10

CHAPTER
Cardiovascular and
Lymphatic Systems

Pretest
Multiple Choice. Select the best answer, and write the letter
of your choice to the left of each number. To check your
answers go to Appendix 11.

1. The cardiovascular system includes the heart and

a. lungs
b. digestive organs
c. blood vessels
d. endocrine system
2. The thick, muscular layer of the heart wall is the
a. endocardium
b. valve
c. myocardium
d. apex
3. An upper chamber of the heart is a(n)
a. ventricle
b. atrium
c. base
d. systole
4. A vessel that carries blood away from the heart is a(n)
a. vein
b. chamber
c. lymph node
d. artery
5. The tonsils, spleen, and thymus are part of the
a. digestive system
b. endocrine system
c. epicardium
d. lymphatic system
6. The medical term for a “heart attack” is
a. cerebrovascular accident
b. myocardial infarction
c. aneurysm
d. pneumonia
7. The accumulation of fatty deposits in the lining of a
vessel is called
a. obesity
b. stent
c. atherosclerosis
d. angiogenesis
8. Phlebitis is inflammation of a
a. vein
b. heart
c. blood cell
d. nerve

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 Learning Objectives
After careful study of this chapter, you should be able to:

1 Describe the structure of the heart. P317 8 Describe the main disorders that affect the cardiovascular
and lymphatic systems. PP328, 341
2 Trace the path of blood flow through the heart. P317
9 Define medical terms pertaining to the cardiovascular and
3 Trace the path of electrical conduction through the
lymphatic systems. PP334, 342
heart. P319
10 List the functions and components of the lymphatic
4 Identify the components of an electrocardiogram. P319
system. P337
5 Differentiate among arteries, arterioles, capillaries,
11 Interpret medical abbreviations referring to
venules, and veins. P321
circulation. P346
6 Explain blood pressure and describe how blood pressure is
12 Analyze medical terms in case studies involving
measured. P321
circulation. PP315, 354
7 Identify and use the roots pertaining to the cardiovascular
and lymphatic systems. PP326, 340

Case Study: Carlos’s Arrhythmia During Army Boot Camp

Chief Complaint heart’s electrical activity. Electrodes (small, plastic patches
Carlos, a 19 y/o man recently enlisted that stick to the skin) were placed at certain locations on Car-
into the army, successfully passed los’s chest and abdomen. The electrodes were attached to
the army physicals and reported to the small ECG box by wires. The physician further explained
Fort Knox for basic training. The first to Carlos and his family that he suspected an abnormal
2 weeks were uneventful as Carlos heartbeat had caused the fainting spells. The monitor would
became acclimated to the vigorous daily schedules of record any arrhythmias or other abnormalities that might
army life. As the physical training progressed, the pla- occur during the next 48 hours. He told Carlos to keep a
toon would go on long runs in full gear. Carlos passed diary of his activities and symptoms during the test.
out during two of these runs. The first time he was taken
to the infirmary, where he was examined, cleared, and Clinical Course
returned to duty. With the second incident, he was put on At the conclusion of the 48-hour test, Carlos saw the cardi-
a sick leave and sent home for additional follow-up. ologist again. The results of the Holter monitor indicated
that he had an abnormal heart rhythm known as atrial
Examination fibrillation. The physician explained the two methods of
When Carlos came home, his family took him to see his treatment for the condition: a medical approach using
primary care physician, who referred him to a cardiologist. anticoagulants to prevent blood clots and medication to
Carlos explained to the physician that on some of the slow the heart rate, and a surgical procedure called an
long, rigorous runs with full gear he would become short ablation. It was decided after reviewing the test results
of breath and feel his heart start to race. He would then and discussion with family on the pros and cons of the
become dizzy and pass out. When he woke up, he would be various treatment options that a pulmonary vein catheter
lying on the ground with his sergeant standing over him. ablation was the treatment of choice for Carlos.
The physician ordered some laboratory tests and also a
Holter monitor that Carlos was to wear for the next 48 hours. Case Study Revisited: Once you complete this
The physician explained that the Holter monitor is a porta- chapter, please review the case follow-up on p. 347.
ble electrocardiogram (ECG) that continuously records the
Chapter 10 ■ Cardiovascular and Lymphatic Systems 315

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 316 Part II ■ Body Systems

Ancillaries At-A-Glance
Visit the web resource to access the following resources.

Learning Resources
■ eBook ■ TestPrep
■ A&P Module with Heart & Lung Sounds ■ Animations
■ Image Bank ■ Audio Pronunciation Glossary

circulation. Its vessels drain fluid and proteins left in the

Introduction tissues and return them to the bloodstream. The lymphatic
Blood circulates throughout the body in the cardiovascu­ system plays a part in immunity and in the digestive process
lar system, which consists of the heart and the blood ves­ as well, as explained in Chapters 11 and 13. This chapter
sels (FIG. 10-1). This system forms a continuous circuit that discusses the circulatory system in detail, in both its normal
delivers oxygen and nutrients to all cells and carries away and clinical aspects, and then proceeds to study the lym­
waste products. The lymphatic system also functions in phatic system.

Head and arms

Superior Left
vena cava pulmonary
artery
Aorta

Right Left Pulmonary

lung lung circuit

Right
atrium
Left
atrium

Left
Right Left pulmonary
ventricle ventricle vein
Inferior
vena cava Internal organs

Legs

Blood high in oxygen

Blood low in oxygen
Systemic circuit
FIGURE 10-1 The cardiovascular system. The pulmonary circuit carries blood to and from the
lungs; the systemic circuit carries blood to and from all other parts of the body.

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 317

Aortic arch To systemic capillaries

Pulmonary trunk

Right pulmonary
Left pulmonary artery
artery
Pulmonary valve
Ascending aorta

Left pulmonary
Superior veins
vena cava
Left atrium
Right atrium
Aortic valve
Left atrioventricular
(mitral) valve
10
Inferior vena cava

Left ventricle

Right atrioventricular Interventricular septum

(tricuspid) valve
Apex
Right ventricle
Oxygen-rich blood
Endocardium Oxygen-poor blood
Myocardium
Epicardium
FIGURE 10-2 The heart and great vessels. The arrows show the direction of blood flow through the heart. The right
heart has blood low in oxygen; the left heart has blood high in oxygen.

The Heart is also a septum between the atrium and ventricle on each
side.
The heart is located between the lungs, with its point, or The heart pumps blood through two circuits. The right
apex, directed toward the inferior and left (FIG. 10-2). The side pumps blood to the lungs to be oxygenated through the
wall of the heart consists of three layers, all named with the pulmonary circuit. The left side pumps to the remainder of
root cardi, meaning “heart.” Moving from the innermost to the body through the systemic circuit (see FIG. 10-1).
the outermost layer, these are the:

1. Endocardium—a thin membrane that lines the chambers BLOOD FLOW THROUGH THE HEART
and valves (the prefix endo- means “within”). The pathway of blood through the heart is shown by the
arrows in FIGURE 10-2. The sequence is as follows.
2. Myocardium—a thick muscle layer that makes up most
of the heart wall (the root my/o means “muscle”). 1. The right atrium receives blood low in oxygen from all
3. Epicardium—a thin membrane that covers the heart (the body tissues through the superior vena cava and the infe­
prefix epi- means “on”). rior vena cava.
2. The blood then enters the right ventricle and is pumped
A fibrous sac, the pericardium, contains the heart
to the lungs through the pulmonary artery.
and anchors it to surrounding structures, such as the ster­
num (breastbone) and diaphragm (the prefix peri- means 3. Blood returns from the lungs high in oxygen and enters
“around”). the left atrium through the pulmonary veins.
Each of the heart’s upper receiving chambers is an 4. Blood enters the left ventricle and is forcefully pumped
atrium (plural: atria). Each of the lower pumping cham­ into the aorta to be distributed to all tissues.
bers is a ventricle (plural: ventricles). The chambers of the
heart are divided by walls, each of which is called a sep­ One-way valves in the heart keep blood moving in a for­
tum. The interventricular septum separates the two ven­ ward direction. The valves between the atrium and ventricle
tricles; the interatrial septum divides the two atria. There on each side are the atrioventricular (AV) valves (see FIG. 10-2).

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 318 Part II ■ Body Systems

The valve between the right atrium and ventricle is the right oxygen and nourishment and to remove waste products.
AV valve, also known as the tricuspid valve because it has Together, these blood vessels form the coronary circu­
three cusps (flaps). The valve between the left atrium and lation. The main arteries that supply blood to the heart
ventricle is the left AV valve, which is a bicuspid valve with muscle are the right and left coronary arteries (FIG. 10-3),
two cusps; it is often called the mitral valve (named for a named because they encircle the heart like a crown. These
miter, the pointed, two-sided hat worn by bishops). arteries, which are the first to branch off the aorta, arise
The valves leading into the pulmonary artery and the just above the cusps of the aortic valve and branch to
aorta have three cusps. Each cusp is shaped like a half- all regions of the heart muscle. They receive blood only
moon, so these valves are described as semilunar valves when the ventricles relax because the aortic valve must
(lunar refers to the moon). The valve at the entrance to the be closed to expose the entrance to these vessels. The left
pulmonary artery is specifically named the pulmonary valve; coronary artery (LCA) branches into the circumflex artery
the valve at the entrance to the aorta is the aortic valve. and the left anterior descending (LAD) artery (also known
Heart sounds are produced as the heart functions. The as the anterior interventricular branch of the LCA). The
loudest of these, the familiar “lub” and “dup” that can be right coronary artery (RCA) snakes around the heart just
heard through the chest wall, are produced by alternate inferior to the right atrium, giving off a major branch
closings of the valves. The first heart sound (S1) is heard called the posterior descending artery (also known as the
when the valves between the chambers close. The second posterior interventricular artery). After passing through
heart sound (S2) is produced when the valves leading into the capillaries in the myocardium, blood drains into a sys­
the aorta and pulmonary artery close. Any sound made as tem of cardiac veins that brings blood back toward the
the heart functions normally is termed a functional mur­ right atrium. Blood finally collects in the coronary sinus,
mur. (The word murmur used alone with regard to the heart a dilated vein that opens into the right atrium near the
describes an abnormal sound.) inferior vena cava.

BLOOD SUPPLY TO THE MYOCARDIUM THE HEARTBEAT

Only the endocardium comes into contact with the blood Each contraction of the heart, termed systole (SIS-to-le),
that flows through the heart chambers. Therefore, the is followed by a relaxation phase, diastole (di-AS-to-le),
myocardium must have its own blood vessels to provide during which the chambers fill. Each time the heart beats,

Aorta
Left coronary
artery (LCA)
Coronary
Left
atrium sinus (in
Left
atrium Right coronary
Circumflex atrium sulcus)
Right artery
atrium

Left anterior
Right Right coronary
descending
coronary Right Left artery (RCA)
artery (LAD)
artery ventricle ventricle Right
Left ventricle
(RCA: in ventricle Posterior
coronary descending
sulcus) artery

A Anterior view B Posterior view

FIGURE 10-3 Blood vessels that supply the myocardium. Coronary arteries and cardiac veins constitute the heart’s circulatory
pathways. A. Anterior view. B. Posterior view.

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 319

Sinoatrial
node

Internodal
pathways Left atrium

Right
atrium Left ventricle

Atrioventricular 10
node
Atrioventricular
bundle (bundle
of His)

Right and left

bundle branches
Right ventricle Purkinje fibers
FIGURE 10-4 The heart’s electrical conduction system. Impulses travel from the
sinoatrial (SA) node to the atrioventricular (AV) node, then to the atrioventricular bundle,
bundle branches, and Purkinje fibers. Internodal pathways carry impulses throughout the
atria.

both atria contract, and immediately thereafter both ventri­ Although the heart itself generates the heartbeat, fac­
cles contract. The number of times the heart contracts per tors such as nervous system stimulation, hormones, and
minute is the heart rate. The wave of increased pressure pro­ drugs can influence the rate and the force of contractions.
duced in the vessels each time the ventricles contract is the
pulse. Pulse rate is usually counted by palpating a peripheral
artery, such as the radial artery at the wrist or the carotid
ELECTROCARDIOGRAPHY
artery in the neck (see FIG. 3-9). Electrocardiography (ECG) measures the heart’s electrical
Cardiac contractions are stimulated by a built-in sys­ activity as it functions (FIG. 10-5). Electrodes (leads) placed
tem that regularly transmits electrical impulses through on the body’s surface detect the electrical signals, which
the heart. The components of this conduction system are then amplified and recorded as a tracing. A normal, or
are shown in FIGURE 10-4. In the sequence of action, they sinus rhythm, which originates at the SA node, is shown
include the: in FIGURE 10-5A. FIGURE 10-5B shows the letters assigned to
individual components of one complete cycle:
1. Sinoatrial (SA) node, located in the upper right atrium
and called the pacemaker because it sets the rate of the 1. The P wave represents electrical change, or depolariza­
heartbeat. tion, of the atrial muscles.

2. Atrioventricular (AV) node, located at the bottom of the 2. The QRS component shows depolarization of the ven­
right atrium near the ventricle. Internodal fibers between tricles.
the SA and AV nodes carry stimulation throughout both 3. The T wave shows return, or repolarization, of the ven­
atria. tricles to their resting state. Atrial repolarization is hid­
3. AV bundle (bundle of His) at the top of the interventric­ den by the QRS wave.
ular septum. 4. The small U wave, if present, follows the T wave. It is of
4. Left and right bundle branches, which travel along the uncertain origin.
left and right sides of the septum. An interval measures the distance from one wave to the
5. Purkinje (pur-KIN-je) fibers, which carry stimulation next; a segment is a smaller component of the tracing. Many
throughout the walls of the ventricles (see information heart disorders, some of which are described later in the
on naming in BOX 10-1). chapter, appear as abnormalities in ECG components.

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 320 Part II ■ Body Systems

FOCUSS ON WORDS
RD
DS BOX 101
Name Th
hat
hat Structure
Strructturre

An eponym (EP-o-nim) is a name that is based on the name of a thyroid; Addison and Cushing, involving the adrenal cortex;
person, usually the one who discovered a particular structure, and Down syndrome, a hereditary disorder. The genus and
disease, principle, or procedure. Everyday examples are gra- species names of microorganisms often are based on the
ham cracker, Ferris wheel, and boycott. In the heart, the bun- names of their discoverers: Escherichia, Salmonella, Pasteu­
dle of His and Purkinje fibers are part of that organ’s electrical rella, and Rickettsia to name a few.
conduction system. Korotkoff sounds are heard in the vessels Many reagents, instruments, and procedures are named
when taking blood pressure. Cardiovascular disorders named for their developers too. The original name for a radiograph
for people include the tetralogy of Fallot, a combination of was roentgenograph (RENT-jen-o-graf), named for Wilhelm
four congenital heart defects; Raynaud disease of small ves- Roentgen, discoverer of x-rays. A curie is a measure of radi-
sels; and the cardiac arrhythmia known as Wolff–Parkinson– ation, derived from the name of Marie Curie, a co-discoverer
White syndrome. In treatment, Doppler echocardiography is of radioactivity.
named for a physicist of the 19th century. The Holter monitor Although eponyms give honor to physicians and scien-
and the Swan–Ganz catheter give honors to their developers. tists of the past, they do not convey any information and may
In other systems, the islets of Langerhans are cell clusters be more difficult to learn. There is a trend to replace these
in the pancreas that secrete insulin. The graafian follicle in the names with more descriptive ones; for example, auditory tube
ovary surrounds a mature egg cell. The eustachian tube con- instead of eustachian tube, mature ovarian follicle for graafian
nects the middle ear to the throat. follicle, pancreatic islets for islets of Langerhans, and trisomy
Many disease names are eponymic: Parkinson and 21 for Down syndrome.
Alzheimer, which affect the brain; Graves, a disorder of the

A
5 mm
0.2 sec
0.5 mV
5 mm

P-R S-T
seg seg T
P
U

TP P-R QRS TP
interval interval Q-T interval
interval

B
FIGURE 10-5 Electrocardiography (ECG). A. ECG tracing showing a normal sinus
rhythm. B. Components of a normal ECG tracing. Shown are the P, QRS, T, and U waves,
which represent electrical activity in different parts of the heart. Intervals measure
from one wave to the next; segments are smaller components of the tracing.

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 321

The Vascular System under high pressure. All veins, except the pulmonary vein
(and the umbilical vein in the fetus), carry blood low in
The vascular system consists of: oxygen. Veins have thinner, less elastic walls and tend to
give way under pressure. Like the heart, veins have one-way
1. Arteries that carry blood away from the heart (FIG. 10-6)
valves that keep blood flowing forward. Veins are classified
2. Arterioles, vessels smaller than arteries that lead into the as superficial or deep. The deep veins usually parallel arter­
capillaries ies and carry the same names (see FIG. 10-7).
3. Capillaries, the smallest vessels, through which exchanges Nervous system stimulation can cause the diameter
take place between the blood and the tissues of a vessel to increase (vasodilation) or decrease (vasocon­
striction). These changes alter blood flow to the tissues and
4. Venules, small vessels that receive blood from the capil­
affect blood pressure.
laries and drain into the veins
5. Veins that carry blood back to the heart (FIG. 10-7)
BLOOD PRESSURE
All arteries, except the pulmonary artery (and the Blood pressure (BP) is the force exerted by blood against
umbilical artery in the fetus), carry highly oxygenated the wall of a blood vessel. It falls as the blood travels away 10
blood. They are thick-walled, elastic vessels that carry blood from the heart and is influenced by a variety of factors,

Temporal
Facial External carotid
Internal carotid
Subclavian Common carotid

Brachiocephalic Aorta
Celiac trunk to:
Axillary Left gastric
Splenic
Common hepatic
Brachial Superior mesenteric
Renal
Ulnar Gonadal
Radial Inferior mesenteric
Common Iliac
Internal Iliac
External Iliac
Superficial
palmar arch

Femoral
Deep femoral
Popliteal

Anterior tibial

Fibular

Posterior
Dorsalis pedis
tibial

Arcuate
FIGURE 10-6 Principal systemic arteries.

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 322 Part II ■ Body Systems

Temporal
Superficial vein Facial
Deep vein External jugular
Internal jugular
Superior vena cava Subclavian
Brachiocephalic
Azygous
Brachial
Inferior vena cava
Cephalic Hepatic
Basilic Renal
Median cubital
Radial Gonadal

Ulnar Common Iliac

Internal Iliac
External Iliac

Palmar
digitals

Femoral

Great saphenous
Popliteal
Anterior tibial
Posterior tibial
Small saphenous

Plantar venous arch

Dorsal digitals

FIGURE 10-7 Principal systemic veins.

including cardiac output, vessel diameters, and total blood millimeters mercury (mm Hg), that is, the height to which
volume. Vasoconstriction increases BP in a vessel; vasodila­ the pressure can push a column of mercury in a tube. The
tion decreases pressure. examiner wraps the cuff around the patient’s upper arm and
The most common site for BP measurement is the bra­ inflates it with air until the brachial artery is compressed
chial artery of the arm. In taking blood pressure, both sys­ and the blood flow is cut off. Then, listening with a stetho­
tolic (heart contracts) and diastolic (heart relaxes) pressures scope, he or she slowly lets air out of the cuff until the first
are measured. pulsations (Korotkoff sounds) are heard. At this point, the
The instrument used to measure blood pressure is a pressure in the cuff is equal to the systolic pressure, and this
sphygmomanometer (sfig-mo-mah-NOM-eh-ter) (FIG. 10-8), pressure is read. Then, more air is let out gradually until a
more simply called a blood pressure cuff or blood pres­ characteristic muffled sound indicates that the vessel is open
sure apparatus. The sphygmomanometer is an inflatable and the diastolic pressure is read off of a gauge or digital dis­
cuff attached to a pressure gauge. Pressure is expressed in play. Newer devices measure blood pressure electronically:

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 323

No sounds (pressure Korotkoff No sounds (pressure

above systolic) sounds below diastolic)

Pressure
gauge

Cuff

Systolic pressure
10
Diastolic pressure
(sounds appear)
Pressure (mm Hg)

(sounds disappear)
Stethoscope
120

Inflator
80
Arterial pressure Cuff pressure

A B Time
FIGURE 10-8 Measurement of blood pressure. A. A sphygmomanometer, or blood pressure cuff set to measure pressure in the left
brachial artery. B. As the clinician lowers the cuff pressure, Korotkoff sounds begin at the systolic pressure and disappear at the diastolic
pressure.

the examiner simply applies the cuff, which self-inflates and pressure first, then diastolic pressure, separated by a slash,
provides a digital reading. A typical normal systolic pressure such as 120/80. This reading would be reported verbally as
is less than 120 mm Hg; a typical normal diastolic pressure “120 over 80.” (See BOX 10-2 for more information on blood
is less than 80 mm Hg. Blood pressure is reported as systolic pressure measurement.)

CLINICAL PERSPECTIVES BOX 10-2

Hemodynamic Monitoring: Measuring Blood Pressure From Within

Because arterial blood pressure decreases as blood flows far- direct route to the heart, but the subclavian and femoral veins
ther away from the heart, measurement of blood pressure may also be used. The catheter’s position in the heart is con-
with a simple inflatable cuff around the arm is only a reflection firmed by a chest x-ray, and when appropriately positioned,
of the pressure in the heart and pulmonary arteries. Precise the atrial and ventricular blood pressures are recorded. As the
measurement of pressure in these parts of the cardiovascular catheter continues into the pulmonary artery, pressure in this
system is useful in diagnosing certain cardiac and pulmonary vessel is readable. When the balloon is inflated, the catheter
disorders. becomes wedged in a branch of the pulmonary artery, block-
More accurate readings can be obtained using a catheter ing blood flow. The reading obtained is called the pulmonary
(thin tube) inserted directly into the heart and large vessels. capillary wedge pressure (PCWP). It gives information on
One type commonly used is the pulmonary artery catheter pressure in the heart’s left side and on resistance in the lungs.
(also known as the Swan–Ganz catheter), which has an inflat- Combined with other tests, hemodynamic monitoring with a
able balloon at the tip. This device is threaded into the right Swan–Ganz catheter can be used to diagnose cardiac and pul-
side of the heart through a large vein. Typically, the right in- monary disorders such as shock, pericarditis, congenital heart
ternal jugular vein is used because it is the shortest and most disease, and heart failure.
 324 Part II ■ Body Systems

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Cardiovascular System
Normal Structure and Function
aorta The largest artery; it receives blood from the left ventricle and branches to all parts of the body
a-OR-tah (root: aort/o)

aortic valve The valve at the entrance to the aorta

a-OR-tik

apex The point of a cone-shaped structure (adjective: apical); the apex of the heart is formed by the
A-peks left ventricle and is pointed toward the inferior and left

artery A vessel that carries blood away from the heart; all except the pulmonary and umbilical
AR-teh-re arteries carry oxygenated blood (roots: arter, arteri/o)

arteriole A small vessel that carries blood from the arteries into the capillaries (root: arteriol/o)
ar-TE-re-ole

atrioventricular (AV) node A small mass in the lower septum of the right atrium that passes impulses from the sinoatrial
a-tre-o-ven-TRIK-u-lar (SA) node toward the ventricles

atrioventricular (AV) valve A valve between the atrium and ventricle on the right and left sides of the heart; the right AV
valve is the tricuspid valve; the left is the mitral valve

atrium An entrance chamber, one of the two upper receiving chambers of the heart (root: atri/o)
A-tre-um

AV bundle A band of fibers that transmits impulses from the atrioventricular (AV) node to the top of the
interventricular septum; it divides into the right and left bundle branches, which descend along
the two sides of the septum; the bundle of His

blood pressure The force exerted by blood against the wall of a vessel

bundle branches Branches of the AV bundle that divide to the right and left sides of the interventricular septum

capillary A microscopic blood vessel through which materials are exchanged between the blood and the
KAP-ih-lar-e tissues

cardiovascular system The part of the circulatory system that consists of the heart and the blood vessels
kar-de-o-VAS-ku-lar

coronary circulation The blood vessels in the heart that provide oxygen and nourishment and remove waste
KOR-o-na-re products from the myocardium

depolarization A change in electrical charge from the resting state in nerves or muscles
de-po-lar-ih-ZA-shun

diastole The relaxation phase of the heartbeat cycle (adjective: diastolic)

di-AS-to-le

electrocardiography (ECG) Study of the electrical activity of the heart as detected by electrodes (leads)placed on the
e-lek-tro-kar-de-OG-rah-fe surface of the body; also abbreviated EKG from the German electrocardiography

endocardium The thin membrane that lines the chambers of the heart and covers the valves
en-do-KAR-de-um

epicardium The thin outermost layer of the heart wall

ep-ih-KAR-de-um

functional murmur Any sound produced as the heart functions normally

heart The muscular organ with four chambers that contracts rhythmically to propel blood through
hart vessels to all parts of the body (root: cardi/o)

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 325

Terminology Key Terms (Continued)

heart rate The number of times the heart contracts per minute; recorded as beats per minute (bpm)

heart sounds Sounds produced as the heart functions: the two loudest sounds are produced by alternate
closing of the valves and are designated S1 and S2

inferior vena cava The large inferior vein that brings blood low in oxygen back to the right atrium of the heart
VE-nah KA-vah from the lower body

left AV valve The valve between the left atrium and the left ventricle; the mitral valve or bicuspid valve

mitral valve The valve between the left atrium and the left ventricle; the left AV valve or bicuspid valve
MI-tral

myocardium
mi-o-KAR-de-um
The thick middle layer of the heart wall composed of cardiac muscle 10
pericardium The fibrous sac that surrounds the heart
per-ih-KAR-de-um

pulmonary artery The vessel that carries blood from the right side of the heart to the lungs
PUL-mo-nar-e

pulmonary circuit The system of vessels that carries blood from the right side of the heart to the lungs to be
SER-kit oxygenated and then back to the left side of the heart

pulmonary veins The vessels that carry blood from the lungs to the left side of the heart

pulmonary valve The valve at the entrance to the pulmonary artery

pulse The wave of increased pressure produced in the vessels each time the ventricles contract
puls

Purkinje fibers The terminal fibers of the cardiac conducting system; they carry impulses through the walls of
pur-KIN-je the ventricles

repolarization A return of electrical charge to the resting state in nerves or muscles

re-po-lar-ih-ZA-shun

right AV valve The valve between the right atrium and right ventricle; the tricuspid valve

septum A wall dividing two cavities, such as two chambers of the heart
SEP-tum

sinus rhythm Normal heart rhythm

SI-nus RITH-um

sinoatrial (SA) node A small mass in the upper part of the right atrium that initiates the impulse for each heartbeat;
si-no-A-tre-al the pacemaker

sphygmomanometer An instrument for determining arterial blood pressure (root sphygm/o means “pulse”); blood
sfig-mo-mah NOM–eh-ter pressure apparatus or cuff

superior vena cava The large superior vein that brings blood low in oxygen back to the right atrium from the
VE-nah KA-vah upper body

systemic circuit The system of vessels that carries oxygenated blood from the left side of the heart to all tissues
sis-TEM-ik SER-kit except the lungs and returns deoxygenated blood to the right side of the heart

systole The contraction phase of the heartbeat cycle (adjective: systolic)

SIS-to-le

valve A structure that keeps fluid flowing in a forward direction (roots: valv/o, valvul/o)
valv

vein A vessel that carries blood back to the heart. All except the pulmonary and umbilical veins
vane carry blood low in oxygen (roots: ven/o, phleb/o)

(continued)

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 326 Part II ■ Body Systems

Terminology Key Terms (Continued)

ventricle A small cavity. One of the two lower pumping chambers of the heart (root: ventricul/o)
VEN-trik-l

venule A small vessel that carries blood from the capillaries to the veins
VEN-ule

vessel A tube or duct to transport fluid (roots: angi/o, vas/o, vascul/o)

VES-el

Roots Pertaining to the Cardiovascular System

See TABLES 10-1 and 10-2.

Table 10-1 Roots for the Heart

Root Meaning Example Definition of Example
a
cardi/o heart cardiomyopathy any disease of the heart muscle
kar-de-o-mi-OP-ah-the
atri/o atrium atriotomy surgical incision of an atrium
a-tre-OT-o-me
ventricul/o cavity, ventricle supraventricular above a ventricle
su-prah-ven-TRIK-u-lar
valv/o, valvul/o valve valvulotome instrument for incising a valve
VAL-vu-lo-tome
a
Preferred over myocardiopathy.

Exercise 10-1
Complete the exercise. To check your answers go to Appendix 11.

Fill in the blanks.

1. A valvuloplasty (val-vu-lo-PLAS-te) is plastic repair of a(n) _____________________________________________ .

2. Atriotomy (a-tre-OT-to-me) means surgical incision of a(n) _____________________________________________ .
3. Interventricular (in-ter-ven-TRIK-u-lar) means between the _____________________________________________ .
4. The word cardiomegaly (kar-de-o-MEG-ah-le) means enlargement of the _________________________________ .

Write the adjective for the following definitions. The proper suffix is given for each.

5. Pertaining to an atrium (-al) _____________________________________________

6. Pertaining to the myocardium (-al; ending differs from
adjective ending for the heart) _____________________________________________
7. Pertaining to the heart (-ac) _____________________________________________
8. Pertaining to a valve (-ar) _____________________________________________
9. Pertaining to a ventricle (-ar) _____________________________________________
10. Pertaining to the pericardium (-al) _____________________________________________

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 327

Exercise 10-1 (Continued)

Following the example, write a word for the following definitions pertaining to the tissues of the heart.

11. Inflammation of the fibrous sac around the heart _____________________________________________

12. Inflammation of the heart’s lining (usually at a valve) _____________________________________________
13. Inflammation of the heart muscle _____________________________________________

Write a word for the following definitions.

14. Originating (-genic) in the heart _____________________________________________

15. Surgical incision of a valve _____________________________________________
16. Pertaining to an atrium and a ventricle _____________________________________________ 10
17. Between (inter-) the atria _____________________________________________
18. Study (-logy) of the heart _____________________________________________

Table 10-2 Roots for the Blood Vessels

Root Meaning Example Definition of Example
angi/oa vessel angiography x-ray imaging of a vessel
an-je-OG-rah-fe
vas/o, vascul/o vessel, duct vasospasm sudden contraction of a vessel
VA-so-spazm
arter/o, arteri/o artery endarterial within an artery
end-ar-TE-re-al
arteriol/o arteriole arteriolar pertaining to an arteriole
ar-te-re-O-lar
aort/o aorta aortoptosis downward displacement of the aorta
a-or-top-TO-sis
ven/o, ven/i vein venous pertaining to a vein
VE-nus
phleb/o vein phlebotomy incision of a vein to withdraw blood
fleh-BOT-o-me
a
The root angi/o usually refers to a blood vessel but is used for other types of vessels as well. Hemangi/o refers specifically to a blood vessel.

Exercise 10-2
Complete the exercise. To check your answers go to Appendix 11.

Fill in the blanks.

1. Angioedema (an-je-o-eh-DE-mah) is localized swelling caused by changes in _______________________________ .
2. Vasodilation (vas-o-DI-la-shun) means dilation of a(n) _________________________________________________ .
3. Aortostenosis (a-or-to-steh-NO-sis) is narrowing of ____________________________________________________ .
4. Endarterectomy (end-ar-ter-EK-to-me) is removal of the inner lining of a(n) ________________________________ .
5. Arteriolitis (ar-te-re-o-LI-tis) is inflammation of a(n) ___________________________________________________ .
6. Phlebectasia (fleb-ek-TA-ze-ah) is dilatation of a(n) ____________________________________________________ .
7. The term microvascular (mi-kro-VAS-ku-lar) means pertaining to small ___________________________________ .

(continued)

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 328 Part II ■ Body Systems

Exercise 10-2 (Continued)

Define the following words.

8. arteriorrhexis (ar-te-re-o-REK-sis) ____________________________________________________________________

9. intraaortic (in-trah-a-OR-tik) ________________________________________________________________________
10. angiitis (an-je-I-tis) (note spelling); also angitis or vasculitis _______________________________________________
11. phlebitis (fleb-I-tis) _________________________________________________________________________________
12. cardiovascular (kar-de-o-VAS-ku-lar) __________________________________________________________________

Use the ending -gram to form a word for a radiograph of the following.

13. vessels (use angi/o) _____________________________________________

14. aorta _____________________________________________
15. veins _____________________________________________

Use the root angi/o to write words with the following meanings.

16. Plastic repair (-plasty) of a vessel _____________________________________________

17. Any disease (-pathy) of a vessel _____________________________________________
18. Dilatation (-ectasis) of a vessel _____________________________________________
19. Formation (-genesis) of a vessel _____________________________________________

Use the appropriate root to write words with the following meanings.

20. Excision of a vein _____________________________________________

21. Hardening (-sclerosis) of the aorta _____________________________________________
22. Within (intra-) a vein _____________________________________________
23. Incision of an artery _____________________________________________

Clinical Aspects of the but most of its effects are seen in the coronary vessels of the
heart, the aorta, the carotid arteries in the neck, and vessels
Cardiovascular System in the brain. The techniques described later for treating cor­
onary artery disease (CAD) are used for these other vessels
ATHEROSCLEROSIS as well.
The accumulation of fatty deposits within the lining of Atherosclerosis is the most common form of a more
an artery is termed atherosclerosis (FIG. 10-9). This type of general condition known as arteriosclerosis in which ves­
deposit, called plaque (plak), begins to form when a ves- sel walls harden from any cause. In addition to plaque,
sel receives tiny injuries, usually at a point of branching. calcium salts and scar tissue may contribute to arterial
Plaques gradually thicken and harden with fibrous mate- wall thickening, with a narrowing of the lumen and loss
rial, cells, and other deposits, restricting the vessel’s lumen of elasticity.
(opening) and reducing blood flow to the tissues, a condi­
tion known as ischemia (is-KE-me-ah). A major risk fac-
tor for the development of atherosclerosis is dyslipidemia, THROMBOSIS AND EMBOLISM
abnormally high levels or imbalance in lipoproteins that Atherosclerosis predisposes a person to thrombosis, the
are carried in the blood, especially high levels of choles- formation of a blood clot within a vessel (see FIG. 10-9).
terol-containing, low-density lipoproteins (LDLs). Other The clot, called a thrombus, interrupts blood flow to the
risk factors for atherosclerosis include smoking, high blood tissues supplied by that vessel, resulting in necrosis (tissue
pressure, poor diet, inactivity, stress, and a family history death). Blockage of a vessel by a thrombus or other mass
of the disorder. Atherosclerosis may involve any arteries, carried in the bloodstream is embolism, and the mass

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 329

Normal

Aorta
Direction of
normal blood
flow

Blood entering
wall of artery
Blood
entering
10
wall of
artery
Blood in
artery
FIGURE 10-10 Dissecting aortic aneurysm. Blood separates the
layers of the arterial wall.
Plaque

aneurysm sites. In a dissecting aneurysm (FIG. 10-10), blood

Thrombosis hemorrhages into the arterial wall’s thick middle layer, sepa­
rating the muscle as it spreads and sometimes rupturing the
FIGURE 10-9 Coronary atherosclerosis. In this example, a
vessel. The aorta is most commonly involved. Surgeons can
branch of the left coronary artery is shown in cross-section during
replace the damaged arterial segment of a dissecting aneu­
three stages of atherosclerosis: no plaque present (top), a well-
rysm surgically with a graft. In many cases they can insert a
formed plaque blocking 30% of the vessel lumen (middle), and
stent (small tube) to seal off the aneurysm and carry blood
formation of a thrombus (blood clot) (bottom). through the expanded portion of the vessel.

itself is called an embolus. Usually, the mass is a blood HYPERTENSION

clot that breaks loose from a vessel’s wall, but it may also High blood pressure, or hypertension (HTN), is a contrib­
be air (as from injection or trauma), fat (as from marrow uting factor in all of the conditions described above. In
released after a bone break), bacteria, or other solid mate­ simple terms, HTN is defined as a systolic pressure greater
rials. Often a venous thrombus will travel through the than 140 mm Hg or a diastolic pressure greater than 90
heart and then lodge in an artery of the lungs, resulting in mm Hg. HTN causes the left ventricle to enlarge (hyper­
a life-threatening pulmonary embolism. An embolus from trophy) as a result of increased work. Some cases of HTN
a carotid artery often blocks a cerebral vessel, causing a are secondary to other disorders, such as kidney malfunc­
cerebrovascular accident (CVA), commonly called stroke tion or endocrine disturbance, but most of the time, the
(Chapter 7). causes are unknown, a condition described as primary, or
The use of anticoagulant drugs (“blood thinners”) essential, HTN.
when appropriate has greatly reduced the incidence of these
conditions. These drugs include heparin, which inhibits Treatment of Hypertension
thrombin formation; warfarin (Coumadin), which inhibits Even though there is much individual variation in blood
formation of vitamin K; and newer oral anticoagulants that pressure, physicians have established guidelines for the
interfere with thrombin formation and do not require regu­ diagnosis and treatment of hypertension. Blood pressure
lar tests of blood levels, as does Coumadin. readings of 120/80 to 139/89 describe prehypertension, a
warning sign for the future development of high blood pres­
sure. This condition is treated by lifestyle modifications such
ANEURYSM as increased physical exercise, a low-salt, low-fat diet, and
An arterial wall weakened by atherosclerosis, malforma­ if necessary, weight loss and smoking cessation. Any con­
tion, injury, or other changes may balloon out, forming an firmed blood pressure over 140/90 (at least two readings on
aneurysm. If an aneurysm ruptures, hemorrhage results. two separate occasions) is treated with medication as well
Rupture of a cerebral artery is another cause of stroke. as lifestyle changes. A physician may opt to prescribe anti-
The abdominal aorta and carotid arteries are also common hypertensive medication for someone in the upper range of

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 330 Part II ■ Body Systems

prehypertension who is at risk of a heart attack or stroke.

Drugs used to treat hypertension include the following:

■ Diuretic (di-u-RET-ik) drugs that promote salt and water

loss through the kidneys
■ Drugs that limit production of renin or block its action
■ Drugs that relax blood vessels, including adrenergic
blockers and calcium channel blockers

HEART DISEASE
Coronary Artery Disease A B
Coronary artery disease (CAD) results from atherosclerosis FIGURE 10-11 Coronary angiography. Coronary vessels are
in the vessels that supply blood to the heart muscle. It is a imaged after administration of a dye during cardiac catheterization.
leading cause of death in industrialized countries (see FIG. 10-9). A. Angiography shows narrowing in the mid-left anterior descending
An early sign of CAD is the type of chest pain known as (LAD) artery (arrow). B. The same vessel after angioplasty, a procedure
angina pectoris. This is a feeling of constriction around to distend narrowed vessels. Note the improved blood flow through
the heart or pain that may radiate to the left arm or shoul­ the artery distal to the repair.
der, usually brought on by exertion. Often there is anxiety,
diaphoresis (profuse sweating), and dyspnea (difficulty in
breathing). CAD is diagnosed by ECG, stress tests, echocar­
diography, and coronary angiography. This invasive x-ray CAD is treated by control of exercise and diet and by
imaging method requires injection of a dye into the coro­ drug therapy and surgical intervention when appropriate.
nary arteries by means of a catheter threaded through blood Drugs, such as nitroglycerin, may be used to dilate coronary
vessels into the heart (FIG. 10-11). Coronary CT angiography vessels. Other drugs may be used to regulate the heartbeat,
(CTA) is a noninvasive procedure that can be used in the strengthen the force of heart contraction, lower cholesterol,
diagnosis of heart disease. It employs computed tomog­ or prevent blood clot formation.
raphy scans following injection of a small amount of dye Patients with severe CAD may be candidates for angio­
into the arm. A coronary calcium scan (heart scan) reveals plasty, surgical dilatation of the blocked vessel by means of
vessel-narrowing calcium deposits in the coronary arterial a balloon catheter, a procedure technically called percutane­
walls. Researchers have also found that a substance called ous transluminal coronary angioplasty (PTCA) (FIGS. 10-11
C-reactive protein (CRP) is associated with poor cardio­ and 10-12). Angioplasty may include placement of a stent, a
vascular health. This protein is produced during systemic small mesh tube, to keep the vessel open (FIG. 10-13). Stents
inflammation, which may contribute to atherosclerosis. prevent recoil of the vessel and are available in different
CRP levels can indicate cardiovascular disease and predict versions. The basic type is the bare metal stent; another is
its outcome (prognosis). A more specific test for heart attack the drug-eluting stent, which releases drugs to prevent vas­
risk is the more accurate hs-CRP (high-sensitivity CRP) test. cular restenosis. The newest form of stent is a completely

Balloon catheter
headed toward
coronary artery
Deflated balloon catheter approaches blockage

Inflated balloon crushes blockage

Circulation reestablished

FIGURE 10-12 Coronary angioplasty (PTCA).

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 331

A Deflated balloon (obstruction). The resultant area of myocardial necrosis is

termed an infarct, and the process is known as myocardial
infarction (MI), the “heart attack” that may cause sudden
death. Symptoms of MI include pain over the heart (precor­
Plaque Closed stent
dial pain) or upper part of the abdomen (epigastric pain)
Catheter
B Inflated balloon that may extend to the jaw or arms, pallor (paleness), dia­
phoresis, nausea, fatigue, anxiety, and dyspnea. There may
be a burning sensation similar to indigestion or heartburn.
In women, because degenerative changes more commonly
C Plaque Open stent affect multiple small vessels rather than the major coronary
pathways, MI symptoms are often more long-term and are
more subtle and diffuse than the intense chest pain that is
more typical in men.
Open stent MI is diagnosed by ECG and assays for specific sub­
FIGURE 10-13 Arterial stent. A. Stent closed, before balloon
stances in the blood. Creatine kinase (CK) is an enzyme
normal to muscle cells. It is released in increased amounts 10
inflation. B. Stent open, balloon inflated; stent will remain expanded
when muscle tissue is injured. The form of CK specific to
after balloon is deflated and removed. C. Stent open, balloon removed.
cardiac muscle cells is creatine kinase MB (CK-MB). Tro­
ponin (Tn) is a protein that regulates contraction in muscle
bioabsorbable device that is gradually metabolized and cells. Increased serum levels, particularly the forms TnT and
absorbed into the body. TnI, indicate MI.
If further intervention is required, surgeons can bypass Patient outcome is based on the degree of damage and
the blocked vessel or vessels with a vascular graft (FIG. 10-14). the speed of treatment to dissolve the clot and to reestablish
In this procedure, known as a coronary artery bypass graft normal blood flow and heart rhythm.
(CABG), another vessel or a piece of another vessel, usually
the left internal mammary artery or part of the leg’s saphe­ Arrhythmia
nous vein, is grafted to carry blood from the aorta to a point Arrhythmia is any irregularity of heart rhythm, such as an
past the coronary vessel obstruction. altered heart rate, extra beats, or a change in the pattern
of the beat. Bradycardia is a slower-than-average rate, and
Myocardial Infarction tachycardia is a higher-than-average rate.
Degenerative changes in the arteries predispose a per­ Damage to cardiac tissue, as by MI, may result in heart
son to thrombosis and sudden coronary artery occlusion block, an interruption in the heart’s electrical conduction

External iliac vein

Great saphenous
vein
Intact communicating Left subclavian
veins artery
Internal
Small mammary
saphenous artery graft
vein
Saphenous
vein graft
Left anterior descending
(LAD) artery
Right coronary artery
(RCA)

FIGURE 10-14 Coronary artery bypass graft (CABG). In a bypass graft, a healthy vessel segment is used to carry blood
around an arterial blockage. This figure shows two CABGs. On the left, a segment of the saphenous vein is used to carry blood
from the aorta to a part of the right coronary artery that is distal to the occlusion. On the right, the mammary artery is grafted
to bypass an obstruction in the LAD artery.

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 332 Part II ■ Body Systems

the pacemaker is inserted under the skin below the clavicle,

and leads are threaded through veins into one or both of the
right chambers. Some pacemakers act only when the heart
is not functioning on its own, and others adjust to the need
for a change in heart rate based on activity.
MI is also a common cause of fibrillation, an extremely
Bundle of His rapid, ineffective heartbeat, especially dangerous when
it affects the ventricles. (Carlos in the opening case study
had atrial fibrillation.) Cardioversion is the general term
for restoration of a normal heart rhythm, either by drugs
Bundle or application of electric current. Hospital personnel use
branches external chest “paddles” or “pads” for emergency electrical
defibrillation. In addition to cardiopulmonary resuscitation
AV node (CPR), automated external defibrillators (AEDs) can help
save lives when available for high-risk patients or in public
places, such as malls, schools, churches, aircrafts, and sports
FIGURE 10-15 Potential sites for heart block in the venues. The AED detects fatal arrhythmia and automati-
atrioventricular (AV) portion of the heart’s conduction system. cally delivers a correct preprogrammed shock. An implant-
able cardioverter defibrillator (ICD), applied much like a
system resulting in arrhythmia (FIG. 10-15). Heart block is pacemaker, detects potential fibrillation and automatically
classified in order of increasing severity as first-, second-, or shocks the heart to restore normal rhythm.
third-degree heart block. Block in a bundle branch is desig- A newer approach to the treatment of heart rhythm
nated as a left or right bundle branch block (BBB). irregularities is cardiac ablation, destruction of that portion
If, for any reason, the SA node is not generating a nor- of the conduction pathway that is involved in the arrhyth-
mal heartbeat or there is heart block, an artificial pacemaker mia. Electrode catheter ablation uses high-frequency sound
may be implanted to regulate the beat (FIG. 10-16). Usually, waves, freezing (cryoablation), or electrical energy delivered
through an intravascular catheter to ablate a defect in the
Pacemaker lead conduction pathway.
enters external
jugular vein Heart Failure
The general term heart failure refers to any condition in
which the heart fails to empty effectively. The resulting
increased pressure in the venous system leads to edema,
justifying the description congestive heart failure (CHF).
Left-side failure results in pulmonary edema with breath-
ing difficulties (dyspnea); right-side failure causes peripheral
edema with tissue swelling, especially in the legs, along with
weight gain from fluid retention. Other symptoms of CHF
are cyanosis and syncope (fainting).
Heart failure is treated with rest, drugs to strengthen
heart contractions, diuretics to eliminate fluid, and restric-
tion of salt in the diet.
Heart failure is one cause of shock, a severe disturbance
in the circulatory system resulting in inadequate blood deliv-
ery to the tissues. Shock is classified according to cause as:

■ Cardiogenic shock, caused by heart failure

Tip of lead ■ Hypovolemic shock, caused by loss of blood volume
lodged in
apex of right ■ Septic shock, caused by bacterial infection
Pacemaker placed ventricle ■ Anaphylactic shock, caused by severe allergic reaction
beneath skin
in pectoral region
Congenital Heart Disease
FIGURE 10-16 Placement of a pacemaker. The lead is placed A congenital defect is any defect that is present at birth.
in an atrium or ventricle, usually on the right side. A dual-chamber The most common type of congenital heart defect is a septal
pacemaker has leads in both chambers. defect, a hole in the septum (wall) that separates the atria or

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 333

Arch of aorta indicate heart abnormalities that could be treated immedi-

ately but might not otherwise become evident until after the
Ductus
Superior arteriosus baby leaves the hospital. The test is inexpensive and has a
vena cava low false-positive rate.
Another congenital defect that results from persistence of
Foramen
ovale
a fetal modification is patent ductus arteriosus (see FIG. 10-17D).
In this case, a small bypass between the pulmonary artery and
Pulmonary Left atrium the aorta fails to close at birth. Blood then can flow from the
trunk
aorta to the pulmonary artery and return to the lungs.
Right Heart valve malformation is another type of congenital
atrium heart defect. Failure of a valve to open or close properly is
Inferior evidenced by a murmur, an abnormal sound heard as the
vena cava heart cycles. A localized aortic narrowing, or coarctation
of the aorta, is a congenital defect that restricts blood flow
A through that vessel (see FIG. 10-17E). Most of the congenital
defects described now can be corrected surgically. A patent 10
ductus arteriosus may also respond to drug treatment.

Rheumatic Heart Disease

In rheumatic heart disease, infection with a specific type of
Streptococcus sets up an immune reaction that ultimately
damages the heart valves. The infection usually begins as a
“strep throat,” and most often the mitral valve is involved.
Scar tissue fuses the valve’s leaflets, causing a narrowing or
stenosis that interferes with proper function. People with
rheumatic heart disease are subject to repeated valvular
B D infections and may need to take antibiotics prophylactically
(preventively) before invasive medical or dental procedures.
Severe cases of rheumatic heart disease may require surgical
correction or even valve replacement. The incidence of rheu-
matic heart disease has declined with the use of antibiotics.

DISORDERS OF THE VEINS

A breakdown in the valves of the veins in combination with
a chronic dilatation of these vessels results in varicose veins
(FIG. 10-18). These appear twisted and swollen under the skin,

C E
FIGURE 10-17 Congenital heart defects. A. Normal fetal heart
showing the foramen ovale and ductus arteriosus. B. Persistence of
the foramen ovale results in an atrial septal defect. C. A ventricular
septal defect. D. Persistence of the ductus arteriosus (patent
ductus arteriosus) forces blood back into the pulmonary artery.
E. Coarctation of the aorta restricts outward blood flow in the aorta.

the septum that separates the ventricles (FIG. 10-17). An atrial

septal defect often results from persistence of an opening,
the foramen ovale, that allows blood to bypass the lungs
in fetal circulation. A septal defect permits blood to shunt
from the left to the right side of the heart and return to the
lungs instead of flowing out to the body. The heart has to
work harder to meet the tissue’s oxygen needs. Symptoms
of septal defect include cyanosis (leading to the description
“blue baby”), syncope, and clubbing of the fingers.
Most U.S. hospitals are now required to screen for con-
genital heart defects at birth with pulse oximetry, a test that
measures oxygen levels in the blood. Low oxygen levels may FIGURE 10-18 Varicose veins.
 334 Part II ■ Body Systems

most commonly in the legs. Contributing factors include valves in the veins. Such inflammation typically initiates blood
heredity, obesity, prolonged standing, and pregnancy, which clot formation, resulting in thrombophlebitis. Any veins are
increase pressure in the pelvic veins. Varicosities can impede subject to thrombophlebitis, but the more serious condition
blood flow and lead to edema, thrombosis, hemorrhage, or involves the deep veins as opposed to the superficial veins, in
ulceration. Treatment includes the wearing of elastic stockings the condition termed deep vein thrombosis (DVT). The most
and, in some cases, surgical removal of the varicose veins, after common sites for DVT are the deep leg veins, causing serious
which collateral circulation is naturally established. A varicose reduction in venous drainage from these areas.
vein in the rectum or anal canal is referred to as a hemorrhoid. Vascular technologists obtain information on the blood
Phlebitis is any inflammation of the veins and may be vessels and circulation to aid in diagnosis. BOX 10-3 for infor­
caused by infection, injury, poor circulation, or damage to mation on this career.

HEALTH PROFESSIONS BOX 103

Vascular Technologists

Vascular technologists perform noninvasive diagnostic studies Unlike early workers in this field who were often trained
to evaluate the blood vessels (arteries and veins) in the head, on the job, vascular technologists today complete a 2- or
neck, extremities, and abdomen to help physicians diagnose vas- 4-year educational program accredited by the Commission on
cular disorders. Vascular technologists obtain two-dimensional Accreditation of Allied Health Education Programs (CAAHEP).
images of the blood vessels using ultrasound and measure the Certification specific to vascular technology is available from
velocity and direction of blood flow using Doppler ultrasound. the American Registry for Diagnostic Medical Sonography
They use other instrumentation to measure blood pressure, at ardms.org and from other organizations. Certification
changes in blood volume, and the blood’s oxygen saturation. requires appropriate education, clinical experience, exam-
Most vascular technologists work in hospitals, where ination, and continuing education. Certification will be a
they prepare patients for tests, take clinical histories, perform requirement of all vascular technologists working in IAC
limited physical examinations, carry out diagnostic tests, and (Intersocietal Accreditation Commission) accredited vascular
report results. They may also work in offices, clinics, or labo- laboratories beginning in 2017. Additional information on
ratories. Although most of their patients are elderly, vascular this career is available from the Society for Vascular Ultra-
studies may be required on patients of any age. sound at svunet.org.

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Cardiovascular Disorders
aneurysm A localized abnormal dilation of a blood vessel, usually an artery, caused by weakness of the
AN-u-rizm vessel wall; may eventually burst

angina pectoris A feeling of constriction around the heart or pain that may radiate to the left arm or
an-JI-nah PEK-to-ris shoulder, usually brought on by exertion; caused by insufficient blood supply to the heart

arrhythmia Any abnormality in the rate or rhythm of the heartbeat (literally “without rhythm”; note
ah-RITH-me-ah doubled r); also called dysrhythmia

arteriosclerosis Hardening (sclerosis) of the arteries, with loss of capacity and loss of elasticity, as from fatty
ar-tere-e-o-skler-O-sis deposits (plaque), deposit of calcium salts, or scar tissue formation

atherosclerosis The development of fatty, fibrous patches (plaques) in the lining of arteries, causing
ath-er-o-skler-O-sis narrowing of the lumen and hardening of the vessel wall; the most common form of
arteriosclerosis (hardening of the arteries) (root ather/o means “porridge” or “gruel”)

bradycardia A slow heart rate of less than 60 bpm

brad-e-KAR-de-ah

cerebrovascular accident (CVA) Sudden damage to the brain resulting from reduction of blood flow; causes include
ser-eh-bro-VAS-ku-lar atherosclerosis, embolism, thrombosis, or hemorrhage from a ruptured aneurysm; commonly
called stroke

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 335

Terminology Key Terms (Continued)

clubbing Enlargement of the ends of the fingers and toes caused by growth of the soft tissue around
KLUB-ing the nails (see FIG. 3-17); seen in a variety of diseases in which there is poor peripheral
circulation

coarctation of the aorta Localized narrowing of the aorta with restriction of blood flow (see FIG. 10-17E)
ko-ark-TA-shun

C-reactive protein (CRP) Protein produced during systemic inflammation, which may contribute to atherosclerosis;
high CRP levels can indicate cardiovascular disease and its prognosis

cyanosis Bluish discoloration of the skin caused by lack of oxygen in the blood (adjective: cyanotic)
si-ah-NO-sis (see FIG. 1-17)

deep vein thrombosis (DVT)

throm-BO-sis
Thrombophlebitis involving the deep veins 10
diaphoresis Profuse sweating
di-ah-fo-RE-sis

dissecting aneurysm An aneurysm in which blood enters the arterial wall and separates the layers; usually
involves the aorta (see FIG. 10-10)

dyslipidemia Disorder in serum lipid levels, which is an important factor in development of

dis-lip-ih-DE-me-ah atherosclerosis; includes hyperlipidemia (high lipids), hypercholesterolemia (high cholesterol),
and hypertriglyceridemia (high triglycerides)

dyspnea Difficult or labored breathing (-pnea)

DISP-ne-ah

edema Swelling of body tissues caused by the presence of excess fluid (see FIG. 3-2); causes include
eh-DE-mah cardiovascular disturbances, kidney failure, inflammation, and malnutrition

embolism Obstruction of a blood vessel by a blood clot or other matter carried in the circulation
EM-bo-lizm

embolus A mass carried in the circulation; usually a blood clot, but also may be air, fat, bacteria, or
EM-bo-lus other solid matter from within or from outside the body

fibrillation Spontaneous, quivering, and ineffectual contraction of muscle fibers, as in the atria or the
fih-brih-LA-shun ventricles

heart block An interference in the electrical conduction system of the heart resulting in arrhythmia (see
FIG. 10-15)

heart failure A condition caused by the inability of the heart to maintain adequate blood circulation

hemorrhoid A varicose vein in the rectum

HEM-o-royd

hypertension A condition of higher-than-normal blood pressure; essential (primary, idiopathic)

hi-per-TEN-shun hypertension has no known cause

infarct An area of localized tissue necrosis (death) resulting from a blockage or a narrowing of the
in-FARKT artery that supplies the area

ischemia Local deficiency of blood supply caused by circulatory obstruction (root: hem/o)
is-KE-me-ah

murmur An abnormal heart sound

myocardial infarction (MI) Localized necrosis (death) of cardiac muscle tissue resulting from blockage or narrowing
mi-o-KAR-de-al in-FARK-shun of the coronary artery that supplies that area; myocardial infarction is usually caused by
formation of a thrombus (clot) in a vessel

(continued)

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 336 Part II ■ Body Systems

Terminology Key Terms (Continued)

occlusion A closing off or obstruction, as of a vessel
o-KLU-zhun

patent ductus arteriosus Persistence of the ductus arteriosus after birth; the ductus arteriosus is a vessel that connects
PA-tent DUK-tus the pulmonary artery to the descending aorta in the fetus to bypass the lungs (see FIG. 10-17D)
ar-tere-e-O-sus

phlebitis Inflammation of a vein

fleh-BI-tis

plaque A patch; with regard to the cardiovascular system, a deposit of fatty material and other
Plak substances on a vessel wall that impedes blood flow and may block the vessel; atheromatous
plaque

rheumatic heart disease Damage to heart valves after infection with a type of Streptococcus (group A hemolytic
ru-MAT-ik Streptococcus); the antibodies produced in response to the infection produce valvular
scarring usually involving the mitral valve

septal defect An opening in the septum between the atria or ventricles; a common cause is persistence of
SEP-tal the foramen ovale (for-A-men o-VAL-e), an opening between the atria that bypasses the lungs
in fetal circulation (see FIG. 10-17B,C)

shock Circulatory failure resulting in an inadequate blood supply to the tissues; cardiogenic shock
is caused by heart failure; hypovolemic shock is caused by a loss of blood volume; septic
shock is caused by bacterial infection

stenosis Constriction or narrowing of an opening

steh-NO-sis

stroke See cerebrovascular accident

syncope A temporary loss of consciousness caused by inadequate blood flow to the brain; fainting
SIN-ko-pe

tachycardia An abnormally rapid heart rate, usually over 100 bpm

tak-ih-KAR-de-ah

thrombophlebitis Inflammation of a vein associated with formation of a blood clot

throm-bo-fleh-BI-tis

thrombosis Development of a blood clot within a vessel

throm-BO-sis

thrombus A blood clot that forms within a blood vessel (root: thromb/o)
THROM-bus

varicose vein A twisted and swollen vein resulting from breakdown of the valves, pooling of blood,
VAR-ih-kose and chronic dilatation of the vessel (root: varic/o); also called varix (VAR-iks) or varicosity
(var-ih-KOS-ih-te) (see FIG. 10-18)

Diagnosis and Treatment

ablation Removal or destruction. In cardiac ablation, a catheter is used to destroy a portion of the
ab-LA-shun heart’s conduction pathway to correct an arrhythmia

angioplasty A procedure that reopens a narrowed vessel and restores blood flow; commonly
AN-je-o-plas-te accomplished by surgically removing plaque, inflating a balloon within the vessel, or
installing a device (stent) to keep the vessel open (see FIGS. 10-11 to 10-13)

artificial pacemaker A battery-operated device that generates electrical impulses to regulate the heartbeat; it may
be external or implanted, may be designed to respond to need, and may have the capacity to
prevent tachycardia (see FIG. 10-16)

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 337

Terminology Key Terms (Continued)

cardiopulmonary resuscitation Restoration of cardiac output and pulmonary ventilation after cardiac arrest using artificial
(CPR) respiration and chest compression or cardiac massage
kar-de-o-PUL-mo-nar-e re-sus-ih­
TA-shun

cardioversion Correction of an abnormal cardiac rhythm; may be accomplished pharmacologically, with

KAR-de-o-ver-zhun antiarrhythmic drugs, or by application of electric current (see defibrillation)

coronary angiography Radiographic study of the coronary arteries after introduction of an opaque dye by means of
KOR-o-na-re an-je-OG-rah-fe a catheter threaded through blood vessels into the heart (see FIG. 10-11)

coronary artery bypass Surgical creation of a shunt to bypass a blocked coronary artery; the aorta is connected to

10
graft (CABG) a point past the obstruction with another vessel or a piece of another vessel, usually the left
internal mammary artery or part of the leg’s saphenous vein (see FIG. 10-14)

coronary calcium scan Method for visualizing vessel-narrowing calcium deposits in coronary arteries; useful
for diagnosing coronary artery disease in people at moderate risk or those who have
undiagnosed chest pain; also known as a heart scan

creatine kinase MB (CK-MB) Enzyme released in increased amounts from cardiac muscle cells following myocardial
KRE-ah-tin KI-naze infarction (MI); serum assays help diagnose MI and determine the extent of muscle damage

CT angiography (CTA) Computed tomography scan used to visualize vessels in the heart and other organs; requires
an-je-OG-rah-fe only a small amount of dye injected into the arm; can rule out blocked coronary arteries that
may cause a myocardial infarction (heart attack) in people with chest pain or abnormal stress
tests

defibrillation Use of an electronic device (defibrillator) to stop fibrillation by delivering a brief electric
de-fib-rih-LA-shun shock to the heart; the shock may be delivered to the surface of the chest, as by an automated
external defibrillator (AED), or directly into the heart through wire leads, using an
implantable cardioverter defibrillator (ICD)

echocardiography A noninvasive method that uses ultrasound to visualize internal cardiac structures
ek-o-kar-de-OG-rah-fe

lipoprotein A compound of protein with lipid; lipoproteins are classified according to density as very
lip-o-PRO-tene low-density (VLDL), low-density (LDL), and high-density (HDL); relatively higher levels of
HDLs have been correlated with cardiovascular health

percutaneous transluminal Dilatation of a sclerotic blood vessel by means of a balloon catheter inserted into the vessel
coronary angioplasty (PTCA) and then inflated to flatten plaque against the arterial wall (see FIG. 10-12)

stent A small metal device in the shape of a coil or slotted tube that is placed inside an artery to
keep the vessel open, for example, after balloon angioplasty (see FIG. 10-13)

stress test Evaluation of physical fitness by continuous ECG monitoring during exercise; in a thallium
stress test, a radioactive isotope of thallium is administered to trace blood flow through the
heart during exercise

troponin (Tn) A protein in muscle cells that regulates contraction; increased serum levels, primarily in the
tro-PO-nin forms TnT and TnI, indicate recent myocardial infarction (MI)

and the upper left side into the thoracic duct (left lymphatic
The Lymphatic System duct), which travels upward through the chest and empties
The lymphatic system is a widely distributed system with into the left subclavian vein near the heart (see FIG. 10-19).
multiple functions (FIG. 10-19). Its role in circulation is to The right lymphatic duct drains the body’s upper right side
return excess fluid and proteins from the tissues to the and empties into the right subclavian vein.
bloodstream. Blind-ended lymphatic capillaries pick up Another major function of the lymphatic system is to
these materials in the tissues and carry them into larger ves­ protect the body from impurities and invading microorgan­
sels (FIG. 10-20). The fluid carried in the lymphatic system is isms (see discussion of immunity in Chapter 11). Along the
called lymph. Lymph drains from the lower part of the body path of the lymphatic vessels are small masses of lymphoid

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 338 Part II ■ Body Systems

Internal jugular
veins

Right lymphatic
duct
Submandibular
node

Right lymphatic Right subclavian

duct Cervical vein
node
Brachiocephalic
veins
Axillary node Thoracic Left subclavian
Mammary vessel duct vein
Thoracic duct
Cisterna
chyli
B The lymphatic ducts

Inguinal node
Drained by
right lymphatic
duct

Femoral vessel
Drained by
thoracic duct

Popliteal node

Tibial vessel
C Body regions drained by
the lymphatic ducts

FIGURE 10-19 Vessels and nodes of the lymphatic system.

Lymphatic vessels serve almost every area in the body. Lymph nodes
are distributed along the path of the vessels. A. Lymph nodes and
vessels. B. The thoracic and right lymphatic ducts drain into the
A The lymphatic network subclavian veins. C. Body regions drained by the two lymphatic ducts.

Lymphatic Blood capillary bed

capillary
Tissue
cells

Venule

FIGURE 10-20 Lymphatic drainage in the tissues. Lymphatic

capillaries pick up fluid and proteins left in the tissues and carry them
Lymphatic vessel Arteriole back to the bloodstream.

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 339

tissue, the lymph nodes (FIG. 10-21). Their function is to filter

the lymph as it passes through. They are concentrated in the Tonsils
cervical (neck), axillary (armpit), mediastinal (chest), and
inguinal (groin) regions. Other protective organs and tissues
of the lymphatic system include the following:

■ Tonsils, located in the throat (pharynx). They filter

inhaled or swallowed materials and aid in immunity
early in life. The tonsils are further discussed in Chapter
12.
■ Thymus, in the chest, above the heart. It processes and
stimulates lymphocytes active in immunity. Thymus
■ Spleen, in the upper left region of the abdomen. It filters
blood and destroys old red blood cells.
■ Appendix, attached to the large intestine. It may aid in 10
the development of immunity.
■ Peyer patches, in the lining of the intestine. They help
protect against invading microorganisms.
Spleen
A final function of the lymphatic system is to absorb
digested fats from the small intestine (Chapter 13). These Peyer
fats are then added to the blood with the lymph that drains patches
from the thoracic duct.

Appendix
FIGURE 10-21 Location of lymphoid organs and tissue.

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Lymphatic System
Normal Structure and Function

appendix A small, finger-like mass of lymphoid tissue attached to the first part of the large intestine
ah-PEN-diks

lymph The thin, plasma-like fluid that drains from the tissues and is transported in lymphatic
Limf vessels (root: lymph/o)

lymph node A small mass of lymphoid tissue along the path of a lymphatic vessel that filters lymph (root:
lymphaden/o)

lymphatic system The system that drains fluid and proteins from the tissues and returns them to the
lim-FAT-ik bloodstream; this system also participates in immunity and aids in absorption of fats from
the digestive tract

Peyer patches Aggregates of lymphoid tissue in the lining of the intestine

PI-er

right lymphatic duct The lymphatic duct that drains fluid from the body’s upper right side

spleen A large reddish-brown organ in the upper left region of the abdomen; it filters blood and
destroys old red blood cells (root: splen/o)

(continued)

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 340 Part II ■ Body Systems

Terminology Key Terms (Continued)

thoracic duct The lymphatic duct that drains fluid from the upper left side of the body and all of the lower
body; left lymphatic duct

thymus A lymphoid organ in the upper part of the chest beneath the sternum; it functions in
THI-mus immunity (root: thym/o)

tonsil Small mass of lymphoid tissue located in region of the throat (pharynx)
TON-sil

Roots Pertaining to the Lymphatic System

See TABLE 10-3.

Table 10-3 Roots for the Lymphatic System

Root Meaning Example Definition of Example
lymph/o lymph, lymphatic system lymphoid resembling lymph or lymphatic tissue
LIM-foyd
lymphaden/o lymph node lymphadenitis inflammation of a lymph node
lim-fad-eh-NI-tis
lymphangi/o lymphatic vessel lymphangiogram x-ray image of lymphatic vessels
lim-FAN-je-o-gram
splen/o spleen splenalgia pain in the spleen
sple-NAL-je-ah
thym/o thymus athymia absence of the thymus
ah-THI-me-ah
tonsil/o tonsil tonsillar pertaining to a tonsil
TON-sil-ar

Exercise 10-3
Complete the exercise. To check your answers go to Appendix 11.

Fill in the blanks.

1. Tonsillectomy (ton-sil-EK-to-me) is surgical removal of a(n) _____________________________________________ .

2. Thymopathy (thi-MOP-ah-the) is any disease of the ___________________________________________________ .
3. Lymphadenectomy (lim-fad-eh-NEK-to-me) is surgical removal of a(n) ___________________________________ .
4. Lymphedema (limf-eh-DE-mah) means swelling caused by obstruction of the flow of _______________________ .
5. A lymphangioma (lim-fan-je-O-mah) is a tumor of ____________________________________________________ .
6. Splenic (SPLEN-ik) means pertaining to the __________________________________________________________ .

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 341

Exercise 10-3 (Continued)

Identify and define the root in the following words.

Root Definition
7. lymphangial (lim-FAN-je-al) _______________________ ________________________
8. perisplenitis (per-e-sple-NI-tis) _______________________ ________________________
9. lymphadenography (lim-fad-eh-NOG-rah-fe) _______________________ ________________________
10. tonsillectomy (ton-sil-EK-to-me) _______________________ ________________________
11. hypothymism (hi-po-THI-mizm) _______________________ ________________________

Use the appropriate root to write words with the following meanings. 10
12. Enlargement (-megaly) of the spleen _______________________ ________________________
13. Inflammation of a tonsil _______________________ ________________________
14. Any disease (-pathy) of the lymph nodes _______________________ ________________________
15. Inflammation of lymphatic vessels _______________________ ________________________
16. Pertaining to (-ic) the thymus _______________________ ________________________
17. A tumor (-oma) of lymphatic tissue _______________________ ________________________

Clinical Aspects of the vessels, called lymphangitis. Obstruction of lymphatic ves­

Lymphatic System
sels because of surgical excision or infection results in tissue
swelling, or lymphedema (BOX 10-4). Any neoplastic disease
Changes in the lymphatic system are often related to infec- involving lymph nodes is termed lymphoma. These neoplastic
tion and may consist of inflammation and enlargement disorders affect the white blood cells found in the lymphatic
of the nodes, called lymphadenitis, or inflammation of the system, and they are discussed more fully in Chapter 11.

CLINICAL PERSPECTIVES BOX 104

Lymphedema: When Lymph Stops Flowing

Fluid balance in the body requires appropriate distribution of during mastectomy, which disrupts lymph flow from the ad-
fluid among the cardiovascular system, lymphatic system, and jacent arm. Lymphedema may also occur following prostate
the tissues. Edema occurs when the balance is tipped toward surgery.
excess fluid in the tissues. Often, edema is due to heart failure. Therapies that encourage the flow of fluid through the
However, blockage of lymphatic vessels (with resulting fluid lymphatic vessels are useful in treating lymphedema. These
accumulation in the tissues) can cause another form of edema, therapies may include elevation of the affected limb, manu-
called lymphedema. The clinical hallmark of lymphedema is al lymphatic drainage through massage, light exercise, and
chronic swelling of an arm or leg, whereas heart failure usually firm wrapping of the limb to apply compression. In addition,
causes swelling of both legs. changes in daily habits can lessen the effects of lymphedema.
Lymphedema may be either primary or secondary. Prima- For example, further blockage of lymph drainage can be pre-
ry lymphedema is a rare congenital condition caused by ab- vented by wearing loose clothing and jewelry, carrying a purse
normal development of lymphatic vessels. Secondary lymph- or handbag on the unaffected arm, and not crossing the legs
edema, or acquired lymphedema, can develop as a result of when sitting. Lymphangitis requires the use of appropriate
trauma to a limb, surgery, radiation therapy, or infection of the antibiotics. Prompt treatment is necessary because in addition
lymphatic vessels (lymphangitis). One of the most common to swelling, other complications include poor wound healing,
causes of lymphedema is the removal of axillary lymph nodes skin ulcers, and increased risk of infection.

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 342 Part II ■ Body Systems

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Lymphatic Disorders
lymphadenitis Inflammation and enlargement of lymph nodes, usually as a result of infection
lim-fad-eh-NI-tis

lymphangitis Inflammation of lymphatic vessels as a result of bacterial infection; appears as painful red streaks
lim-fan-JI-tis under the skin (FIG. 10-22A)

lymphedema Swelling of tissues with lymph caused by obstruction or excision of lymphatic vessels
lim-feh-DE-mah (see FIG. 10-22B and BOX 10-4)

lymphoma Any neoplastic disease of lymphoid tissue

lim-FO-mah

A B
FIGURE 10-22 Lymphatic disorders. A. Lymphangitis is inflammation of lymphatic vessels. Note the linear red streak
proximal to a skin infection. B. Lymphedema of the upper right extremity following removal of axillary lymph nodes and
blockage of lymph flow.

Terminology Enrichment Terms

The terms listed below expand on the key terms to increase your knowledge of this chapter topic.
Normal Structure and Function
apical pulse Pulse felt or heard over the heart’s apex; it is measured in the fifth left intercostal space (between
AP-ih-kal the ribs) about 8 to 9 cm from the midline

cardiac output The amount of blood pumped from the right or left ventricle per minute

compliance The ease with which a structure expands under pressure, as in a blood vessel expanding to receive blood

Korotkoff sounds Arterial sounds heard with a stethoscope during determination of blood pressure with a cuff
ko-ROT-kof

perfusion The passage of fluid, such as blood, through an organ or tissue

per-FU-zhun

precordium The anterior region over the heart and the lower part of the thorax; adjective: precordial
pre-KOR-de-um

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 343

Terminology Enrichment Terms (Continued)

pulse pressure The difference between systolic and diastolic pressure

stroke volume The amount of blood ejected by the left ventricle with each beat

Valsalva maneuver Bearing down, as in childbirth or defecation, by attempting to exhale forcefully with the nose and
val-SAL-vah throat closed; this action has an effect on the cardiovascular system

Symptoms and Conditions

bruit An abnormal sound heard in auscultation
brwe

cardiac tamponade Pathologic accumulation of fluid in the pericardial sac; may result from pericarditis or injury to the
tam-pon-ADE heart or great vessels 10
ectopic beat A heartbeat that originates from some part of the heart other than the SA node
ek-TOP-ik

extrasystole Premature heart contraction that occurs separately from the normal beat and originates from a part
eks-trah-SIS-to-le of the heart other than the SA node

flutter Very rapid (200–300 bpm) but regular contractions, as in the atria or the ventricles

hypotension A condition of lower-than-normal blood pressure

hi-po-TEN-shun

intermittent claudication Pain in a muscle during exercise caused by inadequate blood supply; the pain disappears with rest
claw-dih-KA-shun

mitral valve prolapse Movement of the mitral valve cusps into the left atrium when the ventricles contract
PRO-laps

occlusive vascular disease Arteriosclerotic disease of the vessels, usually peripheral vessels

palpitation A sensation of abnormally rapid or irregular heartbeat

pal-pih-TA-shun

pitting edema Edema that retains the impression of a finger pressed firmly into the skin (FIG. 10-23)

(continued)

FIGURE 10-23 Pitting edema.

When the skin is pressed firmly with
the finger (A), a pit remains after the
finger is removed (B). A B

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 344 Part II ■ Body Systems

Terminology Enrichment Terms (Continued)

polyarteritis nodosa Potentially fatal collagen disease causing inflammation of small visceral arteries; symptoms depend
no-DO-sah on the organ affected

Raynaud disease A disorder characterized by abnormal constriction of peripheral vessels in the arms and legs on
ra-NO exposure to cold

regurgitation A backward flow, such as the backflow of blood through a defective valve
re-gur-jih-TA-shun

stasis Stoppage of normal flow, as of blood or urine; blood stasis may lead to dermatitis and ulcer
STA-sis formation

subacute bacterial Bacterial growth in a heart or valves previously damaged by rheumatic fever
endocarditis (SBE)

tetralogy of Fallot A combination of four congenital heart abnormalities: pulmonary artery stenosis, interventricular
fal-O septal defect, displacement of the aorta to the right, and right ventricular hypertrophy

thromboangiitis obliterans Inflammation and thrombus formation resulting in occlusion of small vessels, especially in the legs; most
common in young men and correlated with heavy smoking; thrombotic occlusion of leg vessels may lead
to gangrene of the feet; patients show a hypersensitivity to tobacco; also called Buerger disease

vegetation Irregular bacterial outgrowths on the heart valves; associated with rheumatic fever

Wolff–Parkinson–White A cardiac arrhythmia consisting of tachycardia and a premature ventricular beat caused by an
syndrome (WPW) alternative conduction pathway

Diagnosis
cardiac catheterization Passage of a catheter into the heart through a vessel to inject a contrast medium for imaging,
diagnosis, obtaining samples, or measuring pressure

central venous pressure (CVP) Pressure in the superior vena cava

cineangiocardiography The photographic recording of fluoroscopic images of the heart and large vessels using motion
sin-eh-an-je-o-kar-de-OG­ picture techniques
rah-fe

Doppler echocardiography An imaging method used to study the rate and pattern of blood flow

Holter monitor A portable device that can record from 24 hours to 1 month of an individual’s ECG readings during
normal activity

homocysteine An amino acid in the blood that at higher-than-normal levels is associated with increased risk of
ho-mo-SIS-te-ene cardiovascular disease

phlebotomist Technician who specializes in drawing blood

fleh-BOT-o-mist

phonocardiography Electronic recording of heart sounds

fo-no-kar-de-OG-rah-fe

plethysmography Measurement of changes in the size of a part based on the amount of blood contained in or passing
pleh-thiz-MOG-rah-fe through it; impedance plethysmography measures changes in electrical resistance and is used in the
diagnosis of deep vein thrombosis

pulmonary capillary wedge Pressure measured by a catheter in a branch of the pulmonary artery. It is an indirect measure of
pressure (PCWP) pressure in the left atrium (see BOX 10-2)

radionuclide heart scan Imaging of the heart after injection of a radioactive isotope; the PYP (pyrophosphate) scan using
technetium-99m (99mTc) is used to test for myocardial infarction because the isotope is taken up by
damaged tissue; the MUGA (multigated acquisition) scan gives information on heart function

Swan–Ganz catheter A cardiac catheter with a balloon at the tip that is used to measure pulmonary arterial pressure; it is
flow guided through a vein into the right side of the heart and then into the pulmonary artery

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 345

Terminology Enrichment Terms (Continued)

transesophageal Use of an ultrasound transducer placed endoscopically into the esophagus to obtain images of the
echocardiography (TEE) heart

triglyceride Simple fat that circulates in the bloodstream

tri-GLIS-er-ide

ventriculography X-ray study of the heart’s ventricles after introduction of an opaque dye by means of a catheter
ven-trik-u-LOG-rah-fe

Treatment and Surgical Procedures

atherectomy Removal of atheromatous plaque from the lining of a vessel; may be done by open surgery or

10
ath-er-EK-to-me through the vessel’s lumen

commissurotomy Surgical incision of a scarred mitral valve to increase the size of the valvular opening
kom-ih-shur-OT-o-me

embolectomy Surgical removal of an embolus

em-bo-LEK-to-me

intraaortic balloon pump A mechanical assist device that consists of an inflatable balloon pump inserted through the femoral
(IABP) artery into the thoracic aorta; it inflates during diastole to improve coronary circulation and
deflates before systole to allow blood ejection from the heart

ventricular assist device A pump that takes over a ventricle’s function in delivering blood into the pulmonary or systemic
(VAD) circuit; these devices are used to assist patients awaiting heart transplantation or those who are
recovering from heart failure; most common is a left ventricular assist device (LVAD)

Drugs
angiotensin-converting A drug that lowers blood pressure by blocking the formation of angiotensin II, a substance that
enzyme (ACE) inhibitor normally acts to increase blood pressure

angiotensin receptor A drug that blocks tissue receptors for angiotensin II; angiotensin II receptor antagonist
blocker (ARB)

antiarrhythmic agent A drug that regulates the rate and rhythm of the heartbeat

beta-adrenergic blocking Drug that decreases the rate and strength of heart contractions; beta-blocker
agent

calcium-channel blocker Drug that controls the rate and force of heart contraction by regulating calcium entrance into
the cells

Coumadin Drug that inhibits clotting by inhibiting formation of vitamin K, a factor necessary for blood
KU-mah-din coagulation. Trade name for the generic warfarin

digitalis A drug that slows and strengthens heart muscle contractions

dij-ih-TAL-is

diuretic Drug that eliminates fluid by increasing the kidney’s output of urine; lowered blood volume
di-u-RET-ik decreases the heart’s workload

heparin Substance that inhibits blood clotting by interfering with the conversion of prothrombin to
HEP-ah-rin thrombin (Chapter 11)

hypolipidemic agent Drug that lowers serum cholesterol

hi-po-lip-ih-DE-mik

lidocaine A local anesthetic that is used intravenously to treat cardiac arrhythmias

LI-do-kane

loop diuretic Drug that increases urine output by inhibiting electrolyte reabsorption in the kidney nephrons
(loops) (Chapter 14)

(continued)

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 346 Part II ■ Body Systems

Terminology Enrichment Terms (Continued)

nitroglycerin A drug used in the treatment of angina pectoris to dilate coronary vessels
ni-tro-GLIS-er-in

statins Drugs that act to lower lipids in the blood; the drug names end with -statin, such as lovastatin,
pravastatin, and atorvastatin

streptokinase (SK) An enzyme used to dissolve blood clots

strep-to-KI-nase

tissue plasminogen A drug used to dissolve blood clots; it activates production of a substance (plasmin) in the blood
activator (tPA) that normally dissolves clots

vasodilator A drug that widens blood vessels and improves blood flow
vas-o-di-LA-tor

Terminology Abbreviations
The abbreviations listed below are emphasized in this chapter. These are also found, collectively, with all chapter
abbreviations in Appendix 2.

ACE Angiotensin-converting enzyme CPR Cardiopulmonary resuscitation

AED Automated external defibrillator CRP C-reactive protein

AF Atrial fibrillation CTA Computed tomography angiography

AMI Acute myocardial infarction CVA Cerebrovascular accident

APC Atrial premature complex CVD Cardiovascular disease

AR Aortic regurgitation CVI Chronic venous insufficiency

ARB Angiotensin receptor blocker CVP Central venous pressure

AS Aortic stenosis; arteriosclerosis DOE Dyspnea on exertion

ASCVD Arteriosclerotic cardiovascular disease DVT Deep vein thrombosis

ASD Atrial septal defect ECG (EKG) Electrocardiogram, electrocardiography

ASHD Arteriosclerotic heart disease HDL High-density lipoprotein

AT Atrial tachycardia hs-CRP High-sensitivity C-reactive protein (test)

AV Atrioventricular HTN Hypertension

BBB Bundle branch block (left or right) IABP Intra-aortic balloon pump

BP Blood pressure ICD Implantable cardioverter defibrillator

bpm Beats per minute IVCD Intraventricular conduction delay

CABG Coronary artery bypass graft JVP Jugular venous pulse

CAD Coronary artery disease LAD Left anterior descending (coronary artery)

CCU Coronary/cardiac care unit LAHB Left anterior hemiblock

CHD Coronary heart disease LDL Low-density lipoprotein

CHF Congestive heart failure LV Left ventricle

CK-MB Creatine kinase MB LVAD Left ventricular assist device

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 Chapter 10 ■ Cardiovascular and Lymphatic Systems 347

Terminology Abbreviations (Continued)

LVEDP Left ventricular end-diastolic pressure PVD Peripheral vascular disease

LVH Left ventricular hypertrophy PYP Pyrophosphate (scan)

MI Myocardial infarction S1 First heart sound

mm Hg Millimeters of mercury S2 Second heart sound

MR Mitral regurgitation, reflux SA Sinoatrial

MS Mitral stenosis SBE Subacute bacterial endocarditis

MUGA Multigated acquisition (scan) SK Streptokinase

MVP Mitral valve prolapse SVT

99m
Supraventricular tachycardia
10
MVR Mitral valve replacement Tc Technetium-99m

NSR Normal sinus rhythm TEE Transesophageal echocardiography

P Pulse Tn Troponin

PAC Premature atrial contraction tPA Tissue plasminogen activator

PAP Pulmonary arterial pressure VAD Ventricular assist device

PCI Percutaneous coronary intervention VF, v fib Ventricular fibrillation

PCWP Pulmonary capillary wedge pressure VLDL Very-low-density lipoprotein

PMI Point of maximal impulse VPC Ventricular premature complex

PSVT Paroxysmal supraventricular tachycardia VSD Ventricular septal defect

PTCA Percutaneous transluminal coronary VT Ventricular tachycardia

angioplasty
VTE Venous thromboembolism
PVC Premature ventricular contraction
WPW Wolff–Parkinson–White syndrome

Case Study Revisited

Carlos’s Follow-Up pushing or pulling heavy objects, such as mowing the

Carlos was scheduled the next day for his procedure. lawn, and to stop any activity before becoming tired.
He arrived at the hospital in the morning and was taken Before his parents took him home, Carlos scheduled a
to the operating room after the nurse prepared him for follow-up appointment with the cardiologist in 1 week.
surgery. His cardiologist performed a pulmonary vein At his 1-week follow-up appointment Carlos said
catheter ablation. The procedure involved destruction he initially had some mild chest pain for 2 days follow-
of that portion of the heart’s conduction pathway that ing the surgery but that pain had since gone away. His
is involved in the arrhythmia. The surgery was unevent- procedure site had healed nicely and his ECG showed
ful with no complications and Carlos was released to normal sinus rhythm. At his extended follow-up
go home that day. He was told he might feel some appointments with the cardiologist he had no recur-
discomfort at the catheter insertion site and might also rence of the atrial fibrillation. Carlos’s pre-existing heart
experience mild chest discomfort, mild shortness of condition, however, prohibited him from performing
breath, and fatigue. Discharge instructions included required duties in the army, so he was not able to
restricted activity during the next week, including not return to boot camp. He was released from the service
lifting an object weighing more than 10 pounds, no and returned to civilian life.

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