Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley CHAPTER Medical Language Second Edition Cardiology 5

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Learning Objectives 1.Identify the structures of the cardiovascular system. 2.Describe the process of circulation. 3.Describe common cardiovascular diseases and conditions, laboratory and diagnostic procedures, medical and surgical procedures, and drug categories.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Learning Objectives 4.Give the medical meaning of word parts related to the cardiovascular system. 5.Build cardiovascular words from word parts and divide and define cardiovascular words. 6.Spell and pronounce cardiovascular words.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Learning Objectives 7.Analyze the medical content and meaning of a cardiology report. 8.Dive deeper into cardiology by reviewing the activities at the end of this chapter and online at Medical Terminology Interactive.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Multimedia Directory Slide 76Electrocardiogram Video Slide 84Ventricular Fibrillation Video Slide 86Blood Pressure Video Slide 104Cardiac Stress Technologist Video Slide 105Cardiac Stress Technology and Medical Terminology Video

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Cardiology The medical specialty that studies the anatomy and physiology of the cardiovascular system and uses diagnostic tests, medical and surgical procedures, and drugs to treat cardiovascular diseases.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-1 Cardiovascular system

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley The Cardiovascular System A continuous, circular body system –Includes heart and blood vessels  arteries, capillaries, and veins Moves blood throughout the body Transports oxygen, carbon dioxide, nutrients, and wastes in the blood

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System Heart –A muscular organ that contracts at least once every second to pump blood through the body –Has an extensive electrical system that initiates and coordinates its contractions

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-2 Surface of the heart

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) The heart contains four chambers, two on the top and two on the bottom. –Upper chamber is an atrium. –Lower chamber is a ventricle. –The (intraventricular) septum divides the heart into right and left halves. –The inferior tip of the heart is the apex.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-3 Chambers and valves of the heart

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Four valves control the flow of blood through the heart: –Tricuspid –Pulmonary –Mitral (bicuspid) –Aortic

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley The valves of the human heart open and close to pump 6 quarts (0.9 liters) of blood a day through 60,000 miles of vessels. That's equivalent to 20 treks across the United States from coast to coast.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-4 Aortic valve

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Table 5-1 Layers and Membranes of the Heart

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Heart Muscle = Myocardium composed of cardiac muscle –Responds to electrical impulses –Contracts in a coordinated way to pump blood –Thickest on the left side of the heart

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Mediastinum –Contains the heart and parts of the great vessels  aorta, superior vena cava, inferior vena cava pulmonary arteries and veins  thymus, trachea, and the esophagus

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Blood Vessels –Vascular channels through which blood circulates –Have a central opening, or lumen, through which the blood flows –Lined with endothelium, a smooth inner layer

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Three kinds of blood vessels: –Arteries –Capillaries –Veins Angiogram of a human heart shows blood vessels in sharp detail.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Arteries –Large blood vessels –Smaller branches of an artery are arterioles

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) All arteries share characteristics and functions: –They carry blood away from the heart to the body. –They carry bright red blood that has a high level of oxygen. –Most arteries lie deep beneath the skin. –All arteries have smooth muscle in their walls.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-7 Vasoconstriction and vasodilation

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Capillaries –Smallest blood vessels –The lumen of a capillary is so small that blood cells must pass through in single file.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Veins –Capillaries combine to form small veins  known as venules, –Then combine to form the largest veins.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) All veins share characteristics and functions: –They carry blood from the body back to the heart. –They carry dark red-purple blood with a low level of oxygen. –The largest veins have valves that keep the blood flowing in one direction―toward the heart.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-8 Valves in a vein

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Aorta –Largest artery in the body –Receives blood from the left ventricle of the heart

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-10 Arteries in the body

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Arteries –Coronary artery –Carotid artery –Subclavian artery –Axillary artery (armpit) –Brachial artery (upper arm) –Radial artery (thumb side of the lower arm) –Ulnar artery (little finger side of the lower arm)

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Thoracic Aorta and Arterial Branches –The thoracic aorta travels inferiorly through the thoracic cavity. –It branches into arteries that bring blood to the esophagus, muscles between the ribs, diaphragm, upper spinal cord, and the back.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Abdominal Aorta and Arterial Branches –Brings oxygenated blood to the stomach, liver, pancreas, spleen, gallbladder, small and large intestines, adrenal glands, kidneys, ovaries, testes, and the lower spinal cord –Abdominal aorta ends where right and left iliac arteries begin

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Abdominal Aorta and Arterial Branches –Iliac artery –Femoral artery (upper leg) –Popliteal artery (near the knee joint) –Tibial artery (front and back of the lower leg) –Peroneal artery (little toe side of the lower leg)

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) Two major veins of the body –Superior vena cava –Inferior vena cava Other major veins –Jugular vein –Portal vein –Saphenous and femoral veins

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Anatomy of the Cardiovascular System (cont’d) The Circulatory System –The cardiovascular system or circulatory system circulates blood through the blood vessels. –Systemic circulation includes the arteries, capillaries, and veins everywhere in the body, except in the lungs. –Pulmonary circulation includes the arteries, capillaries, and veins going to, within, and coming from the lungs.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-11 Circulation of the blood

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Atrial Blood Flow Animation Click on the screenshot to view an animation on atrial blood flow. Back to Directory

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Atrial Contraction Animation Click on the screenshot to view an animation on the contraction of the atria. Back to Directory

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Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Physiology of a Heartbeat Heart contracts and relaxes in a regular rhythm coordinated by the conduction system

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Physiology of a Heartbeat (cont’d) 1.Sinoatrial node (SA node), or pacemaker of the heart, initiates the electrical impulse that begins each heartbeat 2.Atrioventricular node (AV node) receives the impulse to contract from the SA node 3.Purkinje fibers, a network of nerves, cause both ventricles to contract simultaneously

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-12 Conduction system of the heart

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Physiology of a Heartbeat (cont’d) Two Heartbeat Phases –Systole (contraction) –Diastole (resting period)

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Systole and Diastole Animation Click on the screenshot to view an animation on systole and diastole of the heart. Back to Directory

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Diseases and Conditions Myocardium –Acute coronary syndrome –Angina pectoris –Cardiomegaly –Cardiomyopathy –Congestive heart failure (CHF) –Myocardial infarction (MI)

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-14 Peripheral edema Antonia Reeve/Photo Researchers, Inc.l

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Angina Video Click on the screenshot to view a video on the topic of angina. Back to Directory

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Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Myocardial Damage Animation Click on the screenshot to view an animation on the topic of myocardial damage. Back to Directory

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Diseases and Conditions (cont’d) Heart Valves and Layers of the Heart –Endocarditis –Mitral valve prolapse (MVP) –Murmur –Pericarditis –Rheumatic heart disease

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-15 Vegetation on the mitral valve Abrahas/Custom Medical Stock Photo, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Diseases and Conditions (cont’d) Conduction System –Arrhythmia –Bradycardia –Fibrillation –Flutter –Heart block

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-16 Arrhythmias on an EKG tracing

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Diseases and Conditions (cont’d) Conduction System –Premature contraction –Sick sinus syndrome –Tachycardia –Asystole –Palpitation

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Diseases and Conditions (cont’d) Blood Vessels –Aneurysm –Arteriosclerosis –Bruit –Coronary artery disease (CAD) –Hyperlipidemia –Hypertension (HTN) –Hypotension –Peripheral artery disease (PAD)

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-27 An aneurysm (b) Michael English, M.D./Custom Medical Stock Photo, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-18 Mild atheromatous plaque SIU BioMed/Custom Medical Stock Photo, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-19 Severe atherosclerotic plaque in an artery C. Abrahams, M.D./Custom Medical Stock Photo, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Diseases and Conditions (cont’d) Blood Vessels –Peripheral vascular disease (PVD) –Phlebitis –Raynaud’s disease –Varicose veins

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-23 Severe varicose veins in the leg SPL/Photo Researchers, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Laboratory and Diagnostic Procedures Blood Tests –Cardiac enzymes –C-reactive protein (CRP) –Homocysteine –Lipid profile –Troponin

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Laboratory and Diagnostic Procedures (cont’d) Diagnostic Heart Procedures –Cardiac catheterization –Cardiac exercise stress test –Electrocardiography (ECG, EKG) –Electrophysiologic study (EPS)

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-22 Electrocardiography Jupiter Images – PictureArts Corporation/Brand X Pictures-Royalty Free

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-23 An EKG tracing

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Laboratory and Diagnostic Procedures (cont’d) Diagnostic Heart Procedures –Holter monitor –Pharmacologic stress test –Telemetry

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-21 Treadmill exercise stress test Fotopic/Miles Simons/Phototake NYC

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Laboratory and Diagnostic Procedures (cont’d) Radiology and Nuclear Medicine Procedures –Angiography –Echocardiography

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-24 Echocardiogram Custom Medical Stock Photo, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-25 Doppler ultrasonography Matt Meadows/Science Photo Library/Photo Researchers, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Laboratory and Diagnostic Procedures (cont’d) Radiology and Nuclear Medicine Procedures (cont’d) –Multiple-gated acquisition (MUGA) scan –Myocardial perfusion scan –Single-photon emission computed tomography (SPECT) scan

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Medical and Surgical Procedures Medical Procedures –Auscultation –Cardioversion –Sclerotherapy –Vital signs

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-26 Defibrillation Pearson Education/PH College

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-27 Pulse points

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-28 Carotid pulse Michal Heron/Pearson Education/PH College

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-29 Measuring the blood pressure

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Medical and Surgical Procedures (cont’d) Surgical Procedures –Aneurysmectomy –Cardiopulmonary bypass –Carotid endarterectomy

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Medical and Surgical Procedures (cont’d) Surgical Procedures –Coronary artery bypass graft (CABG) –Heart transplantation –Pacemaker insertion

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) –Percutaneous transluminal coronary angioplasty (PTCA) –Pericardiocentesis –Valve replacement –Valvoplasty –Radiofrequency catheter ablation

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-30 Open heart surgery F. Schussler/PhotoDisc/Getty Images

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-31 Pacemaker (left) English/Custom Medical Stock Photo, Inc. (right) Alvis Upitis/Jupiter Images-PictureArts Corporation/Brand X Pictures-Royalty Free

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-32 Balloon angioplasty

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-33 Stent

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-34 Valve replacement surgery Custom Medical Stock Photo, Inc.

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Abbreviations

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Abbreviations

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Drug Categories These categories of drugs are used to treat cardiovascular Diseases and Conditions: –Angiotensin converting enzyme inhibitor drugs –Antiarrhythmic drugs –Anticoagulant drugs –Antihypertensive drugs –Aspirin

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Drug Categories (cont’d) These categories of drugs are used to treat cardiovascular Diseases and Conditions: –Beta-blocker drugs –Calcium channel blocker drugs –Digitalis drugs –Diuretic drugs

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Drug Categories (cont’d) These categories of drugs are used to treat cardiovascular Diseases and Conditions: –Drugs for cardiac arrest –Drugs for hyperlipidemia –Nitrate drugs –Thrombolytic drugs

Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Medical Language, Second Edition Susan Turley Figure 5-35 The Starry Night