CARDIOVASCULAR

SYSTEM
Mohammad Hadi Goharbari

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STRUCTURES OF THE CARDIOVASCULAR
SYSTEM

The major structures of the cardiovascular system are

• Heart
• Blood vessels
• Blood

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FUNCTIONS OF THE CARDIOVASCULAR
SYSTEM
1. Heart pumps blood into the vessels.
2. Blood is a fluid tissue that transports oxygen and nutrients to the
body tissues.
3. Blood returns some waste products from these tissues to the
kidneys and carries carbon dioxide back to the lungs.
4. Blood cells also play important roles in the immune system, and in
the endocrine system.

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Heart
• Heart is a hollow, muscular organ located in the thoracic cavity,
between the lungs.

• This small organ, about the size of a fist, is a very effective pump that
furnishes the power to maintain the blood flow needed throughout
the entire body.

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The Walls of the Heart
The walls of the heart are made up of three layers:

1. Epicardium is the external layer of the heart.

2. Myocardium is the middle and thickest of the heart's three layers. Also
known as myocardial muscle, this consists of specialized cardiac muscle
tissue that is capable of the constant contraction and relaxation that
creates the pumping movement necessary to maintain the flow of blood
throughout the body.
3. Endocardium, which consists of epithelial tissue, is the inner lining of the
heart.

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Blood Supply to the Myocardium

• Coronary arteries supply oxygen-rich blood to the myocardium.

• Coronary veins remove waste products from the myocardium.

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The Chambers of the Heart
The heart is divided into four chambers, each of which has a specialized function:
• Atria
• are the two upper chambers of the heart
• divided by the interatrial septum
• are the receiving chambers, and all blood enters the heart through these
chambers.
• Ventricles
• are the two lower chambers of the heart
• divided by the interventricular septum.

Note:
The walls of the ventricles are thicker than those of the atria because the ventricles must pump
blood throughout the entire body.

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The Valves of the Heart
The flow of blood through the heart is controlled by four valves.
1. Tricuspid valve
• controls the opening between the right atrium and the right ventricle.
2. Pulmonary semilunar valve
• is located between the right ventricle and the pulmonary artery.
• Semilunar means half-moon. This valve is shaped like a half-moon.
3. Mitral valve
• is located between the left atrium and left ventricle.
• This valve is also known as the bicuspid
4. Aortic semilunar valve
• is located between the left ventricle and the aorta.
• Semilunar means half-moon, which describes the shape of this valve.
Note:
The pulmonary semilunar valve and the aortic semilunar valve are shaped like a half moon.
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Blood Flow Through the Heart
Two types of blood flow through the heart:

1. Oxygenated means oxygen rich, or containing an adequate supply of

oxygen.
2. Deoxygenated means oxygen poor, or not yet containing an adequate
supply of oxygen.

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Systemic and Pulmonary Circulation
Blood is pumped through the systemic and pulmonary circulation systems.

 Pulmonary circulation is the flow of blood only between the heart and lungs.
• The pulmonary arteries carry deoxygenated blood out of the right ventricle and into the
lungs. This is the only place in the body where deoxygenated blood is carried by arteries
instead of veins.
• In the lungs, carbon dioxide from the body is exchanged for oxygen from the inhaled air.
• The pulmonary veins carry the oxygenated blood from the lungs into the left atrium of the
heart. This is the only place in the body where veins carry oxygenated blood.

 Systemic circulation is the flow of blood to all parts of the body except the lungs.
• Oxygenated blood flows out of the left ventricle and into arterial circulation.
• The veins carry deoxygenated blood into the right atrium.

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Heartbeat
• Heartbeat
• The contraction and relaxation of the heart produce heartbeat.
• The rate and regularity of the heartbeat is determined by electrical impulses
from nerves that stimulate the myocardium of the chambers of the heart.
• Electrical impulses
• also known as the conduction system, these electrical impulses are controlled
by the sinoatrial (SA) node, atrioventricular (AV) node, the bundle of His,
and Purkinje fibres.

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The Sinoatrial Node
Sinoatrial node is often referred to as the SA node.

• SA node located in the posterior wall of the right atrium near the entrance of the
superior vena cava.

• The SA node establishes the basic rhythm and rate of the heartbeat. For this reason,
it is known as the natural pacemaker of the heart.

• Electrical impulses from the SA node start each wave of muscle contraction in the
heart.

• The impulse in the right atrium spreads over the muscles of both atria, causing them
to contract simultaneously. This contraction forces blood into the ventricles. 21
The Atrioventricular Node
• The impulses from the SA node travel to the atrioventricular node,
which is also known as the AV node.

• The AV node is located on the floor of the right atrium near the
interatrial septum.

• From here, it transmits the electrical impulses onward to the bundle

of His.

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The Bundle of His & Purkinje fibers
• Bundle of His (HISS)
• Group of fibers located within the interventricular septum.
• Serves to transmit the electrical impulse from the AV node to the Purkinje
fibres of the ventricles.

• Purkinje fibers
• Specialized conductive fibers located within the walls of the ventricles.
• Relay the electrical impulses to the cells of the ventricles, and cause the
ventricles to contract.
.

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Electrical Waves
Sinus rhythm
• refers to the normal beating of the heart.
Electrocardiogram (EKG or ECG)
• The activities of the electrical conduction system of the heart can be visualized as wave
movements on a monitor or as an electrocardiogram (EKG or ECG).

1. P wave is due to the contraction of the atria.

2. QRS complex shows the contraction of the ventricles.

3. T wave is the relaxation of the ventricles.

Note
• The atria relax as the ventricles contract.
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THE BLOOD VESSELS

There are three types of blood vessels:

1. Arteries
2. Capillaries
3. Veins

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Arteries
Function:
• Arteries are large blood vessels that carry blood away from the heart to all regions of the body.
• Arterial blood is bright red in color because it is oxygen rich.
Structure:
• The walls of the arteries are composed of three layers, intima, media, and externa (adventitia).
• This structure makes the arteries muscular and elastic so they can expand and contract with the
pumping beat of the heart.

• Endarterial means within an artery or pertaining to the inner portion of an artery.

• Aorta is the largest blood vessel in the body. It begins from the left ventricle of the heart and
forms the main trunk of the arterial system.

• Carotid arteries
• The major arteries that carry blood upward to the head.
• The common carotid artery is located on each side of the neck. It divides into the internal carotid artery, which
brings oxygen-rich blood to the brain, and the external carotid artery brings blood to the face.

• Arterioles are the smaller, thinner branches of arteries that deliver blood to the capillaries.
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Capillaries
Structure:
• Capillaries, which are only one epithelial cell in thickness, are the smallest blood
vessels in the body.
Function:
• Capillaries form networks of expanded vascular beds that have the important role of
delivering oxygen and nutrients to the cells of the tissues.

• It is here that the exchange of oxygen, nutrients, and waste materials occur within
the surrounding cells.

• After leaving the cells, 90% of this fluid, which is now oxygen poor and contains
some waste products, enter the opposite end of the capillary bed through the
venules.

• The 10% of this fluid that is left behind in the tissues becomes lymph.

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Veins
Function:
• veins form a low-pressure collecting system to return oxygen-poor blood to the heart.
Structure:
• Vein consists of three main layers. The outer layer is connective tissue, called adventitia or externa; a middle
layer of smooth muscle called the media, and the inner layer lined with endothelial cells called intima.
Note:
The walls of the veins are thinner and less elastic than those of the arteries.

• Venules
• The smallest veins that join to form the larger veins.
• Valve
• veins have valves that enable blood to flow only toward the heart and to prevent it from flowing away from
the heart.
• Superficial veins
• located near the body surface.
• Deep veins
• located within the tissues and away from the body surface.
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venae cavae
Venae cavae are the two largest veins in the body. These are the veins
that return blood into the heart (singular, vena cava).

• Superior vena cava

• Transports blood from the upper portion of the body to the heart.

• Inferior vena cava

• Transports blood from the lower portion of the body to the heart.

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Pulse and Blood Pressure
 Pulse
• The rhythmic pressure against the walls of an artery caused by the
contraction of the heart.

 Blood pressure
• The measurement of the amount of systolic and diastolic pressure exerted
against the walls of the arteries.
1. Systolic pressure
• Occurs when the ventricles contract, is the highest pressure against the walls of an
artery.
2. Diastolic pressure
• Occurs when the ventricles are relaxed, is the lowest pressure against the walls of an
artery.

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Blood
• Blood is the fluid tissue in the body.

• It is composed of
55% liquid plasma
45% formed elements (erythrocytes, leukocytes, thrombocytes)

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Plasma
Plasma is a straw-colored fluid that contains two main parts:
1. water (91%)
2. nutrients, hormones, proteins, and waste products (9%)

• Serum is plasma fluid after the clotting proteins have been removed.

• Fibrinogen and prothrombin

• The clotting proteins found in plasma.
• They have an important role in clot formation to control bleeding.

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Formed Elements of the Blood
The formed elements of blood include

1. Erythrocytes
2. Leukocytes
3. Thrombocytes

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Erythrocytes
Erythrocytes, also known as red blood cells (RBCs), are mature red
blood cells produced by the red bone marrow.

• The primary role of these cells is to transport oxygen to the tissues.

• Oxygen is transported by hemoglobin, which is the oxygen-carrying blood

protein pigment of the erythrocytes.

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Leukocytes
Leukocytes, also known as white blood cells (WBCs), are the blood cells
involved in defending the body against infective organisms and foreign
substances.

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 Groups of leukocytes:
1. Neutrophils
• formed in red bone marrow
• the most common type of WBC.
• Through phagocytosis, neutrophils play a major role in the immune system.
2. Basophils
• formed in red bone marrow
• the least common type of WBC.
• Basophils are responsible for causing the symptoms of allergies.
3. Eosinophils
• formed in red bone marrow
• These cells destroy parasitic organisms.
4. Lymphocytes
• formed in red bone marrow, lymph nodes, and in the spleen.
• Lymphocytes identify foreign substances and germs (bacteria or viruses) in the body and produce antibodies
that specifically target them.
5. Monocytes
• formed in red bone marrow, lymph nodes, and the spleen.
• Through phagocytosis, monocytes provide immunological defenses against many infectious organisms.

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Phagocytosis
• Phagocytosis is the process of destroying pathogens by
surrounding and swallowing them.

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Thrombocytes
Thrombocytes, which are also known as platelets, are the smallest
formed elements of the blood.
• They play an important role in the clotting of blood. When a blood vessel is
damaged, the thrombocytes are activated and become sticky.
• This action causes the thrombocytes to clump together to form a clot to stop
the bleeding.

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Blood Types
Blood types are classified according to the presence or absence of
certain antigens on the RBC. (An antigen is any substance that the body
regards as being foreign.)

• The four major blood types are A, AB, B, and O. The A, AB, and B groups are
based on the presence of the A and/or B antigens on the red blood cells. In
contrast, in type O blood both the A and B antigens are absent.

• Traditionally blood type is listed as type followed by Rh factor (such as A− or

O+).

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The Rh factor
The Rh factor defines the presence or absence of the Rh antigen on red
blood cells.
• About 85% of population have the Rh antigen, and these individuals are
described as being Rh positive (Rh+).
• The remaining 15% of population do not have the Rh antigen, and these
individuals are described as being Rh negative (Rh−).
• The Rh factor is an important consideration in crossmatching blood for
transfusions.
• The Rh factor can cause difficulties when an Rh-positive infant is born to an
Rh-negative mother.

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Blood gases
Blood gases are gases that are normally dissolved in the liquid portion
of blood.
• The major blood gases are
Oxygen (O2)
Carbon dioxide (CO2)
Nitrogen (N2)

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MEDICAL SPECIALTIES RELATED TO
THE CARDIOVASCULAR SYSTEM
• Cardiologist
• physician who specializes in diagnosing and treating abnormalities, diseases,
and disorders of the heart.

• Hematologist
• physician who specializes in diagnosing and treating abnormalities, diseases,
and disorders of the blood and blood forming tissues.

• Vascular surgeon
• physician who specializes in the surgical treatment of disorders of the blood
vessels.

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PATHOLOGY OF THE CARDIOVASCULAR
SYSTEM

1. Heart Diseases
2. Blood Vessel Diseases
3. Blood Diseases

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Heart Diseases

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Heart Diseases

• Disorders of the heart can be

1. Congenital: present from or before birth

2. Acquired: can develop at any time throughout life

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Congenital Heart Defects

Congenital heart defects are structural abnormalities caused by the

failure of the heart to develop normally before birth.

• Some congenital heart defects are apparent at birth, whereas others

may not be detected until later in life.

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Coronary Artery Disease (CAD)
Coronary artery disease (CAD), also known as coronary heart disease
(CHD) and ischemic heart disease.
• It is due to atherosclerosis of the coronary arteries that reduces the blood
supply to the heart muscle. This creates an insufficient supply of oxygen that
can cause angina (pain), a myocardial infarction (heart attack), or death.

• CAD is the most common type of heart disease.

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Atherosclerosis
• Atherosclerosis
• Hardening and narrowing of the arteries caused by a buildup of cholesterol
plaque on the interior walls of the arteries (ather/o means plaque or fatty substance, and
-sclerosis means abnormal hardening).
• The plaque can protrude outward into the lumen from the wall of the blood
vessel or protrude inward into the wall of the vessel.
• Atheroma
• Characteristic of atherosclerosis
• Abnormal accumulation of material in the inner layer of the wall of an artery.
• The material consists of mostly macrophage cells, or debris, containing lipids, calcium
and a variable amount of fibrous connective tissue. It is a deposit of plaque on or within
the arterial wall.

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Ischemia
• Ischemia
• Condition in which there is an insufficient supply of oxygen in the tissues due
to restricted blood flow to a part of the body.

• For example, cardiac ischemia is the lack of blood flow and oxygen to the
heart muscle.

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Angina
Angina, also known as angina pectoris,
• Condition in which severe episodes of chest pain occur due to an inadequate
blood flow to the myocardium.
• These episodes are due to ischemia of the heart muscle.

1. Stable angina
• occurs during exertion (exercise) and resolves with rest.
2. Unstable angina
• occur either during exertion or rest and is a precursor to a myocardial infarction.

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Myocardial Infarction
Myocardial infarction,
• Commonly known as a heart attack,
• The occlusion (blockage) of one or more coronary arteries caused by plaque buildup,
causing damage to the heart muscle.

• Infarct
• A localized area of dead tissue caused by a lack of blood. Tissue death is known as
necrosis, from the Greek word for death.
• This damage to the myocardium impairs the heart's ability to pump blood
throughout the body
• The most frequently recognized symptoms of a myocardial infarction include pain or
pressure in the middle of the chest that may spread to the back, jaw, or left arm.
• Women are more likely to have atypical symptoms, including weakness and fatigue.

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Heart Failure
• Heart failure
• also referred to as congestive heart failure (CHF), occurs most commonly in the
elderly, often after the heart has been weakened or damaged by other health issues.
In this chronic condition the heart is unable to pump out all of the blood that it
receives. The decreased pumping action causes congestion. The term congestion
describes a fluid buildup.
1. Left-sided heart failure
• causes an accumulation of fluid in the lungs also known as pulmonary edema. This occurs
because the left side of the heart, which is its main pumping chamber, is unable to efficiently
pump oxygen-rich blood from the lungs to the rest of the body.
2. Right-sided heart failure
• causes fluid buildup throughout the rest of the body. This occurs because the right side of the
heart is unable to efficiently pump blood throughout the rest of the body. Due to the pressure
of gravity, this edema, or swelling, is first noticeable in the feet and legs. As this swelling
worsens, it can also affect the liver, gastrointestinal tract, or the arms.

• Cardiomegaly
• Abnormal enlargement of the heart that is frequently associated with heart failure as
the heart enlarges in an effort to compensate for its decreased pumping ability.
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Carditis
Carditis
• Inflammation of the heart

1. Endocarditis
• Inflammation of the inner lining of the heart.
• Bacterial endocarditis is an inflammation of the lining or valves of the heart caused by the presence of bacteria in the
bloodstream. One cause of this condition is bleeding during dental surgery because it allows bacteria from the mouth to enter
the bloodstream.

2. Pericarditis
• Inflammation of the pericardium. This inflammation causes an accumulation of fluid within the
pericardial sac, and this excess fluid restricts the movement of the heart, reducing the ability of the heart to
pump blood throughout the body.

3. Myocarditis
• Inflammation of the myocardium (heart muscle) that develops as a rarely seen
complication of a viral infection.

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Diseases of the Myocardium
• Cardiomyopathy
• The term used to describe all diseases of the heart muscle.

• Dilated cardiomyopathy
• Disease of the heart muscle that causes the heart to become enlarged and to
pump less strongly.

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Heart Valves Diseases
• Heart murmur
• Abnormal blowing or clicking sound heard when listening to the heart or a
neighboring large blood vessels.
• Heart murmurs are most often caused by defective heart valves.
• Valvulitis
• Inflammation of a heart valve.
• Valvular prolapse
• Abnormal protrusion of a heart valve that results in the inability of the valve
to close completely.
• Valvular stenosis
• Condition in which there is narrowing, stiffening, thickening, or blockage of
one or more valves of the heart.
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 Cardiac Arrest and Arrhythmia
• Arrhythmia
• Loss of the normal rhythm of the heartbeat.
• This can be a minor, temporary episode, or it can be a fatal event.
• The severity of this episode depends on how much the heart's ability to pump blood is compromised.
• Asystole
• known as a flat line
• the complete lack of electrical activity in the heart
• Cardiac arrest
• (1) the heart abruptly stops beating
• (2) develops an arrhythmia that prevents heart from pumping blood effectively.
• Sudden cardiac death
• occurs when treatment of cardiac arrest is not provided within a few minutes.
• Heart block
• congenital or acquired arrhythmia caused by the electrical signal moving through the heart being partially or completely blocked from reaching the ventricles.
• Bradycardia
• abnormally slow resting heart rate. The term bradycardia is usually applied to a heartbeat rate of less than 60 beats per minute.
• Tachycardia
• abnormally rapid resting heart rate The term tachycardia is usually applied to a heartbeat rate of greater than 100 beats per minute (BPM).
• Supraventricular tachycardia
• also known as paroxysmal supraventricular tachycardia
• an episode that begins and ends abruptly during which there are very rapid and regular heartbeats that originate at or above the atrioventricular (AV) node .
• Note: A fast and sudden onset of heartbeat is known as paroxysmal tachycardia.
• Ventricular tachycardia
• also known as V-tach, is a very rapid heartbeat that begins within the ventricles.
• This condition is potentially fatal because the heart is beating so rapidly that it is unable to adequately pump blood through the body. For some patients, this condition can be controlled
with an implantable cardioverter-defibrillator.
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Atrial and Ventricular Fibrillations
Fibrillation is a life-threatening fast and irregular heartbeat.

1. Atrial fibrillation, also known as A-fib,

• The most common type of tachycardia.
• It is a rapid, uncontrolled twitching of the muscular heart wall.
• This causes an irregular and quivering action of the atria.
2. Ventricular fibrillation, also known as V-fib,
• Consists of rapid, irregular, and useless contractions of the ventricles.
• The heart muscle quivers ineffectively.
• This condition is the cause of many sudden cardiac deaths.

• Palpitation
• pounding or racing heartbeat with or without irregularity in rhythm.
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(A) Normal sinus rhythm. (B) Atrial fibrillation. (C) Supraventricular tachycardia. (D) Ventricular fibrillation.

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Blood Vessel Diseases

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Blood Vessel Abnormalities
• Vasculitis, also known as angiitis,
• inflammation of a blood vessel
• types of vasculitis:
1. phlebitis (inflammation of the veins)
2. arteritis (inflammation of the arteries)
• Polyarteritis
• Arteritis several arteries at the same time
• Autoimmune disease that affects arteries

• Temporal arteritis, also known as giant cell arteritis,

• inflammation of the temporal arteries
• it can cause headaches, visual impairment, jaw pain, and other symptoms
• diagnosed when a biopsy shows the presence of abnormally large cells
• can cause unilateral or bilateral blindness, and more rarely, a stroke
• Angiospasm
• sudden contraction of a blood vessel
• Angiostenosis
• abnormal narrowing of a blood vessel
• Hemangioma
• benign tumor made up of newly formed blood vessels
• Hypoperfusion
• reduced amount of blood flow in an organ or tissue 79
Arteries Diseases
• Aneurysm
• Balloon-like enlargement of the wall of an artery caused by weakness in the
arterial wall.
• The rupture of an aneurysm can be fatal because of the rapid loss of blood.

• Arteriosclerosis,
• Hardening of the arteries

• Arteriostenosis
• Abnormal narrowing of an artery or arteries

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Veins Diseases
• Chronic venous insufficiency, also known as venous insufficiency,
• Condition in which venous circulation is inadequate due to partial vein blockage or to
the leakage of venous valves.
• This condition primarily affects the feet and ankles, and the leakage of venous blood
into the tissues causes discoloration of the skin.
• Phlebitis
• the inflammation of a vein
• also known as thrombophlebitis, because the walls of the vein are often infiltrated
and a clot (thrombus) formed.
• usually occurs in a superficial vein.
• Varicose veins
• abnormally swollen veins
• usually occur in the superficial veins of the legs.
• occurs when the valves in these veins do not function properly, so blood pools in the
veins, causing them to enlarge.
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Thromboses and Embolisms
• Thromboses and embolisms are serious conditions that can result in
the blockage of a blood vessel.

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Thrombosis
• Thrombosis
• abnormal condition of having a thrombus
• Thrombus
• blood clot attached to the interior wall of an artery or vein
• Thrombotic occlusion
• blocking of an artery by a thrombus
• Coronary thrombosis
• thrombus blocking a coronary artery.
• it cause damage to the heart muscle
• Deep vein thrombosis (DVT),
• also known as deep venous thrombosis
• the condition of having a thrombus attached to the interior wall of a deep vein
• Note Sometimes deep vein thrombosis occurs in the legs of a bedridden patient or in someone who has remained seated too
long in an airplane or car.
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Embolism
• Embolism
• sudden blockage of a blood vessel by an embolus

• Embolus
• foreign object, such as a blood clot, a quantity of air or gas, or a bit of tissue
or tumor, that is circulating in the blood.
• For example: air embolism, fat embolism, etc.

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Peripheral Vascular Diseases
• Peripheral vascular diseases
• disorders of blood vessels that are located outside of the heart and brain
• usually involve narrowing of the vessels that carry blood to the legs, arms, stomach, or
kidneys.
• Peripheral arterial disease (PAD)
• also known as peripheral arterial occlusive disease,
• a peripheral vascular disease that is caused by arteriosclerosis.
• impaired circulation to the extremities and vital organs can cause changes in the skin color
and temperature
• one method of determining the severity of PAD is to compare the blood pressure at the ankle
with the blood pressure in the arm using the ankle-brachial index.
• Intermittent claudication can be caused by peripheral arterial disease as well.
• Raynaud's disease
• peripheral arterial occlusive disease in which intermittent attacks are triggered by cold or
stress.
• the symptoms, which are due to constricted circulation, include pallor (paleness), cyanosis
(blue color), and redness of the fingers and toes.

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Hypertension & Hypotension
 Hypertension (HTN), commonly known as high blood pressure,
• elevation of arterial blood pressure to a level that is likely to cause damage to the cardiovascular
system

• Essential hypertension,
• also known as primary hypertension or idiopathic hypertension,
• elevated blood pressure of unknown cause. Idiopathic means a disease of unknown cause.
• Secondary hypertension
• high blood pressure caused by another condition or disease. Such as kidney disease, adrenal disease, thyroid problems and obstructive sleep
apnea.

 Hypotension
• lower-than-normal arterial blood pressure.
• Symptoms can include dizziness, light-headedness, or fainting. Hypotension is the opposite of
hypertension.

• Orthostatic hypotension,
• also known as postural hypotension,
• low blood pressure that occurs relating to an upright or standing position.

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Blood Diseases

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Blood Disorders
• Blood dyscrasia
• any pathologic condition of the cellular elements of the blood
• Hemochromatosis
• also known as iron overload disease
• genetic disorder in which the intestines absorb too much iron.
• excess iron that is absorbed enters the bloodstream and accumulates in organs, and causes damage.
• Leukopenia
• decrease in the number of white blood cells (WBC) circulating in the blood
• also known as a low white blood cell count.
• Polycythemia
• abnormal increase in the number of red cells in the blood due to excess production of these cells by the bone marrow.
• Sepsis
• also known as septicemia,
• a potentially life-threatening infection that results from bacteria or other infectious organisms entering the bloodstream.
• referred to as blood poisoning, can result in damage to multiple organ systems as the chemicals released into the bloodstream to fight the infection
trigger inflammatory responses throughout the body.
• Thrombocytopenia
• abnormally small number of platelets circulating in the blood
• Because these cells help the blood to clot, this condition is sometimes associated with abnormal bleeding.
• Thrombocytosis
• abnormal increase in the number of platelets in the circulating blood
• Hemorrhage
• loss of a large amount of blood in a short time
• Transfusion reaction
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serious and potentially fatal complication of a blood transfusion in which a severe immune response occurs because the patient's blood and the donated
blood do not match.
Cholesterol
• Cholesterol
• fatty substance that travels through the blood and is found in all parts of the
body.
• It aids in the production of cell membranes, some hormones, and vitamin D.
• Some cholesterol comes from dietary sources, and some is created by the liver.
• Excessively high levels of certain types of cholesterol can lead to heart disease.

• Hyperlipidemia
• elevated levels of fatty substances in the blood.
• For example:
• Hypercholesterolemia
• Hypertriglyceridemia

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Cancers
• Myelodysplastic syndrome is a type of cancer in which there is
insufficient production of one or more types of blood cells due to
dysfunction of the bone marrow.
Note: this condition is also known as preleukemia condition, because some patients
later develop acute myeloid leukemia.

• Leukemia is a type of cancer characterized by a progressive increase in

the number of abnormal leukocytes (WBC).
 Types of leukemia are named based on how quickly they progress and
the type of white blood cells involved. The four most common types of
leukemia are acute or chronic myeloid leukemia and acute or chronic
lymphoblastic leukemia.
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Anemias
• Anemia
• lower-than-normal number of erythrocytes (red blood cells) in the blood
• causing fatigue and shortness of breath.
• The severity of this condition is usually measured by a decrease in the amount of hemoglobin in the blood.

(1) Aplastic anemia

• absence of all formed blood elements caused by the failure of blood cell production in the bone marrow.
 Anemia, a low red blood cell count, leads to fatigue and weakness.
 Leukopenia, a low white blood cell count, causes an increased risk of infection.
 Thrombocytopenia, a low platelet count, results in bleeding especially from mucous membranes and skin.
(2) Iron-deficiency anemia
• the most common form of anemia
• Iron deficiency can be caused by blood loss, poor absorption of iron, or inadequate dietary intake of iron.
(3) Megaloblastic anemia
• anemia in which the red blood cells are larger than normal .
• This condition usually results from a deficiency of folic acid or vitamin B12.
(4) Pernicious anemia
• caused by a lack of the protein intrinsic factor (IF) that helps the body absorb vitamin B12 from the gastrointestinal tract.
• Vitamin B12 is necessary for the formation of red blood cells.
(5) Hemolytic anemia
• premature destruction of red blood cells by the spleen
• can be inherited or acquired
• The most common examples are two types that are hereditary: sickle cell anemia and thalassemia.
• Sickle cell anemia
• serious genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape.
• sickle shape interferes with normal blood flow, resulting in damage to most of the body systems.
• Thalassemia
• inherited blood disorder that causes mild or severe anemia due to reduced hemoglobin and fewer red blood cells than normal. 100
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DIAGNOSTIC PROCEDURES OF THE
CARDIOVASCULAR SYSTEM
• Angiography
• radiographic (x-ray) study of the blood vessels after the injection of a contrast medium.
• The resulting film is an angiogram that is used to study blood flow in the arteries, veins, and blood
vessels of the heart.
• Cardiac catheterization
• diagnostic and treatment procedure in which a catheter is passed into a vein or artery and then
guided into the heart.
• Digital subtraction angiography (DSA)
• uses angiography with computer assistance to clarify the view of the area of interest in the
cardiovascular system by “subtracting” the soft tissue and bones from the images.
• Duplex ultrasound
• to image (1)the structures of the blood vessels and (2)the flow of blood through these vessels.
• Venography
• also known as phlebography
• image of specific veins after a contrast dye is injected.
• The resulting film is a venogram.
• This is a very accurate test for detecting deep vein thrombosis.

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Angiography

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Cardiac catheterization

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Electrocardiography
• Electrocardiography
• noninvasive process of recording the electrical activity of the myocardium.
• Electrocardiogram (EKG or ECG)
• record of the electrical activity of the myocardium.
• Holter monitor
• portable electrocardiograph that is worn by an ambulatory patient to continuously
monitor the heart rates and rhythms over a 24- or 48-hour period.
• Stress test
• performed to assess cardiovascular health and function during and after stress.
• This involves monitoring with an electrocardiograph while the patient exercises on a
treadmill, or is injected with a chemical to increase the patient's heart rate if he or
she is unable to use a treadmill.
• Thallium stress test
• performed to evaluate how well blood flows through the coronary arteries of the
heart muscle during exercise by injecting a small amount of thallium into the
bloodstream. If it is not taken up equally by all heart muscle cells, it shows a
decrease in blood flow to part of the heart.
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TREATMENT PROCEDURES OF THE
CARDIOVASCULAR SYSTEM

• Medications
• Nutritional Interventions
• Cardiac Surgery
• Clearing Blocked Arteries and Veins
• Coronary Artery Bypass Graft
• Treatment of Cardiac Arrest and Arrhythmias
• Blood Vessels, Blood, and Bleeding procedures

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Medications
• Many heart conditions are controlled with medications; however,
successful treatment depends on patient compliance.

• Compliance is the accuracy and consistency with which the patient

follows the physician's instructions.

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Antihypertensives
Antihypertensive
medication administered to lower blood pressure. Some of these drugs are also used to treat
other heart conditions.
1. ACE inhibitor (angiotensin-converting enzyme)
• blocks the action of the enzyme that causes the blood vessels to contract, resulting in hypertension.
When this enzyme is blocked, the blood vessels are able to dilate (enlarge), and this reduces the blood
pressure.
2. Angiotensin II receptor blockers (ARBs)
• have a similar action and effect of ACE inhibitor
3. Beta-blocker
• reduces the workload of the heart by slowing the rate of the heartbeat. They are commonly prescribed
to lower blood pressure, relieve angina, or treat heart failure.
4. Calcium channel blocker
• agents cause the heart and blood vessels to relax by decreasing the movement of calcium into the cells
of these structures. This relaxation reduces the workload of the heart by increasing the supply of blood
and oxygen.
5. Diuretic
• administered to stimulate the kidneys to increase the secretion of urine to rid the body of excess sodium
and water.
• These medications are administered to treat hypertension and heart failure by reducing the amount of
fluid circulating in the blood.

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Additional Medications
• (1) Antiarrhythmic
• medication administered to control irregularities of the heartbeat.
• (2) Anticoagulant
• slows coagulation and prevents new clots from forming. Coagulation is the process of clotting
blood.
Coumadin®, which is a brand name for warfarin
Heparin is another common anticoagulant. It works faster than warfarin, but must be
administered by injection or in an IV solution.
• (3) Aspirin
• taken in a very small daily dose, such as 81 mg, which is commonly known as baby aspirin, may
be recommended to reduce the risk of a heart attack or stroke by reducing the ability of the
blood to clot.
• (4) Cholesterol-lowering drugs
• used to combat hyperlipidemia by reducing the undesirable cholesterol levels in the blood
• (5) Digitalis
• such as digoxin, (1)strengthens the contraction of the heart muscle, (2) slows the heart rate
• The drug is used to treat and prevent certain types of arrhythmias, and as well as for some
other heart conditions. 113
Additional Medications
• (6) Thrombolytic
• also known as a clot-busting drug
• dissolves or causes a thrombus to break up
• Tissue plasminogen activator (tPA) is a thrombolytic that is administered to some patients having
a heart attack or stroke. If administered within a few hours after symptoms begin, this medication
can dissolve the damaging blood clots.
• (7) Vasoconstrictor
• causes blood vessels to narrow. Examples of these medications include antihistamines and
decongestants.
• (8) Vasodilator
• causes blood vessels to expand. A vasodilator is the opposite of a vasoconstrictor.
• Nitroglycerin
• a vasodilator that is prescribed to prevent or relieve the pain of angina by dilating the blood vessels to the
heart.
• This increases the blood flow and oxygen supply to the heart. Nitroglycerin can be administered sublingually
(under the tongue), transdermally (through the skin), or orally as a spray. In the event of myocardial infarction.

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Nutritional Interventions
• Patients with hypertension as well as other cardiac issues such as
heart failure are often prescribed a diet with restricted sodium intake.
Salty foods as well as most fast food and processed foods tend to be
high in sodium.

• Patients with high cholesterol or other cardiac disease might be

prescribed a diet limited in cholesterol. All foods that come from
animals (i.e., dairy, poultry, meat, eggs) contain cholesterol.

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Cardiac Surgery
Heart surgery today ranges from the correction of congenital heart
defects in children to complete heart transplantation.

• Cardiopulmonary bypass (CPB)

• also known as a heart-lung machine
• device sometimes used to maintain the circulation of blood and oxygen to the
body during surgery.
• bypassing the heart allows surgeons the opportunity to operate on the heart
without it beating.

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Clearing Blocked Arteries and
Veins
• Angioplasty
• the technique of mechanically widening a narrowed or obstructed blood vessel
• Percutaneous transluminal coronary angioplasty (PTCA)
• also known as a balloon angioplasty.
• a procedure in which a small balloon on the end of a catheter is used to open a partially blocked coronary
artery by flattening the plaque deposit and stretching the lumen.
• Laser angioplasty
• involves a laser on the end of a catheter, which uses beams of light to remove the plaque deposit.
• Stent
• a wire-mesh tube that is commonly placed after the artery has been opened.
• This provides support to the arterial wall, keeps the plaque from expanding again, and prevents restenosis.
 Restenosis describes the condition when an artery that has been opened by angioplasty closes again.
• Atherectomy
• the surgical removal of plaque buildup from the interior of an artery
• Endarterectomy
• the surgical removal of the lining of an artery
• Carotid endarterectomy
• the surgical removal of the lining of a portion of a clogged carotid artery leading to the brain

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Coronary Artery Bypass Graft
• Coronary artery bypass graft (CABG)
• also known as bypass surgery.
• In this operation, which requires opening the chest, a piece of vein from the
leg or chest is implanted on the heart to replace a blocked coronary artery
and to improve the flow of blood to the heart.

• Minimally invasive coronary artery bypass

• known as a keyhole bypass or a buttonhole bypass
• This procedure is performed with the aid of a fiber-optic camera through
small openings between the ribs

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Treatment of Cardiac Arrest and Arrhythmias
• Defibrillation
• also known as cardioversion
• the use of electrical shock to restore the heart's normal rhythm. This shock is provided by a device known as a defibrillator.
• Automated external defibrillator (AED)
• designed for use by nonprofessionals in emergency situations when defibrillation is required
• Artificial pacemaker
• used primarily as treatment for bradycardia or atrial fibrillation,
• This electronic device can be attached externally or implanted under the skin with connections leading into the heart to regulate the heartbeat.
 Implantable cardioverter-defibrillator (ICD)
 a double-action pacemaker. (1) It constantly regulates the heartbeat to ensure that the heart does not beat too slowly. (2) If a dangerous disruption of the heart's rhythm occurs,
it acts as an automatic defibrillator.
• Cardiac ablation
• also called catheter ablation,
• a procedure that uses radio-frequency energy (heat) or cryoablation (extreme cold) to scar or destroy the heart tissue triggering an abnormal heart rhythm.
• Valvuloplasty
• surgical repair of a heart valve
• Heart valve replacement
• surgery to replace one of the heart's four valves, usually the aortic or mitral valve.
• The defective valve is replaced with either a mechanical valve or one made up of animal or human tissue.
• Cardiopulmonary resuscitation
• commonly known as CPR,
• an emergency procedure for life support consisting of artificial respiration and manual external cardiac compression.

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Blood Vessels, Blood, and Bleeding
• Aneurysmectomy
• surgical removal of an aneurysm
• Aneurysmorrhaphy
• surgical suturing of an aneurysm
• Arteriectomy
• surgical removal of part of an artery
• Hemostasis
• stop or control bleeding.
• Plasmapheresis
• also known as plasma exchange
• removal of whole blood from the body and separation of the blood's cellular elements. The
red blood cells, white blood cells, and platelets are suspended in saline or a plasma
substitute and returned to the circulatory system.
• Patients with certain autoimmune disorders receive their own red blood cells and platelets
back cleansed of antibodies. 125
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