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The Cardiovascular System / Edited by Kara Rogers, Senior Editor.—1St Ed Published in 2011 by Britannica Educational Publishing (a trademark of Encyclopædia Britannica, Inc.) in association with Rosen Educational Services, LLC 29 East 21st Street, New York, NY 10010. Copyright © 2011 Encyclopædia Britannica, Inc. Britannica, Encyclopædia Britannica, and the Thistle logo are registered trademarks of Encyclopædia Britannica, Inc. All rights reserved. Rosen Educational Services materials copyright © 2011 Rosen Educational Services, LLC. All rights reserved. Distributed exclusively by Rosen Educational Services. For a listing of additional Britannica Educational Publishing titles, call toll free (800) 237-9932. First Edition Britannica Educational Publishing Michael I. Levy: Executive Editor J.E. Luebering: Senior Manager Marilyn L. Barton: Senior Coordinator, Production Control Steven Bosco: Director, Editorial Technologies Lisa S. Braucher: Senior Producer and Data Editor Yvette Charboneau: Senior Copy Editor Kathy Nakamura: Manager, Media Acquisition Kara Rogers: Senior Editor, Biomedical Sciences Rosen Educational Services Hope Lourie Killcoyne: Senior Editor and Project Manager Joanne Randolph: Editor Nelson Sá: Art Director Cindy Reiman: Photography Manager Nicole Russo: Designer Matthew Cauli: Cover Design Introduction by Adam Chodosh, M.D. Library of Congress Cataloging-in-Publication Data The cardiovascular system / edited by Kara Rogers, senior editor.—1st ed. p. cm.—(The human body) “In association with Britannica Educational Publishing, Rosen Educational Services.” Includes bibliographical references and index. ISBN 978-1-61530-251-2 (eBook) 1. Cardiovascular system. I. Rogers, Kara. QP101.C2927 2011 612.1—dc22 2010001624 Cover © www.istockphoto.com/Sebastian Kaulitzki/ P. 12 This view of a human heart reveals the inner structures, or anatomy, including the valves. 3D4Medical.com/Getty Images; p. 21 (top), 44, 70, 87, 112, 150, 181, 201, 239, 240, 242, 244 © www.istockphoto.com/Logan Dance. CONTENTS Introduction 12 Chapter 1: The Human Heart 21 Origin and Development 24 Pericardium 26 External Surface of the Heart 27 Chambers of the Heart 28 Atria 29 23 Ventricles 29 Valves of the Heart 30 The Heart Wall 32 Blood Supply to the Heart 34 Heartbeat 36 The Conduction System 37 Nervous Control of the Heart 40 Cardiac Output 40 Systole and Diastole 41 Heart Sounds and Murmurs 42 Chapter 2: The Blood Vessels 44 Arteries 45 45 The Aorta and Its Principal Branches 48 Renal Artery 51 The Pulse 53 Veins 54 Venae Cavae 57 56 Portal System 61 Venous Pulmonary System 63 Capillaries 63 Pulmonary Circulation 65 Systemic Circulation 67 Human Fetal Circulation 67 Angiogenesis 68 Chapter 3: Congenital Heart Disease 70 Causes and Diagnosis of Congenital Heart Disease 71 Types of Congenital Heart Diseases 73 Abnormalities of Individual Heart Chambers 74 Abnormalities of the Atrial Septum 75 Abnormalities of the Ventricular 82 Septum 76 Abnormal Origins of the Great Arteries 78 Abnormalities of the Valves 79 Abnormalities of the 88 Myocardium and Endocardium 79 Abnormalities of the Coronary Arteries 80 Abnormalities of the Aorta 80 Anomalous Pulmonary Venous Return 83 Anomalies of the Venae Cavae 83 Repair of Congenital Cardiac Defects 84 Chapter 4: Acquired Heart Disease 87 Coronary Artery Disease 87 Coronary Heart Disease 89 Epidemiology 90 Risk Factors 91 Angina Pectoris 91 Heart Attack 94 Survival During and After a Heart Attack 99 Sudden Death 100 Prevention of Coronary Heart 95 Disease 101 Diseases of the Pulmonary Artery and Aorta 102 Rheumatic Heart Disease 102 Pulmonary Heart Disease (Cor Pulmonale) 105 Other Diseases of the Pulmonary Artery and Aorta 107 Chapter 5: Diseases of Heart Tissues, Disturbances in Cardiac Rhythm, and Heart Failure 112 Diseases of Heart Tissues 112 Diseases of the Endocardium and Valves 113 Diseases of the Myocardium 118 138 Diseases of the Pericardium 122 Disturbances in Cardiac Rhythm and Conduction 123 Determinants of Cardiac Rhythm 125 Premature Contractions 128 Arrhythmia 128 Heart Failure 139 Congestive Heart Failure 140 Ventricular Dysfunction in Heart Failure 141 Treatment of Heart Failure 145 Chapter 6: Diseases of the Blood Vessels 150 Diseases of the Arteries 150 Atherosclerosis 151 159 Thrombosis 162 Embolism 163 Stroke 165 Arteritis 168 Arteriovenous Fistula 170 Raynaud Syndrome 171 Acrocyanosis 172 Erythromelalgia 173 Aortic Arch Syndrome 173 Other Injuries to Arteries 174 Diseases of the Veins 175 Thrombophlebitis 175 Varicose Veins 176 Hemorrhoids 178 Venospasm 178 Diseases of the Capillaries 179 Angioma 180 Chapter 7: Hemodynamic 182 Disorders and Shock 181 Hemodynamic Disorders 181 Hypertension 182 Hypotension 186 Bainbridge Reflex 187 Syncope 188 Physiological Shock 190 Shock Due to Inadequate Blood Volume 192 Shock Due to Inadequate Cardiac Output 194 Bacteremic Shock 194 195 Anaphylactic Shock 196 Psychogenic Shock 197 Drugs and Shock 197 Neurogenic Shock 198 Endocrine Causes of Shock 199 Refractory and Irreversible Shock 199 Chapter 8: Approaches to Cardiovascular Evaluation and Treatment 201 Modern Developments in 203 Cardiology 202 Noninvasive Evaluation Techniques 204 Echocardiography 204 Ballistocardiography 205 Radionuclide Imaging 206 Electrocardiography 210 Phonocardiography 212 Cardiac Magnetic Resonance Imaging 213 Invasive Evaluation Techniques 214 Cardiac Catheterization 214 Angiocardiography 216 211 Angiography 217 Surgical and Emergency Cardiac Treatments 218 Open-Heart Surgery 219 Cardiopulmonary Bypass 219 Mechanical Hearts 222 Valvular and Pericardial Surgeries 225 Cardiac Pacemakers 227 Repair of Heart Wounds 228 Coronary Artery Bypass Surgery 229 223 Angioplasty 230 Heart Transplantation 231 Cardiopulmonary Resuscitation 233 Defibrillation 235 Conclusion 239 Glossary 240 Bibliography 242 Index 244 230 INTRODUCTION 7 Introduction 7 ohn is a 54-year-old high school AP physics teacher. JOne spring morning while walking his dog around the block, John developed the sudden onset of crushing chest pain. So severe was the attack that he collapsed in front of his neighbour’s house. Hearing the dog’s frantic barking, the neighbour rushed out, saw that John was in need of immediate medical attention, and ran to call 911. Within minutes John was taken directly to the local hospital by an ambulance. Whisked into the emergency room, a doctor performed an electrocardiogram on John, then diagnosed him as having had a myocardial infarction. (Commonly referred to as a heart attack, this is when heart muscle dies because a blocked artery causes an interruption in blood supply to the heart.) John was then quickly brought to a catheterization laboratory. There, a cardiologist threaded a small catheter into the major blood vessel leading into the blocked artery in John’s heart. By inflating a tiny balloon, the doctor opened the blocked passage, thereby restoring blood fl ow to John’s heart. Thanks to that prompt, precise, and practiced attention, John survived, going on to do quite well after what was a near-fatal episode. Although it was a happy ending indeed, the fact that John and far too many others throughout the world suffer such attacks in the fi rst place is a phenomenon science is working to minimize. The accurate diagnosis and life-saving treatment that John received has evolved over hundreds of years. This volume will put into perspective the foundations of car- diac development and pathophysiology laid out by the forefathers of modern cardiology, guiding readers through the development of diagnostic and therapeutic options that exist today. In addition, the structure and function of the heart and blood vessels as well as the technologies that are used to evaluate and monitor the health of these 13 7 The Cardiovascular System 7 fundamental components of the human cardiovascular system are described in detail. The human heart, a complex organ vital to life, pumps blood throughout the body, giving the body the oxygen it needs to function properly. Normally about the size of a fist, the heart is divided into four chambers. The upper chambers, called atria, collect blood returning to the heart. They then empty the blood into the two lower chambers, called ventricles, which are the major pumping chambers of the heart. The heart is divided into a right side and a left side. The heart’s right atrium receives blood from the veins throughout the body and delivers it into the right ventricle. The right ventricle in turn pumps the blood to the lungs to pick up oxygen. The oxygen-rich blood then goes into the left atrium. Finally, the left ventricle pumps the blood through the aorta (the main artery in the body). The blood then continues on its way to all of the body organs and tissues. Four heart valves, located between each chamber, route blood flow in the proper direction. Closure of the cardiac valves produces the “lub-dub” sounds one hears when listening to the heart. The other integral system of the heart is its ability to intrinsically conduct electricity. The electrical system is responsible for initiating and coordinating the mechanical activity of the heart. Cardiac electro-physiology is the branch of cardiology in which the electrical and arrhythmic activities of the heart are monitored, measured, studied, and treated. Though the heart has been regarded throughout history as a vital organ, the structure and function of the cardiovascular system have nonetheless been mis- understood for a large segment of that time. The Greek physician Galen in the second century CE is credited 14 7 Introduction 7 with having first recognized that the heart
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