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The Ca2*releasedduring the activation process(and bound to troponin C) is removed from the cytoplasm and returned to storagesitesin the SR by the SR Ca2*ATPase. ,pumping blood. (2) The rate of Ca2*uptake can be regulated,so that the rate of removal of cytoplasmic Ca2*can be adjusted. (3) This ATPaseis probably concentration-gradientdriven and may automatically operatefasterwhen more Ca2*is releasedfrom the SR. d. Changesin Na*-Ca2*exchange(the Ca2*turret pump). To prevent an increasingaccumulation of Caz*in the cell, the small amount of Ca}*that entersthe fiber during phase 2 of the action potential must be removed from the cytoplasm.

Afterloadl Afterload2 ln a Nutshell ESV2 ESVI EDV (constant) Figure l'4-15. The effect of changing afterload on SV. 2. Mitral regurgitation,patent ductus arteriosus,septaldefects,and arteriovenousfistulaeall representconditions in which the left ventricular afterload is reduced,resulting in an increasedstroke volume. The inverse relationship between afterload and stroke volume provides the rationale for vasodilator therapy in congestiveheart failure. 3 . In theseconditions, the left ventricular and diastolic volume generallyincreases,which in many casesallows a normal or near normal stroke volume to be maintained.

Pressurein peripheral veins is greatly affectedby gravity, reaching 90 mm Hg in the lower extremities in the upright human. However, the venous side is very compliant, and sudden changesin position allow the blood in the peripheral veins to stretch 58 Physiology the vesselwalls and transiently pool, thereby decreasingvenous return to the heart. Three main mechanismsare involved in maintaining venous blood flow toward the heart: a. Abdominothoracic pump of inspiration.

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2008 Kaplan USMLE Step 1 Home Study Program-Brand New Volume III: Organ Systems Book 1 by Kaplan

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