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The function of the heart as a pump is ultimately dependent on the coordinated contractions of its chambers to move blood throughout the body. These contractions are produced by cardiac myocytes, the muscle cells of the heart. Understanding of the structure and function of these cells on an individual level provides insights into adaptations of the heart due to normal as well as pathophysiological...
The intrinsic conduction system of the heart is comprised of several specialized subpopulations of cells that either spontaneously generate electrical activity (pacemaker cells) or preferentially conduct this activity throughout the chambers in a coordinated fashion. This chapter will discuss the details of this known anatomy as well as put such discoveries into a historical context. The cardiac action...
The autonomic nervous system and the role it plays in governing the behavior of the cardiovascular system is immense in both its complexity and importance to life. The antagonistic nature of the parasympathetic and sympathetic branches of this system allows rapid and essential changes in cardiac parameters such as heart rate, contractility, and stroke volume in order to deliver metabolites and nutrients...
Cellular physiological functions are regulated via signaling mechanisms in essentially any cell type of any organ. While myocardial cells are unique in that they are interconnected to each other via gap junctions and thus act as an electrical syncytium, there is nevertheless an enormous number of important cellular receptors that allow individual cells to receive and respond to various signals. Inflammation...
Ischemia and reperfusion injuries can lead to major compromises in cardiac function. While the intent of many of the past cardioprotective therapies was to protect the myocardium from ischemic necrosis, it may be that reperfusion injury following ischemia may occur despite such preventative attempts. There are continued efforts to identify improvements in myocardial protective strategies, and their...
With the aging population and an increase in health problems such as obesity, diabetes, and coronary artery disease, the perioperative management and induction of general anesthesia in such patients, while providing cardiovascular stability, continues to offer both challenges and new developments in this field. These developments include new anesthesia medications, medical equipment and/or surgical...
The primary purpose of this chapter is to familiarize the reader with the basic concepts of blood pressure, heart tones, and some common diagnoses. It remains the general consensus that even the most sophisticated electronic monitors cannot fully reduce the need for sound clinical skills like proper patient inspection, palpation, percussion, and auscultation. Furthermore, it is important to reinforce...
The recorded electrocardiogram (ECG) remains as one of the most vital monitors of a patient’s cardiovascular status and is used today in nearly every clinical setting. This chapter discusses the ECG as a measure of how the electrical activity of the heart changes over time, as action potentials within each myocyte propagate throughout the heart during each cardiac cycle. By utilizing the resultant...
Monitoring of hemodynamic and mechanical parameters of the heart are reviewed. Clinical methodologies are discussed along with tools used in a research setting. Specifically, these include: arterial blood pressure, central venous pressure, pulmonary artery pressure, mixed venous oxygen saturation, cardiac output, pressure–volume loops, flow monitoring, and Frank–Starling curves. These parameters are...
This chapter reviews the metabolic pathways involved in transferring the chemical energy stored in dietary carbon substrates (primarily glucose and fatty acids) into adenosine triphosphate (ATP) and the regulatory systems that integrate the functions of these pathways and make them responsive to changes in energy demand. Normal cardiac function depends upon both the adequate delivery of carbon substrates...
The use of ultrasound to provide noninvasive evaluation of cardiac structure and function was a revolutionary advancement in cardiac care in the late 20th century. Today, echocardiography allows for detailed serial examinations of: (1) heart development; (2) cardiac structure and function; and (3) changes in normal physiologic states and pathologic conditions. The goals of this chapter are to: (1)...
The need for monitoring of patients has grown as the health care system has developed the ability to care for more critically ill patients. Monitors serve several purposes including identification of shock and abnormal cardiac physiology, evaluation of cardiovascular function, and/or to allow for optimizing titration of therapy. An important function of an effective monitoring device is reliable detection...
Cardiovascular magnetic resonance imaging (MRI), or simply cardiac MR, is considered the “gold” standard for noninvasively characterizing cardiac function and viability, having 3D capabilities and a high spatial and temporal resolution. This imaging modality has proven to be an invaluable tool in diagnosing complex cardiomyopathies. Several clinical uses of cardiac MR include: (1) measuring myocardial...
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