The Anatomy of the Cardiovascular System

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Lecture on the Anatomy of the Cardiovascular System (part 1). Reference is Gray's Anatomy and Ellis Clinical Anatomy 11th Edition. Pictures and text not mine. Lecture given to BS Biology students of …

Lecture on the Anatomy of the Cardiovascular System (part 1). Reference is Gray's Anatomy and Ellis Clinical Anatomy 11th Edition. Pictures and text not mine. Lecture given to BS Biology students of USLS 2010-2011

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  • 1. The Cardiovascular System Anatomy Lecture Lectured by Bien Nillos, MD Reference: Gray’s Anatomy and Ellis Clinical Anatomy 11 th edition
  • 2. 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.
  • 3. 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
  • 4. 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.
  • 5.  
  • 6. 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.
  • 7.
    • 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.
  • 8.  
  • 9. 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
  • 10.  
  • 11.
    • 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.
  • 12.
    • 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.
  • 13.  
  • 14.
    • 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
  • 15. 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.
  • 16.  
  • 17.  
  • 18.
    • 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.
  • 19.
      • 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
  • 20.
    • 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.
  • 21.  
  • 22.  
  • 23.
    • 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.
  • 24.  
  • 25. Blood Supply to the Heart
    • derived from the right and left coronary arteries whose main branches lie in the interventricular and atrioventricular grooves
  • 26. 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.
  • 27.  
  • 28. 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.
  • 29.  
  • 30. 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.
  • 31. Coronary Sinus
    • It receives:
    • the great cardiac vein in the anterior interventricular groove;
    • the middle cardiac vein the inferior interventricular groove
    • the small cardiac vein — accompanying the marginal artery along the lower border of the heart;
    • the oblique vein— descends obliquely on the posterior aspect of the left atrium.
  • 32.  
  • 33. 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.
  • 34. Surface Anatomy of the Heart
    • the 2nd left costal cartilage 0.5in (12mm) from the edge of the sternum;
    • the 3rd right costal cartilage 0.5in (12mm) from the sternal edge;
    • the 6th right costal cartilage 0.5in (12mm) from the sternum;
    • the 5th left intercostal space 3.5in (9cm) from the midline (corresponding to the apex beat).
  • 35.  
  • 36.
    • 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
  • 37. End of Part One “ The heart has reasons that reason does not understand.” - Jacques Benigne Bossuel 
  • 38. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 No. 8 No. 9 No. 10
  • 39. Start of Part Two The Cardiovascular System (Hingagaw Session)
  • 40.
    • “ 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
  • 41.
    •   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.
  • 42. 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. 
  • 43. Parts of the Aorta
    • ascending aorta  
    • arch of the aorta  
    • descending aorta  
      • thoracic  
      • abdominal aorta
  • 44. 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.
  • 45. 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.
  • 46.  
  • 47.
    • 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.
  • 48.
    • 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.
  • 49.  
  • 50. 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.
  • 51.  
  • 52.
    • 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.
  • 53.
    • 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.
  • 54. 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
  • 55.  
  • 56. 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
  • 57. 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. 
  • 58.
    • 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.
  • 59. 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
  • 60.  
  • 61. 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 .
  • 62.
    • branches of the subclavian artery are:
      • Vertebral*
      • Internal mammary (thoracic)
      • Thyrocervical
      • Costocervical.
      • *union forms Basilar Artery
  • 63. 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.
  • 64. 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
  • 65.
    • 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.
  • 66.  
  • 67. Branches of the Axillary Artery
    • First Portion : Highest Thoracic Artery
    • Second Portion : Thoracoacromial, Lateral Thoracic
    • Third Portion : Subscapular, Posterior Humeral Circumflex, Anterior Humeral Circumflex.
  • 68. 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
  • 69.  
  • 70. Branches of the Brachial Artery
    • Profunda Brachii
    • Superior Ulnar Collateral
    • Nutrient
    • Inferior Ulnar Collateral
    • Muscular
  • 71. Descending Aorta
    • Two parts: Thoracic part and Abdominal part
    • Remember at what level the aorta pierces through the diaphragm
  • 72. 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
  • 73.
    • 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. 
  • 74. 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.
  • 75. Visceral Branches
    • Celiac
    • Superior Mesenteric
    • Inferior Mesenteric
    • Middle Suprarenals
    • Renals
    • Internal Spermatic
    • Ovarian
  • 76. Parietal Branches
    • Inferior Phrenics
    • Lumbar
    • Middle Sacral
    • * Terminal branches – Left and Right Common Iliac Arteries
  • 77. 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
  • 78.  
  • 79. 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.
  • 80. 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
  • 81. Splenic Artery (Lienal)
    • the largest branch of the celiac artery
    • Branches:
      • Pancreatic
      • Short Gastric.
      • Left Gastroepiploic.
  • 82. 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
  • 83.  
  • 84. 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 .
  • 85.
    • Branches:
      • Inferior epigastric
      • Deep iliac circumflex
  • 86. Femoral Artery
  • 87.
    • 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 .
  • 88.
    • The first 4 cm. of the vessel is enclosed, together with the femoral vein, in a fibrous sheath—the femoral 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 ).
  • 89. 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.
  • 90. 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
  • 91. Branches of the Femoral Artery
    • Superficial Epigastric
    • Deep External Pudendal
    • Superficial Iliac Circumflex
    • Muscular
    • Superficial External Pudendal.
    • Profunda Femoris.
    • Highest Genicular.
  • 92. 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.
  • 93. 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.
  • 94. 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.
  • 95.  
  • 96. 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.
  • 97. 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.
  • 98. 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.
  • 99. “ 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