חוברת אגודה - לב

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: " -: , . . , . ) (vena cavae . . , . , . , " . ) (MV , . , .100mmHg : 08/021 ) (. : 09/051. , ) .(AV , .AV - ).(Subclavicular , . :

1

, , . , " . , . , . .0-120mmHg )( ) (, " . , . , AV. , AV, . " , , , . . , , . . , AV . . ,run off ) (. , , AV. " = = .stroke volume = SV , - ,MV- AV. , MV. Iso-volumetric relaxation , . , . , . , . Iso-volumetric contraction . . MV. . AV. - ,MV . .8mmHg ) " ( ).(stroke ,CVA . - ,120mmHg , . , AV, .80mmHg ),(AV . 2

AV . MV . , . , " . , . AV , - ,dicrotic notch recoil . : . , . , . = Compliance = " . , . . , SV 65-75 ml. ) = (cardiac output =CO ' = . 5 , 07 . .70 ml = , 04 . ) (atrial kick , : . - %04-03. %02-01. ) (atrial fibrillation , . . . . , , ,MV recoil . : , " . . . ,MV , . = SV 70-80 ml . -: ". " . P . QRS . , , . T , . 3

-: . = I .MV . = II .AV = III .

: " : )021 , 08 (, . . , - 3 : .adventicia ,media ,intima 3 , - ,media , . . ).(Collapse )( '. ), 40 m vena cavae :

. . , , ., . ; , . - . . , . : = ; = . . . - .30m .4 m - RBC ,7-8 m .

4

: / , . , , . = = .A1*V1 = A2*V2 = Q .Q V ) (; A .2.V

1 A - 2 ,A , - 1 V2.A

2 V1 NR . ,3000 < NR . 0003 < 2000 < NR .

, , , . . . = Flow / P. , Flow , . ) (. ) (:

, , , . P+1/2v2 + gh = Constant

, : , , , . 2 P =1/2v 1 .v2>>v 2.P =4*v . . . . US , . : , , . P" . 36 = P" ,AV , " . " .AV , P .Q : , , P. : , , , " . " ) (A1*V1 = A2*V2 = Q , ,A . , )

51

(, . . P, P. 2.P =4*v . P , . . : ,P . R , . , ,SV - Q .

: " Swan-Ganz - 06. . ) '(. , . . , , , ,TV .PV . , . . . , . . * ,TV . , =) wedging (. , . , , , .

61

, . . , ,MV , . , - , : . , , . . , . , . , . , . " , . = . . : 1. : , ", Q . , , . , : " . 2. : . , . ? . " , ) (. . ARDS . - " ,Swan-Ganz . , ; , .

71

: : , .

" , , . + =

& Q [O 2 ] V + VO 2 = Q [O 2 ] a

.

* ) + ( = * . = .250 ml/min . . " , .

[O 2 ] a , . , . , , .

=Q

[O2 ] a [O2 ] V

& 2VO

[O 2 ] V , " Swan-Ganz . : . , . . , , . , " , .

) 2 q = c Q (t 1 t = c = Q

c dt/(tq c dt

1

)2 t

= or QSeconds

q ) 2 c (t 1 t

q ; c = . , , . , , .

81

= ,0.2 min 01 - .lit

q = 5 mg dye %c = 0.25 mg t1-t2=12 sec

: :

.Q = 5/ (0.25*0.2) = 100 dL/min = 10 lit/min - %) .mg/100ml = mg 01 - (lit V, , . . : ventricular septal defect = VSD ) ( . , . )( ; , , ) (, ; , , , . - .VSD

, ) '(. - :Thermo dilution 00c - ) (. - q )( , . , , , . , . , . , " , ' . :

91

: COThermodilu tion

=

) V inj (T body T Saline )0 73( 01 = 76.16 = )( T t 1 21 2 2

cm

3

sec

7.3 =

L

min

" , .

Vinj .

, .

: "

:

C B D AESV

- X ; - Y . . , , . , .

02

. + - .atrial kick

A

.end diastolic volume = EDV ) (EDP , -. - MV ) -. - EDP , . = . -, .

B

: - MV, - AV , . , . , .

C

: , , , . C- ,D AV. ,B .

D

:

Isovolumic Relaxation Before MV opening

At end diastole

A

Isovolumic contraction before AV opening

During Ventricular ejection

D

B

C A B

. (PreLoad) PL . , , , . - ,AfterLoad , .

, .

. , - afterload.

12

, , . , , , "" , : . . , . = = . , , - .PL afterload. "

D

) (

- afterload. ,AV .

- afterload" " .AV - preload , . - ,preload , )(, , , . - preload , : , . , , , , . . : . , ) (, . - .preload , , , . , - .afterload - afterload, , . , - afterload . , , . . , " . afterload ) (. , , . , , )" , (. , afterload . . )-( . ? " . , , ; , , .

22

, "

, . - preload - .CO . , , - preload . , " -, ) (. . )(. ) , ( . , , . . ) (preload -, . , . . preload , . - : . , " , . 2 : , . , AV, . , , . , , : . , . )- afterload(, , , . . , : , ) ( . ) (SV - afterload. .SV = EDV ESV - afterload. : . ) X = (. 32

preload . , - .preload , , , " . , ) EDV (, , ESV . " SV . , . - preload - ,afterload - preload , - preload.Left ventricular pressure curves with tangents :indicating dP/dt A - normal )B - hyperdynamic (NE C hypodynamic (heart )failure

. , . , , , - .loads , - . , - EDV ,AV ) (, " . : . 1 .

42

:

T P R " . . . - .afterload . ] , . , , .[ , , ,P . T . . , . T - afterload . - preload .

,

. ) ; ( ) preload- .(afterload , . : - ,afterload , . , , , , . , SV, . , ! , , . . , . . : )= ( , )" ( , ! 52

, . , "" ) (. Pv . - preload . - .central venous pressure = CVP .P = Pa Pv Pa . .Q = P/R R .

0 = ,Q . , . . , - Pa Pv. = ,Compliance , . , . C = V/ P . , .

Control state5=Qh2 = Pv 201 = Pa

Onset of cardiac arrest0 = Qh201 = Pa 2 = Pv

5=Qr 02=R

5 = Qr 02 = RPa decreases and Pv increases rapidly

Cardiac arrest: steady state No flow

0 = Qh7 = Pv 7 = Pa

Cardiac resuscitation 1 = Qh6 = Pv 62 = Pa

0 = Qr 02 = R

1 = Qr 02 = R

62

: ,Ca* Pa = Cv* Pv . 91 = .Pa / Pv , - 95 mmHg - 5 mmHg . , : .Pa = Pv = 7mmHg , . , , . , ,1 lit/min - .26mmHg - ,19 mmHg . ) - R(. - ) 6 mmHg " (. " , .

Vascular function curve

, . - X ; - Y .Pv - Q, - Pv, , . - Q , - 0 = ,Pv , ! = . - X ) PRA (; Y . - PRA, . ) ( , = 7mmHg = Pmc= Psf . , .Pv = 6mmHg ,Q = 1 lit - vascular function curve . , 3/2 . )( , . ) (, ) (VR . . .

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, , Pmc , . ) ( - Pmc . ) ,(SVR . PRA , . , : R, VR. , , " ) C( - ) V( . C- V, P. . , - R , - VR . , . : , . ,

. , . , . , - CO . , , : , . - Pmc .

: ) - ,(preload . , . , , . , , , , , . PRA , ! , , CO. 2 ) Cardiac function , .(vascular function curve . . , , , . , , . 82

- ) ( , , . . , , ) , , 10-36 mmHg , - 4 mmHg(. , , ) (. , . , , . . ) , ( . , , , . , , . : . . . . , . . , , . - SV . , . , " . , , . , , , . , . . . , , . , , , .

92

: , ) (, , , . , . , , CO . , ) ( ,CO . : , . ) (. , . . : , . , , . : 1. , .A - , , . A , " . - CO , Pv . , , E . 2. ) (. CO , . , CO. , , - CO , Pv .

03

"

)=( . .RBC 03 ) 3 (. . . , . , "", Gap junctions ; , . . , . - .(Brain Blood Barrier) BBB Tight Junction .)Flux=PS(Ci-Co

:

, P , S . S ,P , . , . , . ) ( , . ! " . - 2 CO , , . , , , ) %20.0 (, P . , P . , : . . , , . : , . . . , . . . .

13

) ( . , . : . , , " . , . . . , ) (. , ) " ( . , . :

. . ;P = 32 mmHg .P= 15 mmHg . , . , ) ( , . , . ) (. " . . , , . , - thorasic duct - .Subclavian vein

])Qw = K[(Pc Pi) (pc-pi Qw . p . i . P ; c ;

K , . : , , K. .

23

pi, . , , . , . - . = :Edema

(.

Qw

. )Pc , : 1. ;

2. , : = , , = , , , . , . . 3. )(, , , . . , Pc . : 1. , . 2. . . , , pc ,K , , . , . ) (, pi. " Qw . : 1. = " , . 2. . : : , . . , . , - Pi , . , : , , . : , , , .

33

: ) (Flow ) 01( ).(2 ml/min : 01 . , . : , . , -02 " . , : , , . Tight Junctions . , , . : . , . (. Qw , )Pc . - . - , . " .

:

: )( ) ,RBC (. , , , , . %55 . %7 . 2 : . 2 . %54 . . , . = RBC = , . : , . : , . , . " , " .

43

: 4 : .AB ,O ,B ,A ,B ,A .O , ,RBC . ) .(self A -B ) (, .A O A .B AB . , : B ,A A ,B . .B AB , . O .O O , B ,A . ) Rh( . , RBC Rh Rh, . , . , , . : RBC 7 , , . . : %03 , %5 , - %56 = - ) %59, %4 %1(. : . - . (Tissue Factor =) TF ' VII - . . . )(, ) (. . " , -. , )= (, . , ) . , , !(. . " . ) (PL " ) ( . . 53

,

.RBC .

) (, , ,RBC - RBC . , . TF , . , - TF , . . , . , , , . , . = . , 52 , .bed rest " . ) (. . - , . : = , . : , . . LDL , . - LDL . . . , . ) (. , - TF . , . * . , . ? , : )" (, , . , , , , , , . TF , . , . , ) (13-15 atm , . " , TF" . , . : " . : " , , . 63

'

:Excitation-Contraction Coupling " . , , . - ECG . " . - ? . , . = , ' 1 . ) (VF . . , VF , 2-1 . . - -. . , ', . , , : QT, , . - 04-03 - , ". Q- T ,ECG " . " , " , . , , . )( " , ". ), , Automaticity

. .

. . .

.

(. )-( , ". " . , . , .

73

:

. - ) SA node (SAN , - .SVC - ) AV node (AVN , - ,bundle of His . . , )- .(4m/sec )01 (. .1m/sec " :

- SAN . . . - AVN , ? , , . - SAN , - 07 . - , . , . - ,AVN delay . - delay . 2 : : - . , . : , - . " , - ,SAN " - AVN, .delay , " - AVN WPW . - .ECG . - AVN - delay? " , . " 2-1 ) (. 05 " - .AVN , " - ,AVN , . . .

83

" , Skeletal muscle

: " - 002 - ) 2-1 - (. " . , " " -

Cardiac muscle

". " , . , ", " -, . . , " . , " " " , , " . ' " . , . " . " , " . . :

Skeletal muscle

, ) (.

: - , ". " . : - SR ) (. ; , . . - %03 - , - %07 - -.SR " , . .

93

: " , . ! , 000,01 10-3nM 10-7nM . ]: ,140nM - 3; [. 10-6nM , 0001 . , . . , ) (. , - SR. - SR , , - ,SR " . . %07 - SR- %03 . - S...