Cardiovascular System - Anatomy of the Great Vessels

Scope: This lecture examines the anatomy of the three vessel networks that carry blood from the heart to the body and back again,
from the heart to the lungs and back again, and through the portal hepatic circulation of the liver. We begin by identifying and
describing the structure of the various vessels that form these networks. Next, we examine separately the major circulatory routes for
the blood: arterial and venous systemic circulation, pulmonary circulation, and hepatic portal circulation.

I. The lecture will examine the network of vessels. Each vessel belongs to either the right or left side of the vascular system.
A. The left, or arterial, side pumps against the high resistance of the systemic arteries. It distributes oxygenated blood
and nutrients to the body.
B. The right, or venous, side is a lower-pressure system that carries deoxygenated blood back to the heart from the
lungs.
C. Pulmonary circulation
1. Pulmonary arteries carry deoxygenated blood from the heart to the lungs.
2. Pulmonary veins carry oxygenated blood from the lungs to the heart.

II. Overview and definitions

A. The systemic and pulmonary circulations are both closed-loop systems with the heart as the pump at the center.
1. Systemic circulation carries blood from the heart to arteries, then to capillaries, then to veins, then back to
the heart.
2. Pulmonary circulation carries blood from the heart to lung arteries, then to capillaries, then to veins, then
back to the heart.
B. Blood vessels are named for either the specific part of the body they supply or an area surrounding that specific part.
Vessels can change names as they run through different parts of the body.
1. The brachiocephalic (”arms and head”) trunk is the division of the aorta immediately after the aorta leaves
the heart.
2. The brachiocephalic trunk splits into the carotid artery, which supplies the head, and the subclavian (”under
the collarbone”) artery.
3. The subclavian artery becomes the axillary (”armpit”) artery, then the brachial (”arm”) artery as it moves
outward along the arm. It splits into the radial and ulnar arteries, which run along the radius and ulna bones.

C. On the arterial side, vessels decrease in size in the following sequence: large arteries, medium arteries, small
arteries, arterioles, and finally, arterial capillaries (microscopic).
D. Venous vessels increase in size as blood returns from venous capillaries to venules, then to small veins, then to
medium veins, and finally, to large veins.
E. Veins and arteries generally share the same name; for example, a brachial artery will have a brachial vein next to it.
Exceptions include the jugular vein and the vena cava.
F. Exchange of oxygen, carbon dioxide, nutrients, and waste materials occurs at the capillary level.
1. The capillaries are the only functioning exchange part of the vascular system.
2. The other vessels are merely channels or conduits for the passage of blood.
3. The smooth muscle of the arteries regulates blood pressure, distribution, and volume.
4. Capillaries comprise most of the 50,000 miles of vessels.
G. The vasa vasorum (”vessels of the vessels”) feed the walls of the blood vessels themselves.

H. Arteries
1. The word artery is derived erroneously from words meaning ”to carry air.”
2. Artery walls are composed of elastic tissue and smooth muscle, which is involuntary, out of conscious
control.
3. The lumen is the hollow center through which blood flows.
4. The walls of arteries are thicker than those of veins.
5. Conducting arteries are large-sized and contain more elastic tissue than muscle tissue.
a. The largest elastic arteries are the aorta, the carotid, and pulmonary arteries.
b. Elastic recoil maintains pressure between pumping strokes.
c. Back pressure closes the semilunar valves in the aorta.
d. These arteries are larger than 3/4 inch in diameter.
 6. Distributing arteries are small- and medium-sized, and they contain more muscular tissue than elastic
tissue.
a. The main function of distributing arteries is to distribute blood flow to parts of the body that need it.
b. They are smaller than 3/4 inch in diameter.
c. They contain smooth muscle in a circular arrangement.
d. These arteries contract when stimulated by the sympathetic nervous system (Lecture Ten).
e. These arteries stop bleeding, regulate blood pressure, and shunt blood flow to where it is needed
most.

7. Arterioles
a. Arterioles are very small but visible with the naked eye.
b. They precede the capillaries and contain a good deal of smooth muscle relative to their size.
c. They regulate blood flow to specific capillary beds.
d. They are very numerous (far more than distributing arteries).
e. They are additional important regulators of blood pressure.

8. Capillaries (”hair-like”) are the location of the blood's microcirculation.

a. They are the final smallest pathway for blood.
b. They connect the arterial side with the venous side.
c. The diameter of a capillary's lumen is slightly larger than one red blood cell (RBC). Every blood
cell, therefore, is near the wall of the vessel. This small lumen gives the RBC ready access for gas
exchange.
d. The precapillary sphincter is a smooth muscle band preceding every capillary. It opens and closes
at different times, shunting blood between various capillary beds.
e. Every cell in the body is near a capillary.
f. Metabolically active cells (brain, heart, kidneys) have many capillaries.
g. Metabolically inactive cells (bone, tendons, and joints) have few capillaries.
h. The lens and cornea of the eye are the only tissues in the body that have no blood supply. They
get nutrition by diffusion.
9. Anastomosis refers to the joining of vessels of similar size to supply the same anatomic area. It is a critical
safety factor in creating a redundant blood supply for vital organs (heart, brain, intestines).
a. A kidney has only one blood supply vessel, known as an end vessel.
b. Each of the two kidneys can function by itself, however, making that system redundant as well.

I. Veins
1. On the venous side, blood flows in the reverse direction from the arterial side.
2. The venous side returns deoxygenated blood to the heart.
3. Venules receive blood from the capillaries. They empty into progressively larger veins until they reach the
heart via the superior and inferior vena cavae.
4. The veins have thinner walls with less elastic tissue than arteries. The inability of lacerated veins to
constrict and shut off blood flow can be fatal.
5. Larger veins below the heart have valves to prevent backflow. No valves are necessary above the heart
because of gravity.
6. Because the capillaries are under low pressure, they need help to get the blood back to the heart.
7. Muscles massage the veins so that the blood can flow to the heart.

8. Pooling and clotting in veins can be a problem during prolonged muscular inactivity, such as on a long
airline flight.
a. A clot (thrombus) can block circulation in that vein.
b. If the clot breaks loose, it will move through the circulatory system. A loose clot is called
an embolus.
 c. Once an embolus moves through the heart, it will encounter smaller vessels and become lodged
in a capillary bed somewhere in the body.
d. If the embolus blocks pulmonary capillaries, it is called a pulmonary embolism.
e. If the embolus blocks arterial capillaries, it is called an arterial embolism.
f. An embolism in the brain is called a stroke.
g. Smaller embolisms cause localized cell death; larger embolisms are fatal.

9. The body does not have a sufficient volume of blood for all capillary beds to be open at once. Capillary
shunting routes blood to needed areas.
10. Clinical applications:
a. Young, healthy patients can maintain good blood pressure even after losing a large amount of
blood. Their ability to shut down capillary beds can cause sudden cardiac arrest as the heart runs
out of blood to pump, and a critical line is crossed. This kind of cardiac arrest is almost invariably
fatal.
b. Anesthesia can also cause a collapse of blood pressure in young patients, because it relaxes the
smooth muscles that close the capillary beds and prevent fatal bleeding and cardiac arrest.

11. The blood-shunting system is very effective at directing blood to the right areas.
12. The brain's need for blood can shut down every other organ except the heart when blood is at a premium.
13. The venous system contains 60% of the body's blood.
14. Arterial-venous fistulas are places where blood moves directly from arteries to veins, bypassing capillaries.
Fistulas can cause heart failure as the heart works harder to supply blood to capillary beds that are not
receiving enough