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Chapter 11 Cardiovascular System. Blood Vessels- (angi/o); (vas/o; vascul/o) –1. Arteries (arter/o; arteri/o) The large vessels that lead away from the.

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Presentation on theme: "Chapter 11 Cardiovascular System. Blood Vessels- (angi/o); (vas/o; vascul/o) –1. Arteries (arter/o; arteri/o) The large vessels that lead away from the."— Presentation transcript:

1 Chapter 11 Cardiovascular System

2 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 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

3 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 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

4 Pulmonary Embolism

5 Copyright © 2001 by W. B. Saunders Company. All rights reserved. Atherosclerosis. Fig (Modified from Kumar V, Cotran R, Robbins SL: Basic Pathology, 6th ed. Philadelphia, WB Saunders, 1997, page 319.) Forward Back MENU

6 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 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

7 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 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

8 Copyright © 2001 by W. B. Saunders Company. All rights reserved. Blood vessels. Fig (Some parts modified from Damjanov I: Pathology for the Health-Related Professions. Philadelphia, WB Saunders, 1996, page 155.) Forward Back MENU

9 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) 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)

10 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 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

11 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 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

12 Copyright © 2001 by W. B. Saunders Company. All rights reserved. The walls of the heart and pericardium. Fig Forward Back MENU

13 Copyright © 2001 by W. B. Saunders Company. All rights reserved. The aorta and arteries. Fig Forward Back MENU

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

15 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 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

16 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 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

17 Copyright © 2001 by W. B. Saunders Company. All rights reserved. Pathway of blood through the heart. Fig Forward Back MENU

18 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 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

19 Copyright © 2001 by W. B. Saunders Company. All rights reserved. Phases of the heartbeat. Fig Forward Back MENU

20 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 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

21 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 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

22 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 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

23 Copyright © 2001 by W. B. Saunders Company. All rights reserved. A) Conduction system of the heart. B) Electrocardiogram. Figs / (Part B from Applegate MS: The Anatomy and Physiology, 6th ed. Philadelphia, WB Saunders, 1997, page 253.) Forward Back MENU 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

24 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 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

25 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 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

26 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 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

27 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- 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)

28 Endocarditis

29 Coronary Artery Disease

30 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 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

31 Mitral Valve Prolapse

32 Rheumatic Heart Disease

33 Petechiae- Pinpoint hemorrhages (epicardium of heart) Often due to low platelet count.

34 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 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

35 Laboratory Procedures Ultrasound- –Doppler ultrasound: sound waves on a blood vessel –Echocardiography (ECHO)- pulses of high- frequency sound waves and shows valves, chambers, and surfaces of the heart X-Ray –Angiography- dye injected into blood steam and x- ray taken of heart and vessels –Digital subtraction angiography (DSA)- x-ray done then dye injected and x-ray taken; a comparison is then done Ultrasound- –Doppler ultrasound: sound waves on a blood vessel –Echocardiography (ECHO)- pulses of high- frequency sound waves and shows valves, chambers, and surfaces of the heart X-Ray –Angiography- dye injected into blood steam and x- ray taken of heart and vessels –Digital subtraction angiography (DSA)- x-ray done then dye injected and x-ray taken; a comparison is then done

36 Echocardiography

37 Echocardiogram

38 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 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

39 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 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

40 Cardiac Catheterization

41 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 heart’s 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) 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 heart’s 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)

42 Abbreviations AV BP CABG CAD CCU Cath CHF CPK DVT ECG, EKG ECHO HDL LDL LDH MI VT AV BP CABG CAD CCU Cath CHF CPK DVT ECG, EKG ECHO HDL LDL LDH MI VT

43 Scenario Mr. AchyBrachyHeart was seen by the EMT’s and found to have tachycardia. Lidocaine (a cardiac antiarrhymic drug) was started and by the time he reached the ER his HR was 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. Mr. AchyBrachyHeart was seen by the EMT’s and found to have tachycardia. Lidocaine (a cardiac antiarrhymic drug) was started and by the time he reached the ER his HR was 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.

44 Copyright © 2001 by W. B. Saunders Company. All rights reserved. Coronary artery bypass graft (CABG) surgery. Fig Forward Back MENU

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


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