Cardiopulmonary Anatomy and Physiology

by Des Jardins, Terry R.

• ISBN13: 9780827382565
• ISBN10: 0827382561
• Format: Paperback
• Copyright: 1997-10-01
• Publisher: Delmar Pub

Table of Contents

Foreword	xvii
Preface	xix
Acknowledgments	xxi
The Anatomy of the Respiratory System	1	(56)
Objectives	1	(4)
The Upper Airway	5	(6)
The Nose	5	(4)
Oral Cavity	9	(1)
The Pharynx	10	(1)
The Lower Airways	11	(16)
The Larynx	11	(5)
The Tracheobronchial Tree	16	(10)
Bronchial Blood Supply	26	(1)
The Sites of Gas Exchange	27	(4)
Alveolar Epithelium	28	(1)
Pores of Kohn	29	(1)
Alveolar Macrophages	30	(1)
Interstitium	30	(1)
Pulmonary Vascular System	31	(3)
Arteries	31	(1)
Arterioles	31	(1)
Capillaries	32	(2)
Venules and Veins	34	(1)
The Lymphatic System	34	(3)
Neural Control of the Lungs	37	(1)
The Lungs	38	(3)
The Mediastinum	41	(1)
The Pleural Membranes	41	(1)
The Thorax	42	(1)
The Diaphragm	43	(9)
The Accessory Muscles of Ventilation	44	(1)
The Accessory Muscles of Inspiration	45	(4)
The Accessory Muscles of Expiration	49	(3)
Review Questions	52	(5)
Ventilation	57	(50)
Objectives	57	(21)
Pressure Differences Across the Lungs	58	(3)
Role of the Diaphragm in Ventilation	61	(1)
Static Characteristics of the Lungs	62	(1)
Elastic Properties of the Lung	63	(5)
Surface Tension and Its Effect on Lung Expansion	68	(10)
Dynamic Characteristics of the Lungs	78	(8)
Poiseuille's Law for Flow and Pressure Applied to the Bronchial Airways	78	(4)
Airway Resistance	82	(2)
Time Constants	84	(1)
Dynamic Compliance	84	(2)
Ventilatory Patterns	86	(5)
The Normal Ventilatory Pattern	86	(1)
Alveolar Ventilation versus Deadspace Ventilation	87	(4)
How Normal Intrapleural Pressure Differences Cause Regional Differences in Normal Lung Ventilation	91	(1)
The Effect of Airway Resistance and Lung Compliance on Ventilatory Patterns	92	(2)
Overview of Specific Ventilatory Patterns	94	(5)
Clinical Applications	99	(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