| Foreword |
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xiii | |
| Preface |
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xv | |
| A note on active and problem-based learning |
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xvii | |
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xix | |
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1 Overview of the cardiovascular system |
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1 | (14) |
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1.1 Diffusion: its virtues and limitations |
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1 | (2) |
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1.2 Functions of the cardiovascular system |
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3 | (1) |
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1.3 The circulation of blood |
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3 | (3) |
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1.4 Cardiac output and its distribution |
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6 | (1) |
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1.5 Introducing `hydraulics': flow, pressure and resistance |
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7 | (2) |
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1.6 Blood vessel structure |
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9 | (1) |
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1.7 Functional classes of vessel |
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10 | (2) |
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1.8 The plumbing of the circulation |
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12 | (1) |
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13 | (2) |
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15 | (14) |
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2.1 The gross structure of the heart |
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15 | (2) |
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2.2 The ventricular cycle |
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17 | (3) |
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2.3 The atrial cycle and jugular venous pressure waves |
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20 | (1) |
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2.4 Altered phase durations when heart rate increases |
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21 | (1) |
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2.5 Heart sounds and valve abnormalities |
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21 | (2) |
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2.6 Clinical assessment of the cardiac cycle |
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23 | (6) |
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3 The cardiac myocyte: excitation and contraction |
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29 | (20) |
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3.1 The importance of calcium |
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29 | (1) |
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3.2 Ultrastructure of a cardiac myocyte |
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30 | (2) |
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3.3 Mechanism of contraction |
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32 | (1) |
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3.4 Resting membrane potential |
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33 | (4) |
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3.5 Role of pumps and exchangers |
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37 | (1) |
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3.6 Cardiac action potentials |
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37 | (3) |
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3.7 Advanced aspects: structure-function relations of ion channels |
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40 | (3) |
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3.8 Physiological and pathological changes in action potential |
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43 | (1) |
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3.9 Excitation-contraction coupling and the calcium cycle |
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44 | (3) |
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3.10 Regulation of contractile force |
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47 | (1) |
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3.11 Store overload, afterdepolarization and arrhythmia |
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47 | (2) |
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4 Initiation and nervous control of heartbeat |
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49 | (18) |
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4.1 Organization of the pacemaker-conduction system |
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49 | (2) |
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4.2 Electrical activity of the pacemaker |
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51 | (3) |
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4.3 Transmission of excitation |
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54 | (1) |
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4.4 Regulation of heart rate |
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55 | (3) |
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4.5 Effects of sympathetic stimulation |
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58 | (2) |
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4.6 Effects of parasympathetic stimulation |
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60 | (1) |
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4.7 Local neuromodulators and autonomic co-transmitters |
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61 | (1) |
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4.8 Dangers of an altered ionic environment |
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62 | (1) |
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4.9 Pharmacological manipulation of cardiac currents |
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63 | (1) |
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4.10 Mechano-electrical feedback |
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63 | (4) |
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5 Electrocardiography and arrhythmias |
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67 | (20) |
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5.1 Principles of electrocardiography |
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67 | (1) |
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5.2 Relation of ECG waves to cardiac action potentials |
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68 | (2) |
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70 | (2) |
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72 | (1) |
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5.5 The excitation sequence |
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72 | (1) |
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5.6 Why the QRS complex is complex |
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73 | (1) |
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5.7 The electrical axis of the heart |
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74 | (1) |
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5.8 The inverse problem of electrocardiography and ECG imaging (ECGi) |
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75 | (1) |
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5.9 ECG in ischaemic heart disease |
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75 | (1) |
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5.10 Arrhythmogenic mechanisms: a trigger, vulnerable window and substrate |
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76 | (2) |
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78 | (9) |
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6 Control of stroke volume and cardiac output |
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87 | (26) |
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87 | (1) |
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6.2 Contractile properties of isolated myocardium |
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88 | (1) |
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6.3 Mechanisms underlying the length-tension relation |
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89 | (2) |
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6.4 The Frank-Starling mechanism |
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91 | (3) |
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6.5 Stroke work and the pressure-volume loop |
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94 | (1) |
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6.6 Central venous pressure and cardiac filling |
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95 | (2) |
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6.7 Operation of the Frank-Starling mechanism in humans |
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97 | (1) |
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6.8 Laplace's law and dilated hearts |
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98 | (1) |
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6.9 Multiple effects of arterial pressure on the heart |
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99 | (2) |
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6.10 Sympathetic regulation of contractility |
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101 | (3) |
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6.11 Other positive inotropic influences |
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104 | (1) |
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6.12 Negative inotropism, ischaemia and arrhythmia |
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105 | (2) |
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6.13 Co-ordinated control of cardiac output |
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107 | (2) |
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6.14 Cardiac energetics and metabolism |
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109 | (4) |
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7 Assessment of cardiac output and arterial pulse |
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113 | (8) |
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7.1 Fick's principle and pulmonary oxygen transport |
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113 | (2) |
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7.2 Indicator and thermal dilution methods |
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115 | (1) |
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7.3 Aortic flow by pulsed Doppler method |
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116 | (1) |
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7.4 Central arterial pulse and its relation to cardiac output |
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117 | (1) |
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7.5 Radionuclide ventriculography, 2-D echocardiography, cardiac magnetic resonance imaging and other methods |
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118 | (3) |
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8 Haemodynamics: flow, pressure and resistance |
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121 | (28) |
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8.1 Hydraulic principles: the laws of Darcy and Bernoulli |
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121 | (2) |
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8.2 Patterns of blood flow: laminar, turbulent, single-file |
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123 | (2) |
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8.3 Measurement of blood flow |
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125 | (1) |
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8.4 The arterial pressure pulse |
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126 | (5) |
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8.5 Mean arterial pressure and pressure measurement |
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131 | (4) |
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135 | (1) |
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8.7 Peripheral resistance, Poiseuille's law and Laplace's wall mechanics |
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135 | (4) |
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8.8 Viscous properties of blood |
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139 | (2) |
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8.9 Pressure-flow relationships and autoregulation |
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141 | (1) |
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8.10 Venous pressure and volume |
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141 | (2) |
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8.11 Effects of gravity on the venous system |
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143 | (2) |
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8.12 Venous blood flow and the accessory pumps |
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145 | (4) |
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149 | (22) |
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9.1 Outline of endothelial functions |
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149 | (2) |
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9.2 Structure of endothelium |
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151 | (4) |
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9.3 Ion channels, calcium and endothelial function |
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155 | (1) |
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9.4 Nitric oxide production by endothelial cells |
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156 | (3) |
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9.5 Other vasoactive endothelial products: endothelium-derived hyperpolarization, prostacyclin and endothelins |
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159 | (1) |
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9.6 Actions of endothelium on blood |
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160 | (1) |
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9.7 Endothelial permeability and its regulation |
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161 | (1) |
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9.8 Endothelium and the inflammatory response |
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161 | (2) |
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9.9 Endothelium and angiogenesis |
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163 | (1) |
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9.10 Endothelium and atheroma |
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164 | (1) |
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9.11 Endothelium, platelets and coagulation |
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165 | (6) |
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10 The microcirculation and solute exchange |
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171 | (20) |
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10.1 Organization and perfusion of exchange vessels |
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171 | (2) |
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10.2 Three types of capillary |
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173 | (1) |
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10.3 Diffusion, convection and reflection across a porous membrane |
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174 | (3) |
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10.4 The concept of `permeability' |
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177 | (1) |
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10.5 Lipid-soluble molecules diffuse extremely rapidly across the endothelium |
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177 | (1) |
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10.6 Small lipid-insoluble molecules permeate the small pore system |
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178 | (2) |
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10.7 Large lipid-insoluble molecules pass through a large pore system |
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180 | (1) |
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10.8 The blood-brain barrier and carrier-mediated transport |
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181 | (1) |
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10.9 Extraction and clearance in capillaries |
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182 | (2) |
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10.10 How blood flow affects solute transfer |
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184 | (1) |
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10.11 Physiological regulation of solute transfer |
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185 | (6) |
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11 Circulation of fluid between plasma, interstitium and lymph |
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191 | (30) |
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11.1 The Starling principle of fluid exchange |
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191 | (3) |
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11.2 Capillary blood pressure (Pc) and its regulation |
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194 | (2) |
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11.3 Osmosis across capillaries: plasma colloid osmotic pressure (πp) |
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196 | (2) |
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11.4 Magnitude and dynamics of extravascular COP (πi, πg) |
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198 | (1) |
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11.5 Interstitial matrix and interstitial fluid pressure (Pi) |
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199 | (1) |
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11.6 Tissue fluid balance: filtration versus absorption |
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200 | (4) |
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11.7 Interstitial compliance and conductivity: effect of oedema |
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204 | (1) |
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11.8 Lymph and the lymphatic system |
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205 | (5) |
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11.9 Challenges to tissue fluid balance: orthostasis and exercise |
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210 | (1) |
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211 | (2) |
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11.11 The swelling of inflammation |
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213 | (8) |
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12 Vascular smooth muscle: excitation, contraction and relaxation |
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221 | (18) |
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221 | (2) |
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12.2 Structure of a vascular myocyte |
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223 | (1) |
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12.3 Contractile properties and role of Ca2+ |
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224 | (2) |
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12.4 Vascular ion channels |
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226 | (5) |
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12.5 From sympathetic stimulation to contractile response |
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231 | (4) |
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12.6 Vasomotion (rhythmic contractions) |
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235 | (1) |
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12.7 Physiological vasodilator mechanisms |
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235 | (4) |
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13 Control of blood vessels: intrinsic control |
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239 | (16) |
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13.1 Overview of vascular control and its roles |
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239 | (2) |
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13.2 Myogenic response to blood pressure changes |
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241 | (1) |
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13.3 Regulation by endothelium |
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242 | (2) |
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13.4 Regulation by metabolic vasoactive factors |
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244 | (2) |
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13.5 Regulation by autacoids |
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246 | (1) |
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13.6 Autoregulation of blood flow |
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247 | (2) |
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13.7 Metabolic (functional) hyperaemia |
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249 | (3) |
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13.8 Post-ischaemic (reactive) hyperaemia |
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252 | (1) |
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13.9 Ischaemia-reperfusion injury |
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252 | (3) |
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14 Control of blood vessels: extrinsic control by nerves and hormones |
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255 | (20) |
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14.1 Sympathetic vasoconstrictor nerves |
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255 | (6) |
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14.2 Parasympathetic vasodilator nerves |
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261 | (1) |
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14.3 Sympathetic vasodilator nerves |
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262 | (1) |
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14.4 Nociceptive C-fibre-mediated vasodilatation |
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263 | (2) |
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14.5 Hormonal control of the circulation |
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265 | (1) |
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14.6 Adrenaline and noradrenaline |
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265 | (1) |
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14.7 Vasopressin (antidiuretic hormone) |
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266 | (2) |
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14.8 Renin-angiotensin-aldosterone system |
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268 | (1) |
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14.9 Natriuretic peptides |
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269 | (1) |
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14.10 Special features of venous control |
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270 | (5) |
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15 Specialization in individual circulations |
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275 | (28) |
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15.1 Coronary circulation |
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275 | (7) |
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15.2 Skeletal muscle circulation |
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282 | (3) |
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15.3 Cutaneous circulation |
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285 | (5) |
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15.4 Cerebral circulation |
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290 | (5) |
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15.5 Pulmonary circulation |
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295 | (8) |
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16 Cardiovascular receptors, reflexes and central control |
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303 | (22) |
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16.1 Arterial baroreceptors |
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304 | (2) |
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306 | (3) |
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16.3 Receptors in the heart and pulmonary arteries |
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309 | (2) |
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16.4 Reflexes from cardiac receptors in humans |
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311 | (1) |
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16.5 Long-term regulation of arterial blood pressure: the kidney link |
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312 | (2) |
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16.6 Excitatory inputs: muscle work receptors, arterial chemoreceptors, lung stretch receptors |
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314 | (3) |
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16.7 Central pathways: role of the medulla oblongata |
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317 | (2) |
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16.8 Central pathways: role of higher regions |
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319 | (1) |
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16.9 Overview of central control |
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320 | (5) |
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17 Co-ordinated cardiovascular responses |
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325 | (18) |
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17.1 Posture (orthostasis) |
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326 | (1) |
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17.2 The Valsalva manoeuvre |
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327 | (1) |
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328 | (5) |
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17.4 Physical training and performance |
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333 | (2) |
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17.5 Feeding, digestion and the splanchnic circulation |
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335 | (1) |
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335 | (1) |
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336 | (2) |
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17.8 Sleep and the alerting response |
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338 | (5) |
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18 Cardiovascular responses in pathological situations |
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343 | (26) |
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343 | (3) |
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18.2 Shock and haemorrhage |
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346 | (3) |
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18.3 Transient loss of consciousness (syncope) |
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349 | (1) |
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350 | (6) |
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18.5 Chronic heart failure |
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356 | (13) |
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19 Experimental models and measurements to study cardiovascular physiology |
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369 | (16) |
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19.1 The experimental approach |
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369 | (1) |
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370 | (1) |
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19.3 Measurements in isolated cells |
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371 | (3) |
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19.4 Multicellular preparations |
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374 | (2) |
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19.5 Measurements in multicellular preparations |
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376 | (3) |
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19.6 Animal studies in vivo |
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379 | (1) |
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19.7 Measurements in animal studies in vivo |
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379 | (2) |
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381 | (4) |
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20 Experimental perturbations to investigate cardiovascular physiology |
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385 | (12) |
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20.1 Physical manipulation |
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385 | (2) |
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20.2 Chemical manipulation |
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387 | (2) |
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20.3 Genetic manipulation |
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389 | (4) |
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20.4 Human clinical studies |
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393 | (4) |
| Clinical cases for problem-based learning |
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397 | (10) |
| Appendix 1 Human cardiovascular parameters |
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407 | (4) |
| Index |
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411 | |
