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Chapter 30
The Circulatory System
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4 Main Parts of the Circulatory System
1. The heart
– Acts like a pump
2. The blood vessels
– Act like the plumbing
3. The blood
– The circulating fluid
4. The lymphatic system
– Acts to provide auxiliary fluid
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The Anatomy of the Heart
• Located behind the sternum and in between
the lungs
• Two-thirds of the heart is on the left side of
the chest
• The heart is about the size of a clenched fist
• The tricuspid valve is located between the
right atrium and ventricle
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The Internal Heart Structures
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The External Heart Structures
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The Heart Sounds
• The lubb-dupp sounds
– Lubb
• First sound
• Caused by the valves slamming shut
– Dupp
• Second sound
• Caused by the closure of the semilunar valves
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The Pacemaker of the Heart
• A specialized group of nerve cells located in
the right atrium is called the sinoatrial (SA)
node or the “pacemaker.”
• These cells generates the electrical impulse
that starts the wave of muscle contractions in
the heart.
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5 Types of Blood Vessels
1. Arteries
– Vessels throughout the body that expand and
contract as they carry fresh, oxygenated blood
away from the heart
– The only exception is the pulmonary artery, which
carries deoxygenated blood to the lungs.
2. Arterioles
– Connect arteries to capillaries
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Major Arteries of the Body
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5 Types of Blood Vessels
3.Capillaries
– Thin walls and have are one cell structures
– Oxygen-rich blood enters the capillary bed, where
the exchange of gasses occurs.
– When blood leaves the capillary bed, it carries
away carbon dioxide and waste.
– Capillary beds reduce the rate of blood flow and
allow oxygen and nutrients to enter the tissue
cells in exchange for carbon dioxide and waste.
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5 Types of Blood Vessels
4.Veins
– Similar to arteries, but the walls are thinner and
they lack elastic fibers
– Veins carry deoxygenated blood back to the heart
– Exception: The pulmonary veins return
oxygenated blood from the lungs to the heart.
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Major Veins of the Body
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5 Types of Blood Vessels
5. Venules
– Join together with the capillaries to form veins that
eventually enter the heart through the vena cava
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Portal Circulation
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Portal Circulation
1. Arteries branch off the aorta as it descends to
the internal organs.
2. Each organ then receives the substances on
which it reacts.
3. These substances can be sugar, salt,
hormones, chemicals, nutrients, or waste.
4. Everything you eat, drink, inhale, or inject
enters the circulatory system.
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The Pathway of Blood through the
Pulmonary Circulation
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The Pathway of Blood through the
Systemic Circulation
1. Blood leaves the left ventricle and enters the
aorta.
2. Blood travels throughout the body in the
aorta.
3. The aorta divides at the fourth lumbar
vertebra.
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The Pathway of Blood through the
Systemic Circulation
4. The external branch becomes the femoral
artery and continues down the leg.
5. The arteries become arterioles and join the
capillaries.
6. Deoxygenated blood leaves the capillaries and
enters the venules and veins.
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The Pathway of Blood through the
Systemic Circulation
7. The major veins of the lower extremities join
with the inferior vena cava.
8. The major veins of the upper extremities join
with the superior vena cava.
9.The superior and inferior vena cava empty
into the right atrium of the heart.
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The Structure of the Lymphatic System
• The lymphatic system is made up
of:
– Lymph nodes
– Lymph (a straw-colored fluid)
– Lymph vessels
– Spleen
– Lymph tissue
– Tonsils
– Thymus gland
Lymph fills the spaces between
the cells, acts as a bridge
between cells and capillaries,
and contains blood plasma.
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• Adenitis- Lymph nodes
become swollen
• Bradycardiaconsistently slow heart
rate
• Spleen is located just
beneath the left side of
the diaphragm
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The Components of Whole
Blood and Their Roles
• Red blood cells (RBCs)
– Erythrocytes
– Contain hemoglobin which gives blood its red
color
– Hemoglobin attracts and carries oxygen and
carbon dioxide in the blood.
– Erythrocytes live about 4 months.
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The Components of Whole Blood
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The Components of Whole
Blood and Their Roles
• Plasma
– Serum globin in blood plasma assists in the
formation of antibodies
• White blood cells (WBCs)
– Leukocytes
– Leukocytes play a vital role in defending the body
against invasion by chasing down bacteria.
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The Components of Whole
Blood and Their Roles
• Granulocytes are white blood cells produced
in the red bone marrow.
• There are three types:
– Neutrophils
– Eosinophils
– Basophils
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The Components of Whole
Blood and Their Roles
• Neutrophils
– Surround, swallow, and digest bacteria
• Eosinophils
– Respond to allergic reactions or parasites
• Basophils
– Respond to chronic infection
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The Components of Whole
Blood and Their Roles
• Agranulocytes
– White blood cells produced by bone marrow and
lymph tissue that break down into two types:
1. Lymphocytes produce immunity by developing
antibodies and attaching to and destroying foreign
bodies.
2. Monocytes eat and destroy bacteria.
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The Components of Whole
Blood and Their Roles
• Platelets
– Thrombocytes
– Smallest of the three cells
– Formed in the bone marrow from cell fragments
– Platelets function in the process of clotting blood
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The Clotting Process
1. The cut vessel attracts or catches platelets.
2. Platelets form a small mass at the cut.
3. Platelets release a chemical that causes the
vessel to narrow and decreases blood loss
until a clot forms.
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The Clotting Process
4.Platelets and the injured tissue release
thromboplastin, which begins to create a
reaction that forms a network of fine mesh
fibers over the cut.
5.This net catches the red blood cells, platelets,
and plasma and forms the clot.
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Blood Types and Their Importance
• Blood types are determined by the presence
of a protein factor, called an antigen, on the
surface of the red blood cell.
• There are 4 types of blood:
1.A
2.B
3.AB- Universal recipient
4.O- Universal donor
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Blood Types and Their Importance
• Blood plasma also has a protein substance,
called an antibody, that reacts to the protein
on the surface of the blood cell.
• Blood clumps and forms clots if antigens and
antibodies of the same type come together.
• During blood transfusions, determining the
blood type can prevent this reaction.
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The Importance of the Rh Factor
• Originally detected in, and named after, the
Rhesus monkey
• An antigen that may or may not be present in
the red blood cell (Rh + or Rh -)
• If a person without the antigen receives blood
with the antigen, the body produces
antibodies that can cause serious
complications.
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Arteriography
• X-ray examination of the arteries after
injection of a contrast medium
• This test indicates the status of blood flow,
aneurysms, or the presence of hemorrhage.
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Cardiac Catheterization
• A catheter is inserted into the brachial or
femoral artery and is passed up into the heart.
• A contrast medium is injected into the
catheter to permit visualization of the heart
chambers, valves, and pulmonary and
coronary arteries.
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Doppler Ultrasonography
• Sound waves are transmitted through the skin
and are reflected by blood cells moving
through the blood vessels.
• This test evaluates blood vessels and can
diagnose deep vein thrombosis, aneurysms,
and arterial blockages.
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Echocardiograph
• Uses high-frequency sound waves to make
images of the internal heart structures.
• This test evaluates cardiac function, the
condition of the heart valves, defects in the
heart walls, and the presence of fluid between
layers of the pericardium.
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Electrocardiograph
• Abbreviated EKG or ECG
• Provides a graphic recording of the electrical
activity of the heart
• This test identifies heart rhythms and provides
a method of detecting the progression of
cardiac disease
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Holter Monitor
• An ambulatory EKG that records heart activity
over a 24-hour period.
• This test helps to evaluate symptoms that
occur irregularly.
• This test can also evaluate the status of
recovering cardiac patients.
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Heart Scan
• Computerized CT scan that sweeps electron
beams so fast that it freezes the beating
motion of the heart.
• This test diagnoses the presence of plaque
and coronary occlusion.
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MUGA SCAN
• Multiple-gated acquisition scan
• After isotopes are injected into the vein and
taken up by the myocardium, a camera
records the motion of the heart.
• This test evaluates the condition of the
myocardium.
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Myocardial Perfusion Imaging
• This test measures the passage of blood
through the coronary arteries to the
myocardium.
• The blood vessels are dilated and a radioactive
material is injected.
• This material concentrates in the areas of the
myocardium with good blood flow.
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Venogram
• X-ray studies using a contrast medium to
determine the condition of the deep veins of
the legs
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Anemia
• Term used to indicate elements that are lacking in
the blood
• Iron-deficiency anemia
– Lack of iron
• Aplastic anemia
– Injury or destruction of blood cell formation by the
bone marrow
• Blood loss anemia
– Condition of low red blood cell count occurring over
an extended period of time
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Aneurysm
• Ballooning out of the wall of an artery
• Often associated with atherosclerosis or
arteriosclerosis
• Cerebral aneurysms
– Occur in the brain
• Thoracic aneurysms
– Occur in the chest
• Abdominal aneurysms
– Occur in the abdomen
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Angina
• Severe chest pain that radiates down the inner
surface of the left arm
• Usually associated with emotional stress or
physical exertion
• May last from a few seconds to several
minutes
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Cardiac Arrest
• Complete, sudden cessation of heart action
• Rapidly fatal
• Produces brain damage after 5 minutes
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Arrhythmia
• Any abnormal changes in the heart rhythm
• Can range from mild to life threatening
• Classified according to the origin (e.g., atria)
or the irregularity (e.g., premature,
fibrillation)
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Arteriosclerosis
• “Hardening” of the arteries and arterioles
• Causes: Muscular and elastic tissue is replaced
by fibrous tissue and calcification.
• The heart must exert more pressure because
the vessels no longer expand and recoil with
each heartbeat.
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Atherosclerosis
• The development of fatty material along the
lining of the arteries.
• The openings of the arteries may be partially
or completely blocked, reducing or eliminating
blood flow to the area.
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Athletic Heart Syndrome
• Cardiac changes that occur as a result of
strenuous exercise
• The heart enlarges, especially the ventricles,
because of the need for increased output.
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Carditis
• Inflammation of the heart
• Results from an infectious process caused by
the invasion of a virus, fungus, or bacterial
pathogen
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Cerebrovascular Accident
• Sudden impairment of the flow of blood to
the brain that interrupts the flow of oxygen
and causes damage or destruction to brain
tissue
• Commonly called a stroke
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Congestive Heart Failure
• A group of cardiac dysfunctions that results in
poor performance of the heart with related
congestion of the circulatory system
• This disorder can be a complication of
coronary artery disease.
• The myocardium of the left ventricle is most
commonly affected.
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Coronary Artery Disease
• A disease of the arteries that surround the
heart and carry oxygen and nutrients to the
myocardium
• Causes angina-like symptoms, nausea,
vomiting, fainting, and perspiration
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Embolism
• Foreign matter that enters and circulates in
the bloodstream
• This matter can be made up of blood, exudate,
fat, or air.
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Heart Failure
• A condition, particularly with the aged, in
which the heart pumps too weakly to supply
the body with blood.
• Severe failure shortens life expectancy.
• Heart transplant may be one treatment
option.
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Heart Replacement
• The diseased heart is removed and replaced
with a healthy donor heart after much
physical, financial, legal, emotional, and
ethical preparation.
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Hypertension
• Blood pressure readings consistently above 140/90
• Foremost contributing factor to stroke and kidney
damage
• Essential
– No known cause for the elevation
• Secondary
– Elevation is the result of disease.
• Benign
– The increase occurs over a long time period.
• Malignant
– Rapid, severe increase
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Hypertrophic Cardiomyopathy
• Results in thickening of the walls of the
ventricles in the heart (markedly thickened)
• The heart becomes stiff and cannot fill with
blood or pump efficiently.
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Hypotension
• Blood pressure that results in readings below
the normal range
• Hypotension may become life threatening
when blood circulation becomes impaired and
gas exchange is inadequate.
• Poor diet is not a common cause of
hypotension.
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Leukemia
• Malignant disease of the bone marrow or
lymph tissue
• Leukemia can be present in an acute or
chronic form
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Murmur
• Abnormal sounds made by blood leaking
through a heart valve; can be heard with a
stethoscope
• The murmur is named for the valve that is
leaking.
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Myocardial Infarction
• Also called a “heart attack”
• A complication of coronary artery disease that
results from partial or complete blockage of
the artery and causes destruction of
myocardial tissue.
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How to Recognize a Heart Attack
• A sensation of uncomfortable pressure,
fullness, squeezing, aching, or pain, usually in
the center of the chest
• Pain, aching, or heaviness in the shoulders,
neck, jaw, arms, or upper back, or spreading
to the chest
• Pain accompanied by lightheadedness,
fainting, sweating, nausea, vomiting, or
shortness of breath
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Phlebitis
• Localized inflammation of a vein that causes
an alteration of the epithelial lining; is likely to
form a blood clot
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Sickle Cell Anemia
• Congenital form of anemia that occurs primarily
among African Americans
• Red blood cells have a hemoglobin defect in their
molecular structure that causes the cell to become
sickle shaped.
• These cells, which carry oxygen, cannot easily pass
through blood vessels.
• Inherited condition due to an autosomal recessive
trait
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Stasis Ulcer
• A secondary condition resulting from chronic
venous insufficiency
• Causes redness, swelling, scaling, cracks in the
skin, and ulcers
• The most common site for stasis ulcers is the
ankles.
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Thrombophlebitis
• An acute condition that results from
inflammation of the vein walls and the
formation of a blood clot (thrombus)
• Usually develops in superficial veins, but deep
vein thrombosis can affect small or large
veins; the clot interrupts blood flow and can
break off and become an embolus
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Varicosities
• The result of veins that have become dilated
or twisted, and are inefficient
• Usually results from weakness of the valves
• This weakness permits blood to leak backward
and causes dilation of the vessel.
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Definitions to know
•
•
•
•
•
Tachycardia- Consistently fast heart rate
Bradycardia- Consistently slow heart rate
Systole- contraction phase of a heart beat
Diastole- relaxation phase of a heart beat
Defibrillator- device used to discharge a strong electrical current
into a patient’s heart through electrode paddles held against the
bare chest wall
• Premature atrial contractions (PACs)- cause the atria to contract
ahead of the anticipated time
• Premature junctional contractions (PJCs)- these have the ectopic
pacemaker focused at the junction of the AV node and the bundle
of His
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Cont.
• Premature ventricular contractions (PVC)- originate in the
ventricle and cause contraction ahead of the next anticipated
beat
• Low- density lipoprotein- “bad” cholesterol
• High- density lipoprotein- “good” cholesterol
• Stasis- stagnation of blood
• Stent- stainless steel mesh tube commonly used with a
balloon catheter to prop open a coronary artery
• Benign- form of hypertension in which the blood pressure
rises moderately over a fairly long period
• Infarction- interference with circulation
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One more full of definitions
• Transient ischemic attack- small, temporary interruption of
blood flow, also known as a warning sign
• Stenotic- refers to a leaking valve
• Hemorrhagic stroke- stroke in which a blood vessel ruptures,
and the escaping blood damages brain tissue either by
pressure against it or from lack of circulation through the
tissue
• Malignant- form of hypertension in which blood pressure rises
rapidly and severely, and may not respond to treatment
• Regurgitate- backward flow of blood into the left atrium
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Locations
• Know the location of each major vein; jugular, femoral,
pulmonary, cephalic, brachial, tibial, inferior vena cava,
superior vena cava, saphenous, common iliac
– Jugular- from the head and neck
– Femoral- in the thigh from the knee into the pelvis
– Pulmonary- from the lungs to the left atrium of the heart
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