Cardiovascular Physiology Concepts

Cover......Page 1
Half Title Page......Page 3
Title Page......Page 5
Copyright......Page 6
PREFACE......Page 7
ACKNOWLEDGMENTS......Page 8
CONTENTS......Page 9
THE NEED FOR A CIRCULATORY SYSTEM......Page 15
THE ARRANGEMENT OF THE CARDIOVASCULAR SYSTEM......Page 16
Heart......Page 18
THE REGULATION OF CARDIAC AND VASCULAR FUNCTION......Page 19
THE CONTENT OF THE FOLLOWING CHAPTERS......Page 20
REVIEW QUESTIONS......Page 21
ANSWERS TO REVIEW QUESTIONS......Page 22
LEARNING OBJECTIVES......Page 23
Resting Membrane Potentials......Page 24
Maintenance of Ionic Gradients......Page 26
Ion Channels......Page 28
Action Potentials......Page 30
Electrical Conduction within the Heart......Page 35
Regulation of Conduction Velocity......Page 37
Tachycardia caused by Reentry......Page 38
ECG Tracing......Page 40
Interpretation of Normal and Abnormal Cardiac Rhythms from the ECG......Page 42
Volume Conductor Principles and ECG Rules of Interpretation......Page 44
ECG Leads: Placement of Recording Electrodes......Page 46
ELECTROPHYSIOLOGICAL CHANGES DURING CARDIAC ISCHEMIA......Page 49
SUMMARY OF IMPORTANT CONCEPTS......Page 50
REVIEW QUESTIONS......Page 51
ANSWERS TO REVIEW QUESTIONS......Page 52
ANSWERS TO PROBLEMS AND CASES......Page 53
SUGGESTED RESOURCES......Page 54
Myocytes and Sarcomeres......Page 55
Excitation–Contraction Coupling......Page 57
Regulation of Contraction (Inotropy)......Page 59
Regulation of Relaxation (Lusitropy)......Page 62
VASCULAR STRUCTURE AND FUNCTION......Page 63
Vascular Smooth Muscle Cells......Page 64
Vascular Endothelial Cells......Page 68
SUMMARY OF IMPORTANT CONCEPTS......Page 69
REVIEW QUESTIONS......Page 70
ANSWERS TO REVIEW QUESTIONS......Page 71
ANSWERS TO PROBLEMS AND CASES......Page 72
SUGGESTED RESOURCES......Page 73
Functional Anatomy of the Heart......Page 74
Autonomic Innervation......Page 75
Phase 1. Atrial Systole: AV Valves Open; Aortic and Pulmonic Valves Closed......Page 76
Phase 2. Isovolumetric Contraction: All Valves Closed......Page 78
Phase 5. Isovolumetric Relaxation: All Valves Closed......Page 79
Summary of Intracardiac Pressures......Page 80
CARDIAC OUTPUT......Page 81
Effects of Ventricular Compliance on Preload......Page 83
Effects of Preload on Tension Development (Length–Tension Relationship)......Page 85
Effects of Venous Return on Stroke Volume (Frank-Starling Mechanism)......Page 88
Factors Determining Ventricular Preload......Page 89
Effects of Afterload on the Velocity of Fiber Shortening (Force–Velocity Relationship)......Page 91
Effects of Afterload on Pressure–Volume Loops......Page 93
Effects of Inotropy on Length-Tension Relationship......Page 94
Effects of Inotropy on Pressure–Volume Loops......Page 95
Cellular Mechanisms of Inotropy......Page 96
INTERDEPENDENCE OF PRELOAD, AFTERLOAD, AND INOTROPY......Page 97
MYOCARDIAL OXYGEN CONSUMPTION......Page 98
How Myocardial Oxygen Consumption is Determined......Page 99
Factors Influencing Myocardial Oxygen Consumption......Page 100
SUMMARY OF IMPORTANT CONCEPTS......Page 101
REVIEW QUESTIONS......Page 102
ANSWERS TO REVIEW QUESTIONS......Page 103
ANSWERS TO PROBLEMS AND CASES......Page 105
SUGGESTED RESOURCES......Page 106
Vascular Network......Page 107
Distribution of Pressures and Volumes......Page 109
Mean Arterial Pressure......Page 111
Aortic Pulse Pressure......Page 112
Effects of Vessel Length, Radius, and Blood Viscosity on Resistance to Blood Flow......Page 114
Laminar versus Turbulent Flow......Page 116
Series and Parallel Arrangement of the Vasculature......Page 117
Calculation of Systemic Vascular Resistance......Page 120
Venous Blood Volume and Compliance......Page 121
Mechanical Factors Affecting Central Venous Pressure and Venous Return......Page 123
Summary of Factors Affecting Central Venous Pressure......Page 126
Systemic Vascular Function Curves......Page 127
Interactions between Cardiac and Systemic Vascular Function Curves......Page 130
SUMMARY OF IMPORTANT CONCEPTS......Page 132
REVIEW QUESTIONS......Page 133
ANSWERS TO REVIEW QUESTIIONS......Page 135
ANSWERS TO PROBLEMS AND CASES......Page 136
SUGGESTED RESOURCES......Page 137
Autonomic Innervation of the Heart and Vasculature......Page 138
Baroreceptor Feedback Regulation of Arterial Pressure......Page 144
Chemoreceptors......Page 148
HUMORAL CONTROL......Page 149
Circulating Catecholamines......Page 150
Renin-Angiotensin-Aldosterone System......Page 151
Atrial Natriuretic Peptide......Page 153
Vasopressin (Antidiuretic Hormone)......Page 154
INTEGRATION OF NEUROHUMORAL MECHANISMS......Page 155
SUMMARY OF IMPORTANT CONCEPTS......Page 156
REVIEW QUESTIONS......Page 157
ANSWERS TO REVIEW QUESTIONS......Page 159
ANSWERS TO PROBLEMS AND CASES......Page 160
SUGGESTED RESOURCES......Page 161
DISTRIBUTION OF CARDIAC OUTPUT......Page 162
Tissue Factors......Page 163
Endothelial Factors......Page 166
Extravascular Compression......Page 167
Autoregulation of Blood Flow......Page 168
Reactive and Active Hyperemia......Page 170
Coronary Circulation......Page 171
Cerebral Circulation......Page 175
Skeletal Muscle Circulation......Page 178
Cutaneous Circulation......Page 182
Splanchnic Circulation......Page 183
Renal Circulation......Page 184
Pulmonary Circulation......Page 187
Summary of Special Circulations......Page 189
REVIEW QUESTIONS......Page 190
ANSWERS TO REVIEW QUESTIONS......Page 192
SUGGESTED RESOURCES......Page 193
MECHANISMS OF EXCHANGE......Page 194
Diffusion......Page 195
Oxygen Diffusion......Page 196
Oxygen Delivery and Extraction......Page 197
TRANSCAPILLARY FLUID EXCHANGE......Page 200
Physical Mechanisms Governing Fluid Exchange......Page 201
Capillary Exchange Model......Page 206
EDEMA FORMATION......Page 207
REVIEW QUESTIONS......Page 208
ANSWERS TO REVIEW QUESTIONS......Page 209
ANSWERS TO PROBLEMS AND CASES......Page 210
SUGGESTED RESOURCES......Page 211
CARDIOVASCULAR RESPONSES TO EXERCISE......Page 212
Mechanisms Involved in Cardiovascular Response to Exercise......Page 213
Steady-State Changes in Cardiovascular Function during Exercise......Page 215
Factors Influencing Cardiovascular Response to Exercise......Page 217
MATERNAL CHANGES IN CARDIOVASCULAR FUNCTION DURING PREGNANCY......Page 219
Causes of Hypotension......Page 220
Compensatory Mechanisms during Hypotension......Page 221
Decompensatory Mechanisms Following Severe and Prolonged Hypotension......Page 224
HYPERTENSION......Page 226
Essential (Primary) Hypertension......Page 227
Secondary Hypertension......Page 228
Physiologic Basis for Therapeutic Intervention......Page 229
Causes of Heart Failure......Page 230
Systolic versus Diastolic Dysfunction......Page 231
Systemic Compensatory Mechanisms in Heart Failure......Page 233
Exercise Limitations Imposed by Heart Failure......Page 235
Physiologic Basis for Therapeutic Intervention......Page 236
Valve Stenosis......Page 237
Valve Regurgitation......Page 240
REVIEW QUESTIONS......Page 243
ANSWERS TO REVIEW QUESTIONS......Page 245
ANSWERS TO CASES......Page 247
SUGGESTED RESOURCES......Page 248
INDEX......Page 249