ventricle
pumps it into the pulmonary circula-tion where oxygen and carbon dioxide are ex-changed between the blood and alveolar gases.The left side of the heart comprises the leftatrium and the left ventricle. The blood leavingthe lungs enters the
left atrium
by way of thepulmonary veins. Blood then flows from theleft atrium into the left ventricle. The
left ven-tricle
ejects the blood into the
aorta,
whichthen distributes the blood to all the organs viathe arterial system. Within the organs, the vas-culature branches into smaller and smaller ves-sels, eventually forming capillaries, which arethe primary site of exchange. Blood flow fromthe capillaries enters veins, which return bloodflow to the right atrium via large systemic veins(the superior and inferior vena cava).As blood flows through organs, some of thefluid, along with electrolytes and smallamounts of protein, leaves the circulation andenters the tissue interstitium (a processtermed fluid filtration). The
lymphatic ves-sels,
which are closely associated with smallblood vessels within the tissue, collect the ex-cess fluid that filters from the vasculature andtransport it back into the venous circulation by way of lymphatic ducts that empty into large veins (subclavian veins) above the right atrium.It is important to note the overall arrange-ment of the cardiovascular system. First, theright and left sides of the heart, which are sep-arated by the pulmonary and systemic circula-tions, are
in series
with each other (see Fig.1-1). Therefore, all of the blood that is pumpedfrom the right ventricle enters into the pul-monary circulation and then into the left side of the heart from where it is pumped into the sys-temic circulation before returning to the heart.This in-series relationship of the two sides of the heart and the pulmonary and systemic cir-culations requires that the output (volume of blood ejected per unit time) of each side of theheart closely matches the output of the other sothat there are no major blood volume shifts be-tween the pulmonary and systemic circulations.Second, most of the major organ systems of thebody receive their blood from the aorta, andthe blood leaving these organs enters into the venous system (superior and inferior vena cava)that returns the blood to the heart. Therefore,the circulations of most major organ systemsare
in parallel
as shown in Figure 1-2. Onemajor exception is the liver, which receives alarge fraction of its blood supply from the ve-nous circulation of the intestinal tract thatdrains into the hepatic portal system to supply the liver. The liver also receives blood from theaorta via the hepatic artery. Therefore, most of the liver circulation is in series with the intesti-nal circulation, while some of the liver circula-tion is in parallel with the intestinal circulation.This parallel arrangement has significanthemodynamic implications as described inChapter 5. Briefly,
the parallel arrangement of
INTRODUCTION TO THE CARDIOVASCULAR SYSTEM
3
RALARVLVAoPAPulmonaryCirculationSystemic Circulation
FIGURE 1-1
Overview of the cardiovascular system. The right side of the heart, pulmonary circulation, left side of theheart, and systemic circulation are arranged in series.
RA,
right atrium;
RV,
right ventricle;
PA,
pulmonary artery;
Ao,
aorta;
LA,
left atrium;
LV,
left ventricle.