Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care

Cover
IFC
Dedication
Title Page
Copyright
Statement
Contents
List of Tables
List of Clinical Connections
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Foreword
Preface
Overview
Organization
New to the Sixth Edition
Clinical Connections
Chapter 1: The Anatomy and Physiology of the Respiratory System
Chapter 2: Ventilation
Chapter 3: Pulmonary Function Measurements
Chapter 4: The Diffusion of Pulmonary Gases
Chapter 5: The Anatomy and Physiology of the Circulatory System
Chapter 6: Oxygen and Carbon Dioxide Transport
Chapter 7: Acid–Base Balance and Regulation
Chapter 8: Ventilation-Perfusion Relationships
Chapter 9: Control of Ventilation
Chapter 10: Fetal Development and the Cardiopulmonary System
Chapter 11: Aging and the Cardiopulmonary System
Chapter 12: Electrophysiology of the Heart
Chapter 13: The Standard 12-ECG Lead System
Chapter 14: ECG Interpretation
Chapter 15: Hemodynamic Measurements
Chapter 16: Renal Failure and Its Effects on the Cardiopulmonary System
Chapter 17: Sleep Physiology and Its Relationship to the Cardiopulmonary System
Chapter 18: Exercise and Its Effects on the CardiopulmonarySystem
Chapter 19: High Altitude and Its Effects on the Cardiopulmonary System
Chapter 20: High-Pressure Environments and Their Effects on the Cardiopulmonary System
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Acknowledgments
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Supplements At-a-Glance
Section One: The Cardiopulmonary System—The Essentials
Ch 1: The Anatomy and Physiology of the Respiratory System
Objectives
The Airways
The Upper Airway
The Nose
Oral Cavity
The Pharynx
Nasopharynx
Oropharynx
Laryngopharynx
The Larynx
Cartilages of the Larynx
Interior of the Larynx
Laryngeal Musculature
Ventilatory Function of the Larynx
The Lower Airways
The Tracheobronchial Tree
Histology of the Tracheobronchial Tree
The Cartilaginous Airways
The Noncartilaginous Airways
Bronchial Cross-Sectional Area
Bronchial Blood Supply
The Sites of Gas Exchange
Alveolar Epithelium
Pores of Kohn
Alveolar Macrophages
Interstitium
The Pulmonary Vascular System*
Arteries
Arterioles
Capillaries
Venules and Veins
The Lymphatic System
Neural Control of the Lungs
The Lungs
The Mediastinum
The Pleural Membranes
The Thorax
The Muscles of Ventilation
The Accessory Muscles of Ventilation
The Accessory Muscles of Inspiration
External Intercostal Muscles
Scalenus Muscles
Sternocleidomastoid Muscles
Pectoralis Major Muscles
Trapezius Muscles
The Accessory Muscles of Expiration
Rectus Abdominis Muscles
External Abdominis Obliquus Muscles
Internal Abdominis Obliquus Muscles
Transversus Abdominis Muscles
Internal Intercostal Muscles
Chapter Summary
Review Questions
Ch 2: Ventilation
Objectives
Introduction
Mechanisms of Pulmonary Ventilation
Pressure Gradients (Pressure Differences)
Boyle’s Law and Its Relationship to Pressure Gradients in Ventilation
Balloon Model of Ventilation
The Primary Mechanisms of Ventilation Applied to the Human Airways
Elastic Properties of the Lung and Chest Wall
Lung Compliance
Chest Wall Compliance
Hooke’s Law
Surface Tension and Its Effect on Lung Expansion
Surface Tension
Laplace’s Law
Laplace’s Law Applied to the Alveolar Fluid Lining
How Pulmonary Surfactant Regulates Alveolar Surface Tension
Summary of the Elastic Properties of the Lungs
Dynamic Characteristics of the Lungs
Poiseuille’s (Pwah-Sō–y) Law for Flow and Pressure Applied to the Bronchial Airways
Poiseuille’s Law Arranged for Flow
Poiseuille’s Law Arranged for Pressure
Poiseuille’s Law Rearranged to Simple Proportionalities
Airway Resistance
Laminar Flow
Turbulent Flow
Tracheobronchial or Transitional Flow
Time Constants
Dynamic Compliance
Ventilatory Patterns
The Normal Ventilatory Pattern
Alveolar Ventilation versus Dead Space Ventilation
Anatomic Dead Space
Alveolar Dead Space
Physiologic Dead Space
How Normal Pleural Pressure Differences Cause Regional Differences in Normal Lung Ventilation
The Effect of Airway Resistance and Lung Compliance on Ventilatory Patterns
Overview of Specific Breathing Conditions
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 3: Pulmonary Function Measurements
Objectives
Lung Volumes and Capacities
Lung Volumes
Lung Capacities
Lung Volumes and Capacities in Obstructive and Restrictive Lung Disorders
Indirect Measurements of the Residual Volume and Capacities Containing the Residual Volume
Pulmonary Mechanics
Pulmonary Mechanic Measurements
Forced Vital Capacity (FVC)
Forced Expiratory Volume Timed (FEVT)
Forced Expiratory Volume1 Sec/Forced Vital Capacity Ratio (FEV1/FVC Ratio)
Key Pulmonary Function Measurements Used to Differentiate between an Obstructive or Restrictive Pulmonary Disorder
Forced Expiratory Flow25%–75% (FEF25%–75%)
Forced Expiratory Flow200–1200 (FEF200–1200)
Peak Expiratory Flow Rate (PEFR)
Maximum Voluntary Ventilation (MVV)
Flow-Volume Loop
Factors Affecting Predicted Normal Values
How the Effects of Dynamic Compression Decrease Expiratory Flow Rates
The Effort-Dependent Portion of a Forced Expiratory Maneuver
The Effort-Independent Portion of a Forced Expiratory Maneuver
Dynamic Compression of the Bronchial Airways
Diffusion Capacity of Carbon Monoxide (DLCO)
Maximum Inspiratory and Expiratory Pressure
Rapid Shallow Breathing Index (RSBI) Ratio
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 4: The Diffusion of Pulmonary Gases
Objectives
Introduction
Dalton’s Law
Partial Pressures of Atmospheric Gases
Gas Diffusion—Pressure Gradients versus Diffusion Gradients
The Partial Pressures of Gases in the Air, Alveoli, and Blood
The Ideal Alveolar Gas Equation
The Diffusion of Pulmonary Gases
Oxygen and Carbon Dioxide Diffusion Across the Alveolar-Capillary Membrane
Gas Diffusion
Fick’s Law
Henry’s Law
Graham’s Law
Clinical Application of Fick’s Law
Perfusion-Limited Gas Flow
Diffusion-Limited Gas Flow
How Oxygen Can Be Either Perfusion or Diffusion Limited
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 5: The Anatomy and Physiology of the Circulatory System
Objectives
Introduction
The Blood
Red Blood Cells (Erythrocytes)
White Blood Cells (Leukocytes)
Granulocytes
Agranulocytes
Platelets
Plasma
The Heart
The Pericardium
The Wall of the Heart
Blood Supply of the Heart
Arterial Supply
Venous Drainage
Blood Flow through the Heart
The Pulmonary and Systemic Vascular Systems
Neural Control of the Vascular System
The Baroreceptor Reflex
Other Baroreceptors
Pressures in the Pulmonary and Systemic Vascular Systems
The Cardiac Cycle and Its Effect on Blood Pressure
The Blood Volume and Its Effect on Blood Pressure
The Distribution of Pulmonary Blood Flow
Gravity
Determinants of Cardiac Output
Ventricular Preload
Ventricular Afterload
Myocardial Contractility
Vascular Resistance
Active Mechanisms Affecting Vascular Resistance
Passive Mechanisms Affecting Vascular Resistance
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 6: Oxygen and Carbon Dioxide Transport
Objectives
Introduction
Oxygen Transport
Oxygen Dissolved in the Blood Plasma
Oxygen Bound to Hemoglobin
Hemoglobin
Quantity of Oxygen Bound to Hemoglobin
Total Oxygen Content
Case Study: Anemic Patient
Oxyhemoglobin Dissociation Curve
Clinical Significance of the Flat Portion of the Curve
Clinical Significance of the Steep Portion of the Curve
The P50
Factors That Shift the Oxyhemoglobin Dissociation Curve pH
Temperature
Carbon Dioxide
2,3-Biphosphoglycerate (formally called 2,3-Diphosphoglycerate)
Fetal Hemoglobin
Carbon Monoxide Hemoglobin
Clinical Significance of Shifts in the Oxyhemoglobin Dissociation Curve
Right Shifts—Loading of Oxygen in the Lungs
Right Shifts—Unloading of Oxygen at the Tissues
Left Shifts—Loading of Oxygen in the Lungs
Left Shifts—Unloading of Oxygen at the Tissues
Oxygen Transport Calculations
Total Oxygen Delivery
Arterial-Venous Oxygen Content Difference
Oxygen Consumption
Oxygen Extraction Ratio
Mixed Venous Oxygen Saturation
Pulmonary Shunting
Absolute Shunt
Relative Shunt
Venous Admixture
Shunt Equation
Case Study: Motorcycle Crash Victim
The Clinical Significance of Pulmonary Shunting
Hypoxia
Hypoxemia versus Hypoxia
Hypoxic Hypoxia
Low Alveolar Oxygen Tension (Decreased PAO2)
Diffusion Defects
Ventilation-Perfusion (V-diacritic/Q-diacritic Ratio) Mismatch
Pulmonary Shunting
Anemic Hypoxia
Circulatory Hypoxia
Histotoxic Hypoxia
Cyanosis
Carbon Dioxide Transport
The Six Ways Carbon Dioxide is Transported to the Lungs
In Plasma
In Red Blood Cells
Carbon Dioxide Elimination at the Lungs
Carbon Dioxide Dissociation Curve
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 7: Acid–Base Balance and Regulation
Objectives
Introduction
The Basic Principles of Acid–Base Reactions and pH
Acids and Bases
Acids
Bases
pH: Acid–Base Concentration
The Chemical Buffer Systems and Acid–Base Balance
Carbonic Acid–Bicarbonate Buffer System and Acid–Base Balance
The Henderson-Hasselbalch Equation
Clinical Application of the H-H Equation
Phosphate Buffer System and Acid–Base Balance
Protein Buffer System and Acid–Base Balance
The Respiratory System and Acid–Base Balance
The Renal System and Acid–Base Balance
The Role of the PCO2 /HCO3–/pH Relationship in Acid–Base Balance
Acid–Base Balance Disturbances
Respiratory Acid–Base Disturbances
Acute Ventilatory Failure (Respiratory Acidosis)
Renal Compensation
Acute Alveolar Hyperventilation (Respiratory Alkalosis)
Renal Compensation
General Comments
Metabolic Acid–Base Imbalances
Metabolic Acidosis
Metabolic Acidosis with Respiratory Compensation
Combined Metabolic and Respiratory Acidosis
Metabolic Alkalosis
Metabolic Alkalosis with Respiratory Compensation
Combined Metabolic and Respiratory Alkalosis
Base Excess/Deficit
Example of Clinical Use of PCO2/HCO3-/pH Nomogram
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 8: Ventilation-Perfusion Relationships
Objectives
Ventilation-Perfusion Ratio
How the Ventilation-Perfusion Ratio Affects the Alveolar Gases
Increased V-diacritic/Q-diacritic Ratio
Decreased V-diacritic/Q-diacritic Ratio
O2–CO2 Diagram
How the Ventilation-Perfusion Ratio Affects the End-Capillary Gases
Respiratory Quotient
Respiratory Exchange Ratio
How Respiratory Disorders Affect the V-diacritic/Q-diacritic Ratio
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 9: Control of Ventilation
Objectives
Introduction
Control of Respiration
The Medullary Respiratory Centers
Ventral Respiratory Groups
Dorsal Respiratory Groups
The Pontine Respiratory Centers—And Their Influence on the Medullary Respiratory Centers
Factors That Influence the Rate and Depth of Breathing
Central Chemoreceptors
Peripheral Chemoreceptors
Other Factors That Stimulate the Peripheral Chemoreceptors
Other Responses Activated by the Peripheral Chemoreceptors
Other Important Factors That Influence Breathing
Hering-Breuer Reflex
Deflation Reflex
Irritant Reflex
Juxtapulmonary-Capillary Receptors
Peripheral Proprioceptor Reflexes
Hypothalamic Controls
Cortical Controls
Aortic and Carotid Sinus Baroreceptor Reflexes
Miscellaneous Factors That May Influence Breathing
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 10: Fetal Development and the Cardiopulmonary System
Objectives
Fetal Lung Development
Embryonic Period
Pseudoglandular Period
Canalicular Period
Terminal Sac Period
Placenta
Fetal Circulation
Fetal Lung Fluids
Number of Alveoli at Birth
Birth
First Breath
Circulatory Changes at Birth
Control of Ventilation in the Newborn
Peripheral Chemoreceptors
Central Chemoreceptors
Infant Reflexes
Trigeminal Reflex
Irritant Reflex
Head’s Paradoxical Reflex
Clinical Parameters in the Normal Newborn
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 11: Aging and the Cardiopulmonary System
Objectives
Introduction
The Effects of Aging on the Respiratory System
Static Mechanical Properties
Lung Volumes and Capacities
Dynamic Maneuvers of Ventilation
Pulmonary Diffusing Capacity
Alveolar Dead Space Ventilation
Pulmonary Gas Exchange
Arterial Blood Gases
Arterial-Venous Oxygen Content Difference
Hemoglobin Concentration
Control of Ventilation
Defense Mechanisms
Exercise Tolerance
Pulmonary Diseases in the Elderly
The Effects of Aging on the Cardiovascular System
Structure of the Heart
Work of the Heart
Heart Rate
Stroke Volume
Cardiac Output
Peripheral Vascular Resistance
Blood Pressure
Aerobic Capacity
Chapter Summary
Review Questions
Section Two: Advanced Cardiopulmonary Concepts and Related Areas—The Essentials
Ch 12: Electrophysiology of the Heart
Objectives
Introduction
The Five Phases of the Action Potential
Depolarization
Repolarization
Properties of the Cardiac Muscle
Refractory Periods
The Conductive System
Autonomic Nervous System
Chapter Summary
Review Questions
Ch 13: The Standard 12-ECG Lead System
Objectives
Introduction
The Standard 12-ECG Lead System
Standard Limb Leads
Precordial (Chest) Leads
Modified Chest Lead
Normal ECG Configurations and Their Expected Measurements (Lead II)
The ECG Paper
The P Wave
The PR Interval
The QRS Complex
The ST Segment
The T Wave
The U Wave
The QT Interval
Chapter Summary
Review Questions
Ch 14: ECG Interpretation
Objectives
How to Analyze the Waveforms
Step 1: Does the General Appearance of the ECG Tracing Appear Normal or Abnormal?
Step 2: Does the Ventricular Activity (QRS Complexes) Appear Normal or Abnormal?
Rate
Rhythm
Shape
Step 3: Does the Atrial Activity Appear Normal or Abnormal?
Step 4: Does the Atrioventricular (AV) Relationship Appear to be Normal?
Step 5: What Is the ECG Interpretation?
Normal Sinus Rhythm
Common Cardiac Dysrhythmias
The Sinus Mechanisms
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhythmia
Sinus (SA) Block
Sinus Arrest
The Atrial Mechanisms
Premature Atrial Complex
Atrial Bigeminy
Atrial Tachycardia
Atrial Flutter
Atrial Fibrillation
The Ventricular Mechanisms
Premature Ventricular Contraction
Ventricular Tachycardia
Ventricular Flutter
Ventricular Fibrillation
Asystole (Cardiac Standstill)
AV Conduction Defects
Sinus Rhythm with First-Degree AV Block
Sinus Rhythm with Second-Degree AV Block: The Wenckebach Phenomenon
Complete AV Block
Chapter Summary
Review Questions
Ch 15: Hemodynamic Measurements
Objectives
Hemodynamic Measurements Directly Obtained by Means of the Pulmonary Artery Catheter
Hemodynamic Values Computed from Direct Measurements
Stroke Volume
Stroke Volume Index
Cardiac Index
Right Ventricular Stroke Work Index
Left Ventricular Stroke Work Index
Vascular Resistance
Pulmonary Vascular Resistance
Systemic or Peripheral Vascular Resistance
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 16: Renal Failure and Its Effects on the Cardiopulmonary System
Objectives
Introduction
The Kidneys
The Nephrons
Blood Vessels of the Kidneys
Urine Formation
Glomerular Filtration
Tubular Reabsorption
Tubular Secretion
Urine Concentration and Volume
Countercurrent Mechanism
Selective Permeability
Regulation of Electrolyte Concentration
Sodium Ions
Potassium Ions
Calcium, Magnesium, and Phosphate Ions
Role of the Kidneys in Acid–Base Balance
Blood Volume
Capillary Fluid Shift System
The Renal System
Renal Failure
Common Causes of Renal Disorders
Congenital Disorders
Infections
Obstructive Disorders
Inflammation and Immune Responses
Neoplasms
Classification of Renal Disorders
Prerenal Conditions
Renal Conditions
Postrenal Conditions
Mechanical Ventilation as a Cause of Renal Failure
Cardiopulmonary Disorders Caused by Renal Failure
Hypertension and Edema
Metabolic Acidosis
Renal Acid–Base Disturbances Caused by Electrolyte Abnormalities
Anemia
Bleeding
Cardiovascular Problems
Chapter Summary
Review Questions
Clinical Application Questions
Case 1
Case 2
Ch 17: Sleep Physiology and Its Relationship to the Cardiopulmonary System
Objectives
Introduction
Types of Sleep
Eyes Open—Wake
Eyes Closed—Wake
Non-REM Sleep (N Sleep)
Stage N1
Stage N2
Stage N3
REM Sleep
Normal Sleep Cycles
Functions of Sleep
Restoration
Energy Conservation
Circadian Rhythms
Normal Sleep Patterns
Newborns and Infants
Toddlers and Preschoolers
Children and Adolescents
Young and Older Adults
Factors Affecting Sleep
Common Sleep Disorders
Insomnia
Hypersomnia
Narcolepsy
Sleep Apnea
Periodic Limb Movement Disorder
Restless Legs Syndrome
Normal Cardiopulmonary Physiology During Sleep
Autonomic Nervous System
Musculoskeletal System
Thermal Regulation
Renal Function
Genital Function
Gastrointestinal Function
Endocrine Function
Cardiovascular Function
Sleep-Related Arrhythmias
Cerebral Blood Flow
Respiratory Physiology
Chapter Summary
Review Questions
Clinical Application Questions
Section Three: The Cardiopulmonary System During Unusual Environmental Conditions
Ch 18: Exercise and Its Effects on the Cardiopulmonary System
Objectives
Introduction
Ventilation
Control of Ventilation
Alveolar Ventilation
Oxygen Consumption
Arterial Blood Gas Levels During Exercise
Oxygen Diffusion Capacity
Alveolar-Arterial PO2 Difference
Circulation
Sympathetic Discharge
Cardiac Output
Increased Stroke Volume
Increased Heart Rate
Arterial Blood Pressure
Pulmonary Vascular Pressures
Muscle Capillaries
Interrelationships among Muscle Work, Oxygen Consumption, and Cardiac Output
The Influence of Training on the Heart and Cardiac Output
Stroke Volume versus Heart Rate in Increasing Cardiac Output
Body Temperature/Cutaneous Blood Flow Relationship
Pulmonary Rehabilitation
Phase I
Phase II
Phase III
Chapter Summary
Review Questions
Ch 19: High Altitude and Its Effects on the Cardiopulmonary System
Objectives
High Altitude
Ventilation
Pulmonary Function and Mechanics
Polycythemia
Acid–Base Status
Oxygen Diffusion Capacity
Alveolar-Arterial PO2 Difference
Ventilation-Perfusion Relationships
Cardiac Output
Pulmonary Vascular System
Other Physiologic Changes
Sleep Disorders
Myoglobin Concentration
Acute Mountain Sickness
High-Altitude Pulmonary Edema
High-Altitude Cerebral Edema
Chronic Mountain Sickness
Chapter Summary
Review Questions
Ch 20: High-Pressure Environments and Their Effects on the Cardiopulmonary System
Objectives
Introduction
Diving
Breath-Hold Diving
The CO2–O2 Paradox
The Mammalian Diving Reflex
Decompression Sickness
Barotrauma
Hyperbaric Medicine
Indications for Hyperbaric Oxygenation
Chapter Summary
Review Questions
Glossary
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Appendix I: Symbols and Abbreviations
Primary Symbols
Secondary Symbols
Abbreviations
Hemodynamic Measurement Abbreviations
Metric Measurement Abbreviations
Appendix II: Units of Measurement
Metric Length
Metric Volumes
Metric Weight
Weight Conversions (Metric and Avoirdupois)
Weight Conversions (Metric and Apothecary)
Approximate Household Measurement Equivalents (Volume)
Weight
Liquid Measure
Volume Conversions (Metric and Apothecary)
Length Conversions (Metric and English System)
Appendix III: Poiseuille’s Law
Poiseuille’s Law for Flow Rearranged to a Simple Proportionality
Poiseuille’s Law for Pressure Rearranged to a Simple Proportionality
Appendix IV: DuBois Body Surface Chart
Appendix V: Cardiopulmonary Profile
Appendix VI: PCO2/HCO3-/pH Nomogram
Appendix VII: Calculating Heart Rate by Counting the Number of Large ECG Squares
Appendix VIII: Answers to Review Questions in Text
The Anatomy and Physiology of the Respiratory System
Ventilation
Clinical Application Questions
Pulmonary Function Measurements
Clinical Application Questions
The Diffusion of Pulmonary Gases
Clinical Application Questions
The Anatomy and Physiology of the Circulatory System
Clinical Application Questions
Oxygen and Carbon Dioxide Transport
Clinical Application Questions
Acid–Base Balance and Regulation
Clinical Application Questions
Ventilation-Perfusion Relationships
Clinical Application Questions
Control of Ventilation
Clinical Application Questions
Fetal Development and the Cardiopulmonary System
Clinical Application Questions
Aging and the Cardiopulmonary System
Electrophysiology of the Heart
The Standard 12-ECG Lead System
ECG Interpretation
Hemodynamic Measurements
Clinical Application Questions
Renal Failure and Its Effects on the Cardiopulmonary System
Clinical Application Questions
Sleep Physiology and Its Relationship to the Cardiopulmonary System
Clinical Application Questions
Exercise and Its Effects on the Cardiopulmonary System
High Altitude and Its Effects on the Cardiopulmonary System
High-Pressure Environments and Their Effects on the Cardiopulmonary System
Bibliography
General Anatomy and Physiology
Cardiopulmonary Anatomy and Physiology
Hemodynamics
Pulmonary Function Testing
Arterial Blood Gases
Selected Oxygenation Topics
Selected Hypoxic-Drive Topics
Respiratory Pharmacology
Sleep Physiology
Pathophysiology
Pulmonary Disorders
Cardiopulmonary Anatomy and Physiology of the Fetus and the Newborn
Aging and the Cardiopulmonary System
Exercise and Its Effects on the Cardiopulmonary System
High Altitude and Its Effects on the Cardiopulmonary System
High-Pressure Environments and Their Effect on the Cardiopulmonary System
Fundamentals of Respiratory Care
Respiratory Care Equipment
Mechanical Ventilation
Medical Dictionaries
Websites of Interest
Index
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