1. Chapter 25 Circulatory System
3/ 14/ 2011 online

2. Two Circulatory Systems
Blood-vascular System- major portion- transports blood
Consists of heart, arteries, capillaries and veins
Lymphatic System- minor portion –
collects fluid from tissue spaces, filters through lymph system

3. Two Systems make up Circulatory System
Both carry oxygen and nutrients to tissues in continuous, endless uni-direction
Both transport waste products to organs of excretion- what are those 4 organs?
Skin
Lungs
Liver
kidneys

4. Heart has 2 circulation routes branching off it:
Systemic (arterial circuit)- carries oxygenated blood to organs and tissues
Pulmonary –carries blood to lungs for carbon dioxide exchange and re-oxygenation of blood

5. Pulmonary, systemic, and portal circulation
red = oxygenated blue = deoxygenated purple -nutrient-rich

6. Systemic Circulation
Pumps blood to organs

7. Pulmonary Circulation
Takes returning blood to lungs to exchange carbon dioxide for oxygen
Carries oxygenated blood from lungs to heart
These are only veins in post-fetal human body carrying oxygenated (red) blood

8. Portal System Venous drainage from abdominal organs to liver-
Filtered -
Back to inferior vena cava
Liver has 2 blood supplies!

9. Anatomy: Heart 4 chambers 2 atria 2 ventricles
Myocardium - muscular wall of heart
Endocardium -membrane lining interior of heart
Pericardial sac- double-walled membrane enclosing heart
exterior wall is fibrous
thin inner wall- Epicardium - covers heart

10. Great Vessels of Heart Deoxygenated/Oxygenated Blood Flow
Pulmonary artery- vessel carrying venous blood to lungs
Aorta- carry oxygenated blood for systemic circulation
Vena Cava
Inferior and Superior - return of venous blood to heart
Pulmonary Veins- carry oxygenated blood to left artrium

11. Anatomy: Heart
Right side of heart- handles venous, or deoxygenated blood
Left side of heart- handles arterial, or oxygenated blood

12. Atria act as receiving chambers
Function of Chambers
Atria act as receiving chambers
Right atrium receives venous blood from superior and inferior vena cavae
Left atrium receives oxygenated blood from right and left pulmonary veins

13. Ventricles act as distributers of blood
Left ventricle pumps blood into aorta and systemic cirulation
Right ventricle pumps blood into pulmonary circulation

14. Heart Valves Right atrioventricular (AV) valve or tricuspid valve
controls opening between right atrium and right ventricle
Left AV valve or mitral valve
controls opening between left atrium and left ventricle

15. Coronary arteries supply blood to myocardium (muscular wall of heart)
Left Coronary artery
Right Coronary artery
Coronary sinus

16. Myocardial infarction (MI)
Commonly known as a heart attack
interruption of blood supply to part of heart, causing some heart cells to die
most commonly due to occlusion (blockage) of a coronary artery

17. CABG (Coronary Artery Bypass Graft)
Surgery called revascularization to improve blood flow to heart in people with severe coronary artery disease (CAD)
CAD - occurs when coronary arteries become blocked due to buildup (plaque) on inside of blood vessels.
If severe enough:chest pain (angina), shortness of breath, possible heart attack and death
Healthy artery or vein grafted, to blocked artery bypassing blocked portion -new passage routes oxygen-rich blood around blockage to heart muscle
Replacing vessel will take over role previously performed by piece removed
Up to 4 major blocked coronary arteries can be bypassed during 1 surgery.

18. Blood -Vascular System Radiological Studies

19. Angiography Exam of vascular structures using contrast medium
Arteriography - exam of arteries
Venography - exam of veins

20. Indications Claudication – Stenosis - Occlusion – Aneurysm –
leg pain and cramping
Stenosis -
narrowing of vessel
Occlusion –
blockage of a vessel
Aneurysm –
weakened area of artery
“ballooning”
Suspected tumors
Anatomic variances

21. Contrast dye is injected
Automatic injector is most commonly used
Manual injection is done rarely
Injectors are programmed to coincide with imaging sequence
Rapid film changers are rarely seen

22. Digital Equipment
Digital subtraction -instantly “subtracts” overlying bony structures
better visualization of contrast-filled vascular structures

23. Equipment

24. Catheterization
Catheter - small, flexible tube inserted into vessel through which contrast is introduced
Femoral artery most common introduction site
Radial
Brachial
Axillary
Jugular
Subclavian

25. Possible Complications!
Bleeding at puncture site
Allergic reaction to contrast
Nerve, vessel, or tissue damage
Stroke
Heart attack
Death

26. Venography

27. Indications For Venography
Deep vein thrombosis: Formation of blood clot inside blood vessel
When blood vessel injured:
body forms blood clot to prevent loss of blood
If too much clotting & clot breaks free
travels in bloodstream – blocks blood vessel - obstructs circulation (embolism)
If goes to lungs - can rupture pulmonary artery, causing death

28. Other Indications for Venography
Venous obstruction
Recurrent varicose veins
Swollen legs of unknown etiology
Varicose ulcers
Venous malformations

29. Main Veins of Upper Extremity
Cephalic vein
Basilic vein
Subclavian vein
Injection usually in median cubital

30. Injection usually in median cubital

31. Peripheral Venography
Examines superficial and deep veins of extremities
Less common today-replaced by advances in ultrasound

32. Lower-Limb Venogram
AP of entire extremity
Lateral of entire extremity

33. Central Venography
Superior venacavogram performed by accessing axillary or subclavian vein
Inferior venacavogram performed by accessing femoral vein and placing catheter in common iliac vein or inferior aspect of inferior vena cava