The document provides an overview of the cardiovascular system, including: 1. The major structures and tissues of the heart, such as the chambers, valves, and cardiac muscle. 2. The direction of blood flow through the heart and into the major blood vessels. 3. The functions of arteries, veins, and capillaries in circulating blood throughout the body. 4. Common cardiovascular conditions like hypertension and heart failure.

2. 
At the end of this chapter you should be able to :
1-describe the function of cardiovascular system.
2-Identify types of tissues found in the cardiovascular
system(cardiac muscles in the heart
smooth muscles in the blood vessels.
3-Describe and identify the major heart structures
including the pericardium , heart chambers and
valves.
4- Map the direction of blood flow through the heart.
5- Identify the major blood vessels of the heart that
transport blood from and to the heart.
6- Explain the basic physiology of the electrical conduction
system of the heart.
7-Describes the structural and functional differences between arteries , veins
and
capillaries.
8- Identify the major subdivisions of systemic circulation
9-Describes common diseases affecting the cardiovascular system.

4. Valves
Great
vessels
Chambers
LA
Septa
RA
LV
LV
Walls
Tissues,
and layers
Coronary
circulation
and
venous
drainage
RV
Location
and
surface
anatomy
size

7. The
heart
Superior
and
inferior
vena cava
veins
Aorta
Main
component
s of the
circulatory
system
Big
arteries
Small
arteries
Venules
capillaries

8. Important tissues in the
circulatory system
Cardiac muscles
smooth muscles
Found in the heart
Found in blood vessels
Responsible for heart
contraction (involuntary)
Responsible for
vasoconstriction and
vasodilation in response to
chemical mediators
Non striated
Striated
Has tight junction and intercalated disk
Act as one syncytium

9. The heart is a hollow
muscular organ designed to
Provide the necessary force
to circulate blood to all
tissues and cells of the body.
So that oxygen and and
nutrients can reach all cells
of the body and waste
products are removed
The heart, is a small
organ, approximately the
size of a fist. It is located
in the mediastinum, with
the heart tip pointing to
the left of the body's
midline.

11. The heart is enclosed in a protective, two-layer
membrane
is made up of dense connective tissue.
, with the outermost parietal
layer adherent to the fibrous pericardium and the inner visceral layer
(epicardium) adherent to the heart's surface.
Between these two layers, the pericardial cavity contains lubricating
pericardial fluid that decreases friction caused by the beating of the
heart.

14. Valves allow blood to flow in one direction only, preventing
backflow .
The valves open and close
in response to pressure
differences caused by
contraction and relaxation of
the heart chambers.
This allows blood to flow
from areas with higher
pressure to those with lower
pressure.

16. Difference Between Systole and
Diastole
Diastole:
Systole:
During
diastole
the
ventricles relax , the A-V
valves are opened , the
semilunar valves are closed
, the ventricles are filling
During
systole
the
ventricles contract , the A-V
valves are closed , the
semilunar
valves
are
opened , the ventricles are
ejecting
blood
into
corresponding large arteries
Exhibit 2

17. Atrioventricular valves Vs.
semilunar valves (in systole and
Diastole)

18. Coronary circulation
Exhibit 3

19. ACUTE CORONARY SYNDROMES
• These are number of conditions that results from
Obstruction of a coronary artery
• According to percentage and location of obstruction
NSTEMI
STEMI
Sudden cardiac
death
Also referred to as a heart attack, may be caused by several
conditions but is most frequently attributed to narrowing of the
coronary blood vessels due to atheromatous plaques.

20. •
Chest discomfort / pain with or without dyspnea.
•
Nausea.
•
Diaphoresis .
•
A diagnosis is made by
a) ECG changes
b) by the use of specific serologic markers.

21. • Healing time for an acute myocardial infarction has changed to
four weeks (28 days) in ICD-10-CM from the 8-week time frame
used in ICD-9-CM.
• New code category for a subsequent (new) acute myocardial
infarction occurring within the 4-week time frame of healing
from the initial acute myocardial infarction
• Change in subsequent episode of care designation.
Subsequent episode of care in ICD-10-CM is no longer used for
re-evaluation, observation, or treatment of an acute myocardial
infarction treated on a previous admission. The subsequent
episode of care is limited to a subsequent (new) acute
myocardial infarction during the 4-week healing period of the
initial myocardial infarction
• Old myocardial infarction is classified under chronic ischemic
heart disease in ICD-10-CM

22. ICD-9-CM
ICD-10-CM
1. Acute myocardial infarction.
Unspecified
1- Acute myocardial infarction. unspecified
2-AMI documented as nontransmural
or subendocardial but site provided
If an AMI is documented as
nontransmural or subendocardial, but the
site is provided, it is still coded as a
subendocardial AMI. If NSTEMI evolves
to STEMI, assign the STEMI code. If
STEMI converts to NSTEMI due to
thrombolytic therapy, it is still coded as
STEMI
2-AMI documented as nontransmural or
subendocardial but site provided
If only STEMI or transmural Ml without the site is
If only STEMI or transmural Ml without the site documented, assign code I 21.3.
is documented, query the provider as to the
site, or assign a code from subcategory 410.9
If an AMI is documented as nontransmural or
subendocardial, but the site is provided, it is still coded as
a subendocardial AMI.

23. ICD-9-CM
ICD-10-CM
3-Subsequent acute myocardial infarction
A code from category I22, Subsequent ST
elevation (STEMI) and non ST elevation (NSTEMI)
myocardial infarction, is to be used when a patient
who has suffered an AMI has a new AMI within the
4 week time frame of the initial AMI. A code from
category I22 must be used in conjunction with a
code from category 121. The sequencing of the I22
and 121 codes depends on the circumstances of the
encounter.

24. 1- Bypass:
Bypass is defined as altering the route of passage of
the contents of a tubular body part.
Bypass is coded when the objective of the procedure is
to reroute the contents of a tubular body part.
Example of Bypass circulatory system procedures:
coronary artery bypass graft (CABG)
2- Dilation: This root operation is coded when the objective of the procedure is to
enlarge the diameter of a tubular body part or orifice. The orifice can be a natural orifice
or an artificially created orifice. A device placed to maintain the new diameter is an
integral part of the Dilation procedure, and is coded to the sixth-character device value in
the procedure code.
Examples: -Percutaneous transluminal coronary angioplasty (PTCA).
-PTCA with insertion of either drug-eluting or non drug-eluting stent

25. • Cardiac Catheterization
(cardiac cath) is a
procedure that examines
the inside of your heart's
blood vessels using special
X-rays called angiograms.
Dye visible by X-ray is
injected into blood vessels
using a thin hollow tube
called a catheter.

27. A Coronary Stent is a tiny wire mesh tube
used to prop open an artery during
angioplasty. The stent stays in the artery
permanently. The stent will also improve
blood flow to the heart muscle and will
relieve chest pain (angina).

28. CORONARY ANGIOGRAM
•
•
is a special X-ray test performed to find out if your coronary arteries are clogged,
where and by how much. During an angiogram, your doctor inserts a thin tube
(catheter) into an artery and up to the heart. Once in place, a dye that is visible by
X-rays (contrast dye) is injected into the bloodstream. The X-ray machine takes a
series of images (angiograms) which will show any areas of narrowing. This
procedure is done as part of the cardiac catheterization procedure.

30. ICD-10-PCS AND THE CIRCULATORY SYSTEM
• ALL codes in ICD-10-PCS are seven characters in length

31. CHARACTER DEFINITION FOR CIRCULATORY SYSTEM
•
Character 1:
• Medical and Surgical, 0
•
Character 2:
• 5 of 31 body systems pertain to the circulatory system
1.
Heart and Great Vessels (character value 2)
2.
Upper Arteries (character value 3)
3.
Lower Arteries (character value 4)
4.
Upper Veins (character value 5)
5.
Lower Veins (character value 6)

32. CHARACTER 3:
SOME ROOT OPERATIONS RELATED TO CIRCULATORY SYSTEM
Alteration
Division
Inspection
Reposition
Bypass
Drainage
Map
Resection
Change
Excision
Occlusion
Restriction
Control
Extirpation
Reattachment
Revision
Creation
Extraction
Release
Supplement
Destruction
Fragmentation
Removal
Transfer
Detachment
Fusion
Repair
Transplantation
Dilation
Insertion
Replacement

33. • Character 4: Body Part
• body part or specific anatomical site where the procedure was performed. Examples:
Character Value
Heart and Great Vessels
0
Coronary Artery, One Site
1
Coronary Artery, Two Sites
2
Coronary Artery, Three Sites
3
Coronary Artery, Four or More Sites

34. Sample Grid for Combinations of characters 4 to 7
Percutaneous Transluminal Angioplasty with Stent of a
single artery
= 02705DZ

35. DEVELOPMENT OF ICD 10 PCS

36. The right atrium

37. the middle cardiac vein

39. Before conduction of action potential specialized
autorhythmic cells in the cardiac muscle generate electric
impulses that initiate the heart beat ( example the SAN , the
AVN )
conduction system conducts action potential to all muscle
cells to stimulates the contraction of the heart to make it
pump effectively.
Exhibit 4

43. Normal ECG …P wave…QRS complex……….ST segment……….T wave

44. In patients with acute
coronary syndrome watch
for the followings:

45. A cardiac cycle is
the sequence of
events that occur
during each heart
beat.

46. impulse from
the SA node
The four chambers of
the heart then relax,
and the cycle begins
again.
The increased ventricular
pressure forces the SL
valves open, ejecting blood
from the heart.(ventricular
ejection)
Ejecting 70cc leaving 60cc
(ESV)
ventricles contract
The atria relax
Atrial systole
ventricular
diastole
Atria contraction forces
blood through the open
A V valves to the
ventricles.
ventricle is able to fill
with approximately 130
cc of blood, a volume
referred to as the enddiastolic volume (EDV)

48. Blood vessels
• Although there are variations in the function of each particular blood
vessel, the walls of most have the following three layers:
1.
2.
3.
Tunica interna: Innermost layer of the vessel that contains a single layer of
endothelium on the inner surface that helps influence blood flow.
Tunica media: Thick middle layer of mostly smooth muscle cells and extensive
elastic fibers.
Tunica externa: Outermost layer of the vessel, its function is to attach the
vessel to the surrounding tissue. It is made up of collagen, elastic fibers, and many
nerves.

49. Blood vessels anatomy
and sequence of flow
Large Arteries transport
blood away from heart
to all organs and cells
of the body.
1- Large arteries : are Elastic,
conducting, arteries ,that
receive blood from ventricles
Which are high pressure
chambers
That’s why they should be thick
walled , elastic
include the aorta, pulmonary
trunk, brachiocephalic,
common carotid, common iliac,
and subclavian arteries.

50. 2- Muscular (distributing) arteries : are mid-size arteries
that are branches of the elastic large arteries.
Varying in size from the pencil-sized axillary and femoral
arteries to the small, string-size arteries that carry blood to
organs, the thick walls of these arteries are able to regulate
blood flow with vasoconstriction and vasodilatation.
ie: the brachial and radial arteries of the arm
• Those arteries are responsible for peripheral
resistance ..and control blood pressure to
certain extent

51. CO2
O2

52. Venules then begin to reunite and become successively
larger veins, eventually returning the blood full of
wastes poor in oxygen to the right atrium via the inferior and
superior vena cava.

53. Large veins carries blood to the the heart
in reverse
Direction : against gravity in the lower ½ of
the body
That’s why they are provided with valves

55. Blood pressure (BP),
sometimes referred to
as arterial blood
pressure.
is the pressure exerted
by circulating blood
upon the walls of blood
vessels, and is one of
the principal vital signs.

56. During each heartbeat, blood
pressure varies between a
maximum (systolic)
and a minimum (diastolic)
pressure.
The blood pressure in the
circulation is principally due to:
a)the pumping action of the
heart.
b)peripheral resistance of
arterioles

57. Old methods for classification of hypertension used in ICD-9-CM

58. Classification of Hypertension in ICD-10-CM
• ICD-10-CM classifies hypertension and
hypertensive diseases to the Hypertensive
diseases section (I10–I15)
Sub-categories:
• I10, Essential (primary) hypertension
• I11, Hypertensive heart disease
• I12, Hypertensive chronic kidney disease
• I13, Hypertensive heart and chronic kidney
disease
• I15, Secondary hypertension

59. Classification of Hypertension in ICD-10-CM
• Hypertension is classified by type, primary or
secondary, in ICD-10-CM.
• The nature of hypertension (benign, malignant,
unspecified) no longer exists for classifying
hypertension in ICD-10-CM.
• There is only one code, I10, for essential or primary
hypertension.
• Assign I10 if the physician documented any of the
following: arterial hypertension, benign hypertension,
essential hypertension, malignant hypertension,
primary hypertension or systemic hypertension

60. Hypertensive Heart Disease
• Hypertensive Heart Disease – Category I11
– I11 Hypertensive heart disease
– I11.0 Hypertensive heart disease with heart failure
– I11.9 Hypertensive heart disease without heart
failure
• Documentation must indicate a relationship
between the heart disease and hypertension

61. Hypertension and Chronic Kidney
Disease
• Hypertensive Chronic Kidney Disease – Category I12
– ICD-10-CM presumes a cause-and-effect relationship between chronic
kidney disease and hypertension.
• Hypertensive Heart and Chronic Kidney Disease –
Category I 13
– combination category for hypertensive heart
disease (I11) and hypertensive chronic kidney
disease (I12)

62. Heart Failure
congestive heart failure (CHF) or congestive cardiac failure (CCF),
occurs when the Heart is unable to provide sufficient pump
action to maintain blood flow to meet the needs of the body.
Common risk factors of heart
failure in the united states
• Ischemic heart disease 62%
• Cigarette smoking 16%
• Hypertension (high blood
pressure) 10%
• Obesity 8%
• Diabetes 3%
• Valvular heart disease 2% (much
higher in older populations)

63. Systolic dysfunction
Diastolic dysfunction
2 pathophysiological types failure of the ventricle to adequately
It is of heart failure exist
It is failure of the pump function of the
heart. It is characterized by a decreased
ejection fraction (less than 45%).
-caused by dysfunction or destruction of
cardiac myocytes or their molecular
components.
-The most common mechanism of
damage is ischemia causing infarction and
scar formation.
-On echocardiogram, this is manifest by
abnormal wall motion (hypokinesia) or
absent wall motion (akinesia), ventricular
end-diastolic pressure and volumes
increase.
relax and typically denotes a stiffer
ventricular wall. This causes inadequate
filling of the ventricle, and therefore
results in an inadequate stroke volume.
The failure of ventricular relaxation also
results in elevated end-diastolic
pressures, and the end result is identical
to the case of systolic dysfunction
(pulmonary edema in left heart failure,
peripheral edema in right heart failure.)

64. Systolic dysfunction
Diastolic dysfunction
This is transmitted to the atrium. On the left
side of the heart, the increased pressure is
transmitted to the pulmonary vasculature,
and the resultant hydrostatic pressure favors
extravasation of fluid into the lung
parenchyma, causing pulmonary edema. On
the right side of the heart, the increased
pressure is transmitted to the systemic
venous circulation and systemic capillary
beds, favoring extravasation of fluid into the
tissues of target organs and extremities,
resulting in dependent peripheral edema.
Heart failure may be described as chronic when it is stable .
Acute decompensated heart failure is worsening of symptoms, typically shortness
of breath (dyspnea ) , edema and fatigue ,

65. a) Imaging
Diagnosis
Echocardiography used to determine :
1-stroke volume (SV, the amount of blood in the heart that exits the ventricles with
each beat).
2-end-diastolic volume (EDV, the total amount of blood at the end of diastole),
3-ejection fraction (EF). the SV in proportion to the EDV, Normally, the EF should be
between 50% and 70%; in systolic heart failure, it drops below 40%.
4-identify Valvular heart disease
5-Assess the state of the pericardium .
6-Echocardiography may also aid in deciding what treatments will help the patient,
such as medication, insertion of an implantable cardioverter-defibrillator or cardiac
resynchronization therapy.
b) Angiography Heart failure may be the result of coronary artery disease, and
its prognosis depends in part on the ability of the coronary arteries to supply blood
to the myocardium (heart muscle). As a result, coronary catheterization may be used
to identify possibilities for revascularization through percutaneous coronary
intervention or bypass surgery.
c) Blood tests An elevated B-type natriuretic peptide (BNP) is a specific
test indicative of heart failure

66. Management of heart failure
•
•
Diet and lifestyle measures.
Fluid restriction : consider an individualized fluid prescription, potentially based on patient body
weight, sodium intake, and likelihood of adherence.
Generally water intake should be limited to 1.5 L daily or less in patients with hypernatremia.
• Pharmacological management
Diuretic agents, vasodilator agents, positive inotropes, ACE inhibitors, beta blockers, and aldosterone
antagonists (e.g. Spironolactone). Some drugs which increase heart function, such as the positive
inotrope Milrinone, lead to increased mortality, and are contraindicated.
ACE inhibitor (ACE) therapy is recommended for all patients with systolic heart failure, irrespective of
symptomatic severity or blood pressure. ACE inhibitors improve symptoms, decrease mortality and
reduce ventricular hypertrophy.
• Devices.
Patients with NYHA class III or IV, left ventricular ejection fraction (LVEF) of 35% or less and a QRS
interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT; pacing both the
left and right ventricles), through implantation of a bi-ventricular pacemaker, or surgical remodeling of
the heart. These treatment modalities may make the patient symptomatically better, improving
quality of life and in some trials have been proven to reduce mortality.
• Surgery The final option, if other measures have failed, is heart transplantation or (temporary or
prolonged) implantation of an artificial heart. These remain the recommended surgical treatment
options

67. Some Procedures done to heart failure
patients
• cardiac resynchronization therapy (CRT; pacing both the left and right
ventricles), through implantation of a bi-ventricular pacemaker which is is
a small battery-operated device that helps your heart beat in a regular
rhythm. It does this with a small electric stimulation that helps your heart
to beat regularly. It is puts the under the skin on your chest, just under
your collarbone. It’s hooked up to your heart with tiny wires

68. A heart transplant, or a cardiac transplant
is a surgical transplant procedure performed on patients with endstage heart failure or severe coronary artery disease. As of 2008 the
most common procedure was to take a working heart from a
recently deceased organ donor (cadaveric allograft) and implant it
into the patient. The patient's own heart is either removed
(orthotopic procedure) or, less commonly, left in place to support
the donor heart (heterotopic procedure); both were controversial
solutions to an enduring human ailment. Post-operation survival
periods averaged 15 years. Heart transplantation is not considered
to be a cure for heart disease, but a life-saving treatment intended
to improve the quality of life for recipients.

69. ICD-9-CM vs. ICD-10-CM and coding for heart failure
ICD-9-CM
428 heart failure
ICD-10-CM
I 50 heart failure
428.0 congestive heart failure ,
unspecified
428.1 left heart failure .
I50.1 left ventricular failure
428.2 Systolic heart failure .
I50.2 Systolic (congestive) heart failure
428.20 unspecified
I50.20 unspecified systolic
(congestive) heart failure
428.21 acute
I50.21 Acute systolic (congestive)
heart failure
428.22 chronic
I50 .22 Chronic systolic (congestive)
heart failure
428.23 Acute on chronic
I50 .23 Acute on chronic systolic
(congestive) heart failure

70. ICD-9-CM vs. ICD-10-CM and coding
for heart failure (cont.)
ICD-9-CM
ICD-10-CM
428.3 Diastolic heart failure .
I50.3 Diastolic (congestive) heart
failure
428.30 unspecified
I50.30 unspecified diastolic
(congestive) heart failure
428.31 acute
I50.31 Acute diastolic
(congestive) heart failure
428.32 chronic
I50 .32 Chronic diastolic
(congestive) heart failure
428.33 Acute on chronic
I50 .33 Acute on chronic diastolic
(congestive) heart failure

71. ICD-9-CM vs. ICD-10-CM and coding for heart failure (cont.)
ICD-9-CM
428.4 combined Systolic and
Diastolic heart failure.
ICD-10-CM
I50.4 combined Systolic (congestive) and
Diastolic (congestive) heart failure
428.40 unspecified
I50.40 unspecified combined Systolic
(congestive) and Diastolic
(congestive) heart failure
428.41 acute
I50.41 Acute combined Systolic
(congestive) and Diastolic
(congestive) heart failure.
428.42 chronic
I50 .42 Chronic combined Systolic
(congestive) and Diastolic
(congestive) heart failure
428.43 Acute on chronic
I50 .43 Acute on chronic combined
Systolic (congestive) and
Diastolic (congestive) heart
failure

72. ICD-9-CM vs. ICD-10-CM and coding
for heart failure (cont.)
ICD-9-CM
428.9 heart failure unspecified
Cardiac failure NOS
heart failure NOS
myocardial failure NOS
Weak heart
ICD-10-CM
I50.9
heart failure unspecified
Biventricular (heart) failure NOS
Cardiac , heart or myocardial failure NOS
Congestive heart disease
Congestive heart failure NOS
Right ventricular failure (secondary to heart
failure)

73. • As the coder can observe the close similarity in
classification and coding of heart failure in both
ICD -9-Cm and ICD -10-CM, by first classifying
heart failure into systolic and diastolic , as well as
combined and each class is further subdivided
into acute , chronic and acute on chronic with
the only difference ion the code range values in
both systems (numeric in ICD-9-CM belonging to
category 428-- and alphanumeric in ICD-10-CM
belonging to category I50 ).
• Also both require that the coder code first due to
hypertension.

74. ICD-9-CM versus ICD-10-PCS and
heart failure procedures
• Coding for transvenous ventricular pacing for heart failure.
ICD-9-CM
ICD-10-PCS
37.71 initial insertion of transvenous lead
[electrode] into ventricle
02HK3JZ Insertion of pacemaker lead into
right ventricle , percutaneous approach.
02HL3JZ Insertion of pacemaker lead into
left ventricle , percutaneous approach.

75. ICD-10-PCS and the Circulatory System
• ALL codes in ICD-10-PCS are seven characters in length

76. Character Definition for Circulatory System
• Character 1:
– Medical and Surgical, 0
• Character 2:
– 5 of 31 body systems pertain to the circulatory
system
1.
2.
3.
4.
5.
Heart and Great Vessels (character value 2)
Upper Arteries (character value 3)
Lower Arteries (character value 4)
Upper Veins (character value 5)
Lower Veins (character value 6)

77. CHARACTER 3:
Some Root Operations related to circulatory system
Alteration
Division
Inspection
Reposition
Bypass
Drainage
Map
Resection
Change
Excision
Occlusion
Restriction
Control
Extirpation
Reattachment
Revision
Creation
Extraction
Release
Supplement
Destruction
Fragmentation
Removal
Transfer
Detachment
Fusion
Repair
Transplantation
Dilation
Insertion
H Replacement

78. • Character 4: Body Part
– body part or specific anatomical site where the
procedure was performed. Examples:
Character Value
Heart and Great Vessels
4
Coronary vein
6
Atrium right
7
Atrium left
k
Ventricle right
L
Ventricle left

79. 0 Medical and Surgical
2 Heart and great vessels
H Insertion putting in a non biological appliance that monitors , assists , performs , or prevents a
physiological function but does not physically take the place of a body part
4 Coronary vein
6 Atrium right
7 Atrium left
K Ventricle right
L Ventricle left
0 Open
3
Percutaneous
4
Percutaneous Endoscopic
0 monitoring Device,
pressure sensor
2 monitoring device
3 Infusion device
D Intraluminal device
J Cardiac lead , pacemaker
K Cardiac lead , defibrillator
M Cardiac lead
Sample Grid for Combinations of characters 4 to 7
Insertion of pacemaker lead into right ventricle ,
percutaneous approach.
= 02HK3JZ

80. ICD-9-CM versus ICD-10-PCS and Coding for
cardiac transplantation
ICD-9-CM
37.51 Heart transplantation.
00.93 transplant from cadaver.
ICD-10-PCS
02YA0Z0 Transplantation of heart ,
Allogeneic ,open approach
02YA0Z1 Transplantation of heart ,
Syngeneic ,open approach.
02YA0Z0 Transplantation of heart ,
Zooplastic ,open approach

81. 0 Medical and Surgical
2 Heart and great vessels
Y Transplantation : Putting in or on all or a portion of a living body part taken from another individual or animal
to physically take the place and /or function of all or a portion of a similar body part
A Heart
0 Open
No device
0 Allogeneic
1 Syngeneic
2 Zooplastic

82. Types of circulations

83. The aorta, which is approximately one inch
in diameter, is the largest artery in the
body. From every part of the aorta, other
arteries branch off into a network of
successively smaller arteries until they
eventually divide into arterioles and finally
capillaries, where the exchange of oxygen,
nutrients, and waste products takes place
within the individual organs.

86. Aortic Divisions
First Order Branches
Second Order Branches

87. CO2 O2
CO2 O2

91. 40
%
40
%
34
%
34
%
20
%
20
%
4%
cerebral aneurysms
are inclined to
develop at the
arterial junctions

94. the carotid and vertebral arteries
supply oxygenated blood to the brain.
• The carotid arteries are
easily palpated under
the jaw:

95. • Deoxygenated blood is removed from the brain via the jugular vein

96. Portal Circulation
What is meant by
portal circulation?
CO2 O2
a portal system
consists of a
network of blood
vessels through
which blood is
transported after
passing through
one capillary bed
to another
network of
capillaries prior to
being returned to
systemic
circulation.
CO2 O2

97. • The portal venous system channels blood from parts
of the digestive tract, spleen, and pancreas to the
liver for processing prior to returning to the heart.
Blood flow to the liver
differs from that in the
general circulation since the
liver receives oxygenated
blood, as well as partially
deoxygenated blood.
Oxygenated blood from the
hepatic artery mixes with
the nutrient rich blood from
the portal vein in the liver
sinusoids.

98. Rheumatic heart diseases and valvular problems
Rheumatic fever is an inflammatory disease that occurs following a
Streptococcus pyogenes infection, such as streptococcal pharyngitis.
Believed to be caused by antibody cross-reactivity that can involve the
heart, joints, skin, and brain,[1] the illness typically develops two to three
weeks after a streptococcal infection.
Depending on the extent of heart inflammation involved, patients with the
acute form of the disease may develop:
1- heart failure.
2-pericarditis
3-myocarditis.
4-endocarditis, which is manifested as insufficiency of the mitral (65 to 70
percent of cases) and aortic valves (25 percent of cases).
commonly appears in children between the ages of 6 and 15, with
only 20% of first-time attacks occurring in adults.[1] The illness is so
named because of its similarity in presentation to rheumatism
Usually manifested in the form of valvular lesions such as Mitral stenosis ,
Mitral incompetence, and aortic valve diseases.

99. Exhibit 6
Exhibit 7
Stenosis means narrowing or constriction of a path
Regarding the valves it is caused by a multitude of
factors, such as calcification , rheumatic degeneration
or congenital malformation.

100. Mitral stenosis is a problem when
the valve is supposed to be opened
mid diastolic rumbling murmur

101. For acute rheumatic heart conditions, there is a one-to-one mapping of
the appropriate ICD-9-CM code to the appropriate ICD-10-CM code.
For instance, ICD-9-CM code 391.0 for acute rheumatic
pericarditis
directly correlates to code I 01.1 in ICD-10-CM.
ICD-9-CM
ICD-9-CM does classify some
conditions as rheumatic in nature
ICD-10-CM
ICD-10-CM has distinguished, in
large part, specific valvular diseases
caused by rheumatic fever versus
those not related to the disease, as
well as the specific valve