1 A DESIGN SPECIFICATION FOR THE CARDIOVASCULAR SYSTEM 1
Oxygen consumption 2
Carriage of oxygen in blood 4
Cyanosis 6
The battle against the hydrogen ion:acid-base balance 6
Cell injury and cell death 7
Overall functional structure of the cardiovascular system 9
Circulation time 11
Structure and function of blood vessels 11
Angiogenesis 14
From cradle to grave-the presentation of heart disease 14
2 CARDIAC MUSCLE STRUCTURE AND FUNCTION 17
Cardiac muscle 18
Structure of cardiac muscle 18
Contractile mechanism in cardiac muscle 19
Cardiac electrical activity 20
Drugs which act on the heart 24
3 THE HEART AS A PUMP:VALVE FUNCTION AND VALVE DISEASE 27
Functional anatomy of the heart 28
The cardiac cycle 29
Valve pathology 30
History taking for cardiac disease 33
Clinical examination of the cardiovascular system 34
Investigations of heart disease:imaging the heart 35
Sudden cardiac death 37
4 REGULATION OF CARDIAC FUNCTION 39
Introduction 40
Venous return 40
Control of cardiac output 41
Regulation of heart rate 41
Regulation of stroke volume 42
Preload effects on the heart 42
Contractility effects on the heart 45
Afterload effects on the heart 47
Summary 48
5 BLOOD SUPPLY TO THE HEART 49
Anatomy of the arterial supply and venous drainage of the heart 50
Regulation of coronary blood flow 51
Ischaemic heart disease 53
Thrombosis 53
Angina 55
Myocardial infarction 57
Coronary angioplasty and stenting 59
Coronary artery bypass grafting 59
6 HEART FAILURE 61
Systolic vs diastolic failure 62
Haemodynamic events 63
Metabolic events in heart failure 64
Neurohormonal aspects of heart failure 66
Drug therapy for heart failure 68
7 THE ELECTROCARDIOGRAM(ECG) 71
Introduction 72
Producing a 12-lead ECG 73
The components of the ECG trace 75
Practical use of the ECG 76
The ECG and rhythm disturbances 78
Cardiac structure and the ECG 82
Ischaemia and the ECG 83
Potassium and the ECG 84
Drugs and the ECG 84
8 LARGE BLOOD VESSELS 85
Introduction 86
Haemorheology:the physical characteristics of blood flow 86
Pathology of arteries and veins 90
Atherosclerosis 90
Vasculitis 93
Varicose veins 93
Vascular pathology of diabetes mellitus 93
Aneurysms 94
Non-invasive techniques for the assessment of arteries and veins 94
9 RESISTANCE BLOOD VESSELS 97
Introduction 98
Resistance to blood flow 98
Vascular smooth muscle 99
Local control of vascular smooth muscle 101
Hormonal control of blood vessel diameter 105
Autonomic nervous system and peripheral circulation control 108
Special circulations 108
10 ARTERIAL BLOOD PRESSURE 113
Introduction 114
Arterial baroreceptors 115
Cardiopulmonary reflexes 117
Chemoreceptor reflexes 117
Measurement of arterial blood pressure 117
Pathological consequences of raised arterial pressure 121
Treatment of hvpertension 122
Hydrostatic pressure in the circulation 123
11 CAPILLARY FUNCTION AND THE LYMPHATIC SYSTEM 125
Structure of capillaries 126
Movement of substances across capillary walls 127
Water movement across capillary walls 127
The lymphatic system 130
Oedema 132
12 FETAL CARDIOVASCULAR SYSTEM AND CONGENITAL HEART DISEASE 135
Intoduction 136
How does the transition from fetal to adult circulation occur? 137
The normal ECG in childhood 139
Congenital heart disease 140
Early and late management of congenital heart disease 147
13 EXERCISE AND THE CARDIOVASCULAR SYSTEM 151
Physiological responses to exercise 152
Dynamic(isotonic)exercise 152
Oxygen debt and the recovery from exercise 155
Cardiovascular responses to static exercise 156
Training effects of exercise 157
Cardiovascular health benefits of exercise 157
Clinical uses of exercise testing 158
14 HAEMORRHAGE AND CIRCULATORY SHOCK 161
Introduction 162
Arterial blood pressure changes in response to haemorrhage 162
Short-term responses which help to restore lost blood volume 164
Longer term responses which help to restore lost blood volume and electrolytes 165
Decompensated or irreversible shock following haemorrhage 166
Causes of shock 167
Fluid replacement therapy 167
Glossary 171
Index 175