The Circulatory System

1. 1. 2. 3. 4. 5. 6. 7. Match the terms 1-10 with their definitions a-j: cell erythrocyte haematopoiesis immunoglobulin leukocyte lymph medulla a. b. c. d. e. f. g. h. i. j. a minute colourless disk-like body of blood that assists in blood clotting a small, usually microscopic, mass a substance in food which is necessary to provide energy or to help the body grow a usually clear coagulable fluid derived from body tissues that contains white blood cells any of several types of blood cells that help defend the body from infection; white blood cell any of the glycoproteins in the blood serum that are induced in response to invasion by foreign antigens any of the haemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red colour of blood bone marrow the fluid part of blood the formation of blood or of blood cells uses for clotting. All blood cells 18. ... produced in the bone marrow. In children, most of the bones produce blood. However, with age, blood production is reduced to just the bones of the vertebrae, sternum, ribs, pelvis and small parts of the upper arm and leg. Bone marrow that actively produces blood cells is called red marrow, while bone marrow that 19. ... longer produces blood cells is called yellow marrow. The process by which the body produces blood is called haematopoiesis. All blood cells come 20. ... the same type of cell, called the pluripotential haematopoietic stem cell. This group of cells has the potential to form any of the different types of blood cells and also to reproduce itself. 3. For gaps 21-30 choose the best variant: A, B or C:

8. nutrient 9. plasma 10. platelet 2.

Fill in gaps 11-20 with ONE suitable word:

Blood is made up 11. ... two components: cells and plasma. The heart pumps blood through the arteries, capillaries and veins 12. ... carry oxygen and nutrients to the cells of the body and to remove wastes. If there was no blood, the body 13. ... stop working. The adult human body contains approximately 5 litres of blood accounting 14. ... 7-8% of a persons body weight. Almost 3 litres of blood is plasma whereas the rest is the cellular portion. Plasma is the liquid part of the blood. Blood cells like red blood cells float in the plasma. Electrolytes, nutrients and vitamins (absorbed from the intestines or produced 15. ... the body), hormones, clotting factors, and proteins such as albumin and immunoglobulins are also dissolved in the plasma. Plasma is responsible 16. ... the distribution of the substances it contains as it circulates throughout the body. The cellular portion of blood contains red blood cells (RBCs), white blood cells (WBCs) and platelets. The red blood cells carry oxygen 17. ... the lungs; the white ones help to fight infection whereas platelets are parts of cells which the body

Haematopoietic stem cells (HSCs) 21. ... in the medulla and have the ability to give rise to all of the different mature blood cell types. HSCs are self- 22. ... : when they reproduce, at least some of their daughter cells remain as HSCs, so that the pool of stem cells does not become 23. ... . If necessary, the liver, thymus, and spleen may resume their haematopoietic function. This is called extramedullary haematopoiesis. It may 24. ... these organs to increase in size substantially. Because in foetuses bones and bone marrow develop later, the liver functions as the main haematopoietic organ. Red blood cells 25. ... the most important blood duty. A single drop of blood contains millions of red blood cells which are constantly travelling through the body 26. ... oxygen and removing waste. Without these cells, the body could not survive. Red blood cells contain a protein chemical, called haemoglobin, which is bright red in colour. Haemoglobin contains iron, making it an excellent carrier of oxygen and carbon dioxide. As blood passes through the lungs, oxygen molecules 27. ... to the haemoglobin. As the blood goes through the bodys tissues, the haemoglobin 28. ... the oxygen to the cells. The empty haemoglobin molecules then 29. ... with the tissues carbon dioxide or other waste gases, transporting it away. Over time, the red blood cells become worn out and eventually die. The average life cycle of a red blood cell is 120 days but bones continually produce new blood cells, 30. ... the supply. 21. 22. 23. 24. 25. 26. 27. 28. A. A. A. A. A. A. A. A. reside producing depleted convince play producing attach sets B. B. B. B. B. B. B. B. found inventing out cause act delivering add frees C. C. C. C. C. C. C. C. habit renewing absent encourage perform transmitting insert releases
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The Circulatory System

29. A. link 30. A. replenishing 4. B. bond B. upbringing C. relate C. rising An aneurism may also occur in parts 47. ...... the aorta. Aortic aneurysms can occur in the area below the stomach (abdominal aneurysm) or in the chest (thoracic aneurysm). An abdominal aortic aneurysm is usually located below the kidneys. Aortic dissection can occur in the aorta and 48. ...... main branches. If a section of the heart wall becomes damaged after a heart attack, scarring occurs and the heart wall grows thinner and weaker. This may 49. ...... a ventricular aneurysm to form. The weakened area of aneurysm does not work well, which makes the heart work harder to pump blood to the 50. ...... of the body. Ventricular aneurysms may cause shortness of breath, chest pain, or arrhythmia. If a ventricular aneurysm leads to congestive heart failure, left ventricular heart failure, or arrhythmia, surgery may be encouraged. 6. For questions 51-60 make a new word from the one in brackets which fits in the gap:

For gaps 31-40 make a new word from the one in brackets which fits in the gap:

Platelets, or thrombocytes, are small, 31. ... (REGULAR)-shaped anuclear cells, which are derived from 32. ... (FRAGMENT) of precursor megakaryocytes. The average lifespan of a platelet is between 8 and 12 days. Platelets play a fundamental role in haemostasis and are a natural source of 33. ... (GROW) factors. They circulate in the blood and are involved in haemostasis, leading to the 34. ... (FORM) of blood clots. If the number of platelets is too low, excessive bleeding can occur. However, if the number of platelets is too high, blood clots can form (thrombosis), which may cause blood vessel 35. ... (OBSTRUCT) and lead to a stroke, heart attack, pulmonary embolism or the blockage of blood vessels to other parts of the body, such as the extremities of the arms or legs. An 36. ... (ABNORMAL) or disease of the platelets is called a thrombocytopathy, which could be either a low number of platelets (thrombocytopenia), a decrease in function (thrombasthenia), or an increase in the number of platelets (thrombocytosis). The function of platelets is the 37. ... (MAINTAIN) of haemostasis. This is achieved 38. ... (PRIMARY) by the formation of thrombi, when damage to the endothelium of blood vessels occurs. Thrombus formation must be inhibited at times when there is no damage to the endothelium. Since the human body 39. ... (CONTINUE) produces more blood, it is safe for healthy adults to donate blood. 40. ... (INITIAL) after giving blood, the donor may feel some momentary light-headedness due to the loss of oxygen-rich red blood cells and blood sugar. The body quickly stabilises itself. 5. Use ONE word to fill in gaps 41-50:

An aneurysm is a balloon-like protuberance in an artery. Aneurysms can develop in arteries 41. ...... all sizes. Aneurysms occur when 42. ...... pressure of blood passing through part of a weakened artery forces the vessel 43. ...... bulge outward, forming what might 44. ...... thought of as a blister. However, not all aneurysms are life-threatening. But if the bulging stretches the artery 45. ...... far, the vessel may burst, causing a person to bleed to death. Aneurysms which bleed into the brain can lead to stroke or death. An aneurysm that occurs in the arteries which supply blood 46. ...... the brain is called a cerebral aneurysm.

All conditions that cause the walls of the arteries to 51. ...... (WEAK) can lead to an aneurysm. Some of the risks which may lead to an aneurysm or an 52. ...... (AORTA) dissection are: - atherosclerosis - high blood pressure - smoking - deep wounds, injuries, or 53. ...... (INFECT) of the blood vessels - a congenital 54. ...... (NORMAL) - inherited diseases, there are inherited diseases such as Marfan syndrome, which affects the bodys 55. ...... (CONNECT) tissue, causes people to have long bones and very flexible joints. People with this syndrome often have aneurysms. - a 56. ...... (DEFECT) gene. Aneurysms can be detected by physical exam, on a basic chest or stomach xray, or by using ultrasound. The size and location can be found through echocardiography or radiological imaging, such as arteriography, magnetic resonance imaging (MRI), and computed tomography (CT) scanning. Symptoms are 57. ...... (DIFFER) depending on the type and location of the aneurysm. Symptoms result from the pressure caused by an aneurysms 58. ...... (PRESS) against 59. ...... (NEAR) organs, nerves, and other blood vessels. For example, aortic aneurysms may cause 60. ...... (SHORT) of breath, a croaky or raspy voice, backache, or pain in the left shoulder or between the shoulder blades. 7. For questions 61-70 choose the best option:
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The Circulatory System

Aortic dissection may cause 61. ...... and severe pain, and patients often feel 62. ...... something is ripping or tearing inside of them. The pain is 63. ...... felt in the chest, but it can 64. ...... to the back or between the shoulder blades. Aortic dissection may also cause stomach ache, lower back pain, or symptoms typical for influenza. If blood 65. ...... from the dissection and builds up in the chest, the blood may enter the pericardial space (the sac that 66. ...... the heart) and it will 67. ...... the heart from filling properly. This can 68. ...... to a life-threatening condition called cardiac tamponade. Abdominal aortic aneurysms may cause pain or tenderness below the stomach and make one less 69. ...... . Cerebral aneurysms may have no symptoms, although one may have headaches, pain in the neck and face, or trouble 70. ...... and talking. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 8. A. A. A. A. A. A. A. A. A. A. sudden when mainly swell leaks hides evade conduct starving seeing B. B. B. B. B. B. B. B. B. B. hasty as essentially spread spills binds avoid lead hungry looking C. C. C. C. C. C. C. C. C. C. speedy like unlikely widen drips surrounds prevent guide famished viewing For patients with aortic dissection, surgery is usually recommended right away, 78. ......... . For dissections farther from the heart, patients will be administered medicines 79. ......... . However, in case the dissection begins to leak blood, cause a blockage, or get bigger, surgery is needed. Nowadays, a nonsurgical technique can be used to treat high-risk patients with abdominal aortic aneurysms. It is useful for 80. ......... . The procedure uses a catheter to insert a device called a stent graft. The stent graft is placed within the artery at the site of the aneurysm. The blood flows through the stent graft, decreasing the pressure on the wall of the weakened artery. This decrease in pressure can prevent the aneurysm from bursting. A. B. C. D. E. F. G. H. I. J. K. L. M. 9. that happen in the vessels that supply blood to the arms, legs, and head that lowers blood pressure, to relieve the stress on the aortic walls that has been known to be a very serious condition and location of the aneurysm and the patients overall health patients may live with the aneurysm for years and the dissection will be watched closely and the area below the stomach (the descending thoracic and abdominal parts of the aorta) patients who are not willing to undergo surgery patients who cannot have surgery because their overall health would make it too dangerous and weight of the patient having the condition especially if the dissection is in the part of the aorta closest to the heart the doctor may want the patient to have surgery to stop the aneurysm from bursting the doctor will usually ask patients to come in for regular check-ups so the growth of the aneurysm can be followed For questions 81-90 choose the best option from the suggestions in italics: There are two types of haemochromatosis: primary and secondary. A(n) 81.

For questions 71-80 choose a proper ending A-M. There are more endings than you need:

Treatment depends on the size 71. .......... . Aneurysms in the upper chest (the ascending aorta) are usually operated on right away. Aneurysms in the lower chest 72. ......... may not be as life-threatening. Aneurysms in these locations are watched regularly. If they become about 5 centimetres in diameter, continue to grow, or begin to cause symptoms, 73. ...... . For aortic aneurysms or aneurysms 74. ......... (the peripheral vessels), surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft. For patients with smaller or stable aneurysms in the descending aorta or abdominal parts of the aorta those farthest from the heart, 75. ...... . If the aneurysm does not grow much, 76. ......... . Doctors may also prescribe medicine, especially medicine like a beta blocker 77. ......... . Medicine to lower blood pressure is especially useful for patients where the risk of surgery may be greater than the risk of the aneurysm itself.

defect/ mistake/ error in the genes that control how much iron the body 82. draws/ absorbs/ attracts from food causes primary haemochromatosis. Secondary haemochromatosis usually is the 83. product/ result/ produce of another disease or
condition that causes iron overload. Most people who have primary haemochromatosis inherit it from their parents. If one person inherits two haemochromatosis genes, one from each parent, the person is at 84. risk/ menace/ hazard for iron overload. The two faulty genes cause the body to absorb more iron

The Circulatory System

than 85. familiar/ usual / accustomed from the foods eaten. However, not everyone who has haemochromatosis has signs or symptoms of the disease. Estimates of how many people develop signs and symptoms 86. deviate/ diverge/ vary greatly. Some estimates 87. propose/ suggest/ advise that as many as half of all people who have the disease do not have signs or symptoms. The 88. severity/ strictness/ rigorousness of haemochromatosis also varies from person to person. Some patients do not have complications, even with high 89. sums/ totals/ amounts of iron in their bodies. Others have severe complications or die from the disease. Certain factors can 90. affect/ shape/ change how severe the disease is. For instance, a high intake of vitamin C can make haemochromatosis worse. This is because vitamin C helps the body to absorb iron from food. Alcohol use can worsen liver damage and cirrhosis caused by haemochromatosis. Conditions such as hepatitis also can further damage or weaken the liver. 10. Fill in the gaps 91-100 with ONE word: The cardiovascular system, which 91. ...... also called the circulatory system, consists 92. ...... the heart, a muscular pumping device, and a closed system of vessels called arteries, veins, and capillaries. 93. ...... all the vessels of this network in the body were laid end-to-end, they would extend 94. ...... almost 100,000 kilometres. The blood in the circulatory system is pumped 95. ...... the heart around a closed circuit of vessels as it passes again and again through the various circulations of the body. The heart is enclosed by a sac known 96. ...... the pericardium. The heart wall is formed by three layers of tissues. The outer layer of the heart wall is the epicardium, the middle layer is the myocardium, and the inner layer is the endocardium. The internal cavity of the heart is divided 97. ...... four chambers: the right atrium, the right ventricle, the left atrium and the left ventricle. The two atria are chambers with thin walls 98. ...... receive blood from the veins. Unlike the atria, the two ventricles are thick-walled chambers that forcefully pump blood 99. ...... of the heart. The differences in the thickness of the heart chamber walls are due 100. ...... variations in the amount of myocardium present, which reflects the amount of force each chamber needs to produce. 11. For questions 101-105 make a new word from the one in brackets which fits in the gap: The right atrium receives 101. ...... (OXYGEN) blood from the body through the superior vena cava (head and upper body) and inferior vena cava (legs and lower torso). The sinoatrial node or sinus node, a small mass of tissue that is 102. ...... (BED) in the musculature of the right atrium which originates the impulses stimulating the heartbeat sends an impulse that causes the cardiac muscle tissue of the atrium to contract in a coordinated, wave-like manner. The tricuspid valve, which separates the right atrium from the right ventricle, opens in order to allow the deoxygenated blood accumulated in the right atrium to flow into the right ventricle. Because of the 103. ...... (CONTRACT) of the right atrium, deoxygenated blood is pumped into the right ventricle. The pulmonary valve leading into the pulmonary artery closes, allowing the ventricle to fill with blood. When the ventricles are full, they contract. As the right ventricle contracts, the tricuspid valve closes and the pulmonary valve opens. The tricuspid valve closes to prevent blood from flowing back into the right atrium and the opening of the pulmonary valve allows the blood to flow into the pulmonary artery toward the lungs. The left atrium collects oxygenated blood from the lungs through the pulmonary vein. As the contraction caused by the sinoatrial node progresses through the atria, the blood passes through the mitral valve into the left ventricle. The left ventricle receives oxygenated blood as the left atrium contracts. The blood goes through the mitral valve into the left ventricle. The 104. ...... (AORTA) valve which leads into the aorta is closed, thus allowing the ventricle to fill with blood. When the ventricles are full, they contract. As the left ventricle contracts, the mitral valve closes allowing the aortic valve to open. The closure of the mitral valve prevents blood from flowing back into the left atrium whereas the opening of the aortic valve allows the blood to flow into the aorta and then throughout the body. It is important to realise that both atria contract at the same time as do both ventricles. The heart works as two pumps, one on the right and one on the left, functioning 105. ...... (SIMULTANEOUS). Blood flows from the right atrium to the right ventricle, and then is pumped to the lungs to be oxygenated. From the lungs, the blood flows to the left atrium, then to the left ventricle. From there it is pumped to the systemic circulation. 12. For questions 106-115 choose the best variant: The tricuspid valve 106. ...... the right atrium from the right ventricle. It opens to allow the deoxygenated blood 107. ...... in the right atrium to flow into the right ventricle. It 108. ...... at the same time as the right ventricle 109. ...... , preventing blood from flowing back into the right atrium forcing it to exit through the pulmonary valve into the pulmonary artery. The mitral valve separates the left atrium from the left ventricle. It 110. ...... to allow the oxygenated blood collected in the left atrium to flow into the left
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The Circulatory System

ventricle. It closes as the left ventricle contracts, 111. ...... blood from returning to the left atrium, 112. ...... it to exit through the aortic valve into the aorta. The pulmonary valve is the one that separates the right ventricle from the pulmonary artery. As the ventricles contract, it opens to allow the deoxygenated blood temporarily 113. ...... in the right ventricle to flow to the lungs. It closes as the ventricles relax, preventing blood from returning to the heart. The aortic valve separates the left ventricle from the aorta. When the ventricles contract, the aortic valve opens to 114. ...... the oxygenated blood collected in the left ventricle to flow throughout the body. It closes as the ventricles 115. ...... , preventing blood from backing into the heart. 106. 107. 108. 109. 110. 111. 112. 113. 114. 115. A. A. A. A. A. A. A. A. A. A. isolates collected closes pulls releases forbidding pushing stored allocate relax B. B. B. B. B. B. B. B. B. B. separates remained locks shortens unlocks preventing forcing paused allow unwind C. C. C. C. C. C. C. C. C. C. disconnects flown seals contracts opens inhibiting propelling halted tolerate loosen A. B. C. D. E. that carry oxygen-rich and nutrient-rich blood to the cardiac muscle tissue that the red blood cells must travel in single line that allow the oxygenated blood to flow throughout the body to bring oxygen to the contracting cells and to remove waste products to take them away from the heart to be disposed through the lungs, kidneys and liver F. which needs a permanent supply of oxygen and nutrients in order to function efficiently G. which receives blood from the veins 14. For questions 121-130, match the terms with their definitions A-J: 121. arteriole 122. artery 123. blood vessel 124. capillary 125. pulmonary artery 126. systemic circulation 127. tunica 128. vein 129. venule 130. ventricle A. B. C. D. E. F. G. H. I. J. a blood vessel taking blood from the heart to the tissues of the body a blood vessel which takes deoxygenated blood containing waste carbon dioxide from the tissues back to the heart a small vein or vessel leading from tissue to a larger vein a tiny blood vessel between the arterioles and the venules, which carries blood and nutrients into the tissues a cavity in an organ, especially in the heart or brain passage through which deoxygenated blood is taken from the heart to the lungs for oxygenation any tube which carries blood round the body a very small artery a layer of tissue which covers an organ the circulation of blood around the whole body, except the lungs, starting with the aorta and returning through the venae cavae

13. For gaps 116-120 choose a suitable ending A-G. There are two endings that you do not need to use: The myocardium of the heart wall is a working muscle 116. ...... . Consequently, the cardiac muscle has an extensive network of blood vessels 117. ...... . The right and left coronary arteries are at the basis of the network of blood vessels 118. ...... . The larger vessels travel along the surface of the heart while the smaller ones penetrate the heart muscle. The smallest branches, also known as capillaries, are so narrow 119. ....... . In the capillaries, the red blood cells supply oxygen and nutrients to the cardiac muscle tissue and bond with carbon dioxide and other metabolic waste products 120. ...... . When cholesterol plaque accumulates blocking the flow of blood through a coronary artery, the cardiac muscle tissue fed by the coronary artery is deprived of oxygen and nutrients, this leading to the cessation of cardiac muscle tissue to function properly. A myocardial infarction or heart attack is the condition when a coronary artery becomes blocked causing damage to the cardiac muscle tissue it serves.

15. For gaps 131-140 make a new word from the one in brackets which fits in the gap: Blood vessels are the channels through which blood is distributed to body tissues. The vessels make up two closed systems of tubes which begin and end at the heart. One system, made up of the pulmonary vessels, transports blood from the right
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The Circulatory System

ventricle to the lungs and back to the left atrium. The other system, the systemic vessels, carries blood from the left ventricle to the tissues in all parts of the body and then carries the blood back to the right atrium. 131. ...... (BASIS) on their structure and function, blood vessels can be 132. ...... (CLASS) as arteries, capillaries, or veins. Arteries take blood away from the heart. Pulmonary arteries transport deoxygenated blood from the right ventricle to the lungs. Systemic arteries transport oxygenated blood from the left ventricle to the body tissues. Blood is pumped from the ventricles into arteries that branch 133. ...... (REPEAT) into smaller and smaller arteries until the branching results in 134. ...... (MICROSCOPE) arteries called arterioles. These arterioles play a key role in regulating blood flow into the tissue capillaries. The systemic arterial system contains approximately 10% of the total blood volume at any given time. Three layers make up the wall of an artery. The innermost one, the tunica intima, contains simple squamous epithelium, basement membrane and connective tissues. The epithelium is in direct contact with the blood flow. The middle layer, the tunica media, is primarily smooth muscle and is usually the thickest layer. It provides support for the vessel and changes vessel diameter in order to regulate blood flow and blood 135. ...... (PRESS). The outermost layer, which attaches the vessel to the surrounding tissue, is the tunica externa, also known as tunica adventitia. This layer is connective tissue with varying amounts of elastic and 136. ...... (COLLAGEN) fibres. Veins carry blood toward the heart. After blood passes through the capillaries, it enters the smallest veins, called venules. From the venules, blood flows into 137. ...... (PROGRESS) larger and larger veins until it reaches the heart. In the pulmonary circuit, the pulmonary veins transport blood from the lungs to the left atrium of the heart. This blood has been oxygenated in the lungs. Systemic veins transport blood from the body tissue to the right atrium of the heart. The walls of veins are thinner than those of arteries, consequently blood in the veins has less pressure than in the arteries. Because the walls of the veins are thinner and less rigid than arteries, veins can hold more blood. Approximately 70% of the total blood volume can be found in the veins at any given time. Capillaries, the smallest and most 138. ...... (NUMBER) of the blood vessels, form the link between the vessels that carry blood away from the heart and the vessels that return blood to the heart. Their primary function is the 139. ...... (CHANGE) of materials between the blood and tissue cells. The epidermis of the skin and the lens and cornea of the eye completely lack a capillary network. About 5% of the total blood volume is in the systemic capillaries at any given time whereas another 10% is in the lungs. Apart from forming the connection between the arteries and veins, capillaries play a vital role in the exchange of gases, nutrients, and 140. ...... (METABOLISM) waste products between the blood and the tissue cells. 16. Fill in gaps 141-150 with ONE word only: The heart beats around 70 times 141. ...... minute. The human heart will contract 142. ...... 3 billion times during a normal lifetime. One heartbeat, 143. ...... cardiac cycle, includes atrial contraction and relaxation, ventricular contraction and relaxation, and a short pause. The cardiac cycle consists 144. ...... two parts: systole (contraction of the heart muscle in the ventricles) and diastole (relaxation of the ventricular heart muscles). When the ventricles contract, they expel the blood 145. ...... their chambers into the arteries leaving the heart. The left ventricle empties into the aorta and the right ventricle into the pulmonary. The increased pressure on the arteries 146. ...... to the contraction of the ventricles is called systolic pressure. When the ventricles relax, blood enters from the atria. The decreased pressure due to the relaxation of the ventricles (heart resting) is called diastolic pressure. Blood pressure is measured in millimetres 147. ...... mercury, with the systole in ratio to the diastole. Healthy young adults are supposed 148. ...... have a ventricular systole of 120mm, and 80mm at ventricular diastole, or 120/80. High blood pressure usually has 149. ...... symptoms. Actually, many people have high blood pressure for several years without knowing it. Hypertension is the medical term for high blood pressure. A single elevated blood pressure reading does not mean that one has high blood pressure, it is rather a sign 150. ...... further observation is necessary. Certain diseases, such as kidney disease, can cause high blood pressure, although in 90 to 95 % of cases, the cause of high blood pressure is unknown.

The Circulatory System

17. Rearrange the following stages (A-J) of taking a patients blood pressure in the correct order 151-160: 151. A. The health care provider will close the valve on the rubber inflating bulb and then will squeeze it rapidly to inflate the cuff until the dial or column of mercury reads 30 mmHg higher than the usual systolic pressure. B. The health care provider will locate the large artery on the inside of the elbow by feeling for the pulse and will place the head of the stethoscope over this artery, below the cuff. C. To measure a patients blood pressure, the health care provider will wrap the blood pressure cuff around the patients upper arm, positioning it in such a way that the lower edge of the cuff is about 3-4 centimetres above the bend of the elbow. D. As the pressure falls, the level on the dial or mercury tube at which the sound of blood pulsing is first heard is recorded. E. The head of the stethoscope should not come in contact with the cuff or any clothing because these noises may block out the pulse sounds. F. As the air continues to be let out, the sounds will disappear. The point at which the sound disappears is recorded. G. Next, the valve is opened slightly, allowing the pressure to fall gradually (2 to 3 mmHg per second). H. This is the systolic pressure. I. If the usual systolic pressure is unknown, the cuff is inflated to about 210 mmHg. J. This is the diastolic pressure (the lowest amount of pressure in the arteries as the heart rests). 165. visceral ............ 166. ............ 167. fibrous ............ 168. ............ 169. parietal ............ 170. serous ............ the inner layer of serous pericardium, attached to the wall of the heart the inner layer of the pericardium which lines the walls of the heart the outer part of the pericardium which surrounds the heart, and is attached to the main blood vessels the middle layer of the wall of the heart, formed of heart muscle the outer layer of the serous pericardium, not in direct contact with the heart muscle, which lies inside and is attached to the fibrous pericardium the inner part of the pericardium, forming a double sac which contains fluid to prevent the two parts of the pericardium from rubbing together

152. 153.

154. 155. 156. 157. 158. 159. 160.

19. Use ONE word to fill in gaps 171-180: Atherosclerosis or the hardening and narrowing 171. ...... the arteries, slowly blocks arteries, putting blood flow 172. ...... risk. Atherosclerosis is the common cause of heart attacks, strokes, and peripheral vascular disease. Arteries are lined 173. ...... a thin layer of cells called the endothelium. The endothelium works 174. ...... keep the inside of arteries toned and smooth, which keeps blood flowing. Atherosclerosis starts when high blood pressure, smoking, or high cholesterol damages the endothelium. This is when cholesterol plaque formation begins. Atherosclerosis usually causes no symptoms until middle 175. ...... older age. Once narrowings become severe, they block blood flow and can cause pain. Blockages can also suddenly rupture, causing blood to clot 176. ...... an artery at the site of the rupture. Plaques from atherosclerosis can behave in different ways. They can stay within the artery wall. There, the plaque grows 177. ...... a certain size and stops. Plaques do not block blood flow, thus they may never cause any symptoms. They can grow in 178. ...... slow, controlled way into the path of blood flow. Eventually, they cause significant blockages. Pain on exertion (in the chest or legs) is the usual symptom. Plaques can suddenly rupture, allowing blood to clot inside an artery. In the brain, this causes a stroke; in the heart, a heart attack. The majority 179. ...... adults older than 60 have some atherosclerosis but often do not have noticeable symptoms. However, in the last three decades rates of death from atherosclerosis have fallen significantly. This is thanks 180. ...... both better lifestyles and improved treatments. Atherosclerosis is progressive, but it is also preventable. For example, nine risk
7

18. The prefixes in the box can combine with the root -cardium. Make new words for the following definitions: endohydroperi161. ............ 162. ............ 163. ............ 164. ............ epimyohaemoperiperi-

a condition in which blood is found in the pericardium a membrane which lines the heart a membrane which surrounds and supports the heart an accumulation of liquid round the heart

The Circulatory System

factors are to blame for up to 90% of all heart attacks: smoking, high cholesterol, high blood pressure, diabetes, abdominal obesity, stress, not eating fruits and vegetables, excess alcohol intake (more than one drink for women, one or two drinks for men, per day) and not exercising regularly. 20. For questions 181-195 choose the best variant: Coronary artery disease is atherosclerosis of the coronary 181. ...... , producing blockages in the vessels which 182. ...... the heart itself. Atherosclerosis occurs when the arteries become 183. ...... and narrowed, restricting blood 184. ...... . Without adequate blood flow from the coronary arteries, the heart becomes 185. ...... of the oxygen and the vital nutrients it needs to work properly. Coronary arteries are 186. ...... and elastic, allowing blood to flow freely. At a relatively young age, fat can start to deposit in the blood vessel walls. As people 187. ...... older, the fat builds up. This causes injury to blood vessel walls. In a(n) 188. ...... to heal itself, the fatty tissues release chemicals that promote the process of healing but make the inner walls of the blood vessel sticky. Other substances, such as inflammatory cells, proteins, and calcium that travel in the bloodstream start sticking to the inside of the vessel walls. The fat and other substances combine to form plaque, which can 189. ...... the flow of blood in the artery, a 190. ...... that is called atherosclerosis. Some plaque deposits are hard on the outside and soft and mushy on the inside. Some plaque is fragile, cracking or tearing, exposing the soft, fatty inside. When this happens, platelets come to the area, and blood clots 191. ...... on the injured vessel wall, which causes the artery to narrow even more. Sometimes, the blood clot 192. ...... by itself, and blood supply is 193. ...... . Eventually, a narrowed coronary artery may develop new blood vessels that go around the 194. ...... to get blood to the heart. However, during times of increased exertion or stress, the new arteries may not be able to 195. ...... enough oxygen-rich blood to the heart muscle. In other cases, the blood clot may totally block the blood supply to the heart muscle, causing what is called an acute coronary syndrome. 181. 182. 183. 184. 185. 186. 187. A. A. A. A. A. A. A. veins feed packed flow impoverished even mature B. B. B. B. B. B. B. arteries nurture congested flowing deprived levelled grow C. C. C. C. C. C. C. capillaries nourish clogged course depressed smooth raise 188. 189. 190. 191. 192. 193. 194. 195. A. A. A. A. A. A. A. A. attempt narrow situation accumulate comes off returned blocking take B. B. B. B. B. B. B. B. challenge lessen condition gather breaks apart restored jam carry C. C. C. C. C. C. C. C. dispute decrease case collect destroys repaired blockage supply

21. For gaps 196-215 make a new word from the one in brackets that fits in the gap: Cardiac ischemia is a situation in which the flow of oxygen-rich blood to the heart muscle is impeded, resulting in 196. ...... (ADEQUATE) oxygenation of the heart. The most common cause of cardiac ischemia is plaque build-up in the arteries due to the long-term effects of coronary artery disease. This plaque build-up narrows the arteries to the point where the amount of blood flowing through the arteries is not enough to supply oxygen-rich blood to the heart, 197. ...... (SPECIAL) during times of physical exertion or emotional stress. The lack of oxygen is often temporary, and symptoms can include a type of chest pain, pressure or 198. ...... (COMFORT) called angina. These episodes may last anywhere from 2 to 20 minutes. However, many episodes of ischemia do not have any associated symptoms (silent ischemia). 199. ...... (LENGTH) episodes of cardiac ischemia can be a sign of a heart attack. A heart attack occurs when a blood clot blocks the flow of blood to the heart muscle. It can occur in an artery already narrowed by plaque, or a heart attack can occur after a blood clot breaks off from its original site and travels through the arteries. The blockage causes a sudden and 200. ...... (POSSIBLE) complete interruption of oxygen-rich blood flow, and the resulting heart attack could cause permanent damage and 201. ...... (SCAR) to the portion of the heart muscle supplied by the blocked artery. Prevention and treatment are related to modifying the underlying factors that promote the development of atherosclerosis and blood clot formation. Ischemia, whether silent or 202. ...... (SYMPTOM), is associated with increased risk for heart attack and other serious cardiac events. In people with silent ischemia, the first 203. ...... (INDICATE) of heart trouble is frequently a major heart attack. Studies have demonstrated that silent ischemia can be more common among certain ethnic or racial groups. For example, recent reports find that Asian Americans, in 204. ...... (COMPARE) to white Americans, experience 205. ...... (SIGNIFICANCE) fewer episodes of ischemic chest pain. Other symptoms, however, occur more frequently, such as 206. ...... (SHORT) of breath, fatigue and palpitations.
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The Circulatory System

Angina (or angina pectoris) is a type of temporary chest pain, pressure or discomfort. It is often described as a crushing, burning, heavy sensation, and it frequently radiates from the chest into other parts of the body, such as the neck, back, arms, jaw and abdomen. In women, angina may be experienced as 207. ...... (ABDOMEN) pain. 208. ...... (TYPE) episodes of angina can last anywhere from two to 15 minutes. Angina occurs when the heart is temporarily deprived of oxygen. If the angina occurs at 209. ...... (PREDICT) times, usually after exercise or exertion, it is called stable angina. If the angina occurs at unpredictable times, including at rest, and lasts longer than typical angina episodes, it is known as 210. ...... (STABLE) angina. It may 211. ...... (SIGN) an impending heart attack. People experiencing unstable angina should seek medical attention immediately. The angina treatment a patient receives depends on the severity of the 212. ...... (LIE) problem, namely the amount of damage to the heart. For most people with mild angina, a combination of drugs and lifestyle changes can control the symptoms. Lifestyle changes include: eating a hearthealthy diet, 213. ...... (LOW) cholesterol, getting regular exercise, quitting smoking, and controlling diabetes and high blood pressure. Some drugs used to treat angina work by either increasing the amount of oxygen delivered to the heart muscle or reducing the hearts need for oxygen. For people with more serious or 214. ...... (WORSE) angina, the doctor may recommend treatment to open blocked arteries. Before coronary angioplasty is done, the doctor will need to know the location and extent of the blockages in the coronary arteries. For this purpose, coronary angiography will be used. This test uses dye and special x-rays to show the insides of the patients arteries. During angiography, a small tube (or tubes) called a catheter is inserted in an artery, usually in the upper thigh. The catheter is threaded to the coronary arteries. Special dye, which can be seen on an x-ray, is injected through the catheter. X-ray pictures are taken as the dye flows through the coronary arteries. This 215. ...... (LINE) blockages, if any are present, and tells the doctor the location and extent of the blockages. For the angioplasty procedure, another catheter with a balloon on its tip (a balloon catheter) is inserted in the coronary artery and positioned in the blockage. The balloon is then expanded. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow. A small mesh tube called a stent usually is placed in the artery during angioplasty. The stent is wrapped around the deflated balloon catheter before the catheter is inserted in the artery. When the balloon is inflated to compress the plaque, the stent expands and attaches to the artery wall. The stent supports the inner artery wall and reduces the chance of the artery becoming narrowed or blocked again. Some stents are coated with medicines that are slowly and continuously released into the artery. These are called drug-eluting stents. The medicines help prevent the artery from becoming blocked with scar tissue that grows in the artery. 22. Use ONE word to fill in gaps 216-225: The hearts four valves help direct the flow of blood through its chambers. All of these valves are composed 216. ...... thin leaflets that when closed prevent a backflow of blood and when open permit the blood to move forward to its next destination. When a valve fails to close properly, as 217. ...... the case in a common disorder called mitral valve prolapse, there is a regurgitation or backflow of blood. A valve that fails to open properly a condition called valvular stenosis impairs the forward flow of blood to the body. In 218. ...... case, the heart has to work harder to pump enough blood to the body, eventually leading to heart muscle damage. Congestive heart failure, fainting, and arrhythmias are common signs of valve disease. In many cases, people can have a diseased heart valve for many years without suffering 219. ...... symptoms or even being aware 220. ...... the problem. Diseased valves can be detected by murmurs or other unusual sounds heard through a stethoscope. Ultrasound examination of the heart, also called echocardiography, in which sound waves are used to map internal structures, is also helpful. The most precise diagnosis is made by cardiac catheterisation and angiocardiography. Depending on the type of valvular problem, patients can often go for many years 221. ...... any special treatment. Drugs to treat heart valve disease do not provide a cure; they are used to relieve symptoms and prevent complications. For example, in mitral valve prolapse, a beta-blocking drug may be prescribed to treat worrisome symptoms such as palpitations and chest pain, even 222. ...... the condition itself is not serious. A diuretic may be added to prevent retention of salt and water; a salt-restricted diet may be recommended for the same reason. Anticoagulant drugs may be prescribed to prevent blood clots and antiarrhythmic drugs may be used to maintain a normal heart rate and rhythm. Since diseased heart valves are highly susceptible to a serious infection called bacterial endocarditis, it is important to take antibiotics before any dental or surgical procedure that may release bacteria 223. ...... the bloodstream. Depending on the severity of the disease, a doctor also may recommend avoiding strenuous activities and taking frequent rest periods during the day to minimise the workload on the heart. When the heart valves are seriously damaged and impairing blood flow to the rest of the body or causing heart muscle damage, surgery to replace the defective valve may 224. ...... recommended. For example, in rare cases of mitral valve prolapse, the valve may become so weakened that there is excessive backflow of blood or a danger of the
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The Circulatory System

valves rupturing, which can lead to death. In such unusual circumstances, replacement of the defective valve is necessary. 225. ...... number of durable and highly efficient artificial valves have been developed from animal parts, plastic, and metal. There are also newer surgical techniques to reconstruct defective heart valves. 23. For gaps 226-245 make a new word from the one in brackets that fits in the gap: The mitral valve prolapse, which is also referred to as the floppy mitral valve syndrome, is very common, especially among women. In fact, many experts consider it a 226. ...... (VARY) of normal function rather than a disease per se. Mitral valve prolapse is characterised by 227. ...... (FAIL) of a mitral valve leaflet to close properly. This makes a characteristic clicking sound that a doctor can usually hear. The floppy valve may also allow a backflow of some of the blood that normally should pass through the valve to the left ventricle. Most of the time, the condition is benign and entirely 228. ...... (SYMPTOM). In other instances, it can cause a variety of rather vague symptoms, including palpitations, chest pain, easy fatigue, feelings of 229. ...... (BREATH), and perhaps fainting. In rare cases, the person may develop serious cardiac 230. ...... (RHYTHM). 231. ...... (RECUR) can be prevented by establishing the proper diagnosis an echocardiogram can detect the abnormal valve and administering beta-blockers or other medication to control the heart rhythm. There are two major categories of cardiomyopathy: primary cardiomyopathy, defined as changes in the structure or function of the heart muscle that cannot be attributed to a specific cause, and secondary, which is associated with disorders of the heart or other organs. 232. ...... (CONGEST) cardiomyopathy is the most common primary form of heart muscle disease. Other types include hypertrophic and 233. ...... (RESTRICT). Heart muscle disease related to coronary artery disease is called ischemic cardiomyopathy. Instead of afflicting the elderly like most other heart diseases, heart muscle disease more 234. ...... (COMMON) strikes younger people. This group of disorders directly damages the muscle, impairing its ability to pump blood to other parts of the body. The causes of primary cardiomyopathy are frequently unknown. Some possible causes in congestive cases are infectious or non-infectious heart muscle inflammation, excessive alcohol 235. ...... (CONSUME), nutritional 236. ...... (DEFICIENT), complications of childbirth, and genetic disorders. Hypertrophic cardiomyopathy appears to be an inherited disease. Restrictive cardiomyopathy is usually caused by a disease called amyloidosis, which is associated with cancers of the blood. Men seem to be affected by congestive cardiomyopathy more often than women. Most cases of cardiomyopathy cannot be prevented. Avoiding smoking and excessive alcohol intake, 237. ...... (SURE) proper nutrition, and regular exercise are the only known preventive measures. In congestive cardiomyopathy, the heart becomes enlarged and 238. ...... (WEAK) and is unable to pump effectively. Hypertrophic cardiomyopathy, in contrast to the congestive type, involves an 239. ...... (LARGE) or overgrowth of the heart muscle, usually that of the left ventricle, but sometimes the right chamber is also involved. In one form of hypertrophic disease, the septum becomes 240. ...... (LARGE) and obstructs the flow of blood from the left ventricle into the aorta. The mitral valve also may be distorted by the 241. ...... (THICK) septum, leading to mitral insufficiency. The major symptoms are shortness of breath, 242. ...... (DIZZY) or fainting, chest pain, and cardiac arrhythmias. The condition can usually be diagnosed by characteristic physical findings, electrocardiogram, echocardiogram, and cardiac 243. ...... (CATHETERISE). A biopsy of the heart wall tissue may help distinguish between the different types of cardiomyopathy. Patients with cardiomyopathy should avoid cigarette smoking, 244. ...... (EXCESS) alcohol intake, too much salt consumption, and drugs that may have a toxic effect on the heart. Maintaining normal weight and blood pressure are important because this reduces the hearts workload. In some cases of hypertrophic cardiomyopathy, 245. ...... (STRESS) physical activity should be limited. 24. For questions 246-255 choose the best alternative from the ones in italics:

effect/ result/ product of other generalised infection or inflammatory disease.

Myocarditis is an inflammation of the heart muscle, usually as a(n) 246.

Myocarditis may start with flulike symptoms over a month or two. The most common 247. supplementary/ additional/ extra symptoms are disturbances in heart rhythm. If there is generalised weakening of the heart muscle, there may also be symptoms of heart failure. Myocarditis should be 248. suspected/ assumed/ supposed if these symptoms appear during a widespread viral infection, especially if there is no previous history of heart disease. Unfortunately, some cases of myocarditis are diagnosed only after they have advanced to produce heart failure. A physical exam and chest x-ray and echocardiogram then 249. present/ uncover/ show an enlarged heart and chest congestion. An electrocardiogram may 250. indicate/ point/ signify the damage to the hearts function. In some cases, drugs may be prescribed to treat specific cardiac symptoms, such as arrhythmias or heart failure. Rest to reduce the hearts workload is important, as is avoiding alcohol and other substances that may be toxic or irritating to the heart.
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The Circulatory System

Endocarditis is an infection involving the valves in the heart. It is always a serious infection and, if left 251. ignored/ untreated/ unprocessed, will result in death. Most often, endocarditis is caused by bacteria. 252. Families/ Groups/ Colonies of microorganisms, most commonly streptococcus or staphylococcus, form wartlike growths on the surface (endocardium) of the heart valves. These clusters of bacteria also contain blood cells and other material such as fibrin (a protein instrumental in blood clotting). Endocarditis is dangerous in two ways. Most commonly, the infection will eventually destroy the heart valves, leading to heart failure. In some cases, a cluster of bacteria and the surrounding debris, known as an embolus, can 253. break off/ come out/ cut off from the heart valve and travel through the bloodstream to other parts of the body. Depending on where the embolus travels to, it can cause heart attack, stroke, infection in the spleen or liver, and cut-off of blood supply to the arm or leg. Streptococcus and staphylococcus are the most 254. ordinary/ common/ regular bacteria that cause endocarditis, however heart valve infection can be caused by many other bacteria and fungi. Viruses are not known to cause endocarditis. Endocarditis most often occurs in people who already have a damaged heart valve, have congenital abnormalities of the heart, or have received an artificial heart valve. The abnormal valve or artificial valve can become seeded with bacteria after a seemingly minor procedure. Possible warning signs include weakness, fatigue, a slight fever, 255. hurting/ paining/ aching joints, and appearance of new, tiny dotlike areas on the back, chest, fingers, and toes. There is often a heart murmur indicating an abnormal valve or other heart defect. An eye exam may show small haemorrhages in the mucous membranes. In some cases, the disease comes on suddenly, with high fever, shaking, chills, and rapid destruction of the involved heart valve. Blood tests and cultures should be performed to identify the invading microorganism. An echocardiogram is used to check heart valves for bacterial growth and damage. 25. For questions 256-265 choose the best variant A, B or C: 256. ...... many people believe that all heart diseases are brought about by outside factors this is not true as one of the most 257. ...... types is congenital heart disease. The term congenital or 258. ...... heart disease refers to heart disease which is passed down through the family, and this is considered as being a(n) 259. ...... type as it is principally inevitable and unpreventable. Although congenital heart disease can be caused by many factors, some of them are actually 260. ...... . Causes may include unhealthy practices such as poor diet, little or no exercise, and smoking. All of these aspects can contribute to heart problem and can create the 261. ...... of congenital heart disease. Congestive heart failure occurs when the heart does not pump 262. ...... blood to the other organs in the body. Congestive heart failure can often result from heart problem and 263. ...... arteries. Congestive heart failure results in a heart which works a lot less efficiently than it should and can lead to further problems. Symptoms regularly consist of swelling and oedema, shortness of breath, and kidney problems which in turn can lead to mysterious weight gain. Even elevated blood pressure and alcohol 264. ...... can lead to congestive heart failure. A patient may be examined for congestive heart failure if they have suffered from heart problem in the past, are alcoholic, have a family 265. ...... of heart problems or show one or all of the symptoms that are caused by congestive heart failure. Treatment should begin instantly, starting with changes to diet and exercise, as patients should abolish salt from the diet altogether and sternly limit their fluid intake. Further treatment should be done by a professional. 256. 257. 258. 259. 260. 261. 262. 263. 264. 265. A. A. A. A. A. A. A. A. A. A. despite regular hereditary ingrained escapable progression adequate slim abuse description B. B. B. B. B. B. B. B. B. B. although universal traditional congenital preventable order satisfactory constricted mistreatment account C. C. C. C. C. C. C. C. C. C. however common transmissible habitual unnecessary sequence tolerable slight maltreatment history

26. For gaps 266-275, make a new word from the one in brackets: Pulmonary heart disease is a disease that comes from a lung, or pulmonary disorder, or a 266. ...... (COMPLICATE) of lung problems where the blood flow into the lungs is slowed or even totally blocked, resulting in increased pressure on the lungs. There are a number of different symptoms that 267. ...... (TYPE) come with pulmonary heart disease, such as shortness of breath, syncope, dyspnoea, and chest pain. It is a state which is often 268. ...... (DIAGNOSE), and has frequently progressed to late stages by the time that it is actually correctly diagnosed. It has been previously chronic and 269. ...... (TREAT) with a poor survival rate. However, there
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The Circulatory System

are now numerous new treatments which are accessible and which have 270. ...... (EXTEND) improved the overall prognosis of this disease. 271. ...... (RHEUMATISM) heart disease frequently derives from strep throat infections. This can be a reason for alarm for many because strep throat, while often 272. ...... (PREVENT), is a quite common condition that affects many people who do not treat a minor sore throat infection in time. However, rheumatic heart disease that comes from strep throat is fairly rare. If rheumatic fever, which happens due to chronic strep throat, is contracted and leads to rheumatic heart disease, the situation can be treated in a way that is much easier than the common treatments for other types of heart problem. This treatment usually involves taking anti-273. ...... (INFLAME) medication to reverse any possible cardiac problems the fever might make. This does not rule out the risk for the 274. ...... (REQUIRE) for more advanced treatment such as surgery, but it does signify the 275. ...... (PROBABLE) for a simple, yet effective treatment. Glossary bulge - bend outward, become swollen or protuberant haemochromatosis - hereditary disorder of metabolism involving the deposition of iron-containing pigments in the tissues that is characterised especially by joint or abdominal pain, weakness, and fatigue and that may lead to bronzing of the skin, arthritis, diabetes, cirrhosis, or heart disease if untreated ischemia - deficient supply of blood to a body part (as the heart or brain) that is due to obstruction of the inflow of arterial blood Marfan syndrome - disorder of connective tissue that is inherited as a dominant trait and is characterised by abnormal elongation of the long bones and often by ocular and circulatory defects megakaryocyte - large cell that has a lobulated nucleus, is found especially in the bone marrow, and is the source of blood platelets replenish - to fill or build up again strep throat - inflammatory sore throat caused by streptococci and marked by fever, also called septic sore throat

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