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CONTENTS
List of Tables xiii
Foreword xv
Preface xvii
Acknowledgments xx
I SECTION ONE The Cariopulmonary 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 22
The Sites of Gas Exchange 34
The Pulmonary Vascular System 37
The Lymphatic System 41
Neural Control of the Lungs 43
The, Lungs 44
The Mediastinum 46
The Pleural Membranes 48
The Thorax 49
The Diaphragm 50
Chapter Summary 58
Review Questions 59
CHAPTER 2
Ventilation 63
Pressure Differences Across the Lungs 64
Role of the Diaphragm in Ventilation 67
Positive Pressure Ventilation 69
Static Characteristics of the Lungs 71
Dynamic Characteristics of the Lungs 86
Ventilatory Patterns 94
How Normal Intrapleural Pressure Differences Cause
Regional Differences in Normal Lung Ventilation
100
The Effect of Airway Resistance and Lung Compliance on
Ventilatory Patterns 101
Overview of Specific Ventilatory Patterns 102
Chapter Summary 106
Clinical Applications 109
Review Questions 112
Clinical Application Questions 115
CHAPTER 3
The Diffusion of Pulmonary Gases 117
Gas Laws 118
The Partial Pressures of Atmospheric Gases 120
The Ideal Alveolar Gas Equation 122
The Diffusion of Pulmonary Gases 123
Oxygen and Carbon Dioxide Diffusion Across the Alveolar
Capillary Membrane 124
Gas Diffusion 128
Perfusion-Limited Gas Flow 130
Diffusion-Limited Gas Flow 131
How Oxygen Can Be Either Perfusion or Diffusion Limited
134
Chapter Summary 136
Clinical Applications 136
Review Questions 139
Clinical Application Questions 141
CHAPTER 4
Pulmonary Function Measurements 143
Lung Volumes and Capacities 144
Pulmonary Mechanics 148
How the Effects of Dynamic Compression Decrease
Expiratory Flow Rates 157
Chapter Summary 161
Clinical Applications 162
Review Questions 166
Clinical Application Questions 168
CHAPTER 5
The Anatomy and Physiology of the Circulatory System 169
The Blood 170
The Heart 175
The Pulmonary and Systemic Vascular Systems 183
Pressures in the Pulmonary and Systemic Vascular
Systems 187
The Cardiac Cycle and Its Effect on Blood Pressure 188
The Distribution of Pulmonary Blood Flow 192
Chapter Summary 203
Clinical Applications 205
Review Questions 208
Clinical Application Questions 210
CHAPTER 6
Oxygen Transport 211
Oxygen Transport 213
Oxygen Dissociation Curve 216
Oxygen Transport Studies 229
Tissue Hypoxia 240
Cyanosis 242
Polycythemia 243
Chapter Summary 244
Clinical Applications 244
Review Questions 248
Clinical Application Questions 250
CHAPTER 7
Carbon Dioxide Transport and Acid-Base Balance 251
Carbon Dioxide Transport 252
Carbon Dioxide Elimination at the Lungs 254
Carbon Dioxide Dissociation Curve 256
Acid-Base Balance 259
The Role of the PC02 /HC03-/pH Relationship in Acid-Base
Balance 261
Chapter Summary 270
Clinical Applications 270
Review Questions 273
Clinical Application Questions 275
CHAPTER 8
Ventilation-Perfusion Relationships 277
Ventilation-Perfusion Ratio 277
Chapter Summary 286
Clinical Applications 287
Review Questions 290
Clinical Application Questions 291
CHAPTER 9
Control of Ventilation 293
The Respiratory Components of the Medulla Oblongata 294
The Influence of the Pontine Respiratory Centers on the
Respiratory Components of the Medulla Oblongata
296
Monitoring Systems That Influence the Respiratory
Components of the Medulla Oblongata 298
Reflexes That Influence Ventilation 304
Chapter Summary 306
Clinical Applications 307
Review Questions 309
Clinical Application Questions 311
CHAPTER 10
Fetal Development and the Cardiopulmonary System 313
Fetal Lung Development 314
Placenta 316
Fetal Circulation 319
Birth 321
Control of Ventilation in the Newborn 323
Clinical Parameters in the Normal Newborn 324
Chapter Summary 326
Clinical Applications 326
Review Questions 329
Clinical Application Questions 330
CHAPTER 11
Aging and the Cardiopulmonary System 333
The Effects of Aging on the Respiratory System 335
Pulmonary Gas Exchange 339
Arterial Blood Gases 339
The Effects of Aging on the Cardiovascular System 340
Chapter Summary 344
Review Questions 344
II SECTION TWO Advanced Cardiopulmonary Concepts
and Related Areas-The Essentials 347
CHAPTER 12
Electrophysiology of the Heart 349
The Five Phases of the Action Potential 351
Properties of the Cardiac Muscle 352
Chapter Summary 355
Review Questions 356
CHAPTER 13
The Standard 12-ECG System 357
The Standard 12-ECG System 358
Normal ECG Configurations and Their Expected
Measurements (Lead 11) 364
Chapter Summary 371
Review Questions 371
CHAPTER 14
ECG Interpretation 373
How to Analyze the Waveforms 374
Common Cardiac Dysrhythmias 378
Chapter Summary 397
Review Questions 398
CHAPTER 15
Hemodynamic Measurements 403
Hemodynamic Measurements Directly Obtained by Means
of the Pulmonary Artery Catheter 403
Hemodynamic Values Computed From Direct
Measurements 405
Chapter Summary 411
Clinical Applications 412
Review Questions 414
Clinical Application Questions 416
CHAPTER 16
Renal Failure and Its Effects on the Cardiopulmonary
System 417
The Kidneys 418
The Nephrons 420
Blood Vessels of the Kidneys 421
Urine Formation 421
Urine Concentration and Volume 425
Regulation of Electrolyte Concentration 426
Role of the Kidneys in Acid-Base Balance 427
Blood Volume 428
Renal Failure 429
Cardiopulmonary Disorders Caused by Renal Failure 432
Chapter Summary 434
Clinical Applications 434
Review Questions 437
Clinical Application Questions 439
III SECTION THREE The Cardiopulmonary System During
Unusual Environmental conditions 441
CHAPTER 17
Exercise and Its Effects on the Cardiopulmonary System 443
Ventilation 444
Circulation 448
Interrelationships Between Muscle Work, Oxygen
Consumption, and Cardiac Output 453
The Influence of Training on the Heart and Cardiac
Activity 454
Stroke Volume Versus Heart Rate in Increasing Cardiac
Output 455
Body Temperature/ Cutaneous Blood Flow Relationship 456
Cardiovascular Rehabilitation 457
Chapter Summary 458
Review Questions 458
CHAPTER 18
High Altitude and Its Effects on the Cardiopulmonary
System 461
High Altitude 461
Other Physiologic Changes 466
Chapter Summary 469
Review Questions 469
CHAPTER 19
High-Pressure Environments and Their Effects on the
Cardiopulmonary System 471
Diving 471
Hyperbaric Medicine 475
Chapter Summary 477
Review Questions 477
Glossary 479
Appendices
I Symbols and Abbreviations 499
II Units of Measurement 503
III Poiseuille's Law 509
IV DuBois Body Surface Chart 513
V Cardiopulmonary Profile 515
VI PcO2/HC03 - /pH Nomogram 517
VII Calculating Heart Rate by Counting the Number of
Large ECG Squares 519
VIII Answers to Review Questions in Text 521
Bibliography 533
Index 541
LIST OF TABLES
1-1 Major Structures and Corresponding Generations of
the Tracheobronchial Tree 23
1-2 Some Effects of Autonomic Nervous System
Activity 44
2-1 Causes of Pulmonary Surfactant Deficiency 84
2-2 Effect of Breathing Depth and Frequency on
Alveolar Ventilation 99
3-1 Gases That Compose the Barometric Pressure 120
3-2 Partial Pressure (in mm Hg) of Gases in the Air,
Alveoli, and Blood 121
3-3 Relationship Between Temperature, Absolute
Humidity, and Water Vapor Pressure 122
3-4 Factors That Affect Measured DLco 134
4-1 Approximate Lung Volumes and Capacities in the
Average Normal Subject 20 to 30 Years of Age 145
4-2 Average Dynamic Flow Rate Measurements in
Healthy Men and Women 20 to 30 Years of Age 157
4-3 Maximum Inspiratory and Expiratory Pressures 160
5-1 Formed Elements of the Blood 171
5-2 Normal Differential Count 173
5-3 Chemical Composition of Plasma 175
5-4 Summary of the Effects of Active and Passive
Mechanisms on Vascular Resistance 204
6-1 Normal Blood Gas Value Ranges 212
6-2 Factors That Increase the C(a - V )O, 231
6-3 Factors That Decrease the C(a - v)O2 231
6-4 Factors That Increase Oxygen Consumption 232
6-5 Factors That Decrease Oxygen Consumption 232
6-6 Factors That Increase the 02ER 233
6-7 Factors That Decrease the 02ER 233
6-8 Factors That Decrease the SvO2 234
6-9 Factors That Increase the SV02 234
6-10 Clinical Factors Affecting Various Oxygen Transport
Study Values 235
7-1 Carbon Dioxide (C02) Transport Mechanisms 256
10-1 Approximate Lung Volumes (mL) and Capacities
of the Normal Newborn 325
10-2 Vital Sign Ranges of the Normal Newborn 325
12-1 Cardiac Response to Autonomic Nervous System
Changes 355
13-1 ECG Lead Systems 358
13-2 Summary of Normal ECG Configurations and Heart
Activity 370
14-1 Systematic Approach to ECG Interpretation 374
14-2 Calculating Heart Rate by Counting the Number
of Large ECG Squares 376
14-3 Common Cardiac Dysrhythmias 378
15-1 Hemodynamic Values Directly Obtained by Means
of the Pulmonary Artery Catheter 405
15-2 Computed Hemodynamic Values 405
15-3 Factors Increasing and Decreasing Stroke Volume
(SV), Stroke Volume Index (SVI), Cardiac Output
(CO), Cardiac Index (CI), Right Ventricular Stroke
Work Index (RVSWI), and Left Ventricular Stroke
Work Index (LVSWI) 406
15-4 Factors That Increase Pulmonary Vascular
Resistance (PVR) 410
15-5 Factors That Decrease Pulmonary Vascular
Resistance (PVR) 411
15-6 Factors That Increase and Decrease Systemic
Vascular Resistance (SVR) 411
16-1 Forces of Glomerular Filtration 424
16-2 Factors That Obstruct Urinary Flow 430
16-3 Prerenal Abnormalities 431
16-4 Renal Abnormalities 431
16-5 Postrenal Abnormalities 432
19-1 Indications for Hyperbaric Oxygenation 477
