the cardiovascular final !!!!!!!

7/31/2019 The Cardiovascular Final !!!!!!!

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MED


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It is an organ system that passesnutrients (such as amino acids,electrolytes and lymph), gases,hormones, blood cells, etc. to andfrom cells in the body to help fightdiseases, stabilize body temperature

and pH, and to maintainhomeostasis.


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This system may be seen strictly as ablood distribution network, but someconsider the circulatory system ascomposed of the cardiovascular system,

which distributes blood,and the lymphaticsystem, which returns excess filteredblood plasma from the interstitial fluid(between cells) as lymph. While humans,as well as other vertebrates, have a

closed cardiovascular system (meaningthat the blood never leaves the networkof arteries, veins and capillaries), someinvertebrate groups have an opencardiovascular system.


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Covered by the pericardium. Has two sides with two chambers. Blood flows through the heart inone direction. Valves control the blood flow. The cardiac conduction systemcontrols the electrical impulses thatcause the heart to contract.


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Two types of fluids move through thecirculatory system: blood and lymph.Lymph is essentially recycled blood plasma

after it has been filtered from the bloodcells and returned to the lymphaticsystem. The blood, heart, and bloodvessels form the cardiovascular (from Latinwords meaning 'heart'-'vessel') system.

The lymph, lymph nodes, and lymphvessels form the lymphatic system. Thecardiovascular system and the lymphaticsystem collectively make up the circulatory

system.


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The main components of the humancardiovascular system are the heart, blood,and blood vessels.[4] It includes: thepulmonary circulation, a "loop" through the

lungs where blood is oxygenated; and thesystemic circulation, a "loop" through the restof the body to provide oxygenated blood. Anaverage adult contains five to six quarts

(roughly 4.7 to 5.7 liters) of blood, whichconsists of plasma, red blood cells, whiteblood cells, and platelets. Also, the digestivesystem works with the circulatory system toprovide the nutrients the system needs to

keep the heart pumping.


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The heart is a double pump

heartarteries arterioles veinsvenules capillaries


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Heart as known to be called asDouble pump as it consist of doublecirculation.

Coronary circulation.

Pulmonary circulation.

Systemic circulation


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The pulmonary circulatory system isthe portion of the cardiovascularsystem in which oxygen-depletedblood is pumped away from theheart, via the pulmonary artery, tothe lungs and returned, oxygenated,

to the heart via the pulmonary vein.
http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Lungshttp://en.wikipedia.org/wiki/Pulmonary_veinhttp://en.wikipedia.org/wiki/Pulmonary_veinhttp://en.wikipedia.org/wiki/Lungshttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Oxygen


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Systemic circulation is the circulation ofthe blood of to all parts of the body exceptthe lungs. Systemic circulation is the

portion of the cardiovascular system whichtransports oxygenated blood away fromthe heart, to the rest of the body, andreturns oxygen-depleted blood back to the

heart. Systemic circulation is, distance-wise, much longer than pulmonarycirculation, transporting blood to everypart of the body.


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The coronary circulatory systemprovides a blood supply to the heart.

As it provides oxygenated blood tothe heart, it is by definition a part ofthe systemic circulatory system.


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In the human heart there is one atrium and oneventricle for each circulation, and with both asystemic and a pulmonary circulation there arefour chambers in total: left atrium, left ventricle,right atrium and right ventricle. The right atrium is

the upper chamber of the right side of the heart.The blood that is returned to the right atrium is

deoxygenated (poor in oxygen) and passed intothe right ventricle to be pumped through thepulmonary artery to the lungs for re-oxygenation

and removal of carbon dioxide. The left atriumreceives newly oxygenated blood from the lungs aswell as the pulmonary vein which is passed into thestrong left ventricle to be pumped through theaorta to the different organs of the body.
http://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Atrium_%28heart%29http://en.wikipedia.org/wiki/Ventricle_%28heart%29http://en.wikipedia.org/wiki/Left_atriumhttp://en.wikipedia.org/wiki/Left_ventriclehttp://en.wikipedia.org/wiki/Right_atriumhttp://en.wikipedia.org/wiki/Right_ventriclehttp://en.wikipedia.org/wiki/Right_ventriclehttp://en.wikipedia.org/wiki/Right_atriumhttp://en.wikipedia.org/wiki/Left_ventriclehttp://en.wikipedia.org/wiki/Left_atriumhttp://en.wikipedia.org/wiki/Ventricle_%28heart%29http://en.wikipedia.org/wiki/Atrium_%28heart%29http://en.wikipedia.org/wiki/Heart


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The cardiovascular systems ofhumans are closed, meaning that theblood never leaves the network of

blood vessels. In contrast, oxygenand nutrients diffuse across the bloodvessel layers and entersinterstitial fluid, which carries oxygenand nutrients to the target cells, andcarbon dioxide and wastes in theopposite direction. The othercomponent of the circulatory system,the lymphatic system, is not closed.
http://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Blood_vessels


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Heart chamber is a general termused to refer to any chambers of themammalianheart. The heart consists

of four chambers: the right and leftatrium and the right and leftventricle. The top chambers areconnected to the bottom chambersby valves and are separated by thecoronary sulcus. The left and rightside of the heart are separated by the

posterior interventricular sulcus.
http://en.wiktionary.org/wiki/chamberhttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Coronary_sulcushttp://en.wikipedia.org/wiki/Posterior_interventricular_sulcushttp://en.wikipedia.org/wiki/Posterior_interventricular_sulcushttp://en.wikipedia.org/wiki/Coronary_sulcushttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Mammalhttp://en.wiktionary.org/wiki/chamber


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Right atrium: Situated in the upper right section of theheart, this chamber receives oxygen-depleted blood fromthe body from two major veins, the superior vena cavaand the inferior vena cava. This chamber then pumpsblood through the tricuspid valve into the right ventricle

situated below. Right ventricle: Located below the right atrium, thischamber receives oxygen-depleted blood from the rightatrium and pumps it through the pulmonary valve and intothe lungs via the right and left pulmonary artery.

Left atrium: This chamber sits opposite the right atriumand is the upper part of the heart that receives oxygen-

rich blood from the lungs via the right and leftpulmonary veins and pumps it through the bicuspid valveor mitral valve into the left ventricle.

Left ventricle: This chamber is the lower part of the heartthat receives oxygen-rich blood from the left atrium aboveit, and pumps it through the aortic valve to be distributedthroughout the entire body via the aorta, including to theheart muscle itself through the coronary arteries.
http://en.wikipedia.org/wiki/Atrium_%28anatomy%29http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Superior_vena_cavahttp://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Tricuspid_valvehttp://en.wikipedia.org/wiki/Ventricle_%28heart%29http://en.wikipedia.org/wiki/Pulmonary_valvehttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Pulmonary_veinhttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Aortic_valvehttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Coronary_arterieshttp://en.wikipedia.org/wiki/Coronary_arterieshttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Aortic_valvehttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Pulmonary_veinhttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Pulmonary_valvehttp://en.wikipedia.org/wiki/Ventricle_%28heart%29http://en.wikipedia.org/wiki/Tricuspid_valvehttp://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Superior_vena_cavahttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Atrium_%28anatomy%29


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Each heart chamber includes valvesvital to the efficiency of thecirculatory system. These valves

open to allow the blood to flow in theright direction into, within, or out ofthe heart, and close to prevent thebackflow of blood. There are fourmain valves that allow the chambersof the heart to carry out theirfunction efficiently and they relax

and contract during a heartbeat.
http://en.wikipedia.org/wiki/Cardiac_cyclehttp://en.wikipedia.org/wiki/Cardiac_cycle


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The Tricuspid ValveThe Mitral Valve


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The tricuspid valve is locatedbetween the right atrium and theright ventricle. Blood passively fillsthe right atrium during diastole phaseof the right atrium. When the rightatrium is in systole phase, the

contraction forces this valve open,thereby forcing any additional de-oxygenated blood into the ventricle.
http://en.wikipedia.org/wiki/Diastolehttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Systolehttp://en.wikipedia.org/wiki/Diastole


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The mitral valve is located betweenthe left atrium and the left ventricle.Similar to the tricuspid valve, duringthe atrium's systole phase, the valveis forced open to allow theoxygenated blood from the lungs to

enter into the left ventricle.


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The semi-lunar aortic valve is located atthe exit of the aorta and the left ventricle.

The function of this valve mirrors that ofthe semi-lunar pulmonary valve, with oneexception. Once the pressure in the leftventricle falls back during relaxationphase, oxygenated blood will fill up in thecusps of the semi-lunar aortic valve

eventually causing them to close. Thisblood is what supplies the right and leftcoronary arteries which distribute blood tothe muscle tissues of the heart.


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The two ventricles are separated by aseptum into the left ventricle and the rightventricle. The ventricles of the heart aremuscular chambers because they areresponsible for propelling blood out of theheart.The left ventricle is the thickest ofthe four chambers because it is the finalchamber that oxygenated blood must be

pumped through before it is distributedthroughout the body via thecirculatory system. The ventricles are alsolarger in size compared to the atria.
http://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Circulatory_system


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The blood vessels are the part ofthe circulatory system that transportsblood throughout the body. There are

three major types of blood vessels:the arteries, which carry the bloodaway from the heart; the capillaries,which enable the actual exchange of

water and chemicals between theblood and the tissues; and the veins,which carry blood from the capillaries

back toward the heart.
http://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Bodyhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Tissue_%28biology%29http://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Tissue_%28biology%29http://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Bodyhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Circulatory_system


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There are various kinds of bloodvessels:

ArteriesVeinsCapillaries


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Arteries (from the Greek -art ria , "windpipe, artery"areblood vessels that carry blood away

from the heart. This blood is normallyoxygenated, exceptions made for thepulmonary and umbilical arteries.

The EABV (Effective Arterial Blood

Volume) is that ICF fluid which fillsthe arterial system.

Further divided in to smaller units

known as Arterioles.
http://en.wikipedia.org/wiki/Greek_languagehttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Pulmonary_arterieshttp://en.wikipedia.org/wiki/Umbilical_arteryhttp://en.wikipedia.org/wiki/EABVhttp://en.wikipedia.org/wiki/EABVhttp://en.wikipedia.org/wiki/Umbilical_arteryhttp://en.wikipedia.org/wiki/Pulmonary_arterieshttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Greek_language


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The anatomy of arteries can beseparated into :-

Gross anatomy Microscopic Anatomy.


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The arterial system of thehuman body is divided intosystemic arteries, carrying blood

from the heart to the whole body,and pulmonary arteries, carryingblood from the heart to the lungs.
http://en.wikipedia.org/wiki/Human_bodyhttp://en.wikipedia.org/w/index.php?title=Systemic_arteries&action=edit&redlink=1http://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/w/index.php?title=Systemic_arteries&action=edit&redlink=1http://en.wikipedia.org/wiki/Human_body


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The outermost layer is known as thetunica externa formerly known as "tunicaadventitia" and is composed ofconnective tissue. Inside this layer is the

tunica media, or media, which is madeup ofsmooth muscle cells and elastictissue. The innermost layer, which is indirect contact with the flow of blood is

the tunica intima, commonly called theintima. This layer is made up of mainlyendothelial cells. The hollow internalcavity in which the blood flows is calledthe lumen.
http://en.wikipedia.org/wiki/Tunica_externa_%28vessels%29http://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Tunica_mediahttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Tunica_intimahttp://en.wikipedia.org/wiki/Endotheliumhttp://en.wikipedia.org/wiki/Lumen_%28anatomy%29http://en.wikipedia.org/wiki/Lumen_%28anatomy%29http://en.wikipedia.org/wiki/Endotheliumhttp://en.wikipedia.org/wiki/Tunica_intimahttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Tunica_mediahttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Tunica_externa_%28vessels%29


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In the circulatory system, veins(from the Latinvena) areblood vessels that carry blood

towards the heart. Most veins carrydeoxygenated blood from the tissuesback to the heart; exceptions are the

pulmonary and umbilical veins, bothof which carry oxygenated blood tothe heart.
http://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Latin_languagehttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Pulmonary_veinhttp://en.wikipedia.org/wiki/Umbilical_veinhttp://en.wikipedia.org/wiki/Umbilical_veinhttp://en.wikipedia.org/wiki/Pulmonary_veinhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Latin_languagehttp://en.wikipedia.org/wiki/Circulatory_system


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Superficial veins :- Are those whosecourse is close to the surface of thebody, and have no corresponding

arteriesDeep veins :-Are deeper in the body

and have corresponding arteries.


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Communicating veins :-(or perforatorveins) are veins that directly connectsuperficial veins to deep veins.

Pulmonary veins :-Thepulmonary veins are a set of veinsthat deliver oxygenated blood fromthe lungs to the heart.

Systemic veins:- Systemic veins drainthe tissues of the body and deliverdeoxygenated blood to the heart
http://en.wikipedia.org/wiki/Pulmonary_veinhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Systemic_veinhttp://en.wikipedia.org/wiki/Systemic_veinhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Pulmonary_vein


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ArteriesTransport blood away

from the heartTransport blood away

from the heart. Carry OxygenatedBlood(except in the case ofthe Pulmonary Artery).

Do not have valves(except for the semi-lunar valves of thepulmonary artery andthe aorta).

VeinsTransport blood

towards the heart. Carry De-oxygenated

Blood(except in the case ofthe Pulmonary Vein).

Transports blood underlower pressure (than

arteries). Have valves.


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Heart is composed of three layersthat are as follows:-

PericardiumEpicardiumEndocardium


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Pericardium is a tough double layeredmembrane which covers the heart.

The space between the two layers of

it is filled with a pericardium fluidwhich protects the heart from anykind of external jerk or shock.


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Epicardium describes the outerlayer ofheart tissue (from Greek; epi-outer, cardium heart). When

considered as a part of thepericardium, it is the inner layer, orvisceral pericardium, continuous with

the serous layer.
http://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Greek_languagehttp://en.wikipedia.org/wiki/Pericardiumhttp://en.wikipedia.org/wiki/Pericardiumhttp://en.wikipedia.org/wiki/Greek_languagehttp://en.wikipedia.org/wiki/Heart


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The endocardium is the innermostlayer of tissue that lines thechambers of the heart. Its cells are

embryologically and biologicallysimilar to the endothelial cells thatline blood vessels.
http://en.wikipedia.org/wiki/Cell_%28biology%29http://en.wikipedia.org/wiki/Embryologyhttp://en.wikipedia.org/wiki/Biologyhttp://en.wikipedia.org/wiki/Endotheliumhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Endotheliumhttp://en.wikipedia.org/wiki/Biologyhttp://en.wikipedia.org/wiki/Embryologyhttp://en.wikipedia.org/wiki/Cell_%28biology%29


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Cardiac muscle (heart muscle) is atype of involuntary striated musclefound in the walls and histological

foundation of the heart, specificallythe myocardium.
http://en.wikipedia.org/wiki/Striated_musclehttp://en.wikipedia.org/wiki/Hearthttp://en.wiktionary.org/wiki/myocardiumhttp://en.wiktionary.org/wiki/myocardiumhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Striated_muscle


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AutomaticityConductivityContractilityExcitability


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Automaticity is a characteristic unique tocardiac muscle and refers to the heart's abilityto generate its own signal to contract. Ratherthan receiving input from the central nervoussystem, at rest the heart relies on pacemakercells located in the right upper chamber tospontaneously generate electrical signals,which lead to the rhythmic contractionsknown as heartbeats. The rate of theheartbeat is based on how long it takes thepacemaker cells to fire, reset and fire again.


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In order to transmit the electrical signal that isgenerated in the upper right quadrant of the heartto the rest of the myocardium, the muscle fibersmust be able to conduct electricity. Cardiac musclehas the ability to pass the electrical signal fromone fiber to the next until it has spread throughoutthe entirety of the heart. Once each fiber has beengiven the signal, the heart will contract as a whole.Contracting in this fashion allows for a significantamount of force to be generated by the two lowerchambers of the heart, which will allow blood to bedelivered to the lungs and throughout the whole

body. Without conductivity, each muscle fiberwould need to have its own pacemaker and wouldlikely disrupt the synchronicity, rhythm andefficiency of myocardial contractions.


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Contractility is the ability of the heartto generate tension, or produce force,in order to eject blood from the heart.

It is, in essence, the physicalexpression of the electrical signalsinitiated by the pacemaker cells and

passed throughout the heart muscle.


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Although cardiac muscle cangenerate its own electrical signal, thepacemaker cells fire at a very steady

rate. Because of this, any increasesin heart rate have to be governed byan external stimulus. The heart's

ability to respond to an additionalstimulus and change its rate ofcontraction is known as excitability.


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Cardiac cycle is consist of followingphases:-

Systole (0.3 sec)Diastole (0.5 sec)One systole and one diastole

together forms a cardiac cycle.


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stroke volume (SV) is the volume ofblood pumped from one ventricle ofthe heart with each beat.

Stroke volume is an importantdeterminant ofcardiac output, whichis the product of stroke volume and

heart rate.
http://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Ventricles_of_the_hearthttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Heart_ratehttp://en.wikipedia.org/wiki/Heart_ratehttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Ventricles_of_the_hearthttp://en.wikipedia.org/wiki/Blood


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Cardiac output is the volume of bloodbeing pumped by the heart, inparticular by a left or right ventricle

in the time interval of one minute.An average resting cardiac output

would be 5.6 L/min for a human

male and 4.9 L/min for a female.
http://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Ventricle_%28heart%29http://en.wikipedia.org/wiki/Ventricle_%28heart%29http://en.wikipedia.org/wiki/Heart


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Total peripheral resistance (TPR)is the sum of the resistance of allperipheral vasculature in thesystemic circulation. Vasculaturethroughout the entire body can bethought of as two separate circuits -one is the systemic circulation, whilethe other is the pulmonary

circulation.TPR should not be confused with

Pulmonary Vascular Resistance (PVR),which is the resistance in the

pulmonary circulation.
http://en.wikipedia.org/wiki/Systemic_circulationhttp://en.wikipedia.org/wiki/Vascular_resistancehttp://en.wikipedia.org/wiki/Vascular_resistancehttp://en.wikipedia.org/wiki/Systemic_circulation


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Stroke Volume (SV) = EDV ESVEjection Fraction (EF) = (SV / EDV)

100%Cardiac Output (Q) = SV HRCardiac Index (CI) = Q / Body Surface

Area (BSA) = SV HR/BSA

HR is Heart Rate, expressed as BPM(Beats Per Minute)


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The sounds of the heart are caused by theclosing of the valves.

The lub sound- quieter, longer, lowerpitched- caused by the bicuspid and

tricuspid valves closing.The dub sound- louder, shorter, higher

pitched- caused by the semi lunar valvesclosing.

A heart murmur is an abnormal sound ofthe heart. It is usually an indication ofdamaged valves.


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Blood pressure is the blood pressingagainst the blood vessel walls. It ismeasured by a sphygmomanometer.

The pressure varies along the circuit decreasing from artery to arteriole tocapillary to venule to vein.

Pressure is highest at the start of the

artery and lowest at the entrance to theatrium.

Blood pressure is much higher in theaorta than in the pulmonary artery.


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The measures of a persons bloodpressure it taken at a large artery inthe upper arm. It is the pressure needto stop blood flow in this artery and ismeasured at diastole and systole.Standard healthy readings are 80 mmHg diastolic, 120 mm Hg systolic.

People with a diastolic number at or

above 95 have hypertension (highblood pressure). It is usually causedby blockages in the arteries.


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Blood pressure = Cardiac output xTPR

It is evident from the formula thatany increase in the cardiac output orin the total peripheral resistance

would result in the increase in theblood pressure.


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Most MIs & strokes occur in individuals with

normal levels of BP

Most people have

normal BP levels.

Relationship between

BP & CV risk is linear

(i.e no threshold)

+


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Hypertension risk factors

Target organ damageHeart

Brain

Eyes

Kidneys

Clues to 2o HTSymptoms

Drugs

Signs

Other CV risk factorsLipids

Smoking

Diabetes

Exercise

oncurrent conditionsAsthma

Gout

Pregnancy


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Non-pharmacological/ lifestyle

Pharmacological


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BPBP

ClassificationClassification

SBPSBPmmHg*mmHg*

DBPDBPmmHgmmHg

LifestyleLifestyleModificationModification

DrugDrugTherapy*Therapy*

**

NormalNormal


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Flow-mediated vasodilation (FMD)


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Measures that lower blood pressure:q weightq salt intakeq alcohol consumptionq physical exerciseq

fruit & vegetable consumption

Measures to reduce cardiovascular risk:q Stop smokingq saturated fat, poly- & mono-unsaturatesq oily fish consumptionq total fat intake

BHS Guidelines 2010


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Brit Med Bull2009;50:272-98

Total

nu

mbe

rofi n

dividu

als

affe

cte

d

Stroke CHD All vascular

deaths

All other

deaths

1200

1000

800

600

400

200

% reduction

in odds

38%

SD 4

16%

SD 4

T C

T C

T C

T C

Fatal events

Non-fatal events

T=treatment

C=control

Th id l A tih t i ?


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The ideal Antihypertensive ?

q No contraindicationsq Inexpensive

q Effective in Mono therapy.

q Simple once daily dosageq Prevents / reverses target organ damage

q Improves mortality / morbidity

q No side-effects or adverse metabolic effectsq Combinable with other drugs

q Genetically targeted


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q Most hypertensive will need 2 drugs to control BPq Drug combinations may be synergistic

Diuretic

Beta-blocker

Calcium-channel

blocker

ACE-inhibitor

(Alpha-blocker)

Angiotensin receptor

blocker


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ACE inhibitor (AII antagonist) A

or

-blocker B

Calcium antagonist C Diuretic D

One drug: Younger, non-black AorBOlder, black CorD

Two drugs: (AorB) + (CorD)

Three drugs: (AorB) +C+D


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Heart

HR

Arteries

SVR

VeinsStroke

Volume


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ThiazidesThiazides

Veins Mechanism: inhibit Na/K pumps in

the distal tubule

Examples:

Hydrocholorthiazide 12.5-25 mg daily

Chlorthalidone 12.5-50 mg daily

Effective first line agent and provides

synergistic benefit

As single agent more effective if CrCl

>30 ml/min

Compelling indications: HF, High

CAD risk, Diabetes, Stroke, ISH


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ThiazidesThiazides

LoopsLoops

Aldosterone Ant.Aldosterone Ant.

Veins Mechanism: inhibit aldosterones

effect at the receptor, reducing Naand water retention

Examples:

Spironolactone 25 mg daily

Can provide as much as 25 mmHg

BP reduction on top of 4 drug

regimen in resistant hypertension

Monitor SCr and K

Compelling indications: HF

Am J Hypertension. 2003; 16:925-930.


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ThiazidesThiazides

LoopsLoops


NitratesNitrates

Veins Mechanism: Direct venodilation by

release of nitric oxide

Examples:

Isosorbide dinitrate 10 mg TID

IMDUR 30 mg daily

In renal patients with resistant

hypertension addition to 3-4 drug

regimen may help get patient to goal

Provide 8h nitrate free interval daily

Compelling indications: Angina


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ThiazidesThiazides

LoopsLoops


NitratesNitrates

ACEIACEI

ARBARB

Veins

Mechanism: Inhibit vasoconstriction

by inhibiting synthesis or blocking

action of angiotensin II; provides

balanced vasdilation

Examples:

Enalapril 2.5-40 mg daily BIDLisinopril 5 40 mg daily

Irbesartan 150-300 mg daily

Losartan 25-100 mg Daily - BID

Monitor: SCr, K

Compelling indications: HF, post-MI,

High CAD risk, Diabetes, CKD,

Stroke


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Beta BlockersBeta Blockers

Heart

Mechanism: Competitively inhibit the

binding of catecholamines to beta-

adrenergic receptors

Examples:

Atenolol 25-100 mg PO daily

Metoprolol 25 -100 mg PO daily or BID

Carvedilol 6.25-25 mg PO BID

Monitor: HR, Blood Glucose in DM

Not contraindicated in asthma orCOPD but use caution

Compelling indications: HF, post-MI,

High CAD risk, Diabetes


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Beta BlockersBeta Blockers

DiltiazemDiltiazem

VerapamilVerapamil

Via CentralVia CentralMechanism:Mechanism:

ClonidineClonidine

Heart

Mechanism: false neurotransmitters

reduce sympathetic outflow reducing

sympathetic tone

Examples:

Clonidine 0.1-0.6 mg PO BID-TID;

patchMethyldopa, Guanabenz, Guanfacine

Monitor: HR

Side effects often limiting: Dry

mouth, orthostasis, sedation

Clonidine patch can be useful in

elderly patients with labile blood

pressure


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DihydropyridineDihydropyridine

CCBsCCBs

Arteries

Mechanism: Decrease calcium influx

into cells of vascular smooth muscle Examples:

Amlodipine 2.5-10 mg PO daily

Felodipine2.5-10 mg PO daily

Do not use immediate release

nifedipine

Monitor: Peripheral edema, HR (can

cause reflex tachycardia)

Good add on agent if cost is not an

issue


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CCBsCCBsHydralazineHydralazine

MinoxidilMinoxidil

Arteries

Mechanism: Direct vasodilation of

arterioles via increased intracellular

cAMP

Examples:

Hydralazine 20-400 mg BID-QID

Minoxidil 2.5-40 mg PO daily-BID

Monitor: HR (can cause reflex

tachycardia), Na/Water retention

Hydralazine is an alternative in HF ifACEI contraindicated

Consider minoxidil in refractory

patients on multi-drug regimens


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CCBsCCBsHydralazineHydralazine

MinoxidilMinoxidil

AlphaAlpha11 BlockersBlockers

Arteries

Mechanism: Inhibit peripheral post-

synaptic alpha1 receptors causingvasodilation

Examples:

Terazosin 1 20 mg daily

Doxazosin 1 16 mg daily

Cause marked orthostatic

hypotension, give dose at bedtime

Consider only as add on therapy

Can be beneficial in patients with

BPH


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< 140/90 mmHg

. except in those with diabetes or

chronic renal disease

< 130/80 mmHg


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Topic ContentsTopic Contents


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Topic ContentsTopic Contents

Structure and functions ofStructure and functions ofvascular endothelial cell.vascular endothelial cell.

The endothelial dysfunction.The endothelial dysfunction.

The oxidant- stress inducedThe oxidant- stress induced

endothelial dysfunction.endothelial dysfunction.

How to assess endothelialHow to assess endothelialfunctions.functions.

SummarySummary


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Historically viewed as a passiveHistorically viewed as a passive

ascular liningascular lining..


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Many important roles to maintain vascularhomeostasis: Vascular tone regulation

VSMC proliferation

Inflammatory responses

Haemostasis

It produces and releases vasoactive,thromboregulatory and growth factor substances.

Endothelial cell functionsEndothelial cell functions


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Tousoulis, et al., Heart 2005; 91Tousoulis, et al., Heart 2005; 91: 353-358.: 353-358.

Endothelial cell functionsEndothelial cell functions

taining the vascular tone: Vasodilation and Vasoconst


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Functional targets Physiological

action/MediatorsHaemostasis Prothrombotic

AntithromboticPAI-1 PGI2, TPA

Calles-Escandon and Cipolla, Endocrine Rev 2001; 22: 36-52.


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Factors affecting vascular tone and structureFactors affecting vascular tone and structure


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Xanthine oxidase, NADP/NADPH oxidaseuncoulpled eNOS

NObioavailability


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A general term that covers a numberof diseases which affect the heart,including coronary artery disease,

heart-failure and angina.Heart Disease is the number one

killer in the.

Three major reasons of the heartdiseases in the world populations areas follows:-


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HURRY

WORRY

CURRY


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HypertensionCoronary Artery disease.

Angina(Myocardial Ischemia)

Heart Attack(Myocardial Infarction)


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Heart FailureArrhythmias


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Atherosclerosis is a specific form of

arteriosclerosis (thickening & hardeningof arterial walls) affecting primarily theintima of large and medium-sizedmuscular arteries and is characterized by

the presence of fibrofatty plaques oratheromas.The term atherosclerosis is derived from

atheroma (meaning porridge) referringto the soft lipid-rich material in thecentre of atheroma, and sclerosis(scarring) referring to connective tissuein the plaques.


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Most commonly affected arteries byatherosclerosis include large andmedium sized arteries like aorta,coronary, popliteal and cerebralarteries.Major complications resulting from

ischemia due to atherosclerosis

include myocardial infarction leadingto heart attacks and cerebralinfarction leading to strokes.Less common complications include

eri heral vascular disease


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Most commonly affected arteries byatherosclerosis include large andmedium sized arteries like aorta,coronary, popliteal and cerebralarteries.Major complications resulting from

ischemia due to atherosclerosis

include myocardial infarction leadingto heart attacks and cerebralinfarction leading to strokes.Less common complications include

eri heral vascular disease


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Atherosclerosis is the cause of more thanhalf of all deaths in the westernindustrialized nations.

Incidence progressively increasing indeveloping nations too in an epidemicproportion over the last few decades dueto fast changing lifestyles.

Deaths from myocardial infarction (20-25% of all deaths) are mostly related tounderlying atherosclerosis.

Cardiovascular disease related to


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Major risk factors1) Major Constitutional riskfactors:

i. Age ii. Sex iii.Genetic factors

iv. Familial and racial factors

2) Major Acquired risk factors:i. Hyperlipidaemia ii.Hypertension

iii. Diabetes mellitus iv. Smoking


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Minor Risk Factors:

1. Environmental influences2. Obesity3. Hormones: Oestrogen deficiency,

oral contracep.4. Physical inactivity5. Stressful life


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HYPERLIPIDAEMIA

Hypercholesterolaemia has directlyproportionate relationship withatherosclerosis and IHD because:

The atherosclerotic plaques containcholesterol and cholesterol esterslargely derived from the lipoproteins inthe blood.

The lesions of atherosclerosis can beinduced in experimental animals byfeeding them cholesterol-rich diet.

beneficial effect on reducing the risk ofIHD


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Individuals with hypercholesterolemia dueto various causes such as diabetesmellitus, myxoedema, nephrotic syndromeand familial hypercholesterolaemia have

increased risk of developingatherosclerosis and IHD.

Populations having hypercholesterolaemiahave higher mortality from IHD. Dietary

regulation and administration ofcholesterol-lowering drugs have


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Mevalonate Pathway..


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Pathophysiology of myocardial ischemia:


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Under conditions of rest, myocardial oxygen supply and

delivery of nutrients through the coronary arteries

should match the metabolic requirements of the

heart. When the metabolic needs of the heart

increase, the coronary blood flow must increaseaccordingly.

The myocardial oxygen balance is affected by

several factors that:

a) will increase the oxygen and nutrient demand of the

myocardium as: exercise, stress and cold.

b) will increase coronary blood flow as cardiac

metabolites and nitric oxide.

Myocardial Ischemia



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With age and progressive occlusion of coronary arteries, smaller

collateral vessels may begin to carry a greater proportion of blood

and provide an alternate means of perfusion for an area of

myocardium. These collateral blood vessels may run parallel to the

larger coronary arteries and be connected to other small coronary

vessels by vascular connections called anastomoses.

Development of collateral circulation may reduce or delay the

occurrence of symptoms from myocardial ischemia until the blockage

is very progressed.

The presence of extensively developed collateral circulation might

also explain why many older individuals often survive serious heart

attacks when younger individuals, who have not yet developed

collateral circulation, often do not.


MyocardialIschemiaManifestation of myocardial ischemia:


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It is the major symptom of myocardial ischemia.

Angina pectoris most commonly presents as pain, pressure or a burning

sensation in the area of the sternum.

Manifestation of myocardial ischemia:

Angina pectoris

1. Classic or exertional angina:

Pain is precipitated by increased workload on the heart. May becaused by exercise, emotions, stress and cold exposure.

Symptoms may remain stable for a number of years or progress

in severity.

There are three types of Angina pectoris

MyocardialIschemia



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2. Unstable anginaAngina that occurs at rest.

Also referred to as pre-infarct angina since it is usually associated with

extensive blockage of coronary arteries. Coronary blood flow does not meet the

needs of the heart even at rest.

Requires intensive treatment and evaluation.

3. Variant angina (vasospastic angina, Prinzmetals angina)

Caused by vasospasm of the coronary arteries.

Usually associated with coronary artery disease but may result from excess

sympathetic activity.

Frequently occurs at night, at rest or during minimal exercise.

May be precipitated by stress, cold exposure or smoking.



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Silent ischemia

is a particularly dangerous form of myocardial

ischemia as there is a lack of clinical

symptoms, i.e., ischemia without angina.

Usually diagnosed by exercise stress testing

or Holter monitoring


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Myocardial Ischemia


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Treatment of myocardial ischemia and the resulting angina can

involve two strategies:

1. Increase coronary blood flow by dilating coronary arteries.

2. Reduce cardiac workload by reducing heart rate and/or force

of contraction

Rationale for treatmentof myocardial ischemia:


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Pharmacologic treatment

Treatment of myocardial ischemia:


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Mechanism of action:

Dilate coronary arteries and increase myocardial blood flow.

Dilate peripheral arteries and reduce afterload.

Dilate peripheral veins and reducepreload.

Examples

Amyl nitrate, nitroglycerine, isosorbide dinitrite

Route of administration : Inhalation, sublingual, oral, transdermal,

intravenous

Long-acting forms such as isosorbide dinitrite used for prophylaxis of

angina

Short-acting forms such as sublingual nitroglycerin may be used during

angina attacks

Major adverse effects :include headache, hypotension. Tolerance may

develop rapidly.

g

Organic Nitrates

Pharmacologic treatment



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Mechanism of action: Block myocardial -adrenergic receptors. Reduce heart rate and cardiac output (reduced

myocardial workload and oxygen demand).Examples of -Adrenergic Receptor Antagonists : May be selective 1 (atenolol), or

nonselective 1 and 2 blockers (propranolol)

Major adverse effects : include bradycardia, reduced cardiac output,

pacemaker depression and bronchoconstriction with nonspecific

dru s

g

-Adrenergic blockers


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S



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Coronary angioplasty

Uses a balloon catheter to open occluded blood vessels

Usually performed under local anesthetic

5% mortality, high rate of vessel re-occlusion

Use of metal stents in opened vessel reduces rate of occlusion

Surgical treatment

Coronary artery bypass graft

Revascularization procedure in which a blood vessel is taken from elsewhere in

the body and surgically sutured around a blocked coronary artery

May involve multiple (one to five) blood vessels

Re-occlusion of transplanted vessel is possible


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Safe And Fit

Lives Long


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the cardiovascular final !!!!!!!

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