Updated: 11/17/2018

Baroreceptors and Chemoreceptors

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Questions
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Snapshot
  • A 20-year-old woman presents to the emergency room for palpitations. She has previously had 1 or 2 episodes of this in the past few months. She reports that coughing or performing the Valsalva maneuver resolves the palpitations. However, this time the maneuver had no effect. Her pulse is 184/min, blood pressure is 100/60 mmHg, and respirations are 20/min with O
    2
    saturation of 99% on room air. The physician presses on her neck and her pulse returns to 80/min. (Carotid massage)
Introduction
  • Mean arterial pressure is in part maintained by baroreceptors and chemoreceptors
    • both function as part of an afferent system
  • These peripheral receptors are located at the
    • aortic arch
      • transmits via vagus nerve (cranial nerve [CN] X) to the solitary nucleus of the medulla
    • carotid sinus
      • where common carotids bifurcate
      • transmits via carotid sinus nerve and glossopharyngeal nerve (CN IX) to the solitary nucleus of the medulla
Baroreceptors
  • Baroreceptors and mechanoreceptors
    • they respond to ↑ or ↓ in pressure or stretch
      • the strongest stimulus is a rapid change in arterial pressure
    • a change in pressure or stretch causes a change in membrane potential
      • this triggers action potentials in the afferent nerves that travel to the brain stem
    • sensitivity of baroreceptors can be changed by chronic diseases
  • Carotid sinus
    • responds to ↑ or ↓ in arterial pressure
  • Aortic arch
    • responds to primarily ↑ in arterial pressure
  • Baroreceptor reflex
    • a neutrally-mediated reflex that attempts to keep the arterial pressure constant via the sympathetic and parasympathetic nervous systems
    • response to increased arterial pressure
      • ↑ blood pressure is sensed by baroreceptors
        • ↑ pressure = ↑ stretch
      • ↑ firing rate of carotid sinus nerve (which connects to the glossopharyngeal nerve) and afferent vagus nerve
      • solitary nucleus of the medulla receives this information
        • ↑ efferent parasympathetic outflow 
          • to the sinoatrial node
          • ↓ heart rate
        • ↓ efferent sympathetic outflow
          • ↓ cardiac contractility and ↓ heart rate → ↓ cardiac output (CO)
          • ↓ vasoconstriction → ↓ total peripheral resistance (TPR)
          • recall that arterial pressure = CO x TPR
      • once the arterial pressure reaches the homeostatic pressure, baroreceptor activity will return to baseline level
    • response to hemorrhage
      •  acute ↓ blood pressure is sensed by baroreceptors
        • ↓ pressure = ↓ stretch
      • ↓ firing of afferent nerves CN IX and CN X
      • solitary nucleus of the medulla receives this information
        • ↓ parasympathetic outflow
          • ↑ heart rate
        • ↑ sympathetic outflow 
          • ↑ cardiac contractility
          • ↑ heart rate
          • ↑ vasoconstriction
          • ↑ arterial pressure
    • valsalva maneuver
      • ↑ intrathoracic pressure → ↓ venous return to heart → ↓ CO
        • ↓ arterial pressure
      • baroreceptor reflex kicks in to ↑ arterial pressure (as described above)
    • carotid massage
      • ↑ pressure on carotid artery → ↑ stretch → ↑ firing of baroreceptors
        • ↑ atrioventricular node refractory period
        • ↓ heart rate
Chemoreceptors
  • Chemoreceptors sense levels of oxygen, carbon dioxide, and pH
  • Peripheral chemoreceptors
    • carotid bodies in the carotid sinus and aortic bodies along the aortic arch
    • sensitive to
      • ↓ partial pressure of oxygen (PO
        2
        ) (< 60 mmHg)
      • ↓ pH
      • ↑ partial pressure of CO
        2
        (PCO
        2
        )
    • chemoreceptors are more sensitive to changes in PO
      2
      if ↑ PCO
      2
      or ↓ pH
    • response to ↓ arterial PO
      2
      • ↑ firing of afferent nerves
      • ↑ sympathetic outflow
        • ↑ vasoconstriction
      • ↑ parasympathetic outflow
        • ↓ heart rate (transient)
      • ↑ ventilation
  • Central chemoreceptors
    • located in the medulla
    • sensitive to ↑ or ↓ in PCO
      2
      or pH
    • response to brain ischemia
      • ↓ pH and ↑ PCO
        2
        immediately
      • ↑ sympathetic outflow
        • ↑ vasoconstriction → ↑ TPR
        • blood flow shunted to the brain to maintain perfusion
Cushing Reaction
  • Cushing reaction
    • a triad of hypertension, bradycardia, and respiratory depression
    • combination of both cerebral chemoreceptors to maintain cerebral blood flow and baroreceptors to induce reflex bradycardia
  • ↑ Intracranial pressure constricts vessels → cerebral ischemia
    • ↓ pH and ↑ PCO
      2
      → ↑ firing of chemoreceptors
  • ↑ Sympathetic outflow → ↑ TPR → ↑ arterial pressure
    • hypertension → ↑ stretch → ↑ firing of baroreceptors
      • reflex bradycardia
 

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Questions (2)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

(M1.CV.27) Paramedics respond to a call regarding an 18-year-old male with severe sudden-onset heart palpitations. The patient reports symptoms of chest pain, fatigue, and dizziness. Upon examination, his heart rate is 175/min and regular. His blood pressure is 110/75 mm Hg. Gentle massage below the level of the left mandible elicits an immediate improvement in the patient, as his heart rate returns to 70/min. What was the mechanism of action of this maneuver? Review Topic

QID: 100543
1

Increasing the refractory period in ventricular myocytes

7%

(7/105)

2

Increasing sympathetic tone in systemic arteries

5%

(5/105)

3

Decreasing the length of phase 4 of the SA node myocytes

9%

(9/105)

4

Slowing conduction in the AV node

23%

(24/105)

5

Decreasing the firing rate of carotid baroreceptors

55%

(58/105)

M1

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PREFERRED RESPONSE 4
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