CARDIOVASCULAR SYSTEM  The left side pumps to the remainder of the body

through the systemic circuit

 Blood circulates throughout the body in the
cardiovascular system, which consists of the heart BLOOD FLOW THROUGH THE HEART
and the blood vessels  The sequence is as follows:
 This system forms a continuous circuit that 1. The right atrium receives blood low in oxygen
delivers oxygen and nutrients to all cells and from all body tissues through the superior
carries away waste products vena cava and the inferior vena cava
 The lymphatic system also functions in 2. The blood then enters the right ventricle and is
circulation. pumped to the lungs through the pulmonary
 Its vessels drain fluid and proteins left in the artery
tissues and return them to the bloodstream 3. Blood returns from the lungs high in oxygen
LOCATION OF THE HEART and enters the left atrium through the
pulmonary veins.
 located between the lungs, with its toward the 4. Blood enters the left ventricle and is forcefully
inferior and left point, or apex, directed pumped into the aorta to be distributed to all
 The wall of the heart consists the root cardi, tissues
meaning "heart." of three layers, all named with
Moving from the innermost to the outermost PARTS OF THE HEART
layer, these are the:  The heart is divided into right and left sides.
o Endocardium-a thin membrane that lines the  The left side of the heart pumps oxygen-rich
chambers and valves (the prefix endo- means blood from the lungs to all other areas of the body
"within").  The right atrium and right ventricle on the right
o Myocardium-a thick muscle layer that makes side are separated from the left atrium and left
up most of the heart wall (the root my/o means ventricle on the left side by a muscular partition
muscle"). called a septum (plural, septa)
o Epicardium-a thin membrane that covers the
STRUCTURE AND FUNCTION
heart (the prefix epi- means "on").
 A fibrous sac, the pericardium, contains the heart  The heart pumps blood through the blood vessels
and anchors it to surrounding structures, such as to all the cells of the body
the sternum (breastbone) and diaphragm (the  The average adult heart is about 5 inches long and
prefix peri- means "around") • 3.5 inches wide and weighs anywhere from 7
 Each of the heart's upper receiving chambers is an ounces to almost 14 ounces, depending on an
atrium (plural atria). Each of the lower pumping individual's size and gender.
chambers is a ventricle (plural: ventricles).
 The chambers of the heart are divided by walls, VALVES OF THE HEART
each of which is called a septum.  Atrioventricular (AV) valves. The valves between
 The interventricular septum separates the two the atrium and ventricle on each side of the heart.
ventncles: the interatrial septum divides the two One-way valves in the heart keep blood moving in
atria a forward direction.
 There is also a septum between the atrium and o Tricuspid valve-The valve between the right
ventricle on each side atrium and ventricle is the right AV valve, has
 The heart pumps blood through two circuits. three cusps (flaps)
 The right side pumps blood to the lungs to be o Mitral valve-The valve between the left atrium
oxygenated through the pulmonary circuit. and ventricle is the left AV valve, has two
 cusps (named for a miter, the pointed, two- 1. Sinoatrial (SA) node, located in the upper
sided hat worn by bishops). right atrium and called the pacemaker
o Semilunar valves (lunar refers to the moon)- because it sets the rate of the heartbeat.
The valves leading into the pulmonary artery Normal heart rhythm is Sinus Rhythm
and the aorta have three cusps. Pulmonary Heart rate (60 to 100 in normal adult)
valve-The valve at the entrance to the 2. Atrioventricular (AV) node located at the
pulmonary artery bottom of the right atrium near the
o Aortic valve -the valve at the entrance to the ventricle. Internodal fibers between the SA
aorta and AV nodes carry stimulation
throughout both atria
HEART SOUNDS 3. AV bundle (bundle of His) at the top of the
 are produced as the heart functions interventricular septum.
 The loudest of these, the familiar "lub" and "dup" 4. Left and right bundle branches, which
that can be heard through the chest wall, are travel along the left and right sides of the
produced by alternate closings of the valves septum
o (S1) -is heard when the valves between the 5. 5. Purkinje (pur-KIN-je) fibers, which
chambers close carry stimulation throughout the walls of
o (S2) -is produced when the valves leading into the ventricles
the aorta and pulmonary artery close Although the heart itself generates the
o Functional murmur-Any sound made as the heartbeat, factors such as nervous
system stimulation, hormones, and
heart functions normally
drugs can influence the rate and the
o Murmur-used alone with regard to the heart
force of contractions
describes an abnormal sound.
ELECTROCARDIOGRAPHY
THE HEARTBEAT
 Electrocardiography (ECG) measures the heart's
 Each contraction of the heart, termed systole (SIS-
electrical activity as it functions (FIG. 10-5).
to-le), is followed by a relaxation phase, diastole
 Electrodes (leads) placed on the body's surface
(di-AS-to-le) during which the chambers fill Each
detect the electrical signals, which are then
time the heart beats, both atria contract, and
amplified and recorded as a tracing
immediately thereafter both ventricles contract
 A normal, or sinus rhythm, which originates at the
 The number of times the heart contracts per
SA node, is shown in FIGURE 10-5A FIGURE
minute is the heart rate. The wave of increased
10-58 shows the letters assigned to individual
pressure produced in the vessels each time the
components of one complete cycle
ventricles contract is the pulse
1. The P wave represents electrical change,
o Pulse rate- is usually counted by palpating
or depolarization of the atrial muscles
a peripheral artery, such as the radial
2. The QRS component shows depolarization
artery at the wrist or the carotid artery in
of the ventricles
the neck
3. T wave shows return, or repolarization of
CARDIAC CONDUCTION SYSTEM the ventricles to their resting state Atrial
repolanzation is hidden by the QRS wave
 Cardiac contractions are stimulated by a built-in 4. The small U wave, if present, follows the
system that regularly transmits electrical impulses T wave It is of uncertain origin
through the heart Components of conduction
system in sequence VASCULAR SYSTEM
  The vascular system consists of o Arteriole- A small vessel that carries blood
1. Arteries that carry blood away from the from the arteries into the capillaries (root:
heart (FIG. 10-6) arteriol/o)
2. Arterioles, vessels smaller than arteries o atrioventricular (AV) node- A small mass in
that lead into the capilanes the lower septum of the right atrium that
3. Capillaries, the smallest vessels, through passes impulses from the sinoatrial (SA) node
which exchanges take place between the toward the ventricles
blood and the tissues o atrioventricular (AV) valve- A valve between
4. Venules, small vessels that receive blood the atrium and ventricle on the right and left
from the capillaries and ran into the veins sides of the heart, the right AV valve is the
5. Veins that carry blood back to the heart tricuspid valve; the left is the mitral valve
BLOOD PRESSURE o Atrium- An entrance chamber, one of the two
upper receiving chambers of the heart (root:
 is the force exerted by blood against the wall of a at/n)
blood vessel o AV bundle-A band of fibers that transmits
o Systole reported as the first (contraction) impulses from the atrioventricular (AV) node
o Diastole is the second (relaxation) to the top of the interventricular septum; it
 A typical normal systolic pressure is less than 120 divides into the right and left bundle branches,
mm Hg, and a typical normal diastolic pressure is which descend along the two sides of the
less than 80 mm Hg septum, the bundle of His
 Pulse pressure (40) represents the difference o blood pressure-The force exerted by blood
between the diastolic and systolic readings against the wall of a vessel
Terminology- Key Terms o bundle branches- Branches of the AV bundle
that divide to the right and left sides of the
 The terms listed below are emphasized in this interventricular septum
chapter. Knowing them will help you organize o capillary- A microscopic blood vessel through
and prioritize your learning. These boldface terms which materials are exchanged between the
are also found, collectively, with all chapter key blood and the tissues
terms in the Glossary. o cardiovascular system - The part of the
 Cardiovascular System (Normal Structure and circulatory system that consists of the heart
Function) and the blood vessels
o Aorta- The largest artery, it receives blood o coronary circulation- The blood vessels in the
from the left ventricle and branches to all parts heart that provide oxygen and nourishment
of the body (root: aort/ο) and remove waste products from the
o aortic valve- The valve at the entrance to the myocardium
aorta o depolarization- A change in electrical charge
o Apex- The point of a cone shaped structure from the resting state in nerves or muscles
(adjective: apical); the apes of the heart is o diastole - The relaxation phase of the heartbeat
formed by the left ventricle and is pointed cycle (adjective: diastolic di-AS-to-le
toward the inferior and left o electrocardiography - Study of the electrical
o Artery- A vessel that carries blood away from activity of the heart as detected by electrodes
the heart, all except the pulmonary and (leads)placed on the surface of the body; also
umbilical arteries carry oxygenated blood abbreviated EKG from the German
(roots: arter, arteri/o) electrocardiography
o endocardium- The thin membrane that lines o Purkinje fibers - the terminal fibers of the
the chambers of the heart and covers the cardiac conducting system, they carry
o epicardium - The thin outermost layer of the impulses through the walls of the ventricles
heart wall o Repolarization- A return of electrical charge to
o functional murmur - Any sound produced as the resting stare is nerves or muscles
the heart functions normally o right AV valve- The valve between the right
o heart - The muscular organ with four atrium and right ventricle: the tricuspid valve
chambers that contracts rhythmically to propel o septum- A wall dividing two cavities, soch as
blood through vessels to all parts of the body two chambers of the heart
(root: cardio) o sinus rhythm- Normal heart rhythm
o heart rate- The number of times the heart o sinoatrial (SA) node- A small mass in the
contracts per minute, recorded as beats per upper part of the right strium that witiates the
minute (bpm) the pacemaker
o heart sounds- Sounds produced as the heart o sphygmomanometer- An instrument for
functions: the two loudest sounds are determining arterial blood pressure
produced by alternate closing of the valves o superior vena cava- The large superior vein
and are designated S, and S, that brings blood low in oxygen back to the
o inferior vena cava- The large inferior vein right the upper body
that brings blood low in oxygen back to the o systemic circuit- The system of vessels that
right atrium of the heart from the lower body carries oxygenated blood from the left side of
left AV valve The valve between the left the heart except the lungs and returns
atrium and the left ventricle deoxygenated blood to the right side of the
o the mitral valve or bicuspid valve- The valve heart
between the left atrium and the left ventricle, o systole- The contraction phase of the heartbeat
the left AV valve of bicuspid valve mitral cycle (adjective: systolic
valve MI-tral o valve- A structure that keeps fluid flowing in a
o myocardium- The thick middle layer of the forward direction (roots, valvto, valve
heart wall composed of cardiac muscle o vein- A vessel that carries blood back to the
o pericardium- The fibrous sac that surrounds heart. All except the pulmonary and umbal
the heart carry blood low in oxygen (roots: ven/o,
o pulmonary artery- The vessel that carries phlebío)
blood from the right side of the heart to the o Ventricle- A small cavity. One of the two
lungs lower pumping chambers of the heart venule
o pulmonary circuit- The system of vessels that VEN-ule A small vessel that carries blood
carries blood from the right side of the heart to from the capilares to the ves vessel VES-el A
the lungs to be oxygenated and then back to tube or duct to transport fluid (roots angilo,
the left side of the heart vaslo, vasculo)
o pulmonary veins- The vessels that carry blood
ABBREVIATIONS AND MEANING
from the lungs to the left side of the heart
o pulmonary valve- The valve at the entrance to  AV-Atrioventricular
the pulmonary artery  BP- Blood Pressure
o pulse- the wave of increased pressure  Bpm-beats per minute
produced in the vessels each time the  CABG-Coronary Artery Bypass
ventricles contract  CAD-Coronary Artery Disease
  CCU-Coronary care Unit  Blockage of a vessel by a thrombus or other mass
 CHF-Congestive Heart Failure carried in the bloodstream is embolism, and the
 CVA-Cerebro Vascular Accident mass itself is called an embolus.
 ECG-Electrocardiogram  the mass is a blood clot that breaks loose from a
 ECHO-Echocardiogram vessel's wall, but it may also be air (as from
 HR-Heart Rate injection or trauma), fat (as from marrow released
 MI- Myocardial Infarction or Mitral Insufficiency after a bone break), bacteria, or other solid
 PVC Premature ventricular Contraction materials
 PTCA percutaneous transluminal coronary  Often a venous thrombus will travel through the
angioplasty heart and then lodge in an artery of the lungs,
 SA-Sinoatrial resulting in a life-threatening pulmonary
embolism.
ATHEROSCLEROSIS
 An embolus from a carotid artery often blocks a
 The accumulation of fatty deposits within the cerebral vessel, causing a cerebrovascular accident
lining of an artery is termed atherosclerosis (CVA), commonly called stroke
 This type of deposit, called plaque (plak), begins o Treatment
to form when a vessel receives tiny injuries,  use of anticoagulant drugs ("blood
usually at a point of branching.0 thinners")
 Plaques gradually thicken and harden with fibrous  heparin, which inhibits thrombin
material, cells, and other deposits, restricting the formation, warfarin (Coumadin), which
vessel's lumen (opening) and reducing blood flow inhibits formation of vitamin K, and newer
to the tissues, a condition known as ischemia oral anticoagulants that interfere with
 In addition to plaque, calcium salts and scar tissue thrombin formation and do not require
may contribute to arterial wall thickening, with a regular tests of blood levels, as does
narrowing of the lumen and loss of elasticity. Coumadin
MAJOR RISK FACTOR OF ATHEROSCLEROSIS ANEURYSM
1. Dyslipidemia-abnormally high levels or  An arterial wall weakened by atherosclerosis,
imbalance in lipoproteins that are carried in the malformation, injury, or other changes may
blood, especially high levels of cholesterol- balloon out, forming an aneurysm
containing, low-density lipoproteins  If an aneurysm ruptures, hemorrhage results.
2. Smoking Rupture of a cerebral artery another cause of
3. High blood pressure stroke
4. Poor diet  Aneurysm sites
5. Inactivity o abdominal aorta
6. Stress o carotid arteries
7. and a family history of the disorder  Dissecting aneurysm
THROMBOSIS AND EMBOLISM o blood hemorrhages into the arterial wall's
thick middle layer, separating the muscle
 formation of a blood clot within a vessel) as it spreads and sometimes rupturing the
 The clot, called a thrombus, interrupts blood flow vessel.
to the tissues supplied by that vessel, resulting in o The aorta is most commonly involved.
necrosis (tissue death).  Treatment
 o Surgeons can replace the damaged arterial o Angina pectoris -early sign of CAD, a type
segment of a dissecting aneurysm of chest pain with feeling of constriction
surgically with a graft. around the heart or pain that may radiate to
o In many cases they can insert a stent the left arm or shoulder, usually brought
(small tube) to seal off the aneurysm and on by exertion. ✓
carry blood through the expanded portion o Anxiety
of the vessel o Diaphoresis (profuse sweating), and
o Dyspnea (difficulty in breathing).
HYPERTENSION (High blood pressure, or
hypertension (HTN))
o ECG,
 A systolic pressure greater than 140 mm Hg or a o Stress tests
diastolic pressure greater than 90 mm Hg o Echocardiography,
 HTN causes the left ventricle to enlarge o coronary angiography- This invasive x-ray
(hypertrophy) as a result of increased work imaging method requires injection of a dye
 Blood pressure readings of 120/80 to 139/89 into the coronary arteries by means of a
describe prehypertension catheter threaded through blood vessels
 Treatment of Hypertension into the heart
o lifestyle modifications such as increased  Treatment:
physical exercise, a low-salt, low-fat diet o exercise and diet
and if necessary, weight loss and smoking o drug therapy (nitroglycerin, may be used
cessation
to dilate coronary vessels.)
o Any confirmed blood pressure over 140/90
o surgical intervention when appropriate.
(at least two readings on two separate
Drugs, such as the nitroglycerin, may be
occasions) is treated with medication as
used to dilate coronary vessels.
well as lifestyle changes
 Patients with severe CAD may be candidates for
o Antihypertensive medication for someone
angioplasty-surgical dilatation of the blocked
in the upper range of prehypertension who vessel by means of a balloon catheter, a procedure
is at risk of a heart attack or stroke technically called percutaneous transluminal
o Drugs used to treat hypertension include coronary angioplasty (PTCA)
the following:  Angioplasty may include placement of a stent, a
 Diuretic (di-u-RET-ik) drugs that small mesh tube, to keep the vessel open
promote salt and water loss through  Stents prevent recoil of the vessel and are
the kidneys available in different versions.
 Drugs that limit production of renin  If further intervention is required, surgeons can
or block its action bypass the blocked vessel or vessels with a
 Drugs that relax blood vessels, vascular graft In this procedure, known as a
including adrenergic blockers and coronary artery bypass graft (CABG), another
calcium channel blockers vessel or a piece of another vessel, usually the left
HEART DISEASE internal mammary artery or part of the leg's
saphenous vein, is grafted to carry blood from the
Coronary Artery Disease (CAD) aorta to a point past the coronary vessel
 results from atherosclerosis in the vessels that obstruction
supply blood to the heart muscle Myocardial Infarction
 Early Signs of CAD
  Degenerative changes in the arteries predispose a
person to thrombosis and sudden coronary artery
occlusion Heart block
 The resultant area of myocardial necrosis is  classified in order of increasing severity as:
termed an infarct, and the process is known as o first-degree heart block
myocardial infarction (MI), the "heart attack" that o second-degree heart block
may cause sudden death. o third-degree heart block.
 Symptoms  Block in a bundle branch is designated as a left or
o pain over the heart (precordial pain) or upper right bundle branch block (BBB)
part of the abdomen (epigastric pain) that may  If, for any reason, the SA node is not generating a
extend to the jaw or arms, normal heartbeat or there is heart block, an
o pallor (paleness), diaphoresis, nausea, fatigue, artificial pacemaker may be implanted to regulate
anxiety, and dyspnea the beat, pacemaker is inserted under the skin
o There may be a burning sensation similar to below the clavicle
 Fibrillation-common cause of MI, an extremely
indigestion or heartburn
rapid, ineffective heartbeat, especially dangerous
o In women, because degenerative changes
when it affects the ventricles
more commonly affect multiple small vessels  Cardioversion -is the general term for restoration
rather than the major coronary pathways, of a normal heart rhythm, either by drugs or
 Diagnosis/Treatment application of electric current.
 ECG  Chest "paddles" or "pads" for emergency
 Assays for specific substances in the blood electrical defibrillation •
o Creatine kinase (CK) -is an enzyme normal to  Cardiopulmonary resuscitation (CPR), automated
muscle cells. external defibrillators (AEDs) can help save lives
o Creatine kinase MB (CK-MB)-released in when available for high-risk patients or in public
places, such as malls, schools, churches, aircrafts,
increased amounts when muscle tissue is
and sports venues
injured.
 Cardiac ablation- a new approach treatment of
o Troponin (Tn) is a protein that regulates
heart rhythm irregularities, a destruction of that
contraction in muscle cells. Increased serum portion of the conduction pathway that is involved
levels, particularly the forms TnT and Tnl, in the arrhythmia. Electrode catheter ablation uses
indicate MI. high-frequency sound waves, freezing
Note: Patient outcome is based on the (cryoablation), or electrical energy delivered
degree of damage and the speed of through an intravascular catheter to ablate a defect
treatment to dissolve the clot and to in the conduction pathway 54
reestablish normal blood flow and
heart rhythm. Heart Failure

Arrhythmia  refers to any condition in which the heart fails to

 is any irregularity of heart rhythm, such as an empty effectively resulting increased pressure in
altered heart rate, extra beats, or a change in the the venous system that leads to edema, justifying
pattern of the beat the description congestive heart failure (CHF)
 Bradycardia is a slower-than-average rate, and o Left-side failure results in pulmonary edema
tachycardia is a higher-than-average rate with breathing difficulties (dyspnea).
 Damage to cardiac tissue, as by MI, may result in o Right-side failure causes peripheral edema
heart block, an interruption in the heart's electrical with tissue swelling, especially in the legs,
conduction system resulting in arrhythmia 51 52 along with weight gain from fluid retention.
53 54
  Other symptoms of CHF are cyanosis and syncope Most of the congenital defects
(fainting) described now can be corrected
 Treatment surgically. A patent ductus arteriosus
o rest may also respond to drug treatment
o drugs to strengthen heart contractions
o diuretics to eliminate fluid
o restriction of salt in the diet.
 Heart failure is one cause of shock, a severe
disturbance in the circulatory system resulting in
inadequate blood delivery to the tissues.
Classification of Shock
 Cardiogenic shock, caused by heart failure
 Hypovolemic shock, caused by loss of blood volume
 Septic shock, caused by bacterial infection
 Anaphylactic shock, caused by severe allergic
reaction
Congenital Heart Disease
 any defect that is present at birth. most Types of
congenital heart defect is a:

1. Septal defect- a hole in the septum

(wall) that separates the atria or
indicate heart abnormalities that could
be treated immediately but might not
otherwise become evident until after
the baby leaves the hospital. The test is
inexpensive and has a low false-
positive rate.
2. Patent ductus arteriosus - a small
bypass between the pulmonary artery
and the aorta fails to close at birth.
Blood then can flow from the aorta to
the pulmonary artery and return to the
lungs

 Heart valve malformation is another type of

congenital heart defect. Failure of a valve to open
or close properly is evidenced by a murmur, an
abnormal sound heard as the heart cycles
o Coarctation of the aorta localized aortic
narrowing, a congenital defect that
restricts blood flow through that vessel