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  • Book
    Charles Kenney.
    Contents:
    Early history of the New Quality movement
    The birth of IHI
    The Annenberg Conference on Error
    To err is human
    First, do no harm
    The Cincinnati children's triumvirate: Uma Kotagal, Jim Anderson, Lee Carter
    Virginia Mason Medical Center and the Toyota production system
    Josie King
    The learning journey of Jönköping County, Sweden
    Kaiser Permanente and future of health care
    The Holy Grail.
    Digital Access eBook Comp Acad 2010
  • Article
    Downing SE, Hellenbrand WE, Lee JC, Nudel DB.
    Am J Physiol. 1978 Feb;234(2):H173-9.
    Evidence for adrenergic regulation of the coronary vessels was sought in 27 newborn lambs. Sympathetic activity was altered by temporarily lowering cephalic perfusion pressure (CPP) from 90 to 20 mmHg while aortic pressure was held constant. Heart rate (HR) and left ventricular dP/dt max increased markedly, while end-diastolic pressure and stroke volume fell. These changes were accompanied by an increase in coronary blood flow (CBF), myocardial O2 consumption (MVO2), and reduced coronary resistance (CF) (P less than 0.005). After beta blockade, which prevented an augmentation of metabolic demand, the same maneuver resulted in coronary vasoconstriction, reflected by reduced CBF and increased CR (P less than 0.02). This response was eliminated by alpha blockade with phentolamine (2 mg/kg). In 13 lambs subjected to bilateral adrenalectomy or sham operation, lowering CPP elicited similar positive chronotropic and inotropic changes, increases of MVO2 and CBF, and reduced CR. Following beta blockade, lowering CPP in the sham group caused coronary constriction. However, no changes in CBF or CR were elicited in the adrenalectomized lambs. These observations indicate that integrity of the adrenal glands is required for adrenergic control of the coronary vessels in the newborn. Chronotropic and inotropic regulation is mediated by direct neural action and is not dependent on adrenal function.
    Digital Access Access Options