CONTENTS Introduction Circulatory system Diseases related to circulatory system Lymphatic system Diseases related to Lymphatic system Summary References
Introduction The cardiovascular system is divided for descriptivepurposes into two main parts. • The circulatory system. • The lymphatic system. The circulatory system consist of the heart, which actsas a pump, the blood vessels and the blood. The lymphatic system consist of lymph nodesthe lymph vessels and the lymph. The two systems communicate with one another andare intimately associated.
The circulatory system The heart pumps blood into two anatomically separatesystems of blood vessels. • The pulmonary circulation. • The systemic circulation. The right side of the heart pumps blood to the lungs(thepulmonary circulation) where gas exchange occurs. The left side of the heart supplies the blood intothe systemic circulation, which supplies blood tothe rest of the body.
The blood vessels: The heart pumps the blood intovessels that vary in structure, size andfunction and there are several types:Arteries, arterioles, capillaries, venulesand veinsThe walls of the blood vessel aremade up of three layers of tissue:•Tunica adventitia•Tunica media•Tunica intima
Control of blood vessel diameter When nervous activity isincreased the smooth muscle oftunica media contracts andthickens; this process is calledvasoconstriction. Decreased nerves stimulationrelaxes the smooth musclethinning the vessel wall andenlarging the lumen . Thisprocess is calledVasodilatation.
The Heart: The heart is roughly cone-shapedhollow muscular organ. The heart lies in the thoracic cavity inthe mediastinum (the space between the Courtesylungs). The heart is composed of three layersof tissue; • Pericardium: is made up of two sacs the outer sac consist of fibrous tissue and inner of a continuous double layer of serous membrane.
• myocardium : is composed of specialized cardiac muscle found only in heart. • endocardium: This lines the chamber and valves of the heart. It is a thin smooth glistening membrane that permits smooth flow of the blood inside the heart. The heart is supplied with arterial blood by the right and leftcoronary arteries, the arteries receive about 5% of bloodpumped from heart.
Interior of the heart The heart is divided into right and leftside by the septum. Each side is divided by anatrioventricular valve into an upperchamber, The atrium and a lowerchamber, The ventricle.The right atrioventricular valve istricuspid valve and the leftatrioventricular valve is mitral valve.
The valves between the atria and ventricles openand close passively according to changes in pressurein chambers.The opening of the pulmonary artery is guarded bythe pulmonary valve and the opening of aorta isguarded by the aortic valve.
Conducting system of the heart Small group of specializedneuromuscular cells in the myocardiuminitiate and conduct impulses, causingcoordinated and synchronizedcontraction of the heart muscle .Sinoatrial node (SA node) •Mass of specialized cells •Lies in the wall of right atrium •Is the pacemaker of heart •Firing of SA node causes atrial contraction.
Atrioventricular node (AV node) • situated in the wall of atrial septum near the atrioventricularvalve • conducts the impulse that arrive from SA node, passes it through AV bundle and purkinje fibres which in turn convey the impulse to the ventricle.
Pulmonary circulation and systemic circulation : In the pulmonary circulation the bloodcirculates from the right ventricle of the heartto the lungs and back to the left atrium.In lungs, carbon dioxide is excreted andoxygen is absorbed.The pulmonary artery carries deoxygenatedblood to the lungs.Two pulmonary veins leave each lung returning oxygenated blood to left atrium.During the ventricular systole the blood is forced into aorta, the first artery ofgeneral circulation which carries it to different organs of the body and returns toright atrium by superior and inferior vena cavae.
Diseases of the blood vessels Atheroma : Atheromatousplaques are patchy changes thatdevelop in tunica intima of arteries. Arteriosclerosis: progressivedegeneration of arterial walls,associated with ageing. Atheroma Arteriosclerosis Varicose Veins: Veins bulgewith pools of blood when they failto circulate the blood properly.These visible and bulging veins,called varicose veins. Varicose vein and spider vein
Diseases of heart Myocardial infarctionCommonly known as a heart attack, isthe interruption of blood supply to a partof the heart, causing heart cells to die. This is most commonly due toocclusion (blockage) of a coronaryartery following the rupture ofa vulnerable atherosclerotic plaque, in thewall of an artery.The resulting ischemia(restriction in blood supply) and oxygenshortage, if left untreated for a sufficient period of time, can causedamage or death (infarction) of heart muscle tissue (myocardium)
Symptomschest anxiety pain, shortness of breath nausea, vomiting,palpitations, sweatingRisk factorsDiabetes , Tobacco smoking, Hypercholesterolemia ,Low HDLHigh Triglycerides, High blood pressure, Family history of ischaemicheart disease ,Obesity, age, Stress and Alcohol
Diagnostic TestECG (Electrocardiogram)An ECG is a simple test that detects and records the heartselectrical activity. The test shows how fast the heart is beating andits rhythm (steady or irregular). An ECG also records the strengthand timing of electrical signals as they pass through each part ofthe heart.Blood TestsCommonly used blood tests include troponin tests, CK or CK–MBtests, and serum myoglobin tests.Coronary AngiographyCoronary angiography is a test that uses dye and special x rays toshow the insides of your coronary arteries. This test often is doneduring a heart attack to help find blockages in the coronaryarteries.
TreatmentCertain treatments usually are started right away if a heart attack issuspected, even before the diagnosis is confirmed. These include:•Oxygen therapy•Aspirin to thin the blood and prevent further blood clotting•Nitroglycerin to reduce hearts workload and improve blood flow throughthe coronary arteries•Treatment for chest pain.Once the diagnosis of a heart attack is confirmed or strongly suspected,doctors start treatments to try to promptly restore blood flow to the heart. Thetwo main treatments are "clot-busting" medicines and angioplasty, aprocedure used to open blocked coronary arteries
MedicinesBeta blockers. Beta blockers decrease hearts workload.ACE( angiotensin converting enzyme) inhibitors.• ACE inhibitors lower blood pressure and reduce strain on heart.• They also help slow down further weakening of the heart muscle.Anticoagulants. Anticoagulants, or "blood thinners," prevent blood clotsfrom forming in arteries. These medicines also keep existing clots from gettinglarger.Anti clotting medicines. Anti clotting medicines stop platelets fromclumping together and forming unwanted blood clots. Examples of anti clottingmedicines include aspirin and clopidogrel.
Angioplasty•Angioplasty is a nonsurgical procedure that opens blocked or narrowedcoronary arteries.•A thin, flexible tube with a balloon or other device on the end is threadedthrough a blood vessel to the narrowed or blocked coronary artery.•Once in place, the balloon is inflated to compress the plaque against the wallof the artery. This restores blood flow through the artery.•During the procedure, a small mesh tube called a stent is put in the artery.The stent helps prevent blockages in the artery in the months or years afterangioplasty.Coronary artery bypass grafting (CABG)• May be used to treat a heart attack. During CABG, a surgeon removes ahealthy artery or vein from body.•The artery or vein is then connected, or grafted, to the blocked coronaryartery.•The grafted artery or vein bypasses (that is, goes around) the blockedportion of the coronary artery.•This provides a new route for blood to flow to the heart muscle
Angina Pectoris Is chest pain or discomfort that occurs if anarea of heart muscle doesnt get enough oxygen-rich blood. Angina may feel like pressure or squeezing inchest. The pain also can occur in shoulders, arms,neck, jaw, or back. Angina isnt a disease; its a symptom of an underlying heart problem.Angina pain may even feel like indigestion.Angina usually is a symptom of coronary heart disease (CHD )Types of Angina: stable, unstable, variant (Prinzmetals), and microvascular.
Stable Angina• It occurs when the heart is working harder than usual.• Stable angina has a regular patternUnstable Angina•Unstable angina doesnt follow a pattern•Unstable angina also can occur with or without physical exertion, andrest or medicine may not relieve the pain.Variant (Prinzmetals) Angina•Variant angina is rare.• A spasm in a coronary artery causes this type of angina.•Variant angina usually occurs while at rest, and the pain can besevere.• It usually happens between midnight and early morning.Microvascular Angina•Microvascular angina can be more severe and last longer than othertypes of angina.• Medicine may not relieve this type of angina
Diagnostic TestsEKG (Electrocardiogram)Stress TestingChest X RayCoronary Angiography and Cardiac CatheterizationBlood Tests
TreatmentNitrates :For aborting or terminating angina attack , sublingual GTN (glyceryl trinitrate)tablet or spray is taken.The major action of nitrate is direct nonspecific smooth muscle relaxation.Hence when there is an angina attack due to narrowing of coronaryartery, nitrates help the vascular smooth muscle to relax thereby dilating thevessel and increasing the blood flow to that particular area.The GTN tablet may be crushed under teeth and spread over buccal mucosaIt acts within 1-2 min because of direct absorption in the systemic circulationbypassing the liver.
β Blockers:Certain hormones such as epinephrine (adrenaline) non epinephrineand other such hormones act on the β receptors of various body tissueand produce stimulative effect.The effect of these hormones on the heart is more forceful contractionof the heart muscle.β blockers are the agents that block the action of these hormones onthe receptors of the body tissue.Thus leading to decrease heart rate, decrease force of contraction anddecrease cardiac output .Examples of β blockers are metoprolol, propranolol etc.
Congestive Cardiac FailureIs a condition in which the heartcan’t pump enough blood to meetthe body’s needs In some cases, the heart can’t fillwith enough blood. In othercases, the heart can’t pump blood tothe rest of the body with enoughforce Right-side heart failure occurs if the heart can’t pump enoughblood to the lungs to pick up oxygen. Left-side heart failure occursif the heart can’t pump enough oxygen-rich blood to the rest ofthe body.
Right sided (congestive) failure:•The right ventricle fails when the pressure developed within it isless than the force needed to push blood through the lungs.•When the ventricles is not emptying completely the right atriumand vena cavae become congested with blood.•The organs affected are liver, spleen kidney. Oedema of limbsusually follows.Left sided( left ventricular ) failure:•This occurs when the pressure developed in the left ventricle bythe contracting myocardium is less than the pressure in the aortaand the ventricle cannot pump out all the blood it receives.•This leads to dilatation atrium increase in pulmonary bloodpressure and eventually to congestion in lungs leading topulmonary oedema.
Causes of Congestive Heart FailureCoronary artery diseaseHigh blood pressure (hypertension)Longstanding alcohol abuseDisorders of the heart valvesUnknown (idiopathic) causes, such as after recovery frommyocarditisLess common causes include viral infections of the stiffening ofthe heart muscle, thyroid disorders, disorders of the heartrhythm, and many others.
TreatmentDigoxin:These are glycosidic drugs having cardiac inotropic property i.e.they increase the force of contraction of the myocardial muscle.They increase the myocardial contractibility in failing heart withoutproportionate increase in the oxygen consumption .Since they increase the force of contraction there is more completeemptying of the failing , dilated ventricles thereby increasing theefficiency of the heart.
Diuretics:Diuretics help in treating the symptoms of the CHF.They help to keep the fluid from building up in lungs and other tissues bypromoting the flow of fluid through kidney thus preventing the pulmonaryoedema and oedema in any other parts of the body.Examples of diuretics are furosemide(lasix),bumetamide(bumex) etc.Vasodilators __ ACE inhibitors, nitratesβ blockers ___ metorolol etc.
Following devices may be recommended for certainpatients with heart failure:•A pacemaker to help treat slow heart rate or other signalingproblem.•A biventricular pacemaker to help both side of heart contractat same time.Surgery and medication can repair underlying causes ofheart failure, however once the heart’s ability to pump bloodis severely, permanently impaired no surgery can repair thedamage, the only alternative remain is a heart transplant
Other disorders related to heart includes Mitral valve stenosis Rheumatic heart disease Infective endocarditis Cardiac arrhythmias Congenital abnormalities
Diseases related to blood pressure Hypertension or high bloodpressure is a condition in whichthe blood pressure in thearteries is chronically elevated.Blood pressure is the force of blood that is pushing up againstthe walls of the blood vessels.If the pressure is too high, the heart has to work harderto pump, and this could lead to organ damage and several illnessessuch as heart attack, stroke, heart failure, aneurysm, or renal failure.
The normal level for blood pressure is below 120/80, where120 represents the systolic measurement (peak pressure in thearteries) and 80 represents the diastolic measurement(minimum pressure in the arteries).Blood pressure between 120/80 and 139/89 is calledprehypertension (to denote increased risk of hypertension), anda blood pressure of 140/90 or above is consideredhypertension.Hypertension may be classified as essential or secondary.•Essential hypertension is the term for high blood pressure withunknown cause. It accounts for about 95% of cases.•Secondary hypertension is the term for high blood pressurewith a known direct cause, such as kidney disease, tumors,or birth control pills.
What causes hypertension?Though the exact causes of hypertension are usually unknown, there areseveral factors that have been highly associated with the condition. Theseinclude:•Smoking•Obesity or being overweight•Diabetes•Sedentary lifestyle•Lack of physical activity•High levels of salt intake (sodium sensitivity)•Insufficient calcium, potassium, and magnesium consumption•Vitamin D deficiency•High levels of alcohol consumption•Stress•Aging•Medicines such as birth control pills•Genetics and a family history of hypertension•Chronic kidney disease•Adrenal and thyroid problems or tumors
Clinical trial Morphine In Acute Myocardial Infarction (MIAMI) This study is currently recruiting participants. Verified on January 2010 by French Cardiology Society First Received on August 20, 2010. Last Updated on June 21, 2011 Sponsor French Cardiology Society Institute National de la Santé Et de la Collaborator: Recherche Médicale, France Information provided by: French Cardiology SocietyClinicalTrials.gov Identifier: NCT01186445 The purpose of this study is to determine whether intracoronary injection of morphine chlorhydrate is effective to limit Purpose ischemia-reperfusion lesion during percutaneous coronary angioplasty in patients with acute myocardial infarction (AMI).
Study Type: Interventional Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel AssignmentStudy Design: Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment Evaluation of the Cardioprotective Effect of Intracoronary Injection of MorphineOfficial Title: During Reperfusion in Acute Myocardial Infarction Condition Acute Myocardial Infarction Drug: morphine chlorhydrateintervention Drug: saline solution Phase Phase III
The Lymphatic SystemComponents of lymphaticsystem Lymph fluid • Intermediary between blood in capillary and tissues Lymphatic organs • Lymph nodes • Tonsils • Spleen • Thymus Lymph vessels
Functions of lymphatic system Returns excess interstitial fluid to circulatorysystem Absorption of fat and fat soluble vitamins fromGI system Defense against invading pathogens and disease
Lymph 90% of fluid that leaves capillaries is returned the 10% that does not return becomes part of theinterstitial fluid. Similar in composition to plasma •Without erythrocytes and large protein molecules •Contains lymphocytes, granulocytes, water, respiratory gases, nutrients, hormones, ions, urea
Lymphatic VesselsNot found in nails, hair. Form an extensive system that flows one way towardthe heart Several types of lymphatic vessels• Lymphatic capillaries• Lymphatic collecting vessels•Lymphatic trunks• Lymphatic ducts
Movement of Lymph There is no “pump” like in circulatory system Very low pressure Flow accomplished because of three factors– Skeletal muscle pump– Respiratory pump– Valves prevent backflow Failure to move lymph results in accumulation of interstitialfluid (edema)
Lymph Nodes Situated in between two lymphaticcollecting vessels are lymph nodes Nodes serve as filters to captureforeign material or abnormal cells(cancer) Site of lymphocyte production Can become inflamed/ engorged with infectious material Can be found in large clusters in inguinal, cervical, and axillae
Lymphoid Organ: Spleen Largest lymphoid organ Primary purpose is toremove aged RBCs Provides a place to screenfor pathogenic agents Stores large amount ofRBCs that can be accessedduring periods of stress
ThymusFound in superior mediastinum Produces lymphocytes Does not directly fight antigens Can be considered an endocrineorgan because it produces thehormone thymosin.Thymosin stimulates production of lymphoid cells Largest in infancy and early childhood Atrophys as we age
D ISORDER OF LYMPHATIC SYSTEMLymphadentis: An inflammatory condition of the lymph nodes, usuallythe result of systemic neoplastic disease, bacterial infection, or otherinflammatory condition. The nodes may be enlarged, hard, smooth orirregular, red, and may feel hot.Lymphangitis : An inflammation of one or more lymphaticvessels, usually resulting from an acute streptococcal infection of one of theextremities. It is characterized by fine red streaks extending from theinfected area to the axilla or groin, and by fever, chills, headache, andmyalgia. The infection may spread to the bloodstream. Lymphedema: A primary or secondary disorder characterized by theaccumulation of lymph in soft tissue and swelling, caused byinflammation, obstruction, or removal of lymph channelsSplenomegaly: This is enlargement of the spleen usually due toinfection, circulatory disorders, blood disease etc.
Summary Circulatory systemCardiovascular system Lymphatic system The heartCirculatory system The blood vessels The blood The lymph Lymphatic system The lymphatic vessels The lymphoid organs
Atheroma Related to blood vessel , arteriosclerosis, varicose veinDisorders of circulatory Myocardial infarction, angina Related to heartsystem pectoris, congestive heart failure, mitral valve stenosis, etc Related to blood pressure Hypertension and hypotension Lymphadentis Lymphangitis Lymphedema Disorders of the lymphatic system Splenomegaly
References•Anne waugh, allison grant “Anatomy and physiology in health andillness”10th edition .•http://www.nlm.nih.gov/medlineplus/heartdiseases.html•http://www.dherbs.com/articles/lymphatic-system-disorders•http://en.wikipedia.org/wiki/Circulatory_system•http://www.healthcare-online.org/Cardiovascular_Diseases.htm•http://www.mayoclinic.com/health/heart-disease• KD Tripathi “ essentials of medical pharmacology” 5th edition.