CV Physio

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medman88

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So in my BRS Physio it says that with increasing TPR the slopes of the the CO and venous return change, however in FA pg 282 it shows that with increasing TPR the slope of the CO curve changes while the venous return curve moves down parallel

So was hoping for some input on what you guys think is right. I haven't really been able to find a definitive answer on the web.
 
So in my BRS Physio it says that with increasing TPR the slopes of the the CO and venous return change, however in FA pg 282 it shows that with increasing TPR the slope of the CO curve changes while the venous return curve moves down parallel

So was hoping for some input on what you guys think is right. I haven't really been able to find a definitive answer on the web.

BRS physio is correct, they do change. That FA chart isn't the best. Hemorrhage isn't truly a TPR change, it's a pre-load change.

I would go with BRS physio, it's what I learned in class also.
 
BRS physio is correct, they do change. That FA chart isn't the best. Hemorrhage isn't truly a TPR change, it's a pre-load change.

I would go with BRS physio, it's what I learned in class also.

Jack, what do you mean haemorrhage isn't truly a TPR change? If you lose blood --> arterial vasoconstriction --> increased TPR.
 
Jack, what do you mean haemorrhage isn't truly a TPR change? If you lose blood --> arterial vasoconstriction --> increased TPR.

I guess that's why this is a tricky question, when you learn these curves, you're basically learning how one alteration affects the curve.

BRS Physio:
blood loss/hemorrhage: venous return curve parallel shift left + decrease in mean systemic pressure
increase in TPR: venous return curve counter-clockwise shift (decreased slope) + no change in mean systemic pressure

FA:
Increase in TPR (e.g. hemorrhage): venous return curve parallel shift left + decrease in mean systemic pressure

FA definitely treats the scenario differently than BRS physio, I only meant that the isolated response of hemorrhage (without compensation) would just result in a parallel left shift, while an increase in TPR should decrease the slope of that curve (OR hemorrhage + compensation).
 
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I finally get it, so perhaps I can work better with Jack here.

The red dotted lines in FA on p. 282 are misrepresenting. The higher and lower red dotted lines should have increased and decreased magnitude of negative slope, respectively. They should not demonstrate a parallel relationship. The only reason they do is because it's apparent that FA was trying to depict multiple relationships all independent of one another on one graph, when in actuality, there should have been two graphs: one showing the interdependence of the variables and the other the independent value-changes.

To answer your question:

Since moving along a venous return curve to the right and down means increased venous compliance and moving to the left and up means decreased compliance, if the TPR is greater and the equilibrium point (point of intersection of the CO-VR curves) is of lower magnitude, all at constant volume/inotropic state, there must be arterial/arteriolar vasoconstriction such that a lesser proportion of blood is retained on the venous side of the circulation. This means that subsequent modulation of venous compliance would induce a lesser change in RA filling. This is why a decreased equilibrium point should result in a reduced slope of the venous return curve. Similarly, increased blood volume at this point would carry a lesser impact on CO because the veins are less distended (i.e. a greater available venous reservoir is available) and greater volume would need to be added in order to restore comparable RAEDV.

Theoretically, if increased TPR occurred, inotropic state would increase to compensate. The net result would be a maintenance of the equilibrium point, not a reduction of it.

Bottom line: increased TPR at constant volume/inotropic state results in an attenuated impact of added blood volume on CO or altered venous compliance on venous return; the converse is true for decreased TPR.
 
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