibration

Sound (murmur)

Wasteful energy

8/13/2019 4xunhuan2

17/155

8/13/2019 4xunhuan2

18/155

Empirical equation: Reynoldsnumber: NR=DV/

(rho): density of fluid.

D: diameter of the tube.V: velocity of flow.

NR< 2000 laminar flowNR< 3000 turbulent flow

8/13/2019 4xunhuan2

19/155

2. Resistanceto blood flow:P1-P2 81

F = R =R r4

Resistance comes from external

friction (L, r) ,internalfriction().

Total peripheral resistanceis mainlydetermined by arterioles(6070%).

8/13/2019 4xunhuan2

20/155

8/13/2019 4xunhuan2

21/155

Resistance and arterial blood

pressureaffect blood flow of

organ and redistribution of

blood flow of organs

8/13/2019 4xunhuan2

22/155

8/13/2019 4xunhuan2

23/155

3.Blood pressure. 1mmHg = 0.133 Kpa.

Two requirements for blood pressureformation:

(1) Blood filling in cardiovascularsystem.

Mean circulatory filing pressureblood volume

= 7mmHgvascular volume

affect venous return to heart.

8/13/2019 4xunhuan2

24/155

(2) Heart workPressure energy + Kinetic energy

Pressure (systole)

diastolic forward flow

pressure

8/13/2019 4xunhuan2

25/155

8/13/2019 4xunhuan2

26/155

8/13/2019 4xunhuan2

27/155

Fall of blood pressure is in direct

proportion to resistanceto blood

flow

8/13/2019 4xunhuan2

28/155

8/13/2019 4xunhuan2

29/155

8/13/2019 4xunhuan2

30/155

2. Determinants of arterial blood

pressure

(1) arterial blood volume(2) arterial compliance

Volume/pressure

8/13/2019 4xunhuan2

31/155

8/13/2019 4xunhuan2

32/155

If we assume that arterial compliance

remains constant, arterial blood

pressure will depend on arterial blood

volumeand vascular volume

Blood volumeBP vascular volume

8/13/2019 4xunhuan2

33/155

If a vascular volume does not change

arterial blood volumearterial BP

8/13/2019 4xunhuan2

34/155

Arterial blood volume is determined by the

rate of inflowand outflow of arterial system.

Rate of inflowcardiac output

Rate of outflow:resistance andBP.

AP = F R = HRSVRInflow outflow arterial blood AP

volume> <

= - -

8/13/2019 4xunhuan2

35/155

3. Factors affecting arterial

pressure

(1) stoke volume

(2) heart rate

(3) peripheral resistance

(4) aorta large artery

(5)circulatory blood flow

8/13/2019 4xunhuan2

36/155

8/13/2019 4xunhuan2

37/155

Factors results

SV HR PR E BV SP DP PP

8/13/2019 4xunhuan2

38/155

8/13/2019 4xunhuan2

39/155

2. Effect ofgravityon

venous pressure

Orthostatic hypotension

8/13/2019 4xunhuan2

40/155

3. Venous return and affecting factors(1) Mean circulatory filling pressure

(2) Cardiac contractility(3) Sympathetic nerve

(4) Muscle pump

(5) Thoracic pump

8/13/2019 4xunhuan2

41/155

8/13/2019 4xunhuan2

42/155

.Microcirculation1. Architecture of microcirculation.

(1) Thoroughfare or preferential

channel.(2) A-V anastomosis or A-v shunt.

(3) Arteriole metareriole precapillary sphincter true

capillary venule.

8/13/2019 4xunhuan2

43/155

8/13/2019 4xunhuan2

44/155

8/13/2019 4xunhuan2

45/155

4. Hemodynamic of microcirculation

(1) big cross section area

slow velocity of blood flow

(2) capillary pressure depends on

precapillary resistance / postcapillary

resistance: 5:1

(3) alternate opening and closing of

capillaries

8/13/2019 4xunhuan2

46/155

8/13/2019 4xunhuan2

47/155

2. Exchange of substances between

blood and interstitial fluid(1) Diffusion:the most important way.

Lipid soluble substances: O2, CO2

non-lipid soluble substances:

Rate of diffusion =(DA/a)(Co-Ci)

D: diffusion coefficient

(2) Pinocytosis.

8/13/2019 4xunhuan2

48/155

(3) Filtration and absorptionOutward force > inward force filtration

< reabsorption

Capillary hydrostatic interstitial

pressure hydrostatic pressure

Interstitial colloid plasma colloidosmotic pressure osmotic pressure

8/13/2019 4xunhuan2

49/155

VI Formation of interstitial fluid

V = Kf[ ( Pc+if)(p+ Pif) ]

8/13/2019 4xunhuan2

50/155

8/13/2019 4xunhuan2

51/155

3. Factors affecting the formation of

interstitial fluid.

(1) Capillary hydrostatic pressure.

(2) Colloid osmotic pressure.

(3) Lymph return.

(4) Capillary permeability.

8/13/2019 4xunhuan2

52/155

8/13/2019 4xunhuan2

53/155

SECTION 4

REGULATION OF

CARDIOVASCULAR ACTIVITY

8/13/2019 4xunhuan2

54/155

Significance:

To maintain normal blood pressure,

blood flow to be relativity constant.

To redistribute blood supply to

different tissue and organs.

To redistribute blood supply to

different tissue and organs.

8/13/2019 4xunhuan2

55/155

Ways of regulation:

BP = cardiac out Resistance8L

R = r4

Neural control: reflex

Humoral control; humoral factors

Autoregulation: intrinsic regulation

8/13/2019 4xunhuan2

56/155

Cardiovascular reflex(1) Arterial baroreflexes:

Carotid sinus baroreflexAortic baroreflex

(2) Cardiopulmonary reflex

(3) Chemoreceptor reflex

8/13/2019 4xunhuan2

57/155

A. Neural regulation

1. Innervation of the heart

dual innervation(1) cardiac sympathetic nerve

(2) cardiac parasympathetic nerve

Cardiac Symp n Cardiac Vagal n

8/13/2019 4xunhuan2

58/155

y p g

IML1-5 Amgiguus N, Dorsal

motor N of vagus

Preganglionic f Preganglionic f

ACh ACh

Postganglionic N

N receptor

Postganglionic f Postganglionic f

NE Effects Achinotropic

receptor chronotropic M receptor

dromotropic

propranolol Blocker atropine

8/13/2019 4xunhuan2

59/155

(1) Effects of vagal nerve

Vagal nerve ending ACh.

binds to M cholinergic receptor

permeability to K+results

in:

automaticity of S-A node:

8/13/2019 4xunhuan2

60/155

contractilitydue to :

K+efflux at phase 3 repolarization

AP duration Ca2+influx

[Ca2+]i;

ACh inhibits Ca2+influx [Ca2+]i

contractility.

conductivity

8/13/2019 4xunhuan2

61/155

8/13/2019 4xunhuan2

62/155

TheleftVagus n:conductivity in

A-V node

The rightVagus n: automaticity

in S-A node.

8/13/2019 4xunhuan2

63/155

(2) Effects of cardiac sympatheticnerve:

Cardiac sympathetic nerve ending noradrenaline binds to -

adrenergic receptorpermeability

to Ca2+leads to:

8/13/2019 4xunhuan2

64/155

Automaticity

ConductivityContractility

8/13/2019 4xunhuan2

65/155

The leftSymp ncontractility.The rightSymp nHR.

8/13/2019 4xunhuan2

66/155

8/13/2019 4xunhuan2

67/155

2. Innervation of blood vessels

(1) Vasoconstriction fiber

8/13/2019 4xunhuan2

68/155

Pre ganglionic ganglionic

neurons neurons

IML T1-L2 adrenergic f

cholinergic f. ACh NE

N receptor

receptor vasoconstrictionreceptor vasodilation

8/13/2019 4xunhuan2

69/155

Sympathetic

vasoconstrictor vascular tone

tone

vasoconstriction

vasodilation

tonic activity bidirectional regulation

8/13/2019 4xunhuan2

70/155

8/13/2019 4xunhuan2

71/155

Density of symp vasoconstriction

fiber in organs;

Skin > Skeletal > Visceral organs,

Cerebral vessels,

Coronary vessels.

8/13/2019 4xunhuan2

72/155

(2) Vasodilation nerve fibebs

1) Sympathetic vasodilation never fibers

Cerebral cortex relay in hypothalamus and

Midbrain medulla oblongata spinal

cord Sym fiber ACh Vasodilation

in skeletal M.

No tonic activity; defense reaction.

8/13/2019 4xunhuan2

73/155

8/13/2019 4xunhuan2

74/155

8/13/2019 4xunhuan2

75/155

3)Non-cholinergic, non-adrenergicfibersNO, peptides

8/13/2019 4xunhuan2

76/155

B. Cardiovascular center1.Cardiovascular center in medulla

oblongata

After transection between pon and

medulla oblongata, BP remains normal.

Stimulation of sciatic nerve induces theincrease in BP.

8/13/2019 4xunhuan2

77/155

After transection at obex in medulla,

BP drops to 40 mmHg, no response of

BP to stimulation of sciatic nerve.

Medulla can maintain normal BP, and

is called basal centerof

cardiovascular activity integration.

8/13/2019 4xunhuan2

78/155

(1) Rostral ventrolateral medulla

(RVLM)

(2) Caudal ventrolateral medulla

(CVLM)(3) Nucleus of solitary tract

(NTS)

(4) Cardiac vagal center

8/13/2019 4xunhuan2

79/155

(1) Rostral ventrolateral medulla

(RVLM)

Cardiac sympathetic tone

Sympathetic vasoconstriction tone

8/13/2019 4xunhuan2

80/155

Stimulationof RVLMBP,HR.Destructionof RVLM, BP decreases

to 40mmHg.

RVLM is very important center in

maintain normal BP, it has vasomotor

tonity.

8/13/2019 4xunhuan2

81/155

8/13/2019 4xunhuan2

82/155

8/13/2019 4xunhuan2

83/155

8/13/2019 4xunhuan2

84/155

(2) Caudal ventrolateral edulla

(CVLM)

Receives signals from NTS

sends axons to RVLM

Inhibition of RVLM

8/13/2019 4xunhuan2

85/155

(3) Nucleus of solitary tract (NTS)

receives signals from arterial

baroreceptors and cardiopulmanary

receptors

sends axons to vagal center and

CVLM

8/13/2019 4xunhuan2

86/155

(4) Cardiac vagal center

nucleus ambiguus, dorsal

motor nucleus of vagus

receives axons fom NTS

8/13/2019 4xunhuan2

87/155

8/13/2019 4xunhuan2

88/155

NTS CVLM RVLM

N.ambiguous Symp. Preganlionic

dorsal motor neurons in IML.

N of vagus

3 H th l

8/13/2019 4xunhuan2

89/155

3. Hypothalamus

(1) Hypothalamus is higher

integrated centerof autonomic

system, including feeding,

regulation of body temperature,

fluid balance and endocrinesecretion.

(2) Anterior hypothalamus

8/13/2019 4xunhuan2

90/155

(2). Anterior hypothalamusStimulation causes the decrease in BP

and HR

Sends axons directly to SPN of IML in

spinal cord.

Receives axons of NTS in medulla.

Plays role in arterial baroreflex.NTS AH IML Symp.f.

8/13/2019 4xunhuan2

91/155

(3) Posterior and lateral hypothalamusStimulation of defence area

cause defensive reaction:

Behavior: Rage, attack reaction or fighting

associated with hissing, growling, spitting,

piloerection, pupil dilation, biting

8/13/2019 4xunhuan2

92/155

Cardiovascular reactions:

BP,HR, Vasodilation in skeletal

muscle.

vasoconstriction in skin and splanchnic

organs.

4 Cerebral cortex

8/13/2019 4xunhuan2

93/155

4. Cerebral cortex.

(1) Limbic area regulates the activity of

lower centers.

(2) Motor and premotor area causes

vasoconstriction of skin, splanchnic and

renal vessels, but vasodilation in skeletal

muscles.(3) Responses of BP to pain, anxiety and

during exercise.

8/13/2019 4xunhuan2

94/155

(1). Barorecrptor is located in adventitia of

8/13/2019 4xunhuan2

95/155

(1). Barorecrptoris located in adventitia of

carotid sinus and aortic arch

Characteristics:

a. Response to stretch, not to pressure

itself

b. Activity is directly related to BP level

c. More sensitive to pulsatile pressure

than nonpulsatile pressure.

8/13/2019 4xunhuan2

96/155

8/13/2019 4xunhuan2

97/155

8/13/2019 4xunhuan2

98/155

(2) Afferent ner e: B ffer ner es

8/13/2019 4xunhuan2

99/155

(2) Afferent nerve: Buffer nerves

Carotid sinus nerve - a branch of

glossopharyngeal nerve connected

with carotid sinus baroreceptor

Aortic nerve-running in vagus n

connected with aortic baroreceptor

Reflex arc

BP

8/13/2019 4xunhuan2

100/155

Carotid &aortic

receptors

NTS

vagal center cardiac vagus HR

cardiac symp SV

CVLM RVLM MIL CO

symp vasoconstrictor PR

BP

8/13/2019 4xunhuan2

101/155

(3) Function of baroreflex.

a.Experimental evidence:

(a) Effect of carotid clamping;

(b) Buffer nerve cut or stimulated

(c) Perfusion of isolated carotidsinus.

8/13/2019 4xunhuan2

102/155

MethodResults:

baroreflex function curve.Features of the curve:

8/13/2019 4xunhuan2

103/155

8/13/2019 4xunhuan2

104/155

A i S h

8/13/2019 4xunhuan2

105/155

Anti S shape

Sinus threshold pressure

Sinus saturation pressure working range

Equilibrium point or operating point ( Setpoint):ISP = arterial pressure.

Negative slope (gain) - Negative feedback

Slope is no uniform.

8/13/2019 4xunhuan2

106/155

(4) Functional significances of arterialbaroreflex:

To keep arterial pressure at normal levelTo stabilize arterial pressure and prevent

arterial pressure from largefluctuation

8/13/2019 4xunhuan2

107/155

8/13/2019 4xunhuan2

108/155

Baroreflex resetting.

Operating point and baroreflex

function curve shift upward or

downward.

8/13/2019 4xunhuan2

109/155

2. Cardiopulmonary reflex(1). Atrial volume receptor

Location: in the junction of pulmonaryvein and left atrium, vena cava and

right atrium

8/13/2019 4xunhuan2

110/155

Reflex action:

Tachycardia (bainbridge reflex) 1895.

Increase in urine due torenal

Sympathetic efferent activityand

antidiuretic hormone.

(2) Left ventricular receptor

8/13/2019 4xunhuan2

111/155

(2).Left ventricular receptor.

a. Mechanoreceptors:Location: Left ventricle.

Stimulation of ventricle.

Afferent n: vagus n.

Reflex action: similar to arterial

baroreflex, i.e. decrease in BP

and HR.

b. Chemoreceptor in ventricle:

8/13/2019 4xunhuan2

112/155

p

Coronary chemoreflex(Bezold- Jarisch

reflex)

Reflex effects: decrease in BP and HR

Stimulation: Veratridine, nicotine,

bradykinin, prostagladins, myocardial

infarction.

Vagal afferent n.

2 Ch t fl

8/13/2019 4xunhuan2

113/155

2. Chemoreceptor reflex

(1) Respiratory depth and frequency

increases;

(2) Vasoconstriction in skeletal M,

splanchnic viscera, kidney.

(3) Blood flow in brain and liverincreases. BP inceases

8/13/2019 4xunhuan2

114/155

(4)HR, cardiac outputdue to

a.respiration rate and depth

b.catecholamine from adrenal

medulla.

If i ti t d d th k

8/13/2019 4xunhuan2

115/155

If respiration rate and depth keep

constant BP

a.HR, cardiac output

b. vasoconstriction in skeletal M

Splanchnic organs and kidneys

c. Coronary vosodilation

Diving rflex

Si ifi f h t fl

8/13/2019 4xunhuan2

116/155

Significances of chemoreceptor reflex

Uunder normal condition chemoreflex playsa litte role in control of cardiovascular

activity, but in an emergency(asphyxia,

hypoxia, acidosis, severe hypotension) blood

pressure is maintained by this reflex,

because bilateral buffer nerves are cut,

blood pressure will drop to very low level.

8/13/2019 4xunhuan2

117/155

8/13/2019 4xunhuan2

118/155

B. Humoral regulation of

cardiovascular system

1. Renin - angiotension system.

i i ( 2 l b li )

8/13/2019 4xunhuan2

119/155

angiotensinogen ( 2-globulin)kidney renin

angiotensin(decapeptide)converting enzyme

angiotensin(octapeptide)angiotensinase A AT1receptor

angiotensin(heptapeptide)

8/13/2019 4xunhuan2

120/155

(1).Action

8/13/2019 4xunhuan2

121/155

a. The increase in BP

Arterial constrictiontotal peripheral

resistance

Venous constrictionvenous returnSV.

Stimulation of secretion of aldosterone

renal tubule reabsorption of Na+,H2O

blood volume.

Facilitation of NE releasefrom adrenergic

8/13/2019 4xunhuan2

122/155

fiber endings, modulation of sympathetic

function.

Central effectsof angiotensin .

Action site: Circumventricular organs;

Organum vasoculosum of the lamina

terminalis (OVLT), Subfornical organ

(SFO), Area postrema (AP).

8/13/2019 4xunhuan2

123/155

8/13/2019 4xunhuan2

124/155

Regulation of renin release

a. Renal mechanisms:

renal vascular baroreceptor.

b. Renal sympathetic n

c. Plasm Na+,plasm K+

Hemorrhage

8/13/2019 4xunhuan2

125/155

2.Epinephrine(adrenaline EP)

norepinephrine (noradrenaline NE)

Origin: adrenal medulla.

Secretion: EP 80%, NE 20%.

8/13/2019 4xunhuan2

126/155

Effect: similar to that of sympathetic

nerve.

(1)Heart: positive chronotropic and

inotropic effect.(2)Blood vessels:

-adrenergic receptor: vasoconstriction.

-adrenergic receptor: vasodilation.

8/13/2019 4xunhuan2

127/155

The action of EP and NE on

cardiovascular system has some

differences which depend on the

distribution and affinityof - and

- receptors.

8/13/2019 4xunhuan2

128/155

8/13/2019 4xunhuan2

129/155

8/13/2019 4xunhuan2

130/155

3. Antidiuretic hormone (vasopressin)

Synthesisin supraoptic nucleus

and paraventricular nucleus.

Storein posterior pituitary gland

(neurohypophysis).

ReleaseADH to blood stream.

Action :

8/13/2019 4xunhuan2

131/155

V1 receptor: constriction of bloodvessel increase in blood pressure.

V2 receptor: reabsorption of H2O

from collecting duct.

Dehydration, hemorrhage:AVP

8/13/2019 4xunhuan2

132/155

4. Endothelium-derived vasoactivesubstances. Prostacyclin (PGI2)

(1) Endothelium-derived relaxing factor:Nitric oxide (NO)

NO synthaseL-Argine NO + L-citrulline

NO ti t l l l hi h

8/13/2019 4xunhuan2

133/155

NO activates guanylyl cyclasewhich

increases cGMP formation. cGMP

decreases [Ca2+]iand relaxes vascular

smooth muscle.

Phosphodiesterase hydrolyses cGMP

Factors of activation NOS: ACh,

bradykinin, substance P, mechanical stress

3 Endothelin

8/13/2019 4xunhuan2

134/155

3.Endothelin

21 amino acid residues, strong

vasoconstrictor

i vendothelin causes first decrease in

BP and followed by long-term of the

increase in BP

5. Atrial natriuretic peptide (ANP)

8/13/2019 4xunhuan2

135/155

5. Atrial natriuretic peptide (ANP)

Action:vasodilation, cardiac output HR

extracellular fluid volume:

excretion of water and Na+

release of renin and aldosterone

Factors of releasing ANP:

atrial blood volume.

6. Kallikrein-kinin system

8/13/2019 4xunhuan2

136/155

Kallikreins: proteolytic enzymes

kininogens

Plasma Kallikrein

tissue Kallikrein

kinins: bradykinin, lysylbradykinin

angiotensin converting enzyme (ACE)

Vasodilator, capillary permibility

8/13/2019 4xunhuan2

137/155

8/13/2019 4xunhuan2

138/155

8/13/2019 4xunhuan2

139/155

C. Local regulation of blood flow

1. Active hyperemia

2. Blood flow aytoregulation

8/13/2019 4xunhuan2

140/155

D. Blood volume and long term

regulation of blood pressureRenal-body fluid control system

8/13/2019 4xunhuan2

141/155

SECTION 4 CORONARY

CIRCULATION

8/13/2019 4xunhuan2

142/155

CIRCULATIONI. Anatomic consideration.

II. Feature of coronary flow.

PF =

R

P: perfusion pressure (aortic P -

atrial P), R: resistance

8/13/2019 4xunhuan2

143/155

During systole myocardial contraction

8/13/2019 4xunhuan2

144/155

compress coronary vessels which result

in the increase in coronary resistance.

During diastole release of compression

leads to the decrease in coronary

resistance. Therefore, coronary flow

depends on: 1.diastolic pressure.

2.duration of diastole.

8/13/2019 4xunhuan2

145/155

Cyclic change of

coronary flow

Pressure gradient

.Regulation of coronary blood flow.

8/13/2019 4xunhuan2

146/155

Normal value: 60-80ml/100g.min.

Exercise 300-400ml/100g.min

O2consumption 7-9ml/100g.min.

O2 extraction 65-70%

O2content in coronary venous blood

is 5ml/100ml. O2content in skeletal

muscle venous blood is 17-18ml/100ml.

1. Myocardial metabolic level

8/13/2019 4xunhuan2

147/155

cardiac activity, cardiac

consumption O2 ,PO2,

adenosine

CO2, H+, lactic acid, K+,

prostaglandins.

Effects of PO2on coronary flow

ATP

8/13/2019 4xunhuan2

148/155

PO2

ADP

AMP

5nucleotidase

adenosinevasodilationadenosine adenosine

Kinase diaminase

inosine

8/13/2019 4xunhuan2

149/155

2. Neurol control

(1).Sympathetic nerve: NE

-receptor vasoconstriction

-receptormyocardial

contraction metabolism,

coronary vasodilation

8/13/2019 4xunhuan2

150/155

(2). vagal nerve:

ACh coronary dilation.

metabolism coronary

constriction

8/13/2019 4xunhuan2

151/155

3.Hormone regulation

NE, EP, thyroxin coronary

dilationAngiotensin, vasopressioncoronary constriction.

8/13/2019 4xunhuan2

152/155

(2).Regulation of vasopressin release

a.Osmotic control;

O ti t i t i t l thi d

8/13/2019 4xunhuan2

153/155

Osmotic receptor in anterioventral third

Ventricle (AV3V)

plasmaosmotic PVN,SON

pressure ADH

Reabsorption of water

From collecting

Blood volume

8/13/2019 4xunhuan2

154/155

b. non-osmotic control.* volume receptor

vagal afferent nerve(+)

ADH

* arterial baroreceptors (+)

8/13/2019 4xunhuan2

155/155

sinus n and aortic n

ADH

* Pain, Surgical stress,

emotion stress ADH