CHAPTER
23
The Cardiovascular
System
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23-2
Learning Outcomes
23.1 Describe the structure of the heart and the
function of each part.
23.2 Trace the flow of blood through the heart.
23.3 List the most common heart sounds and
what events produce them.
23.4 Explain how heart rate is controlled by the
electrical conduction system of the heart.
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23-3
Learning Outcomes (cont.)
23.5 List the different types of blood vessels and
describe the functions of each.
23.6 Define blood pressure and tell how it is
controlled.
23.7 Trace the flow of blood through the
pulmonary and systemic circulation.
23.8 List the major arteries and veins of the body
and describe their locations.
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23-4
Learning Outcomes (cont.)
23.9 List and describe the components of blood.
23.10 Give the functions of red blood cells, the
different types of white blood cells, and
platelets.
23.11 List the substances normally found in
plasma.
23.12 Explain how bleeding is controlled.
23.13 Explain the differences among blood types
A, B, AB, and O.
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23-5
Learning Outcomes (cont.)
23.14 Explain the difference between Rh-positive
blood and Rh-negative blood.
23.15 Explain the importance of blood typing and
tell which blood types are compatible.
23.16 Describe the causes, signs and symptoms,
and treatments of various diseases and
disorders of the cardiovascular system.
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23-6
Introduction
•
The cardiovascular system consists of heart
and blood vessels
•
Sends blood to
– Lungs for oxygen
– Digestive system for nutrients
•
Also circulates waste products to certain
organ systems for removal from the blood
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23-7
Structures of the Heart
•
•
•
•
Cone-shaped organ
about the size of a
loose fist
In the mediastinum
Extends from the
level of the second rib
to about the level of
the sixth rib
Slightly left of the
midline
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23-8
Structures of the Heart (cont.)

Heart is bordered:




Laterally by the lungs
Posteriorly by the vertebral
column
Anteriorly by the sternum
Rests on the diaphragm
inferiorly
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23-9
Structures of the Heart (cont.)
•
Heart coverings
– Pericardium
•
•
Covers the heart and
large blood vessels
attached to the heart
Visceral pericardium
– Innermost layer
– Directly on the heart
•
Parietal pericardium
– Layer on top of the
visceral pericardium
Click for Larger View
• Heart walls:
– Epicardium
• Outermost layer
• Fat to cushion heart
– Myocardium
• Middle layer
• Primarily cardiac muscle
– Endocardium
• Innermost layer
• Thin and smooth
• Stretches as the heart
pumps
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23-11
Structures of the Heart (cont.)
•
Four chambers
– Two atria
•
•
•

Upper chambers
Left and right
Separated by
interatrial septum
– Two ventricles
•
•
•
Lower chambers
Left and right
Separated by
interventricular
septum
Atrioventricular septum separates the atria
from the ventricles
Click for
View of
Heart
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23-12
Structures of the Heart (cont.)
•
•
•
•
Tricuspid valve – prevents blood from flowing
back into the right atrium when the right ventricle
contracts
Bicuspid (mitral) valve – prevents blood from
flowing back into the left atrium when the left
ventricle contracts
Pulmonary semilunar valve – prevents blood
from flowing back into the right ventricle
Aortic semilunar valve – prevents blood from
flowing back into the left ventricle
Click for
View of
Heart
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23-14
Blood Flow Through the Heart
Deoxygenated
blood in from
body
Oxygenated
blood out to
body
Oxygenated blood
in lungs
Deoxygenated
blood out
to lungs
Atria Contract
Ventricles Contract
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23-15
Blood Flow Through the Heart (cont.)
Right
Atrium
Tricuspid
Valve
Right
Ventricle
Pulmonary
Valve
Body
Lungs
Aortic
Semilunar
Valve
Left
Ventricle
Bicuspid
Valve
Left
Atrium
Pulmonary
Semilunar
Valve
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23-16
Cardiac Cycle

One heartbeat = one cardiac cycle


Atria contract and relax
Ventricles contract and relax
• Right atrium contracts
– Tricuspid valve opens
– Blood fills right ventricle
• Right ventricle contracts
– Tricuspid valve closes
– Pulmonary semilunar valve
opens
– Blood flows into pulmonary
artery
• Left atrium contracts
– Bicuspid valve opens
– Blood fills left ventricle
• Left ventricle contracts
– Bicuspid valve closes
– Aortic semilunar valve
opens
– Blood pushed into aorta
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23-17
Cardiac Cycle (cont.)
• Influenced by
– Exercise
– Parasympathetic nerves
– Sympathetic nerves
– Cardiac control center
– Body temperature
– Potassium ions
– Calcium ions
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23-18
Heart Sounds
•
One cardiac cycle – two heart sounds
(lubb and dubb) when valves in the heart
snap shut
– Lubb – first sound
•
When the ventricles contract, the tricuspid and
bicuspid valves snap shut
– Dubb – second sound
•
When the atria contract and the pulmonary and
aortic valves snap shut
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23-19
Cardiac Conduction System
• Group of structures that send electrical impulses through
the heart
• Sinoatrial node (SA node)
–
–
–
–
• Bundle of His
Wall of right atrium
Generates impulse
Natural pacemaker
Sends impulse to AV node
• Atrioventricular node (AV
node)
– Between ventricles
– Two branches
– Sends impulse to Purkinje
fibers
• Purkinje fibers
– Between atria just above ventricles
– Atria contract
– Sends impulse to the bundle of His
– Lateral walls of ventricles
– Ventricles contract
Click the i below for a
Diagram
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23-20
Cardiac
Conduction
System
Back
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23-21
Apply Your Knowledge
Match the following:
ANSWER:
C Tricuspid valve
__
A. Two branches; sends impulse to Purkinje
fibers
F Bicuspid valve
__
B. Covering of the heart and aorta
__
B Pericardium
C. Between the right atrium and the right
ventricle
E SA node
__
D. In the lateral walls of ventricles
A Bundle of His
__
E. Natural pacemaker
__
D Purkinje fibers
F. Between the left atrium and the left ventricle
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23-22
Blood Vessels
• Closed pathway that
carries blood from the
heart to cells and
back to the heart
• Types
– Arteries
– Arterioles
– Veins
– Venules
– Capillaries
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23-23
Arteries and Arterioles
•
•
•
Strongest of the
blood vessels
Carry blood away
from the heart
Under high pressure
– Vasoconstriction
– Vasodilation
•
Arterioles
– Small branches of
arteries
• Aorta
– Takes blood from the
heart to the body
• Coronary arteries
– Supply blood to heart
muscle
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23-24
Veins and Venules
•
Blood under no pressure
in veins
– Does not move very easily
– Skeletal muscle
contractions help move
blood
– Sympathetic nervous
system also influences
pressure
•
Valves prevent backflow
• Venules
– Small vessels formed when
capillaries merge
• Superior and inferior vena
cava
– Largest veins
– Carry blood into right
atrium
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23-25
Capillaries
•
Branches of arterioles
•
Smallest type of blood vessel
•
Connect arterioles to venules
•
Only about one cell layer thick
•
Oxygen and nutrients can pass out of a capillary into
a body cell
•
Carbon dioxide and other waste products pass out of
a body cell into a capillary
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23-26
Apply Your Knowledge
How do arteries control blood pressure?
ANSWER: The muscular walls of arteries can
constrict to increase blood pressure or dilate to
decrease blood pressure.
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23-27
Blood Pressure
•
Force blood exerts on the inner walls of blood vessels
– Highest in arteries
– Lowest in veins
•
Systolic pressure
– Ventricles contract
– Blood pressure in arteries is at its greatest
•
Diastolic pressure
– Ventricles relax
– Blood pressure in arteries is at its lowest
•
Reported as the systolic number over the diastolic
number
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23-28
Blood Pressure (cont.)
•
•
•
Control is based mainly on the amount of blood pumped
out of the heart
The amount of blood entering should equal the amount
pumped from the heart
Starling's law of the heart
– Blood entering the left ventricle stretches the wall of the ventricle
– The more the wall is stretched
•
•
The harder it will contract and
The more blood it will pump out
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23-29
Blood Pressure (cont.)
• Baroreceptors
– Also help regulate blood pressure
– Located in the aorta and carotid arteries
– High blood pressure in aorta  message to
cardiac center in brain  decreases heart
rate
 lowers blood pressure
– Low blood pressure in aorta  message to
cardiac center in the brain  increases heart
rate  increases blood pressure
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
23-30
Apply Your Knowledge
What is the difference between the systolic
pressure and diastolic pressure?
ANSWER: Systolic pressure is the result of the
contraction of the ventricles increasing the pressure in
the arteries. Diastolic pressure is the result of the
relaxation of the ventricles lowering the pressure in the
arteries.
Good
Answer!
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23-31
Circulation
•
Pulmonary circuit
right atrium  right ventricle  pulmonary
artery trunk  pulmonary arteries  lungs
 pulmonary veins  heart (left atrium)
•
Systemic circuit
left atrium  left ventricle  aorta  arteries 
arterioles  capillaries  venules  veins 
vena cava  heart (right atrium)
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23-32
Circulation (cont.)
•
Arterial system
– Carries oxygen-rich
blood away from the
heart
– Pulmonary arteries
carry oxygen-poor
blood
– Paired – left and right
artery of the same
name
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23-33
Circulation (cont.)
•
Venous system
–
Carries oxygen-poor
blood toward the
heart
•
–
Except pulmonary veins

Hepatic portal system

Collection of veins
carrying blood to the
liver
Most large veins
have the same
names as the
arteries they are
next to
Click for Larger View
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23-35
Apply Your Knowledge
Do pulmonary arteries carry blood with high levels
of oxygen or low levels of oxygen?
ARTERIES: Pulmonary arteries carry oxygen-poor blood.
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23-36
Blood
•
A type of connective
tissue
– Red blood cells
(erythrocytes)
– White blood cells
(leukocytes)
– Platelets – cell
fragments
– Plasma – fluid part of
blood
Average-sized adult has
4 to 6 liters of blood
Amount depends on:
 Size of person
 Amount of adipose tissue
 Concentrations of ions
 Females have less than
males
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23-37
Blood Components
• Hematocrit
– The percentage of
red blood cells
– Normal is about
45%
• White cells and
platelets = 1%
• Plasma = 55%
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23-38
Red Blood Cells
•
•
•
•
Erythrocytes
Transport oxygen throughout the body
Small biconcave-shaped cells
Hemoglobin is a pigment in RBCs
–
–
Oxyhemoglobin carries oxygen; bright red
Deoxyhemoglobin does not carry oxygen; darker
red
•
–
•
Carries carbon dioxide, so also called carboxyhemoglobin
Anemia – low RBC count
Erythropoietin – regulates production of
RBCs
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23-39
Red Blood Cells (cont.)
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White Blood Cells
•
Granulocytes
– Neutrophils (55%) –destroy bacteria, viruses, and
toxins in the bloodstream (phagocytes)
– Eosinophils (3%) – get rid of parasitic infections such
as worm infections
– Basophils (1%) – control inflammation and allergic
reactions
• Agranulocytes
– Monocytes (8%) – destroy bacteria, viruses, and
toxins in blood
– Lymphocytes (33%) – provide immunity for the body
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23-41
White Blood Cells (cont.)
• WBC count normally 5000 to 10,000 cells
per cubic millimeter of blood
– Leukocytosis
• Elevated WBC count
• Usually due to infection
– Leukopenia
• Low WBC count
• Some viral infections and other conditions
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23-42
Platelets
•
•
•
•
Fragments of cells found in the
bloodstream
Also called thrombocytes
Important in the clotting process of blood
Normal count
– 130,000 to 360,000 platelets per cubic
millimeter of blood
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23-43
Plasma
• Liquid portion of blood
composed mostly of
water
• Proteins
– Albumins
• Smallest plasma proteins
• Pull water in to help
maintain blood pressure
– Globulins – transport lipids
and fat-soluble vitamins
– Fibrinogen – needed for
blood clotting
• Nutrients
–
–
–
–
Amino acids
Glucose
Nucleotides
Lipids from the
digestive tract
• Gases – oxygen,
carbon dioxide, and
nitrogen
• Electrolytes
• Waste products
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23-44
Bleeding Control
•
Hemostasis – the control of bleeding
•
Three processes of hemostasis
–
–
–
Blood vessel spasm
Platelet plug formation
Blood coagulation
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23-45
Platelet plug formation:
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23-46
Blood Types
• Types are
distinguished by
antigens and
antibodies
• Agglutination
– Clumping of red blood
cells
– Antigens on surface of
RBCs bind to
antibodies in plasma
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23-47
Blood Types (cont.)
Blood Type
Antigen
Present
Antibody
Present
Blood That Can
Be Received
A
A
B
A and O
B
B
A
B and O
AB
AB
None
O
None
A and B
A, B, AB, and
O
O
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23-48
Blood Types (cont.)
•
Rh antigen – protein
on RBCs
•
Rh-positive
– RBCs contain the
Rh antigen
•
Rh-negative
– RBCs do not contain
the Rh antigen
•
Rh-positive blood is
given to Rh-negative
person
– Antibodies form
•
If Rh-negative person
receives more
Rh-positive blood
– Antibodies bind to the
donor cells
– Agglutination occurs
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
23-49
Apply Your Knowledge
True or False:
ANSWER:
F Hematocrit is the percentage of WBCs in the blood. RBCs
__
__
T Neutrophils destroy bacteria, viruses, and toxins in the
bloodstream.
__
T Platelets are important to the clotting process.
pulls water into
__
F Albumin is a small plasma protein that pushes water out of the
bloodstream.
__
T Hemostasis is the control of bleeding.
receive any type of blood
__
F A person with type AB blood can only receive type AB blood.
__
T Blood should be matched for Rh factor.
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23-50
Chest Pain
• Cardiac
–
–
–
–
Myocardial infarction
Angina
Pericarditis
Coronary spasm
• Non-cardiac
–
–
–
–
–
–
–
Heartburn
Panic attacks
Pleurisy
Costochondritis
Pulmonary embolism
Sore muscles
Broken ribs
Take all complaints of
chest pain seriously!
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23-51
Chest Pain (cont.)
• Determine cause
–
–
–
–
–
–
Electrocardiogram
Stress tests
Blood tests
Chest x-ray
Nuclear scan
Coronary
catheterization
– Echocardiogram
– Endoscopy
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23-52
Diseases and Disorders of the Cardiovascular
System
Disease
Anemia
Description
Aneurysm
The blood does not have enough red blood
cells or hemoglobin to carry an adequate
amount of oxygen to the body’s cells
A ballooned, weakened arterial wall
Arrhythmias
Abnormal heart rhythms
Carditis
Inflammation of the heart
Endocarditis
Inflammation of the innermost lining of the
heart, including valves
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23-53
Diseases and Disorders of the Cardiovascular
System (cont.)
Disease
Myocarditis
Pericarditis
Congestive
heart failure
Description
Inflammation of the muscular layer of the
heart
Inflammation of the membranes that
surround the heart (pericardium)
Weakening of the heart over time; heart is
unable to pump enough blood to meet
body’s needs
Coronary
Atherosclerosis; narrowing of coronary
artery disease arteries caused by hardening of the fatty
(CAD)
plaque deposits within the arteries
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23-54
Diseases and Disorders of the Cardiovascular
System (cont.)
Disease
Description
Hypertension High blood pressure; consistent resting
blood pressure equal to or greater than
140/90 mm Hg
Leukemia
Bone marrow produces a large number of
abnormal WBCs
Murmurs
Abnormal heart sounds
Myocardial
infarction
Heart attack; damage to cardiac muscle due
to a lack of blood supply
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
23-55
Diseases and Disorders of the Cardiovascular
System (cont.)
Disease
Description
Sickle cell
anemia
Abnormal hemoglobin causes RBCs to
change to a sickle shape; abnormal cells
stick in capillaries
Thalassemia
Inherited form of anemia; defective
hemoglobin chain causes, small, pale, and
short-lived RBCs
Thrombophlebi Blood clots and inflammation develop in a
tis
vein
Varicose
veins
Twisted, dilated veins
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23-56
Apply Your Knowledge
The doctor has told your patient she has anemia.
How would you explain this to her?
ANSWER: Anemia is a condition in which a person does not
have enough red blood cells or hemoglobin in the blood to
carry an adequate amount of oxygen to body cells.
Bravo!
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23-57
In Summary
23.1 The structures of the heart include the pericardium,
epicardium, myocardium, and endocardium.
– The chambers of the heart consist of the upper atria
and the lower ventricles.
– The septums are interatrial, interventricular, and
atrioventricular.
– The four valves within the heart are tricuspid,
bicuspid, pulmonary semilunar valve, and the aortic
semilunar valve.
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23-58
In Summary (cont.)
23.2 Superior and inferior vena cavae → right atrium
→ tricuspid valve → right ventricle → pulmonary
semilunar valve → pulmonary trunk → right and left
pulmonary arteries → the lungs → pulmonary veins
→ left atrium → bicuspid valve →left ventricle →
aortic semilunar valve → aorta → body organs and
tissues.
23.3 Heart sounds are described as lubb dubb. Lubb is
created when the ventricles contact and the tricuspid
and bicuspid valves snap shut. Dubb occurs when the
atria contract and the pulmonary and aortic semilunar
valves snap shut.
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23-59
In Summary (cont.)
23.4 The sinoatrial node generates an impulse to the
atrioventricular node. The AV node then sends the
impulse to the bundle of His. The bundle splits into
the left and right bundle branches and sends the
impulse to the Purkinje fibers in the ventricles.
23.5 The arterial system is composed of the aorta, arteries,
and arterioles (largest to smallest) bring blood from
the heart to the body. The capillaries act as the
connectors between the arterioles and venules. From
the venules, blood returns to the heart via the veins to
the superior and inferior vena cavae.
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23-60
In Summary (cont.)
23.6 Blood pressure is the force exerted on the inner wall
of blood vessels by blood as it flows through vessels.
It is highest in arteries and lowest in veins.
Clinically, BP refers to the force of blood within the
arteries.
Blood pressure is largely controlled by the amount of
blood pumped out of the heart, but various other
events may also raise and lower BP.
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23-61
In Summary (cont.)
23.7 Pulmonary circulation: right atrium→ tricuspid valve
→ right ventricle→pulmonary semilunar valve →
pulmonary trunk→pulmonary
arteries→lungs→pulmonary veins→left atrium.
Systemic circulation: left atrium→bicuspid valve→left
ventricle→aortic semilunar valve → aorta → arteries
→ arterioles→capillaries→venules→veins→vena
cavae→right atrium.
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23-62
In Summary (cont.)
23.8 The largest artery in the body is the aorta. Other
major arteries include lingual, facial, occipital,
maxillary, ophthalmic, axillary, brachial, ulnar, radial,
intercostals, lumbar, external iliac, common iliac,
femoral, popliteal, and tibial.
The largest veins in the body are the superior and
inferior vena cavae. Other major veins are jugular,
brachiocephalic, axillary, brachial, ulnar, radial,
intercostals, azygos, gastric, splenic, mesenteric,
hepatic portal, hepatic, iliac, femoral, popliteal, and
saphenous.
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23-63
In Summary (cont.)
23.9 The components of blood are red blood cells (RBC),
white blood cells (WBC), platelets, and plasma.
23.10 Red blood cells carry oxygen and carbon dioxide
throughout the body. White blood cells are divided
into two types: granulocytes and agranulocytes.
Granulocytes include neutrophils, eosinophils, and
basophils. Agranulocytes include lymphocytes and
monocytes. Platelets are essential in the blood
clotting process.
23.11 Plasma contains three major proteins: albumins,
globulins, and fibrinogen.
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23-64
In Summary (cont.)
23.12 Hemostasis is bleeding control. When a blood vessel
breaks, the vessel wall spasms and reduces blood
loss.
Platelets stick to the broken area and to each other,
forming a platelet plug.
A blood clot occurs when fibrinogen converts to fibrin,
which sticks to the damaged area of the blood vessel,
creating a meshwork to trap blood cells and platelets,
which will remain while tissues repair themselves.
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23-65
In Summary (cont.)
23.13 Blood types are named for the antigen present on the
cell surfaces. The “opposite” letter is the name of the
antibody present. Blood type A has antigen A and
antibody B; blood type B has antigen B and antibody
A; blood type AB has antigens A and B and 0 (zero)
antibodies; Blood type O has no antigens present
and both A and B antibodies.
23.14 Rh-positive blood contains the Rh antigen on its
RBCs. Rh-negative blood carries no such antigen.
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23-66
In Summary (cont.)
23.15 Due to the antibodies present on different blood
types, it is important for blood typing to be done prior
to any transfusion.
It is equally important to know if a patient’s blood type
is positive or negative for the same reason.
A negative blood type will “fight” the positive antigen
found on a positive blood type.
An Rh-negative woman carrying an Rh-positive fetus
will develop antibodies against the child’s blood type.
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23-67
In Summary (cont.)
23.16 Many different types of cardiac and blood diseases
are described in this chapter. The signs, symptoms,
and treatments are as varied as the diseases
themselves. The Pathophysiology section of this
chapter outlines the most common of these diseases,
their signs and symptoms, as well as the treatments.
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23-68
End of Chapter 23
Your work is to discover
your world and then with
all your heart give
yourself to it.
~ Buddha
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.