This book focuses on established cardiovascular principles and highlights some of the progress achieved by recent research in the cardiovascular field. The authors report the basic concepts related to the functioning of the cardiovascular system necessary for medical students to understand. To foster learning, in each chapter the fundamental points are highlighted in italics and/or bold. In addition, we have added boxes that contain some more detailed information about physiological mechanisms or clinical aspects are analyzed and described in greater detail. The book describes the structure and function of the heart and vascular system for the reader to understand how the cardiovascular system responds in both health and disease. The book conveys a unified vision of the function of the heart and the vascular system, explaining the complexity of the system that goes far beyond the integrated connection between preload, afterload and cardiac contractility. The endothelium covers the internal part of the whole cardiovascular system; therefore, endothelial physiology is treated in several chapters. Given the importance of coronary circulation in cardiac pathophysiology, this special circulation is described in detail and enriched with the most up-to-date information. Several paragraphs and boxes on clinical implications are dedicated to the principles of electrophysiology and the electrocardiogram. A space is also dedicated to myocardial ischemia/reperfusion injury and cardioprotective procedures. The book is written in a linear and simple language without compromising the scientific rigor of the various topics covered.
Author(s): Pasquale Pagliar, Claudia Penna, Raffaella Rastaldo
Series: River Publishers in Research and Business Chronicles: Biotechnology and Medicine
Publisher: River Publishers
Year: 2020
Language: English
Pages: 438
City: Gistrup
Front Cover
Basic Cardiovascular Physiology: From Molecules to Translational Medical Science
Contents
Preface
Acknowledgments
List of Boxes
List of Abbreviations
1 Cardiovascular System
1.1 Overview of the Cardiovascular System
1.2 Conditions Necessary for Blood Movements in the Cardiovascular System
1.3 The Sections of the Cardiovascular System
1.4 The Blood Contenied in the Various Sections of the Cardiovascular System
2 Structure and Function of the Myocardial Fiber
2.1 Myocardial Fiber
2.2 Myofibrillar or Contractile Proteins
2.3 Regulatory Proteins
2.4 Structural Proteins
3 Cardiac Electrophysiology
3.1 Cardiac Electrophysiology: Overview
3.2 Genesis of Resting Membrane Potential
3.3 The Action Potential
3.4 After Depolarizations
4 Functional Tissue of the Heart
4.1 The Properties of Functional Tissues of the Heart
4.1.1 Automatism or Chronotropism
4.1.2 Excitability or Bathmotropism
4.1.3 Conductivity or Dromotropism: Origin and Diffusion of the Cardiac Impulse
4.1.4 Contractility or Inotropism
4.1.4.1 The cross-bridge muscle contraction cycle
4.1.4.2 Isometric and isotonic contraction
4.1.4.3 Isotonic contraction with a suspended load
4.1.4.4 Mixed contraction: isometric and isotonic contraction with a sustained load
4.1.4.5 Mixed contraction with different preload and afterloads
4.1.4.6 Contractility and the strength of contraction in the heart
4.2 Cardiac Contractility and Heavy Meromyosin Isoforms
4.3 Excitation-Contraction Coupling
5 The Cardiac Cycle
5.1 The Heart as a Pressure Gradient Generator
5.2 The Phases of the Cardiac Cycle
5.2.1 The Isovolumic Systole
5.2.2 The Ventricular Ejection Phase
5.2.2.1 The ejection with acceleration
5.2.2.2 The ejection with deceleration
5.2.3 The Protodiastole
5.2.4 The Isovolumic Relaxation Phase
5.2.5 The Rapid Ventricular Filling Phase
5.2.6 The Slow Ventricular Filling Phase
5.2.7 The Atrial Systole Phase
5.3 The Atrial Pressure Curve
5.4 The Cycle of the Right Heart
5.5 Changes in the Heart Rate and Duration of the Phases of the Cardiac Cycle
5.6 The Hemodynamic Role of Atrial Systole
5.7 The Aortic Flow Curve
5.7.1 The Sounds and the Heart Murmurs
5.7.2 Auscultation Points (Figure 5.7)
5.7.3 Murmurs (Figure 5.8)
5.8 Cardiac Volumes and Ejection Fraction
5.9 The Ventricular Pressure-Volume Loop
6 Cardiac Output and the Venous Return to the Heart
6.1 The Cardiac Output
6.2 Factors Determining the Venous Return to the Heart
6.3 The Central Venous Pressure
6.4 The Cardiac Output and the Venous Return
6.5 The Cardiac Output in the Compensated and Decompensated Heart Failure
6.5.1 The Valsalva Maneuver
7 Regulation of Cardiac Contraction Force
7.1 Intrinsic and Extrinsic Regulation of the Heart Contractile Force
7.1.1 Intrinsic Heterometric Regulation of Contractile Force
7.1.1.1 Mechanisms of the Frank-Starling law
7.1.2 Intrinsic Homeometric Regulation of Contractile Force: Anrep Phenomenon and Bowditch or Scale Phenomenon
7.1.2.1 The phenomenon of Anrep
7.1.2.2 The Bowditch effect or staircase phenomenon
7.1.3 Extrinsic Nervous and Humoral Regulation
7.1.3.1 The Nervous Regulation
7.1.4 The Humoral Regulation
7.2 Combined Effect of Heterometric and Homeometric Regulation
7.3 The Regulation of Cardiac Contraction Force and Heart Failure
7.4 Heart Efficiency: Effort Required by the Heart for Ventricular End-Diastolic Volume
8 Arterial Pressure
8.1 The Device and the Law of Poiseuille
8.2 The Mechanical Factors of Arterial Pressure
8.2.1 Increased Stroke Volume
8.2.2 Increase in Heart Rate
8.2.3 Increasing Total Peripheral Resistance
8.3 Measurement of Resistance
8.4 Parallel Arrangement of District Resistance
8.5 The Regulation of Vascular Resistance
8.6 The Arterial Windkessel and the Arterial Pressure
8.7 The Impedance to Ventricular Ejection
8.8 The Velocity of Propagation and the Length of Pressure Wave
8.9 The Oscillations of I, II and III Order of Arterial Pressure
8.10 The Mechanisms of Control of Arterial Pressure
8.10.1 Short-term Control Mechanisms
8.10.1.1 Ischemic response of the central nervous system (CNS)
8.10.1.2 Baroreceptor system
8.10.1.3 Chemoreceptor system
8.10.2 Medium-term Control Mechanisms
8.10.2.1 Exchanges of liquid through the capillary wall
8.10.2.2 Renin-angiotensin-aldosterone system
8.10.2.3 Stress-relaxation phenomenon
8.10.3 The Long-term Control Mechanisms
8.10.3.1 Kidney-body fluids system
8.11 Hemodynamic and Arterial Pressure Modifications in the Physical Exercise
8.12 The Measurement of Arterial Pressure in Humans
8.13 The Arterial Pulse
8.14 The Venous Pulse
9 Work and Heart Metabolism
9.1 The Work of the Heart
9.2 Heart Performance
9.3 The Metabolism of the Myocardium
10 Electrocardiogram
10.1 The Definition of Electrocardiogram and Dipole Theory
10.2 Morphology and the Meaning of Electrocardiographic Waves
10.2.1 Electrocardiographic Intervals and Segments
10.3 Electrocardiographic Leads on the Front Plane and the Electrical Axis of the Heart
10.3.1 Leads on the Frontal Plane
10.3.1.1 Bipolar limb leads
10.3.1.2 Unipolar limb leads
10.3.2 Leads on the Horizontal Plane
10.4 Electrocardiographic Aspects of Conduction Disorders and of the Main Arrhythmias
10.4.1 Conduction Disorders
10.4.1.1 Sino-atrial block
10.4.1.2 Atrio-ventricular blocks
10.4.1.3 The bundle-branch block
10.4.2 Extrasystoles and Tachyarrhythmias
10.4.2.1 Extrasystoles
10.4.2.2 Tachyarrhythmias
11 Vascular Hemodynamics
11.1 Introduction
11.2 The Total Energy of Fluids
11.2.1 The Lateral, Head and Tail Pressures (Figure 11.1)
11.3 The Blood Viscosity
11.4 The Laminar Flow and the Turbulent Flow
11.5 The Visco-Elastic and Contractile Features of Vessels
11.6 The Miogenic Regulation of the Radius of Resistance Vessels
11.7 The Flow of the Blood According to the Waterfall Model
11.8 The Wave of Flow Along the Arterial Tree
11.9 The Microcirculation
12 Nervous Control of the Cardiovascular System
12.1 The Innervation of the Cardiovascular System
12.2 Action of the Sympathetic and Vagal Nerves on the Heart
12.2.1 Action of the Sympathetic Nerves on the Heart
12.2.2 Action of the Vagus on the Heart
12.3 Action of the Sympathetic Fibers on the Vessels
12.4 The Sympathetic and Parasympathetic Receptors of the Cardiovascular Apparatus
12.4.1 Adrenergic Receptors
12.4.1.1 Alpha-receptors
12.4.1.2 Beta-receptors
12.4.2 Acetylcholine Receptors
12.5 The Nervous Control Centers of the Cardiovascular Apparatus
12.6 The Nervous Reflex Control of the Cardiovascular Apparatus
12.6.1 The Baroreceptors
12.6.2 The Ventricular Receptors
12.6.3 Atrial Receptors are of Different Types
12.6.4 Chemoreceptors
12.6.5 The Axonic Reflexes
12.7 The Control of the Blood Volume and the Bainbridge Reflex
13 Humoral Control of the Cardiovascular System
13.1 Catecholamines
13.2 Endothial Factors
13.2.1 Nitric Oxide
13.2.2 Endothelial Derived Hyperpolarizing Factors
13.2.3 Endothelial Contraction Factors
13.2.4 Endothelial Dysfunction
13.3 Other Humoral Factors That Act on the Cardiovascular Apparatus
13.3.1 Serotonin
13.3.2 Prostaglandins
13.3.3 Plasma Kinins
13.3.4 Histamine
13.3.5 Antidiuretic Hormone
13.3.6 Natriuretic Factors
13.3.7 Orexins or Hypocretins
13.4 Renin-Angiotensin-Aldosterone System
13.5 Apeline and the APJ Receptor
14 District Circulations
14.1 Coronary Circulation
14.1.1 The Coronary Arteries and the Microcirculation
14.1.2 The Venous Coronary Circulation
14.1.3 Anastomosis of the Coronary Circulation
14.1.4 The Resistance of the Coronary Circulation
14.1.4.1 The phasic coronary flow and the compressive resistance
14.1.4.2 Coronary autoregulative resistance
14.1.4.3 Coronary viscous resistance
14.1.5 Metabolic Mechanism
14.1.6 Nervous Mechanisms
14.1.7 Humoral Mechanisms
14.1.8 Endothelial Mechanisms
14.1.9 Myogenic Mechanism
14.1.10 Coronary Flow at Rest and Under Stress
14.1.11 Reactive Hyperemia
14.1.12 The Coronary Reserve
14.2 Cerebral Circulation
14.2.1 Autoregulation and Metabolic Regulation
14.2.2 Nervous Regulation
14.3 Splanchnic Circulation
14.3.1 The Splenic Circulation and the Spleen
14.3.2 The Mesenteric Circulation and the Intestinal Villi
14.3.3 The Hepatic Circulation
14.4 Circulation in the Skeletal Muscle
14.5 Renal Circulation
14.6 Cutaneous Circulation
15 Pulmonary Circulation
15.1 The Characteristics of Pulmonary Circulation
15.2 Variations of Volume of the Lung and the Resistance to the Blood Flow
15.3 The Chemical and Nervous Regulation of the Pulmonary Circulation
15.4 The Formation of the Pulmonary Edema
16 Coordinated Cardiovascular Adaptations
16.1 Physical Exercise
16.2 Alerting Response
16.3 Responses to Hemorrhage
17 Myocardial Protection Against Ischemia-Reperfusion Injury
17.1 Ischemia and Reperfusion Injury
17.2 Pre-Conditioning and Post-Conditioning
17.3 Pharmacological Pre-Conditioning and Post-Conditioning
18 Lymphatic Circulation
18.1 Formation of the Linfa
18.2 Lymphatic Vessels
18.3 Lymphatic Flow
19 Functional Imaging of the Cardiovascular System: How to Study Human Physiology In Vivo
19.1 Functional Imaging vs Anatomical Imaging
19.2 Functional Methods of Analysis
19.2.1 Cardiac Catheterization
19.2.1.1 Measurement of cardiac output
19.2.1.2 Fractional flow reserve (FFR)
19.2.1.3 Electrophysiological mapping
19.2.1.4 Positron emission tomography (PET)
19.2.2 Single-Photon Emission Tomography (SPECT)
19.2.3 Echocardiography
19.2.4 Computerized Axial Tomography (CAT or CT)
19.2.5 Cardiovascular Magnetic Resonance
19.3 Physiological Parameters in Clinical Practice
19.3.1 Contractile Function
19.3.2 Myocardial Perfusion
19.3.3 Myocardial Vitality
19.3.4 Assessment of Blood Flow in Large Vessels and Cardiac Output
19.3.5 Myocardial Oxygenation
19.3.6 Electric Activation
About the Authors
Back Cover
