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3.4: Going Downhill, Heavy alcohol intake (35 standards per week), Male,…

- - - - Reduced BP
        
        Renin release by juxtaglomerular cells in kidney
        
        Angiotensinogen (from liver) conversion to angiotensin I
        
        Angiotensin I conversion to Angiotensin II by ACE (in lungs & vasculature)
        
        Angiotensin II binds to angiotensin II type 1 receptor
        
        AT1R in adrenal cortex
        
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        AT1R in vessels
        
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        Reduced firing rate of baroreceptor neurons in the carotid body and aortic arch
        
        Reduced afferent signals to the medullary cardiovascular centre
        
        Reflex activation of the sympathetic nervous system
        
        Direct cardiotoxicity
        
        Cardiac myocyte damage and necrosis
        
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        Increased heart rate and contractility via beta1 adrenoreceptors on cardiac pacemaker and contractile cells
        
        Increased potential for dysrhythmias
        
        Increased myocardial oxygen demand
        
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        Beta blockers (bisprolol, carvedilol, metropolol succinate, nebivolol) antagonise beta adrenoreceptors
        
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        Vasoconstriction via alpha1 adrenoreceptors on vascular smooth muscle cells
        
        Activation of the RAAS via beta1 adrenoreceptors on juxtaglomerular cells
        
        Reduced effective circulating blood volume
        
        Increase ADH release
        
        Increase fluid reabsorption
        
        Increase blood volume
        
        Increase arterial blood pressure
      - Frank-Starling Mechanism
        
        Short term: SV increases in response to increase in EDV
        
        Allows cardiac output to be synchronised with VR and arterial blood supply
        
        Long term: Increase in SV result in increase in LV pressure
        
        Continued increased in LV pressure result in less increase in SV
        
        Stretch or increase in cardiac chamber volume
        
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        Insufficient SV to meet demand
- - - - Fevers, cough, flu-like symptoms
      - Increased oxygen demand and cardiac afterload
        
        Acute exacerbation of chronic heart failure