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Circulatory (cardiovascular) system

Author: Niamh Gorman, MSc • Reviewer: Francesca Salvador, MSc Last reviewed: September 12, 2023 Reading time: 34 minutes

The circulatory system, also called cardiovascular system ,   is a vital organ system that delivers essential substances to all cells for basic functions to occur. Also commonly known as the cardiovascular system, is a network composed of the heart as a centralised pump, blood vessels that distribute blood throughout the body, and the blood itself, for transportation of different substances.

The circulatory system is divided into two separate loops: The shorter pulmonary circuit that exchanges blood between the heart and the lungs for oxygenation; and the longer systemic circuit that distributes blood throughout all other systems and tissues of the body. Both of these circuits begin and end in the heart.

This article will explain everything that is important about the circulatory system, as well as the clinical relations to it.

Pulmonary circulation

Systemic circulation, coronary circulation, portal system, shunts and anastamoses, erythrocytes (red blood cells), leukocytes (white blood cells), thrombocytes (platelets), vascular diseases, cardiac diseases, blood disorders.

The main function of the circulatory (or cardiovascular) system is to deliver oxygen to the body tissues, whilst simultaneously removing carbon dioxide produced by metabolism. Oxygen is bound to molecules called haemoglobin that are on the surface of the red blood cells in the blood.

Beginning in the heart , deoxygenated blood (containing carbon dioxide) is returned from systemic circulation to the right side of the heart . It is pumped into pulmonary circulation and is delivered to the lungs , where gas exchange occurs. The carbon dioxide is removed from the blood and replaced with oxygen. The blood is now oxygenated, and returns to the left side of the heart .

Have you already learned the basic anatomy of the heart? Test your knowledge with our heart diagrams, quizzes and worksheets.

From there, it is pumped into the systemic circuit, delivers oxygen to the tissues , and returns again to the right side of the heart . The blood also acts as an excellent transport medium for nutrients, such as electrolytes, as well as hormones. The blood also transports waste products, that are filtered from the blood in the liver.

The heart is a muscular pump that is the central component of the circulatory system. It is divided into a right and left side by a muscular septum . The muscular component of the heart, the myocardium , is composed of involuntary cardiac muscle . It is lined by a membrane called the endocardium internally, as well as an external epicardium . Contraction of the cardiac muscle cells is stimulated by electrical impulses that are sporadically fired from the regulatory centres of the heart: the sinuatrial node in the roof of the right atrium , and the atrioventricular node in the septum between the atria and the ventricles . The sinuatrial node is widely regarded as the natural pacemaker of the heart.

The heart is continuously going through a series of contractions and relaxations. Systole refers to when the ventricles of the heart simultaneously contract, diastole is when the ventricles relax. During systole, blood is forcibly pumped out of the ventricles into the outflow tracts of their corresponding circulation. The atria are filling with blood at the same time. During diastole, the ventricles are relaxed, and blood flows from the atria into the corresponding ventricles.

Deoxygenated blood from systemic circulation returns to the right atrium via the superior and inferior vena cava . The coronary sinus , returning blood from the coronary circulation, also opens into the right atrium. The blood in the right atrium flows into the right ventricle through the right atrioventricular valve ( tricuspid valve ) during diastole. During systole, the right ventricle contracts, directing the blood into the conus arteriosus at the base of the pulmonary trunk . Contraction of the ventricle causes the tricuspid valve to shut, preventing backflow of blood into the right atrium. Between the conus arteriosus and the pulmonary trunk is a valve; the pulmonary valve . In diastole, the valve closes to prevent backflow of blood into the right ventricle.  

The pulmonary trunk splits into a right and a left pulmonary artery , serving the right and left lung respectively. Deoxygenated blood flows into the capillaries of each lung, where it is then oxygenated. The pulmonary veins collect the newly oxygenated blood from the lung, and return it to the left atrium, where it will be passed into systemic circulation.

Oxygenated blood enters the left atrium from the pulmonary circulation via the pulmonary veins . During diastole, blood passes from the left atrium to the left ventricle through the left atrioventricular valve ( bicuspid valve ). In systole, the left ventricle contracts, forcing blood into the aorta . The blood passes through the false into the ascending aorta .

The ascending aorta becomes the arch of the aorta , where three large arteries branch from it: the brachiocephalic trunk , the left common carotid artery and the left subclavian artery. These arteries supply oxygenated blood to the head and neck , and to the upper limbs .

The descending aorta is the continuation of the arch of the aorta inferiorly. In the thorax it is referred to as the descending or thoracic aorta , and gives off numerous branches in the thorax.

The latter passes into the abdominal cavity through the diaphragm through the aortic hiatus at the level of T12. From there, it is referred to as the abdominal aorta . The abdominal aorta gives branches to the structures in and surrounding the abdominal cavity, and terminates by bifurcating into the common iliac arteries , which will supply the pelvic cavity and lower limbs .

The branches of the aorta passes towards their intended structures, with branching occurring along their length. The terminal branches enter the tissues, and pass towards the capillary beds of the tissues in vessels called arterioles . Gas exchange occurs between the blood and the tissues. The blood is collected from the capillaries by venules , which unite to form the veins of the systemic circulation. These veins ultimately drain to the right atrium via the superior and inferior venae cavae.

The coronary circulation refers to the blood supply to the heart  itself. It is a component of the systemic circulation . The right and left coronary arteries branch directly from the ascending aorta, immediately above the aortic valve. The right coronary artery passes to the right and gives off two main branches: the right marginal branch along the right border of the heart and the posterior interventricular ( posterior descending ) artery, which descends along the interventricular septum on the base of the heart.

Learn everything about the coronary arteries and veins with the following study unit and quiz. 

The left coronary artery passes to the left, and gives off the anterior interventricular ( Ieft anterior descending ) artery which descends on the anterior aspect of the interventricular septum to anastamose with the posterior interventricular artery at the apex of the heart. It also gives off the circumflex artery .

The venous drainage of the heart is achieved by the coronary sinus , which drains the main veins of the heart:

• the great cardiac vein ,
• the middle cardiac vein , and
• the small cardiac vein , which drains directly into the right atrium.

The portal system is the system of veins that drain the blood from the intestines and directs it to the liver to be filtered. The superior and inferior mesenteric veins , draining the jejunum  down as far as the upper rectum , along with the splenic vein draining the spleen,   pancreas , and stomach , unite to form the hepatic portal vein , which empties blood into the liver. Toxins are filtered out by the liver, and the filtered blood is returned to the inferior vena cava via the hepatic veins.

Types of blood vessels

Arteries carry blood away from the heart. They have thick walls and a narrow lumen , to resist the high pressure from the blood being forced out of the heart. As the arteries travel toward the more peripheral tissues, they begin a process of segmentation, decreasing in diameter and wall thickness with each division. The major arterial outflow tracts of the heart are the aorta (systemic), and the pulmonary trunk (pulmonary). The coronary arteries are the arteries that supply oxygenated blood to the tissues of the heart itself. 

Arteries are typically divided into three types:

• distributing arteries that transport blood to specific organ systems, with a high muscular component in their walls;
• the small and muscular resistance vessels or arterioles

Pressure in these arteries decrease from its highest level in the conducting arteries to the lowest in the arterioles. The walls of the arteries are divided into 3 layers: the tunica intima (internal), the tunica media (middle) and the tunica externa (external).

For descriptive purposes, it is easiest to describe the types of blood vessels in the sequence that they occur as they pass from the heart to the peripheral tissues, and form the peripheral tissue back to the heart.

How's your knowledge of the major arteries of the cardiovascular system? Our cardiovascular system diagrams, quizzes and free worksheets are the best way to find out. 

Types of arteries

Large elastic arteries : are the conducting arteries and examples include the aorta and its main branches; the brachiocephalic trunk, the left common carotid artery, the left subclavian artery and the terminal common iliac arteries. These carry blood from the heart to the smaller conducting arteries. The pressure in the these arteries is at the highest level of the entire circulatory system. The tunica intima is lined by endothelium and the tunica media has a large elastic component .   Muscular arteries : are the distributing arteries and contain a large proportion of smooth muscle  in their tunica media. They are lined internally by endothelium. The tunica externa is composed of fibromuscular connective tissue , with a larger proportion of elastic fibres than collagen contributing to the elasticity of this layer in the muscular arteries.

Arterioles : are the connecting vessels between the muscular arteries and capillary beds of the organs. They have small endothelial cells with nuclei projecting into the lumen of the vessel, a thin muscular wall about two layers thick, and a thin tunica externa. They control the flow of blood into the capillaries by contraction of the smooth muscle in the tunica media, which acts as a sphincter.   Capillaries : are the closest vessels to the organs. Their walls measure one large endothelial cell in thickness and provide the only barrier between the blood and the interstitial fluid of the tissues. They have a narrow lumen which is just thick enough to allow the passage of the largest blood cells. The permeability of capillaries varies depending on the surrounding tissues and the type of junctions between the adjacent endothelial cells in the vessels wall.

Types of veins 

Venules : are formed when two or more capillaries converge. They are lined by flat endothelial cells and a thin tunica externa. These are called postcapillary venules. The muscular component appears in venules as their lumen increases, producing muscular venules.   Veins : are formed with the union of muscular venules. In comparison to arteries, veins have a relatively thin wall and a larger lumen . The structure of the walls is similar to that of arteries, but a considerably smaller amount of muscle is present in the tunica media of veins. Veins are capacitance vessels , meaning they have a distensible wall and can expand to accommodate large volumes of blood.

Most peripheral veins have structures called valves , which are projections of the tunica interna into the lumen of the vessel. Valves prevent the backflow of blood through the veins, by passively closing when the direction of flow of the blood reverses. Valves are absent in the veins of the thorax and abdomen .   The overall hierarchy of blood vessels follows this order: arteries → arterioles → capillaries → venules → veins.

So now you know the types of blood vessels - but what about their histological features? Learn and test your knowledge at the same time using our blood vessels diagrams and artery and vein quizzes.  

Arteries form connections between each other called anastomoses, which creates a continuous supply of blood throughout different areas. In the event of occlusion of an artery to a specific area, blood supply can be maintained to the tissue via the anastomosis with an artery of an adjacent area.

A direct anastomosis occurs where two arteries are joined directly to each other, such as in the radial and ulnar arteries via the palmar arches. Convergence anastomoses occur where two arteries unite to form a single artery, as in when the vertebral arteries join to form the basilar artery . A transverse anastomosis is where a small artery connects two larger arteries, for example, the anterior communicating artery connecting the right and left anterior cerebral arteries .

Connections between the arterial and venous systems are present throughout the body. For example, in the mesentery , metarterioles can connect the arterioles to venules, and blood can either flow into or bypass the capillary beds. Control of this flow is by local demand of the individual tissues.

Arteriovenous anastomoses are a direct connection between small arteries and small veins. These occur in regions such as the skin of the nose, lips and ears , in the mucosa of the alimentary canal, and nasal  and oral cavities .

A portocaval anastomosis occurs where there is a connection between the systemic and portal system of veins. These occur at venous plexuses, such as around the oesophagus , the umbilicus , and the rectum.

The blood is the mobile component of the circulatory system. Blood is bright red when oxygenated and dark red/purple when deoxygenated. Blood consists of a cellular component suspended in a liquid called plasma. 

Plasma is a clear fluid that accounts for approximately 55% of blood, and is composed  of over 90% water. Plasma contains a high concentration of electrolytes , such as sodium, potassium and calcium. Also dissolved in plasma are plasma proteins . These include clotting factors, mainly prothrombin, immunoglobulin, polypeptides and other protein molecules, and hormones.

Erythrocytes are the most abundant of blood cells, accounting for approximately 99% of all blood cells. They are biconcave disc shaped cells that lack a nucleus. Erythrocytes have a globulin protein called haemoglobin on their surface for oxygen to bind to. The proportion of red blood cells to plasma is called the haematocrit . Measured as a percentage, it is used as a reference point for the oxygen carrying capacity of a person; when there is a higher percentage of red blood cells present, more haemoglobin is present to carry oxygen.

Aged erythrocytes are ingested by macrophages in the liver and spleen . The iron released in the breakdown of the erythrocytes is used to synthesise new erythrocytes, or is stored in the liver as ferritin .

Blood Grouping

Antigens are present on the surface of erythrocytes, and can react with antibodies causing agglutination of the red blood cells. This is the basis of the ABO blood grouping system . Individuals inherit two alleles, one from each parent, that code for a specific blood group. Blood groups can be homozygous , where the alleles are the same, or  heterozygous  where alleles are different:

Specific blood groups have antibodies that are sensitive to the alleles absent from their erythrocytes. For example, blood group A will carry the A antigen and the anti-B antibodies.

These are divided in 5 groups: monocytes, lymphocytes , neutrophils , basophils and eosinophils . These groups are distinguishable from each other by cell size, shape of nucleus and cytoplasm composition. These groups can themselves be grouped into 2 groups: granulocytes and agranulocytes . This classification is based on the presence or lack of granules in the cytoplasm of the cell. Collectively, white blood cells form part of the immune response .

Granulocytes

Neutrophils, eosinophils and basophils fall into this category of white blood cells. Leukocytes are classified into this group based on the presence of vesicles, called granules, in their cytoplasm. Granulocytes are largely involved in inflammatory and allergic responses .

Neutrophils : are the most abundant white blood cells, accounting for about 40-75% of all leukocytes. The number of neutrophils varies, and increases in response to acute bacterial infections. They have an irregular, segmented nucleus. They mainly function in the defence of the body against microorganisms, and can ingest foreign substances by phagocytosis . They are also involved in inflammation. Neutrophils have a short life span, spending 4-7 hours in circulation and a few days in connective tissue. 

Eosinophils : are similar to neutrophils, but are far fewer in number. Their nucleus is prominently bilobed, and the granules in the cytoplasm are large. Their motility mirrors that of other leukocytes, and they migrate from the circulation into the tissues. They increase in number in allergic reactions, and play a prominent role in the defense against parasites . They are only weakly phagocytotic, involved more so in the breakdown of particles too large for phagocytosis. The circulate for approximately 10 hours, and spend a few days in the tissues.

Basophils : are the smallest of the granulocytes. They are small in number, accounting for 0.5-1% of all leukocytes. They are distinguishable by the large, clearly visible granules in their cytoplasm. Their nucleus is irregular shaped, and sometimes bilobed, but is often obscured by the granules. The granules are membrane bound vesicles containing a variety of inflammatory agents. These vesicles herniate, dumping their contents and triggering immediate allergic hypersensitivity , such as seen in reactions like hay fever. The dumping of these agents also triggers the migration of other granulocytes to the area.

Agranulocytes

Monocytes and lymphocytes fall into this category due to the absence of granules in their cytoplasm. They are also referred to as mononuclear leukocytes, referring to the presence of a single lobed nucleus.

Monocytes : are the largest leukocytes in relation to physical size. They account for 2-8% of all leukocytes. They typically have large uni-lobed nuclei with a characteristic indentation on one side. Monocytes are phagocytic cells . Circulating monocytes transition into macrophages when they migrate from the circulation to the tissues.

Lymphocytes : are the second most abundant leukocyte, accounting for 20-30%. They are the only white blood cell that can re-enter circulation having migrated to the tissues. They are variable in size and lifespan: some live merely days, others are long-lived, and are involved in immunological memory . Lymphocytes are divided into two types: B-lymphocytes and T-lymphocytes.

B-lymphocytes synthesize and secrete antibodies specific to foreign molecules. They also stimulate other non-lymphocytic leukocytes to phagocytose. B-lymphocytes are involved in adaptive immunity , and produce memory B cells, which remain in the body and are activated in response to a specific antigen. 

T-lymphocytes develop and mature in the thymus , then migrate to and are stored in secondary lymphoid organs. They are involved in the ongoing immunity of the cell, with their function not solely dependent on the response to an antigen. T-lymphocytes are divided into three subgroups. Cytotoxic T cells directly target infected cells; Helper T cells direct destruction by recruitment of other immune cells; and Regulatory T cells are involved in developing the tolerance of cells to an antigen.

Platelets are small, irregular shaped cells that lack a nucleus. They are present in large numbers and have highly adhesive properties. Platelets are highly involved in haemostasis . They are activated in the event of damage to a blood vessel. They accumulate at the site of injury and essentially plug the wound. Following adherence at the site of injury, platelets and the surrounding tissues release factors that trigger a complex sequence of events. A clot is formed to close the wound. The clot is then retracted and the edges of the wound are pulled together to close it and repair the vessel. Platelets circulate in the blood for approximately 10 days, before they are removed from the blood by macrophages .

Want some practice identifying blood cells? Then try the quiz below!

Clinical notes

Diseases affecting the cardiovascular system are collectively referred to as cardiovascular diseases. Vascular diseases relate to the blood vessels. Cardiac diseases affect the heart itself. Hematologic diseases are those of the blood. Diseases of the cardiovascular system can be congenital (present since birth) or acquired (related to age, diet, lifestyle and predisposition). 

Arteriosclerosis is the thickening of the walls of arteries, reducing function. Atherosclerosis is a specific form of arteriosclerosis, where plaque builds up on the endothelium of arteries, causing them to narrow and reducing oxygen delivery to the tissues. 

Coronary artery disease occurs in the arteries supplying the heart itself, with narrowing of the coronary arteries causing reduced oxygen delivery to the heart tissue. This can result in a condition called angina , which is essentially spasming of the coronary arteries due to reduced blood flow. Myocardial Infarction (heart attack) is also caused by the narrowing of the coronary arteries due to atherosclerosis. A myocardial infarction occurs when the artery becomes completely occluded due to dislodged plaque or development of a thrombus (blood clot). 

Cerebrovascular disease affects the arteries supplying the brain . One of the most common presentations is ischemic stroke , which is also caused by atherosclerosis. Ischemic stroke results in a reduced blood flow to brain regions, leading to impaired brain function. It can be caused by the development of a thrombus or the passing of an embolus (blockage causing substance) from another region of the body to the cerebral circulation.

Peripheral artery disease is reduced blood flow to the limbs due to atherosclerosis. 

An aneurysm is a localised weakening in the wall of a blood vessel. It can result in bulging of the vessel wall. Thrombus formation and embolisation can also occur. Aneurysms can rupture, leading to significant blood loss depending on where they occur. Particularly lethal sites of aneurysm formation are in the abdominal aorta, the circle of Willis in cerebral circulation, and in the renal vessels. 

Varices occur where blood vessels become enlarged and twisted. They can occur at multiple sites in the body. One of the most prominent sites of varices is in the veins of legs, termed varicose veins. Other common sites of varices are at sites of portocaval anastamoses, such as esophageal varices, umbilical varices (caput medusae) and anorectal varices (hemorrhoids or piles).

Cardiovascular diseases can also solely affect the heart. Cardiomyopathy is a collection of diseases that affects the heart muscle. The muscle can become enlarged (hypertrophic) and rigid, causing decreased heart function, arrhythmias (irregular heart rate), and sometimes even heart failure .

The valves of the heart can also be affected by disease. There are two main types: valve incompetence , in which the valve is unable to function sufficiently; and valve stenosis , where the orifice between the valve narrows as the valve is unable to open fully. Mitral valve disease affects the mitral valve that lies between the left atrium and ventricle. It is normally caused by a combination of valve incompetence and stenosis. Aortic valve disease affects the aortic valve, and is largely caused by stenosis of the valve with contribution from regurgitation, which is backflow through the valve. 

Inflammation of the heart tissues can also occur. It includes inflammation of the inner endocardium ( endocarditis ) and the middle muscular layer ( myocarditis ). Pericarditis is the inflammation of the pericardium , which comprises the outer layer of the heart itself and the pericardial sac which encloses the heart in the thoracic cavity.

Congenital heart diseases

Congenital heart diseases are those which have been present since birth. They are largely present as left to right shunts , where blood is shunted from areas of higher pressure to areas of lower pressure. Oxygenated blood is passed back to the right side of the heart and mixed with deoxygenated blood. Such shunts can go unnoticed in a number of patients, while others may require surgical intervention.

An atrial septal defect occurs when blood is shunted from the left atrium (higher pressure) to the right atrium (lower pressure) through an opening in the  interatrial septum . This opening usually results from the failure of an embryological shunt, the foramen ovale, to close after birth. This defect is specifically referred to as a patent foramen ovale . A ventriculoseptal defect is when an opening in the interventricular septum allows blood to pass from the left ventricle into the right ventricle.

Another embryological shunt exists near the heart in the embryo, shunting blood from the pulmonary trunk into the aorta. This is called the ductus arteriosus , and pressure changes after birth usually force this opening to shut. A patent ductus arteriosus occurs when the ductus does not close after birth, and allows blood to flow from the higher pressure arch of the aorta into the lower pressure pulmonary trunk.

These are disorders affecting the components of the blood. They can largely be divided depending on which of the blood cells they affect. 

Anemia is a blood disorder affecting red blood cells . Patients suffering with anemia have a decreased oxygen carrying capacity due to a decrease in the number of red blood cells, or a reduced amount of haemoglobin in the blood. There are multiple different types of anemia, some of which are the following:

• Iron deficient anemia is the most common form of anemia. It is the result of insufficient intake of iron, an increase in the amount of iron lost, or inadequate absorption of iron. Women are more likely to be affected by this from of anemia due to menstruation and the higher demands of iron placed on their body during pregnancy.
• Megaloblastic anemia is caused by a decrease in the intake or absorption of vitamin B12 or folic acid. This results in the production of large, insufficient red blood cells.
• Perniciou s anemia is the result of insufficient hemopoiesis, or production  of red blood cells by bone marrow.
• Hemorrhagi c anemia is caused by loss of red blood cells through excessive bleeding.
• Aplasti c anemia occurs due to the destruction of red bone marrow , which leads to a reduction in the number of red blood cells being produced.
• Sickl e cell anemia is a condition in which the shape of the red blood cells is altered into a sickle shape. These cells cannot easily pass through capillaries and tend to clump together, blocking the blood vessel. They are also prone to rupturing, with their rapid break down resulting in a reduced oxygen carrying capacity.

Leukemia refers to a group of cancers affecting the red bone marrow . Theses cancers cause abnormal white blood cells to multiply uncontrollably, which interferes with normal red blood cell, white blood cell and platelet production. This results in a decrease in oxygen carrying capacity, susceptibility to infection, and abnormal clotting. Leukemia spreads easily from the bone marrow to the lymph nodes , liver and spleen, causing them to enlarge. Symptoms are caused mainly by disruption to the production of other blood cells, including fatigue, pale skin and cold intolerance that is usually observed in anemia.

There are two methods of classification of leukemia. The first is based on the presentation of the disease: Acute leukemia refers to those that have developed rapidly; Chronic leukemia develops over an extended period of time. The second classification is based on the type of cells affected: Lymphoblastic affects lymphoid stem cells; Myelogenous affects myeloid stem cells. Thus, there are four types of leukemia:

• Acute lymphoblastic leukemia is the most common form of the disease occurring in children, though it can also affect adults as well.
• Acute myelogenous leukemia is found in both adults and children.
• Chroni c lymphoblastic leukemia is usually present in adults, especially those over the age of 55.
• Chronic myelogenous leukemia usually affects adults.

Treatment of leukemia involves methods such as chemotherapy, radiation therapy, stem cell transplantation and blood transfusion among others.

Thrombocytopenia

This is a disorder of the thrombocytes , or platelets. It results in a low number of platelets in the blood. Patients with this disorder are prone to excessive bleeding and may experience frequent nose bleeds or bleeding gums, as well as excessive bruising. 

This is an inherited blood disorder that causes spontaneous bleeding or bleeding where only minor trauma has occurred. It is caused by deficiencies of different clotting factors and can vary significantly in severity.

Reference List:

• F. Netter: Atlas of Human Anatomy, 6th Edition, Elsevier Saunders (2014).
• G.J. Tortora, B. Derrickson: Principles of Anatomy & Physiology, 13th Edition, Wiley (2012).
• J.A. Gosling, P.F. Harris, J.R. Humpherson et al.: Human Anatomy, Colour Atlas and Textbook, 5th Edition, Mosby Elsevier (2008).
• M.H Ross, W. Pawlina: Histology: A Text and Atlas, Wolters Kluwer, 7th Edition (2016).
• R. Drake, A.W. Vogl, A.W.M. Mitchell: Gray’s Anatomy for Students, 3rd Edition, Churchill Livingston Elsevier (2015).

Illustrators:

• Overview of the heart in situ (ventral view) - Yousun Koh
• Aortic arch (ventral view) - Yousun Koh
• Overview of coronary arteries and cardiac veins - Yousun Koh
• Anastamosis between superior mesenteric artery and inferior pancreatic artery (ventral view) - Esther Gollan
• Coronary circulation in a cadaver - Prof. Carlos Suárez-Quian

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• Biology Article
• Human Circulatory System Transportation

Human Circulatory System

The human body is a complex machine, requiring many processes to function efficiently. To keep these crucial processes running without any hitches, vital elements and components need to be delivered to the various parts of the body.

This role of transportation is undertaken by the human circulatory system, moving essential nutrients and minerals throughout the body and metabolic waste products away from the body. Below is a neat labelled  Circulatory system diagram.

Read more:  Human Body Anatomy

Read on to explore intricate about the human circulatory system and its components in greater detail.

Table of Contents

Double Circulation

• Blood Cells

Blood Vessels

Lymphatic system, human circulatory system diagram.

The human circulatory system consists of a network of arteries, veins, and capillaries, with the heart pumping blood through it. Its primary role is to provide essential nutrients, minerals, and hormones to various parts of the body. Alternatively, the circulatory system is also responsible for collecting metabolic waste and toxins from the cells and tissues to be purified or expelled from the body.

Features of Circulatory System

The crucial features of the human circulatory system are as follows:

• The human circulatory system consists of blood, heart, blood vessels, and lymph.
• The human circulatory system circulates blood through two loops (double circulation) – One for oxygenated blood, another for deoxygenated blood.
• The human heart consists of four chambers – two ventricles and two auricles.
• The human circulatory system possesses a body-wide network of blood vessels. These comprise arteries, veins, and capillaries.
• The primary function of blood vessels is to transport oxygenated blood and nutrients to all parts of the body. It is also tasked with collecting metabolic wastes to be expelled from the body.
• Most circulatory system diagrams do not visually represent its sheer length. Theoretically, if the veins, arteries, and capillaries of a human were laid out, end to end, it would span a total distance of 1,00,000 kilometres (or roughly eight times the diameter of the Earth).

Organs of Circulatory System

The human circulatory system comprises 4 main organs that have specific roles and functions. The vital circulatory system organs include:

• Blood (technically, blood is considered a tissue and not an organ)
• Lymphatic system

The heart is a muscular organ located in the chest cavity, right between the lungs. It is positioned slightly towards the left in the thoracic region and is enveloped by the pericardium. The human heart is separated into four chambers; namely, two upper chambers called atria ( singular: atrium ), and two lower chambers called ventricles.

Heart, a major part of the human circulatory system

Though other animals possess a heart, the way their circulatory system functions is quite different from humans. Moreover, in some cases, the human circulatory system is much more evolved when compared to insects or molluscs.

Read More:   Human Heart

The way blood flows in the human body is unique, and it is quite efficient too. The blood circulates through the heart twice, hence, it is called double circulation. Other animals like fish have single circulation, where blood completes a circuit through the entire animal only once.

The main advantage of double circulation is that every tissue in the body has a steady supply of oxygenated blood, and it does not get mixed with the deoxygenated blood.

Further Reading: Double circulation

Circulation of blood in humans – Double circulation

Blood is the body’s fluid connective tissue, and it forms a vital part of the human circulatory system. Its main function is to circulate nutrients, hormones, minerals and other essential components to different parts of the body. Blood flows through a specified set of pathways called blood vessels. The organ which is involved in pumping blood to different body parts is the heart.  Blood cells, blood plasma, proteins, and other mineral components (such as sodium, potassium and calcium) constitute human blood.

Blood is composed of:

• Plasma  – the fluid part of the blood and is composed of  90%  of water.
• Red blood cells, white blood cells and platelets constitute the solid part of blood.

Types of Blood Cells

The human body consists of three types of blood cells, namely:

• Red blood cells (RBC) / Erythrocytes

Red blood cells are mainly involved in transporting oxygen, nutrients, and other substances to various parts of the body. These blood cells also remove waste from the body.

• White blood cells (WBC) / Leukocytes

White blood cells are specialized cells, which function as a body’s defence system. They provide immunity by fending off pathogens and harmful microorganisms.

• Platelets / Thrombocytes

Platelets are cells that help to form clots and stop bleeding. They act on the site of an injury or a wound.

Blood vessels are a network of pathways through which blood travels throughout the body.  Arteries and veins are the two primary types of blood vessels in the circulatory system of the body.

Arteries are blood vessels that transport oxygenated blood from the heart to various parts of the body. They are thick, elastic and are divided into a small network of blood vessels called capillaries. The only exception to this is the pulmonary arteries, which carries deoxygenated blood to the lungs.

Veins are blood vessels that carry deoxygenated blood towards the heart from various parts of the body.  They are thin, elastic and are present closer to the surface of the skin. However, pulmonary and umbilical veins are the only veins that carry oxygenated blood in the entire body.

Also Read:  Blood

The human circulatory system consists of another body fluid called lymph. It is also known as tissue fluid. It is produced by the lymphatic system which comprises a network of interconnected organs, nodes and ducts.

Lymph is a colourless fluid consisting of salts, proteins, water, which transport and circulates digested food and absorbed fat to intercellular spaces in the tissues. Unlike the circulatory system, lymph is not pumped; instead, it passively flows through a network of vessels.

Functions of Circulatory System

The most important function of the circulatory system is transporting oxygen throughout the body. The other vital functions of the human circulatory system are as follows:

• It helps in sustaining all the organ systems.
• It transports blood, nutrients, oxygen, carbon dioxide and hormones throughout the body.
• It protects cells from pathogens.
• It acts as an interface for cell-to-cell interaction.
• The substances present in the blood help repair the damaged tissue.

Explore More: Circulatory System

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Chapter 8:  The Cardiovascular System

Jonathon W. Homeister; Karen L. Kelly

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Introduction, normal anatomy of blood vessels.

• DISEASES OF THE VASCULAR SYSTEM
• CONGENITAL HEART DISEASE
• CARDIOMYOPATHIES
• VALVULAR HEART DISEASE
• CARDIAC TUMORS
• PERICARDIAL DISEASES
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The heart is at the center of the cardiovascular system. The left side of the heart pumps blood oxygenated in the lungs through the aorta, arteries, arterioles, and capillaries, to the organs of the body. The organ tissues extract oxygen and nutrients from the blood in the capillaries, in exchange for carbon dioxide and waste products. The deoxygenated blood is returned to the right side of the heart through venules, veins, and the venae cavae. The right side of the heart pumps the blood through the lungs where it is again oxygenated, and back to the left side of the heart. Blood moves through this system due to pressure gradients and unidirectional valves, similar to a household plumbing system. However, unlike the static household system, the living components of our cardiovascular system are dynamic, adjusting pressure and flow to regulate blood flow and delivery to the organs of the body as dictated by physiologic need to maintain organ function and homeostasis.

This chapter covers the pathology of the tissues and organs of the cardiovascular system. The first part of the chapter discusses vascular diseases, and the second part focuses on diseases of the heart and its structures, although, as you will see, they are sometimes intertwined. Like other organ systems, diseases of this system can be either congenital or acquired. Like all organ systems, the various etiologies of these diseases can be put into general categories that physicians remember by using the mnemonic VINDICATE: vascular, infectious, neoplastic degenerative, iatrogenic/intoxication, congenital, autoimmune, traumatic, and endocrine/metabolic. You will see one or more of these etiologies causing the pathogenesis of the diseases discussed. This chapter focuses primarily on diseases of the heart and arterial system. Diseases of the venous system are not directly discussed, nor are diseases of the lymphatic system. Diseases of the pulmonary vascular system will be discussed in Chapter 9.

Blood vessels consist of arteries and veins that are categorized according to their structure, size, and function (Figure 8-1) . The arterial system carries oxygenated blood away from the heart to provide oxygen and nutrients to the cells of the body. It also modulates peripheral resistance and therefore is responsible for maintaining blood pressure. In the organs, the capillary system is responsible for the exchange of oxygen and nutrients, and waste products. The venous system carries the deoxygenated blood with its waste products back to the heart for transport to the lungs for oxygen replenishment.

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Case Study – A Tiny Heart (old version)

This case study was revised in 2023, get the NEW VERSION !

This case study focuses on a baby boy who was born with a problem with his heart.  The story is based on a real scenario, though some of the names have been changed, and the parents gave permission to include photos of the infant.

Students will read about symptoms that occur when a baby is born with stenosis, or a narrowing of the artery.   Students consider treatment options and compare the circulation of a fetus to that of an adult.   Finally, the Ross Procedure is described where a valve from the pulmonary artery is moved to the aorta.

This case study was made for a high school anatomy class, and may not be appropriate for younger audiences.  Students should have already completed the chapter on the circulatory system and have a strong foundation in how the circulatory system works.  Case studies are designed to be completed in small groups so that students can have discussions and help each other with difficult vocabulary.

HS-LS1-2 Develop and use a model to illustrate the hierarchical organization of interacting systems that provide specific functions within multicellular organisms

Shannan Muskopf

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Case 6 - Woman with Ischemic Heart Disease Admitted due to Chest Pain and Shock

Rafael amorim belo nunes.

Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, SP - Brazil

Hilda Sara Montero Ramirez

Vera demarchi aiello.

A 67-year-old woman sought emergency medical care due to prolonged chest pain. In April 2009 the patient had prolonged chest pain and at that time she sought medical care. She was admitted at the hospital and diagnosed with myocardial infarction.

The patient had hypertension, diabetes mellitus, dyslipidemia and was a smoker.

During the patient's evolution, after the myocardial infarction, she was submitted to a coronary angiography in, which disclosed the presence of lesions with 70% obstruction in the right coronary, anterior descending and circumflex arteries. A left ventriculography revealed apical akinesia with signs of intracavitary thrombus in that region.

The echocardiogram (May 2009) disclosed ventricular dysfunction accentuated by diffuse hypokinesis, with a 28% left ventricular ejection fraction. Clinical and drug treatment was recommended to the patient.

The patient's evolution was asymptomatic until October 2009, when she had a cerebrovascular accident, with motor sequela.

On December 30, 2009, the patient had an episode of severe chest pain that lasted for one hour and she sought medical care.

At the physical examination, the heart rate (HR) was 100 beats per minute, blood pressure was 100/60 mmHg. Pulmonary assessment was normal. The heart examination disclosed a ++/ 6+ systolic murmur in the mitral area. The remainder of the physical examination was normal. The electrocardiogram (1h 19 min; Dec 30, 2009) showed sinus rhythm, HR of 103 bpm, PR interval of 122 ms, QRS duration of 159 ms, QT interval of 367 ms, and corrected QT of 480 ms.

There was left atrial overload, low voltage of the QRS complex in the frontal plane, probable inferior electrically inactive area, and left bundle branch block ( Figure 1 ). Chest x-ray disclosed the presence of a large pleural effusion in the right hemithorax.

Electrocardiogram - Sinus rhythm, low voltage of the QRS complex in the frontal plane, electrically inactive area in the inferior wall and left bundle branch block.

The laboratory tests showed hemoglobin 13 g/dL, hematocrit 40%, MCV 91 fL, leukocytes 12,400/mm 3 (66% neutrophils, 1% eosinophils, 1% basophils, 19% lymphocytes and 13% monocytes), 421,000/mm 3 , total cholesterol 228 mg/dL, HDL-cholesterol 35 mg / dL, LDL-cholesterol 162 mg/dL, triglycerides 157 mg/dL, CK-MB mass 5.63 ng / mL, Troponin I 0.21 ng/mL, urea 33 mg/dL, creatinine 0.66 mg/dL, sodium 137 mEq/L, and potassium 3.4 mEq/L. Venous blood gasometry showed pH 7.46, pCO 2 39.3 mmHg, pO 2 36.3 mmHg, O 2 saturation 62.7%, bicarbonate 27.7 mEq/L and base excess 4.1 mEq/L.

Approximately two hours after hospital admission, she had seizures and cardiac arrest with pulseless electrical activity, reversed in 5 min.

The electrocardiogram after the cardiac arrest (4:18 am; Dec 30, 2009) showed a HR of 64 bpm, absence of P waves, and left bundle branch block. The QRS complex alteration, in relation to the previous tracing, was a positive QRS complex in the V6 lead ( Figure 2 ).

Electrocardiogram - Sinus rhythm, left bundle branch block and positive T waves on an also positive derivative of the QRS complex.

She had a new cardiac arrest 20 min later, which was also reversed. After half an hour, a new episode of cardiac arrest occurred, which was irreversible, and the patient died (5:45 am; Dec 30, 2009).

Clinical aspects

This patient is a 67-year-old woman with cardiovascular risk factors and ischemic cardiomyopathy, with severe left ventricular systolic dysfunction. Cardiac catheterization disclosed multivessel coronary disease and apical akinesis with an intracavitary thrombus. During outpatient follow-up, clinical treatment was chosen, possibly influenced by the patient's clinical status, as well as the characteristics of the coronary anatomy.

The indication of surgical treatment with myocardial revascularization in patients with coronary heart disease with heart failure and severe left ventricular systolic dysfunction is still debatable, but recent data from the STICH study suggest a long-term survival benefit in patients undergoing myocardial revascularization. 1

During follow-up in October 2009, the patient had a clinical picture suggestive of a cerebrovascular accident that may have been of atherothrombotic origin due to the multiple cardiovascular risk factors or of cardioembolic origin, associated with intracavitary thrombi.

In December 2009 the patient was admitted to the emergency room with acute chest pain. She had mild tachycardia and borderline systolic blood pressure of 100 mmHg. The electrocardiogram showed sinus tachycardia, left atrial overload and left bundle branch block.

In patients with acute chest pain and electrocardiogram with acute or undetermined left bundle branch block, the possibility of acute myocardial infarction should be considered, especially in case of hemodynamic instability. Criteria such as those proposed by Sgarbossa et al., 2 and Smith et al., 3 modified by other authors can contribute to the diagnostic accuracy improvement in this context. 2 , 3 However, one should consider that the occurrence of left bundle branch block is more commonly a marker of previous structural heart disease.

The patient had a cardiorespiratory arrest with pulseless electrical activity (PEA) within a short time after hospital admission. In cases of acute myocardial infarction, PEA can occur in patients with severe ventricular dysfunction and cardiogenic shock and/or mechanical complications such as rupture of the left ventricular free wall with cardiac tamponade, papillary muscle rupture and / or severe dysfunction and acute interventricular septal defect.

Other conditions should be considered in patients with acute chest pain who present with rapid clinical deterioration such as aortic dissection and pulmonary thromboembolism. The chest x-ray showed a massive pleural effusion in the right hemithorax, although this finding was not readily apparent at the physical examination. In this patient, pleural effusion may be due to chronic heart failure decompensation but may also be associated with other conditions, such as rheumatologic diseases, tuberculosis or pleural carcinomatosis due to neoplasias. The last two conditions mentioned here are not uncommon in patients with chronic heart diseases.

Additionally, massive pleural effusions may coexist, in some conditions, with pericardial involvement and consequent cardiac tamponade. 4 Pleural effusion may also be present in patients with acute aortopathies, such as dissection of the aorta and aortic ulcer with associated rupture, but usually the most frequent effusion is located in the left pleural space as a consequence of the aortic anatomy. (Dr. Hilda Sara Montero Ramirez)

Main hypothesis: Acute myocardial infarction complicated by cardiogenic shock. ( Dr. Hilda Sara Montero Ramirez )

Differential diagnoses: Cardiac tamponade, Pulmonary thromboembolism and Dissection of the aorta. ( Dr. Hilda Sara Montero Ramirez )

The heart weighed 422 g and showed increased volume, with cross-sections (short axis of the ventricles) disclosing a healed transmural myocardial infarction in the left ventricular anterior and septal walls. There was wall thinning and fibrosis, with antero-apical aneurysm and thrombus at the apex ( Figure 3 ). Signs of a previous systemic thromboembolism, with previous renal and cerebral infarctions were also found, with the latter being a cavitated infarction affecting the temporal and occipital regions of the left cerebral hemisphere.

Cross-sections of the heart at the level of the ventricles (short axis) showing previous transmural infarctions in the anterior and septal walls (arrows). These same places show thinning of the wall and, localized slight dilatation (aneurysm). There is also a cavitary thrombus in the ventricular apex (asterisk).

The aorta and coronary arteries showed marked atherosclerotic involvement, with ulcerated plaques in the aorta and obstructions > 70% in the initial and middle thirds of the anterior interventricular branch of the left coronary artery and between 50 and 70% in the circumflex branch of the same artery and in the right coronary artery. Signs of congestive heart failure were found in the lungs and liver.

The terminal cause of death was pulmonary thromboembolism on the right, with infarction organization at the pulmonary base ( Figure 4 ). The right pleura showed fibrin deposits and the histological analysis showed acute fibrinous pleuritis ( Figure 5 ). There was also pleural effusion on the right (500mL of citrine-colored fluid) ( Prof. Dr. Vera D. Aiello ).

Right lung cross-section at its long axis showing the presence of thromboembolism in the central branch of the pulmonary artery (arrow). At the base, there are two triangular areas (asterisks) where the parenchyma is homogeneous and reddish in color, corresponding to recent pulmonary infarctions.

Photomicrography of the right pleura showing neutrophilic exudate on the surface (asterisk), characterizing acute pleuritis. Hematoxylin-eosin staining, objective magnification = 10X.

Anatomopathological diagnoses

• - Ischemic heart disease with healed transmural infarctions in the anterior wall and ventricular septum and anteroseptal aneurysm.
• - Apical thrombus in the left ventricle.
• - Systemic and coronary atherosclerosis of moderate to high degree.
• - Previous infarctions in the kidneys and in the temporal and occipital cortex of the left cerebral hemisphere.
• - Pulmonary thromboembolism on the right, with recent pulmonary infarction.
• - Acute fibrinous pleuritis on the right, with pleural effusion (500mL) ( Prof. Dr. Vera D. Aiello )

The patient described herein sought emergency care with chest pain and was known to have ischemic heart disease. The clinical investigation for acute infarction was inconclusive and the patient died less than 24 hours after hospital admission.

Necropsy showed previous infarctions and signs of congestive heart failure. We found no evidence of a recent infarction and attributed the chest pain to the finding of a recent pulmonary thromboembolism on the right, with pulmonary infarction and acute fibrinous pleuritis.

In a study carried out at our institution, which assessed the agreement between clinical diagnoses and necropsy findings, the greatest discrepancy occurred in cases of pulmonary thromboembolism (34.1%). 5 ( Prof. Dr. Vera Demarchi Aiello )

Section Editor: Alfredo José Mansur ( rb.psu.rocni@rusnamja )

Associated Editors: Desidério Favarato ( rb.psu.rocni@otaravaflcd ) Vera Demarchi Aiello ( rb.psu.rocni@arevpna )

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Pathophysiology: The Cardiovascular System

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CASE STUDY 1: ACUTE ANTEROLATERAL MYOCARDIAL INFARCTION

Present illness.

Patient A is white, 60 years of age, and works as a cab driver. While driving home after work, he develops an aching in his chest and slight, regular palpitations. The ache is still present when he goes to bed, when he wakes several times during the night, and when he gets up in the morning, seven hours after retiring. He drinks some soda water, but when the aching does not improve, he decides to go to the emergency department.

At the hospital, Patient A complains of chest pain accompanied by diaphoresis, slight shortness of breath, and nausea. Relief of pain is obtained with IV morphine sulfate. When the patient is admitted to the critical care unit (CCU), his symptoms are generally unremarkable except for recurrent pain.

Medical History

Patient A experienced the usual childhood illnesses without rheumatic fever. As an adult, he has a history of hypertension (documented on discharge from the Army at 45 years of age and when hospitalized two years ago) that has not been treated. Past surgery includes tonsillectomy and adenoidectomy as a child. A cataract was removed from his right eye two years ago.

Patient A's father died of an MI at 55 years of age. His mother is alive and well, although the patient does not know her age. Two brothers, 65 and 58 years of age, are alive and well. The patient lives alone and works approximately 72 hours per week. He has been married and divorced twice; the last divorce was four years ago. He has no children.

Assessment and Diagnosis

Upon admittance to the CCU, a full physical exam is conducted ( Table 4 ). An ECG is done and shows ST elevation. Several laboratory tests are ordered, with the following results:

Serum cardiac enzymes:

CK: 164 IU/L

LDH: 219 IU/L

Serum glutamic-oxaloacetic transaminase (SGOT): 31 IU/L

CBC: Within normal limits

Electrolytes: Within normal limits

Urinalysis: Within normal limits

PATIENT A'S PHYSICAL EXAM RESULTS

Parameter

Findings

General appearance

White male in mild distress, appears his stated age Height: 5 feet 9 inches (176 cm) Weight: 195 pounds (88.5 kg) Normocephalic Left pupil briskly reactive to light Phacotomy scar on right pupil Optic fundi show sharp disks with narrow arteries, no hemorrhages or exudates Supple, without masses or thyromegaly Jugular venous pulse not visualized Without masses, tenderness, or splenomegaly Liver palpated at rib border Bowel sounds normal Oriented to person, place, and time Cranial nerves II–XII grossly intact Deep tendon reflexes 2+ with symmetrical flexor plantar responses Motor and sensory grossly normal Based on the results of the assessment, Patient A is diagnosed with: Acute anterolateral MI, generally uncomplicated Atherosclerotic cardiovascular disease Hypertension: Untreated for 15 years, probably essential hypertension given age at onset Patient A's vital signs are stable for the remainder of the day, with a sinus bradycardia of 56 bpm. Early in the morning the next day, the patient awakes with nausea and diaphoresis. His blood pressure has decreased to 90/60 mm Hg with sinus bradycardia of 40 bpm. PVCs are present. The patient is treated with 0.5 mg IV atropine sulfate twice, after which his heart rate increases to 70 bpm and his blood pressure increases to 130/68 mm Hg. Unifocal PVCs are then treated with 150 mg of amiodarone IV over 10 minutes followed by an amiodarone drip at 1 mg/minute for 6 hours, then 0.5 mg/minute for 12 hours. Later in the day, Patient A's vital signs are: Blood pressure: 130/90 mm Hg Temperature: 98.4° F Heart rate: 60 bpm Respiratory rate: 18 breaths per minute The patient has no further chest pain, but he reports that his nausea persists after meals. Two days later, Patient A's LDH value rises to 310 IU/L; other enzyme levels remain essentially the same as the admission values. ECG shows ST elevation diminishing from previous levels. The amiodarone is discontinued without return of the PVCs. His vital signs remain stable, no further arrhythmias are noted, and his nausea is resolved. On day three, Patient A is moved out of the CCU and started on cardiac rehabilitation. On day four, a treadmill test is done at 50% effort with negative results. Patient A is discharged on day seven. The medical plan is to continue treatment of his hypertension with propranolol. The patient plans to return to driving his cab, but for fewer hours per week. Study Questions List Patient A's major risk factors for CHD and discuss other possible risk factors for heart disease. Discuss the pathophysiology of CHD and the signs and symptoms (i.e., classic physical exam findings) exhibited by the acutely ill patient during an MI. What are the common complications post-infarction? What patient history points indicate the diagnosis of MI in Patient A's case? Correlate the pathology, complications, and nursing care for a patient with MI with the patent's progress from the CCU to home. Review the action, side effects, and specific nursing care for the drugs commonly used in the treatment of patients with MI, including: Analgesics (e.g., morphine) Sedatives (e.g., phenobarbital) Antianxiety medications (e.g., diazepam) Anticoagulants (e.g., heparin) Laxatives/stool softeners Vasopressors (e.g., norepinephrine) Vasodilators (e.g., nitroglycerin) Diuretics (e.g., furosemide) Cardiotonics (e.g., digoxin) Cardiac stimulants (e.g., epinephrine, isoproterenol) Cardiac depressants (e.g., amiodarone) Antilipidemic drugs (e.g., atorvastatin) Describe the treatment for MI. What diagnostic tests usually confirm an MI? Nursing care of the patient with MI is directed toward detecting complications, preventing further myocardial damage, and promoting comfort, rest, and emotional well-being. Discuss the specific care needs for each situation listed below: On admission to the CCU During episodes of chest pain Fluid retention Elimination Exercise and immobility Psychologic stress Patient teaching and discharge planning for a cardiac rehabilitation program Psychologic support is imperative for the well-being of the patient with MI. Discuss the patient's potential anxieties and fears and the best means to provide realistic emotional support and reassurance. Should Patient A make specific lifestyle changes? If so, what changes and how can these be encouraged? Define silent MI. How common is it? CASE STUDY 2: ANGINA PECTORIS Patient B is 42 years of age and works as a newspaper editor. He presents to the emergency department complaining of chest pain radiating into both arms, accompanied by diaphoresis and shortness of breath. He has been having episodes of transient substernal and shoulder pain over the past week. He is admitted to the CCU. Patient B is being treated for hypertension and is currently taking 100 mg metoprolol twice per day. He does not exercise and has smoked a pack of cigarettes daily for 20 years. He reports being under considerable job stress. He is overweight, with a body mass index of 35. Upon admittance to the CCU, a full physical exam is conducted ( Table 5 ). An ECG shows ST segment depression and T wave inversion consistent with subendocardial ischemia in the inferior and anterior leads. An incomplete left bundle branch block is also noted. Laboratory studies (CBC, urinalysis, and cardiac isoenzyme levels) are all within normal limits, although cardiac isoenzymes are in the upper range. PATIENT B'S PHYSICAL EXAM RESULTS Parameter Findings General appearance Well-developed, overweight, anxious, diaphoretic, white male complaining of pain in both arms Height: 5 feet 8 inches (172.7 cm) Weight: 230 pounds (104.3 kg) Normocephalic Pupils equal, round, reactive to light and accommodation Extraocular movements intact Midline trachea Thyroid not palpable Protuberant, soft, and nontender Active bowel sounds No masses or organ enlargement Peripheral pulses present, equal, and strong Full range of motion Normal male Rectal exam deferred Sinus rhythm No rubs, murmurs, or gallops Based on the results of the assessment, Patient B is diagnosed with: Angina pectoris Subendocardial ischemia Patient B stays in the CCU for three days. During that time, serum cardiac enzyme levels and repeat ECGs confirm a diagnosis of subendocardial ischemia rather than MI. Coronary artery angiography is done to clarify the coronary artery anatomy and finds a 35% to 45% occlusion of the left anterior descending artery. The possibility of coronary artery vasospasm is not excluded because no ergonovine trial is done. Repeat evaluation for coronary artery bypass surgery is planned for the future, with conservative medical treatment in the interim. At discharge, Patient B is prescribed: Digoxin (Lanoxin): 0.25 mg daily Controlled-release nitroglycerin: 6.5 mg every 12 hours Nifedipine (Procardia): 10 mg three times daily Sublingual nitroglycerin (Nitrostat): 0.4 mg as needed for chest pain Distinguish between the symptoms of angina and MI. What are the signs and symptoms of stable angina? Define unstable angina. How is it diagnosed and treated? Describe Prinzmetal (variant) angina. What clues suggest the common noncardiac causes of chest pain? List specific nursing measures regarding medications, diet, activity, lifestyle changes, and emotional support that should be implemented for Patient B. During his stay in the CCU, Patient B asks if he has to change his lifestyle, as he really did not have a "heart attack." How would you respond? Discuss the nursing diagnosis of self-concept in regard to patients with angina. How does this major problem impact their perception of self? Their relationships with others? CASE STUDY 3: CARDIAC FAILURE AND PULMONARY EDEMA Patient C, 44 years of age, is brought to the emergency department by ambulance after collapsing at an airport prior to departing on a business trip. He had eaten a large lunch before going to the airport. During the assessment and initiation of treatment, the patient is anxious to return to work. After several short bursts of ventricular tachycardia cause him to become nauseated and short of breath, Patient C agrees to be admitted to the CCU until he feels better. About three years ago, Patient C noted chest discomfort unrelated to exertion. He tried without success to relieve the chest discomfort with various over-the-counter antacids. Eventually, the pain subsided and he dismissed it with various rationalizations. Two years ago, an ECG done during a routine physical exam was interpreted as normal. This is his first hospital admission. Family history is positive for early CHD among the men and type 2 diabetes among the women. There are no family members with renal disease, tuberculosis, or cancer. Patient C is a vice president for a large advertising agency. His job involves frequent travel and entertainment of clients, and he reports frequently drinking alcohol as part of "doing business." This usually consists of a martini at lunch and two whiskey sours before dinner. He smokes occasionally, especially while working on important business deals. He engages in no regular exercise program but does play racquetball occasionally as part of his business-related social life. He owns a home in an affluent neighborhood with his wife; their lifestyle includes entertaining at home and at their country club. Their three teenaged children attend private schools. Upon admittance to the CCU, a full physical exam is conducted ( Table 6 ). ECG shows sinus tachycardia with frequent PVCs. The atrial and ventricular rate is 114 bpm, and ST segment elevation and depression are noted. Extensive laboratory studies find: Blood chemistry levels: Sodium: 140 mEq/L Potassium: 4.3 mEq/L Calcium: 109 mEq/L Carbon dioxide: 23 mEq/L Blood glucose: 112 mg/dL Blood urea nitrogen: 17 mEq/L Uric acid: 6.1 mEq/L LDH: 237 IU/L Gamma-glutamyltransferase 1: 26 IU/L SGOT: 25 IU/L Total: 685 IU/dL CK-MM: 529 IU/L CK-MB 126 IU/L Total bilirubin: 0.5 mEq/L Total cholesterol: 220 mEq/L Hematology: Red blood cell: 4.84 cells/mcL Hemoglobin: 16.4 g/dL Hematocrit: 47.2% Mean corpuscular volume: 97.5 fL Mean cell hemoglobin: 34.0 pg Mean cell hemoglobin concentration: 34.8% White blood cell count: 5.1 x 10 9 cells/L PATIENT C'S PHYSICAL EXAM RESULTS Parameter Findings General appearance Pale, gray, diaphoretic, dyspneic Hispanic man Height: 5 feet 10 inches (177.8 cm) Weight: 190 pounds (86.2 kg) Supple Nodes and thyroid not palpable Jugular venous distention to angle of jaw while supine Symmetrical excursion Moist rales and rhonchi scattered through both lung fields Oriented to person, place, and time Cranial nerves II–XII grossly intact Deep tendon reflexes 2+ with symmetrical flexor plantar responses Heart sounds distant without rubs or murmurs Normal sinus rhythm with frequent PVCs A second set of serum enzymes shows an LDH of 298 IU/L and a SGOT of 192 IU/L. Urinalysis reveals straw-colored urine with specific gravity of 1.009, pH of 6, and rare white blood cells per high power field. Patient C's ABGs are also assessed ( Table 7 ). PATIENT C'S ABG REPORT Parameter On Room Air On Oxygen (4 L/minute by cannula) pH 7.45 7.43 pCO 32 mm Hg 34 mm Hg pO 63 mm Hg 95 mm Hg O 85.4 mm Hg 90.3 mm Hg Bicarbonate (HCO ) 22.3 mEq/L 22.7 mEq/L Based on the results of the assessment, Patient C is diagnosed with acute anterior and inferior MI with early carcinogenic shock. In the emergency department, oxygen is administered at 4 L/minute via a nasal cannula. Patient C is given lidocaine, 100 mg, as a bolus IV; a lidocaine infusion is started at 2 mg/minute. On arrival in the CCU, the patient is noted to have frequent PVCs as well as one period of five ectopic ventricular beats. A 0.5 mg/kg bolus of IV lidocaine is given, and the infusion rate is increased to 4 mg/minute. The nurse instructs Patient C to notify them if he develops numbness or tingling, chest pain, light-headedness, or other discomfort. A portable chest x-ray is done shortly after he arrives in the CCU and shows pulmonary vascular congestion. IV furosemide (Lasix), 20 mg, is administered, and an indwelling urinary catheter is inserted and connected to a urinometer. One hour after his arrival in the CCU, Patient C's blood pressure is noted to be barely audible at 60/35 mm Hg. An arterial line is placed in the left radial artery, and a pulmonary artery thermodilution catheter is placed via the left subclavian artery. An infusion of dopamine hydrochloride (400 mg in 500 mL D5W) is begun at 5 mg/kg/minute. Morphine sulfate is titrated intravenously to reduce the patient's pain, anxiety, and dyspnea. Patient C continues to have 10 to 15 PVCs per minute despite the lidocaine infusion continuing at 4 mg/minute. The oxygen is changed to 15 L/minute by mask. Sodium nitroprusside is cautiously administered as an IV infusion of 50 mg in 250 mL D5W at 0.5 mcg/kg/minute. The patient's blood pressure and cardiac output begin to improve. Identify and list Patient C's risk factors for developing atherosclerosis. Define the etiology, pathology, clinical manifestations, and therapeutic treatment of carcinogenic shock. What clinical clues in this case suggest cardiogenic shock? Explain the rationale for the use of dobutamine, dopamine, and norepinephrine to support blood pressure in the management of shock. What nursing outcomes would be desirable for Patient C? What interventions are needed to accomplish these outcomes? What interventions would be appropriate if Patient C continues to state that he wishes to leave the hospital? Patient D, 73 years of age, has a history of severe CHD and is admitted to the hospital with a chief complaint of increasing difficulty with angina pectoris that is not controlled with her current medications. PATIENT D'S PHYSICAL EXAM RESULTS Parameter Findings General appearance Pale, gray-haired, pleasant, and alert white woman lying in bed Height: 5 feet 3 inches (160 cm) Weight: 166 pounds (75.3 kg) Normocephalic Pupils equal, round, reactive to light and accommodation Corneas clear Sclera white Supple Nodes and thyroid not palpable Jugular venous distention to angle of jaw while supine Carotid pulses equal and without bruits Symmetrical excursion Lungs clear to auscultation and percussion Flat with well-healed right upper quadrant scar Bowel sounds present in all quadrants No bruits heard No tenderness, masses, or organomegaly No clubbing, cyanosis, or edema Pulses present and equally moderate in upper and lower extremities Normal female Rectal exam deferred Oriented to person, place, and time Cranial nerves II–XII grossly intact Deep tendon reflexes symmetrical and 2+ in upper extremities Ankle and knee jerk absent in right lower extremity Plantar flexion present in both feet Heart sounds normal without gallops, rubs, or murmurs Normal sinus rhythm without ectopic activity Patient E is a man, 65 years of age, who presents to the emergency department with a two-day history of high-grade fever with chills. He tells the nurse that he does not feel well and believes he may have the flu. He also complains of "some painful bumps" that appeared on his fingers and toes last night. The patient denies any pain other than the lesions on his fingers and toes. He also denies cough, chest pain, breathing problems, palmar or plantar rashes, and vision problems. He does display mild malaise and some loss of appetite. About NetCE About TRC Healthcare Do Not Sell My Personal Information Copyright © 2024 NetCE · Contact Us Pardon Our Interruption As you were browsing something about your browser made us think you were a bot. There are a few reasons this might happen: You've disabled JavaScript in your web browser. You're a power user moving through this website with super-human speed. You've disabled cookies in your web browser. A third-party browser plugin, such as Ghostery or NoScript, is preventing JavaScript from running. Additional information is available in this support article . To regain access, please make sure that cookies and JavaScript are enabled before reloading the page. If you're seeing this message, it means we're having trouble loading external resources on our website. If you're behind a web filter, please make sure that the domains *.kastatic.org and *.kasandbox.org are unblocked. To log in and use all the features of Khan Academy, please enable JavaScript in your browser. 168 IMAGES Circulatory System Solved CASE STUDY 6-3: CIRCULATORY SYSTEM DISORDERS, Chapter 6-Circulatory System Diagram Circulatory System Case Study by Engaging Science Instruction the summary Diagram Of The Circulatory System With Labels COMMENTS Solved CASE STUDY 6-3: CIRCULATORY SYSTEM DISORDERS, CASE STUDY 6 - 3: CIRCULATORY SYSTEM DISORDERS, DIAGNOSTIC TESTS, AND VEIN SELECTION. A phlebotomist is called to the ER to draw a STAT hct, hgb, and plt ct on a young girl who appears extremely pale and very close to being unconscious. While checking for a good puncture site, the phlebotomist notes the " M " pattern of veins on both ... Solved Case Studies Chapter Theory 12 CASE STUDY 6-1: Give a reason for your selection of specimen type CASE STUDY 6-3: CIRCULATORY SYSTEM DISORDERS, DIAGNOSTIC TESTS, AND VEIN SELECTION A phlebotomist is called to the ER to draw a STAY het. hgb, and pltct on a young girl who appears extremely pale and very close to being unconscious. While checking for a good puncture site, the phlebotomist notes ... Circulatory system: Structure, function, parts, diseases Circulatory system. The circulatory system, also called cardiovascular system, is a vital organ system that delivers essential substances to all cells for basic functions to occur. Also commonly known as the cardiovascular system, is a network composed of the heart as a centralised pump, blood vessels that distribute blood throughout the body, and the blood itself, for transportation of ... Circulatory system case study Flashcards Proper adherence to medications like antiplatelets, beta-blockers, and statins is crucial for managing risk factors and preventing complications. Missing doses may lead to inadequate protection, increasing the likelihood of further cardiac events or complications. Study with Quizlet and memorize flashcards containing terms like symptoms of ... Human Circulatory System The human circulatory system possesses a body-wide network of blood vessels. These comprise arteries, veins, and capillaries. The primary function of blood vessels is to transport oxygenated blood and nutrients to all parts of the body. It is also tasked with collecting metabolic wastes to be expelled from the body. CIRCULATORY SYSTEM- CASE STUDY QUESTIONS Flashcards Quizlet has study tools to help you learn anything. Improve your grades and reach your goals with flashcards, practice tests and expert-written solutions today. Scheduled maintenance: June 20, 2024 from 09:30 PM to 11:30 PM The Cardiovascular System Read chapter 8 of Pathology: A Modern Case Study, 2e online now, exclusively on AccessMedicine. AccessMedicine is a subscription-based resource from McGraw Hill that features trusted medical content from the best minds in medicine. ... The heart is the principal organ of the blood circulatory system, pumping blood throughout the body and ... Phlebotomy Essentials Chapter 6: Circulatory System Circulatory System. Carry oxygen and nutrients to the cells of the body and carbon dioxide and waste away from the cells. Pericardium. Thin fluid filled sac around the heart. Septa (Septum) Partitions that separate the right and left chambers of the heart. Epicardium. Thin outer layer of the heart. Myocardium. Circulation Cardiovascular Case Series Circulation. Cardiovascular Case Series. Cardiovascular medicine provides proof of the clear benefits of evidence-based care. The evaluation and treatment of many conditions are well-defined and practice is uniform. Despite the large size and quality of this evidence base, however, the majority of clinical practice relies on the accurate ... The circulatory system review (article) The human circulatory system consists of several circuits: The pulmonary circuit provides blood flow between the heart and lungs. The systemic circuit allows blood to flow to and from the rest of the body. The coronary circuit strictly provides blood to the heart (not pictured in the figure below). Image credit: Blood flow from the heart by ... Case Study This case study was revised in 2023, get the NEW VERSION! This case study focuses on a baby boy who was born with a problem with his heart. The story is based on a real scenario, though some of the names have been changed, and the parents gave permission to include photos of the infant. Students will read about symptoms that occur when a baby ... Case 6 A 67-year-old woman sought emergency medical care due to prolonged chest pain. In April 2009 the patient had prolonged chest pain and at that time she sought medical care. She was admitted at the hospital and diagnosed with myocardial infarction. The patient had hypertension, diabetes mellitus, dyslipidemia and was a smoker. Course Case Studies Upon admittance to the CCU, a full physical exam is conducted ( Table 4 ). An ECG is done and shows ST elevation. Several laboratory tests are ordered, with the following results: Serum cardiac enzymes: CK: 164 IU/L. LDH: 219 IU/L. Serum glutamic-oxaloacetic transaminase (SGOT): 31 IU/L. Circulatory System Case Study (1) (docx) Biology document from Treasure Valley Community College, 2 pages, Bio 232 Circulatory System Case Study 12 March 2024 Part 1 1. 2. 3. In a fetal heart, the blood flows directly between the atriums instead of flowing to the ventricles. This is from an opening in the interatrial septum. In an adult heart, the blood flows Circulatory system anatomy and physiology About this unit. Your heart sits in the middle of your chest and pumps blood from about 4 weeks after conception until the day that you die. This little pump is the size of your clenched fist and it never stops. Watch these videos to learn more about how the heart works, blood flow in arteries and veins, blood pressure, and lymphatics. Solved CASE STUDY 6-2: CIRCULATORY SYSTEM DISORDERS, CASE STUDY 6-2: CIRCULATORY SYSTEM DISORDERS, DIAGNOSTIC TESTS, AND VEIN SELECTION A phlebotomist receives a request to collect a specimen for a PT and D-dimer on a patient. The phlebotomist remembers drawing the patient in the ER when he was complaining of leg pain. Because the patient was a difficult draw, the phlebotomist wanted to draw from ... Solved CASE STUDY 6-3: CIRCULATORY SYSTEM DISORDERS, CASE STUDY 6-3: CIRCULATORY SYSTEM DISORDERS, DIAGNOSTIC TESTS, AND VEIN SELECTION A phlebotomist is called to the ER to draw a STAT het, hgb, and plt ct on a young girl who appears extremely pale and very close to being unconscious. While checking for a good puncture site, the phlebotomist notes the "M" pattern of veins on both arms but really ... Answered: CASE STUDY 6-1: CIRCULATORY SYSTEM… CASE STUDY 6-3: CIRCULATORY SYSTEM DISORDERS, DIAGNOSTIC TESTS, AND VEIN SELECTION A phlebotomist is called to the ER to draw a STAT hct, hgb, and plt ct on a young girl who appears extremely pale and very close to being unconscious. While checking for a good puncture site, the phlebotomist notes the "M" pattern of veins on both arms but really ... Circulatory Case Studies Flashcards allows blood to flow from the right atrium to the left atrium. Ductus arteriosus. allows blood to flow from the pulmonary artery to the aorta. Infant first breath. 1) Lungs expand. 2) Rising oxygen levels stimulate constriction of ductus arteriosus. 3) Rising pressure in the left atrium closes the foramen ovale. Embryonic lungs. Solved 120 Unit Overview of the Human Body A AST sana store It means death of cardiac tissue or heart muscle due to decreased or no supply of blood t …. 120 Unit Overview of the Human Body A AST sana store is being Case Studies Case Study 6-1: Circulatory System Disorders and Diagnostic Tests QUESTIONS A phlebotomist receives a request to collect specimens for stat electrolytes, CK, and AST on a ... assignment essay homework paper phd report resume review speech thesis