Cardiovascular System

The cardiovascular/circulatory system transports food, hormones, metabolic wastes, and gases
(oxygen, carbon dioxide) to and from cells. Components of the circulatory system include:
blood: consisting of liquid plasma and cells
blood vessels (vascular system): the "channels" (arteries, veins, capillaries) which carry
blood to/from all tissues. (Arteries carry blood away from the heart. Veins return blood to
the heart. Capillaries are thin-walled blood vessels in which gas/ nutrient/ waste
exchange occurs.)
heart: a muscular pump to move the blood

There are two circulatory "circuits": Pulmonary circulation, involving the "right heart," delivers
blood to and from the lungs. The pulmonary artery carries oxygen-poor blood from the "right
heart" to the lungs, where oxygenation and carbon-dioxide removal occur. Pulmonary veins carry
oxygen-rich blood from tbe lungs back to the "left heart." Systemic circulation, driven by the "left
heart," carries blood to the rest of the body. Food products enter the sytem from the digestive
organs into the portal vein. Waste products are removed by the liver and kidneys. All systems
ultimately return to the "right heart" via the inferior and superior vena cavae.

A specialized component of the circulatory system is the lymphatic system, consisting of a moving
fluid (lymph/interstitial fluid); vessels (lymphatics); lymph nodes, and organs (bone marrow, liver,
spleen, thymus). Through the flow of blood in and out of arteries, and into the veins, and through
the lymph nodes and into the lymph, the body is able to eliminate the products of cellular
breakdown and bacterial invasion.
 Blood Components
Adults have up to ten pints of blood.
Forty-five percent (45%) consists of cells - platelets, red blood cells, and white
blood cells (neutrophils, basophils, eosinophils, lymphocytes, monocytes). Of
the white blood cells, neutrophils and lymphocytes are the most important.

Fifty-five percent (55%) consists of plasma, the liquid component of blood.

Component Type Source Function
Platelets, cell fragments Bone marrow Blood clotting
life-span: 10 days

Lymphocytes (leukocytes) Bone marrow, Immunity

spleen, lymph T-cells attack cells containing viruses. B-
nodes cells produce antibodies.

Red blood cells (erythrocytes), Bone marrow Oxygen transport

Filled with hemoglobin, a life-span: 120 days
compound of iron and protein

Neutrophil (leukocyte) Bone marrow Phagocytosis

Plasma, consisting of 90% water 1. Maintenance of pH level near

and 10% dissolved materials -- 7.4
nutrients (proteins, salts, glucose), 2. Transport of large molecules
wastes (urea, creatinine), (e.g. cholesterol)
hormones, enzymes 3. Immunity (globulin)

4. Blood clotting (fibrinogen)

Vascular System - the Blood Vessels

Arteries, veins, and capillaries comprise the vascular system. Arteries and veins run parallel
throughout the body with a web-like network of capillaries connecting them. Arteries use vessel
size, controlled by the sympathetic nervous system, to move blood by pressure; veins use one-
way valves controlled by muscle contractions.

Arteries
Arteries are strong, elastic vessels adapted for carrying blood away from the heart at relatively
high pumping pressure. Arteries divide into progressively thinner tubes and eventually become
fine branches called arterioles. Blood in arteries is oxygen-rich, with the exception of the
pulmonary artery, which carries blood to the lungs to be oxygenated.

The aorta is the largest artery in the body, the main artery for systemic circulation. The major
branches of the aorta (aortic arch, ascending aorta, descending aorta) supply blood to the head,
abdomen, and extremities. Of special importance are the right and left coronary arteries, that
supply blood to the heart itself.
 Major Branches of Systemic Circulation
Source: Joel DeLisa and Walter C. Stolov, "Significant Body Systems," in: Handbook of Severe Disability, edited
by Walter C. Stolov and Michael R. Clowers. US Department of Education,
Rehabilitation Services Administration, 1981, p. 40.

Name Serves
Head Carotid Brain & skull

Abdomen Mesenteric Intestines

Celiac (Abdominal) Stomach, liver, spleen
Renal Kidney
Iliac Pelvis

Upper Extremity Brachial (axillary) Upper arm

Radial & Ulnar Forearm & hand
Dorsal Carpal Fingers

Lower Extremity Femoral Thigh

Popliteal Leg
Dorsal pedis Foot
Posterior tibial Foot

Capillaries
The arterioles branch into the microscopic capillaries, or capillary beds, which lie bathed in
interstitial fluid, or lymph, produced by the lymphatic system. Capillaries are the points of
exchange between the blood and surrounding tissues. Materials cross in and out of the capillaries
by passing through or between the cells that line the capillary. The extensive network of
capillaries is estimated at between 50,000 and 60,000 miles long. 1

Veins
Blood leaving the capillary beds flows into a series of progressively larger vessels, called venules,
which in turn unite to form veins. Veins are responsible for returning blood to the heart after the
blood and the body cells exchange gases, nutrients, and wastes. Pressure in veins is low, so
veins depend on nearby muscular contractions to move blood along. Veins have valves that
prevent back-flow of blood.

Blood in veins is oxygen-poor, with the exception of the pulmonary veins, which carry oxygenated
blood from the lungs back to the heart. The major veins, like their companion arteries, often take
the name of the organ served. The exceptions are the superior vena cava and the inferior vena
cava, which collect body from all parts of the body (except from the lungs) and channel it back to
the heart.

HEART

The heart is about the size of a man's fist. Located between the lungs, two-thirds of it lies left of
the chest midline The heart, along with the pulmonary (to and from the lungs) and systemic (to
and from the body) circuits, completely separates oxygenated from deoxygenated blood.

Internally, the heart is divided into four hollow chambers, two on the left and two on the right. The
upper chambers of the heart, the atria (singular: atrium), receive blood via veins. Passing through
valves (atrioventricular (AV) valves), blood then enters the lower chambers, the ventricles.
Ventricular contraction forces blood into the arteries.
.

Oxygen-poor blood empties into the right atrium via the superior and inferior vena cavae. Blood
then passes through the tricuspid valve into the right ventricle which contracts, propelling the
blood into the pulmonary artery. The pulmonary artery is the only artery that carries oxygen-poor
blood. It branches to the right and left lungs. There, gas exchange occurs -- carbon dioxide
diffuses out, oxygen diffuses in.

Pulmonary veins, the only veins that carry oxygen-rich blood, now carry the oxygenated blood
from lungs to the left atrium of the heart. Blood passes through the bicuspid (mitral) valve into the
left ventricle. The ventricle contracts, sending blood under high pressure through the aorta, the
main artery for systemic circulation. The ascending aorta carries blood to the upper body; the
descending aorta, to the lower body.

What is the Liver?

The liver is the largest glandular organ of the body. It weighs about 3 lb (1.36 kg). It
is reddish brown in color and is divided into four lobes of unequal size and shape.
The liver lies on the right side of the abdominal cavity beneath the diaphragm. Blood
is carried to the liver via two large vessels called the hepatic artery and the portal
vein. The heptic artery carries oxygen-rich blood from the aorta (a major vessel in
the heart). The portal vein carries blood containing digested food from the small
intestine. These blood vessels subdivide in the liver repeatedly, terminating in very
small capillaries. Each capillary leads to a lobule. Liver tissue is composed of
thousands of lobules, and each lobule is made up of hepatic cells, the basic metabolic
cells of the liver.
What is its major function?

The liver has many functions. Some of the functions are: to produce substances that
break down fats, convert glucose to glycogen, produce urea (the main substance of
urine), make certain amino acids (the building blocks of proteins), filter harmful
substances from the blood (such as alcohol), storage of vitamins and minerals
(vitamins A, D, K and B12) and maintain a proper level or glucose in the blood. The
liver is also responsible fore producing cholesterol. It produces about 80% of the
cholesterol in your body.

Diseases of the Liver?

Several diseases states can affect the liver. Some of the diseases are Wilson's
Disease, hepatitis (an inflammation of the liver), liver cancer, and cirrhosis (a chronic
inflammation that progresses ultimately to organ failure). Alcohol alters the
metabolism of the liver, which can have overall detrimental effects if alcohol is taken
over long periods of time.

Hemochromatosis can cause liver problems.

Medications that negatively effect the liver?

Medications have side effects that may harm your liver. Some of the medications that
can damage your liver are: serzone, anti-cancer drugs (tagfur, MTX, and cytoxan),
and medications used to treat diabetes.

Serzone is a prescription drug manufactured by Bristol-Myers Squibb for the

treatment of depression.

The possible side effects of Serzone are: agitation, dizziness, clumsiness or

unsteadiness, difficulty concentrating, memory problems, confusion, severe nausea,
gastroenteritis, abdominal pain, unusually dark urine, difficult or frequent urination,
fainting, skin rash or hives yellowing of the skin or whites of the eyes (jaundice) or a
prolonged loss of weight or loss of appetite.

If you or a family member have suffered serious side effects or a fatal injury after
taking Serzone, you or the family member may be eligible to file a claim against
the manufacturer. You should contact an attorney that specializes in class action
lawsuits immediately.

To help prevent liver damage, let your doctor know about your liver condition when
being treated for other conditions. Medications come in many forms and it is best to
find out what is in them and what it can do to your liver.
Malaria - the disease
This factsheet is for people who have malaria. For information on how to prevent getting malaria, please see the
separate BUPA factsheet:
Malaria - prevention

Malaria is caused by infection with a parasite called Plasmodium that is transmitted by the female of the Anopheles
species of mosquito.

Malaria is mainly found in tropical areas such as Africa, Central and South America, South East Asia and the Pacific
islands.1 Over 2000 people a year in the UK get infected with malaria whilst abroad. 1,2

Malaria parasite

You can get malaria if a female of the Anopheles species of mosquito bites someone carrying the malaria parasite, then
bites you, passing it to you.

There are four different types of Plasmodium parasite:

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

Each causes a slightly different type of illness.

P. falciparum (the most serious form) and P. vivax are the most common infections. 3 It is possible to get infected with
more than one type of Plasmodium parasite and this occurs in five to seven percent of infections. 4

Parasite lifecycle
The malaria parasite passes through your blood into your liver, where it grows and develops.

After it has completed its development it travels back into your blood stream, and eventually attacks your red blood
cells that are needed to carry oxygen around your body. The symptoms of malaria then appear.

Symptoms of malaria

The first symptoms of malaria are like having the flu. You may have:

a headache1,2
aching muscles1,2
tummy ache2
weakness or lethargy1,2

A day or so later, your temperature may rise and you may have:

a fever1,2
shivers1,2
mild chills2
 a severe headache2
a loss of appetite2
vomiting1

Your symptoms can appear any time after you are bitten by a mosquito carrying the malaria parasite.

The time it takes your symptoms to appear can vary with the type of parasite that the mosquito was carrying. 1,2

If you are bitten by a mosquito carrying the P. falciparum parasite, symptoms usually appear within
three months of being bitten.2
If you are bitten by a mosquito carrying the P. vivax, P. ovale or P. malariae parasite, symptoms can
appear a year or more after being bitten. This is because the parasite can lay dormant in your liver
and become active months later.2 These parasites may also cause you to have repeat symptoms.
An infection with P. malariae, for example, can cause you to have recurrent fevers decades after
your initial infection.5

If you have an illness with a fever and have travelled to a malarious region within the last year, you should visit your
GP.

Severe malaria
If you get infected with P. falciparum your malaria can progress to a more severe form and you may have
symptoms including:

low blood pressure6

severe anaemia2,6
jaundice2,6
fluid on your lungs (pulmonary oedema)2,6
kidney failure2,6
internal bleeding2,6
convulsions6
paralysis6
coma2,6

Severe malaria can also affect your brain and central nervous system and can be fatal. 2,6

Symptoms of severe malaria can appear within hours or days of your first symptoms of malaria. 2 It is important to seek
urgent medical advice if you suspect you have severe malaria.

Diagnosis

Your doctor will examine you and ask you about your symptoms. He or she will need to know which countries or
regions you have recently visited, including any stopovers.

Your doctor will usually do a blood test to see if you have malaria. This may need to be repeated as the levels of
malaria parasite in your blood can vary. If you have taken antimalarial drugs for example, the levels of parasite may be
too low to detect. Repeating the test can help to confirm if you have malaria.

Treatment
There are a number of drug treatments that are effective if you start taking them soon after your symptoms appear. 5
Resistance to certain drugs is a growing problem worldwide, particularly with P. falciparum.5 Therefore your doctor
will ask you which region you have visited and take this into account.

Some of the drug treatments for malaria can also help prevent malaria. For more information on preventive antimalarial
drugs, please see the separate BUPA factsheet:
Malaria - prevention

If you have taken a preventive antimalarial drug you should not take the same drug to treat malaria. You should tell
your doctor about any drug treatments you have recently taken.

A common treatment for P. falciparum malaria is artemether with lumefantrine (Riamet).

Proguanil hydrochloride with atovaquone (Malarone) is also often used, particularly to treat malaria contracted in sub-
Saharan Africa where there is resistance to other antimalarial drugs.

Quinine is a safe alternative for pregnant women although you may get side-effects such as nausea and tinnitus (ringing
in the ears). Quinine can also be combined with doxycycline for the treatment of P. falciparum malaria. Pyrimethamine
with sulfadoxine (Fansidar) can be used with, or following, quinine. 7,8

Mefloquine (Larium) can treat both P.falciparum and P. vivax malaria. It is now rarely used to treat P. falciparum
however, due to resistance. Mefloquine is a prescription-only drug and is not suitable for everybody - ask your doctor
or a travel health adviser whether it is appropriate for you. You should not take mefloquine if you are pregnant for
example.7,8

Primaquine is used to destroy P. vivax and P. ovale parasites in your liver (see Parasite lifecycle above).

You may need to take a different type of drug if the first treatment does not improve your symptoms after a couple of
days.7

If your illness is mild you may take medication at home. However, you may need hospital treatment if you develop
complications or need medication through an intravenous drip if you are not able to swallow tablets.