The Circulatory System

The Cardiovascular System The essential components of the human cardiovascular system are the heart,
blood and blood vessels.[6] It includes the pulmonary circulation, a "loop" through the lungs where blood is oxygenated;
and the systemic circulation, a "loop" through the rest of the body to provide oxygenated blood. The systemic circulation
can also be seen to function in two parts – a macrocirculation and a microcirculation. An average adult contains five to
six quarts (roughly 4.7 to 5.7 liters) of blood, accounting for approximately 7% of their total body weight.[7] Blood
consists of plasma, red blood cells, white blood cells, and platelets. Also, the digestive system works with the circulatory
system to provide the nutrients the system needs to keep the heart pumping.[8]

The cardiovascular systems of humans are closed, meaning that the blood never leaves the network of blood vessels. In
contrast, oxygen and nutrients diffuse across the blood vessel layers and enter interstitial fluid, which carries oxygen and
nutrients to the target cells, and carbon dioxide and wastes in the opposite direction. The other component of the
circulatory system, the lymphatic system, is open.

Arteries
Main article: Artery
See also: Arterial tree

Oxygenated blood enters the systemic circulation when leaving the left ventricle, through the aortic semilunar valve. The
first part of the systemic circulation is the aorta, a massive and thick-walled artery. The aorta arches and gives branches
supplying the upper part of the body after passing through the aortic opening of the diaphragm at the level of thoracic
ten vertebra, it enters the abdomen. Later it descends down and supplies branches to abdomen, pelvis, perineum and
the lower limbs. The walls of aorta are elastic. This elasticity helps to maintain the blood pressure throughout the body.
When the aorta receives almost five liters of blood from the heart, it recoils and is responsible for pulsating blood
pressure. Moreover, as aorta branches into smaller arteries, their elasticity goes on decreasing and their compliance
goes on increasing.

Capillaries
Arteries branch into small passages called arterioles and then into the capillaries.[9] The capillaries merge to bring blood
into the venous system.[10]

Veins
Main article: Vein
Capillaries merge into venules, which merge into veins. The venous system feeds into the two major veins: the superior
vena cava – which mainly drains tissues above the heart – and the inferior vena cava – which mainly drains tissues below
the heart. These two large veins empty into the right atrium of the heart.
The Circulatory System
Portal veins

Main article: Portal vein

The general rule is that arteries from the heart branch out into capillaries, which collect into veins leading back to the
heart. Portal veins are a slight exception to this. In humans the only significant example is the hepatic portal vein which
combines from capillaries around the gastrointestinal tract where the blood absorbs the various products of digestion;
rather than leading directly back to the heart, the hepatic portal vein branches into a second capillary system in the liver.

Heart
Main article: Heart

View from the front

The heart pumps oxygenated blood to the body and deoxygenated blood to the lungs. In the human heart there is one
atrium and one ventricle for each circulation, and with both a systemic and a pulmonary circulation there are four
chambers in total: left atrium, left ventricle, right atrium and right ventricle. The right atrium is the upper chamber of the
right side of the heart. The blood that is returned to the right atrium is deoxygenated (poor in oxygen) and passed into
the right ventricle to be pumped through the pulmonary artery to the lungs for re-oxygenation and removal of carbon
dioxide. The left atrium receives newly oxygenated blood from the lungs as well as the pulmonary vein which is passed
into the strong left ventricle to be pumped through the aorta to the different organs of the body.

Coronary vessels
Main article: Coronary circulation

The heart itself is supplied with oxygen and nutrients through a small "loop" of the systemic circulation and derives very
little from the blood contained within the four chambers. The coronary circulation system provides a blood supply to the
heart muscle itself. The coronary circulation begins near the origin of the aorta by two coronary arteries: the right
coronary artery and the left coronary artery. After nourishing the heart muscle, blood returns through the coronary
veins into the coronary sinus and from this one into the right atrium. Back flow of blood through its opening during atrial
systole is prevented by Thebesian valve. The smallest cardiac veins drain directly into the heart chambers.[8]

Lungs
Main article: Pulmonary circulation

The pulmonary circulation as it passes from the heart. Showing both the pulmonary and bronchial arteries.

The circulatory system of the lungs is the portion of the cardiovascular system in which oxygen-depleted blood is
pumped away from the heart, via the pulmonary artery, to the lungs and returned, oxygenated, to the heart via the
pulmonary vein.
The Circulatory System
Oxygen-deprived blood from the superior and inferior vena cava enters the right atrium of the heart and flows through
the tricuspid valve (right atrioventricular valve) into the right ventricle, from which it is then pumped through the
pulmonary semilunar valve into the pulmonary artery to the lungs. Gas exchange occurs in the lungs, whereby CO2 is
released from the blood, and oxygen is absorbed. The pulmonary vein returns the now oxygen-rich blood to the left
atrium.[8]

A separate system known as the bronchial circulation supplies blood to the tissue of the larger airways of the lung.

Systemic circulation

The systemic circulation and capillary networks shown and also as separate from the pulmonary circulation

Systemic circulation is the portion of the cardiovascular system which transports oxygenated blood away from the heart
through the aorta from the left ventricle where the blood has been previously deposited from pulmonary circulation, to
the rest of the body, and returns oxygen-depleted blood back to the heart.[8]

Brain
Main article: Cerebral circulation

The brain has a dual blood supply that comes from arteries at its front and back. These are called the "anterior" and
"posterior" circulation respectively. The anterior circulation arises from the internal carotid arteries and supplies the
front of the brain. The posterior circulation arises from the vertebral arteries, and supplies the back of the brain and
brainstem. The circulation from the front and the back join (anastomise) at the Circle of Willis.

Kidneys
The renal circulation receives around 20% of the cardiac output. It branches from the abdominal aorta and returns blood
to the ascending vena cava. It is the blood supply to the kidneys, and contains many specialized blood vessels.

Lymphatic system
Main article: Lymphatic system

The lymphatic system is part of the circulatory system in many complex animals such as mammals and birds. It is a
network of lymphatic vessels and lymph capillaries, lymph nodes and organs, and lymphatic tissues and circulating
lymph. One of its major functions is to carry the lymph, draining and returning interstitial fluid back towards the heart
for return to the cardiovascular system, by emptying into the lymphatic ducts. Its other main function is in the adaptive
immune system.[11]
The Circulatory System
Development

Main article: Fetal circulation

The development of the circulatory system starts with vasculogenesis in the embryo. The human arterial and venous
systems develop from different areas in the embryo. The arterial system develops mainly from the aortic arches, six
pairs of arches that develop on the upper part of the embryo. The venous system arises from three bilateral veins during
weeks 4 – 8 of embryogenesis. Fetal circulation begins within the 8th week of development. Fetal circulation does not
include the lungs, which are bypassed via the truncus arteriosus. Before birth the fetus obtains oxygen (and nutrients)
from the mother through the placenta and the umbilical cord.[12]

Heart
Main article: Heart development

Arteries

Main article: Aortic arches

Animation of a typical human red blood cell cycle in the circulatory system. This animation occurs at a faster rate (~20
seconds of the average 60-second cycle) and shows the red blood cell deforming as it enters capillaries, as well as the
bars changing color as the cell alternates in states of oxygenation along the circulatory system.

The human arterial system originates from the aortic arches and from the dorsal aortae starting from week 4 of
embryonic life. The first and second aortic arches regress and form only the maxillary arteries and stapedial arteries
respectively. The arterial system itself arises from aortic arches 3, 4 and 6 (aortic arch 5 completely regresses).

The dorsal aortae, present on the dorsal side of the embryo, are initially present on both sides of the embryo. They later
fuse to form the basis for the aorta itself. Approximately thirty smaller arteries branch from this at the back and sides.
These branches form the intercostal arteries, arteries of the arms and legs, lumbar arteries and the lateral sacral
arteries. Branches to the sides of the aorta will form the definitive renal, suprarenal and gonadal arteries. Finally,
branches at the front of the aorta consist of the vitelline arteries and umbilical arteries. The vitelline arteries form the
celiac, superior and inferior mesenteric arteries of the gastrointestinal tract. After birth, the umbilical arteries will form
the internal iliac arteries.

Veins

The human venous system develops mainly from the vitelline veins, the umbilical veins and the cardinal veins, all of
which empty into the sinus venosus.

Function

Cardiovascular system
The Circulatory System
Main article: Blood § Oxygen transport

About 98.5% of the oxygen in a sample of arterial blood in a healthy human, breathing air at sea-level pressure, is
chemically combined with hemoglobin molecules. About 1.5% is physically dissolved in the other blood liquids and not
connected to hemoglobin. The hemoglobin molecule is the primary transporter of oxygen in mammals and many other
species.

Lymphatic system

Main article: Lymphatic system § Function

Clinical significance

Many diseases affect the circulatory system. These include a number of cardiovascular diseases, affecting the
cardiovascular system, and lymphatic diseases affecting the lymphatic system. Cardiologists are medical professionals
which specialize in the heart, and cardiothoracic surgeons specialize in operating on the heart and its surrounding areas.
Vascular surgeons focus on other parts of the circulatory system.

Cardiovascular disease

Main article: Cardiovascular disease

Diseases affecting the cardiovascular system are called cardiovascular disease.

Many of these diseases are called "lifestyle diseases" because they develop over time and are related to a person's
exercise habits, diet, whether they smoke, and other lifestyle choices a person makes. Atherosclerosis is the precursor to
many of these diseases. It is where small atheromatous plaques build up in the walls of medium and large arteries. This
may eventually grow or rupture to occlude the arteries. It is also a risk factor for acute coronary syndromes, which are
diseases that are characterized by a sudden deficit of oxygenated blood to the heart tissue. Atherosclerosis is also
associated with problems such as aneurysm formation or splitting ("dissection") of arteries.

Another major cardiovascular disease involves the creation of a clot, called a "thrombus". These can originate in veins or
arteries. Deep venous thrombosis, which mostly occurs in the legs, is one cause of clots in the veins of the legs,
particularly when a person has been stationary for a long time. These clots may embolise, meaning travel to another
location in the body. The results of this may include pulmonary embolus, transient ischaemic attacks, or stroke.

Cardiovascular diseases may also be congenital in nature, such as heart defects or persistent fetal circulation, where the
circulatory changes that are supposed to happen after birth do not. Not all congenital changes to the circulatory system
are associated with diseases, a large number are anatomical variations.

Investigations
The Circulatory System
Magnetic resonance angiography of aberrant subclavian artery

The function and health of the circulatory system and its parts are measured in a variety of manual and automated ways.
These include simple methods such as those that are part of the cardiovascular examination, including the taking of a
person's pulse as an indicator of a person's heart rate, the taking of blood pressure through a sphygmomanometer or
the use of a stethoscope to listen to the heart for murmurs which may indicate problems with the heart's valves. An
electrocardiogram can also be used to evaluate the way in which electricity is conducted through the heart.

Other more invasive means can also be used. A cannula or catheter inserted into an artery may be used to measure
pulse pressure or pulmonary wedge pressures. Angiography, which involves injecting a dye into an artery to visualise an
arterial tree, can be used in the heart (coronary angiography) or brain. At the same time as the arteries are visualised,
blockages or narrowing’s may be fixed through the insertion of stents, and active bleeds may be managed by the
insertion of coils. An MRI may be used to image arteries, called an MRI angiogram. For evaluation of the blood supply to
the lungs a CT pulmonary angiogram may be used.