Cardiovascular Physiology
Mosby Physiology Monograph Series (with Student Consult Online Access)
10th Edition
Published on 17. December 2012
Book
Paperback/Softback
304 pages
978-0-323-08697-4 (ISBN)
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!
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!
More details
Series
Edition
10th Revised edition
Language
English
Place of publication
St Louis
United States
Publishing group
Elsevier - Health Sciences Division
Target group
College/higher education
Edition type
Revised edition
Illustrations
Approx. 220 illustrations (200 in full color)
Dimensions
Height: 235 mm
Width: 191 mm
ISBN-13
978-0-323-08697-4 (9780323086974)
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited or by the publishers or by their respective licensors: all rights reserved.
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Previous edition
Matthew N. Levy | Withrow Gil Wier | Mark T. Nelson
Cardiovascular Physiology
Mosby Physiology Monograph Series
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Content
vii
CON T E N T S
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
CON T E N T S
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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
C H A P T E R 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