Assignment Discussion: Cardiovascular System
Assignment Discussion: Cardiovascular System
Answer the following questions only using the powerpoint or case study attached.
1. Define the following medical terms from the cardiovascular system:
Sinoatrial node, myocardium, sphygmomanometer, phlebotomy.
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2. Bradycardia, Tetralogy of Fallot, coronary artery disease and aneurysm are four pathological conditions of the cardiovascular system. Define each one and briefly explain signs, symptoms, diagnosis and treatment.
3. Read the cardiovascular system case study attached and answer the questions. Assignment Discussion: Cardiovascular System
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Chapter_11_LO.pptChapter 11
Cardiovascular SystemCopyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Learning Objectives
- Name the parts of the heart and associated blood vessels and their functions in the circulation of blood.
- Trace the pathway of blood through the heart.
- Identify and describe major pathologic conditions affecting the heart and blood vessels.
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Learning Objectives (cont’d.)
- Define combining forms that relate to the cardiovascular system.
- Describe important laboratory tests and clinical procedures pertaining to the cardiovascular system, and recognize relevant abbreviations.
- Apply your new knowledge to understand medical terms in their proper context, such as in medical reports and records. Assignment Discussion: Cardiovascular System
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Chapter 11
Lesson 11.1Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Introduction
- Cardiovascular System: delivers oxygen and nutrients to cells of body tissue
- Heart (muscular pump)
- Blood vessels (fuel line and transportation network)
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- What are three types of blood vessels in the body?
- What are the primary differences between them? (See next slide.)
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BLOOD VESSELS AND THE CIRCULATION OF BLOOD
- Arteries are the vessels that lead oxygenated blood away from the heart.
- Veins are thinner walled vessels compared to arteries. They move deoxygenated blood toward the heart from the tissues.
- Capillaries are the smallest vessels. They form the point of exchange for oxygen and nutrients into body cells and waste products coming from body cells. Assignment Discussion: Cardiovascular System
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- What are smaller branches of arteries called? (arterioles)
- What are small veins that carry waste-filled blood back to the heart called? (venules)
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BLOOD VESSELS
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- Point out the discrete layers of each vessel.
- Compare and contrast the substructures of each type of vessel.
- Why is the muscle layer in an artery thicker than that of a vein?
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systemic circulation
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- Make sure students understand this basic flow in order to fully understand the pathology.
- The anatomic terminology here is often associated with any pathology. Assignment Discussion: Cardiovascular System
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Major vessels
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- The major pulse points should be considered. For example, the brachial artery is important because blood pressure is routinely measured at this junction.
- What symptoms are associated with potential blockage in these vessels?
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Anatomy of the heart
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- Fill in the identified structures and mention their specific functions. Identify the major valves of the heart and important blood vessels.
- Which of the four chambers has the thickest walls and why? (The left ventricle walls have three times the thickness of the right ventricle walls; it requires great force to pump blood throughout the body.)
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Anatomy of the heart
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- Fill in the identified structures and mention their specific functions. Identify the major valves of the heart and important blood vessels.
- Which of the four chambers has the thickest walls and why? (The left ventricle walls have three times the thickness of the right ventricle walls; it requires great force to pump blood throughout the body.)
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Major valves of the heart
- tricuspid valve (cusps are flaps of the valves): between right atrium and right ventricle
- pulmonary valve: between right ventricle and pulmonary artery
- mitral valve: between left atrium and the left ventricle
- aortic valve: between left ventricle and aorta. Assignment Discussion: Cardiovascular System
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- Point these out on the diagram from the previous slide to reinforce.
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Pathway of blood through the heart
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- Go through each step of how the blood travels through the heart.
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HEARTBEAT AND HEART SOUNDS
- Two phases of the heartbeat:
- diastole: relaxation
- systole: contraction
- The diastole-systole cardiac cycle occurs between 70-80 times per minute (100,000 times per day).
- The heart pumps 3 ounces of blood with each contraction. This means that about 5 quarts are pumped per minute (75 gallons an hour and about 2000 gallons a day). Assignment Discussion: Cardiovascular System
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- Which valves open and which valves close during diastole? (The tricuspid and mitral valves open as blood passes from the right and left atria into the ventricles. The pulmonary and aortic valves close.)
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Heart sounds
Closure of valves associated with sounds “lubb-dubb, lubb-dubb”
- lubb: closure of the tricuspid and mitral valves at the beginning of systole
- dubb: closure of the aortic and pulmonary valves at the end of systole
- murmur: abnormal heart sound caused by improper valve closure
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- Borrow a stethoscope to demonstrate.
- Audio recordings are also available online. Many also contain pathological sounds.
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PHASES OF THE HEARTBEAT
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PHASES OF THE HEARTBEAT
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Have students fill in the labels using this slide. Assignment Discussion: Cardiovascular System
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CONDUCTION SYSTEM OF THE HEART
sinoatrial node (SA node): pacemaker of the heart
pacemaker: origin of electrical impulse causing walls of the atria to contract and force blood into the ventricles (ending diastole)
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- Where in the heart is the SA node located? (in a small region of specialized muscle tissue in the posterior portion of the right atrium.)
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Conduction system of the heart (cont’d.)
- atrioventricular node (AV node): This sends the excitation wave to a bundle of specialized fibers called atrioventricular bundle or Bundle of His.
- Bundle of His (pronounced “hiss”): Helps form conduction myofibers that extend to ventricle walls and stimulate them to contract, beginning systole. A short rest period follows.
- The pacemaker begins wave of excitation again.
- ECG or EKG (electrocardiogram): The record used to detect electrical changes in heart muscle as the heart beats.
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- Where is the AV node? (in the posterior portion of the interatrial septum)
- The normal ECG shows five waves (deflections) that represent the electrical changes as a wave of excitation spreads through the heart. What are the deflections called? (P, QRS, and T waves.)
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CONDUCTION SYSTEM OF THE HEART
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CONDUCTION SYSTEM OF THE HEART
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Electrocardiogram
- P wave = spread of excitation wave over the atria just before contraction; QRS wave = spread of excitation wave over the ventricles as the ventricles contract; T wave = electrical recovery and relaxation of ventricles. A heart attack (myocardial infarction or MI) can be recognized by an elevation in the S-T segment of the ECG. Thus, one type of MI is an S-T elevation MI or STEMI. Assignment Discussion: Cardiovascular System
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- The EKG diagnoses electrical problems in the heart, such as arrhythmias.
- Identify deflections on the EKG.
- What is happening in the heart with each wave complex?
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Electrocardiogram
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- The EKG diagnoses electrical problems in the heart, such as arrhythmias.
- Identify deflections on the EKG.
- What is happening in the heart with each wave complex?
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Electrocardiogram
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- The EKG diagnoses electrical problems in the heart, such as arrhythmias.
- Identify deflections on the EKG.
- What is happening in the heart with each wave complex?
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BLOOD PRESSURE
- Blood pressure: The force that blood exerts on arterial walls.
- Measured using sphygmomanometer
- Expressed as a fraction:
systolic pressure/
diastolic pressure
- example: 120/80 mm Hg
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- How does the sphygmomanometer work?
- Compare this device to over-the-counter electronic monitors.
- What effect does exercise have on blood pressure measurements?
- What causes increases and decreases in blood pressure?
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COMBINING FORMS
AND TERMINOLOGY- angi/o vessel
- aort/o aorta
- arter/o artery
- arteri/o artery
- ather/o yellowish plaque
- atri/o atrium
Combining Form Meaning
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COMBINING FORMS
AND TERMINOLOGY- brachi/o arm
- cardi/o heart
- cholesterol/o cholesterol
- coron/o heart
- cyan/o blue
- myx/o mucus
Combining Form Meaning
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COMBINING FORMS
AND TERMINOLOGY- ox/o oxygen
- pericardi/o pericardium
- phleb/o vein
- sphygm/o pulse
- steth/o chest
- thromb/o clot
Combining Form Meaning
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- valvul/o valve
- valv/o valve
- vas/o vessel
- vascul/o vessel
- ven/o, ven/i vein
- ventricul/o ventricle
Combining Form Meaning
COMBINING FORMS
AND TERMINOLOGYCopyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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QUICK QUIZ:
The double-layered membrane surrounding the heart is the ___________
pericardium
arteriole
endocardium
endothelium
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CORRECT Answer is A, pericardium
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QUICK QUIZ:
2. The contraction phase of the heartbeat is called _________
diastole
vena cava
systole
septum
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CORRECT Answer is C, systole.
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Chapter 11
Cardiovascular System
Lesson 11.2Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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PATHOLOGY:
THE HEART AND BLOOD VESSELSHEART
arrhythmias
Bradycardia and heart block (atrioventricular block)
Flutter
Fibrillation:
Atrial AF
Ventricular VF
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- What device establishes normal heart rhythm?
- What term describes the action of applying a defibrillator to give an electric shock to the heart?
- On the list, which terms are associated with “palpitations”?
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PATHOLOGY:
THE HEART AND BLOOD VESSELSHEART
congenital heart disease
coarctation of the aorta (CoA)
patent ductus arteriosus (PDA)
septal defects (ASD and VSD)
tetralogy of Fallot
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- What is a “blue baby”?
- In terms of septal defects, what are two recent procedures that serve as alternatives to traditional surgery? (trans-catheter closure and minimally invasive heart surgery)
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PATHOLOGY:
THE HEART AND BLOOD VESSELSHEART
Congestive heart failure (CHF): The heart is unable to pump the required amount of blood.
In U.S., primarily the result of high blood pressure and coronary artery disease (see next slide)
Results in pulmonary edema
Fatal if untreated
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- What drugs improve the performance of the heart and its pumping activity? (angiotensin-converting enzyme (ACE) inhibitors and beta-blockers)
- What device do patients awaiting a transplant use to help assist the heart’s pumping? (a left ventricular assist device or LVAD). Assignment Discussion: Cardiovascular System
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PATHOLOGY:
THE HEART AND BLOOD VESSELSHEART
coronary artery disease (CAD)
- Atherosclerosis
thrombotic occlusion
ischemia
necrosis
myocardial infarction
- Acute Coronary Syndrome (ACS)
unstable angina (chest pain)
myocardial infarction (MI)
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- What is atherosclerosis? (the deposition of fatty compounds on the inner lining of the coronary arteries)
- What is ACS? (It describes the consequences after plaque rupture in coronary arteries.)
- What is unstable angina? (chest pain at rest or chest pain of increasing frequency)
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PATHOLOGY:
THE HEART AND BLOOD VESSELSHEART
Coronary artery disease
Drug therapies for CAD
nitrates –nitroglycerin (vasodilator)
Aspirin (Anticoagulant)
calcium channel blockers (muscle relaxant)
Statins ( lower cholesterol levels)
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- What drug is given for acute attacks of angina? (Nitroglycerin is given sublingually.)
- This drug is one of several nitrates that is a powerful vasodilator that increases coronary blood flow and lowers blood pressure. Assignment Discussion: Cardiovascular System
- What do statins do?
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PATHOLOGY:
THE HEART AND BLOOD VESSELSHEART
Coronary artery disease
Surgical therapies for CAD
- percutaneous coronary intervention (PCI) – Catheterization with balloons and stents open clogged arteries
- coronary artery bypass grafting (CABG) – open heart surgery replacing clogged vessels.
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- What is CABG? (an open heart operation to treat coronary artery disease by replacing clogged vessels)
- What is PTCA? (catheterization with balloons and stents opens clogged coronary arteries)
- What is TMLR? (a laser makes holes in the heart muscle to induce angiogenesis or growth of new blood vessels)
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PATHOLOGY:
THE HEART AND BLOOD VESSELSHEART
Other Pathologic conditions
- endocarditis (vegetations)
- hypertensive heart disease
- mitral valve prolapse (MVP)
- murmur
- pericarditis
- rheumatic heart disease
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- What is endocarditis? (inflammation of the inner lining of the heart caused by bacteria)
- What is MVP? (improper closure of the mitral valve)
- What is rheumatic heart disease? (heart disease caused by rheumatic fever)
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PATHOLOGY:
THE HEART AND BLOOD VESSELSBLOOD VESSELS
- aneurysm
- deep vein thrombosis (DVT)
- hypertension (HTN)
- peripheral vascular disease (PVD)
- Raynaud disease
- varicose veins
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- What is PVD? (blockage of blood vessels outside the heart)
- A sign of PVD in the lower extremities is intermittent claudication, an absence of pain or discomfort in a leg at rest, but a recurrence of pain, tension, and weakness after walking has begun.
- What are the signs of Raynaud disease?
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QUICK QUIZ:
3. Which arrhythmia refers to rapid, random, inefficient and irregular contractions of the atria and ventricles (350 beats or more per minute)?
fibrillation
flutter
bradycardia
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CORRECT Answer is A, fibrillation
Chapter 11
Lesson 11.3*
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LABORATORY TESTS
- BNP test
- Cardiac biomarkers
- lipid test profile
- lipoprotein electrophoresis
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- What are lipid tests?
- What is lipoprotein electrophoresis? Why is this test ordered?
- What are serum enzyme tests? Why is this test ordered?
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CLINICAL PROCEDURES: DIAGNOSTIC
X-Ray
- angiography and arteriography
- computerized tomography angiography
- digital subtraction angiography (DSA)
- Electron beam computed tomography (EBCT or EBT)
Ultrasound Tests
- Doppler ultrasound
- echocardiography (ECHO)
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- What determines when each of these tests should be used?
- Differentiate between invasive and noninvasive diagnostic tests.
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CLINICAL PROCEDURES: DIAGNOSTIC
Nuclear Cardiology
- positron emission tomography (PET) scan
- technetium (Tc) 99m Sestamibi scan (Cardiolite)
- Thallium-201 scan
Magnetic Resonance Imaging (MRI)
- cardiac MRI
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- Are there any risks or side effects from having these tests performed?
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CLINICAL PROCEDURES: DIAGNOSTIC
Other diagnostic procedures:
- cardiac catheterization
- electrocardiography (ECG, EKG)
- Holter monitoring
- stress test (ETT)
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- What is the anticipated or theorized cardiac problem that leads a person to get a test?
- Be as specific as possible when describing the procedures. Find one unique thing about each test that makes it memorable. Have the students help you do this.
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CLINICAL PROCEDURES: DIAGNOSTIC
- Identify the normal sinus rhythm and arrhythmias
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CLINICAL PROCEDURES: DIAGNOSTIC
A Normal sinus rhythm. Notice the regularity of the P, QRS, and T waves.
B Atrial flutter. Notice the rapid atrial rate (P wave) compared to the slower ventricular rate (ARS).
C Atrial fibrillation. P waves are replaced by irregular and rapid fluctuations. There are no effective atrial contractions.
D Ventricular tachycardia. Ventricular rate may be as high as 250 beats per minute. The rhythm is regular, but the atria are not contributing to ventricular filling and blood output is poor.
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CLINICAL PROCEDURES: TREATMENT
- Defibrillation
- endarterectomy
- extracorporeal circulation
- heart transplantation
- thrombolytic therapy
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- Use photographs or online images to show some of the equipment used routinely to diagnose and treat the heart during acute abnormalities.
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CLINICAL PROCEDURES
Treatment- Coronary artery bypass graft (CABG) surgery. A, Section of a vein is removed from the leg and anastomosed to a coronary artery to bypass an area of arteriosclerotic blockage. B, An internal mammary artery is grafted to a coronary artery to bypass blockage.
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Treatment procedures (cont’d.)
- percutaneous coronary intervention (PCI)
- includes: percutaneous transluminal coronary angioplasty (PTCA), stent placement, laser angioplasty, and atherectomy
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Abbreviations
- MI
- PCI
- HTN
- LDL
- ECHO
- CAD
- BP
- VF
- AF
- ECG
-
- CABG
- MVP
- ETT
- HDL
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- Ask students to identify the terms associated with these abbreviations.
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QUICK QUIZ:
4. Which procedure involves insertion of a balloon-tipped catheter into a coronary artery?
thrombolytic therapy
coronary artery bypass grafting
percutaneous coronary intervention
endarterectomy
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CORRECT Answer is C, percutaneous coronary intervention (also known as PCI) see page 415 for more information.
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COMBINING FORMS
angi/o ______________
aort/o ______________
arter/o ______________
arteri/o ______________
ather/o ______________
atri/o ______________
Combining Form Meaning
REVIEW SHEET
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COMBINING FORMS
- angi/o vessel
- aort/o aorta
- arter/o artery
- arteri/o artery
- ather/o yellowish plaque
- atri/o atrium
Combining Form Meaning
REVIEW SHEET
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COMBINING FORMS
brachi/o ______________
cardi/o ______________
cholesterol/o ______________
coron/o ______________
cyan/o ______________
myx/o ______________
Combining Form Meaning
REVIEW SHEET
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COMBINING FORMS
- brachi/o arm
- cardi/o heart
- cholesterol/o cholesterol
- coron/o heart
- cyan/o blue
- myx/o mucus
Combining Form Meaning
REVIEW SHEET
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COMBINING FORMS
ox/o ______________
pericardi/o ______________
phleb/o ______________
sphygm/o ______________
steth/o ______________
thromb/o ______________
Combining Form Meaning
REVIEW SHEET
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COMBINING FORMS
- ox/o oxygen
- pericardi/o pericardium
- phleb/o vein
- sphygm/o pulse
- steth/o chest
- thromb/o clot
Combining Form Meaning
REVIEW SHEET
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COMBINING FORMS
valvul/o ______________
valv/o ______________
vas/o ______________
vascul/o ______________
ven/o, ven/i ______________
ventricul/o ______________
Combining Form Meaning
REVIEW SHEET
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COMBINING FORMS
- valvul/o valve
- valv/o valve
- vas/o vessel
- vascul/o vessel
- ven/o, ven/i vein
- ventricul/o ventricle
Combining Form Meaning
REVIEW SHEET
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SUFFIXES
-constriction ______________
-dilation ______________
-emia ______________
-graphy ______________
-lysis ______________
-megaly ______________
Suffix Meaning
REVIEW SHEET
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SUFFIXES
- -constriction narrowing
- -dilation widening; stretching; expanding
- -emia blood condition
- -graphy process of recording
- -lysis breakdown; separation;
destruction; loosening
- -megaly enlargement
Suffix Meaning
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SUFFIXES
- -meter ______________
- -oma ______________
- -osis ______________
- -plasty ______________
- -sclerosis ______________
- -stonosis ______________
- -tomy ______________
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Suffix Meaning
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SUFFIXES
- -meter measure
- -oma tumor; mass; fluid collection
- -osis condition; usually abnormal
- -plasty surgical repair
- -sclerosis hardening
- -stonosis tightening; structure
- -tomy process of cutting
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Suffix Meaning
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PREFIXES
a-, an ______________
brady- ______________
de- ______________
dys- ______________
endo- ______________
hyper- ______________
Prefix Meaning
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PREFIXES
- a-, an no; not; without
- brady- slow
- de- lack of; down; less; removal of
- dys- bad; painful; difficult; abnormal
- endo- in; within
- hyper- above; excessive
Prefix Meaning
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PREFIXES
hypo- ______________
inter- ______________
peri- ______________
tachy- ______________
tetra- ______________
tri- ______________
Prefix Meaning
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Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
PREFIXES
- hypo- deficient; below; under; less than
normal
- inter- between
- peri- surrounding
- tachy- fast
- tetra- four
- tri- three
Prefix Meaning
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CardiovascularSystemCaseStudy.docx
Cardiovascular System Case Study
Shani’s third patient is 44-year-old banker Ronaldo Luna. His chart shows recent chest pain and difficulty breathing. Today, he is scheduled for a Holter monitor that will be followed up tomorrow with a cardiac exercise stress test. His physician has also sent him to an outside laboratory for serum lipid testing. As Shani attaches the leads for the Holter monitor and explains the importance of recording his daily activities, Ronaldo mentions that CAD runs in his family and that his father died in his late 40s of a heart attack. Assignment Discussion: Cardiovascular System
1. What is chest pain called?
2. What does the abbreviation CAD stand for?
3. What is the medical term that means heart attack?
4. Measurements of cholesterol and triglyceride levels are part what test? Define and explain
5. What is a portable electrocardiographic device that is worn to provide an extended recording of the electrical activity of the heart?