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40 PA R T I / Anatomy and Physiology

During inspiration, the time between closure of the aortic and pul- 9. Keith, A., & Flack, M. (1907). The form and nature of the muscular con-
monic valves is increased, probably because a decrease in pulmonary nections between the primary divisions of the vertebrate heart. Journal of
vascular impedance leads to a longer right ventricular ejection time. Anatomy and Physiology, 41, 172–189.
10. Silverman, M. E., & Hollman, A. (2007). Discovery of the sinus node by
Keith and Flack: On the centennial of their 1907 publication. Heart, 93,
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Cardiac Events 11. Bachmann, G. (1916). The inter-auricular time interval. American Journal
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12. James, T. N. (1963). The connecting pathways between the sinus node
Systolic Events and A-V node and between the right and the left atrium in the human
The stroke volume is the volume ejected by the ventricle in a sin- heart. American Heart Journal, 66, 498–508.
gle contraction. Stroke volume multiplied by the number of car- 13. Scher, A., & Spach, M. (1979). Cardiac depolarization and repolarization
diac cycles per minute (heart rate) equals the cardiac output. A and the electrocardiogram. In R. Berne (Ed.), Handbook of physiology. Sec-
tion 2. The cardiovascular system, vol 1, the heart (pp. 357–392). Bethesda,
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typical volume ejected by the ventricle is 60 to 130 mL/m body MD: American Physiological Society.
surface area/s, illustrated by the ventricular volume downstroke of 14. Spach, M., & Barr, R. (1976). Cardiac anatomy from an electrophysio-
Figure 1-38. The stroke volume, which is the difference between logical viewpoint. In C. Nelson & D. Geselivitz (Eds.), The theoretical ba-
the ventricular end-diastolic and end-systolic volume, is approxi- sis of electrocardiography (pp. 3–20). Oxford: Clarendon Press.
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mately 24 to 36 mL/beat/m of body surface area. 15. Fawcett, D. (1986). A textbook of histology. Philadelphia: WB Saunders.
16. Tarawa, S. (1906). Das Reisleitungs system des Saugetierherzens [The con-
The ejection fraction is the percentage of total ventricular vol- duction system of the mammalian heart]. Jena, Germany: Gustav Fischer.
ume ejected during each contraction (i.e., stroke volume divided 17. Fabiato, A. (1983). Calcium-induced release of calcium from the cardiac
by end-diastolic volume). The ejection fraction is a frequently sarcoplasmic reticulum. American Journal of Physiology, 245, C1–14.
used index of ventricular function; normally, it is greater than 18. Titus, J. L., Daugherty, G. W., & Edwards, J. E. (1963). Anatomy of the
normal human atrioventricular conduction system. American Journal of
55% and usually is approximately 65%. Anatomy, 113, 407–415.
The maximal rate of left ventricular force development and 19. Anderson, R. H., Becker, A. E., Brechenmacher, C., et al. (1975). The hu-
rise of left ventricular pressure over time (peak dP/dt) occurs dur- man atrioventricular junctional area. A morphological study of the A-V
ing isovolumic ventricular contraction. Peak dP/dt is sometimes node and bundle. European Journal of Cardiology, 3, 11–25.
used as a clinical measure of ventricular contractility. 20. Hecht, H. H., Kossmann, C. E., Childers, R. W., et al. (1973). Atrioven-
tricular and intraventricular conduction. Revised nomenclature and con-
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Diastolic Events 21. His, W. (1893). Die Thätigkeit des embryonalen Herzens und deren Bedeu-
Diastole comprises a greater portion of the cardiac cycle (approx- tung für die Lehre von der Herzbewegung beim Erwachsenen. [The function
imately 65%) than does systole (approximately 35%) at normal of the embryonic heart and its significance in the interpretation of the heart
action in the adult]. Arbeit aus der Medizin Klinik zu Leipzig, 14–50.
heart rates (see Table 1-6). At faster heart rates, both systole and 22. Hudson, R. E. (1967). Surgical pathology of the conducting system of the
diastole are shortened, diastole proportionally more so than sys- heart. British Heart Journal, 29, 646–670.
tole. For example, at a heart rate of 180 beats/min, diastole com- 23. Kent, A. (1914). The right lateral auriculo-ventricular junction of the
prises approximately 40% and systole approximately 60% of the heart. Journal of Physiology, 48, 22–24.
cardiac cycle. At fast heart rates, diastolic filling is increasingly im- 24. Kent, A. F. (1893). Researches on the structure and function of the mam-
malian heart. Journal of Physiology, 14, i2–254.
portant in terms of the decreased amount of time available for 25. Mahaim, I. (1947). Kent’s fibers and the A-V paraspecific conduction
ventricular and coronary artery filling, which may lead to im- through the upper connections of the bundle of His-Tawara. American
paired myocardial functioning. Heart Journal, 33, 651–653.
The jugular venous and the carotid arterial pulses normally re- 26. Mahaim, I., & Winston, M. (1941). Recherches d’lanatomic comparee et
du pathologic experimentale sur les connexions hautes du faisceau de His-
flect right and left heart events, respectively. All cardiovascular as- Tawara. Cardiologia, 5, 189–260.
sessment and treatment plans intimately depend on an apprecia- 27. Anderson, R. H., Becker, A. E., Brechenmacher, C., et al. (1975). Ven-
tion of the cardiac cycle. tricular preexcitation. A proposed nomenclature for its substrates. Euro-
pean Journal of Cardiology, 3, 27–36.
28. Massing, G. K., & James T. N. Anatomical configuration of the His bun-
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