THE CIRCULATORY SYSTEM

The cardiovascular system is transport system of body

It comprises blood, heart and blood vessels.

The system supplies nutrients to and remove waste

products from various tissue of body.

The conveying media is liquid in form of blood which

flows in close tubular system.
FUNCTION OF CARDIOVASCULAR SYSTEM
 Transport nutrients, hormones
 Remove waste products
 Gaseous exchange
 Immunity
 Blood vessels transport blood
• Carries oxygen and carbon dioxide
• Also carries nutrients and wastes
 Heart pumps blood through blood vessels
 COMPONENTS

BLOOD
BLOOD VESSELS
HEART
 BLOOD
Connective tissue in fluid form
Fluid of life – carries oxygen from lungs to all parts of body
and carbon-di-oxide from all parts of the body to the lungs

Fluid of growth – carries nutritive substances from the

digestive system and hormones from endocrine gland to all the
tissues.

Fluid of health – protects the body against diseases and

get rid of unwanted substances by transporting them into excretory
organs like kidney.
• Thicker than water
• 8 % of total body weight
• Blood volume
»70 mL/kg of body weight
»5 - 6 liters in males
»4 - 5 liters in females
• Temperature - 100.40F
• pH - 7.35 to 7.45
 BLOOD
1. Transport gases, nutrients and waste
products
2. Transport processed molecules
example: vitamin D produced in the skin is
transported by the blood to the liver and kidneys for
processing into active vit.D. BLOOD transports vit. D
to the small intestine where it helps absorption of
calcium.
 THE BLOOD
3. Transport of regulatory molecules : e.g.
hormones and enzymes
4. Regulation of pH and osmosis (maintains fluid
and ion balance)
5. Maintenance of body temperature
6. Protection against foreign substance.
7. Clot formation
 BLOOD COMPOSITION
1. BLOOD PLASMA 3. fibrinogen: for clotting
• Straw colored clear liquid 4. Serum: plasma w/o clotting factors
• Contains 90% water
• 2% other substances
• 7% plasma proteins  Nutrients, electrolytes, gases,
created in liver hormones, waste products
confined to bloodstream
PLASMA PROTEINS:
1. albumin: maintain blood osmotic
pressure
2. Immunoglobulins
• antibodies bind to foreign
substances called antigens
• form antigen-antibody
complexes
 Functions of plasma proteins
1. Coagulation of blood – Fibrinogen to fibrin
2. Defense mechanism of blood – Immunoglobulins
3. Transport mechanism – α Albumin, β globulin transport hormones,
gases, enzymes, etc.
4. Maintenance of osmotic pressure in blood
5. Acid-base balance
6. Provides viscosity to blood
7. Provides suspension stability of RBC
8. Reserve proteins
 FORMED ELEMENTS
1.RED BLOOD CELLS: erythrocytes 95%
2.WHITE BLOOD CELLS: leukocytes 5%
3.PLATELETS: thrombocytes
 HEMATOPOIESIS
Hemato : blood
Poiesis: making

“the making of blood”

All the formed elements of blood are derived
from a single population of cells called stem cells.
Refer to the image found in your book p. 299
 HEMATOPOIESIS
• Blood cells need certain nutrients to form
properly.
• Examples include…..
—Iron
—Folic acid
—Vitamin B12
 RED BLOOD CELLS
 Transport oxygen from the lungs to  Hemoglobin carries oxygen
the various tissues of the body from the lungs to the rest of the
 Help transport of carbon dioxide body and carbon dioxide binds to
from the tissues to the lungs. the RBC and is taken to the
 Erythrocytes or RBCs are the most lungs to be exhaled.
abundant cell in the blood
READ: page 301 why is there more
 Formed in the bone marrow production of RBC when body has low
 Shaped as biconcave disks oxygen level?
 Life span of about 120 days
 Hemoglobin (iron protein)is
found in the RBC
 WHITE BLOOD CELLS
 Also called Leukocytes There are five different types of
 Largest sized blood cells WBCs
 Formed in the bone marrow and 1. Neutrophils
some in lymph glands 2. Eosinophils
 Primary cells of the immune system 3. Basophils
 Fights disease and foreign invaders 4. Lymphocytes
 Certain WBCs produce antibodies 5. Monocytes
 Life span is from 24 hours to several
years
 Size is 8-20 micrometers in diameter
 WHITE BLOOD CELLS
GRANULOCYTES: AGRANULOCYTES:
1. Neutrophils : phagocytizes 1. Lymphocytes: part of immune
microorganisms and other foreign system, produces antibodies,
substances, accumulates pus in the aids in allergic reaction, rejects
site of infection grafts, and control tumors.
2. Basophils: release histamine and 2. Monocytes: when they enlarge,
other chemicals that promote they become macrophages
inflammation, releases heparin which eats bacteria, dead cells,
which prevents formation of clots. and other debris within the
3. Eosinophils: involved in the tissues. Breaks down foreign
inflammatory response associated substances
with allergies and asthma, destroys
certain worm parasites.
 PLATELETS
 Thrombocytes or PLTs
 Formed in the bone marrow Fragments from the
cytoplasm of megakaryocytes
 Smallest of the blood cells
 1-4 micrometers in diameter
 Shape can be round, oval, or appear spiky
 Life span of around 8-12 days
 PLATELETS
 Involved in the clotting process
 Seal wounds and prevent blood loss
 Help repair damaged vessels
 150,000 – 400,000 per microliter of blood
 Platelets stain bluish with reddish or purple granules
 Preventing Blood Loss
When blood vessels are damages, blood
can leak into other tissues and interfere with
normal tissue function or blood can be lost
from the body.
1. Vascular spasm
2. Platelet plug formation
3. Blood clotting
 Preventing Blood Loss
Vascular spasm:
 immediate but temporary constriction of a
blood vessel that results when smooth muscle
within the wall of the vessel contracts.
Can close vessels completely
 Preventing Blood Loss
Platelet plug formation
 accumulation of platelets that can seal up
a small break in the blood.
Blood clotting
 when a blood vessel is severely damaged,
blood clotting or coagulation results in the
formation of a clot
 Preventing Blood Loss
CLOT: a network of threadlike protein fibers called
fibrin, that traps blood cells and fluid.
Please refer to page 305, figure 11.10 for the clot formation process.
 CONTROL OF CLOT FORMATION
 Without control, clotting would spread from the point of its
initiation throughout the blood vessels
 ANTICOAGULANTS: prevents clotting factors from forming
clots under normal conditions.
e.g. antithrombin and heparin
 THROMBUS FORMATION: when platelets encounter
damages or diseased areas of blood vessels or heart walls an
attached clot forms.
 EMBOLI: a thrombus that breaks loose and begin to float
through the circulation – can block the circulation and can
lead to death
 BLOOD GROUPING
TRANSFUSION: transfer of blood or blood components from
one individual to another

INFUSION: introduction of fluid other than blood such as saline

or glucose solution into the blood.

TRANSFUSION REACTIONS: clumping or rupture of blood cells

and clotting within blood vessels.
(antigens + antibodies = agglutination / clumping of cells)
 BLOOD GROUPING
TRANSFUSION: transfer of blood or blood components from one
individual to another

INFUSION: introduction of fluid other than blood such as saline or

glucose solution into the blood.

TRANSFUSION REACTIONS: clumping or rupture of blood cells

and clotting within blood vessels.
(antigens + antibodies = agglutination / clumping of cells)

HEMOLYSIS: rupture of the red blood cells – causes severe

damage to kidneys = death
 BLOOD GROUPING
ABO Blood group: SYSTEM used to CATEGORIZE
blood. Refer to page 307, figure 11.12 for ABO blood group
illustration.

Rh Blood group: studied in “Rhesus Monkeys”

- danger in Rh incompatibility.
P. 309 figure 11.14
 DIAGNOSTIC BLOOD TESTS
1. Type and Crossmatch 3. Differential white blood
 Blood typing count: percentage of each of
 Crossmatching : no agglutination the 5 kinds of WBC.
1. Complete blood count
- red blood count 4. Clotting:
hemoglobin Platelet count
Hematocrit Prothrombin time
measurement
- white blood count
Blood chemistry
 Leukopenia: lower than normal
 Leukocytosis: abnormally high
THE HEART
Our heart beats 100,000 times a day,
pushing 5,000 gallons of blood
through our body every 24 hours.

It delivers oxygen- and nutrient-rich

blood to our tissues and carries away
waste
• Heart is a four chambered, hollow muscular
organ approximately the size of your fist
Location:
– Superior surface of diaphragm
– Left of the midline
– Anterior to the vertebral column, posterior to the
sternum
The heart consists of four chambers:
Atria: the two upper chambers (they receive blood).
Ventricles: the two lower chambers (they discharge blood).
The left atria and left ventricle are separated from the right atria and right ventricle by a wall of muscle called
the septum.

The wall of the heart consists of three layers of tissue:

Epicardium — protective layer mostly made of connective tissue.

Myocardium — the muscles of the heart.
Endocardium — lines the inside of the heart and protects the valves and chambers.
These layers are covered in a thin protective coating called the pericardium (layers: fibrous and serous).
 The valves
The heart has four valves that help ensure that blood only flows in one direction:
• Aortic valve: between the left ventricle and the aorta.
• Mitral valve: between the left atrium and the left ventricle.
• Pulmonary valve: between the right ventricle and the pulmonary artery.
• Tricuspid valve: between the right atrium and right ventricle.
Most people are familiar with the sound of a human heartbeat. It is often described as a
"lub-DUB" sound.

The "lub" sound is produced by the tricuspid and mitral valves closing, and the "DUB"
sound is caused by the closing of the pulmonary and aortic valves.
 How do the heart valves work?
• As the heart muscle contracts and relaxes, the valves open
and shut. This lets blood flow into the ventricles and atria at
alternate times.
Here is a step-by-step description of how the valves work
normally in the left ventricle:
1. When the left ventricle relaxes, the aortic valve closes and
the mitral valve opens. This lets blood flow from the left
atrium into the left ventricle.
2. The left atrium contracts. This lets even more blood to flow
into the left ventricle.
 How do the heart valves work?
3. When the left ventricle contracts, the mitral valve closes and
the aortic valve opens. This is so blood flows into the aorta and
out to the rest of the body.
4. While the left ventricle is relaxing, the right ventricle also
relaxes. This causes the pulmonary valve to close and the
tricuspid valve to open. This lets blood flow into the right
ventricle that was returned to the right atrium from the body.
5. When the left ventricle contracts, the right ventricle also
contracts. This causes the pulmonary valve to open and the
tricuspid valve to close. Blood flows out from the right ventricle
to the lungs before it is returned to the left atrium as fresh,
oxygenated blood.
 Heart valve disease

When heart valves fail to open and close

correctly, the damage to the heart can be
serious. The harm can affect the heart's
ability to pump blood through the body.
 Heart valve disease
1. Regurgitation is a leaky valve.
This means the valve doesn't fully close and the blood flows backward
through the valve. This results in leakage of blood back into the atria from
the ventricles in the case of the mitral and tricuspid valves.

Or it leaks back into the ventricles in the case of the aortic and pulmonary
valves.

This can cause the chambers to be overworked because they have repump
the extra blood that was returned.

Over time, this can cause structural and functional changes in the heart
chambers. These changes prevent the chambers from pumping blood
normally.
 Heart valve disease
2. Stenosis is a narrowed valve.
With stenosis, the valve opening is narrowed and the valve
doesn't open correctly. This makes it harder for the heart to
pump blood across the narrowed valve.

The heart must use more force to pump blood through the stiff
(stenotic) valve or valves.

This can also cause structural and functional changes to the

different chambers of the heart. These changes prevent the
heart from pumping blood normally.
 Heart valve disease
3. Atresia.
This means the valve opening doesn't develop normally during
childhood.

This prevents blood from passing from an atria to a ventricle, or

from a ventricle to the pulmonary artery or aorta. Blood must find
another route.

This is usually through a problem present at birth (congenital). This

might be an atrial septal defect or a ventricular septal defect. This
acts as another route for the blood to move through the heart
 The heart's electrical system
• To pump blood throughout the body, the muscles of the heart
must be coordinated perfectly — squeezing the blood in the
right direction, at the right time, at the right pressure.
• The heart's activity is coordinated by electrical impulses.
• The electrical signal begins at the sino-atrial (or sinus, SA)
node — the heart's pacemaker, positioned at the top of the
right atrium. This signal causes the atria to contract, pushing
blood down into the ventricles.
 The heart's electrical system
• The electrical impulse travels to an area of cells at the bottom
of the right atrium called the atrioventricular (AV) node.
• These cells act as a gate; they slow the signal down so that the
atria and ventricles do not contract at the same time — there
needs to be a slight delay.
• From here, the signal is carried along special fibers called
Purkinje fibers within the ventricle walls; they pass the
impulse to the heart muscle, causing the ventricles to
contract.
 HEART ATTACK !!!
• A heart attack occurs when the flow of blood to the heart is blocked. The
blockage is most often a buildup of fat, cholesterol and other substances,
which form a plaque in the arteries that feed the heart (coronary arteries).

• The plaque eventually breaks away and forms a clot. The interrupted
blood flow can damage or destroy part of the heart muscle.

• A heart attack, also called a myocardial infarction, can be fatal, but

treatment has improved dramatically over the years. It's crucial to call
emergency medical help if you think you might be having a heart attack.
 Symptoms
Common heart attack signs and symptoms include:
1. Pressure, tightness, pain, or a squeezing or aching
sensation in your chest or arms that may spread to your
neck, jaw or back
2. Nausea, indigestion, heartburn or abdominal pain
3. Shortness of breath
4. Cold sweat
5. Fatigue
6. Lightheadedness or sudden dizziness
 Risk factors
• Age.
Men age 45 or older and women age 55 or older are more likely to
have a heart attack than are younger men and women.
• Tobacco.
This includes smoking and long-term exposure to secondhand
smoke.
• High blood pressure.
Over time, high blood pressure can damage arteries that feed your
heart. High blood pressure that occurs with other conditions, such
as obesity, high cholesterol or diabetes, increases your risk even
more.
 Risk factors
• High blood cholesterol or triglyceride levels.
A high level of low-density lipoprotein (LDL) cholesterol (the "bad"
cholesterol) is most likely to narrow arteries. A high level of
triglycerides, a type of blood fat related to your diet, also ups your
risk of heart attack. However, a high level of high-density
lipoprotein (HDL) cholesterol (the "good" cholesterol) lowers your
risk of heart attack.
• Obesity.
Obesity is associated with high blood cholesterol levels, high
triglyceride levels, high blood pressure and diabetes. Losing just 10
percent of your body weight can lower this risk, however.
 Risk factors
• Diabetes.
Not producing enough of a hormone secreted by your
pancreas (insulin) or not responding to insulin properly causes
your body's blood sugar levels to rise, increasing your risk of
heart attack.
• Metabolic syndrome.
This occurs when you have obesity, high blood pressure and
high blood sugar. Having metabolic syndrome makes you twice
as likely to develop heart disease than if you don't have it.
 Risk factors
• Family history of heart attack.
If your siblings, parents or grandparents have had early heart
attacks (by age 55 for male relatives and by age 65 for female
relatives), you might be at increased risk.
• Lack of physical activity.
Being inactive contributes to high blood cholesterol levels and
obesity. People who exercise regularly have better cardiovascular
fitness, including lower high blood pressure.
• Stress.
You might respond to stress in ways that can increase your risk of a
heart attack.
 Risk factors
• Illicit drug use.
Using stimulant drugs, such as cocaine or amphetamines, can
trigger a spasm of your coronary arteries that can cause a
heart attack.
• A history of preeclampsia.
This condition causes high blood pressure during pregnancy
and increases the lifetime risk of heart disease.
• An autoimmune condition.
Having a condition such as rheumatoid arthritis or lupus can
increase your risk of heart attack.
 Complications
Abnormal heart rhythms (arrhythmias).
Electrical "short circuits" can develop, resulting in abnormal heart
rhythms, some of which can be serious, even fatal.
Heart failure.
An attack might damage so much heart tissue that the remaining
heart muscle can't pump enough blood out of your heart. Heart
failure can be temporary, or it can be a chronic condition resulting
from extensive and permanent damage to your heart.
Sudden cardiac arrest.
Without warning, your heart stops due to an electrical disturbance
that causes an arrhythmia. Heart attacks increase the risk of
sudden cardiac arrest, which can be fatal without immediate
treatment.
 THE CARDIAC CYCLE
The period of time that begins with contraction of the atria and ends with
ventricular relaxation is known as the cardiac cycle.

The period of contraction that the heart undergoes while it pumps blood into
circulation is called systole.

The period of relaxation that occurs as the chambers fill with blood is called
diastole.

Both the atria and ventricles undergo systole and diastole, and it is
essential that these components be carefully regulated and coordinated
to ensure blood is pumped efficiently to the body.
 Phases of the Cardiac Cycle
The cardiac cycle therefore proceeds in four stages:

1. Atrial systole: lasts about 0.1 seconds - both atria contract and force
the blood from the atria into the ventricles.
2. Ventricular systole: lasts about 0.3 seconds - both ventricles contract,
blood is forced to the lungs via the pulmonary trunk, and the rest of
the body via the aorta.
3. Atrial diastole: lasting about 0.7 seconds - relaxation of the atria,
during which the atria fill with blood from the large veins (the vena
cavae).
4. Ventricular diastole: lasts about 0.5 seconds - begins before atrial
systole, allowing the ventricles to fill passively with blood from the
atria.
Phases of the Cardiac Cycle
 Control of Cardiac Cycle
1. Intrinsic: Internal control
2. Extrinsic: External control

The heart functions in response to a

combination of factors both within the
heart muscle itself and outside of the
cardiovascular system.
 Control of Cardiac Cycle
Intrinsic control is due to specialized cells that
initiate and distribute electrical impulses in an
orderly manner through out the heart.

A). Unique Characteristics of Cardiac Muscles

1). automaticity.
2). The heart contracts as a unit
3). Long refractory period
 Control of Cardiac Cycle
B). Action Potential of Pacemaker Cells

1).Decrease in K+ permeability but a continuous Na+

permeability that upsets the Na+ and K+ balance.
2). Ca++ channels open allowing Ca++ in until the
action potential is reached.
3). K+ cannel open allowing for repolarization and
than the K+ channels are closed.
 Control of Cardiac Cycle
Extrinsic Control of the Cardiac Cycle
A). autonomic nervous system.

1). sympathetic system enhances activity

2). The parasympathetic system inhibits activity
Thus extrinsic control is the result of a balance between both
the parasympathetic and the sympathetic nervous system.
 Control of Cardiac Cycle
Extrinsic Control of the Cardiac Cycle
B). During times of physical or emotional stress:
The sympathetic system releases norepinephrine and epinephrine allowing the
heart to reach threshold faster and the SA node to fire faster.

C). When the stress is over or during depression:

The parasympathetic system releases acetylcholine which hyperpolarizing the
heart and thus the SA node does not fire as often.
D). Other extrinsic controls on the cardiac cycle:
1). Pressoreceptors that detect blood pressure.
2). Hormones such as epinephrine and thyroxine
3). Age
4). Exercise
5). Body temperature
BARORECEPTOR REFLEX
 Heart Conditions
1. Coronary artery disease: Over the years, cholesterol
plaques can narrow the arteries supplying blood to the
heart. The narrowed arteries are at higher risk
for complete blockage from a sudden blood clot (this
blockage is called a heart attack).
2. Stable angina pectoris: Narrowed coronary arteries cause
predictable chest pain or discomfort with exertion. The
blockages prevent the heart from receiving the extra
oxygen needed for strenuous activity. Symptoms typically
get better with rest.
3. Unstable angina pectoris: Chest pain or discomfort that is
new, worsening, or occurs at rest. This is an emergency
situation as it can precede a heart attack, serious
abnormal heart rhythm, or cardiac arrest.
4. Myocardial infarction (heart attack): A coronary artery is
suddenly blocked. Starved of oxygen, part of the heart
muscle dies.
5. Arrhythmia (dysrhythmia): An abnormal heart rhythm due
to changes in the conduction of electrical impulses
through the heart. Some arrhythmias are benign, but
others are life-threatening.
6. Congestive heart failure: The heart is either too weak or
too stiff to effectively pump blood through the body.
Shortness of breath and leg swelling are common
symptoms.
7. Cardiomyopathy: A disease of heart muscle in which the
heart is abnormally enlarged, thickened, and/or stiffened.
As a result, the heart's ability to pump blood is weakened.
8. Myocarditis: Inflammation of the heart muscle, most often
due to a viral infection.
9. Pericarditis: Inflammation of the lining of the heart
(pericardium). Viral infections, kidney failure, and
autoimmune conditions are common causes.
10.Pericardial effusion: Fluid between the lining of the heart
(pericardium) and the heart itself. Often, this is due to
pericarditis.
11.Atrial fibrillation: Abnormal electrical impulses in the atria
cause an irregular heartbeat. Atrial fibrillation is one of the
most common arrhythmias.
12.Pulmonary embolism: Typically a blood clot travels
through the heart to the lungs.
13.Heart valve disease: There are four heart valves, and each
can develop problems. If severe, valve disease can cause
congestive heart failure.
14.Heart murmur: An abnormal sound heard when listening
to the heart with a stethoscope. Some heart murmurs are
benign; others suggest heart disease.
15.Endocarditis: Inflammation of the inner lining or heart
valves of the heart. Usually, endocarditis is due to a serious
infection of the heart valves.
16.Mitral valve prolapse: The mitral valve is forced backward
slightly after blood has passed through the valve.
17.Sudden cardiac death: Death caused by a sudden loss of
heart function (cardiac arrest).
18.Cardiac arrest: Sudden loss of heart function.
15.Septal Defect: hole in the septum between left and
right sides of the heart allowing blood to flow from
one side to the other greatly reducing the heart’s
pumping effectiveness
16.Patent Ductus Arteriosus: ductus arteriosus fails to
close after birth allowing blood to flow from the
aorta to the pulmonary trunk under a higher
pressure, which damages the lungs; also, the left
ventricle must work harder to maintain adequate
systemic pressure
THE BLOOD VESSELS
• There are 100,000 miles of blood vessels.
• That’s enough to circle the world 4 times!
• 1/5 of the blood is in the lungs.
• The brain receives 1.5 pints of blood every
minute.
• With the exception of cartilage (which is
avascular), no cell is more than a few cell
diameters away from a blood vessel, so they
can get oxygen, nutrients, remove waste. 79
• Arteries are the vessels that leave the heart. They
get smaller and thinner and are then called arterioles.
• Arterioles get smaller and thinner until their lumen
is just one red blood cell in diameter. At this point,
they are called capillaries, and this is where the
oxygen exchange takes place.
• Capillaries take waste products away from the cells
in the capillary bed and head back to the heart; they
get larger and are now called venules.
• The venules get bigger and bigger, until they are
large enough to be called veins, and they return to
the heart. 80
• From the heart the blood is pumped to the lungs to get
more oxygen.
• They leave the heart, so they are arteries, but they are blue.
On their way to the lungs, they get smaller again until they
are arterioles, then capillaries, then they get the oxygen
from the lungs and drop off the waste products (carbon
dioxide).
• Then they return to the heart, so they are now called
venules, although they are red.
• Then they get larger until they are called veins, and the
blood returns to the heart to get pumped out to the body
again.
• All blood vessels (except the smallest) look similar.
81
Please refer to figure 13.6 page 353 on your
books for the illustration of Major Arteries

Please refer to figure 13.14 page 360 on your

books for the illustration of Major Veins
Structure of Arteries,
Veins, and Capillaries
Structure of Blood Vessels
Tunica intima
• ENDOTHELIUM: simple squamous epithelium.
Allows for smooth flow of blood. We need for this
layer to be smooth so platelets don’t catch on it and
start a blood clot. The endothelium is similar to
endocardium.
• SUBENDOTHELIUM: loose connective tissue.
84
Tunica media
• SMOOTH MUSCLE: allows vasoconstriction.
Allows blood to be directed to parts of body.
• ELASTIC FIBERS: within smooth muscles.
Allows for a vessel to return to normal size
after it was forced open (vasodilation) during
heart contraction.

85
 TUNICA ADVENTITIA (TUNICA EXTERNA):
dense fibrous connective tissue which thins out to
loose connective tissue.
• Protects the blood vessel (strong)
• Gives vessel strength for shape
• Anchors vessel to surrounding tissue; loosens with
age.
Lumen – central blood-filled space of a vessel
86
Tunica intima
Endothelium
Subendothelium
Tunica media
Smooth muscles
Elastic fibers
Tunica adventitia
Vasa vasorum

87
 Arteries
 Arteries carry blood away from the heart.

 Pulmonary arteries transport blood that has a low oxygen content from the right
ventricle to the lungs.

 Systemic arteries transport oxygenated blood from the left ventricle to the body
tissues.

Blood is pumped from the ventricles into large elastic arteries that branch repeatedly
into smaller and smaller arteries until the branching results in microscopic arteries
called arterioles.

 The arterioles play a key role in regulating blood flow into the tissue capillaries.
About 10 percent of the total blood volume is in the systemic arterial system at
any given time.
 Types of Arteries
Elastic arteries – the largest arteries
– Diameters range from 1 - 2.5 cm
– Includes the aorta and its major branches
– High elastin content dampens surge of blood
pressure
– Largest, closest to heart.
– Has to take the full force of the systolic contraction; compensates by
expanding a lot.
– There of lots of elastic fibers in the tunica intima as well.
– Does blood flow during diastole? Yes; elastic arteries return to original
size, pumps blood.
– This is another pump besides the heart.
90
 91
Figure 19.2a
 Muscular Arteries
Muscular (distributing) arteries
– Distal to elastic arteries
– From 0.3 mm- 1 cm
– Includes most of the named arteries
– Tunica media is thick
– Function is to distribute blood, and help control which regions of the body get
blood.
– When you are exercising, you want the blood from the GI system to go to
muscles.
– When your hands are cold, your body is using its blood for something more
important. Therefore, the vessels will constrict in the hands.
– Dilation is just lack of constriction.
92
93
 Capillaries
• Capillaries, the smallest and most numerous of the blood
vessels, form the connection between the vessels that carry blood
away from the heart (arteries) and the vessels that return blood to
the heart (veins).
• The primary function of capillaries is the exchange of materials
between the blood and tissue cells.
• Capillary distribution varies with the metabolic activity of body
tissues. Tissues such as skeletal muscle, liver, and kidney have
extensive capillary networks because they are metabolically active
and require an abundant supply of oxygen and nutrients.
 Capillaries
• Other tissues, such as connective tissue, have a less abundant
supply of capillaries.

• The epidermis of the skin and the lens and cornea of the eye
completely lack a capillary network. About 5 percent of the total blood
volume is in the systemic capillaries at any given time. Another 10
percent is in the lungs.

• Smooth muscle cells in the arterioles where they branch to form

capillaries regulate blood flow from the arterioles into the capillaries.
What do capillaries do?
• In the small intestines – receive digested nutrients
• In endocrine glands – pick up hormones
• In the kidneys – removal of nitrogenous wastes

CAPILLIARY PERMEABILITY: Intercellular clefts – gaps of unjoined membrane where

small molecules can enter and exit

Three types of capillaries

1. Continuous – most common
2. Fenestrated (“window”) – have pores
3. Discontinuous (Sinusoids) – have very large gaps

97
 Continuous Capillary
 All capillaries are made of simple
squamous epithelium.
 Continuous capillaries are most
common, found throughout the body.
 They have intracellular clefts, the
function of which is essential for plasma
to leak out and bathe each cell with
extracellular fluid, which is rich in
oxygen and nutrients.
 Erythrocytes and platelets don’t fit
through, but leukocytes can squeeze
through so they can enter and leave the
blood vessels as needed.

98
Figure 19.4a
 Fenestrated Capillary

 These have a lot more leakage

because there are more pores
(holes).
 Found in areas where lots of
fluids need to be moved back
and forth (synovial membranes,
small intestine, CSF).

99
Figure 19.4b
 DISCONTINUOUS CAPILLARIES
(sinusoidal capillaries) Sinusoids
 These have very large gaps in the
capillary.
 Anything can go in and out here,
including erythrocytes.
 These are found in red bone
marrow, where RBCs are made, and
they need to enter the circulation
by way of the sinusoidal capillaries.
 These capillaries are also in the liver
and spleen, where red blood cells
are destroyed.

100
Figure 19.4c
 Capillary Beds
 A small muscle in front of each capillary,
controls the flow of blood to individual
capillaries.
 ARTERIOLES direct the blood flow to the
specific tissue.
 PRE-CAPILLARY SPHINCTERS direct the
blood flow to specific cells.
 If one cell is starving, the capillary next to it
will open. The sphincter opens and closes
depending on the needs of individual cells.
 There is not enough blood to go around, so
blood always flows only to those cells and
tissues that need it.
 They drop off nutrients, pick up CO2 and
other wastes.
101
Figure 19.3b
 Veins
Veins carry blood toward the heart. After blood passes through the
capillaries, it enters the smallest veins, called venules.

From the venules, it flows into progressively larger and larger veins until
it reaches the heart.

In the pulmonary circuit, the pulmonary veins transport blood from
the lungs to the left atrium of the heart. This blood has a high oxygen
content because it has just been oxygenated in the lungs.

Systemic veins transport blood from the body tissue to the right atrium
of the heart. This blood has a reduced oxygen content because the
oxygen has been used for metabolic activities in the tissue cells.
 Veins
The walls of veins have the same three layers as the arteries.
Although all the layers are present, there is less smooth muscle
and connective tissue.

This makes the walls of veins thinner than those of arteries, which
is related to the fact that blood in the veins has less pressure
than in the arteries.

Because the walls of the veins are thinner and less rigid than
arteries, veins can hold more blood.
 Veins
Almost 70 percent of the total blood volume is in the veins at any
given time. Medium and large veins have venous valves, similar to
the semilunar valves associated with the heart, that help keep the
blood flowing toward the heart.

Venous valves are especially important in the arms and legs,

where they prevent the backflow of blood in response to the pull of
gravity.
 Clinically Significant Veins
• Greater Saphenous vein: used for coronary bypass; most likely
becomes varicose. Because there are two veins that travel with each
artery, we can do without one of the veins.

• Facial vein: “Danger triangle” infection spreads to meninges in brain.

• Renal vein: oxygen poor, and contains the lowest concentration of

nitrogen waste.

106
• A sac-like out-pouching of an artery
– Can rupture at any time; in aorta
or brain can cause death within a
Aneurysm
few seconds.
– Symptoms: Swelling or throbbing
(asymptomatic in brain)

locations for aneurysms include:

– Aorta
– Brain
– Leg
– Intestine (mesenteric artery
aneurysm)
– Splenic artery aneurysm (can form
during pregnancy)
107
Causes of an aneurysm: Aneurysm
1. Defect in part of the artery wall
2. High blood pressure (abdominal
aortic aneurysms)
3. Congenital (present at birth)

• Usually not detected except by

an angiogram or ultrasound.

• Treatment: surgical repair

108
MRI for Blood Vessels

109
Stroke

110
Aneurysm

111
 How to Recognize a Stroke (“STROKE”)
S * Ask the individual to SMILE.

T * Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently; i.e.
It is sunny out today)

R * Ask him or her to RAISE BOTH ARMS.

O * Open the mouth and stick out the tongue

K * Keep them comfortable and still

E * Get EMERGENCY help. 112

 Fun facts
• You don’t have enough blood to go
around; you only have 5 liters for
100,000 miles of blood vessels.

• At any given time, most blood

vessels will be closed (except at
lungs).

• When your legs run low on

oxygen, the vessels there will
open up again. When your leg falls
asleep, there is pressure on an
artery which stops the blood flow.
When the nerves are deprived of
oxygen, they tingle. 113
 Clinically significant arteries
• Femoral artery: easy to find pulse at the
groin, but since it is so superficial, it is also
susceptible to injury.
• Circle of Willis: loop of arteries around
pituitary and optic chiasma. Common area
for stroke to cause blindness.

114
116
Circle of Willis

117
 Varicose Veins
The valves become incompetent:
• They can’t close all the way because
too much fluid has built up in them and
the lumen has stretched too wide.
• The blood takes longer to return to
the heart, and it accumulates, usually
in the legs.
• The waste products build up, including
CO2, which is an acid.
• They might be asymptomatic or they
may be painful (phlebitis). 118
 Telangiectasias
(Spider veins)
Small dilated blood vessels (varicose
veins) near the surface of the skin or
mucous membranes that blanch (turn
colorless) with direct pressure.
They can develop anywhere on the
body but are commonly seen on the
face around the nose, cheeks, and
chin. They can also develop on the
legs, specifically on the upper thigh,
below the knee joint, and around the
ankles.

119
 Edema
• If the veins are varicose for a long time, plasma may leak out into
the tissues, causing edema.
• Edema means swelling anywhere in the body (including from an
injury or from hanging your legs down too long like when on an
airplane), but it frequently occurs from incompetent veins in the
legs.
There are two types of edema:
1. Pitting Edema
2. Non-pitting edema is hardened tissue that does not leave your
fingerprint. It is just as bad in the morning as it is at the end of the
day. This is more severe because it does not go away easily.

120
Pitting edema is when you can
push your finger into the skin and it
leaves behind your print when you
remove it.

This type is less serious; it tends to

be better in the morning since the
legs have been horizontal all night.

• It will improve if a pressure bandage

(Ace wrap or support hose) is
applied.
121
 Venous Stasis Ulcers
Might occur after the formation of
varicose veins, when plasma has
leaked out into the tissues, causing
edema.
• Acid products from the blood
plasma (carbon dioxide, etc) can
eventually erode all the way to the
skin.
• Common in diabetics.
• Treatment must address sugar
levels, vein problem, and the open
wound.

122
 PHLEBITIS
• Inflammation of a vein
• Usually in the legs.
• When phlebitis is associated with the formation of blood clots
(thrombosis), usually in the deep veins of the legs, the
condition is called Deep Vein Thrombophlebitis (DVT).
• We worry about these because a piece can break off, travel to
the lungs, and kill the patient. It is a medical emergency.

123
 DEEP VEIN THROMBOPHLEBITIS
Signs and Symptoms
• Redness (erythema) and
warmth with a temperature
elevation of a degree or more
above the baseline
• Pain or burning along the
length of the vein
• Swelling (edema)
• Vein being hard, and cordlike
• Need ER if all symptoms are
present
124
Severe DVT

125
 Tissue Necrosis (gangrene)
• Necrosis = dead
• Caused by infection, toxins, or trauma
• Almost always detrimental and can be fatal

126
 Gangrene
Gangrene is a serious and potentially life-threatening condition that arises
when a considerable mass of body tissue dies (necrosis).
This may occur after an injury or infection, or in people suffering from any
chronic health problem affecting blood circulation.
The primary cause of gangrene is reduced blood supply to the affected
tissues, which results in cell death.
Diabetes and long-term smoking increase the risk of suffering from
gangrene

127
 Types of Gangrene
• Dry gangrene begins at the distal part of
Dry gangrene the limb due to ischemia, and often
occurs in the toes and feet of elderly
Wet gangrene patients due to arteriosclerosis.
Gas gangrene
Necrotising fasciitis: • Dry gangrene is mainly due to arterial
occlusion. There is limited putrefaction
flesh-eating bacteria and bacteria fail to survive.

• Dry gangrene spreads slowly until it

reaches the point where the blood supply
is adequate to keep tissue viable.
128
 Dry Gangrene
• The affected part is dry, shrunken
and dark reddish-black, resembling
mummified flesh.
• The dark coloration is due to
liberation of hemoglobin from
hemolyzed red blood cells, which is
acted upon by hydrogen sulfide (H2S)
produced by the bacteria, resulting in
formation of black iron sulfide that
remains in the tissues.
• There is a line of separation where
the blood supply becomes adequate,
and the gangrenous tissue falls off by
itself if it is not removed surgically,
also called autoamputation.
129
 Wet Gangrene
Wet gangrene occurs in naturally moist
tissue and organs such as the mouth,
bowel, lungs, cervix, and vulva.
• Bedsores occurring on body parts such
as the sacrum, buttocks, and heels are
also categorized as wet gangrene
infections.
• It is characterized by numerous bacteria
and has a poor prognosis (compared to
dry gangrene) due to septicemia
(bacterial infection of the bloodstream).

130
 Wet Gangrene
• In wet gangrene, the tissue is infected by • The affected part is edematous, soft,
saprogenic microorganisms (those that eat putrid, rotten and dark.
dead organic matter) such as Clostridium • The darkness in wet gangrene occurs
perfringens or Bacillus fusiformis, which due to the same mechanism as in dry
cause tissue to swell and emit a fetid
smell. gangrene.
• Wet gangrene is coagulative necrosis
• Wet gangrene usually develops rapidly due
to blockage of venous (mainly) and/or progressing to liquefactive necrosis
arterial blood flow. (transformation of dead tissue into a
• The affected part is saturated with liquid).
stagnant blood, which promotes the rapid
growth of bacteria.
• The toxic products formed by bacteria are
absorbed, causing systemic manifestation
of septicemia and finally death.
131
 Gas Gangrene
• This is a bacterial infection that
produces gas within tissues.
• It is a deadly form of gangrene usually
caused by Clostridium
perfringens bacteria.
• Infection spreads rapidly as the gases
produced by bacteria expand and
infiltrate healthy tissue in the vicinity.
• Because of its ability to quickly spread
to surrounding tissues, gas gangrene
should be treated as a medical
emergency. 132
 Necrotizing Fasciitis
(flesh-eating disease)
This is a rare infection of the deeper layers of skin and subcutaneous
tissues, easily spreading across the fascial plane within the subcutaneous
tissue.

133
 Gangrene Treatment
• Debridement (laser or mechanical)
• Maggot therapy
• Amputation
• Antibiotics
• Vascular surgery
• Hyperbaric oxygen therapy

134
 Migraines
• Migraines are severe headaches that cause vomiting and
photosensitivity (the person cannot tolerate any light).
• They can be caused by several things, including muscle
spasms in the blood vessels.
• Caffeine can cause them, and so can caffeine withdrawal.
• Treatments may include medicines, botox injections, and
magnesium infusions.

135
 Buerger's disease
• This is a non-atherosclerotic vascular disease also known
as thromboangiitis obliterans (TAO), and is strongly
associated with heavy tobacco use, usually in men over
40.

136
 Systemic Lupus Erythematosus
• SLE is an autoimmune disease that can affect any part of the body.
• SLE most often harms the heart, joints, skin, lungs, blood vessels, liver,
kidneys, and nervous system.
• The course of the disease is unpredictable, with periods of illness (called
flares) alternating with remissions.
• The disease occurs nine times more often in women than in men,
especially in women in child-bearing years ages 15 to 35, and is also
more common in those of non-European descent.
• Typical skin manifestations are a butterfly rash on the face
and photosensitivity.
137
SLE Butterfly Rash

138
 SELF LEARNING ACTIVITY #1 BLOOD
1. What are the functions of your blood? List and briefly
explain them all.
2. What is plasma? List all its components.
3. What is the function of plasma?
4. What is hematopoiesis?
5. What are stem cells?
6. What are red blood cells? What do they do?
7. Name the different types of formed elements.
8. How and where do formed elements arise from?
9. Describe the 2 basic parts of a hemoglobin molecule.
10. Which part of the hemoglobin is associated with iron?
11. Why are the vitamins folate and B12 important in red
blood cell production?
12. How is red blood cell production influenced or affected
by our blood oxygen level?
13. What happens to the broken down products of red
blood cells?
14. What are the functions of your white blood cells?
15. What are the 5 types of white blood cells and
state the function of each.
16. What are platelets?
17. How are platelets formed?
18. Explain how bleeding is prevented? (discuss the
role of blood vessel constriction and platelet plug
formation).
19. What are clotting factors?
20. What are anticoagulants?
21. What is clot retraction?
22. What is fibrinolysis and name the
chemicals responsible for this process.
23. Why is a person with blood type “O”
considered a universal donor?
24. What is meant by the term: Rh positive?
How can Rh incompatibility affect pregnancy.
 Deadline
for the Self Learning on
“Blood”
is on
October 27, 2021
11:00 pm
 SELF-LEARNING ACTIVITY
“THE HEART”
1. Describe the location of the heart including its base
and apex.
2. What is the function of your pericardium?
3. What chambers make up the left and right sides of the
heart? What are their functions?
4. What is the function of your tricuspid, bicuspid and
semilunar valves?
5. What are the functions of your atria and ventricles?
6. Draw the correct flow of blood starting from your right
atrium. You can draw using arrows or shapes as long as the
blood flow and direction is clear and comprehensive. You
can use one page of your activity notebook for this.
7. What is a heart attack?
8. What is atherosclerosis?
9. Describe the 3 layers of the heart? Which among them
help in making your heart contract?
10. What is an action potential?
11. What is the function of the conduction system of the
heart?
12. As seen in movies, why do patients who are dying or
having a cardiac arrest treated by electric shocks coming
from a defibrillator?
13. How does an electrocardiogram work?
14. What is a systole and diastole?
15. How do heart valves work? When do they open and
close?
16. How is your first and second heart sound produced?
17. What is a murmur?
18. What does the term stenosis mean?
19. Define cardiac output, stroke volume and heart
rate.
20. What is the normal heart rate for infants and
adults?
21. How does the nervous system respond to low
blood pressure and high blood pressure?
22. What is the effect of epinephrine on the heart
rate and stroke volume?
23. How does emotion affect heart functions?
24. What happens to your cardiac output when
there is decrease in blood pH (acidity and
alkalinity)?
25. What happens to your cardiac output when
there is an increase in blood carbon dioxide?
26. How does temperature affect your heart rate?
27. List at least 3 common age-related heart
problems as people get older/as people age.
 Deadline
for the Self Learning on
“The Heart”
is on
October 30, 2021
11:00 pm