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Download Care of the Critically Ill Patient by P. A. Poole-Wilson (auth.), Jack Tinker BSc, FRCP, FRCS, PDF

By P. A. Poole-Wilson (auth.), Jack Tinker BSc, FRCP, FRCS, DIC, Professor Warren M. Zapol MD (eds.)

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E. Wright Pulmonary/Critical Care Medicine Vanderbilt University Nashville, Tennessee, USA F. M. A. 1). The blood flow is sufficient to provide the body tissues with O 2 and substrate and to remove the products of metabolism, particularly CO 2 and heat. Since the heart rate at rest is 72 beats/min, the amount of blood ejected from the heart with each beat, the stroke volume, is 83 m!. During exercise the requirements of the body for blood flow increase substantially. Cardiac output in trained athletes can be as high as 35 litres/min.

An estimate of the energy (ATP) consumed by the heart can be obtained from the area under the aortic pressure curve (tension - time index = TTl) [88], Under normal conditions the ATP being utilized is related to oxygen consumption. It is probably more accurate but less practical to consider the area under the left ventricular pressure curve rather than the aortic curve. Coronary flow occurs predominantly during diastole and is determined by the area marked OPTI (diastolic pressure - time index).

The Bowditch effect is observed in all species with the exception of the adult rat, which has an unusually short action potential. The effect is related to the availability and release of calcium from cellular stores to the myofibrils. An increased contractility of the heart with increasing heart rate is more difficult to observe in whole animals or in man. There are apparently contradictory results [16,21,41,57,60,64,69]. The discrepancies may arise partly because the increment in heart rate and the control heart rate are very different in these studies.

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