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 Front Cover
 Foreword
 Acknowledgement
 Table of Contents
 Main






Group Title: heart and circulatory system
Title: The Heart and circulatory system
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 Material Information
Title: The Heart and circulatory system
Physical Description: Book
Language: English
Creator: Florida Department of Education
Publisher: Florida Department of Education
Place of Publication: Tallahassee, Fla.
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General Note: Florida Department of Education bulletin 711
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Bibliographic ID: UF00080792
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
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Table of Contents
    Front Cover
        Front Cover 1
        Front Cover 2
    Foreword
        Page i
        Page ii
    Acknowledgement
        Page iii
        Page iv
    Table of Contents
        Page v
        Page vi
    Main
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
Full Text



BULLETIN 711


'The











T 0


DEPARTM
TALLAHASSEE FL
FLOYD T. CHI
DIVISION
BUREAU


ENT OF EDUCA*W W/ ',"*
ORIDA
RISTIAN, COMMISSIONER
OF SECONDARY AND ELEMENTARY EDUCATION
OF CURRICULUM AND INSTRUCTION























FOREWORD




This resource bulletin is designed to serve as resource for all teachers who have direct
and/or indirect responsibility for teaching health education. It is hoped that this
accumulation of material on the heart and circulatory system will serve as a ready
source of information and offer useful teaching suggestions.




The bulletin is a result of the joint efforts of the Curriculum Guide Committee
composed of representatives from the State Board of Health, Florida Heart Associa-
tion, Department of Education, University of Florida and Classroom Teachers. The
bulletin has been field-tested in over 100 secondary schools and appreciation is
expressed to all those taking part in the evaluation to improve the bulletin contents.




As this resource bulletin is implemented, it is suggested that proper emphasis is placed
on good health practices and activities which promote a better understanding of the
importance of good health.





4 _0A7G1


Floyd T. Christian
COMMISSIONER OF EDUCATION










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ACKNOWLEDGEMENTS


This resource bulletin for secondary teachers, THE HEART
AND CIRCULATORY SYSTEM, is published through the
continuing efforts of a number of individuals and groups over
a period of several years.


The Curriculum committee was assisted in the development
and implementation of the bulletin by staff members of the
American Heart Association, Inc. and the Florida Health
Association, Inc.


Appreciation is expressed to everyone contributing to the
development of this resource bulletin and especially to the
following committee members who were responsible for its
completion: Wayne T. Sandefur, Ph. D., Committee Chair-
man, Chairman, Professional Curriculum, College of Health
and Physical Education, University of Florida; Kenneth L.
Briney, Ph. D., Director of School Health, American Heart
Association, Inc.; M. E. Groover, Jr., M.D., Director, Heart
Disease Program, Division of Health of the Florida Depart-
ment of Health and Rehabilitative Services; Mrs. Marie


Howard, Supervisor, Elementary Physical Education, Hills-
borough County Schools; Mrs. Grace Lanning, R.N., Associ-
ate Director, Florida Heart Association, Inc.; Mrs. Janice E.
May, Curriculum Coordinator, Health Education Project,
Duval County Schools; and Harvey G. Tousignant, M.D.,
M.P.H., Director, Escambia County Health Department.


Among the staff members of the Division of Elementary and
Secondary Education, Bureau of Curriculum and Instruction,
Department of Education, who assisted with the preparation
of this bulletin are: Ed Williamson, Administrator, Health,
Physical Education, Driver Education and Summer Programs;
Benton F. Clifton, Jr., School Health Consultant; and Grey L.
Wilson, Consultant, Physical Education and Summer Pro-
grams.


Mr. Shelley S. Boone, Director, Division of Elementary and
Secondary Education and Dr. Joseph W. Crenshaw, Bureau
Chief, Bureau of Curriculum and Instruction have also given
their professional support to this publication.









TABLE OF CONTENTS















Page

F orew ord . . . . . . . . . . . . . . . . . . . . . . . . . i

Acknowledgments ........................................... iii

I. Purpose of Circulation: Introduction ............................ 1
A. Metabolic transportation ................................. 1
B R regulatory ........................................... 1
C. Disease Control ................... ... ............ 1

II. Structure and function of the circulatory system .................... 1
A. Heart ............ ....................... ........ 1
B. Blood vessels ............................... .......... 5
C. Blood .............................................. 8
D. The circulatory process ................................. 13
E. Circulatory system as related to other systems
of the body ........................................ 14

III. Diseases and Abnormalities of the circulatory system ................ 18
A. The heart ................... ........................ 18
B. The blood vessels ..................................... 20
C. Blood ............................................. 22
D. Special problem s .......................... ............ 23

IV. Care and protection of the cardiovascular system .................. 24
A. Specific diseases ..................................... 24
B. General ................... ....................... 29
C. Vigorous activity .................... ...... ............ 30
D. Sufficient sleep and rest ..................... ........... 31
E. Abstinance from harmful drugs and habits ................... . 31
F. Observance of sound dental practices ........................ 31
G. Maintenance of emotional stability .......................... 31
H. Tobacco Florida Committee ............................. 31

V. Transplantation of Hearts .................................. 31

VI. Bibliography .......................... .............. 34
A. Information and Education ............................... 34
B. Suggested Activities and Experiences ........................ 35
C. Some Tests Used by Physicians ............................ 35
D. Reference Sources ................. ............... .. 35













THE HEART AND CIRCULATORY SYSTEM


CONTENTS


METHODS


I. Purpose of Circulation:

A. METABOLIC TRANSPORTATION OF

1. Nutrient material
2. Respiratory gases
3. Hormones

B. REGULATORY

1. Maintenance of body temperature
2. Elimination of waste


1. The purpose of this introductory section is to present
in very general terms the concept of circulation and the
various purposes which circulation accomplishes.
Specifics probably should be avoided here, because
each of these functions is included more in detail a
later place in the outline. An excellent introductory
film is Hemo the Magnificent.


C. DISEASE CONTROL

1. Formed elements


Red cells
White cells
Platelets


2. Plasma

a. Fluid volume
b. Antibodies


II. Structure and function of the circulatory system


A. HEART


1. Size
2. Location


2. Disease control may be studied in terms of what may
be called a defensive role, typified by the destruction
of invasive organisms by the white cells, and by anti-
body formation. On the other hand, the maintenance
of a normal range of function is also of significance in
preventing certain types of diseases or disorders. Illus-
trative of the significance of the blood in this connec-
tion are the following: the maintenance of the red cell
count, preventing anemia; the maintenance of blood
volume, preventing shock; the maintenance of clotting
capacity of the blood as the result of the production of
sufficient blood clotting elements, including platelets.


3. A good student activity throughout this unit would be
to maintain a glossary of new words.


1. In studying the structure and function of the heart, the
use of models, pictures, and other types of aids is very
important. (See "Heart Drawings" and "The Circula-
tory System" in supplementary materials.)


2. Where appropriate and feasible, the use of the heart of
an animal such as a pig, either as a demonstration or as
a group activity, will be very helpful.


3. Raise the question, "How big do you think your heart
is, and indicate where you think it is located?"



























3. Purpose


4. Type of muscle


5. Structure and function
a. Four-chambered organs
(1) Atria-right and left
(a) Nature of the muscle wall
(b) Purpose

(2) Ventricles- right and left
(a) Nature of the muscle wall
(b) Purpose

(3) Valves
(a) i A trial
(b) Ventricular


4. Direct each student to make a fist of his left hand, and
place it over his breast bone so that:

a. It is at about a 45 degree angle to the body, with
the lower portion falling on the left side of the
breast bone and the upper side on the right side of
the breast bone.

b. The thumb is very slightly above the breast line.

c. About 1/3 of the fist falls to the right side of the
breast bone, and 2/3 of the fist to the left.

This is the approximate size and location of the heart.
(See "Heart Drawings," supplementary material.)

5. Compare the heart, in purpose with that of the fuel
pump in an automobile.

6. Point out that the heart tissue is a special kind of
muscle called cardiac muscle. Just like any other
muscle, however, it must have its own supply of blood
to furnish fuel and remove wastes. Consequently, it
must have its own supply of arteries, veins and capil-
laries. Sometimes these blood vessels get closed off by
a blood clot so that a part of the heart is cut off from
circulation. This results in what is commonly called a
"heart attack" or "coronary." This problem will be
taken up more in detail later on in the unit. (See
"Heart Attack," supplementary materials.)

7. Using charts and models, describe and illustrate the
anatomical structure of the heart.

Terminology which may be stressed might include
some of the following:

a. Aorta
b. Atria
c. Pulmonary artery
d. Pulmonary veins
e. Septum
f. Valves
1) Biscuspid or mitral
2) Tricuspid
3) Aortic
4) Pulmonary
g. Ventricles

8. Have the class draw or diagram the heart.
(See "Your Heart and How it Works," supplementary
material. These may be ordered in quantity from the
Florida Heart Association, 4126 Sixteenth Street,
North, St. Petersburg, Florida.)















SINO-AURICULAR
NODE "


BUNDLE OF HIS RIGHT
tf FT BRANCHES


ATRIO-
VENTRICULAR
NODE


ARBORIZATION







(4) Division into right and left hearts.
(a) Right heart and pulmonary
circulation
(b) Left heart and systemic circula-
tion






(5) Conduction system within the heart.










(a) Anatomical structure



(b) Functioning


9. Explain the difference between systemic circulation
and pulmonary circulation, and indicate which side of
the heart is involved with each. From this information
solicit from the class what differences result in the
structure and capacity for work of each side of the
heart as a result of the different functions performed
by each. Responses should be concerned with an in-
crease in the size and power of the left side as con-
trasted with the right.

10. Explain that cardiac muscle has an inherent rhythmical
property which enables it to contract and relax auto-
matically. Hearts may be removed from animals and
kept beating for days. In some instances, the heart may
be directed into various sections and each kept beating
separately. They will, however, beat at different rates
when separated, but at the same rate when beating as a
unit. This is because there is a pacemaker built into the
heart muscle. (See illustration page 3.)

11. Explain that the pace for the human heart is set in the
right atrium by the SA node. The impulse arises here,
spreads to the left atrium. A second specialized mass,
the AV node, acts as a relay station passing the impulse
on to the rest of the heart by means of a conducting
fiber called the Bundle of His. This divides and re-
divides, servicing the remainder of the heart.

12. Diagram the heart on the black board, showing the
location of the SA node, the AV node and the Bundle
of His.

13. Explain how the wave of contraction spreads from the
atria to the ventricles, and solicit responses to the ques-
tion, "Why do not the atria and the ventricles contract
simultaneously?" Responses should be concerned with
the time required for the heart to fill. For example, if
both atria and ventricles were to contract simulta-
neously, there would need to be a long pause between
heart beats, so as to allow for time for the heart to fill.
Since, however, the heart contracts as a wave of im-
pulses, the atria may start to fill while the ventricles are
still partially contracted, thus reducing the length of
the resting time required for proper filling.

14. Let the class listen to the heart through a stethoscope.
Compare with tapes and recording of abnormal heart
sounds.

15. Locate the pulse and count the heart rate during differ-
ent work loads i.e., sitting, standing, after a brief
exercise, etc. The ability to recuperate after physical
activity is a good guide for determining how strenu-
ously you should exercise. Breathlessness and pounding









B. BLOOD VESSELS
1. Arteries
a. Description


(1) Relative thickness

(2) Elasticity





(3) Branching aspects




b. Function
(1) Role in transportation of blood.
(2) Pulmonary circulation
(3) Systemic circulation
(4) Role in maintaining blood pressure.


2. Capillaries
a. Description
(1) Relative thickness
(2) Number and distribution









b. Function


of the heart are natural reactions to exercise but should
return to normal a few minutes after you finish the
activity.

16. Ask questions such as: "What is an artery?" "What do
you think an artery looks like?" "Are they all the same
size?" "Do you imagine that some are too small to be
seen with the naked eye?"

17. Define an artery as a blood vessel which carries blood
away from the heart. Note here that it is relatively
thick walled and elastic. The healthy artery is very soft
and pliable, having the ability to stretch to accommo-
date larger quantities of blood. It also rebounds from
this stretching process to force blood along its path.

18. Note that arteries divide and redivide, becoming
smaller and smaller as they get closer to the surface of
the body.

19. Explain that the primary function of the arteries is to
carry oxygenated blood to the tissues. However,
according to the description of an artery, it carries
blood away from the heart. Ask the question, "Do you
think that one or more arteries may be involved with
the carrying of non-oxygenated blood?"

Use this discussion as a spring board to explain the
difference between systemic and pulmonary circula-
tion.

20. Knowing of the elastic quality of the arteries, one
should be able to explain how they help to maintain
the blood flow, by rebounding from their stretched
state, thus forcing the blood onward. Question the
class to see if this response can be deduced from the
information at hand.

21. This topic may be introduced as follows: "You may
have heard that capillaries are very small and very thin
walled. How small do you think they are? How exten-
sive?"

The discussion should bring out that they are:
a. Single celled in thickness and cannot be seen by
the naked eye.
b. Very extensively distributed throughout the body.
It could be pointed that, if spread out, they would
cover an area equal to a football field.

22. Review the general function of circulation, pointing
out that circulation exists primarily to get transported
substances into the cell and to remove the waste prod-










































EXTERNAL VIEW


CUTAWAY OF A VEIN


VALVE OF A VEIN


kl--


wl i















3. Veins
a. Description
(1) Relative thickness
(2) Inelasticity
(3) Branching aspects
(4) Valves


b. Function


4. Lymphatics
a. Description


b. Function


ucts of metabolism. Show how the structure and the
distribution of the capillaries make them suited to
carry out the function of diffusion and osmosis. Ex-
plain these terms.

23. Compare veins with arteries with respect to thickness,
elasticity, and branching aspects.



24. Explain the fact that the veins have valves, which the
arteries do not have. (See drawing, opposite page).

25. Compare the function of veins with that of the arteries.
Included in the discussion should be:

a. Type of blood transported.
b. Direction of flow.
c. Function of the valves.
d. The role of the veins in pulmonary circulation.

26. At this point, recall how substances are being lost from
the blood, through the capillary wall, into the cell.
These exchanges are being made from the blood,
through the capillary wall, into a fluid called interstitial
fluid which bathes the cell, and thus into the cell itself.
These exchanges are made at the arterial end of the
capillaries. At the venous end, however, the direction
of flow is reversed, and substances are returned to the
blood.

27. Note that not all of the fluid portion gets back into
circulation through the capillaries, however, the bal-
ance is returned by means of the lymphatic system, a
network of tubes similar to blood vessels, which is
formed in most tissue. These tubes connect with the
venous system, and return the fluid to circulation
through this route.

28. Explain that, in addition to the function of returning
fluid to the circulatory system, the lymphatics perform
other important functions. These include:

a. Serves as a point of entry into the circulatory
system for food absorbed from the small intestine.

b. Disease control (see item 29)

29. Discuss the role of the lymph gland or lymph node in
disease control. Show how these glands are made of a
specialized kind of tissue, and that they contain many
cells which destroy bacteria, and also many disease pre-
venting substances called antibodies. Thus, the lymph
glands filter out and destroy many harmful substances.









C. BLOOD
1. Nature


2. Function
a. Metabolic transportation of


(1) Nutrient material





(2) Respiratory gases





(3) Hormones


b. Regulatory
(1) Body temperature


30. Explain that the blood contains fluid, several kinds of
cells, and other minute bodies. These will be discussed
in detail.

31. Explain that the primary function of the blood is to
transport vital substances. List these on the black-
board, and discuss as follows:

a. Fuel for energy and the maintenance of body
temperature. This is present in the blood largely in
the form of sugar, or glucose, and in the muscle
and liver in the form of glycogen.

b. Oxygen is needed to support combusion. When
glycogen or sugar is oxidized or burned heat and
enery are given off,just as when gasoline is burned
to drive a car.

c. Hormones are substances secreted by endocrine
glands and carried by the blood stream. They regu-
late a number of bodily functions, including
growth, heart rate and blood pressure, metabolic
rate, sex development and the menstrual cycle,
and many others.

32. Explain how the blood is constantly loading and un-
loading substances, and yet bodily responses are bal-
anced so finely that the composition of the fluid
portion of the blood remains relatively constant. Sub-
stances entering the blood include:

a. Oxygen from the lungs.
b. Food and water from the intestines.
c. Waste materials from the cells.
d. Hormones from the endocrine glands.
e. Glucose (sugar) from the liver.


Substances leaving the blood include:

a. Carbon dioxide to the lungs.
b. Nutriments to the cells.
c. Water to organs such as the sweat glands and kid-
neys.
d. Oxygen to the tissues.
e. Excess food to storage regions.


33. Relate the blood's role in the maintenance of the body
temperature to phenomena which are readily observed.
For example, when a person becomes heated, his skin
becomes flushed. Standing under a hot shower causes
excessive redness to the skin. Ask for explanations.

















(2) Elimination of waste










c. Disease Control


3. Composition
a. Red cells
(1) Description


(2) Function


Show that, when the body becomes excessively heated,
blood vessels lying close to the surface dilate, allowing
the blood to circulate freely in this area. Thus, the
blood's proximity to the outside environment permits
maximum cooling. When the body is cold, the surface
blood vessels constrict, and the reverse happens.

34. Use the analogy of the exhaust from the automobile to
show that there are waste products derived from all
combustion. In the case of the waste products of
metabolism, a large part is in the nature of carbon
dioxide which is formed in the body when glycogen is
oxidized. This is formed deep within the body in
tissues such as muscles. Thus, this product must be
carried by the blood back to the lungs where it is
expelled from the body.

35. Discuss in general terms the two major contributions
which the blood makes to the control and prevention
of disease. These, which will be discussed later on in
greater detail, include:

a. The destruction of the organisms by the white
cells of the blood.

b. The production of antibodies which afford
immunity to specific diseases.

1) As a result of having contracted the disease
2) As a result of specific innoculation

36. Facts of interest in this connection may include the
following:

a. Nature largely hemoglobin which contains iron
and protein. The importance of diet should be
stressed at this point as it relates to maintaining an
adequate red cell count.

b. Shape- tiny discs with biconcave surfaces, but
with remarkable elasticity, permitting them to
bend and to twist into a variety of shapes. Show
why this quality is necessary to permit the red cell
to travel its course through the body.

c. Size- microscopic with between 4,000,000 to
5,000,000 in each cubic millimeter of blood or a
total of 25-30 trillion.

37. Review the body's need for oxygen to carry on
metabolic processes.

38. Show how the red cells, circulating in the blood, pass
through the capillaries of the lungs where oxygen,















(3) Formation


(4) Destruction


because of its strong affinity for hemoglobin, is picked
up and delivered to the innermost cells in the body.
Red cells also aid in the elimination of carbon dioxide
from the cell, carrying it back to the lungs where it is
discharged.

39. Stress here should be on the great numbers needed and
the relatively short life of the cell. Formed in the bone
marrow, the life of the cell is, on the average, about
four months.

40. The red cell, and the stresses to which it is subjected, is
discussed very vividly and effectively in the state
adopted health texts. A student report on this informa-
tion, or having this section read to the class might
prove helpful at this point.

41. Destruction here refers to the filtering out of worn-out
and broken-up red cells, so that the iron content may
be salvaged to reconstitute new cells. This filtering
action is accomplished by the liver and the spleen.

42. Point out that the reconstituted elements are insuffici-
ent to meet the total body needs and that diet is im-
portant in the maintenance of the red cell count.

43. Using food tables showing minimum daily require-
ments of nutrients, compute quantities of meat and
other iron yielding foods necessary to meet these re-
quirements (One such reference is State adopted
Health Texts.)

44. Facts which may be of interest might include the fol-
lowing:

a. Nature -there are several kinds of white cells
performing several different functions, all con-
cerned with defense of the body against invasion.
They are able to move about freely through the
body, changing shape as necessary, and have the
ability to pass through the capillary wall into the
tissue. Note that red cells do not have this capabil-
ity.

45. Point out that the body is constantly being invaded by
foreign substances. The internal environment of the
human body is conducive to the growth and develop-
ment of many organisms. White cells meet these inva-
sions head on and destroy or neutralize them in a
number of ways, such as:
a. Engulfing and digesting them
b. Walling them off
c. Poisoning them with chemicals


(2) Function


b. White cells
(1) Description













(3) Formation


46. Another function of the white cells is in the matter of
antibody production. Discuss the importance of this in
disease control.

47. Point out that there are fewer white cells than red cells
formed about one white cell to each 600 red cells.
However, the life span is only about 3-4 days, so these,
too, must be produced at a prodigious rate. This is
done in the bone marrow, the lymph nodes and in the
spleen.

Note that during time of infection, the white cell count
may rise from a normal of 5,000 10,000 per cubic
millimeter of blood to 30,000. This rise in white cell
count is used by the physician to diagnose certain
diseases such as appendicitis.


c. Platelets
(1) Description


(2) Function
(3) Formation


d. Plasma
(1) Description


48. Facts which may be presented include:


a. Nature tiny flat bodies, about 1/20 as numerous
as red cells
b. Aid in clotting
c. Formed in the bone marrow

49. Show that 50-60% of the blood by volume is plasma,
or the liquid content, with the other 40-50% being
made up of the formed elements. The fluid volume is
about 90% water, but included in the plasma are a
number of substances having to do with metabolism,
protection against disease and regulatory functions.
Included are the following:


a. Respiratory gases
b. Food materials (sugar)
c. Antibodies
d. Hormones
e. Trace elements
f. Enzymes


(2) Function


50. Explain that function is concerned with transportation
of the various substances to perform such tasks as
previously listed.

51. Note the further role of plasma in maintaining blood
pressure. Explain that shock is a lowering of blood
pressure, or loss of blood volume, due to the relaxation
of the blood vessels and a consequent pooling of the
blood in the circulatory system. Solicit a response to
the question "What is the role of plasma in combating
the effects of shock?"

52. Another role of the plasma is the transportation of
antibodies. Explain that these are substances developed





















4. Blood types
a. Need for typing







b. Classification


(1) Type A


(2) Type B


(3) Type 0


(4) TypeAB


(5) The Rh factor


to combat specific kinds of organisms. Thus there may
be an antibody to combat the measles virus, tetanus
toxin, and many others.

53. Have the class develop a suggested plan and time table
for the various kinds of immunizations and periodic
booster doses which one should have throughout his
life span. See Florida State Department of Education
Bulletin 4D, p.p. 56-58.

54. The subject of blood types may be introduced by
showing that often, as a result of an operation or of a
serious bleeding injury, it is necessary for a person to
receive blood donated by another person. Raise the
question of whether any person may give blood to any
other person, and if not, why not. Note that typing is
based on corpuscle types.

55. The incidence of various blood types in the population
varies from race to race, and even from nationality to
nationality. The percentages cited below are approxi-
mate figures.

a. Type A includes about 42% of the total popula-
tion. The addition of type B or type AB blood to a
type A patient will cause the blood to agglutinate,
or gather in clumps, and the patient is likely to
die.

b. Type B includes about 10% of the population and
agglutination results from the addition of types A
or AB blood.

c. Type 0 includes about 45% of the population.
These people "universal donor" may give blood to
any of the other types that is, there is no sub-
stance in the cell to cause the blood to agglutinate.

d. Type AB includes about 3% of the population.
These people "universal recipient" may receive
blood from anyone in an emergency.

e. In blood transfusions, it is safer to match blood
than to use blood groups in selecting blood for
patients.


56. Survey the class to see how many know their blood
type. Discuss whether or not everyone should have his
blood type on file.


57. The following facts about the Rh factor may be pre-
sented:









a. About 85% of the population is Rh positive, and
15% Rh negative.

b. The addition of Rh positive blood to Rh negative
blood causes the latter to produce antibodies to
combat the effects of this foreign substance.

c. When an expectant mother is Rh negative and the
baby is Rh positive (inherited from the father)
blood from the baby gets into the mother's blood
which stimulates the development of antibodies.
These antibodies get into the blood of the baby,
destroying the red cells. Death before birth may
result. If the child may be brought to term, a com-
plete transfusion of blood may save his life.
D. THE CIRCULATORY PROCESS

1. The Cardiac cycle 58. The cardiac cycle may be diagrammed on the black-
board in the following terms. (See supplementary
material, "Your Heart and How It Works.")

a. Diastole Diastole is the relaxing part of the heart beat.


a. Blood is entering both atria through the inferior
and superior vena cavae on the right, and through
the pulmonary veins on the left. Blood entering
the right heart is unoxygenated and is returning
from the body tissues. Blood entering the left side
of the heart is returning from the lungs, where it
has unloaded carbon dioxide, and picked up a
supply of oxygen.

b. The valves between the atria and the ventricles
(the tricuspid on the right and the mitral on the
left) are open so that the blood is free to enter the
ventricles. The pulmonary valve on the right, and
the aortic valve on the left are closed.

c. Blood pressure reaches its lowest stage at this
point and is referred to as diastolic pressure.

d. See supplementary material, "The Wonderful
Human Machine," for a review of the structure of
the heart with specific reference to valves.

b. Systole 59. The heart contraction begins in the atria and proceeds
as a wave from the atria to the ventricles. Thus, blood
is squeezed out of the atria, and ventricular filling
becomes complete. Systole begins with ventricular
contraction.

When the wave of contractions abates in the atria and
moves into the ventricles the pressure built up in the
ventricles:


















c. The Cycle Repeated


2. Pulmonary circulation

3. Systemic circulation


a. Forces the tricuspid and the mitral valve shut.

b. Increased pressure forces open the pulmonary
valve and the aortic valve. Blood is thus forced out
of the ventricles to the lungs, and to the body
systems.

c. Blood pressure reaches its peak during systole.

60. Diastole begins with the closure of the pulmonary and
the aortic valves.

a. This cycle is repeated at the approximate rate of
72 times per minute at rest.

b. This rate may vary with age and physical condi-
tion.

61. A discussion of blood pressure might be of interest to
the class. A sphygmomanometer may be borrowed and
blood pressure measured. A discussion of "normal"
blood pressure and high blood pressure might be of
interest at this point. It might be pointed out that:

a. Blood pressure tends to increase with age. (Why?)

b. Blood pressure is recorded as systolic pressure over
diastolic pressure, as, for example, 120/80. This
means that systolic pressure is equal to that gener-
ated by a column of mercury 120 MM high.

c. Blood pressure may vary with the position of the
body (sitting or standing, for example) and with
the amount of activity. (Why?)

62. The sphygmomanometer may be used to show the
effects of various postures and activities on blood
pressures such as standing, sitting or after a brief period
of exercise. (See supplementary material, "The Circula-
tory System".)

63. Diagram the circulatory process on the blackboard.
Show that the right side of the heart circulates blood
through the lungs while the left side supplies the force
for circulation to all body tissue. Since the left ven-
tricle has to pump against higher resistance than the
right (Why?), it is thicker walled and performs more
work, although both move the same amount of blood.
Explain.


E. CIRCULATORY SYSTEM AS RELATED TO
OTHER SYSTEMS OF THE BODY


1. Respiratory system
a. The body's need for oxygen


64. Review the necessity for oxgen to carry on all meta-
bolic functions necessary to sustain life.







b. How oxygen gets into the cell
(1) Through the conductive mechanisms 65.
(a) nose
(b) pharynx
(c) Bronchi and bronchioles


(2) Muscles which are involved in breath- 66.
ing
(a) diaphragm
(b) intercostals
(c) others 67.




(3) How oxygen gets into the blood 68.
stream
(a) alveoli
(b) respiratory bronchioles


(4) Principles governing diffusion of 69.
gases



(5) Application of the laws governing the 70.
diffusion of gases
(a) oxygen
(b) carbon dioxide


(c) How circulation completes the 72.
respiratory function


Diagram the respiratory system on the blackboard.
Point out that the function of the nose and bronchi is
to carry oxygen to the interior of the lungs where it
will be diffused into the blood stream. (See supplemen-
tary material, "The Respiratory System.")

Discuss the principle that "nature abhors a vacuum."
Apply this principle to the mechanism of breathing.


Explain that these muscles, like all other muscles, need
oxygen to carry out their function. Sometimes, when
we are running, we may get a "stitch" in the side. This
may be for the reason that these muscles are suffering
from insufficient oxygen.
Present the following kinds of information about the
alveoli:

a. Present in grape-like clusters
b. Thin walled single cell thick
c. Extensive in area if spread out, would cover an
area the size of a tennis court.
d. Are interlaced with capillaries
e. Oxygen diffuses out of alveoli, into the capillaries,
and thence into the blood stream which carries it
to each body cell.
f. Carbon dioxide, returning from the cell to the
lungs via the blood stream, diffuses out of the
blood stream, into the alveoli, and is expelled
through the lungs.


To illustrate that gases are constantly moving, use the
example of smokers in a room. Cigarette smoke
diffuses across the room until the smoke is evenly dis-
tributed.

Explain that the blood which has just completed its
trip to the cell and is returning to the lungs is high in
carbon dioxide, and low in oxygen. In the lungs, the
stage is set for the exchange of gases between the blood
and lungs. Teachers may wish to further explore this
problem by explaining the cloride shift.


Ask each individual to prepare a chart showing the
relative oxygen and carbon dioxide pressures in the
alveoli, and in the blood, and indicate the resultant
direction of flow of each of these gases in each of these
tissues.


Summarize the information concerning oxygen utiliza-
tion by pointing out that oxygen which has been taken
into the alveoli of the lungs:





























2. Musculo-skeletal system


3. The nervous system
a. Role in the regulation of the heart beat







(1) Sympathetic nervous system


a. Diffuses across the cell wall of the alveoli, and the
cell wall of the capillaries in the lungs.

b. Is picked up by the red cells in the blood as they
pass through the lungs.

c. Is released by the red cell to the body tissue by
diffusing through the capillary wall into the inter-
stitial fluid which surrounds each cell, and thence
enters through each cell.

73. Question the class on the resulting physiological status
if we could increase aveoli, capillaries and/or red cells.
Discuss these effects individually, and show how
cardio-vascular fitness (endurance or "wind") is, in
part, a summation of the results of these increases.

74. Ask the question, "Does the skeletal system make any
contribution to the circulatory process? The muscular
system? If so, how?" This should serve to recall the
following:

a. The role of the bone marrow in producing red
cells.

b. The role of muscles in forcing blood back to the
heart. Thus, the contraction of the muscle (i.e. the
milking action) stimulates the venous return of the
blood thereby facilitating the return of blood to
the heart.

75. Ask the question, "How can an exhausted runner who
has crossed the finish line recover the fastest, and
why?"

a. by sitting down
b. by lying down
c. by walking


76. Explain that the nervous system automatically controls
certain responses in the body so that a constant in-
ternal environment may be maintained. Thus the
sympathetic nervous system is concerned with speeding
up circulatory processes, while the parasympathetic
system has as its function the slowing down of circula-
tory processes.
For example, during period of stress, the heart is
stimulated to beat faster. Thus, during fear, certain
endocrine secretions excite the sympathetic nervous
system which, in turn speeds up the heart rate. Like-
wise, when carbon dioxide accumulates in the body,
the sympathetic nervous system again acts to speed up
circulation.








(2) Parasympathetic nervous system During period of inactivity or rest, the vagus nerve
which is a part of the parasympathetic system acts to
restore the heart beat to a lower rate.

Similarly, during periods of stress, certain muscles or
organs require much blood, and certain require little.
For example, during an athletic contest, the big
muscles of the legs, need much blood. Why?

b. Role in regulating blood flow On the other hand, the digestive organs would need
little. Thus, the nervous system acts to:

a. Dilate the blood vessels of the legs
b. Constrict the blood vessels of digestive tract

c. Other functions 77. Explain that actions of the nervous system to fit a man
to meet emergencies demanding fight or flight include:


a. A rise in arterial blood pressure by:
1) accelerating the heart rate
2) increasing the force of the heart contractions
3) Constriction of the small arteries, especially in
the skin, and of arteries to organs not in ex-
tensive use.

b. Dilation of the coronary arteries and blood vessels
in the circulatory system.
c. Stimulation of the release of sugar into the blood
stream from the liver to serve as fuel for the
muscles.
d. Contraction of the spleen, discharging additional
red cells into the blood stream to build up the
oxygen carrying capacity of the blood.
e. Dilation of the bronchii of the lungs and the in-
hibition of secretions of the respiratory tract to
permit an increase of oxygen intake.

78. A good approach to stimulate the application of learn-
ing would be to list the changes illustrated in item 77,
above, on the board, and ask for discussion from the
class as to how this action benefits physical perfor-
mance during stress.

79. An application may be made here to "Second Wind"
which probably occurs after these initial circulatory
adjustments have been made.

80. What are the physiological effects of eating a big meal
immediately before strenuous physical activity? This
question should stimulate responses about the reduc-
tion of "wind," the occurrence of cramps and similar
answers. What is wanted is the fact of the divergence of









4. The digestive system


5. The excretory system


b. Other excretory organs
(1) Large intestine





(2) The skin


oxygen to the digestive tract, thus reducing oxygen to
the working muscles. Continue to probe until this
answer is elicited.


81. The digestive system prepares and delivers the essential
nutrients which are transported by the circulatory
system to all parts of the body. One illustration of this
function is reflected in item 77C, above.

82. Diagram on the board the location of the kidneys in
relation to the circulatory system. (See supplementary
material, "The Circulatory System.")

83. Explain that each kidney is really an extraordinary
filtering system through which blood passes. In this
process, wastes are filtered out and eliminated and vital
substances are filtered out and returned to the blood
stream. Of about 175 quarts of water, waste, and food
which the kidney filters out each day, approximately 3
pints are discharged as waste, and the balance is re-
turned to the blood. Specifically, the kidney:

a. Filters out and excretes wastes, such as urea, uric
acid and salt. These are waste products of meta-
bolism.
b. Reabsorbs vital substances such as water and sugar
back into the blood stream.
c. Secretes hormones which produce important circu-
latory adjustments.
d. Maintains an acid-base balance in the blood
stream.

84. Water is absorbed into the blood stream from the waste
materials in the large intestine. Show here that consti-
pation results from wastes remaining in the intestines
too long, with the consequent over-absorption of
water. How can one promote regularity?

85. Note the excretory function of the skin through per-
spiration. The skin has another very important func-
tion that of regulating body temperature.

86. From the information furnished in item 85, attempt to
draw from the class the explanation for rapid fatigue
and "short-windedness" during strenuous physical
exertion on a hot day. Loss of water and salt are likely
answers. Probe for the explanation that blood is
diverted for cooling, leaving a short supply for meta-
bolic functions.


III. Diseases and Abnormalities of the Circulatory System


A. The heart
1. Congenital


1. Using heart models, pictures, or the actual heart of an
animal, review the structure and function of the heart,















a. Septal defects


with particular emphasis on the septum and the work-
ing of the valves.

2. Review pulmonary circulation, recalling the color of
unoxygenated blood.

3. Explain that, in fetal circulation, there is no need for
the blood to go to the lungs. This is obvious, since the
lungs are not functioning before birth. This is made
possible by the fact that metabolic functions are per-
formed by the mother, and the products of these func-
tions get from maternal to fetal blood systems by
transferring across the placenta, through the umbilical
cord, into fetal circulation.

Since there is no need for fetal blood to be circulated
in the lungs, nature provides an opening in the wall
between the right and left atria. This permits fetal
blood to enter the right atrium, and to by-pass
pulmonary circulation by entering directly into the left
heart. Thus, it enters directly into systemic circulation.
The opening in the septum through which the blood is
diverted is called the foramen ovale.

4. Diagram the above on the blackboard.

5. Raise questions as to the nature of the circulatory
deficiency known as "blue baby" and attempt to draw
from the group the physiological explanation. Explain
the term "cyanosis".

6. Review the structure and function of the valves of the
heart. Compare these valves with the water faucets in
our home. When the washers in the faucets are worn so
that they do not fit properly, a water leak or dripping
faucet results. In the same manner, when the valves of
the heart are imperfectly formed at birth, the blood
"leaks" out of its normal circulatory route. For
example, if the tricuspid valve controlling the flow of
blood from the right auricle to the right ventricle were
leaky, blood intended for the lungs by way of the
pulmonary artery would, under pressure from the con-
traction of the ventricle leak back into the auricle, or
the atrium. This backward flow of the blood obviously
decreases the quantity of blood going to the lungs, thus
causing the heart to work harder and, in all probability,
an oxygen insufficiency during periods of greater
physical activity.

7. Use the chart "Your Heart and How it Works" (supple-
mentary material) to explain the facts as outlined in
item 6 above. Two reference bulletins, "Heart Disease
in Children", (EM 56) and "If Your Child Has a Con-
genital Heart Defect", (EM 250) may be used by the
teacher.


b. Valvular defects


c. Others








2. Acquired
a. Infections


b. Non-infectious










B. THE BLOOD VESSELS

1. Arteries
a. Congenital


8. There are several diseases which may damage the heart
valves by producing inflammation and scar tissue.
Examples of these are:

a. Rheumatic fever
b. Syphilis
c. Certain bacterial infections

9. Assign class reports on one or more of the above
topics. A report on rheumatic fever should be espe-
cially interesting because of its prominence in heart
disease. Such a report should include:

a. There is evidence to support the belief that it is
caused by an allergic reaction to the Streptococcus
bacillus ("Strep throat")

b. Prevention is related to the prevention or early
treatment of sore throat.

c. Its non-contagious nature. ("Strep throat", how-
ever, is contagious)

d. Providing for a child with a history of rheumatic
fever and the importance of regular and con-
tinuous medical care.

10. Explain that the heart, like any other organ or tissue in
the body, must be supplied with blood through a net-
work of arteries, veins, and capillaries just as is any
other body organ or tissue. The most important non-
infectious diseases of the heart are primarily diseases of
the blood vessels of the heart. These will be considered
under the more general topic of diseases of the blood
vessels.

11. Review fetal circulation (See item 3) recalling the fact
-that fetal blood does not circulate in the lungs of the
fetus, but rather is shunted directly from the left heart
to the right heart. Show how blood coming into the
heart from the superior vena cava is not flowing
directly at the septual opening between the right and
left auricles. Thus, some of this blood misses the open-
ing and passes into the ventricle and thence into the
pulmonary artery which leads to the lungs. In order to
provide for this blood which fails to by-pass, nature
provides in the fetus a second opportunity to shunt.

This is in the form of a duct, the ductus arteriosus,
which connects the pulmonary artery directly to the
aorta before the blood reaches the lungs. Along with
the foramen ovale, it should close at birth. Failure to
do so causes a leaking back of oxygenated blood from
the aorta, because of the higher pressure in the blood
vessel, to be forced back into the pulmonary artery,













(2) Coarctation



(3) Aneurism








b. Acquired
(1) Infectious

(2) Non-infectious


2. Veins
a. Varicose condition


thus sending the blood back to the lungs. This will also
reduce the oxygen supply to the tissues. Why?
Cyanosis is not a sympton of patent ductus arteriosus.
Why?

12. Explain that the term "coarctation" applies to narrow-
ing of the walls of the aorta, thus limiting the amount
of blood flow.

13. Point out that an aneurism is a weakness in the wall of
a blood vessel, usually the aorta, which forms into a
sacculation or balooning of the blood vessel. There is a
danger of rupture from increased blood pressures. Once
common cause of aneurism is Atherosclerosis. The
reference bulletin "Heart Attack", (EM 150) may be
used by the teacher.


14. Explain the role of syphilis in producing aneurisms.

15. Atherosclerosis is a form of arteriosclerosis (Hardening
of the arteries.)

In atherosclerosis, the passageway through the arteries
becomes roughened and narrowed by fatty deposits
that harden into patches along the inner lining of the
artery. This process has been compared to the forma-
tion of lime deposits in a water pipe. Around these
patches, scarlike fibrous tissue forms in the artery wall
so that the channel is narrowed and there is less room
for the blood to flow through.

16. Introduce the term "coronary thrombosis". Show that
if a clot forms in a coronary artery that part of the
heart which is nourished by that artery will die from
lack of oxygen. If the total part of the heart affected is
large, death will probably ensue. If it is small, the heart
may heal, with scar tissue being formed around the
affected part.

17. Discuss the follow-up care of patients with coronary
thrombosis and the importance of complete rest while
the injured part of the heart is healing.

18. Point out that a clot may occlude any blood vessel. For
example, when this happens in the brain, a stroke
results, the intensity of which depends upon the extent
of the area involved and the location.

19. Explain that varicose veins are those in which the walls
have become dilated and degenerate, so that blood
flows very slowly in them and the valves have become
ineffective. The condition occurs at the superficial
veins near the surface of the body, because the deep
lying veins are protected by the muscle tissue which






















b. Phlebitis


C. BLOOD


1. Formed elements


a. Red cells
(1) Abnormal increase






(2) Abnormal decrease


b. White cells
(1) Abnormal increase


surrounds them. Hemorrhoids, or piles, are varicose
veins of the rectum. Reference: Varicose Veins EM
181.

20. Point out that standing on one's feet a great deal pro-
motes varicose veins. Other predisposing factors in-
clude heredity, obesity and lack of exercise. Solicit
responses to the question of the effects of walking and
other forms of exercise on the prevention of varicose
veins. Note that milking action of the muscles reduces
stagnation of blood in the deeper veins. Muscle action
does not improve the circulation in superficial veins.
21. Phlebitis is an inflammation of the inner membrane of
a vein.


22. Discuss the following diseases and abnormalities of the
blood, and others in which the class may have an
interest.

a. Polycythemia a disease in which there is an over
production of red cells. This is an abnormal
increase in circulating red cells as compared to the
normal increase in red cells in response to living in
high altitudes.

b. Iron deficiency anemia a disease in which red
cells lack hemoglobin. It is more common in chil-
dren than in adults and is related to dietary habits
which may be in part, because the body fails to
assimilate essential minerals. Symptoms include
pallor, fatigue and loss of resistance to infection.
Stimulate answers to the question, "What effect
would anemia have on a mile runner? Explain."

c. Pernicious Anemia This is a disease of the red-
cell-forming centers in the bone marrow.
Formerly, this used to be a fatal disease. Vitamin
B12 is now used to stimulate the formation of red
cells.

d. Leukocytosis Is the secondary increase in white
cells. Any infection may cause temporary increase
in a white cell count. This may be an indication of
appendicitis. Question the class as to why this rise
occurs.
e. In leukemia the white cell forming centers in the
lymph gland and the bone marrow go wild, devel-
oping white cells at an unchecked rate. Eventually,
the red cell forming centers are literally crowded
out.
Although the common impression is that the white
cells destroy the red cells, this is not so. The
manufacture of red cells is interfered with so that
they cannot be produced as fast as they die off.













(2) Abnormal decrease




c. Platelets


2. Fluid


D. SPECIAL PROBLEMS
1. Sensitivity reactions
a. Transfusion reaction



b. Rh Factor

2. Deficiencies of the coagulation system


Recent studies indicate that specific viruses may
cause leukemia. Although therapy may provide
temporary improvement, there is no permanent
cure for this disease.

f. Leukopenia This term refers to an abnormally
low leucocyte count in the blood. This condition
may reduce resistance to infection. Question the
class as to the logical effects of this condition.
23. Question the class as to what logical consequences they
can foresee in the event of an abnormal increase or
decrease in the number of platelets. Refer to the
function of the platelets.

Blood platelets are small pieces of megakaryocytes
which break off these cells in the bone marrow. They
are very important in the blood clotting tendency.
Certain diseases of the bone marrow such as leukemia
and anemia, and allergic diseases and poisoning are
associated with a decrease in the number of platelets.


Some scientists (Dr. O'Brien in England) have shown
that the injection of Noredinephrine or fright in an
animal will increase the stickyness of platelets thus in-
creasing the blood clotting tendency.

24. Review the role of plasma in maintaining blood pres-
sure. Describe how shock or loss of blood can reduce
blood pressure.



25. Transfusion reactions were covered in blood typing
(see Items II: 54-55). A brief review of these might be
helpful at this point.

26. Review Item II: 57 as necessary.


27. Cover hemophelia, either by a class report or class dis-
cussion. The following points may be brought out:

a. Hemophelia is a condition in which the blood fails
to clot or clots very slowly. Persons with hemo-
phelia are called bleederss."

b. It is probably a deficiency in one of the plasma
proteins, called antihemophelic globulin.

c. It is inherited as a sex linked characteristic, passing
from the grandfather, through the mother to one-
half her sons, where the grandmother is neither a
carrier nor a bleeder. In this case, none of the
daughters would be bleeders, but all would be
carriers.








d. When the father is a bleeder and the mother is a
carrier, one-half the sons and one-half the
daughters would be carriers.

e. If both father and mother are bleeders, all the chil-
dren will be bleeders.

28. There may be sufficient interest to explore in detail the
mechanics by which sex-linked characteristics are trans-
mitted.

IV. Care and Protection of the Cardiovascular System

A. Specific Diseases The heart and blood vessels are subject to many types of
disorders. A broad general understanding of each type is
necessary for the intelligent care and protection of the
cardiovascular system.


1. The broad types may be classified as follows: con-
genital, rheumatic, hypertensive, atherosclerotic, in-
fectious, metabolic, nutritional, sedentary.

a. Congenital heart disease this condition is a
developmental defect and occurs during the early
development of the fetus. Valves may leak and the
chambers of the heart may be too small or too
large or abnormal openings may be present in the
wall between the chambers. These and other
defects interfere with the efficient pumping action
of the heart. (For an explanation of the genetic
basis for congenital defects see Heredity, An
Introduction to Genetics, A. M. Winchester).

b. Rheumatic heart disease this type of heart
disease is caused by the antibodies produced
against a certain type of streptococcus. For some
reason the antibody which normally kills the
streptococcus attacks the heart valves and connec-
tive tissue in the heart and joints. If the infection
is not controlled, and the concentration of anti-
bodies reduced, the valves become deformed and
allow the blood to leak back into the chambers of
the heart. This causes the heart to work much
harder than normal and it is not capable of pump-
ing enough blood to supply the body during in-
creased exercise.

c. Hypertensive heart disease- this is a condition
that develops because the pressure in the arteries is
unusually high. The heart has to work much
harder than usual to pump blood into the arteries
against the increased pressure. If the person is not
aware of the condition, and does not seek treat-
ment from his physician, the heart first begins to








enlarge and eventually fails to keep up with the
demand and the person develops heart failure.

d. Arteriosclerotic heart disease this condition is a
disease of arteries. Since the heart muscle is not
able to receive sufficient blood for its nourishment
from the chambers, it is supplied with its own
system of arteries. Because these two arteries circle
the base of the heart and give off branches that
supply the muscular wall of the ventricles, they
look like a crown and are called coronary arteries.
The disease atherosclerosis gets its name from the
fatty deposits that form on the lining of large and
medium size arteries, including the coronary
arteries. The material in these deposits was
thought to resemble porridge and the Greek word,
atheros, was used to describe the condition which
means porridge-like deposits on the lining of
arteries. When these deposits are large enough to
obstruct the flow of blood through a branch of the
coronary artery, the section of muscle supplied by
this vessel dies and is replaced by scar tissue. If a
large part of the heart muscle is replaced by scar
tissue, the heart is no longer able to pump an
adequate volume of blood to maintain the body
and the person is said to have atherosclerotic heart
disease..
e. Infectious heart disease- Many acute infections
accompanied by fever cause the heart rate to in-
crease without producing any detectable damage
to the heart muscle. Some infections actually in-
volve heart valves and heart muscle. These infec-
tions may be of bacterial or viral origin and they
require the expert treatment of a physician. Most
individuals recover quickly; others must restrict
their activity for weeks until their physician
decides they are well.

f. Metabolic heart disease this type of disease is
part of a chemical disease and requires the expert
attention of a physician with a good laboratory for
proper diagnosis and treatment.

g. Nutritional heart disease several types of heart
disease fall into this category. Those associated
with anemia and lack of protein in the diet and the
disease caused by the lack of Vitamin B in the diet
are the best examples.

h. Sedentary heart disease this is not a disease in
the true sense of the word, but is probably the
most important condition in the care and protec-
tion of the cardiovascular system that school chil-
dren should understand because it is at this age









when good habits should be formed. The heart is a
muscular pump and like all muscle, it will respond
to the amount of work required of it. When a
person has some disease of the heart, it is neces-
sary to restrict activity until the heart has recover-
ed. Regular physical exercises increases the effici-
ency of the heart muscle and increases the dia-
meter of the coronary arteries of a normal heart.A
good example of the effect of training can be
found in the heart rate immediately after exercise
and the time required for recovery in a well-
trained athlete as compared to one who has been
inactive for several months.

2. The prevention of each type of heart disease varies
greatly. Some disease can be effectively prevented,
others only partially so. Take up each type and discuss
the value of preventive efforts.

a. Congenital heart disease while the exact cause of
all cases of congenital heart disease is not com-
pletely understood at this time, some facts are
known that would be helpful. Since this condition
occurs during the first few months of fetal life,
preventive measures are directed toward factors
influencing the mother in the first three months of
pregnancy.

1. A number of drugs are thought to increase the
tendency to develop defects.

2. German measles are in the mother during
early pregnancy.

3. Some women seem to have a tendency to
transmit defects in their offspring without any
known cause. See standard text on genetics.

The prevention of congenital defects in the light of
present knowledge consists of:

1. Avoiding the use of drugs that are not abso-
lutely necessary.

2. Avoiding German measles during early
pregnancy. Investigate the advisability of
measles vaccine in young women susceptible
to Rubella.

3. Education of the public so that those with a
tendency to have defective children can avoid
subsequent pregnancies. Women should con-
sult their physician on this subject if they
have a strong family history of congenital
defects in their own or their husband's family.









b. Rheumatic heart disease ideally, the prevention
of rheumatic heart disease could be accomplished
by the eradication of the Group A Beta Hemolytic
streptococcus. Since only a few people who have
the sore throat with this infection actually develop
rheumatic fever, and severe heart disease appears
to develop only after repeated infection, the
practical method of preventing heart disease is to
prevent secondary or recurrent infections in those
who have had one attack of rheumatic fever. Some
physicians think the tendency to develop rheuma-
tic fever in those who do have the streptococcal
infection can be influenced by a diet rich in
Vitamin C and protein.

General measures:

1. Diet rich in protein and citrus fruits.

2. Outdoor exercise.

3. Avoiding contact with those who have sore
throats.

Specific measures:

1. Consult a physician with any severe sore
throat. If he determines the presence of
rheumatic fever, follow his instructions in tak-
ing the medicine he prescribes to prevent a
recurrence of the infection.

c. Hypertensive heart disease the prevention of this
disease cannot be accomplished without the help
of your physician. The main point to be under-
stood is that the disease can be diagnosed and
successfully treated in most cases by the family
physician. The physician has no way of knowing
you need help unless you tell him and seek his
advice. The tendency to have this disease can be
detected by having the blood pressure measured.
Many health departments will be glad to test your
blood pressure and tell you whether or not you
should see your physician. The prevention of this
disease can be accomplished by a periodic screen-
ing test and a visit to your doctor. If the blood
pressure is abnormally high, your physician can
make the necessary examinations to determine the
type of treatment necessary to reduce the blood
pressure before any damage is done to the heart.
Does your county health department have a heart
screening program?

d. Atherosclerotic heart disease while the exact
cause of this disease is not well understood, many
doctors have found that certain conditions and









habits of individuals are often found in those who
have heart attacks. Some of these are considered
to be subject to alteration by the individual and
are called correctable risk factors. Some people
seem to inherit the tendency to have heart attacks
in the absence of these risk factors. However, the
majority of people with this type of heart disease
are thought to have one or more of these risk
factors, and the prevention of heart attacks has
been approached through efforts to alter them
favorably. See AHA pamphlet #(EM 392 PHE)
(EM 427 PHE) (EM 414 PHE). The risk factors are
as follows:

1. A high concentration of fat and cholesterol in
the blood.

2. Being overweight.

3. Having high blood pressure.

4. Smoking cigarettes.

5. Not exercising enough.

6. Untreated or uncontrolled diabetes.

The presence of a high blood cholesterol or high blood
fat concentration can only be detected by a blood test.
The presence of high blood pressure can be determined
by having the blood pressure measured. The presence
of diabetes can be detected by a special kind of blood
test. The lack of exercise, being overweight, and
cigarette smoking are all known to us without any
special tests.

The first step in the prevention of atherosclerotic heart
disease should be that of: taking exercise, eating less of
the fattening foods, not smoking.

The second step would be that of having the test for
diabetes, blood cholesterol and blood pressure.

The third step, that of consulting your physician, if
any of these tests are found to be abnormal.

Some county health departments operate a cardiovas-
cular screening program in which the blood test and
blood pressure readings are made. Have the students in
the senior high school determine whether or not these
services are available in your county.

e. Infectious heart disease- the prevention of this
type of heart disease is practically impossible
except for those measures which promote good








health and increase one's resistance to infection.
This is an illustration of the need to consult your
physicians early in the course of infectious disease.

f. Metabolic heart disease this condition is very
rare. It is caused by a group of chemical disorders
and no method effective in its prevention is
known. It is mentioned as a group of diseases that
can be diagnosed only by a physician and illus-
trates the advisability of consulting the family
physician early in the course of illness.

g. Nutritional heart disease this group of diseases,
beri beri, the heart disorder that accompanies
anemia, the heart disease found in alcoholics, are
not completely understood, but they serve to
emphasize the need for a well balanced diet.

h. Sedentary heart disease while this is not a true
disease, physicians have found that the inactive
man is less likely to survive a heart attack than
those accustomed to regular vigorous physical
exercise. Lack of exercise is one of the risk factors
in atherosclerotic heart disease. Increased physical
exercise with the avoidance of fats and sweets also
helps to control excess weight. Avoiding animal
fats and eggs, while increasing physical exercise,
also tends to reduce the blood cholesterol.

3. Emotional tension and heart disease the effects of
emotions on the heart is well known to all. Fright,
anger, joy, and anticipation all effect the heart rate.
While the mechanism involved is poorly understood,
physicians do occasionally see patients who have heart
attacks or die suddenly during periods of emotional
stress. It is impossible to live a life free of emotional
stress. Even if this were so, it would be a dull existence.
Some people are subjected to much more emotional
stress than others, and atherosclerotic heart disease
seems to be more common and to occur at an earlier
age in these than in the general population.

4. Tobacco and the heart cigarette smoking is asso-
ciated with an increase in the number of deaths from
heart attacks. The relationship is not as close as that
between cancer of the lung and cigarette smoking. It is
never the less very important, the death rate being
200% greater in smokers than in non-smokers. Have
children read AHA pamphlet EM 427 PHE. Teachers
refer to Teacher Guide on Smoking and Health.

B. GENERAL 1. The general concept of nutrition may be reviewed at
this time. The following are related specifically to
normal, healthy functioning of the cardiovascular
system:








a. Need for proteins -they are the primary sub-
stances from which body tissue (except fat and
water) is made. Thus, protein is necessary to devel-
op blood cells; antibodies, and the protein content
of the plasma, as well as to repair any damage to
the system as a whole.
b. Need for minerals iron is the essential mineral in
the maintenance of the hemoglobin content of the
red cell.

c. Role of fats hydrogenated primarily in animal
fats and vegetable oils, which are solid at room
temperatures. These include meat fats, butter,
oleo, shortening, and the like.

It is believed that fats play an important role in
arteriosclerosis. (See Item 111:15).

2. Consult nutrition tables to determine minimum daily
requirements for iron and protein. From lists of foods
showing nutritional quantities present, plan meals to
meet all requirements. In addition to the information
gained, this is a good way to develop attitudes and
more lasting impressions about food selections. Obtain
assistance from Florida State Board of Health nutrition
consultant.

3. Make a list of foods which are high in fat, and evaluate
these nutritionally.

4. Point out that, whereas most physicians recommend
reduced cholesterol in the diet, we are by no means
sure of the effectiveness of such abstinence, since the
body is able to synthesize cholesterol without a lot of
fat in the diet. There is a continuous evaluation of the
role of cholesterol being made.

C. VIGOROUS ACTIVITY 5. Stress the role of physical activity for any kind of
development. In relation to cardiovascular health, the
following results of physical activity should be
emphasized:

a. A stronger heart is produced.
b. A more effective lung ventilation results making
more oxygen available to be picked up by the
blood stream in the event of emergency or stress.
c. Greater capillarization of the muscles, meaning
that oxygen can be unloaded at the tissues easier.
In this connection, compare the white meat of the
breast of the chicken (little used muscle) with the
dark meat of the legs (used muscle). The differ-
ence is in the number of capillaries.

d. May reduce cholesterol levels, but this is not
definitely established.



















D. Sufficient sleep and rest


E. Abstinance from harmful drugs and habits


F. Observance of sound dental practices


G. Maintenance of emotional stability


H. Tobacco
Health


Florida Committee on Smoking and


V. HEART TRANSPLANTS


e. Increasing evidence of a positive role in the preven-
tion of degenerate diseases.
f. Very important to continue exercise in adult life.

6. Stress the point that vigorous exercise cannot hurt a
healthy heart. On the contrary, it can strengthen it.
This is not true for a defective heart. People with
defective hearts should act upon the advice of their
physician.

7. Discuss proper balance of sleep, rest, and activity with
the group. Help them to evaluate their own regimes.

8. This topic could be quite general or the class may want
to deal with it very specifically. It could include a
range of things not properly classified as harmful drugs.
For example, it could include:

a. Stimulants tea, coffee, etc.
b. Habit forming drugs narcotics
c. Other drugs tranquilizers, pep pills, etc.
d. Tobacco- Florida Committee on Smoking and
Health
e. Alcohol Guide on Alcoholism and Narcotics

Where the more general approach is used, moderation
rather than abstinence, should be the point of stress for
certain of the products in common use.

9. Relate toxins from infected and decayed teeth to
general systemic poisoning.

10. Discuss hypertension and the fast pace of modern life.

11. Make a study of the kind of people and the kind of
jobs that promote hypertension.

12. Discuss the role of physical activity in relieving stress.

13. List and discuss ways of developing a more tranquil
approach to life.

14. Request list of available material from Florida Com-
mittee on Smoking and Health, Box 210, Jacksonville,
Florida.



While this manual is primarily interested in the prevention
of heart disease, a word should be said about heart trans-
plants.

The simple mechanics of removing the heart from one
animal and placing it in another has been mastered by
modern physicians and scientists.








V. Heart Transplant continued


There were several problems that had to be overcome be-
fore the heart would function in the new animal.


Some of the problems were as follows:

1. A suitable anesthetic had to be developed.
2. Techniques for keeping the animal alive while the
new heart was being connected. (Heart lung machine)
3. The clotting of blood had to be controlled.
4. They had to learn to stop the heart beat and to
start it again after it had been properly connected.
5. The coronary blood flow had to be maintained
while the heart was being transferred.
6. They had to overcome the problem of rejection.


To understand the rejection phenomenon one must under-
stand that the human, as well as lower animals, has the
ability to combat infections by producing a substance
which changes the chemical character of the infecting germ.
This also applies to small parasites. For instance, cows may
develop substances in their blood that will kill ticks which
have become attached to suck the cow's blood. As the tick
burrows its mouth into the cow's skin, some of the tick
secretions are absorbed by the cow. After several weeks or
months the cow will produce substances which injure all
ticks of this type, so that the cows eventually get rid of the
ticks.


This same type of reaction may occur when the heart from
one person is transplanted in the chest of another. The
recipient of the heart recognizes this new heart as a bit of
foreign protein. Just as the head of the tick under the cow's
skin causes antibodies to develop against the ticks, the new
heart causes antibodies to develop against the new or
foreign heart protein.

Many new methods are being tried to solve the problem of
rejection. Many physicians and scientists believe that this
problem will be solved eventually.

The American Heart Association and the Florida Heart
Association have stated their official position on the subject
of heart transplants. Their position may be summed up as
follows:


The transplantation of sound hearts to people with failing
hearts is in the experimental stage at the present time and
probably should not be considered as an acceptable
approach to incurable heart disease at this time.









V. Heart Transplant continued An artificial heart may be developed in the future free from
the chemical and mechanical limiting characteristics and
with an acceptable degree of dependability for the use in
people with incurable heart disease.


In the meantime, tremendous strides may be accomplished
by the application of available knowledge in the field of
preventative cardiology and in the field of cardiopulmonary
resuscitation in modern coronary care units.

While heart transplantation may be hailed as a major break-
through, it must at this stage be considered only in its
infancy. Viewed in proper perspective, heart transplanta-
tion is far from the answer to the tragic death rate due to
heart and blood vessel disease. Perhaps one day there will
be such a thing as a completely artificial heart. In the mean-
time all efforts should be made to continue research in the
area of prevention.


Tremendous strides have been made in saving lives by
monitoring patients early in a special unit called an Inten-
sive Coronary Care Unit staffed with specially trained
nurses.


Heart Associations everywhere have joined with medical
societies, teaching institutions and health departments to
promote cardiopulmonary resuscitation, a procedure that
saves many lives inside and outside the hospital.









VI. Bibliography


A. INFORMATION AND EDUCATION


The Florida Heart Association


The Florida Heart Association and its chapters and
divisions provide educational and informative
materials of great variety for the cardiac patient
and his family, for physicians and allied profes-
sional persons, and for the general public. These
services include:

FOR THE CARDIAC PATIENT AND HIS
FAMILY


Home teaching services, books,
phlets, charts, diagrams, etc.


pam-


FOR SOCIAL AND CIVIC CLUBS AND
OTHER GROUPS

Speakers, films, exhibits, slides, record-
ings, programs, etc.


FOR THE PHYSICIAN AND OTHER PRO-
FESSIONAL PERSONS

Speakers, films, slides, recordings, profes-
sional publications, books, pamphlets,
exhibits, heart models, cardiac seminars, etc.


FOR THE GENERAL PUBLIC

Books, pamphlets, films, speakers,
exhibits, informative articles, radio and tele-
vision scripts, newspaper articles, etc.

Contact your nearest heart association or
division (see list under Section VI, following)
or write to the Florida Heart Association for
any of the above educational and informative
materials and services.


Heart Disease Control Program
Florida State Board of Health
P. O. Box 210
Jacksonville, Florida 32201


Information and guidance on public
health aspects and services in the area of heart
disease.


Department of Education
Knott Building
Tallahassee, Florida


SERVICES

Consultative services to county school
systems in the development of programs for
exceptional children.

Includes services to physically impaired,
visually handicapped, blind, deaf and hard of
hearing, speech irregulars, special health prob-
lems, hospital and homebound services,
psychological services, and services to the
mentally gifted and retarded.

Department of Health &
Rehabilitative Services
Florida State Department of Education
725 South Bronough Street
Tallahassee, Florida


SERVICES

The Division provides rehabilitation
counseling, training for a vocation; surgery,
hospitalization and treatment needed in order
to remove or diminish a disability which is a
vocational handicap; artificial appliances
necessary to enable handicapped persons to
work; assistance in finding a job. Services are
provided to youth and adults of working age
who may have a physical, mental or emotional
impairment severe enough to be a job handi-
cap.

Services are available to persons with cir-
culatory or cardiac problems. These services
may include cardiological evaluation, heart
catheterization, open-heart surgery and medi-
cal management of certain cardiovascular
problems.

Services are provided in each county


SERVICES









through sixteen District Vocational Rehabili-
tation offices located in major population
centers of the State. These offices can be
located through the Florida Educational
Directory.

B. A FEW SUGGESTED EXPERIENCES/
ACTIVITIES FOR OTHER CLASSES

Agriculture

1. Farm Accidents
2. First aid


Biology


1. Make blood counts
2. Discuss elements of blood


Chemistry


1. Coagulate some blood
2. Study the effect of certain chemicals on coagula-
tion


Home Economics

1. Discuss reason for blood tests
2. Study and discuss iron deficiencies


Physical Education and Athletics

1." Study safety and first aid
2. Discuss importance of physical fitness, condition-
ing warm-up and recovery time (Take pulse count
before and after activity)

NOTE: A glossary of heart terms must be compiled
for all classes.


C. SOME TESTS USED BY PHYSICIANS TO
DETERMINE HOW THE HEART IS WORK-
ING


Ballistocardiogram is used to measure the force
of the heart's contraction and to indicate the
condition of large blood vessels.


Blood Pressure is the force of blood against the
artery walls which is generated by the heart as


it pumps or beats. Everyone has blood pres-
sure it may be either high, normal or low.


Blood Tests are used to detect many abnormali-
ties. For instance, white cell count to detect
evidence of an infection or red cell count to
detect anemia and blood sugar test for
diabetes.


Electrocardiograph is a machine used to record
the electrical activity produced by the heart
beat. It is used to detect some types of heart
disorder.


Plethysmograph an instrument for recording
variations in the size of various parts of the
body, especially such variations as is caused
by the circulation of the blood.


Sphygmometer an instrument for measuring the
force and frequency of the pulse.


Stethoscope an instrument which emphasizes
sounds. The ear-piece is placed on the body
and the sound travels along the tubes to the
physician's ears. The sounds heard are fre-
quently described as "lubb" and "dubb."



D. REFERENCE SOURCES


1. American Heart Association, 44 East 23
Street, New York, N.Y. 10010
2. American Medical Association, 535 North
Dearborn Street, Chicago, Illinois 60610
3. American National Red Cross, Southeastern
Area, 1955 Monroe Drive, N.E., Atlanta,
Georgia
4. Florida Committee on Smoking and Health,
Box 210, Jacksonville, Florida 32201
5. Florida Heart Association, 4126 16th Street
North, St. Petersburg, Florida 33703
6. Florida State Board of Health, Audio-Visual
Library, P.O. Box 210, Jacksonville, Florida
32201
7. U. S. Department of Health, Education and
Welfare, Public Health Service, 4040 North
Fairfax Drive, Arlington, Virginia 22203








NOTE: Since reference materials are constantly
changing to keep abreast of current
scientific and medical information it is
important to contact the various sources to
maintain a current file. In developing and
improving materials, assistance should be
sought first at the local and state levels.
Selected References

"A Handbook of Heart Terms," 30 cents per copy,
(HEW)

"A Guide to Grade Level Placement of Instruc-
tional Materials on the Heart and Circulatory
System." (AHA)

"A Bibliography of Basic Materials on Smoking
and Health." (Fla. Comm. on Smoking and
Health)

"Defense Against Invasion" (A film available from
State Board of Health)

"Health Careers," (Two filmstrips) To preview and
purchase write to: Lawren Productions, Inc.,
4233 Wooster Avenue, San Mateo, California
94403


"Heart Association Materials" (A kit containing
drawings, charts, pamphlets, etc.) (FHA)

"Hemo the Magnificent" (A film available from
local Bell Telephone Co.)

"The Healthy Life" How diet and exercise
affect your heart and vigor-(A special report
published by Time, Inc., New York)

"Risk Factors" (A kit on cardiovascular diseases)
(AHA)

"Smoking and Heart Disease." (Smoking emphasis
kit) (AHA)

"Structure and Function of the Heart" $1.32 per
copy, D.C. Heath and Company, 285 Colum-
bus Avenue, Boston, Massachusetts

"Tips on Athletic Training" (A sequence I-VIII)
(AMA)

"Whats New in Educational Materials on Smoking
and Health?" (Bibliography materials from
AAHPER, American Cancer Society,
American Heart Association and National
Tuberculosis Association) (HEW)




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