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Click the section links to expand or collapse the menu. Introduction Objectives Section I: The Cardiovascular System Lesson 1: Structure and Function Lesson 2: Diagnostic Tests and Procedures Lesson 3: Cardiovascular Pathologies Section II: The Lymphatic System Lesson 1: Anatomy and Physiology Lesson 2: Disorders of the Lymphatic System Section III: Building Your Word Bank Section IV: Applications Learning Links
2/4/2008 10:02 AM
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Introduction This module is the first in a series devoted to individual body systems. In this module, you will learn more about the medical terms associated with the cardiovascular and lymphatic systems. When you complete this module, you should be familiar with the terms that describe the anatomy of those systems and have a good understanding of terms that specify disorders affecting them. You will be able to recognize terms for tests that are used to diagnose disorders of the cardiovascular and lymphatic systems. You'll also learn about the therapeutic measures used to treat these conditions, including the categories of drugs that improve cardiac and lymphatic function. As you work through this module, you may need to refer to the basics of word structure that were introduced in Module 1. Remember that this integrated learning program is intended as a supplement to your text— not as a substitute. Be sure to keep your text available for ready reference. NOTE: Not all terms presented in your text will appear in this module. Some terms in this module may not appear in your text.
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Objectives In this module, you will learn to:
Recognize names of the structures of the cardiovascular system and define terms associated with these structures.
State the function of the lymphatic system and analyze associated terminology.
Label the major structures of the lymphatic system.
Write the meaning of word parts associated with the cardiovascular and lymphatic systems and use the word parts to build and analyze terms.
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1.1 Threaded Case Study: Fred Before we begin to explore the anatomy of the cardiovascular system, let's meet Fred Sibley. Fred is a 34-year-old man who's visiting with his doctor today to report some recent health problems. Fred mentioned to his doctor that he's had "some swelling" in his throat. He said he is often fatigued and has recently noticed an unintended drop in his weight. He also complained of occasional periods of rapid heart beat. Fred will undergo a thorough physical assessment to help his doctor understand the cause of these complaints. As we learn more about Fred's health problems, we'll be able to see the cardiovascular and lymphatic systems at work.
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1.2 Cardiovascular Blood Flow (animation) The cardiovascular system consists of the heart and a closed network of blood vessels that carry blood throughout the body. This system transports nutrients and oxygen to the cells to power the body's many functions. The blood vessels also carry carbon dioxide and waste products to the lungs and kidneys to be eliminated. You'll notice two important combining forms in the term cardiovascular: cardi/o, which means heart, and vascul/o, which means vessel.
Cardiovascular System and Blood Flow
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1.3 External View of the Heart The heart is the muscular, cone-shaped organ that serves as the pump of the cardiovascular system. It is approximately the size of a closed fist. The heart is almost 5 inches in length, about 3 inches wide at its broadest part, and slightly more than 2 inches in depth. It weighs an average of 10 ounces in men and 8 ounces in women.
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1.4 Location of the Heart The heart lies between the lungs in the mediastinum of the thoracic cavity. The term mediastinum is built from the combining form mediastin/o, meaning middle region. Behind the heart are the esophagus, major blood vessels, and the spinal column. The heart rests on the diaphragm and is rotated to the left.
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1.5 Layers of the Heart Wall The heart wall has three distinct layers. The endocardium—the inner layer—is made of smooth membranous tissue. The endocardium lines the interior of the heart and the heart valves. The thick middle layer of the heart wall is called the myocardium; it is composed of cardiac muscle. The epicardium is the thin outer layer of the heart wall. At the lower, more pointed end of the heart, the epicardium becomes continuous with the loose-fitting, double-layered sac called the pericardium, in which the heart is encased.
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1.6 Terms Pertaining to Layers of the Heart Wall Analyzing the word parts in the terms that designate the layers of the heart wall will help you remember their definitions. In each of the terms—endocardium, myocardium, epicardium, and pericardium—we see the combining form cardi/o, which, as you know, means heart. The suffix -ium, which also appears in each of the terms, is defined as membrane. The job of distinguishing these terms, therefore, falls to the prefixes. The prefix endo- means inside, thus the endocardium is the inner layer of the heart. The combining form my/o, which means muscle, refers to the muscular layer—the myocardium. The epicardium is the outermost layer, indicated by the prefix epi-, meaning upon or above. The prefix peri- means around; therefore, pericardium is the term for the sac that encloses the heart.
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1.7 Chambers of the Heart The heart has four chambers. The two upper chambers are called the atria (sing., atrium); the lower two are the ventricles. The left and right atria are abbreviated LA and RA, respectively; the abbreviations for the ventricles are similarly LV and RV. The atria receive blood returning to the heart from the veins throughout the body. The ventricles pump blood from the heart, through the arteries to the body's tissues. The combining forms atri/o and ventricul/o refer, respectively, to the atria and ventricles. The left and right sides of the heart are separated by the cardiac septum. This term contains the combining form sept/o, meaning partition.
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1.8 Cardiac Valves The upper and lower chambers of the heart are connected by valves that keep the blood flowing in one direction. The combining forms that mean valve are valv/o and valvul/o. Thus, valvar and valvular are terms that mean pertaining to a valve. The tricuspid valve connects the right atrium and the right ventricle; the mitral or bicuspid valve connects the left atrium and left ventricle. Together the tricuspid and bicuspid valves are known as the atrioventricular (AV) valves. The pulmonary valve is located between the right ventricle and the pulmonary artery. The aortic valve connects the left ventricle and the aorta. These two valves are called the semilunar valves.
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1.9 Coronary Arteries The systemic circulation supplies blood to the heart muscle by means of the coronary arteries. The term coronary is based on the combining form coron/o, which means crown, because these arteries encircle the heart like a crown. Because of the common association between the heart and the coronary arteries, the combining form coron/o has also come to mean heart, and coronary means pertaining to the heart.
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1.10 Systemic vs. Pulmonary Circulation (animation) The circuit that the blood follows from the heart to the body's organs and back is called the systemic circulation. The combining form system/o means system and in this case refers to the general circulation of the blood throughout the body. The pulmonary circulation is the blood's route from the heart through the lungs, where it receives a fresh supply of oxygen, and back to the heart. You will recall that pulmon/o is a combining form that means lung.
Systemic vs. Pulmonary Circulation
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1.11 Systole, Diastole Blood is forced through the circulatory system by the rhythmic contraction and relaxation of the heart. This pumping activity occurs in three phases that constitute the cardiac cycle. The three phases are atrial contraction, ventricular contraction, and rest. Systole is the term for the phases of the cardiac cycle when the heart contracts. This term usually applies specifically to ventricular contraction. Diastole is the period during which the heart relaxes between contractions.
The heart pumps about 5 quarts of blood a minute, 75 gallons an hour, and about 2000 gallons a day.
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1.12 Heart's Electrical Conduction (animation) The myocardium consists of two types of cardiac muscle tissue: contracting tissue and conducting tissue. The heart's contractions are generated by a tiny electric current called the cardiac impulse that travels along pathways in the conducting tissue. This electrical wave coordinates the series of muscular contractions that occur in the contracting tissue during the cardiac cycle. The cardiac impulse begins in the right atrium in conducting myocardium called the sinoatrial (SA) node that serves as the heart's pacemaker. The impulse spreads in circular waves over the atrial walls, causing the atria to contract. The impulse then passes through the atrioventricular (AV) node, a second area of conducting myocardium. From this node, it passes through a band of conducting muscle that connects the atria to the ventricles and is called the bundle of His. The bundle of His divides into the left and right bundle branches, conducting the cardiac impulse to the left and right ventricles. The bundle branches further divide into Purkinje fibers, fine
strands of conducting muscle that transmit the impulse to the contracting muscle of the ventricles. This diagram illustrates the electrical conduction system of the heart.
Cardiac Electrical Conduction
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1.13 Activity: Write It, Find It
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1.14 Threaded Case Study: Fred Now that we've looked at the structure and function of the heart, we'll move on to explore the anatomy of the blood vessels. But first, let's visit with Fred, whose doctor has begun the physical examination. The physician is gathering a wealth of data about the function of Fred's heart and blood vessels. Fred will describe his personal health habits, review his health history, and be encouraged to recall any additional symptoms he has experienced. We'll return soon to see how his exam is progressing.
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1.15 Relative Size of Blood Vessels There are three major types of blood vessels: arteries, veins, and capillaries. Arteries carry blood containing oxygen and other nutrients away from the heart to the body's cells. Because they need to withstand the force of the blood as it leaves the heart, the arteries are large, strong vessels with elastic walls. The largest artery in the body is the aorta, indicated in medical terms by the combining form aort/o. Aortic means pertaining to the aorta. The suffix -ole means small. Arterioles are small arteries that carry blood from the larger arteries to the tiniest of the blood vessels, the capillaries.
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1.16 Microcirculation The capillaries are microscopic blood vessels with thin walls that permit the exchange of oxygen and nutrients from the blood into the interstitial fluid surrounding the body's cells. These tiny vessels also allow carbon dioxide and waste materials from the cells to pass into the blood from the interstitial fluid. The oxygen-poor and waste-filled blood then passes from the capillaries to small veins called venules. The venules carry the blood to the veins, which transport it back to the heart. Because venous return of blood to the heart is less forceful than blood flow through the arteries, the walls of the veins are thinner and less elastic. Valves in the veins keep the blood flowing toward the heart. The largest veins in the body are called the venae cavae. The superior vena cava receives blood from the veins of the upper body and the inferior vena cava receives blood from the lower body. Both venae cavae connect with the right atrium of the heart.
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1.17 Categories of Blood Vessels Let's review some of the word parts that are used to refer to the blood vessels. Angi/o and vas/o are combining forms that mean vessel; they may be used to indicate any of the three categories of blood vessels. You may recall that angiography refers to radiography of blood vessels using a contrast medium. Angioplasty is the term for repair or reconstruction of a vessel. The term vascular means pertaining to a vessel or to multiple vessels. Arter/o and arteri/o refer specifically to the arteries. Arterial means pertaining to an artery or arteries. Arteriography is the term for x-ray imaging of arteries. By joining the combining form arteri/o to the suffix -ole—meaning little— we form the term arteriole, which you'll remember means small artery. Three combining forms—phleb/o, ven/o, and ven/i—are all defined as vein. Both venipuncture and phlebotomy are terms for the procedure of entering a vein with a needle to draw blood for analysis or to inject medication. The combining form venul/o is used to build another familiar term, venule, meaning small vein.
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1.18 Activity: Sequencing Let's review the material covered in this lesson by completing the activities that follow.
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1.19 Activity: Fill-In
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1.20 Activity: Word Shop
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2.1 Pulse Points The force of the blood as it is ejected from the heart causes a regular expansion and contraction of the arterial walls called the pulse. These arterial pulsations can be felt at a number of sites on the body. The most commonly used pulse point is over the radial artery on the anterolateral aspect of the wrist. The pulse rate is the number of heartbeats per minute. The rate and quality of pulse are indicators of heart function. You will recall from Module 6 that the pulse rate is one of the vital signs that is part of a physical examination or routine physical assessment. The normal pulse rate is between 60 and 100 beats per minute. Bradycardiaâ€”using the prefix brady-, which means slow, and the word root for heartâ€”is defined as a slow heart rate of less than 60 beats per minute. Tachycardia, a term built from the same word root, but preceded by the prefix tachy-, which means fast, is a condition in which the heart beats faster than 100 beats per minute.
Using the second and third fingers of one hand, try to locate your radial pulse. Be aware that, with one pulsation, all the events in the cardiac cycle and the conduction process have just occurred.
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2.2 Blood Pressure Blood pressure is the force that the circulating blood exerts against the walls of the blood vessels. The measurement of blood pressure is one diagnostic indicator of health of the cardiovascular system. Blood pressure is determined by blood volume, the size and tone of the blood vessel, and the force of the heart's contraction as it ejects blood into the arteries. Blood pressure is measured using a stethoscope and an instrument called a sphygmomanometer. When measuring blood pressure, the stethoscope is used to hear the pulsation within an artery. You will recall from Module 6 that a stethoscope is an instrument used for auscultation, listening to the sounds of breathing and heartbeat within the chest. The combining form steth/o means chest.
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2.3 Sphygmomanometer The pressure in the aorta and large arteries of a healthy young adult is approximately 120 mm Hg (millimeters of mercury) during systole, when the ventricles are contracting, and 80 mm Hg during diastole, when the heart is relaxed. Both the systolic and diastolic pressures are measured and reported. Using the example above, the blood pressure would be written as 120/80. Abnormally high blood pressure is called hypertension; when the blood pressure is lower than normal, it is described as hypotension.
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2.4 Electrocardiography Diagnosis of rhythmic irregularities of the heart is aided by a process known as electrocardiography, which records the heart's electrical activity. The record produced by electrocardiography is called an electrocardiogram (see illustration), an ECG or EKG. Because Fred has complained of occasional rapid beating of his heart, he will undergo an ECG. A portable electrocardiograph, called a Holter monitor, can be worn by patients to record heart function over a long period of time and during various activities. This test aids in the diagnosis of cardiac problems that occur intermittently. An ECG stress test, also called an exercise tolerance test, is used to evaluate whether the blood supply to the heart muscle is adequate. The ECG is monitored and recorded while the patient performs exercise, usually on a treadmill. The patient's blood pressure and pulse are also monitored during the test. Resting ECGs are usually performed both before and after the exercise portion of the test.
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2.5 Nuclear Medicine Procedures Another test used to evaluate the blood supply to the heart is the thallium test, a nuclear medicine scan, also called myocardial perfusion imaging. This test shows how well blood flows to and within the heart muscle. The most common form of thallium test is called thallium stress testing. The patient performs exercise on a treadmill or bicycle. When the patient reaches his or her maximum level of exercise, a small amount of a radioactive substance called thallium is injected into the bloodstream through a vein in the arm. Then the patient lies on a special table and a gamma camera senses the radioactivity and maps its flow through the heart muscle. The scan may be repeated after several hours of rest or a resting scan may be recorded prior to the exercise. Positron emission tomography (PET) scanning is another nuclear medicine procedure that uses radioactive material to evaluate the vascular perfusion of the heart.
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2.6 Echocardiography Echocardiography (ECHO), the use of high-frequency sound waves to visualize the structures and record the function of the heart, is another imaging modality used in the diagnosis of cardiovascular conditions. Doppler ultrasound methodology allows recording of flow phenomena in color and permits demonstration of both arteries and veins. Doppler ultrasound is used extensively to detect vascular disease.
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2.7 Angiography Many radiographic procedures aid in the diagnosis of cardiovascular conditions. The chest x-ray (CXR) examination is a simple, noninvasive procedure that provides information about the size and configuration of the heart. As you will see in a subsequent lesson, heart problems can have a significant effect on the lungs as well, so x-ray images of the heart and lungs are valuable as a screening test and to monitor patients with heart problems periodically during the course of their treatment. You'll recall that angiography is the process of obtaining radiographic images of the blood vessels following injection of a contrast medium. Angiography refers to a number of different procedures that also have specific names. For example, arteriography is radiographic imaging of arteries. Arteriography may be named more specifically for the artery visualized; for example, a coronary arteriogram is a study of the coronary arteries that supply the heart. Aortography demonstrates the aorta, and angiocardiography demonstrates the interior of the heart and the great vessels that connect to the heart.
Phlebography and venography are terms that refer to the radiographic imaging of veins. Computed tomography angiography (CTA) is a method of demonstrating blood vessels using the latest types of computed tomography (CT) scanners. Incredibly clear 3-dimensional images of major vessels can be obtained by this method. The illustration demonstrates a CTA image of the renal vessels. Angioscopy is the visual examination of blood vessels using a fiber-optic microscope introduced via catheter. Angioscopy has been demonstrated to be very sensitive in detecting problems within arteries. Experimental computer systems permit evaluation of vessels by means of virtual angioscopy using data input from other imaging methods.
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2.8 Cardiac Catheterization (video) In addition to procedures such as electrocardiography and echocardiography, cardiac catheterization provides several different approaches to the diagnosis and monitoring of heart disease. Cardiac catheterization involves the placement of a flexible catheter in the heart. Catheters threaded through the aorta, as in this video, may be used to deliver a contrast agent for angiocardiography, to place a fiber-optic camera for angioscopy, or to perform angioplasty. Specialty catheters can also be placed in the heart via an intravenous route. These catheters may be left in place and are used to monitor blood flow and pressure within the heart.
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2.9 Magnetic Resonance Angiography (MRA) Magnetic resonance imaging (MRI) uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed images of many structures within the body. Magnetic resonance angiography (MRA) is a specific application of magnetic resonance imaging used to produce pictures of the heart and blood vessels. MRA is unique in that it can create detailed images of blood vessels without the use of contrast material, but special MRI contrast agents are often used to enhance visualization of arteries. The accompanying illustration of an MRA demonstrates a large middle cerebral artery aneurysm (arrow).
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2.10 Laboratory Tests In addition to physical examination and imaging techniques, a variety of laboratory techniques help establish a diagnosis in cases of cardiovascular disease. When a heart attack causes damage to the heart muscle, certain enzymes are released into the bloodstream and can be measured in laboratory tests. The tests are named for the enzymes they measure: lactate dehydrogenase test (LDH) and creatine kinase test (CK). The CK test is also called creatine phosphokinase test (CPK).
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2.11 Laboratory Tests for Cardiovascular Risk Factors Blood tests are also used to screen for risk factors such as high levels of substances called lipoproteins that transport lipids (fats) in the blood. There are three types of these substances: HDL cholesterol, LDL cholesterol, and triglycerides. HDL stands for high density lipoprotein, sometimes called the "good cholesterol," and LDL stands for low density lipoprotein, "bad cholesterol." The accompanying illustration demonstrates the structure of a lipoprotein. High levels of these substances, especially LDL cholesterol, are known to be associated with an elevated risk of arteriosclerosis. This term is built from arteri/o, which you know means artery, and -sclerosis, meaning hardening, so arteriosclerosis is the condition of hardening of the arteries. The condition of an abnormally high level of cholesterol in the blood is called hypercholesterolemia. When diet and exercise fail to adequately lower high cholesterol levels, medications in the class of antilipidemic drugs may be prescribed for this purpose.
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2.12 Activity: Write It, Find It Let's review the material covered in this lesson by completing the activities that follow.
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2.13 Activity: Listen and Spell
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3.1 Inflammatory Heart Conditions We'll begin our review of cardiac pathology by considering infectious or inflammatory conditions that affect the heart. Some clues to help you identify this group of conditions will be the combining form cardi/o and the suffix -itis. By now, you're well aware that addition of that suffix to a word root indicates inflammation. Let's look at several of those terms now.
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3.2 Endocarditis Endocarditis is inflammation of the inner lining of the heart. Also known as bacterial endocarditis (pictured here), this disease occurs when microorganisms infect the endocardial surface. Because the endocardium lines both the heart and the valves, endocarditis frequently affects the cardiac valves.
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3.3 Pericarditis Pericarditis is inflammation of the pericardium, the double-layered sac that encloses and protects the heart. Pericarditis may be caused by viral or bacterial infection. It may also be secondary to trauma or other illnesses. One possible complication of pericarditis is the accumulation of blood or fluid in the pericardial space. If the amount of accumulated fluid becomes significant, the heart may become compressed. This condition is called cardiac tamponade. Pericardiocentesis is then performed to puncture the pericardial sac and aspirate the excess fluid. Myocarditis, as you've probably guessed, is inflammation of the thick, muscular middle layer of the heart. This condition also can have a variety of causes.
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3.4 Cardiovalvulitis An inflammatory reaction can involve any structure in the cardiovascular system. Cardiovalvulitis is a condition characterized by inflammation of the heart valves. Note the presence of the combining form valvul/o, meaning valve. Cardiovalvulitis may cause lesions to form on the valve leaflets, which then thicken, harden, and lose their mobility, a condition known as valvular stenosis. When the mitral valve undergoes these kinds of inflammatory changes, the condition is called mitral valve stenosis. Both the term stenosis and the suffix -stenosis mean narrowing or constriction.
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3.5 Valvular Insufficiency Valvular insufficiency, also known as regurgitation, is often caused by inflammatory disease. This disorder is characterized by a backflow of blood from the ventricles into the atria because of failure of the valves to close properly. Mitral valve prolapse is a kind of valvular insufficiency in which the leaflets, or cusps, of the valve protrude back into the left atrium during systole, allowing blood to flow backward.
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3.6 Threaded Case Study: Heart Murmur Another manifestation of valvular dysfunction, as well as of many other cardiovascular disorders, is the heart murmur, an abnormal, prolonged sound heard between normal heart beats. Murmurs occur as a result of alterations in blood flow and/or structure of the heart or blood vessels. Here, the physician listens with a stethoscope to ensure that Fred's heart sounds are normal.
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3.7 Angiocarditis Now let's turn our attention to some terms that refer to disorders of the blood vessels. Angiopathy is a general term that describes any disease of the blood vessels. Angiocarditis describes inflammation of the heart and the large blood vessels (see illustration). The combining form angi/o indicates the involvement of the blood vessels in the disorder. Aortitis is a specific angiopathy characterized by inflammation of the aorta. Phlebitis, sometimes called thrombophlebitis, is the inflammation of a vein. The word part thromb/o in that term tells us that phlebitis is often accompanied by the formation of a thrombus or blood clot.
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3.8 Therapeutic Management Therapeutic management of inflammatory cardiovascular disease typically consists of the administration of antibiotics and anti-inflammatory agents. Depending on the severity and the degree of damage to the heart and/or vessels caused by infection, changes in life style—diet and physical activity, for example—may be required. Surgical repair or replacement of damaged heart structures with prosthetic devices, such as the artificial valves shown in the accompanying illustration, may also be necessary.
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3.9 Normal Heartbeat; Dysrhythmia (animation) Earlier in this module, we talked about the regular, rhythmic contraction and relaxation of the heart muscle that forms the cardiac cycle. Each contraction of the heart is triggered by a wave of electricity that spreads across certain cardiac pathways and structures. Pathologic conditions of the cardiovascular system can cause the normal pattern of the heart's rhythm to be altered. The terms dysrhythmia, and more commonly arrhythmia, are both used to refer to disturbances in the heart's normal rhythmic pattern. As you can see, both terms are built from combining forms that mean rhythm, rrhythm/o and rhythm/o.
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3.10 Heart Block Heart block occurs when there is a delay or interruption in conduction of the electrical impulse. The block is named specifically for the location of the blockage. For example, when the block occurs between the atria and the ventricles it is called an atrioventricular (AV) block and prevents impulses from reaching either ventricle. A right bundle branch block prevents impulses from stimulating the right ventricle, but the left ventricle is not affected. This conduction delay or failure may happen intermittently or with such frequency that virtually no impulses reach the ventricles.
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3.11 Atrial Flutter Flutter is a type of arrhythmia characterized by rapid, but regular, contractions of the atria or ventricles. In atrial flutter, the heart rate may average between 250 to 350 beats per minute. The subjective experience of a racing or pounding heart is called palpitations. Palpitations may occur as a result of emotional stress or may be associated with heart disease.
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3.12 Fibrillation Fibrillation (shown on the accompanying ECG strip) is an arrhythmia in which there is a marked disturbance of the heart's rhythm. Fibrillation is characterized by rapid, disorganized, and ineffectual contractions of the atria or ventricles. Severe alterations in the heart's rhythm, such as fibrillation, can result in cardiac arrest or asystole, the cessation of the heart's activity.
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3.13 Treatment of Cardiac Arrhythmias Cardiac arrhythmias may be treated in a variety of ways, depending on their type and severity. Antiarrhythmic medications may be given alone or together with other forms of treatment. Termination of the rapid, uncoordinated quivering associated with fibrillation is often accomplished by using a defibrillator, an electrical device that delivers a shock through the chest wall to the myocardium. This procedure, called defibrillation, helps to reestablish normal contraction rhythm in a heart that is not beating properly. The restoration of normal heart rhythm using electric shock is called cardioversion (Fig. A). To maintain normal rhythm in instances of interference with the heart's electrical impulses, a cardiac pacemaker, a battery-powered device that initiates the heart beat, may be implanted (Fig. B).
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3.14 Activity: Memory Match
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3.15 Activity: Write It, Find It
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3.16 Cardiomyopathy Now that we've considered some examples of abnormal heart rhythms and inflammatory heart conditions, we'll look at a few other categories of heart and blood vessel disorders. First let's consider some general descriptors that apply to many cardiac disorders. Cardiomyopathy is any disease of the heart muscle. Cardiomyopathic disorders primarily affect the structure and function of the myocardium. Cardiomegaly, enlargement of the heart (see illustration), may be observed in a variety of disorders ranging from those present at birth to acquired conditions in which there is excessive demand on the heart's pumping ability.
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3.17 Congenital Heart Disease Congenital heart disease forms a third category of cardiac illness. Congenital heart disease refers to structural or functional abnormalities of the heart that are present at birth. Septal defects, abnormal openings in the walls that separate the atria and ventricles, are examples of congenital heart disease (see illustration). When an abnormal opening is formed between the atria, it is called an atrial septal defect (ASD); a ventricular septal defect (VSD) is the term used when the opening is between the ventricles.
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3.18 Additional Congenital Heart Conditions Coarctation of the aorta (CoA) (Fig. A) is a congenital narrowing of the aorta, most commonly just distal to the area where vessels branch off to the left arm. This condition causes hypertension. Coarctation is the term for stricture or contraction of the walls of a vessel, particularly the aorta. Patent ductus arteriosus (PDA) (Fig. B) is an abnormal opening between the pulmonary artery and the aorta caused by failure of the fetal ductus arteriosus to close after birth. This condition occurs most often in premature infants. The term patent means open or unobstructed. This condition permits blood to bypass the circulation to the lungs, decreasing the oxygen content of the blood. The defect often corrects itself within several months of birth but may require infusion of chemicals, the placement of "plugs" via catheters, or surgical closure. Perhaps you recall from Module 5 that the prefix tetra- means four and that the tetralogy of Fallot (TOF) (Fig. C) is a group of four congenital heart abnormalities that quite commonly occur together. The four defects are:
1. ventricular septal defect 2. pulmonic stenosis (narrowing of the valve leading to the pulmonary arteries) 3. aorta "overrides" the ventricular septal defect 4. hypertrophy (thickening) of the right ventricle In tetralogy of Fallot there is decreased flow of blood to the lungs and mixing of the blood from the two sides of the heart. Despite its seeming complexity, this condition is quite common and usually can be completely repaired.
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3.19 Congestive Heart Failure Congestive heart failure (CHF), another disease category, is a syndrome in which the heart is unable to pump the amount of blood required to meet the body's metabolic needs. Among the many possible causes of CHF are inflammatory cardiac disorders, cardiomyopathy, and congenital heart disease. Congestive heart failure may be predominantly left- or right-sided. Heart failure affects the kidneys' ability to dispose of sodium and water. The retained water causes edema, particularly in the lower extremities, as seen in this illustration. Fluid can also accumulate in the lungs. Cardiomegaly is often a compensatory mechanism in persons with CHF, wherein the fibers of the heart muscle stretch to try to increase the force of contractions.
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3.20 Heart Transplantation Treatment of CHF often includes pharmacologic and nutritional components. Cardiac drugs may be given to improve the pumping action of the heart and to promote excretion of fluids. Dietary sodium and fluid intake may be restricted. If efforts to control CHF with medications and diet fail, heart transplantation, the surgical removal of a donor heart and transfer of the organ to a recipient, may be a treatment option.
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3.21 Discussion Board
With three other members of the class, research and prepare a written opinion about the criteria used to select heart transplant recipients.
Post your report on the Discussion Board titled "Heart Transplant" for your classmates to review and comment.
Read your classmates' opinions and respond to their comments.
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3.22 Activity: Sound It Out
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3.23 Pathologic Cardiac Conditions Now to a final grouping of pathologic cardiac conditions: disorders of the coronary arteries and the vascular system. A large number of illnesses fall within this category.
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3.24 Atherosclerosis The most common type of coronary artery disease is caused by atherosclerosis, the formation of fatty deposits along the inner linings of the arteries. Atherosclerosis is a kind of arteriosclerosis, a term that refers to conditions in which there is hardening or thickening of the arterial walls, or loss of their elasticity. The collection of atherosclerotic deposits in arteries causes them to narrow and become less flexible. Their smooth inner surfaces become rough. Eventually the arteries become occluded, partially or completely blocked, preventing the free flow of blood. Atherosclerosis affecting the arteries that supply blood to the heart is called coronary artery disease (CAD). CAD is the leading cause of death in the Western world.
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3.25 Occluded Artery Roughening of the vessel lining can result in thrombosis, the abnormal clotting of blood that may block a coronary artery. Arterial blockage, whether by atherosclerosis or thrombosis, causes ischemia, a decrease in the supply of oxygenated blood to a body part, in this case, the heart muscle. Angiography and Doppler ultrasound studies are useful in the diagnosis of vascular occlusion. Atherectomy and endarterectomy are surgical procedures for removing atheromas, deposits of fat, from arterial walls.
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3.26 Angina Pectoris Now let's consider some of the possible consequences of insufficient blood supply to the heart. Angina pectoris, often simply referred to as "angina," is a specific type of chest pain that occurs when the heart's demand for oxygen cannot be met because the flow of blood in a coronary artery has been impeded. The illustration demonstrates the location of chest pain during angina. Mild, transient attacks of angina pectoris are treated with the sublingual administration of nitroglycerine tablets. You will recall that sublingual means under the tongue. This medication acts as a vasodilator, causing the vessel walls to relax and expand, permitting greater blood flow and relieving the pain. Cardiodynia and cardialgia are terms that are also used to refer to pain in the anterior chest.
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3.27 Myocardial Infarction and CPR Complete interruption of blood flow in a coronary artery causes myocardial infarction (MI), destruction of myocardial tissue, which is also called a heart attack. As you learned in Lesson 2 of this module, blood tests for the cardiac enzymes LDH and CK are used to confirm the diagnosis of myocardial infarction. The terms infarct and infarction refer to localized areas of necrosis (death) in a tissue due to local ischemia from an interruption in the blood supply to the area. When a heart attack results in cardiac arrest, cardiopulmonary resuscitation (CPR) is the emergency procedure for providing basic life support. Artificial ventilation and external cardiac massage are applied to maintain circulation to the brain until further treatment enables the heartbeat to resume unaided. Medications in the drug class called beta blockers are often prescribed for patients who have had a heart attack because these drugs reduce the force and speed of the heartbeat and lower blood pressure.
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3.28 Percutaneous Transluminal Coronary Angioplasty (PTCA) Treatment of CAD typically begins with administration of medications to enhance coronary blood flow. Percutaneous transluminal coronary angioplasty (PTCA) is a nonsurgical intervention for treatment of coronary artery disease. During PTCA, a balloon-tipped catheter and a meshlike tube called a stent are threaded into a coronary artery to dilate the clogged vessel. The stent is designed to prevent closure of the vessel during and after angioplasty. Another type of nonsurgical treatment for coronary occlusion is laser angioplasty. This procedure causes the destruction of obstructing plaque in an artery, using a tiny laser device that is introduced via catheter in the course of arteriography, or attached to the fiber-optic probe used for angioscopy.
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3.29 Coronary Artery Bypass Graft (CABG) If coronary artery obstruction is too extensive or is unresponsive to medical therapy, a coronary artery bypass graft (CABG) may be performed. In this surgical procedure, a blood vessel is grafted onto one of the coronary arteries to bypass the area of occlusion. A triple bypass is illustrated.
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3.30 Vasoconstriction and Vasodilation Now we'll discuss some conditions that may affect blood vessels other than the coronary arteries. Vasoconstriction is the narrowing (constriction) of blood vessels. When blood vessels constrict, the flow of blood is restricted or slowed and the blood pressure becomes elevated. Vasoconstriction may be referred to as angiostenosis. Vasoconstriction may be slight or severe. It can result from disease, or it may be caused temporarily by the response of the nervous system to medications or emotions. Medications that cause vasoconstriction are called vasoconstrictors; they include decongestants and caffeine. Vasodilation and vasodilatation are terms that refer to the expansion of blood vessels. This increase in the diameter of the vessels increases the volume of blood flow to a part. Extreme vasodilation causes hypotension and shock. Vasodilation may be treated with vasoconstrictors. Vasodilators are medications that cause vasodilation; they are used to treat or prevent vasoconstriction.
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3.31 Aneurysms An aneurysm, indicated in medical terms by the combining form aneurysm/o, is the dilation, or ballooning, of a weakened portion of an arterial wall (Figs. A-C). Although aneurysms of the peripheral arteries may occur, these outpouchings most commonly affect the aorta. Atherosclerosis is a frequent cause of aortic aneurysms. Aneurysms are often detected by chest x-ray, but electrocardiography, echocardiography, computed tomography, and magnetic resonance imaging may also be used to diagnose and assess the severity of aneurysms.
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3.32 Aneurysmectomy Therapeutic management of aneurysms aims to prevent rupture, and surgery is typically the treatment of choice. Aneurysms in smaller arteries may be treated by clamping off the blood flow to the weakened portion of the vessel. Larger arteries require aneurysmectomy, surgical excision of the aneurysm (as seen in the illustration), often with application of a synthetic graft over the arterial defect.
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3.33 Deep Vein Thrombosis Venous thrombosis, also called phlebothrombosis, is a condition characterized by the presence of a blood clot in a vein. A clot may form in response to injury to the vein, infection, or slowed or halted blood flowâ€” called venous stasisâ€”that may occur following surgery or during prolonged periods of inactivity, or in hematologic disorders in which the blood tends to clot more rapidly than is normal. As the clot enlarges, the body responds by producing an inflammatory reaction in the area. Venous thrombosis with inflammation is called thrombophlebitis. Symptoms of this condition include tenderness, pain, swelling, warmth, and discoloration of the skin (as seen in the accompanying illustration). This condition is potentially life-threatening because a portion of the blood clot can break off, forming an embolus, an object that travels through the bloodstream until it lodges in a smaller vessel and blocks it. Often the blocked vessel is the pulmonary artery. Anticoagulant medications, such as heparin, that help to prevent blood from clotting, and thrombolytic agents that dissolve existing clots, are administered to treat venous thrombosis.
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3.34 Varicose Veins Varicose veins are swollen and twisted veins, usually found in the lower extremities. Varicosities occur when the venous valves become damaged and fail to prevent the backward flow and pooling of blood in the legs. The blood then collects in the veins and the veins become distended. Causes of varicose veins include pregnancy, obesity, heredity, illness, and injury. Conservative treatment consists of leg elevation and the use of elastic stockings; for more severe cases, surgery may be required. Surgical removal of a vein is called a phlebectomy and is commonly referred to as a "vein stripping."
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3.35 Hypertension Hypertension is a major risk factor for vascular disease. It is defined as a sustained elevation of blood pressure above 140/90 mm Hg. The etiology of hypertension is categorized as either essential or secondary. Essential hypertension, the most frequently occurring kind, has no identifiable cause. However, it is associated with obesity, a sedentary lifestyle, increased sodium intake, smoking, high cholesterol levels, and a family history of high blood pressure. Therapeutic interventions include lifestyle modifications and antihypertensive medication. Calcium channel blockers are drugs that reduce the myocardial oxygen demand, causing arterial relaxation. These medications are used to treat hypertension as well as angina and congestive heart failure.
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3.36 Discussion Board
Discuss the link between obesity and cardiovascular disorders. With all the emphasis during the last decade on diet and exercise, are Americans more physically fit now than in the past? Post your discussion on the Discussion Board in this module titled "Obesity and Cardiovascular Disorders."
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3.37 Secondary Hypertension (slide show) Secondary hypertension has a specific cause that is responsible for the elevated blood pressure. Known causes of hypertension include renal disease, endocrine disorders, and neurologic disorders. Treatment of secondary hypertension may involve medication and/or surgery to address the underlying cause.
Hypertension in Body Systems
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3.38 Activity: Fill-In Let's review the material covered in this lesson by completing the activities that follow.
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3.39 Activity: Multiple Choice
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1.1 Basic Structure and Function The lymphatic system is a complex network of vessels, ducts, nodes, and organs that perform many important functions in the body. The lymphatic system transports proteins and excess tissue fluid that leak from the capillaries, returning them to the venous blood. This process is essential to maintain the fluid balance in the body. The lymphatic vessels absorb and transport fat from the small intestine to the general circulation. The lymphatic system also plays an important role in immunity by helping to protect the body from foreign, disease-causing microorganisms. The combining forms lymphat/o and lymph/o are used to refer to the lymphatic system. Lymph/o also refers to lymph, the fluid transported by the system.
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1.2 Lymph Lymph is a clear, watery liquid that flows through the lymphatic vasculature. It is derived from the interstitial fluid surrounding the body's cells. Under the microscope, we can see both the liquid portion and the cellular composition of lymph. The liquid part contains water, salts, sugar, proteins, lipids (fats), and metabolic wastes. Lymph also contains a variety of white blood cells. As we learned in the preceding module, these cells play an important part in protecting the body against infection.
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1.3 Threaded Case Study: Fred Laboratory examination of Fred's blood reveals some abnormal findings, including red blood cell irregularities and an elevation in the number of white blood cells. Later in the module, we'll learn more about what these findings mean.
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1.4 Lymphatic Capillary The lymphatic vessels begin in the intercellular spaces of the soft tissues of the body. There, fluid that has filtered out of the blood capillaries flows into small single-layered vessels called lymph capillaries. Networks of lymphatic capillaries are widely distributed throughout the body.
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1.5 Lymph Drainage Pathways (animation) Lymph capillaries merge to form larger tubules known as lymph vessels. Lymph vessels are greater in diameter than the lymph capillaries, and they have thicker walls. Like veins, the lymph vessels have valves to ensure a one-way flow of lymph toward two large ducts in the upper chest. From these ducts, lymph flows into the venous return system and rejoins the cardiovasculature. Thus, while the lymphatic system is distinct from the cardiovascular system, the two are intimately connected.
Lymph Drainage Pathways
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1.6 Lymph Nodes Lymph nodes are small oval structures that occur in clusters along the paths of the lymph vessels. The nodes vary in size: some are as tiny as a pinhead; others are as large as a lima bean. Lymph is conveyed via the vessels to the lymph nodes, which act as filters, removing invading microorganisms and other noxious agents. The largest clusters of lymph nodes are found in the neck (cervical), in the armpit (axillary), between the lungs (mediastinal), and in the groin (inguinal). Assessment of Fred's lymph nodes will be an important part of his physical examination.
About 3 liters of lymph are pumped into the bloodstream during a 24-hour period. Because the lymphatic system does not have a muscular pumping organ comparable to the heart, flow of lymph depends on the movements associated with breathing and on contractions of the skeletal muscles. Consequently, during physical exercise, lymph flow may increase 10- to 15-fold.
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1.7 Tonsils, Adenoids In the next module on the respiratory system, you'll learn more about the adenoids and tonsils. For now, know that these organs, paired masses of lymphatic tissue, also play an important role in defending the body against disease. Located in the throat, the tonsils and adenoids serve as a first line of protection against germs entering the body through the nose and mouth. The combining forms adenoid/o and tonsill/o are used to designate these structures. The term adenoid derives from aden/o, meaning gland, and -oid, meaning like or resembling. You know that the suffix -ectomy means surgical removal or excision. Tonsillectomy, therefore, means excision of the tonsils, and adenoidectomy is the term for removal of the pharyngeal tonsils or adenoids. When both procedures are performed at the same time, the combined surgery is called a tonsilloadenoidectomy, which is abbreviated T&A.
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1.8 Thymus The thymus, indicated in medical terms by the combining form thym/o, lies in the mediastinum, between the lungs, extending into the lower neck. Unlike the tonsils and adenoids, the thymus is a single organ, consisting of two lobes that contain lymphoid cells. The thymus appears to perform its most important work during the prenatal period and early childhood when its size, relative to the rest of the body, is largest. The thymus is essential to the development of the body's immune system.
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1.9 Threaded Case Study: The Spleen The spleen is an organ with an ovoid shape that is located in the left upper quadrant of the abdominal cavity, between the stomach and the diaphragm. Although it is seldom essential to life, it performs a variety of important functions. As blood flows through the spleen, harmful micro-organisms are filtered out and old red blood cells and platelets are destroyed. White blood cells are produced and activated within the spleen. The spleen, which is the largest lymphatic organ in the body, also acts as a reservoir for blood storage. The combining form splen/o is used in terms that refer to the spleen. Fred's spleen appears to be slightly enlarged. The doctor will integrate this information with other findings in arriving at a diagnosis of Fred's condition.
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1.10 Activity: Fill-In Let's review the material covered in this lesson by completing the activities that follow.
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1.11 Activity: Identification
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2.1 Disorders of the Lymphatic System In the previous lesson, we looked at the organs and functions of the lymphatic system. In this lesson, we'll consider some disorders of the lymphatic system. You may recall that the relationship between the spread of cancer and the lymphatic system was first mentioned in Module 3. Cancer cells can travel through lymph vessels; they may be filtered from the lymph in a lymph node and begin to grow a new cancer there, or they may be transported to other sites in the body via the network of lymphatic vessels. The spread of cancer to a site remote from the initial tumor is called metastasis, and metastatic means pertaining to metastasis. A metastatic tumor is a malignant growth that occurs secondary to the original, or primary, tumor and is not directly connected to it.
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2.2 Inflammatory Conditions of the Lymphatic System Many of the terms used to indicate inflammatory conditions of the lymphatic system are built from word parts. Typically these terms are constructed by appending the suffix -itis to word roots that give us specific information about the affected structure. One such term is lymphangitis, an inflammation of one or more lymphatic vessels (Fig. A). The definitions of the word parts in the term lymphadenitis (Fig. B) tell us that the inflammation affects the glands of the lymphatic system. A more general term, lymphadenopathy, is used to refer to any disease characterized by enlargement of the lymph nodes or vessels.
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2.3 Obstruction of Lymph Flow You'll recall in the previous lesson that we pointed out an important difference between the cardiovascular and lymphatic systems: the lymphatic system does not have a muscular pumping organ comparable to the heart. Instead, the flow of lymph depends on movements associated with breathing and with contraction of the skeletal muscles. Inflammation, obstruction, or removal of lymph channels can stop the flow of lymph, a condition known as lymphostasis. As lymph accumulates within the tissues, lymphedema, or swelling, occurs. Disorders of the lymphatic vessels are diagnosed with the use of lymphangiography, a type of radiographic imaging.
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2.4 Threaded Case Study: Fred Physical examination revealed enlargement of Fred's cervical and axillary lymph nodes. Lymphangiography, radiographic studies, computed tomography scans, and a lymph node biopsy were performed to provide a definitive diagnosis of Fred's condition. We'll soon learn more about what the doctor believes is responsible for Fred's health complaints.
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2.5 Splenomegaly As an organ of the lymphatic system, the spleen plays a vital role in providing the body with immunity from disease. It is also a site for blood cell production and blood storage. Enlargement of the spleen, splenomegaly, is associated with a variety of infectious processes and blood disorders.
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2.6 Thymoma A thymoma, as you can tell from the word parts, is a tumor of the thymus gland, an organ of the lymphatic system. Thymomas are slow-growing lesions and usually behave in a benign fashion. A subgroup of these tumors has an aggressive nature and is called invasive thymoma. A thymoma may result from an immune system disorder; it may also be associated with other types of illnesses, particularly myasthenia gravis. Myasthenia gravis is a disorder of neuromuscular transmission associated with immunological abnormality. It causes fatigue, muscle weakness, and a variety of other symptoms. Surgery is the preferred method of treating thymomas. Excision of the thymus is called thymectomy.
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2.7 Lymphomas Lymphomas, the fifth most common type of cancer in the United States, are malignant neoplasms of the lymph nodes and lymph tissues. The two major types of lymphoma are Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). The origin of Hodgkin 's disease is unknown, but it is associated in the majority of cases with a few specific viruses, particularly the Epstein-Barr virus that causes mononucleosis and the measles virus. It is characterized by progressive enlargement of lymphoid tissue.
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2.8 Non-Hodgkin's Lymphoma The symptoms and course of both types of lymphoma are very similar, but the lymphatic tissue in Hodgkin's disease contains specific cells—Reed-Sternberg cells—that are not found in any other cancerous lymphomas or cancers. These cells distinguish Hodgkin's disease from non-Hodgkin's lymphomas. Those with early stages of lymphoma are treated with high-dose radiation; advanced disease may be treated with intensive chemotherapy alone or in combination with radiation. A high rate of cure is obtained with these treatment methods.
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2.9 Threaded Case Study: Fred Fred's physician has concluded that his symptoms—lymphadenopathy, splenomegaly, occasional arrhythmia, fatigue, weight loss, anemia, and an elevated white blood cell count—are manifestations of Hodgkin's lymphoma. Fred and his doctor have discussed treatment options and plan to manage this condition with chemotherapy and radiation to the involved sites. A team of medical providers will help Fred address the physical and psychosocial implications of his diagnosis, and he is encouraged to learn of the favorable prognosis for many of those with Hodgkin's disease.
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2.10 Activity: Listen and Spell Let's review the material covered in this lesson by completing the activity that follows.
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Word Parts If you've studied the combining forms, prefixes, and suffixes in your text, you're now ready for the additional practice you'll receive with word parts in this module. Check your glossary for definitions of all the word parts used in the following exercises. To review the construction of medical terms using prefixes, combining forms, and suffixes, return to earlier modules in this series. Click Next to continue.
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Activity: Write It, Find It
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Activity: Word Shop
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Activity: Part Puzzler
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Case Study 1
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Case Study 2
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Learning Links For additional information about the cardiovascular and lymphatic systems, visit the following web sites:
American Heart Association Congenital Heart Information Network HeartPoint NovaOnline Medlineplus Health Information Lymphoma Information Network
Module 8: Cardiovascular and Lymphatic Systems Section I: The Cardiovascular System Lesson 1: Structure and Function Screen 01
Fred. From PhotoDisk CD, Getty Images, Seattle, WA (#18164).
CV system and blood flow. Modified from Birmingham J: Medical terminology: A self-learning text, ed 3, 1999, St. Louis, Mosby.
External view of the heart. From Seidel HM, et al: Mosby's guide to physical examination, ed 5, 2003, St. Louis, Mosby, Inc.
Heart's relation to thoracic cavity. Modified from Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Heart wall layers. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis, Mosby/Elsevier.
Chambers of the heart. Modified from Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Cardiac valves. Modified from Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Coronary arteries. From Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Systemic v. pulmonary circulation. From Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Systole/diastole. Modified from Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Heart's electrical conduction. Modified from Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Fred. From PhotoDisk CD, Getty Images, Seattle, WA (#18164).
Relative size of blood vessels. Modified from Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Microcirculation. From Thibodeau GA, Patton KT: Anatomy & physiology, ed 5, 2003, St. Louis, Mosby/Elsevier.
Categories of blood vessels. Modified from Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Lesson 2: Diagnostic Tests and Procedures Screen 01
Pulse points. From Ignatavicius D, Workman M: Medical-surgical nursing: Critical thinking for collaborative care, ed 4, vol. 1, 2002, Philadelphia, W.B. Saunders.
Taking blood pressure. From Perry AG, Potter PA: Clinical nursing skills & techniques, ed 5, 2004, St. Louis, Mosby/Elsevier.
Types of sphygmomanometers. From Mosby's medical dictionary, ed 6, 2002, St. Louis, Mosby, Inc.
Normal ECG. From LaFleur Brooks M: Exploring medical terminology, ed 4, 1998, St. Louis, Mosby. ECG with tachycardia. From Thibodeau GA, Patton KT: Anatomy & physiology, ed 5, 2003, St. Louis, Mosby/Elsevier.
PET scan. From Pagana KD, Pagana TJ: Mosby's manual of diagnostic and laboratory tests, ed 2, 2002, St. Louis, Mosby.
Echocardiography. From Mosby's medical dictionary, ed 6, 2002, St. Louis, Mosby, Inc. Image. From Ballinger P, Frank G: Merrill's atlas of radiographic positions and radiologic procedures, vol. 3, ed 10, 2003, St. Louis, Mosby, Inc.
Computed tomography angiography. From Ballinger P, Frank G: Merrill's atlas of radiographic positions and radiologic procedures, vol. 3, ed 10, 2003, St. Louis, Mosby, Inc.
Cardiac catheterization. From Kern MJ: Procedural skills for the cardiac cath team, No. 1, St. Louis, Mosby.
Magnetic resonance angiography. From Ballinger P, Frank G: Merrill's atlas of radiographic positions and radiologic procedures, vol. 3, ed 10, 2003, St. Louis, Mosby, Inc.
Laboratory testing. From PhotoDisk CD: Getty Images, Seattle, WA.
Lipoprotein. From Thibodeau GA, Patton KT: Anatomy & physiology, ed 5, 2003, St. Louis, Mosby/Elsevier .
Lesson 3: Cardiovascular Pathologies Screen 02
Bacterial endocarditis. From Damjanov I, Linder J: Pathology: A color atlas, 2000, St. Louis, Mosby.
Pericarditis. From Damjanov I: Pathology for the health-related professions, ed 2, 2000, Philadelphia, W.B. Saunders.
Mitral valve stenosis. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis, Mosby/Elsevier.
Mitral valve prolapse. From Thibodeau GA, Patton KT: Anatomy & physiology, ed 5, 2003, St. Louis, Mosby/Elsevier.
Stethoscope to chest for heart sound. From PhotoDisk CD: Getty Images, Seattle, WA (#18029).
Angiocarditis. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 5, 2000, St. Louis, Mosby.
Artificial valves. From Ignatavicius D, Workman M: Medical-surgical nursing: Critical thinking for collaborative care, ed 4, vol. 1, 2002, Philadelphia, W.B. Saunders.
Normal heart beat. From Seidel HM, et al: Mosby's guide to physical examination, ed 5, 2003, St. Louis, Mosby, Inc.
Heart block. Modified from Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Atrial flutter. Modified from Ignatavicius D, Workman M: Medical-surgical nursing: Critical thinking for collaborative care, ed 4, vol. 1, 2002, Philadelphia, W.B. Saunders.
Ventricular and atrial fibrillation. From Ehrlich RA, McCloskey ED, Daly JA: Patient care in radiography, ed 6, 2004, St. Louis, Mosby/Elsevier.
Defibrillation. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 5, 2000, St. Louis, Mosby. Cardiac pacemaker. From Ignatavicius D, Workman M: Medical-surgical nursing: Critical thinking for collaborative care, ed 4, vol. 1, 2002, Philadelphia, W.B. Saunders. Inset. From Ballinger P, Frank G: Merrill's atlas of radiographic positions and radiologic procedures, vol. 3, ed 10, 2003, St. Louis, Mosby, Inc.
Cardiomegaly. From Zitelli BJ, Davis HW: Atlas of pediatric diagnosis, ed 4, 2002, St. Louis,
Mosby/Elsevier. Screen 17
Septal defects. Modified from Seidel HM, et al: Mosby's guide to physical examination, ed 5, 2003, St. Louis, Mosby, Inc.
Coarctation of the aorta. Modified from Seidel HM, et al: Mosby's guide to physical examination, ed 5, 2003, St. Louis, Mosby, Inc. Patent ductus arteriosus. Modified from Seidel HM, et al: Mosby's guide to physical examination, ed 5, 2003, St. Louis, Mosby, Inc. Tetralogy of Fallot. Modified from Seidel HM, et al: Mosby's guide to physical examination, ed 5, 2003, St. Louis, Mosby, Inc.
Pitting edema from congestive heart failure. From Mosby's medical dictionary, ed 6, 2002, St. Louis, Mosby, Inc.
Heart transplantation. From Ignatavicius D, Workman M: Medical-surgical nursing: Critical thinking for collaborative care, ed 4, vol. 1, 2002, Philadelphia, W.B. Saunders.
Progressive development of atherosclerosis. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis, Mosby/Elsevier.
Occluded artery. From McCance KL, Huether SE: Pathophysiology: The biologic basis for disease in adults & children, ed 4, 2002, St. Louis, Mosby/Elsevier.
Location of chest pain during angina pectoris. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis,
Mosby/Elsevier. Screen 27
Myocardial infarction. Modified from Ignatavicius D, Workman M: Medical-surgical nursing: Critical thinking for collaborative care, ed 4, vol. 1, 2002, Philadelphia, W.B. Saunders.
Percutaneous transluminal coronary angioplasty. From Ignatavicius D, Workman M: Medical-surgical nursing: Critical thinking for collaborative care, ed 4, vol. 1, 2002, Philadelphia, W.B. Saunders.
Coronary artery bypass graft. Modified from Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Aneurysms. Modified from Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis, Mosby/Elsevier.
Aneurysmectomy. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis, Mosby/Elsevier.
Deep vein thrombosis. From Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis, Mosby/Elsevier.
Varicose veins. Modified from Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: Assessment and management of clinical problems, ed 6, 2004, St. Louis, Mosby/Elsevier.
Treating hypertension. From PhotoDisk CD: Getty Images, Seattle, WA.
General anatomy highlighting urinary, endocrine, and CNS. From Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Section II: The Lymphatic System Lesson 1: Anatomy and Physiology Screen 01
Lymphatic system. From Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Lymph node cortex. From Gartner LP, Hiatt JL: Color textbook of histology, ed 2, 2001, Philadelphia, W.B. Saunders.
Fred. From PhotoDisk CD, Getty Images, Seattle, WA (#18164).
Lymph capillary. Modified from Thibodeau GA, Patton KT: Anatomy & physiology, ed 5, 2003, St. Louis, Mosby/Elsevier.
Lymph drainage pathways. Modified from Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Lymph nodes. From Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Tonsils, adenoids. From Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier.
Relative size of thymus in adult and child. From Seidel HM, et al: Mosby's guide to physical examination, ed 4, 1999, St. Louis, Mosby, Inc.
Spleen. Modified from Herlihy B, Maebius NK: The human body in health and illness, ed 2, 2003, Philadelphia, W.B. Saunders/Elsevier. Palpating spleen. From Seidel HM, et al: Mosby's guide to physical examination, ed 5, 2003, St. Louis, Mosby, Inc.
Lesson 2: Disorders of the Lymphatic System Screen 01
Lymphatic system. From Thibodeau GA, Patton KT: The human body in health & disease, ed 4, 2005, St. Louis, Elsevier/Mosby.
Lymphangitis. From Zitelli BJ, Davis HW: Atlas of pediatric diagnosis, ed 4, 2002, St. Louis, Mosby/Elsevier. Lymphadenitis. From Zitelli BJ, Davis HW: Atlas of pediatric diagnosis, ed 4, 2002, St. Louis, Mosby/Elsevier.
Lymphedema from lymph flow obstruction. From Mosby's medical dictionary, ed 6, 2002, St. Louis, Mosby, Inc.
Fred. From PhotoDisk CD, Getty Images, Seattle, WA (#18164).
Splenomegaly. From Zitelli BJ, Davis HW: Atlas of pediatric diagnosis, ed 4, 2002, St. Louis, Mosby/Elsevier.
Thymoma. From Damjanov I, Linder J: Pathology: A color atlas, 2000, St. Louis, Mosby.
Enlargement of lymph nodes in Hodgkin's disease. From Mosby's medical, nursing, & allied health dictionary, ed 5, 1998, St. Louis, Mosby.
Variant of non-Hodgkin lymphoma. From Stevens A, Lowe J: Pathology, ed 2, 2000, St. Louis, Mosby.
Fred. From PhotoDisk CD, Getty Images, Seattle, WA (#18164).
Section IV: Applications Case Study 1
85 yo Charlie. From PhotoDisk CD Everyday People 2, Getty Images, Seattle, WA (#SS33085).
Case Study 2
Mildred. From PhotoDisk CD Everyday People 2, Getty Images, Seattle, WA (#SS33051).