By L. Sprague De Camp

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Perforations of the walls of an artery or the aorta, a heart chamber, or a coronary artery also can occur rarely. Fluid should never be forced through a catheter from which blood cannot be withdrawn, particularly if the catheter is in the ascending aorta; a clot can be expressed and embolize peripherally to the brain. THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS Plate 2-10 Physiology NORMAL SATURATIONS (O2) AND PRESSURE mm Hg a 10 5 25 20 v 97% c 97% L. atrium: mean < 8 140 120 10 5 Aorta 95% 120/80 R.

In valve closure, because the areas of adjacent lunulae appose each other, such perforations do not cause insufficiency of the valve and are functionally of no significance. THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS Plate 1-12 Anatomy Ascending aorta Atrioventricular part Membranous septum Interventricular part Superior vena cava Sinoatrial (SA) nodal artery Pulmonary valve Atrioventricular (AV) node Sinoatrial (SA) node Atrioventricular (AV) bundle (of His) Right bundle Crista terminalis Purkinje fibers Septomarginal trabecula (moderator band) Anterior papillary muscle Subendocardial branches (Purkinje fibers) Right fibrous ring (of tricuspid valve) Inferior vena cava Right side Specialized Conduction System of Heart The specialized heart tissues include the sinoatrial (SA) node, atrioventricular (AV) node, common atrioventricular bundle or bundle of His, right and left bundle branches, and peripheral ramifications of these bundle branches, which make up the subendocardial and intramyocardial Purkinje network.

The response may be tachycardia or bradycardia, depending on whether the sympathetic or parasympathetic system is activated more strongly in the individual patient. Tachycardia is the common response in excitement. 25 Plate 2-7 Cardiovascular System Hematologic changes in pregnancy 60 Estrogen Plasma volume Percent increase in intravascular volumes (% increase) Renin Angiotensin II Aldosterone Na+/H2O retention Erythropoiesis 50 Blood volume 40 30 20 Red cell volume 10 Human chorionic somatomammotropin 5 10 15 20 25 Weeks of gestation 30 35 40 Multifactorial stimulation of fluid retention and erythropoiesis in pregnancy results in a 50% increase in plasma volume and a 30% increase in red cell mass, creating a relative “physiologic” anemia and an increased blood volume.

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A Gun for Dinosaur by L. Sprague De Camp

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