ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

CARDIOVASCULAR SYSTEM
▪
(AnaPhy Notes) Parietal Pericardium – lines
the interior of the fibrous
pericardium.
▪ Epicardium/Visceral
Functions of the Heart: Pericardium – is a part of
• Transportation the heart wall. In other
• Muscular Pump words it is the innermost
later of the pericardium and
the outermost layer of the
Heart heart wall.

The Heart is a hollow, muscular organ located in

the centre of the thorax where it occupies the
space between the Lungs (mediastinum) and
rest at the Diaphragm

The Heart Walls are composed of:

➢ The pumping action of the heart is • Epicardium

accomplished by the rhythmic contraction and • Myocardium
relaxation of its muscular wall • Endocardium

• During Systole (Contraction of the muscle)

• During Diastole (relaxation of the muscle)
• The heart is encased in a thin fibrous sac
called Pericardium
❖ Pericardium is composed of three
layers:
▪ Fibrous Pericardium – is the
loosely fitting superficial
part. It helps protect the
heart and anchors the
surrounding structures,
such as the diaphragm and
sternum.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

➢ The Four Valves in the Heart permit blood

flow in only one direction.
o The Valves, which are
• The four chambers of the heart composed of thin leaflets of
constitute the right and left-sided fibrous tissue, open and close
pumping systems. in response to the movement of
o The right side of the heart, blood and pressure changes
made up of: within the chambers.
➢ The right atrium and right ventricle, ➢ Two types of valves:
distributes venous blood (deoxygenated ➢ These valves are responsible for one way
blood) to the lungs via the pulmonary artery flow of blood into the heart.
(pulmonary circulation) for oxygenation. 1. Atriovencular
o The right atrium receives blood – Tricuspid and Biscuspid
returning from the 2. Semilunar
➢ Superior vena cava head, neck, and upper - Pulmonic and aortic
extremities
Atrioventicular Valves
➢ Inferior vena cava
- trunk and lower extremities ➢ The tricuspid valve, so named because it is
➢ Coronary Sinus composed of three cusps or leaflets
- Coronary circulation ➢ The mitral or bicuspid (two cusps) valve, lies
o The left side of the heart, between the left atrium and the left ventricle
composed of the left atrium
and left ventricle, distributes
oxygenated blood to the
remainder of the body via the
aorta (systemic circulation).
➢ The left atrium receives oxygenated blood
from the pulmonary circulation via the
pulmonary veins.

➢ The valve between the right ventricle and the

pulmonary artery is called the pulmonic valve.

Semilunar Valves

➢ The two semilunar valves are composed of

three half moon-like leaflets.
➢ The valve between the right ventricle and the
pulmonary artery is called the pulmonic valve.
➢ The valve between the left ventricle and the
Heart Valves
aorta is called the aortic valve.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

➢ The valve between the right ventricle and the

pulmonary artery is called pulmonic view.

Coronary Arteries

➢ The left and right coronary arteries and their

branches supply arterial blood to the heart.
➢ The heart has large metabolic requirements,
extracting approximately 70% to 80% of the
oxygen delivered (other organs consume, on
average, 25%).

Cardiac Muscle

➢ The myocardium composed of specialized

muscle tissue.
➢ Myocardial muscle resembles smooth muscle
because its contraction is involuntary.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

AV NODE

• The AV (located in the right atrial wall near the

tricuspid valve) consists of another group of
PHYSIOLOGY OF THE HEART
specialised muscle cells similar to those of the
SA node.
• The bundle of His divides into the right bundle
Function of the Heart:
branch (conducting impulses to the right
➢ The specialised heart cells of the cardiac ventricle) and the left bundle branch
conduction system methodically generate and (conducting impulses to the left ventricle).
coordinate the transmission of electrical • To transmit impulses to the largest chamber of
impulses to the myocardial cells. the heart, the left bundle branch bifurcates into
➢ Three physiologic characteristics of the cardiac the left anterior and the left posterior bundle
conduction cells account for this coordination: branches.
• Automaticity: ability of initiate an • Impulses travel through the bundle branches to
electrical impulse reach the terminal point in the conduction
• Excitability: ability to respond to an system, called the Purkinie fibers.
electrical impulse • This is the point at which the myocardial cells
• Conductivity: ability to transmit an are stimulated, causing ventricular contraction.
electrical impulse from one cell to
another
➢ Two systems act to regulate heart activity: Cardiac Cycle and Heart Sounds
1. The nerves of the autonomic nervous
• The term cardiac cycle refers to the events of
system, which acts like brakes and
one complete heartbeat, during which both
accelerator to increase the heart rate
atria and ventricles contract then relax
2. The intrinsic conduction system or nodal
• Systole and Diastole mean heart contraction
system, that is built into the heart tissue.
and relaxation
This system causes heart muscle
depolarisation in one direction-from atria to We will consider the cardiac cycle in terms of events
ventricles during the five periods

➢ The SA node in a normal resting heart has an • Atrial Diastole (ventricular filling)
inherent firing rate of 60 to 100 impulses per ▪ Begins with the heart completely
minute relaxed
▪ Pressure is low
▪ The AV valves are open and the blood is
flowing passively through the atria into
the ventricles
▪ The semilunar are closed
• Atrial Systole
▪ The ventricles remain diastole as the
atria contract forcing blood into the
ventricles to complete the ventricular
filling
• Isovolumetric contraction
▪ Atrial systole ends and ventricular
systole begins
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

▪ Initial rise in intraventricular pressure • If we used normal resting values of heart rate =
closes the AV valves, preventing 75 beat/minute and stroke volume =
backflow of the blood into the atria. 70ml/beat
▪ The ventricles are completely closed • CO = HR (75bpm x SV 70ml /beat)
chamber • CO = 5250ml/min = 5.52L/min
• Ventricular Systole (ejection phase) • The normal adult blood volume is 6,000ml. CO
▪ The ventricles continue to contact, rises when the stroke volume is increased or the
causing the intraventricular pressure to heart beats faster, it decreases if both of these
surpass the pressure in the major factors decrease.
arteries leaving the heart
▪ This causes the semilunar valves to
open and blood to be ejected from the REGULATION OF STROKE VOLUME
ventricles
▪ The atria are again relaxed and filling • According to Starling’s law of Heart, the critical
with blood factor controlling stroke volume is how much
• Isovolumetric relaxation cardiac muscle cells are stretched just before
▪ Ventricular diastole begins, the pressure they contact. The more they stretched the
in the ventricles falls below that in the stronger the contraction will be. The important
major arteries, and the semilunar valves factor stretching the heart is venous return, the
close to prevent backflow into amount of blood entering the heart and
ventricles. distending the ventricles.
▪ The ventricles are completely closed
and intraventricular pressure continue
to decrease Factors
▪ Atria has been in diastole filling with
• Neural (ANS control)
blood
• Hormones and ions
• Physical factors (age, gender, exercise, and
body temperature)
➢ Heart sounds are often described by “lub” and
“dub”. The first sound is caused by closing of
the AV valves, The second heart occurs when
the semilunar valves close at the end of
systole.

Cardiac Output

• It is the amount of blood pumped out by each

side of the heart in 1 minute.
• It is the product of Heart rate and stroke
volume

Stroke Volume

• Is the volume of blood pumped out by

ventricle wit each other heart beat
• Stroke volume increases as the force of Blood Vessels
ventricular contraction increases
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

• Blood circulates inside which form a closed • It is where substances and molecules are
transport system, is so called vascular system. exchanged between the blood and tissue
• As the heart beats, the blood is propelled into underneath
large arteries leaving the heart. It then moves • The transparent walls of capillaries are only on
into successively smaller and smaller arteries cell layer thick- just the tunica intima. Because
and the atrioles, which feed the capillary beds of this exceptional thinness, exchanges are
in tissues. Capillary beds are drained by venules easily made between the blood and tissue cells.
which in turn empty into veins that finally • The tiny capillaries tend to form interweaving
empty into vena cavae entering the heart. network called capillary beds
• In most regions capillary bed consists of two
Arteries (no valve)
types of blood vessels:
• Carries blood away from the heart 1. Vascular shunt – a vessel that directly
• Are strong elastic blood vessels made up of connects the arteriole and venule at
three tunics opposite ends of the bed
• Arteries which are closer to the pumping action 2. True capillaries – the actual exchange of
of the heart, must be able to expand as blood is vessels
forced into them and recoil passively as the
blood flows off into the circulation during
diastole.
▪ Their walls must be strong and stretchy
enough to take these continuous
change in pressure

Arterioles

• Composed if a thick layer of smooth muscle in

tunica media and have a relatively narrow
lumen.
• It helps reduce turbulent blood flow into steady,
smooth flow

Veins (has valves)

• Return blood to the heart and serves as fluid

reservoir.
• The lumens of veins tend to be much larger
than those of corresponding arteries, and the
larger veins have valves that prevent backflow
of blood.

Capillaries
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

LAYERS OF BLOOD VESSELS

• Tunica intima
➢ Which lines the lumens, or interior of the
vessels.
➢ Is a thin layer of endothelium (squamous
epithelium) resting on basement membrane
• Tunica media
➢ is the bulky middle coat.
➢ It is mostly smooth muscle and elastic
fibres
• Tunica externa
➢ Outermost tunic
➢ Composed largely of fibrous connective
tissue and its function is basically to
support and protect the vessels.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

▪ The L. Common Carotid artery is the

second branch of aortic arch. It divides
MAJOR ARTERIES OF THE SYSTEMIC forming the L. internal carotid which
CIRCULATION serves the brain, and the L. External
carotid which serves the skin and
• Aorta – the largest artery of the body. It spring muscles of the head and neck.
upward from the left ventricle of the heart as ▪ The third branch of the aortic arch, the
the ascending aorta, arches to the left as the L. Subclavian artery, gives off important
aortic arch, and then plunges downward the branch – the vertebral artery which
following the spine (thoracic aorta), finally pass serves part of the brain. In the axilla, it
through the diaphragm into the abdominopelvic becomes the axillary artery and
cavity, where it becomes the abdominal aorta. continues into the arms as the brachial
artery, which supplies the arm. At the
elbow, the brachial artery splits to form
radial and ulnar arteries, which serves
ARTERIAL BRANCHES OF ASCENDING AORTA the forearm.

• Right and Left coronary arteries – which serve

the heart.

ARTERIAL BRAMCHES OF THORACIC AORTA

• The intercostal arteries supply the muscles of

the thorax wall. Other supply the lungs
(bronchial artery), the esophagus (esophageal
• The brachiocephalic trunk splits into the R. artery) and the diaphragm (phrenic arteries)
Common carotid artery and R. Subclavian
artery.
• the right common carotid will further branches
into right internal (serves the brain) and right
external carotid arteries (skin and muscles of
the head and neck) and the Right subclavian
artery
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

▪ Renal Artery – supplies the kidney

▪ Gonadal arteries – supply the gonads. They are
called ovarian in females and testicular arteries
in males.
▪ Lumbar Arteries – are several pairs of arteries
serving the heavy muscles of the abdomen and
trunk walls
▪ Inferior mesenteric artery – is a small, unpaired
artery supplying the second half of the large
intestine
▪ Common Iliac arteries – are the final branches
of abdominal aorta which divides into:
➢ Internal Iliac artery – which supplies
the pelvic organs (bladder, rectum, and
so on)
➢ External Iliac artery – enters the thigh
where it becomes femoral artery. Its
branch:
o Deep artery of the thigh –
ARTERIAL BRANCHES OF ABDOMINAL AORTA
serves the thigh
• The celiac trunk is the first branch of the o Popliteal artery – the knee,
abdominal aorta. which then splits into anterior
• It has three branches: and posterior tibial arteries,
▪ L. Gastric artery – supplies the stomach which then supply the leg and
▪ Splenic artery – supplies the spleen foot. The anterior tibial artery
▪ Common hepatic artery - supplies the terminates in the dorsalis pedis
liver artery which via the acuate
artery supplies the dorsum of
the foot. The Dorsalis pedis is
often palpated in patients with
circulatory problems of the legs
to determine whether the distal
part of the leg has adequate
circulation.

Other Branches of Abdominal Aorta

▪ The unpaired superior mesenteric artery

supplies most small intestines and first half of
the large intestine or colon.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

MAJOR VEINS OF THE SYSTEMIC CIRCULATION

VEINS DRAINING INTO SUPERIOR VENA CAVA
• Veins draining the head and the arms empty into
Superior Vena Cava and those draining the lower • Radial and Ulnar veins – are deep veins draining
part of the body empty into the Inferior Vena the forearm, they unite to form the deep
Cava brachial vein, which drains the arm and empties
into the axillary vein in the axillary region.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

▪ Vertebral vein – drains the posterior part of the

▪ Cephalic vein – provides for superficial
head.
drainage of the lateral aspect of the arm and
▪ Internal Jugular vein – drains the dural sinuses
empties into the axillary vein.
of the brain
▪ Basilic vein – is a superficial vein that drains
▪ Brachiocephalic veins – are large veins that
the medial aspect of the arm and empties into
receive venous drainage from the subclavian,
the brachial vein proximally. The basilic and
vertebral, and internal jugular veins on their
cephalic vein are joined at the anterior aspect of
respective sides. The brachiocephalic join to
the elbow by median cubital vein. It is often
form the superior vena cava, which enters the
choses as the site for blood extraction for the
heart.
purpose of blood testing.

▪ Subclavian vein – receives venous blood from ▪ Azygos vein – is a single vein that drains the
the arm through the axillary vein and from the thorax and enters the superior vena cava just
skin and muscles of the head through the before it joins the heart.
external jugular vein
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

VEINS DRAINING IN THE INFERIOR VENA CAVA

• The Anterior and Posterior tibial veins and

fibular veins drain the leg (calf and foot). The
posterior tibial veins becomes the popliteal
vein at the knee and then the femoral vein in
the thigh. The femoral vein becomes the
external iliac vein as it enters the pelvis

▪ Renal Veins – drains kidney

▪ Hepatic Portal Vein – is a single vein that drains
the digestive tract organs and carries this blood
through the liver before it enters the systemic
circulation.
▪ Hepatic Veins – drain the liver

▪ Great Saphenous Veins – are the longest veins

in the body. They receive the superficial
drainage of the leg. They begin at the dorsal
venous arch in the foot and travel up the medial
aspect of the leg to empty into the femoral vein
in the thigh. The Common Iliac Veins join to
form the inferior vena cava, which then
ascends superiorly in the abdominal cavity.
▪ Right Gonadal Vein – drains the right ovary in
females and the right testicle in males.
Left Gonadal Vein – empties into the left renal
vein superiorly.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

SPECIAL CIRCULATIONS

ARTERIAL SUPPLY OF THE BRAIN AND THE CIRCLE OF

WILLIS

• The Brain is supplied by two pairs of arteries,

the internal carotid arteries and the vertebral
arteries.
▪ The internal carotid arteries, branches
of the common carotid arteries, run
through the neck and enter the skull
through the temporal bone. Once inside
the cranium each divides into the
anterior and middle cerebral arteries,
which supply most of the cerebrum.
▪ The anterior and posterior blood
supplies of the brain are united by small
communicating arterial branches. The
result is a complete circle of connecting
blood vessels called either the cerebral
arterial circle or the circle of Willis,
which surrounds the brain. The cerebral
arterial circle protects the brain by
providing more than one route for
blood to reach brain tissue in case of
clot or impaired blood flow anywhere in
the system.

▪ The vertebral arteries pass upward

from the subclavian arteries at the base
of the neck. Within the skull, the
vertebral arteries join to form the single
basilar artery. This artery serves the
brain system and cerebellum as it
travels upward. At the base of the
cerebrum, the basilar artery divides to
form posterior cerebral arteries, which
supply the posterior part of the
cerebrum.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

enter the right ventricle is pumped out

the pulmonary trunk, where it meets a
second shunt, the ductus arteriosus, a
short vessel that connects the aorta and
pulmonary trunk. Because the collapsed
lungs are a high- pressure area, blood
tends to enter the systemic circulation
through the ductus arteriosus. The
aorta carries blood to the tissues of the
placenta through the umbilical arteries.

FETAL CIRCULATIONS

• The umbilical cord contains three blood vessels:

one large umbilical vein and two smaller
umbilical arteries
▪ The umbilical vein carries blood rich in
nutrients and oxygen to the fetus. The
umbilical arteries carry carbon dioxide
and debris laden blood flow superiorly
toward the heart of the fetus, most

▪ Some of the blood entering the right

atrium is shunted directly into the left
atrium through the foramen ovale, a
flaplike opening in the interatrial
septum. Blood that does manage to
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

HEPATIC PORTAL CIRCULATION

• The veins of the hepatic portal circulation drain

the digestive organs, spleen, and pancreas and
deliver this blood to the liver through hepatic
portal vein.
▪ The three major vessels composing the
hepatic portal circulation include the
Inferior and Superior Mesenteric Veins,
the Splenic vein and the Left Gastric
Vein
➢ Inferior Mesenteric Vein –
draining the terminal part of the
splenic vein, which itself drains
the spleen, pancreas, and the
left side of the stomach
➢ Splenic Vein & Superior
Mesenteric Vein – (which drains
the small intestine and the first
part of the colon) join to form
the hepatic portal vein.
➢ Left Gastric Vein – which drains
the right side of the stomach,
drains directly into the hepatic
vein.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

CORONARY CIRCULATION

• Blood supplied to the myocardium is provided

by the right and left coronary arteries. These
exit the ascending aorta just beyond the aortic
semilunar valve. The Left Coronary Artery gives
rise to its major branches – the anterior
interventricular and circumflex arteries the
Right Coronary Artery give rise to the Posterior
Interventricular and Marginal Arteries
▪ The great cardiac vein and the middle
cardiac vein return blood from the
myocardial capillaries to the coronary
sinus and then the right atrium.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

PHYSIOLOGY OF CIRCULATION

ARTERIAL PULSE

• It is the alternating expansion and recoil of an

artery that occurs with each beat of the left
ventricle creates a pressure wave.

BLOOD PRESSURE

• Is the pressure the blood exert against the

inner walls of the blood vessels, and it is the
force that keeps blood circulating continuously
even heart beats

MEASURING BLOOD PRESSURE

• Systolic pressure, the pressure in the arteries at

the peak of ventricular contraction
• Diastolic pressire, the pressure when the
ventricles are relaxing
• It is measured in mmHG
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

BLOOD • Albumin: acts as a carrier to shuttle certain

molecules through the circulation
• It is “the river of life” • Fibrinogen: clotting of blood
• It transports everything that must be carried • Globulins: Defence (antibodies and lipid
from one place to another within the body transport)
(nutrients, wastes and body heat) through blood Substances transported by blood:
vessels
• Nutrients (glucose, fatty acids, aminoacids,
vitamins)
• Waste productrs of metabolism (urea and uric
Components/ Composition of the Blood
acid)
• Formed Elements – Erythrrocytes, Leukocytes, • Respiratory gases (O2 and CO2)
Platelets/Thrombocytes (45%)
• Plasma – Nonliving fluid matrix (55%)
FORMED ELEMENTS

• Erythrocyte
• Neutrophils
• Eosinophils
• Basophils
• Lymphocytes
• Monocytes
• Platelets

ERYTHROCYTES (Red Blood Cells)

• Ferry oxygen in the blood to all cells in the body

• Anucleate
• Contains hemoglobin, an iron bearing protein,
PLASMA transport the bulk of oxygen

• Liquid part of the blood

• Consist 90% of water
• Straw coloured fluid

THE BLOOD ALSO CONTAINS

Water

• Solvent for carrying other substances; absorbs

LEUKOCYTES (White Blood Cells)
heat
• Contains salts/electrolytes (sodium potassium, • It forms a protective, movable army that helps
calcium, magnesium, chloridem and defend the body against bacteria, viruses,
bicarbonate) parasites, and tumor cells
• Osmotic balance, pH buffering, regulation of • They are the complete cells in the blood, which
membrane permeability contains nuclei, and organelles
Plasma Proteins • Diapedesis: able to slip into and out of blood
vessels
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

MONOCYTES

• The largest of the WBC

• U-shaped or kidney shaped nucleus
• They change this macrophage – important in
fighting chronic infections such as tubercolosis

EOSINOPHILS

• The Number increase during allergies and

infection by parasitic worms ingested in food
or entering via skin
• Have blue-red Nucleus, that resembles as
telephone receiver and sport coarse

PLATELETS

• They are fragments of bizzare mulyinucleate

cells called – megakaryoctes, which pinch off
thousands of anucleate platelet pieces that
quickly seal themselves off from the
surrounding fluids

LYMPHOCYTES

• Have large purple nucleus

• Tend to take up residence in lymphatic tissues
immune response
• Second most numerous in the blood
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

HEMATOPOESIS HEMOSTASIS

• Stoppage of bleeding

MAJOR PHASES

1. Vascular Spasm
▪ Vasoconstriction
FORMATION OF RED BLOOD CELLS ▪ Decreasing blood loss until clotting can
occur
▪ Factors causing spasm: stimulation of
pain recerptor, released of serotonin by
anchored platelets
2. Platelet Plug Formation
▪ Platelets are repelled by intact
endothelium, but when it is broken so
that underlying collagen fibres are
exposed, the platelet become sticky
and cling to the damaged site.
3. Coagulation
▪ Releasing tissue factor substance play
an important role in clotting
▪ PF3 – coats inteacts with TF, vit k and
other blood protein factors and
calcium ions to form an activator that
triggers the clotting cascade
▪ Thromobin joins the soluble fibrinogen,
which forms a meshwork that traps
RBC and form the basis to stop. Within
the hour, the clot begins to retract,
squeezing serum from the mass and
pulling the ruptured edges of the blood
vessels closer together.
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM

▪ Kidney failure
▪ Fever
▪ Chills
▪ Nausea
▪ Vomiting
• ABO groups are beased on which of two
antigens, type A or type B
• Absence of both antigens result in type O
blood
• Presence of both antigens lead to type AB
• The presence of either of A or B antigen yields
type A or Type B

RH BLOOD GOUPS

• Named because one if the eight Rh antigens

(agglutinogen D) was originally identified in
Rhesus monkeys.
BLOOD GROUPS • Rh+, means that their RBCs carry Rh antigen
• Unlike the antibodies of the ABO system, anti-
Rh antibodies are not automatically formed by
Rh negative. However, if an Rh-persons
receives Rh+ blood, shortly after the
transfusion his/her immune system becomes
sensitized and begins producing antibodies
against foreign blood types
• Hemolysis – doesn’t occur in Rh- person with
the first transfusion of Rh+ blood because it
takes time for the body to react and start
making antibodies

• Antigen – is a substance that the body

recognises as foreign
• Antibodies – present in plasma that attach to
RBC’s bearing surface antigens different from
those on the patient’s (recipient) RBCs
• Binding of an antibodies causes the foreign RBCs
to clump, a phenomenon called Agglutination,
which leads to clogging of small blood vessles.
During the next few hours, the foreign RBCs are
lysed, and their hemoglobin is released into the
bloodstream,
• Transfusion reactions:
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM
ANATOMY AND PHYSIOLOGY: CARDIOVASCULAR SYSTEM