Anatomy

HEART AND CIRCULATORY SYSTEM

Date | Lecture LE #1

I. CARDIOVASCULAR SYSTEM
Circulatory system
• transports fluids throughout the body
• consists of the cardiovascular and lymphatic systems
• Cardiovascular
o heart and blood vessels make up the blood transportation network,
o heart pumps blood through the body’s vast system of blood vessels
o blood carries nutrients, oxygen, and waste products to and from the cells
VASCULAR CIRCUITS
• Heart → consists of two muscular pumps
o Muscular organ that pumps blood through the body’s vast system of blood vessels
o Blood carries nutrients, oxygen, and waste products to and from the cell
o Cardiac muscles: Striated, Involuntary muscles; adjacently located; act in series
o 4 Chambers
▪ Atrium
 Left – receives oxygenated blood from lungs
 Right – receives unoxygenated blood from body
▪ Ventricles
 Left – pumps oxygenated blood to body
 Right – pumps unoxygenated blood to lungs
o the Pulmonary and Systemic circulations or circuits
▪ Pulmonary Circulation
 This circuit, from the right ventricle through the lungs to the left atrium, is
the pulmonary circulation
 Brings unoxygenated blood to lungs
▪ Systemic Circulation
 This circuit, from left ventricle to right atrium, is the systemic circulation
 Distributes oxygenated blood to the rest of the body
BLOOD VESSELS
• Three types of blood vessels:
o Arteries
o Veins
o Capillaries
• Blood under high pressure leaves the heart and is distributed to the body by a branching system
of thick-walled Arteries.
• The final distributing vessels Arterioles, deliver oxygen-rich blood to Capillaries.
• Capillaries
o form a capillary bed, where the interchange of oxygen, nutrients, waste products, and
other substances with the extracellular fluid occurs
o Blood from the capillary bed passes into thin-walled venules, which resemble wide
capillaries
o Venules drain into small veins that open into larger veins
o Largest veins →Superior and Inferior Venae Cavae – return poorly oxygenated blood
to the heart
• Most vessels of the circulatory system have three coats, or tunics:
1) Tunica intima
o inner lining consisting of a single layer of extremely flattened epithelial cells,
▪ endothelium, supported by delicate connective tissue.
o Capillaries
▪ consist only of this tunic
▪ with blood capillaries also having a supporting basement
membrane.
2) Tunica media
o a middle layer consisting primarily of smooth muscle;
o most variable coat.
o Arteries, veins, and lymphatic ducts are distinguished by the thickness of this layer relative to the size of the lumen,
its organization,
o In arteries, the presence of variable amounts of elastic fibers.
3) Tunica adventitia
o outer connective tissue layer or sheath

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 ARTERIES
• carry blood from the heart and distribute it to the body
• blood passes through arteries of decreasing caliber
• Types of Arteries are distinguished on the basis of:
→ overall size
→ elastic tissue amounts
→ muscle in the tunica media amounts
→ lumen wall thickness
→ function
• Artery Size and Type are continuum
→ there is a gradual change in morphological characteristics from one type to another
→ There are three types of arteries:
1) Large Elastic – conducting arteries
▪ have many elastic layers (sheets of elastic fibers) in their walls
▪ initially receive the cardiac output.
▪ elasticity enables them to expand when they receive the cardiac output from the ventricles
o minimizing the pressure change
o return to normal size between ventricular contractions, as they continue to push the blood into the
medium arteries downstream.
o maintains the blood pressure in the arterial system between cardiac contractions
(at a time when ventricular pressure falls to zero)
o minimizes the ebb in blood pressure as the heart contracts and relaxes
▪ Examples:
o Aorta
o Brachiocephalic trunk
o Subclavian
o Carotid arteries
o Pulmonary trunk and arteries
2) Medium Muscular – distributing arteries
▪ walls that consist chiefly of circularly disposed smooth muscle fibers.
▪ ability to decrease their diameter (vasoconstrict) regulates the flow of blood to different parts of
▪ the body as required by circumstance
o activity, thermoregulation
▪ Pulsatile contractions of their muscular walls (regardless of lumen caliber) temporarily and rhythmically
constrict their lumina in progressive sequence, propelling and distributing blood to various parts of the body
▪ Most of the named arteries, including those observed in the body wall and limbs during dissection such as the
brachial or femoral arteries, are medium muscular arteries.
3) Small Arteries and Arterioles
▪ narrow lumina and thick muscular walls.
▪ degree of filling of the capillary beds and level of arterial pressure within the vascular system are regulated
mainly by the degree of tonus (firmness) in the smooth muscle of the arteriolar walls
▪ If the tonus is above normal, hypertension (high blood pressure) results
▪ Small arteries are usually not named or specifically identified during dissection
▪ arterioles can be observed only under magnification.

Anastomoses
• communications between multiple branches of an artery
• provide numerous potential detours for blood flow in case the usual pathway is obstructed by compression due to the position of a
joint, pathology, or surgical ligation
• If a main channel is occluded
o the smaller alternate channels can usually increase in size over a period of time
o providing a collateral circulation or alternate pathway that ensures the blood supply to structures distal to the blockage
• Collateral pathways require time to open adequately
o insufficient to compensate for sudden occlusion or ligation.
o There are areas, where collateral circulation does not exist or is inadequate to replace the main channel.
• Arteries that do not anastomose with adjacent arteries → true (anatomic) terminal arteries (end arteries)
o Occlusion of an end artery interrupts the blood supply to the structure or segment of an organ it supplies.
o True terminal arteries supply the retina, for example, where occlusion will result in blindness.
• While not true terminal arteries, functional terminal arteries (arteries with ineffectual anastomoses) supply segments of the brain, liver,
kidneys, spleen, and intestines; they may also exist in the heart.

Circulatory Routes
• Venous anastomosis
→ Most common
→ One vein empties directly into another
→ Reason vein blockage is less serious than arterial blockage
• Arteria anastomosis
→ Two arteries merge
→ Provides collateral alternative routes of blood supply to a tissue
→ Coronary circulation and around joints

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 VEINS
• generally return low-oxygen blood from the capillary beds to the heart
• gives the veins a dark blue appearance
• The large pulmonary veins
o atypical
o carry oxygen-rich blood from the lungs to the heart
• Lower blood pressure in the venous system
o Walls (specifically, the tunica media) of veins are thinner than those of their companion arteries
o Normally, veins do not pulsate and do not squirt or spurt blood when severed.
o There are three sizes of veins:
1) Venules
→ Smallest veins; unnamed
→ Drain capillary beds
→ Join similar vessels to form small veins
→ Magnification is required to observe venules
→ Small veins are the tributaries of larger veins that unite to form venous plexuses (vein networks)
 Dorsal venous arch of foot
2) Medium veins
→ Drain venous plexuses
→ Accompany medium arteries
→ Have flap valves that permit blood to flow toward the heart but not in the reverse direction
 In the limbs
 In some other locations where the flow of blood is opposed by Gravity pull
→ Examples
 Superficial veins (Cephalic and Basilic veins)
 Great and small Saphenous veins of Lower Limbs
3) Large veins
→ wide bundles of longitudinal smooth muscle
→ a well-developed tunica adventitia
→ Example
 Superior vena cava.
• more abundant than arteries
• walls are thinner, their diameters are usually larger than those of the corresponding artery
• The thin walls allow veins to have a large capacity for expansion and do so when blood return to the heart is impeded by compression
or internal pressures
• Example
o Valsalva maneuver - taking a large breath and holding it
• arteries and veins make up a circuit
• expected that half the blood volume would be in the arteries and half in the veins
o veins’ larger diameter and ability to expand
o only 20% of the blood occupies arteries
o 80% is in the veins.
• often depicted as single vessels in illustrations for simplicity, veins tend to be double or multiple.
• Those that accompany deep arteries —accompanying veins (L. venae comitantes)—surround them in an irregular
• branching network
• Accompanying Veins
o arrangement serves as a countercurrent heat exchanger
▪ the warm arterial blood warming the cooler venous blood as it returns to the heart from a cold limb.
o occupy a relatively unyielding Fascial vascular sheath with the artery they accompany
▪ stretched and flattened as the artery expands during contraction of the heart,
▪ Arteriovenous pump – aid in driving venous blood toward the heart
• Systemic Veins
o more variable than arteries, and venous anastomoses
o Venous anastomoses
▪ natural communications, direct or indirect, between two veins—occur more often between them.
o Musculovenous Type of Venous pump
▪ The outward expansion of the bellies of contracting skeletal muscles in the limbs
▪ limited by the deep fascia
▪ compresses the veins, “milking” the blood superiorly toward the heart;
o The valves of the veins break up the columns of blood
▪ relieving the more dependent parts of excessive pressure
▪ allowing venous blood to flow only toward the heart.
o The venous congestion that hot and tired feet experience at the end of a busy day is relieved by resting the feet on a
footstool that is higher than the trunk (of the body)
▪ This position of the feet also helps the veins return blood to the heart

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 BLOOD CAPILLARIES
• Oxygen and Nutrients
o Carried by arteries → to benefit cells that make up the tissues of the body
o Must leave the transporting vessels
o Enter the extravascular space between the cells, extracellular (intercellular) space in which the cells live
• simple endothelial tubes connecting the arterial and venous sides of the circulation
• allow the exchange of materials with the interstitial or extracellular fluid (ECF)
• generally arranged in capillary beds → networks that connect the arterioles and venules
• blood enters the capillary beds through arterioles that control the flow and is drained from them by venules
• Capillary walls are relatively impermeable to plasma proteins.
o Downstream, at the venous end of the capillary bed
o ECF—now containing waste products and carbon dioxide—is reabsorbed into the blood
▪ result of the osmotic pressure from the higher concentrations of proteins within the capillary
→ principle is referred to as the Starling hypothesis
• Arteriovenous anastomoses (AVAs) / AV shunts
o direct connections between the small arterioles and venules proximal to the capillary beds they supply and drain
o permit blood to pass directly from arterial to the venous side of circulation w/o passing through capillaries
o Numerous in skin, in some regions such as fingers
• In some situations, blood passes through two capillary beds before returning to the heart;
• Portal venous system
o a venous system linking two capillary beds
• Hepatic Portal system
o The venous system by which nutrient-rich blood passes from the capillary beds of the alimentary tract to the capillary beds
or sinusoids of the liver
How to Describe Arteries (e.g. Axillary Artery)
• Description: Location and Relations
o Axillary Fossa Supplying Structures around the shoulder
• Commencement: Exact Point where it starts
o Outer border of first rib
• Origin: artery from which it arises from
o Subclavian artery
• Termination: landmark where it ends
o Lower border of Teres major
• Branches: 6 branches
• Continuation: brachial artery

CLINICAL BOX
CARDIOVASCULAR SYSTEM
Arteriosclerosis: Ischemia and Infarction
• The most common acquired disease of arteries and a common finding in cadaver dissection → arteriosclerosis
• Atherosclerosis
o hardening of the arteries
o a group of diseases characterized by thickening and loss of elasticity of the arterial walls.
o a common form, atherosclerosis, is associated with the buildup of fat (mainly cholesterol) in the arterial walls.
o Atheromatous plaque (atheroma)
▪ calcium deposit
▪ well-demarcated, hardened yellow areas or swellings on the intimal surfaces of arteries (Fig. B1.9A).
o Thrombosis
▪ consequent arterial narrowing and surface irregularity
▪ formation of a local intravascular clot, or thrombus)
▪ occlude the artery or be flushed into the bloodstream and block smaller vessels distally as an embolus
o Embolus
▪ a plug occluding a vessel
• Consequences of atherosclerosis:
o Ischemia – reduction of blood supply to an organ or region
o Infarction – local death, or necrosis, of an area of tissue or an organ resulting from reduced blood supply).
o These consequences are particularly significant in regard to the
▪ Heart = ischemic heart disease and myocardial infarction or heart attack
▪ Brain = stroke
▪ Distal parts of limbs = gangrene

Varicose Veins
• When walls of veins lose their elasticity, they become weak.
• weakened vein → dilates under the pressure of supporting a column of blood against gravity → results in varicose veins
• abnormally swollen, twisted veins most often seen in the legs
• have a caliber greater than normal, and their valve cusps do not meet or have been destroyed by inflammation.
• have incompetent valves → column of blood ascending toward the heart is unbroken, placing increased pressure on weakened walls,
• further exacerbating the varicosity problem. occur in the presence of degenerated deep fascia.
• Incompetent fascia is incapable of containing the expansion of contracting muscles;
o (musculofascial) musculovenous pump is ineffective

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