Cardiovascular system

Blood circulation system

Lymphatic system
 Blood circulation system
• Function: transportation of O2, nutrients, hormons, products of
metabolism, drugs ...
warmth distribution
• Blood – sanguis: volume - 6 % of body weight (5-6 L)
Plasma – 5 % of body weight (3,5 L) – minerals, proteins,
saccharides, nutrients, products of metabolism
Blood cells: erythrocytes (4.6-5.0 T/L) – haemoglobin
leucocytes (5-8 G/L): neutrophils (60-70 %)
basophils (0.5-1.0 %)
eosinophil (3-5 %)
lymphocytes (25-30 %)
thrombocytes (platelets) 200-300 G/L
Haematocrit – blod cells/plasma = 40-45 %
 Blood circulation system

• Heart – cor
• Arteries
• Arterioles
• Capillaries
• Venules
• Veins
• Lesser circle – pulmonary
circulation
• Greater circle –
systematic circulation
• Portal circulation
Blood circulation
Blood vessels
 Vessel wall
• Tunica intima –
endothelium, lamina
basalis
• Tunica media – smooth
muscle, collagen, elastic
fibres (lamina elastica
interna, muscularis,
elastica externa)
• Tunica adventitia –
connective tissue, nerves,
vessels (vasa vasorum)
 Types of blood vessels
• Conducting – arteries of
elastic type
(aorta – diameter 30 mm,
cross-sectional area 7
cm2)
• Distributing – arteries of
muscular type
• Resistance - arterioles
(diameter 10 μm, cross-
sectional area 150 cm2
• Exchange – capillaries,
venules
• Capacitance – veins
Venous valves – valvulae venosae
Capillaries
 Blood flow through the tissues
• End arteries
• Collateral circulation –
arterial anastomoses
(end-to-end,
convergent,
transverse)
• Arteriovenous
anastomoses
 Heart - Cor
• size: 8x12x6cm
weight: M 300 g (0.45 % of
body weight), F 250 g (0.40 %
of body weight)
• configuration:
base
apex
sternocostal surface (anterior)
diaphragmatic surface
(posterior)
right margin (margo acutus)
left margin (margo obtusus)
 Cardiac wall
• Endocardium
• Myocardium: striated
muscle, cells 120x20-
30 μm, junctional
complex –
intercalated discs
• Epicardium
 Heart chambers
• Atrium dextrum
• Septum interatriale
• Atrium sinistrum
• Sulcus atrioventricularis (coronarius)
• Ventriculus dexter
• Septum interventriculare - pars membranacea
pars muscularis
• Ventriculus sinister
• Sulcus interventricularis anterior/posterior
Heart chambers
 Atrium dextrum
• Structures:
sinus venarum cavarum
tuberculum intervenosum
crista/sulcus terminalis
mm. pectinati
auricula dextra
fossa ovalis – limbus fossae ovalis
• Openings:
ostium v. cavae superioris
ostium v. cavae inferioris
(valvula Eustachii)
ostium sinus coronarii
(valvula Thebesii)
ostium venarum minimarum
ostia vv. ventriculi dx. anteriorum
 Ventriculus dexter
• Structures:
trabeculae carneae
mm. papillares – chordae
tendineae
crista supraventricularis
infundibulum/conus (trunci
pulmonalis)
• Openings: ostium
atrioventriculare dextrum –
valva tricuspidalis (cuspis ant.,
post., septalis)
ostium trunci pulmonalis -
valva trunci pulmonalis
(valvula semilunaris ant., dx.,
sin.
 Atrium sinistrum
• Structures:
mm. pectinati
auricula sinistra
valvula foraminis
ovalis
• Openings:
ostia venarum
pulmonalium
 Ventriculus sinister
• Structures:
trabeculae carneae
m. papillaris anterior
posterior
chordae tendineae
vestibulum aortae
• Openings: ostium
atrioventriculare sinistrum –
valva bicuspidalis/mitralis
(cuspis ant., post., cuspides
commissurales)
ostium aortae – valva aortae
(valvula semilunaris dx., sin.,
post.)
 Fibrous skeleton of the heart
• Anulus fibrosus dexter
• Anulus fibrosus sinister
• Anulus aorticus
• Anulus trunci pulmonalis
• Trigonum fibrosum
dextrum
• Trigonum fibrosum
sinistrum
• Tendo infundibuli (conus
ligament)
• (Tendo valvulae v. cavae
inf.- tendon of Todaro)
 Valvulae semilunares
• Nodulus valvulae
semilunaris (Aranzii)
• Lunula
• Sinus aortae
(Valsalvae)
Valva tricuspidalis – Valva
bicuspidalis (mitralis)
 Heart valves
systole - diastole
 Atrial myocardium
• Superficial layer:
transverse fibres across
both atria, fasciculus
interauricularis
horizontalis / verticalis
• Deep layer: for each
atrium separate, loops
origin and end on fibrous
skeleton, circles around
opening of auricles and
veins and in the atrial
septum, deepest layer
forms mm. pectinati
 Myocardium of ventricles
• Superficial layer: spirals
from fibrous skeleton
anticlockwise to apex –
vortex cordis, then
connect with the deep
layer
• Middle layer: for each
ventricle separate, forms
interventricular septum
• Deep layer: longitudinal,
forms mm. papillares and
trabeculae carneae
 Myocardium
• Atrium dextrum –
2 mm
• Atrium sinistrum –
3 mm
• Ventriculus dexter –
3 – 5 mm
• Ventriculus sinister –
8 - 12 mm
Systema conducens cordis – apparatus stimulans
Conducting system – excitomotor apparatus
• Nodus sinuatrialis (Keith-Flack): 10-20x3x1 mm, right
atrial wall anteriorly to opening of SVC, sinus rhythm
70/min.
• Nodus atrioventricularis (Aschoff-Tawara): 7-8x3x1 mm,
Koch´s triangle, rhythm 40-60/min.
• Fasciculus atrioventricularis
truncus (His)
crus dextrum (trabecula septomarginalis)
crus sinistrum (apex cordis)
• Rami subendocardiales (Purkyně /Purkinje)
• Automatic rhythm of ventricular myocardium: 20-40/min.
Systema conducens cordis
 Trigonum Kochi
• Tendo valvulae v.
cavae inferioris
(Todaro)
• Cuspis septalis
valvae tricuspidalis
• Ostium sinus
coronarii
Spread of cardiac excitation –
depolarization - ECG
 Arteriae coronariae
• A. coronaria dextra:
r. coni arteriosi
r. nodi sinuatrialis
rr. atriales
r. marginalis dexter
r. nodi atrioventricularis
rr. atrioventriculares
r. interventricularis posterior
• A. coronaria sinistra
r. interventricularis anterior
(RIA)
r. coni arteriosi
r. lateralis
rr. interventriculares septales
r. circumflexus
rr. atriales
r. nodi sinuatrialis
r. marginalis sinister
r. posterior ventriculi sinistri
 Venae cordis
• Sinus coronarius:
v. cordis magna (sin.):← v.
interventricularis ant., v. marginalis sin., v.
obliqua atrii sin., v. ventriculi sin. post.
v. cordis media - v. interventricularis post.
v. cordis parva (dx.): (vv. ventriculi dx.
ant.), v. marginalis dextra
• Vv. ventriculi dextri anteriores
• Vv. cordis minimae (Thebesii)
Heart vessels
Distribution of coronary arteries
 Heart lymphatics
• Plexus lymphaticus subepicardialis
myocardialis
subendocardialis
• Truncus lymphaticus cordis dexter →
sulcus coronarius dx. → nodus
brachiocephalicus sin.
• Truncus lymphaticus cordis sinister→
sulcus interventricularis ant. → sulcus
coronarius sin.→nodus trachebronchialis
Heart lymphatics
 Heart innervation
• Sympathicus (tachycardia)
ganglion cervicale sup. – n.
cardiacus cervicalis sup.
gangl. cervicale medium – n.
cardiacus cervicalis medius,
gangl. stellatum – n. cardiacus
cervicalis inf., ganglia
thoracica 2-4 – rr. cardiaci
thoracici
• Plexus cardiacus
• Ganglia cardiaca
• Parasympathicus
(bradycardia)
n. vagus
rr. cardiaci cervicales
superiores
inferiores
rr. cardiaci thoracici
• Plexus cardiacus:
pars superficialis (between
aorta and truncus pulmonalis)
pars profunda (between
arcus aortae and trachea)
• Ganglia cardiaca
Heart innervation
Pericardium
 Pericardium
• Pericardium fibrosum
ligg. sternopericardiaca
membrana
bronchopericardiaca
• Pericardium serosum
lamina parietalis
lamina visceralis =
epicardium: tunica serosa
tela subserosa
• Cavitas pericardii
 Cavitas pericardii
• Porta arteriarum
• Porta venarum
• Sinus transversus
pericardii (between porta
arteriarum and porta
venarum
• Sinus obliquus pericardii
(between vv. pulmonales
sin., vv. pulmonales dx.,
v. cava inf.)
 Pericardial vessels and nerves
• A.
pericardiacophrenica
← a. thoracica interna
• Vv.
pericardiacophrenicae
→ vv. thoracicae int.,
vv. brachiocephalicae
• N. phrenicus
 Heart X-ray
• Right margin:
v. brachiocephalica
v. cava superior
atrium dextrum
v. cava inferior
• Left margin:
arcus aortae
a. pulmonalis sin.
auricula sin.
ventriculus sin.
Heart X-ray
 Heart size
• Distantia mediosinistra –
4-4.5 cm
• Distantia mediodextra –
8-9 cm
• Transversala (Ms+Md) –
12-14 cm (<15 cm)
• Longitudino cordis
• Latitudo cordis
• Angulus α – 45°
Heart position
Heart development - phylogeny
 Heart development- ontogeny
• Heart tube
• Looping of heart tube
• Canalis
atrioventricularis
sinus venosus – atria
ventricular part
bulbus cordis
truncus arteriosus
 Development of septum
• Septum interatriale
primum ↓foramen primum
→foramen secundum
septum secundum ↓
→ foramen ovale
• Septum interventriculare
pars muscularis
pars mebranacea –
foramen interventriculare
Development of truncus arteriosus
 Aortic arches
• 1st and 2nd arch -
disappear
• 3rd → a. carotis
• 4th → truncus
brachiocephalis, a.
subclavia dx., arcus
aortae
• 5th-6th – disappear
 Vitia cordis congenita
- congenital heart defects
• 0.6 – 1 % of newborns
• Incompatible with life: agenesis cordis, ectopia cordis
• Compatible with early survival but must be treated:
transposition of great vessels (+ foramen ovale)
left-to right shunting:
foramen interventriculare persistens
foramen ovale apertum
ductus arteriosus patens
right-to left shunting – cyanosis
Fallot´s tetralogy (stenosis of pulmonary infundibulum,
dextroposition of aorta, ventricular septal defect)
without shunting: coarctation of aorta .