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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