27-1
The Cardiovascular System
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-2
Introduction

The cardiovascular system consists of heart,
blood vessels, and blood

Sends blood to



Lungs for oxygen
Digestive system for nutrients
CV system also circulates waste products to
certain organ systems for removal from the blood
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Functions of the Heart

Generating blood pressure

Routing blood


Ensuring one-way blood flow


Heart separates pulmonary and systemic circulations
Heart valves ensure one-way flow
Regulating blood supply

Changes in contraction rate and force match blood
delivery to changing metabolic needs
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27-4
The Heart: Structures




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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27-5
The Heart: Structures (cont.)

Heart is bordered:




Laterally by the lungs
Posteriorly by the vertebral
column
Anteriorly by the sternum
Rests on the diaphragm
inferiorly
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Size, Shape, Location
of the Heart
Size
of a closed fist
Shape
Apex:
Blunt rounded
point at the bottom
pointing towards left
hip.
Base: Flat part at
opposite of end of
cone
Located
in thoracic
cavity in mediastinum
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Coverings of the Heart: Anatomy

Pericardium – a double-walled sac around
the heart composed of:
1.
2.
A superficial fibrous pericardium
A deep two-layer serous pericardium
a.
The parietal layer lines the internal surface of
the fibrous pericardium
b.
The visceral layer or epicardium lines the
surface of the heart

They are separated by the fluid-filled pericardial
cavity that helps to minimize friction during heart
beats.
7
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Pericardial Layers of the Heart
Figure 18.2
8
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27-9
The Heart: Structures (cont.)

Heart walls:

Epicardium (visceral layer)



Myocardium




Outermost layer
Fat to cushion heart
Click for Larger View
Middle layer
Primarily cardiac muscle
Actually contracts
Endocardium



Innermost layer
Thin and smooth
Stretches as the heart pumps
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27-11
The Heart: Structures (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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27-13
The Heart: Structures (cont.)




Tricuspid valve – prevents blood from flowing back
into the right atrium when the right ventricle
contracts
Bicuspid valve – prevents blood from flowing back
into the left atrium when the left ventricle contracts
Pulmonary valve – prevents blood from flowing
back into the right ventricle
Aortic valve – prevents blood from flowing back Click for
View of
into the left ventricle
Heart
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Location of Heart Valves
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27-15
Heart Valves
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27-16
The Heart: Blood Flow
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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27-17
The Heart: Blood Flow (cont.)
Right
Atrium
Tricuspid
Valve
Right
Ventricle
Pulmonary
Valve
Body
Lungs
Aortic
Semilunar
Valve
Left
Ventricle
Bicuspid
Valve
Left
Atrium
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Systemic and Pulmonary
Circulation
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Myocardial Thickness and Function
Thickness of myocardium varies according to the function of the
chamber
Atria are thin walled, deliver blood to adjacent ventricles
Ventricle walls are much thicker and stronger


right ventricle supplies blood to the lungs (little flow resistance)
left ventricle wall is the thickest to supply systemic circulation
19
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Thickness of Cardiac Walls
Myocardium of left ventricle is much thicker than the right.
20
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Pathway of Blood Through the Heart
and Lungs
Figure 18.5
21
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27-23
The Heart: 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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Cardiac Cycle
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27-25
The Heart: Cardiac Cycle (cont.)

Influenced by







Exercise
Parasympathetic nerves
Sympathetic nerves
Cardiac control center
Body temperature
Potassium ions
Calcium ions
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27-26
The Heart: Heart Sounds

One cardiac cycle – two heart sounds (lubb
and dubb) when valves in the heart snap shut

Lubb – First sound


Dubb – Second sound


When the ventricles contract, the tricuspid and
bicuspid valves snap shut
When the atria contract and the pulmonary and aortic
valves snap shut
Third heart sound (occasional)

Caused by turbulent blood flow into ventricles and detected near
end of first one-third of diastole
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27-27
The Heart: Cardiac Conduction System

Group of structures that send electrical impulses through the heart

Sinoatrial node (SA node)





Wall of right atrium
Generates impulse
Natural pacemaker
Sends impulse to AV node
Atrioventricular node (AV
node)




Between atria just above ventricles
Atria contract
Sends impulse to the bundle of His
Bundle of His




Between ventricles
Two branches
Sends impulse to Purkinje
fibers
Purkinje fibers


Lateral walls of ventricles
Ventricles contract
Link to
Diagram
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Electrocardiogram

Action potentials through
myocardium during cardiac
cycle produces electric
currents than can be measured

Pattern

P wave


QRS complex



Atria depolarization
Ventricle
depolarization
Atria repolarization
T wave:

Ventricle repolarization
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Heart Excitation Related to ECG
Figure 18.17
30
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Cardiac Arrhythmias




Tachycardia: Heart rate in excess of 100bpm
Bradycardia: Heart rate less than 60 bpm
Sinus arrhythmia: Heart rate varies 5% during
respiratory cycle and up to 30% during deep
respiration
Premature atrial contractions: Occasional
shortened intervals between one contraction and
succeeding, frequently occurs in healthy people
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Alterations in Electrocardiogram
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Events during Cardiac Cycle
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Mean Arterial Pressure (MAP)


Average blood pressure in aorta
MAP=CO x PR

CO is amount of blood pumped by heart per
minute

CO=SV x HR




SV: Stroke volume of blood pumped during each heart beat
HR: Heart rate or number of times heart beats per minute
Cardiac reserve: Difference between CO at rest and
maximum CO
PR is total resistance against which blood must be
pumped
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Cardiac Output: Example

CO (ml/min) = HR (75 beats/min) x SV (70
ml/beat)

CO = 5250 ml/min (5.25 L/min)
35
Chapter 18, Cardiovascular
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27-36
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27-37
Blood Vessels: 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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27-38
Blood Vessels: 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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27-39
Blood Vessels: 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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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27-41
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-42
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.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Gross Anatomy
of
Circulatory System
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Coronary Circulation


Coronary circulation is the functional blood
supply to the heart muscle itself
Collateral routes ensure blood delivery to
heart even if major vessels are occluded
44
Chapter 18, Cardiovascular
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Coronary Circulation: Arterial Supply
45
© 2009 The McGraw-Hill Companies, Inc. All Figure
rights 18.7a
reserved
Coronary Circulation: Venous Supply
46
Chapter 18, Cardiovascular
© 2009 The McGraw-Hill Companies, Inc. All Figure
rights 18.7b
reserved
Circle of Willis = Cerebral Arterial Circle
= Ring of vessels
surrounding pituitary
gland - supplies cerebrum
and cerebellum
ic
Brain can receive blood from
carotids or vertebrals
(significance?)
Fig 22.13
v
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Circle of Willis
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Pulmonary Circuit
Right ventricle into
pulmonary trunk to
pulmonary arteries to
lungs
Return by way of 4
pulmonary veins to left
atrium
Fig 22.9
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Major Systemic Arteries
The Systemic Circuit
Contains 84% of blood
volume
Supplies entire body:
except for pulmonary
circuit
Supplies entire body:
except for
Figure 21-20
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Systemic Arteries

Blood moves from left ventricle:

into ascending aorta
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
The Aorta

The ascending aorta:




rises from the left ventricle
curves to form aortic arch
turns downward to become descending aorta
Branches of the Aortic Arch deliver blood to head
and neck:



brachiocephalic trunk
left common carotid artery
left subclavian artery
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
The Common Carotid Arteries


Carry blood to head and neck
Each common carotid divides into:

external carotid artery-Supplies structures of:
Neck, lower jaw, face

internal carotid artery-Enters skull and divides
into: opthalmic artery, anterior cerebral artery,
middle cerebral artery
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Aortic Arch
Left common
2
carotid
Brachiocephalic
1
trunk
3
Left subclavian
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Descending aorta
• thoracic aorta
• abdominal aorta
Abdominal aorta
Common iliac
External iliac
Femoral
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The Abdominal Aorta

Divides at terminal segment of the aorta into:


left common iliac artery
right common iliac artery
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Descending Aorta
- Thoracic Area
Bronchial arteries - supply
bronchi and lungs
Pericardial arteries - supply
pericardium
Mediastinal arteries - supply
mediatinal structures
Esophageal arteries - supply
esophagus
Paired intercostal arteriesthoracic wall
Superior phrenic arteries - supply
diaphragm
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Descending Aorta
- Abdominal Area
Celiac trunck - 3 branches – to liver,
gallbladder, esophagus, stomach,
duodenum, pancreas, and spleen
Superior mesenteric– to pancreas and
duodenum, small intestine and
colon
Paired suprarenal - to adrenal glands
Paired renal – to kidneys
Paired gonadal – to testes or ovaries
Inferior mesenteric – to terminal
colon and rectum
Paired lumbar – to body wall
Fig 22.17
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Major Systemic Veins
All Systemic Veins
Drain into either:
Superior vena
cava (SVC)
or Inferior vena
cava (IVC)
Figure 21-27
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
The Superior Vena Cava (SVC)

Returns blood to the heart from:





head
neck
chest
shoulders
upper limbs
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Veins of the Neck

Temporal and maxillary veins:


drain to external
jugular vein
Facial vein:

drains to internal
jugular vein
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27-62
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-63
Superior sagittal
sinus
Falx cerebri
Inferior sagittal
sinus
Straight sinus
Cavernous
sinus
Junction of
sinuses
Transverse
sinuses
Sigmoid sinus
Jugular foramen
Right internal
jugular vein
(b)
Dural Sinuses In The Cranium
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
The Inferior Vena Cava (IVC)

Returns blood to the heart from:

Regions inferior to the diaphram
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27-66
Dissection of the posterior abdominal wall
Right
Left
Diaphragm
Hepatic
veins
Inferior
vena cava
Renal veins
Abdominal
aorta
Common
iliac veins
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Placental Blood Supply
Blood flows to the placenta:
through a pair of umbilical
arteries
which arise from internal iliac
arteries
and enter umbilical cord
Blood returns from placenta:
in a single umbilical vein
which drains into ductus venosus
Ductus venosus:
empties into inferior vena cava
Figure 21-33a
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
68
Atrial Septal Defect


Present at birth
Treated naturally


Surgery
Or catheterization
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27-69
Treatment of patent foramen oval aka
“Atrial Septal Defect”
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Ventricular Septal Defect
70
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
UNDERSTANDING YOUR
BLOOD PRESSURE
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
So…high blood pressure is a condition that most people
willhave
havehigh
at some
point
in their lives.
65 million adults
blood
pressure
in this country.
1 in 3 American adults have high blood pressure
“Silent Killer”
NEW RESEARCH STATES…
that at age 55 or older, those who do not have
high blood pressure have a 90% chance of
developing it during their lifetimes.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
What Is Blood Pressure?
Blood is carried to
all parts of your
body in vessels
called arteries.
Blood pressure is
the force of blood
pushing against
the arteries.
What Is Blood Pressure?
Each time the heart beats
(about 60-70 times a
minute at rest), it pumps
out blood into the arteries.
This is called SYSTOLIC pressure.
Your blood pressure is at
its highest when the heart
beats, pumping the blood.
120/ 80
When the heart is
at rest, between
beats, your blood
pressure falls.
Bottom number
This is called DIASTOLIC pressure.
Your blood pressure is always given as these two numbers
with one above or before the other.
http://www.hsfpe.org/
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
What Is Normal Blood Pressure?
Category
Normal
Systolic
(Top Number)
Diastolic
(Bottom Number)
Less than 120
Less than 80
“Normal” blood pressure is when both
numbers are lower than 120/80.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
“Prehypertension”
Prehypertension
Which of the
following blood
pressure readings are
considered
“prehypertensive”?
Top Number
Bottom Number
120-139
80-89
138/82
118/78
128/89
This category was created to alert people to their risk of developing
high blood pressure so they could make lifestyle changes that may
help to avoid developing this condition.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
“Prehypertension”
If your blood pressure is in the prehypertensive range:
Prehypertension
120-139
80-89
It means that you don’t have high blood pressure now,
but you are likely to develop it in the future.
Unless you take ACTION to prevent it!
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
What Is High Blood Pressure?
When blood pressure stays elevated over a long period of
time it is called high blood pressure or “hypertension”.
http://diseases-explained.com/
High blood pressure is dangerous because
it makes the heart work too hard and
contributes to hardening of the arteries
(atherosclerosis).
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
What Is High Blood Pressure?
“Hypertension”
A blood pressure of
140/90 is considered high blood pressure.
High Blood Pressure
Systolic
Diastolic
Stage 1
140-159
90-99
Stage 2
160 or higher
100 or higher
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
High Blood Pressure
Warning Signs:
1.
2.
3.
4.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
Why Is High Blood Pressure Important?
Increases your risk for :
Heart disease & Stroke –
the 1st and 3rd leading causes of
death for Americans.
If left uncontrolled, high blood pressure can also cause:
Heart failure
Heart Attack
Kidney disease
Blindness
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
What can high blood pressure do to your body?
Stroke
Heart Attack
High blood pressure is the most
important risk factor for stroke. Very
high pressure can cause a break in a
weakened blood vessel, which then
bleeds in the brain. This can cause a
stroke. If a blood clot blocks one of
the narrowed arteries, it can also
cause a stroke.
High blood pressure is a
major risk factor for
heart attack. The
arteries bring oxygencarrying blood to the
heart muscle. If the
heart cannot get enough
oxygen, chest pain, can
occur. If the flow of
blood is blocked, a heart
attack results.
Blindness
High blood pressure can
eventually cause blood
vessels in the eye to burst or
bleed. Vision may become
blurred or otherwise impaired
and can result in blindness.
Heart failure
The heart is unable to
pump enough blood
to supply the body's
needs.
Arteries
Kidney disease
As people get older,
arteries throughout the
body "harden,"
especially those in the
heart, brain, and
kidneys. High blood
pressure is associated
with these "stiffer"
arteries. This, in turn,
causes the heart and
kidneys to work harder.
Kidneys act as filters to
rid the body of waste.
High blood pressure can
narrow and thicken the
blood vessels of the
kidneys. The kidneys
filter less fluid and waste
builds up in the blood.
The kidneys may fail
altogether.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
The Good News is…
You can take action to prevent getting high blood pressure
or take steps to control it!
See your doctor for regular blood pressure check ups
If youMaintaining
drink alcoholic
beverages,
a healthy
weightdrink
in moderation
Eat a healthy diet rich in
vegetables and fruits, and low
Choose
prepare
foods with less salt
fatand
dairy
foodsactive
Get
physically
If you smoke, think about quitting
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
27-84
Factors that affect Blood Pressure
1.
2.
3.
4.
5.
Neural factors: Sympathetic nervous system
causes vasoconstriction or narrowing of blood
vessels.
Kidneys: release renin which triggers
angiotensin a potent vasoconstrictor.
Temperature: Cold is vasoconstricting Heat
is the opposite.
Chemicals: Medication, nicotine, alcohol
Diet: salt, fat, and cholesterol balance
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-85
Blood Pressure

Force blood exerts on the inner walls of blood vessels



Systolic pressure



Ventricles contract
Blood pressure is at its greatest in the arteries
Diastolic pressure



Highest in arteries
Lowest in veins
Ventricles relax
Blood pressure in arteries is at its lowest
Reported as the systolic number over the diastolic number
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-86
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-87
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!
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-88
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.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-89
Diseases and Disorders of the
Cardiovascular System
Disease
Description
Anemia
The blood does not have enough red blood cells
or hemoglobin to carry an adequate amount of
oxygen to the body’s cells
Aneurysm
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-90
Diseases and Disorders of the
Cardiovascular System (cont.)
Disease
Description
Myocarditis
Inflammation of the muscular layer of the heart
Pericarditis
Inflammation of the membranes that surround
the heart (pericardium)
Congestive
Heart Failure
Weakening of the heart over time; heart is
unable to pump enough blood to meet body’s
needs
Coronary Artery Atherosclerosis; narrowing of coronary arteries
Disease (CAD) caused by hardening of the fatty plaque deposits
within the arteries
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-91
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
27-92
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
Thrombophlebitis Blood clots and inflammation develops in a vein
Varicose Veins
Twisted, dilated veins
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
By-pass Graft
93
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Percutaneous Transluminal Coronary
Angioplasty
94
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Artificial Heart
95
© 2009 The McGraw-Hill Companies, Inc. All rights reserved