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Chapter 1 Overview of the Circulation and Blood 1
The Circulatory System 1
Blood 5
Erythrocytes 5
Leukocytes 6
Lymphocytes 7
Blood Is Divided into Groups by Antigens Located on Erythrocytes 7
Summary 9
Case 1-1 9
Chapter 2 Excitation: The Cardiac Action Potential 11
Cardiac Action Potentials Consist of Several Phases 11
The Principal Types of Cardiac Action Potentials Are the Slow and Fast Types 12
Ionic Basis of the Resting Potential 13
The Fast Response Depends Mainly on Voltage-Dependent Sodium Channels 15
Ionic Basis of the Slow Response 24
Conduction in Cardiac Fibers Depends on Local Circuit Currents 25
Conduction of the Fast Response 25
Conduction of the Slow Response 27
Cardiac Excitability Depends on the Activation and Inactivation of Specific Currents 27
Fast Response 27
Slow Response 28
Effects of Cycle Length 28
Summary 29
Case 2-1 29
Chapter 3 Automaticity: Natural Excitation of the Heart 31
The Heart Generates Its Own Pacemaking Activity 31
Sinoatrial Node 32
Ionic Basis of Automaticity 34
Overdrive Suppression 35
Atrial Conduction 36
Atrioventricular Conduction 37
Ventricular Conduction 39
An Impulse Can Travel Around a Reentry Loop 41
Afterdepolarizations Lead to Triggered Activity 42
Early Afterdepolarizations 43
Delayed Afterdepolarizations 43
Electrocardiography Displays the Spread of Cardiac Excitation 44
Scalar Electrocardiography 44
Dysrhythmias Occur Frequently and Constitute Important Clinical Problems 47
Altered Sinoatrial Rhythms 47
Atrioventricular Transmission Blocks 48
Premature Depolarizations 48
Ectopic Tachycardias 49
Fibrillation 49
Summary 51
Case 3-3 52
Chapter 4 The Cardiac Pump 55
The Gross and Microscopic Structures of the Heart Are Uniquely Designed for Optimal Function 55
The Myocardial Cell 55
Structure of the Heart: Atria, Ventricles, and Valves 60
The Force of Cardiac Contraction Is Determined by Excitation-Contraction Coupling and the Initial Sarcomere Length of the Myocardial Cells 63
Excitation-Contraction Coupling Is Mediated by Calcium 63
Mechanics of Cardiac Muscle 65
The Sequential Contraction and Relaxation of the Atria and Ventricles Constitute the Cardiac Cycle 69
Ventricular Systole 70
Echocardiography Reveals Movement of the Ventricular Walls and of the Valves 73
The Two Major Heart Sounds Are Produced Mainly by Closure of the Cardiac Valves 74
The Pressure-Volume Relationships in the Intact Heart 75
Passive or Diastolic Pressure-Volume Relationship 75
Active or End-Systolic Pressure-Volume Relationship 77
Pressure and Volume during the Cardiac Cycle: The P-V Loop 77
Preload and Afterload during the Cardiac Cycle 77
Contractility 78
The Fick Principle Is Used to Determine Cardiac Output 79
Summary 89
Case 4-1 90
Chapter 5 Regulation of the Heartbeat 91
Heart Rate is Controlled Mainly by the Autonomic Nerves 91
Parasympathetic Pathways 92
Sympathetic Pathways 93
Higher Centers Also Influence Cardiac Performance 97
Heart Rate Can Be Regulated via the Baroreceptor Reflex 97
The Bainbridge Reflex and Atrial Receptors Regulate Heart Rate 98
Respiration Induces a Common Cardiac Dysrhythmia 99
Activation of the Chemoreceptor Reflex Affects Heart Rate 101
Ventricular Receptor Reflexes Play a Minor Role in the Regulation of Heart Rate 102
Myocardial Performance Is Regulated by Intrinsic Mechanisms 102
The Frank-Starling Mechanism Is an Important Regulator of Myocardial Contraction Force 103
Changes in Heart Rate Affect Contractile Force 107
Myocardial Performance Is Regulated by Nervous and Humoral Factors 110
Nervous Control 110
Cardiac Performance Is Also Regulated by Hormonal Substances 113
Summary 116
Case 5-1 117
Chapter 6 Hemodynamics 119
Velocity of the Bloodstream Depends on Blood Flow and Vascular Area 119
Blood Flow Depends on the Pressure Gradient 120
Relationship Between Pressure and Flow Depends on the Characteristics of the Conduits 122
Resistance to Flow 125
Resistances in Series and in Parallel 126
Flow May Be Laminar or Turbulent 127
Shear Stress on the Vessel Wall 128
Rheologic Properties of Blood 129
Summary 133
Case 6-6 134
Chapter 7 The Arterial System 135
The Hydraulic Filter Converts Pulsatile Flow to Steady Flow 135
Arterial Elasticity Compensates for the Intermittent Flow Delivered by the Heart 137
The Arterial Blood Pressure Is Determined by Physical and Physiological Factors 140
Mean Arterial Pressure 140
Cardiac Output 142
Peripheral Resistance 142
Pulse Pressure 144
Stroke Volume 144
Arterial Compliance 145
Total Peripheral Resistance and Arterial Diastolic Pressure 146
The Pressure Curves Change in Arteries at Different Distances from the Heart 147
Blood Pressure Is Measured by a Sphygmomanometer in Human Patients 148
Summary 150
Case 7-1 150
Chapter 8 The Microcirculation and Lymphatics 153
Functional Anatomy 153
Arterioles Are the Stopcocks of the Circulation 153
Capillaries Permit the Exchange of Water, Solutes, and Gases 154
The Law of Laplace Explains How Capillaries Can Withstand High Intravascular Pressures 155
The Endothelium Plays an Active Role in Regulating the Microcirculation 156
The Endothelium is at the Center of Flow-Initiated Mechanotransduction 157
The Endothelium Plays a Passive Role in Transcapillary Exchange 158
Diffusion Is the Most Important Means of Water and Solute Transfer Across the Endothelium 159
Diffusion of Lipid-Insoluble Molecules Is Restricted to the Pores 159
Lipid-Soluble Molecules Pass Directly Through the Lipid Membranes of the Endothelium and the Pores 162
Capillary Filtration Is Regulated by the Hydrostatic and Osmotic Forces Across the Endothelium 163
Balance of Hydrostatic and Osmotic Forces 165
The Capillary Filtration Coefficient Provides a Method to Estimate the Rate of Fluid Movement Across the Endothelium 165
Pinocytosis Enables Large Molecules to Cross the Endothelium 167
The Lymphatics Return the Fluid and Solutes That Escape Through the Endothelium to the Circulating Blood 167
Summary 168
Case 8-1 169
Case 8-2 169
Chapter 9 The Peripheral Circulation and its Control 171
The Functions of the Heart and Large Blood Vessels 171
Contraction and Relaxation of Arteriolar Vascular Smooth Muscle Regulate Peripheral Blood Flow 172
Cytoplasmic Ca++ Is Regulated to Control Contraction, via MLCK 175
Contraction Is Controlled by Excitation-Contraction Coupling and/or Pharmacomechanical Coupling 176
Control of Vascular Tone by Catecholamines 178
Control of Vascular Contraction by Other Hormones, Other Neurotransmitters, and Autocoids 178
Intrinsic Control of Peripheral Blood Flow 179
Autoregulation and the Myogenic Mechanism Tend to Keep Blood Flow Constant 179
The Endothelium Actively Regulates Blood Flow 180
Tissue Metabolic Activity Is the Main Factor in the Local Regulation of Blood Flow 181
Extrinsic Control of Peripheral Blood Flow Is Mediated Mainly by the Sympathetic Nervous System 183
Impulses That Arise in the Medulla Descend in the Sympathetic Nerves to Increase Vascular Resistance 183
Sympathetic Nerves Regulate the Contractile State of the Resistance and Capacitance Vessels 184
The Parasympathetic Nervous System Innervates Blood Vessels Only in the Cranial and Sacral Regions of the Body 185
Epinephrine and Norepinephrine Are the Main Humoral Factors That Affect Vascular Resistance 185
The Vascular Reflexes Are Responsible for Rapid Adjustments of Blood Pressure 185
The Peripheral Chemoreceptors Are Stimulated by Decreases in Blood Oxygen Tension and pH and by Increases in Carbon Dioxide Tension 189
The Central Chemoreceptors Are Sensitive to Changes in Paco2 189
Other Vascular Reflexes 190
Balance Between Extrinsic and Intrinsic Factors in Regulation of Peripheral Blood Flow 191
Summary 192
Case 9-1 194
Chapter 10 Control of Cardiac Output: Coupling of Heart and Blood Vessels 195
Factors Controlling Cardiac Output 195
The Cardiac Function Curve Relates Central Venous Pressure (Preload) to Cardiac Output 196
Preload or Filling Pressure of the Heart 196
Cardiac Function Curve 196
Factors That Change the Cardiac Function Curve 197
The Vascular Function Curve Relates Central Venous Pressure to Cardiac Output 200
Mathematical Analysis of the Vascular Function Curve 203
Venous Pressure Depends on Cardiac Output 205
Blood Volume 205
Venomotor Tone 206
Blood Reservoirs 206
Peripheral Resistance 206
Cardiac Output and Venous Return Are Closely Associated 207
The Heart and Vasculature Are Coupled Functionally 207
Myocardial Contractility 209
Blood Volume 209
Peripheral Resistance 210
The Right Ventricle Regulates Not Only Pulmonary Blood Flow but Also Central Venous Pressure 211
Heart Rate Has Ambivalent Effects on Cardiac Output 214
Ancillary Factors Affect the Venous System and Cardiac Output 216
Gravity 216
Muscular Activity and Venous Valves 218
Respiratory Activity 219
Artificial Respiration 220
Summary 221
Case 10-1 221
Chapter 11 Coronary Circulation 223
Functional Anatomy of the Coronary Vessels 223
Coronary Blood Flow Is Regulated by Physical, Neural, and Metabolic Factors 225
Physical Factors 225
Neural and Neurohumoral Factors 227
Metabolic Factors 228
Diminished Coronary Blood Flow Impairs Cardiac Function 230
Energy Substrate Metabolism During Ischemia 231
Coronary Collateral Vessels Develop in Response to Impairment of Coronary Blood Flow 233
Summary 235
Case 11-1 236
Chapter 12 Special Circulations 237
Cutaneous Circulation 237
Skin Blood Flow Is Regulated Mainly by the Sympathetic Nervous System 237
Ambient Temperature and Body Temperature Play Important Roles in the Regulation of Skin Blood Flow 239
Skin Color Depends on the Volume and Flow of Blood in the Skin and on the Amount of O2 Bound to Hemoglobin 240
Skeletal Muscle Circulation 240
Regulation of Skeletal Muscle Circulation 240
Cerebral Circulation 243
Local Factors Predominate in the Regulation of Cerebral Blood Flow 243
The Pulmonary and Systemic Circulations Are in Series with Each Other 245
Functional Anatomy 245
Pulmonary Hemodynamics 247
Regulation of the Pulmonary Circulation 249
The Renal Circulation Affects the Cardiac Output 250
Anatomy 250
Renal Hemodynamics 252
The Renal Circulation Is Regulated by Intrinsic Mechanisms 252
The Splanchnic Circulation Provides Blood Flow to the Gastrointestinal Tract, Liver, Spleen, and Pancreas 254
Intestinal Circulation 254
Hepatic Circulation 256
Fetal Circulation 257
Changes in the Circulatory System at Birth 259
Summary 260
Case 12-1 262
Case 12-2 262
Case 12-3 262
Chapter 13 Interplay of Central and Peripheral Factors that Control the Circulation 263
Exercise 264
Mild to Moderate Exercise 264
Severe Exercise 268
Postexercise Recovery 268
Limits of Exercise Performance 269
Physical Training and Conditioning 269
Hemorrhage 269
Hemorrhage Evokes Compensatory and Decompensatory Effects on the Arterial Blood Pressure 270
The Compensatory Mechanisms Are Neural and Humoral 270
The Decompensatory Mechanisms Are Mainly Humoral, Cardiac, and Hematologic 273
The Positive and Negative Feedback Mechanisms Interact 275
Summary 276
Case 13-1 277
Case 13-2 277
Appendix: Case Study Answers 279
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Add Cardiovascular Physiology: Mosby Physiology Monograph Series (with Student Consult Online Access), Cardiovascular Physiology gives you a solid understanding of how the cardiovascular system functions in both health and disease. Ideal for your systems-based curriculum, this title in the Mosby Physiology Monograph Series explains how, Cardiovascular Physiology: Mosby Physiology Monograph Series (with Student Consult Online Access) to your collection on WonderClub |