well welcome to the second part of this presentation where we're looking at terminology relating to the cardiovascular system now the first section dealt with terminology relating to the heart specifically we now want to go on to the second part of the cardiovascular system which is just that the vascular system so first of all we want to look at terminology relating to vessels in general and then we'll look at terminology relating specifically to arteries and then to veins so we're starting off with a short section looking at terminology relating to vessels in general now angio is the word meaning vessels or pertaining to vessels and this comes from the Greek angon the Greek word for vessel so angio Rafi now Rafi is a surgical term that means to sew up or to suture so an angori would be a suturing surgical repair of a blood vessel so if a blood vessel was injured a surgeon might sew it up to prevent the Hemorrhage that would be an angori angioma now Omar is a lump now angomas are benign tumors affecting blood vessels sometimes they can actually affect lymphatic vessels as well and these tend to become more common with age but there can also be a symptom of liver disease so always consider that as a possibility and one of the most common types are cherry hemangiomas cherry as because they're cherry color Hemangioma these benign tumors in blood vessels and these are sometimes called Campbell deor Morgan spots after the British surgeon Campbell de Morgan who first identified them but the good thing about them is that they're benign and geography is where we visualize blood vessels now if you take a plain x-ray blood vessels are not usually visible because they are soft tissues so angiography is a technique which allows us to visualize blood vessels so it's an x-ray technique and typically a contrast medium will be injected into an area with blood vessels and the contrast medium medum will be x-ray opaque so as the medium goes through the vessels that illuminates the vessels to the X-ray and the vessels can be clearly visualized so there could be coronary Ang geography looking at the coronary arteries or the pulmonary angiography looking at the pulmonary vessels or cerebral angiography looking at the cerebral vessels perusing the brain or extremity Ang geography where we might examine the blood vessels in the arms or the legs for example if someone had peripheral vascular disease we might want to do peripheral leg extremity Ang geography so we can examine the leg vasculature anoplasty refers to widening a blocked or narrowed blood vessel and this involves passing a uh a line a thin line into the blood vessel and once the line is in the blood vessel a balloon around about that line is blown up and as the balloon blows up that presses on the inside of the vessel and expands it and typically after a Bloon angioplasty a stent will be put in as part of the procedure so this can be a percutaneous transluminal coronary angioplasty for example ptca percutaneous means through the skin very often the access to this will be through the right radial artery transluminal means via the Lumen of the blood vessel coronary means related to the coronary arteries and angioplasty is a widening of narrow vessels so there could be a percutaneous transluminal coronary anoplasty so still thinking about termin techology relating to the vascular system and the vessels in general the prefix vas or Vaso means to do with a vessel or a duct so vascular means to do with the blood vessels so we might talk about a tissue being highly vascular so for example the brain contains a lot of blood vessels or the liver or the kidneys are highly vascular organs they contain a lot of blood vessels and that's important because if organs like the liver or the kidneys are damaged they can be a lot of bleeding they can be torrential Hemorrhage because they are very vascular organs but alternatively we might say that other tissues are relatively avascular such as the subcutaneous adipose tissue contains relatively few blood vessels therefore if it's injured it's less likely to be Associated or it won't really be associated with significant Hemorrhage having said that there's blood vessels above it in the skin and blood vessels below it in the muscles and other tissues but the adipose tissue itself is relatively avascular cerebrovascular the cereal part comes from cerebrum to do with the brain so cerebrovascular is talking about the blood vessels taking blood to and from the brain and you might have heard the term cerebrovascular accident a cerebrovas muscular accident is where there is some pathology in the cereal vessels normally we're talking about the arterial vessels so there might be a thrombus followed by embolization from that thrombus reducing the blood supply to parts of the brain or indeed cutting blood supply to parts of the brain off alt together resulting a cerebral vascular accident or there could be an aneurysm in a cerebral vessel resulting in a hemorrhage caused a cerebral hemorrhage these are pathologies related to the cerebral vasculature that's why we call them cerebrovascular accidents actually they're not really accidents they're pathological processes but that's what we call them cvas cardiovascular relates to the system of the heart and the blood vessels it's describing the whole system so this whole section of videos is about the cardiovascular system and the terminology related to it cardio heart vascular the blood vessels vasos spasm now vasos spasm Vaso the blood vessels spasm is where the blood vessels close down the muscular walls in the blood vessels contract and that will greatly reduce the Lumen through which blood can travel to profus a tissue if there's a a vasospasm so vasospasm can lead to es schia of a tissue and if the vasospasm is prolonged it can lead to necrosis of a tissue so this could occur in the heart for example there could be some spasm of the coronary arteries leading to myocardial esea or there could be a cerebral vasospasm now this can occur after subarachnoid hemorrhage where there is hemorrhage into the subarachnoid space containing the cerebos spinal fluid there can be a cereal vasospasm causing a period of unconsciousness if we inject adrenaline or that's epinephrine into a tissue that will cause fairly profound localized vasospasm it will close down the blood vessels this is why when we're giving local anesthetics if we're giving local anesthetics in into a digit into a finger or a toe we make sure it doesn't contain adrenaline or epinephrine because that will cause a profound Vaso constriction cutting the blood supply off to that digit because the only way the blood is going to get to a tissue is via the Lumin in the vasculature so carrying on with this prefix vas or Vaso vasod dilation refers to widening of the blood vessels so the vasom motor tone how constricted or relaxed the smooth muscle in the walls of blood vessels is is controlled by the Vaso motor Center in the brain stem and if there's reduced stimulation of the blood vessel smooth muscle walls they'll naturally dilate there'll be a Vaso dilation and that can be good because it will allow more blood to go through to a tissue or we might think about the situation where it's warm if we're in a warm environment there can be a peripheral vascular vasod dilation to allow more warm blood to go to the surface of the body so this can be an entirely physiological process maintaining homeostasis and organizing the amounts of blood regulating the amounts of blood that are going through to a particular tissue at a particular time to meet the metabolic requirements of that tissue vasodilators are usually chemical substances which will bring about vasod dilation so nitric oxide for example is a physiological vasodilator it's released by the vascular endothelium the cells lining the capillaries and lining the blood vessels and when that's released it will cause local vasod dilation under the influence of nitric oxide but we also give vasod dilators as therapeutic IC pharmacological agents so nitrates for example such as Glycerine TR nitrate Glycerine TR nitrate is a short acting vasod dilator so glycerin TR nitrate will dilate the coronary vessels that's good because the coronary arterial vasod dilation will increase myocardial profusion hopefully relieving the symptoms of angina and Glycerine TR nitrate will also dilate the larger blood vessels as well meaning the heart doesn't have to work as hard or we might want to lower blood pressure so we can give Angiotensin converting enzyme Inhibitors such as linil that will cause Vaso dilation thereby lowering peripheral res resistance thereby lowering blood pressure because blood pressure is determined by the cardiac output multiplied by the peripheral resistance so if we lower peripheral resistance we're going to lower blood pressure and that's exactly what ACE inhibitors do the Angiotensin converting enzyme Inhibitors and other hypotensive agents the think of amlodipin for example the calcium channel blocker amlodipin will also lower blood pressure via this mechanism of vasod dilation so very often therapeutically pharmacologically useful and we give vasod dilators vasculitis refers to inflammation of blood vessels now this can be infective there can be infection in blood vessels but very often vasculitis is what we call an autoimmune disease where the body's immune system is for some reason attacking its own tissues it's a pathological process and this causes blood vessels to swell and narrow so for example might have heard of giant cell or temporal arteritis inflammation of the arteries in the the temporal area at the side of the head causing aching in the temporal area and the patients often complain of um pain in their masticatory muscles when they're eating or double vision and it can be associated with polymyalgia usually responds quite well to steroids because steroids are going to reduce inflammation but look at the word it's got VAs on front on the front the prefix the suffix is itus so we know it's going to be inflammation related to the vascular system the prefix Vaso means that it's to do with the vessels and the vagel part there on the end the suffix vagal means to do with the vagus nerve now the vagus nerve is the 10th cranial nerve and it's a parasympathetic nerve so vasovagal attacks can sometimes be called neurocardiogenic events because the brain triggers off this event it could be an emotional disturbance but it if you're very upset about something or very fearful or it could be um a physical thing like standing too long or or being in the heat but the brain triggers this so it's neuro it's mediated VI the Vegas nerve but it's also cardiogenic because what the vagus nerve will do is it will because it's parasympathetic it will slow the heart rate down so the person will get a very slow heart rate and the Vagas nerve because it's parasympathetic it will override the sympathetic Vaso constricting stimulus of the sympathetic nervous system and you'll get a Vaso dilation so you'll get a bradicardia and a vasod dilation at the same time that means that the heart rate will be reduced reducing cardiac output and you'll also reduce peripheral resistance and both of those factors are going to lower blood pressure significantly and that means that the brain is not profused and if this is bad enough to make you faint this is called a Syncopy a Vaso Veo or a neurocardiogenic Syncopy so the person might um well initially actually you often feel very warm because of the Vaso dilation then you tend to feel cold afterwards and you can be very shivery and very sweaty afterwards because of the sympathetic compensation but it's a horrible feeling so do be sympathetic to people that faint because it's it's not a trivial thing for them it really feels quite horrible when it happens a Vaso regular episode in this next section we want to consider terminology which is specific to the arterial system specific to the arteries an artery being any blood vessel carrying blood away from the heart the English word artery comes from arteria which is the Greek word so it comes from classical Roots like so many of these words do now if you got arteria a or arterio that's relating to or pertaining to arteries so the a l on the end actually means pertaining to so arterial means pertaining to an artery and an artery is simply defined as any vessel which carries blood away from the heart and you might remember that there's the systemic arterial system carrying blood to the body and there's the pulmonary arterial system carrying blood to the lungs now the old o l e on the end the all suffix all means very small or tiny so we've got the prefix arteria on the front a r t r i arteria on the front but then because we've got an O on the end that means it's small so this is an artery which is small so an arterial is a small artery and it's the arterials that communicate between the very small arteries and the capillaries so the arterials are the very small ones arteritis is inflammation of the arteries and we dealt with this just recently when we looked at um vasculitis so I'm not going to do it again here arterio stenosis so arterio the prefix means we're talking about the arteries an osis on the end osis means a condition of and the Sten part means narrowing so St nois means narrowing an abnormal pathological narrowing of an arter of an artery so arterio stenosis is narrowing now why might there be a narrowing of the artery and particularly we're thinking about the arterial Lumin the inside part of the artery that the blood must pass through well syphilis can be a cause of arteriostenosis it can affect the aor but more commonly in Western countries there can be a buildup of fatty atheromatous plaques inside the arteries so if there's bulky fatty material accumulating inside the artery that means there's less space for the blood to pass through so that can cause an arterio stenosis so this next word is arteriosclerosis now the arterio means it's to do with arteries the osis on the end again means an abnormal or a pathological condition and the scur part means hardening so sclerosis is abnormal hardening a condition of pathological hardening the artery has become sclerosed abnormally hardened and this might occur in arterial disease where there's calcification for example in the wall of the artery making it harder so arterio stenosis is narrowing arteriosclerosis is hardening now arterial sclerosis can you see this is arterial sclerosis not arterial sclerosis so this is hardening of the arterials because it's arterial sclerosis hardening of of the small blood vessels and hardening of the small arterials is particularly problematic because that means they can no longer smooth out the blood flow and that reduces the quality of the perfusion of the tissues leading to exacerbation of es schic disorders now the main condition affecting arteries in the western world is atherosclerosis now the athero part means that there is the accumulation of atheroma the abnormal fatty material inside the arteries so in atherosclerosis there's atheroma and that is often associated with hardening which is the sclerosis part endarterectomy end or Endo means inside a r t r so we know we're talking about an artery an ectomy means the surgical removal of so this is cleaning out the inside of an artery so for example if someone's getting cerebrovascular esmia and probable transient ischemic attacks and they're at risk of thromboembolic cerebrovascular accident then a cored endarterectomy may be performed to clean out the inside of the koted arteries thereby in improving the profusion of blood to to the brain via the cored artery well we've talked about an angiogram or angiography which was blood vessels and the gram part on the end means to make a picture or a recording of so an arteriogram is is an x-ray visualization of arteries so an arteriogram is actually a type of angiogram so technically you could have an angiogram looking at the arteries or the veins whereas the arteriogram is specific to the arteries now just to finish off this section on terminology relating to the arterial system aneurism now aneurism is Greek for dilatation or widening so an aneurism is a weakness in the wall of a blood vessel and if the wall of the blood vessel is weak then the pressure of the blood inside can Bloon it out forming an expansion so aneurism is a weakness in the wall of the artery very often giving rise to dilation there's different types of aneurism a fusiform aneurism tends to have a uniform dilation but in parts of the body particularly on The Circle of Willis for example the circle of arteries at the base of the brain there can be congenital ber aneurysms which are ber shaped aneurisms and they can have very serious consequences if they're to rupture and to bleed now ectasis means a dilation or expansion of so an arter ectasis is a dilation of an artery but it's not a term we use very commonly but that's what it would mean arter arter ectasis abnormal dilation or widening of an artery well this brings us to the last section of our consideration of terminology relating to the cardiovascular system we looked at terms relating to the heart terms relating to vessels in general terms relating to arteries in specific and now terms relating specifically to the Venus system and a vein is any vessel carrying blood towards the heart and again we have systemic veins carrying blood from the body back to the heart and we have pulmonary veins carrying blood from the lungs back to the heart the two parts of the Venus system fleo fleo means to do with veins actually the word fleo comes from the Greek for blood vessel but we always use it to relate to veins so fitus is going to be itus inflammation of the veins sometimes called a venius fitis or venius or ventis it would all mean the same thing but I think fitis is the more correct term usually a fitis would affect the superficial veins with heat pain redness and swelling as you would expect in an inflammatory condition and there's two types of futis it can be sterile or it can be infective and it's important to note the difference now A Sterile fiters could be caused by us giving certain intravenous fluids for example high concentrations of glucose or dextrose or some intensive care type drugs have to be given via Central veins because they'll cause stero fitis if they're given into superficial veins purely because the chemical agent in the infusion will cause irritation and inflammation of the the veins but a stabius can also occur in autoimmune disease such as SLE systemic lupus orthosis and it can also be a Paran neoplastic effect as it might occur with pancreatic breast or ovarian cancers but of course fitis can also be infective now this is particularly likely to occur when we have catheters that we leave in patient's veins for prolonged periods of time more than 48 hours for example and the canulas can become infected usually with bacteria from the surface of the skin such as staf cocosa Oria or staus epidermis and when that's the case we have to remove it because because it's the intravascular devices inside a blood vessel it means that the bacteria can potentially spread around the body in the blood so it would have to be removed and replaced if it's still required in an alternative site thrombo fitis would be fitis associated with thrombus formation so if there's disruption to the internal Tunica intima the inner lining of the blood vessel that can lead to thrombus formation now this can occur in superficial veins and if this thrombo flit is in superficial veins that's unlikely to cause EMB that are going to go to the lungs but if it's in a central vein that's very serious because the Deep Venus thrombosis can embolize leading to pulmonary embolism but look at the word thrombo fitis thrombus an abnormal blood clot or a blood clot in a vessel associated with a fitis otomy means to make an opening into or to cut into so photomy is making an opening into a vein as we would do for Vena puncture for removing blood samples or for placing an intravenous catheter into a vein there would be a phlebotomy fleos sclerosis is hardening of a vein sometimes called venosclerosis sometimes it's CA caused by Veno fibrosis where there's um fibrous tissue developing in the wall of the vein this can occur as a consequence of long-term inflammation for example and it's also sometimes called induration inur of a vein is where there's more fibrous tissue reduced elasticity and general hardness so phlebosclerosis is a descriptive term it does describe the condition well but we actually don't use it very frequently in clinical practice osis means pertaining to so thenen the prefix is to do with veins osis is pertaining to so Venus simply means pertaining to veins or the Venus system ven puncture as we've just seen is a photomy taking blood from a vein we are puncturing the vein to take blood out Veno thromboembolism this is called VT there is a thrombus in the vein that produces emali so the thrombus is the abnormal blood clot and the EMB are bits of that that break off and embolize into the Venus circulation so for example a deep Venus thrombosis can lead to a pulmonary embolism so DVT and PE deep Venus thrombosis and Pulmonary embolism are both under this more umbrella term of VTE Veno thrombo embolism