Heart

and Blood Vessels

Grace Mendoza-Bardelosa, MD, FPDS

Department of Human Structural Biology

 Intended Learning Outcomes
•  DifferenCate the walls of the heart and blood
vessels.
•  DifferenCate the types of cardiac muscles.
•  Discuss the supporCng Cssues of the heart.
•  Describe the types of blood vessels.
•  Discuss common clinical condiCons that affect
the heart and blood vessels.
 Circulatory System
•  Pumps and directs blood to all Cssues
•  Blood and lymphaCc vascular system
•  Cardiovascular or Blood vascular system
–  Heart
–  Arteries
–  Capillaries
–  Veins
HEART
 Walls of the Heart
•  Endocardium
•  Myocardium
•  Epicardium
Heart
 Endocardium
•  Thin layer of endothelium + supporCng
connecCve Cssue (CT)
•  Middle myoelasCc layer of smooth muscles
(SM) and CT
•  Subendocardium, a deep layer of CT
–  Modified cardiac muscles
–  Impulse-conducCng system of the heart
Endocardium
 Endothelium
•  Single layer of squamous epithelium
•  Lines all internal components of blood and
lymphaCc systems
•  SelecCvely permeable
•  AnCthrombogenic barrier
•  Determines diapedesis
•  Secretes paracrine factors for vessel dilaCon,
constricCon, growth of adjacent cells
Endothelium
 Purkinje fiber
•  Modified cardiac muscle cells located in the
AV bundle and its branches
–  Reduced number of myofibrils
–  More sarcoplasm and abundant glycogen
–  More rounded nucleus in groups of 2 or more
–  Larger diameter
–  Lack transverse tubules of cardiac muscles
Purkinje fibers
 Myocardium
•  Thickest layer
•  Spirally arranged cardiac muscles
•  Thicker in walls of ventricles
•  Strands of connecCve Cssues and vascular
network in between cells.
 Myocardium
•  Cardiac muscle cells
•  Striated
•  Involuntary
•  Cylindrical with branching
•  Mononucleated or binucleated
•  Centrally-located nucleus
•  Intercalated discs
Cardiac Muscle
 Epicardium
•  Visceral layer of the pericardium
•  Lined by a single layer of squamous
mesothelial cells
•  Subepicardium: thin layer of CT
•  During heart movements
–  Adipose Cssues
–  Lubricant fluid
 Epicardium
•  Pericardial cavity
–  Space between epicardium and parietal
pericardium
–  Serous fluid: secreted by mesothelial cells
–  Layers glide freely
Epicardium
 Cardiac Skeleton
•  Septum membranaceum
•  Trigona fibrosa
•  Annuli fibrosi
 Cardiac Skeleton
•  Dense irregular CT in endocardium
•  FuncCons
–  Anchor and support heart valves
–  Provide firm points of inserCon for cardiac muscle
–  Help coordinate heartbeat by acCng as electrical
insulaCon between atria and ventricles
 Septum Membranaceum
•  Upper fibrous part of the interventricular
septum
•  A[achment for free ends of fibers of cardiac
muscles
Septum Membranaceum
 Trigona fibrosa
•  Between arterial foramina & AV canals
•  Provides support
•  Maintains the integrity of all four orifices
•  Without these rings of support the orifices
would stretch and the valves would be unable
to funcCon properly
Trigona Fibrosa
 Annuli Fibrosi
•  Fibrous ring
•  Principal a[achment of muscular fibers
of atria, ventricles, and AV valves
•  Main porCon of the cardiac skeleton
•  Dense CT that surround the openings of
the four orifices
•  AorCc ring is the strongest
Annuli Fibrosi
BLOOD VESSELS
 Tissues of the Vascular Wall
•  Endothelium
•  Smooth muscles
•  ConnecCve Cssue
 Walls of Blood Vessels
•  Tunica in;ma
–  Endothelium, LCT
–  Internal elasCc lamina (IEL)
•  Tunica media
–  Concentric layers of helically arranged SM cells
–  ElasCc fibers, external elasCc lamina (EEL)
•  Tunica adven;;a
–  Tunica externa
–  Collagen type I & elasCc fibers
 Vasa vasorum
•  Vessel of the vessel
•  Arterioles, capillaries, venules
•  In advenCCa and outer part of media
•  Large veins have more vasa than arteries
Vasa vasorum
Vasa vasorum
 Nervi vasorum
•  Nerve supply of blood vessels
•  Unmyelinated autonomic nerve fibers
Nervi vasorum
 ElasCc Arteries
•  Aorta, pulmonary artery, & their largest
branches
•  Conduc;ng arteries
–  Carry blood to smaller arteries
•  InCma: well developed, smooth muscles (SM)
cells in subendothelial CT
–  IEL is not prominent
•  Media: thick; alternate elasCc lamillae + SM
fibers
ElasCc artery
 Muscular arteries
•  Distribu;ng arteries
•  Help regulate BP by contracCng and relaxing
SM in the media
•  InCma
–  Thin subendothelium; prominent IEL
•  Media
–  40 layers of SM cells & elasCc lamellae (large only)
•  AdvenCCa
–  CT, LV, VV, NV, may reach media
Muscular artery
Muscular artery
 Arterioles
•  Indicate the beginning of an organ’s
microvasculature
•  IEL absent
•  AdvenCCa is thin and inconspicuous
•  Resistance vessels
•  Major determinants of systemic blood
pressure
Arterioles
Microvasculature
 Capillaries
•  Branch extensively
•  Single layer of endothelial cells on a
basement membrane rolled in a tube
•  Pericytes
–  Perivascular contracCle cells
–  Facilitate blood flow
–  Give rise to SM and CT during microvascular repair
•  Average diameter: 4 to 10 μm
•  Individual length: not > 50 μm
 Capillaries
•  Most capillaries are essenCally empty at any
given Cme
•  Thin walls
•  Extensive surface area
•  Slow, pulsaCle blood flow
Capillary with Pericytes
 ConCnuous capillaries
•  Tight, well-developed occluding juncCons
•  Between slightly overlapping endothelial cells
•  Muscle
•  ConnecCve Cssue
•  Lungs
•  Exocrine glands
•  Nervous Cssue
ConCnuous capillary
ConCnuous capillary
 Fenestrated capillaries
•  Sieve-like structure
•  Allows more extensive molecular exchange
across the endothelium
•  Endothelial cells penetrated by fenestraCons
•  Some are covered with diaphragm of
proteoglycans
•  Basal lamina is conCnuous and covers
fenestraCons
 Fenestrated capillaries
•  Fenestrated with diaphragm
–  Endothelium: pores of 80-100 um closed by very
thin porous diaphragm
–  Ex: Pancreas, GIT, choroid plexus, ciliary body
•  Fenestrated without diaphragm
–  Pores are not closed
–  Ex: Renal glomeruli
Fenestrated capillary
Fenestrated capillary
 DisconCnuous capillaries
• Endothelium: lined of relaCvely large caliber
and irregular cross-secConal outline
• Greatly enlarged diameter
• DisconCnuous lining in walls
• With phagocyCc cells
• DisconCnuous basal lamina
• Found in the liver, spleen, bone marrow,
some endocrine glands
Sinusoidal capillary
Sinusoidal capillary
 Venules
•  Postcapillary, collecCng, muscular
–  Tunica inCma
•  Single layer of fla[ened endothelial cells
–  Tunica media
•  Very indisCnct
•  Incomplete layer of smooth muscle
–  Tunica advenCCa
•  None
Venules
 Small veins
•  Tunica inCma
–  Endothelial cells
–  Thin subendothelium; absent at Cmes
•  Tunica media
–  Small bundles of SM
•  Tunica advenCCa
–  Thick layer of LCT
Small vein
 Medium veins
•  Tunica inCma
–  Thin layer
–  Fla[ened endothelium and subendothelium
•  Tunica media
–  Circularly arranged smooth muscles
–  C & E
•  Tunica advenCCa
–  Well-developed
–  Forms the bulk
–  C & E

Medium vein
Medium vein
 Large veins
•  Tunica inCma
–  Endothelium: polygonal cells
–  Subendothelium: C & E
–  IEM: ?
•  Tunica media
–  Poorly-developed
–  Thin smooth muscles, few elasCc fibers
•  Tunica advenCCa
–  Greater part
–  Bundled longitudinal SM
–  LCT, C & E
Large vein
 Differential points Artery Vein

Lumen Smaller Bigger

Thickness of wall Thicker Thinner

Thickest coat Tunica media Tunica adventitia

Rigidity of wall More rigid Less rigid

Internal Elastic Membrane Present Absent

Muscle and Elastic tissue More abundant Prominent only in large

veins
Valves Absent Present in veins of
medium-sized caliber
Tunica intima Appears scalloped after Never scalloped after
death death
Vasa vasorum Extends up to tunica Extends up to tunica intima
media
CLINICAL CORRELATES
 Atherosclerosis
•  Aka arterioscleroCc vascular disease (ASVD)
•  An artery wall thickens
•  Invasion and accumulaCon of WBC’s,
cholesterol and triglycerides, other crystallized
materials
•  Plaque-formaCon
•  Hardening of an artery specifically due to an
atheromatous plaque
 Hemangioma
•  Benign and usually self-involuCng tumor of
blood vessels
•  Endothelium
•  Increased number of normal and abnormal
vessels filled with blood
•  1st weeks of life, grows rapidly over first 6
months
 Cardiomyopathy
•  Literally “heart muscle disease”
•  Measurable deterioraCon of funcCon of the
myocardium for any reason
•  Leads to heart failure
•  Dyspnea, peripheral edema, irregular heart
beat, sudden cardiac death
 Hyperplasia
•  Increase in the number of cells
•  May result in gross enlargement of an organ
 Hypertrophy
•  Increase in the volume of an organ or Cssue
•  Enlargement of its component cells
THANK YOU