Cardiovascular System: Blood Vessels

Blood Vessel Anatomy:

● Three types of blood vessels:
○ Arteries - carry blood away from the heart to capillaries.
○ Capillaries - allow for the exchange of materials between the blood
and tissues.
■ Where oxygenation takes places
○ Veins - deliver blood from the capillaries back to the heart.
○ A is for away
○ V is for vavalik

Vessel Anatomy:
● Structure of Arteries and Veins
○ Tunica Externa
■ Outermost layer
■ Composed of loose connective tissue
● Anchor vessel to surrounding tissue
● Passage for nerves & small vessels supplying blood to
external wall
○ Fed by diffusion
● Tunica media
○ Middle & thickest layer
■ Composed of smooth muscle fibers
■ More muscular in arteries than in veins
■ Has presence of elastic fibers
○ Cause changes in blood vessel diameter
■ Due to having smooth muscle and elastic fibers
■ Can dilate & constrict
● Tunica Interna
○ Lining of the vessel wall
○ Endothelium - lining inside of blood vessel
■ Composed of simple squamous epithelial tissue & fibrous
tissue
○ Smooth, secretes chemical to repel platelets
■ If not, platelets would stick & cause clogs/blocks
Structural Diff Between an Artery & a Vein:

● In the vein, blood flow is one

way due to valve
● Artery can contract in
response to stimuli
Arteriole and Venule:
● Artery smaller than vein.

Types of Arteries:
● Conducting Arteries
○ Largest of the arteries
○ Pulmonary arteries,the aorta, & common carotid arteries
○ Carry blood away from the heart
■ Withstand the high pressure generated by ventricular systole
● Have the most muscle & elastic fibers in their walls so
that they can expand with each heartbeat & then return
to shape
● If they can’t withstand pressure, it could cause injury
● Distributing Arteries
○ These arteries are medium-size.
○ Distribute blood from the conducting arteries to organs
○ Examples: the hepatic artery & renal arteries (liver & kidney artery)
○ Have some elastic fibers in their walls to hold their shape
■ Don’t need to expand as much as conducting arteries with
every heartbeat
● Resistance Arteries
○ smallest of the arteries.
○ Examples are the small arterioles that deliver blood to the capillaries.
■ Arterioles have little, if any, elastic fibers.
■ Vein counterpart of arterioles is venules
○ Each arteriole can feed a bed of approx.100 capillaries.
○ Precapillary sphincters (circular muscles) in the arterioles open
/close to regulate blood flow to the capillaries.
○ Whatever type of artery, they all have muscle that enable it to
dilate/constrict while veins remain open

Connection among Blood Vessels:

● Arterioles - circular, smooth muscle cells
○ act as precapillary sphincters to control blood flow to capillaries
○ Connect directly to small veins (venules), forming an
arteriovenous(AV) shunt
Capillaries:
● Most numerous and smallest of all vessels
○ Wall consists of endothelium
■ One cell thick with its basement membrane
● site of exchange of fluids and other materials(eg O2, CO2) between the
blood and tissues.
● Blood cells move in a single file
○ Ensure max.transfer of materials
● Most abundant in active tissues
○ Because active tissues need more O2 & nutrients
● Less abundant in connective tissues
● 3 kinds:
○ Continuous capillaries
■ Formed by continuous endothelial cells and basal lamina
● Act as selective filters
○ Fenestrated capillaries
■ Have small openings called fenestrations/fenestra
● Allow components of blood and interstitial fluid to
bypass endothelial cells on their way to /from tissue
○ Arise from pinocytic vesicles which open onto
both luminal / basal surfaces of the cell
○ Discontinuous capillaries
■ Formed by fenestrated endothelial cells, w/ch may not even
form a complete layer of cells
■ AKA sinusoidal capillary
● Incomplete basal lamina
● Form large irregularly shaped cells called sinusoids
○ Found where a very free exchange of substances /
even cells between bloodstream and organ is
advantageous (eg liver, spleen, red bone marrow)

Veins:
● Return blood back to the heart.
● Has big diameter
● Blood flows from capillaries into venules.
○ Venules unite to form medium veins, which in turn unite to form large
veins.
■ As diameter of veins increases, so does their volume
■ Total volume of all veins is greater than than of the arteries
● Increase volume -> blood pressure is less in veins than
in arteries
● Decrease in pressure -> walls need not to be thick as it is
in the arteries
 ● Walls of veins collapse when a vein is empty

Veins:
● Venules – smallest of the veins
○ Receive blood from capillaries
○ No smooth muscle in the tunica media
● Medium veins
○ Have smooth muscle in the tunica media
○ Ex: in Radial and ulnar veins
○ Valves formed by folds of tunica externa
■ Help direct blood flow of blood to the heart to prevent
backflow
● Large veins
○ Smooth muscle in all 3 tunics
○ Ex: Vena cavae, pulmonary veins, internal jugular veins, renal veins

Circulatory Routes:
● Coronary Route
● Systemic Route
● Alternative Routes
○ Portal Routes
○ Anastomoses

Coronary Route:
● Supplies blood to the heart.
● Heart – 0.5% of body wt., 5% of circulating blood
○ Rich blood supply – reliant on aerobic metabolism
■ w/ch is why it need O2 rich blood
○ Has its own circulation for nutrition
■ Like coronary arteries and veins
● Pressure of blood filling the cusps of the valve as it tries to return to the
heart during ventricular diastole forces oxygen-rich blood into the right
and left coronary arteries
● 20% of blood from capillaries is directly returned to the right atrium from
small veins
○ The rest is collected by the great cardiac vein and the middle cardiac
vein and emptied to the coronary sinus before entering the right
atrium
Coronary Circulation (anterior view)

Coronary Circulation (Posterior view)

Blood Supply to the Heart:

● Left coronary artery - left side of the
aorta, passes posterior to the
pulmonary trunk
● Branches
○ Branches is where the main
artery is divided into
● Left Coronary Arter branches:
○ The anterior interventricular
artery – supplies the
interventricular septum and
 onto the anterior walls of both ventricles.
○ The circumflex artery - supplies the left
atrium and the posterior part of the left
ventricle.
● Right coronary artery - right side of the aorta
and descends in the coronary sulcus on the
anterior surface of the heart
○ supply the right atrium and almost all
of the right ventricle.
● R. Coronary artery Branches:
○ Marginal artery
○ Posterior interventricular artery in the
posterior interventricular sulcus.
● Cardiac veins - carry deoxygenated blood
from the heart wall to the right atrium
● Coronary sinus - largest
○ returns almost all the venous blood from the heart to the right
atrium.
○ Tributaries - like the branches but diff. Term for the veins
■ Great cardiac vein
■ middle cardiac vein
■ small cardiac vein
■ anterior cardiac veins

Blood Flow:
Circulatory routes:
● The typical systemic route includes one capillary bed.
● Heart → arteries → capillaries → veins → heart

Pulmonary Circulation:
● RV → pulmonary arteries (O2 poor blood away from the heart to the lungs)
→ arteriole → capillaries covering air sacs (alveoli) in the lungs
○ O2 is loaded within capillaries, CO2 unloaded
○ O2 poor blood must have contact w/ capillaries as that is where
oxygenation happens
● Capillaries → venules → Pulmonary veins (returning oxygen rich blood to
the heart) →Left atrium
● Purpose of Pulmonary circulation is to oxygenate O2 poor blood

Circulatory routes:
● Alt. routes vary in the No. of capillary beds / involve the merging of vessels.
● 2 types (portal and anastamoses)
○ Portal routes
○ Anastomoses

Portal Route:
● Portal route – contains 2 capillary beds before blood is returned to the
heart
○ Allows materials to be exchanged 2x between blood and tissues
before returning to heart
■ Eg. Hypothalamus and pituitary gland, kidney, between
intestines and liver
○ Route: Heart → arteries → capillaries → intervening vessels →
capillaries → veins → heart
● Has 2 capillary exchange happen in the portal route!

Hepatic Portal Route:

● Route:
● Heart → arteries → capillaries (nutrients in the intestines)→ veins in the
hepatic portal vein (intervening vessels)→ capillary beds in the liver →
processing of nutrients → hepatic veins → 2 capillary beds → heart

Anastomoses:
● Anastomoses – involves blood vessels merging together
 ● 3 types:
○ Arteriovenous anastamoses
■ often called a shunt.
■ Merges an artery w/ a vein, therefore capillary bed is skipped
■ Eg. Fingers, palms, toes, ears (extreme cold) -> heat is not lost
■ Why fingers turn blue when cold
○ Arterial anastomoses
■ 2 arteries merge to provide collateral routes to the same area.
■ Around joints
■ Heart and brain
○ Venous anastomoses
■ Most common
■ Merging veins to drain in an organ

Venous Return:
● Blood is returned to heart through veins by 5 mechanisms:
○ Pressure gradient – pressure in the veins due to the action of heart
propel blood toward heart
■ If there is enough pressure, blood goes back to heart
○ Gravity – blood moves through veins above the heart due to gravity, &
it flows downhill
○ Thoracic pump – Increase in volume and decrease pressure w/in the
chest
■ As air rushes in to equalize pressure, blood in the veins of the
abdominal cavity is sucked into the IVC( Inferior vena cava) of
the thoracic cavity
○ Cardiac suction - atria return to shape during atrial diastole
■ Less pressure in the atria than in the SVC, IVC and pulmonary
vein
● Blood is sucked into the atria from the veins
○ Skeletal muscle pump – skeletal muscle massages blood through the
veins, whole valves in the veins prevent backflow

Blood Pressure, Resistance, and Flow:

● Blood flow is the amount of blood flowing to an area in a given amount of
time (expressed in mL/min).
● Blood pressure - the force of blood against vessel walls.
○ dependent on cardiac output, blood volume, & resistance.
○ Cardiac output – takes into account the force of ventricular
contractions
○ ex:. How strong is the pump from the hose?
● Blood volume – more blood exerts a greater force on the vessel walls
 ○ Eg. How far is the hose’s water faucet turned on?
● 3 Factors that affects Resistance:
○ Blood viscosity (thickness) – Depends on amount of albumin(protein)
& RBCs
■ Thicker blood - more resistance to flow and requires more
pressure to get it to move.
■ Patients w/ thicker blood are more likely to have strokes / heart
attacks / kidney failure
● Diabetics - thicker blood due to being rich in sugar
● SMOKERS! SMOKING MAKES BLOOD VISCOUS!! IT ALSO
CONTRACTS ARTERIES & INCREASES PRESSURE!
○ Vessel length
■ The greater the vessel length, the more friction occurs between
the blood and the vessel walls.
● Friction slows blood
● Obese persons – more pressure is needed to propel
blood through their longer system of vessels to feed
increased tissue mass
○ Vessel radius
■ the smaller the radius, the more blood comes in contact with
the walls of the vessel.
● Blood pressure is measured as systolic pressure/diastolic pressure with
the sphygmomanometer
● Ex. 120/70 mmHg
○ 1st no. - Systolic pressure created in the brachial artery during
ventricular systole - 120 mmHg
○ 2nd no. - Diastolic pressure created in the brachial artery during
ventricular diastole - 70mmHg
● Pulse pressure = systolic pressure/diastolic pressure.( 120/70 mmHg )
○ Pulse Pressure is then = to 50
○ Increase in stroke volume, Increase in pulse pressure

Terms to Remember:
● Hypotension – chronic low blood pressure <90/60 mmHg
● Prehypertension – resting systolic blood pressure is 120-139 mmHg and/or
diastolic pressure is 80-89 mmHg
● Hypertension – resting pressures are >140/90mmHg
● These are critical as they could kill a patient, albeit slowly

Mean Arterial Pressure:

● Ave. pressure that the arteries must be able to withstand.
○ MAP = diastolic pressure x 1/3 pulse pressure.
 ○ Cardiac cycle includes rest between heartbeats
■ More time in a relaxed state than in a contracted state
■ Blood pressure is further altered by arteries expanding and
then recoiling, so pressure doesn’t reach a peak and then
drop to zero

Regulation of Blood Pressure and Flow:

● Blood pressure and flow can be regulated locally, hormonally, and neurally.
● Local Control:
○ Opening of precapillary sphincters
○ Inflammation
○ Reactive hyperemia
○ Angiogenesis
● Local control:
○ Opening of precapillary sphincters
■ Controlled by waste product and nutrient levels (eg CO2, lactic
acid, H+)
■ Wastes – vasodilation -> opening of precapillary sphincters –
increase blood flow -> more O2 to remove wastes-> closure of
precapillary sphincters
○ Inflammation
■ Injury, pathogen -> damaged tissues or Basophils release
vasodilators
● Vasodilation -> increasing blood flow -> More WBCs to
fight pathogens -> inflammation
○ Reactive hyperemia
■ If Circulation is cut off -> vessels overdilate -> flushing area
with blood
○ Angiogenesis
■ Persistent build up of metabolic wastes -> Growth of new
vessels
● Collateral (additional) circulation in the heart
● Fast growing cancer tumors
● Hormonal control
○ ADH/ Antidiuretic Hormone
■ AKA Vassopressin
■ Increases blood volume and blood pressure
○ Aldosterone
■ Mineralocorticoid
■ Increases absorption Na ions and causes H2O retention
increase in the effects of ADH
■ Remember: Where Na goes H2O follows
○ Angiotensin II
 ■ Potent vasoconstrictor which increases resistance and blood
pressure
○ Epinephrine
■ Vasoconstriction increases blood pressure
● Neural control
○ Vasomotor center in medulla oblongata – sympathetic fibers
(vasoconstriction) except cardiac and skeletal muscles
○ 3 reflexes involved:
■ Baroreflex – aortic arch & carotid arteries response to high BP
● High BP stretches carotid arteries triggering a reflex->
increase vagal stimulation -> decrease blood pressure
■ Chemoreflex – du to levels of O2, CO2 and pH
● High CO2 or pH (decrease pH) trigger vasoconstriction
and increase blood pressure -> increase blood flow to
lungs for better gas exchange -> Increase O2, decrease
CO2, increase pH .
■ Medullary ischemic reflex – blood flow to the brain
● A direct monitor of cerebral blood pressure (eg.
Standing after being in supine position)
● Decrease blood flow to brain ->increase HR,
vasoconstriction -> Increases pressure and blood flow
to the brain

Shock:
● Serious, life-threatening condition characterized by the body’s organ
systems not getting enough blood flow to sustain normal function
● Cardiogenic shock – heart cannot pump enough blood to meet body’s
needs
○ Myocardial infarction, arrhythmias, dysfunctional valves, rupture in
septum
● Hypovolemic shock – body undergoes severe fluid and blood loss
○ Not enough blood to pump to meet body’s needs
○ Blood loss, extreme perspiration, diarrhea, vomiting
○ Basically, not enough blood, not enough warmth and O2Body would
do everything in order to save up fluids
○ Maglalabas si body ng aldosteron to save Na, where Na goes H2O
follows and body is trying to save fluids
● Septic shock – any microorganism causing an infection
○ No ability to fight infection -> infection causes decrease in BP ->
organ dysfunction
● Neurogenic shock – stimulus to sympathetic nervous system is lost
○ Inability to keep appropriate amount of muscle tone in the tunica
media of blood vessels
 ■ Pooling of blood

Effects of Exercise on Cardiac Output:

● Propioceptors -> +responses in cardiac accelerator center in the medulla
oblongata -> stimulates sympathetic nervous system -> increase cardiac
output by raising the heart rate and the stroke volume.
● Increase metabolic wastes in tissues -> vasodilation and opening of
precapillary sphincters -> increase blood flow -> wastes away from the
blood -> stimulate chemoreceptor -> increase blood flow to lungs
● Muscles massage veins -> increase venous return -> increase stroke volume
-> increase Cardiac output
○ Chronic exercise – trigger angiogenesis, increase growth of new
blood vessels to improve collateral circulation
○ Cardiac reserve – 4-5x larger than resting CO
○ Heart muscle becomes stronger.
○ Stroke volume is higher at rest.
○ Heart rate is slower at rest.

Effects of Aging on Cardiovascular System:

● If blood pressure remains normal throughout life, age-related changes to
the cardiovascular system may be minimal.
● If an individual is hypertensive, age-related changes may include an
increase in vascular resistance, decreased stroke volume, and thicker, less
elastic vessels that are prone to atherosclerosis.
● Lifestyle choices like exercising, dieting, and not smoking can make a
difference.
○ Physical conditioning – improve aerobic capacity
■ Slow / reduces vascular stiffening
○ Increase collateral circulation in the heart
○ Diet low in sodium – keep BP under control
○ Stop smoking - helps keep blood from becoming thick, decrease
workload of the heart
○ 1 way to lower BP is to take restrict on Na
○ Another way to lwer BP is to stop smoking

Diagnostic Cardiovascular Tests:

● Assess Physiology of Heart and Anatomy
○ Electrocardiography - evaluates the electrical activity of the heart
○ Echocardiography - AKA 2D Echo; uses sound waves to create a
picture of the heart M-mode image
 ○ The Heart CT Scan - computerized tomography of the heart; Usually
for cancer
○ Nuclear Heart Scan - uses radioactive dye to view the heart
● Assess Cardiac Function During Activity
○ Holter Monitor - a machine continuously worn by the patient to
monitor heart rhythms during everyday activity
○ Stress Test - monitors the heart’s electrical activity, blood pressure,
and heart ; rate while the patient is exercising; What type of exercise
provokes chest pain
● Visualize Coronary Vessels, Arteries and Veins
○ Cardiac Catherization - uses contrast dye to examine the movement
of the dye through the valves, heart chambers, and coronary
arteries
■ The dye movement is viewed by X- ray.
■ to determine w/ch vessel is blocked
○ CT Angiography - a noninvasive way to perform coronary
angiography using a CT scan
○ Ultrasound - uses sound waves to visualize internal structures
○ Venography - uses contrast dye examined under X-ray to view blood
vessels.

Murmur:
● Is an abnormal heart sound
○ Functional murmur – not a problem; is normal
○ Pathological murmur- Not normal, due to disease

Prolapsed Valve:
● Valve leaflet that “billows'' or bends in a way that prevents it from closing
properly
● Since it can’t close properly, there is spilling or a bot of backflow
○ Degeneration of the valve or the chorda tendinae
■ Inability to close -> regurgitation
■ Ventricular enlargement, arrhythmias, endocarditis, stroke
● Mitral valve prolapse – most common
● Tx: surgery, supportive

Atherosclerosis:
● Build-up of fatty deposits w/in arterial walls
○ Causes walls to roughen and project to the lumen
○ Hastened by hypertension, &/or viral infection
■ Weakens the arterial wall
 ■ Monocytes in tunica interna -> tunica media
■ Fatty deposits (atheromatous plaque)
■ Deposition of platelets -> obstruction -> blood clots
● Arteriosclerosis – calcification of atheroma
● Coronary artery disease (CAD) – obstruction of coronary arteries
● Dx: coronary angiography, 2d echo, ecg, stress test, nuclear stress test
● Tx: decrease BP, surgery, lifestyle changes

Non-pharmacological Treatments:
● Angioplasty – threading a balloon-tipped catheter through a vessel in the
leg to the blocked coronary artery
○ Balloon is inflated within the blockage to open vessel lumen
○ Stent may be used as part of balloon system to hold vessel open
● Coronary artery bypass surgery
○ Harvesting a vessel and inserting its ends before and after the
obstruction to effectively bypass the blockage
○ Eg. Great saphenous vein, collateral branch of mammary artery
○ Papalitan yung non-funct’n na vessel w/ another one from another
part of the body

Thrombophlebitis:
● Inflammation of a vein caused by thrombosis
● Etiology: surgery, immobility, clotting abnormality
● Types:
○ Deep venous thrombosis – deep veins
○ Superficial thrombophlebitis – veins close to skin’s surfaces
● Symptoms: pain, redness, tenderness on affected area
● Dx: ultrasound, venography
● Tx: NSAIDs, antibiotic, anti- coagulants, thrombolytics
● Complication
○ Swelling
○ Pulmonary embolism – blood clot travelled to the lung; could lead to
death

Varicose Veins:
● Veins in which the valves that prevent the backflow of blood are not
working properly
● Etiology: thrombophlebitis, pregnancy
● Treatment: supportive, surgery
Myocardial Infarction (MI):
● AKA heart attack
● Lack of blood flow (ischemia) - > myocardial infarction (MI)
○ Death of myocardial tissue fed by the affected artery
○ It is like strangling the heart to the neck
● Symptoms:
○ Crushing pain radiating to neck, jaw, left arm
○ Shortness of breath
○ Sweating
○ Nausea
○ Feeling of impending doom
○ Others: light-headedness, sleep disturbance, indigestion, anxiety,
fatigue

Angina Pectoris:
● Heaviness or pain in the chest caused by temporary or reversible
myocardial ischemia
● Hypoxemia from reduced blood flow -> heart uses anaerobic respiration
○ However, it could lead to build-up of lactic acid- w/ch is waste
product, makes pain

Congestive Heart Failure (CHF)

● Occurs when one ventricle is not as efficient as the other ventricle.
○ Blood pressure builds in the circuit before the ventricle, resulting in
edema in the preceding tissues.
■ Pulmonary edema
■ Systemic edema

Left-Sided Heart Failure leading to Pulmonary Edema

● More blood ejected from right than L. Ventricle
● BP build in capillaries w/in lungs & cause swelling
● High BP in lungs forces fluid out into pulmonary tissue
○ Why patients have a feeling of drowning
○ Because lungs are filled w/ fluid

Right- Sided Heart Failure leading to Systemic Edema

● More blood is ejected from L. ventricle than the right
● The BP build in capillaries out in the body tissues
● It therefore forces fluid out into systemic tissues
○ Why patients have swollen feet/foot
Disorders of the Heart and Vessels:
● Congenital Heart Defects
○ Patent ductus arteriosus (PDA)
■ Incomplete closure of the ductus arteriosus after birth
■ This lead to circulation disturbance
■ It leads to mixing of oxygenated and deoxygenated blood
■ Eto di nagclose yung duct ng maayos
○ Atrial septal defect (ASD)
■ Hole in the septum dividing the right and left atrium
● Oxygenated blood from the left atrium to mix with
deoxygenated blood from the right atrium
● Eto may hole sa mismomg wall separating them
○ Ventricular septal defect (VSD)
■ Hole in the septum dividing the right and left ventricle
● Oxygenated blood in left ventricle mixes w/
deoxygenated blood in the right ventricle
● Same w/ the one before this kas sa ventricles yung hole
● Valve defects
○ Stenosis – narrowing of valves
○ Atresia – valve that lacks a hole for blood to travel through
○ Regurgitation – a valve that does not close tightly enough and allows
blood to flow back through; insufficient valve closing

Tetralogy of Fallot:
● Pulmonary valve stenosis, VSD, overriding aorta, and right ventricular
hypertrophy.
○ Overriding of aorta – aorta is positioned between right and left
ventricles, allowing deoxygenated blood from the right ventricle to
flow to the aorta instead of the pulmonary artery

-MANGALINDAN, FM
BSPH-1A