Chapter 25Chapter 25

Circulatory Circulatory SystemSystem

3/ 14/ 2011 online

Two Circulatory SystemsTwo Circulatory Systems

Blood-vascular System- Blood-vascular System- major major portion- transports bloodportion- transports blood Consists of heart, arteries, capillaries Consists of heart, arteries, capillaries

and veinsand veins

Lymphatic System- Lymphatic System- minor portion minor portion – – collects fluid from tissue spaces, filters collects fluid from tissue spaces, filters

through lymph systemthrough lymph system

Two SystemsTwo Systems make up make up Circulatory SystemCirculatory System

Both carry oxygen and nutrients to Both carry oxygen and nutrients to tissues in continuous, endless uni-tissues in continuous, endless uni-directiondirection

Both transport waste products to organs of excretion- what are those 4 organs? Skin Lungs Liver kidneys

Heart has 2 circulation routes Heart has 2 circulation routes branching off it:branching off it:

Systemic (arterial circuit)- Systemic (arterial circuit)- carries oxygenatedcarries oxygenated bloodblood to to organs and tissuesorgans and tissues

PulmonaryPulmonary –carries blood to lungs –carries blood to lungs for carbon dioxide exchange and re-for carbon dioxide exchange and re-oxygenation of bloodoxygenation of blood

Pulmonary, systemic, and portal circulation

red = oxygenated blue = deoxygenated purple -nutrient-rich

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Systemic Systemic CirculationCirculation

Pumps blood to Pumps blood to organsorgans

Pulmonary CirculationPulmonary Circulation

Takes returning Takes returning bloodblood to to lungs to exchange carbon lungs to exchange carbon dioxide for oxygendioxide for oxygen

Carries Carries oxygenated oxygenated bloodblood from lungs to from lungs to heartheart

These are only veinsThese are only veins in post-fetal human body in post-fetal human body carrying oxygenated (red) carrying oxygenated (red) bloodblood

Portal SystemPortal System

Venous drainage Venous drainage from abdominal from abdominal organs to liver-organs to liver-

Filtered -Filtered -

Back to inferior vena Back to inferior vena cavacava

Liver has 2 blood Liver has 2 blood supplies!supplies!

Anatomy: HeartAnatomy: Heart 4 chambers 4 chambers

2 atria2 atria 2 ventricles2 ventricles

MyocardiumMyocardium - - muscular wall of heartmuscular wall of heart EndocardiumEndocardium -membrane lining interior of heart -membrane lining interior of heart

Pericardial sac- Pericardial sac- double-walled membrane double-walled membrane enclosing heartenclosing heart exterior wall is fibrousexterior wall is fibrous thin inner wall- thin inner wall- EpicardiumEpicardium - covers heart - covers heart

Great Vessels of Great Vessels of Heart Heart DeoxygenatedDeoxygenated//OxygenatedOxygenated Blood Flow Blood Flow

Pulmonary artery- vessel Pulmonary artery- vessel carrying venous blood to carrying venous blood to lungslungs

Aorta- carry oxygenated Aorta- carry oxygenated blood for systemic blood for systemic circulationcirculation

Vena CavaVena Cava Inferior and Superior - return of Inferior and Superior - return of

venous blood to heartvenous blood to heart

Pulmonary Veins- Pulmonary Veins- carry carry oxygenated blood to left oxygenated blood to left artriumartrium

Anatomy: HeartAnatomy: Heart

Right side of heart-Right side of heart- handles venous, or handles venous, or deoxygenated deoxygenated bloodblood

Left side of heart-Left side of heart- handles arterial, or handles arterial, or oxygenated bloodoxygenated blood

Function of ChambersFunction of Chambers

Atria act as Atria act as receiving chambersreceiving chambers Right atrium Right atrium

receives venous blood receives venous blood from superior and from superior and inferior vena cavaeinferior vena cavae

Left atrium Left atrium receives receives oxygenated blood from oxygenated blood from right and left right and left pulmonary veinspulmonary veins

Ventricles act as distributers Ventricles act as distributers of bloodof blood

Left ventricle pumps blood into aorta and systemic cirulation

Right ventricle pumps blood into pulmonary circulation

Heart ValvesHeart Valves Right Right

atrioventricular (AV)atrioventricular (AV) valve or valve or tricuspid tricuspid valve valve controls opening controls opening

between right atrium between right atrium and right ventricleand right ventricle

Left AV valve or Left AV valve or mitral valvemitral valve controls opening controls opening

between left atrium between left atrium and left ventricleand left ventricle

Coronary arteriesCoronary arteries supply blood supply blood to to myocardiummyocardium (muscular wall of (muscular wall of

heart)heart)

Right Coronary artery

Left Coronary artery

Coronary sinus

Myocardial infarctionMyocardial infarction ( (MIMI)) Commonly known Commonly known

as a as a heart attackheart attack

interruption of blood interruption of blood supply to part of supply to part of heart, causing some heart, causing some heart cells to dieheart cells to die

most commonly due most commonly due to occlusion to occlusion (blockage) of a (blockage) of a coronary arterycoronary artery

CABG (CABG (Coronary Artery Bypass Graft)

Surgery called revascularization to improve blood flow to heart in people with severe coronary artery disease (CAD)

CAD - occurs when coronary arteries become blocked due to buildup (plaque) on inside of blood vessels.

If severe enough:chest pain (angina), shortness of breath, possible heart attack and death

Healthy artery or vein grafted, to blocked artery bypassing blocked portion -new passage routes oxygen-rich blood around blockage to heart muscle

Replacing vessel will take over role previously performed by piece removed

Up to 4 major blocked coronary arteries can be bypassed during 1 surgery.

Blood -Vascular SystemBlood -Vascular System Radiological StudiesRadiological Studies

Exam of vascular structures using Exam of vascular structures using contrast mediumcontrast medium

ArteriographyArteriography - exam of arteries- exam of arteries

VenographyVenography - exam of veins - exam of veins

Angiography

IndicationsIndications Claudication –

leg pain and cramping

Stenosis - narrowing of vessel

Occlusion – blockage of a vessel

Aneurysm – weakened area of artery

“ballooning”

Suspected tumors

Anatomic variances

Contrast dye is injected Contrast dye is injected

Automatic injector is most commonly Automatic injector is most commonly usedused Manual injection is done rarelyManual injection is done rarely

Injectors are programmed to coincide Injectors are programmed to coincide with imaging sequencewith imaging sequence

Rapid film changers are rarely seenRapid film changers are rarely seen

Digital subtractionDigital subtraction -instantly -instantly “subtracts” “subtracts” overlying bony overlying bony structuresstructures

better better visualization of visualization of contrast-filled contrast-filled vascular structuresvascular structures

Digital EquipmentDigital Equipment

EquipmentEquipment

CatheterizationCatheterization

CatheterCatheter - - small, flexible tube small, flexible tube inserted into vessel through which inserted into vessel through which contrast is introducedcontrast is introduced

Femoral artery most commonFemoral artery most common introduction siteintroduction site Radial Radial BrachialBrachial AxillaryAxillary Jugular Jugular Subclavian Subclavian

Possible Possible Complications!Complications! Bleeding at puncture siteBleeding at puncture site Allergic reaction to Allergic reaction to

contrastcontrast Nerve, vessel, or tissue Nerve, vessel, or tissue

damagedamage StrokeStroke Heart attackHeart attack DeathDeath

VenographyVenography

IndicationsIndications For For VenographyVenography

Deep vein thrombosis: Deep vein thrombosis: Formation of Formation of blood clot inside blood vesselblood clot inside blood vessel

When blood vessel injured:When blood vessel injured: body forms blood clot to prevent loss of bloodbody forms blood clot to prevent loss of blood

If too much clotting & clot breaks freeIf too much clotting & clot breaks free

travelstravels in bloodstream – blocks blood vessel - in bloodstream – blocks blood vessel - obstructs circulation obstructs circulation (embolism)(embolism)

If goes toIf goes to lungslungs - can rupture pulmonary artery, - can rupture pulmonary artery, causing causing deathdeath

Other IndicationsOther Indications for for VenographyVenography

Venous obstruction Venous obstruction

Recurrent varicose veinsRecurrent varicose veins

Swollen legs of unknown etiologySwollen legs of unknown etiology

Varicose ulcersVaricose ulcers

Venous malformationsVenous malformations

Main Veins of Upper Main Veins of Upper ExtremityExtremity

Cephalic veinCephalic vein Basilic veinBasilic vein Subclavian veinSubclavian vein

Injection usually in median cubital

Injection usually in median cubital

Peripheral VenographyPeripheral Venography Examines superficial and deep Examines superficial and deep

veins of extremitiesveins of extremities Less common today-replaced by Less common today-replaced by

advances in ultrasoundadvances in ultrasound

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AP of entire AP of entire extremityextremity

Lateral of entire Lateral of entire extremityextremity

Lower-Limb Venogram

CentralCentral Venography Venography

Superior venacavogramSuperior venacavogram performed by accessing performed by accessing axillary or subclavian veinaxillary or subclavian vein

Inferior Inferior venacavogramvenacavogram performed by accessing performed by accessing femoral vein and placing femoral vein and placing catheter in common iliac catheter in common iliac vein or inferior aspect of vein or inferior aspect of inferior vena cavainferior vena cava