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  1. 1. The Heart and Circulation Cardiovascular System = Heart, Blood and Vessels Lymphatic System = Lymph nodes, Organs and Vessels
  2. 2. The Heart <ul><li>External Innervation </li></ul><ul><ul><li>Vagus (parasympathetic) </li></ul></ul><ul><ul><li>C + T sympathetic chain ganglion </li></ul></ul><ul><li>Pericardium (3 layers) </li></ul><ul><ul><ul><li>1) Outer-fibrous pericardium </li></ul></ul></ul><ul><ul><li>Serous pericardium </li></ul></ul><ul><ul><ul><li>2) parietal </li></ul></ul></ul><ul><ul><ul><li>3) visceral (epicardium) </li></ul></ul></ul><ul><li>Pericardial Cavity </li></ul><ul><ul><li>between layers of serous pericardium </li></ul></ul><ul><ul><li>serous fluid </li></ul></ul><ul><ul><li>lubricate heart while beating </li></ul></ul>pg 502
  3. 3. Location of Heart in Chest <ul><li>Oblique Position </li></ul><ul><li>Apex = Left of Midline (5th ICS), Anterior to rest of heart </li></ul><ul><li>Base (posterior surface) sits on vertebral column </li></ul><ul><li>Superior Right = 3rd Costal Cartilage, 1” right midsternum </li></ul><ul><li>Superior Left = 2nd Costal Cartilage, 1” left midsternum </li></ul><ul><li>Inferior Right = 6th Costal Cartilage, 1” right midsternum </li></ul><ul><li>Inferior Left = 5th Intercostal Space at Midclavicular line </li></ul>
  4. 4. Location of Heart in Thorax pg 501
  5. 5. External Features of Heart <ul><li>Interventricular sulcus </li></ul><ul><li>Coronal/Coronary sulcus </li></ul><ul><li>Auricles of atria </li></ul><ul><li>Apex </li></ul><ul><li>Base </li></ul><ul><li>Coronary vessels </li></ul><ul><li>Ligamentum Arteriosum </li></ul>pg 504
  6. 6. The Great Vessels and major branches <ul><li>Aorta (from Left Ventricle) </li></ul><ul><li>Ascending </li></ul><ul><ul><li>Coronary arteries </li></ul></ul><ul><li>Aortic Arch </li></ul><ul><ul><li>Brachiocephalic trunk </li></ul></ul><ul><ul><li>Left Common Carotid </li></ul></ul><ul><ul><li>Left Subclavian </li></ul></ul><ul><li>Descending (Thoracic/Abdominal) </li></ul><ul><ul><li>Many small branches to organs </li></ul></ul><ul><li>Pulmonary Trunk (from Rt Ventricle) </li></ul><ul><ul><li>-2 Pulmonary Arteries into lungs </li></ul></ul><ul><li>Inferior/Superior Vena Cava </li></ul><ul><li>- Coronary sinus </li></ul>Pg 504, 532
  7. 7. Layers of Heart <ul><li>Epicardium (most superficial) </li></ul><ul><li>– Visceral pleura </li></ul><ul><li>Myocardium (middle layer) </li></ul><ul><ul><li>Cardiac muscle </li></ul></ul><ul><ul><li>Contracts </li></ul></ul><ul><li>Endocardium (inner) </li></ul><ul><ul><li>Endothelium on CT </li></ul></ul><ul><ul><li>Lines the heart </li></ul></ul><ul><ul><li>Creates the valves </li></ul></ul>pg 502
  8. 8. Right Heart Chambers: Pulmonary Pump <ul><li>Right Atrium (forms most of base of heart) </li></ul><ul><ul><li>Receives O 2 -poor blood from body via IVC, SVC, Coronary sinus </li></ul></ul><ul><ul><li>Ventral wall = rough Pectinate muscle </li></ul></ul><ul><ul><li>Fossa Ovalis - on interatrial septum, remnant of Foramen Ovale </li></ul></ul><ul><li>Right Ventricle </li></ul><ul><ul><li>Receives O 2 -poor blood from right atrium through tricuspid valve </li></ul></ul><ul><ul><li>Pumps blood to lungs via Pulmonary Semilunar Valve in pulmonary trunk </li></ul></ul><ul><ul><li>Trabeculae Carnae muscle ridges along ventral surface </li></ul></ul><ul><ul><li>Papillary Muscle -cone-shaped muscle to which chordae tendinae are anchored </li></ul></ul><ul><ul><li>Moderator Band - muscular band connecting anterior papillary muscle to interventricular septum </li></ul></ul>
  9. 9. Left Heart Chambers: Systemic Pump <ul><li>Left Atrium </li></ul><ul><ul><li>Receives O 2 -rich blood from 4 Pulmonary Veins </li></ul></ul><ul><ul><li>Pectinate Muscles line only auricle </li></ul></ul><ul><li>Left Ventricle (forms apex of heart) </li></ul><ul><ul><li>Receives blood from Left Atrium via bicuspid valve </li></ul></ul><ul><ul><li>Pumps blood into aorta via Aortic Semilunar Valve to body </li></ul></ul><ul><ul><li>Same structures as Rt Ventricle: Trabeculae carnae , Papillary muscles , Chordae tendinae </li></ul></ul><ul><ul><li>No Moderator Band </li></ul></ul>
  10. 10. Chambers of Heart
  11. 11. Heart Valves: Lub*- Dub** <ul><li>*Tricuspid Valve : Right AV valve </li></ul><ul><ul><li>3 Cusps (flaps) made of endocardium and CT </li></ul></ul><ul><ul><li>Cusps anchored in Rt. Ventricle by Chordae Tendinae </li></ul></ul><ul><ul><li>Chordae Tendinae prevent inversion of cusps into atrium </li></ul></ul><ul><ul><li>Flow of blood pushes cusps open </li></ul></ul><ul><ul><li>When ventricle is in diastole (relaxed), cusps hang limp in ventricle </li></ul></ul><ul><ul><li>Ventricular contraction increases pressure and forces cusps closed </li></ul></ul><ul><li>* Bicuspid (Mitral) Valve : Left AV valve </li></ul><ul><ul><li>2 cusps anchored in Left Ventricle by chordae tendinae </li></ul></ul><ul><ul><li>Functions same as Rt. AV valve </li></ul></ul><ul><li>** Semilunar valves : prevents backflow in large arteries </li></ul><ul><ul><li>Pulmonary Semilunar Valve: Right Ventricle and Pulmonary Trunk </li></ul></ul><ul><ul><li>Aortic Semilunar Valve: Left Ventricle and Aorta </li></ul></ul><ul><ul><li>3 cusps: blood rushes past they’re flattened, as it settles they’re pushed down (valve closed) </li></ul></ul>
  12. 12. Heart Valves pg 506
  13. 13. Flow of Blood <ul><li>O 2 -poor blood (S+I VC, Coronary Sinus) enters Rt Atrium </li></ul><ul><li>Travels through Tricuspid Valve into Rt Ventricle </li></ul><ul><li>Pumped out through Pulmonary Semilunar Valve into Pulmonary trunk (branches into Pulmonary Arteries) and to lungs </li></ul><ul><li>After circulating through lungs, O 2 -rich blood returns to the heart through 4 Pulmonary veins </li></ul><ul><li>The O 2 -rich blood enters the Left Atrium </li></ul><ul><li>Travels through Bicuspid/Mitral Valve into Left Ventricle </li></ul><ul><li>Pumped out through Aortic Semilunar Valve into Aorta to be distributed to rest of body by descending aorta and branches of aortic arch </li></ul>
  14. 14. Cardiovascular Circuits pg 500
  15. 15. Circuits <ul><li>Pulmonary Circuit </li></ul><ul><ul><li>Vessels carrying blood to and from lungs </li></ul></ul><ul><ul><li>Pulmonary arteries and veins </li></ul></ul><ul><li>Systemic Circuit </li></ul><ul><ul><li>Vessels carrying blood to and from the rest of the body </li></ul></ul><ul><ul><li>All other vessels </li></ul></ul>
  16. 16. Blood Flow to Supply the Heart Muscle <ul><li>Heart wall too thick for diffusion of nutrients </li></ul><ul><li>Rt and Lft Coronary Arteries </li></ul><ul><ul><li>Branch from Ascending Aorta </li></ul></ul><ul><ul><li>Have multiple branches along heart </li></ul></ul><ul><ul><li>Sit in Coronary Sulcus </li></ul></ul><ul><ul><li>Coronary Heart Disease </li></ul></ul><ul><li>Cardiac Veins </li></ul><ul><ul><li>Coronary Sinus (largest) </li></ul></ul><ul><ul><li>Many branches feed into sinus </li></ul></ul><ul><ul><li>Sits in Coronary Sulcus </li></ul></ul>
  17. 17. Anatomy of Arteries and Veins <ul><li>Tunica externa </li></ul><ul><ul><li>Outermost layer </li></ul></ul><ul><ul><li>CT w/elastin and collagen </li></ul></ul><ul><ul><li>Protects, Strengthens, Anchors </li></ul></ul><ul><li>Tunica media </li></ul><ul><ul><li>Middle layer </li></ul></ul><ul><ul><li>Circular Smooth Muscle </li></ul></ul><ul><ul><li>Collagen & Elastic Fibers </li></ul></ul><ul><ul><li>Vaso-constriction/dilation </li></ul></ul><ul><li>Tunica intima </li></ul><ul><ul><li>Innermost layer </li></ul></ul><ul><ul><li>Endothelium </li></ul></ul><ul><ul><li>Minimize friction </li></ul></ul><ul><li>Lumen </li></ul>pg 525
  18. 18. Vessels of Cardiovascular System: Arteries <ul><li>Carry blood AWAY from heart </li></ul><ul><li>Systemic Circuit: carry O 2 blood </li></ul><ul><li>Pulmonary Circuit: carry de-O 2 blood </li></ul><ul><li>Walls thicker than Veins </li></ul><ul><ul><li>Tunica media > Tunica externa </li></ul></ul><ul><li>3 Types </li></ul><ul><ul><li>Conducting (elastic) </li></ul></ul><ul><ul><ul><li>large, elastin, high pressure </li></ul></ul></ul><ul><ul><li>Distributing (muscular) </li></ul></ul><ul><ul><ul><li>medium size, to organs </li></ul></ul></ul><ul><ul><li>Arterioles </li></ul></ul><ul><ul><ul><li>smallest </li></ul></ul></ul>pg 532
  19. 19. Vessels of Cardiovascular System: Capillaries <ul><li>Smallest blood vessels </li></ul><ul><li>Single layer of endothelium surrounded by basal lamina </li></ul><ul><li>Deliver O 2 and nutrients to cells and remove waste </li></ul><ul><li>Capillary Beds: networks of caps. Regulating amount of blood going to cells throughout tissues </li></ul><ul><li>Tendons, Ligaments poorly vascularized </li></ul><ul><li>Epithelium, cartilage has no capillaries </li></ul>
  20. 20. Vessels of Cardiovascular System: Veins <ul><li>Carry blood from capillaries INTO the heart </li></ul><ul><li>Systemic Circuit: O 2 poor blood </li></ul><ul><li>Pulmonary Circuit: O 2 –rich blood </li></ul><ul><li>Thinner walls than arteries </li></ul><ul><ul><li>Tunica externa > tunica media, Less elastin </li></ul></ul><ul><li>Larger lumen than arteries </li></ul><ul><li>Contain valves (made of T. intima) </li></ul><ul><li>Normal movement, Muscular contraction push blood through </li></ul><ul><li>Venules- smallest veins </li></ul>
  21. 21. Movement through Veins Pg 529
  22. 22. Cardiovascular Blood Flow <ul><li>Heart  Arteries  (conducting-distributing)  Arterioles  Capillaries of tissues </li></ul><ul><li>At Capillaries O 2 is delivered and CO 2 picked up </li></ul><ul><li>Capillaries  Venules  Veins  Heart </li></ul><ul><li>Portal System : Special vascular circulation where blood goes through 2 capillary beds before returning to the heart to achieve 2 nd function </li></ul><ul><ul><li>(eg) Hepatic Portal System: aids digestion by picking up digestive nutrients from stomach + intestines and delivers to liver for processing/storage </li></ul></ul><ul><ul><li>Pick-up occurs at capillaries of stomach and intestine </li></ul></ul><ul><ul><li>Via Hepatic Portal Vein goes to capillaries of liver </li></ul></ul><ul><ul><li>Via Hepatic Vein blood goes back to heart </li></ul></ul>
  23. 23. Hepatic Portal System pg 548
  24. 24. Vascular Anastomoses <ul><li>Vessels unite and connect </li></ul><ul><li>Arteriole Anastomoses </li></ul><ul><ul><li>Communication between arteries </li></ul></ul><ul><ul><li>Joints, Abdominal Organs, Brain, Heart </li></ul></ul><ul><li>Venous Anastomoses </li></ul><ul><ul><li>Communication between veins </li></ul></ul><ul><ul><li>More common </li></ul></ul><ul><ul><li>(eg) back of hand </li></ul></ul><ul><li>Vaso Vasorum </li></ul><ul><ul><li>Tiny arteries, veins, capillaries in tunica externa of vessels to nourish them (outer half) </li></ul></ul>
  25. 25. Fetal Circulation: 2 main differences <ul><li>1) Fetus must transport blood to and from the placenta </li></ul><ul><li>2) Lungs are not functional, and do not need much blood </li></ul><ul><li>All major vessels are in place by 3 rd month </li></ul><ul><li>Blood flows in same direction as in adults </li></ul>
  26. 26. Fetal Circulation: Blood to Placenta <ul><li>Fetus must supply placenta w/blood </li></ul><ul><li>Umbilical Vessels: carries blood to/from placenta </li></ul><ul><ul><li>2 Umbilical Arteries = bring blood that contains waste & little O 2 from fetus to placenta </li></ul></ul><ul><ul><li>1 Umbilical Vein = brings blood w/O 2 and nutrients to fetus from placenta (some goes to portal vein to process in liver) </li></ul></ul><ul><li>Ductus Venosus = shunt taking blood returning from placenta to fetus directly to heart, largely bypassing liver </li></ul><ul><ul><li>Too much blood for liver to handle </li></ul></ul><ul><ul><li>Results in highly O 2 blood going to heart </li></ul></ul>
  27. 27. Fetal Circulation: Bypassing the Lungs <ul><li>Fetal Lungs are not functional and do not need large amounts of blood </li></ul><ul><li>Foramen Ovale (becomes Fossa Ovalis ) </li></ul><ul><ul><li>Small hole in inter-atrial septum allows blood to flow directly from Rt. Atrium to Lft. Atrium </li></ul></ul><ul><ul><li>This largely bypasses the Rt. Ventricle  Pulmonary trunk that would bring blood to lungs </li></ul></ul><ul><li>Ductus Arteriosus (becomes Ligamentum Arteriosum ) </li></ul><ul><ul><li>Shunt directs blood from Pulmonary Trunk to Aortic arch, largely bypassing lungs </li></ul></ul>
  28. 28. Bypassing the Lungs Pg 555
  29. 29. Remnants of Fetal Circulation <ul><li>Ligamentum teres = Round ligament </li></ul><ul><ul><li>Remnant of the umbilical vein </li></ul></ul><ul><ul><li>Anterior abdominal wall </li></ul></ul><ul><li>Ligamentum venosum </li></ul><ul><ul><li>Remnant of ductus venosum </li></ul></ul><ul><ul><li>On liver’s inferior surface </li></ul></ul><ul><li>Medial Umbilical Ligaments </li></ul><ul><ul><li>Remnant of umbilical arteries </li></ul></ul><ul><ul><li>Anterior abdominal wall below navel </li></ul></ul><ul><ul><li>Also gives branch to urinary bladder </li></ul></ul>
  30. 30. The Lymphatic System <ul><li>Function: to collect excess tissue fluid collecting at arteriole end of capillary beds, and return leaked blood proteins to blood (maintain osmotic pressure needed to take up water into bloodstream) </li></ul><ul><li>Lymph is moved through vessels </li></ul><ul><ul><li>Pulse of nearby arteries </li></ul></ul><ul><ul><li>Contraction of surrounding skeletal muscle </li></ul></ul><ul><ul><li>Regular movement of body (wiggling legs) </li></ul></ul><ul><ul><li>Muscle in Tunica Media </li></ul></ul><ul><li>Lacteals -lymphatic capillaries w/unique function </li></ul><ul><ul><li>In mucosa of small intestine, receive digested fat from intestine </li></ul></ul><ul><ul><li>Fatty lymph becomes milky = Chyle </li></ul></ul><ul><ul><li>Chyle goes to bloodstream </li></ul></ul>
  31. 31. Lymphatic System …The Players: <ul><li>Lymph - clear fluid from loose CT at capillaries </li></ul><ul><li>Lymphatic capillaries (near blood capillaries)  </li></ul><ul><li>Lymph collecting vessels (small, 3 tunicas, # valves)  </li></ul><ul><li>Lymph nodes (sit along collecting vessels)-clean lymph of pathogens, they are NOT glands </li></ul><ul><li>Lymphatic trunks  (convergence large collecting vessels) </li></ul><ul><ul><li>Lumbar, intestinal, bronchomediastinal, subclavian, jugular </li></ul></ul><ul><li>Lymphatic ducts  empty into veins of neck </li></ul>