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heart Together, these actions serve to maintain normal blood pressure and allow re ex maintenance of blood pressure with changes in body position Two types of baroreceptors function as the afferent component of this re ex arc by sensing pressure gradients across the walls of large blood vessels Those in the carotid sinus and aortic arch are sensitive to reductions in pulse pressure (the difference between systolic and diastolic blood pressure), while those in the right heart chambers and pulmonary vessels respond more to alterations in blood volume The carotid sinus baroreceptors are rapidly responsive and capable of detecting beat-to-beat changes, in contrast to the aortic arch nerves, which have a longer response time and discriminate only the larger and more prolonged alterations in pressure The nerves arising from these receptors are small-caliber, thinly myelinated bers that course in cranial nerves IX and X and terminate in the NTS In response to increased stimulation of these receptors, vagal efferent activity is reduced, resulting in re ex cardioacceleration This is accomplished through polysynaptic connections between the NTS and the dorsal motor nucleus of the vagus; it is from this structure that vagal neurons project to the sinoatrial node Increased systemic vascular resistance is effected concurrently through parallel connections between the NTS and the medullary pressor areas that project, in turn, to the intermedolateral cells of the midthoracic cord The main sympathetic out ow from these segments is via the greater splanchnic nerve to the celiac ganglion, the postganglionic nerves of which project to the capacitance vessels of the gut The splanchnic capacitance veins act as a reservoir for as much as 20 percent of the total blood volume, and interruption of the splanchnic nerves results in severe postural hypotension After a high-carbohydrate meal there is a marked hyperemia of the gut and compensatory peripheral vasoconstriction in the muscles and skin It has also been noted that the mesenteric vascular bed is responsive to the orthostatic redistribution of blood volume but not to mental stress The opposite response to the one described above, namely bradycardia and hypotension, results when vagal tone is enhanced and sympathetic tone reduced This response can be triggered by baroreceptors, or it may arise from cerebral stimuli such as fear or sight of blood in susceptible individuals Two slower-acting humoral mechanisms regulate blood volume and complement the control of systemic vascular resistance Pressure-sensitive renal juxtaglomerular cells release renin, which stimulates production of angiotensin and in uences aldosterone production, both of which effect an increase of blood volume Of lesser in uence in the control of blood pressure is antidiuretic hormone, discussed in the next chapter; but the effects of this peptide become more important when autonomic failure forces a dependence on secondary mechanisms for the maintenance of blood pressure More recently, in addition to its presence in autonomic ganglia, nitric oxide has been found to have an important local role in maintaining vascular tone, mainly by way of attenuating the response to sympathetic stimulation The extent to which this latter function is under neural control is not clear Emergency and Alarm Reactions Inasmuch as the autonomic nervous system and the adrenal glands were accepted for many years as the neural and humoral basis of all instinctive and emotional behavior, it is remarkable how little sound information has been acquired about their roles in disease In states of chronic anxiety and acute panic reactions, depressive psychosis, mania, and schizophrenia, all of which are characterized by an altered emo-.

As was indicated brie y in Chap 18, blood pressure depends on the adequacy of intravascular blood volume, on systemic vascular resistance, and on the cardiac output Both the autonomic and endocrine systems in uence the muscular, cutaneous, and mesenteric (splanchnic) vascular beds, pulse rate, and stroke volume of the

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tionality, no consistent autonomic or endocrine dysfunction has been demonstrated except perhaps for diminished responses of growth hormone in panic disorders This has been disappointing, since Cannon, with his emergency theory of sympathoadrenal action, had provided such a promising concept of the neurophysiology of acute emotion, and Selye had extended this theory so plausibly to explain all the reactions to stress in animals and humans According to these theories, strong emotion, such as anger or fear, excites the sympathetic nervous system and the adrenal cortex [via corticotropin releasing factor (CRF) and adrenocorticotropic hormone (ACTH)], which are under direct neural as well as endocrine control These sympathoadrenal reactions are brief and sustain the animal in ight or ght (pages 443 and 447) Animals deprived of adrenal cortex or human beings with Addison disease cannot tolerate stress because they are incapable of mobilizing both the adrenal medulla and adrenal cortex Prolonged stress and production of ACTH activates all the adrenal hormones, referred to collectively as steroids (glucocorticoids, mineralocorticoids, and adrenocorticoids) In animals, exercise, cold, oxygen lack, and surgical injury are all said to evoke the same sympathoadrenal reactions as anger or fear Selye s extension of Cannon s theory to his more comprehensive theory of stress, although attractive, has received little support Critics have pointed out that the conditions to which his experimental animals had been subjected are so different from human disease that conclusions as to the similarities of the two cannot be drawn More critical studies of the anatomy and physiology of the hypothalamus, hypophysis, adrenal glands, and autonomic nervous system are still needed to fully test these hypotheses

With few exceptions, such as testing pupillary reactions and examination of the skin for abnormalities of color and sweating, the neurologist tends to be casual in evaluating the function of the autonomic nervous system Nonetheless, several simple but informative tests can be used to con rm one s clinical impressions and to elicit abnormalities of autonomic function that may aid in diagnosis A combination of tests is usually necessary, because certain ones are particularly sensitive to abnormalities of sympathetic function and others to parasympathetic or baroreceptor afferent function These are described below and are summarized in Table 26-1 A scheme for the examination of pupillary abnormalities has been presented in Fig 14-8 Responses of Blood Pressure and Heart Rate to Changes in Posture and Breathing These are among the simplest and most important tests of autonomic function and are currently automated in most laboratories McLeod and Tuck state that in changing from the recumbent to the standing position, a fall of more than 30 mmHg systolic and 15 mmHg diastolic is abnormal; others give gures of 20 and 10 mmHg They caution that the arm on which the cuff is placed must be held horizontally when standing, so that the decline in arm pressure will not be obscured by the added hydrostatic pressure The main cause of an orthostatic drop in blood pressure is hypovolemia In the context of recurrent fainting, however, an excessive drop re ects inadequate sympathetic vasoconstrictor activity The use of a tilt table, as described on page 330, is the most sensitive means of inducing orthostatic changes and also elicits

Now that we have a fairly decent understanding of index and ETF products, we can look at how we utilize these products in everyday trading The options market on many index and ETF products is fairly active The most active markets will be the ETF products that follow broad-based indices In these products you will nd active option trades where liquidity is of little concern We can apply a number of methods to index options for diversi ed investing As a product that follows an index, you are receiving the bene t of diversi cation in a single investment action If we consider utilizing ETF investments, as we would an individual stock, we have numerous strategies that apply If you are trying to gain a long position in the market with a growth objective utilizing options, consider these strategies for index ETF options: Selling put premiums With a short put strategy on broadbased indices, you are capturing premium on markets that statistically year after year have gains When selling a put

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