基本説明
Explains how the latest concepts apply to real-life clinical situations. Prev. ed.: 2006.
Full Description
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 the latest concepts apply to real-life clinical situations. Get clear, accurate, and up-to-the-minute coverage of the physiology of the cardiovascular system. Master the material easily with objectives at the start of each chapter; self-study questions, summaries, and key words and concepts; and a multiple-choice review exam to help prep for USMLEs. Grasp the latest concepts in vascular, molecular, and cellular biology as they apply to cardiovascular function, thanks to molecular commentaries in each chapter.Apply information to clinical situations with the aid of clinical commentaries and highlighted clinical vignettes throughout.Access the fully searchable text and downloadable images online at www.studentconsult.com!
Contents
viiCON T E N T SC H A P T E R 1AND BLOOD 1The Circulatory System 1Blood 5Erythrocytes 5Leukocytes 6Lymphocytes 7Blood Is Divided into Groups by AntigensLocated on Erythrocytes 7Summary 9Case 1-1 9C H A P T E R 2EXCITATION: THE CARDIACACTION POTENTIAL . 11Cardiac Action Potentials Consist of SeveralPhases 11The Principal Types of Cardiac ActionPotentials Are the Slow and FastTypes 12Ionic Basis of the RestingPotential 13The Fast Response Depends Mainly onVoltage-Dependent SodiumChannels 15Ionic Basis of the Slow Response 24Conduction in Cardiac Fibers Depends onLocal Circuit Currents 25Conduction of the Fast Response 25Conduction of the Slow Response 27Cardiac Excitability Depends on theActivation and Inactivation of SpecificCurrents 27Fast Response 27Slow Response 28Effects of Cycle Length 28Summary 29Case 2-1 29C H A P T E R 3AUTOMATICITY: NATURALThe Heart Generates Its Own PacemakingActivity 31Sinoatrial Node 32Ionic Basis of Automaticity 34Overdrive Suppression 35Atrial Conduction 36Atrioventricular Conduction 37Ventricular Conduction 39An Impulse Can Travel Around a ReentryLoop 41Afterdepolarizations Lead to TriggeredActivity 42Early Afterdepolarizations 43Delayed Afterdepolarizations 43Electrocardiography Displays the Spread ofCardiac Excitation 44Scalar Electrocardiography 44Dysrhythmias Occur Frequently andConstitute Important ClinicalProblems 47Altered Sinoatrial Rhythms 47Atrioventricular Transmission Blocks 48Premature Depolarizations 48Ectopic Tachycardias 49Fibrillation 49Summary 51Case 3-3 52C H A P T E R 4THE CARDIAC PUMP 55The Gross and Microscopic Structures of theHeart Are Uniquely Designed for OptimalFunction 55The Myocardial Cell 55Structure of the Heart: Atria, Ventricles,and Valves 60The Force of Cardiac Contraction IsDetermined by Excitation-ContractionCoupling and the Initial Sarcomere Lengthof the Myocardial Cells 63Excitation-Contraction Coupling IsMediated by Calcium 63Mechanics of Cardiac Muscle 65The Sequential Contraction and Relaxation ofthe Atria and Ventricles Constitute theCardiac Cycle 69Ventricular Systole 70Echocardiography Reveals Movement ofthe Ventricular Walls and of theValves 73The Two Major Heart Sounds AreProduced Mainly by Closure of theCardiac Valves 74The Pressure-Volume Relationships in theIntact Heart 75Passive or Diastolic Pressure-VolumeRelationship 75Active or End-Systolic Pressure-VolumeRelationship 77Pressure and Volume during the CardiacCycle: The P-V Loop 77Preload and Afterload during the CardiacCycle 77Contractility 78The Fick Principle Is Used to DetermineCardiac Output 79Summary 89Case 4-1 90C H A P T E R 5HEARTBEAT 91Heart Rate is Controlled Mainly by theAutonomic Nerves 91Parasympathetic Pathways 92Sympathetic Pathways 93Higher Centers Also Influence CardiacPerformance 97Heart Rate Can Be Regulated via theBaroreceptor Reflex 97The Bainbridge Reflex and AtrialReceptors Regulate Heart Rate 98Respiration Induces a Common CardiacDysrhythmia 99Activation of the Chemoreceptor ReflexAffects Heart Rate 101Ventricular Receptor Reflexes Play aMinor Role in the Regulation of HeartRate 102Myocardial Performance Is Regulatedby Intrinsic Mechanisms 102The Frank-Starling Mechanism Is anImportant Regulator of MyocardialContraction Force 103Changes in Heart Rate Affect ContractileForce 107Myocardial Performance Is Regulated byNervous and Humoral Factors 110Nervous Control 110Cardiac Performance Is Also Regulated byHormonal Substances 113Summary 116Case 5-1 117C H A P T E R 6HEMODYNAMICS 119Velocity of the Bloodstream Depends onBlood Flow and Vascular Area 119Blood Flow Depends on the PressureGradient 120Relationship Between Pressure and FlowDepends on the Characteristics of theConduits 122Resistance to Flow 125Resistances in Series and in Parallel 126Flow May Be Laminar or Turbulent 127Shear Stress on the Vessel Wall 128Rheologic Properties of Blood 129Summary 133Case 6-6 134C H A P T E R 7THE ARTERIAL SYSTEM . 135The Hydraulic Filter Converts Pulsatile Flowto Steady Flow 135Arterial Elasticity Compensates for theIntermittent Flow Delivered by theHeart 137The Arterial Blood Pressure Is Determined byPhysical and Physiological Factors 140Mean Arterial Pressure 140Cardiac Output 142Peripheral Resistance 142Pulse Pressure 144Stroke Volume 144Arterial Compliance 145Total Peripheral Resistance and ArterialDiastolic Pressure 146The Pressure Curves Change in Arteries atDifferent Distances from the Heart 147Blood Pressure Is Measured by aSphygmomanometer in HumanPatients 148Summary 150Case 7-1 150C H A P T E R 8THE MICROCIRCULATIONAND LYMPHATICS. 153Functional Anatomy 153Arterioles Are the Stopcocks of theCirculation 153Capillaries Permit the Exchange of Water,Solutes, and Gases 154The Law of Laplace Explains HowCapillaries Can Withstand HighIntravascular Pressures 155The Endothelium Plays an Active Role inRegulating the Microcirculation 156The Endothelium is at the Center of Flow-Initiated Mechanotransduction 157The Endothelium Plays a Passive Role inTranscapillary Exchange 158Diffusion Is the Most Important Means ofWater and Solute Transfer Across theEndothelium 159Diffusion of Lipid-Insoluble Molecules IsRestricted to the Pores 159Lipid-Soluble Molecules Pass DirectlyThrough the Lipid Membranes of theEndothelium and the Pores 162Capillary Filtration Is Regulated by theHydrostatic and Osmotic Forces Acrossthe Endothelium 163Balance of Hydrostatic and OsmoticForces 165The Capillary Filtration CoefficientProvides a Method to Estimate the Rateof Fluid Movement Across theEndothelium 165Pinocytosis Enables Large Molecules toCross the Endothelium 167The Lymphatics Return the Fluid and SolutesThat Escape Through the Endothelium tothe Circulating Blood 167Summary 168Case 8-1 169Case 8-2 169C H A P T E R 9THE PERIPHERAL CIRCULATIONAND ITS CONTROL 171The Functions of the Heart and Large BloodVessels 171Contraction and Relaxation of ArteriolarVascular Smooth Muscle RegulatePeripheral Blood Flow 172Cytoplasmic Ca++ Is Regulated to ControlContraction, via MLCK 175Contraction Is Controlled by Excitation-Contraction Coupling and/orPharmacomechanical Coupling 176Control of Vascular Tone byCatecholamines 178Control of Vascular Contraction by OtherHormones, Other Neurotransmitters,and Autocoids 178Intrinsic Control of Peripheral BloodFlow 179Autoregulation and the MyogenicMechanism Tend to Keep Blood FlowConstant 179The Endothelium Actively Regulates BloodFlow 180Tissue Metabolic Activity Is the MainFactor in the Local Regulation of BloodFlow 181Extrinsic Control of Peripheral Blood Flow IsMediated Mainly by the SympatheticNervous System 183Impulses That Arise in the MedullaDescend in the Sympathetic Nervesto Increase Vascular Resistance 183Sympathetic Nerves Regulate theContractile State of the Resistance andCapacitance Vessels 184The Parasympathetic Nervous SystemInnervates Blood Vessels Only in theCranial and Sacral Regions of theBody 185Epinephrine and Norepinephrine Are theMain Humoral Factors That AffectVascular Resistance 185The Vascular Reflexes Are Responsible forRapid Adjustments of BloodPressure 185The Peripheral Chemoreceptors AreStimulated by Decreases in BloodOxygen Tension and pH and byIncreases in Carbon DioxideTension 189The Central Chemoreceptors Are Sensitiveto Changes in Paco2 189Other Vascular Reflexes 190Balance Between Extrinsic and IntrinsicFactors in Regulation of Peripheral BloodFlow 191Summary 192Case 9-1 194C H A P T E R 10BLOOD VESSELS . 195Factors Controlling Cardiac Output 195The Cardiac Function Curve Relates CentralVenous Pressure (Preload) to CardiacOutput 196Preload or Filling Pressure of theHeart 196Cardiac Function Curve 196Factors That Change the CardiacFunction Curve 197The Vascular Function Curve Relates CentralVenous Pressure to Cardiac Output 200Mathematical Analysis of the VascularFunction Curve 203Venous Pressure Depends on CardiacOutput 205Blood Volume 205Venomotor Tone 206Blood Reservoirs 206Peripheral Resistance 206Cardiac Output and Venous Return AreClosely Associated 207The Heart and Vasculature Are CoupledFunctionally 207Myocardial Contractility 209Blood Volume 209Peripheral Resistance 210The Right Ventricle Regulates Not OnlyPulmonary Blood Flow but Also CentralVenous Pressure 211Heart Rate Has Ambivalent Effects on CardiacOutput 214Ancillary Factors Affect the Venous Systemand Cardiac Output 216Gravity 216Muscular Activity and VenousValves 218Respiratory Activity 219Artificial Respiration 220Summary 221Case 10-1 221C H A P T E R 11CORONARY CIRCULATION . 223Functional Anatomy of the CoronaryVessels 223Coronary Blood Flow Is Regulated byPhysical, Neural, and MetabolicFactors 225Physical Factors 225Neural and Neurohumoral Factors 227Metabolic Factors 228Diminished Coronary Blood Flow ImpairsCardiac Function 230Energy Substrate Metabolism DuringIschemia 231Coronary Collateral Vessels Develop inResponse to Impairment of CoronaryBlood Flow 233Summary 235Case 11-1 236C H A P T E R 12SPECIAL CIRCULATIONS 237Cutaneous Circulation 237Skin Blood Flow Is Regulated Mainly bythe Sympathetic Nervous System 237Ambient Temperature and BodyTemperature Play Important Roles inthe Regulation of Skin BloodFlow 239Skin Color Depends on the Volume andFlow of Blood in the Skin and on theAmount of O2 Bound toHemoglobin 240Skeletal Muscle Circulation 240Regulation of Skeletal MuscleCirculation 240Cerebral Circulation 243Local Factors Predominate in theRegulation of Cerebral BloodFlow 243The Pulmonary and Systemic CirculationsAre in Series with Each Other 245Functional Anatomy 245Pulmonary Hemodynamics 247Regulation of the PulmonaryCirculation 249The Renal Circulation Affects the CardiacOutput 250Anatomy 250Renal Hemodynamics 252The Renal Circulation Is Regulated byIntrinsic Mechanisms 252The Splanchnic Circulation Provides BloodFlow to the Gastrointestinal Tract, Liver,Spleen, and Pancreas 254Intestinal Circulation 254Hepatic Circulation 256Fetal Circulation 257Changes in the Circulatory System atBirth 259Summary 260Case 12-1 262Case 12-2 262Case 12-3 262C H A P T E R 13PERIPHERAL FACTORS THATCONTROL THE CIRCULATION 263Exercise 264Mild to Moderate Exercise 264Severe Exercise 268Postexercise Recovery 268Limits of Exercise Performance 269Physical Training and Conditioning 269Hemorrhage 269Hemorrhage Evokes Compensatory andDecompensatory Effects on the ArterialBlood Pressure 270The Compensatory Mechanisms AreNeural and Humoral 270The Decompensatory Mechanisms AreMainly Humoral, Cardiac, andHematologic 273The Positive and Negative FeedbackMechanisms Interact 275Summary 276Case 13-1 277Case 13-2 277APPENDIX: CASE STUDYANSWERS . 279
