Cardiovascular Physiology: Mosby Physiology Monograph Series / Edition 9

Cardiovascular Physiology: Mosby Physiology Monograph Series / Edition 9

by Achilles J. Pappano

ISBN-10: 0323034462

ISBN-13: 9780323034463

Pub. Date: 09/26/2006

Publisher: Elsevier Health Sciences

The Mosby Physiology Monograph Series offers the fundamentals of body systems physiology in a clear and concise manner. Each volume in the series is written by experts in the field for an authoritative, yet readable introduction to the physiology relevant to a particular organ system.

This new 9th edition of Cardiovascular Physiology offers:

• Clear,


The Mosby Physiology Monograph Series offers the fundamentals of body systems physiology in a clear and concise manner. Each volume in the series is written by experts in the field for an authoritative, yet readable introduction to the physiology relevant to a particular organ system.

This new 9th edition of Cardiovascular Physiology offers:

• Clear, accurate and up-to-the-minute coverage of the physiology of the cardiovascular system focusing on the needs of the student.
• Pathophysiology content throughout that serves as a bridge between normal function and disease.
• Integrated student-friendly tools, including learning objectives, overview boxes, key words and concepts, chapter summaries, and clinical cases with questions and explained answers
• Access to Student Consult ®! is an innovative website that allows you to build a personalized, fully integrated, online library, where you’ll find the entire contents of every STUDENT CONSULT title purchased, integration links to bonus content in other STUDENT CONSULT titles, and much more.

Product Details

Elsevier Health Sciences
Publication date:
Mosby's Physiology Monograph Series
Edition description:
Product dimensions:
7.50(w) x 9.20(h) x 0.60(d)

Table of Contents

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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