Cardiovascular Physiology Concepts

by Richard E. Klabunde PhD

Overview

Selected as a Doody's Core Title for 2022 and 2023!

Praised for its concise coverage, this highly accessible monograph lays a foundation for understanding the underlying concepts of normal cardiovascular function and offers a welcome alternative to a more mechanistically oriented approach or an encyclopedic physiology text. Clear explanations, ample illustrations and engaging clinical cases and problems provide the perfect guidance for self-directed learning and prepare you to excel in clinical practice. 

• Chapter Learning Objectives highlight key concepts at a glance.
• Problems and Clinical Cases with Answers to Problems reinforce fundamental physiological concepts.
• Summary of Important Concepts boxes provide bulleted quick-review of essential chapter content.
• Multiple-choice Review Questions and Answers to Review Questions (with full explanations for each answer choice) enable self-assessment and alert you to areas requiring further study.
• A chapter on Cardiovascular Integration, Adaptation, and Pathophysiology integrates cardiovascular concepts in the context of normal and clinically relevant conditions.

Product Details

ISBN-13:	9781975150075
Publisher:	LWW
Publication date:	03/18/2021
Series:	Lippincott Connect
Edition description:	Third
Pages:	272
Sales rank:	902,541
Product dimensions:	7.00(w) x 10.00(h) x (d)

Table of Contents

Preface v

Acknowledgments vi

1 Introduction to the Cardiovascular System 1

The Need for a Circulatory System 1

The Arrangement of the Cardiovascular System 2

The Functions of the Heart and Blood Vessels 4

Heart 4

Vascular System 5

Interdependence of Circulatory and Organ Function 5

The Regulation of Cardiac and Vascular Function 5

The Content of the Following Chapters 6

Summary of Important Concepts 7

Review Questions 7

Answers to Review Questions 8

2 Cellular Structure and Function 9

Cardiac Cell Structure and Function 9

Myocytes and Sarcomeres 9

Excitation-Contraction Coupling 11

Regulation of Contraction (Inotropy) 14

Regulation of Relaxation (Lusitropy) 16

Cardiac Myocyte Metabolism 17

Vascular Structure and Function 17

Vascular Smooth Muscle Ceils 18

Vascular Endothelial Cells 22

Summary of Important Concepts 24

Review Questions 24

Answers to Review Questions 25

Answers to Problems and Cases 26

Suggested Resources 27

3 Electrical Activity of the Heart 28

Cell Membrane Potentials 29

Resting Membrane Potentials 29

Maintenance of Ionic Gradients 32

Ion Channels 33

Action Potentials 36

Arrhythmias Caused by Abnormal Action Potential Generation 40

Conduction of Action Potentials within the Heart 41

Electrical Conduction within the Heart 41

Regulation of Conduction Velocity 43

Abnormal Conduction 44

Tachycardia Caused by Reentry 44

The Electrocardiogram 46

ECG Tracing 46

Interpretation of Normal and Abnormal Cardiac Rhythms from the ECG 47

Volume Conductor Principles and ECG Rules of Interpretation 50

ECG Leads: Placement of Recording Electrodes 53

Electrophysiological Changes During Cardiac Ischemia 56

Summary of Important Concepts 58

Review Questions 59

Answers to Review Questions 61

Answers to Problems and Cases 62

Suggested Resources 63

4 Cardiac Function 64

Cardiac Anatomy 65

Functional Anatomy of the Heart 65

Autonomic Innervation 66

The Cardiac Cycle 66

Cardiac Cycle Diagram 66

Phase 1 Atrial Systole 66

Phase 2 Isovolumetric Contraction 68

Phase 3 Rapid Ejection 69

Phase 4 Reduced Ejection 69

Phase 5 Isovolumetric Relaxation 69

Phase 6 Rapid Filling 70

Phase 7 Reduced Filling 70

Summary of Intracardiac Pressures 70

Ventricular Pressure-Volume Relationship 71

Cardiac Output 71

Measurement of Cardiac Output 73

Influence of Heart Rate and Stroke Volume on Cardiac Output 73

Effects of Preload on Stroke Volume 74

Effects of Ventricular Compliance on Preload 74

Effects of Preload on Tension Development (Length-Tension Relationship) 75

Effects of Venous Return on Stroke Volume (Frank-Starling Mechanism) 78

Summary of Effects of Increase Preload on Cardiac Muscle Mechanics and Ventricular Function 80

Factors Determining Ventricular Preload 80

Effects of Afterload on Stroke Volume 81

Effects of Afterload on the Velocity of Fiber Shortening (Force-Velocity Relationship) 82

Effects of Afterload on Frank-Starling Curves 84

Effects of Afterload on Pressure-Volume Loops 84

Summary of Effects of Increased Afterload on Cardiac Muscle Mechanics and Ventricular Function 85

Effects of Inotropy on Stroke Volume 85

Effects of Inotropy on Length-Tension Relationship 85

Effects of Inotropy on Force-Velocity Relationship 86

Effects of Inotropy on Frank-Starling Curves 86

Effects of Inotropy on Pressure-Volume Loops 86

Summary of Effects of Increased Inotropy on Cardiac Muscle Mechanics and Ventricular Function 87

Factors Influencing Inotropic State 87

Cellular Mechanisms of Inotropy 88

Interdependence of Preload, Afterload, and Inotropy 88

Myocardial Oxygen Consumption 90

How Myocardial Oxygen Consumption Is Determined 90

Factors Influencing Myocardial Oxygen Consumption 91

Summary of Important Concepts 93

Review Questions 93

Answers to Review Questions 95

Answers to Problems and Cases 96

Suggested Resources 97

5 Vascular Function 98

Anatomy and Function 98

Vascular Network 98

Distribution of Pressures and Volumes 100

Arterial Blood Pressure 101

Mean Arterial Pressure 102

Aortic Pulse Pressure 103

Hemodynamics (Pressure, Flow, and Resistance) 105

Effects of Vessel Length, Radius, and Blood Viscosity on Resistance to Blood Flow 105

Laminar Versus Turbulent Flow 108

Series and Parallel Arrangement of the Vasculature 110

Regulation of Systemic Vascular Resistance 111

Calculation of Systemic Vascular Resistance 112

Vascular Tone 112

Venous Blood Pressure 113

Venous Blood Volume and Compliance 113

Mechanical Factors Affecting Central Venous Pressure and Venous Return 114

Summary of Factors Affecting Central Venous Pressure 117

Venous Return and Cardiac Output 118

The Balance between Venous Return and Cardiac Output 118

Systemic Vascular Function Curves 119

Cardiac Function Curves 122

Interactions Between Cardiac and Systemic Vascular Function Curves 122

Summary of Important Concepts 124

Review Questions 124

Answers to Review Questions 126

Answers to Problems and Cases 127

Suggested Resources 128

6 Neurohumoral Control of the Heart and Circulation 129

Autonomic Neural Control 130

Autonomic Innervation of the Heart and Vasculature 130

Baroreceptor Feedback Regulation of Arterial Pressure 135

Chemoreceptors 140

Other Autonomic Reflexes Affecting the Heart and Circulation 141

Humoral Control 142

Circulating Catecholamines 142

Renin-Angiotensin-Aldosterone System 144

Natriuretic Peptides 146

Vasopressin (Antidiuretic Hormone) 147

Integration of Neurohumoral Mechanisms 148

Summary of Important Concepts 149

Review Questions 150

Answers to Review Questions 152

Answers to Problems and Cases 153

Suggested Resources 154

7 Organ Blood Flow 155

Distribution of Cardiac Output 155

Local Regulation of Blood Flow 156

Tissue Factors 157

Endothelial Factors 159

Smooth Muscle (Myogenic) Mechanisms 161

Extravascular Compression 161

Autoregulation of Blood Flow 161

Reactive and Active Hyperemia 163

Special Circulations 165

Coronary Circulation 165

Cerebral Circulation 171

Skeletal Muscle Circulation 174

Cutaneous Circulation 178

Splanchnic Circulation 180

Renal Circulation 181

Pulmonary Circulation 184

Summary of Special Circulations 186

Summary of Important Concepts 187

Review Questions 187

Answers to Review Questions 189

Answers to Problems and Cases 190

Suggested Resources 191

8 Exchange Function of the Microcirculation 192

Mechanisms of Exchange 193

Diffusion 193

Bulk Flow 194

Vesicular and Active Transport 194

Exchange of Oxygen and Carbon Dioxide 194

Oxygen Diffusion 194

Oxygen Delivery and Extraction 196

Carbon Dioxide Diffusion 198

Transcapillary Fluid Exchange 198

Physical Mechanisms Governing Fluid Exchange 200

Capillary Exchange Model 204

Edema Formation 205

Summary of Important Concepts 206

Review Questions 207

Answers to Review Questions 208

Answers to Problems And Cases 209

Suggested Resources 210

9 Cardiovascular Integration, Adaptation, and Pathophysiology 211

Cardiovascular Responses to Exercise 211

Mechanisms Involved in Cardiovascular Response to Exercise 212

Steady-State Changes in Cardiovascular Function during Exercise 214

Factors Influencing Cardiovascular Response to Exercise 216

Peripheral Vascular Disease 218

Hemodynamics of Peripheral Artery Disease in the Leg 218

Maternal Changes in Cardiovascular Function During Pregnancy 220

Fetal Circulation and Changes at Birth 221

Hypotension and Shock 223

Causes of Hypotension 223

Circulatory Shock 225

Compensatory Mechanisms during Hypotension 226

Decompensatory Mechanisms Following Severe and Prolonged Hypotension 229

Physiologic Basis for Therapeutic Intervention 230

Hypertension 231

Essential (Primary) Hypertension 232

Secondary Hypertension 233

Physiologic Basis for Therapeutic Intervention 235

Heart Failure 236

Causes of Heart Failure 236

Systolic versus Diastolic Dysfunction 236

Systemic Compensatory Mechanisms in Heart Failure 239

Exercise Limitations Imposed by Heart Failure 241

Physiologic Basis for Therapeutic Intervention 242

Valve Disease 243

Valve Stenosis 244

Valve Regurgitation 246

Summary of Important Concepts 249

Review Questions 250

Answers to Review Questions 252

Answers to Cases 255

Suggested Resources 255

Index 257

Editorial Reviews

Reviewer: Robert A. Augustyniak, PhD (Lincoln Memorial University)
Description: This book presents detailed descriptions of each component of the cardiovascular system, highlighting its beautiful complexity in a simple and understandable way. While most of the book is devoted to describing fundamental concepts in cardiovascular physiology, the intra-chapter cases and the last chapter provide context and clinical application for the readers. The website (by the same author as the text) provides abbreviated content with a primary focus on the application of cardiovascular physiology concepts during cardiovascular disease. While the website contains primarily text and figures, there are numerous hyperlinks to aid users. The second edition was published in 2012.
Purpose: In the preface, the author clearly indicates that his overarching objective in writing this text is to demystify, as well as simplify, cardiovascular physiology so that it can be understood by medical students in their pre-clerkship years. This indeed is a worthy objective, as most current medical students have little interest in reading a big, thick textbook. This book is easy to read, so far as a textbook goes, and the fact that my students read it is a clear indicator to me that it is needed. The book is available in both text and online formats. Albeit, the online content is more focused on the fundamentals of cardiovascular disease rather than principles of normal cardiovascular like the text. Thus, the text and online content are not identical, but the value obtained from presenting the material in both print and online formats is primarily derived from the ability to tap into various readers' preferred approach to obtaining the content. The book definitely meets the objectives listed at the beginning of each chapter. As indicated above, the online content is focused on cardiovascular disease, so it does not directly address the objectives listed in the book. With that said, the online content provides a direct application of the underlying cardiovascular principles described in the objectives in the book.
Audience: The target audience is first- and second-year medical students. The book squarely hits that target in that it does an excellent job of simplifying complex cardiovascular concepts and, moreover, provides numerous clinical applications, which is key to garnering the attention of medical students. Author Dr. Klabunde has over four decades of experience in biomedical research in both academia and industry, with over 50 publications. Of note, he is also an award-winning, widely recognized expert in teaching cardiovascular physiology to medical students. His credibility is without question.
Features: To cover the physiology of the cardiovascular system, the book follows a logical sequence that builds upon foundational concepts. It begins by describing the relevant cells of the cardiovascular system and the principles of muscle contraction and relaxation. It then continues on to describe electrophysiology and how it couples to contraction. After providing overviews of cardiac and vascular function, it continues to describe neurohumoral regulation and control of blood flow and microcirculatory exchange. Finally, the foundational principles are applied to various cardiovascular diseases. The sections on electrophysiology, cardiac function, and neurohumoral control of the circulation are particularly clear and well written. The important features of the book are the problems and cases in each chapter that provide context for the readers. I have used this book to teach medical students for more than 10 years and I have yet to want more or to have found descriptions to be inadequate. The nice thing about this book is its simplicity. More thorough, deeper descriptions could be added, but this would detract from its simplicity and would transform it from an easy book into a thick textbook.
Assessment: I cannot speak highly enough of this book. The author does an excellent job simplifying concepts that are often difficult for medical students to understand. The numerous clinical examples provided aid toward this endeavor. The accompanying websites ("Cardiovascular Physiology Concepts" and "Cardiovascular Pharmacology Concepts") help students to integrate the content. I am not aware of a text that is better suited to teach cardiovascular physiology to medical students than this one. The third edition contains a great deal of new content since the second edition was printed in 2012, justifying its publication.

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