The Cardiovascular System ata Glance PHILIP I. AARONSON mo. Senior Lecturer in Pharmacology Guy's, King’s and St Thomas’ School of Medicine, Dentistry and Biomedical Sciences King's College, London JEREMY P.T. WARD pap Reader in Respiratory Cell Physiology Guy's, King’s and St Thomas’ School of Medicine, Dentistry and Biomedical Sciences ‘King’s College, London CHARLES M. WIENER wo Associate Profesor of Medicine and Physiology Johns Hopkins School of Medieine Baltimore, MD, USA. STEVEN P. SCHULMAN wp Associate Professor of Medicine Johns Hopkins School of Medicine Baltimore, MD, USA JASWINDER S. GILL ma,mo, rece Consultant Cardiologist Cardiothoracic Centre ‘St Thomas’ Hospital, London b Blackwell Science© 199967 Blackwell Science Ld editorial Ooo ‘Osney Mead, Oxford OX2 OBL 25 Jon Stet, London WCIN 281 23 Ainslie Place, Edinburgh EHS 6A 350 Main See, Malden MA.02148 5018, USA. ‘4 University Stet, Carton ‘Victoria 3053, Australia 10,r0eCasimie Delavigne "75006 Paris, France Oier Eaitorial Otties: ‘Blackwell Wissenschafts-Verlag Gmblt ‘Kurfrstendamm $7 10707 Beri, Germany Blackwell Science KK MG Kodeamacho Building 7-10 Kedenmacho Nihorbashi Chuo-ku, Tokyo 104, Japan| The Fight of the Authors tobe identified asthe Authors of this Work hasbeen asserted in aesordance With the Copyright, Designs and Patents ct 1988, All rights reserved, No part of this publication may be repreduced, ‘stored ina revival system, of ‘wansnited in any fom or by any means, electronic, mechanical, photocopying, recording oratherwise, except as permite bythe UK Copyright, Design and Patents Act 1988, without te prior permission ofthe copyright owner Firs published 1999 Repritod (with comections) 2000, ‘Setby Graphicraft Limited Hong Kong. Printed and bound in the UK by ‘Alden Group, Oxford and Northampton “The Blackwell Science logo isa trademark of Blackwell Science Lt registered at the United Kingdom “Trade Marks Registy ‘Marston Book Services Lud PO Box 269 ‘Abingdon, Oxon OX14 4YN (Onder: Tel: 01235 468500 ax 01235465555) Usa ‘Blackwell Selene, le. Commerce Pace 350 Main Steet ‘Malden, MA 02148 5018 (Onders: Te: 800759 6102 781388 8250 ax: 781 388 £255) Canada Login Brothers Book Company 324 Sauteaus Crescent Winnipeg, Manitoba R33 372 (Oniers: Tel: 204 887-2987) Austalia Blackwell Science Py Ld 54 University Steet Casiton, Vieoria 3053 (Orders: Tel: 39347 0300 Fax: 39347 5001) Acatalogue record fortis title isavailabl om the British Library ISBN 0-632-06971-5, Library of Congress (Cataloging-in-publcation Data ‘Aaronson, Philp. “The cardiovascular system ata glance Philp Aaronson, Jeremy Ward, Charles M, Wiener, Steven P. Schulman & SaswinderS Gil, Bem Inches index, ISBN0-632-04971-5 1. Cardiovascular systemPhysology 2, Candiovascular system—Pathophysiology. L Wird, Jeremy. I. Tite [DNEM: 1. Cardiovascular System, WG 100 Alle 1999}, QP 101.418 1999 616, 14621 DNLMDLC for Library of Congress 9e-st927 For further information on Dlackwell Science, vist our webs: wor backwellscience.comContents 1B 4 1s 16 a 18 19 20 21 2 B Preface, 4 Sources of illustrations, 5 Introduction Overview of the cardiovascular system, 6 Anatomy and histology Gross anatomy and histology of the heart, 8 Vascular anatomy, 10 Vascular histology and smooth muscle cell ultrastructure, 12 Blood and body fluids Constituents of blood, 14 Erythropoiesis, haemoglobin and anaemia, 16 Hacmostasis and thrombosis, 18 Blood groups and transfusions, 20 Biochemistry and cellular physiology Membrane potential, ion channels and pumps, 22 Electrophysiology of cardiac muscle and the origin of the heart beat, 24 Excitation-contraction coupling in cardiac muscle cells, 26 ‘Vascular smooth muscle excitation-contraction coupling, 28 Form and funetion Cardiac eycle, 30 Control of cardiac output and Starling’s Law of the Heart, 32 Electrical conduction system in the heart, 34 ‘The electrocardiogram, 36 Haemodynamies, 38 Blood pressure and flow in the arteries and arterioles, 40 ‘The microcirculation and the lymphatic system, 42 Fluid filtration in the microcirculation, 44 ‘The venous system, 46 Local control of bloodflow, 48. Regulation of the vasculature by the endothelium, 50 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39. 40 41 2 B 48 46 47 48 49 30 su 52 3 34 55 ‘The coronary, skeletal muscle, cutaneous and cerebral circulations, $2 ‘The pulmonary and fetal circulations, 54 Integration and regulation Cardiovascular reflexes, 56 Autonomic control ofthe cardiovascular system, 58 The control of blood volume, 60 Cardiovascular effects of exercise, 62 Shock and haemorrhage, 64 Pathology and therapeutics Risk factors for cardiovascular disease, 66 Clinical measurement of cardiac and vascular function, 68 Hyperlipidaemias, 70 Atherosclerosis, 72 Diagnosis and treatment of hypertension, 74 ‘Mechanisms of primary hypertension, 76 Stable and variant angina, 78 Unstable angina and revascularization, 80 Pharmacological management of angina, 82 Pathophysiology of acute myocardial infarction, 84 Clinical aspects of acute myocardial infarction, 86 Emerging approaches to therapy of coronary artery disease, 88 Chronic heart failure, 90 ‘Treatment of chronic heart failure, 93 Mechanisms of arinythmia, 96 Specific arrhythmias, 98 Antiarrhythmic drugs, 100 Diseases of the aortic valve, 102, Diseases of the mitral valve, 104 Congenital heart disease, 106 Cardiac transplantation, 108 Case studies: diagnosis, treatment, result Case study: heart faifure, 110 Case study: valvular heart disease, 112 Case study: ischaemic heart disease, 114 Case studies: arrhythmias, 116 Index, 119