3
Cellular Structure and Function.
............................................................
41
INTRODUCTION.
.............................................................................................................
41
CARDIAC CELL STRUCTURE AND FUNCTION.
....................................................
41
Myocytes and Sarcomeres.
.....................................................................................
41
Excitation-Contraction Coupling.
.........................................................................
43
Regulation of Contraction (Inotropy).
................................................................
45
Regulation of Relaxation (Lusitropy).
.................................................................
48
Cardiac Myocyte M etabolism .
...............................................................................
49
VASCULAR STRUCTURE AND FUNCTION.
...........................................................
49
Vascular Smooth Muscle Cells.
.............................................................................
50
Vascular Endothelial C ells.
.....................................................................................
54
SUMMARY OF IMPORTANT CONCEPTS.
................................................................
55
REVIEW QUESTIONS.
...................................................................................................
56
ANSWERS TO REVIEW QUESTIONS.
......................................................................
57
ANSWERS TO PROBLEMS AND CASES.
................................................................
58
SUGGESTED RESOURCES.
..........................................................................................
59
4
Cardiac Function.
........................................................................................
60
INTRODUCTION.
.............................................................................................................
60
CARDIAC ANATOMY.
....................................................................................................
60
Functional Anatom y of the H eart.
.......................................................................
60
Autonom ic Innervation.
...........................................................................................
61
THE CARDIAC CYCLE.
..................................................................................................
62
Cardiac Cycle D iagram .
...........................................................................................
62
Phase 1. Atrial Systole.
............................................................................................
62
Phase 2. Isovolumetric C ontraction.
...................................................................
64
Phase 3. Rapid Ejection.
.........................................................................................
65
Phase 4. Reduced E jection.
...................................................................................
65
Phase 5. Isovolumetric R elaxation.
.....................................................................
65
Phase 6. Rapid Filling.
.............................................................................................
66
Phase 7. Reduced F illing.
.......................................................................................
66
Summary of Intracardiac Pressures.
....................................................................
66
Ventricular Pressure-Volume Relationship .
......................................................
67
CARDIAC OUTPUT.
........................................................................................................
67
Measurement of Cardiac O utput .
........................................................................
69
Influence of Heart Rate and Stroke Volume on Cardiac O u tp u t.
...............
69
EFFECTS OF PRELOAD ON STROKE VOLUME.
...................................................
69
Effects of Ventricular Compliance on Preload.
................................................
69
Effects of Preload on Tension Development
(Length-Tension R elationship).
.........................................................................
71
Effects of Venous Return on Stroke Volume
(Frank-Starling Mechanism ).
..............................................................................
74
Factors Determining Ventricular Preload.
..........................................................
75
EFFECTS OF AFTERLOAD ON STROKE VOLUME .
.............................................
77
Effects of Afterload on the Velocity of Fiber Shortening
(Force-Velocity Relationship).
...........................................................................
77
Effects of Afterload on Frank-Starling Curves.
................................................
79
Effects of Afterload on Pressure-Volume Loops .
...........................................
79
viii
CONTENTS
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