Chapter 11 Cardiovascular System Cardiovascular System Blood Vessels-

Chapter 11 Cardiovascular System Cardiovascular System  Blood Vessels-

Chapter 11 Cardiovascular System Cardiovascular System Blood Vessels- (angi/o); (vas/o; vascul/o) 1. Arteries (arter/o; arteri/o) The large vessels that lead away from the heart Walls of are made of connective tissues, muscle tissue, elastic fibers, and epithelial cells Elastic walls allow for expansion as heartbeat forces blood into the system Small branches of arteries are called arterioles. Arterioles are thinner and carry blood to the

tiniest of blood vessels, the capillaries Arterial Conditions in Blood vessels Aneurysm- a local widening of an artery Hypertension- high blood pressure Peripheral vascular disease- claudication Raynaud phenomenon Embolus- floating blood clot or other material in the vessel Atherosclerosis- hardening of the arteries caused by fatty or calcium deposits in the artery walls causing them to thicken

Pulmonary Embolism Atherosclerosis. Atherosclerosis. Fig. Fig. 11-11. 11-11. (Modified from Kumar V, Cotran R, Robbins SL: Basic Pathology, 6th ed. Philadelphia, WB Saunders, 1997, page 319.) Copyright 2001 by W. B. Saunders Company. All rights reserved.

Back MENU Forward Capillaries Walls are only one endothelial cell thick Carry nutrient-rich, oxygenated blood from the arteries and arterioles to the body cells Waste products (CO2 and H2O) pass out of the cell and into the thin-wall capillaries

Waste-filled blood then flows back to the heart in venuoles, which branch to form veins Veins (phleb/o; ven/o) Thinner walled than arteries Conduct blood toward the heart from the tissues Lower pressure than arteries Veins have valves to prevent backflow of blood and keep the blood moving in one direction Muscular action helps movement of blood Varicose Veins Phlebitis- inflammation of a vein

Phlebotomy- incision of a vein Blood Blood vessels. vessels. (Some parts modified from Damjanov I: Pathology for the Health-Related Professions. Philadelphia, WB Saunders, 1996, page 155.) Copyright 2001 by W. B. Saunders Company. All rights reserved.

Back MENU Fig. Fig. 11-1. 11-1. Forward Anatomy of the Heart

Heart- (cardi/o; coron/o) It is a two-sided double pump; Rt side of heart send O2 deficient blood to lungs where the blood picks up O2 and releases CO2 O2 rich blood returns to left side of heart and left side of heart pumps blood to rest of the body Size of your fist Lies in the thoracic cavity Four Chambers: Two upper chambers called atrium

Two lower chambers called ventricles (ventricul/o) Anatomy of the heart Four Valves; (valvul/o; vavl/o) cusps or flaps of valves Tricuspid- b/w rt atrium and rt ventricle Pulmonary- b/w rt ventricle and pulmonary artery Mitral- b/w left atrium and left ventricle Aortic- prevents return of aortic blood to left ventricle Patent= to open

Anatomy of the heart Septum- divides the right side of the heart from the left side; wall or portion within heart Three layers of the heart: Endocardium- smooth cells that line the inside of the heart and valves Myocardium- the thickest layer, consists of muscle tissue; this layer pumps blood throughout the body Pericardium (pericardi/o)- double membrane that covers the outside of the heart. Prevents damage from ribs and surrounding structures (pads the heart) *Cardiomyopathy- disease of heart muscle

The The walls of of the the heart heart and pericardium. Fig. Fig. 11-5. 11-5. Copyright 2001 by W. B. Saunders Company. All rights reserved. Back

MENU Forward The The aorta aorta and and arteries. arteries. Fig. Fig. 11-3.

11-3. Copyright 2001 by W. B. Saunders Company. All rights reserved. Back MENU Forward Structure Structure of the heart. Fig.

Fig. 11-4. 11-4. (Modified from Damjanov I: Pathology for the Health-Related Professions. Philadelphia, WB Saunders, 1996, page 154.) Copyright 2001 by W. B. Saunders Company. All rights reserved. Back MENU Forward

Pulmonary Circulation

Superior and Inferior Vena Cava Right Atrium Tricuspid Valve Right Ventricle Pulmonary Valve Pulmonary Artery Lungs Pulmonary Vein Left Atrium Mitral Valve Left Ventricle

Aortic Valve Aorta (aort/o) To body Systemic Circulation O2 rich blood leaves heart thru the aorta the largest artery in the body Ascending aorta Descending aorta Arteries Arterioles Tissue Capillaries Venules

Veins Superior and Inferior Vena Cava Pathway Pathway of of blood blood through through the the heart. heart. Fig. Fig. 11-6.

11-6. Copyright 2001 by W. B. Saunders Company. All rights reserved. Back MENU Forward Physiology of the Heart Heartbeat (2 phases)

1. Diastole= relaxation Blood comes from the vena cava and pulmonary veins Tricuspid and mitral valves open Pulmonary and aortic valves closed 2. Systole= contraction phase of heart - Ventricles contract to pump blood via pulmonary artery and aorta - Tricuspid and mitral valve are closed Phases Phases of of the

the heartbeat. heartbeat. Fig. Fig. 11-7. 11-7. Copyright 2001 by W. B. Saunders Company. All rights reserved. Back MENU Forward

Physiology of Heart Diastole-Systole Cycle 70-80 times per minute 5 quarts of blood per minute 75 gallons per hour 2000 gallons per day Heart Sounds lub sound= closure of tricuspid valve and mitral valves at the beginning of systole and is first heart sound dub sound= closure of aortic and pulmonary valves at end of systole and is second heart sound

murmur= abnormal heart sound Physiology of heart Conduction System Sinoatrial Node (SA node)= pacemaker of the heart; sensitive tissue in the rt atrium wall that begins the heart beat Posterior of rt atrium Electrical impulse Atria contracts and force blood into the ventricle Physiology of Heart

Atrioventricular Node- (AV node)= sends the electrical wave to the Bundle of HIS (muscle fibers); located in posterior portion of inter-arterial septum Bundle of HIS= divides right and left bundle branches to the ventricle walls and stimulate them to contract Systole occurs and blood is pumped away from the heart Diastole= short period of rest A) A) Conduction

Conduction system system of of the the heart. heart. B) B) Electrocardiogram. P wave= spread of excitation over atria before contraction QRS wave= spread of excitation over ventricles as contraction occurs

T wave= electrical recovery and relaxation of ventricles Figs. Figs. 11-8 11-8 // 11-9. 11-9. (Part B from Applegate MS: The Anatomy and Physiology, 6th ed. Philadelphia, WB Saunders, 1997, page 253.) Copyright 2001 by W. B. Saunders Company. All rights reserved. Back

MENU Forward Blood Pressure Blood pressure= force that the blood exerts on the arterial walls Sphygmomanometer- a device to measure blood pressure (sphygm/o=pulse) Auscultation- to listen with a stethoscope First sound= systolic pressure (pressure in the artery when the left ventricle is contracting to force

the blood into the aorta); pumping blood to the body Second sound= diastolic blood pressure (pressure in the artery when the ventricles are relaxing and the heart is filling); when the heart relaxes Written as a fraction: 120/80= systolic/diastolic Pathological Conditions Ischemia- can lead to a Myocardial Infarction (MI); blood held from an area and can be caused by thrombotic occlusion of a blood vessel Arrhythmia- abnormal heart rhythms Heart block (AV block); failure of proper

conduction of impulses thru AV node to AV Bundle of HIS; pacemakers can help Flutter- rapid but regular contraction of atria or ventricles Fibrillation- rapid, random, ineffectual contraction of the heart Palpitations- uncomfortable sensations in the chest Pathological Conditions Congenital Heart Disease- abnormalities in the heart at birth Coarctation of the Aorta (CoA)

Patent ductus arteriosus (PDA) Septal defects- sm holes in the septa b/w atria or ventricles Tetralogy of Fallot (pg 389) Pulmonary artery stenosis Ventricular septal defect Shift of aorta to the right Hypertrophy of right ventricle Pathological Conditions

Endocarditis- inflammation of inner lining of heart due to bacteria Congestive Heart Failure- heart is unable to pump required amount of blood Coronary Artery Disease- (CAD); blockage of arteries surrounding the heart and leads to ischemia MI= Myocardial Infarction (Heart Attack) Angina pectoris= chest pain; nitroglycerin can help: vasodilator (relaxes vessels) Endocarditis Coronary Artery Disease

Pathological Conditions Hypertensive heart disease- high blood pressure Mitral Valve Prolapse (MVP)- improper closure of the mitral valve Murmur- extra heart sound between beats Pericarditis- inflammation of membrane surrounding heart Rheumatic heart disease- heart disease caused by strep infection Cyanosis- bluish coloration of skin

Mitral Valve Prolapse Rheumatic Heart Disease PetechiaePinpoint hemorrhages (epicardium of heart) Often due to low platelet count. http://www-medlib.med.utah.edu/WebPath/ATHHTML/ATH035.html

Laboratory Tests Serum Enzyme- when the heart is damaged the tissues release enzymes into blood stream CPK-creatine phosphokinase LDH- lactate dehydrogenase Lipoprotein electrophoresis- proteins that carry lipids in blood steam (LDL& HDL)

Lipid tests- tests amount of cholesterol and triglycerides Lipids are fatty substances found in foods Laboratory Procedures Ultrasound Doppler ultrasound: sound waves on a blood vessel Echocardiography (ECHO)- pulses of highfrequency sound waves and shows valves, chambers, and surfaces of the heart X-Ray Angiography- dye injected into blood steam and xray taken of heart and vessels Digital subtraction angiography (DSA)x-ray done then dye injected and x-ray taken; a

comparison is then done Echocardiography Echocardiogram Procedures MRI- Magnetic Resonance Image; beamed at heart and image is produced Nuclear Cardiology Positron Emission Tomography (PET)- IV radiopharmaceutical and glucose injected then images are made; localizes in the

myocardium Thallium 210 Scintigraphy- radioactive isotope given IV; taken up by myocardial tissue and then scarred tissue does not extract the isotope Procedures Cardiac Cath- incision in the groin and a catheter is threaded into the circulatory system to the heart Cardioversion (defibrillation)- discharge of electricity applied across the chest to stop arrhythmia

Coronary Bypass surgery- (CABG) vessel grafts are anastomosed to detour around blockages Electrocardiography (EKG,ECG)- recording of the electricity of the heart Normal sinus rhythm= normal heart beat Cardiac Catheterization Procedures Endarterectomy- surgical removal of the innermost lining of an artery Heart Transplantation- a donor heart is transferred to recipient

Holter Monitoring- monitor attached to chest to record cardiac activity for 24 hours and an EKG is taken during daily activities Stress Test- determines the hearts response to physical exertion Thrombolytic therapy- drugs used to dissolve clots; must be done within 12 hours after the onset of a heart attack (thromb/o=clot) Abbreviations

AV BP CABG CAD CCU Cath CHF CPK DVT ECG, EKG ECHO HDL

LDL LDH MI VT Scenario Mr. AchyBrachyHeart was seen by the EMTs and found to have tachycardia. Lidocaine (a cardiac antiarrhymic drug) was started and by the time he reached the ER his HR was 75-80 bpm with a normal sinus rhythm. BP was 156/88. He had a good carotid pulse bilaterally. No cardiomegaly and no murmurs.

He was started on a cardiac monitor and observed for any EKG change. He had no episodes of hypotension and no further arrhythmia. There was no evidence to do cardiac enzyme studies and patient was discharged. Coronary Coronary artery artery bypass bypass graft graft (CABG) (CABG) surgery. surgery.

Fig. Fig. 11-23. 11-23. Copyright 2001 by W. B. Saunders Company. All rights reserved. Back MENU Forward Placement

Placement of an intracoronary artery stent. Fig. Fig. 11-25ABC. 11-25ABC. Copyright 2001 by W. B. Saunders Company. All rights reserved. Back MENU

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