Cardiovascular Physiology

<p>Chapter 1 OVERVIEW OF THE CIRCULATION AND BLOOD</p> <p>The Circulatory System</p> <p>Blood</p> <p>Erythrocytes</p> <p>Leukocytes</p> <p>Lymphocytes</p> <p>Platelets</p> <p>Blood Is Divided into Groups by Antigens Located on Erythrocytes</p> <p>Summary</p> <p>Case 1-1</p> <p>Chapter 2 EXCITATION: THE CARDIAC ACTION POTENTIAL</p> <p>Cardiac Action Potentials Consist of Several Phases</p> <p>The Principal Types of Cardiac Action Potentials Are the Slow and Fast Types</p> <p>Ionic Basis of the Resting Potential</p> <p>The Fast Response Depends Mainly on Voltage-Dependent Sodium Channels</p> <p>Ionic Basis of the Slow Response</p> <p>Conduction in Cardiac Fibers Depends on Local Circuit Currents</p> <p>Conduction of the Fast Response</p> <p>Conduction of the Slow Response</p> <p>Cardiac Excitability Depends on the Activation and Inactivation of Specific Currents</p> <p>Fast Response</p> <p>Slow Response</p> <p>Effects of Cycle Length</p> <p>Summary</p> <p>Case 2-1</p> <p>Chapter 3 AUTOMATICITY: NATURAL EXCITATION OF THE HEART</p> <p>The Heart Generates Its Own Pacemaking Activity</p> <p>Sinoatrial Node</p> <p>Ionic Basis of Automaticity</p> <p>Overdrive Suppression</p> <p>Atrial Conduction</p> <p>Atrioventricular Conduction</p> <p>Ventricular Conduction</p> <p>An Impulse Can Travel Around a Reentry Loop</p> <p>Afterdepolarizations Lead to Triggered Activity</p> <p>Early Afterdepolarizations</p> <p>Delayed Afterdepolarizations</p> <p>Electrocardiography Displays the Spread of Cardiac Excitation</p> <p>Scalar Electrocardiography</p> <p>Dysrhythmias Occur Frequently and Constitute Important Clinical Problems</p> <p>Altered Sinoatrial Rhythms</p> <p>Atrioventricular Transmission Blocks</p> <p>Premature Depolarizations</p> <p>Ectopic Tachycardias</p> <p>Fibrillation</p> <p>Summary</p> <p>Case 3-1</p> <p>Chapter 4 THE CARDIAC PUMP</p> <p>The Microscopic and Gross Structures of the Heart </p> <p>Cardiac Muscle (myocardial) Cell Morphology</p> <p>Structure of the Heart: Atria, Ventricles, and Valves</p> <p>The Force of Cardiac Contraction Is Determined by Excitation-Contraction Coupling and the Initial Sarcomere Length of the Myocardial Cells</p> <p>Excitation-Contraction Coupling Is Mediated by Calcium</p> <p>Mechanics of Cardiac Muscle</p> <p>The Sequential Contraction and Relaxation of the Atria and Ventricles Constitute the Cardiac Cycle</p> <p>Ventricular Systole</p> <p>Echocardiography Reveals Movement of the Ventricular Walls and of the Valves</p> <p>The Two Major Heart Sounds Are Produced Mainly by Closure of the Cardiac Valves</p> <p>The Pressure-Volume Relationships in the Intact Heart</p> <p>Passive or Diastolic Pressure-Volume Relationship</p> <p>Active or End-Systolic Pressure-Volume Relationship</p> <p>Pressure and Volume during the Cardiac Cycle: The P-V Loop</p> <p>Preload and Afterload during the Cardiac Cycle</p> <p>Contractility</p> <p>The Fick Principle Is Used to Determine Cardiac Output</p> <p>Metabolism of ATP and its Relation to Mechanical Function</p> <p>Fatty Acid Metabolism</p> <p>Carbohydrate Metabolism</p> <p>Interrelation between Fatty Acid and Carbohydrate Metabolism</p> <p>Effects of plasma substrate and insulin levels</p> <p>Cardiac O₂ Consumption and the Link between Ventricular Function and Cardiac Metabolism</p> <p>Summary</p> <p>Case 4-1</p> <p>Chapter 5 REGULATION OF THE HEARTBEAT</p> <p>Heart Rate is Controlled Mainly by the Autonomic Nerves</p> <p>Parasympathetic Pathways</p> <p>Sympathetic Pathways</p> <p>Higher Centers Also Influence Cardiac Performance</p> <p>Heart Rate Can Be Regulated via the Baroreceptor Reflex</p> <p>The Bainbridge Reflex and Atrial Receptors Regulate Heart Rate</p> <p>Respiration Induces a Common Cardiac Dysrhythmia</p> <p>Activation of the Chemoreceptor Reflex Affects Heart Rate</p> <p>Ventricular Receptor Reflexes Play a Minor Role in the Regulation of Heart Rate</p> <p>Myocardial Performance Is Regulated by　Intrinsic Mechanisms</p> <p>The Frank-Starling Mechanism Is an Important Regulator of Myocardial Contraction Force</p> <p>Changes in Heart Rate Affect Contractile Force</p> <p>Myocardial Performance Is Regulated by Nervous and Humoral Factors</p> <p>Nervous Control</p> <p>Cardiac Performance Is Also Regulated by Hormonal Substances</p> <p>Summary</p> <p>Case 5-1</p> <p>Chapter 6 HEMODYNAMICS</p> <p>Velocity of the Bloodstream Depends on Blood Flow and Vascular Area</p> <p>Blood Flow Depends on the Pressure Gradient</p> <p>Relationship Between Pressure and Flow Depends on the Characteristics of the Conduits</p> <p>Resistance to Flow</p> <p>Resistances in Series and in Parallel</p> <p>Flow May Be Laminar or Turbulent</p> <p>Shear Stress on the Vessel Wall</p> <p>Rheologic Properties of Blood</p> <p>Summary</p> <p>Case 6-1</p> <p>Chapter 7 THE ARTERIAL SYSTEM</p> <p>The Hydraulic Filter Converts Pulsatile Flow to Steady Flow</p> <p>Arterial Elasticity Compensates for the Intermittent Flow Delivered by the Heart</p> <p>The Arterial Blood Pressure Is Determined by Physical and Physiological Factors</p> <p>Mean Arterial Pressure</p> <p>Cardiac Output</p> <p>Peripheral Resistance</p> <p>Pulse Pressure</p> <p>Stroke Volume</p> <p>Arterial Compliance</p> <p>Total Peripheral Resistance and Arterial Diastolic Pressure</p> <p>The Pressure Curves Change in Arteries at Different Distances from the Heart</p> <p>Blood Pressure Is Measured by a Sphygmomanometer in Human Patients</p> <p>Summary</p> <p>Case 7-1</p> <p>Chapter 8 The MICROCIRCULATION AND LYMPHATICS</p> <p>Functional Anatomy</p> <p>Arterioles Are the Stopcocks of the Circulation</p> <p>Capillaries Permit the Exchange of Water, Solutes, and Gases</p> <p>The Law of Laplace Explains How Capillaries Can Withstand High Intravascular Pressures</p> <p>The Endothelium Plays an Active Role in Regulating the Microcirculation</p> <p>The Endothelium is at the Center of Flow-Initiated Mechanotransduction</p> <p>The Endothelium Plays a Passive Role in Transcapillary Exchange</p> <p>Diffusion Is the Most Important Means of Water and Solute Transfer Across the Endothelium</p> <p>Diffusion of Lipid-Insoluble Molecules Is Restricted to the Pores</p> <p>Lipid-Soluble Molecules Pass Directly Through the Lipid Membranes of the Endothelium and the Pores</p> <p>Capillary Filtration Is Regulated by the Hydrostatic and Osmotic Forces Across the Endothelium</p> <p>Balance of Hydrostatic and Osmotic Forces</p> <p>The Capillary Filtration Coefficient Provides a Method to Estimate the Rate of Fluid Movement Across the Endothelium</p> <p>Hypoxia-inducible factor(s) and angiogenesis</p> <p>Pinocytosis Enables Large Molecules to Cross the Endothelium</p> <p>The Lymphatics Return the Fluid and Solutes That Escape Through the Endothelium to the Circulating Blood</p> <p>Summary</p> <p>Case 8-1</p> <p>Case 8-2</p> <p>Chapter 9 The PERIPHERAL CIRCULATION AND ITS CONTROL</p> <p>The Functions of the Heart and Large Blood Vessels</p> <p>Contraction and Relaxation of Arteriolar Vascular Smooth Muscle Regulate Peripheral Blood Flow</p> <p>Cytoplasmic Ca⁺⁺ Is Regulated to Control Contraction, via MLCK</p> <p>Contraction Is Controlled by Excitation-Contraction Coupling and/or Pharmacomechanical Coupling</p> <p>Control of Vascular Tone by Catecholamines</p> <p>Control of Vascular Contraction by Other Hormones, Other Neurotransmitters, and Autocoids</p> <p>Intrinsic Control of Peripheral Blood Flow</p> <p>Autoregulation and the Myogenic Mechanism Tend to Keep Blood Flow Constant</p> <p>The Endothelium Actively Regulates Blood Flow</p> <p>Tissue Metabolic Activity Is the Main Factor in the Local Regulation of Blood Flow</p> <p>Extrinsic Control of Peripheral Blood Flow Is Mediated Mainly by the Sympathetic Nervous System</p> <p>Impulses That Arise in the Medulla Descend in the Sympathetic Nerves to Increase Vascular Resistance</p> <p>Sympathetic Nerves Regulate the Contractile State of the Resistance and Capacitance Vessels</p> <p>The Parasympathetic Nervous System Innervates Blood Vessels Only in the Cranial and Sacral Regions of the Body</p> <p>Epinephrine and Norepinephrine Are the Main Humoral Factors That Affect Vascular Resistance</p> <p>The Vascular Reflexes Are Responsible for Rapid Adjustments of Blood Pressure</p> <p>The Peripheral Chemoreceptors Are Stimulated by Decreases in Blood Oxygen Tension and pH and by Increases in Carbon Dioxide Tension</p> <p>The Central Chemoreceptors Are Sensitive to Changes in Paco_2</p> <p>Other Vascular Reflexes</p> <p>Balance Between Extrinsic and Intrinsic Factors in Regulation of Peripheral Blood Flow</p> <p>Summary</p> <p>Case 9-1</p> <p>Chapter 10 CONTROL OF CARDIAC OUTPUT: COUPLING OF HEART AND BLOOD VESSELS</p> <p>Factors Controlling Cardiac Output</p> <p>The Cardiac Function Curve Relates Central Venous Pressure (Preload) to Cardiac Output</p> <p>Preload or Filling Pressure of the Heart</p> <p>Cardiac Function Curve</p> <p>Factors That Change the Cardiac Function Curve</p> <p>The Vascular Function Curve Relates Central Venous Pressure to Cardiac Output</p> <p>Mathematical Analysis of the Vascular Function Curve</p> <p>Venous Pressure Depends on Cardiac Output</p> <p>Blood Volume</p> <p>Venomotor Tone</p> <p>Blood Reservoirs</p> <p>Peripheral Resistance</p> <p>Cardiac Output and Venous Return Are Closely Associated</p> <p>The Heart and Vasculature Are Coupled Functionally</p> <p>Myocardial Contractility</p> <p>Blood Volume</p> <p>Peripheral Resistance</p> <p>The Right Ventricle Regulates Not Only Pulmonary Blood Flow but Also Central Venous Pressure</p> <p>Heart Rate Has Ambivalent Effects on Cardiac Output</p> <p>Ancillary Factors Affect the Venous System and Cardiac Output</p> <p>Gravity</p> <p>Muscular Activity and Venous Valves</p> <p>Respiratory Activity</p> <p>Artificial Respiration</p> <p>Summary</p> <p>Case 10-1</p> <p>Chapter 11 CORONARY CIRCULATION</p> <p>Functional Anatomy of the Coronary Vessels</p> <p>Coronary Blood Flow Is Regulated by Physical, Neural, and Metabolic Factors</p> <p>Physical Factors</p> <p>Neural and Neurohumoral Factors</p> <p>Metabolic Factors</p> <p>Diminished Coronary Blood Flow Impairs Cardiac Function</p> <p>Energy Substrate Metabolism During Ischemia</p> <p>Coronary Collateral Vessels Develop in Response to Impairment of Coronary Blood Flow</p> <p>Summary</p> <p>Case 11-1</p> <p>Chapter 12 SPECIAL CIRCULATIONS</p> <p>Cutaneous Circulation</p> <p>Skin Blood Flow Is Regulated Mainly by the Sympathetic Nervous System</p> <p>Ambient Temperature and Body Temperature Play Important Roles in the Regulation of Skin Blood Flow</p> <p>Skin Color Depends on the Volume and Flow of Blood in the Skin and on the Amount of O₂ Bound to Hemoglobin</p> <p>Skeletal Muscle Circulation</p> <p>Regulation of Skeletal Muscle Circulation</p> <p>Cerebral Circulation</p> <p>Local Factors Predominate in the Regulation of Cerebral Blood Flow</p> <p>The Pulmonary and Systemic Circulations Are in Series with Each Other</p> <p>Functional Anatomy</p> <p>Pulmonary Hemodynamics</p> <p>Regulation of the Pulmonary Circulation</p> <p>The Renal Circulation Affects the Cardiac Output</p> <p>Anatomy</p> <p>Renal Hemodynamics</p> <p>The Renal Circulation Is Regulated by Intrinsic Mechanisms</p> <p>The Splanchnic Circulation Provides Blood Flow to the Gastrointestinal Tract, Liver, Spleen, and Pancreas</p> <p>Intestinal Circulation</p> <p>Hepatic Circulation</p> <p>Fetal Circulation</p> <p>Changes in the Circulatory System at Birth</p> <p>Summary</p> <p>Case 12-1</p> <p>Case 12-2</p> <p>Case 12-3</p> <p>Chapter 13 INTERPLAY OF CENTRAL AND PERIPHERAL FACTORS THAT CONTROL THE CIRCULATION</p> <p>Exercise</p> <p>Mild to Moderate Exercise</p> <p>Severe Exercise</p> <p>Postexercise Recovery</p> <p>Limits of Exercise Performance</p> <p>Physical Training and Conditioning</p> <p>Hemorrhage</p> <p>Hemorrhage Evokes Compensatory and Decompensatory Effects on the Arterial Blood Pressure</p> <p>The Compensatory Mechanisms Are Neural and Humoral</p> <p>The Decompensatory Mechanisms Are Mainly Humoral, Cardiac, and Hematologic</p> <p>The Positive and Negative Feedback Mechanisms Interact</p> <p>Summary</p> <p>Case 13-1</p> <p>Case 13-2</p> <p>Appendix A: End-of-Chapter CASE STUDY ANSWERS</p> <p>Appendix B: Comprehensive Examination</p>