CHAPTER 7

CARDIOVASCULAR
SYSTEM

GENERAL ANATOMY
AUTHOR: Dr YOGESH SONTAKKE,
JIPMER, PONDICHERRY
 As per:
Competency based Undergraduate curriculum
•AN 5.1 Differentiate between blood vascular and lymphatic system.
• AN 5.2 Differentiate between pulmonary and systemic circulation.

• AN 5.3 List general differences between arteries and veins

• AN 5.4 Explain function difference between elastic, muscular arteries, and

arterioles.

Human Anatomy/Yogesh Sontakke 2

 As per:
Competency based Undergraduate curriculum
• AN 5.5 Describe portal system giving examples.

• AN 5.6 Describe the concept of anastomoses and collateral circulation

with significance of end arteries.

• AN 5.7 Explain function of meta-arterioles, precapillary sphincters,

arterio- venous anastomosis.

• AN 5.8 Define thrombosis, infraction, and aneurysm.

Human Anatomy/Yogesh Sontakke 3

 INTRODUCTION
• Cardiovascular system: consists of heart and blood vessels. Heart
collects the blood and pump it into the blood vessels.
• Blood vessels: tubular channels that provide passage for blood circulation.
There are various types of blood vessels that include
– Arteries: carry blood away from the heart.
– Veins: carry blood toward the heart.
– Capillaries: connect arteries and veins and act as a site of metabolic and
gaseous exchange.
 FUNCTIONS OF CARDIOVASCULAR SYSTEM
Q. List the functions of circulatory system.
 The cardiovascular system performs the following functions:
1. Carries blood
2. Exchange of nutrients, waste products and gases with tissue
3. Transport substances
4. Regulates blood pressure
5. Directs blood flow to the tissues
 COMPONENTS OF CARDIOVASCULAR
SYSTEM
Q. List and describe in brief the components of cardiovascular system.

Q. Why the blood is specialized connective tissue.

• The cardiovascular system consists of the following components.

1. Blood
2. Heart
3. Blood vessels
 BLOOD
 Blood – specialized body fluid that circulate through the heart and blood
vessels.
 Similar characteristics with other connective tissue, the blood is
classified specialized connective tissue. These characteristics include
1. Blood contains cells – RBCs, WBCs, and platelets.
2. Extracellular matrix in the form of plasma.
3. Instead of connective tissue fibers such as collagen, the blood contains
soluble proteins such as fibrinogen (which get converted into insoluble
fibers – fibrin)
 The blood makes up to 8% of the total body weight
 COMPOSITION OF THE BLOOD
• The blood consists of:
1. Plasma which has proteins (albumin, globulin, and fibrinogen),
water, and minerals
2. Blood cells:
– Erythrocytes
– White blood cells – neutrophils, lymphocytes, monocytes,
eosinophils, basophils
– Platelets
 COMPOSITION OF THE BLOOD
• Erythrocytes (red blood cells, RBCs); disc-shaped cells; do not have
nuclei and mitochondria; have hemoglobin that helps in carrying oxygen.
• White blood cells (WBCs, leukocytes)

• These are further subdivided into:

–Granulocytes: Numerous cytoplasmic granules. For example,

neutrophils, eosinophils, basophils
– Agranulocytes: Do not have specific cytoplasmic granules. For
example, lymphocytes and monocytes.
 COMPOSITION OF THE BLOOD
• Lymphocytes : Grouped into three types based on the presence of cluster
of differentiation (CD) molecules:

• T cells, B cells and natural killer (NK) cells:

o T cells – maintain cell-mediated immunity
o B cells – maintain humoral immunity of secreting antibodies.
o Natural killer cells– destroy antibody-bound cells
o T cells mature in the thymus. B cells differentiate in bone marrow and
mature to form plasma cells that secrete antibodies.
 COMPOSITION OF THE BLOOD
• Platelets: Minute fragments of cell; small amount of cytoplasm
surrounded by cell membrane. In bone marrow megakaryocytes give rise
to platelets; stops bleeding as it is involved in the formation of blood clot
at the site of injury.
• Functions Of Platelets:
a. Secrete a serotonin and thromboxane A2 that causes
vasoconstriction and reduces blood loss.
b. Derived growth factors (PDGF) promotes growth of cells at the
site of injury.
c. Fibrinogen that is converted into fibrin at the site of injury.
 COMPOSITION OF THE BLOOD
• Plasma:
– Constitutes 55% amount of the blood. It is a yellow fluid.
– Consists of 91% water, 7% proteins and 2% other solutes.
– Plasma proteins include albumin, globulins and fibrinogen.
– Albumins: Mainly produced in liver. They maintain osmotic pressure
of the blood which is essential for water balance between blood and
tissue.
– Globulins: Antibodies and complement. These are mainly part of
immune system.
 COMPOSITION OF THE BLOOD
– Fibrinogen : Clotting factor and its activation form thread-like protein
– fibrin
– Some albumins and globulins are carrier of hormones and other
molecules.
– Note: Serum = Plasma– clotting factors
White blood cell Description Functions
Neutrophil (10–12 µm) Nucleus: 3–5 lobes Cytoplasm: Phagocytosis of microorganism
shows pink or reddish-purple
granules

Basophils (10–12 µm) Nucleus: segmented Cytoplasm: Release histamine, promote

dark, basophilic granules (contain inflammation
histamine)

Eosinophil (10–14 µm) Nucleus: bilobed Cytoplasm: dark Phagocytose antigen-antibody

eosinophilic granules complexes, induce allergic
reactions, and asthma, attack
parasites
Lymphocytes (6–14 µm) Round nucleus, thin rim of T lymphocytes: cell-mediated
cytoplasm immunity B lymphocytes:
antibody-mediated immunity NK
cells: destroy cancer cells

Monocytes (12–20 µm) Kidney-shaped nucleus Phagocytosis Differentiate into

mononuclear phagocytic cells
(e.g. macrophages)
 CLINICAL INTEGRATION
• Immunization: During vaccination/immunization inactivated
microorganism or its part is injected/given orally and nasally. It activates
B cells to form mature memory B cells that remains in dormant phase in
spleen, lymph nodes and other places. On exposure to microorganism or
its antigen, these cells get activated to for B plasms cells. They produce
antibodies which protect the body through humoral immunity.
• Blood as route for spread blood act as vehicle for spread of
microorganisms, toxins, cancer cells and so on.
 HEART
• Conical hollow muscular organ enclosed within the pericardium. It is about the
size of a clenched fist of the individual.
• Consists of four chambers: Right atrium, right ventricle, left atrium, and left
ventricle.
1. Right atrium receives deoxygenated blood from superior and inferior venae
cavae and transfer to the right ventricle.
2. Right ventricle passes the blood to the lungs through pulmonary trunk and
later pulmonary arteries.
3. Left atrium receives oxygenated blood from lungs through four pulmonary
veins and later passes it to the left ventricle.
4. Left ventricle supplies the blood to entire body through aorta.
 BLOOD VESSELS
Classification Of Blood Vessels:
• Arteries carry blood away from heart, capillaries nourish the tissue,
whereas veins carry blood toward heart.
• Blood vessels are classified as follows:
A. Arteries:
1. Elastic or large arteries (conducting arteries)
2. Muscular arteries (medium-sized or distributing arteries)
3. Arterioles: Terminal arterioles and meta-arterioles
 BLOOD VESSELS
B. Capillaries:
1. Continuous capillaries
2. Fenestrated (visceral) capillaries
3. Sinusoid or sinusoidal capillaries
C. Veins:
4. Venules: Post-capillary venules, muscular venules
5. Small veins
6. Medium-sized veins
7. Large veins
 BLOOD VESSELS
Functionally the blood vessels are classified as:
1. Distributing vessels: arteries
2. Resistance vessels: arterioles with precapillary sphincter
3. Exchange vessels: capillaries, sinusoids, precapillary
venules
4. Reservoir or capacitance vessels: Larger venules and
veins
5. Shunts: anastomoses.
FLOWCHART 13.1: BLOOD CIRCULATION THROUGH VESSELS
 BASIC STRUCTURE OF BLOOD VESSELS
• Blood vessels show three basic
layers in their transverse
section: Tunica intima, tunica
media and tunica adventitia
(tunica = coat). Presence and
thickness of these layers
depend on size and type of the
Fig. 13.2: GENERAL STRUCTURE OF BLOOD VESSEL
blood vessel.
 BASIC STRUCTURE OF BLOOD VESSELS
1. Tunica intima: Innermost layer
of blood vessel; consists of
endothelium, subendothelial
connective tissue, and internal
elastic lamina (inside outwards).
Endothelium consists of simple
squamous epithelium. Internal
elastic membrane consists of
many fenestrated elastic sheets;
fenestrations permit Fig. 13.2: GENERAL STRUCTURE OF BLOOD VESSEL
transmission of nutrients to the
outer wall of blood vessels from
its lumen.
 BASIC STRUCTURE OF BLOOD VESSELS
2. Tunica media: Middle layer of blood vessels; consists of
concentric layers of spirally oriented smooth muscles; thicker
and contains more smooth muscles than that of veins. External
elastic lamina separates tunica media from tunica adventitia.
Smooth muscle cells of tunica media can produce contraction or
relaxation under autonomic neuronal control.
3. Tunica adventitia: Outermost and connective tissue layer of
blood vessels.
FLOWCHART 13.2: STRUCTURE OF BLOOD VESSEL
 ENDOTHELIUM
• A lining epithelium of internal
surface of cardiovascular system.
• simple squamous epithelium;
flattened, elongated and polygonal
cells; shows small quantity of
cytoplasm and elongated, flat,
densely stained nucleus. Adjacent
endothelial cells are connected with Fig. 13.1: (A) Endothelial cells. Note: Long axis of endothelial
cells lies parallel to the direction of blood flow. (B) Practice
each other by tight junctions. figure for endothelial cells.
 ENDOTHELIUM
Functions Of Endothelium:
1. Smooth surface: Provides a smooth
nonadherent surface for flowing blood
columns.
2. Selective permeability barrier: Allows
movement of selected substances across it
through simple diffusion, pinocytosis, and
receptor-mediated endocytosis. Transport of
substance mainly depends on its size and Fig. 13.1: (A) Endothelial cells. Note: Long axis of
endothelial cells lies parallel to the direction of blood flow.
charge.
(B) Practice figure for endothelial cells.
 ENDOTHELIUM
3. Release of von Willebrand Factor
(plasminogen activator inhibitor):
Damaged endothelium release von
Willebrand factor that induces
platelet aggregation and clot
formation [Erik Adolf von
Willebrand, 1870–1949, Finnish
physician].
4. Release of nitric oxide (NO) and
prostacyclin: Vasodilator agents.
 ENDOTHELIUM
5. Release of endothelin, angiotensin-converting enzyme (ACE):
vasoconstrictor agents; With the help of vasodilator and vasoconstrictor
agents, endothelium controls blood flow through the vessels.
6. Hormone synthesis: Synthesizes and secretes many growth factors such
as colony stimulating factors, fibroblast growth factors, platelet-derived
growth factors.
7. Release of endothelial-derived relaxing factor (EDRF): Produces
vasodilatation with the help of nitric oxide (NO).
8. Synthesis of type IV collagen fibers: Responsible for the formation of
basal lamina.
 ARTERIES
Features:

1. Carry the blood away from the heart.

2. Thick -walled vessels.
3. Smaller and regular/round lumen as compared to veins.
4. Do not have valves.
5. Neurovascular bundle: Artery along with accompanying vein
and nerve form neurovascular bundle.
 ARTERIES
Classification:
• Classified based on characteristics of tunica media as follows:
1. Elastic Or Large Arteries (conducting arteries):
• Multiple layers of vascular smooth muscles and elastic lamellae in
tunica media.
• Diameter is more than 10 mm.
• Examples: Aorta, pulmonary trunk, brachiocephalic artery, common
carotid artery, subclavian artery, common iliac artery, pulmonary artery .
 ARTERIES
[Link] Arteries (medium-sized or distributing arteries):
• More smooth muscles and less elastic lamellae and diameter of 2–
10 mm.
• Prominent feature of muscular arteries is presence of a greater
number of smooth muscles and less amount of elastic material in
tunica media.
• Because of less amount of elastic material in tunica media, internal
elastic lamina (part of tunica intima) can be easily identified.
• Examples: Brachial artery, femoral artery, and other arteries of
limbs.
 ARTERIES
3. Arterioles:
• Smallest divisions of the arteries. They have only a single layer of
smooth muscles and diameter 10–100 m).

Fig. 13.8: PHOTOMICROGRAPH. Layers of medium-sized artery (muscular artery) and medium-sized vein (H&E
stain, high magnification).
• Resistance vessels as they are the main source of peripheral resistance to blood flow due to
their narrow lumen and surrounding smooth muscles. They regulate diastolic pressure.
• Terminal arterioles have diameter less than 50 m. In meta-arterioles, the smooth muscles
are replaced by discontinuous noncontractile cells called pericytes or Rouget cells. Distally,
meta-arterioles form capillary plexuses.

Fig. 13.9: ARTERIOLE AND VENULE (PRACTICE FIGURE).

 ARTERIAL PULSE
• Rhythmic expansion and contraction of arterial walls as blood in ejected
from the heart into arteries during each heartbeat.
• Palpation of arteries: Some arteries can be palpated (felt) through the skin.
• Important part of clinical examination; gives valuable information about the
overall cardiovascular health.
1. Presence or absence
2. Rhythm
3. Rate
4. Strength or amplitude.
TABLE: ARTERIES AND LOCATIONS OF THEIR PALPATION
Arterial pulse Site of palpation
Radial Radial side of front of forearm at wrist lateral to the
tendon of flexor carpi radialis
Branchial Infront of elbow, medial to the tendon of biceps
Carotid In the neck, along the anterior border of
sternocleidomastoid muscle, at the level of cricoid
cartilage
Dorsalis pedis Over the dorsum of the foot, just medial to the tendon
of extensor hallucis longus
Posterior tibial On the medial side of the ankle, midway between
medial malleolus and tendo-calcaneous
Popliteal Behind the knee, in the middle of the popliteal fossa
 CAPILLARIES
• A network of vessels in tissue and are sites for exchange of nutrients;
average diameter of 8 μm (4–10 μm); Human body has ~50,000
miles of capillaries.
• Consists of endothelium and its basal lamina. There is no tunica
media and tunica adventitia in capillaries. In some capillaries,
pericytes are present. Pericytes lie embedded in basal lamina of
endothelium.

Classification:
• Classified into three groups based on continuity of wall and basal
lamina as follows:
 CAPILLARIES
1. Continuous Capillaries : continuous endothelial cells and basal lamina.
Locations: Continuous capillaries are found in connective tissue,
muscles, skin, lungs, and central nervous system.

Fig. 13.12: CLASSIFICATION OF CAPILLARIES.

 CAPILLARIES
2. Fenestrated (Visceral) Capillaries: endothelial cells have numerous circular openings
called fenestrations (fenestrations = aperture or pores) (size of fenestrations: 50–80 nm).
Basal lamina is continuous and covers entire capillary.
Locations: Present in renal glomeruli, pancreas, endocrine glands, intestinal villi,
choroid plexus, ciliary process of eye, and gallbladder.

Fig. 13.12: CLASSIFICATION OF CAPILLARIES.

 CAPILLARIES
3. Sinusoid Or Sinusoidal Capillaries: fenestrated endothelial cells and
discontinuous basal lamina. In liver, sinusoidal wall shows two special
cells: Kupffer cells (Phagocytic macrophages), and Ito cells (vitamin A
storing cells).

Fig. 13.13: CLASSIFICATION OF CAPILLARIES (PRACTICE FIGURE).

 CAPILLARIES
• Functions: The blood flow through the sinusoids is sluggish that provide sufficient time
for exchange of large molecules between the blood and tissue fluid.
• Locations: Liver, spleen, lymph nodes, bone marrow, endocrine glands (adrenal cortex,
hypophysis cerebri, parathyroid gland), and carotid bodies.
• Note: Some authors consider sinusoid as a separate group of vessels.

Fig. 13.13: CLASSIFICATION OF CAPILLARIES (PRACTICE FIGURE).

Flowchart 13.6: CLASSIFICATION OF CAPILLARIES
 VEINS
• Carries blood toward the heart.

Features Of Veins:
[Link] walled.
[Link] of capillaries or small veins.
[Link] and irregular lumen than arteries.
[Link] the unidirectional blood flow.
[Link] veins are surrounded by dead space that permits their
expansion during increased venous return.
 VEINS
Classification:
• Grouped into four groups based on their size as follows:
1. Venules (diameter 10–100 μm): receives blood from capillaries.
Venules are of two types:
a. Post-capillary venules (10–50 μm diameter): receives blood
from capillaries. They are lined by endothelium and pericytes.
b. Muscular venules (50–100 μm diameter): lined by endothelium,
1–2 layers of smooth muscles and surrounded by thick layer of
connective tissue.
 VEINS
2. Small veins (diameter 0.1–1 mm) drain blood from muscular
venules.

Fig. 13.11: MICROCIRCULATION AND ROLE OF PRECAPILLARY SPHINCTER AND METARTERIOLE.

 VEINS
2. Medium-sized veins (diameter 1–10 mm): They accompany medium-sized arteries. For example, radial vein,
tibial vein, popliteal vein, and so on.
3. Large veins (diameter >10 mm): Tunica adventitia is the thickest layer of large vein. It consists of
longitudinally arranged smooth muscle cells. Examples: Superior vena cava, inferior vena cava.

Fig. 13.11: MICROCIRCULATION AND ROLE OF PRECAPILLARY SPHINCTER AND METARTERIOLE.

TABLE 13.3: DIFFERENCES BETWEEN ARTERY AND VEIN
Q. List the differences between artery and vein
Feature Artery Vein
Wall Thicker than vein Thinner than artery
Lumen Oval, circular, patent (open) Collapsed, irregular
Internal elastic lamina well defined in medium and small arteries Absent or not well defined

Tunica media Thicker than veins. Thinner than arteries.

Thicker than adventitia of arteries Thinner than adventitia of veins
Consists of many layers of smooth muscle Consists of a few layers of smooth muscle
cells and elastic fibers cells, collagen fibers, and fibroblasts

Tunica adventitia Consists of connective tissue Consists of longitudinal smooth muscle

cells and elastic fibers (especially in large
veins)
Layers All three layers of vessel are well defined In small and medium-sized veins, all three
layers of vessel are not clearly identified
 Table 13.2: Differences between elastic artery and
muscular artery
Q. List the differences between elastic artery, muscular artery, and arteriole.
Layer Elastic artery Muscular artery Arteriole

Tunica intima Significant amount of Subendothelial connective tissue is Subendothelial connective tissue is
subendothelial connective tissue is scanty. thin or absent.
present. Internal elastic lamina is clearly Internal elastic lamina is present
Internal elastic lamina is not visible only in large arterioles.
clearly identifiable

Tunica media Many thick fenestrated elastic Very less amount of elastic fibers Elastic fibers absent.
laminae are present. present. 2–3 layers of smooth muscle are
Smooth muscles (up to 50 layers) Up to 40 layers of smooth muscles present.
are present intermittently between are present
elastic laminae

Tunica adventitia It is relatively thin layer of It is relatively thick layer of It is thin.

connective tissue fibroelastic connective tissue
Examples Aorta, carotids, and subclavian Brachial artery, femoral artery
arteries

Note: In capillaries, subendothelial connective tissue, internal elastic lamina, smooth muscles, and tunica adventitia are absent.
TABLE 13.2: DIFFERENCES BETWEEN CAPILLARIES AND SINUSOIDS.
Q. List the differences between capillaries and sinusoids.

Feature Capillaries Sinusoids

Size Smaller (5–8 μm) Larger (5–30 μm)

Lumen Circular (regular) Irregular

Lining epithelium Endothelium Endothelial cells with few

phagocytic cells

Basal lamina Continuous Discontinuous

Locations Continuous capillaries are found in muscles, skin, In liver, spleen, lymph nodes, bone
lungs. marrow.
Fenestrated capillaries are present in renal
glomeruli, pancreas, endocrine glands.
TABLE 13.4: DIFFERENCES BETWEEN LARGE-SIZED
VEIN, MEDIUM-SIZED VEIN AND VENULE
Q. List the differences between large-sized vein, medium-sized vein and venule.
Feature Large-sized vein Medium-sized vein Venule
Diameter Larger (>10 mm) Smaller (1–10 mm) 10–100 μm
Tunica intima Subendothelial connective Subendothelial connective Subendothelial
tissue is thin. tissue is thin or absent. connective tissue is
absent.

Tunica media Longitudinal smooth Few collagen fibers and 1–2 layers of smooth
muscles, difficult to smooth muscle cells are muscle cells.
differentiate from present.
adventitia.

Tunica adventitia Thick. Longitudinally Thick. Longitudinally Thin layer of collagen

oriented smooth muscle oriented bundles of collagen fibers and few fibroblasts.
cells. fibers fibroblasts.
 BOX: ARTERIOVENOUS (AV) SHUNTS/ANASTOMOSIS
Q. Write a short note on AV shunts.

• Connects arteriole to venule and bypasses capillary network. It helps to

divert blood from capillaries (short-circuit).
• Locations: Skin of fingertips, nose, lips, erectile tissue of penis and
clitoris.

Structure:

• AV shunts may be straight or coiled. Wall of AV shunt is lined by

endothelium and several layers of smooth muscle cells. Contraction of
these smooth muscle cells close AV shunt and enhance blood supply to
capillary plexus.
 BOX: ARTERIOVENOUS (AV) SHUNTS/ANASTOMOSIS
Functions Of AV Shunts:
• Thermoregulation - In skin, opening of AV shunts help to bypass capillary
plexus and help to conserve heat.
• Erectile function - In erectile tissue, AV shunts divert blood to cavernous
spaces and initiate erection.
• AV shunts of newborn are not well formed and in old age, number of AV shunt
decreases. Hence, thermoregulation is not good in newborns and old.
• Glomus - a specialized form of AV shunt that is formed by rounded bunch of
vessels. It is found in skin, at the tip of finger and toes, lips, and tip of the
tongue and nose. Smooth muscle cells lining connecting vessels in glomus are
epithelioid cells because they appear as epithelial cells.
 CLINICAL INTEGRATION
• Function of elastic arteries as a diastolic pump: During ventricular systole, elastic
arteries dilate to acquire a sudden rush of blood from ventricles (accommodate blood).
During ventricular diastole (relaxation), because of elastic recoil, these arteries push the
blood into medium-sized arteries and maintain continuous blood flow. Thus, elastic
arteries pump blood during diastole of ventricles.

• Hypertension: It is the sustained diastolic pressure above 90 mm Hg or sustained

systolic blood pressure above 140 mm Hg. It affects most of the elderly people because
of increased vascular resistance, atherosclerotic changes, increased vascular smooth
muscle cells, decreased amount of elastic fibers, and increased amount of collagen
fibers in vessel walls.
• Varicose veins: These are abnormally dilated veins. It is especially seen in the veins of
lower limbs in older people because of failure of valves, decreased vascular smooth
muscle tone, and prolonged standing.
 VENOUS VALVES
• To maintain unidirectional blood flow towards the heart veins above
valves. These valves also help to maintain the blood flow against the
gravity and from superficial to deep veins.
• Each venous valve has cusps that make the valve to open only in one
direction.
• Valves are more numerous in the veins of lower to maintain blood flow
against gravity.
• Valves near the termination of internal jugular, subclavian and femoral
veins prevent the venous blood backflow during increased intrathoracic
pressure (during inspiration and coughing) and during increased intra-
abdominal pressure (during defecation).
 VENOUS VALVES
• The following veins do not have valves in their lumen:
1. Superior and inferior vena cava
2. Hepatic veins and portal veins
3. Renal veins
4. Uterine and ovarian veins
5. Pulmonary veins
6. Facial veins
 VENOUS VALVES
• The following veins do not have muscular tissue in their wall:
1. Dural venous sinuses
2. Pial veins
3. Retinal veins
4. Veins of erectile tissue of penis
5. Veins of spongy bone.
 FACTORS HELPING VENOUS RETURN
Q. List the factors helping venous return.

• The following factors help in venous return to the heart

1. Vis-a-tergo: It is a forward push of blood from behind by the blood pumped by heart.
2. Negative intrathoracic pressure sucks the blood into the heart from all major veins of body.
3. Gravity helps in venous return from upper part of the body.
4. Muscle contractions help to press the veins passing deep or through the substance of the
muscles. It helps in venous return. Contraction calf muscle (soleus) helps in venous return
from lower limb; hence, it is called peripheral heart.
5. Arterial pulsations: Most of the veins are accompanied by arteries. These artery pulsations
drive the venous blood towards heart.
6. Venous valves prevent backflow of blood and maintain unidirectional blood flow.
 CLINICAL INTEGRATION
Site Of Venipuncture:

• Collection of blood samples. The superficial veins are commonly used for
the venipuncture.

Varicose Veins:

• Dilated tortious veins; Continuous standing for a long period may induce
varicose veins; caused by weakness of venous valves, weakness of walls
of veins.
• It results in pooling blood in veins. It may occur commonly in veins of
lower limb (especially great saphenous vein). It may occur at the lower
end of esophagus or in the anal canal.
 ANASTOMOSIS
Q. Write a short note on anastomosis.

• Definition: Communication between neighboring vessels through a

collateral channel. The circulation through anastomosis is collateral
circulation.

Types of anastomoses:

• There are three types of anastomoses: arterial, venous, and

arteriovenous.

Arterial anastomosis:

• is the communication between two arteries. It may be actual or potential

anastomosis.
 ANASTOMOSIS
A. Actual anastomosis may be two types: end-to-end
anastomosis and convergent anastomosis.
1. End-to-end anastomosis: Arteries joint end to end. For
example, palmar arches, plantar arch, circle of Willis, labial
branches of facial arteries.
2. Convergent anastomosis: Two arteries join to form a
larger artery. For example, vertebral arteries join to form a
larger basilar artery.
 ANASTOMOSIS
B. Potential arteries anastomosis: Between terminal arterioles. In
such anastomosis, collateral channel dilates gradually over a
period. Sudden occlusion of the main artery, the potential
anastomosis may fail to compensate the loss of blood supply. For
example, anastomosis of coronary arteries.

Venous Anastomosis:
• Communication between adjacent veins. For example, dorsal arches
of hand and foot.
 ANASTOMOSIS
Arteriovenous Anastomosis (Shunt):
• Communication between artery and vein; helps to supply the blood
to the organ as per the need; shunt vessel prevent/ the permit entry of
blood as per requirement.
• For example (sites): Skin of nose, lips, external ear, mucous
membrane of nose, erectile tissue of sexual organ, tongue, tip of
fingers and nail bed.
 END ARTERIES
Q. Write a short note on end arteries.
Definition: The arteries or their branches that do not anastomose
with the adjacent arteries are called end arteries.
Examples:
1. Central artery of retina
2. Labyrinthine artery of car
3. Central branches of cerebral arteries
4. Vasa recta of mesenteric arteries
5. Arteries of spleen, kidney, lung, metaphysis of long bones
 END ARTERIES
• If the end artery is blocked, the area supplied such artery
undergo ischemia and necrosis.
• Functional End Arteries: In case of coronary arteries and
central branches of cerebral arteries, there is potential
anastomosis. Here, sudden blockage of these arteries is not
capable of development of collateral circulation. Such arteries
are called functional end arteries.
 TYPES OF CIRCULATION
• There are various types of circulation in human body. These
includes the following:

1. Systemic circulation

2. Pulmonary circulation

3. Portal circulation

4. Fetal circulation (during embryonic life)

 TYPES OF CIRCULATION
1. Systemic Circulation:

• Definition: Circulation of the blood ejected from the left ventricle

through the body which has only one set of capillaries.
• Pathway:

• Left ventricle → aorta → artery → capillaries → veins → vena cava →

right atrium

• In the systemic circulation, there is only one set of capillaries in the

tissue.
• Carries oxygenated blood from heart to the tissue.
 TYPES OF CIRCULATION
2. Pulmonary Circulation:
• Definition: The transport of the deoxygenated blood from the
night ventricle to the lungs and to bring back oxygenated blood
from lungs to the left atrium.
• Pathway: Right ventricle → Pulmonary trunk and arteries →
Capillaries in lungs → Oxygenated blood → 4 pulmonary veins
→ Left atrium
• Carries deoxygenated blood.
 TYPES OF CIRCULATION
3. Portal Circulation:

• Definition: Circulation in which the blood flows through two consecutive capillary
network before returning to the heart.
• Pathway: Heart → Artery → 1st capillary network → Portal vein → 2nd capillary
network → Vein → Heart

Examples:

Hepatic portal circulation:

• It is present liver.
• Pathway: Arteries supplying intestine → 1st set of capillaries in the wall of
intestine → portal vein → sinusoids in liver → hepatic veins → inferior vena cava
 TYPES OF CIRCULATION
• Functions: Nutrients absorbed in the intestine are modified and
stored in the liver using this circulation.

Hypothalamo–hypophyseal Portal Circulation:

• It is present in pituitary gland.
• Pathway: Arteries → 1st capillary plexus in hypothalamus → portal
vessels → 2nd capillary plexus in pituitary gland → systemic veins
• Functions: Helps to transfer stimulatory/inhibitory hormones of
hypothalamus to pituitary for controlling its hormone secretion
 TYPES OF CIRCULATION
4. Renal Portal Circulation:
• It is present in kidney.
• Pathway: Renal artery → Capillaries in glomerulus → efferent
arteriole → capillary plexus around the renal tubules
(peritubular capillary plexus) → renal vein
• Function: Helps to maintain required electrolyte balance and to
eliminate waste products.
 TYPES OF CIRCULATION
Fetal Circulation:

Q. Write a short note on fetal

circulation.
• Developing fetus receives nutrition
from placenta. The fetus is
dependent on mother for:
1. Nutrients and oxygen intake
2. Carbon dioxide and waste
Fig.19.17: FETAL CIRCULATION.
product excretion
 TYPES OF CIRCULATION
Special structures in fetal circulation:

1. Placenta: It is a site of exchange of substances between mother and fetus.

2. Umbilical vein: Carries nutrients and oxygen to fetus.
3. Umbilical arteries: Carry waste products and carbon dioxide away from
fetus.
4. Foramen ovale: Helps blood to bypass lungs. It transmits most of the blood
from right atrium to left atrium.
5. Ductus venosus: Transmits oxygenated blood from umbilical vein and left
branch of portal vein to inferior vena cava and thus blood bypasses liver.
6. Ductus arteriosus: Helps blood to bypass fetal lungs. It transmits the blood
from left pulmonary artery to aorta.
 TYPES OF CIRCULATION
Peculiarities of fetal circulation:

Following are the peculiarities of the fetal circulation:

• Blood shunts three times in fetus at following places: Ductus arteriosus, foramen
ovale and ductus venosus to bypass lungs and liver.
• Regulation of oxygenated blood in fetal circulation: Sphincter at junction of left
umbilical vein and ductus venosus regulates flow of oxygenated blood to the fetus.
• Mixing of oxygenated and venous blood takes place at the following places: Liver,
both atria, distal part of arch of aorta and terminal part of inferior vena cava.
• Trans-septal blood circulation: Through foramen ovale blood enters from right atria
into left atria.
Table: Differences Between Systemic And Pulmonary Circulation
Systemic circulation Pulmonary circulation

Carry oxygenated blood away from heart to Carry deoxygenated blood away from heart
body tissues to lungs
Carry deoxygenated blood towards heart Carry oxygenated blood towards heart from
from tissues lungs
Starting point: Left ventricles Starting point: Right ventricle

End point: Right atrium End point: Left atrium

Destination: All organs except lungs Destination: Lungs

Gaseous exchange at capillary network: Gaseous exchange at capillary network: CO2

CO2 is picked up is expelled and O2 is absorbed
 Table: Differences Between Blood Vascular And
Lymphatic Systems.
Feature Blood vascular system Lymphatic system
Circulatory fluid Blood Lymph

Function Transport of gases, nutrients, Carry excess interstitial fluid

waste products
Vessels Arteries, veins, capillaries Lymphatic capillaries, lymphatic
vessels, trunk, and duct

Pumping Heart pump the blood Capillary action and muscle

mechanism contraction helps in lymphatic
drainage
Circulation Blood moves away and back to the Lymph moves towards heart
heart only
 THROMBOSIS, INFARCTION, ANEURYSM
Thrombosis:
 Definition: Medical condition characterized by the formation of a
blood clot, known as a thrombus, inside a blood vessel.
 Obstruct or partially block the affected blood vessel, disrupting
normal blood flow.
 Occurs in arteries or veins.
 When a thrombus dislodges from its original site and travels through
the bloodstream, it is called an embolus, which can potentially block
smaller blood vessels elsewhere in the body, causing serious
complications such as a pulmonary embolism or stroke.
 THROMBOSIS, INFARCTION, ANEURYSM

Causes Of Thrombosis:

[Link] damage – injury, trauma, surgery, or inflammation.

[Link] or blood flow disturbance – prolonged immobility (e.g.,
during long periods of bed rest or air travel), congestive heart
failure, and venous insufficiency
[Link] (increased tendency to clot)
[Link] wall injury in atherosclerosis
 THROMBOSIS, INFARCTION, ANEURYSM

Infarction:
 Definition: Tissue death due to inadequate blood supply to the
affected area.
 Caused by artery blockages, rupture, mechanical compression,
or vasoconstriction.
 The resulting dead tissue or lesion is called infarct.
 THROMBOSIS, INFARCTION, ANEURYSM

Causes Of Infarction:

[Link]
[Link]
[Link]
[Link]
[Link]
[Link]
 THROMBOSIS, INFARCTION, ANEURYSM
Aneurysm:
 Definition: It is a sac-like dilatation of arterial wall (tunica media)
because of its weakness (aneurysm means dilatation, in Greek).
 Associated with replacement of elastic fibers with collagen fibers.
 Usually seen in old age because of atherosclerosis, syphilis, Marfan
syndrome.
 CLINICAL INTEGRATION
• Deep Venous Thrombosis (Dvt): In medium-sized veins, especially of
lower limb, thrombus may form. It is especially seen in patients with
prolonged bed rest and in orthopedic cases with casts for treatment of
fractures. Part of such clots may get separated, enter pulmonary
circulation and forms blockage (pulmonary embolism).
• Thromboangiitis Obliterans (Buerger Disease): recurring progressive
inflammation and thrombosis (clotting) of small and medium arteries and
veins of the hands and feet. It is commonly found in tobacco users and
smokers. The main symptom is pain in the affected areas. [Leo Buerger,
Austrian American surgeon, 1879–1943].
 QUESTIONS
1. Enumerate functions of cardiovascular system
2. Enlist the components of blood.
3. Draw a well-labelled diagram of heart.
4. List the differences between arteries, veins, and capillaries.
5. Write a short note on
a. Capillaries
b. Sinusoids
c. Portal circulation
d. Arteriovenous anastomosis
e. End arteries
Thank You!