The Cardiovascular

System
Anatomy Lecture
Lectured by Bien Nillos, MD
Reference: Gray’s Anatomy and Ellis Clinical Anatomy 11 th edition
 The Vascular System
(a) the blood vascular system - comprises the
heart and blood vessels for the circulation of the
blood.
(b) the lymph vascular system - consisting of
lymph glands and lymphatic vessels, through
which a colorless fluid, the lymph, circulates.
It must be noted, however, that the two systems
communicate with each other and are intimately
associated developmentally.
 The Heart

 the central organ of the blood vascular system, and

consists of a hollow muscle; by its contraction the blood
is pumped to all parts of the body through a complicated
series of tubes, termed arteries  arterioles 
capillaries  venules  veins  Back to the heart
 The Heart
 The human heart is divided by septa into right
and left halves, and each half is further divided
into two cavities, an upper termed
the atrium and a lower the ventricle. 
 The heart therefore consists of four chambers:
two, the right atrium and right ventricle, forming
the right half, and two, the left atrium and left
ventricle the left half.
 The right half of the heart contains venous
blood; the left, arterial blood.
 The Circulation System
 The atria are receiving chambers, and the ventricles
distributing ones.
 From the cavity of the left ventricle the pure blood is
carried into a large artery, the aorta,  is distributed to all
parts of the body, with the exception of the lungs.
 changed from arterial into venous blood, which is collected
by the veins and through them returned to the right atrium
of the heart.
 From this cavity the venous blood passes into the right
ventricle, and is conveyed through the pulmonary
arteries to the lungs.
 In the capillaries of the lungs it again becomes arterialized,
and is then carried to the left atrium by the pulmonary
veins. 
 From the left atrium it passes into the left ventricle, from
which the cycle once more begins.
 The course of the blood from the left
ventricle through the body generally to the
right side of the heart constitutes the
greater or systemic circulation, 
 Its passage from the right ventricle
through the lungs to the left side of the
heart is termed the lesser or pulmonary
circulation.
 Portal Circulation
 The blood which circulates through the spleen,
pancreas, stomach, small intestine, and the
greater part of the large intestine is not returned
directly from these organs to the heart, but is
conveyed by the portal vein to the liver.
 In the liver this vein divides, like an artery, and
ultimately ends in capillary-like vessels
(sinusoids), from which the rootlets of a series
of veins, called the hepatic veins, arise;
 these carry the blood into the inferior vena
cava, whence it is conveyed to the right atrium
 The blood in the portal vein carries certain
of the products of digestion: the
carbohydrates, which are mostly taken up
by the liver cells and stored as glycogen,
and the protein products which remain in
solution and are carried into the general
circulation to the various tissues and
organs of the body.
 The heart is irregularly conical in shape, and it is
placed obliquely in the middle mediastinum.
 Viewed from the front, portions of all the heart
chambers can be seen. The right border is
formed entirely by the right atrium, the left
border partly by the auricular appendage of the
left atrium but mainly by the left ventricle, and
the inferior border chiefly by the right ventricle
but also by the lower part of the right atrium
and the apex of the left ventricle.
 Anterior Surface – Right Ventricle and
Right Atrium
 Diaphragmatic Surface – Right and Left
Ventricles
 Posterior Surface – Left Atrium and, to a
lesser extent, the Right Atrium
 The Chambers of the Heart
 The Right Atrium
– receives the superior vena cava in its upper and
posterior part, the inferior vena cava and coronary
sinus in its lower part, and the anterior cardiac vein
(draining much of the front of the heart) anteriorly.
– The openings of the inferior vena cava and the
coronary sinus are guarded by rudimentary valves;
that of the inferior vena cava being continuous with
the annulus ovalis around the shallow depression on
the atrial septum, the fossa ovalis, which marks the
site of the fetal foramen ovale.
 Right Ventricle
– joined to the right atrium by the way of the
vertically disposed tricuspid valve, and with
the pulmonary trunk through the pulmonary
valve.
– A muscular ridge, the infundibuloventricular
crest, between the atrioventricular and
pulmonary orifices, separates the ‘inflow’ and
‘outflow’ tracts of the ventricle.
– The outflow tract of the ventricle or infundibulum is
smooth-walled and is directed upwards and to the
right towards the pulmonary trunk.
– The pulmonary orifice is guarded by the pulmonary
valves, comprising three semilunar cusps
 Left Atrium
– rather smaller than the right but has somewhat
thicker walls.
– On the upper part of its posterior wall it presents the
openings of the four pulmonary veins and on its
septal surface there is a shallow depression
corresponding to the fossa ovalis of the right atrium.
– As on the right side, the main part of the cavity is
smooth-walled but the surface of the auricle is
marked by a number of ridges due to the underlying
pectinate muscles.
 The Left Ventricle
– communicates with the left atrium by way of
the mitral valve which possesses a large
anterior and a smaller posterior cusp attached
to papillary muscles by chordae tendineae.
– the wall of the left ventricle is marked by thick
trabeculae carneae.
– The aortic orifice is guarded by the three
semilunar cusps of the aortic valve,
immediately above which are the dilated
aortic sinuses.
– The mouths of the right and left coronary
arteries are seen in the anterior and left
posterior sinus respectively.
 Blood Supply to the Heart

 derived from the right and left coronary arteries

whose main branches lie in the interventricular
and atrioventricular grooves
 Right Coronary Artery
 Arises from the anterior aortic sinus and passes
forwards between the pulmonary trunk and the
right atrium to descend in the right part of the
atrioventricular groove.
 At the inferior border of the heart it continues
along the atrioventricular groove to anastomose
with the left coronary at the posterior
interventricular groove.
 It gives off a marginal branch along the lower
border of the heart and the posterior
interventricular branch which runs forward in
the inferior interventricular groove and to
anastomose near the apex of the heart with the
corresponding branch of the left coronary artery.
 Left Coronary Artery
 is larger than the right, rises from the left
posterior aortic sinus. Passing first behind and
then to the left of the pulmonary trunk, it
reaches the left part of atrioventricular groove in
which it runs laterally round the left border of
the heart as the circumflex artery to reach the
posterior interatrial groove.
 Its most important branch - anterior
interventricular artery = supplies the anterior
aspect of both ventricles, passes around the
apex of the heart to anastomose with the
posterior interventricular branch of the right
coronary.
 Venous Drainage of the Heart
 The bulk of the venous drainage of the heart is
achieved by veins which accompany the
coronary arteries and which open into the right
atrium. The rest of the blood drains by means of
small veins (venae cordis minimae) directly into
the cardiac cavity.
 The coronary sinus lies in the posterior
atrioventricular groove and opens into the right
atrium just to the left of the mouth of the
inferior vena cava.
 Coronary Sinus
 It receives:
1. the great cardiac vein in the anterior
interventricular groove;
2. the middle cardiac vein the inferior
interventricular groove
3. the small cardiac vein — accompanying the
marginal artery along the lower border of the
heart;
4. the oblique vein— descends obliquely on the
posterior aspect of the left atrium.
 The Nerve Supply of the Heart
 The nerve supply of the heart is derived
from the vagus (cardio-inhibitor) and the
cervical and upper 5 thoracic sympathetic
ganglia (cardioaccelerator) by way of
superficial and deep cardiac plexuses.
 Surface Anatomy of the Heart
1. the 2nd left costal cartilage 0.5in
(12mm) from the edge of the sternum;
2. the 3rd right costal cartilage 0.5in
(12mm) from the sternal edge;
3. the 6th right costal cartilage 0.5in
(12mm) from the sternum;
4. the 5th left intercostal space 3.5in (9cm)
from the midline (corresponding to the
apex beat).
 The left border of the heart (indicated by the
curved line joining points 1 and 4) is formed
almost entirely by the left ventricle (the auricular
appendage of the left atrium peeping around
this border superiorly)
 The lower border (the horizontal line joining
points 3 and 4) corresponds to the right
ventricle and the apical part of the left ventricle.
 the right border (marked by the line joining
points 2 and 3) is formed by the right atrium
 End of Part One
“The heart has reasons that reason does not
understand.” - Jacques Benigne Bossuel 
 No. 1 No. 5 No. 6 No. 7

No. 2 No. 8

No. 9
No. 3

No. 10

No. 4
Start of Part Two
The Cardiovascular System
(Hingagaw Session)
 “THE DISTRIBUTION of the systematic arteries is like a
highly ramified tree, the common trunk of which, formed
by the aorta, commences at the left ventricle, while the
smallest ramifications extend to the peripheral parts of
the body and the contained organs.” – Henri Gray
  The arteries, in their distribution,
communicate with one another, forming
what are called anastomoses, and these
communications are very free between the
large as well as between the smaller
branches.
The Aorta
 the main trunk of a series of vessels
which convey the oxygenated blood
to the tissues of the body for their
nutrition.
 begins at the upper part of the left
ventricle
 after ascending for a short distance,
arches backward and to the left side
 descends within the thorax on the
left side of the vertebral column
 passes into the abdominal cavity
through the aortic hiatus in the
diaphragm,
 ends opposite the lower border of the
fourth lumbar vertebra, by dividing
into the right and left common iliac
arteries. 
 Parts of the Aorta
 ascending aorta 
 arch of the aorta 
 descending aorta 
– thoracic 
– abdominal aorta
 Ascending Aorta
 Branches.—The only branches of the
ascending aorta are the two coronary
arteries which supply the heart; they arise
near the commencement of the aorta
immediately above the attached margins
of the semilunar valves.
 Arch of the Aorta
 The branches given off from the arch of
the aorta are three in number:
the innominate
(brachiocephalic), the left common
carotid, and the left subclavian.
 The innominate artery is the largest
branch of the arch of the aorta
 It divides into the right common carotid
and right subclavian arteries.
 occasionally a small branch,
the thyreoidea ima, arises from it.
 sometimes it gives off
a thymic or bronchial branch.
 The innominate artery sometimes divides
above the level of the sternoclavicular
joint, less frequently below it.
 When the aortic arch is on the right side,
the innominate is directed to the left side
of the neck.
 The Common Carotids
 The principal arteries of supply to the
head and neck
 each divides into two branches:
(1) the external carotid, supplying the
exterior of the head, the face, and the
greater part of the neck
(2) the internal carotid, supplying to a
great extent the parts within the cranial
and orbital cavities.
 The right begins at the bifurcation of the
innominate artery behind the
sternoclavicular joint and is confined to
the neck.
 The left springs from the highest part of
the arch of the aorta to the left of, and on
a plane posterior to the innominate artery,
and therefore consists of a thoracic and a
cervical portion.
 The common carotid usually gives off no
branch previous to its bifurcation, but it
occasionally gives origin to the superior
thyroid or its laryngeal branch, the
ascending pharyngeal, the inferior thyroid,
or, more rarely, the vertebral artery.
 The External Carotid Artery
 begins opposite the upper border of the
thyroid cartilage, and, taking a slightly
curved course, passes upward and
forward, and then inclines backward to the
space behind the neck of the mandible
 it divides into the superficial temporal
and internal maxillary arteries
Branches of the External Carotid
 Anterior Group: Superior Thyroid, Lingual,
External Maxillary
 Posterior Group: Occipital, Posterior
Auricular
 Ascending Group: Ascending Pharyngeal
 Terminal Group* : Superficial Temporal,
Internal Maxillary
 Internal Carotid Artery
 supplies the anterior part of the brain, the
eye and its appendages, and sends
branches to the forehead and nose.
 Its size, in the adult, is equal to that of the
external carotid, though, in the child, it is
larger than that vessel. 
 In considering the course and relations of
this vessel it may be divided into four
portions: 
– cervical - The cervical portion of the internal
carotid gives off no branches.
– petrous
– Cavernous - Ophthalmic.
– cerebral - Anterior Cerebral, Middle Cerebral,
Posterior Communicating.
 Circle of Willis
 The cerebral arteries are derived from the
internal carotid and vertebral, which at the base
of the brain form a remarkable anastomosis
 formed in front by the anterior cerebral
arteries, branches of the internal carotid, which
are connected together by the anterior
communicating; behind by the two posterior
cerebral arteries, branches of the basilar,
which are connected on either side with the
internal carotid by the posterior
communicating
 The Subclavian Arteries
 The artery which supplies the upper extremity
continues as a single trunk from its
commencement down to the elbow
 That part of the vessel which extends from its origin to
the outer border of the first rib is termed
the subclavian; 
 beyond this point to the lower border of the axilla it is
named the axillary; 
 and from the lower margin of the axillary space to the
bend of the elbow it is termed brachial; 
 here the trunk ends by dividing into two branches:
the radial and ulnar.
 branches of the
subclavian artery are:
– Vertebral*
– Internal mammary
(thoracic)
– Thyrocervical
– Costocervical.

*union forms Basilar Artery

 Basilar Artery
 named from its position at the base of the
skull, is a single trunk formed by the
junction of the two vertebral arteries
 It ends by dividing into the two posterior
cerebral arteries.
 Branches: Pontine, Anterior Inferior
Cerebellar, Internal Auditory, Superior
Cerebellar, Posterior Cerebral.
 The Axillary Artery
 the continuation of the subclavian,
commences at the outer border of the first
rib, and ends at the lower border of the
tendon of the Teres major, where it
takes the name of brachial.
 3 portions
 first portion of the axillary artery is
covered anteriorly by the clavicular portion of
the Pectoralis major and the coracoclavicular
fascia, and is crossed by the lateral anterior
thoracic nerve
 second portion of the axillary artery is
covered, anteriorly, by the Pectorales major and
minor;
 third portion of the axillary artery extends
from the lower border of the Pectoralis minor to
the lower border of the tendon of the Teres
major.
 Branches of the Axillary Artery
 First Portion : Highest Thoracic Artery
 Second Portion : Thoracoacromial,
Lateral Thoracic
 Third Portion : Subscapular, Posterior
Humeral Circumflex, Anterior Humeral
Circumflex.
 Brachial Artery
 commences at the lower margin of the tendon of
the Teres major, and, passing down the arm,
ends about 1 cm. below the bend of the elbow,
where it divides into the radial and ulnar*
arteries.
 At first the brachial artery lies medial to the
humerus; but as it runs down the arm it
gradually gets in front of the bone, and at the
bend of the elbow it lies midway between its two
epicondyles.
* Ulnar is larger than the radial artery
 Branches of the Brachial Artery
 Profunda Brachii
 Superior Ulnar Collateral
 Nutrient
 Inferior Ulnar Collateral
 Muscular
 Descending Aorta

 Two parts:
Thoracic part and
Abdominal part
 Remember at what level the
aorta pierces through the
diaphragm
 Thoracic Aorta
 contained in the posterior mediastinal
cavity.
 begins at the lower border of the T4
where it is continuous with the aortic arch,
and ends in front of the lower border of
T12 at the aortic hiatus in the diaphragm
 Branch groups: Visceral group and Parietal
Group
 Visceral Branches: Pericardial, Bronchial,
Esophageal, Mediastinal
 Parietal Branches: Intercostal, Subcostal,
Superior Phrenic
 A small aberrant artery is sometimes found arising from the right
side of the thoracic aorta near the origin of the right bronchial. 
 The Abdominal Aorta
 begins at the aortic hiatus of the
diaphragm, in front of the lower border of
the body of the last thoracic vertebra,
and, descending in front of the vertebral
column, ends on the body of the fourth
lumbar vertebra, by dividing into the two
common iliac arteries.
 Visceral Branches
 Celiac
 Superior
Mesenteric
 Inferior
Mesenteric
 Middle
Suprarenals
 Renals
 Internal
Spermatic
 Ovarian
 Parietal Branches
 Inferior Phrenics
 Lumbar
 Middle Sacral

* Terminal branches – Left and Right

Common Iliac Arteries
 Celiac Artery
 a short thick trunk, about 1.25 cm. in
length, which arises from the front of the
aorta, just below the aortic hiatus of the
diaphragm, and, passing nearly horizontally
forward, divides into three large branches:
 left gastric, the hepatic, and
the splenic
 Left Gastric Artery
  smallest of the three branches of the celiac
artery
 distributes branches to the esophagus;
 others supply the cardiac part of the stomach
 It then runs from left to right, along the lesser
curvature of the stomach to the pylorus,
between the layers of the lesser omentum;
 it gives branches to both surfaces of the
stomach and anastomoses with the right gastric
artery.
 Hepatic Artery
 in the fetus, it is the largest of the three
branches of the celiac artery. 
 divides into two branches, right and left.
 Branches:
– Right Gastric
– Gastroduodenal - right gastroepiploic and the superior
pancreaticoduodenal. 

– Cystic
 Splenic Artery (Lienal)
 the largest branch of the celiac artery
 Branches:
– Pancreatic
– Short Gastric.
– Left Gastroepiploic.
 Common Iliac Arteries
 They diverge from the termination of the
aorta, pass downward and lateralward,
and divide, opposite the intervertebral
fibrocartilage between the last lumbar
vertebra and the sacrum, into two
branches, the external
iliac* and hypogastric arteries
*external iliac artery is larger than the hypogastric artery
 External Iliac Artery
 passes obliquely downward and
lateralward along the medial border of the
Psoas major, from the bifurcation of the
common iliac to a point beneath the
inguinal ligament, midway between the
anterior superior spine of the ilium and the
symphysis pubis, where it enters the thigh
and becomes the femoral artery.
 Branches:
– Inferior
epigastric
– Deep iliac
circumflex
Femoral Artery
 begins immediately behind the inguinal
ligament, midway between the ASIS and
the symphysis pubis, and passes down the
front and medial side of the thigh.
 It ends at the junction of the middle with
the lower third of the thigh, where it
passes through an opening in the
Adductor magnus to become the
popliteal artery.
 The first 4 cm. of the vessel is enclosed,
together with the femoral vein, in a
fibrous sheath—thefemoral sheath. 
 In the upper third of the thigh the femoral
artery is contained in the femoral
triangle (Scarpa’s triangle), and in the
middle third of the thigh, in the adductor
canal (Hunter’s canal).
 Femoral
Triangle
  Its apex is directed
downward, and the
sides are formed
laterally by the
medial margin of the
Sartorius, medially by
the medial margin of
the Adductor longus,
and above by the
inguinal ligament.
 Hunter’s Canal
 an aponeurotic tunnel in
the middle third of the
thigh, extending from
the apex of the femoral
triangle to the opening in
the Adductor magnus. It
is bounded, in front and
laterally, by the Vastus
medialis; behind by the
Adductores longus and
magnus
Branches of the Femoral Artery
 Superficial Epigastric
 Deep External Pudendal
 Superficial Iliac Circumflex
 Muscular
 Superficial External Pudendal.
 Profunda Femoris.
 Highest Genicular.
 Popliteal Artery
  the continuation of the femoral, and courses
through the popliteal fossa.
 It extends from the opening in the Adductor
magnus, at the junction of the middle and lower
thirds of the thigh, downward and lateralward to
the intercondyloid fossa of the femur, and then
vertically downward to the lower border of the
Popliteus
 divides into anterior and posterior tibial
arteries.
Popliteal Fossa
 lozenge-shaped space,
at the back of the knee-
joint. Laterally it is
bounded by the Biceps
femoris above, and by
the Plantaris and the
lateral head of the
Gastrocnemius below;
medially it is limited by
the Semitendinous and
Semimembranosus
above, and by the
medial head of the
Gastrocnemius below.
 Anterior Tibial Artery
 commences at the bifurcation of the popliteal, at
the lower border of the Popliteus, passes
forward between the two heads of the
Tibialis posterior, and through the aperture
above the upper border of the interosseous
membrane, to the deep part of the front of the
leg: it here lies close to the medial side of the
neck of the fibula.
 becomes the dorsalis pedis.
 Posterior Tibial Artery
 divides beneath the origin of the Adductor
hallucis into the medial and lateral
plantar arteries.  
 Lateral is much larger than the medial
plantar artery.
 Take Home
 Study the Major Veins of the Neck,
Thorax, Abdomen, Upper and Lower
Extremity and trace their tributaries
 Study the difference between an artery
and a vein.
 Group Paper
 Group 1: Atherosclerosis, Arteriosclerosis: Causes,
how they develop, Symptoms and how they are
diagnosed and treated
 Group 2: Varicose Veins: Causes, how they
develop, treatment.
 Group 3: The Fetal Circulation. Trace the
circulation of blood inside a Fetus, take note the
differences in an adult circulation
 Group 4: Different Problems of Heart Valves. How
are they different from each other. Causes.
Treatment?
 Group 5: Blood and Blood Components.
“I do not hold the key to our liberation, I do not know all the
solutions to our many problems. All I know is that if the
situation continues in the Philippines, then blood will flow,
and when blood flows, there will be no victor and there will
be no vanquished because all of us will be a victim of our
folly” – Ninoy Aquino