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Chapter Nine
CIRCULATORY SYSTEM
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Circulatory System
Cardiovascular system
Lymphatic system
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Circulatory Composition and Functions
 Cardiovascular (CV)
structures


Heart and great vessels
Arteries and veins
 Lymphatic structures
 Organs (spleen, thymus),
lymph nodes, and lymph
vessels
 Functions
 Transportation of
substances

To cells


Oxygen, nutrients, other
substances
Away from cells

Waste products
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Circulatory Study Hints
 Arteries, veins, and lymphatic structures are often




named for the anatomical body parts that they serve
(e.g., Brachial arteries are in the arm: brachi/o =
arm).
Directional terminology (superior vena cava returns
blood from the upper body: super/o = upward)
Oxygenated vessels (usually arteries) are colored
red.
Deoxygenated vessels (usually veins) are colored
blue.
Lymphatic vessels and nodes are colored green.
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Word Parts
cardi/o, coron/o,
cordi/o, = heart
angi/o, vas/o, vascul/o
= vessel
Cardiovascular Structures
 Heart
 Vessels
 Arteries
 Veins
arteri/o = artery
ven/o, phleb/o = vein
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PCS Guideline Alert!
 B2.1b Body systems designated as upper or lower
contain body parts located above or below the
diaphragm, respectively.
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Special Note
 Any vessel that an individual is born with is termed a
“native vessel,” as opposed to those that may be
acquired from another individual, an animal, or
made from synthetic fibers. Note that the word
native is derived from nat/o = birth and -ive
meaning pertaining to those vessels that come with
one’s birth.
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Word Parts
Circulation of the Blood
 Pulmonary circulation
pulmon/o = lung
ox/i, ox/o = oxygen
capn/o = carbon dioxide
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Word Parts
aort/o = aorta
arteriol/o = arteriole
cyt/o, cellul/o = cell
ren/o = kidney
hepat/o = liver
Circulation of the Blood
 Systemic circulation

Overall

Heart -> aorta -> arteries -> arterioles
-> capillaries -> cells -> capillaries ->
venules -> veins -> upper (or lower)
vena cava -> heart
 Renal circulation
 Hepatic portal circulation
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Word Parts
vascul/o, angi/o, vas/o
= vessel
tunica = coat
Vessels
 Tunica externa (adventitia)
 Tunica media
 Tunica interna (intima)
externa = outside
media = middle
interna = inside
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Word Parts
apic/o = apex
pre- = in front of
cordi/o = heart
-um = structure
atri/o = atrium
ventricul/o = ventricle
sept/o = septum
Heart and Great Vessels
 Size/location/description
 Chambers

Atria
Right atrium (RA)
 Left atrium (LA)

 Ventricles
Right ventricle (RV)
 Left ventricle (LV)

 Septa
 Atrial
septum
 Ventricular septum
 Atrioventricular septum
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Heart and Great Vessels
Chambers of the heart
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Word Parts
Heart and Great Vessels
 Pulmonary arteries and veins
Pulmonary trunk
pulmon/o = lung

aort/o = aorta
 Aorta
 Superior and inferior venae cavae
 In PCS, the inferior vena cava is
classified as a “lower vein”!
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Word Parts
endocardi/o =
endocardium
myocardi/o =
myocardium
pericardi/o =
pericardium
viscer/o = viscera, organs
Layers of the Heart Wall
 Endocardium
 Myocardium
 Pericardium


Visceral pericardium (epicardium)
Parietal pericardium
 Terms related to heart wall disorders

Transmural
pariet/o = wall
trans- = through
mur/o = wall
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Word Parts
Heart Surface
 Left heart
anter/o = anterior (front)

infer/o = inferior (below)

later/o = lateral (side)
Left coronary sulcus
Obtuse margin
 Right heart
 Right coronary sulcus
 Walls
 Anterior
 Inferior
 Lateral
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Word Parts
atri/o = atrium
Structures of the Atria
 Atria

Left atrium
Left auricular appendage
 Sinus venosus
 Coronary sinus

auricul/o = ear

Right atrium
Right auricular appendage
 Sinus venosus

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Word Parts
ventricul/o = ventricle
chord/o = cord
con/o = cone
Structures of the Ventricles
 Ventricles




Chordae tendineae
Trabeculae carnae
Papillary muscle
Conus arteriorus
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Word Parts
and
Abbreviations
Blood Flow Through the Heart
pulmon/o = lung
tricuspid valve ( TV)
pulmonary arteries
(PA)
pulmonary veins (PV)
right atrium (RA)
mitral (bicuspid) valve
(MV)
left atrium (LA)
right ventricle (RV)
left ventricle (LV)
annul/o = ring
 Valves
 Annulus
 Chordae tendinae
 Papillary muscles
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Word Parts
Blood Flow Through the Heart
 Coronary arteries
coron/o = heart
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Review Question
 The upper chambers of the heart are the:
A. arterioles
B. atria
C. venules
D. ventricles
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Did You Know?
 A good way to remember how the blood flows
through the heart valves is to memorize the phrase
“Try (tri) before you buy (bi).” In the heart, blood
flows through the tricuspid valve and then through
the bicuspid (mitral) valve.
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Blood Flow Through the Heart
 Ejection fraction
 Normal: approximately 65%
 Heart rate
 Beats per minute (BPM)
 Normal: 60-100 BPM
 Pulse points
Pulse points
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Conductive Mechanism System
 Blood pressure (BP)
 Sphygmomanometer
 Electrical pathway
 Sinoatrial node (SA)
 Atrioventricular node (AV)
 Bundle of His/
atrioventricular bundle
 Purkinje fibers
 Bundle of Kent
Electrical conduction
pathways of the heart
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EKG Recording of the Cardiac Cycle
Conductive mechanism of the heart
through the use of an electrocardiogram
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ST segment
24
Arteries: Upper and Lower
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Arteries: Naming and Division
 Upper/lower divisions based on relation to the
diaphragm
 Many named by the anatomical structure that they
supply

Subdivisions may include information about the direction or
position (ascending/descending, anterior/posterior,
superior/inferior)
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PCS Guideline Alert!
 Medial and Surgical
B4.12 Nerves and Vessels
Section (Section 0)
B2.2 Body systems
designated as upper or
lower contain body parts
located above or below
the diaphragm,
respectively.
Nerves and vessels that
are not identified by a
separate body part value
are coded to the closest
proximal branch
identified by a body part
value.
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Upper Arteries
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Word Parts
Upper Arteries
 Head and neck

•cerebr/o = cerebrum
Right common carotid

•tempor/o = temple
•lingu/o = tongue
• Lingual, facial, occipital
•faci/o = face
•occipit/o = occiput
Internal and external carotid
 Cerebral (from external)
 Temporal

Right subclavian
 Right vertebral
• Basilar
• Circle of Willis
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Word Parts
Upper Arteries
 Thoracic aorta
cost/o = rib
Right and left internal mammary
arteries (also called internal thoracic
arteries)
bronchi/o = bronchi


clav/i = clavicle
pericardi/o =
pericardium
esophag/o = esophagus
mediastin/o =
mediastinum
phren/o = diaphragm
Right and left subclavian arteries
 Superior and inferior thyroid artery
 Intercostal
 Bronchial
 Pericardial
 Esophageal
 Mediastinal
 Superior phrenic
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Word Parts
brachi/o = arm
uln/o = ulna
radi/o = radius
Upper Arteries
 Arteries to the arms




Brachial arteries
Ulnar arteries
Radial arteries
Hand arteries
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Lower Arteries
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Word Parts
celi/o = abdomen
gastr/o = stomach
Lower Arteries
 Abdomen, pelvis, and legs

Begin at abdominal aorta

hepat/o = liver
• Hepatic
• Splenic
splen/o = spleen
mesenter/o = midgut
col/o = colon, large
intestine
ren/o = kidney
supra- = above
Celiac artery
 Gastric
Superior mesenteric
 Colic arteries
 Renal
 Inferior mesenteric
 Suprarenal
 Common iliac
 Right and left internal and external
iliac arteries

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Word Parts
Lower Arteries
 Right and left femoral

femor/o = thighbone
perone/o = tibia
ped/o = foot

Branches from the external iliac
Popliteal
Anterior and posterior tibial
 Peroneal
 Dorsalis pedis
 Arcuate

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Veins: Upper and Lower
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Upper Veins
 Facial veins
 Intracranial
 Vertebral
 External jugular
 Internal jugular
 Subclavian
 Brachiocephalic
 Superior vena cava
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Word Parts
Upper Veins
 Chest drainage

azyg/o = without a yoke
inter- = between
cost/o = rib
bronchi/o = bronchus
pericardi/o =
pericardium





Azygos
Hemiazygos
Accessory hemiazygos
Intercostal
Bronchial
Pericardial
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Word Parts
ante- = before
brachi/o = arm
Upper Veins
 Veins of the arms and hands

Hands and fingers


cubit/o = elbow
Palmar/volar digital and metacarpal veins
Lower arms

cephal/o = head
Deep drainage
 Radial and ulnar
 Anastomose at brachial vein

Superficial drainage
 Median antebrachial vein
 Median cubital vein
 Connect to basilic and cephalic veins

Upper arms

Brachial and cephalic
 Drain into axillary vein
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Lower Veins
 Lower veins are those below the diaphragm.
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Word Parts
Lower Veins
 Legs

metatars/o =
metatarsal

poplite/o = behind the
knee

perone/o = fibula

femor/o = thigh



Digital and metatarsal
Greater and lesser saphenous
Peroneal
Posterior tibial
Popliteal vein
Femoral
External iliac
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Word Parts
Lower Veins
 Abdominopelvic cavity

hepat/o = liver
Hepatic
 Gastric
 Splenic
 Pancreatic
 Inferior and superior mesenteric
 Esophageal

gastr/o = stomach
splen/o = spleen
pancreat/o = pancreas
mesenter/o = midgut
esophag/o =
esophagus
adren/o = adrenal
gland
Hepatic portal system



Adrenal and renal
Inferior phrenic
Internal iliac
ren/o = kidney
phren/o = diaphragm
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Upper Veins: Be Careful!
The cephalic veins are in the arms, not in the head!
Don’t confuse the basilic vein in the arms with the
basilar artery in the head.
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ICD-10-PCS Medical Surgical Divisions for the
Circulatory System
 Heart
and great vessels
 Upper arteries
 Lower arteries
 Upper veins
 Lower veins
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Note
In ICD-10-PCS: The superior vena cava is classified as
a great vessel of the heart, even though it is usually
described as one of the two largest veins of the body.
The inferior vena cava is classified as a lower vein.
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Fetal Circulation
Before birth
After birth
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Lymphatic System
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Lymphatic System
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Word Parts
bucc/o = cheek
infra- = under, beneath
pre- = in front of,
before
Lymphatic System
 Lymph nodes in the head




sub- = under

auricul/o = ear

par- = near

ot/o = ear

mandibul/o = mandible

Buccinators
Infraauricular
Infraparotid
Preauricular
Submandibular
Submaxillary
Submental
Subparotid
Suprahyoid
maxill/o = maxilla
ment/o = chin
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Word Parts
cervic/o = neck
post- = after, behind
auricul/o = ear
occipt/o = occiput
retro- = behind
pharyng/o = pharynx
supra- = above
clavicul/o = clavicle
Lymphatic System
 Lymph nodes in the neck









Cervical
Jugular
Postauricular
Occipital
Retropharyngeal
Supraclavicular
Right jugular trunk
Right lymphatic duct
Right subclavian trunk
clav/o = clavicle
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Word Parts
brady- = slow
-cardia = heart condition
Circulatory Signs and
Symptoms (R00-R99)
 Bradycardia
 Tachycardia
ECGs
A, normal B, bradycardia C, tachycardia
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Circulatory Signs and Symptoms (R00-R99)
 Cardiac murmur
 Cardiac bruit
 Palpitations
Be Careful! Do not confuse palpation, which means examination by
touch, palpebration, which means blinking, and palpitation, which means
a pounding or racing of the heart.
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Word Parts
emesis = to vomit
dys- = difficult
-pnea = breathing
orth/o = straight
pulmon/o = lung
-ary = pertaining to
Circulatory Signs and
Symptoms (R00-R99)
 Nausea
 Emesis
 Pallor
 Dyspnea

Dyspnea on exertion (DOE)
 Orthopnea
 Shortness of breath (SOB)
 Pulmonary congestion
 Syncope
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Word Parts
cyan/o = blue
-osis = abnormal
condition
cardi/o = heart
-algia = pain
Circulatory Signs and
Symptoms (R00-R99)
 Cyanosis
 Diaphoresis
 Cardialgia



Atypical
Ischemic
Precordial
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Review Question
 The term that means profuse sweating is:
A. cyanosis
B. diaphoresis
C. emesis
D. syncope
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Congenital Disorders of the Heart (Q20-Q28)
 Coarctation of the aorta
 Patent ductus arteriosus
(PDA)
Coarctation of the aorta
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Word Parts
sept/o = septum, wall
-al = pertaining to
tetra- = four
-logy = study of
dextr/o = right
-cardia = heart
condition
Congenital Disorders of the
Heart (Q20-Q28)
 Septal defect


Atrial septal defect
(ASD)
Ventricular septal defect
(VSD)
 Tetralogy of Fallot
 Dextrocardia/levocardia
levo- = left
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Word Parts
rheumat/o = watery
flow
hyper- = excessive,
above
-tension = pressure
Rheumatic Fever and
Hypertensive Diseases
(I00-I15)
 Rheumatic heart disease
 Hypertension




Essential (primary)
Secondary
Controlled
Uncontrolled
 Guideline Alert! Coders need to
examine the record for the causes
of the hypertension.
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Word Parts
pector/o = chest
-is = structure
Ischemic Heart Diseases
(I20-I25)
 Angina pectoris

Unstable angina

Accelerating/crescendo angina and
intermediate coronary syndrome
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Word Parts
myocardi/o = heart
muscle
Ischemic Heart Diseases
(I20-I25)
 Acute myocardial infarction
-al = pertaining to
Be Careful! Infarction refers to tissue death. An
infraction refers to a breaking, as in an
incomplete bone fracture.
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Did You Know?
 Research results show that men and women often
experience different heart attack symptoms. Although men
are more likely to experience crushing pressure or pain,
nausea, and shortness of breath, women may not. Many
women report extreme fatigue, weakness, dizziness, and a
cold sweat, along with shortness of breath. Unfortunately,
because most women are unaware that these symptoms
may signal a life-threatening condition, they often delay
seeking medical assistance.
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Ischemic Heart Diseases (I20-I25)
 Aneurysm (of heart)
 Coronary atherosclerosis
 Atherosclerotic coronary artery disease (CAD)
Coronary atherosclerosis
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Word Parts
pulmon/o = lung
-ary = pertaining to
hyper- = excessive
-tension = pressure
cor = heart
cardi/o = heart
-ac = pertaining to
Pulmonary Heart/Circulation
and Other Heart Diseases
(I26-I52)
 Pulmonary hypertension
 Acute cor pulmonale
 Pulmonary embolism (PE)
infarction
 Cardiac tamponade
 Heart failure
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Word Parts
stenosis = narrowing
Pulmonary Heart/Circulation
and Other Heart Diseases
(I26-I52)
 Mitral stenosis (MS)
 Tricuspid stenosis (TS)
Valvular heart disease
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Word Parts
pro- = forward
-lapse = fall
Pulmonary Heart/Circulation
and Other Heart Diseases
(I26-I52)
 Mitral valve prolapse (MVP)
 Mitral regurgitation
MVP
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Word Parts
cardi/o = heart
-megaly = enlargement
cardiomy/o = heart
muscle
Pulmonary Heart/Circulation
and Other Heart Diseases
(I26-I52)
 Cardiomegaly
 Cardiomyopathy
-pathy = disease
Cardiomegaly
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Word Parts
endocardi/o =
endocardium
-itis = inflammation
pericardi/o =
pericardium
Pulmonary Heart/Circulation
and Other Heart Diseases
(I26-I52)
 Endocarditis
 Pericarditis
Acute bacterial endocarditis
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Word Parts
dys- = abnormal
rhythm/o = rhythm
-ia = condition
a- = no, not, without
atri/o = atrium
-al = pertaining to
ventricul/o = ventricle
Cardiac Dysrhythmias
(Arrhythmias) (I44-I49)
 Dysrhythmia/ arrhythmia
 Flutter
 Fibrillation


Atrial
Ventricular
 Ectopic beats
 Atrial vs. ventricular
-ar = pertaining to
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Word Parts
venticul/o = ventricle
Cardiac Dysrhythmias
(Arrhythmias) (I44-I49)
 Heart block
-ar = pertaining to

tachy- = rapid

-cardia = heart
condition
Atrioventricular block
Bundle branch block (BBB)
 Sick sinus syndrome (SSS)
 Ventricular tachycardia
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Cerebrovascular Diseases (I60-I69)
 Cerebral infarction
 Intracerebral hemorrhage
 Subarachnoid hemorrhage (SAH)
 Monoplegia
Cerebral infarction, also called cerebrovascular accident (CVA).
A, Events causing stroke. B, MRI showing hemorrhagic stroke in
right cerebrum. C, Areas of the body affected by CVA.
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Word Parts
 Aphasia
 Dysarthria
 Apraxia
a- = no, not, without
phas/o = speech
 Ataxia
-ia = condition
prax/o = purposeful
movement
tax/o = order,
coordination
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Word Parts
arteri/o = artery
-sclerosis = abnormal
condition of hardening
occlus/o = blockage
-ion = process of
vascul/o = vessel
syn- = together
-drome = run
-itis = inflammation
angi/o = vessel
Diseases of Arteries,
Arterioles, and Capillaries
(I70-I79)
 Aortic aneurysm
 Arteriosclerosis
 Intermittent claudication
 Peripheral arterial occlusion
 Peripheral vascular disease (PVD)
 Raynaud’s syndrome

Raynaud’s phenomenon
 Vasculitis
 Angiitis
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Diseases of Veins (I80-I89)
 Esophageal varices
 Hemorrhoids
 Thrombophlebitis
 Varicose veins
A, Deep vein thrombophlebitis (DVT).
B, Large embolus derived from a lower extremity DVT and now
located in a pulmonary artery branch.
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Word Parts
hypo- = below, deficient
tens/o = stretching
-ion = process of
Other and Unspecified
Disorders of the Circulatory
System (I95-I99)
 Gangrene
 Hypotension


Orthostatic
idiopathic
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Word Parts
lymphaden/o = lymph
gland
-itis = inflammation
lymphangi/o = lymph
vessel
-ectasia = expansion,
dilation
Disease of Lymphatic Vessels
and Lymph Nodes (I88-I89)
 Lymphadenitis
 Lymphangiectasia
 Lymphangitis
 Lymphedema
 Splenomegaly
-edema = swelling
splen/o = spleen
-megaly = enlargement
Lymphedema
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Splenomegaly
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Benign Neoplasms of the Circulatory System
 Atrial myxoma
 Hemangioma
 Thymoma
Hemangioma
Atrial myxoma
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Terms Related to Malignant Neoplasms
 Cardiac myxosarcoma
 Hemangiosarcoma
Cardiac myxosarcoma
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Word Parts
thym/o = thymus gland
-oma = tumor
Terms Related to Malignant
Neoplasms
 Hodgkin lymphoma

Reed-Sternberg cells
 Non-Hodgkin lymphoma
 Malignant thymoma (thymic
carcinoma)
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Review Question
 Extremely rapid and irregular heartbeats:
A. ectopic beats
B. fibrillation
C. flutter
D. angina pectoris
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Review Question
 Inflammation of a vein with formation of a clot is:
A. varicose veins
B. thrombophlebitis
C. claudication
D. Raynaud’s disease
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Did You Know?
 Since 1900, cardiovascular disease has been the
number one killer in the United States every year
except for 1918. Cardiovascular disease claims
almost 10,500 more lives each year than the next six
leading causes of death combined.
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Circulatory System Procedures
 Procedures related to the cardiovascular system
 Procedures related to the lymphatic system
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PCS Guideline Alert!
 The coronary arteries are classified as a single body
part that is further specified by number of sites
treated, not by name or number of arteries. Separate
body part values are used to specify the number of
sites treated when the same procedure is performed
on multiple sites in the coronary arteries.
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Terms Related to Laboratory Tests
 Cardiac enzymes test
 C-reactive protein (CRP) test
 Homocysteine levels
 Lipid profile
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Procedures of the Great Vessels and Aorta
 Angiocardiography
 Digital subtraction
angiography (DSA)
DSA
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Word Parts
angi/o = vessel
-tripsy = crushing
-plasty = surgically
repair
Procedures of the Great
Vessels and Aorta
 Angiotripsy
 Angioplasty: Percutaneous
transluminal coronary
angioplasty (PTCA)

Stent
PTCA
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Word Parts
aort/o = aorta
-plasty = surgically
forming
trans- = through
Procedures of the Great
Vessels and Aorta
 Aortoplasty
 Transmyocardial
revascularization
myocardi/o =
myocardium
-al = pertaining to
re- = again
vascul/o = vessel
-ization = process
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Procedures of the Heart
 Cardiac catheterization
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Word Parts
cardi/o = heart
Procedures of the Heart
 Cardioplegia
 Cardioversion
-plegia = paralysis
-version = turning
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Procedures of the Heart
 Coronary artery bypass graft (CABG)
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Word Parts
pericardi/o = sac
surrounding the heart
-centesis = surgical
puncture
-lysis = releasing,
destroying, breaking
down
Procedures of the Heart
 Pericardiocentesis
 Pericardiolysis
 Septoplasty
 Valvuloplasty
sept/o = wall, partition
-plasty = surgically
forming
valvul/o = valve
aort/o = aorta
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Cardiac Procedures
 Left ventricular assist device (LVAD)
 Minimally invasive direct coronary artery bypass
(MIDCAB)
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Word Parts
electr/o = electricity
cardi/o = heart
-graphy = recording
echo- = sound
Procedures of the Heart and
Great Vessels
 Electrocardiography
(ECG/EKG)
 Echocardiography

Transesophageal echocardiography
trans- = through
esophag/o = esophagus
Echocardiography
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PCS Guideline Alert!
 B4.4 The coronary arteries are classified as a single
body part. They are further specified by number of
sites treated, not by name or number of arteries.
Separate body part values are provided to indicate
the number of sites treated, when the same
procedure is performed on multiple sites in the
coronary arteries.
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Word Parts
arteri/o = artery
-rrhaphy = suturing
end- = within
-ectomy = cutting out
phleb/o = vein
-graphy = recording
-tomy = cutting
ven/o = vein
Procedures of the Arteries and
Veins
 Arteriorrhaphy
 Endarterectomy
 Phlebectomy
 Phlebography
 Phlebotomy
 Sclerotherapy
 Venotripsy
-tripsy = crushing
Endarterectomy
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PCS Guideline Alert!
 B3.5 Bypass procedures are coded according to the
direction of flow of the contents of a tubular body
part; the body part value identifies the origin of the
bypass and the qualifier identifies the destination of
the bypass. Note: coronary arteries are coded
differently. The body part value identifies the
number of coronary artery sites bypassed. The
qualifier identifies the origin of the bypass.
 B3.6c If multiple coronary artery sites are bypassed,
a separate procedure is coded for each coronary
artery site that uses a different device and/or
qualifier.
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Word Parts
lymphaden/o = lymph
gland/node
-ectomy = cutting out
lymphangi/o = lymph
vessel
-graphy = recording
splen/o = spleen
-pexy = suspension
Procedures of the Lymph
Glands, Spleen, and
Thymus
 Lymphadenectomy
 Lymphangiography
 Splenectomy
 Splenopexy
 Thymectomy
thym/o = thymus gland
Lymphangiography
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Suffixes and Root Operations for the Circulatory
System
 -centesis
 -ectomy
 -lysis
 -pexy
 -plasty
 -rrhaphy
 -tomy
 -tripsy
drainage
excision, resection
release
repair, reposition
dilation, repair, replacement,
supplement
repair
drainage
occlusion
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Pharmacology
 Angiotensin-converting enzyme inhibitors
 Angiotension II receptor blockers
 Antiarrhythmic drugs
 Anticoagulants
 Antihyperlipidenics
 Beta-blockers
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Pharmacology
 Calcium channel blockers
 Diuretics
 Nitrates
 Thrombolytics
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Sort these terms into their correct categories
Terms
1. pericardiocentesis
2. angina pectoris
3. hemangioma
4. atria
5. splenopexy
Categories
__ A + P
__ Pathology
__ Procedures
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Take Aways
 It’s easier to remember the names and locations of the
arteries/veins and lymph nodes if you have a solid
knowledge of combining forms from the organization
of the body and the musculoskeletal chapters.
 Medical terminology often includes multiple
combining forms for the same structure: mur/o,
sept/o, pariet/o and diaphragm/o all refer to partitions
or walls. Study them together!
 Practice makes perfect – use all of your exercises in the
text and on Evolve to help you remember these new
terms.
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