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.
Table of ContentsChapter 1 OVERVIEW OF THE CIRCULATION AND BLOOD
- The Circulatory System
- Blood
- Erythrocytes
- Leukocytes
- Lymphocytes
- Platelets
- Blood Is Divided into Groups by Antigens Located on Erythrocytes
- Summary
- Case 1-1
Chapter 2 EXCITATION: THE CARDIAC ACTION POTENTIAL
- Cardiac Action Potentials Consist of Several Phases
- The Principal Types of Cardiac Action Potentials Are the Slow and Fast Types
- Ionic Basis of the Resting Potential
- The Fast Response Depends Mainly on Voltage-Dependent Sodium Channels
- Ionic Basis of the Slow Response
- Conduction in Cardiac Fibers Depends on Local Circuit Currents
- Conduction of the Fast Response
- Conduction of the Slow Response
- Cardiac Excitability Depends on the Activation and Inactivation of Specific Currents
- Fast Response
- Slow Response
- Effects of Cycle Length
- Summary
- Case 2-1
Chapter 3 AUTOMATICITY: NATURAL EXCITATION OF THE HEART
- The Heart Generates Its Own Pacemaking Activity
- Sinoatrial Node
- Ionic Basis of Automaticity
- Overdrive Suppression
- Atrial Conduction
- Atrioventricular Conduction
- Ventricular Conduction
- An Impulse Can Travel Around a Reentry Loop
- Afterdepolarizations Lead to Triggered Activity
- Early Afterdepolarizations
- Delayed Afterdepolarizations
- Electrocardiography Displays the Spread of Cardiac Excitation
- Scalar Electrocardiography
- Dysrhythmias Occur Frequently and Constitute Important Clinical Problems
- Altered Sinoatrial Rhythms
- Atrioventricular Transmission Blocks
- Premature Depolarizations
- Ectopic Tachycardias
- Fibrillation
- Summary
- Case 3-1
Chapter 4 THE CARDIAC PUMP
- The Microscopic and Gross Structures of the Heart
- Cardiac Muscle (myocardial) Cell Morphology
- Structure of the Heart: Atria, Ventricles, and Valves
- The Force of Cardiac Contraction Is Determined by Excitation-Contraction Coupling and the Initial Sarcomere Length of the Myocardial Cells
- Excitation-Contraction Coupling Is Mediated by Calcium
- Mechanics of Cardiac Muscle
- The Sequential Contraction and Relaxation of the Atria and Ventricles Constitute the Cardiac Cycle
- Ventricular Systole
- Echocardiography Reveals Movement of the Ventricular Walls and of the Valves
- The Two Major Heart Sounds Are Produced Mainly by Closure of the Cardiac Valves
- The Pressure-Volume Relationships in the Intact Heart
- Passive or Diastolic Pressure-Volume Relationship
- Active or End-Systolic Pressure-Volume Relationship
- Pressure and Volume during the Cardiac Cycle: The P-V Loop
- Preload and Afterload during the Cardiac Cycle
- Contractility
- The Fick Principle Is Used to Determine Cardiac Output
- Metabolism of ATP and its Relation to Mechanical Function
- Fatty Acid Metabolism
- Carbohydrate Metabolism
- Interrelation between Fatty Acid and Carbohydrate Metabolism
- Effects of plasma substrate and insulin levels
- Cardiac O2 Consumption and the Link between Ventricular Function and Cardiac Metabolism
- Summary
- Case 4-1
Chapter 5 REGULATION OF THE HEARTBEAT
- Heart Rate is Controlled Mainly by the Autonomic Nerves
- Parasympathetic Pathways
- Sympathetic Pathways
- Higher Centers Also Influence Cardiac Performance
- Heart Rate Can Be Regulated via the Baroreceptor Reflex
- The Bainbridge Reflex and Atrial Receptors Regulate Heart Rate
- Respiration Induces a Common Cardiac Dysrhythmia
- Activation of the Chemoreceptor Reflex Affects Heart Rate
- Ventricular Receptor Reflexes Play a Minor Role in the Regulation of Heart Rate
- Myocardial Performance Is Regulated by Intrinsic Mechanisms
- The Frank-Starling Mechanism Is an Important Regulator of Myocardial Contraction Force
- Changes in Heart Rate Affect Contractile Force
- Myocardial Performance Is Regulated by Nervous and Humoral Factors
- Nervous Control
- Cardiac Performance Is Also Regulated by Hormonal Substances
- Summary
- Case 5-1
Chapter 6 HEMODYNAMICS
- Velocity of the Bloodstream Depends on Blood Flow and Vascular Area
- Blood Flow Depends on the Pressure Gradient
- Relationship Between Pressure and Flow Depends on the Characteristics of the Conduits
- Resistance to Flow
- Resistances in Series and in Parallel
- Flow May Be Laminar or Turbulent
- Shear Stress on the Vessel Wall
- Rheologic Properties of Blood
- Summary
- Case 6-1
Chapter 7 THE ARTERIAL SYSTEM
- The Hydraulic Filter Converts Pulsatile Flow to Steady Flow
- Arterial Elasticity Compensates for the Intermittent Flow Delivered by the Heart
- The Arterial Blood Pressure Is Determined by Physical and Physiological Factors
- Mean Arterial Pressure
- Cardiac Output
- Peripheral Resistance
- Pulse Pressure
- Stroke Volume
- Arterial Compliance
- Total Peripheral Resistance and Arterial Diastolic Pressure
- The Pressure Curves Change in Arteries at Different Distances from the Heart
- Blood Pressure Is Measured by a Sphygmomanometer in Human Patients
- Summary
- Case 7-1
Chapter 8 The MICROCIRCULATION AND LYMPHATICS
- Functional Anatomy
- Arterioles Are the Stopcocks of the Circulation
- Capillaries Permit the Exchange of Water, Solutes, and Gases
- The Law of Laplace Explains How Capillaries Can Withstand High Intravascular Pressures
- The Endothelium Plays an Active Role in Regulating the Microcirculation
- The Endothelium is at the Center of Flow-Initiated Mechanotransduction
- The Endothelium Plays a Passive Role in Transcapillary Exchange
- Diffusion Is the Most Important Means of Water and Solute Transfer Across the Endothelium
- Diffusion of Lipid-Insoluble Molecules Is Restricted to the Pores
- Lipid-Soluble Molecules Pass Directly Through the Lipid Membranes of the Endothelium and the Pores
- Capillary Filtration Is Regulated by the Hydrostatic and Osmotic Forces Across the Endothelium
- Balance of Hydrostatic and Osmotic Forces
- The Capillary Filtration Coefficient Provides a Method to Estimate the Rate of Fluid Movement Across the Endothelium
- Hypoxia-inducible factor(s) and angiogenesis
- Pinocytosis Enables Large Molecules to Cross the Endothelium
- The Lymphatics Return the Fluid and Solutes That Escape Through the Endothelium to the Circulating Blood
- Summary
- Case 8-1
- Case 8-2
Chapter 9 The PERIPHERAL CIRCULATION AND ITS CONTROL
- The Functions of the Heart and Large Blood Vessels
- Contraction and Relaxation of Arteriolar Vascular Smooth Muscle Regulate Peripheral Blood Flow
- Cytoplasmic Ca++ Is Regulated to Control Contraction, via MLCK
- Contraction Is Controlled by Excitation-Contraction Coupling and/or Pharmacomechanical Coupling
- Control of Vascular Tone by Catecholamines
- Control of Vascular Contraction by Other Hormones, Other Neurotransmitters, and Autocoids
- Intrinsic Control of Peripheral Blood Flow
- Autoregulation and the Myogenic Mechanism Tend to Keep Blood Flow Constant
- The Endothelium Actively Regulates Blood Flow
- Tissue Metabolic Activity Is the Main Factor in the Local Regulation of Blood Flow
- Extrinsic Control of Peripheral Blood Flow Is Mediated Mainly by the Sympathetic Nervous System
- Impulses That Arise in the Medulla Descend in the Sympathetic Nerves to Increase Vascular Resistance
- Sympathetic Nerves Regulate the Contractile State of the Resistance and Capacitance Vessels
- The Parasympathetic Nervous System Innervates Blood Vessels Only in the Cranial and Sacral Regions of the Body
- Epinephrine and Norepinephrine Are the Main Humoral Factors That Affect Vascular Resistance
- The Vascular Reflexes Are Responsible for Rapid Adjustments of Blood Pressure
- The Peripheral Chemoreceptors Are Stimulated by Decreases in Blood Oxygen Tension and pH and by Increases in Carbon Dioxide Tension
- The Central Chemoreceptors Are Sensitive to Changes in Paco2
- Other Vascular Reflexes
- Balance Between Extrinsic and Intrinsic Factors in Regulation of Peripheral Blood Flow
- Summary
- Case 9-1
Chapter 10 CONTROL OF CARDIAC OUTPUT: COUPLING OF HEART AND BLOOD VESSELS
- Factors Controlling Cardiac Output
- The Cardiac Function Curve Relates Central Venous Pressure(Preload) to Cardiac Output
- Preload or Filling Pressure of the Heart
- Cardiac Function Curve
- Factors That Change the Cardiac Function Curve
- The Vascular Function Curve Relates Central Venous Pressure to Cardiac Output
- Mathematical Analysis of the Vascular Function Curve
- Venous Pressure Depends on Cardiac Output
- Blood Volume
- Venomotor Tone
- Blood Reservoirs
- Peripheral Resistance
- Cardiac Output and Venous Return Are Closely Associated
- The Heart and Vasculature Are Coupled Functionally
- Myocardial Contractility
- Blood Volume
- Peripheral Resistance
- The Right Ventricle Regulates Not Only Pulmonary Blood Flow but Also Central Venous Pressure
- Heart Rate Has Ambivalent Effects on Cardiac Output
- Ancillary Factors Affect the Venous System and Cardiac Output
- Gravity
- Muscular Activity and Venous Valves
- Respiratory Activity
- Artificial Respiration
- Summary
- Case 10-1
Chapter 11 CORONARY CIRCULATION
- Functional Anatomy of the Coronary Vessels
- Coronary Blood Flow Is Regulated by Physical, Neural, and Metabolic Factors
- Physical Factors
- Neural and Neurohumoral Factors
- Metabolic Factors
- Diminished Coronary Blood Flow Impairs Cardiac Function
- Energy Substrate Metabolism During Ischemia
- Coronary Collateral Vessels Develop in Response to Impairment of Coronary Blood Flow
- Summary
- Case 11-1
Chapter 12 SPECIAL CIRCULATIONS
- Cutaneous Circulation
- Skin Blood Flow Is Regulated Mainly by the Sympathetic Nervous System
- Ambient Temperature and Body Temperature Play Important Roles in the Regulation of Skin Blood Flow
- Skin Color Depends on the Volume and Flow of Blood in the Skin and on the Amount of O2 Bound to Hemoglobin
- Skeletal Muscle Circulation
- Regulation of Skeletal Muscle Circulation
- Cerebral Circulation
- Local Factors Predominate in the Regulation of Cerebral Blood Flow
- The Pulmonary and Systemic Circulations Are in Series with Each Other
- Functional Anatomy
- Pulmonary Hemodynamics
- Regulation of the Pulmonary Circulation
- The Renal Circulation Affects the Cardiac Output
- Anatomy
- Renal Hemodynamics
- The Renal Circulation Is Regulated by Intrinsic Mechanisms
- The Splanchnic Circulation Provides Blood Flow to the Gastrointestinal Tract, Liver, Spleen, and Pancreas
- Intestinal Circulation
- Hepatic Circulation
- Fetal Circulation
- Changes in the Circulatory System at Birth
- Summary
- Case 12-1
- Case 12-2
- Case 12-3
Chapter 13 INTERPLAY OF CENTRAL AND PERIPHERAL FACTORS THAT CONTROL THE CIRCULATION
- Exercise
- Mild to Moderate Exercise
- Severe Exercise
- Postexercise Recovery
- Limits of Exercise Performance
- Physical Training and Conditioning
- Hemorrhage
- Hemorrhage Evokes Compensatory and Decompensatory Effects on the Arterial Blood Pressure
- The Compensatory Mechanisms Are Neural and Humoral
- The Decompensatory Mechanisms Are Mainly Humoral, Cardiac, and Hematologic
- The Positive and Negative Feedback Mechanisms Interact
- Summary
- Case 13-1
- Case 13-2
Appendix A: End-of-Chapter CASE STUDY ANSWERS
Appendix B: Comprehensive Examination