The Circulatory System

Anatomy and Physiology
The heart pumps blood from the body to the lungs to become oxygenated which goes round the body where the oxygen is used then brought back to the heart to repeat the process.
The left side of the heart has the largest muscle because it pumps blood to the extremities (as symbolised by the stick man on the diagram) through the aorta. It comes from the body through the superior vena cava and to the lungs via the pulmonary artery.

Arteries and veins have different anatomy for their different purposes. Arteries carry blood from the heart to the body which requires a thicker vessel wall to handle the high pressure of blood from the heart. Veins carry blood from the extremities back to the heart. They have valves to prevent blood from flowing backwards and thinner vessel walls than arteries do.

Physical assessment of the Cardiovascular System
Observations
Clubbing and splinter haemorrhaging may indicate infective endocarditis but there are other things associated with clubbing which are more common in other body system diseases. Cyanosis of the lips and tongue may indicate; shock, a cold environment or heart failure.

Jugular Venous Pressure
The JVP should be between 3 and 4 cm. This is a rough measure of the pressure of the jugular vein. If it is raised this can indicate constrictive pericarditis, cardiac tamponade, renal disease, excessive fluids or superior vena cava obstruction.

Inspection
Inspect the chest for kyphoscliosis, obvious scars which may indicate a pacemaker, a bulge indicating cardiac enlagment and abdominal pulsations (a lack of which may indicate an abdominal aortic aneurysm).

Palpation
Palpate for the 4 areas and the apex. Feel for heaves which may indicate right ventricular or left atrial enlargement. Also feel for thrills which indicate a palpable murmur. If the apex beat cannot be found this is usually due to obesity but can also indicate; emphysema, pericardial or pleural effusion.

Auscultation
Auscultate the 4 areas for murmurs caused by things like; a stenotic valve or regurgitation.

Cardiovascular pathologies
Ischemic heart disease
Atherosclerosis is the hardening of an artery’s inner wall caused by a plaque. Arteriosclerosis is a more general term used to describe any hardening of the artery inner wall including loss of elasticity by any cause. It is generally thought that atherosclerosis is made of an adipose plaque but in fact the plaque is made up of white blood cells which have gathered in the area of damage to the endothelial wall which has become saturated with red blood cells, fat and other cells. This collection of cells and fat create an inflammatory response whereby the body tries to protect itself from what seems to be a hostile cell by bringing in macrophages/ antibodies to fight. These are found in white blood cells and are what create the plaque, as mentioned above.

Smoking, obesity, diabetes, and hypertension can all contribute and sometimes cause atherosclerosis. Obesity, smoking and diabetes are associated with hypercholesterolemia which will influence the pathology above. Hypertension increases the pressure of the blood in the arteries and this in itself can sometimes cause damage to the endothelial wall.

It can occur from child hood and culminate in a trans ischaemic attach (stroke) or myocardial infarction (heart attack) later in life; usually around the middle ages. A change in diet and lifestyle is usually the best way to prevent this from happening as it is not symptomatic until another pathology occurs as a result. For example, the plaque can cause a blockage of the artery thereby cutting off the circulation to parts of the body and causing cell death through starvation of oxygen. This is how strokes and heart attacks occur, each area, either heart or brain, has been starved of oxygen.

Trans ischemic attack/ Stroke is otherwise known as a “brain attack” these can be deadly. They occur when either a part of a blood clot elsewhere in the body breaks off and blocks an artery in the brain (embolic stroke) or a blood clot occurs in the brain itself (thrombotic stroke). Sometimes the pressure in these blockages is too much and can haemorrhage bursting the artery walls and leaking into the brain (a simple hemorrhagic stroke) or the cerebrospinal fluid (subarachnoid haemorrhage). Other causes include arteritis (inflammation of the arteries), mass lesions (such as tumours). In children causes are usually different such as; congenital heart disease, drug abuse, clotting disorders, CNS (central nervous system) infection, neurofibromatosis, vasculitis, fibromuscular dysplasia, Marfan disease, tuberous sclerosis and tumours.

TIAs are acute and usually have happened before a health professional sees the patient. Symptoms are signs which occur after are speech difficulties, movement difficulties (usually affecting gait) and memory.

Myocardial Infarction/ Heart attack occurs when the blood supply is prevented from getting to the myocardium starving it of oxygen (hypoxia) resulting in cell death (necrosis). The symptoms usually present as a feeling of chest tightness and a sharp pain running down the left arm and up the neck up to the jaw. These can result in death. Usually a person at risk does not know they are until the myocardial infarction occurs. Blood thinners are the orthodox treatment to prevent this from happening however; these do leave the person at risk of severe bleeding.

Right/Left heart failure is brought about when the muscle of the heart can no longer fully pump as it once did. Left heart failure is the most common. This results in an accumulation of blood in the ventricle putting more pressure on the heart. Eventually it can spill over back into the lungs, as can be seen in the diagram above. Right heart failure gives a far wider ranging set of problems because blood backs up into the extremities. Oedema around the ankles is one of the most obvious symptoms of this. In both cases, if it is left untreated it can result in death. However, heart failure is not an acute problem the process usually happens over a long time period so it is possible to catch it before death occurs.

Angina is caused by ischemia (lack of blood supply resulting in hypoxia) to the heart muscle. This results in a severe pain as described for a myocardial infarction. Usually it is caused by either an embolism or spasm of the artery.

Arteritis is inflammation of an artery.

Vasculitis is inflammation of a blood vessel.

Peripheral vascular disease

Chronic and acute lower limb ischemia occur when the blood supply to the lower limbs are cut off by an embolism (break off of a blood clot) or a thrombus (break off from a plaque). Acute sufferers will complain of pain, paleness, paresthesia (a sensation of tingling, pricking and numbness) and paralysis. Chronic sufferers will complain of severe cramp on exercise and intermittent claudication (attacks of lameness and pain when walking).

Aneurysm is used to describe an artery which has thinning walls. This can sometimes rupture. Until they rupture the condition is asymptomatic (there are no symptoms). Abdominal aortic aneurysms can be deadly they cause severe pain, hypotension, tachycardia, profound anaemia and sudden death.

Raynaud’s disease is caused when constriction of the blood vessels prevents a full blood supply to the fingers (sometimes the toes). It is aggravated by cold weather and made better with warmth. When it is particularly chronic fingers can be lost to the disease.

Buerger’s disease occurs in young men who smoke. It seems to be caused by arteritis and sometimes vasculitis resulting in atherosclerosis leading to severe claudication and pain on rest leading to gangrene.

Peripheral Venous disease

Varicose veins occur when the vein becomes dilated these can usually be clearly seen on the leg and often cause pain to the patient.

Venous thrombosis is a general term used for thrombosis (blood clot) of any vein. Deep vein thrombosis is one such example. These usually occur after an injury to the vein or large periods of inactivity.

Valvular heart disease refers to diseases which affect the valves of the heart. Namely stenosis (hardening) of the valve or regurgitation which can occur after stenosis. These are called:
- Aortic stenosis
- Aortic regurgitation
- Mitral stenosis
- Mitral regurgitation
- Tricuspid stenosis
- Tricuspid regurgitation
- Pulmonary stenosis
- Pulmonary regurgitation

Cardiomyopathy, meaning a disease of the cardiac muscle, is a title used to classify a group of diseases. They are subdivided by their presentation into; dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy.
All the information in this paper was found in Kumar and Clarks (2002) section on cardiovascular disease.

Herbs for the Heart
These herbs are listed here for their affinity to the heart however, they do not just work on the circulatory system, and they are far more complex than this. Below is the use of each herb in relation to the circulatory system only.
Achillea millefolium this herb helps bring blood to the peripheries and promotes sweating
Cinammomum zeylanicum this herb opens the arteries allowing blood to flow more freely in cases of tension
Crataegus lavaegata this herb strengthens the heart muscle and can be used for hypertension and hypotension alike
Leonurus cardiac this is another herb which strengthens the heart but is traditionally used in high blood pressure, not low
Rosmarianus officianlis this herb increases circulation to the peripheries as well and has an affinity to the brain thus helping with headaches caused by poor circulation from stress (which causes constriction and prevents blood flow)
Zingiber officinalis is a hot herb, as is Rosmarianus, it helps bring blood to the peripheries and prevents sweating like Achillea does.