Which of the following may occur if the mitral valve were to undergo ischemic damage?

During strenuous exercise, the sympathetic nervous system functions to increase cardiac output in order to match the metabolic activity of the body. Which of the following is a mechanism of action to increase cardiac output?

What specialized area of tissue delays the proliferation of electrical stimulation in the heart, allowing the heart chambers to fill with blood?

Both the sympathetic and the parasympathetic nervous systems are essential for homeostasis and for survival. For example, when we are trying to run away from a threat, the sympathetic nervous system is in full effect to allow us to escape from danger. However, when there is no obvious threat, the parasympathetic nervous system tends to be more in control. 

There are similarities and differences between the sympathetic and the parasympathetic nervous systems. In preganglionic nerve fibers, both the sympathetic and the parasympathetic nervous system utilize the neurotransmitter acetylcholine. Closer to the target organ, the parasympathetic nervous system remains dependent on acetylcholine whereas norepinephrine and epinephrine are the predominant neurotransmitters utilized by the sympathetic nervous system. 

When norepinephrine and epinephrine bind to their receptors, different effects are carried out based on the type of receptor, affinity, and location of the receptor. For example, epinephrine has a higher affinity for the beta-2 receptor. When epinephrine binds to the beta-2 receptor, common effects include vasodilation and bronchodilation. Norepinephrine has a stronger affinity for the alpha-1, alpha-2 and beta-1 receptors. When norepinephrine binds to its receptor, common effects on the body include vasoconstriction (alpha-1), increased heart rate (beta-1) and uterine contraction (alpha-1).

In patients with heart failure, the physician might prescribe a beta blocker to help with the condition. How will a beta blocker be useful in patients with heart failure?

Carbonic anhydrase is a very important enzyme that is utilized by the body. The enzyme catalyzes the following reaction:

A class of drugs that inhibits this enzyme is carbonic anhydrase inhibitors (eg. acetazolamide, brinzolamide, dorzolamide). These drugs are commonly prescribed in patients with glaucoma, hypertension, heart failure, high altitude sickness and for the treatment of basic drugs overdose.   

In patients with hypertension, carbonic anhydrase inhibitors will prevent the reabsorption of sodium chloride  in the proximal tubule of the kidney. When sodium is reabsorbed back into the blood, the molecule creates an electrical force. This electrical force then pulls water along with it into the blood. As more water enters the blood, the blood volume increase. By preventing the reabsorption of sodium, water reabsorption is reduced and the blood pressure decreases. 

When mountain climbing, the atmospheric pressure is lowered as the altitude increases. As a result of less oxygen into the lungs, ventilation increases. From the equation above, hyperventilation will result in more  being expired. Based on Le Chatelier’s principle, the reaction will shift to the left. Since there is more bicarbonate than protons in the body, the blood will become more basic (respiratory alkalosis). To prevent such life threatening result, one would take a carbonic anhydrase inhibitor to prevent the reaction from shifting to the left.  

Carbonic anhydrase inhibitors are useful in patients with a drug overdose that is acidic. The lumen of the collecting tubule is nonpolar. Due to the lumen's characteristic, molecules that are also nonpolar and uncharged are able to cross the membrane and re-enter the circulatory system. Since carbonic anhydrase inhibitors alkalize the urine, acidic molecules stay in a charged state.

How can taking a carbonic anhydrase inhibitor help a patient with signs of heart failure?