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33559238.Pdf HAEMODYNAMICS AND VASOACTIVE AGENTS The haemodynamic effects of vasoactive agents in rats with chronic arteriovenous fistula by Liang Guo Bachelor of Medicine A thesis submitted to the School of Graduate Studies in partial fulfillment of the degree of Master of Science Division of Basic Medical Sciences, Faculty ofMedicine Memorial University of Newfoundland June 2006 St. John's, Newfoundland Library and Bibliotheque et 1+1 Archives Canada Archives Canada Published Heritage Direction du Branch Patrimoine de !'edition 395 Wellington Street 395, rue Wellington Ottawa ON K1A ON4 Ottawa ON K1A ON4 Canada Canada Your file Votre reference ISBN: 978-0-494-30467-9 Our file Notre reference ISBN: 978-0-494-30467-9 NOTICE: AVIS: The author has granted a non­ L'auteur a accorde une licence non exclusive exclusive license allowing Library permettant a Ia Bibliotheque et Archives and Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par telecommunication ou par I' Internet, preter, telecommunication or on the Internet, distribuer et vendre des theses partout dans loan, distribute and sell theses le monde, a des fins commerciales ou autres, worldwide, for commercial or non­ sur support microforme, papier, electronique commercial purposes, in microform, et/ou autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve Ia propriete du droit d'auteur ownership and moral rights in et des droits moraux qui protege cette these. this thesis. Neither the thesis Ni Ia these ni des extraits substantiels de nor substantial extracts from it celle-ci ne doivent etre imprimes ou autrement may be printed or otherwise reproduits sans son autorisation. reproduced without the author's permission. In compliance with the Canadian Conformement a Ia loi canadienne Privacy Act some supporting sur Ia protection de Ia vie privee, forms may have been removed quelques formulaires secondaires from this thesis. ont ete enleves de cette these. While these forms may be included Bien que ces formulaires in the document page count, aient inclus dans Ia pagination, their removal does not represent il n'y aura aucun contenu manquant. any loss of content from the thesis. ••• Canada ii ABSTRACT An arteriovenous fistula is an abnormal direct passage between an artery and a vein. The existence of an arteriovenous fistula generates a high output low total peripheral resistance state that resembles the hyper-haemodynamic condition of several diseases such as vascular injury, congenital malformation, chronic severe anemia, severe hepatic or renal disorders, and septic shock. In the present study, we investigated the haemodynamic changes in rats with chronic arteriovenous fistulae and the haemodynamic effects of noradrenaline, arginine vasopressin, and sodium nitroprusside in this model. Creation of a chronic fistula between abdominal aorta and inferior vena cava increased cardiac output compared to sham-operated rats. The haemodynamic factors when compared to respective values in sham-operated rats changed in the following ways: 1) total peripheral resistance and resistance to venous return decreased; 2) heart rate and cardiac contractility based on dP/dt values recorded remained stable at the baseline level; and 3) blood volume and mean circulatory filling pressure increased. The augmentation of total blood volume, mean circulatory filling pressure and reduction in vascular resistance together contributed to the increase in cardiac output. Noradrenaline infusion did not change the cardiac index in rats with chronic arteriovenous fistulae. Administration of noradrenaline 1) increased total peripheral resistance and resistance to venous return; 2) increased heart rate and cardiac contractility based on dP/dt values recorded; and 3) did not change total blood volume but increased mean circulatory filling pressure. The positive effects of noradrenaline on heart rate, iii cardiac contractility, and total body venous tone tended to increase cardiac index. However, the increase of cardiac index was prevented due to the increase in total peripheral resistance and resistance to venous return. Administration of arginine vasopressin did not change the cardiac index in rats with chronic arteriovenous fistulae. Upon arginine vasopressin infusion, 1) total peripheral resistance and resistance to venous return increased; 2) heart rate did not change while cardiac contractility increased based on dP/dt value recorded; and 3) total blood volume and mean circulatory filling pressure increased. Unlike its actions in the intact animal, administration of arginine vasopressin ·in rats with chronic arteriovenous fistulae reversed the preload-afterload mismatch by increasing mean circulatory filling pressure and total blood volume with little effect on resistance to venous return. Therefore, cardiac index did not fall despite of elevation of the afterload. Administration of sodium nitroprusside had limited effects on cardiac index in rats with chronic arteriovenous fistula. The circulatory parameters altered in the following manner: 1) total peripheral resistance and resistance to venous return remained at the baseline level; 2) heart rate did not change while cardiac contractility decreased at the highest dose based on dP/dt value recorded; and 3) total blood volume and mean circulatory filling pressure was kept unchanged. Due to the special condition in our experimental model such as low vascular resistance and maximal vasodilation, administration of sodium nitroprusside had limited haemodynamic effects. iv In conclusion, in rats with well compensated chronic arteriovenous fistulae vasoactive agents have little effects on cardiac output. Therefore, in diseases resembling the pathophysiology of a chronic arteriovenous fistula such as septic shock administration of · these drugs may have limited effect and little benefit. v ACKNOWLEDGMENTS I would like to thank Dr. R. Tabrizchi for his patient and excellent supervision, guidance and cooperation. Many thanks to my committee members: Dr. D. Bieger and Dr. G. Kirouac. I also want to thank all the people in the group of cardiovascular and renal science. Special thanks to my Mum and Dad for their support. vi TABLE OF CONTENTS Abstract Pg. II Acknowledgments Pg. V List of Contents Pg. VI List of Tables Pg.VIII List of Figures Pg. IX 1. Introduction Pg.l 1.1. Regulation of Cardiac Output Pg.l 1.1.1 Resistance Pg.2 1.1.2. Heart pumping capacity Pg.4 1.1.3. Blood Volume Pg.8 1.1.4. Vascular compliance Pg.8 1.2. Haemodynamic effects of noradrenaline Pg.11 1.3. Haemodynamic effects of arginine vasopressin Pg.15 1.4. Haemodynamic effects of sodium nitroprusside Pg.19 1.5. Haemodynamics in rat with arteriovenous fistula Pg.22 1.6. Nature ofProblem Pg.27 ·1.1. Objective Pg.30 2. Materials and Methods Pg.32 2.1. Preparation of animals with arteriovenous fistula Pg.32 2.2. Surgical preparation Pg.33 2.3. Measurement of cardiac output Pg.)5 2.4. Measurement of mean circulatory filling pressure Pg.35 2.5. Measurement of blood volume Pg.36 2.6. Measurement of the organ weight Pg.36 2. 7. Experimental designs and protocols Pg.37 2.8. Chemicals Pg.38 2.9. Calculations and statistical analysis Pg.38 3. Results Pg.41 3.1. Haemodynamics in rats with chronicAVF Pg.41 3.2 Haemodynamic effects of noradrenaline in rats with chronic AVF Pg.41 · 3.3 Haemodynamic effects of arginine vasopressin in rats with chronic AVF Pg.57 3.4 Haemodynamic effects of sodium nitroprusside in rats with chronic AVF Pg.62 3.5. Haematocrit, plasma volume and total blood volume Pg.63 3 .6. Organ weight and body weight Pg.65 VII 4. Discussion Pg.67 . 5. Reference List Pg.81 viii LIST OF TABLES Table 1 Cardiac index, fistula flow index, heart rate and dP/dt in Pg.42 anaesthetized rats with chronic arteriovenous fistula and sham­ operated rats. Table 2 Blood pressure, pulse pressure, venous pressure, and mean Pg.43 circulatory filling pressure in anaesthetized rats with chronic arteriovenous fistula and sham-operated rats. Table 3 Total peripheral resistance and resistance to venous return in Pg.44 anaesthetized rats with chronic arteriovenous fistula and sham­ operated rats. Table 4 Haematocrit, plasma volume and total blood volume values Pg.45 during administration of noradrenaline, arginine vasopressin, sodium nitroprusside, and saline in anaesthetized rats with chronic arteriovenous fistula and sham-operated rats. Table 5 Weights of wet lung, dry lung, weight ratio of dry lung to wet Pg.64 lung, weights of right kidney, left kidney, right ventricle, left ventricle plus septum, and weight ratio of right ventricle to left ventricle plus septum after administration of noradranline, arginine vasopressin, sodium nitroprusside, and saline in anaesthetized rats with chronic arteriovenous fistula and sham­ operated rats and mean body weight in each group. Table 6 Baseline values of cardiac index, fistula flow index, systemic Pg.66 flow index, blood pressure, pulse pressure, venous pressure, mean circulatory filling pressure, heart rate, dP/dt, total peripheral resistance, resistance to venous return, systemic resistance, and resistance of fistula before administration of noradrenaline; arginine vasopressin; sodium nitroprusside; saline in anaesthetized rats with chronic arteriovenous fistula. ix LIST OF FIGURES Figure 1 Daily body weight of rats with chronic arteriovenous fistula Pg.46 and sham-operated rats . Figure 2 Percent
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