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Flashcards in Outcome 7 Circulation Deck (70):

List the following sections of the aorta in order, from most proximal to most distal:
-descending aorta
-aortic arch
-abdominal aorta
-ascending aorta

1)ascending aorta
2)aortic arch
3)descending thoracic aorta
4)abdominal aorta


List two exterior landmarks of the body that correspond to the bifurcation of the aorta

-umbilicus (belly button)
-iliac crests
-lumbar spinal body 4


The smooth muscle layer of arterial walls is known as

Tunica media


Which term best describes the external carotid arterys relationship to the internal carotid artery?

Anterior and lateral


The right vertebral artery branches off the

Right subclavian artery


True or false: blood pressure is very low in the IVC



True or false regarding the SVC: its proximal end is at the confluence of the right and left brachiocephalic veins



True or false: the portal vein carries nutrient rich deoxygenated blood from the digestive organs to the liver, where solute and nutrient levels are regulated, and foreign matter is removed



Dural sinuses

Are contained within the folds of the dura mater


Which is more anterior, the SVC, or the thoracic aorta



Which lies more right, the IVC or the aorta?



Describe the how cerebral sinuses are similar to veins

-they both collect deoxygenated blood and return it to the heart


Arteries have three layers to their walls but veins only have two



The blood pressure in the portal vein is higher than the blood pressure in the IVC



How many pulmonary veins are there?



Arterial blood is pumped from the ❤️through a series of large distribution vessels the ____



The largest artery is the ____



Arteries subdivide into vessels that become progressively smaller and finally become tiny ____ that control the flow into microscopic exchange vessels called _____

Arterioles, capillaries


What happens in capillary beds

The exchange of nutrients and respiratory gases occurs between the blood and tissue fluid around the cells


Blood exits, or is drained from capillary beds and then enters the small ____, which join with other venues and increase in size becoming ____

Venules, veins


List these in order:

Arteries -> arterioles -> venules -> veins


Types of blood vessels

-ARTERIES: carry blood away from the heart and toward the capillaries
-VEINS: carry blood towards the heart and away from capillaries
-CAPILLARIES: carry blood from the arterioles to the venules



Carry blood away from the heart and toward the capillaries



Carry blood toward the heart and away from capillaries



Carry blood from the arterioles to the venules


The largest veins are often called ____ and are the _____ and _____

Often called sinuses and are the superior vena cava and inferior vena cava


Structure of arteries

-TUNICA INTIMA : inner layer of endothelial cells
-TUNICA MEDIA: smooth muscle; thick in arteries; some elastic tissue; important in blood pressure regulation
-TUNICA EXTERNA: outer layer of fibrous connective elastic tissue


Structure capillaries (microscopic vessels)

-only one layer thick: TUNICA INTIMA
-very thin
-precapillary sphincters determine how much blood will flow into each of the capillaries


Structure veins

-TUNICA INTIMA: inner layer; valves prevent retrograde movement of blood
-TUNICA MEDIA: smooth muscle; thin in veins
-TUNICA EXTERNA: heavy layer of fibrous connective tissue in many veins


Function of arteries

-distribute nutrients, gases etc
-carried in the blood by way of high pressure
-assist in maintaining the arterial blood pressure
-serve as blood reservoirs


Functions of capillaries

Serve as exchange vessels for nutrients, wastes, and fluids


Functions of veins

-collect blood for return to the heart
-low pressure flow of blood (compared to arteries)


Systemic circulation

-carries blood throughout the body
-path goes from left ventricle through aorta, smaller arteries, arterioles, capillaries, venules, venae cavae, to right atrium


Pulmonary circulation

-carries blood to and from the lungs
-arteries deliver deoxygenated blood to the lungs for gas exchange
-path goes from right ventricle through pulmonary arteries, lungs, pulmonary veins, to left atrium


Hepatic portal circulation

-unique blood route through the liver
-veins from the spleen, stomach, pancreas, gallbladder and intestines do not pour blood directly to inferior vena cava as do the other veins from the abdomen all organs instead their blood flow is funnelled to the liver
-blood leaves the liver by way of the hepatic veins, which drain into the inferior vena cava
-vein (hepatic portal vein) exists between two capillary beds
-assists with homeostasis of blood glucose levels


The detour of venous blood through a secondary capillary bed serves some valuable purposes:

-blood leaving the liver usually has a somewhat normal blood glucose concentration
-liver cells also remove and detoxify various poisonous substances that may be present in the blood


True or false: The aorta is the major artery leaving the left ventricle of the heart



What are the major 3 branches that arise from the arch of the aorta?

-brachiocephalic artery
-left common carotid artery
-left subclavian artery


Brachiocephalic trunk bifurcated into the

-right common carotid artery
-right subclavian artery
-the site of bifurcation for each common carotid artery is at the approximate level of the fourth cervical vertebra


Circle of willis

-the posterior brain circulation communicates with the anterior circulation along the base of the brain in the arterial circle (or circle of willis)
-5 arteries or branches that make up the arterial circle are: anterior communicating artery, anterior cerebral artery, branches of the internal carotid arteries, posterior communicating artery, posterior cerebral arteries
-certain aneurisms may occur in the vessels that make up the arterial circle


The important "master gland", the hypophysis (pituitary gland), and its surrounding bony structure, the sella tursica are located within _____

The arterial circle (circle of willis)


The right and left ______ veins join to form the superior vena cava

Right and left brachiocephalic veins


Abdominal aorta is anterior to the vertebrae and extends from the diaphragm to approximately L4, where it bifurcates into:

The right and left common iliac arteries


The lower limbs receive blood from the

External iliac arteries
-significant in angiography and is used to study each lower limb


What does the mesenteric vein usually have to do with?

The small and large intestine and sometimes rectum


The arterial circulation of the upper limb is generally considered to begin at the ______ artery

-subclavian artery
-origin of subclavian artery differed from the right to left side
-on the right side it arises from the BRACHIOCEPHALIC ARTERY
-on the left side originates directly from aortic arch
-subclavian continues to become the AXILLARY ARTERY, which gives rise to the BRACHIAL ARTERY, the brachial artery bifurcates into the ULNAR and RADIAL ARTERIES at approximately the level of the next of the radius


Anterior cubical vein

-vein most common used to draw blood
-anterior to the elbow joint
-connects the superficial drainage systems of the forearm


Atrial circulation of the lower limb begins at the ______ artery and ends at the arteries of the foot

-external iliac arteries


What is the largest vein in the body

Great saphenous vein


What is the only vein that carries oxygenated blood

Pulmonary veins


How blood travels through the heart

SVC+IVC➡️ right atrium➡️tricuspid valve➡️right ventricle➡️pulmonary valve➡️pulmonary artery➡️lungs➡️pulmonary veins (4 of them)➡️left atrium➡️mitral valve➡️left ventricle➡️aortic valve➡️aortic arch


Which chamber of the heart is most anterior

Right ventricle


Patent ductus arteriosis

-the ductus arteriosis is a vessel that runs from the bifurcation of a fetuses pulmonary artery to aorta, just distal to the left subclavian artery. It prevents blood from circulating to the fetuses undeveloped lungs. It should close at, or shortly after birth. If it remains "patent" (open) after birth, the neonate is said to have patent ductus arteriosis. This condition is more likely to occur in premi infants
-after birth, blood pressure is greater on the systemic side of the heart than on the pulmonary side, so some of the blood in the aorta, gets shunted back to the pulmonary trunk through the patent ductus arteriosis. The increased blood flow in the pulmonary arteries, lungs, left atrium and ventricle, and proximal aorta causes enlargement of these affected anatomical parts. Pulmonary hypertension can ultimately balance or reverse the left-to-right shunt
-chest x-rays will provide an initial assessment of the size, shape, and position of the heart and pulmonary vasculature
-small defects may resolve on their own, but medication or surgery may be required


Atrial septal defect

-the foramen ovale normally closes off during the first year of life, but in this condition it fails to do so
-blood from the higher pressure left atrium is shunted to the lower pressure right atrium after birth, which in turn increases the workload of the right ventricle and leads to increased blood flow to the lungs
-chest x-rays will show enlargement of the pulmonary "outflow tract" (leading to the pulmonary valve, right atrium and ventricle, with increased lung markings due to increased blood flow to the lungs


Ventricular septal defect

-an abnormal opening between the right and left ventricles that causes a left to right shunting of blood flow
-increased blood flow to and from the lungs. Increased workload for the left atrium and ventricle leading to enlargement of these chambers. Note: the right ventricle does not enlarge as shunting occurs during systole only, so blood shunted to the right ventricle is immediately pushed into the pulmonary artery
-chest x-rays will show enlargement of the pulmonary trunk, left atrium and ventricle, as well as increased pulmonary vascular volume (markings)


Tetrology of fallot

-a combination of four defects 1) pulmonary valve stenosis 2) high (superior) ventricular septal defect 3) overriding aorta (the opening of the aorta arches over the ventricular septal defect so that it ends up opening into both the right and left ventricles) 4) hypertrophy of right ventricle
-the pulmonary valve stenosis causes increased pressure in the right atrium leading to hypertrophy. It also prevents the normal amount of blood from reaching the lungs for oxygenation. Deoxygenated blood is pumped out of the body because of the overriding aorta and ventricular septal defect.
-chest x-rays will show enlarged right ventricle causing upward lateral displacement of the apex of the heart. Heart shadow will have classic "coeur en sabot" or "wooden shoe" appearance. 1/4 of patients will have the aorta on the right side.
-with surgery most patients will die before puberty and in some cases surgery is palliative only
-major sign of this is blue baby (cyanosis)


Coarctation of the aorta

-a stenosis of the descending aorta, just distal to the arteries that branch off to supply blood to the head, neck, and upper extremities
-because of the location of the stenosis, circulation to the upper extremities and head is normal, but there is decreased blood flow to the lower limbs and abdomen. This is the most common cause of hypertension in children. Can be treated with aortic resection
-the descending aorta has bulges on either side of the narrowing, which causes figure 3 sign to be visualized on a chest radiograph and a figure E to be visualized on an esophagram. Bony erosions occur in the ribs due to enlargement of collateral vessels


Arteriosclerosis and atherosclerosis

"Hardening of the arteries"
Arteriosclerosis: a general term that describes a thickening and loss of elasticity in the walls of the arteries
Atherosclerosis: is a more specific term that refers to the buildup of fibro-fatty deposits (plaque). The abdominal aorta, common iliacs, femoral, cerebral, and coronary arteries are most often affected. Most prevalent risk in humans! Risk factors include: high cholesterol diet, smoking, obesity, lack of exercise, diabetes, hypertension and genetics
-stenosis or occlusion of affected arteries can cause pathologies related to ischemia or necrosis of body tissues. For example: CAD, cerebrovascular accidents, and myocardial infarction. Increases the risk for aneurysm.
-conventional x-rays will show calcification on vessel walls in advanced stages. Angiography is modality of choice for diagnosis


CAD coronary artery disease

-atherosclerosis in the coronary arteries which supply blood to the heart. Prevents coronary vessels from expanding properly during systole
-decreased blood supply to the heart muscle leading to ischemia, or necrosis (infarct). Symptoms range from angina pectoris, to myocardial infarction (heart attack). May be treated with medications or surgical interventions, such as angioplasty or bypass surgery



- a weakness in the wall of an artery that causes a localized bulging. SACCULAR involves one side of artery. FUSIFORM involves entire circumference; DISSECTING involves separation of the tunica intima from the tunica media. Causes include arteriosclerosis, trauma, genetics or infection. Abdominal aorta aneurysms (AAA) usually occur inferior to the renal arteries
-hemorrhage may lead to death
-aortography done in angio is invasive, but effective


Myocardial infarction

-death of some portion of the heart muscle (heart attack) most commonly caused by an acute thrombus in the coronary arteries. In men symptoms include severe chest pain, SOB, profuse diaphoresis, nausea and vomiting. In women symptoms are less severe
-angina pectoris: is severe chest tightness, and pain that radiates to the jaw, neck and left arm, because of a temporarily insufficient supply of oxygen to the heart. It can occur when increased oxygen demands are placed on the heart during exercise, a heavy meal, emotional stress or a severe cold
-myocardial infarction: (heart attack) is death of some portion of the heart muscle due to lack of oxygen. The degree of heart muscle involvement will determine the patients prognosis.
-thrombolytic therapy is treatment of choice especially if administered within hours of initial attack


Heart failure

-Left sided heart failure: (congestive heart failure) occurs when the LV cannot pump blood effectively. It is usually caused by CAD, valve disease or hypertension.
-right sided heart failure: most often secondary to severe left-sided heart failure because back up of blood in the lungs is too much for the right-ventricle to overcome. Can also be caused by pulmonary valve stenosis, emphysema, and pulmonary emboli
-left sided heart failure complications: decreased systemic pumping pressure causes widespread fluid retention in body tissues, cardiomegaly, and back up of blood in the pulmonary circulation
-right sided heart failure complications: dilation of the RA, RV, and SVC and edema in the lower extremities. Liver congestion may elevate the right hemi diaphragm.
-cardiomegaly, increased lung density due to pulmonary edema, pleural effusion, elevated right hemi diaphragm



Any condition where the heart cannot beat in a normal rhythm
-bradycardia: slow heart rhythm
-tachycardia: fast heart rhythm
-sinus dysthymia: a heart rate that increases with inspiration and decreases with expiration
-premature contractions: (extrasystoles) heart contractions that occur before the expected time. May be caused by lack of sleep, anxiety, cold medication, too much caffeine or nicotine
-fibrillation: individual cardiac muscle fiber contractions are out of sync with one another
-ventricular fibrillation complications: is immediately life threatening!!!!!!!!!! but can sometimes be treated with electrical shock using and AED
-atrial fibrillation complications: can be treated through atrial ablation which is a surgical process that involves intentional localized destruction of some heart muscle
-artificial pacemakers can be implanted in patients that are prone to cardiac fibrillation or other dysthymias


Valvular disease

What is it?
1) a heart valve is stenotic or
2) a heart valve is insufficient and cannot close properly, so that blood is able to leak backwards through the valve (regurgitation)
-either condition will cause a characteristic sound of abnormal blood flow known as a "heart murmur"
-most commonly occurs in mitral valve or aortic valves secondary to rheumatic fever
-mitral valve stenosis slows blood flow between the left atrium and the left ventricle which in turn leads to hypertrophy of the left atrium and the right side of the heart (think of volume delays in the right side of the heart because blood returning from the lungs cant flow into the already "full" left atrium. The enlarged LA can displace surrounding structures such as the esophagus, or mainstream bronchus.
-a stenotic aortic valve increases the workflow of the LV
-artificial valves will be seen on chest x-ray


Pulmonary edema

-buildup of fluid in the interstitial spaces of the lung parenchyma, due to increased pulmonary venous pressure. Most commonly caused by left-sided heart failure, but may also originate from valve disease, left atrial tumor, or lymphatic blockage
-compromised lung function, sometimes described as "drowning from the inside out"
-treatment includes avoiding physical stress, decreasing salt intake, wearing compressive stockings, and medications to reduce fluid retention
-loss of clearly defined lung markings. Severe cases that involve the alveolar sacs will cause the "bats wing or butterfly sign". Right sided pleural effusion is also common


DVT- deep vein thrombosis

-DVT is a blood clot formed in a lower extremity vein. May be caused by trauma, bacterial infection, prolonged bed rest, and oral contraceptives. Emboli can also be composed of fat, air, cancer cells or pyogenic bacteria.
-pulmonary embolism, anytime an embolus occludes an artery, affected tissues will become necrosed.
-may be placed on anticoagulants or receive thrombolytic therapy


Pulmonary emboli

-an acute pathology that occurs when a piece of thrombus that has broken loose, enters the blood stream and becomes lodged in a pulmonary artery thereby obstructing blood flow to the lungs. Most often (95% of the time) originates from a DVT
-may lead to ARDS (acute respiratory distress syndrome), heart failure, or cardiogenic shock, depending on extent of obstruction, and patient history. Risk increases with bed rest and inactivity. Anticoagulants are administered to dissolve or prevent the development of DVT


Varicose veins

-veins that are permanently dilated and tortuous, because of blood that has pooled in them. Most often found in the superficial veins in the lower extremities. Causes include: congenital weakness of valves or venous walls, deep vein thrombophlebitis, hemostasis caused by pregnancy or occupations that require alot of standing
-the dilation of the venous lumen gives rise to leaky "incompetent" valves. The compromised venous flow can lead to superficial ulcers. Compression stockings, leg elevation, and exercise that promotes muscular contraction of leg muscles will help to minimize pooling.
-hemostasis can lead to development of phleboliths which are calcified blood clots in the affected veins



Where the aorta bifurcates


What condition requires implantation of an IVC filter? (Looks like an umbrella)

-mobile blood clot, embolism