Chapter 13. Circulatory system
Higher category : 【Biology】 Biology Index
1. Blood composition and function
2. Circulatory system and heart
5. Hemostasis and Blood Coagulation
1. Blood composition and function
⑴ Blood centrifugation : Separate blood by component
① Centrifugation with Anticoagulant : Separated from below into red blood cells, soft layers, and plasma
○ Soft layer (buffy coat) : neutrophils + platelets
○ Plasma : Liquid composition of blood
② Centrifugation without anticoagulant : Separated into blood clots and serum from below
○ Blood clot : Ingredients of coagulated blood, red blood cells + neutrophils + platelets + blood coagulation factors
○ Serum : Liquid components remaining after blood clotting, removal of fibrinogen and other components from plasma
○ Cellular elements are entangled by fibrinogen in plasma
③ Erythrocyte volume fraction (hematocrit) : Ratio of red blood cell volume to total blood volume
○ Normal adult man : 0.41 to 0.51
○ Normal adult woman : 0.36 to 0.45
○ Why men use power more than women
○ Anemic people have small hematocrit
○ Viscosity is proportional to erythrocyte volume fraction
⑵ Composition of blood
① Blood : 7% of female weight, 8% of male weight
② Blood = plasma (55%) + cellular urea (45%)
③ Plasma = Water (92%) + Protein (7%) + Other (1%)
○ Water : Solvents Carrying Other Materials
○ Na+, K+, Ca2+, Mg2+, Cl-, HCO3- : Osmotic balance, membrane permeability control
○ HCO3-, H2PO4-, Albumin, Hb (Bore effect) : pH buffer
○ Albumin : Osmotic balance, involved in the transport of lipids, stored energy sources in plasma, 3.5 to 5 g / dl
○ Fibrinogen : Blood clotting elements
○ Immunoglobulins (antibodies), interferon : Defensive function, acting faster than NK cells
○ Lipoprotein : Carrying fat
○ Hormone binding protein : Especially fat-soluble hormones
○ Transferrin : Iron-carrying protein
○ Nutrients, Metabolic Wastes, Respiratory Gases (O2, CO2), Hormones
④ Cellular elements
⑶ Cellular elements : Red blood cells
① Structure : Concave, flexible disc-shaped cells on both sides filled with hemoglobin
○ Concave disc : Increased gas exchange efficiency by increasing the contact area between oxygen and red blood cells
○ Structure that can be folded and crumpled, making it easier to pass narrow capillaries
○ Hemoglobin is about 3 million per red blood cell
○ Hemoglobin : The iron is red because it contains iron
② Function
○ Hemoglobin has the ability to bind to O2, which can carry oxygen
○ Erythrocytes are also involved in the transport of CO2
③ Produce
○ Derived from bone marrow stem cells (or myeloid cells) in the ribs, thorax, pelvis, vertebrae, etc.
○ Erythrocyte : Erythrocyte precursor cells
○ During fetal period, blood cell production from liver, spleen and bone marrow
○ 5 to 6 million pieces per mm3
○ 84% of human cells are red blood cells
○ Erythropoietin (EPO) produced by the kidney regulates red blood cell production
④ Maturity : Other organelles are destroyed when the amount of hemoglobin in red blood cells reaches 30%
○ No oxygen consumption due to mitochondria removal and lactic acid fermentation to produce ATP during maturation
○ Only glucose is used as an energy source
○ Mammalia : Nucleated cells (nucleated), lack of nucleus, capable of containing large amounts of hemoglobin
○ Remainder : Nucleated cells
⑤ Place of destruction : Liver
○ Erythrocyte lifespan : About 120 days
○ Spleen damage in sickle cell anemia
○ Zira (splenic) : Located in the back of the stomach, the ability to produce neutrophils and destroy waste red blood cells
○ Bile formation with bilirubin produced as a result of destroying red blood cells
⑥ theory of evolution : Number of hemoglobin amino acids that differ from humans
○ Gorilla 1, Rhesus Macaque 8, Dog 15, Horse 25, Chicken 45, Frog 67, Seven Growth 125
⑷ Cellular elements : neutrophils (white blood cell)
① Originated from myeloid stem cells, 5,000 to 10,000 per 1 mm3
② life span : 100 to 200 days
③ Characteristic
○ Unlike red blood cells, they also exist in intracellular and lymphatic fluids
○ Nucleus is present and used for karyotyping
○ The shape is not constant and amoeba movement
○ Swarming : Free movement within the organization
④ Produce : Produced by colony stimulating factor (CSF) produced by endothelial cells, bone marrow fibroblasts and neutrophils
⑤ Granulocyte : Phagocytosis, pus formation, allergic reactions, inflammatory reactions
○ Main feature : High density due to many polymorphonucleus and granules
○ Classification of neutrophils, eosinophils, basophils according to dyes for staining granulocytes
○ Neutrophils (neutrophils)
○ Function : Antibody-Coated Pathogen Phagocytosis
○ Distribution : Account for 60-65% of total neutrophils, 12-14 μm
○ Granule form : Forming three lumps
○ Eosinophilic neutrophils (eosinophils)
○ Function : Antibody-Coated Parasite Death and Allergic Hypersensitivity Involvement
○ Distribution : Accounted for 1% of total neutrophils
○ Shape : 2 clumps formed, relatively large granules, 12 to 17 μm
○ Dyed red by Eosin
○ Basophil neutrophils (basophils)
○ Function : Histamine and heparin release promotes T lymphocyte development
○ Distribution : 0 of all neutrophils.2% occupy
○ Shape : Granules dispersed form, large granules, 14 ~ 16 ㎛
○ Dyed in dark purple by methylene blue
⑥ Mast cells : Release of histamine, leukotriene, etc., due to damage or antigen binding
○ Refers to basophilic neutrophils that act on tissue cells
○ Mast Cells Are Not Associated with Obesity
⑦ Monocytes : Phagocytosis, differentiation into macrophages, 4% of total neutrophils, ~ 20 μm
○ Monocytes = macrophages + foreign body giant cells
⑧ Macrophages : Microbial predation and digestion, antigen presentation, T lymphocyte activation
○ Brain microglia (microglia) are also a type of macrophage
⑨ Dendritic cells : Antigen Expression in T Lymphocytes
⑩ Lymphocytes : B lymphocytes, T lymphocytes, natural killer cells, accounting for 20-35% of all neutrophils, 6-9 μm
○ Lymphocytes do not move into the blood vessels and only work within the lymph vessels
○ High percentage of nuclei compared to other neutrophils
⑷ Cellular elements : Platelets
① A fragment of the cytoplasm of bone marrow special cells (bone marrow megakaryocytes)
○ Characteristic : Nucleus-Free, Blood Coagulation
○ Uneven in shape and very small compared to erythrocytes and neutrophils
② Produce
○ 250,000 to 400,000 pieces per mm3
○ Produced by TPO (thrombopoietin) produced by the liver
③ life span : 9-12 days
④ Blood Coagulation (See. 5. Hemostasis and blood coagulation)
2. Circulatory system and heart
⑴ Circulatory system
① Type of circulatory system
○ Open circulatory system
○ Object : Arthropods and molluscs
○ Simplicity : No distinction between hemolymph and interstitial fluid due to lack of capillaries
○ Saving : Low hydraulic pressure saves energy and eliminates the need for capillary networks
○ Closed circulatory system
○ Object : Large or highly mobile organisms, such as annulus, cephalopods, vertebrates
○ Complexity : Capillaries exist to separate blood and tissue fluid
○ Efficiency : High hydraulic pressure for efficient delivery of oxygen or nutrients and formation of osmotic pressure with macromolecules in the blood
② Cardiovascular system of vertebrates : Closed circulation system
○ Animals with faster metabolism have more complex blood vessels and stronger hearts than animals without
○ The complexity and distribution of blood vessels in an individual is also proportional to the metabolism of each organ.
③ Vertebrate heart
○ Fish (1 Atrium, 1 Ventricle) : Monocyclic
○ There is no distinction between the body circulation system and the pulmonary circulation system, so you have to go through the capillary network twice before blood returns to the heart.
○ Maintain blood flow rate through exercise of skeletal muscle
○ Only venous blood flows to the heart
○ Amphibians (2 Atrium, 1 Ventricle) : Double circulation
○ Distinct circulatory system and pulmonary circulation system, supplying a large amount of blood to brain and muscle, but mixing venous and arterial blood efficiency ↓
○ Development of skin circulatory system to compensate for insufficient oxygen
○ Reptiles (2 Atrial Incomplete 2 Ventricle) : Double circulation
○ Increased efficiency of mass exchange due to less mixing between venous and arterial blood
○ Birds, mammals (2 atrium complete 2 ventricle) : Double circulation
○ Venous and arterial blood are completely separated for efficient material exchange
○ Circulatory system required for warm-blooded animals, which consume about 10 times more energy than warm-blooded animals of the same size
○ Human circulatory system
○ Body circulation : Left ventricle → Aorta → Whole body (capillaries) → Large vein → Right atrium
○ Pulmonary circulation : Right ventricle → Pulmonary artery → Pulmonary (capillary) → Pulmonary vein → Left atrium
⑵ Structure of the heart
① Located under the sternum, most of the heart muscle is fist-sized
② It consists of the atrium, which receives blood, and the ventricle, which delivers blood.
③ The ventricles have a thicker muscle layer than the atria and have a stronger contractile force.
○ In particular, the left ventricle contracts with much stronger force, sending blood to each organ in the body
○ The left ventricle contracts more powerfully than the right ventricle, but the same amount of blood is released in one contraction
④ Valve : Four valves in the heart prevent blood from flowing back
○ Atrioventricular valve : Between the atria and the ventricles, tricuspid and bicuspid
○ Meniscus : Between the ventricle and the artery
○ Abnormal sound (heart noise) occurs when blood is ejected through an incomplete valve when the valve is abnormal
⑶ Heart muscle
① Characteristic
○ Capillaries and mitochondria high density (organic breathing)
○ Red due to high myoglobin content
○ Nutrition : Fatty acids ≫ Glucose, lactic acid (∴ Organic breathing only)
○ Coronary artery : Blood supply to heart muscle, lack of blood supply to heart muscle causes cardiac arrest, heart attack, myocardial infarction
② Beating potential of autonomic beating cells
○ Autonomic beating cells : Magnolia (right atrium), Atrioventricular node (right atrium), Purkysop fiber
○ Magnolia : Generate pulsating potential without external electrical signal
○ Atrioventricular nodules, Purkysop fiber : Potential amplification upon receiving external electrical signal
○ Orthogonal nodules decrease the diastolic period and increase the number of beats due to the sympathetic nerve.
○ Magnolia increase the diastolic period and decrease the number of beats due to the effects of parasympathetic nerves.
○ The autonomic nerve acting on the nodule is the vagus n.Kind of)
③ Flat dislocation of the ventricular muscle
○ Ventricular muscles are only affected by the sympathetic nerve and one-time cardiac output is controlled
④ Contraction mechanism of ventricular muscle
⑷ Electrocardiography (ECG)
① Summary
○ Electrical signal of heartbeat, not directly attached to heart
○ Divided into waves and segments
○ Wave : If it goes up above the baseline and then goes down
○ Segment : Baseline between two waves
② P wave : Depolarization of the nodule
○ SA node, sinoatrial node : Organizations that voluntarily generate action potentials
○ Atrial depolarization as a signal of ipsilateral nodules causing atrial contraction
○ Initial state of valve : Atrioventricular valve open, meniscus closed
○ The heart muscles of the atrial are all connected to the junction, so the electrical signals of the nodule move all over the atrium in an instant.
③ P-Q interval : Room delay
○ Room delay : Action potential is approximately zero in atrioventricular node.Delayed by 1 second, measuring the time that atrial blood flow enters the ventricles
○ Atrioventricular node (Av node, atripventricular node) : Junction passage between the atria and ventricles, iso-dong dong, which causes the fibrillation after receiving signals from the nodules, synchronized with the nodules
④ Q point : Action potential reached heath color
⑤ QRS wave : Depolarization of heather, purky fibrous fibers, ie depolarization of ventricles
○ Depolarization of Purkysop Fiber → Ventricular Depolarization → Induces Ventricular Contraction
○ Ventricular contraction is triggered, resulting in atrial repolarization → atrial relaxation
○ Valve state : Atrioventricular valve closed to prevent blood flow from the ventricles to the atria
○ 1 heart sound : Heart sound as the atrioventricular valve closes
⑥ QRS-T thickness : The stage where the ventricles really contract
○ Valve state : Atrioventricular valve closed, meniscus valve open
○ After the ventricles contract, the meniscus opens and blood flows to the arteries.
○ Increasing and decreasing intraventricular pressure
⑦ T wave : Ventricular repolarization, including a few ST segments
○ Ventricular repolarization → trigger ventricular relaxation
○ Valve state : Atrioventricular valve closed to prevent blood flow from the artery to the ventricles
○ 2 heart sounds : Meniscus with closing meniscus
⑧ U wave
○ Small wave after T wave
○ Estimation of relaxation signal by vesicles after depolarization
⑨ Valve state clearance
○ Lub Dub : Sound of closing heart valve
○ Lub (Q time point) : Atrioventricular valve closing. Meniscus closed.
○ S point : Atrioventricular valve closed. Meniscus valve opening.
○ Dub (just before T) : Atrioventricular valve closed. Meniscus closing.
○ Just after T : Atrioventricular valve opening. Meniscus closed.
⑩ Electric shaft of the heart
⑹ Cardiac cycle : How the heart pumps and receives blood
① Pulse : Changes in blood vessels according to the cardiac cycle
② Systolic : Blood flow in the ventricles → arteries
③ Diastolic : Blood flow atrium → ventricles
④ Atrium, Ventricular Relaxation : Intravenous → Atrium → Ventricular, Tricuspid and Tricuspid open, Meniscal closed (0.4 seconds)
⑤ Atrial contraction, ventricular relaxation : Atrial blood → ventricles, tricuspids and tricuspids open, meniscus closed (0.1 second)
⑥ Ventricular Contraction, Atrial Relaxation : Venous blood → Atrial, ventricles release blood, tricuspid and tricuspid valve closed, meniscus open (0.3 seconds)
⑦ Delayed time so that the atria and the ventricles do not contract at the same time (0.1 second) is due to the atrioventricular delay
⑺ Cardiac arrest
① Cardiac arrest due to synchronization failure, fibrillation, arrhythmia
② Synchronization by electric shock (re-defibrillation)
⑻ Blood pressure : Pressure within the artery
① Ventricular Contraction Pressure (Max) : 1 heart rate, release rate
○ Increased ventricular contraction pressure when the aorta decreases in distensibility
○ Increasing volume of single stroke increases ventricular contraction pressure
② Ventricular relaxation pressure (lowest) : Peripheral circulation resistance, time to next systolic
○ Decreased elongation of the aorta reduces ventricular diastolic pressure
○ Single stroke does not affect ventricular relaxation
③ Pulse pressure (= systolic blood pressure-diastolic blood pressure) ← 1 stroke volume, elasticity of the aorta
④ Cardiac output : The volume of blood ejected from the ventricle for 1 minute, the volume change of the ventricles × heart rate for 1 minute
⑤ Blood pressure 120/80 (mmHg) is the pressure exerted in addition to the existing atmospheric pressure
⑥ Measurement of blood pressure
⑦ Blood pressure changes according to the cardiac cycle
⑧ Blood pressure = full load × post load
○ Full load : Proportional to blood volume, long-term regulation, regulation in the kidneys
○ After load : Proportional, short-term control of capillary perfusion resistance, control through arterial contraction and rela» xation
○ Vascular resistance
○ (Important) The body’s distal blood pressure is greater than the pressure of the heart because it has to go against gravity, and skeletal muscle is involved.
○ (Note) Figure. 13.Is not identified because is a major vessel
⑼ Fetal heart
① Blood with gas and mass exchange in the placenta enters the right atrium through the inferior vena cava (93% circulatory circulation, 7% pulmonary circulation)
② Oval : Pathway between the left atrium and the right atrium during fetal period
○ 60% of the blood going to the pulmonary artery goes to the aorta
○ At birth, the left atrium contractions are greater than the right atrium contractions, which push the lid of the oocyte and block it.
○ Ovarian obstruction (atrial septal defect) : Less obturation of the oocyte, resulting in a mixture of pulmonary and body circulation, reduced motor performance (congenital)
③ Arterial canal (bottal canal) : Blood from the pulmonary artery of the fetus moves into the blood of the aorta
○ Arteriovascular obstruction (arterial patency) (congenital)
3. Vascular system
⑴ blood vessel
① Artery : Consists of three layers (intima, media, outer membrane), many elastic fibers and muscle fibers (smooth muscle), aorta (with 11% blood)
○ The proportion of elastic tissue is relatively higher than that of veins → elasticity ↑
○ With thick blood vessel walls, can withstand high blood pressure
○ The elasticity of the artery wall allows the artery to return to its original state and maintain high blood pressure when the heart relaxes
○ (Important) The aorta regulates its contraction and relaxation by itself
○ (Important) Arterioles are controlled by contraction and relaxation by autonomic nerves
② Vein : Consists of three layers (intima, media, and outer membrane), the presence of valves and muscle fibers (smooth muscle), vena cava and predetermined vein (61% blood)
○ More than the artery and larger in diameter, holding more than half the blood in the circulatory system
○ The smallest blood flow resistance due to the largest radius among blood vessels
○ Thinner, less elastic, and lower blood pressure than arteries to prevent backflow
○ In addition to smooth muscle, there is a regulatory action of adjacent skeletal muscle
③ Capillaries
○ Capillary wall consists of a very thin layer of epithelial cells. No smooth muscle
○ Capillary pore (opening) : Pores in a tube of endothelial cells. Not in the brain with strict control of BBB
○ Basement : Peripheral, easy to permeate with endothelial cells → material exchange
○ Hydrophobic, small hydrophilic : Simple diffusion of endothelial cell membrane. Carbon dioxide, water, glucose, amino acids, etc.
○ Large Hydrophilic Material : Pass through transcytosis. Liver and small intestine have large endothelial cell spacing
○ Cells 100 μm away from capillaries die
④ Blood pressure, total cross-sectional area, blood flow rate
○ Blood pressure : Arteries> Capillaries> Veins
○ Total cross section : Capillaries> Veins> Arteries
○ Blood flow rate : Arteries> Veins> Capillaries (∵ Continuous Equation)
⑵ Material transport through the walls of capillaries
① Capillaries have a single layer of cells and have the largest cross-sectional area, which is advantageous for mass exchange.
② Mass exchange method
○ Simple diffusion or accelerated diffusion : Oxygen, carbon dioxide, small molecules, some ionic material
○ Transcytosis : When moving large molecules (blood cells, proteins, etc.)
○ Movement through capillary pores
○ Active transport
○ Osmotic pressure
③ Driving force for mass exchange
○ Blood pressure
○ Blood osmotic pressure : Formed by large molecules remaining in the capillaries
⑶ Mechanism of blood flow to the heart through veins
① Disruptors of Vein Blood Flow
○ Veins have low blood pressure, which can reverse intravenous pressure depending on external conditions
○ Example. Gravity : Obstruct the flow of blood from bottom to top through an artery or vein
② Vein Blood Flow Mechanism : Helps blood flow to the heart
○ Valve : Prevent blood flow in the vein from reversed → Prevent blood flow reversed during muscle contraction and relaxation
○ Periodic contraction of smooth muscles surrounding the veins
○ When muscles contract, blood moves towards the heart
○ When the muscles relax, the valve closes to prevent blood backflow
○ Skeletal muscle contracting during exercise
○ Example. Efficacy in removing blood clots formed in veins when traveling long distances
○ Pressure changes in the chest cavity (negative pressure) dilate the vena cava around the heart
③ If an abnormality occurs in the valve of a vein, varicose veins develop : Blood stagnation, increased load, risk of pulmonary blood
⑷ Exchange of blood and tissue fluid
① Tissue fluid and lymphatic fluid
○ Tissue
○ No plasma components, neutrophils, erythrocytes and platelets from capillaries
○ Tissue fluid is secreted from the capillaries to supply the cells with the nutrients and materials they need
○ Function : Cell and substance exchange, immune function
○ Return of tissue : About 85% of tissue fluid goes to capillaries, about 15% of tissue fluid goes to lymphatic vessels
○ Lymphatic fluid
○ Tissue fluid entering the lymphatic vessel
○ No blood cells, protein, etc.
② Exchange of blood and tissue fluid through capillaries
○ Hydrostatic pressure (or capillary pressure) (Pc) : Blood pressure acts as a force to push liquid
○ Plasma osmotic pressure (πp) : High osmotic pressure acts as a force to draw water from tissue fluid
○ Tissue Fluid Osmotic Pressure (PIF)
○ Tissue Fluid Osmotic Pressure (πIF)
○ Net Filtration Pressure at End of Artery = (Pc-PIF)-(πp-πIF) = (35-0)-(28-3) = 10 mmHg
○ End venous net filtration pressure = (Pc-PIF)-(πp-πIF) = (15-0)-(28-3) = -10 mmHg
③ Return of liquid components through the lymphatic system : Lymph circulation is 1/3000 of cardiac output
○ Formation of the lymphatic system : The amount of water that has drained into the tissue fluid is greater than the amount of water that has entered the blood
○ Function
○ Lymph nodes : Along the main lymphatic vessels of birds and mammals, various immune cell locations, swelling upon infection
○ Absorption of fat-soluble nutrients : Lymphatic system has thin walls and high permeability, allowing fat-soluble nutrients to move
○ Tissue fluid → return to blood
○ Lymphatic fluid recovery : Capillary Lymph Trachea → Chest Tube → Relative Vein → Subclavian Vein → Heart
○ Backflow prevention mechanism
○ Lymphatic vessels have leaflets (limbs) that allow lymph to enter the chest tube without reflux
○ Shifted to the pressure the lymphatic vessel receives by surrounding skeletal muscle contraction
④ Dropsy : Increased tissue fluid beyond recovery imbalance or lymphatic system
4. Blood flow control
Nerve signals, hormones, chemicals (ex. Histamine → smooth muscle relaxation) becomes a signal for blood flow regulation
⑴ Overall control : Blood flow control
① Soft water : Autonomic nervous system
○ PH detection of cerebrospinal fluid → control breathing and circulation
○ Since H+ does not pass through BBB, pH change is detected through simple diffusion of CO2 and carbonate reaction.
② Arterial pressure vessels : Signals are sent to the aortic arch, carotid sinuses, and training
○ The carotid arch is more efficient than the aortic arch
③ Blood Flow Control Process
○ 1st. Increased blood pressure → arterial pressure receptors act on soft water
○ 2nd. Training promotes parasympathetic nerves by acting directly on parasympathetic nerves
○ Parasympathetic nerve endings : Acetylcholine Release, Beating Delay
○ 3rd. Soft water acts on the inhibitory neurons of the spinal cord to suppress sympathetic nerves
○ Sympathetic nerve endings : Epinephrine Release, Pulsation Promotion
○ Cardiac : Epinephrine
○ 4th. Parasympathetic ↑, sympathetic ↓ : Relaxation of the small arteries, delayed pulsation, decreased cardiac output
⑵ Local regulation : Contraction and Relaxation of Arterial Smooth Muscle
① Arterial smooth muscle is controlled by the autonomic nervous system
② General : When the sympathetic nervous system acts, the arteries toward the internal organs contract and the arteries toward the skeleton relax.
③ Transient hyperemia : The arterioles near tissues with low oxygen partial pressure and high carbon partial pressure relax and increase blood flow
④ Active hyperemia : Local activity (eg : Blood flow in proportion to changes in metabolism
⑤ Reactive hyperemia : Blood supply in response to blood flow decline
⑶ Local regulation : Capillary Microcirculation Control
① Contraction and Relaxation of Total Capillary Sphincter or Endothelial Cells
○ Relaxation of the arterioles increases full load → increases capillary blood pressure
② Quantitative explanation : Blood flow resistance R is inversely proportional to the square of the radius of the tube r.. 2-⑻-⑧)
③ Small adjustments to the radius of one capillary can easily control the flow of blood to other capillaries
5. Hemostasis and Blood Coagulation : Blood loss prevention
⑴ Exogenous coagulation : Coagulation outside the vessel. General coagulation process
① 1st. Endothelial Surface Changes : Collagen exposure on endothelial cell surface
② 2nd. Primary hemostasis
○ 2nd-1st. Platelets adsorb to collagen in connective tissue and physically block
○ 2nd-2nd. Secretion of substances that bind platelets to better bind nearby platelets
③ 3rd. Secondary hemostasis : Clumps blood cells in the blood while forming fibrin aggregates. Platelet plug formation
○ 3rd-1st. Fibrin Formation by Multistage Enzyme Reaction of Platelets, Damaged Cells, and Plasma Coagulation Factors
○ 3rd-1st-1st. Secretion of clotting factors such as thrombokinase from damaged tissue cells
○ 3rd-1st-2nd. Blood coagulation factor is activated by Ca2 +
○ 3rd-1st-3rd. Activated coagulation factor activates prothrombin to thrombin together with Ca2 +
○ 3rd-1st-4th. Thrombin activates fibrinogen as fibrin
○ Plasma proteins, including thrombin in blood coagulation, protein lyase
○ 3rd-2nd. Fibrin conglomerates (blood clots) form as fibrin entangles and forms platelet stoppers to close wounds
④ 4th. Vasoconstriction : Aggregated platelets contract smooth muscle, synthesizing thromboxane A2 and releasing chemical mediators
○ 4th-1st. Arachidonic acid → prostaglandins : cyclooxygenase is involved
○ 4th-2nd. Prostaglandins → Thromboxane : thromboxane synthetase is involved
⑤ 5th. Wound closure
○ 5th-1st. PDGF secretion from platelets
○ 5th-2nd. PDGF receptors on epithelial cells show tyrosine kinase activity
○ 5th-3rd. Increased collagen fibers in fibroblasts → wound closure
⑵ Endogenous coagulation : Coagulation in blood vessels
① Hagueman argument involved
② Generally speaking, blood coagulation refers to exogenous coagulation, not endogenous coagulation.
⑶ Regulation of blood clotting
① Vitamin K : Essential for blood clotting; other vitamins are virtually independent of blood clotting
② Prostacyclin (PGI2), Nitric Oxide (NO) : Inhibit platelet aggregation
○ From endothelial cells
○ Prevent platelet plugs from forming at the site of injury
③ Aspirin
○ Anticoagulant effect by inhibiting cyclooxygenase involved in thromboxane synthesis
○ Heart attack prevention effect
○ Used as a thrombolytic
④ Heparin, hirudin : Anticoagulant action by inhibiting the activation of protein lyase
○ Heparin : Mast cells. Most of the carboxyl groups are negatively charged. Present in the liver
○ 1st . Heparin and anti-thrombin III bind
○ 2nd. The three-dimensional structure of antithrombin changes
○ 3rd. Heparin and antithrombin conjugates irreversibly bind thrombin
○ 4th. When antithrombin binds to thrombin, heparin loses its binding capacity
○ 5th. Heparin is recycled and combined with another antithrombin
○ Hirudin : Secreted by leeches to prevent blood clotting
⑤ Warfarin : Competitive inhibitor of vitamin K, anticoagulant action by inhibiting prothrombin formation
⑥ EDTA, sodium citrate, sodium oxalate : Anticoagulant by removing calcium
⑦ Plasmin : Blood clot removal
⑷ Blood type and blood coagulation
① Type A standard serum (anti-B) : Antigen A and Aggregate β
② Type B standard serum (anti-A) : Antigen B and agglutinin α are present
③ Aggregate reaction between antigen A and agglutinin α, antigen B and agglutinin β
④ Blood type A : Aggregation reaction with type B standard serum (anti-A) with antigen A and very small aggregates β
⑤ Blood type B : Aggregation reaction with type A standard serum (anti-B) with antigen B and very small aggregates α
⑥ AB blood : Agglutination reaction with type A and B standard serum without antigen A and antigen B
⑦ O blood : No antigen and no aggregate reaction due to aggregate α and aggregate β
6. Cardiovascular disease
⑴ Arteriosclerosis : Oil in blood vessels causes arteries to harden
① 1st. Lipoproteins, such as LDL, become entangled in the arterial endothelium
○ case 1 : Cholesterol deposits on damaged sites after damage to the vessel’s inner wall
○ case 2 : Cholesterol deposition around the inside of blood vessels : Decreased elasticity of blood vessels
② 2nd. Macrophages eat them and transform them into fat-rich foam cells
③ 3rd. Plaque (a.K.a bamboo tomb formed : The secretion of extracellular substrates (such as collagen) results in larger lipoprotein masses.
④ 4th. Plaque also joins T lymphocytes and smooth muscle cells in the vessel wall
⑤ 5th. Part of the smooth muscle cells form a fibrous cap that separates the plaque from the blood
⑥ 6th. Foam cells in plaque die and release cellular residue and cholesterol
○ When plaque explodes, blood clots develop in arteries
○ Example. If the coronary artery is blocked → causing angina
○ If the plaque does not burst and continues to grow, the artery is blocked
⑦ 40 years to hematoma and clot formation
⑵ Heart attack and stroke
① heart attack : Caused by coronary artery blockage, oxygen supply to heart muscle is blocked and cardiomyocytes die
② Stroke : The death of tissue due to lack of oxygen due to the inability to flow blood to the cerebrovascular system
○ Ischemic stroke : If the artery in the head is blocked → block the blood supply to the underlying tissues
○ Hemorrhagic stroke : When the arteries of the head burst
○ Treatment of stroke patients within 3 hours can completely reverse the consequences of a stroke
③ These two diseases are also caused by blood clots
⑶ High blood pressure
① Defition : Symptoms with a contraction pressure of at least 140 mmHg and a relaxation pressure of at least 90 mmHg
② Cause : Increased cardiac output, increased peripheral resistance
③ Characteristic : In hypertensive patients, carotid and aortic pressure receptors recognize hypertension as normal and do not perform subcutaneous reflexes.
⑷ Anemia : Red blood cells do not carry oxygen well
① Hemolytic anemia (eg : Sickle cell anemia) : Insufficient red blood cell count
② Iron deficiency anemia
③ Anemia due to hematopoietic disorder
④ Pernicious anemia (eg : Lack of vitamin B12)
⑤ Myeloid dysfunction
⑸ Diagnosis and Treatment of Cardiovascular Diseases
① Cholesterol Level Survey : Investigating LDL / HDL
② Inflammatory Response : Inflammation plays a decisive role in atherosclerosis and thrombosis
○ Cure : Aspirin → Heart Attack Prevents Stroke Again
○ Investigate the amount of CRP (C reactive protein) : Synthetic and inflammatory reactions in the liver increase blood levels
③ Blood pressure probe : In case of hypertension, damage to the inner wall → promote plaque formation
Input : 2015.7.18 00:07
Modify : 2019.2.10 22:34