Chapter 11Cardiovascular SystemCopyright © 2008, 200.docx

Chapter 11
Cardiovascular System
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Learning ObjectivesName 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
*
IntroductionCardiovascular System: delivers oxygen and
nutrients to cells of body tissueHeart (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
BLOODArteries 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 hearttricuspid valve (cusps are flaps of the
valves): between right atrium and right ventriclepulmonary
valve: between right ventricle and pulmonary arterymitral
valve: between left atrium and the left ventricleaortic 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 SOUNDSTwo phases of the
heartbeat:diastole: relaxationsystole: contractionThe 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 systoledubb: closure of the aortic and pulmonary
valves at the end of systolemurmur: 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
*
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.)
*
*

ElectrocardiogramP 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
Electrocardiogram

BLOOD PRESSUREBlood pressure: The force that blood exerts
on arterial walls.Measured using sphygmomanometerExpressed
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 vesselaort/o aortaarter/o
arteryarteri/o arteryather/o yellowish
plaqueatri/o atrium

Combining Form Meaning
*
COMBINING FORMS
AND TERMINOLOGY
brachi/o armcardi/o heartcholesterol/o
cholesterolcoron/o heartcyan/o bluemyx/o
mucus
*
COMBINING FORMS
AND TERMINOLOGY
ox/o oxygenpericardi/o pericardiumphleb/o
veinsphygm/o pulsesteth/o chestthromb/o
clot

*
valvul/o valvevalv/o valvevas/o
vesselvascul/o vesselven/o, ven/i veinventricul/o
ventricle
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:
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:
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:
HEART
coronary artery disease (CAD) Atherosclerosis
thrombotic occlusion
ischemia
necrosis
myocardial infarctionAcute 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:
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:
HEART
Coronary artery disease
Surgical therapies for CAD percutaneous coronary intervention
(PCI) – Catheterization with balloons and stents open clogged
arteriescoronary 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:
HEART
Other Pathologic conditionsendocarditis
(vegetations)hypertensive heart diseasemitral valve prolapse
(MVP)murmurpericarditisrheumatic 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:
BLOOD VESSELSaneurysmdeep vein thrombosis
(DVT)hypertension (HTN)peripheral vascular disease
(PVD)Raynaud diseasevaricose 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 TESTSBNP testCardiac biomarkerslipid test
profilelipoprotein 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-Rayangiography and arteriographycomputerized tomography
angiographydigital subtraction angiography (DSA)Electron
beam computed tomography (EBCT or EBT)
Ultrasound TestsDoppler ultrasoundechocardiography (ECHO)

*What determines when each of these tests should be used?
Differentiate between invasive and noninvasive diagnostic tests.
Nuclear Cardiologypositron emission tomography (PET)
scantechnetium (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?
Other diagnostic procedures:cardiac
catheterizationelectrocardiography (ECG, EKG)Holter
monitoringstress 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: DIAGNOSTICIdentify the normal
sinus rhythm and arrhythmias
*
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:
TREATMENTDefibrillationendarterectomyextracorporeal
circulationheart transplantationthrombolytic 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
TreatmentCoronary 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
MIPCIHTNLDLECHO
CADBPVFAFECG
CABGMVPETTHDL
*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 ______________
REVIEW SHEET
*

COMBINING FORMS
angi/o vesselaort/o aortaarter/o
arteryarteri/o arteryather/o
yellowish plaqueatri/o atrium
REVIEW SHEET
*
COMBINING FORMS
brachi/o ______________
cardi/o ______________
cholesterol/o ______________
coron/o ______________
cyan/o ______________
myx/o ______________
REVIEW SHEET
*

COMBINING FORMS
brachi/o armcardi/o heartcholesterol/o
cholesterolcoron/o heartcyan/o
bluemyx/o mucus
REVIEW SHEET
*
COMBINING FORMS
ox/o ______________
pericardi/o ______________
phleb/o ______________
sphygm/o ______________
steth/o ______________
thromb/o ______________
REVIEW SHEET

*
COMBINING FORMS
ox/o oxygenpericardi/o pericardiumphleb/o
veinsphygm/o pulsesteth/o
chestthromb/o clot
REVIEW SHEET
*
COMBINING FORMS
valvul/o ______________
valv/o ______________
vas/o ______________
vascul/o ______________
ven/o, ven/i ______________
ventricul/o ______________

REVIEW SHEET
*
COMBINING FORMS
valvul/o valvevalv/o valvevas/o
vesselvascul/o vesselven/o, ven/i
veinventricul/o ventricle
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; withoutbrady- slowde- lack of;
down; less; removal ofdys- bad; painful; difficult;
abnormalendo- in; withinhyper- above; excessive
Prefix Meaning
REVIEW SHEET
*

PREFIXES
hypo- ______________
inter- ______________
peri- ______________
tachy- ______________
tetra- ______________
tri- ______________
Prefix Meaning
REVIEW SHEET
*
PREFIXES
hypo- deficient; below; under; less than
normalinter- betweenperi- surroundingtachy-
fasttetra- fourtri- three
Prefix Meaning
REVIEW SHEET

*
PowerPoint Assignment Rubric
You will select two pathological conditions related to one
specific system that was discussed on this course (for example
you can select Coronary Artery Disease (CAD) and Arrythmias
which are both related to the cardiovascular system.) You will
research the diagnosis, signs, symptoms, laboratory tests and
treatment procedures for each condition.
Please note:
1. Your PowerPoint assignment should be based on the
pathological conditions chosen from your specific system. Look
up information regarding signs, symptoms, diagnosis and
treatment of the conditions chosen in addition to any procedures
and lab tests that apply.
2. You also need to relate the medical terms you use in your
presentation to class discussions and readings (highlight or
underline the terms used, divide them, label them and define
them).
3. You will need to use at least two references (peer reviewed
articles or reliable websites) not including the textbook for each
pathologic condition.
4. Material should be accurate, properly organized and
researched. Use figures, pictures and audiovisuals to reflect the
content of your presentation.
5. Assignment should be 10-12 slides (not including your title
slide and your reference slide) and should be in PowerPoint
format.

6. Please upload in the designated section on Canvas before the
due date. Absolutely no assignments will be accepted as email
attachments. Additionally, no assignments are accepted past the
due date. Please plan accordingly to avoid technical problems
on Canvas and to avoid missing the due date.
Point breakdown
Content depth and accuracy 15
Relating research to class readings and division of terms 20
Organization of material 10
Creativity 10
Length of presentation 10
References in APA format 5
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Total 70

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