Kristina C. Erasmo, M.D.

Transport – oxygen, carbon dioxide, nutrients, hormones, waste products Immune defense

Cardiovascular system o Heart o Two systems of blood vessels: o Systemic circulation o Pulmonary circulation Lymph vascular system

Muscular pump that propels blood to the arteries of both systemic and pulmonary circulation Systemic circulation – brings blood from the heart to the rest of the body then back to the heart Pulmonary circulation – brings blood from the heart to the lungs and then back to the heart

Located in the central mediastinum of the thoracic cavity Four chambers: o Left ventricle – systemic circulation o Right ventricle – pulmonary o Left atrium o Right atrium

Connective tissue sac covering the heart o Outer sac (fibrous pericardium) o Inner sac (serous pericardium) o Parietal pericardium o Visceral pericardium o Pericardial cavity – with fluid

Fibrous and parietal pericardia – dense CT (collagen and elastic fibers, fibroblasts, other CT elements) Inner aspect of parietal pericardium – simple squamous epithelium (mesothelium) Visceral pericardium a.k.a. epicardium

Epicardium Myocardium Endocardium

a.k.a. visceral pericardium Outermost layer of heart wall Lining epithelium of external surface: mesothelium

Thickest (thickness varies for different parts) Thickest: left ventricle Thinnest: atria Mainly cardiac muscle fibers

Modified cardiac muscle cells Initiate and conduct the electrical impulse that controls the contraction of the heart Form the impulse-conducting system of the heart Larger, contain more glycogen than ordinary cardiac muscle cells

Atrial natriuretic peptide (ANP) – polypeptide hormone secreted by cardiac muscle cells in atria and interventricular septum o Causes natriuresis – excretion of sodium by the kidneys

Thinnest Lining epithelium: endothelium Continuous with innermost layer of the great blood vessels Lines all internal surfaces of heart

Subendothelial layer – loose CT External to subendothelial layer – dense CT, thickest portion of endocardium

Refers to the system of blood vessels within which blood circulates 3 types of blood vessels: o Arteries o Veins o Capillaries

Arteries – carry blood from the heart to the capillaries Veins – carry blood from the capillaries to the heart

Lining of the luminal surface of all blood vessels Functions: o Lining blood vessels to facilitate blood flow o Secretes components of underlying CT

Functions: o Secrete prostacyclin – inhibits platelet aggregation, promotes vasodilation o Nitric oxide and endothelin I – vasodilator o Von Willebrand factor – blood coagulation

Network of small blood vessels that supply large blood vessels Veins: present in the tunica adventitia and media Arteries: confined to adventitia

Smallest blood vessels (5-10 um) Connect arterioles and venules Function: Allow exchange of gases and materials between blood and surrounding tissue

Wall consists of single layer of endothelial cells and its associated basal lamina Surrounding connective tissue elements

Slender, elongated, perivascular cells that usually accompany capillaries Look like fibroblasts Not part of the endothelium Contain tropomyosin Function: contractile cells that influence the luminal size of capillaries

Continuous (Type I) Fenestrated (Type II) Sinusoids

Found in muscles, lungs, CNS, skin The endothelial cell and the basal lamina do not form openings (which would allow substances to pass the capillary wall without passing through both the endothelial cell and the basal lamina)

Mucous membranes of GIT, renal glomerulus, pancreas, some endocrine glands Endothelial cell body forms small openings (fenestrations) which allow components of the blood and interstitial fluid to bypass the endothelial cells

a.k.a. discontinuous capillaries or sinusoidal capillaries Formed by fenestrated endothelial cells, (which may not even form a complete layer of cells) Basal lamina is also incomplete Found in liver, spleen, red bone marrow (free exchange of substances or even cells between bloodstream and organ is advantageous)

Tunica adventitia Tunica media Tunica intima

Outermost coat of arteries and veins Chiefly made up of connective tissue with cells and fibers arranged longitudinally

Middle coat of arteries and veins Concentrically arranged smooth muscle fibers Interspersed between the muscle cells are connective tissue elements (collagen and elastic fibers)

In large arteries: o External elastic lamina/membrane – outer layer of elastin which demarcates the tunica media from the tunica adventitia

Innermost coat of arteries and veins Consists of a layer of endothelium that rest on a basal lamina Subendothelial layer of loose CT In arteries: o Internal elastic lamina/membrane – demarcates tunica intima from tunica media

Classification: o Small (arteriole) o Medium (muscular or distributing) o Large (elastic or conducting) Decrease in size but increase in number as they go farther from the heart

Smallest arteries (40 – 400 um) Tunica intima: only endothelium, no IEL or subendothelial CT Tunica media: no EEL Tunica adventitia: loose CT

Relatively thick walls and narrow lumens – offer considerable resistance to blood flow (thus able to deliver blood to the capillary beds under greatly reduced pressure)

Muscular arteries – well-developed tunica media Distributing arteries – distribute blood to the different parts of the body Biggest: brachial and femoral arteries

Tunica intima: 3 layers o Endothelium, subendothelium, and IEL Tunica media: Up to 40 layers of circularly arranged smooth muscle fibers, EEL present Tunica adventitia: loose CT, vasa vasorum

Elastic arteries – high elastic tissue content Conducting arteries – major conduits in the transport of blood away from the heart E.g. aorta Recoil is responsible for the flow of blood through the blood vessels during diastole

Tunica intima: o Polygonal endothelial cells, o Subendothelial layer – loose CT o Indistinct IEL

Tunica media: o layers of elastic laminae arranged concentrically o Indistinct EEL Tunica adventitia: o Thin, merges with surrounding CT o Contains vasa vasorum

Carotid bodies and aortic bodies o Sensitive to changes in oxygen and CO 2 tension of blood Carotid sinus o Sensitive to changes in arterial blood pressure

Classification: o Small (venules) o Medium o Large

Carries blood from the capillaries to the heart More numerous than arteries Bigger calibers, more irregular lumens, thinner and less elastic walls Increase in caliber and walls become thicker as they travel toward the heart

The 3 histologic layers of the vessel wall can only be appreciated in venules with a luminal diameter of at least 50 um Like capillaries, they are sites for exchanage of gases and substances

Tunica intima: o Polygonal endothelial cells o Subendothelial layer Tunica media: small bundles of circularly arranged smooth muscle cells Tunica adventitia: bulk of the wall

E.g. inferior and superior vena cava, portal vein Tunica intima: thicker Tunica media: poorly developed, few smooth muscle fibers

Tunica adventitia: very thick, consists of 3 poorly-defined zones o Internal zone – dense CT o Middle zone – longitudinally arranged muscle fibers o Outer zone – collagenous and elastic fibers

ArteriesVeins LumenPatent, RBC not seenLumen may be collapsed, RBC usually seen Endothelial liningWell-definedNot so well-defined Internal elastic lamina (IEL) DistinctPoorly defined Tunica mediaForms 2/3 of thickness of wall 1/3 External elastic lamina (EEL) DistinctPoorly defined Tunica adventitiaForms 1/3 of thickness2/3

Network of conduits that carry lymph Returns the extracellular liquid to the bloodstream (“drainage” system) Lymph circulates in one direction

Functions: o Return the fluid of the tissue spaces to the blood o Upon entering the lymphatic capillaries, this fluid contributes to the formation of the liquid part of the lymph

Functions: o By passing through the lymphoid organs, contributes to the circulation of lymphocytes and other immunological factors

Lymphatic capillaries – absent in cartilage, bone, thymus, teeth, placenta, CNS Lymphatic vessels Lymphatic ducts (2) – drain into the veins at the base of neck

Also lined by endothelium (thin due to incomplete basal lamina) Branch and anastomose more freely than blood capillaries More variable in shape and caliber Not associated with pericytes

Large lumen in relation to the thickness of their walls Endothelial lining + connective tissue layer (collagenous and elastic fibers, occasional smooth muscle) Large vessels: 3 layers (TI, TM, TA) Have valves

Right lymphatic duct Thoracic duct

Smaller, shorter Right side of body above the diaphragm Drains into the right brachiocephalic vein (junction of internal jugular and subclavian vein)

Collects lymph from the other parts of the body not served by the right lymphatic duct Drains at the junction of left jugular and subclavian veins