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Arterial impedance. The average systemic arterial impedance moduli from normotensive baboons under control conditions and during phenylephrine and nitroprusside infusions are illustrated [31]. The impedance concept is an effort to present a quantitative description of the opposition to blood flow presented by the arterial vasculature [32]. Impedance should not be equated with afterload, which is a term that has been developed to describe the opposition to muscle shortening. Nevertheless, impedance can contribute to afterload through its influence on pressure, loading sequence, and geometry.

Tonic excitatory medullary center activity is constantly influenced by inhibitory impulses from cardiovascular mechano- and chemoreceptors. An increase in activity in the carotid sinus and aortic nerves, as well as the vagal afferent fibers from the heart, reflexly reduces neural activity in the efferent sympathetic fibers and augments efferent vagal activity. The sympathetic preganglionic neurons lie in the intermediallateral horns of the spinal cord, leave the spinal cord, synapse with the postganglionic neurons in the chain of ganglia on each side of the spinal cord, and send peripheral sympathetic nerves to the heart and blood vessels.

The afterload against which the myocardium must work is composed of internal stresses, resistance, and inertial components. The external vascular load is composed of compliance, impedance, and resistance characteristics of the arterial vasculature. The components of stress, left ventricular (LV) pressure, mass, and geometry have been described. The viscous drag and inertial forces that must be overcome to generate blood movement are minor and are usually ignored. However, the characteristics of vascular load and their effects on LV ejection and contractility cannot be ignored because they contribute to the internal forces that the myocardium must carry during each contraction.

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