The Cardiovascular System 1

Thomas Secrest











The Cardiovascular System





Last Updated On
Sunday, March 15, 2009

The Cardiovascular System 2
Thomas Secrest

Reading

The cardiovascular system consists of the heart, the arteries and veins, and the blood. Often each
element of the system is studied separately, however, we are going to combine all the elements and discuss
them together. The core of the cardiovascular system is the heart. The heart is a four chambered muscular
pump that drives the blood through the circulatory system. The heart is usually said to be about the size of a
persons clinched fist. It is located in the central part of the chest in an area between the lungs anterior to the
vertebral column and posterior to the sternum. The space, called the mediastinum, also contains the thymus
gland, the trachea, the ascending, arch and descending aorta and the superior and inferior vena cava. The
heart is often described as being two-pumps-in-one. Before we explain the two-pumps-in-one concept
we need to detour for a moment and briefly describe the circulatory system.
The circulatory system consists of arteries and veins that carry blood out to the organs, tissues and
cells of the body and then return the blood to the heart. By definition arteries carry blood away from the
heart and veins carry blood back toward the heart. While it is logical and useful to study the arterial
circulation and the venous circulation it is common to subdivide the circulatory system at least once before
starting with this approach. The initial subdivision is to divide it into the systemic (to the body) circulation
and the pulmonary (to the lungs) circulation. After this subdivision is made, it is much easier to the talk
about the various arteries and veins of the systemic or pulmonary circulations. When needed, these two main
subdivisions can be further subdivided to provide greater accuracy of description. Some examples of
additional subdivisions include the hepatic circulation, cerebral circulation and the coronary circulation.
Now we can return to the two-pumps-in-one concept; the heart can be viewed as two pumps the
right side pump drives blood through the pulmonary circulation
while the left side pump drives blood through the systemic
circulation. Each pump side consists of an atrium and ventricle.
Use the figure on the right and the below to follow blood flow
through the heart. {Blood flow from the systemic veins, through the
right atrium and right ventricle and into the pulmonary arteries is
shown in blue to indicate deoxygenated blood. Blood flow from the
pulmonary veins through the left atrium and left ventricle and into
the systemic arteries is shown in red to indicate oxygenated blood.}
Blood returns to the right atrium from the veins of the
systemic circulation
The right atrium pumps blood into the right ventricle
The right ventricle pumps blood into arteries that supply
the lungs (pulmonary circulation)
Blood passes through pulmonary capillaries and enters
pulmonary veins
Blood returns to the left atrium from the veins of the pulmonary circulation
The left atrium pumps blood into the left ventricle
The left ventricle pumps blood into the arteries of the systemic circulation
Blood passes through systemic capillaries and enters systemic veins


The Cardiovascular System 3
Thomas Secrest


The Valves

To control the flow of blood through the heart and to prevent backflow of blood and insure blood
flow in only one direction, the heart is equipped with two sets of valves. The first set is called the AV
valves or atria-ventricular valves. The valve between the right atrium and right ventricle is called the
tricuspid valve and the valve between the left atrium and left ventricle is called the bicuspid valve or mitral
valve. These vales ensure that blood does not move back into the atria during the powerful contraction of
the ventricles. The second set of valves is called the semilunar valves. The valve between the right ventricle
and the pulmonary trunk is called the pulmonary semilunar valve and the valve between the left ventricle
and the ascending aorta is called the aortic semilunar valve. These valves prevent backflow of blood into the
ventricles while the ventricles relax between heart beats.

Check Point Heart Anatomy

Match the terms with the diagram.

Aortic semilunar valve
Bicuspid valve
Left atrium
Left ventricle
Pulmonary semilunar valve
Right atrium
Right ventricle
Tricuspid valve

A. _____________________
B. _____________________
C. _____________________
D. _____________________
E. _____________________
F. _____________________
G. _____________________
H. _____________________




The Cardiovascular System 4
Thomas Secrest


Check Point Everyday Vocabulary

Instructions: Match the everyday terms in column A (seen in bold print in the above text) with their
contextual meaning in column B.

A B

A. backflow
B. beat (of the heart)
C. briefly
D. carry
E. clinched
F. core
G. detour
H. drives
I. elements
J. ensure
K. equipped
L. fist
M. flow
N. prevent
O. relax
P. sets
Q. valve
R. while

1. a part or piece of something
2. a critical or important part / a central idea
3. to push something forward / to move something along a path
4. to squeeze tightly
5. during the time that something is happening
6. to make sure something happens / to guarantee that something happens
or takes place
7. to circulate / to move in a stream
8. a device that regulates the flow of something
9. to have / to have a something included
10. the hand when all the fingers are flexed and the hand has a somewhat
spherical shape
11. to alternative path or route / a difference path than normal
12. to do something in a way that uses little time
13. to transport
14. to keep something from happening
15. a collection of objects
16. a situation in which a fluid move in the opposite of the desired or
intended direction
17. a condition in which stress, tension or muscle contraction is absent
18. a contraction of the heart muscle



The Cardiovascular System 5
Thomas Secrest


Technical Vocabulary Specialized Vocabulary
Mediastinum
Right atrium
Left atrium
Right ventricle
Left ventricle
Bicuspid valve
Tricuspid valve
Mitral valve
Pulmonary semilunar valve
Aortic semilunar valve
Artery
Vein
Capillary
Oxygenated
Deoxygenated
Thymus
Trachea
Ascending aorta
Arch of the aorta (aortic arch)
Descending aorta
Superior vena cava
Inferior vena cava
Pulmonary arteries
Pulmonary veins
Chest
Heart beat
Blood flow
Contraction
Pulmonary circulation
Systemic circulation
Coronary circulation
Hepatic circulation
Cerebral circulation


Check Point Present perfect and past simple
Present perfect is used to discuss events that started at an unspecified time in the past and are still relevant
now, even if the event has concluded. Past simple is used for events that started in the past, concluded in the
past and dont have any particular relevance to the present.

Instructions: Pick the word and tense that best completes the sentence. Add extra words as needed.

come, complete, be, report, perform, has, come, smoke, become, admit

1. The patients by-pass surgery ______ a complete success.
2. The patient ______ by-pass surgery once before.
3. Have the lab results ______ back yet?
4. I ______ this procedure a million times dont worry!
5. He ______ to the hospital 3 days ago.
6. He ______ chest pain when he was admitted.
7. She ______ since she was a teenager.
8. Coronary by-pass ______ a routine procedure.
9. The patient still ______ out of the recovery room yet, but I expect hell be out soon.
10. The patient ______ out of the recovery room two hours ago.


The Cardiovascular System 6
Thomas Secrest


Check Point -- Major Blood Vessels

Match the items with the letters on the diagram.

Arch of the aorta
Ascending aorta
Descending aorta
Inferior vena cava
Left pulmonary artery
Left pulmonary veins
Pulmonary trunk
Right pulmonary artery
Right pulmonary veins
Superior vena cava

A. _________________________
B. _________________________
C. _________________________
D. _________________________
E. _________________________
F. _________________________
G. _________________________
H. _________________________
I. _________________________
J. _________________________



Check Point Grammar

Instructions: The d or ed used to make the past tense of verbs can have the sound of id {rate
rated} or it can have the sound of a t {fix fixed} or it can have the sound of d {prepare prepared}.
Put the words in the top box into the appropriate column based on their ending sound. ** Which sound
appears to be the most common?

associated / attached / called / chambered / clinched / described / desired / detected / distended / equipped /
flexed / implanted / inflamed / intended / involved / located / occluded / narrowed / perfused / reduced /
relieved /studied / subdivided / thickened / triggered / viewed / weakened
id t d








The Cardiovascular System 7
Thomas Secrest


In Focus Controlling High Blood Pressure

One of the most frequent problems associated with the cardiovascular system is high blood pressure. There
are many different causes of high blood pressure, but essential hypertension is the most common diagnosis.
Essential hypertension is hypertension that is unrelated to another
health problem. Blood pressure (BP) is normally recorded as two
pressure measurements. A common measure of pressure is mmHg
(millimeters of Mercury) and a typical measure is 120 mmHg / 80
mmHg or (120 / 80 or 120 over 80). The top value is the systolic
pressure and the bottom value is the diastolic pressure.
In general the treatment of essential hypertension is directed
at blood volume and the degree of constriction of blood vessels in the
systemic circulation. If blood volume is above normal the heart has to
work harder (generated higher pressures)
to move the extra volume of blood
through the circulation. And if the blood
vessels are constricted the resistance to blood flow is increased and the heart has
to work harder (generated higher pressures) to overcome the increased
resistance. In either case the extra workload puts a strain on the heart, which over
time can lead to cardiac problems.
If a patient presents with high blood pressure (systolic pressure > 150
mmHg and / or diastolic pressure > 90 mmHg) some type of treatment is
initiated. Lifestyle
changes are usually
part of the treatment program, but
pharmacological agents are also usually
included. Initial therapy often consists of a
diuretic. A diuretic is a drug that decreases
blood volume by acting on the kidneys and
causing increase urine production. In many
mild hypertensive cases a diuretic is sufficient
for BP management. However if effective
management is not achieved with a diuretic
other drugs can be used as alternatives or
adjuncts. Two popular types of drugs
influence angiotensin. Angiotensin is a
naturally occurring compound in the body
which causes vasoconstriction. By blocking the effect of angiotensin blood vessel radius is increased and
resistance to blood flow is reduced, thereby reducing blood pressure. One type of drug is called an ACE
inhibitor. This drug prevents the conversion of an angiotensin precursor into angiotensin. The other type of
drug is an ARB angiotensin receptor blocker. This drug bind to the angiotensin receptors of the smooth
muscle found in blood vessels and prevents the angiotensin from binding and causing smooth muscle
contraction. The forth commonly used types of drug used in treating high blood pressure are calcium
channel blockers. These drugs also reduce contraction of smooth muscle in blood vessels and reduce
resistance to blood flow.

The Cardiovascular System 8
Thomas Secrest


Instructions: Match the terms in column A with the contextual definitions in column B.

A B
A. Angiotensin
B. Bind
C. Blocker
D. Calcium channel blocker
E. Diastole
F. Diastolic pressure
G. Diuretic
H. Essential hypertension
I. Hypertension
J. Receptor
K. Resistance
L. Systole
M. Systolic pressure
N. Vasoconstriction
1. The upper number in a blood pressure measurement
2. Contraction of the heart (ventricles)
3. Lower number in a blood pressure measurement
4. Period of cardiac relaxation
5. Naturally occurring compound that can cause a decrease in blood
vessel radius
6. Force that opposes flow
7. Another name for high blood pressure
8. A narrowing of a blood vessel
9. A chemical structure that can bind with a chemical compound
10. A chemical that can bind to a receptor but which has no
biological effect
11. To attach
12. A chemical compound which can increase urine production
13. A chemical that can influence the amount of calcium that enters a
smooth muscle cell
14. Hypertension that is not secondary to another health problem


The Cardiovascular System 9
Thomas Secrest


Clinical Corner
Aneurysm: If an area of a weakened artery
begins to enlarge, bulge or distend the
bulging or distended area is called an
aneurysm. If a medium sized artery aneurysm
ruptures the patient will usually bleed to
death before surgical intervention is possible.
Aneurysms are often detected when they
produced secondary symptoms caused by
pressure they put on nearby structures.

Angina pectoris: An ischemic condition of
the heart which can produce chest pain on
exertion.

Arteriosclerosis: This condition develops
when arterial walls become thickened and
less elastic. The loss of elasticity can often be
seen in the pulse pressure. {Pulse pressure =
systolic pressure diastolic pressure} (arterio
= artery, sclero = hard)

Atherosclerosis: A type of arteriosclerosis
in which there are degenerative changes in
the lining of the blood vessel. The changes
often take the form of plaques. These
elevated plagues present a danger because
that can trigger thrombus formation.
Thrombus formation on a plague in a
coronary artery can lead to a myocardial
infarction. In coronary arteries, reperfusion
can sometimes be achieved through
angioplasty and the insertion of a stint.
(athero = soft, thick, sticky substance)

Bradycardia: An abnormally slow resting
heart rate (less than 60 beats per minute). The
prefix brady means SLOW.

Cardiac pace maker (SA node):
Specialized tissue, located in the posterior
wall of the right atrium, that set the overall
heart beat rate for the heart. If this tissue
fails, patients can have artificial pacemakers
implanted to takeover the function of the
failed pacemaker.

Cardiomyopathies: Any of a number of
diseases that involve progressive
degeneration of the myocardium. The prefix
cardio means HEART, myo means
MUSCLE and pathy means DISEASE.

Coronary artery by-pass surgery: A
procedure in which coronary vessels that
have become dangerously occluded through
deposition of fatty cholesterol deposits are
by-passed with blood vessels grafts taken
from other areas of the body. Two common
graft choices are the internal mamillary
artery in the chest and the saphenous vein
from the leg. The by-pass provides an
alternative pathway for blood to perfuse the
cardiac muscle tissue that is distal to the
narrowed section of the original coronary
artery.

Coronary artery disease (CAD): A
condition in which the coronary arteries are
compromised, weakened or reduced in
diameter.

ECK (EKG): A recording of the electrical
activity of the heart.

Embolus: A blood clot(s) that has broken
free of a vessel wall and is circulating with
the blood. These clots often form in the deep
veins of the legs where blood flow is slow
(sluggish). When they break free and enter
the circulation they can pass through the right
atrium, the right ventricle and enter the
arterial side of the pulmonary circulation.
However, they are too large to pass through
the smallest arteries and capillaries and
become lodged in these vessels causing
pulmonary embolisms.

Endocarditis: Recall that the suffix itis
means inflammation of so endocarditis
means inflammation of the lining or inner
most layer of the heart wall. The
endocardium is an endothelial membrane that
lines the chambers of the heart and is
continuous with the endolethilum of the
blood vessels that enter and exit the heart.
Rheumatic fever is a common cause of
endocarditis. The prefix endo means
INTERNAL.

Heart murmur: A murmur is an abnormal
heart sound, associated with the movement of
blood through the valves of the heart.
Murmurs are usually heard with the use of a
stethoscope. Most murmurs are associated
with some type of cardiac disease. Murmurs
can be caused my stenotic valves (valves
with narrowed passageways) or insufficient
valves (valve that dont close tightly or
properly). Additionally murmurs can be
diastolic murmurs or systolic murmurs. The
type and timing of the murmur is often
diagnostic of the problem and the valve
involved. Generally, a whistling murmur is
caused by a stenotic valve, while a swishing
murmur is caused by an insufficient valve.

Mitral valve prolapse: A condition in
which the mitral valve fails to close properly.

Myocardial infarction (heart attack): A
condition in which a coronary artery become
occluded. The occlusion causes the tissue
distal to the occlusion to become ischemic
and, if the occlusion is not relieved, the tissue
becomes necrotic. The death of myocardial
tissue weakens the heart and limits its
pumping effectiveness. Additionally the dead
tissue can cause impulse conduction
abnormalities that can lead to fibrillation and
ultimately death.

Myocarditis: Inflammation of the
myocardium or cardiac muscle tissue of the
heart.

Myocardium: Another name for the cardiac
muscle that makes up the wall of the heart.

Necrosis: Tissue death as a secondary cause
of another problem.

Pericarditis: The heart rest in a fluid filled
sac within the mediastinum. The sac is called
the pericardium (peri = around). When the
sac and its fluid contents become inflamed
the condition is called pericarditis.

Perfusion: Describes the blood flow to a
tissue or organ.

Stethoscope: Device used to listen to the
chest or to hear arterial sounds while taking a
blood pressure. (stetho = chest, scope = to
examine)

Tachycardia: An abnormally fast resting
heart rate (greater than 100 beats per minute).
The prefix tachy means FAST.

Thrombus: A blood clot within a blood
vessel that is attached to the vessel wall and
as a result is stationary and not circulating
with the blood.

Valvular stenosis: Narrowing of a heart
valve. Stenosis often leads to a high pitched,
whistling type murmur.


The Cardiovascular System 10
Thomas Secrest


Cross Word Puzzle




Across Down
2. inner lining of the chambers of the heart
3. the space in the center of the chest that contains the heart
5. device used to listen to the heart
8. another term for high blood pressure
10. common abbreviation for a heart attack
11. a heart condition that produces severe pain on exertion
12. common name for the SA node
15. a stationary blood clot

1. resting heart rate of less than 60 beats per minute
4. naturally occurring substance that can cause vasoconstriction
6. reduces blood flow to a tissue
7. the valve between the left atrium and the left ventricle
9. a drug that can increase urine production
11. an abnormal bulge in a blood vessel
13. a blood clot that is free in the circulation
14. abnormal heart sound



The Cardiovascular System 11
Thomas Secrest

Check Point Sentence construction

Instructions: Make meaningful sentences by combining the first part of the sentence in column A with the
second part in column B.

A B

1. Blood flow in the deep veins
2. If a coronary artery is completely
3. Low doses of aspirin are often prescribed
4. Patients with a prior history of endocarditis
often
5. Patients with angina pectoris report
6. Plagues in coronary arteries can
7. Pulmonary embolism can result when clots
that were
8. The atherosclerotic plaque had
9. The bulging artery was
10. The distended vessel was
11. The old mans arteries had become thickened
12. the pain was caused by an
13. The patient had a pacemaker
14. The patients ECK showed
15. The patients tachycardia was linked
16. The thrombus had blocked to the blood flow
in a
17. The treatment
18. The whistling sound occurring during
ventricular diastole was determined
19. Well conditioned athletes often
20. When a blood vessel is narrowed the

A. putting pressure on the optic nerve.
B. intervention was successful.
C. detected with a cat scan.
D. partially occlude the vessel.
E. and inelastic with age.
F. area of ischemic heart tissue in the left
ventricle.
G. lead to thrombus formation and cause an mi.
H. to reduce the likelihood of thrombus
formation.
I. have very slow resting heart rates.
J. implanted to takeover the work load of their
own damaged SA node.
K. occluded it is necessary to either by-pass the
artery or perform angioplasty followed by the
insertion of a stint.
L. blood flow through the vessel is reduced,
unless the pressure is increase.
M. an abnormality in the QRS complex.
N. of the legs is often very sluggish, especially if
a person sits most of the day at a desk.
O. to be caused by a stenotic mitral valve.
P. to chronic use of METH.
Q. major vessel and a large part of the right
ventricle had become necrotic.
R. receive prophylactic antibiotics before
invasive dental procedures.
S. formed during deep vein thrombosis break
free from the vessel wall and enter the
circulation.
T. severe chest pain if they over exert
themselves.



The Cardiovascular System 12
Thomas Secrest

Check Point Vocabulary
Instructions: Match the words in column A with their contextual meanings in column B. The words are
taken from the Clinical Corner.

A B
A. associated
B. attached
C. bulge
D. detected
E. distended
F. elastic
G. high pitched
H. implanted
I. inflamed
J. insufficient
K. intervention
L. involved
M. ischemic
N. located
O. narrowed
P. necrotic
Q. occluded
R. plaques
S. reduced
T. relieved
U. sluggish
V. stenotic
W. thickened
X. tightly
Y. trigger
Z. whistling
1. An abnormally enlarge region or area / to bend outward / to push outward
2. stretched / to have an increase volume
3. to find / to discover something / to become aware of something
4. to become thicker / to become more dense
5. to initiate something / to start something
6. where something can be found
7. to put something into something else
8. to be blocked / to prevent flow of something through a tube or passageway
9. to reduce a diameter / to reduce an opening / to reduce a passageway
10. to make smaller
11. to be link with something / to have some type of relationship with something
12. to be a part of something / something that is troublesome
13. to reduce a symptom / to solve a problem
14. a cellular response to an injury / to experience inflammation
15. to adhere to something / to be stuck to something / to be fixed to something
16. a treatment or procedure intended to solve a problem
17. something that is receiving reduced blood flow
18. the ability of something to stretch and return to its original shape
19. a raised area of tissue on the skin or on inner arterial walls
20. to move slowly / to move without enthusiasm / to be without energy
21. a sound associated with high fluid velocity through a constricted opening
22. an opening with a reduced diameter / a passageway that is reduced in size
23. lacking a necessary quality or characteristic
24. dead tissue / tissue death not related to apoptosis
25. a sound with a high frequency
26. to close securely / for things to fit together properly / to fit firmly together

Check Point Grammar
Instructions: Complete the blanks with the best choice. Use the correct form.

cant / dont have to or dont need to / should / shouldnt / need to
1. You _______ smoke anymore and you are going to need to reduce the cholesterol in your diet.
2. You _______ take the entire prescription; once the pain is gone you can stop taking the medication.
3. You _______ start a regular exercise routine. It will help your blood pressure and your cholesterol.
4. You _______ take this medicine whenever you feel any chest pain.
5. If your shoulder hurts, you _______ try putting some ice on it for 15-20 minutes, 3 times a day.
6. You _______ use this medication if you intend to drive and never take it with alcohol.
7. You _______ take the elevator; it will be okay if you climb the stairs, just take it slowly.
8. You _______ take more than 3 per day. However, if the pain is severe you can take up to 5.
9. Until we get his blood pressure stabilized he ________ do any heavy lifting of any kind.
10. Any walking will be good for you; it ________ be fast walking. If you walk slowly, just walk a little
longer.

The Cardiovascular System 13
Thomas Secrest

Talking with the Patient

Instructions: work with a partner. One person can read the part of the doctor and the other person can read
the part of the patient.

1. D: Good afternoon Mr. Hudson how have
you been?
2. P: Quite well doctor and yourself?
3. D: Quite well also thanks.
4. D: I see youre here for a check of your blood
pressure.
5. P: Thats right.
6. D: Well -- please have a seat on the
examination table and take your shirt off.
7. P: Okay.
8. D: Have you had any health problems since I
saw you last?
9. P: Ive had some hay fever problems for
about a month.
10. D: Anything else?
11. P: No, except for that, Ive been feeling
pretty good.
12. D: Are you taking anything for the hay fever?
13. P: I take some over the counter stuff.
14. D: Okay I dont suppose you remember the
name of that stuff do you?
15. P: Its called Contact Cold and Allergy
medicine.
16. D: Thanks and when did you take it last?
17. P: Maybe 2-3 days ago.
18. D: Okay.
19. D: Have you had any headaches, shortness of
breath on exertion, lightheadedness when
you stand up, cough anything like that?
20. P: No, uh well, I have had a slight dry
cough, but I think it is the hay fever.
21. D: Any problems urinating or any problems
with bowl movements?
22. P: No, that all seems fine.
23. D: No skin problems, no muscle aches or
pains, no joint pains?
24. P: No.
25. D: And youre sleeping okay?
26. P: Yes.
27. D: Great well before I take your blood
pressure I want to listen to your chest.
28. P: Okay.
29. D: Well everything sounds fine, so lets take
your blood pressure.
30. D: Let me get this wrap around your arm
there.
31. P: Well how was it?
32. D: Its still a little high. Its 146/94. While
thats a marked improvement from the
first time I saw you 6 months ago, its
still not were we want it to be.
33. P: I was hoping that it would be normal by
now.
34. D: Me too. How is your diet coming along?
It looks like youre still carrying quite a
bit of fat around your abdomen and in
the area around your shoulder blades.
35. P: I think Im making some progress with
my weight.
36. D: Hop down off the table and lets check
your weight.
37. P: Okay if you must.
38. D: We must. Just stand up here on the
scale.
39. D: Lets see you weigh 125 kg.
40. P: Ouch! I was hoping to have lost more.
41. D: Ouch is right. Thats only 3 kg less than
when I first saw you and we talked about
your diet.
42. P: I feel like Im eating a lot less and I get
some amount of exercise almost every
day.
43. D: You may be eating less, but you may
have substituted foods that have a higher
calorie density.
44. P: What can I do?
45. D: Well Im going to send you to a
nutritionist. They will work with you to
help you put together a diet that is
calorie restrictive. They will also give
you some ideas on how to avoid feeling
hungry and also make sure that your
restrictive diet still supplies the proper
nutrition.
46. P: That sound like a great idea.
47. D: While youre here I want to do a finger
stick test to check your blood glucose
and your cholesterol.
48. P: I hate finger sticks cant you take it
from my arm?
49. D: Im going to do that to but I want to
know your cholesterol and glucose now

The Cardiovascular System 14
Thomas Secrest

and the blood work from your arm will
take a couple of days.
50. P: Okay.
51. D: Well that wasnt so bad was it?
52. P: Ill never play the piano again.
53. D: Okay well it looks like your blood sugar
is fine, but your cholesterol is 6.2 mmol / l.
54. P: Ive forgotten is that bad or good?
55. D: It means we can use your blood to fry
potatoes.
56. P: I guess thats bad.
57. D: I think I need to adjust your medications
as you loose weight we may have to
readjust them, but for now I think we need
to get your blood pressure and cholesterol
under control.
58. P: Okay.
59. D: Im going to add a second drug to try to
bring your BP down. Microzide, the
diuretic youre taking now is working, but
it needs some help. This drug is called an
ACE inhibitor. It has long and successful
track record and I think that in conjunction
with the diuretic youre currently taking
that your BP will drop to within normal
levels.
60. P: Okay.
61. D: You understand that I want you to
continue with 50 mg / day of the diuretic
right?
62. P: Yes I understand.
63. D: At higher doses ACE inhibitors can
sometimes cause a dry, hacking cough
but at the dose Im going to start you on, I
dont think that will be a problem.
However, should such a cough develop I
want you to let me know okay?
64. P: Okay.
65. D: As for your high cholesterol Im going to
double the amount of Lipitor you are
taking from 10 mg to 20 mg per day.
You can finish the prescription you have,
just take two tablets each evening, but
the new prescription will be for 20 mg so
you will only need 1 tablet each evening.
66. P: Okay.
67. D: Lastly I want you to stop taking the over
the counter allergy medication. These
medicines can increase your blood
pressure. Instead Im going to give you a
prescription for Claritin, 10 mg, and
Nasonex for your nasal congestion. The
Claritin should be taken once a day until
we get through the allergy season. The
nasal spray should be used to provide
symptomatic relief of congestion.
Neither medicine will affect your blood
pressure.
68. P: Sounds great.
69. D: And of course I want you to see a
nutritionist. Im going to recommend Dr.
Bones please dont let the name put
you off hes excellent and a very
pleasant fellow. Here is his business card
you should call him ASAP to make an
appointment.
70. P: Okay Ill call his office later today.
71. D: Your blood work will be back in a
couple of days -- I will call you if I see
any problems. Ill also fax a copy over to
Dr. Bones hell want to have a look at
it before he talks to you.
72. P: Okay.
73. D: Well, I guess that about does it for this
visit. I want to see you again in 3 months
so we can see how things are going.
74. P: Okay Ill make my next appointment
as I leave.
75. D: Great please call the office if you have
any problems otherwise Ill see you in
3 months.
76. P: Okay see you then. Bye.
77. D: Bye.




The Cardiovascular System 15
Thomas Secrest

Talking with the Patient

Instructions: working with a partner, try to recreate the interview. Dont just reread it try to do the
interview using your own question and answer variations while using the same basic case profile.


Instructions: Review the interview and find line numbers that correspond to the interview elements listed
below. In some cases different aspects of the same interview element may be addressed in different parts of
the interview one such case has been done as an example. The questions in the table below are not in the
sequence of the interview.


Interview element Line numbers
Patient greeting.

Summary of visit objective

Request for information on patients current and recent health

Quick health review with prompts to help patient remember any problems

Request for information about medications being taken by patient

Instructions to patient to do something

Informing the patient about a procedure

Giving information to the patient regarding a test or measurement

Explanation to patient regarding a process

Referral to see another doctor
45 & 69
Explanation for a change in medication

Request for discontinuation of a medication.

Explanation for the addition of new medications

Explanation of how lab results will be handled

Conclusion of patient visit.



Check Point Comprehension

1. What recent health problems does the patient report?
2. What is the purpose of the patients visit to the doctor?
3. How long has the patient been seeing this doctor for his chronic health problem?
4. What chronic health problems does the patient have?
5. Excluding the allergy medication, what medications was the patient taking prior to the visit?
6. What doses of the medications was the patient taking?
7. What are the new doses of medications the patient will be taking?


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Thomas Secrest


Check Point -- Practice Dialog

Instructions: Work with a partner and practice asking and answering the questions regarding the patient
profiled below. As you do your practice interviews, the patient can make up any information that is needed
but not provided in the patient profile. When you make up information, try to be realistic so that it fits with
the patient profile.


Part 1

Formulate questions to get the following information. Practice note taking in English by writing your
partners responses in the space provide.

Question Response

1. Patients name
2. Patients occupation
3. Length of employment
4. Age
5. Height
6. Weight
7. Marital status
8. Children (number of)
9. Chief complaint



Part 2 reverse roles

Question Response

10. Duration of chief complaint
11. Onset of chief complaint
12. Other medical problems
13. Duration of problems
14. Smoker (amount), (duration)
15. Drinker (amount), (duration)
16. Current medications


Patient Profile:
Male, 59 yo, taxi driver (20 years), complains of shortness of breath on exertion (10 days), history of
angina (2 years), smoker -- 40 cigarettes per day (40 years), drinker 4 to 5 beers per day (40 years),
medications: Lipitor, Claritin, Altase, medical problems; hypertension (20 years), hyperlipidemia (20
years), obesity (20 years), seasonal allergies (40 years).

The Cardiovascular System 17
Thomas Secrest

Check Point Vocabulary

Instructions: Use the words or phrases in the box to complete the sentences.

A. allergy medication
B. ASAP
C. bowl movements
D. coming along
E. cursed
F. dry cough
G. finger stick
H. hay fever
I. lightheaded
J. nasal congestion
K. over the counter
L. short of breath
M. successful track record
N. under control
O. within normal levels

1. Not only did the angina cause Mr. Peters pain on exertion, it also left him feeling very ___.
2. The new blood pressure medication was too strong and made the patient feel ___ when he stood up
to quickly.
3. Every autumn Im ___with these awful ___ symptoms.
4. The high doses of medicine needed to control his blood pressure causes a persistent ___ as a side
effect.
5. New generation ___ usually do not adversely affect blood pressure, so they can be safely used by
hypertensive patients.
6. The high protein, low carbohydrate diet was causing the patient to have difficult and painful ___.
7. Lots of walking and reduced fat in the diet had the patients weight loss program ___ nicely.
8. A drop of blood from a ____ can be used to quickly test for several different blood values.
9. With exercise and medication, the patients cholesterol was finally brought ____.
10. This diet plan has a ____ of helping patients lose weight and keep it off.
11. After losing 40 kg, the patients BP was ___ without the use of any medications.
12. You should always report any ___ you are taking to your physician.
13. Sometimes drugs can have serious side effects these should be reported ___.
14. Whenever possible, ___ should be treated with topical medications instead of oral medications.

The Cardiovascular System 18
Thomas Secrest

Check Point Descriptions
Instructions: Work with a partner and take turns describing the movement of blood through the heart. Use
the diagram as a guide and the phrases in the box to help you describe the flow of blood. Start your
description with the blood entering the right atrium. The first two sentences have been done as examples.
Depending on the detail you provide, you may not need all 17 lines.
blood flows from,
blood flows through,
blood enters,
blood leaves,
blood flows into,
blood out of
blood then flows
blood is (then) pumped into
blood is (then) pumped through
from / to / goes / into/ out of

1. Blood enters the right atrium from the superior and inferior
vena cava.
2. Blood is then pumped through the tricuspid valve into the
right ventricle.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.



The Cardiovascular System 19
Thomas Secrest

Talking with the Patient

Instructions: Work with a partner. One person should play the role of the doctor while the other plays the
role of the patient. The doctor should practice asking clear, concise questions to get information about the
outlined items. Once finished, switch roles and repeat. The patient needs to provide realistic information
the patient can pretend to have one of the following: (1) congestive heart failure or (2) angina pectoris.


1) Introductions
a) Give your name and get the patients name, address, age, etc.
b) Ask an open-ended question about the patients CC.
i) What problem brought you in today?
ii) How can I help you today?
2) History of CC.
a) Chest pain
i) Location of chest pain
ii) Character of chest pain
(1) Crushing
(2) Burning
(3) Pressure
(4) Stabbing
(5) Sharp
(6) Dull
iii) Severity of pain
iv) Frequency of pain
v) Radiation of pain
vi) Relieving / Aggravating factors
vii) Related symptoms
(1) Sweating
(2) Nausea
(3) Fatigue
(4) Palpitations
b) Dyspnea
i) On exertion or at rest
ii) Ability to perform daily activities
c) Orthopnea
i) How many pillows are needed to sleep comfortably
d) Nocturnal dyspnea

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Thomas Secrest

e) Ankle edema
f) Palpitations
i) Nature
(1) Fast
(2) Hard
(3) Regular / Irregular
ii) Duration
iii) Related symptoms
(1) Dyspnea
(2) Sweating
(3) Nausea
g) Syncope
i) When
ii) What were the conditions preceding the event
iii) What did the patient feel before it happened
iv) Recovery
h) Claudication
3) Past medical history
a) Asthma
b) Diabetes
c) High blood pressure
d) Angina
e) Stroke
f) Heart attack
g) Surgical procedures associated with the cardiovascular system
4) Drug history (drug and dosage)
a) OTC drugs
b) Prescription drugs
c) Drug allergies
5) Family history
a) Heart attack
b) Stroke
c) High blood pressure
d) Diabetes
e) Hyperlipidemia
6) Lifestyle history

The Cardiovascular System 21
Thomas Secrest

a) Smoking
i) Quantify
b) Drinking
i) Quantify
c) Diet
i) Specify
d) Occupation
i) Stress
7) Any connection to CC

The Cardiovascular System 22
Thomas Secrest

Instructions: Take the self-test to see how well you remember the information presented in this unit.

1. The heart _______ / ________ chambers.
a. Comprised of / 4
b. Consists of / 4
c. Composed of / 4
d. Contains / 4
2. The heart is located inside a protective sac called
the _______.
a. Epicardium
b. Myocardium
c. Mediastinum
d. Pericardium
3. A diuretic is used to lower blood cholesterol.
a. True
b. False
4. A swishing sound is often associated with a
_____ murmur.
a. Stenotic
b. Insufficient
5. Claritin is used to treat ________.
a. Hypertension
b. Hyperlipidemia
c. Allergies
d. Headaches
6. A blood clot that is moving in the circulation is
called a(n) ____________.
a. Embolus
b. Thrombus
c. Platelet
d. Stroke
7. Blood is pumped from the right ventricle into the
________.
a. Systemic circulation
b. Coronary circulation
c. Pulmonary circulation
d. Cerebral circulation
8. The mitral vale is located between the __________
and the __________.
a. Right atrium / left atrium
b. Right ventricle / left ventricle
c. Left atrium / left ventricle
d. Left atrium / right ventricle
9. The other name for the mitral valve is the
___________ valve.
a. Tricuspid
b. Bicuspid
c. Quadracuspid
d. Semilunar
10. A hear rate over 100 beat per minute is termed
__________.
a. Tachycardia
b. Bardycardia
c. Fibrillation
11. The term Myocarditis means _________.
a. Disease of the heart
b. Slow heart rate
c. Inflammation of the muscular layer of the heart
d. Inflammation of the endocardium
12. The prefix brady means ______.
a. Fast
b. Slow
c. Muscle
d. Internal
13. If a blood pressure is 120 mmHg / 80 mmHg, what
does Hg stand for?
a. Hemoglobin
b. Mercury
c. Atmospheric pressure
14. The valve between the right ventricle and the
pulmonary trunk.
a. Bicuspid
b. Ventricular semilunar
c. Pulmonary semilunar
d. Aortic semilunar
15. When a blood clot blocks the flow of blood in a
coronary blood vessel it is called a:
a. MI
b. Stroke
c. Heart attack
d. A or C
16. Blood in the pulmonary arteries is:
a. Rich in oxygen
b. Poor in oxygen
c. On its way to the heart
d. On it way to the body.
17. Arteries always carry blood that is rich in oxygen.
a. True
b. False
18. Veins always carry blood toward the heart.
a. True
b. False
19. The aorta is the initial artery of the systemic
circulation.
a. True
b. False
20. The prefix athero means.
a. Liquid
b. Hard
c. Gooey
d. Gaseous

The Cardiovascular System 23
Thomas Secrest

Suggested Mini-Lectures

The mini-lectures listed below can be used as topics for instructors to add additional information to this unit
or the topics can be assigned to students for classroom presentations.

Further discussion of blood flow through the heart
o Function of valves
Further discussion of heart anatomy
Assign some of the terms from the Clinical Corner section for 2-3 minute long individual class
presentations.
Basic cell structure of cardiac muscle cells
o Sarcolemma
o Sarcoplasmic reticulum
o T-tubules
o Myofibrils
Actin
Troponin
Tropomyosin
Mysosin
Basics of impulse conduction through the heart
o SA node
o AV node
o Bundle branches
o Purkinje fibers
Control of heart rate by the SNS and PNS.
Discussion of blood pressure
o Systolic pressure
o Diastolic pressure
o Pressures within the left ventricle
o Pressures within the right ventricle
o Pressures across the systemic circulation
o Pressures across the pulmonary circulation
Blood makers for a hard attack
o CK-MB
o cTnT
o cTnI
Mechanism of action for:
o ACE inhibitors
o ARB drugs
o Ca Channel blockers