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Chapter 11
Cardiovascular System

Learning Objectives

Name the parts of the heart and associated blood vessels and their functions in the circulation of blood.
Trace the pathway of blood through the heart.
Identify and describe major pathologic conditions affecting the heart and blood vessels.

Learning Objectives (cont’d.)

Define combining forms that relate to the cardiovascular system.
Describe important laboratory tests and clinical procedures pertaining to the cardiovascular system, and recognize relevant abbreviations.
Apply your new knowledge to understand medical terms in their proper context, such as in medical reports and records.

Chapter 11
Lesson 11.1

Introduction

Cardiovascular System: delivers oxygen and nutrients to cells of body tissue
Heart (muscular pump)
Blood vessels (fuel line and transportation network)

What are three types of blood vessels in the body?
What are the primary differences between them? (See next slide.)

BLOOD VESSELS AND THE CIRCULATION OF BLOOD

Arteries are the vessels that lead oxygenated blood away from the heart.
Veins are thinner walled vessels compared to arteries. They move deoxygenated blood toward the heart from the tissues.
Capillaries are the smallest vessels. They form the point of exchange for oxygen and nutrients into body cells and waste products coming from body cells.

What are smaller branches of arteries called? (arterioles)
What are small veins that carry waste-filled blood back to the heart called? (venules)

BLOOD VESSELS

Point out the discrete layers of each vessel.
Compare and contrast the substructures of each type of vessel.
Why is the muscle layer in an artery thicker than that of a vein?

systemic circulation

Make sure students understand this basic flow in order to fully understand the pathology.
The anatomic terminology here is often associated with any pathology.

Major vessels

The major pulse points should be considered. For example, the brachial artery is important because blood pressure is routinely measured at this junction.
What symptoms are associated with potential blockage in these vessels?

Anatomy of the heart

Fill in the identified structures and mention their specific functions. Identify the major valves of the heart and important blood vessels.
Which of the four chambers has the thickest walls and why? (The left ventricle walls have three times the thickness of the right ventricle walls; it requires great force to pump blood throughout the body.)

Anatomy of the heart

Fill in the identified structures and mention their specific functions. Identify the major valves of the heart and important blood vessels.
Which of the four chambers has the thickest walls and why? (The left ventricle walls have three times the thickness of the right ventricle walls; it requires great force to pump blood throughout the body.)

Major valves of the heart

tricuspid valve (cusps are flaps of the valves): between right atrium and right ventricle
pulmonary valve: between right ventricle and pulmonary artery
mitral valve: between left atrium and the left ventricle
aortic valve: between left ventricle and aorta

Point these out on the diagram from the previous slide to reinforce.

Pathway of blood through the heart

Go through each step of how the blood travels through the heart.

HEARTBEAT AND HEART SOUNDS

Two phases of the heartbeat:
diastole: relaxation
systole: contraction
The diastole-systole cardiac cycle occurs between 70-80 times per minute (100,000 times per day).
The heart pumps 3 ounces of blood with each contraction. This means that about 5 quarts are pumped per minute (75 gallons an hour and about 2000 gallons a day).

Which valves open and which valves close during diastole? (The tricuspid and mitral valves open as blood passes from the right and left atria into the ventricles. The pulmonary and aortic valves close.)

Heart sounds

Closure of valves associated with sounds “lubb-dubb, lubb-dubb”

lubb: closure of the tricuspid and mitral valves at the beginning of systole
dubb: closure of the aortic and pulmonary valves at the end of systole
murmur: abnormal heart sound caused by improper valve closure

Borrow a stethoscope to demonstrate.
Audio recordings are also available online. Many also contain pathological sounds.

PHASES OF THE HEARTBEAT

Have students fill in the labels using this slide.

CONDUCTION SYSTEM OF THE HEART

sinoatrial node (SA node): pacemaker of the heart

pacemaker: origin of electrical impulse causing walls of the atria to contract and force blood into the ventricles (ending diastole)

Where in the heart is the SA node located? (in a small region of specialized muscle tissue in the posterior portion of the right atrium.)

Conduction system of the heart (cont’d.)

atrioventricular node (AV node): This sends the excitation wave to a bundle of specialized fibers called atrioventricular bundle or Bundle of His.
Bundle of His (pronounced “hiss”): Helps form conduction myofibers that extend to ventricle walls and stimulate them to contract, beginning systole. A short rest period follows.
The pacemaker begins wave of excitation again.
ECG or EKG (electrocardiogram): The record used to detect electrical changes in heart muscle as the heart beats.

Where is the AV node? (in the posterior portion of the interatrial septum)
The normal ECG shows five waves (deflections) that represent the electrical changes as a wave of excitation spreads through the heart. What are the deflections called? (P, QRS, and T waves.)

CONDUCTION SYSTEM OF THE HEART

Electrocardiogram

P wave = spread of excitation wave over the atria just before contraction; QRS wave = spread of excitation wave over the ventricles as the ventricles contract; T wave = electrical recovery and relaxation of ventricles. A heart attack (myocardial infarction or MI) can be recognized by an elevation in the S-T segment of the ECG. Thus, one type of MI is an S-T elevation MI or STEMI.

The EKG diagnoses electrical problems in the heart, such as arrhythmias.
Identify deflections on the EKG.
What is happening in the heart with each wave complex?

Electrocardiogram

The EKG diagnoses electrical problems in the heart, such as arrhythmias.
Identify deflections on the EKG.
What is happening in the heart with each wave complex?

Electrocardiogram

The EKG diagnoses electrical problems in the heart, such as arrhythmias.
Identify deflections on the EKG.
What is happening in the heart with each wave complex?

BLOOD PRESSURE

Blood pressure: The force that blood exerts on arterial walls.
Measured using sphygmomanometer
Expressed as a fraction:

systolic pressure/

diastolic pressure

example: 120/80 mm Hg

How does the sphygmomanometer work?
Compare this device to over-the-counter electronic monitors.
What effect does exercise have on blood pressure measurements?
What causes increases and decreases in blood pressure?

COMBINING FORMS
AND TERMINOLOGY

angi/o vessel
aort/o aorta
arter/o artery
arteri/o artery
ather/o yellowish plaque
atri/o atrium

Combining Form Meaning

COMBINING FORMS
AND TERMINOLOGY

brachi/o arm
cardi/o heart
cholesterol/o cholesterol
coron/o heart
cyan/o blue
myx/o mucus

Combining Form Meaning

COMBINING FORMS
AND TERMINOLOGY

ox/o oxygen
pericardi/o pericardium
phleb/o vein
sphygm/o pulse
steth/o chest
thromb/o clot

Combining Form Meaning

valvul/o valve
valv/o valve
vas/o vessel
vascul/o vessel
ven/o, ven/i vein
ventricul/o ventricle

Combining Form Meaning

COMBINING FORMS
AND TERMINOLOGY

QUICK QUIZ:

The double-layered membrane surrounding the heart is the ___________

pericardium

arteriole

endocardium

endothelium

CORRECT Answer is A, pericardium

QUICK QUIZ:

2. The contraction phase of the heartbeat is called _________

diastole

vena cava

systole

septum

CORRECT Answer is C, systole.

Chapter 11
Cardiovascular System
Lesson 11.2

PATHOLOGY:
THE HEART AND BLOOD VESSELS

HEART

arrhythmias

Bradycardia and heart block (atrioventricular block)

Flutter

Fibrillation:

Atrial AF

Ventricular VF

What device establishes normal heart rhythm?
What term describes the action of applying a defibrillator to give an electric shock to the heart?
On the list, which terms are associated with “palpitations”?

PATHOLOGY:
THE HEART AND BLOOD VESSELS

HEART

congenital heart disease

coarctation of the aorta (CoA)

patent ductus arteriosus (PDA)

septal defects (ASD and VSD)

tetralogy of Fallot

What is a “blue baby”?
In terms of septal defects, what are two recent procedures that serve as alternatives to traditional surgery? (trans-catheter closure and minimally invasive heart surgery)

PATHOLOGY:
THE HEART AND BLOOD VESSELS

HEART

Congestive heart failure (CHF): The heart is unable to pump the required amount of blood.

In U.S., primarily the result of high blood pressure and coronary artery disease (see next slide)

Results in pulmonary edema

Fatal if untreated

What drugs improve the performance of the heart and its pumping activity? (angiotensin-converting enzyme (ACE) inhibitors and beta-blockers)
What device do patients awaiting a transplant use to help assist the heart’s pumping? (a left ventricular assist device or LVAD)

PATHOLOGY:
THE HEART AND BLOOD VESSELS

HEART

coronary artery disease (CAD)

Atherosclerosis

thrombotic occlusion

ischemia

necrosis

myocardial infarction

Acute Coronary Syndrome (ACS)

unstable angina (chest pain)

myocardial infarction (MI)

What is atherosclerosis? (the deposition of fatty compounds on the inner lining of the coronary arteries)
What is ACS? (It describes the consequences after plaque rupture in coronary arteries.)
What is unstable angina? (chest pain at rest or chest pain of increasing frequency)

PATHOLOGY:
THE HEART AND BLOOD VESSELS

HEART

Coronary artery disease

Drug therapies for CAD

nitrates –nitroglycerin (vasodilator)

Aspirin (Anticoagulant)

calcium channel blockers (muscle relaxant)

Statins ( lower cholesterol levels)

What drug is given for acute attacks of angina? (Nitroglycerin is given sublingually.)
This drug is one of several nitrates that is a powerful vasodilator that increases coronary blood flow and lowers blood pressure.
What do statins do?

PATHOLOGY:
THE HEART AND BLOOD VESSELS

HEART

Coronary artery disease

Surgical therapies for CAD

percutaneous coronary intervention (PCI) – Catheterization with balloons and stents open clogged arteries
coronary artery bypass grafting (CABG) – open heart surgery replacing clogged vessels.

What is CABG? (an open heart operation to treat coronary artery disease by replacing clogged vessels)
What is PTCA? (catheterization with balloons and stents opens clogged coronary arteries)
What is TMLR? (a laser makes holes in the heart muscle to induce angiogenesis or growth of new blood vessels)

PATHOLOGY:
THE HEART AND BLOOD VESSELS

HEART

Other Pathologic conditions

endocarditis (vegetations)
hypertensive heart disease
mitral valve prolapse (MVP)
murmur
pericarditis
rheumatic heart disease

What is endocarditis? (inflammation of the inner lining of the heart caused by bacteria)
What is MVP? (improper closure of the mitral valve)
What is rheumatic heart disease? (heart disease caused by rheumatic fever)

PATHOLOGY:
THE HEART AND BLOOD VESSELS

BLOOD VESSELS

aneurysm
deep vein thrombosis (DVT)
hypertension (HTN)
peripheral vascular disease (PVD)
Raynaud disease
varicose veins

What is PVD? (blockage of blood vessels outside the heart)
A sign of PVD in the lower extremities is intermittent claudication, an absence of pain or discomfort in a leg at rest, but a recurrence of pain, tension, and weakness after walking has begun.
What are the signs of Raynaud disease?

QUICK QUIZ:

3. Which arrhythmia refers to rapid, random, inefficient and irregular contractions of the atria and ventricles (350 beats or more per minute)?

fibrillation

flutter

bradycardia

CORRECT Answer is A, fibrillation

Chapter 11
Lesson 11.3

LABORATORY TESTS

BNP test
Cardiac biomarkers
lipid test profile
lipoprotein electrophoresis

What are lipid tests?
What is lipoprotein electrophoresis? Why is this test ordered?
What are serum enzyme tests? Why is this test ordered?

CLINICAL PROCEDURES: DIAGNOSTIC

X-Ray

angiography and arteriography
computerized tomography angiography
digital subtraction angiography (DSA)
Electron beam computed tomography (EBCT or EBT)

Ultrasound Tests

Doppler ultrasound
echocardiography (ECHO)

What determines when each of these tests should be used?
Differentiate between invasive and noninvasive diagnostic tests.

CLINICAL PROCEDURES: DIAGNOSTIC

Nuclear Cardiology

positron emission tomography (PET) scan
technetium (Tc) 99m Sestamibi scan (Cardiolite)
Thallium-201 scan

Magnetic Resonance Imaging (MRI)

cardiac MRI

Are there any risks or side effects from having these tests performed?

CLINICAL PROCEDURES: DIAGNOSTIC

Other diagnostic procedures:

cardiac catheterization
electrocardiography (ECG, EKG)
Holter monitoring
stress test (ETT)

What is the anticipated or theorized cardiac problem that leads a person to get a test?
Be as specific as possible when describing the procedures. Find one unique thing about each test that makes it memorable. Have the students help you do this.

CLINICAL PROCEDURES: DIAGNOSTIC

Identify the normal sinus rhythm and arrhythmias

CLINICAL PROCEDURES: DIAGNOSTIC

A Normal sinus rhythm. Notice the regularity of the P, QRS, and T waves.

B Atrial flutter. Notice the rapid atrial rate (P wave) compared to the slower ventricular rate (ARS).

C Atrial fibrillation. P waves are replaced by irregular and rapid fluctuations. There are no effective atrial contractions.

D Ventricular tachycardia. Ventricular rate may be as high as 250 beats per minute. The rhythm is regular, but the atria are not contributing to ventricular filling and blood output is poor.

CLINICAL PROCEDURES: TREATMENT

Defibrillation
endarterectomy
extracorporeal circulation
heart transplantation
thrombolytic therapy

Use photographs or online images to show some of the equipment used routinely to diagnose and treat the heart during acute abnormalities.

CLINICAL PROCEDURES
Treatment

Coronary artery bypass graft (CABG) surgery. A, Section of a vein is removed from the leg and anastomosed to a coronary artery to bypass an area of arteriosclerotic blockage. B, An internal mammary artery is grafted to a coronary artery to bypass blockage.

Treatment procedures (cont’d.)

percutaneous coronary intervention (PCI)
includes: percutaneous transluminal coronary angioplasty (PTCA), stent placement, laser angioplasty, and atherectomy

Abbreviations

MI
PCI
HTN
LDL
ECHO

CABG
MVP
ETT
HDL

Ask students to identify the terms associated with these abbreviations.

QUICK QUIZ:

4. Which procedure involves insertion of a balloon-tipped catheter into a coronary artery?

thrombolytic therapy

coronary artery bypass grafting

percutaneous coronary intervention

endarterectomy

CORRECT Answer is C, percutaneous coronary intervention (also known as PCI) see page 415 for more information.

COMBINING FORMS

angi/o ______________

aort/o ______________

arter/o ______________

arteri/o ______________

ather/o ______________

atri/o ______________

Combining Form Meaning

REVIEW SHEET

COMBINING FORMS

angi/o vessel
aort/o aorta
arter/o artery
arteri/o artery
ather/o yellowish plaque
atri/o atrium

Combining Form Meaning

REVIEW SHEET

COMBINING FORMS

brachi/o ______________

cardi/o ______________

cholesterol/o ______________

coron/o ______________

cyan/o ______________

myx/o ______________

Combining Form Meaning

REVIEW SHEET

COMBINING FORMS

brachi/o arm
cardi/o heart
cholesterol/o cholesterol
coron/o heart
cyan/o blue
myx/o mucus

Combining Form Meaning

REVIEW SHEET

COMBINING FORMS

ox/o ______________

pericardi/o ______________

phleb/o ______________

sphygm/o ______________

steth/o ______________

thromb/o ______________

Combining Form Meaning

REVIEW SHEET

COMBINING FORMS

ox/o oxygen
pericardi/o pericardium
phleb/o vein
sphygm/o pulse
steth/o chest
thromb/o clot

Combining Form Meaning

REVIEW SHEET

COMBINING FORMS

valvul/o ______________

valv/o ______________

vas/o ______________

vascul/o ______________

ven/o, ven/i ______________

ventricul/o ______________

Combining Form Meaning

REVIEW SHEET

COMBINING FORMS

valvul/o valve
valv/o valve
vas/o vessel
vascul/o vessel
ven/o, ven/i vein
ventricul/o ventricle

Combining Form Meaning

REVIEW SHEET

SUFFIXES

-constriction ______________

-dilation ______________

-emia ______________

-graphy ______________

-lysis ______________

-megaly ______________

Suffix Meaning

REVIEW SHEET

SUFFIXES

-constriction narrowing
-dilation widening; stretching; expanding
-emia blood condition
-graphy process of recording
-lysis breakdown; separation;

destruction; loosening

-megaly enlargement

Suffix Meaning

REVIEW SHEET

SUFFIXES

-meter ______________
-oma ______________
-osis ______________
-plasty ______________
-sclerosis ______________
-stonosis ______________
-tomy ______________

REVIEW SHEET

Suffix Meaning

SUFFIXES

-meter measure
-oma tumor; mass; fluid collection
-osis condition; usually abnormal
-plasty surgical repair
-sclerosis hardening
-stonosis tightening; structure
-tomy process of cutting

REVIEW SHEET

Suffix Meaning

PREFIXES

a-, an ______________

brady- ______________

de- ______________

dys- ______________

endo- ______________

hyper- ______________

Prefix Meaning

REVIEW SHEET

PREFIXES

a-, an no; not; without
brady- slow
de- lack of; down; less; removal of
dys- bad; painful; difficult; abnormal
endo- in; within
hyper- above; excessive

Prefix Meaning

REVIEW SHEET

PREFIXES

hypo- ______________

inter- ______________

peri- ______________

tachy- ______________

tetra- ______________

tri- ______________

Prefix Meaning

REVIEW SHEET

PREFIXES

hypo- deficient; below; under; less than

normal

inter- between
peri- surrounding
tachy- fast
tetra- four
tri- three

Prefix Meaning

REVIEW SHEET