16   5 Cardiovascular disease (CVD) can occur in the blood vessels of organs such as the brain and the heart. The diagram shows a human heart and the location of a blood clot in one of the blood vessels in this heart. A B C D location of blood clot in vessel E (a) (i) Which labelled blood vessel carries oxygenated blood under lower pressure than the aorta? (1) A B C D (ii) Which labelled blood vessel carries blood from the right ventricle? (1) A B C D Turn over 17   (b) The endothelium of vessel E was damaged and collagen fibres in the vessel wall were exposed. This resulted in the formation of a blood clot. The blood clot blocked vessel E. This caused a heart attack. (i) Sketch an outline on the diagram to show the area of heart muscle that would receive a reduced blood supply. (1) (ii) Describe how this blood clot could have been formed. (4) ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... 18   (c) The risk of a heart attack in humans can be reduced by treatment with platelet inhibitors. The effectiveness of a platelet inhibitor (PI) drug was investigated. One group of patients took a new platelet inhibitor (PI) drug whereas the control group were given no treatment. The graph shows the percentage of these patients who had a heart attack. 15 10 5 0 Percentage of patients who had a heart attack (%) 0 100 200 300 400 PI group control group Days Explain the results of this investigation. (3) ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... (Total for Question 5 = 10 marks) Turn over 19   6 Smoking cigarettes can result in a lung disease called emphysema. The diagram shows stages in the development of emphysema. Healthy lungs Healthy alveolus Inflammatory response triggered Inflammatory chemicals dissolve alveolar septum Harmful particles trapped in alveolus Emphysema Large air cavity forms in alveolus (a) Explain why emphysema affects the rate of gas exchange between the alveolus and the blood. (4) ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... 20   *(b) Forced expiration volume (FEV) is the maximum volume of air a person can breathe out in one second. Emphysema reduces FEV. The effects of ageing and long‑term cigarette smoking on FEV and the development of emphysema have been investigated. The graph shows the results of these investigations. start of symptoms of emphysema severe disability due to emphysema 4 3 2 1 0 FEV / dm3 25 45 65 85 non-smoker smoker Age / years Scientists also investigated the changes in the heart and pulmonary blood vessels of patients with emphysema. The diagrams show the heart and pulmonary blood vessels in a patient with emphysema and a patient without emphysema. with emphysema without emphysema Turn over 21   Evaluate the effects of smoking on the respiratory system, heart and pulmonary circulation. (6) ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................... (Total for Question 6 = 10 marks)