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By W. Leif. Joint Military Intelligence College. 2018.

Major changes occur in each of the five primitive dilations of the developing heart during the week-and-a-half embryonic period beginning in the middle of the fourth week cheap 100mg kamagra soft amex. The sinus venosus forms ing between the chambers during day 24 buy 100 mg kamagra soft with visa, and vessels are the coronary sinus and a portion of the wall of the right atrium. The embry- The ventricle is divided into the right and left chambers by the onic heart generally has begun rhythmic contractions and pump- growth of the interventricular septum. An opening between the two atria called the foramen ovale persists throughout fetal development. This opening is cov- ered by a flexible valve that permits blood to pass from the right to the left side of the heart. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 TABLE 16. Bulbus cordis Incorporated into the walls of the ventricles Fourth pair Right arch forms the base of the right subclavian Sinus venosus Differentiates to form the coronary sinus and artery. Ventricle Divided into right and left chambers by Sixth pair Right arch: proximal portion persists as proximal growth of the interventricular septum part of the right pulmonary artery; distal portion Atrium Partially partitioned into right and left degenerates. No derivative Left arch: proximal portion forms the proximal part The opening in the partition, called the of the left pulmonary artery; distal part persists as foramen ovale, persists throughout prenatal the ductus arteriosus. The third pair of aortic arches form the common carotid arteries and Congenital defects of the cardiac septa are a relatively the external carotid arteries. The first, second, and fifth tricular septal defects are the most common of the cardiac de- fects. An infant with a congenital cardiac defect may suffer from pairs of aortic arches have no derivatives and soon atrophy. The inadequate oxygenation of blood and thus be termed a “blue right sixth aortic arch forms the proximal portion of the right pul- baby. The left sixth arch forms the proximal portion of the left pulmonary artery, and the distal portion of this arch per- sists as an embryonic shunt between the pulmonary trunk and the aorta called the ductus arteriosus. DEVELOPMENT OF THE MAJOR ARTERIES The derivatives of the aortic arches are summarized in table 16. The formation of the major arteries occurs simultaneously with Although the embryonic vessels that develop from the the development of the heart. The most complex and fascinating truncus arteriosus are called aortic arches, they should vascular formation is the development of the aortic arches asso- not be confused with the adult aortic arch; that is, ciated with the pharyngeal pouches and branchial arches in the the major systemic artery leaving the heart. These aortic arches arise from the trun- fourth arch participates in the formation of the adult aortic arch. Although six pairs of aortic arches develop, they An examination of the persisting aortic arches in the adults are not all present at the same time, and none of them persists in of different classes of vertebrates reveals interesting evolutionary entirety through fetal development. Fish have six aortic arches persisting in the gill re- The transformation of the sixaortic arches into the basic gion. Reptiles have only one pair, a branch to the left and one to adult arterial arrangement occurs between the sixth and eighth the right.

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In because of the mixture of less well-oxygenated blood from time buy 100mg kamagra soft overnight delivery, the tissues of the atrial septum fuse; however kamagra soft 100 mg low price, an the right ventricle. This difference is crucial because about anatomic passage that is probably only passively sealed can two thirds of this blood must be used to perfuse the pla- be documented in some adults. In this situation, a lack liver is open for several days after birth but gradually closes of oxygen content is useful. After the fetus begins breathing, the fetal placental ves- sels and umbilical vessels undergo progressive vasocon- The Transition From Fetal to Neonatal striction to force placental blood into the fetal body, mini- Life Involves a Complex Sequence of mizing the possibility of fetal hemorrhage through the Cardiovascular Events placental vessels. Vasoconstriction is related to increased After the newborn is delivered and the initial ventilatory oxygen availability and less of a signal for vasodilator movements cause the lungs to expand with air, pulmonary chemicals and prostaglandins in the fetal tissue. At this point, the right ventricle can maternal placenta as a unit from the lining of the uterus. In time, the reduced workload on fetus is expelled, but external delivery of the placenta can the right ventricle causes its hypertrophy to subside. The separation occurs along the The highly perfused, ventilated lungs allow a large decidua spongiosa, a maternal structure, and requires that amount of oxygen-rich blood to enter the left atrium. The creased oxygen tension in the aortic blood may provide the cause of the placental separation may be mechanical, as the signal for closure of the ductus arteriosus, although suppres- uterus surface area is greatly reduced by removal of the fe- sion of vasodilator prostaglandins cannot be discounted. Normally about any event, the ductus arteriosus constricts to virtual closure 500 to 600 mL of maternal blood are lost in the process of and over time becomes anatomically fused. However, as maternal blood volume the increased oxygen to the peripheral tissues causes con- increases 1,000 to 1,500 mL during gestation, this blood striction in most body organs, and the sympathetic nervous loss is not of significant concern. REVIEW QUESTIONS DIRECTIONS: Each of the numbered (E) Increased vascular resistance during 3. Incoming arterial and portal venous items or incomplete statements in this aerobic exercise blood mix in the liver section is followed by answers or 2. The intestinal blood flow during food (A) As the hepatic artery and portal completions of the statement. Select the digestion primarily increases because of vein first enter the tissue ONE lettered answer or completion that is (A) Decreased sympathetic nervous (B) In large arterioles and portal BEST in each case. Which of the following would be an (B) Myogenic vasodilation associated (D) In the terminal hepatic venules expected response by the coronary with reduced arterial pressure after (E) In the outflow venules of the liver vasculature? As arterial pressure is raised and (A) Increased blood flow when the (C) Tissue hypertonicity and the lowered during the course of a day, heart workload is increased release of nitric oxide onto the blood flow through the brain would be (B) Increased vascular resistance when arterioles expected to the arterial blood pressure is increased (D) Blood flow-mediated dilation by (A) Change in the same direction as (C) Decreased blood flow when mean the major arteries of the abdominal the arterial blood pressure because of arterial pressure is reduced from 90 to cavity the limited autoregulatory ability of 60 mm Hg by hemorrhage (E) Increased parasympathetic nervous the cerebral vessels (D) Decreased blood flow when blood system activity associated with food (B) Change in a direction opposite the oxygen content is reduced absorption change in mean arterial pressure (continued) CHAPTER 17 Special Circulations 289 (C) Remain about constant because (B) Ductus venosus, foramen ovale, (C) The upper body is perfused by the cerebral vascular resistance changes in right ventricle, ascending aorta ductus arteriosus blood flow the same direction as arterial pressure (C) Spiral artery, umbilical vein, left (D) The heart takes less of the oxygen (D) Fluctuate widely, as both arterial ventricle, umbilical artery from the blood in the left ventricle pressure and brain neural activity status (D) Right ventricle, ductus arteriosus, (E) The right ventricular stroke volume change descending aorta, umbilical artery is greater than that of the left ventricle (E) Remain about constant because the (E) Left ventricle, ductus arteriosus, cerebral vascular resistance changes in pulmonary artery, left atrium SUGGESTED READING the opposite direction to the arterial 7. Integration of intestinal struc- pressure the range of arterial pressure over which ture, function and microvascular regula- 5. Which of the following special the cerebral circulation can maintain tion. Am J Physiol vascular resistance and the higher arterial pressure 1991;261:G539–G547. Acta Physiol Scand (B) Cerebral shifts to higher pressures 1998;162:411–419.

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Left ventricular filling subsequently exceeds its circumstances buy kamagra soft 100 mg free shipping, afterload can be equated to the aortic pres- output buy kamagra soft 100 mg mastercard. If arterial pressure is suddenly in- the left ventricle increase, the ventricular force of con- creased, a ventricular contraction (at a given level of con- traction is enhanced. A new steady state is quickly tractility and end-diastolic fiber length) produces a lower reached in which the end-diastolic fiber length is in- stroke volume. This decrease can be predicted from the creased and the previous stroke volume is maintained. The shortening velocity of ventricular muscle de- During the next 30 seconds, the end-diastolic fiber creases with increasing load, which means that for a given length returns toward the control level, and the stroke duration of contraction (reflecting the duration of the ac- volume is maintained despite the increase in aortic pres- tion potential), the lower velocity results in less shortening sure. If arterial pressure times stroke volume (stroke and a decrease in stroke volume (Fig. This leftward shift of the ventricu- lar function curve indicates an increase in contractility. The ventricular radius influences stroke volume because of the relationship be- tween ventricular pressures (Pv) and ventricular wall ten- sion (T). For a hollow structure, such as a ventricle, Laplace’s law states that Pv T (1/r1 1/r2 where r1 and r2 are the radii of curvature for the ventricular FIGURE 14. The pressure inside an inflated balloon is ture, in which curvature occurs in only one dimension (i. The tension is lower in the portion of the balloon with the smaller radius. Pv T (1/r1) or T Pv r1 (4) The internal pressure expands the cylinder until it is ex- actly balanced by the wall tension. In this situation, compensatory events increase central the larger the tension needed to balance a particular pres- blood volume and end-diastolic pressure (see Chapter 18). For example, in a long balloon that has an inflated part higher end-diastolic pressure stretches the stiffer ventricle with a large radius and an uninflated parted with a much and helps restore the stroke volume to normal. The physio- smaller radius, the pressure inside the balloon is the same logical price for this compensation is higher left atrial and everywhere, yet the tension in the wall is much higher in pulmonary pressures. Several pathological consequences, in- the inflated part because the radius is much greater cluding pulmonary congestion and edema, can result. This general principle also applies to noncylin- drical objects, such as the heart and tapering blood vessels. Pressure-Volume Loops Provide Information When the ventricular chamber enlarges, the wall tension required to balance a given intraventricular pressure in- Regarding Ventricular Performance creases. Despite the effect of increased radius on afterload, an represented by one counterclockwise circuit of the loop. At increase in ventricular size (within physiological limits) point 1, the mitral valve opens and the volume of the ven- raises both wall tension and stroke volume. As it does, diastolic ventricular cause the positive effects of adjustment in sarcomere length pressure rises a little, depending on given ventricular dias- overcompensate for the negative effects of increasing ven- tolic compliance.

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Objective vertigo is the perception generic kamagra soft 100 mg fast delivery, on the part of the patient safe 100 mg kamagra soft, that he is still and objects in the room are moving. Answer A: Deficits of eye movement (resulting in diplopia and its name clearly implies, hysterical vertigo is a psychosomatic dis- ptosis) are seen first in about 50% of all patients with myasthenia order. Nystagmus is abnormal rhythmic movements of the eyes, gravis and are eventually seen in approximately 85% of all patients usually with fast and slow components. Ataxia is an inability to co- Q & A’s: A Sampling of Study and Review Questions with Explained Answers 289 ordinate muscle activity resulting in an unsteady gait or other un- the parotid gland. Answer E: Excessive eating (gluttony), which may include a ated with the facial [VII] nerve) and send, to the lacrimal, sub- propensity to attempt to eat things not considered food items, is mandibular, and sublingual glands, respectively. Dysphagia is difficulty in swallowing, and aphagia is ganglia are located in the gut and receive input from the dorsal mo- the inability to eat. Answer B: Bilateral damage to the temporal lobes, as in an au- tomobile collision, may result in damage to the hippocampus. Answer A: The constellation of deficits experienced by this man While remote memory, the ability to recall events that happened is characteristic of the Klüver-Bucy syndrome; this may be seen years or decades ago, is intact, the man will have difficulty “re- following bilateral damage to the temporal poles that includes the membering” recent or immediate events. The Korsakoff syndrome is seen, for exam- difficult, if not impossible, to turn a new experience into longer- ple, in chronic alcoholics, and senile dementia is a loss of cognitive term memory (something that can be recalled in its proper con- and intellectual function associated with neurodegenerative dis- text at a later time). Dysphagia (difficulty swallowing) and eases of the elderly (such as Alzheimer). Wernicke (receptive or dysarthria (difficulty speaking) are deficits usually seen in brain- fluent) aphasia is seen in patients with a lesion in the area of the in- stem lesions. Bilateral sensory losses of the lower portion of the ferior parietal lobule, and the Wallenberg syndrome results from body could be seen with bilateral damage to the posterior para- a lesion in the medulla characterized by alternating hemisensory central gyri (falcine meningioma) or to the anterior white com- losses and, depending on the extent of the damage, other deficits. Answer D: Hearing a sound in the ipsilateral ear with the appli- cation of a tuning fork to the mastoid bone (actually the mastoid 36. Answer C: The Meyer-Archambault loop is composed of optic process of the temporal bone), and then hearing the sound again at radiation fibers that loop through the temporal lobe; these fibers, the external ear by moving the prongs to the external ear after the on each side, convey visual input from the contralateral superior sound disappears at the mastoid is a normal Rinne test. Consequently, a bilateral lesion of tive Rinne test, the sound is not heard at the external meatus after these fibers results as a bilateral superior quadrantanopia. In a normal Weber inferior quadrantanopia is seen in bilateral lesions that would in- test, sound is heard equally in both ears with application of a tun- volve the superior portion of the optic radiations. A localizing Weber test in- perior quadrantanopia is seen in cases of unilateral damage to, re- dicates that sound is heard in the normal ear, but not in the ear with spectively, the left or right Meyer-Archambault loop. Answer B: In Huntington disease, especially in advanced stages, there is a loss of the caudate nucleus and ex vacuo enlargement of 37.

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