Human Diseases, 8th Edition - Chapter 6

Chapter 6: Diseases and Disorders of the Cardiovascular System CHAPTER OVERVIEW The anatomy and physiology of the cardiovascular system is reviewed. Cardiovascular diseases and disorders are explained. Diagnostic tests and procedures for the cardiovascular system are introduced. The treatments for cardiovascular diseases are identified. Preventative measures for cardiovascular diseases are listed. TRANSITION GUIDE/NEW TO THE EIGHTH EDITION Chapter reviewed to ensure accuracy and to include any updates or changes in chapter content. New art was incorporated into the chapter to enhance student learning. Added a section on age-related diseases to the chapter. Expanded the Diseases at a Glance section at the end of the chapter. Updated and reviewed the professional references at the end of the chapter. CHAPTER OUTLINE Anatomy and Physiology Review Structure and Function of the Heart Structure and Function of the Blood Vessels Diagnostic Tests and Procedures Cardiovascular Disease The Role of Lipids and Cholesterol in Cardiovascular Disease Diseases of the Arteries Diseases of the Venous Circulation Heart Disease Disorders Congestive Heart Failure Shock Heart Disease in Infants and Children Congenital Heart Disease Age-Related Diseases CHAPTER OBJECTIVES Describe the normal structure and function of the heart and blood vessels Describe the key characteristics of the diseases of the arterial circulation and heart Explain the association between arteriosclerosis and atherosclerosis Describe the etiology, signs, and risks associated with arterial hypertension Describe the role of varicose veins in peripheral vascular disease Understand the risks associated with venous thrombosis Understand the distinguishing features of heart valve stenosis and heart valve regurgitation Explain the different types of atrial and ventricular arrhythmias Name the etiologies of shock Describe normal fetal circulation Describe the epidemiology, symptoms, etiology, diagnosis, and treatment of congenital heart abnormalities Review the risks and pathological changes associated with heart disease in older adults INSTRUCTIONAL GOALS Objective 1: Describe the normal structure and function of the heart and blood vessels. Utilize the PowerPoint presentations as a starting point for your lecture. Obtain models of the cardiovascular system and demonstrate them to the class. Objective 2: Describe the key characteristics of the diseases of the arterial circulation of the heart. Utilize the PowerPoint presentations as a starting point for your lecture. Utilize one or more of the Classroom Activities to augment the chapter and student learning. (A list of the Classroom Activities and instructions can be found in the preface of the Instructor's Manual.) Choose a Classroom Activity using Box 6-2. Choose a Classroom Activity using Tables 6-1 and 6-2. Objective 3: Explain the association between arteriosclerosis and atherosclerosis. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 4: Describe the etiology, signs, and risks associated with arterial hypertension. Utilize the PowerPoint presentations as a starting point for your lecture. Review the feature Prevention PLUS!: Risk Factors for Coronary Heart Disease. Review the feature Prevention PLUS!: Sodium Intake. Objective 5: Describe the role of varicose veins in peripheral vascular disease. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 6: Understand the risks associated with venous thrombosis. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 7: Understand the distinguishing features of heart valve stenosis and heart valve regurgitation. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 8: Explain the different types of atrial and ventricular arrhythmias. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 9: Name the etiologies of shock. Utilize the PowerPoint presentations as a starting point for your lecture. Utilize one or more of the Classroom Activities to augment the chapter and student learning. (A list of the Classroom Activities and instructions can be found in the preface of the Instructor's Manual.) Choose a Classroom Activity using Table 6-4. Objective 10: Describe normal fetal circulation. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 11: Describe the epidemiology, symptoms, etiology, diagnosis, and treatment of congenital heart abnormalities. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 12: Review the risks and pathological changes associated with heart disease in order adults. Utilize the PowerPoint presentations as a starting point for your lecture. WORKSHEET 1: Define the Terms abdominal aortic aneurysm angina pectoris angioplasty aorta arterioles arteriosclerosis auscultation capillaries cardiac catheterization carotid arteries cerebral aneurysm compression sclerotherapy coronary arteriography diastole dilated cardiomyopathy Doppler echocardiography echocardiography electrocardiogram emboli endocardium essential hypertension fatty streaks fibrous atheromatous plaque fusiform high-density lipoproteins (HDL) hypertrophic cardiomyopathy intermittent claudication ischemia low-density lipoproteins (LDL) mitral valve myocardial infarction myocardium palpitations pericardium peripheral vascular disease prehypertension Purkinje fibers regurgitation restrictive cardiomyopathy saccular secondary hypertension sinoatrial node (SA node) stenosis supraventricular arrhythmias syncope systole thoracic aneurysm thrombosis tricuspid valve valvular insufficiency vegetations venae cavae venous thrombosis ventricular arrhythmias venules WORKSHEET 2: Testbank Questions and Answers 6.1 Multiple-Choice Questions 1) The pericardium is a _____. A) double-layered membrane that encloses the heart B) four chambered structure that lies inside the heart C) single layer of membrane that lines the inside of the heart D) triple-layered membrane that encloses the heart Answer: B Objective 1 2) The valve between the right atrium and right ventricle is named because it has _____. A) three chambers B) three cusps C) two chambers D) two cusps Answer: B Objective 1 3) A small patch of tissue called the _____ acts as the pacemaker of the heart. A) atrioventricular node B) bundle of His C) Purkinje fibers D) sinoatrial node Answer: D Objective 1 4) Heart muscle is influenced by the _____ nervous system and hormones such as epinephrine. A) autonomic B) parasympathetic C) somatic D) sympathetic Answer: A Objective 1 5) The superior and inferior _____ deliver systemic blood to the right atrium. A) arterials B) capillaries C) venae cavae D) venules Answer: C Objective 1 6) Listening through a stethoscope for abnormal hearts sounds is an example of _____. A) auscultation B) percussion C) palpation D) inspection Answer: A Objective 1 7) _____ samples the blood in each heart chamber for oxygen content and pressure. A) Angiocardiography B) Cardiac catheterization C) Coronary arteriography D) Electrocardiography Answer: A Objective 1 8) _____ employs an injected contrast material that permits imaging of blood vessel function. A) Angiocardiography B) Cardiac catheterization C) Coronary arteriography D) Electrocardiography Answer: C Objective 1 9) _____ is the major cholesterol carrier in the blood, and is also known as "bad" cholesterol. A) CAD B) CVI C) HDL D) LDL Answer: D Objective 3 10) Generally, the higher the level of _____, the lower the risk of coronary artery disease. A) CAD B) CVI C) HDL D) LDL Answer: C Objective 3 11) In _____, artery walls thicken and become hard and inflexible. A) arteriosclerosis B) atherosclerosis C) cardiomyopathy D) claudication Answer: A Objective 2 12) The simplest form of atherosclerosis is _____, which are thin, flat discolorations in the arteries that can enlarge and become thicker as they grow in length. A) atheromatous plaque B) fatty streaks C) ischemia D) thrombosis Answer: B Objective 2 13) A fibrous _____ is characterized by the accumulation of lipids and formation of scar tissue, that begins as a white gray thickening of the inner lining of the artery. A) atheromatous plaque B) fatty streaks C) ischemia D) thrombosis Answer: A Objective 2 14) Occlusion of a coronary artery may result in _____. A) atheromatous plaque B) chest pain C) claudication D) peripheral vascular disease Answer: B Objective 2 15) Blockage of the _____ can reduce blood supply to the brain causing a stroke. A) carotid arteries B) coronary arteries C) peripheral veins D) pulmonary veins Answer: A Objective 1 16) In peripheral arterial disease, the most commonly affected arteries are the _____ arteries. A) carotid and renal B) femoral and popliteal C) hepatic and circumflex D) pulmonary and coronary Answer: B Objective 2 17) Raynaud's disease is a disorder of the arteries in the _____. A) arms and legs B) chest and abdomen C) fingers and toes D) neck and head Answer: C Objective 2 18) Hypertension is broadly defined as an arterial pressure greater than _____ on at least three consecutive measures. A) 120/80 B) 140/90 C) 160/100 D) 180/110 Answer: A Objective 5 19) Primary hypertension is also called _____ hypertension. A) essential B) pre- C) secondary D) Stage II Answer: A Objective 5 20) In _____ hypertension, the elevation in blood pressure results from some other disease. A) essential B) pre- C) secondary D) Stage II Answer: C Objective 5 21) _____ veins are small, dense networks of veins that appear as red or blue discolorations on the skin. A) Fusiform B) Saccular C) Spider D) Varicose Answer: C Objective 7 22) Compression sclerotherapy is a treatment used for _____. A) aneurysms B) chronic venous insufficiency C) thrombosis D) varicose veins Answer: D Objective 8 23) The most common cause of CVI is _____. A) a thrombosis B) an aneurysm C) hypertension D) varicose veins Answer: A Objective 8 24) One of the symptoms of CHD is _____, a sensation of a rapid pounding hearbeat. A) angina B) ischemia C) palpitations D) thrombosis Answer: C Objective 2 25) _____ is a procedure used to open a partly occluded artery. A) Angioplasty B) Compression sclerotherapy C) Doppler echocardiography D) Vein stripping Answer: A Objective 2 26) A stent is a cylindrical wire mesh that surrounds an _____. A) anastomosis B) aneurysm C) angioplasty balloon D) atrial node Answer: C Objective 2 27) _____ cardiomyopathy is the most common form of all cardiomyopathies. A) Aneurysmic B) Dilated C) Hypertrophic D) Restrictive Answer: B Objective 2 28) Ventricular hypertrophy is the dominant feature of _____ cardiomyopathy. A) Aneurysmic B) Dilated C) Hypertrophic D) Restrictive Answer: C Objective 2 29) _____ cardiomyopathy is the least common form of cardiomyopathies, and is associated with reduced filling of the heart. A) Aneurysmic B) Dilated C) Hypertrophic D) Restrictive Answer: D Objective 2 30) _____ cardiomyopathy is the most common cause of sudden cardiac death among young people. A) Aneurysmic B) Dilated C) Hypertrophic D) Restrictive Answer: C Objective 2 31) Acute forms of endocarditis involve the formation of nodules, or _____. A) aneurysms B) emboli C) thrombus D) vegetations Answer: D Objective 9 32) The risks factors for rheumatic fever include age and infection with _____. A) group A hemolytic streptococci B) Coxackie virus C) parovirus D) Plasmodium Answer: A Objective 9 33) The signs and symptoms of Rheumatic fever begin approximately 2 _____ following the infection. A) days B) weeks C) months D) years Answer: B Objective 9 34) The supraventricular arrhythmias do NOT include arrhythmias generated in the _____. A) atrioventricular node B) junctional tissue C) sinoatrial node D) ventricular conduction system Answer: D Objective 10 35) _____ is a sustained heart rate greater than 100 beats per minute. A) Atrial fibrillation B) Bradycardia C) Tachycardia D) Ventricular fibrillation Answer: C Objective 10 36) _____ is an abnormally low heart rate less than 50 beats per minute. A) Atrial fibrillation B) Bradycardia C) Tachycardia D) Ventricular fibrillation Answer: B Objective 10 37) _____ is the most common heart rhythm disorder. A) Atrial fibrillation B) Bradycardia C) Tachycardia D) Ventricular fibrillation Answer: A Objective 10 38) _____ is a life-threatening emergency, a form of cardiac arrest. A) Atrial fibrillation B) Bradycardia C) Tachycardia D) Ventricular fibrillation Answer: D Objective 10 39) _____ is a nonsurgical procedure using a catheter inserted into the heart and directs energy to sever the area causing the abnormal rhythm. A) Ablation B) Bypass C) Defibrillator D) Electrocardioversion Answer: A Objective 10 40) The clamping of the umbilical cord and removal from the placental circulation causes an increase in _____ pressure. A) left atrial B) left ventricular C) right atrail D) right ventricular Answer: B Objective 12 6.2 True/False Questions 1) The internal lining of the heart consists of a smooth, delicate membrane called the exocardium. Answer: False Objective 1 2) The mitral valve lies between the right atrium and left atrium. Answer: False Objective 1 3) Coronary veins provide the heart muscle with a reliable blood supply. Answer: False Objective 1 4) Blood flows through two routes: the systemic circulation and the pulmonary circulation. Answer: True Objective 1 5) Arterioles lead into capillaries, the connecting link between arteries and veins. Answer: True Objective 1 6) The walls of arteries are muscular, thick, strong, elastic, and are lined with endothelium. Answer: True Objective 1 7) Arterioles can change their diameter by constricting or dilating, which alters blood flow to the tissues. Answer: True Objective 1 8) Lipids include cholesterol, phospholipids, and triglycerides. Answer: True Objective 4 9) Fat in the human body takes the form of triglycerides. Answer: True Objective 4 10) The most common cause of arteriosclerosis is atherosclerosis. Answer: True Objective 2 11) Claudication, a clot within a blood vessel, forms because of ulceration and turbulent blood flow. Answer: False Objective 2 12) Symptoms of atherosclerosis do not appear until the interior of the vein is occluded. Answer: False Objective 2 13) Ultrasound and angiography will confirm the diagnosis of peripheral artery disease. Answer: True Objective 2 14) Raynaud's disease is triggered by exposure to heat. Answer: False Objective 2 15) Treatment for Raynaud's disease is aimed at reducing triggers for the symptoms. Answer: True Objective 2 16) The danger of an aneurysm is the tendency to increase in size and rupture. Answer: True Objective 2 17) Hypertension is the most common cardiovascular disorder. Answer: True Objective 5 18) Kidney disease can result in primary hypertension. Answer: False Objective 5 19) Aneurysms are caused by blood pooling within the veins because of decreased, stagnated blood flow. Answer: False Objective 7 20) Chronic venous insufficiency is a condition of poor venous blood return to the lower extremities. Answer: False Objective 7 21) Coronary heart disease is the leading cause of death worldwide. Answer: True Objective 2 22) More than 90% of persons with CHD have coronary atherosclerosis. Answer: True Objective 2 23) An EKG can aid in identifying abnormalities in heart rate and rhythm, as well as areas of damaged heart tissue. Answer: True Objective 2 24) Risk factors for myocarditis include viral and bacterial infections. Answer: True Objective 2 25) Patients with severe cardiomyopathy my undergo a heart transplant. Answer: True Objective 2 26) Endocarditis does not affect a healthy heart. Answer: True Objective 9 27) A symptom of infective endocarditis includes a change in the sound or character of a heart murmur. Answer: True Objective 9 28) The incidence of rheumatic fever is highest among the elderly 65 - 75 years of age. Answer: False Objective 9 29) There are two types of cardiac arrhythmias, supraventricular and ventricular. Answer: True Objective 10 30) Ventricular arrhythmias are more serious and potentially life threatening than other types of arrhythmias. Answer: True Objective 10 31) Heart block occurs when the atria and ventricles contract independent of each other. Answer: True Objective 10 32) Treatment for congestive heart failure cannot cure or reverse the condition. Answer: True Objective 2 33) Any condition that reduces the heart's ability to pump effectively or decrease venous return can cause shock. Answer: True Objective 11 34) Fetal circulation is anatomically different than postnatal circulation. Answer: True Objective 12 35) Infants born with Down syndrome and Turner syndrome have an increased risk for congenital heart disease. Answer: True Objective 13 36) The signs and symptoms of congestive heart failure include ankle swelling and shortness of breath with exertion. Answer: True Objective 2 37) A ventricular septal defect is one of the four abnormalities found in congestive heart failure. Answer: False Objective 13 38) Some of the symptoms of Tetrology of Fallot is difficulty eating, failure to gain weight, and poor development. Answer: True Objective 13 39) In transposition of the great arteries, the pulmonary artery is attached to the right ventricle, and the aorta is attached to the left ventricle. Answer: False Objective 13 40) Corrective surgery within the first two to three weeks of life is essential for transposition of the great arteries condition. Answer: True Objective 13 6.3 Short Answer Questions 1) The chamber walls of the heart consist of cardiac muscle known as _____. Answer: myocardium Objective 1 2) The _____ valve lies between the right atrium and the right ventricle. Answer: tricuspid Objective 1 3) The filling period of the heart is known as the _____ phase. Answer: diastolic Objective 1 4) The contracting period of the heart is known as the _____ phase Answer: systolic Objective 1 5) Partitions called the interatrial and interventricular _____ separate oxygenated blood from deoxygenated blood in the atria and ventricles, respectively. Answer: septum Objective 1 6) Arteries continue to divide into smaller and smaller arteries, and eventually into vessels called _____, the smallest arteries. Answer: arterioles Objective 1 7) An _____ is an electrical recording of heart action and aids in the diagnosis of heart diseases. Answer: electrocardiogram Objective 1 8) _____ utilizes high-frequency sound waves to examine the size, shape, and motion of heart structures. Answer: Echocardiography Objective 1 9) _____ describes elevated lipids (fat) in the blood. Answer: Hyperlipidemia Objective 4 10) Cholesterol is transported throughout the systemic circulation by transport proteins called _____. Answer: lipoproteins Objective 4 11) Accumulation of LDL forms a _____ or thick hard deposit that narrows arteries and impedes blood flow. Answer: plaque Objective 3 12) The genetic form of hypercholesterolemia, is _____ hypercholesterolemia. Answer: familial Objective 3 13) _____ is a thickening, narrowing, and hardening of the arteries. Answer: Atherosclerosis Objective 14) Hardening of the arteries in the legs is known as _____ vascular disease. Answer: peripheral Objective 2 15) _____ is a loss of blood and oxygen supply. Answer: Ischemia Objective 2 16) The primary symptom of peripheral artery disease is intermittent _____, or pain with walking. Answer: claudication Objective 2 17) In Raynaud's disease, the arteries suddenly contract, a phenomenon called _____. Answer: vasospasm Objective 2 18) An aortic _____ is an abnormal dilation of the aorta. Answer: aneurysm Objective 2 19) A _____ aneurysm has a uniform shape, tapered at both ends, with symmetrical dilation. Answer: fusiform Objective 2 20) A _____ aneurysm appear as an out-pouching of a portion of the aortic wall. Answer: saccular Objective 2 21) _____ veins are dilated, distorted veins that usually develop in the superficial veins of the leg. Answer: Varicose Objective 7 22) A fatal complication of a thrombus, is an _____, or clot that travels to vital organs such as the lungs. Answer: emboli Objective 7 23) Symptoms of CHD include chest pain, or _____ pectoris. Answer: angina Objective 2 24) One of the most devastating signs of CHD is a heart attack, also known as a myocardial _____. Answer: infarction Objective 2 25) _____ is an inflammatory disease of the heart muscle. Answer: Myocarditis Objective 2 26) _____ is a disorder in which the heart becomes weakened and enlarged or rigid. Answer: Cardiomyopathy Objective 2 27) _____ is an infection of the endocardium and heart valves. Answer: Endocarditis Objective 9 28) Endocarditis _____ consist of the infectious organisms and cellular debris enmeshed in a fibrous clot. Answer: vegetation Objective 9 29) _____ fever is an autoimmune disease of heart tissue and heart valves. Answer: Rheumatic Objective 9 30) _____ refers to a narrowing of the valves opening. Answer: Stenosis Objective 9 31) Valvular insufficiency or _____ refers to a valve that allows backward flow of blood within the heart. Answer: regurgitation Objective 9 32) Abnormal heart rhythms, or _____, develop from irregularity in impulse generation and impulse conduction. Answer: arrhythmias Objective 10 33) Ventricular _____ is disorganized, uncoordinated contraction of ventricles. Answer: fibrillation Objective 10 34) A symptoms of cardiac rhythm disorders is _____, or lightheadedness. Answer: syncope Objective 10 35) _____ heart failure is a chronic and progressive reduction in the ability of the heart to pump blood. Answer: Congestive Objective 2 36) After a child's birth, the decrease in right atrial and left atrial pressure produce closure of the _____ ovale. Answer: foramen Objective 12 37) _____ of Fallot is one of the most serious of the congenital heart defects and consists of four abnormalities. Answer: Tetrology Objective 13 38) At birth, the ductus _____ normally closes. Answer: arteriosus Objective 13 39) _____ of the aorta is a congenital narrowing of the aorta that can occur anywhere along its length. Answer: Coarctation Objective 13 40) Heart _____ is the most frequently reported hospital discharge diagnosis among older adults in the United States. Answer: failure Objective 14 WORKSHEET 3: Discussion Questions and Answers 6.4 Discussion Questions 1. Starting with the aorta, list - in order - the seven different blood vessels in the human body. Answer: Aorta: The aorta is the largest blood vessel in the human body. It carries oxygenated blood to the arteries. Arteries: Arteries are branch off of the aorta, and provide oxygenated blood to the smaller arteries, the arterioles. Arterioles: Arterioles are the smallest arteries, and lead to capillaries. Capillaries: Capillaries are the connecting link between arterioles and venules. Capillaries deliver oxygen and nutrients to tissues and receive carbon dioxide and other wastes from the tissues. Venules: The now deoxygenated blood continues into the venules, the smallest veins and then into larger veins. Veins carry deoxygenated blood back towards the heart, culminating into the superior and inferior venae cavae. Venae cavae: The superior and inferior venae cavase deliver systemic deoxygenated blood to the right atrium 2. List three of the modifiable risk factors and one non-modifiable risk factor for cardiovascular disease. Answers: Modifiable Risk Factors Hypertension Cigarette Smoking Diabetes Obesity Physical Inactivity High Fat and Cholesterol Diet Non-modifiable Risk Factors Age Male Sex Familial History of Premature Death due to Coronary Heart Disease 3. Compare and contrast the difference between arteriosclerosis and atherosclerosis. Answer: "Hardening of the arteries" aptly describes arteriosclerosis. The affected arteries are unable to stretch and rebound in response to the pressure of blood. As a result, arteriosclerosis leads to hypertension. Atherosclerosis is a thickening, narrowing, and hardening of the arteries. Atherosclerosis regions contain a lipid core covered by plaque. As the plaque increases, the artery may eventually become narrowed and blocked, causing reduced blood flow. 4. List the four different stages of blood pressure, and their associated readings. Healthy (normal) Below 120/80 mm Hg Prehypertension 120/80 to 139/89 mm Hg Stage 1 hypertension 140/90 to 159/99 mm Hg Stage 2 hypertension 160/100 mm Hg 5. Briefly describe how artery bypass surgery is performed. Answer: Coronary artery bypass surgery reroutes blood flow around the clogged arteries to improve blood flow and oxygen supply to the heart. A segment of a healthy blood vessel from another part of the body is attached or grafted from the aorta to the coronary artery below the blocked area. Depending on the number of blocked arteries, one or more grafts may be surgically placed. 6. Describe the effect that rheumatic fever has on the heart valves. Answer: Blood clots deposit in the cusps of inflamed valves, forming modular structures called vegetations. The normally flexible cusps thicken and adhere to each other. Later, fibrous tissue develops, which has a tendency to contract. If the adhesions of the cusps seriously narrow the valve opening becomes stenotic. Left untreated, rheumatic fever can cause permanent heart damage. 7. List two of five different types of shock, and their etiology. Answer: Cardiogenic: cardiac arrhythmias; myocardial infarction. Hypovolemic: hemorrhage; trauma; surgery; extensive burns Anaphylactic: allergic reaction Septic: toxins released by a bacterial infection Neurogenic: damage to the central nervous system