9780840022585

Table of Contents


	List of Tables	xiii
	List of Clinical Connections	xv
	Foreword	xxi
	Preface	xxiii
	Acknowledgments	xxxiii
	How to Use the Text and Software	xxxv
	Supplements At-a-Glance	xxxvii
SECTION ONE	THE CARDIOPULMONARY SYSTEM—THE ESSENTIALS	1
Chapter 1	The Anatomy and Physiology of the Respiratory System	3
	The Airways	7
	The Upper Airway	7
	The Lower Airways	27
	The Sites of Gas Exchange	42
	The Pulmonary Vascular System	45
	The Lymphatic System	49
	Neural Control of the Lungs	51
	The Lungs	54
	The Mediastinum	58
	The Pleural Membranes	58
	The Thorax	61
	The Muscles of Ventilation	63
	Chapter Summary	71
	Review Questions	73
Chapter 2	Ventilation	77
	Introduction	79
	Mechanisms of Pulmonary Ventilation	79
	Elastic Properties of the Lung and Chest Wall	91
	Dynamic Characteristics of the Lungs	111
	Ventilatory Patterns	122
	How Normal Pleural Pressure Differences Cause Regional Differences in Normal Lung Ventilation	129
	The Effect of Airway Resistance and Lung Compliance on Ventilatory Patterns	129
	Overview of Specific Breathing Conditions	132
	Chapter Summary	137
	Review Questions	140
	Clinical Application Questions	143
Chapter 3	Pulmonary Function Measurements	145
	Lung Volumes and Capacities	146
	Pulmonary Mechanics	151
	Factors Affecting Predicted Normal Values	164
	How the Effects of Dynamic Compression Decrease Expiratory Flow Rates	165
	Chapter Summary	172
	Review Questions	177
	Clinical Application Questions	179
Chapter 4	The Diffusion of Pulmonary Gases	181
	Introduction	181
	Dalton’s Law	182
	Partial Pressures of Atmospheric Gases	183
	Gas Diffusion—Pressure Gradients versus Diffusion Gradients	184
	The Partial Pressures of Gases in the Air, Alveoli, and Blood	186
	The Ideal Alveolar Gas Equation	187
	The Diffusion of Pulmonary Gases	188
	Oxygen and Carbon Dioxide Diffusion Across the Alveolar-Capillary Membrane	189
	Gas Diffusion	192
	Perfuston-Limited Gas Flow	196
	Diffusion-Limited Gas Flow	197
	How Oxygen Can Be Either Perfusion or Diffusion Limited	199
	Chapter Summary	201
	Review Questions	204
	Clinical Application Questions	206
Chapter 5	The Anatomy and Physiology of the Circulatory System	207
	The Blood	208
	The Heart	215
	The Pulmonary and Systemic Vascular Systems	225
	Pressures in the Pulmonary and Systemic Vascular Systems	230
	The Cardiac Cycle and Its Effect on Blood Pressure	231
	The Distribution of Pulmonary Blood Flow	234
	Chapter Summary	247
	Review Questions	250
	Clinical Application Questions	252
Chapter 6	Oxygen and Carbon Dioxide Transport	255
	Oxygen Transport	256
	Oxyhemoglobin Dissociation Curve	262
	Oxygen Transport Calculations	273
	Hypoxia	285
	Cyanosis	290
	Carbon Dioxide Transport	291
	The Six Ways Carbon Dioxide is Transported to the Lungs	291
	Carbon Dioxide Elimination at the Lungs	294
	Carbon Dioxide Dissociation Curve	294
	Chapter Summary	298
	Review Questions	302
	Clinical Application Questions	304
Chapter 7	Acid-Base Balance and Regulation	305
	Introduction	306
	The Basic Principles of Acid-Base Reactions and pH	307
	The Chemical Buffer Systems and Acid-Base Balance	309
	The Respiratory System and Acid-Base Balance	314
	The Renal System and Acid-Base Balance	315
	The Role of the P_co2/HCO₃-/pH Relationship in Acid-Base Balance	315
	Chapter Summary	342
	Review Questions	345
	Clinical Application Questions	347
Chapter 8	Ventilation-Perfusion Relationships	351
	Ventilation-Perfusion Ratio	351
	Chapter Summary	362
	Review Questions	364
	Clinical Application Questions	365
Chapter 9	Control of Ventilation	367
	Introduction	367
	Control of Respiration	368
	Factors That Influence the Rate and Depth of Breathing	370
	Other Important Factors That Influence Breathing	378
	Miscellaneous Factors That May Influence Breathing	379
	Chapter Summary	383
	Review Questions	385
	Clinical Application Questions	387
Chapter 10	Fetal Development and the Cardiopulmonary System	389
	Fetal Lung Development	390
	Placenta	392
	Fetal Circulation	395
	Birth	399
	Control of Ventilation in the Newborn	401
	Clinical Parameters in the Normal Newborn	402
	Chapter Summary	404
	Review Questions	407
	Clinical Application Questions	408
Chapter 11	Aging and the Cardiopulmonary System	411
	Introduction	411
	The Effects of Aging on the Respiratory System	412
	Pulmonary Gas Exchange	416
	Arterial Blood Gases	416
	The Effects of Aging on the Cardiovascular System	419
	Chapter Summary	423
	Review Questions	423
SECTION TWO	ADVANCED CARDIOPULMONARY CONCEPTS AND RELATED AREAS—THE ESSENTIALS	425
Chapter 12	Electrophysiology of the Heart	425
	Introduction	427
	The Five Phases of the Action Potential	429
	Properties of the Cardiac Muscle	430
	Chapter Summary	434
	Review Questions	434
Chapter 13	The Standard 12-ECG Lead System	437
	Introduction	438
	The Standard 12-ECG Lead System	438
	Normal ECG Configurations and Their Expected Measurements (Lead II)	444
	Chapter Summary	450
	Review Questions	451
Chapter 14	ECG Interpretation	453
	How to Analyze the Waveforms	454
	Common Cardiac Dysrhythmias	457
	Chapter Summary	477
	Review Questions	478
Chapter 15	Hemodynamic Measurements	483
	Hemodynamic Measurements Directly Obtained by Means of the Pulmonary Artery Catheter	483
	Hemodynamic Values Computed from Direct Measurements	485
	Chapter Summary	493
	Review Questions	496
	Clinical Application Questions	497
Chapter 16	Renal Failure and Its Effects on the Cardiopulmonary System	499
	The Kidneys	500
	The Nephrons	500
	Blood Vessels of the Kidneys	504
	Urine Formation	504
	Urine Concentration and Volume	506
	Regulation of Electrolyte Concentration	507
	Role of the Kidneys in Acid-Base Balance	509
	Blood Volume	510
	Renal Failure	511
	Cardiopulmonary Disorders Caused by Renal Failure	514
	Chapter Summary	516
	Review Questions	519
	Clinical Application Questions	520
Chapter 17	Sleep Physiology and Its Relationship to the Cardiopulmonary System	523
	Introduction	524
	Types of Sleep	526
	Normal Sleep Cycles	536
	Functions of Sleep	538
	Circadian Rhythms	538
	Normal Sleep Patterns	539
	Factors Affecting Sleep	540
	Common Sleep Disorders	541
	Normal Cardiopuimonary Physiology During Sleep	546
	Chapter Summary	550
	Review Questions	551
	Clinical Application Questions	553
SECTION THREE	THE CARDIOPULMONARY SYSTEM DURING UNUSUAL ENVIRONMENTAL CONDITIONS	555
Chapter 18	Exercise and Its Effects on the Cardiopulmonary System	557
	Introduction	557
	Ventilation	558
	Circulation	562
	Interrelationships among Muscle Work, Oxygen Consumption, and Cardiac Output	566
	The Influence of Training on the Heart and Cardiac Output	567
	Stroke Volume versus Heart Rate in Increasing Cardiac Output	567
	Body Temperature/Cutaneous Blood Flow Relationship	569
	Pulmonary Rehabilitation	570
	Chapter Summary	572
	Review Questions	572
Chapter 19	High Altitude and Its Effects on the Cardiopulmonary System	575
	High Altitude	575
	Other Physiologic Changes	583
	Chapter Summary	584
	Review Questions	584
Chapter 20	High-Pressure Environments and Their Effects on the Cardiopulmonary System	587
	Diving	587
	Hyperbaric Medicine	592
	Chapter Summary	594
	Review Questions	594
	Glossary	597
	Appendices	629
I	Symbols and Abbreviations	629
II	Units of Measurement	633
III	Poiseuille’s Law	639
IV	DuBois Body Surface Chart	641
V	Cardiopulmonary Profile	643
VI	P_co2/HCO₃-/pH Nomogram	645
VII	Calculating Heart Rate by Counting the Number of Large ECG Squares	647
VIII	Answers to Review Questions in Text	649
	Bibliography	657
	Index	669