The physics of coronary blood flow. With a foreword by Y. C. Fung. (Q2569577)

This book is devoted to the study of a very complex subject -- the dynamics and physics of coronary blood flow -- which the author defines as the blood flow to the heart for its own metabolic needs. The complexity is reflected by the omission of a number of related areas such as microcirculation, venous return, the lymphatic system and regulatory mechanisms. With so much unknown in this complex system the author can focus mainly on the known and limits the study to that part of the coronary circulation extending from the coronary ostia at the base of the aorta to the capillary level of coronary vasculature to construct a model. In the first chapter a very good description of the heart and its basic functions are given. The heart, a very sophisticated small pump, is the most important element of the cardiovascular system. It not only supplies blood to every part of the body but it is also responsible for its own blood supply. Fortunately there are inbuilt regulatory mechanisms. Chapter 2 focuses on modeling preliminaries. Modelling here is justified on the grounds that there is an absence of adequate access to the systems for direct observations or measurements of pressure and flow. The basic elements of the lumped model-resistance (R) inductance (L) and capacitance (C) are introduced. In Chapter 3 the lumped model is discussed in more details. The starting point of any investigation has to be RLC in series. Special relevant cases are examined. One has to go beyond free dynamics in which the system's behaviour depends only on the internal characteristics. The external driving forces also affect the behaviour of the system. Chapter 4 focuses on ``Forced Dynamics of the RLC system''. An analysis is carried out for steady state dynamics. Chapter 5 examines the case of composite wave forms. While attention has been focused on a simple sine or cosine wave, the driving pressure in the dynamics of coronary circulation has a composite wave form such as cardiac pressure wave. Fourier analysis facilitates the bridging of the gap between one simple wave and a composite wave form. This then leads to the very core of the dynamics of the coronary circulation which is the relation between the form of the composite pressure driving the flow and the form of the resulting flow wave. This is the topic of Chapter 6 -- it examines composite pressure flow relations in several cases. The next three chapters focus on two different approaches to modeling the ``Lumped and Unlumped'' approaches. The author makes the following points: (a) the ideal unlumped model is outside of our reach because of among other things the overwhelming details of coronary vasculature and the high degree of variability in the details from one beat to another; (b) given the above one should therefore focus only on the broad features of scale and branching pattern; (c) one of the major differences between the lumped model (a black box) and the unlumped (an open box) is that the former is a function of time while the latter is a function of both time and space; (d) future work lies with the unlumped model. The final chapter is on ``Dynamic Pathology'' which like coronary blood flow can be disruptive. While an integrated model to deal with associated dynamics issues and pathologies does not exist, the lumped and the unlumped models can provide tools for a basic investigation. Or utilization of those models in combination with known dynamic features can provide some insight. Some of those possibilities are pursued in this chapter. This book deserves high praise. The clarity of its writing and the sequence and demonstrated mastery of the contents make it ``an easy to read'' and ``an easy to understand'' fascinating text. I strongly recommend it to all researchers in the field and to all libraries.