INTRODUCTION

The circulatory system means heart and blood vessels system, which is the course taken by
the blood through the arteries, capillaries, and veins and back to the heart In humans the heart is
made up of four chambers, the right and left auricles, and the right and left ventricles. The right
side of the heart pumps oxygen pour blood from the cells of the body back to the lungs for new
oxygen and the left side of the heart receives blood rich in oxygen from the lungs that is pumped
through the arteries to the different parts of the body. It is estimated that a given portion of the
blood completes its course of circulation in approximately 30 seconds. The circulatory system was
invented by William Harvey. The main vascular substance of this system is blood. The main body
components of it are heart and blood vessels. The circulatory system of blood consists of heart that
acts as a force pump for distributing blood to various parts of the body and blood vessels.
CIRCULATORY SYSTEM

The cardiovascular system consists of heart and blood vessels. The system is responsible for
circulation of blood through issues of the body.

CIRCULATION

The heart acts as a pump and provides the force for dis circulation. Blood vessels taking blood
from the heart to the tissues are called arteries. The largest artery in the body called aorta. Arising
from the heart it divides, similar to the branches of a tree, into smaller and smaller branches. The
smallest arteries are called arterioles. The arterioles end in a plexus of thin walled vessels that
permeate the tissues.
 These thin-walled vessels am called capillaries
 Oxygen, nutrition, waste products etc. can pass through the walls of capillaries from blood
tissue, cells and vice versa

In some organs, these vessels are somewhat different in structure from capillaries and are
called sinusoids. Blood from capillaries of sinusoids is collected by another set of vessels that carry
it back to the heart. These are called veins:

 The veins adjoining the capillaries are very small and are called venules.
 Smaller veins join together (similar to tributaries of a river) to form larger and larger veins
 Ultimately, the blood reaches two large veins, superior vena cava and inferior vena cava,
which pour it hack into the heart.
 This blood reaching the heart through the veins has lost most of its oxygen
 A special set of arteries and veins circulate this blood through the lungs where it is again
oxygenated
 This circulation through the lungs, for the purpose of oxygenation of blood, is called
pulmonary circulation, to distinguish it from the main or systemic circulation

Systemic Circulation

Systemic circulation is otherwise known as greater circulation. The blood pumped from left
ventricle passes through a series of blood vessels of arterial system and reaches the tissues.
Exchange of various substances between blood and the tissues takes place in the capillaries. After
the exchange of substances in the capillaries, the blood enters the venous system and returns to
right atrium and then the right ventricles. This completes the systemic circulation.
Pulmonary Circulation

Pulmonary circulation is otherwise called lesser circulation. Blood is pumped from right ventricle
to lungs through pulmonary artery. The exchange of gases occurs between blood and alveoli or of
the lungs through pulmonary capillary membrane. The oxygenated blood returns to left atrium
through the pulmonary veins.

Thus, the left side of the heart contains oxygenated or arterial blood and the right side of the heart
contains the venous blood.

In contrast to all other arteries of the body, pulmonary artery has deoxygenated blood and
pulmonary vein has oxygenated blood.
THORACIC CAVITY
The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected
by the thoracic wall (rib cage and associated skin, muscle, and fascia). The central compartment
of the thoracic cavity is the mediastinum. There are two openings of the thoracic cavity, a
superior thoracic aperture known as the thoracic inlet and a lower inferior thoracic aperture
known as the thoracic outlet.

The thoracic cavity includes the tendons as well as the cardiovascular system which could be
damaged from injury to the back, spine or the neck.

Structure

Structures within the thoracic cavity

include:

 structures of the cardiovascular

system, including
the heart and great vessels,
which include the thoracic aorta,
the pulmonary artery and all its
branches,
the superior and inferior vena
cava, the pulmonary veins, and
the azygos vein
 structures of the respiratory
system, including the diaphragm, trachea, bronchi and lungs[1]
 structures of the digestive system, including the esophagus,
 endocrine glands, including the thymus gland,
 structures of the nervous system including the paired vagus nerves, and the
paired sympathetic chains,
 lymphatics including the thoracic duct.

It contains three potential spaces lined with mesothelium: the paired pleural cavities and
the pericardial cavity. The mediastinum comprises those organs which lie in the centre of the
chest between the lungs. The cavity also contains two openings one at the top, the superior
thoracic aperture also called the thoracic inlet, and a lower inferior thoracic aperture which is
much larger than the inlet.
HEART

The heart is a hollow muscular organ that pumps

blood throughout the circulatory system. It is
present in the middle mediastinum.

Measurements of Heart

 Anteroposterior diameter: 6 cm
 Widest transverse diameter: 8-9 cm
 Length from apex to the base: 12 cm
 Weight (less in females): 230-340 g.

Some Elementary Facts about the Heart

1. The heart is a muscular pump designed to ensure the circulation of blood through the tissues
of the body. Both structurally and functionally, it consists of two halves, namely right and left.
2. The "right heart' circulates blood only through the lungs for the purpose of oxygenation (ie,
through the pulmonary circulation). The "left heart circulates blood to tissues of the entire
body (ie, through the systemic circulation)
3. Each half of the heart consists of an inflow chamber called atrium and of an outflow chamber
called ventricle.
4. The right and left atria are separated by an interatrial septum. The right and left ventricles are
separated by an interventricular septum.
5. The right atrium opens into the right ventricle through the right atrioventricular orifice. This
orifice is guarded by the tricuspid valve. The left atrium opens into the left ventricle through
the left atrioventricular orifice. This orifice is guarded by the mitral valve. These valves allow
flow of blood from atrium to ventricle, but not in the reverse direction.
6. The right atrium receives deoxygenated blood from tissues of the entire body through the
superior and inferior vena cava
7. This blood passes into the right ventricle. It leaves the right ventricle through a large outflow
vessel called the pulmonary trunk. This trunk divides into right and left pulmonary arteries
that carry blood to the lungs
8. Blood oxygenated in the lungs is brought back to the heart by four pulmonary veins (two right
and two left) that end in the left atrium.
9. This blood passes into the left ventricle. The left ventricle pumps this blood into a large
outflow vessel called aorta. The aorta and its branches distribute blood to tissues of the entire
body.
10. It is returned to the heart (right atrium) through the vena cava, thus completing the circuit.

Anatomical Position of Heart

Heart lies in the middle mediastinum in such a fashion that the apex of heart faces downward,
forward and towards the left just medial to the midclavicular line, in the fifth intercostal space.
Base of heart lies upward and backward on right side extending to the right third costal cartilage.

Layers of Wall of
the Heart

Heart is made up of
three layers of
tissues:

 Outer
pericardium
 Middle
myocardium
 Inner
endocardium.

Pericardium

Pericardium is the outer covering of the heart, it is made up of two layers:

 Outer parietal pericardium, which forms a strong protective sac around the heart
 Inner visceral pericardium or epicardium that covers myocardium.

These two layers are separated by a potential space called pericardial cavity, which contains a very
thin film of fluid.

Myocardium

Myocardium is the middle layer of the wall of the heart and it is formed by muscle fibers. It forms
the hulk of the heart and is responsible for the pumping action of the heart. Myocardium is formed
by three types of cardiac muscle fibers:

 Muscle fibers, which form the contractile unit of the heart

 Muscle fibers, which form pacemaker
 Muscle fibers, which form the conductive system.
Muscle fibers, which form the contractile unit of the heart

The major bulk of myocardium is formed by cardiac muscle fibers. These cardiac muscle fibers
are striated fibers and are similar to the skeletal muscles in structure. But, unlike the skeletal
muscle fibers, the cardiac muscle fibers are involuntary in nature. The important difference
between skeletal muscle and cardiac muscle is that the cardiac muscle fiber is branched and the
skeletal muscle is not branched.

Muscle fibers, which form the pacemaker

Some of the muscle fibers of the heart are modified in to a specialized structure known as
pacemakes. The muscle fibers forming the pacemaker have less striation

Pacemaker

Pacemaker is a structure in the heart that generates the impulses for heartbeat. It is formed by the
pacemaker called P cells. Sinoatrial (SA) node forms the pacemaker in human heart.

Muscle fibers, which form the conductive system

The conductive system of the heart is formed by the modified cardiac muscle fibers. The impulses
from SA node are transmitted to the atria directly. However, the impulses are transmitted to the
ventricles, through various components of conducting system

Endocardium

Endocardium is the innermost layer of the heart wall. It is a thin, smooth and glistening membrane.
It is formed by a single layer of endothelial cells lining the inner surface of the heart. Endocardium
continues as endothelium of the blood vessels.

Relations of the Heart

 Superiorly: The aorta, superior vena cava, pulmonary artery and pulmonary veins
 Inferiorly: The apex rests on the central tendon of the diaphragm
 Anteriorly: The ribs and intercostal muscles
 Posteriorly: The esophagus, trachea, left and right bronchus, descending aorta, inferior vena
cava and thoracic vertebrae
 Laterally: The lungs

The left lung overlaps the left side of the heart

Exterior of the Heart

Base, Apex, Surfaces and Borders

The heart has a:

 Base (or posterior surface) directed backwards

 Apex (directed downward, forward and to the left)
 Sternocostal surface (anterior)
 Diaphragmatic surface (inferior)
 Pulmonary surface (left lateral)
 It has four borders-right, left, superior and inferior borders

Base

The base is
located
posteriorly and
is formed
mainly by the
left atrium (the
heart does not
rest on its base).

Apex

The blunt apex

is formed by the
left ventricle. It
is located
posterior to the
fifth left intercostal space in adults, just medial to the midclavicular line (7-9 cm from the median
plane).

Surfaces

1. Sternocostal (anterior) surface of the heart is mainly formed by the right ventricle and partly
by right atrium, left ventricle and left auricle. The left atrium is not seen as it is covered by
aorta and pulmonary trunk
2. Diaphragmatic (inferior) surface of the heart is formed by both ventricles, mainly the left one.
It is related to the central tendon of the diaphragm. The posterior interventricular groove
divides this surface into right one third and left two thirds
3. Pulmonary or left surface of the heart is formed Veins mainly by left ventricle, which occupies
the cardiac notch of the left lung

Borders

The right border is formed by right atrium, the inferior border is formed mainly by right ventricle
and partly the left: the left border is formed mainly by left ventricle and partly by left auricle. The
great vessels enter and leave the superior border of the heart. It is formed by both the atria mainly
the left atrium.

Grooves or Sulci

The atria are separated from the ventricles by a circular atrioventricular or coronary sulcus.

Important Features of Chambers of the Heart

Right Atrium

The right atrium is the right upper chamber of the heart. It forms the right border part of the upper
border, the sternocostal surface and part of the base of the heart. It receives venous blood from the
whole body and pumps it to the right ventricle through the right atrioventricular or tricuspid orifice
(opening).

Features

The right atrium is vertically elongated. It receives the superior vena cava at the upper end and the
inferior vena cava at the lower end. The upper end shows a projection to the left side, the auricle.
The interatrial septum separates the right atrium from the left atrium.

Veins draining into the right atrium

 Superior vena cava

 Inferior vena cava
 Coronary sinus
 Anterior cardiac veins
 Venae cordis minimae (Thebesian veins),

Right Ventricle

External features

The right ventricle forms the inferior border and a large part of the sternocostal surface of the heart.
It is a triangular chamber It receives deoxygenated blood from the right atrium, and pumps it to
the lung through the pulmonary trunk and pulmonary arteries.

Internal features

The interior shows two orifices:

 The right atrioventricular or tricuspid orifice, guardes by the tricuspid valve

 The pulmonary orifice guarded by the pulmonary valve. The wall of the right ventricle is
thinner than that of the left ventricle.

Reason

Pressure in the pulmonary trunk is 20-40 mm Hg, whereas the pressure in the aorta is 80-120 mm
Hg. So, the left ventricle has to pump against a higher resistance, making its wall thicker. The
cavity of the right ventricle is crescentic in section because of the forward bulge of the
interventricular septum. There are three papillary muscles in the right ventricle-anterior, posterior
and septal. One end of the papillary muscles is attached to ventricular wall and other end to the
cusps of tricuspid valve by chordae tendineae. The anterior papillary muscle is the largest.
Interventricular Septum

Interventricular septum is placed obliquely between the two ventricles. The upper part is thin and
membranous and lower part is thick and muscular.

Left Atrium

Left atrium forms the major part of the base of the heart. It is a quadrangular chamber receiving
oxygenated blood from the lungs through four pulmonary veins and pumps it to the left ventricle
through the left atrioventricular or bicuspid or mitral orifice, which is guarded by the mitral valve
(bicuspid valve). The appendage of left atrium, the left auricle projects anteriorly.

Left Ventricle

The left ventricle receives oxygenated blood from the left atrium and pumps it into the aorta. It
forms the apes of the heart, a part of the sternocostal surface, most of the left border and left
surface, and the left two thirds of the diaphragmatic surface

There are two well-developed papillary muscles, anterior and posterior. Chordae tendineae from
both muscles are attached to both cusps of the mitral valve. The interior of the ventricle shows two
orifices:

 The left atrioventricular or bicuspid or mitral orifice. guarded by the mitral valve
 The aortic orifice, guarded by the aortic valve.
 The cavity of the left ventricle is circular in shape.

Blood Supply of the Heart

Arterial Supply

The heart gets its oxygen and

nutrients from two arteries right and
left coronary arteries, which are the
first branches of aorta.

At the beginning of the ascending

aorta, there are three dilatations or
swellings called aortic sinuses. The
right coronary artery arises from the
right aortic sinus and the left
coronary artery from the left aortic
sinus.
The right and left coronary arteries are called 'coronary because they encircle the base of the
ventricles, somewhat similar to a crown

Summary of Distribution of Coronary Arteries

1. Right coronary artery: It supplies the right atzium right ventricle, posterior part of
interventricular septum, whole of the conducting system of the heart except a part of the left
branch of the AV bundle.
2. Left coronary artery: It supplies the left atrium, left ventricle, a small part of the right
ventricle, anterior part of the interventricular septum, part of the left branch of the AV bundle.

The trunk of the left coronary artery is much shorter than the right coronary artery. But it carries a
larger volume of blood, because the bulk of the myocardium supplied by it is larger.

Right coronary artery

Right coronary artery arises from the right aortic sinus of the ascending aorta. It lies between the
pulmonary trunk and right auricle. It ends by anastomosing with the circumflex branch of left
coronary artery

Branches

1. Right conus artery: It is the first branch. It supplies the infundibulum of right ventricle
2. Right anterior ventricular branches: These ate g in number-supply the right ventricle.
3. Right atrial branches: These supply the myscand of right atriom
4. Sinontrial artery: It supplies SA node in 65% individuals. In the test 35%, SA node is
supplied via left coronary artery.
5. Right posterior ventricular branches: They supply diaphragmatic surface of ventricle
6. Right posterior atrial branches: They supply posterior surface of right and left atria.
7. Posterior interventricular branch: It supplies following areas:
 One third of interventricular septum, pottense inferior part
 AV node, in 90% individuals
 • Diaphragmatic surface of right and left ventricles

Left coronary artery

Left coronary artery is wider and larger, and shorter than the right coronary artery. It arises from
the left aortic sinus of ascending aorra. It lies between the pulmonary trunk and the left auricle. It
ends by dividing into anterior interventricular and circumflex branches.
Branches

1. Anterior interventricular artery: It runs in the anterior interventricular groove and gives the
following branches:
 Anterior ventricular rami: These supply sternocostal surface of both ventricles
 Septal rami: Supply the major (ahout two third) part of interventricular septum.
2. Circumflex artery: It runs in the left atrioventricular groove, winds around left border of heart
to reach the posterior atrioventricular groove and ends anastomosing with the right coronary
artery. It gives the following branches:
 Atrial branches to the left atrium
 Ventricular to the left ventricle

Venous Drainage of the

Heart

The walls of the heart are

drained by veins that empty
into the coronary sinus (these
are the great cardiac vein, the
middle cardiac vein, the right
marginal vein, the posterior
vein of the left ventricle and
the oblique vein of the left
atrium) and partly by small veins (anterior cardiac veins or venae cordis minimae or Thebesian
veins) that open directly into the chambers of the heart, especially the right atrium and right
ventricle.

Coronary Sinus

Coronary sinus is the largest vein of the heart. It is situated in the posterior part of coronary
sulcus. It ends by opening into the right atrium, to the left of opening of infer cava. It receives
the following tributaries:

 Great cardiac vein

 Middle cardiac vein
 Small cardiac vein
 Marginal vein.
Nerve Supply of the
Heart

The heart is supplied by

sympathetic and
parasympathetic fibers:

1. Sympathetic supply:
These consist of both
efferent and afferent
fibers, Preganglionic
fibers are derived
from T1 to T4
segments of spinal
cord. Postganglionic
fthers arise from
superior, middle and
inferior cervical
sympathetic ganglia
and T1-T4 thoracic
ganglia.
2. Parasympathetic
supply: These consist of both efferent and afferent. Preganglionic fibers are derived from
nucleus ambiguus and dorsal nucleus of vagus Postganglionic fibers lie in the cardiac plexus

Effects on Heart

1. Sympathetic fibers supply the atria, ventricles and conducting system of the heart:
Sympathetic stimulation leads to
 Increase in heart rate
 Increase in cardiac output
 Vasodilation of coronary artery
 Painful sensation from heart.
2. Parasympathetic fibers supply only the atria and conducting system of heart:
Parasympathetic simulation leads to:
 Decrease in heart rate
 Decrease in coronary blood flow
  Visceral reflexes, which depress cardiac
activity

Vagal Tone

Normally a minimal amount of continuous vagal

discharge occurs in an adult at rest. This keeps
the heart rate at about 70-80/min. This is called
vagal tone. In the absence of vagal one, the heart
rate would be about 160-180/min,

CONDUCTING SYSTEM OF THE HEART

This system consists of specialized cardiac muscle cells that can initiate impulses and conduct
them rapidly through the heart. They co-ordinate the contractions of the 4 chambers of heart.
Thus, both atria contract together, and both ventricles contract together. The atrial contraction
occurs first. The synchronized contraction of the chambers is essential for the efficient pumping
of heart and for the maintenance of systemic and pulmonary circulations.

Parts

1. The sinoatrial or SA node

2. The atrioventricular or AV node
3. The atrioventricular bundle or AV bundle
4. Right and left branches of AV bundle.

SA node is situated in the wall of the right atrium. It is the "natural pacemaker" of the heart,
because it initiates the impulses for contraction.

AV node is located in the interatrial septum. Impulses from both atria reach the AV node, which
conducts them to the ventricles via the AV bundle.

The AV bundle, also called Purkinje fibers, originates in the AV node; this bundle lies in the
interventricular septum. It is the only bridge between the atrial and ventricular myocardium.
Within the interventricular septum, the AV bundle divides into right and left limbs or branches.
Each branch passes deep to the endocardium into the walls of the ventricles.
BLOOD VESSELS

General Structure
(Histology) of Blood
Vessels

All blood vessels with

lumina larger than that of
the capillaries exhibit a
common pattern of
organization. The wall of
each vessel contains 3
concentric coats or tunics.

1. The Tunica intima

Innermost layer
2. The Tunica media
Middle layer
3. The Tunica adventitia -
Outer layer.

The Tunica Intima

It has the following layers:

a. Inner endothelial lining, made up of a single layer of simple squamous epithelium

b. Underlying basal lamina
c. Subendothelial layer of fibroelastic tissue
d. A band of elastic fibers - the internal elastic lamina.

The Tunica Media

The tunica media is made up chiefly of smooth muscle fibers, which are circularly arranged. In
addition, the middle layer has elastic fibers and collagen fibers.

The Tunica Adventitia

The tunica adventitia is principally composed of fibro elastic tissue. Most of the collagen fibers
run parallel to the long axis of the vessel. Closest to the media, there may be a concentration of
elastic fibers - the external elastic membrane. The tunica adventitia merges with connective
tissue of the organ through which the vessel is passing. Vasa vasora (blood vessel supplying the
wall of a blood vessel) lie in the tunica adventitia in larger blood vessels. The inner layers of
blood vessel get O₂ and nourishment by diffusion. In larger blood vessels, the tunics are too thick
to be nourished by diffusion from the lumen.

Veins

Veins are different from arteries in

the following aspects:

1. Blood within the veins are

under much less pressure, so,
veins must accommodate a
greater volume of blood.
2. Because of the above reason,
veins are generally larger in
diameter than their
corresponding arteries.
3. Their walls are thinner, mainly
due to a reduction in muscular
and elastic components.

ARTERIES

Arteries are vessels, which conduct

blood from heart to capillaries.
Arteries branch repeatedly between largest arteries to the capillary plexus.

THE AORTA

It is the largest artery in the body,

which carries oxygenated blood from
the left ventricle and distributes it to
all parts of the body.

Parts

1. The ascending aorta

2. The arch of the aorta
3. The descending aorta:
a. Thoracic aorta
b. Abdominal aorta
THE ASCENDING AORTA

The ascending aorta arises from the

left ventricle. At the root of the
aorta, there are three dilatations of
the vessel wall called the aortic
sinuses. The ascending aorta is
about 5 cm long, it is enclosed in
the pericardium

After arising from the heart (at the

level of 3rd costal cartilage) it runs
upwards, forwards and to the right;
it becomes continuous with the
arch of the aorta at the level of the
sternal angle.

Branches

The coronary arteries right arid left, arise from the right and left aortic sinuses respectively.

THE ARCH OF THE AORTA

It is the continuation of the

ascending aorta. It is situated behind
the lower half of the manubriurn
steni.

Course

It begins at the level of the sternal

angle; runs upwards, backwards and
to the left, arching over the root of
the left lung. It ends at the lower
border of the T4 vertebra (same
horizontal plane as that of the sternal
angle), by becoming continuous with
the descending (thoracic) aorta.
Important Relations

1. Anteriorly and to the left (i) Left phrenic and left vagus nerves; cardiac branches of vagus
and left sympathetic trunk, and (ii) Left pleura and lung.
2. Posteriorly and to the right:
a. Trachea
b. Esophagus
c. Left recurrent laryngeal nerve
d. Thoracic duct
e. Vertebral column.
3. Superiorly: The three branches of the arch of aorta. From right to left, they are (i) The
brachiocephalic trunk (ii) The left common carotid and (iii) The left subclavian arteries.
4. Inferiorly:
a. Bifurcation of pulmonary trunk
b. Left bronchus
c. The ligamentum arteriosum
d. The recurrent laryngeal nerve
The ligamentum arteriosum is the remnant of a short, wide channel connecting the
beginning of left pulmonary artery to the arch of aorta. In the fetal life, it conducts most
of the blood from the right ventricle to the aorta, because the lungs are not functioning. In
the adult, the remnant of ductus artenosus is a fibrous band called ligamentum artenosum.
The left recurrent laryngeal nerve hooks around it. The duct may remain patent after birth
called patent ductus arteriosus (PDA), causing serious problems.
Branches of the Arch of Aorta
1. The brachiocephalic trunk, it divides into right common carotid and right subclavian
arteries
2. The left common carotid artery
3. The left subclavian artery
4. Occasionally, the thyroidea ima artery.
The Brachiocephalic Artery (or Trunk)
The brachiocephalic artery (or trunk) arises behind the manubrium of the sternum from the
convexity of the aortic arch. It is the first and largest branch of the aortic arch. It passes upwards,
backwards and to the right; after 5 cm, divides into right subclavian and right common carotid
arteries.
The Common
Carotid Arteries
(CCA)
The right
common carotid
artery is a branch
of the
brachiocephalic
trunk. The left
CCA is a direct
branch of the arch
of the aorta.
After the origin,
their course and
distribution is
similar. The
common carotid artery passes upwards in the carotid sheath along with the internal jugular vein
and the vagus nerve. At the level of the upper border of thyroid cartilage, it divides into 2
branches - the internal and external carotid arteries.
The External Carotid Artery
It is one of the terminal branches of the common carotid artery. It lies anterior to the internal
carotid artery. It is the chief artery of supply to structures in the neck and face.
The external carotid artery begins in the neck at the upper border of thyroid cartilage (opposite
the intervertebral disc between C3 and C4). It runs upwards, backwards and laterally and
terminates behind the neck of the mandible by dividing into maxillary and superficial temporal
arteries.
Branches (8 branches)
1. Superior thyroid
2. Lingual
3. Posterior auricular
4. Facial
5. Occipital
6. Ascending pharyngeal
7. Superficial temporal
8. Maxillary.
The Internal Carotid Artery

The internal carotid artery is one of the 2 terminal branches of the common carotid artery. It
begins at the level of upper border of thyroid cartilage (opposite the disc between C3 and C4).
This is the principal artery of the brain and eye

The course of the artery can be described under 4 headings:

1. Cervical part in the neck

2. Petrous part-in the carotid canal of the petrous part of temporal bone
3. Cavernous part within the cavernous sinus(paired dural venous sinuses lying on either
side of the body of the sphenoid)
4. The cerebral part related to the base of the brain.

The Subclavian Artery

It is the main artery of upper limb. The right sub clavian artery is a branch of the brachiocephalic
trunk the left subclavian artery is a direct branch of the arch of the aorta.

It passes over the first rib and grooves it. Then it passes behind the clavicle to enter the
upper part of the axilla. At the outer border of first rib, it continues as the axillary artery.

The scalenus anterior muscle crosses the artery brain anteriorly and divides it into 3 parts
- the first part medial, 2nd part posterior and the 3rd part lateral to the muscle.

Branches

The subclavian artery usually gives off 5 branches:

1. Vertebral artery
2. Internal thoracic artery
3. Thyrocervical trunk - it divides into 3 branches:
a. Inferior thyroid artery
b. Suprascapular artery
c. Transverse cervical artery
4. Costocervical trunk, which divides into 2 branches:
a. Superior intercostal
b. Deep cervical
5. Dorsal scapular artery
THE DESCENDING
AORTA

The descending aorta, which is

the continuation of the arch of
the aorta, is divisible into 2
parts:

1. The thoracic part

2. The abdominal part
(abdominal aorta)

The Thoracic Part

It is the continuation of the

arch of the aorta. It lies in the
posterior mediastinum.

The descending thoracic aorta

begins on the left side of the
lower border of T4 vertebra. It
descends with a slight
inclination to the right and
terminates at the lower border
of the 12th thoracic vertebra.

Diameter: About 2 cm

Relations

Anterior relations

1. Root of the left lung

2. Heart, covered by pericardium
3. In the lower part, esophagus
4. The diaphragm.

Posteriorly the vertebral column (T5-T12)

On the right side

1. Esophagus (in the upper part)

2. Azygos vein
3. Thoracic duct
4. Right lung and pleura.

On the left side Left lung and pleura.

Branches

1. Nine pairs of posterior intercostals arteries-to 3rd to 11th intercostal spaces

2. One pair of subcostal arteries
3. Bronchial arteries (one right and 2 left)
4. 2 esophageal branches-supply the middle 1/3 of esophagus
5. Pericardial branches
6. Mediastinal branches.

The posterior intercostal arteries run in the costal grooves along with the intercostal nerves and
veins. Their arrangement, from above downwards, is in the following order-Vein, Artery, Nerve
(VAN). The poste- 2. rior intercostal arteries anastomose with anterior intercostal arteries
(branches of internal thoracic and musculophrenic arteries).

(Since the aorta is situated on the left side of the vertebral column, the right posterior intercostal
arteries are longer).

The Abdominal Aorta

The abdominal aorta begins in the midline at the aortic opening of the diaphragm, opposite the
body of T12 vertebra. It ends in front of the lower part of the body of L4 vertebra, by dividing
into its 2 terminal branches, right and left common iliac arteries.

Relations

Anteriorly From above

downwards, the abdominal
aorta is related to:

1. The body of pancreas and

splenic vein
2. The left renal vein
3. The horizontal part of
duodenum
4. Root of mesentery
5. Coils of small intestine.

Posteriorly: The abdominal aorta is related to the upper four lumbar vertebrae and the
intervertebral discs between them.

To the right side are:

1. The inferior vena cava and the sympathetic chain

2. The right crus of the diaphragm.

To the left side are:

1. The left crus of diaphragm

2. The pancreas
3. The 4th or ascending part of duodenum
4. The left sympathetic chain.

Branches

Branches of abdominal aorta can be classified into the following groups:

1. Ventral branches (they supply the gut tube)

a. Celiac trunk

b. Superior mesenteric artery unpaired arteries

c. Inferior mesenteric artery

2. Lateral branches

a. Right and left inferior phrenic arteries

b. Right and left middle suprarenal arteries

c. Right and left renal arteries

d. Right and left gonadal (either testicular or ovarian) arteries.

3. Dorsal branches:

a. 4 pairs of lumbar arteries

b. An unpaired medial sacral artery

4. Terminal branches-They are the right and left common iliac arteries.
LUNGS

The lungs or pulmones are the essential organs of respiration. Their main function is to
oxygenate blood. They are present in the thoracic cavity.

In healthy people, who live in a clean

environment, the lungs are light pink in color, but
people living in polluted of dust or carbon
particles, which get trapped in the phagocytes.

Each lung is conical in shape; it is enveloped by

double layer serous membrane called pleura. The
lungs are separated from each other by the heart
and the great vessels in the middle mediastinum.
The lungs are attached to the heart and the trachea
by the structures in the roots of the lungs. ie.
Pulmonary artery, pulmonary veins and main
bronchi.

Each lung has an apex at the upper end, base resting on the diaphragm and two surfaces-costal
and medial (or mediastinal).

Presenting Parts

Apex

Apex is the rounded upper end of lung, which extends above the anterior end of the first rib to
about 2.5 cm above the clavicle. It is covered by cervical pleura and the suprapleural membrane.

Base

Base is semilunar in shape and is concave downwards as it rests on the dome of diaphragm. On
right side the right lobe of liver lies below the diaphragm and on the left side are present the left
lobe of liver, fundus of stomach and spleen.

Surfaces (Two Surfaces)

Costal surface

Costal surface is the outer smooth and convex surface - of the lung covered by the costal pleura.
It is related to inner surfaces of the ribs and the costal cartilages with intervening intercostal
spaces. The ribs form their impressions on the lung in the cadaver
Mediastinal surface (medial surface)

The characteristic feature of mediastinal surface of lung is the hilum present in the posterior half.
Hilum is a roughly triangular area that gives passage to the bronchi, pulmonary and bronchial
vessels, nerves and lymphatics. The mediastinal pleura at the hilum forms a tubular sheath,
which connects the hilum to the mediastinum. This is called 'root of lung:

Contents of Root of Lung

 Bronchus
 Pulmonary artery: Single
 Pulmonary vein: Two are present
 Bronchial arteries
 Bronchial veins
 Pulmonary plexus of nerves
 Bronchopulmonary lymph nodes
 Areolar tissue.

Arrangement of structures within the root or hilum of lung. From before backward:

 Superior pulmonary vein

 Pulmonary artery
 Bronchus with its vessels.

Impressions and
relations of
mediastinal surface

In preserved
specimens,
impressions are seen
on mediastinal
surface of lung due to
various mediastinal
structures related to it.
The pleura separates
these structures from
the lung
Lobes of Lung

The right lung is

divided into three
lobes by an oblique
and a horizontal
fissure. The left lung
is however divided
two lobes by a single
oblique fissure.

Left Lung

 Upper lobe
 Lower lobe.

Lingula of left lung

Lingula of left lung is a tongue-shaped projection of lung below the cardiac notch.

Right Lung

 Upper lobe
 Middle lobe
 Lower lobe.
Arterial Supply

Lung is supplied by bronchial and pulmonary arteries

Bronchial Artery

Bronchial artery may arise from the thoracic aorta or ane of the posterior intercostal arteries. It
supplies the bronchial tree (as far as the respiratory bronchioles) and then anastomoses with
pulmonary arteries.

Pulmonary Artery

One pulmonary artery enters the hilum of the lung, carrying deoxygenated blood from the right
ventricle of the heart, it ends in the capillary plexus on the alveolar walls of the lung

Venous Drainage

Venus blood is drained by bronchial and pulmonary veins

Pulmonary Veins

Two veins emerge from the hilum of each lung. They carry oxygenated blood from the lung and
empty into the left atrium.

Lymphatic Drainage

The lymph from both the lungs is drained into respective bronchopulmonary lymph nodes
present at the hilum of lung.

Nerve Supply

1. Parasympathetic supply: It is derived from vagos nerve. The fibers are motor to bronchial
muscles and secretomotor to glands of bronchial tree. Parasympathetic stimulation causes
broncho- constriction
2. Sympathetic supply: Preganglionic fibers are derived from spinal segments of T2 to 15.
Their action is opposite to the parasympathetic supply and cause bronchodilatation.

Structure of Lung

The lung parenchyma is made up of bronchopulmonary tree, branches of pulmonary artery,

tributaries of pulmonary veins, lymphatics and nerves enclosed in a connective tissue
framework.
Bronchopulmonary Segments

Bronchopulmonary segment the independent functional unit of lung made up of a tertiary

bronchus with its bronchial tree up to the alveoli, accompanied by an independent branch from
pulmonary artery. The venous drainage is however, intersegmental. Each lung has 10
bronchopulmonary segments.

Each unit of bronchopulmonary segments is surrounded by connective tissue, which is

continuous with the visceral pleura

Functions of Lung and Tracheobronchial Tree

Lung is the organ of exchange of gases, i.e, oxygen and carbon dioxide, which provides for
oxygenation of blood. Surfactant secreted by pneumocyte-II of alveoli prevent the collapse of
alveoli. This maintains patency of alveoli and allows for exchange of gases to occur during
inspiration and expiration.

Non respiratory functions of lung

1. Angiotensin converting enzyme is present in pulmonary capillary endothelium. This

converts angiotensin-I to angpotensin II, which is responsible for the maintenance of blood
pressure
2. Amine precursor uptake and decarboxylation (APUD) cells or neuroendocrine cells are
presens in the bronchiolar tree. They produce various vasoactive substances such as
vasoactive intestinal peptide (VIP) and substance P, which may have a role in maintaining
tone of bronchioles
3. Lung contains tissue type plasminogen activator, which converts plasminogen to plasmin.
Thus, it has a role in fibrinolytic mechanism of the body.
4. Defense functions of respiratory system.

Mucus secreted by gobiet cells of upper respiratory tract helps to entrap foreign particles.
The cilia of epithelium beat upwards and push the mucus towards the nose and exterior. Mucus
also contains IgA antibodies that provide local immunity.

Alveolar macrophages engulf foreign particies and destroy them by phagocytosis.

Preventing reflexes such as cough, sneezing and bronchoconstriction reflexes help to clear the
passage from inhaled foreign particles. The afferents of the reflex arise from irritant receptors
present in the tracheobronchial tree and travel in the vagus nerve.

PLEURA AND PLEURAL CAVITY

Pleura

The pleura is a serous

membrane lined by a
single layer of
squamous cells (the
mesothelium). There
are two pleural sacs,
one on either side of
the mediastinum.
Each pleural sac is
invaginated from its
medial side by the
lung, so that it has an
outer layer called
parietal pleura and
the inner visceral layer or pulmonary pleura. These two layers are continuous with each other at
the hilum of the long. There is a potential space between the two layers, the pleural cavity, with a
thin film of fluid to prevent friction.
Visceral Pleura

The visceral layer or pulmonary pleura covers the surfaces and fissures of the lung, except at the
hilum. It is firmly attached to the surface of the lung, it cannot be separated from it.

Parietal Pleura

The visceral pleura reflects over itself at the hilum to form an external layer covering the lung
called parietal pleura

Blood Supply

 Visceral pleura: It is supplied by bronchial vessels

 Parietal pleura: It receives blood via intercostal, internal thoracic and musculophrenic
arteries. Corresponding veins drain the pleura.

Lymphatic Drainage

 Visceral pleura: It is drained by bronchopulmonary lymph nodes

 Parietal pleura: The lymph drains into the intercostal, internal mammary, posterior
mediastinal and diaphragmatic nodes.

Nerve Supply

 Visceral pleura: It has the same nerve supply as that of the lung
 Parietal pleura: It is supplied by intercostal nerves and is pain sensitive.

Pleural Cavity

Pleural cavity is the potential space between the two pleurae, which contains a thin layer of
lubricating serous fluid. The intrapleural pressure is -2 mm Hg during expiration and -6 mm Hg
during inspiration. This prevents collapse of lung and also helps in the venous return of body.

PHYSIOLOGY OF RESPIRATION

At rest, a human being breathes about 12-15 times per minute. The 500 ml. of air is taken in each
breath, which equals to 6-8 L of air in 1 minute

Composition of Air

The inspired air is composed of:

 Oxygen: 21%
 Carbon dioxide: 0.03%
  Nitrogen (N.): 78%
 Other inert gases: About 1%.

On breathing out (expiration), the air has 16% 0, and 4% CO2

Respiratory Movements

Respiratory movements consist of two phases:

1. Inspiration: It is accompanied by expansion of lung for uptake of air.

2. Expiration: It is the expulsion of air from lung due to retraction of lungs. These
movements an accompanied by corresponding movements of the thoracic cage.

Inspiration

Inspiration is active process.

There is expasion of intrathoracic
volume resulting in expansion of
lungs. This creates a negative air
pressure in the airway allowing
the air to flow in. In normal
conditions, inspiration lasts for 2
seconds.

The primary muscles of

inspiration are diaphragm and
external intercostals. In addition, scalene, sternocleidomastiods, neck and back muscles act as
accessory muscles or secondary muscles of Inspiration. When the diaphragm contracts, it moves
downward towards the abdomen and the vertical diameter of thoracic cage is increased.

Contraction of external intercostal muscles increases the transverse diameter (bucket handle
effect) and the anteroposterior diameter (water pump-handle effect) of thoracic cage

Expiration

Expiration is a passive process in normal breaming, it occurs due to recoil of lungs at the end of
inspiration. This pushes out air from lungs. In forced expiration, the following muscles are
involved:

 Anterior abdominal wall muscles: These are recus abdominis, internal oblique and
transversus abdominis. Contraction of these muscles increases the intra- abdominal pressure
and pushes up the diaphragm.
 Internal intercostal muscles: Contraction of these muscles pulls the upper ribs downwards.
This decreases the intrathoracic volume.
 Accessory muscles: Adductor muscles of vocal cord. Their contraction is primarily
protective, to prevent entry of food or fluid into trachea.

GASEOUS EXCHANGE IN LUNGS

Gases diffuse from alveoli to blood circulation and vice versa, passing through alveolocapillary
membrane or respiratory membrane. It consists of

 Alveolar epithelium
 Pulmonary capillary endothelium
 Basement membrane of both lining cells
Diffusing Capacity

The diffusing capacity is defined as the volume of gas that diffuses through the respiratory
membrane each minute for a pressure gradient of 1 mm Hg.

Diffusing Capacity for Oxygen and Carbon Dioxide

Diffusing capacity for oxygen is 21 ml/min/mm Hg. Diffusing capacity for carbon dioxide is 400
mL/min/ mm Hg. Thus, the diffusing capacity for carbon dioxide is about 20 times more than
that of oxygen.

TRANSPORT OF GASES BETWEEN LUNGS AND TISSUES

Transport of gases is one of the most important functions of the blood.

Transport of Oxygen

The partial pressure of dissolved O, partial pressure of oxygen (pO2,) in the pulmonary venous
blood is 40 mm Hg and that in the marked pressure gradient, O2, diffuses from the alveolar air
into the pulmonary capillary blood. Howe the pO2, becomes 100 mm Hg when the blood reaches
aorta. This is due to some mixing of blood occurring in the Thebesian vessels and physiological
shunts.

Methods of Oxygen Transport

Methods by which O2 carried by the blood are:

 About 97% of the O, transported from the lungs to tissues is by chemical combination
with hemoglobin (Hb) of red blood cells (RBCs)
 The rest 3% is carried in the dissolved state in plasma
 About 3% of O2 is transported as dissolved form blood

The dissolved O2 exerts the partial pressure, which actually determines the amount of O2 that
combines with Hb. Thus, even though a small amount of 02 is transported in dissolved form, it is
very important in determining the total O2 transport.

REGULATION OF RESPIRATION

Respiration is an automatic process that occurs without any conscious effort, while one is asleep
or awake Rhythmical excitation of respiratory muscles occurs as a result of multiple neuronal
interactions involving all levels of the nervous system
 Various neural and hormonal stimuli as well as chemical changes in blood (ie changes in
blood POPCO and pH) can influence the central control of respiration. Hence, regulation of
respiration can be broadly classified as 'neural regulation' and 'chemical regulation

Nervous Control of Respiration

Nervous regulation of respiration includes:

 Voluntary control
 Automatic control

Voluntary Control

Respiration is a spontaneous (reflex) process. But to some extent, it can be controlled voluntarily
because most of the muscles concerned with respiration are voluntary muscles. The center for
voluntary control is the moto cortex.

Automatic Contral

The automatic centers for control of respiration are located in the pons and medulla. The
tespiratory centers are located bilaterally.
Medullary Centers

The medullary centers include:

 Dorsal respiratory group of neutons (DRG)

 Ventral respiratory group (VRG)

The DRG is located in and near the nucleus of tractus solitarius (NTS). DRG is made up of 1
(inspiratory) neurons. They are active during inspiration. They also receive impulses from lungs,
chemoreceptors and baroreceptors through vagus.

The VRG is located in the ventrolateral part of medulla. It extends through nucleus
ambiguus. VRG is made up of 'E' (expiratory) neurons mainly. 'E' neurons inhibit 'T neurons in
expiration.

Pontine Centers

Although, the rhythmic discharge of medullary respiratory neurons is spontaneous, it is

modified by neurons in the pons. In the upper part of pons there is a pair of respiratory centers
called pneumotaxic center. Pneumotaxic center has inhibitory effect on T neurons. When this
area is stimulated, 'I' neurons are inhibited. Respiration becomes shallow and rapid.

Vagal Influences on Respiration

Stretch of the lungs during inspiration stimulates stretch receptors in lung, which generates vagal
fibers. The impulses inhibit T neurons and produce expiration

Chemical Control of Respiration

Chemical content of respiration is exerted through the central and peripheral chemoreceptors.
The chemoreceptors respond to changes in the pH, pO2, and pCO2, of blood. A rise in pCO2, a
rise in H' concentration of a decrease in pO2, can stimulate respiration

Central Chemoreceptors

Central chemoreceptors are located in the medulla, near the origin of IX and X cranial nerves.

Peripheral Chemoreceptors

Peripheral chemoreceptors are the carotid and aortic bodies. Carotid bodies are located at the
bifurcation of the common carotid arteries. The aortic bodies are located in the arch of aorta.
FETAL CIRCULATION

The structure of the

foetal heart provides for a
patterns of circulation that is
very different from that
required during postnatal life.
During foetal life the lungs
are essentially non-functional
and the liver is only partially
functional, therefore less
blood is needed in these
organs than is required after
birth. The foetal brain
requires the highest oxygen
concentration. The
characteristics of foetal
circulation ensure that the most vital organs and tissues receive the maximum concentration of
vital materials

Blood carrying oxygen and

nutritive material from the placenta
enters the foetal system through the
umbilicus via the large umbilical vein.
The blood then travels to the liver,
where it divides part of the blood enters
the portal and hepatic circulation of the
liver, and the remainder travels directly
to the inferior vena cava (IVC) by way
of the ductus venosus. Because of the
higher pressure of blood entering the
RA from the IVC, it is directed
posteriorly in a straight pathway across
the RA and through the Foramen ovale
to the LA. In this way the better-
oxygenated blood enters the LA and
LV to be pumped through the aorta to the head and upper extremities. Blood from the head and
upper extremities entering the RA from the superior vena cava (SVC) is directed downward
through the tricuspid valve into the RV. From here it is pumped through the PA, where the major
portion is shunted to the descending aorta via the ductus arteriosus. A small amount flows to and
from the non-functioning foetal lungs. Blood is returned to the placenta from the descending aorta
through the two umbilical arteries

Postnatal Development

In infancy
the size of the
heart in relation to
total body size is
larger, and the
heart occupies a
larger space
within the
mediastinum. The
ventricle walls are
more or less equal
in thickness at
birth. With the
increased demand
of the post- natal
peripheral circulation, the left side becomes thicker than the right and pressures on the left side of
the heart rise. Right-sided pressures decrease because the right ventricle is pumping blood to the
low-pressure pulmonary bed. An increase in heart size accompanies the adolescent growth spurt,
with a resulting increase in blood pressure and decrease in heart rate. The heart rate at any age
shows an inverse relationship to body size.

The arteries and veins elongate to keep pace with expanding body dimensions, and the
vessel walls thicken to cope with the increased pressure. The systolic blood pressure after birth is
low, reflecting the weaker LV of the neonate. With the developing strength and power of the left
side of the heart, the systolic pressure rises rather sharply during the first 6 weeks and continues
to rise but at a much slower rate until shortly before puberty, at which point it rises rapidly to adult
levels.
CONCLUSION

The circulatory, or cardiovascular, system is complex. Its structure consists of three parts;
the heart, the blood and blood vessels. The function of the circulatory system is to carry oxygen
and food to all body cells and to carry carbon dioxide and wastes away from the body cells.

In our body the blood circulates twice, once the pure (oxygenated) blood is pumped by the
left ventricle to the other parts of the body and comes back to the heart at the right auricle (one
circulation complete), secondly the blood from the right ventricle is pumped to the heart for
purification and comes back to heart at the left auricle (this is second circulation). Thus is called
double circulation

BIBLIOGRAPHY

 PR Ashalatha , G Deepa Textbook Of Anatomy & Physiology For Nurses. 4th edition, Jaypee
Brothers Medical Publishers (P) Ltd.
 Ross & Wilson Anatomy & Physiology in Health and Illness, 10th edition, Elsevier Health
Sciences
 Marilyn J. Hockenberry, Cheryl C Rodgers, David Wilson, Wong's Essentials of Pediatric
Nursing, 10th Edition, Mosby Publishers