Exercise 1: increasing arterial pressure
Normal value Time120 180
systolic pressure 121.0 132.8 132.8 mmHg
diastolic pressure 75.1 82.2 82.1 mmHg
Right atrial pressure 1.7 2.1 2.1 mmHg
mean capillary pressure 12.7 11.2 11.2 mmHg

heart rate 69.7 51.8 51.8 /min
stroke volume 71.5 79.7 79.7 ml
cardiac output 5.0 4.1 4.1 l/min

total arterial resistance 16.0 21.8 21.8 mmHg.l/min
cardial contractility 1.3 1.0 1.0 l/min/mmHg

Exercise 2: playing with different factors
1. Arterial Resistance:
Arterial Resistance (increase)200 Normal value 120sec 180sec
systolic pressure 121.0 144.9 144.9 mmHg
diastolic pressure 75.1 91.4 91.5 mmHg
Right atrial pressure 1.7 2.2 2.2 mmHg
mean capillary pressure 12.7 10.3 10.3 mmHg

heart rate 69.7 45.6 45.6 /min
stroke volume 71.5 80.2 80.2 ml
cardiac output 5.0 3.7 3.7 l/min

total arterial resistance 16.0 27.6 27.6 mmHg.l/min
cardial contractility 1.3 0.9 0.9 l/min/mmHg

Comments:
1.
No complain

2.
No complain

Arterial Resistance
(decrease)50 Normal value 120sec 180sec
systolic pressure 121.0 93.2 94.4 mmHg
diastolic pressure 75.1 60.3 60.8 mmHg
Right atrial pressure 1.7 1.1 0.9 mmHg
mean capillary pressure 12.7 14.5 14.6 mmHg

heart rate 69.7 133.2 131.8 /min
stroke volume 71.5 45.6 47.1 ml
cardiac output 5.0 6.1 6.2 l/min

total arterial resistance 16.0 9.7 9.6 mmHg.l/min
cardial contractility 1.3 2.0 2.1 l/min/mmHg

Comments:
1.
I FEEL FAINT WHEN I TRY TO STAND UP

2.

SAME AS ABOVE

2. Venous resistance
Venous resistance
(increase)175 Normal value 120SEC 180SEC
systolic pressure 121.0 103.5 144.9 mmHg
diastolic pressure 75.1 70.0 91.5 mmHg
Right atrial pressure 1.7 0.2 2.2 mmHg
mean capillary pressure 12.7 15.0 10.3 mmHg

heart rate 69.7 100.1 45.6 /min
stroke volume 71.5 38.8 47.1 ml
cardiac output 5.0 3.8 3.7 l/min

total arterial resistance 16.0 17.8 27.6 mmHg.l/min
cardial contractility 1.3 1.8 1.8 l/min/mmHg

Comments:
1.
NO COMPLAIN

2.
SAME AS ABOVE

Venous resistance
(decrease)12,5% Normal value 120SEC 180SEC
systolic pressure 121.0 149.8 149.9 mmHg
diastolic pressure 75.1 79.8 79.6 mmHg
Right atrial pressure 1.7 5.3 5.3 mmHg
mean capillary pressure 12.7 7.6 7.6 mmHg

heart rate 69.7 48.7 48.7 /min
stroke volume 71.5 141.4 141.3 ml
cardiac output 5.0 6.9 6.9 l/min

total arterial resistance 16.0 14.2 14.2 mmHg.l/min
cardial contractility 1.3 0.9 0.9 l/min/mmHg

Comments:
1.

I AM RATHER SHORT OF BREATH
2.SAME AS ABOVE

3. Cardiac pump perf
Cardiac pump perf
(increase)200 Normal value 120SEC 180SEC
systolic pressure 121.0 130.2 130.2 mmHg
diastolic pressure 75.1 79.3 79.2 mmHg
Right atrial pressure 1.7 0.6 0.6 mmHg
mean capillary pressure 12.7 13.1 13.1 mmHg

heart rate 69.7 68.1 68.1 /min
stroke volume 71.5 83.6 83.6 ml
cardiac output 5.0 5.7 5.7 l/min

total arterial resistance 16.0 15.0 15.0 mmHg.l/min
cardial contractility 1.3 2.2 2.2 l/min/mmHg

Comments:
1.

NO COMPLAIN
2.
SAME AS ABOVE

Cardiac pump perf
(decrease)25% Normal value 120 180
systolic pressure 121.0 84.2 91.3 mmHg
diastolic pressure 75.1 57.8 62.1 mmHg
Right atrial pressure 1.7 4.6 4.2 mmHg
mean capillary pressure 12.7 11.0 11.4 mmHg

heart rate 69.7 104.5 99.3 /min
stroke volume 71.5 28.1 32.9 ml
cardiac output 5.0 2.9 3.3 l/min

total arterial resistance 16.0 19.6 19.1 mmHg.l/min
cardial contractility 1.3 0.4 0.5 l/min/mmHg

Comments:
1.
I AM VERY TIRED AND EXHAUSTED I DON’T FEEL LIKE DOING ANTHING. I FEEL FAINT WHEN I TRY TO STAND UP

2.
I FEEL FAINT WHEN I TRY TO STAND UP

Intrathoracic pressure
Normal value 120
systolic pressure 121.0 109.9 mmHg
diastolic pressure 75.1 72.1 mmHg
Right atrial pressure 1.7 2.8 mmHg
mean capillary pressure 12.7 12.1 mmHg

heart rate 69.7 85.5 /min
stroke volume 71.5 49.9 ml
cardiac output 5.0 4.3 l/min

total arterial resistance 16.0 17.0 mmHg.l/min
cardial contractility 1.3 1.5 l/min/mmHg

Blood volume increased to 6 Ltrs
Normal value 120SEC 180
systolic pressure 121.0 134.8 134.8 mmHg
diastolic pressure 75.1 78.1 78.0 mmHg
Right atrial pressure 1.7 3.3 3.3 mmHg
mean capillary pressure 12.7 15.6 15.6 mmHg

heart rate 69.7 55.2 55.2 /min
stroke volume 71.5 101.8 101.8 ml
cardiac output 5.0 5.6 5.6 l/min

total arterial resistance 16.0 14.8 14.8 mmHg.l/min
cardial contractility 1.3 1.1 1.1 l/min/mmHg

Blood volume decreased to 3 Ltrs
Normal value 120 180 240
systolic pressure 121.0 52.1 42.4 26.2 mmHg
diastolic pressure 75.1 36.3 29.4 18.0 mmHg
Right atrial pressure 1.7 -0.4 0.1 0.7 mmHg
mean capillary pressure 12.7 4.0 3.6 2.9 mmHg

heart rate 69.7 129.9 121.8 111.7 /min
stroke volume 71.5 15.2 13.1 8.8 ml
cardiac output 5.0 2.0 1.6 1.0 l/min

total arterial resistance 16.0 20.1 20.2 20.2 mmHg.l/min
cardial contractility 1.3 1.2 0.8 0.4 l/min/mmHg

Comments: I FEEL TERRIBLE. I FEEL AS I AM GOING TO DIE MY EUES ARE GOING DARK. WHAT IS HAPPENING TO ME? YOUR PATIENT IS PASSING HARDLY ANY URINE.
2 YOUR PATIENT HAS MERCEFULLY LOST CONSION
3 YOUR PATIENT IS PASSING HARDLY URINE

Exercise 3: Fast and Slow progressive blood loss –
Class I haemorrhage: decrease blood volume by 15% (1000-750 ml) =4250
Normal value 120 180 240
systolic pressure 121.0 106.5 106.0 106.0 mmHg
diastolic pressure 75.1 70.7 70.4 70.4 mmHg
Right atrial pressure 1.7 0.5 0.5 0.5 mmHg
mean capillary pressure 12.7 9.9 9.9 9.9 mmHg

heart rate 69.7 95.0 94.7 94.7 /min
stroke volume 71.5 45.0 44.9 44.9 ml
cardiac output 5.0 4.3 4.2 4.2 l/min

total arterial resistance 16.0 17.5 17.5 17.5 mmHg.l/min
cardial contractility 1.3 1.7 1.7 1.7 l/min/mmHg

Comments:
NO COMPLAIN FOR 1,2AND 3

Class II haemorrhage: decrease blood volume by 30% (1500 ml) =350ML
Normal value 120 180 240SEC
systolic pressure 121.0 85.5 88.0 88.2 mmHg
diastolic pressure 75.1 59.8 61.6 61.7 mmHg
Right atrial pressure 1.7 -0.3 -0.4 -0.4 mmHg
mean capillary pressure 12.7 6.9 7.0 7.0 mmHg

heart rate 69.7 134.8 136.7 137.1 /min
stroke volume 71.5 24.2 24.8 24.1 ml
cardiac output 5.0 3.3 3.4 3.4 l/min

total arterial resistance 16.0 19.5 19.3 19.3 mmHg.l/min
cardial contractility 1.3 1.9 2.2 2.2 l/min/mmHg

Comments:I FEEL FAINT WHEN I TRY TO STAND UP . SAME FOR 180 AND 120

Class III haemorrhage: decrease blood volume by 40% (2000 ml) =300ML
Normal value 120 180 240
systolic pressure 121.0 52.1 42.4 26.2 mmHg
diastolic pressure 75.1 36.3 29.4 18.0 mmHg
Right atrial pressure 1.7 -0.4 0.1 0.7 mmHg
mean capillary pressure 12.7 4.0 3.6 2.9 mmHg

heart rate 69.7 129.9 121.8 111.7 /min
stroke volume 71.5 15.2 131.1 8.8 ml
cardiac output 5.0 2.0 1.6 1.0 l/min

total arterial resistance 16.0 20.1 20.2 20.2 mmHg.l/min
cardial contractility 1.3 1.2 0.8 0.4 l/min/mmHg

Comments:

I FEEL REALLY TERRIBLE. I FEEL AS I AM GOINGTO DIE MY EYES ARE GOING DARK. WHAT HAPPENING TO ME YOUR PATIENT IS PASSING HARDLY ANY URINE.
2 PATIENT IS PASSING HARDLY ANY URINE
3 SAME AS 2

Class IV haemorrhage: decrease blood volume by more than 40% (above 2000 ml)= 2500ML
Normal value 120 89.05SEC 1190SEC
systolic pressure 121.0 21.6 0.00 0.00 mmHg
diastolic pressure 75.1 14.8 0.00 0.00 mmHg
Right atrial pressure 1.7 -0.7 0.00 0.00 mmHg
mean capillary pressure 12.7 1.3 0.00 0.00 mmHg

heart rate 69.7 117.6 0.00 0.00 /min
stroke volume 71.5 7.5 0.00 0.00 ml
cardiac output 5.0 0.9 0.00 0.00 l/min

total arterial resistance 16.0 20.1 20.2 20.02 mmHg.l/min
cardial contractility 1.3 0.7 1.3 0.4 l/min/mmHg

Comments:
YOUR PATIENT HAS MERCEFULLY LOST CONSCIOUNESS YOUR PATIENT IS PASSING HARDLY ANY URINE.

89.0SEC PATIENT DIED APPRENTLY FROM HEMORRHAGIA SHOCK

Exercise 4: Multiple changes blood volume / cardiac pump performance
blood volume 4000 / cardiac pump performance 50% Normal value 120 180 240
systolic pressure 121.0 84.1 89.6 89.4 mmHg
diastolic pressure 75.1 58.0 61.6 61.4 mmHg
Right atrial pressure 1.7 1.4 1.1 1.1 mmHg
mean capillary pressure 12.7 8.2 8.5 8.5 mmHg

heart rate 69.7 114.5 112.9 112.9 /min
stroke volume 71.5 27.0 29.6 29.7 ml
cardiac output 5.0 3.1 3.3 3.3 l/min

total arterial resistance 16.0 19.6 19.3 19.3 mmHg.l/min
cardial contractility 1.3 0.9 1.1 1.1 l/min/mmHg

Comments:

I FEEL FAINT WHEN I TRY TO STAND UP.
180 AND 240 THE SAME AS ABOVE

blood volume 3500 / cardiac pump performance 50% Normal value 120SEC 180SEC 240SEC
systolic pressure 121.0 53.8 41.6 22.9 mmHg
diastolic pressure 75.1 37.2 28.7 15.8 mmHg
Right atrial pressure 1.7 1.2 1.7 2.5 mmHg
mean capillary pressure 12.7 5.5 5.0 4.2 mmHg

heart rate 69.7 115.6 112.7 107.2 /min
stroke volume 71.5 16.9 13.2 7.4 ml
cardiac output 5.0 2.0 1.5 0.8 l/min

total arterial resistance 16.0 20.1 20.2 20.2 mmHg.l/min
cardial contractility 1.3 0.6 0.4 0.2 l/min/mmHg

Comments:

I FEEL REALY TERRIBLE I FEEL AS IF I AM GOING TO DIE MY EYES ARE GOING DARK. SAME AS ABOVE FOR 180 AND 240SEC

Exercise 5: the baroreceptor system
1/ First change Arterial resistance 150% and run twice.
2/ Then continue after cutting the baroreceptor nerves (in menu go to “Model” and select cut buffer nerves).

Normal value Ap150
120SEC Ap150
180SEC Ap 150 +
+cut nerves
240SEC Ap 150 +
+cut nerves
3000SEC
systolic pressure 121.0 132.8 SAME 791.2 788.0 mmHg
diastolic pressure 75.1 82.2 82.1 0.0 0.0 mmHg
Right atrial pressure 1.7 2.1 SAME 0.7 0.7 mmHg
mean capillary pressure 12.7 11.2 SAME 15.0 15.0 mmHg

heart rate 69.7 51.8 SAME 157.9 161.8 /min
stroke volume 71.5 79.7 SAME 2721.1 2700.3 ml
cardiac output 5.0 4.1 SAME 429.7 436.6 l/min

total arterial resistance 16.0 21.8 SAME 30.1 30.3 mmHg.l/min
cardial contractility 1.3 1.0 SAME 2.4 2.4 l/min/mmHg

Comments:

120SEC NO COMPLAIN
180SEC I CAN HARDLY BREATH AT ALL MY HEART IS POUNDING I HAVE A SPLITTING HEADACH
240SEC AND 3000SEC SAME AS 180SEC

Exercises
Exercise 1
Try changing the arterial resistance to 150% of normal and run the model.
(Click Run button. Remember to do at least 2 successive runs in order to observe the full effect of the changes and allow the patient to adjust)
Q – What happens to the blood pressure and heart rate?
Explain the observed changes.
Q – What might give rise to the altered arterial resistance in a natural situation?
Exercise 2
Now look at the effect of increasing and of reducing each of the first 3 changeable factors separately (i.e. Arterial Resistance, Venous Resistance, Cardiac Pump Performance). Restart the run following each set of results to ensure you start with a healthy 70kg 40 year old male volunteer for each run.
Next:
1. Alter the intrathoracic pressure to 0mm Hg and observe the effects
2. try the effect of increasing blood volume to 6 litres
3. try decreasing it to 3 litres.
Look especially at the capillary pressure and cardiac output values. Remember that a rise in capillary pressure will force fluid out of the blood system and into the interstitial fluid bathing the capillaries.
Q – Can you suggest real situations where the changes you have made would be likely to occur?
Exercise 3
You are now going to kill MACMAN in the interest of scientific understanding.
Restart with a new patient and examine the effects of progressive blood loss by altering blood volume. Try reducing the blood volume slowly and rapidly.
Q – Does it make any difference if the blood loss is fast or slow?
Q – What is the eventual cause of death?
Exercise 4
So far, all of the changes have been carried out one at a time. The programme will also allow you to make multiple changes before you continue running the model.
Now try adjusting the blood volume AND the cardiac pump performance together. This might occur in a severely injured patient who already has coronary heart disease.
Q – How much more serious is severe blood loss in a person with only 50% normal cardiac performance?
Exercise 5
You are now going to change another important influence: the baroreceptor system. The baroreceptors are responsible for maintaining blood pressure in response to changed conditions in the circulation.
First, change the arterial resistance again to 150% of normal: the graph to plot the standard run time. Now select cut the buffer nerves (click on Model) and run two more cycles.
Observe and explain the effects.
Q – Would this kill the subject and if so, what would be the eventual cause of death?

WRITING UP MACMAN report
Guideline: Read before to write and submit your report.
The report should be submitted through turnitin and in hard copy with a coursework cover sheet properly filled with all information required on the sheet. The length of the report should be approximately 650-715 words in total
As the MACMAN exercises are computer simulations, the standard practical report format is not suitable and they should be written up as structured exercises, based on the exercises and questions in the schedule.
Suggested format:
Introduction
A brief overview of the physiological control systems relevant to MACMAN baroreceptors, chemoreceptors etc.. is required. A flow diagram is a good way of doing this. You are not expected to give details of the programs themselves. This is also a good place to put a summary table of the starting/default values.
Exercise 1
• Explain what parameters have been changed,
• include the results and explain what you observe,
• answer the questions on the sheet and discuss the reasons for the changes observed i.e.
• explain how the subject is adapting/coping/not coping.
Exercise 2, 3, 4 and 5
As above
No overall conclusions etc are required at the end, a summary of your findings will be sufficient.
References
You should give a reference list and cite your references where appropriate. Standard physiology texts are OK. Also original papers /articles are accepted although not expected (but it is fine to cite these if appropriate).
References of websites or quotations in text will not be considered as appropriate.
Marking:
The marking criteria for this work will be the same as the one found in the general handbook.
Pay attention to the structure the writing and the grammar of the content. The marking apply also to the coversheet and following all the instruction provided.