TABLE OF CONTENTS UNIT I The dna code in the cell nucleus is Transferred to an rna code in the Introduction to Physiology: The Cell Cytoplasm-The Process Cell and General Physiology of Transcription Synthesis of RNA Assembly of the RNa Chain from Activated CHAPTER 1 nucleotides Using the DNA Strand as a Template-The Process of Functional Organization of the “ Transcription Human Body and Control of the Messenger RNA-The Codons “ Internal environment Transfer RNA-The Anticodons Ribosomal rna Cells as the Living Units of the body Formation of proteins on the ribosomes Extracellular fluid-The " internal The Process of Translation" 3 Synthesis of Other Substances in the "Homeostatic"Mechanisms of the Major Functional Systems Control of gene function and Homeostasis Biochemical Activity in Cells Extracellular Fluid Transport and Mixing Genetic Reg System-The Blood Circulatory System Control of Intracellular Function by Origin of Nutrients in the Extracellular Fluid Removal of metabolic end products Regulation of Body Functions 5 Cell Reproduction Reproduction 6 Cell Reproduction Begins witl Control Systems of the Body 6 of dna Examples of Control Mechanisms Chromosomes and Their Replicatic Characteristics of Control Systems Control of cell growth and cel CHAPTER 2 Apoptosis-Programmed Cell Death 40 The Cell and Its Functions Cancer Organization of the Cell hysical Structure of the cell membranous structures of the cell Cytoplasm and Its Organelles Nucleus Nuclear Membrane Membrane Physiology, Nerve, Nucleoli and formation of ribosomes 18 and Muscle Comparison of the Animal Cell with Precellular Forms of life Functional Systems of the Cell 19 CHAPTER 4 Ingestion by the cell-Endocytosis Digestion of Pinocytotic and Phagocytic Transport of Substances Through Foreign Substances Inside the cell- the Cell membrane Function of the Lysosomes The Lipid Barrier of the Cell Membrane, Synthesis and Formation of cellular and Cell Membrane Transport Structures by Endoplasmic Reticulum and Golgi Apparatus Diffusion Extraction of Energy from Nutrients- Diffusion Through the Cell Membrane Function of the mitochondria Diffusion Through Protein Channels, and Locomotion of cells Gating"of These Channels Ameboid Movement Facilitated Diffusion Cilia and Ciliary Movement Factors That Affect Net Rate of diffusion Osmosis Across selectively Permeable embranes-" Net Diffusion" of Water CHAPTER 3 Active Transport"of Substances Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction 27 Primary Active Transport Secondary Active Transport-Co-Transport Genes in the cell nucleus and Counter-Transport Genetic Code Active Transport Through Cellular Sheets
TABLE OF CONTENTS UNIT I Introduction to Physiology: The Cell and General Physiology CHAPTER 1 Functional Organization of the Human Body and Control of the “Internal Environment” 3 Cells as the Living Units of the Body 3 Extracellular Fluid—The “Internal Environment” 3 “Homeostatic” Mechanisms of the Major Functional Systems 4 Homeostasis 4 Extracellular Fluid Transport and Mixing System—The Blood Circulatory System 4 Origin of Nutrients in the Extracellular Fluid 5 Removal of Metabolic End Products 5 Regulation of Body Functions 5 Reproduction 6 Control Systems of the Body 6 Examples of Control Mechanisms 6 Characteristics of Control Systems 7 Summary—Automaticity of the Body 9 CHAPTER 2 The Cell and Its Functions 11 Organization of the Cell 11 Physical Structure of the Cell 12 Membranous Structures of the Cell 12 Cytoplasm and Its Organelles 14 Nucleus 17 Nuclear Membrane 17 Nucleoli and Formation of Ribosomes 18 Comparison of the Animal Cell with Precellular Forms of Life 18 Functional Systems of the Cell 19 Ingestion by the Cell—Endocytosis 19 Digestion of Pinocytotic and Phagocytic Foreign Substances Inside the Cell— Function of the Lysosomes 20 Synthesis and Formation of Cellular Structures by Endoplasmic Reticulum and Golgi Apparatus 20 Extraction of Energy from Nutrients— Function of the Mitochondria 22 Locomotion of Cells 24 Ameboid Movement 24 Cilia and Ciliary Movement 24 CHAPTER 3 Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction 27 Genes in the Cell Nucleus 27 Genetic Code 29 xiii The DNA Code in the Cell Nucleus Is Transferred to an RNA Code in the Cell Cytoplasm—The Process of Transcription 30 Synthesis of RNA 30 Assembly of the RNA Chain from Activated Nucleotides Using the DNA Strand as a Template—The Process of “Transcription” 31 Messenger RNA—The Codons 31 Transfer RNA—The Anticodons 32 Ribosomal RNA 33 Formation of Proteins on the Ribosomes— The Process of “Translation” 33 Synthesis of Other Substances in the Cell 35 Control of Gene Function and Biochemical Activity in Cells 35 Genetic Regulation 35 Control of Intracellular Function by Enzyme Regulation 36 The DNA-Genetic System Also Controls Cell Reproduction 37 Cell Reproduction Begins with Replication of DNA 37 Chromosomes and Their Replication 38 Cell Mitosis 38 Control of Cell Growth and Cell Reproduction 39 Cell Differentiation 40 Apoptosis—Programmed Cell Death 40 Cancer 40 UNIT II Membrane Physiology, Nerve, and Muscle CHAPTER 4 Transport of Substances Through the Cell Membrane 45 The Lipid Barrier of the Cell Membrane, and Cell Membrane Transport Proteins 45 Diffusion 46 Diffusion Through the Cell Membrane 46 Diffusion Through Protein Channels, and “Gating” of These Channels 47 Facilitated Diffusion 49 Factors That Affect Net Rate of Diffusion 50 Osmosis Across Selectively Permeable Membranes—“Net Diffusion” of Water 51 “Active Transport” of Substances Through Membranes 52 Primary Active Transport 53 Secondary Active Transport—Co-Transport and Counter-Transport 54 Active Transport Through Cellular Sheets 55
lV CHAPTER 5 CHAPTER 7 Membrane potentials and action Excitation of skeletal muscle: Potentials 57 Neuromuscular Transmission and Basic Physics of Membrane Excitation-Contraction Coupling Membrane Potentials Caused by Diffusion Endings to Skeletal Muscle Fibers The Neuromuscular Junction Measuring the Membrane Potential Secretion of Acetylcholine by the Nerve Resting Membrane Potential of Nerves Terminals Origin of the Normal Resting Membrane Molecular Biology of Acetylin Formation and release Nerve Action potential Drugs That Enhance or Block Voltage-Gated Sodium and Potassium Transmission at the neuromuscular Junction the Events that cause the Myasthenia Gravis Action Potential Muscle Action potential Roles of other lons During the Action Spread of the Action Potential to the Initiation of the Action Potential Interior of the Muscle Fiber by Way “ Transverse tubu|es” Propagation of the Action Potential Re-establishing Sodium and Potassium Excitation-Contraction Coupling Transverse Tubule-Sarcoplasmic Reticulum lonic Gradients After Action potentials Are Completed-Importance of Energy Release of Calcium lons by the Metabolism Plateau in some action potentials Rhythmicity of Some Excitable Tissues Repetitive Dis ChAPtEr 8 pecial Characteristics of signal Contraction and Excitation of Transmission in Nerve Trunks 68 Smooth Muscle Excitation-The Process of Eliciting the Action potential Contraction of smooth muscle "Refractory Period"After an Action Types of Smooth Muscle Contractile mechanism in Smooth muscle Recording Membrane Potentials and Regulation of Contraction by Calcium lons Action Potentials Nervous and hormonal control of Inhibition of Excitability-Stabilizers Smooth Muscle Contraction and local anesthetics Neuromuscular junctions of smooth Muscle Membrane potentials and action potentials in Smooth muscle Effect of local tissue Factors and Hormones to cause smooth Muscle CHAPTER 6 Contraction Without Action Potentials Contraction of Skeletal Muscle Source of calcium lons that cause gic Anatomy of skeletal Contraction(/)Through the Cell Muscle Membrane and(2)from the Sarcoplasmic Skeletal Muscle Fiber Reticulum General Mechanism of muscle Contraction Molecular Mechanism of muscl U NITIII Contraction Molecular characteristics of the The heart Contractile Filaments Effect of Amount of Actin and Myosin CHAPTEr 9 lament Overlap on Tension Developed by the Contracting Muscle Heart Muscle; The Heart as a Pump Relation of velocity of Contraction to and Function of the heart Valves Load 78 Physiology of Cardiac Muscle Energetics of Muscle Contraction Physiologic Anatomy of Cardiac Muse 103 Work Output During Muscle Contraction 78 Action Potentials in Cardiac Muscle e Sources of Energy for Muscle Contraction The Cardiac Cycle Characteristics of whole muscle Diastole and syst Relationship of the Electrocardiogram to Mechanics of Skeletal Muscle Contraction the Cardiac Cycle Remodeling of Muscle to Match Function Function of the Atria as Primer Pumps Rigor Mortis Function of the Ventricles as Pumps
xiv Table of Contents CHAPTER 5 Membrane Potentials and Action Potentials 57 Basic Physics of Membrane Potentials 57 Membrane Potentials Caused by Diffusion 57 Measuring the Membrane Potential 58 Resting Membrane Potential of Nerves 59 Origin of the Normal Resting Membrane Potential 60 Nerve Action Potential 61 Voltage-Gated Sodium and Potassium Channels 62 Summary of the Events That Cause the Action Potential 64 Roles of Other Ions During the Action Potential 64 Initiation of the Action Potential 65 Propagation of the Action Potential 65 Re-establishing Sodium and Potassium Ionic Gradients After Action Potentials Are Completed—Importance of Energy Metabolism 66 Plateau in Some Action Potentials 66 Rhythmicity of Some Excitable Tissues— Repetitive Discharge 67 Special Characteristics of Signal Transmission in Nerve Trunks 68 Excitation—The Process of Eliciting the Action Potential 69 “Refractory Period” After an Action Potential 70 Recording Membrane Potentials and Action Potentials 70 Inhibition of Excitability—“Stabilizers” and Local Anesthetics 70 CHAPTER 6 Contraction of Skeletal Muscle 72 Physiologic Anatomy of Skeletal Muscle 72 Skeletal Muscle Fiber 72 General Mechanism of Muscle Contraction 74 Molecular Mechanism of Muscle Contraction 74 Molecular Characteristics of the Contractile Filaments 75 Effect of Amount of Actin and Myosin Filament Overlap on Tension Developed by the Contracting Muscle 77 Relation of Velocity of Contraction to Load 78 Energetics of Muscle Contraction 78 Work Output During Muscle Contraction 78 Sources of Energy for Muscle Contraction 79 Characteristics of Whole Muscle Contraction 80 Mechanics of Skeletal Muscle Contraction 81 Remodeling of Muscle to Match Function 82 Rigor Mortis 83 CHAPTER 7 Excitation of Skeletal Muscle: Neuromuscular Transmission and Excitation-Contraction Coupling 85 Transmission of Impulses from Nerve Endings to Skeletal Muscle Fibers: The Neuromuscular Junction 85 Secretion of Acetylcholine by the Nerve Terminals 85 Molecular Biology of Acetyline Formation and Release 88 Drugs That Enhance or Block Transmission at the Neuromuscular Junction 88 Myasthenia Gravis 89 Muscle Action Potential 89 Spread of the Action Potential to the Interior of the Muscle Fiber by Way of “Transverse Tubules” 89 Excitation-Contraction Coupling 89 Transverse Tubule–Sarcoplasmic Reticulum System 89 Release of Calcium Ions by the Sarcoplasmic Reticulum 90 CHAPTER 8 Contraction and Excitation of Smooth Muscle 92 Contraction of Smooth Muscle 92 Types of Smooth Muscle 92 Contractile Mechanism in Smooth Muscle 93 Regulation of Contraction by Calcium Ions 95 Nervous and Hormonal Control of Smooth Muscle Contraction 95 Neuromuscular Junctions of Smooth Muscle 95 Membrane Potentials and Action Potentials in Smooth Muscle 96 Effect of Local Tissue Factors and Hormones to Cause Smooth Muscle Contraction Without Action Potentials 98 Source of Calcium Ions That Cause Contraction (1) Through the Cell Membrane and (2) from the Sarcoplasmic Reticulum 99 UNIT III The Heart CHAPTER 9 Heart Muscle; The Heart as a Pump and Function of the Heart Valves 103 Physiology of Cardiac Muscle 103 Physiologic Anatomy of Cardiac Muscle 103 Action Potentials in Cardiac Muscle 104 The Cardiac Cycle 106 Diastole and Systole 106 Relationship of the Electrocardiogram to the Cardiac Cycle 107 Function of the Atria as Primer Pumps 107 Function of the Ventricles as Pumps 108
Function of the valves Flow of Electrical Currents in the chest Aortic Pressure Curve 109 Around the hea 126 Relationship of the Heart Sounds to Electrocardiographic Leads 127 Heart Pumping Three bipolar Limb leads 127 Work Output of the Heart Chest Leads(Precordial Leads) 129 Graphical Analysis of Ventricular Pum Augmented Unipolar Limb leads l29 Chemical Energy Required for Cardi Contraction: Oxygen Utilization by the heart Regulation of Heart Pumping CHAPTER 1 2 trinsic Regulation of Heart Pumping- Electrocardiographic Interpretation The Frank-starling Mechanism of Cardiac Muscle and Coronary Effect of potassium and calcium lons on Heart Function Blood flow abnormalities: vectorial Effect of Temperature on Heart Function Analysis 131 ncreasing the Arterial Pressure L Principles of Vectorial Analysis of up to a Limit) Does Not Decrease the Electrocardiograms 13l 14 Use of Vectors to Represent Electrical Potentials Direction of a vector is denoted in terms CHAPTER 1 0 of Degrees Rhythmical Excitation of the Heart Ⅰl6 Axis for Each Standard Bipolar Lead and Specialized Excitatory and Conductive Each Unipolar limb Lead Ⅰl6 Vectorial Analysis of Potentials Recorded Sinus(Sinoatrial) Node l16 in Different Leads l33 nternodal Pathways and Transmission of Vectorial Analysis of the Normal the Cardiac Impulse Through the Atria Electrocardiogram Atrioventricular Node, and Delay of Impulse Vectors That occur at successive Intervals Conduction from the atria to the ventricles n 8 During depolarization of the ventricles- Rapid Transmission in the Ventricular The QRS Complex 134 Purkinje System Electrocardiogram During Repolarization- Transmission of the Cardiac Impulse in the The T Wave 134 Ventricular Muscle Depolarization of the Atria-the p ave Summary of the Spread of the Cardiac Vectorcardiogram mpule Through the Hea l20 Mean Electrical Axis of the ventricular Control of excitation and conduction QRS--And Its significance in the heart 120 Determin he Electrical Axis from The Sinus Node as the pacemaker of the Standard Lead Electrocardiograms Heart l20 Abnormal Ventricular Conditions That Cause Role of the Purkinje System in Causing Axis Deviation Synchronous Contraction of the Conditions That Cause Abnormal Ventricular Muscle Voltages of the QRS Complex l40 Control of Heart Rhythmicity and Impulse Increased voltage in the standard bipolar Conduction by the Cardiac Nerves: the Limb leads Sympathetic and Parasympathetic Nerves 121 Decreased Voltage of the Electrocardiogram 140 Prolonged and Bizarre Patterns of the 141 CHAPTER 11 Prolonged QRS Complex as a Result of The Normal Electrocardiogram Cardiac Hy pertrophy or Dilatation 23 Prolonged QRS Complex Resulting from Characteristics of the normal Purkinje System Blocks Electrocardiogram Conditions That Cause Bizarre QRS Depolarization Waves versus Complexes Repolarization Waves 123 Current of Injury Relationship of Atrial and ventriculat Effect of Current of Injury on the QRS Contraction to the waves of the Electrocardiogram 125 The j Point-The Zero Reference Potential Voltage and Time Calibration of the for Analyzing Current of Injur Electrocardiogram 125 Coronary Ischemia as a Cause of Injury Meth。 ds for Recording otential 126 Abnormalities in the T wave Pen Recorder 126 Effect of Slow Conduction of the Flow of current Around the heart During the Cardiac Cycle 126 Characteristics of the t wave Recording Electrical Potentials from a Shortened Depolarization in Portions of Partially Depolarized Mass of Syncytial the ventricular muscle as a cause o Cardiac Muscle 126 T Wave abnormalities
Table of Contents xv Function of the Valves 109 Aortic Pressure Curve 109 Relationship of the Heart Sounds to Heart Pumping 109 Work Output of the Heart 110 Graphical Analysis of Ventricular Pumping 110 Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart 111 Regulation of Heart Pumping 111 Intrinsic Regulation of Heart Pumping— The Frank-Starling Mechanism 111 Effect of Potassium and Calcium Ions on Heart Function 113 Effect of Temperature on Heart Function 114 Increasing the Arterial Pressure Load (up to a Limit) Does Not Decrease the Cardiac Output 114 CHAPTER 10 Rhythmical Excitation of the Heart 116 Specialized Excitatory and Conductive System of the Heart 116 Sinus (Sinoatrial) Node 116 Internodal Pathways and Transmission of the Cardiac Impulse Through the Atria 118 Atrioventricular Node, and Delay of Impulse Conduction from the Atria to the Ventricles 118 Rapid Transmission in the Ventricular Purkinje System 119 Transmission of the Cardiac Impulse in the Ventricular Muscle 119 Summary of the Spread of the Cardiac Impulse Through the Heart 120 Control of Excitation and Conduction in the Heart 120 The Sinus Node as the Pacemaker of the Heart 120 Role of the Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle 121 Control of Heart Rhythmicity and Impulse Conduction by the Cardiac Nerves: The Sympathetic and Parasympathetic Nerves 121 CHAPTER 11 The Normal Electrocardiogram 123 Characteristics of the Normal Electrocardiogram 123 Depolarization Waves Versus Repolarization Waves 123 Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram 125 Voltage and Time Calibration of the Electrocardiogram 125 Methods for Recording Electrocardiograms 126 Pen Recorder 126 Flow of Current Around the Heart During the Cardiac Cycle 126 Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle 126 Flow of Electrical Currents in the Chest Around the Heart 126 Electrocardiographic Leads 127 Three Bipolar Limb Leads 127 Chest Leads (Precordial Leads) 129 Augmented Unipolar Limb Leads 129 CHAPTER 12 Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis 131 Principles of Vectorial Analysis of Electrocardiograms 131 Use of Vectors to Represent Electrical Potentials 131 Direction of a Vector Is Denoted in Terms of Degrees 131 Axis for Each Standard Bipolar Lead and Each Unipolar Limb Lead 132 Vectorial Analysis of Potentials Recorded in Different Leads 133 Vectorial Analysis of the Normal Electrocardiogram 134 Vectors That Occur at Successive Intervals During Depolarization of the Ventricles— The QRS Complex 134 Electrocardiogram During Repolarization— The T Wave 134 Depolarization of the Atria—The P Wave 136 Vectorcardiogram 136 Mean Electrical Axis of the Ventricular QRS—And Its Significance 137 Determining the Electrical Axis from Standard Lead Electrocardiograms 137 Abnormal Ventricular Conditions That Cause Axis Deviation 138 Conditions That Cause Abnormal Voltages of the QRS Complex 140 Increased Voltage in the Standard Bipolar Limb Leads 140 Decreased Voltage of the Electrocardiogram 140 Prolonged and Bizarre Patterns of the QRS Complex 141 Prolonged QRS Complex as a Result of Cardiac Hypertrophy or Dilatation 141 Prolonged QRS Complex Resulting from Purkinje System Blocks 141 Conditions That Cause Bizarre QRS Complexes 141 Current of Injury 141 Effect of Current of Injury on the QRS Complex 141 The J Point—The Zero Reference Potential for Analyzing Current of Injury 142 Coronary Ischemia as a Cause of Injury Potential 143 Abnormalities in the T Wave 145 Effect of Slow Conduction of the Depolarization Wave on the Characteristics of the T Wave 145 Shortened Depolarization in Portions of the Ventricular Muscle as a Cause of T Wave Abnormalities 145
CHAPTER 1 3 Volume-Pressure Curves of the arteria Cardiac Arrhythmias and Their and venous circulations 172 Arterial Pressure pulsations Electrocardiographic Interpretation 147 Transmission of Pressure Pulses to the Abnormal Sinus Rhythms Peripheral Arteries 174 Tachycardia l47 Clinical Methods for Measuring Systolic Bradycardia l47 and Diastolic Pressures 175 Abnormal Rhythms Block of heart s signals Veins and Their Functions Venous Pressures-Right Atrial Pressure Within the (Central Venous Pressure)and Intracardiac Conduction Pathways Peripheral Venous Pressures Sinoatrial block Blood reservoir Function of the veins Atrioventricular block Incomplete Atrioventricular Heart Block Incomplete Intraventricular Block CHAPTER 1 6 Electrical Alternans 150 The Microcirculation and the Premature Contractions Premature Atrial Contractions Lymphatic System: Capillary Flui A-V Nodal or A- Bundle Premature Exchange, Interstitial Fluid, and Contractions 50 Lymph Flow l81 Premature Ventricular Contractions Paroxysmal Tachycardia Structure of the microcirculation and Atrial Paroxysmal Tachycardia 152 Capillary System 181 Flow of Blood in the Capillaries- Ventricular Paroxysmal Tachycardia Vasomotion。n l82 Ventricular Fibrillation Average Function of the Capillary System l83 Phenomenon of Re-entry-Circus Movements as the basis for ventricular Exchange of Water, Nutrients, and Other Substances Between the blood Fibrillation and Interstitial Fluid 183 Chain Reaction Mechanism of fibrillation Electrocardiogram in Ventricular Fibrillation 154 The Interstitium and Interstitial Fluid 183 l84 Hand Pumping of the Heart Fluid Filtration Across Capillaries Is Cardiopulmonary Resuscitation )as Determined by Hydrostatic and an Aid to Defibrillation l55 Colloid Osmotic Pressures, and 155 Capillary Filtration Coefficient l85 Atrial Fibrillation Capillary Hydrostatic Pressure 186 Atrial Flutter Cardiac Arrest nterstitial Fluid Hydrostatic Pressure l87 Plasma Colloid Osmotic Pressure 188 nterstitial Fluid Colloid Osmotic Pressur Exchange of Fluid Volume Through the Capillary Membrane Starling Equilibrium for Capillary Exchange 189 The Circulation emphatic System 190 Lymph Channels of the Body 190 Formation of Lymph CHAPTER 1 4 Rate of Lymph Flow 192 Overview of the circulation: medical Role of the Lymphatic System in Controlling Physics of Pressure, Flow, and Interstitial Fluid Protein Concentration Interstitial Fluid Volume, and Interstitial Resistance 16l Fluid Pressure 193 hysical Characteristics of the Circulation Basic Theory of Circulatory Function CHAPTER 1 7 Interrelationships Among Pressure, Local and Humoral Control of Blood Flow, and Resistance l64 Flow by the Tissu Blood flow Blood Pressure Local Control of Blood Flow in Response Resistance to blood flow to Tissue Need 195 Effects of Pressure on vascular Resistance Mechanisms of blood Flow control 196 and Tissue blood flow 170 Acute Control of local blood Flow Long-Term blood Flow Requlation opment CHAPTER 1 5 Phenomenon of Long- Term Local Blood Vascular Distensibility and Functions Flow Regulation Humoral control of the circulation of the arterial and Venous Systems 17 Vasoconstrictor Agents Vascular Distensibility Vasodilator Agents 202 Vascular Compliance(or Vascular Vascular Control by lons and other 7 Chemical Factors
xvi Table of Contents CHAPTER 13 Cardiac Arrhythmias and Their Electrocardiographic Interpretation 147 Abnormal Sinus Rhythms 147 Tachycardia 147 Bradycardia 147 Sinus Arrhythmia 148 Abnormal Rhythms That Result from Block of Heart Signals Within the Intracardiac Conduction Pathways 148 Sinoatrial Block 148 Atrioventricular Block 148 Incomplete Atrioventricular Heart Block 149 Incomplete Intraventricular Block— Electrical Alternans 150 Premature Contractions 150 Premature Atrial Contractions 150 A-V Nodal or A-V Bundle Premature Contractions 150 Premature Ventricular Contractions 151 Paroxysmal Tachycardia 151 Atrial Paroxysmal Tachycardia 152 Ventricular Paroxysmal Tachycardia 152 Ventricular Fibrillation 152 Phenomenon of Re-entry—“Circus Movements” as the Basis for Ventricular Fibrillation 153 Chain Reaction Mechanism of Fibrillation 153 Electrocardiogram in Ventricular Fibrillation 154 Electroshock Defibrillation of the Ventricle 154 Hand Pumping of the Heart (Cardiopulmonary Resuscitation) as an Aid to Defibrillation 155 Atrial Fibrillation 155 Atrial Flutter 156 Cardiac Arrest 156 UNIT IV The Circulation CHAPTER 14 Overview of the Circulation; Medical Physics of Pressure, Flow, and Resistance 161 Physical Characteristics of the Circulation 161 Basic Theory of Circulatory Function 163 Interrelationships Among Pressure, Flow, and Resistance 164 Blood Flow 164 Blood Pressure 166 Resistance to Blood Flow 167 Effects of Pressure on Vascular Resistance and Tissue Blood Flow 170 CHAPTER 15 Vascular Distensibility and Functions of the Arterial and Venous Systems 171 Vascular Distensibility 171 Vascular Compliance (or Vascular Capacitance) 171 Volume-Pressure Curves of the Arterial and Venous Circulations 172 Arterial Pressure Pulsations 173 Transmission of Pressure Pulses to the Peripheral Arteries 174 Clinical Methods for Measuring Systolic and Diastolic Pressures 175 Veins and Their Functions 176 Venous Pressures—Right Atrial Pressure (Central Venous Pressure) and Peripheral Venous Pressures 176 Blood Reservoir Function of the Veins 179 CHAPTER 16 The Microcirculation and the Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph Flow 181 Structure of the Microcirculation and Capillary System 181 Flow of Blood in the Capillaries— Vasomotion 182 Average Function of the Capillary System 183 Exchange of Water, Nutrients, and Other Substances Between the Blood and Interstitial Fluid 183 Diffusion Through the Capillary Membrane 183 The Interstitium and Interstitial Fluid 184 Fluid Filtration Across Capillaries Is Determined by Hydrostatic and Colloid Osmotic Pressures, and Capillary Filtration Coefficient 185 Capillary Hydrostatic Pressure 186 Interstitial Fluid Hydrostatic Pressure 187 Plasma Colloid Osmotic Pressure 188 Interstitial Fluid Colloid Osmotic Pressure 188 Exchange of Fluid Volume Through the Capillary Membrane 189 Starling Equilibrium for Capillary Exchange 189 Lymphatic System 190 Lymph Channels of the Body 190 Formation of Lymph 191 Rate of Lymph Flow 192 Role of the Lymphatic System in Controlling Interstitial Fluid Protein Concentration, Interstitial Fluid Volume, and Interstitial Fluid Pressure 193 CHAPTER 17 Local and Humoral Control of Blood Flow by the Tissues 195 Local Control of Blood Flow in Response to Tissue Needs 195 Mechanisms of Blood Flow Control 196 Acute Control of Local Blood Flow 196 Long-Term Blood Flow Regulation 200 Development of Collateral Circulation—A Phenomenon of Long-Term Local Blood Flow Regulation 201 Humoral Control of the Circulation 201 Vasoconstrictor Agents 201 Vasodilator Agents 202 Vascular Control by Ions and Other Chemical Factors 202
O CHAPTER1 8 Cardiac Output Regulation Is the Sum of Nervous Regulation of the Circulation, lood Flow Regulation in All the Local and Rapid Control of Arterial Pressure 204 Tissues of the Body-Tissue Metaboli Regulates Most Local Blood Flow 233 Nervous Regulation of the Circulation The Heart Has Limits for the Cardiac Output Autonomic Nervous System 204 hat It Can Achieve 234 Role of the Nervous System in Rapid What is the Role of the Nervous System in Control of arterial Pressure Controlling Cardiac Output? 235 ncrease in Arterial Pressure During Muscle Pathologically High and Pathologically Exercise and Other Types of Stres Low Cardiac Outputs Reflex Mechanisms for Maintaining Normal High Cardiac Output Caused by Reduced Arterial Pressure Total Peripheral Resistanc Central Nervous System Ischemic ow Cardiac Output 237 Response-Control of Arterial Pressure A More Quantitative Analysis of Cardia by the Brain's Vasomotor Center in Output Regulation 237 Response to Diminished Brain Blood Cardiac Output Curves Used in the 212 Quantitative Analysis Special Features of Nervous Control nous Return Curves of Arterial Pressure 213 Analysis of cardiac Output and Right Atrial Role of the skeletal Nerves and skeletal Pressure, Using Simultaneous Cardiac Muscles in Increasing Cardiac Output Output and Venous Return Curves 24l and Arterial Pressure 213 Methods for Measuring Cardiac Respiratory Waves in the Arterial Pressure 214 Output Arterial Pressure"Vasomotor waves. Pulsatile output of the heart as measured Oscillation of pressure reflex control by an Electromagnetic or Ultrasonic Systems 214 Flowmeter Measurement of Cardiac Output Using the xygen Fick Principle 244 CHAPTER 1 9 Indicator Dilution Method for Measuring Dominant Role of the Kidney in Long Cardiac Output 244 Term Regulation of Arterial Pressure and in Hypertension: The Integrated CHAPTER 21 System for Pressure Control 216 Muscle blood flow and cardiac Renal-Body Fluid System for Arterial Output During Exercise; the Pressure Control 216 Coronary Circulation and Ischemic Quantitation of Pressure Diuresis as a basis Heart Disease for Arterial Pressure Control 217 Chronic Hypertension(High Blood Pressure) Blood flow in skeletal muscle Is Caused by Impaired Renal Fluid nd Blood Flow Regulation Excretion 220 During Exercise 246 The Renin-Angiotensin System: ts Role in pressure control and in Control of Blood Flow Through the Skeletal Hypertension Muscles 247 Components of the Renin-Angiotensin Total Body Circulatory Readjustments 223 uring Exercis 247 Types of Hypertension in Which Angiotensin oronary Circulation 249 Is Involved: Hy pertension Caused by a Physiologic Anatomy of the Coronary Blood Renin-Secreting Tumor or by Infusion 249 of Angie 226 Normal Coronary Blood Flow Other Types of Hypertension Caused by Control of Coronary Blood Flow Combinations of volume Loading and Special Features of cardiac Muscle Vasoconstriction 227 "Primary(Essential) Hypertension 228 Summary of the Integrated, Causes of Death After Acute Coronary Multifaceted System for Arterial cclusion 253 Pressure Regulation Stages of Recovery from Acute Myocardial Infarction nction of the Heart After Recovery CHAPTER 20 from Myocardial Infarction Cardiac Output, Venous Return, 255 Surgical Treatment of Coronary Disease 256 and Their regulation 232 ormal Values for Cardiac output at Rest and during Activity 232 CHAPTER 2 Control of Cardiac Output by Venous Cardiac Failure 258 Return-Role of the Frank-Starling Dynamics of the Circulation in Mechanism of the heart 232 Cardiac Failure
Table of Contents xvii CHAPTER 18 Nervous Regulation of the Circulation, and Rapid Control of Arterial Pressure 204 Nervous Regulation of the Circulation 204 Autonomic Nervous System 204 Role of the Nervous System in Rapid Control of Arterial Pressure 208 Increase in Arterial Pressure During Muscle Exercise and Other Types of Stress 208 Reflex Mechanisms for Maintaining Normal Arterial Pressure 209 Central Nervous System Ischemic Response—Control of Arterial Pressure by the Brain’s Vasomotor Center in Response to Diminished Brain Blood Flow 212 Special Features of Nervous Control of Arterial Pressure 213 Role of the Skeletal Nerves and Skeletal Muscles in Increasing Cardiac Output and Arterial Pressure 213 Respiratory Waves in the Arterial Pressure 214 Arterial Pressure “Vasomotor” Waves— Oscillation of Pressure Reflex Control Systems 214 CHAPTER 19 Dominant Role of the Kidney in LongTerm Regulation of Arterial Pressure and in Hypertension: The Integrated System for Pressure Control 216 Renal–Body Fluid System for Arterial Pressure Control 216 Quantitation of Pressure Diuresis as a Basis for Arterial Pressure Control 217 Chronic Hypertension (High Blood Pressure) Is Caused by Impaired Renal Fluid Excretion 220 The Renin-Angiotensin System: Its Role in Pressure Control and in Hypertension 223 Components of the Renin-Angiotensin System 223 Types of Hypertension in Which Angiotensin Is Involved: Hypertension Caused by a Renin-Secreting Tumor or by Infusion of Angiotensin II 226 Other Types of Hypertension Caused by Combinations of Volume Loading and Vasoconstriction 227 “Primary (Essential) Hypertension” 228 Summary of the Integrated, Multifaceted System for Arterial Pressure Regulation 230 CHAPTER 20 Cardiac Output, Venous Return, and Their Regulation 232 Normal Values for Cardiac Output at Rest and During Activity 232 Control of Cardiac Output by Venous Return—Role of the Frank-Starling Mechanism of the Heart 232 Cardiac Output Regulation Is the Sum of Blood Flow Regulation in All the Local Tissues of the Body—Tissue Metabolism Regulates Most Local Blood Flow 233 The Heart Has Limits for the Cardiac Output That It Can Achieve 234 What Is the Role of the Nervous System in Controlling Cardiac Output? 235 Pathologically High and Pathologically Low Cardiac Outputs 236 High Cardiac Output Caused by Reduced Total Peripheral Resistance 236 Low Cardiac Output 237 A More Quantitative Analysis of Cardiac Output Regulation 237 Cardiac Output Curves Used in the Quantitative Analysis 237 Venous Return Curves 238 Analysis of Cardiac Output and Right Atrial Pressure, Using Simultaneous Cardiac Output and Venous Return Curves 241 Methods for Measuring Cardiac Output 243 Pulsatile Output of the Heart as Measured by an Electromagnetic or Ultrasonic Flowmeter 243 Measurement of Cardiac Output Using the Oxygen Fick Principle 244 Indicator Dilution Method for Measuring Cardiac Output 244 CHAPTER 21 Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart Disease 246 Blood Flow in Skeletal Muscle and Blood Flow Regulation During Exercise 246 Rate of Blood Flow Through the Muscles 246 Control of Blood Flow Through the Skeletal Muscles 247 Total Body Circulatory Readjustments During Exercise 247 Coronary Circulation 249 Physiologic Anatomy of the Coronary Blood Supply 249 Normal Coronary Blood Flow 249 Control of Coronary Blood Flow 250 Special Features of Cardiac Muscle Metabolism 251 Ischemic Heart Disease 252 Causes of Death After Acute Coronary Occlusion 253 Stages of Recovery from Acute Myocardial Infarction 254 Function of the Heart After Recovery from Myocardial Infarction 255 Pain in Coronary Heart Disease 255 Surgical Treatment of Coronary Disease 256 CHAPTER 22 Cardiac Failure 258 Dynamics of the Circulation in Cardiac Failure 258