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  <head>
    <title>008-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Haemodynamics and vascular control">
      <outline text="What the circulation must do">
        <outline text="Deliver oxygen, nutrients and heat, clear waste"/>
        <outline text="Match flow to need at adequate pressure"/>
        <outline text="Arteries buffer, arterioles set resistance"/>
        <outline text="Capillaries exchange, veins store and return"/>
        <outline text="Lymphatics return fluid and macromolecules"/>
      </outline>
      <outline text="Pressure, flow, and resistance">
        <outline text="Flow equals pressure gradient divided by resistance"/>
        <outline text="Resistance rises with length and viscosity"/>
        <outline text="Resistance falls with radius to the fourth power"/>
        <outline text="Series adds resistance, parallel beds divide it"/>
        <outline text="Velocity equals flow over total cross-sectional area"/>
        <outline text="Vast capillary area slows transit for exchange"/>
        <outline text="Turbulence needs speed, bore and abrupt narrowing"/>
        <outline text="A silent examination does not exclude disease"/>
      </outline>
      <outline text="Arterial pressure and pulsation">
        <outline text="Pulse pressure is systolic minus diastolic"/>
        <outline text="Mean pressure: diastolic plus one third of pulse pressure"/>
        <outline text="Mean pressure from output and vascular resistance"/>
        <outline text="Cardiac output equals rate times stroke volume"/>
        <outline text="Pulse pressure from stroke volume and compliance"/>
        <outline text="Stiffening raises pulse-wave velocity, widens pulse pressure"/>
        <outline text="Elastic recoil smooths ejection into steadier flow"/>
      </outline>
      <outline text="Arterioles and local control">
        <outline text="Calcium activates myosin light-chain kinase"/>
        <outline text="Relaxation: less calcium, more phosphatase"/>
        <outline text="Alpha one constricts, beta two dilates muscle beds"/>
        <outline text="Metabolic dilators">
          <outline text="Low oxygen, high carbon dioxide and hydrogen ions"/>
          <outline text="Potassium, adenosine and other metabolites"/>
        </outline>
        <outline text="Myogenic response to stretch stabilises flow"/>
        <outline text="Reactive hyperaemia after a released occlusion"/>
        <outline text="Active hyperaemia with rising metabolism"/>
      </outline>
      <outline text="Endothelial signalling">
        <outline text="Senses shear stress, hormones and inflammation"/>
        <outline text="Nitric oxide raises cyclic guanosine monophosphate"/>
        <outline text="Prostacyclin dilates and inhibits platelets"/>
        <outline text="Endothelin constricts"/>
        <outline text="Dysfunction loses dilator and antithrombotic cover"/>
      </outline>
      <outline text="Capillary exchange and lymph">
        <outline text="Diffusion carries most solute">
          <outline text="Lipid-soluble through membranes, water-soluble through clefts"/>
          <outline text="Rate follows area and gradient, falls with distance"/>
        </outline>
        <outline text="Hydrostatic pressure filters, oncotic pressure absorbs"/>
        <outline text="Glycocalyx limits venous-end reabsorption"/>
        <outline text="Oedema when filtration outruns lymph return">
          <outline text="Raised venous or capillary pressure"/>
          <outline text="Low albumin or leaky capillaries"/>
          <outline text="Blocked lymphatics or sodium retention"/>
        </outline>
        <outline text="Valves, muscle and breathing propel lymph"/>
      </outline>
      <outline text="Veins and venous return">
        <outline text="Compliant capacitance vessels hold most volume"/>
        <outline text="Small tone changes shift blood centrally"/>
        <outline text="Return follows the gradient to the right atrium"/>
        <outline text="Venoconstriction, muscle pump, breathing and valves"/>
        <outline text="Standing pools blood below the heart"/>
        <outline text="Immobility promotes stasis and thrombosis"/>
      </outline>
      <outline text="Congestion traced back to an organ">
        <outline text="An organ must discharge blood as well as receive it"/>
        <outline text="Raised venous pressure narrows the gradient"/>
        <outline text="Congestion favours interstitial accumulation"/>
        <outline text="High central venous pressure tracks renal decline"/>
        <outline text="Association is not proof of a single cause"/>
        <outline text="Ask whether blood cannot arrive, cannot leave, or both"/>
      </outline>
      <outline text="Pressure control, fast and slow">
        <outline text="Baroreceptors in carotid sinus and aortic arch"/>
        <outline text="Rising pressure: more vagal, less sympathetic outflow"/>
        <outline text="Resetting limits long-term baroreflex control"/>
        <outline text="Chemoreceptors answer low oxygen and acidity"/>
        <outline text="Long-term control rests on sodium and the kidney"/>
        <outline text="Renin: low perfusion, sympathetic drive, low macula densa sodium"/>
        <outline text="Angiotensin two constricts and retains sodium"/>
        <outline text="Aldosterone trades sodium for potassium"/>
        <outline text="Antidiuretic hormone holds water and constricts"/>
        <outline text="Natriuretic peptides favour excretion and dilation"/>
      </outline>
      <outline text="Hypertension, hypotension and measurement">
        <outline text="Hypertension is multifactorial and usually silent"/>
        <outline text="Injury to brain, kidney, retina and heart"/>
        <outline text="Secondary clues: young, abrupt, resistant, hypokalaemic"/>
        <outline text="Hypotension matters when perfusion fails"/>
        <outline text="Causes: volume, pump, dilation, obstruction, autonomic failure"/>
        <outline text="Cuff size, support, rest, position and repeats"/>
        <outline text="Home and ambulatory monitoring find masked patterns"/>
      </outline>
    </outline>
  </body>
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