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Book Details
Abstract
Gain a foundational understanding of cardiovascular physiology and how the cardiovascular system functions in health and disease. Cardiovascular Physiology, a volume in the Mosby Physiology Series, explains the fundamentals of this complex subject in a clear and concise manner, while helping you bridge the gap between normal function and disease with pathophysiology content throughout the book.
- Helps you easily master the material in a systems-based curriculum with learning objectives, Clinical Concept boxes, highlighted key words and concepts, chapter summaries, self-study questions, and a comprehensive exam to help prepare for USMLEs.
- Keeps you current with the latest concepts in vascular, molecular, and cellular biology as they apply to cardiovascular function, thanks to molecular commentaries in each chapter.
- Includes clear, 2-color diagrams that simplify complex concepts.
- Features clinical commentaries that show you how to apply what you've learned to real-life clinical situations.
Complete the Mosby Physiology Series! Systems-based and portable, these titles are ideal for integrated programs.
- Blaustein, Kao, & Matteson: Cellular Physiology and Neurophysiology
- Cloutier: Respiratory Physiology
- Koeppen & Stanton: Renal Physiology
- Johnson: Gastrointestinal Physiology
- White, Harrison, & Mehlmann: Endocrine and Reproductive Physiology
- Hudnall: Hematology: A Pathophysiologic Approach
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| CARDIOVASCULAR PHYSIOLOGY | i | ||
| Series Page | ii | ||
| CARDIOVASCULAR PHYSIOLOGY | iii | ||
| Copyright | iv | ||
| DEDICATION | v | ||
| PREFACE | vi | ||
| CONTENTS | vii | ||
| 1 - Overview of the Circulation and Blood | 1 | ||
| THE CIRCULATORY SYSTEM | 1 | ||
| BLOOD | 4 | ||
| Erythrocytes | 4 | ||
| Leukocytes | 6 | ||
| Lymphocytes | 6 | ||
| Platelets | 7 | ||
| Blood Is Divided Into Groups by Antigens Located on Erythrocytes | 8 | ||
| 2 - Excitation: The Cardiac Action Potential | 10 | ||
| CARDIAC ACTION POTENTIALS CONSIST OF SEVERAL PHASES | 10 | ||
| The Principal Types of Cardiac Action Potentials Are the Slow and Fast Types | 10 | ||
| The Ionic Basis of the Resting Potential | 11 | ||
| Statistical Characteristics of the “Gate” Concept | 17 | ||
| Genesis of Early Repolarization | 17 | ||
| Genesis of the Plateau | 18 | ||
| Ca++ Conductance During the Plateau | 18 | ||
| K+ Conductance During the Plateau | 20 | ||
| Genesis of Final Repolarization | 21 | ||
| Restoration of Ionic Concentrations | 21 | ||
| IONIC BASIS OF THE SLOW RESPONSE | 22 | ||
| CONDUCTION IN CARDIAC FIBERS DEPENDS ON LOCAL CIRCUIT CURRENTS | 22 | ||
| Conduction of the Fast Response | 23 | ||
| CONDUCTION OF THE SLOW RESPONSE | 24 | ||
| CARDIAC EXCITABILITY DEPENDS ON THE ACTIVATION AND INACTIVATION OF SPECIFIC CURRENTS | 24 | ||
| Fast Response | 25 | ||
| Slow Response | 25 | ||
| Effects of Cycle Length | 26 | ||
| 3 - Automaticity: Natural Excitation of the Heart | 29 | ||
| THE HEART GENERATES ITS OWN PACEMAKING ACTIVITY | 29 | ||
| Sinoatrial Node | 30 | ||
| Ionic Basis of Automaticity | 31 | ||
| Overdrive Suppression | 33 | ||
| Atrial Conduction | 33 | ||
| Atrioventricular Conduction | 33 | ||
| Ventricular Conduction | 36 | ||
| An Impulse can Travel Around a Reentry Loop | 38 | ||
| AFTERDEPOLARIZATIONS LEAD TO TRIGGERED ACTIVITY | 39 | ||
| Early Afterdepolarizations | 39 | ||
| Delayed Afterdepolarizations | 40 | ||
| ELECTROCARDIOGRAPHY DISPLAYS THE SPREAD OF CARDIAC EXCITATION | 40 | ||
| Scalar Electrocardiography | 41 | ||
| Configuration of the Scalar Electrocardiogram | 41 | ||
| Standard Limb Leads | 41 | ||
| DYSRHYTHMIAS OCCUR FREQUENTLY AND CONSTITUTE IMPORTANT CLINICAL PROBLEMS | 43 | ||
| Altered Sinoatrial Rhythms | 43 | ||
| Atrioventricular Transmission Blocks | 43 | ||
| Premature Depolarizations | 44 | ||
| Ectopic Tachycardias | 45 | ||
| Fibrillation | 45 | ||
| 4 - The Cardiac Pump | 49 | ||
| THE MICROSCOPIC AND GROSS STRUCTURES OF THE HEART | 49 | ||
| Structure of the Heart: Atria, Ventricles, and Valves | 53 | ||
| Atrioventricular Valves | 55 | ||
| Semilunar Valves | 55 | ||
| The Pericardium Is an Epithelized Fibrous Sac That Invests the Heart | 56 | ||
| Mechanics of Cardiac Muscle | 60 | ||
| Preload Determines the Strength of Cardiac Contraction | 60 | ||
| Afterload Determines the Velocity of Cardiac Muscle Shortening | 62 | ||
| THE SEQUENTIAL CONTRACTION AND RELAXATION OF THE ATRIA AND VENTRICLES CONSTITUTE THE CARDIAC CYCLE | 63 | ||
| Ventricular Systole | 64 | ||
| Isovolumic Contraction | 64 | ||
| Ejection | 64 | ||
| Echocardiography Reveals Movement of the Ventricular Walls and of the Valves | 67 | ||
| The Two Major Heart Sounds Are Produced Mainly by Closure of the Cardiac Valves | 67 | ||
| THE PRESSURE-VOLUME RELATIONSHIPS IN THE INTACT HEART | 68 | ||
| Passive or Diastolic Pressure-Volume Relationship | 69 | ||
| Active or End-Systolic Pressure-Volume Relationship | 70 | ||
| Pressure and Volume During the Cardiac Cycle: The P-V Loop | 70 | ||
| Preload and Afterload During the Cardiac Cycle | 70 | ||
| Contractility | 70 | ||
| THE FICK PRINCIPLE IS USED TO DETERMINE CARDIAC OUTPUT | 71 | ||
| The Indicator Dilution Technique is a Useful Method for Measuring Cardiac Output | 72 | ||
| Metabolism of ATP and Its Relation to Mechanical Function | 73 | ||
| Fatty Acid Metabolism | 75 | ||
| Interrelation Between Fatty Acid and Carbohydrate Metabolism | 77 | ||
| Effects of Plasma Substrate and Insulin Levels | 78 | ||
| Cardiac O2 Consumption and the Link Between Ventricular Function and Cardiac Metabolism | 78 | ||
| 5 - Regulation of the Heartbeat | 83 | ||
| HEART RATE IS CONTROLLED MAINLY BY THE AUTONOMIC NERVES | 83 | ||
| Sympathetic Pathways | 85 | ||
| Higher Centers Also Influence Cardiac Performance | 88 | ||
| Heart Rate Can Be Regulated via the Baroreceptor Reflex | 88 | ||
| The Bainbridge Reflex and Atrial Receptors Regulate Heart Rate | 89 | ||
| Respiration Induces a Common Cardiac Dysrhythmia | 90 | ||
| Activation of the Chemoreceptor Reflex Affects Heart Rate | 91 | ||
| Ventricular Receptor Reflexes Play a Minor Role in the Regulation of Heart Rate | 94 | ||
| MYOCARDIAL PERFORMANCE IS REGULATED BY INTRINSIC MECHANISMS | 94 | ||
| Changes in Heart Rate Affect Contractile Force | 97 | ||
| MYOCARDIAL PERFORMANCE IS REGULATED BY NERVOUS AND HUMORAL FACTORS | 100 | ||
| Nervous Control | 100 | ||
| Sympathetic Influences | 100 | ||
| Parasympathetic Influences | 102 | ||
| Baroreceptor Reflex | 102 | ||
| Cardiac Performance Is Also Regulated by Hormonal Substances | 102 | ||
| 6 - Hemodynamics | 109 | ||
| VELOCITY OF THE BLOODSTREAM DEPENDS ON BLOOD FLOW AND VASCULAR AREA | 109 | ||
| BLOOD FLOW DEPENDS ON THE PRESSURE GRADIENT | 110 | ||
| RELATIONSHIP BETWEEN PRESSURE AND FLOW DEPENDS ON THE CHARACTERISTICS OF THE CONDUITS | 112 | ||
| RESISTANCE TO FLOW | 114 | ||
| Resistances in Series and in Parallel | 115 | ||
| FLOW MAY BE LAMINAR OR TURBULENT | 116 | ||
| SHEAR STRESS ON THE VESSEL WALL | 117 | ||
| RHEOLOGICAL PROPERTIES OF BLOOD | 118 | ||
| 7 - The Arterial System | 123 | ||
| THE HYDRAULIC FILTER CONVERTS PULSATILE FLOW TO STEADY FLOW | 123 | ||
| ARTERIAL ELASTICITY COMPENSATES FOR THE INTERMITTENT FLOW DELIVERED BY THE HEART | 126 | ||
| THE ARTERIAL BLOOD PRESSURE IS DETERMINED BY PHYSICAL AND PHYSIOLOGICAL FACTORS | 128 | ||
| Mean Arterial Pressure | 128 | ||
| Cardiac Output | 129 | ||
| Peripheral Resistance | 129 | ||
| Pulse Pressure | 131 | ||
| Stroke Volume | 131 | ||
| Arterial Compliance | 132 | ||
| Total Peripheral Resistance and Arterial Diastolic Pressure | 132 | ||
| THE PRESSURE CURVES CHANGE IN ARTERIES AT DIFFERENT DISTANCES FROM THE HEART | 133 | ||
| BLOOD PRESSURE IS MEASURED BY A SPHYGMOMANOMETER IN HUMAN PATIENTS | 135 | ||
| 8 - The Microcirculation and Lymphatics | 139 | ||
| FUNCTIONAL ANATOMY | 139 | ||
| THE ENDOTHELIUM PLAYS AN ACTIVE ROLE IN REGULATING THE MICROCIRCULATION | 142 | ||
| THE ENDOTHELIUM IS AT THE CENTER OF FLOW-INITIATED MECHANOTRANSDUCTION | 143 | ||
| THE ENDOTHELIUM PLAYS A PASSIVE ROLE IN TRANSCAPILLARY EXCHANGE | 145 | ||
| Diffusion Is the Most Important Means of Water and Solute Transfer Across the Endothelium | 145 | ||
| Diffusion of Lipid-Insoluble Molecules Is Restricted to the Pores | 146 | ||
| Lipid-Soluble Molecules Pass Directly Through the Lipid Membranes of the Endothelium and the Pores | 147 | ||
| Capillary Filtration Is Regulated by the Hydrostatic and Osmotic Forces Across the Endothelium | 147 | ||
| Hydrostatic Forces | 147 | ||
| Hydrostatic Pressure Is the Principal Force in Capillary Filtration | 147 | ||
| Osmotic Forces | 148 | ||
| Balance of Hydrostatic and Osmotic Forces | 149 | ||
| The Capillary Filtration Coefficient Provides a Method to Estimate the Rate of Fluid Movement Across the Endothelium | 150 | ||
| Disturbances in Hydrostatic–Osmotic Balance | 150 | ||
| Hypoxia-inducing factor(s) and angiogenesis | 151 | ||
| Pinocytosis Enables Large Molecules to Cross the Endothelium | 151 | ||
| THE LYMPHATICS RETURN THE FLUID AND SOLUTES THAT ESCAPE THROUGH THE ENDOTHELIUM TO THE CIRCULATING BLOOD | 152 | ||
| 9 - The Peripheral Circulation and Its Control | 155 | ||
| THE FUNCTIONS OF THE HEART AND LARGE BLOOD VESSELS | 155 | ||
| CONTRACTION AND RELAXATION OF ARTERIOLAR VASCULAR SMOOTH MUSCLE REGULATE PERIPHERAL BLOOD FLOW | 155 | ||
| Cytoplasmic Ca++ Is Regulated to Control Contraction via Myosin Light-Chain Kinase | 158 | ||
| Contraction Is Controlled by Excitation-Contraction Coupling and/or Pharmacomechanical Coupling | 159 | ||
| Excitation-Contraction Coupling in Vascular Smooth Muscle | 159 | ||
| PHARMACOMECHANICAL COUPLING | 159 | ||
| Control of Vascular Tone by Catecholamines | 159 | ||
| Control of Vascular Contraction by Other Hormones, Other Neurotransmitters, and Autocoids | 161 | ||
| The Endothelium Actively Regulates Blood Flow | 163 | ||
| Tissue Metabolic Activity Is the Main Factor in the Local Regulation of Blood Flow | 164 | ||
| Sympathetic Nerves Regulate the Contractile State of the Resistance and Capacitance Vessels | 166 | ||
| The Parasympathetic Nervous System Innervates Blood Vessels Only in the Cranial and Sacral Regions of the Body | 167 | ||
| Epinephrine and Norepinephrine Are the Main Humoral Factors That Affect Vascular Resistance | 167 | ||
| The Vascular Reflexes Are Responsible for Rapid Adjustments of Blood Pressure | 167 | ||
| Arterial Baroreceptors | 167 | ||
| Cardiopulmonary Baroreceptors | 170 | ||
| The Peripheral Chemoreceptors Are Stimulated by Decreases in Blood Oxygen Tension and pH and by Increases in Carbon Dioxide Tens... | 170 | ||
| The Central Chemoreceptors Are Sensitive to Changes in Paco2 | 171 | ||
| Cerebrum | 172 | ||
| Skin and Viscera | 172 | ||
| Pulmonary Reflexes | 172 | ||
| BALANCE BETWEEN EXTRINSIC AND INTRINSIC FACTORS IN REGULATION OF PERIPHERAL BLOOD FLOW | 172 | ||
| 10 - Control of Cardiac Output: Coupling of Heart and Blood Vessels | 176 | ||
| FACTORS CONTROLLING CARDIAC OUTPUT | 176 | ||
| THE CARDIAC FUNCTION CURVE RELATES CENTRAL VENOUS PRESSURE (PRELOAD) TO CARDIAC OUTPUT | 177 | ||
| Preload or Filling Pressure of the Heart | 177 | ||
| Cardiac Function Curve | 177 | ||
| Factors That Change the Cardiac Function Curve | 177 | ||
| THE VASCULAR FUNCTION CURVE RELATES CENTRAL VENOUS PRESSURE TO CARDIAC OUTPUT | 181 | ||
| Mathematical Analysis of the Vascular Function Curve | 183 | ||
| VENOUS PRESSURE DEPENDS ON CARDIAC OUTPUT | 185 | ||
| Blood Volume | 185 | ||
| Venomotor Tone | 186 | ||
| Blood Reservoirs | 186 | ||
| Peripheral Resistance | 186 | ||
| CARDIAC OUTPUT AND VENOUS RETURN ARE CLOSELY ASSOCIATED | 187 | ||
| THE HEART AND VASCULATURE ARE COUPLED FUNCTIONALLY | 187 | ||
| Myocardial Contractility | 188 | ||
| Blood Volume | 189 | ||
| Peripheral Resistance | 189 | ||
| THE RIGHT VENTRICLE REGULATES NOT ONLY PULMONARY BLOOD FLOW BUT ALSO CENTRAL VENOUS PRESSURE | 191 | ||
| HEART RATE HAS AMBIVALENT EFFECTS ON CARDIAC OUTPUT | 193 | ||
| ANCILLARY FACTORS AFFECT THE VENOUS SYSTEM AND CARDIAC OUTPUT | 194 | ||
| Muscular Activity and Venous Valves | 196 | ||
| Respiratory Activity | 197 | ||
| Artificial Respiration | 198 | ||
| 11 - Coronary Circulation | 201 | ||
| FUNCTIONAL ANATOMY OF THE CORONARY VESSELS | 201 | ||
| CORONARY BLOOD FLOW IS REGULATED BY PHYSICAL, NEURAL, AND METABOLIC FACTORS | 201 | ||
| Physical Factors | 201 | ||
| Neural and Neurohumoral Factors | 204 | ||
| Metabolic Factors | 206 | ||
| DIMINISHED CORONARY BLOOD FLOW IMPAIRS CARDIAC FUNCTION | 207 | ||
| ENERGY SUBSTRATE METABOLISM DURING ISCHEMIA | 208 | ||
| CORONARY COLLATERAL VESSELS DEVELOP IN RESPONSE TO IMPAIRMENT OF CORONARY BLOOD FLOW | 210 | ||
| 12 - Special Circulations | 214 | ||
| CUTANEOUS CIRCULATION | 214 | ||
| SKIN BLOOD FLOW IS REGULATED MAINLY BY THE SYMPATHETIC NERVOUS SYSTEM | 214 | ||
| AMBIENT TEMPERATURE AND BODY TEMPERATURE PLAY IMPORTANT ROLES IN THE REGULATION OF SKIN BLOOD FLOW | 216 | ||
| SKIN COLOR DEPENDS ON THE VOLUME AND FLOW OF BLOOD IN THE SKIN AND ON THE AMOUNT OF O2 BOUND TO HEMOGLOBIN | 216 | ||
| SKELETAL MUSCLE CIRCULATION | 217 | ||
| REGULATION OF SKELETAL MUSCLE CIRCULATION | 217 | ||
| Neural Factors | 217 | ||
| Local Factors | 218 | ||
| CEREBRAL CIRCULATION | 219 | ||
| Local Factors Predominate in the Regulation of Cerebral Blood Flow | 219 | ||
| Blood-Brain Barrier | 220 | ||
| Neural Factors | 220 | ||
| Local Factors | 220 | ||
| THE PULMONARY AND SYSTEMIC CIRCULATIONS ARE IN SERIES WITH EACH OTHER | 222 | ||
| Pulmonary Hemodynamics | 224 | ||
| Pressures in the Pulmonary Circulation | 224 | ||
| Pulmonary Blood Flow | 224 | ||
| Regulation of the Pulmonary Circulation | 225 | ||
| Renal Blood Flow | 228 | ||
| Neural Regulation | 229 | ||
| THE SPLANCHNIC CIRCULATION PROVIDES BLOOD FLOW TO THE GASTROINTESTINAL TRACT, LIVER, SPLEEN, AND PANCREAS | 230 | ||
| Neural Regulation | 230 | ||
| Autoregulation | 232 | ||
| Functional Hyperemia | 232 | ||
| Hemodynamics | 232 | ||
| Regulation of Blood Flow | 232 | ||
| FETAL CIRCULATION | 234 | ||
| Changes in the Circulatory System at Birth | 235 | ||
| Skeletal Muscle Circulation | 236 | ||
| Cerebral Circulation | 236 | ||
| Pulmonary Circulation | 236 | ||
| Renal Circulation | 237 | ||
| Intestinal Circulation | 237 | ||
| Hepatic Circulation | 237 | ||
| Fetal Circulation | 237 | ||
| 13 - Interplay of Central and Peripheral Factors That Control the Circulation | 240 | ||
| EXERCISE | 240 | ||
| Mild to Moderate Exercise | 241 | ||
| Peripheral Resistance Declines During Exercise | 241 | ||
| Cardiac Output Can Increase Substantially in Exercise | 243 | ||
| Venous Return Is Enhanced in Exercise | 243 | ||
| Arterial Pressure Increases Slightly During Exercise | 244 | ||
| Severe Exercise | 244 | ||
| Postexercise Recovery | 244 | ||
| LIMITS OF EXERCISE PERFORMANCE | 244 | ||
| PHYSICAL TRAINING AND CONDITIONING | 245 | ||
| HEMORRHAGE | 246 | ||
| Hemorrhage Evokes Compensatory and Decompensatory Effects on the Arterial Blood Pressure | 246 | ||
| The Compensatory Mechanisms Are Neural and Humoral | 246 | ||
| Baroreceptor Reflexes | 247 | ||
| Chemoreceptor Reflexes | 248 | ||
| Cerebral Ischemia | 248 | ||
| Reabsorption of Tissue Fluids | 248 | ||
| Endogenous Vasoconstrictors | 248 | ||
| Renal Conservation of Salt and Water | 249 | ||
| The Decompensatory Mechanisms Are Mainly Humoral, Cardiac, and Hematologic | 249 | ||
| Cardiac Failure | 249 | ||
| Acidosis | 250 | ||
| Central Nervous System Depression | 250 | ||
| Aberrations of Blood Clotting | 250 | ||
| Depression of the Reticuloendothelial System | 251 | ||
| The Positive and Negative Feedback Mechanisms Interact | 251 | ||
| Hemorrhage | 252 | ||
| A - END-OF-CHAPTER CASE STUDY ANSWERS | 254 | ||
| CASE 1.1 | 254 | ||
| CASE 2.1 | 254 | ||
| CASE 3.1 | 254 | ||
| CASE 4.1 | 254 | ||
| CASE 5.1 | 254 | ||
| CASE 6.1 | 254 | ||
| CASE 7.1 | 255 | ||
| CASE 8.1 | 255 | ||
| CASE 8.2 | 255 | ||
| CASE 9.1 | 255 | ||
| CASE 10.1 | 255 | ||
| CASE 11.1 | 255 | ||
| CASE 12.1 | 256 | ||
| CASE 12.2 | 256 | ||
| CASE 12.3 | 256 | ||
| CASE 13.1 | 256 | ||
| CASE 13.2 | 256 | ||
| B - Comprehensive Review Examination | 257 | ||
| INDEX | 269 | ||
| A | 269 | ||
| B | 270 | ||
| C | 271 | ||
| D | 273 | ||
| E | 273 | ||
| F | 274 | ||
| G | 274 | ||
| H | 274 | ||
| I | 275 | ||
| J | 275 | ||
| K | 275 | ||
| L | 275 | ||
| M | 276 | ||
| N | 276 | ||
| O | 276 | ||
| P | 276 | ||
| Q | 277 | ||
| R | 278 | ||
| S | 278 | ||
| T | 279 | ||
| U | 279 | ||
| V | 279 | ||
| W | 280 | ||
| Z | 280 |