CVS

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  At the end of this session students will be able to :

Understand the components

Major Functions
Structures and
Clinical aspects of CVS

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Cardiovascular system
 Blood Vessels -routes of blood travels
 Heart -pumps or pushes blood through body
 Blood - is liquid connective tissue

 The non-plasma, or cellular, portion of blood is composed of

red blood cells
 white blood cells, and
platelets.
Function of blood
 Transportation
 Regulation
 protection

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RBC produced in the red marrow
 Erythropoiesis the production of
RBCs starts in the red bone
marrow
 hemopoiesis process by which
the formed elements of blood
develop
 RBC are biconcave discs, a shape
that provides a large area for
oxygen exchange.
 Matured red blood cell have no
nucleus
Platelets provide for blood
clotting
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 Platelet
Life span about 10 days
Appear as rounded or
oval cell fragments
derived singly or in
clumps

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 Formed element of blood

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 BLOOD CELLS
1. Erythrocytes (RBC)

2. Leukocytes (WBC)

3. Platelets
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 White blood cells (Leukocytes (WBC)
 have nuclei and do not contain hemoglobin
 Colorless and spherical
 classified as:
1. Agranulocytes
2. Granulocytes

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 Agranulocytes- it has no granules after staining
e.g, monocytes and lymphocytes
T- lymphocytes( T-cell)
B- lymphocytes( B-cell)
Natural killer cell
 Granulocytes- they have granules
Eosinophils Basophils Neutrophils

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 Heart
 muscular, 4
chambered organ
 Wt 350 g
 [clenched fist)
 2 cm long, 9cm wide
& 6 c m thick
 2/3rd on left side of the
body,
 Has apex, and base
 Located in the
mediastinum

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 The mediastinum:
is a space b/n two lungs
Boundaries:
 superior thoracic aperture
 diaphragm
 sternum
 costal cartilages
 bodies of the thoracic vertebrae.
 Contents:
all the thoracic viscera and structures, except the lungs.
 The mediastinum is artificially divided into superior and inferior
parts for purposes of description.

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 The superior mediastinum
 extends inferiorly from the superior thoracic aperture to the horizontal
plane (transverse thoracic plane) passing through the sternal angle
and the IV disc of the T4&T5 vertebra
 It contains:
the superior vena cava (SVC)
brachiocephalic veins
arch of the aorta
thoracic duct
trachea, esophagus, thymus, vagus nerves
left recurrent laryngeal nerve and phrenic nerves.

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 The inferior mediastinum
 between the transverse thoracic plane and the diaphragm
 It is further subdivided by the pericardium into :
 The anterior mediastinum
 containing remnants of the thymus, lymph nodes, fat, and connective tissue
 The middle mediastinum
 containing the pericardium, heart roots of the great vessels, arch of azygos vein,
and main bronchi
 The posterior mediastinum
 containing the esophagus, thoracic aorta, azygos and hemiazygos veins, thoracic
duct, vagus nerves, sympathetic trunks, and splanchnic nerves

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 Structure of the heart
 Pericardium (peri = around)
 is a protective and surrounding membrane of the heart
 it consists of two principal portion:
 the fibrous pericardium
the serous pericardium
 Fibrous pericardium
 is tough inelastic, dense irregular connective tissue, which looks like a bag.
 It rests & attaches to the diaphragm:
 Function of fibrous pericardium
 prevents overstretching of the heart
 provides protection
 anchors the heart in the mediastinum

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The serous pericardium
 is a thinner membrane which forms a double layer
 parietal layer
 is the outer serous pericardium
 visceral layer
The inner serous pericardium
adheres tightly to the surface of the heart.
 pericardial fluid
 is a fluid In the cavity b/n two layers of pericardium
is important to reduce friction b/n the heart and the outer
layers and also prevent the heart from external pressure.
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 Heart orientation

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Layers of the heart wall
 The heart contain 3 distinct layers :
 Epicardium

 thin, external membrane around the heart

 allow protection against friction by rubbing organs
 Myocardium

 thickest layer; consists of cardiac muscle. i.e. the bulk

of the heart wall.
It is involuntary muscle
responsible for the ability of the heart to contract
 Endocardium
 a thin innermost layer; a unique type of epithelial tissue that lines the entire
circulatory system
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 Blood supply of Heart

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Venous drainage
 Coronary sinus receives venous
blood from the heart
 empties into right atrium.
Its tributaries are the small cardiac
vein, middle cardiac vein &
greater cardiac vein.

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 Chambers of the heart
 The heart has four chambers
 two upper chambers - atria
 two lower chambers - ventricles
 Right atrium
 forms the right border of the heart
 it receives deoxygenated blood from
 superior vena cava
 inferior vena cava and
 coronary sinus
 Interatrial septum- is a thin partition between right and left atriums.
 blood passes from the right atrium in to the right ventricle through a valve called
tricuspid valve, it consists of three leaflets of cusps

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 Cont..

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Left atrium
 forms most of the base of the heart
 receives blood from the lungs through four pulmonary vein (2 right
& 2 left)
 Blood passes from the left atrium in to the left ventricle through the
bicuspid (mitral) valve which has two cusps.
Right ventricle
 forms most of the anterior surface of the heart
 left ventricle is separated from the right ventricle by inter
ventricular septum
 Blood passes from right ventricle through the pulmonary valve to a
large artery, pulmonary trunk, which divides in to right and left
pulmonary arteries.

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 Left ventricle
forms the apex of the heart
The most muscular chamber
Pump blood to the body through aorta
Blood passes through the aortic valve in to the largest
artery of the body, aorta, which gives coronary arteries,
descending aorta (thoracic & abdominal aorta) and
ascending aorta.

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Heart Valves:
 prevent back flow of blood and ensure that blood flows in the
proper direction through the heart.
 The valves function is to maintain blood flow in one direction.
 Valves open and close in response to changes in pressure:
Four heart valves are:
 Atrioventricular (AV) valves
 tricuspid - the right AV valves
 bicuspid valves - the left AV valves
 Semilunar valves
Aortic valve - Left Ventricle and Aorta
Pulmonary valve- Rt Ventricle and Pulmonary Trunk

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Atrioventricular (AV) valves
 b/n atrium & ventricles
 prevent backflow of blood from ventricles to atria during
ventricular systole (contraction)
 open when pressure in the atria is greater than pressure in the
ventricles (i.e., during ventricular diastole) and
 closed when pressure in the ventricles is greater than pressure in
atria

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 The AV valves include
tricuspid and
 bicuspid valves
 Tricuspid valve
 located between right atrium and right ventricle,
 hence prevent back flow from right ventricle to right
atrium during ventricular systole
 Bicuspid or Mitral valve

located between left atrium and left ventricle,

hence prevents back flow from left ventricle to left atrium
(during ventricular systole)
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Semilunar valves
 prevent backflow of blood from arteries to ventricles during
ventricular diastole (relaxation)
 open when pressure in the ventricles is greater than pressure in the
arteries (i.e., during ventricular systole)
 closed when pressure in the pulmonary trunk and aorta is greater
than pressure in the ventricles (i.e., during ventricular diastole). It
includes
 Aortic valve - located between left ventricle and the aorta
 Pulmonary valve- located b/n Rt.ventricle & pulmonary a.

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Heart Sounds
Lubb
 first heart sound

 occurs during ventricular systole

 A-V valves closing
Dupp
 second heart sound

 occurs during ventricular diastole

 pulmonary and aortic semilunar valves closing
Murmur
 abnormal heart sound

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 Conducting System
 Sino atrial (SA) node –
pacemaker
 atrioventricular (AV) node
 AV bundle
 right and left bundle branches
 Purkinje fibers
 Innervations of the Heart
 Autonomic Innervation
 Vagus Nerve (parasympathetic)
 cardio inhibitory center
 Sympathetic trunks
cardioaccelatory center

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 The SA node sends out a
stimulus, which cause the
atria to contract.
When this stimulus
reaches the AV node, it
signals the ventricles to
contract.
Impulses pass down the
two branches of the
atrioventricular bundle to
the Purkinje fibers, and
thereafter the ventricles
contract.
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 Types of circulatory routes
1.pulmonary circulation:
 right ventricle --pulmonary artery-- lungs--
pulmonary vein -- left atrium
2.systemic circulation:
left ventricle --aorta--body-- superior and inferior
vena cava--right atrium
 Coronary circulation :
 is part of the systemic circulation and supplies blood to the heart tissues
via coronary arteries and veins.
 Cerebral circulation: the circulation in brain by pair internal carotid
and vertebral artery
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 Blood flow with in the heart

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 Surface anatomy of Heart

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 BLOOD VESSELS
Tunics/histological layers of blood vessels
 Wall of arteries and veins are composed of three distinct
layers (tunics):
1. Tunica intima
 Composed of simple, squamous epithelium called endothelium.
 It has direct contact with blood
 Rests on a connective tissue membrane that is rich in elastic and
collagen fibers.
2.Tunica media
 Makes up the bulk of the arterial wall.
 Includes smooth muscle fibers, which encircle the tube, and a thick
layer of elastic connective tissue.

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3.Tunica adventitia
 Is relatively thin.
 Consists chiefly of connective tissue with irregularly
arranged elastic and collagen fibers.
 Also contains minute vessels that give rise to capillaries and
provide blood to the more external cells of the artery wall.

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 Types blood vessels
 Blood vessels are a network of tubes that carry blood throughout
the entire body.
 There are 5 types of Blood Vessels:
1.
Arteries
2.Arterioles
3. Veins
4.venules
5. Capillaries
Arteries
 The vessels that carry the blood away from the heart
 They carry oxygenated blood

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 Arteries have a smaller lumen than veins of similar size.
 Arterial walls are thicker than venous walls.
 Arteries have more elastin than veins.
 Arteries have no valves
 Because the blood pressure in arteries is high enough that
there is no backflow of blood
Types of Arteries
Elastic Arteries
 Largest arteries
 Largest diameter but walls relatively thin
 Function as pressure reservoir
 Help propel blood forward while ventricles relaxing
 Also known as conducting arteries – conduct blood to medium-sized
arteries
 Ex. aorta, subclavian , brachiocephalic ,common ilia c, common
carotid , pulmonary …
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Muscular arteries
 Tunica media contains more smooth muscle and fewer elastic fibers
than elastic arteries
 Walls relatively thick
 Capable of great vasoconstriction/ vasodilatation to adjust rate of
blood flow
 Also called distributing arteries
 Ex. Brachial artery , radial artery , ulnar artery
Anastomoses
 Union of the branches of two or more arteries supplying the same
body region
 Provide alternate routes – collateral circulation

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Arterioles
 An arteriole ( small artery) is a very small, almost
microscopic, artery that delivers blood to capillaries.
 arterioles consist of little more than a layer of endothelium
 covered by a few smooth muscle fibers
 Abundant vessels in the body

Veins
 Veins carry blood towards
the heart
 They carry blood that is
de-oxygenated
 They have valves that
stop the backflow of blood
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Venules
 Thinner walls than arterial
counterparts
 Postcapillary venule –
smallest venule
 Form part of
microcirculatory
exchange unit with
capillaries
 Muscular venules have
thicker walls with 1 or 2
layers of smooth muscle

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Capillaries
 are tiny blood vessels that pass blood from the arteries into the
veins.
 They are very small, the largest being about 10 micrometers in
diameter.
 Their walls are thin which allows materials to pass into the
capillaries.
 Different types of capillaries exist and perform different
functions for the body.
 Primarily, however, the capillaries are able to profuse the tissues
of the body with needed oxygen and important nutrients supplied
by blood.
 Lack tunica media and tunica externa
Three types of capillary
1. Continuous – most common
2. Fenestrated – have pores
3. Sinusoids(discontinuous)
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 Types of Capillaries
 Continuous capillaries
intercellular clefts are gaps between
neighboring cells
skeletal & smooth, connective tissue
and lungs
 Fenestrated capillaries
plasma membranes have many holes
kidneys, small intestine, choroid
plexuses, ciliary process & endocrine
glands
 Sinusoids
very large fenestrations
incomplete basement membrane
liver, bone marrow, spleen, anterior
pituitary, & parathyroid gland

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Principal Arteries of the body
aorta
ascending aorta
 ascends from the heart (left ventricle)
 The coronary arteries are the only branch of the ascending aorta that
supplies the heart
Aortic arch
 Three vessels arise from the aortic arch :
the brachiocephalic artery–further bifurcates into Right
subclavian and common carotid a that supply the right
upper limbs and head regions
left common carotid artery
left subclavian artery
Descending aorta
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 Cont..

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 Arteries of the neck and head
Common carotid artery

• ascends upwards in the neck lateral to trachea

• Divides slightly below the angle of the mandible into

 the internal carotid artery and

 the external carotid artery
The brain is supplied by four arteries:
• paired vertebral arteries (i.e., right and left) which forms basal
arteries and
• paired internal carotid arteries.

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 1.The vertebral artery
• arises from the subclavian artery
• ascends in the neck through the transverse foramen
• enters the cranial cavity through the foramen magnum.
• The right and left vertebral arteries unite to form the basilar artery.

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 The internal carotid arteries
 is divided into
 the ophthalmic artery
 supplies the eye, and
 the anterior and middle cerebral arteries
 supply the cerebrum.
The external carotid
 branches are named according to the area or structures they
supply
 Superior thyroid artery

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supply hyoid larynx, vocal cords thyroid gland.

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 Ascending pharyngeal artery - supply pharyngeal area
 Lingual artery -supply tongue and sublingual gland
 Facial artery- supply pharyngeal, palate, chin, lips, nasal
region
 Occipital artery
 supply scalp (posteriorly), meninges, mastoid region, some of the
posterior neck muscles
 Maxillary artery
supply teeth, gums, muscles of mastication, nasal cavities,
eyelids
 Superficial temporal artery
 supply parotid gland, side of the head.

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 Arteries of the upper limbs
 Right subclavian- from
brachiocephalic.and
 left subclavian- from aortic arch.
 It has the several branches in the
thorax but becomes the axillary
artery as it passes in the axilla.
 It becomes the brachial artery in
the arm.
 Site for BP(blood pressure)
measurement.

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 The brachial artery bifurcates at the cubital fossa into:
 Radial artery- supplies muscles on the radial side of the
forearm. It is the site of measuring pulse.
 Ulnar artery – supplies muscles on the ulnar side of the
forearm.
 Both arteries form
 palmar arch in the palm and
digital arteries supplying the digits.

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Branches of the thoracic portion of aorta
It is a continuation of the aortic arch
descends though the thoracic cavity to
diaphragm
gives branches to the muscles and organs of
thoracic region;
Pericardial artery
supply the pericardium of heart,
Bronchial artery
supply the systemic circulation to the
lungs.
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 Branches of the abdominal portion of aorta
Abdominal aorta is the segment between
diaphragm and L4
Has three main unpaired branches
Other paired branches
 unpaired
 Celiac trunk
short, thick, branch, which divides into three
vessels:
Splenic artery (to spleen)
Left gastric artery ( to stomach)
Common hepatic (to liver)
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 Superior mesenteric artery
 to the small intestine, cecum, appendix, transverse(1/2), and
ascending colons
 Inferior mesenteric artery
 last major, anterior, unpaired branch just before bifurcation into the
common iliac arteries.
Supplies half part of the transverse colon, the
descending, and sigmoid colons, rectum
 Paired branches
 Renal artery– to kidney
 Suprarenal artery - to adrenal glands
 Testicular artery - to testes
 ovarian artery - to ovaries

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Arteries of the pelvis and lower limbs
 The abdominal aorta terminates by
bifurcating into
 right common iliac arteries
left common iliac arteries
 The common iliac divides into
the internal iliac and
 external iliac.

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The internal iliac artery
 supply gluteal muscles and organs of the pelvic region
Urinary bladder , rectum , anal canal

branches
 Middle rectal - internal visceral organs of the pelvis
 Superior, inferior, middle vesicular arteries - urinary bladder
 Uterine and vaginal arteries - female reproductive organs
 Superior and inferior gluteal arteries - gluteal muscles.
 Obturator artery - upper medial thigh muscles
 Internal pudendal artery - perineum and external genitalia of male
and female

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 The external iliac artery
 passes out of pelvis beneath the inguinal ligament to become the
femoral artery
 Femoral artery
 passes through the femoral triangle on the upper
medial portion of the thigh.
At this point it is close to the surface, hence for

palpation and pressure.

the femoral artery becomes the popliteal artery as
it passes across the posterior aspect of the knee .

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The popliteal artery
 divides into the
anterior tibial and
the posterior tibial arteries
 the anterior tibial artery at the ankle, becomes
 the dorsal pedal artery
forms the plantar arch with the lateral plantar artery of
the posterior tibial artery.
The dorsal pedal artery is the site from which the most
distal pulse is recorded to get information about
circulation.

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 The posterior tibial artery
 forms the large fibular artery which supplies
the peroneal muscles of the leg.
At the ankle it bifurcates into the lateral and
medial plantar arteries.
The lateral plantar artery forms the plantar
arch and gives off digital arteries to the digits
of the foot.

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 Venous drainage of the body
Veins Draining the neck and head
 External jugular vein
 from scalp, portions of face, superficial neck region
 drain into right and left subclavian vein.
 Internal jugular vein
 from brain, meniges, deep regions of face and neck
 larger and deeper than the external jugular vein
 passes in carotid sheath with the common carotid and vagus nerve
beneath sternocleidomastoid muscle
 subclavian vein and internal jugular unite to form the
brachiocephalic vein
 the two brachiocephalic veins merge to form the superior
vena cava, which empties into the right atrium

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 Veins of the upper extremity
 Consists of superficial and deep venous drainage
 Deep veins
 accompany the arteries and bear their names / region
radial vein & ulnar vein
 both drain from deep and superficial palmar
arches
radial and ulnar veins join in the cubital fossa to
form the brachial vein, which continues up on the
medial side of the arm.
Brachial vein -axiliary → subclavian → internal
jugular → brachiocephalic

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 Superficial veins of UL
1. basilic vein
drains blood from ulnar side of forearm, medial side of
arm
merges with brachial vein near the head of the humerus to
form the axillary vein
2. cephalic vein
 drains superficial region of hand and forearm on radial
side
joins axillary vein in the shoulder region
median cubital vein ascends from the cephalic vein to join
basilic vein on radial side.
It is a site of venipuncture

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Figure 12.Anterior view of venous drainage of arm
 Veins of the thorax
 Superior vena cava
 receives blood from the right and left
brachiocephalic veins, which drain head, neck, and
upper limb as well as from azygous veins.
lacks valves which are characteristics of most
veins
 The azygous vein
 extends superiorly along the dorsal abdominal and
thoracic walls on the right side of the vertebral
column

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 …cnt
joins the superior vena cava at T4.
Its tributaries are:
ascending lumbar veins - drain from lumbar and
sacral regions
intercostal veins- from intercostals regions
 accessory hemiazygous and hemiazygous veins– from left of the
vertebral column
Veins of the lower extremity
 have a deep and a superficial group
 The deep veins
 accompany the corresponding arteries

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These include:
 posterior and anterior tibial veins
 originate in the foot and descend upwards in front of the
tibia to the back of the knee where they merge to form
the popliteal vein.
 Popliteal vein
 drains blood from the knee region and above the knee, it
becomes the femoral vein
 the femoral vein
receives blood from the deep femoral vein and above
this, receives from the great saphenous vein, then
becomes the external iliac vein (as it passes under the
inguinal ligament).
 the external iliac vein
 merges with the internal iliac vein to form the common
iliac vein
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 The superficial vein include

 small saphenous vein

arises from the lateral side of the foot, courses
posteriorly along the surface of the calf of the
leg and enters deep into the popliteal vein
behind the knee.
 great saphenous vein
longest vessel in the body, originates at the arch
of the foot and ascends superiorly along the
medial aspect of the leg and thigh before
draining into the femoral vein .

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 Veins of the Abdominal Region
The inferior vena cava
 parallels the abdominal aorta on the right as it ascends
through the abdominal cavity.
It penetrates the diaphragm and empties into the right
atrium
largest in diameter of all vessels in the body
in the abdomen has tributaries corresponding to the
branches of the abdominal aorta

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 paired lumbar veins
renal veins
right and left testicular veins.
right and left ovarian veins
right and left suprarenal veins.
inferior phrenic vein
right and left hepatic veins
common iliac veins

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 Hepatic portal system
Portal vein
is a vein which drains the abdominal part of alimentary
canal except the lowest part of rectum and anal canal.

It carries products of digestion of carbohydrates and

proteins to the liver and contains one –third of the
total volume of blood in the body.

It is formed behind the neck of the pancreas by union

of splenic and superior mesenteric veins.

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 Cont..

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 Cont..

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 Lymph
 Lymph means Fluid (clear water) of the lymphatic system
 is similar in composition to blood plasma& interstitial fluid
 The only difference is Protein concentration of lymph is lower
than in plasma and rate of formation
 The fluid is in the blood stream- plasma
 The fluid is b/n the cell –interstitial fluids
 A fluid when it pass in the lymphatic system is Lymph

103
 Types of Lymphatic organs
 Primary lymphatic organs site where Lymphocytes are
formed
 it includes
 Thymus gland
 Bone marrow
 Secondary lymphatic organs
 sites where lymphocyte activation and proliferation Occur
 most immune response also occur
 Encapsulated, include the spleen , lymph nodes, and lymphatic
nodules.
 Unencapsulated diffuse lymphoid tissue includes gut-associated
lymphoid tissues and the tonsils.
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 Lymph Nodes –are small swellings(bean shaped)
 are widely distributed throughout the body along the
lymphatic pathways.
 Composed of lymphoid tissue
 The reticular tissues contain phagocytic cells which filter or purify
the fluid(lymph).
 Afferent lymphatic vessels carry lymph to the lymph nodes
 Efferent lymphatic vessels carry away from the lymph nodes.
 Lymphatic nodules within the lymph nodes are the sites of
lymphocyte proliferation
 Lymph nodes usually occur in clusters in specific regions of the
body

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 …Cont

 Some of the principal groups of lymph

nodes are:
 Popliteal
 inguinal
 Lumbar
 Cubital lymph nodes
 axillary
 Thoracic
 Cervical
 (payer’s) patches occur in the
ileum.
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Function of Lymph nodes
 Filter the lymph before it is returned to the blood
 Preventing foreign particles from entering the bloodstream
 They also produce lymphocyte
Lymphatics (Lymph vessels )
Tubular vessels transport back lymph to the blood ultimately
replacing the volume lost from the blood during the
formation of the interstitial fluid.
 Lymph capillaries
 Lymph vessels Circulation(path) of lymph
 Lymph node
 Lymphatic trunks
 Lymphatic ducts
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The two main lymph ducts are:
1. Right lymphatic duct
2. Thoracic duct
1. Thoracic duct (larger) - drains from lower limbs, abdomen,
left thoracic and left upper limb, left side of the head and
neck
 ascends along the spinal column and empties into left subclavian
vein
2. Right lymphatic duct (shorter) -drains in to right
subclavian veins from right upper limb, right thoracic
region, right side of head and neck
 The rest of the body is drained by the thoracic duct that
empties into the right subclavian vein

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 Cont..

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 THANK YOU

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