Cardiovascular and Circulatory Systems

Cardiovascular and Circulatory Systems
PowerPoint to accompany Essentials of Medical Language 2e Allan, Lockyer Chapter 6: Cardiovascular and Circulatory Systems The Essentials of the Language of Cardiology Information in this chapter will enable the student to use correct medical terminology to: LO 5.1 Describe the functions and structure of muscle. LO 5.2 Identify the structures and functions of the muscles and tendons of the shoulder girdle and upper limbs. LO 5.3 Describe the structures and functions of the muscles and tendons of the pelvic girdle and lower limbs. LO 5.4 Describe the major diseases of skeletal muscle. 1

Lesson 6.1: The Heart Talking Points: The heart is the principle organ of the cardiovascular system. By the end of lesson 6.1 the student will be able to use correct medical terminology to: • Describe the location, structure, and functions of the heart. • Explain the heart cycle. • Identify the blood supply to the heart. • Detail the electrical properties of the heart.

The Heart Location of the heart –size –shape Talking Points:
Use Figure 6.1(b) to illustrate where the heart lies within the body. The heart is about the size of a fist and weighs approximately 10 ounces. The heart is a blunt cone pointing down and to the left The heart lies slightly to the left side of the sternum. The apex of the heart is the lower tip of the heart. Define mediastinum. The region of the thoracic cavity between the lungs in which the heart lies. The three functions of the heart are to pump blood, route blood, and regulate blood supply.

Abbreviations Define the following abbreviations: – CPR – CVT – ECG
– EKG – SOB Talking Points: It is important to understand abbreviations as they are used as medical terminology shorthand. Define the following abbreviations: CPR—cardiopulmonary resuscitation CVT—cardiovascular technician ECG—electrocardiogram EKG—electrocardiogram SOB—shortness of breath BP is the abbreviation for blood pressure (not yet mentioned in text).

Word Analysis and Definition
Define the following root elements: – cardi – electr – pulmon – thorac Talking Points: Students must memorize root elements in order to form more complex terminology. Define the following root elements: cardi—heart electr—electricity pulmon—lung thorac—chest

The following terms relate to the structure of the heart; identify their prefixes. endocardium myocardium epicardium pericardium Talking Points: The heart wall consists of three layers ( Figure 6.2 ): Endocardium: endo-, inside; connective tissue lining the inside of the heart. Myocardium: does not have a prefix. my/o, muscle; cardi heart; um suffix meaning structure or tissue; cardiac muscle cells that enable the heart to contract. Epicardium: epi-, upon, above; an outer single layer of cells overlying a thin layer of connective tissue. Pericardium: peri-, around; a double-layered connective tissue sac that surrounds and protects the heart. 6

Change the following terms into the adjective form and define them: – endocardium – fibrosis – ischemia – necrosis – pericardium endocardial fibrotic ischemic necrotic pericardial Talking Points: Students must be able to turn a root noun into another form such as an adjective. Answers can be revealed with a mouse click. Define the following terms and change them into the adjective form: Endocardium: the lining of the heart; endocardial. –al pertaining to Fibrosis: repair of dead tissue by forming fibrous tissue; fibrotic. –tic pertaining to Ischemia: lack of blood supply to a tissue; ischemic. –ic pertaining to Necrosis: pathologic death of a tissue; necrotic. Pericardium: membrane covering the heart; pericardial.

Define the following terms related to the blood flow through the heart: atrium ventricle septum bicuspid Talking Points: Atrium: atri-, entrance, atrium; chamber where blood enters the heart on both the right and left sides. Ventricle: Latin for small belly; chamber of the heart (pumps blood). Septum: Latin partition; a thin wall dividing two cavities. Bicuspid: bi-, two; having two points (the bicuspid heart valve has two flaps). 8

Identify the prefix, root, and suffix of the following terms and define them: – interatrial inter- atri- -al – interventricular inter- ventricul- -ar – semilunar semi- lun- -ar Talking Points: Students must memorize word elements to assist them in defining terms. Identify the prefix, root, and suffix of the following terms and define them. Prefixes, roots, and suffixes can be shown using a mouse click. interatrial—between the atria of the heart interventricular—between the ventricles of the heart semilunar—like a half moon

Abbreviations Define the following abbreviations: – AV – IV – O2 – CO2
Talking Points: It is important to understand abbreviations as they are used as medical terminology shorthand. Define the following abbreviations: AV—atrioventricular IV—interventricular O2—oxygen CO2—carbon dioxide 10

The Heartbeat The actions of the four heart chambers are coordinated.
– systole – diastole – stethoscope – murmur Talking Points: Contraction occurs in systole; this is when blood is forced through the heart and circulatory system. Diastole is the period of rest between contractions; this is when the heart chambers refill with blood to be pushed through the heart again. What sounds are heard through a stethoscope when the heart beats? Lub-dub. Explain a murmur. When a valve of the heart does not completely close and blood continues to leak through it, a murmur is heard.

The Heartbeat Electrical properties of the heart – electrocardiogram
Talking Points: The electrocardiograph gives a picture of the electrical activity of the heart. Figure 6.7 illustrates the normal heart beat with its 5 waves. The waves associated with a heart beat are labeled P, Q, R, S, and T. The P wave occurs when the atria contract; the QRS wave occurs when the ventricles contract. The T wave represents the repolarization (recovery) of the ventricles after contraction

Explain the difference between the following sets of terms: – atrial and ventricular – bradycardia and tachycardia – sinus rhythm and arrhythmia – systole and diastole Talking Points: Students should be able to identify opposite meanings of terms. Explain the difference between the following terms: Atrial and ventricular: atrial is pertaining to atrium (where blood enters); ventricular is pertaining to ventricle (where blood is pumped out). The normal heartbeat is called sinus rhythm; arrhythmia is any abnormal cardiac rhythm. Bradycardia and tachycardia: bradycardia is heart rate below 60; tachycardia is heart rate above 100. Sinus rhythm and arrhythmia: sinus rhythm is normal heart rhythm; arrhythmia is an abnormal heart rhythm. Systole and diastole: systole means contraction; diastole means at rest.

Lesson 6.2: Disorders of the Heart Talking Points: By the end of lesson 6.2 the students will be able to use correct medical terminology to: • Name common cardiac arrhythmias. • Discuss common disorders of the heart and heart valves. • Describe coronary heart disease. • Explain hypertensive heart disease. 6.2.5 Define the term cardiomyopathy 14

Disorders of the Heart Abnormal heart rhythms – common arrhythmias
1. premature beats 2. atrial fibrillation 3. ventricular tachycardia 4. ventricular arrhythmia 5. heart block 6. palpitations Talking Points: Arrhythmias are abnormal or irregular heartbeats. There are six types of commonly seen arrhythmias. Premature beats are often associated with caffeine and stress; they feel like the heart skipped a beat. Atrial fibrillation occurs when the atria quiver and don’t contract. This can cause blood to clot and pool in the atrium and can cause paroxysmal atrial tachycardia, which is a period of rapid, but regular, beats. Ventricular tachycardia is a rapid heartbeat arising in the ventricles. Ventricular arrhythmia is irregular heart rate of the ventricles. Heart block is an interference in the electrical conduction system of the heart, causing no coordination between the atria and ventricular contractions. Palpitations are uncomfortable sensations of rapid, irregular heart beats.

Disorders of the Heart Abnormal heart rhythms – pacemakers
– implantable defibrillator – automatic external defibrillator Talking Points: Pacemakers help regulate a patient’s heart beat. They can assist when a rhythm becomes dysfunctional, or they can operate all of the time and override the patient’s heartbeat. An implantable cardioverter/defibrillator will give the heart a small electric shock when it goes into fibrillation to correct the rhythm. An automatic external defibrillator is a defibrillator which sends an electric shock through electrodes place on the chest to stop the heart and allow the heart to restore a regular rhythm. Figure 6.8 is an example of an automatic external defibrillator. © The McGraw-Hill Companies, Inc./Rick Brady

Give the term based on the provided definition: – unpleasant sensations of a rapid beat of the heart palpitation – restoration of a normal heart rhythm by electric shock. cardioversion – uncontrolled quivering of the heart muscle fibrillation Talking Points: Students must be able to give a term when given a definition. Forced rapid beat of the heart is a palpitation. Restoration of a normal heart rhythm by electric shock is cardioversion. The device used to generate electric shock is called a cardioverter. Uncontrolled quivering of the heart is known as fibrillation.

Abbreviations Define the following abbreviations: – AED – ICD – PVC
– A-fib – V-fib – V-tach Talking Points: Students must understand abbreviations and be able to define the terms. Define the following abbreviations: AED—automatic external defibrillator ICD—implantable cardioverter/defibrillator PVC—premature ventricular contraction A-fib—atrial fibrillation V-fib—ventricular fibrillation V-tach—ventricular tachycardia

Disorders of the Heart Disorders of the heart valves
– heart valve malfunction 1. stenosis 2. incompetence Talking Points: Use Figure 6.9 to refamiliarize the students with the locations of the heart valves. Describe the difference between stenosis and incompetence. Stenosis is when valve does not open fully and the opening is constricted; incompetence is when valve does not close fully and blood can regurgitate, flow backward through the valve. Aortic valve stenosis is common in what age population? The elderly. Mitral valve stenosis and incompetence lead eventually to what? Chronic heart failure.

Disorders of the Heart Disorders of the heart
– artificial heart valves 1. prosthetic 2. tissue Talking Points: If a valve requires replacement, there are two types available: mechanical or prosthetic valves made from alloys and plastics; tissue valves from pig, cow; or human hearts Optional detail: Rheumatic fever, usually in childhood, can be a factor in causing the heart valves eventually to fail, thereby requiring a valve replacement.

Disorders of the Heart Disorders of the heart wall 1. endocarditis
2. myocarditis 3. pericarditis 4. cardiomyopathy 5. cor pulmonale Talking Points: What population is at risk for developing endocarditis? IV drug abusers and people with damaged heart valves Myocarditis is an inflammation of the heart muscle itself. Pericarditis interferes with which activity of the heart? The ability of the heart to fully contract. Define cardiomyopathy. A weakening of the heart muscle so that it pumps ineffectively. Can occur in young people. Cor pulmonale is a failure of which ventricle to pump properly? The right ventricle.

What relationship do the following sets of terms have? – pericarditis and tamponade – incompetence, insufficiency, and regurgitate Talking Points: Students should be able to make an association between the terms given in the slide if they know their definitions. What do the following terms have in common? Pericarditis causes an accumulation of fluid to amass between the heart and its outer lining. The fluid causes the heart to be compressed against the fluid-filled sac, causing tamponade, when the heart muscle cannot contract and expand normally and cardiac output falls. Incompetence, insufficiency, and regurgitate. Incompetence and insufficiency all describe a valve that does not completely close, allowing blood to flow back or regurgitate into the heart chamber from where it came from.

– coronary artery disease 1. angina pectoris 2. myocardial infarction 3. cardiogenic shock 4. cardiac arrest Talking Points: Arteries become narrowed by plaque deposits called atheroma. Use Figure 6.10 to illustrate a normal artery and one with plaque deposits. When plaque builds up inside an arterial wall, blood flow is reduced. Narrowing of the coronary arteries means reduced blood flow to the heart muscle. Angina pectoris, chest pain on exertion, is usually the first symptom of reduced oxygen supply and blood flow to the myocardium. What is a myocardial infarction? Death of heart tissue. What are the symptoms of cardiogenic shock? Weak, rapid pulse and decreased blood pressure in a patient who is pale, cold, sweaty, and anxious. Asystole (flat line on an ECG) indicates the heart is in cardiac arrest (no electrical or contraction activity).

– coronary artery disease 1. risk factors – heredity, age, obesity, lack of exercise, tobacco, diabetes, stress, high blood pressure KEYNOTE: All these risk factors, except heredity and age, can be reduced by changes in lifestyle. Talking Points: Have students list the risk factors for coronary artery disease. They include: heredity, age, obesity, lack of exercise, tobacco, diabetes mellitus, stress, high blood pressure, and elevated serum cholesterol. All of the risk factors identified for developing CAD, except heredity and age, can be reduced by lifestyle changes. Ask students to name lifestyle changes that can reduce the risk of CAD.

Abbreviations Define the following abbreviations: CAD ASHD MI NTG PNB
Talking Points: Students must understand abbreviations and be able to define the terms. Define the following abbreviations: CAD—coronary artery disease ASHD—arteriosclerotic heart disease MI—myocardial infarction NTG—nitroglycerin PNB—pulseless nonbreather 25

Describe the differences in the following sets of terms: – occlude and perfuse – sublingual and substernal – arteriosclerosis and atherosclerosis Talking Points: Students should understand terminology related to disorders of the heart found in the previous slides. They should at this point be able to describe the differences in the following terms: Occlude and perfuse: occlude means blockage; perfuse means free flowing. Sublingual and substernal: sublingual is under the tongue; substernal is under the sternum. Arteriosclerosis and atherosclerosis: arteriosclerosis refers to a hardening of the arteries with loss of elasticity; atherosclerosis is a plaque build-up in the arteries and is the commonest form of arteriosclerosis.

– hypertensive heart disease – congestive heart failure – congenital heart disease Talking Points: Hypertension effects about 20% of the adult population. There are 4 types of hypertension: primary or essential hypertension—risk factors are unknown secondary hypertension, which results from other diseases such as kidney disease and hyperthyroidism malignant hypertension, which is a sudden and rapid onset of a life-threatening hypertension, occurs in younger adults, is often associated with kidney disease; it also occurs in women with toxemia of pregnancy. prehypertension, which is defined as systolic pressure below 139 and a diastolic between 80 and 90 What is congestive heart failure? The inability of the heart to supply enough cardiac output to meet the body’s metabolic needs. Congenital heart disease, present at birth, is the result of an abnormal development of the heart in the fetus.

Disorders of the Heart • Congenital heart disease
1. atrial septal defect 2. ventricular septal defect 3. patent ductus arteriosus 4. coarctation of the aorta 5. tetralogy of Fallot Talking Points: In an atrial septal defect, blood flows from the left atrium to the right atrium. In a ventricular septal defect, blood flows from which ventricle to which ventricle? From the left ventricle to the right ventricle. Use Figure 6.12 to illustrate ASD and VSD When the ductus arteriosus does not close after birth, what organs can become damaged? The lungs. Describe coarctation of the aorta. Narrowing of the aorta in its arch. The four congenital defects found in the Tetralogy of Fallot can all be surgically repaired.

Identify the word elements and define the following terms: – hypertension – hypotension – prehypertension Talking Points: The common root of the following three terms is tens-, meaning pressure. The common suffix –ion means condition or action. Hypertension has prefix hyper- excessive or high blood pressure. Hypotension has prefix hypo- low blood pressure. Prehypertension has the additional prefix pre- before, the precursor to (before) hypertension.

Identify the following abbreviations: – ASD – VSD – CHD – CHF – Hg – HTN – PDA – SOB – TOF Talking Points: Students must be able to identify abbreviations as they are commonly used as medical shorthand. Identify the following abbreviations: ASD—atrial septal defect VSD—ventricular septal defect CHD—congenital heart disease CHF—congestive heart failure Hg—mercury HTN- hypertension PDA—patent ductus arteriosus SOB—shortness of breath TOF—tetralogy of Fallot 30

Cardiologic Investigations and Procedures
Blood tests – lipid profile • cholesterol • lipoprotein (HDL and LDL) • triglycerides Talking Points: A lipid profile helps determine the risk of CAD and comprises: • total cholesterol • high-density lipoprotein (HDL) (“good cholesterol”) • low-density lipoprotein (LDL) (“bad cholesterol”) • triglycerides

Diagnostic tests electrocardiogram (ECG or EKG) cardiac stress testing echocardiography Holter monitor ambulatory blood pressure monitor magnetic resonance imaging (MRI) cardiac catheterization coronary angiogram Talking Points: An electrocardiogram (ECG or EKG) is a paper record of the electrical signals of the heart. Cardiac stress testing is an exercise tolerance test to raise the heart rate and monitor its effect on cardiac function. Echocardiography uses ultrasound waves to study cardiac function. A Holter monitor is a continuous ECG recorded on a tape-recorder cassette as a person works, plays, and rests during a 24 hour period. An ambulatory blood pressure monitor provides a record of blood pressure over a 24-hour period as a person goes about his or her daily activities. Magnetic resonance imaging (MRI ) can produce detailed images of the heart and identify sections of cardiac muscle that are not receiving an adequate blood supply. Cardiac catheterization detects patterns of pressures and blood flows in the heart. A thin tube is threaded into the heart under x-ray guidance after being inserted into a vein or an artery. A coronary angiogram uses a contrast dye injected during cardiac catheterization to identify coronary artery blockages. 32

Treatment procedures – thrombolysis – percutaneous transluminal coronary angioplasty – stent placement – coronary artery bypass surgery Talking Points: Thrombolysis of a clot involves injecting a medication designed to dissolve a clot in a blocked vessel so that the blocked blood vessel can reopen. Percutaneous transluminal coronary angioplasty (PTCA) is a procedure in which a balloon is used to open a plaque-filled vessel by compressing the plaque against the vessel wall and restoring blood flow through the vessel. A stent is a device used to prop open and keep open a narrowed blood vessel. Coronary artery bypass surgery (CABG) surgery is a procedure in which a blocked vessel is bypassed by using a healthy blood vessel harvested from the leg, arm or chest. 33

Treatment procedures – cardioversion – defibrillation – heart transplant Talking Points: Cardioversion involves converting a cardiac arrhythmia into a normal rhythm by an electric shock to the heart from a defibrillator. In defibrillation atrial or ventricular fibrillation is terminated and normal rhythm restored by delivery of an electric shock to the heart. Tissue matching must be performed before a heart transplant to decrease the likelihood of a rejection reaction.

Define the following combining forms: – ech/o – cutan/e – thromb/o - scler/o - arteri/o - idi/o - angi/o - ven/o Talking Points: Students must understand the meaning of root elements to build medical terms. Define the following root elements: ech/o—sound cutan/e—skin thromb/o—blood clot scler/o – hardness arteri/o artery idi/o unknown angi/o blood vessel ven/o vein Ask the students to name and define word with these combining forms

Define the following suffix elements: – gram – plasty – ize – ous – tic – ide Talking Points: In order to build medical terms, students must understand word elements. Define the following suffix elements. -gram record Example: angiogram -plasty surgical repair Example: angioplasty -ize action Example: catheterize -ous pertaining to Example: percutaneous -tic pertaining to Example: thrombolytic - ide having a particular quality Example: triglyceride

Lesson 6.3: Circulatory Systems Talking Points: By the end of lesson 6.3 the students will be able to use correct medical terminology to: • Specify the functions of the systemic and pulmonary circulations. • Identify the major arteries and veins in the body. • Explain the hemodynamics and control of blood flow. • Describe common disorders of the circulatory system.

Describe the difference between the following sets of terms: – artery vs. vein – angiogram vs. venogram – pulmonary circulation vs. systemic circulation Talking Points: Students must understand basic terms to understand differences in structures and procedures. Describe the difference between the following terms: artery vs. vein—arteries carry oxygenated blood to tissues; veins carry deoxygenated blood back to the heart. angiogram vs. venogram—an angiogram is a study of the internal arterial wall; a venogram is a study of the interior venous wall. The circulatory system refers to the heart and blood vessels and has two major divisions: pulmonary and systemic circulation. Pulmonary circulation carries deoxygenated blood from the heart to the lungs and returns oxygenated blood to the heart. Systemic circulation supplies oxygenated blood to every organ except the lungs and then returns deoxygenated blood to the heart.

Circulatory System Functions of the circulatory system: transport
maintain homeostasis regulate blood pressure Talking Points: Functions of the Circulatory System • Transport: The circulatory system carries oxygen, nutrients, hormones, and enzymes that diffuse from the blood into the cells. Waste products and carbon dioxide diffuse back from the cells into the system and are carried to the lungs, liver, and kidney for excretion. • Maintain homeostasis: The systemic circulation directs blood flow to tissues to enable them to meet their metabolic needs. • Regulate blood pressure: The ability of the arteries in the systemic circulation to expand and contract in coordination with the systole and diastole of the heartbeat maintains a steady flow of blood and blood pressure to the tissues. (Remember: systole means contraction; diastole means at rest) 39

Define the following root elements: – brachi – ven/a – palpat – capill Talking Points: To build terminology the student must be able to define individual elements. Define the following root elements: brachi—arm brachial ven/a—vein vena cava palpat—touch, stroke palpate capill—hairlike structure capillary

Where in the body would you find the following vessels? – radial artery – temporal artery – cartoid artery – femoral artery – brachial artery Talking Points: By understanding terminology, the student can identify where structures lie within the body. Where in the body would you find the following vessels? radial artery—at the wrist temporal artery—at the head (temple) cartoid artery—side of the neck femoral artery—in the upper thigh near the groin (femur) brachial artery—at the elbow Others: axillary artery—under the arm saphenous artery—in the thigh

Circulatory Systems Circulatory disorders – disorders of veins
Talking Points: Varicose veins are veins that have lost their elasticity and have become swollen and painful. Use Figure 6.15 to illustrate varicose veins for students. What is thrombophlebitis? An inflammation of the lining of a vein. List causes of deep vein thrombosis. Immobility, surgery, prolonged travel, and contraception using estrogen. What is the job title of a person who draws blood from a vein? Phlebotomist. © Dr. P. Marazzi / Photo Researchers Inc.

Circulatory Systems Circulatory disorders – disorders of arteries
1. aneurysm 2. thromboangiitis obliterans 3. Raynaud disease 4. carotid artery disease Talking Points: An aneurysm is a dilation of an artery caused by a weakness in the vessel. An intracranial aneurysm can cause bleeding where? In the brain. Describe thromboangiitis obliterans. An inflammatory disease of the arteries with clot (thrombus) formation, usually in the legs. Raynaud disease is episodes of spasm of the small arteries supplying the fingers, hands, and feet following exposure to cold. It can be associated with connective tissue disorders such as scleroderma and lupus. What procedure is performed to remove plaque from the carotid artery? Endarterectomy.

Identify the root elements and then define the term: – collateral – endarterectomy – phlebotomist – sclerose – edematous later arter phleb/o scler edema Talking Points: To build a medical vocabulary, students must become familiar with root elements. Define the root elements of the following words. collateral: lateral—at the side; situated at the side, often to bypass an obstruction endarterectomy: arter—artery; surgical removal of plaque from an artery phlebotomist: phleb—vein; person skilled in taking blood from veins sclerose: scler—hardening; to harden or thicken edematous: edema—swelling due to excess fluid in tissues; pertaining to or affected by edema. -

Cardiovascular and Circulatory Systems

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