Download Cardiovascular System

NATIONAL REVIEW COURSE
Cardiovascular System
I.
II.
III.
IV.
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Functions of Blood
A.
Transports gases (e.g. oxygen, carbon dioxide), nutrients to the tissues,
waste products from the tissues, and hormones.
B.
Regulates the pH of the body, the amount of fluids in the tissues (by
maintaining a proper osmotic pressure), and body temperature.
C.
Protects against pathogens and blood loss.
Blood Constituents
A.
Blood plasma – the liquid portion of unclotted blood.
1.
Plasma proteins – proteins found in the plasma; include albumins
(help regulate blood pressure), globulins (help with transport and
immunity), and fibrinogen (assists in blood clotting).
B.
Blood serum – the liquid portion of clotted blood; plasma that has had the
fibrinogen and other clotting factors removed so that the blood-clotting
function is minimized.
C.
Formed elements – the blood cells and platelets carried by the plasma.
1.
Erythrocytes (red blood cells) – biconcave, disk-shaped cells that
do not contain nuclei; constitute approximately 40 to 50% of whole
blood, depending on gender; have a life span of approximately 120
days.
a.
Hemoglobin – an oxygen-carrying molecule made from
iron; found in the erythrocytes.
2.
Leukocytes (white blood cells) – cells responsible for the body’s
defenses; contain nuclei and have varied life spans.
3.
Thrombocytes (platelets) – cell fragments without nuclei that assist
in blood clotting; have a life span of approximately 8 to 10 days.
Blood Clotting
A.
Hemostasis – a three-step process of blood clotting; starts with muscle
contraction in response in injury, proceeds to formation of a platelet plug,
and ends with formation of a blood clot.
1.
Muscle contraction – smooth muscle of the blood vessel constricts
when damaged or cut.
2.
Platelet plug formation – platelets in the region of damage become
sticky and bind together with other platelets, blood cells, and the
walls of the vessel.
3.
Blood clot formation – prothrombin is converted to thrombin,
fibrinogen is converted into fibrin (a threadlike protein), and the
fibrin threads form the clot.
B.
Animation: “Hemostasis.”*
Blood Typing
A.
Antigen – a protein bound to the surface of a cell; gives the cell identity;
examples include A, B, Rh, M.
http://www.mhhe.com/biosci/esp/2002_general/Esp/folder_structure/tr/m1/s7/trm1s7_3.htm
1.
2.
3.
V.
VI.
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Type A – antigen A on RBC.
Type B – antigen B on RBC.
Type AB – both antigen A and antigen B on RBC; known as
universal recipient.
4.
Type O – neither antigen A nor antigen B on RBC; known as
universal donor.
B.
Antibody (immunoglobulin) – a component of the immune system found
in the plasma, that attaches to a specific antigen on a cell; binds cells with
other similar cells which prepares the cells for phagocytosis; the body
produces antibodies only for foreign antigens.
C.
Blood transfusion – the infusion of red blood cells into a living body;
requires blood typing to match the recipient with an appropriate donor.
Cardiac Muscle Tissue
A.
Found only in the heart, forming the bulk of the wall of each chamber.
B.
Also known as striated involuntary muscle.
C.
Contracts rhythmically and continuously to provide the pumping action
needed to maintain a constant blood flow.
D.
Cardiac muscle fibers form strong, electrically coupled junctions
(intercalated disks) with other fibers; individual cells also exhibit
branching.
E.
Cardiac muscle fibers form a continuous, contractile band around the heart
chambers that conducts a single impulse across a virtually continuous
sarcolemma.
Location of the Heart
A.
Lies in the mediastinum, behind the body of the sternum between the
points of attachment of ribs 2 through 6; approximately two thirds of its
mass is to the left of the midline of the body and one third to the right.
B.
Posteriorly the heart rests on the bodies of thoracic vertebrae 5 through 8.
C.
Apex lies on the diaphragm, pointing to the left.
D.
Base lies just below the second rib.
E.
Animation: “Heart Formation.”*
http://www.alegent.com/adam/animationplayer/animation_player.html
VII.
Tissues of the Heart
A.
Endocardium – the inner layer of the heart; composed of epithelial and
connective tissues.
B.
Myocardium – the thick middle layer of the heart; composed of cardiac
muscle tissue that contracts regularly.
C.
Epicardium – the outer covering or membrane around the heart; composed
mostly of connective tissue.
D.
Pericardium – the loose-fitting sac around the heart; composed of serous
membranes.
VIII. Heart Chambers
A.
Right atrium – the upper-right chamber; receives deoxygenated blood
from the body.
B.
Right ventricle – the lower-right chamber; pumps blood to the lungs.
C.
Left atrium – the upper-left chamber; receives oxygenated blood from the
lungs.
D.
Left ventricle – the lower-left chamber; pumps blood to the body.
IX.
Heart Valves
A.
Atrioventricular (AV) valves – the valves that separate the atria and
ventricles.
1.
Tricuspid valve – separates the right atrium and the right ventricle.
2.
Bicuspid (mitral) valve – separates the left atrium and the left
ventricle.
B.
X.
XI.
XII.
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Semilunar valves – the valves that separate the ventricles from the blood
vessels that attach to them.
1.
Pulmonary semilunar valve – separates the right ventricle from the
pulmonary trunk.
2.
Aortic semilunar valve – separates the left ventricle from the aorta.
Heart Sounds
A.
Systolic sound – first sound called “lubb”; believed to be caused primarily
by the contraction of the ventricles and by vibrations of the closing AV
valves.
B.
Diastolic sound – second, short, sharp sound called “dubb”; thought to be
caused by vibrations of the closing of SL valves.
C.
Heart sounds have clinical significance because they give information
about the functioning of the valves of the heart
Contraction of the Heart
A.
Cardiac cycle – the cycle involving periods of systole (contraction of the
myocardium) and diastole (relaxation of the myocardium) to fill and
empty the chambers of the heart.
B.
Conduction pathway of the heart – specialized strands of cardiac muscle
tissue that coordinate the rhythmic contractions of the heart.
1.
Sinoatrial (SA) node – acts as the “pacemaker” of the heart;
situated in the posterior wall of the right atrium.
2.
Atrioventricular (AV) node – the relay point for impulses coming
from the sinoatrial node and initiates the contraction of the atria;
situated toward the bottom of the interatrial septum.
3.
Atrioventricular bundle (bundle of His) – the short bundle of fibers
at the top of the interventricular septum that relay the nervous
impulse from the AV node to the left and right ventricles.
4.
Bundle branches – two branches that extend from the AV bundle
and bring the impulse down the interventricular septum.
5.
Purkinje fibers – small fibers at the ends of the bundle branches
that connect to and stimulate the contraction of the myocardium of
the ventricles.
C.
Animation: “Cardiac Conduction System.”*
D.
Cardiac output – the volume of blood pumped out of the heart per minute;
calculated by multiplying the stroke volume of the heart by the heart rate.
1.
Stroke volume – the volume of blood pumped out of the left
ventricle every time it contracts.
2.
Heart rate – the number of times the ventricles contract per minute.
Blood Flow Through the Heart
A.
Systemic circulation – blood flow from the heart to the body and back to
the heart.
1.
Left ventricle → aortic semilunar valve → aorta → arteries →
arterioles → capillaries → venules → veins → caval veins → right
atrium.
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B.
Pulmonary circulation – blood flow from the heart to the lungs and back to
the heart.
2.
Right ventricle → pulmonary semilunar valve → pulmonary trunk
→ pulmonary arteries → pulmonary arterioles → pulmonary
capillaries → pulmonary venules → pulmonary veins → left
atrium.
C.
Animation: “Blood Flow Through the Human Heart.”*
XIII. Blood Supply of the Heart
A.
Coronary arteries – blood vessels that take blood to the heart tissue; first
branches of the aorta.
B.
Cardiac veins – blood vessels that drain the heart tissue.
C.
Coronary sinus – collects blood from the cardiac veins and empties into
the right atrium.
XIV. Blood Vessels
A.
Arteries – blood vessels that carry blood away from the heart.
1.
Arterioles – small arteries.
B.
Veins – blood vessels that carry blood toward the heart.
1.
Venules – small veins.
C.
Capillaries – small blood vessels that connect arterioles and venules;
where exchange of gases, nutrients, wastes, and hormones takes place.
XV. Histology of Blood Vessels
A.
Tunica externa – external layer of connective tissue.
B.
Tunica media – middle layer make up of smooth muscle tissue.
C.
Tunica intima – layer of squamous epithelial tissue (endothelium) that
lines the lumen; the only layer present in capillaries.
D.
Lumen – cavity in the vessel through which the blood flows.
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http://www.sumanasinc.com/webcontent/animations/content/human_heart.html
Diseases of the Cardiovascular System
XVI. General Terminology
A.
Hypoxia – deficiency of oxygen.
B.
Anoxia – absence of oxygen.
C.
Ischemia – a lack of blood supply; results in decreased oxygen and
nutrient supply.
D.
Necrosis – cell or tissue death.
E.
Thrombus – a blood clot attached to the wall of a blood vessel.
F.
Embolus – a free-floating blood clot, clump of fat, mass of cholesterol,
mass of tissue, or even a mass of bacteria.
G.
Cyanosis – bluish discoloration of the skin caused by a deficiency of
oxygen in the blood.
XVII. Disorders
A.
Hypertension – high blood pressure (≥140 mmHg for systolic pressure and
≥90 mmHg for diastolic pressure).
1.
Cause: exact cause is unknown, but many factors contribute (e.g.
old age, obesity, smoking, genetic factors, stress).
2.
Indications/Contraindications: obtain advice and approval of
client’s doctor before performing bodywork; massage is
contraindicated in extreme cases because thrombus formation is
possible; avoid deep tissue work or painful massage in all cases;
soothing massage may reduce high blood pressure and associated
stress.
B.
C.
D.
E.
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3.
Animation: “Hypertension – overview.”*
Hypotension – low blood pressure (<100 mmHg for systolic pressure).
1.
Causes: overall good heath; blood loss.
2.
Indications/Contraindications: consult with client’s doctor; be
careful when the client sits up or stands after massage is
completed.
Anemia – a decrease in the oxygen-carrying capacity of the blood;
accompanied by dizziness, fatigue, nausea, lightheadedness, and pale
coloration of the skin.
1.
Causes: see following definitions of specific types of anemia.
2.
Indications/Contraindications: avoid deep massage because
extreme fluid movement or pressure on surface vessels may be
harmful; massage should be light and soothing.
3.
Sickle cell anemia – a genetic condition causing malformed
hemoglobin molecules; produces fragile sickle or crescent-shaped
red blood cells that are easily destroyed; causes thickening of the
blood, which strains the heart and reduces blood flow.
4.
Hemorrhagic anemia – anemia resulting from a loss of blood
volume.
5.
Hemolytic anemia – anemia resulting from excessive destruction
of red blood cells.
6.
Iron deficiency anemia – anemia resulting from decreased
hemoglobin production; caused by a lack of dietary iron.
7.
Aplastic anemia – anemia in which the number of functioning stem
cells in the bone marrow is decreased; results from drugs,
chemicals, radiation, or cancer.
8.
Pernicious anemia – anemia resulting from deficiency or
malabsorption of vitamin B12.
Leukemia – a disease in which many immature and ineffective white
blood cells are produced; classified according to the type of predominant
WBCs, the severity of symptoms, and the total WBC count.
1.
Cause: disease in which malignant stem cells develop in the bone
marrow.
2.
Indications/Contraindications: obtain approval of client’s doctor
before performing bodywork; all massage should be light because
of the tendency for bleeding and bruising; energy work could be
beneficial.
Hemophilia – characterized by the inability to form a blood clot because
of a deficiency of blood-clotting factors.
1.
Cause: sex-linked genetic disorder.
2.
Indications/Contraindications: obtain advice and approval of
client’s doctor before performing bodywork; massage should be
very light so as not to cause tissue damage or bruising; use
universal precautions in case of bleeding; energy work can be
beneficial.
http://www.alegent.com/adam/animationplayer/animation_player.html
F.
G.
H.
I.
J.
K.
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Shock – a condition in which there is inadequate delivery of oxygenated
blood to the tissues, particularly to the central nervous system; signs and
symptoms include pale or bluish skin, overall weakness, rapid and faint
pulse, restless and anxious behavior, severe thirst, nausea, dilated pupils,
sweating, and shallow and rapid breathing.
1.
Causes: see following definitions of specific types of shock.
2.
Indications/Contraindications: massage is contraindicated; refer to
first aid procedures.
3.
Hypovolemic shock – shock caused by a decrease in blood volume
because of hemorrhage or excessive fluid loss.
4.
Cardiogenic shock – shock caused by inadequate pumping action
of the heart; usually the result of myocardial infarction; leads to
decreased blood pressure.
5.
Septic shock – shock caused by bacterial infection; results in
localized vasodilation and increased blood vessel permeability, and
thus decreased blood pressure.
6.
Anaphylactic shock – shock caused by systemic release of a large
amount of histamine during an allergic response; results in
widespread vasodilation and increased blood vessel permeability,
and thus decreased blood pressure.
Arrhythmia – an abnormal or irregular heartbeat; often benign.
1.
Causes: impulse variations coming into the sinoatrial node from
the vagus nerve; electrolyte imbalances.
2.
Indications/Contraindications: consult with client’s doctor; an
massage should be light and soothing.
3.
Animation: “Arrhythmias.”*
Pericarditis – inflammation of the pericardium.
1.
Causes: bacterial infection; calcium and fibrous deposits around
the heart.
2.
Indications/Contraindications: obtain approval of client’s doctor
before performing bodywork; the presence of infection is a
contraindication to massage.
Phlebitis – inflammation of a vein; quite common; not very serious in
superficial veins; more serious in deep veins.
1.
Cause: unknown (most cases); injury; predisposing factors include
obesity and lack of activity.
2.
Indications/Contraindications: avoid affected area.
Hemorrhoids – a condition characterized by varicose veins of the rectum
and anus.
1.
Causes: increased pressure on the veins of the anus; pregnancy.
2.
Indications/Contraindications: do not massage the surrounding
gluteal and coccygeal areas.
Coarctation of the aorta – localized narrowing of the aorta; impedes blood
flow.
1.
Cause: congenital defect.
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L.
M.
N.
O.
P.
Q.
2.
Indications/Contraindications: consult with client’s doctor.
Aneurysm – a localized bulge in the wall of an artery.
1.
Cause: weakening in the arterial wall.
2.
Indications/Contraindications: avoid the area where the aneurysm
is located; avoid abdominal massage.
Murmur – sound heard when blood escapes through a valve of the heart.
1.
Causes: leaky heart valve (congenital condition); previous
infection of heart tissue.
2.
Indications/Contraindications: many heart murmurs are benign, but
consult with client’s doctor to be sure.
Myocardial infarction – sudden insufficient blood supply to a segment of
heart muscle; results in an area of necrotic cardiac muscle tissue;
symptoms include angina, shortness of breath, and radiating pain.
1.
Cause: usually atherosclerosis of the coronary arteries.
2.
Indications/Contraindications: if client has symptoms of infarction,
refer to doctor immediately.
Angina pectoris – pain in the chest and arm that may be described as dull,
sharp, burning, or aching.
1.
Cause: myocardial ischemia.
2.
Indications/Contraindications: massage can overwork the heart, so
obtain approval of client’s doctor before performing bodywork;
massage should be light and soothing; avoid endangerment areas
and abdominal massage (which may cause increased pressure on
the heart); client is best positioned supine with a cushion under the
right hip to avoid pressure on the inferior vena cava.
Varicose vein – a vein that swells with accumulating blood; condition is
usually permanent.
1.
Cause: excessive pressure on the veins causing failure of the oneway valves.
2.
Indications/Contraindications: avoid massage to directly on or
distal to affected areas because clots that may form could be
broken off into the general circulation; work done proximal to the
area can be beneficial.
Arteriosclerosis – a group of pathologic conditions characterized by
thickening and hardening of the arteries; decreased blood flow to the brain
and extremities may cause dizziness and headaches.
1.
Atherosclerosis – hardening and thickening of the arteries resulting
from buildup of plaque made of cholesterol and lipids; decrease in
elasticity causes narrowing of lumen, leading to decreased blood
flow through the artery; eventually alters the function of the
tissues.
a.
Causes: diabetes; obesity; steroid use; some hereditary
metabolic disorders.
b.
Indications/Contraindications: obtain approval of client’s
doctor before performing bodywork; avoid localized
R.
massage around the carotid artery; avoid deep tissue work;
avoid head and neck region.
c.
Animation: “Atherosclerosis.”*
Raynaud disease – a condition characterized by peripheral
vasoconstriction, most commonly in the digits; most common in women;
symptoms include extreme cold, numbness, and pain in the digits;
differential diagnoses include scleroderma, thoracic outlet syndrome,
stress, and exposure to vibrating machinery.
1.
Cause: unknown.
2.
Indications/Contraindications: massage may increase circulation,
reduce associated stress, and relax affected muscles.
Sample Questions
Which of the following is not a purpose of the blood?
A. Transportation.
B. Digestion.
C. Protection.
D. Regulation.
Type O Rh-positive blood has:
A. the A antigen, B antibody, and Rh antigen.
B. the A and B antigens and the Rh antibody.
C. the A and B antibodies and the Rh antigen.
D. no antigens and the A, B, and Rh antibodies.
Which valves in the heart produce the strong “lubb” sound?
A. Atrioventricular valves.
B. Semilunar valves.
C. Atrioventricular and semilunar valves closing together.
D. Atrioventricular and semilunar valves opening together.
What substance in the blood carries oxygen to other cells of the body?
A. Hemoglobin.
B. Leukocytes.
C. Plasma.
D. Albumin.
Which is the proper sequence of blood flow through the heart?
A. Right ventricle, pulmonary semilunar valve, pulmonary trunk, pulmonary
arteries.
B. Superior vena cava, left atrium, tricuspid valve, left ventricle.
C. Bicuspid valve, aorta, lungs, pulmonary veins.
D. Right atrium, pulmonary semilunar valve, aorta, body.
Which of the following is considered the pacemaker of the heart?
A. Sinoatrial node.
B. Atrioventricular node.
C. Bundle of His.
D. Purkinje fibers.
*
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Hardening of the arteries due to a buildup of plaque made of cholesterol and lipids
is:
A. heart block.
B. atherosclerosis.
C. heart murmur.
D. varicosity.
Which of the following conditions is characterized by pain in the chest that radiates
down the left arm?
A. Arrhythmia.
B. Heart murmur.
C. Phlebitis.
D. Angina pectoris.
When blood leaves the heart it goes through these vessels in order:
A. arterioles, venules, capillaries, veins, arteries.
B. arteries, arterioles, capillaries, venules, veins.
C. arteries, capillaries, venules, veins, arterioles.
D. arterioles, arteries, capillaries, veins.
Once blood exits the right ventricle it goes to the:
A. aorta.
B. lungs.
C. right atrium.
D. muscles of the body.
The deoxygenated blood from the body enters what part of the heart first?
A. The left atrium.
B. The left ventricle.
C. The right atrium.
D. The right ventricle.
The vessel that takes blood from the heart to the lungs is called the:
A. pulmonary vein.
B. aorta.
C. pulmonary artery.
D. capillaries.
A clot traveling through a blood vessel is called a/an:
A. thrombus.
B. embolus.
C. infarction.
D. phlebitis.
When the heart is contracted, this correlates to which number in the blood
pressure?
A. The diastolic.
B. The systolic.
C. The bottom number.
D. Both A and C are correct.
Another name for the sac around the heart is:
A. periosteum.
B. pleural fascia.
C. myocardium.
D. pericardium.
The valve that separates the left atrium from the left ventricle is the:
A. mitral.
B. tricuspid.
C. semilunar.
D. Purkinje.
Destruction of blood cells is called:
A. hemoglobin.
B. hemorrhage.
C. hyperacusis.
D. hemolysis.
Which of the following are mechanisms for blood clotting?
A. Platelet plug.
B. Coagulation.
C. Vascular spasm.
D. All of the above are correct.
When the diameter of the vascular lumen enlarges, it is called:
A. vasoconstriction.
B. vasodialation.
C. myocardial infarction.
D. endocardial fibrosis.