Cardiovascular system

Dr. Gul Fatima/ RPh Lecturer, SICP, Lodhran

Contents
• Heart:
• Location of heart
• Structure of heart
• Blood supply to heart
• Blood vessels:
• Main blood vessels (arising and entering heart)
• Types of blood vessels with examples
 INTRODUCTION
• CVS is transport system of body
• It comprises blood, heart and blood vessels
• It supplies nutrients and oxygen to various
tissues of body
• Remove waste products from various tissues
of body
• The conveying media is liquid in the form of
blood which flows in close tubular system

FUNCTIONS
• Transport of nutrients and hormones
• Remove waste products
• Exchange of gases
• Immunity
• Blood vessels transport blood
- Carries oxygen and Carbon dioxide
- Carries nutrients and wastes
 Components of CVS
• The cardiovascular system is divided into 2 main parts:
• Heart whose constant pumping action ensures the circulation of blood,
• Blood vessels which form a network through which blood flows.
• The CVS ensures a continuous flow of blood to all the body and its function is
subjected to continual physiological adjustments to maintain an adequate blood
supply
• The heart pumps blood into 2 anatomically separate systems of blood vessels.
Pulmonary circulation Systemic circulation
• blood moves between the heart and• blood moves between the heart
the lungs. and the rest of the body.
• It transports deoxygenated blood to• Carries oxygenated blood from
the lungs to absorb oxygen and heart to body
release carbon dioxide. • Return to heart with
• oxygenated blood then flows back to deoxygenated blood
the heart.
 Some important facts….
• During pregnancy;
- The heart starts beating between 3 and 4 weeks after conception.
- At 4 weeks, it beats between 105 and 120 times per minute.
• In young adults, the heart beats between 70 (at rest) and 200 (heavy exercise) times per
minute
• When at rest, the heart can pump approximately 1.3 gallons (5 quarts= 4.73 liters) of
blood per minute.

• Blood circulates through the entire system of blood vessels in

only 20 seconds.
• In a day, the heart pumps around 2,000 gallons (7570 liters) of
blood through thousands of miles of blood vessels

Location of heart
• The heart lies in the thoracic cavity in the mediastinum
(central compartment of thoracic cavity, space between
lungs).
• Its posterior border is near the vertebral column, and its
anterior border is near the sternum.
• It lies obliquely, a little more to the left than the right.
• Base of heart - the upper portion, where it is attached to
several large blood vessels.
• wide portion of the heart lies beneath the second rib.
• Apex of heart:
• The distal end of the heart extends downward, to the left,
ending in a blunt point called the apex, which is even
with the fifth intercostal space.
 Organs associated with the heart
• Inferiorly – the apex rests on diaphragm
• Superiorly – the great blood vessels, i.e. the aorta, superior vena cava,
pulmonary artery and pulmonary veins
• Posteriorly – the esophagus, trachea, left and right bronchus, descending
aorta, inferior vena cava and thoracic vertebrae
• Laterally – the lungs – the left lung overlaps the left side of the heart
• Anteriorly – the sternum, ribs and intercostal muscles

Apexoflung Oesophagus

Clavicle

Trachea
Leftbrachiocephalicvein
Rightbrachiocephalicvein
Aorta
Pulmonaryartery
Superiorvenacava
-Aleftpulmonaryvein

Leftlung(retracted)

-Heart

Diaphragm

Inferiorvenacava Aorta
 Structure of heart
• The heart is a roughly cone shaped hollow muscular organ.
• It is about 10 cm long and is about the size of the owner’s fist.
• It weighs about 225 g in women and is heavier in men (about 310 g)
• The heart wall is composed of 3 layers of tissue:
• Pericardium
• Myocardium
• Endocardium

Pericardium
• The heart is enclosed in the pericardium i.e. outermost double-walled sac
- Fibrous pericardium Outer sac
- Serous pericardium Inner sac
Fibrous pericardium
• consists of tough, dense connective tissue
• It functions to protect the heart and anchor it to surrounding structures like
continuous with the tunica adventitia (outer most layer of blood vessels) of the
great blood vessels above and is adherent to the diaphragm below
• Prevent the heart to overfilled with blood
 Serous pericardium
• lies deep to fibrous pericardium
• consists of a continuous double layer of serous membrane
• thin and slippery membrane with two layers, and forms a closed sac enclosing the heart
• The serous membrane consists of flattened epithelial cells which secretes fluid,
called pericardial fluid
• The pericardial fluid is secreted into the pericardial space (space between the two layers of
serous pericardium) which allows smooth movement between the layers of heart when the
heartbeats. (protects the heart)
• The Outer layer Parietal pericardium lines the fibrous pericardium
• Inner layer Visceral pericardium epicardium attached to the heart muscle
 Myocardium
• It is composed of specialized cardiac muscle found only in the heart
• The cardiac muscles are branched, striated and involuntary sheet like structures
• The ‘sheet’ arrangement of the myocardium enables the atria and ventricles to
contract in a coordinated and efficient manner
• Because of the end-to-end continuity of the fibers, each one does not need to have
a separate nerve supply
• Running through the myocardium is also the network of specialized conducting
fibers responsible for transmitting the heart’s electrical signals. (SA node, AV
node, bundle of His)
• The myocardium is supported by a network of fine fibers that run through all the
heart muscle called the fibrous skeleton of the heart
• The myocardium is thickest at the apex and thins out towards the base
• Also, it is thickest in the left ventricle, which has the greatest workload

Endocardium
• This lines the chambers and valves of the heart.
• It is a thin, smooth membrane to ensure smooth flow of blood
through the heart.
• It consists of flattened epithelial cells, and it is continuous with the
endothelium (inner most layer of blood vessels) lining the blood
vessels
 Internal structure of heart

Heart chambers
• The heart consist of four chambers:
• The upper two are called Atria.
1. Right atrium.
2. Left atrium.
• The lower two are called ventricles.
3. Right ventricle.
4. Left ventricle.

Heart valve
• Each side is divided by an atrioventricular valve into the upper atrium and the
ventricle below.
• Right atrioventricular valve OR tricuspid valve has 3 flaps or cusps
• Left atrioventricular valve OR mitral valve has 2 cusps
Heart tendon
• The chordae tendineae, also known as the heartstrings, are cord like tendons that
connect the papillary muscles to the tricuspid and bicuspid valves of the heart.
• stabilize valves, helping to maintain the unidirectional flow of blood through the
heart.
Semilunar valve
There is another two types of one way valve that prevent the back flow of blood
into the ventricles
Septum
• The heart is divided into a right
and left side that is separated
by the septum (a solid wall-
like structure called septum.
This keeps blood from one side
of the heart from mixing with
blood from the other side)
• Heart valves are flap-like
structures that allow blood to
flow in one direction.
 Atria
• The upper chambers are called atria and receive blood returning to the heart
• The atria are smaller, thin-walled, and contain less myocardium compared to the
ventricles.
• They are able to expand with the addition of blood.
• The force of contraction is weak.
• It is able to force ¼ of the total blood volume entering into the ventricle. The rest of
the blood enters the atria passively.
• A prominent ridges of muscles known as pectinate muscles or musculi pectinati are
found on the anterior atrial wall and inner surface of the auricle.
• They develops a stable and large force of contraction
 Right Atrium
• Situated in the upper right section of the heart,
• receives deoxygenated blood from the body from two major
veins,
- superior vena cava
- inferior vena cava.
• This chamber then pumps blood through the tricuspid
valve into the right ventricle situated below.
• The right atrium contains the SA node which sends an
impulse throughout the heart causing the cardiac muscle of
the atrium to contract in a coordinated manner.

Left Atrium
• Opposite to the right atrium and is the upper part of the
heart
• Four pulmonary veins enter the left atrium, carrying blood
from the lungs
• receives oxygenated blood from the lungs via the right and
left pulmonary veins
• Pumps blood through the left atrioventricular (A-V) or
bicuspid valve or mitral valve into the left ventricle.
• The left atrium makes up most of the base of the heart.
• mitral valve, which prevents it from flowing back into the
left atrium from the ventricle
 Ventricles
• The ventricles are the bottom two chambers of the heart, one on the left and one on the
right side.
• They are separated by septum
• They are larger, thicker and contain more myocardium than the atria.
• The ventricles of the heart are muscular chambers because they are responsible for
propelling blood out of the heart.
• They are connected to arteries that carry blood away from the heart to the lungs and body.
• Chordae tendineae: Thread-like bands of fibrous tissue which attach on one end to the
edges of the tricuspid and mitral valves of the heart and on the other end to the papillary
muscles, small muscles within the heart that serve to anchor the valves.
• It prevents the valves of heart from movement by holding the flaps tightly against the
strong flow of blood. It allows the blood to flow in one direction only.

• The papillary muscles ( large projection) are

muscles located in the ventricles of the heart.
They attach to the cusps of the
atrioventricular valves (also known as the
mitral and tricuspid valves) via the chordae
tendineae.
• prevent inversion or prolapse of these valves
on systole (or ventricular contraction).
• The trabeculae carneae (columnae carneae,
or meaty ridges), are rounded or irregular
muscular columns which project from the
inner surface of the right and left ventricle of
the heart
 Right ventricle
• Located below the right atrium,
• This chamber receives deoxygenated blood from
the right atrium and pumps it through
the pulmonary valve and into the lungs via the
right and left pulmonary artery.

Left ventricle
• This chamber is the lower part of the heart
• left ventricle forms most of the apex
• The cavity of the left ventricle is almost circular.
• that receives oxygen-rich blood from the left atrium
above it,
• pumps blood through the aortic valve to be distributed
throughout the entire body via the aorta, including to
the heart muscle itself through the coronary arteries.
• The left ventricle is the thickest of the four chambers
because it is the final chamber that oxygenated blood
must be pumped through before it is distributed
throughout the body via the circulatory system.
 • Flow of blood in the heart is 1-way; blood
enters the heart via the atria and passes
into the ventricles below
• The valves between the atria and
ventricles open and close passively
according to changes in pressure in the
chambers
• They open when the pressure in the
atria is greater than that in the
ventricles.
• During ventricular systole (contraction)
the pressure in the ventricles rises above
that in the atria and the valves snapshut,
preventing backward flow of blood.

Heart Valves
• Heart valves are flap-like structures that
allow blood to flow in one direction.
• The heart has 2 kinds of valves:
1. Atrioventricular valves
- Mitral Valve
- Tricuspid Valve
2. Semilunar valves
- Pulmonary Valve
- Aortic Valve
 ATRIOVENTRICULAR VALVES
These valves are located between atrium and ventricle. They prevent backflow of blood
from the ventricles to the atria while the ventricles contract
Mitral Valve:
• Also called bicuspid valve
• located between the left atrium and the left ventricle.
• It prevents the back flow of blood as it is pumped from the left atrium to the left
ventricle.

Tricuspid Valve
• Also known as right A-V valve
• located between the right atrium and the right ventricle.
• three flexible projections called cusps
• cusps or flaps of endothelium that are reinforced by cores of connective tissue.
• cusps of the tricuspid valve are attached to strong fibers called chordae tendineae,
which originate from small papillary muscles that project inward from the
ventricle walls
• It prevents the back flow of blood as it is pumped from the right atrium to the right
ventricle.
 SEMILUNAR VALVES
• They are shaped like a half moon, hence the name semilunar.
• They are present in arteries leaving the heart, preventing backflow from arteries to
ventricles.
• Ventricles contract semilunar valves are forced to open causing their cusps to
flatten against the artery walls blood pass through valves increase
intraventricular pressure in aorta and pulmonary trunk
• Ventricle relax blood flow back into heart filling the cups valve closed
• pulmonary trunk and aorta proximal end contained CT ring provide firm
attachment for heart valves and muscle fiber
• They prevent the outlets of the atria and ventricles from dilating during contraction.

Pulmonary Valve:
• located in the right ventricle and opens to the pulmonary trunk to send
deoxygenated blood to the lungs.
• The semi-lunar pulmonary valve is located between the right ventricle and the
pulmonary artery.
• It prevents the back flow of blood as it is pumped from the right ventricle to
the pulmonary artery.
Aortic Valve:
• Present at the base of aorta
• The semi-lunar aortic valve is located between the left ventricle and the aorta.
• aortic valve has three cusps
• This valve opens to allow blood to leave the left ventricle during contraction
and flow into the ascending aorta.
• Blood then flows through the aortic arch and into the descending aorta. When
• the left ventricle relaxes, the valve closes to prevent blood from backing up
into the ventricle.
 Heart sounds
• The audible sounds that can be heard from the heart are made by the
closing of the heart valves. These sounds are referred to as the "lub-
dub" sounds.
• The "lub" sound is made by the contraction of the ventricles and the
closing of the atrioventricular valves.
• The "dub" sound is made by the semilunar valves closing.
 Flow of blood through heart
• Superior and inferior venae cava right atrium right
ventricle pulmonary artery or trunk (the only artery in
the body which carries deoxygenated blood).
• After leaving the heart the pulmonary artery divides into
left and right pulmonary arteries (carrying the venous
blood) lungs
• Two pulmonary veins (carrying oxygenated blood)
left atrium left ventricle aorta (the first artery of the
general circulation)
• Pulmonary trunk leaves the heart from the upperpart of
the right ventricle, and the aorta leaves from the upper
part of the left ventricle

Conducting system of heart

Small groups of specialized cells in the heart that
initiate and conduct impulses, causing
coordinated and synchronized contraction of the Atrioventricular
(AV)node
heart muscle. Sinoatrial
(SA)node
• Sinoatrial (SA) node
BundleofHis
• Atrioventricular (AV) node Leftbundle
branch
• AV bundles (bundle of His)
• Purkinje Fibers
Leftanterior
division

Rightbundle Leftposterior
branch division

Purkiniefibres
 ➢ Sinoatrial node (SA node)
• Autonomic system control rate of heart beat
• Pacemaker of the heart; as it sets heart rate
• lies in the wall of right atrium just lateral to junction of superior vena cava
• Triggers atrial contraction
• Firing rate = 60-80 beats per minute
• Composed of network of specialized cardiac muscle fibers which are thinner than
ordinary cardiac fibers
• Diameter of fiber are 3-4 micrometer
• No intercalated discs found
• Joined by desmosomes and gap junction
• Contained less myofibrils

➢ Atrioventricular node (AV node)

Lies in the wall of the atrial near the atrioventricular valves
transmits the electrical signals from the atria into the ventricles.
secondary pacemaker function
Firing rate = 40–60 beats per minute
Composed of meshwork of small cardiac muscles fibers embedded in collagenous
fibers that contained blood vessels and nerve fibers
Cardiomyocytes of both SA node and AV node are similar
➢ Atrioventricular bundle (AV bundle or bundle of His)
mass of specialized fibers originates from the AV node
At the upper end of the ventricular septum, it divides into right and left bundle
branches
In the ventricles, the branches break up into fine fibers, called the Purkinje fibers
The AV bundle, bundle branches and Purkinje fibers transmit electrical impulses
from the AV node to the apex of the heart where the wave of ventricular
contraction begins, then sweeps upwards and outwards, pumping blood into the
pulmonary artery and the aorta.
 Impulse generating and heart contraction
• SA node generate rhythmic contraction of atrial
myocardium
• Electrical impulse passes through atrial wall and reaches AV
node
• AV node stimulates the contraction of ventricular
myocardium
• Then impulse passes from AV node to specialized muscle
bundles called atrioventricular bundle or Bundle of His
• These bundles splits into two branches in interventricular
septum
• One is called right bundle branch and second is called left
bundle branch
• These branches activates the right and left myocardium of
ventricles
• Both branches of AV bundles taper out to form network
called purkinje fiber which will stimulate individual group

Blood vessels
• The blood vessels are the components of the circulatory system that transports
blood throughout the human body
• Blood vessels vary in structure, size and function
• a tubular structure carrying blood through the tissues and organs; a vein, artery, or
capillary
Functions
• These vessels transport blood cells, nutrients, and oxygen to the tissues of the body
• They also take waste and carbon dioxide away from the tissue
 Structure of Blood Vessels
• Their walls consist of 3 layers of tissue:
• tunica adventitia or outer layer of fibrous tissue
• tunica media or middle layer of smooth muscle and elastic tissue
• tunica intima or inner lining of squamous epithelium called endothelium
• a blood-containing space known as the lumen.
• The amount of muscular and elastic tissue varies in the arteries depending upon their
size and function.
• In large arteries, (sometimes called elastic arteries) tunica media contains more
elastic tissue and less smooth muscle
• In the smallest arteries (called arterioles) tunica media consists almost entirely of
smooth muscle
• Arteries have thicker walls than veins to withstand the high pressure of arterial blood

Tunica interna
• Inner most smooth layer,
• It is made up of a;
- endothelium
- Basement membrane
- Elastin
➢ The endothelium – this layers is in direct contact with lumen.
• made up of squamous epithelium.
• It surrounds the whole of the CVS.
• its smooth surface facilitate the frictionless movement of the blood.
• The endothelium helps prevent blood clotting and may also help in regulating blood
flow.
• It releases nitric oxide to relax smooth muscle of the vessel.
 Tunica interna
The basement membrane
• Present deep to endothelium.
• Give supportive base to the endothelium
• Anchors endothelium to connective tissue.
• Has a framework of collagen fibers which give it flexibility and tensile strength.
Elastic layer
• Made up of elastic fibers
• Make boundary between tunica interna and tunica media.

Tunica media
• Middle layer
• Composed of smooth muscles and elastic fibers.
• Display greatest variation in size and composition among different type of blood
vessels.
• The smooth muscles in tunica media regulate the diameter of vessels.
• It is innervated by sympathetic nervous system which upon stimulation cause
smooth muscle to contract and decrease its diameter (vasoconstriction)
• Play important in blood flow and blood pressure regulation by vasoconstriction
and vasodilatation.
• The tunica media is separated from the next layer, the tunica externa, by a thin
band of fibers known as the external elastic membrane.
Tunica externa/Adventitia
• Thin layer of Connective tissue and
Collagen fibers that protect and
reinforce vessels.
• It is attached to the surrounding tissues
and contains many lymphatic vessels
and nerve fibers.
• The tunica externa of larger blood
vessels contains many tiny blood
vessels, which comprise a system
known as the vasa vasorum.
• This system nourishes the outer tissues
of blood vessel walls. The luminal inner
portions of vessels obtain nutrients
directly from the blood.

Functional classification of Blood Vessels

• Different types of blood vessels include:
• Arteries and arterioles
• Capillaries
• Veins and venules
 Arteries & Arterioles
• Carry blood away from the heart
• Designed to withstand pressure during systole.
• A small-diameter blood vessel which forms part of the microcirculation that
extends from an artery and leads to capillaries are called arterioles. They are
elastic or muscular.
Types of arteries
i. Elastic arteries/ Conducting arteries
ii. Muscular Arteries/ distributing arteries
iii. Arterioles / Resistance arteries

Elastic arteries
• Thick-walled arteries with elastin in all three layers
• located near the heart
• largest diameter (larger than 10mm ) in the body and the
most elastic , with large lumens.
• Large lumen offer low resistance= easier blood flow
• Elastic arteries are also known as conducting arteries
Large diameter of the lumen enables it to accept a large
volume of blood from the heart and conduct it to smaller
branches.
• They include the aorta and its primary branches.
• Examples : aorta, Pulmonary trunk, subclavian artery
 Muscular arteries
• Smaller arteries
• distal to elastic arteries
• Distal muscular arteries, also known as distributing
arteries deliver blood to body organs.
• Thickest tunica media of all blood vessels, in
proportion to their size.
• A muscular artery’s diameter is 0.1-10mm
• tunica media of muscular arteries, in comparison
with elastic arteries, have relatively more smooth
muscle and less elastic tissue.
• Because of this, they have more vasoconstrictive
actions but are less able to stretch.
• Examples: Brachial artery, Femoral artery

Arterioles
• smallest of all arteries
• diameter of their lumens is between 0.3 mm and 10 µm
• The largest arterioles have three tunics,
• a single layer of smooth muscle cells circled around an
endothelial lining.
• The tunica media of larger arterioles is mostly made up of
smooth muscle, with a small amount of elastic fibers in
various areas.
• Arterioles have a poorly defined tunica externa.
• The smaller arterioles lead directly into the capillary beds.
• arterioles are also called resistance vessels because more
pressure is needed to push blood through them than
arteries. This is because they are more constricted.
• Control blood flow via vasoconstriction
 Capillaries
• Functional unit of cardiovascular system
• smallest-diameter blood vessels
• 8- 10 µm in size
• connect the smallest arterioles to the smallest venules.
• Made up only of endothelial tissue (squamous epithelium) and basement membrane
• walls of capillaries are the semipermeable layer through which substances in blood are
exchanged
• contain a thin tunica intima

Types
There are three types of capillaries, which include:
• continuous,
• fenestrated,
• sinusoidal.
 Continuous Capillaries
• Most abundant
• Make continuous tube where cells are held together by tight junctions.
• Have narrow “intercellular clefts” of about 4 nm in endothelial membrane
• endothelium forms a complete lining
• average 1 mm in length with an average lumen diameter of 8 to 10 µm,
• Allows exchange of small molecules like causing red blood cells to move through
them one at a time.
• Some exchange takes place by pinocytosis
• More impermeable in brain (blood brain barrier)
• Found in brain, muscle tissues, skin

-Pericyte

Redblood
cellinlumen

•Intercellular
cleft
-Endothelial
cell

Basement
membrane

Tightjunction Pinocytotic
Endothelial vesicles
nucleus

(a)Continuouscapillary.Leastpermeable,andmost
common(e.g.,skin,muscle).
 Fenestrated Capillaries
• window-like pores(70- 100nm) penetrate the endothelial lining,
• allow rapid exchange of solutes and water between the interstitial fluid and
plasma
• Found in;
- choroid plexus of the brain,
- vessels in endocrine organs such as the hypothalamus, pancreas, and pineal,
pituitary, and thyroid glands.
- absorptive areas of the intestinal tract,
- in the kidneys’ filtration sites.
• The amount of pores and levels of permeability are different between various
organs and between the actual capillaries themselves.

Pinocytotic
vesicles

-Redblood
cellinlumen

-Fenestrations
(pores)

Endothelial •Intercellular
nucleus cleft
Basementmembrane
Tightjunction -Endothelial
cell

(b)Fenestratedcapillary.Largefenestrations(pores)
increasepermeability.Occursinareasofactive
absorptionorfiltration(e.g.,kidney,smallintestine).
 Sinusoidal Capillaries
• sinusoids are similar to fenestrated capillaries but are more irregular in shape, with
a flattened appearance.
• lined with phagocytes are called sinusoids.
• basement membrane is either absent or very thin.
• allow free exchange of solutes and water, including plasma proteins, between
interstitial fluid and blood.
• These capillaries are found in the bone marrow, liver, spleen, and endocrine organs
such as the adrenal and pituitary glands.
• In the sinusoidal capillaries of the liver, bone marrow, and spleen, phagocytic cells
remove damaged red blood cells, cellular debris, and pathogens from the blood.
 Capillary Beds
• Capillaries exist in clusters called capillary beds
• Microcirculation– Interwoven networks of capillaries between arterioles and venules
• Terminal arteriole metarteriole
• any of the delicate blood vessels that branch from the smallest arterioles and connect
with the capillary bed also called precapillary
• Metarteriole continuous with thoroughfare channel (intermediate between capillary
and venule)
• Thoroughfare channel postcapillary venule that drains bed

Capillary Beds: Two Types of Vessels

➢ Vascular shunt (metarteriole—thoroughfare channel)
• A blood vessel that links an artery directly to a vein, allowing the blood to bypass
the capillaries in certain areas.
• Shunt vessels can control blood flow by constriction and dilation.
• Directly connects terminal arteriole and postcapillary venule
➢ True capillaries
• the actual exchange vessels.
• 10 to 100 exchange vessels per capillary bed
• Branch off metarteriole or terminal arteriole
 Figure18.4aAnatomyofacapillarybed.
1Vascularshunt

Precapillarysphincters
MetarterioleThoroughfare
channel

True
capillaries

Terminalarteriole Postcapillaryvenule

(a) Sphinctersopen-bloodflowsthroughtruecapillaries.
©2014PearsonEducation,Inc.

Blood Flow Through Capillary Beds

• Precapillary sphincter surrounds each true capillary’s root at the metarteriole.
• cuff of smooth muscle fibers
• function as a valve, regulating blood flow into the capillary.
• Open precapillary sphincters allow blood to flow through the true capillaries
for tissue cell exchanges.
• Closed precapillary sphincters cause blood to flow through the vascular
shunts, bypassing the tissue cells.
• More than one artery can supply blood to a capillary bed.
 Anastomoses
• Most organs receive blood from more than one
arterial branch
• They provide alternate pathways, called collateral
channels, for blood to reach a given body region
(a)Simplestpathway

Types (1capillarybed)

- arterio-arterial anastomosis between arteries

(b)Portalsystem
- veno-venous anastomosis b/w veins (2capillarybeds)

- arterio-venous anastomosis between an artery

and a vein (c)Arteriovenous
anastomosis
• Common at joints, in abdominal organs, brain, and (shunt)

heart; none in retina, kidneys, spleen

• Vascular shunts of capillaries are examples of
arteriovenous anastomoses
• Venous anastomoses are common
(d)Venous (e)Arterial
anastomoses

End-arteries
• End-artery is an artery that is the sole source of
blood to a tissue,
• Mostly don’t form anastomoses
• e.g. the central artery to the retina of the eye.
• Anatomic End arteries Vessels whose terminal
branches do not anastomose with branches of
arteries supplying adjacent areas.
• Functional End arteries: The terminal branches
do anastomose with those of adjacent arteries,
but the anastomosis is insufficient to keep the
tissue alive if one of the arteries is occluded.
 Veins & Venules
• Veins are the blood vessels that return blood at low pressure to the heart.
• The walls of the veins are thinner (lesser tunica media) than arteries but have the
same three layers of tissue
• Less elastic than arteries
• Greater diameter of lumen
• Veins are called capacitance vessels because they are distensible, and therefore have
the capacity to hold a large proportion ( 65%) of the body’s blood.
• Some veins possess valves (esp. in veins of lower limbs), which prevent backflow of
blood, ensuring that it flows towards the heart
• The smallest veins are called venules.

Venules
• Capillaries join to form venule
• Diameter = 8 and 100 µm
• smallest or postcapillary venules made up only of endothelium, surrounded by
pericytes or contractile cells.
• larger venules have a thin tunica externa o
• ne to two layers of smooth muscle cells making up their tunica media.
• Venules combine to form veins.
 Veins
• Vein contain valve like structure e.g. pulmonary valve between pulmonary vein
and right ventricle that prevent the back flow of blood in heart
• Veins have three tunics thinner walls and larger lumens then arteries
• tunica media has little smooth muscle or elastin.

Types of veins
Deep veins
• These are found in muscles or along bones
• The tunica intima of a deep vein usually has a one-way valve to prevent blood
from flowing backward
• Nearby muscles also compress the deep vein to keep blood moving forward
Superficial veins
• These are located in the fatty layer under your skin
• The tunica intima of a superficial vein can also have a one-way valve
• However, without a nearby muscle for compression, they tend to move blood more
slowly than deep veins do.
Connecting veins
• Blood from superficial veins is often directed into the deep veins through short veins
called connecting veins
• Valves in these veins allow blood to flow from the superficial veins to your deep veins,
but not the other way.
Pulmonary veins
• The pulmonary circuit carries deoxygenated blood from your heart to your lungs
• Once your lungs oxygenate the blood, the pulmonary circuit brings it back to your
heart
• There are four pulmonary veins (2 from each lungs) They’re unique because they carry
oxygenated blood
• All other veins carry only deoxygenated blood
Systemic veins
• The systemic circuit carries deoxygenated blood from the rest of the body back to your
heart, where it then enters the pulmonary circuit for oxygen
• Most veins are systemic vein
Blood supply to vessels
• Thick-walled blood vessels receive their blood supply via a network of blood
vessels called the vasa vasorum
• Thin-walled vessels receive oxygen and nutrients by diffusion from the blood
passing through them

Nerve supply to vessels

• The smooth muscle in the tunica media of veins and arteries is supplied by nerves
of the autonomic nervous system (vagus nerve and sympathetic nerves) which
arise from the cardiovascular center in the medulla oblongata which change the
diameter of blood vessels, controlling the volume of blood they contain.
• The blood vessels most closely regulated by this nervous mechanism are the
arterioles, as they contain proportionately most smooth muscle in their walls

Circulations
• Coronary circulation – the circulation of blood within the heart.
• Pulmonary circulation – the flow of blood between the heart and lungs.
• Systemic circulation – the flow of blood between the heart and the
cells of the body.
• Portal Circulation
 Major Arteries and Veins

Pulmonary Circuit Arteries pulmonary artery

Veins pulmonary vein
Systemic Circuit Vein superior vena cava - coronary vein
- brachiocephalic vein
-jugular vein
-subclavian vein
-axillary vein
- brachial vein
inferior vena cava -Hepatic vein
-Hepatic portal vein
-Superior mesenteric vein
-Inferior mesenteric vein
-renal vein
-gonadal vein
-common iliac vein
- internal iliac vein
- external iliac vein
- femoral vein
Systemic Arteries Aorta
circuit Ascending aorta - Right & left coronary artery
Aortic arch - Brachiocephalic artery
- common carotid artery
- internal carotid artery
- External carotid artery
- Subclavian artery
- Axillary artery
- Brachial artery
- Left common carotid artery
- Left subclavian artery
Descending aorta - Celiac trunk
- Superior mesenteric artery
- Renal artery
- Gonadal artery
- Inferior mesenteric artery
Common iliac a. -Internal iliac artery
-External iliac artery
- Femoral artery

Systemic circulation
• All the systemic arteries arise from aorta
• The aorta is the largest artery of the body,
with a diameter of 2–3 cm
• It emerges from the left ventricle posterior
to pulmonary trunk
• On the basis of anatomic location it can be
divided into four segments:
i. The ascending aorta
ii. The arch of aorta
iii. The thoracic aorta
iv. Abdominal aorta
 Ascending aorta
• Portion of the aorta that emerges from the left
ventricle posterior to the pulmonary trunk is the
ascending aorta
• The ascending aorta is about 5 cm in length and
begins at the aortic valve
• It is covered by pericardium.
• The ascending aorta gives off two coronary arteries
- one from anterior aortic sinus called right coronary
artery
- 2nd from posterior aortic sinus called left coronary
artery.
• The coronary arteries divides to form coronary
circulation.

Arch of aorta
• It is continuation of ascending aorta.
• Three main arteries emerges from the arch
of aorta
i. The brachiocephalic artery- carries
oxygenated blood from the aorta to the
head, neck and arm regions of the body.
It divides into;
• the right common carotid artery
• the right subclavian artery.
ii. The left common carotid artery- supply
oxygenated blood to the left side of head
and neck regions of the body.
iii. The left subclavian artery- supply
oxygenated blood to the upper limb
 Brachiocephalic artery
• 4 to 5cm long,
• It carries oxygenated blood from the aorta to the head, neck and arm regions of
the body.
• It divides into the right common carotid artery and the right subclavian artery.
RIGHT SUBCLAVIAN ARTERY:
Internal thoracic artery Arises from first part of subclavian artery, descends along
the inner surface of the anterior thorax and supplies to chest and breast
Vertebral artery a major branch to the brain
Thyrocervical artery a short trunk serving thyroid gland, trachea, shoulder and
larynx
Costocervical artery serve the upper intercostal muscles, posterior neck muscles,
and the spinal cord and its meninges.

Common Carotid arteries

• right common carotid artery is a branch of the brachiocephalic artery.
• The left common carotid artery arises directly from the arch of the aorta
• At the level of the upper border of the thyroid cartilage they divide into:
• external carotid artery
• internal carotid artery.
 External carotid artery
external carotid artery gives off several branches as it extends upward along the side of the neck
and head. These are:
Superior thyroid artery larynx and vocal folds, and the thyroid gland
Lingual artery tongue and sublingual gland
Facial artery 8 branches supplies to palate, chin, lips, nasal region submandibular
gland, and all of the face.
Occipital artery posterior portion of the scalp, the meninges over the brain and certain
posterior neck muscles
Posterior auricular ear and the scalp posterior to the ear
artery
external carotid artery maxillary artery teeth and gums, the muscles of mastication, the nasal
cavity, the eyelids, and the meninges
superficial temporal artery parotid gland and to the superficial
structures on the side of the head.

Internal carotid artery

• The branches of ICA :
- Ophthalmic artery supply eye and associated structures
- Cerebral arteries ( anterior and middle) supplies the cerebrum
• The paired internal carotid arteries along with paired vertebral arteries make the
four arteries that supply brain.
• At the inferior surface of the brain around the pituitary gland the branches of these
vessels anastomose making the cerebral arterial circle or the circle of willis
 Circle of willis
• junction of arteries at the base of the brain
• The circle of willis is formed by two vertebral arteries and two carotid arteries:
• The vertebral arteries
- arise from the subclavian artery at the base of neck pass superiorly through the
cervical vertebrae and enter the skull through the foramen magnum
- In the cranium (at the level of pons) they unite to form basilar artery
- The basilar artery ascends along the inferior surface of the brain stem and
terminates by forming two posterior cerebral arteries that supply the posterior
portion of the cerebrum
- Posterior cerebral arteries give rise to the posterior communicating arteries
(connects the anterior and posterior circulation)
 Circle of willis
• The internal carotid artery
- On the anterior side the internal carotid arteries give off cerebral arteries which
anastomose with each other though anterior communicating artery
- On the posterior side the internal carotid arteries anastomose with the posterior
communicating arteries
• The anastomoses of vertebral arteries making basilar artery, the anastomoses at
anterior communicating artery and anastomoses of internal carotid arteries with
posterior communicating arteries collectively make the circle of willis
 Thoracic aorta
• The descending aorta is continuous with the aortic arch.
• It runs along the anterior spine.
• 20 cm long,
• The branches of the thoracic aorta are;
Bronchial arise either directly from aorta or from any of its branch supplies the
bronchial ( trachea and bronchi)
Pericardial arise at various levels of aorta and moves forward to supply the pericardial
sac.
Esophageal arise from anterior surface of aorta and supplies all of the esophagus
Mediastinal arteries arise from various levels of mediastinum and supplies the
mediastinal connective tissues and lymph nodes
Intercostal arteries divided into anterior and posterior arteries posterior intercostal arteries
arise from the aorta and in part supply the spine and spinal cord

Abdominal aorta
• The abdominal aorta is the main blood vessel in the abdominal cavity that
transmits oxygenated blood from the thoracic cavity to the organs within the
abdomen and to the lower limbs
• It gives off both parietal and visceral branches
PARIETAL BRANCHES
• Paired
- Inferior Phrenic arteries supplying the diaphragm
- Lumbar arteries supply the abdominal wall and spinal cord.
• Unpaired
- Median sacral artery supply the coccyx, lumbar vertebrae and the sacrum.
 VISCERAL BRANCHES
➢ Unpaired
• Coeliac trunk oxygen-rich blood to the stomach, spleen, liver, esophagus, and
also parts of the pancreas and duodenum.
- left gastric,
- common hepatic
- splenic arteries.
• Superior mesenteric artery provides oxygenated blood and nutrients to the
intestines
• Inferior mesenteric artery distal one-third of the transverse colon, descending
colon and proximal two-thirds of the rectum.
➢ Paired
- Suprarenal arteries supply the adrenal gland
- Renal arteries carry blood from your heart to your kidneys.
- Gonadal arteries supplies to gonads the testicular artery in males and the
ovarian artery in females.

Vertebral Arteries
• The vertebral arteries in the neck supply blood to the brain and spine.
• root of neck emerges from subclavian arteries passes from the foramen of
cervical vertebra enter in skull via foramen magnum branching to the vertebra,
cervical spinal cord, and various deep neck structures
Branches of Vertebral Arteries
• Basilar artery
• Posterior spinal artery
• Anterior spinal artery
• Posterior inferior cerebellar artery
- basilar artery is formed by the joining of the left and right vertebral arteries.
- branches to the cerebellum, pons, and inner ear.
- At the pons–midbrain border, divided into two posterior cerebral arteries. These
arteries supply the inferior sections of the temporal lobes and the occipital lobes.
 Coronary circulation
• Coronary circulation of the heart is the circulation of blood in the blood vessels of
the heart muscle(myocardium).
• Coronary circulation consists of coronary arteries and coronary veins.
Arterial supply
• The heart is supplied with arterial blood by the right and left coronary arteries, which
arise from the aorta, traverse the heart and eventually forming a vast network of
capillaries.
• Left coronary artery is larger in diameter than the right coronary artery.
• Left CA further divides into two branches; the anterior
interventricular and circumflex artery
• The branches of Left CA supplies the left atrium and the posterior part of the left
ventricle, and anterior walls of both ventricles
• Right CA branches to: Marginal artery and posterior interventricular artery
• Overall, the branches of the right coronary artery supply the right atrium and
almost all of the right ventricle.
 Main blood vessels (arising and entering heart)
5 great vessels enter and leave the heart:
• The superior vena cava and inferior vena cava are veins that return deoxygenated
blood from circulation in the body and empty it into the right atrium. (drains the
organs above and below diaphragm)
• The pulmonary artery carries deoxygenated blood from the right ventricle into
the lungs for oxygenation.
• The pulmonary veins carry oxygenated blood from the lungs into the left
atrium where it is returned to systemic circulation.
• The aorta is the largest artery in the body. It carries oxygenated blood from the
left ventricle of the heart into systemic circulation.
• The aorta has many subdivisions that branch off into smaller arteries.
(thoracic aorta and abdominal aorta)

Venous drainage
• The venous blood from heart wall does not drain into the superior vena cava but drains into
the heart by following routes:
• Coronary sinus: An enlarged vessel which receives majority of the veins of the heart.
The coronary sinus returns almost all the venous blood from the heart into the right
atrium. It branches to:
• Great cardiac vein (drains from both ventricles and left atrium)
• Middle cardiac vein (drains from right ventricle)
• Small cardiac vein (drains from right atrium and ventricle)
• Oblique vein (drains from left atrium)
• Anterior cardiac veins: small vessels (2,3 in number) which drain from anterior wall of
right ventricle and end directly into right atrium
• Venae cordis minimae: (Veins of Thebesius) group of smallest cardiac vessels, which
drain directly into the chamber of the heart and are numerous in the right atrium and
right ventricle
Nerve supply to heart:
Heart is supplied by sympathetic and parasympathetic (vagus) nerves originating
from cardiovascular center at medulla oblongata

Portal circulation
• A vein that carries blood from one capillary network to
another is called a portal vein .
• hepatic portal vein – receives gastrointestinal organs and
the spleen delivers to sinusoid of liver
• Hepatic portal system presents nutrient rich food, which
may also be a potential source of microbes and intoxicants,
to the liver for processing and clearance.
• Hepatic portal vein is formed by the union of
- superior mesenteric vein
- splenic vein
 • The superior mesenteric vein receives blood from;
- Jejunal vein drain jejunum
- Ileal vein
- Ileo-colic vein drains the ileum, colon, and cecum
- Right colic vein drains the ascending colon
- Middle colic vein drains the transverse colon
- Pancreaticoduodenal vein drain the head of the pancreas and duodenum
- Right gastroepiploic veins drains blood from the greater curvature and left part
of the body of the stomach

• The splenic vein drains bloods from the stomach, pancreas and portions of large
intestine through
i. The inferior mesenteric vein from the large intestine.
ii. The pancreatic vein from the pancreas
iii. The left gastroepiploic vein from the stomach.
The hepatic portal vein then continues to the liver but before that it receives right
and left gastric veins from stomach and cystic vein from gallbladder
The processed blood then leaves the liver through right and left hepatic veins which
empties into the inferior vena cava before it moves up the diaphragm.
As a result of the hepatic portal system, the absorbed products of digestion must first
pass through the liver before entering the general circulation
Diseases of Heart &
Blood Vessels
 Congestive heart failure
• The heart is unable to pump blood around the body properly. It usually happens because
the heart has become too weak or stiff.
Symptoms of heart failure
• The main symptoms of heart failure are:
- breathlessness after activity or at rest
- feeling tired most of the time and finding exercise exhausting
- feeling lightheaded or fainting
- swollen ankles and legs
Causes
• coronary heart disease
• high blood pressure
• Arrhythmias
• Cardiomyopathy
• congenital heart disease

Heart attack
• It is also called myocardial infarction when a part of the heart muscle doesn’t get
enough blood.
• Coronary artery disease (CAD) is the main cause of heart attack.
• Symptoms of a heart attack are
- Chest pain or discomfort can feel like uncomfortable pressure, squeezing, fullness, or
pain.
- Feeling weak, light-headed, or faint.
- cold sweat
- Pain or discomfort in the jaw, neck, or back.
- Pain or discomfort in one or both arms or shoulders.
- Shortness of breath.
 Angina pectoris
• Angina pectoris or angina is temporary chest pain or discomfort as a
result of decreased blood flow to the heart muscle. It leads to heart
attack
Symptoms of angina include:
• Chest pain or discomfort, such as tightening of the chest
• Discomfort in the jaw, neck, arms, upper abdomen, shoulder or back
• Fatigue
• Sweating
• Nausea
• Dizziness

Cardiomyopathy
It is a disease of the heart muscle that makes it harder for the heart to pump blood to
the rest of the body. It can lead to heart failure.
Symptoms
- Breathlessness with activity or at rest
- Swelling of the legs, ankles and feet
- Fatigue
- Irregular heartbeats that feel rapid, pounding or fluttering
- Dizziness, lightheadedness and fainting
 Mitral valve disease
• it is a problem with the valve located between the left heart chambers (left atrium and left ventricle).
• Mitral valve disease includes:
- Mitral valve regurgitation. The mitral valve flaps (leaflets) may not close tightly, causing blood to
leak backward.
- Mitral valve stenosis. The flaps of the mitral valve become thick or stiff, and they can fuse together.
This narrows the valve opening, which reduces blood flow from the left atrium to the left ventricle.
• Signs and symptoms of mitral valve disease can include:
- Fatigue
- Irregular heart sound (heart murmur)
- Irregular heartbeat
- Shortness of breath
Causes:
- congenital heart defect
- rheumatic fever.

Endocarditis
• It is a rare and potentially fatal infection of the inner lining of the heart (the endocardium).
• It's most commonly caused by bacteria entering the blood and travelling to the heart.
Causes by bacteria which easier to pass immune system in patients having following
conditions:
• Artificial (prosthetic) heart valve
• congenital heart disease
• hypertrophic cardiomyopathy
• damaged heart valves – because of infection or heart disease
Signs and symptoms
• a high temperature
• chills
• headache
• joint and muscle pain
 Atherosclerosis
• Atherosclerosis reduces blood supply to your extremities.
Symptoms
• Chest pain
• shortness of breath
• coldness, especially in the limbs
• numbness, especially in the limbs
• unusual or unexplained pain
• weakness in your legs and arms

Coronary artery disease (CAD)

• CAD is plaque buildup in the arteries that move oxygen-rich blood

through the heart and lungs.
Symptoms of CAD include:
• chest pain or discomfort
• a feeling of pressure or squeezing in the chest
• shortness of breath
• nausea
• feelings of indigestion or gas
REFRERENCE
Ross and Wilson’s Anatomy and physiology, 12th edition
Jahangir Moini Anatomy and Physiology for Health Professionals

Past Papers
• Draw the structure of heart
• Describe the location, histology and coronary blood supply of heart
• Hepatic portal vein
• Blood supply of heart
• Functional classification of blood vessels
• Draw and label heart structure and describe the anatomical difference
between normal heart and diseased heart