Cardiopulmonary Anatomy and Physiology

, by Des Jardins, Terry R.

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ISBN: 9780827382565 | 0827382561
Cover: Paperback
Copyright: 10/1/1997

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Supplemental Materials

Foreword

xvii

Preface

xix

Acknowledgments

xxi

The Anatomy of the Respiratory System

(56)

Objectives

(4)

The Upper Airway

(6)

The Nose

(4)

Oral Cavity

(1)

The Pharynx

(1)

The Lower Airways

(16)

The Larynx

(5)

The Tracheobronchial Tree

(10)

Bronchial Blood Supply

(1)

The Sites of Gas Exchange

(4)

Alveolar Epithelium

(1)

Pores of Kohn

(1)

Alveolar Macrophages

(1)

Interstitium

(1)

Pulmonary Vascular System

(3)

Arteries

(1)

Arterioles

(1)

Capillaries

(2)

Venules and Veins

(1)

The Lymphatic System

(3)

Neural Control of the Lungs

(1)

The Lungs

(3)

The Mediastinum

(1)

The Pleural Membranes

(1)

The Thorax

(1)

The Diaphragm

(9)

The Accessory Muscles of Ventilation

(1)

The Accessory Muscles of Inspiration

(4)

The Accessory Muscles of Expiration

(3)

Review Questions

(5)

Ventilation

(50)

Objectives

(21)

Pressure Differences Across the Lungs

(3)

Role of the Diaphragm in Ventilation

(1)

Static Characteristics of the Lungs

(1)

Elastic Properties of the Lung

(5)

Surface Tension and Its Effect on Lung Expansion

(10)

Dynamic Characteristics of the Lungs

(8)

Poiseuille's Law for Flow and Pressure Applied to the Bronchial Airways

(4)

Airway Resistance

(2)

Time Constants

(1)

Dynamic Compliance

(2)

Ventilatory Patterns

(5)

The Normal Ventilatory Pattern

(1)

Alveolar Ventilation versus Deadspace Ventilation

(4)

How Normal Intrapleural Pressure Differences Cause Regional Differences in Normal Lung Ventilation

(1)

The Effect of Airway Resistance and Lung Compliance on Ventilatory Patterns

(2)

Overview of Specific Ventilatory Patterns

(5)

Clinical Applications

(3)

Review Questions

102

(5)

The Diffusion of Pulmonary Gases

107

(22)

Objectives

107

(1)

Gas Laws

108

(2)

Ideal Gas Law

108

(1)

Boyle's Law

109

(1)

Charles's Law

109

(1)

Gay-Lussac's Law

109

(1)

Dalton's Law

109

(1)

The Partial Pressures of Atmospheric Gases

110

(2)

Partial Pressures of Oxygen and Carbon Dioxide

111

(1)

Water Vapor Pressure

111

(1)

The Ideal Alveolar Gas Equation

112

(1)

The Diffusion of Pulmonary Gases

113

(1)

Oxygen and Carbon Dioxide Diffusion Across the Alveolar-Capillary Membrane

114

(4)

Gas Diffusion

118

(2)

Fick's Law

118

(1)

Henry's Law

118

(1)

Graham's Law

119

(1)

Clinical Application of Fick's Law

120

(1)

Perfusion-limited Gas Flow

120

(1)

Diffusion-limited Gas Flow

120

(3)

How Oxygen Can Be Either Perfusion or Diffusion Limited

123

(2)

Clinical Applications

125

(2)

Review Questions

127

(2)

Pulmonary Function Measurements

129

(22)

Objectives

129

(1)

Lung Volumes and Capacities

130

(3)

Lung Volumes

130

(1)

Lung Capacities

131

(2)

Pulmonary Mechanics

133

(8)

Pulmonary Mechanic Measurements

133

(8)

How the Effects of Dynamic Compression Decrease Expiratory Flow Rates

141

(3)

The Effort-dependent Portion of a Forced Expiratory Maneuver

141

(1)

The Effort-independent Portion of a Forced Expiratory Maneuver

141

(1)

Dynamic Compression of the Bronchial Airways

141

(2)

Diffusion Capacity of Carbon Monoxide (DLco)

143

(1)

Clinical Applications

144

(3)

Review Questions

147

(4)

The Circulatory System

151

(38)

Objectives

151

(1)

Blood

152

(4)

Erythrocytes

153

(1)

Leukocytes

154

(1)

Thrombocytes

155

(1)

Plasma

155

(1)

The Heart

156

(5)

Blood Flow Through the Heart

157

(1)

Blood Supply of the Heart

158

(1)

The Conductive System of the Heart

158

(1)

The Electrocardiogram

159

(2)

The Pulmonary and Systemic Vascular Systems

161

(5)

Neural Control of the Vascular System

163

(1)

The Baroreceptor Reflex

164

(2)

Pressures in the Pulmonary and Systemic Vascular Systems

166

(1)

The Cardiac Cycle and Its Effect on Blood Pressure

167

(3)

The Blood Volume and Its Effect on Blood Pressure

168

(2)

The Distribution of Pulmonary Blood Flow

170

(13)

Gravity

170

(3)

Determinants of Cardiac Output

173

(2)

Vascular Resistance

175

(8)

Clinical Applications

183

(2)

Review Questions

185

(4)

Hemodynamic Measurements

189

(14)

Objectives

189

(1)

Hemodynamic Measurements Directly Obtained by Means of the Pulmonary Artery Catheter

189

(2)

Hemodynamic Values Computed from Direct Measurements

191

(6)

Stroke Volume

191

(2)

Stroke Volume Index

193

(1)

Cardiac Index

193

(1)

Right Ventricular Stroke Work Index

193

(1)

Left Ventricular Stroke Work Index

194

(1)

Vascular Resistance

194

(3)

Clinical Applications

197

(3)

Review Questions

200

(3)

Oxygen Transport

203

(38)

Objectives

203

(5)

Oxygen Transport

204

(1)

Oxygen Dissolved in the Blood Plasma

204

(1)

Oxygen Bound with Hemoglobin

205

(2)

Total Oxygen Content

207

(1)

Oxygen Dissociation Curve

208

(12)

Clinical Significance of the Flat Portion of the Curve

209

(1)

Clinical Significance of the Steep Portion of the Curve

210

(1)

The P50

210

(1)

Factors that Shift the Oxygen Dissociation Curve

210

(2)

Clinical Significance of Shifts in the Oxygen Dissociation Curve

212

(8)

Oxygen Transport Studies

220

(11)

Total Oxygen Delivery

220

(1)

Arterial-Venous Oxygen Content Difference

220

(1)

Oxygen Consumption

221

(1)

Oxygen Extraction Ratio

222

(2)

Mixed Venous Oxygen Saturation

224

(1)

Mechanisms of Pulmonary Shunting

225

(3)

Venous Admixture

228

(1)

Shunt Equation

229

(1)

The Clinical Significance of Pulmonary Shunting

230

(1)

Tissue Hypoxia

231

(2)

Hypoxic Hypoxia

231

(1)

Anemic Hypoxia

232

(1)

Circulatory Hypoxia

232

(1)

Histotoxic Hypoxia

232

(1)

Cyanosis

233

(1)

Polycythemia

234

(1)

Clinical Applications

234

(3)

Review Questions

237

(4)

Carbon Dioxide Transport and Acid-Base Balance

241

(24)

Objectives

241

(1)

Carbon Dioxide Transport

242

(2)

In Plasma

242

(1)

In Red Blood Cells

243

(1)

Carbon Dioxide Elimination at the Lungs

244

(2)

Carbon Dioxide Dissociation Curve

246

(3)

Acid-Base Balance

249

(2)

The pH Scale

249

(1)

The Buffer Systems

250

(1)

The Henderson-Hasselbalch Equation

250

(1)

The Role of the Pco2/HCO3-/pH Relationship in Acid-Base Balance

251

(9)

Respiratory Acid-Base Imbalances

251

(5)

Metabolic Acid-Base Imbalances

256

(3)

Base Excess/Deficit

259

(1)

Example of Clinical Use of Pco2/HCO3-/pH Nomogram

259

(1)

Clinical Applications

260

(2)

Review Questions

262

(3)

Ventilation-Perfusion Relationships

265

(14)

Objectives

265

(1)

Ventilation-Perfusion Ratio

265

(10)

How the Ventilation-Perfusion Ratio Affects the Alveolar Gases

266

(4)

How the Ventilation-Perfusion Ratio Affects the End-capillary Gases

270

(2)

Respiratory Quotient

272

(1)

Respiratory Exchange Ratio

273

(1)

How Respiratory Disorders Affect the V/Q Ratio

273

(2)

Clinical Applications

275

(2)

Review Questions

277

(2)

Control of Ventilation

279

(16)

Objectives

279

(1)

The Respiratory Components of the Medulla

280

(2)

Dorsal Respiratory Group

280

(1)

Ventral Respiratory Group

281

(1)

The Influence of the Pontine Respiratory Centers on the Respiratory Components of the Medulla

281

(1)

Failure of the Respiratory Components of the Medulla

282

(1)

Monitoring Systems that Influence the Respiratory Components of the Medulla

282

(6)

Central Chemoreceptors

282

(6)

Reflexes that Influence Ventilation

288

(2)

Hering-Breuer Inflation Reflex

288

(1)

Deflation Reflex

288

(1)

Irritant Reflex

289

(1)

Juxtapulmonary-capillary Receptors

289

(1)

Reflexes from the Aortic and Carotid Sinus Baroreceptors

289

(1)

Other Stimuli that Affect Ventilation

289

(1)

Clinical Applications

290

(2)

Review Questions

292

(3)

Cardiopulmonary Physiology of the Fetus and the Newborn

295

(1)

Objectives

295

(1)

Fetal Lung Development

296

(2)

Embryonic Period

296

(1)

Pseudoglandular Period

296

(2)

Canalicular Period

298

(1)

Terminal Sac Period

298

(1)

Placenta

298

(3)

Fetal Circulation

301

(2)

Fetal Lung Fluids

303

(1)

Number of Alveoli at Birth

303

(1)

Birth

303

(2)

First Breath

303

(2)

Circulatory Changes at Birth

305

(1)

Control of Ventilation in the Newborn

305

(1)

Peripheral Chemoreceptors

305

(1)

Central Chemoreceptors

306

(1)

Infant Reflexes

306

Normal Clinical Parameters in the Newborn

305

(3)

Clinical Applications

308

(2)

Review Questions

310

Renal Failure and its Effects on the Cardiopulmonary System

295

(40)

Objectives

313

(1)

The Kidneys

314

(5)

The Nephron

316

(2)

Blood Vessels of the Kidneys

318

(1)

Urine Formation

319

(1)

Glomerular Filtration

319

(1)

Tubular Reabsorption

320

(1)

Tubular Secretion

320

(1)

Urine Concentration and Volume

320

(2)

Countercurrent Mechanism

320

(1)

Selective Permeability

321

(1)

Regulation of Electrolyte Concentration

322

(3)

Sodium Ions

322

(1)

Potassium Ions

322

(1)

Calcium, Magnesium, and Phosphate Ions

323

(1)

Role of the Kidneys in Acid-Base Balance

323

(1)

Blood Volume

323

(2)

Renal Failure

325

(3)

Common Causes of Renal Disorders

325

(1)

Classification of Renal Disorders

326

(1)

Mechanical Ventilation as Cause of Renal Failure

327

(1)

Cardiopulmonary Problems Caused

328

(1)

Renal Failure

Hypertension and Edema

328

(1)

Metabolic Acidosis

328

(1)

Renal Acid-base Disturbances Caused by Electrolyte Abnormalities

328

(1)

Anemia

329

(1)

Bleeding

329

(1)

Cardiovascular Problems

329

(1)

Clinical Applications

329

(3)

Review Questions

332

(3)

Aging and Its Effects on the Cardiopulmonary System

335

(14)

Objectives

335

(2)

The Influence of Aging on the Respiratory System

337

(3)

Static Mechanical Properties

338

(1)

Lung Volumes and Capacities

339

(1)

Dynamic Maneuvers of Ventilation

340

(1)

Pulmonary Diffusing Capacity

340

(1)

Alveolar Deadspace Ventilation

340

(1)

Pulmonary Gas Exchange

340

(1)

Arterial Blood Gases

341

(1)

Arterial-Venous Oxygen Content Difference

341

(1)

Hemoglobin Concentration

341

(1)

Control of Ventilation

341

(1)

Exercise Tolerance

341

(1)

Pulmonary Diseases in the Aged

342

(1)

The Influence of Aging on the Cardiovascular System

342

(4)

Structure of the Heart

342

(1)

Work of the Heart

342

(1)

Heart Rate

342

(1)

Stroke Volume

343

(1)

Cardiac Output

343

(1)

Peripheral Vascular Resistance

344

(2)

Blood Pressure

346

(1)

Review Questions

346

(3)

Exercise and Its Effects on the Cardiopulmonary System

349

(18)

Objectives

349

(1)

Ventilation

350

(5)

Control of Ventilation

350

(1)

Alveolar Ventilation

351

(1)

Oxygen Consumption

352

(1)

Arterial Blood Gases During Exercise

353

(1)

Oxygen Diffusion Capacity

353

(1)

Alveolar-Arterial Po2 Difference

354

(1)

Circulation

355

(4)

Sympathetic Discharge

356

(1)

Increased Cardiac Output

356

(1)

Increased Arterial Blood Pressure

357

(1)

Pulmonary Vascular Pressures

357

(1)

Opening of Muscle Capillaries

358

(1)

Interrelationships between Muscle Work, Oxygen Consumption, and Cardiac Output

359

(1)

The Influence of Training on the Heart and on Cardiac Output

360

(1)

Stroke Volume versus Heart Rate in Increasing the Cardiac Output

360

(1)

Body Temperature/Cutaneous Blood Flow Relationship

361

(1)

Cardiovascular Rehabilitation

362

(1)

Phase I: Acute, In-hospital

362

(1)

Phase II: Outpatient, Immediately after Hospitalization

362

(1)

Phase III: Long-term Outpatient

362

(1)

Phase IV: Maintenance

363

(1)

Review Questions

363

(4)

High Altitude and Its Effects on the Cardiopulmonary System

367

(10)

Objectives

367

(1)

High Altitude

367

(6)

Ventilation

369

(1)

Polycythemia

369

(1)

Acid-Base Status

369

(1)

Oxygen Diffusion Capacity

370

(1)

Alveolar-Arterial Po2 Difference

370

(1)

Ventilation-Perfusion Relationship

370

(1)

Cardiac Output

371

(1)

Pulmonary Vascular System

372

(1)

Other Physiologic Changes

373

(2)

Sleep

371

(2)

Myoglobin Concentration

373

(1)

Acute Mountain Sickness

374

(1)

High-altitude Pulmonary Edema

374

(1)

High-altitude Cerebral Edema

374

(1)

Chronic Mountain Sickness

374

(1)

Review Questions

375

(2)

High-Pressure Environments and Their Effects on the Cardiopulmonary System

377

(8)

Objectives

377

(1)

Diving

377

(4)

Breath-hold Diving

379

(1)

The CO2-O2 Paradox

379

(1)

The Dive Response

380

(1)

Decompression Sickness

380

(1)

Hyperbaric Medicine

381

(2)

Indications for Hyperbaric Oxygenation

382

(1)

Review Questions

383

(2)

Glossary

385

(14)

Appendices

399

(20)

I Symbols and Abbreviations Commonly Used in Respiratory Physiology

399

(4)

II Units of Measurement

403

(6)

III Poiseuille's Law

409

(4)

IV Dubois Body Surface Chart

413

(2)

V Cardiopulmonary Profile

415

(2)

VI PCO2/HCO3-/pH Nomogram

417

(2)

Bibliography

419

(8)

Index

427

(11)

Answers to Review Questions

438

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Cardiopulmonary Anatomy and Physiology

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