FACULTY OF MEDICINE OF SOUSSE

Histo-embryology Laboratory,
Cytogenetics, molecular genetics and reproductive biology

Second year
Undergraduate medical studies "PCEM2"

THEME 22: CARDIOVASCULAR SYSTEM

SELF-LEARNING MINIMODULE

HISTOLOGY

OF THE CARDIOVASCULAR SYSTEM

Academic year 2022-2023

Prepared by:

Dr. Ayda Bennour

Pr. Ag. Ines OUAHCHI
Pr. Dorra H'MIDA
Pr. Ali SAAD

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NOTE TO LEARNERS

This document is dedicated to the study of the histology of the cardiovascular system.

The Directed teaching and Practical Work for this module will be delivered in one and a
half hour ED/TP session.

Before the session, you are required to consult the minimodule and validate the pre and
post tests.

At the beginning of the session, you can be tested.

Good reading.

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 REQUIRED

- Cell and Molecular Biology Course (Theme 2)

- Histology of coating epitheliums (Theme 11)
- Histology of connective tissue (Theme 11)
- Histology of muscle tissue (Theme 11)

PRE-TEST

1- Criteria for classifying epitheliums include:

a- Cell size
b- The number of cell layers
c- The existence of lateral junction systems
d- The shape of cells
e- The existence of apical differentiations

2- A simple squamous epithelium

a- Is called squamous epithelium
b- Is called endothelium at the level of the vessels
c- It consists of a single layer of cells
d- Is formed by cells taller than wide
e- Is separated from the underlying chorion by a basement membrane

3- Collagen fibers
a- Are of protein nature
b- Have high tensile strength
c- Are synthesized by mast cells
d- Have transverse striation in electron microscopy
e- Are all visible under an optical microscope

4- The elastic connective tissue

a- Plays a mechanical supporting role
b- Comes from mesenchyma
c- Is rich in reticulin fibers
d- Forms the mucous membrane chorion
e- Is formed by an anastomotic network of reticulin fibers

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OBJECTIVES

After completing this course, you should be able to:

1/ Cite anatomical components of the circulatory system

2/ Describe the general three-layer structure of the different segments of the circulatory
system
3/ Describe the histological structure of an artery and explain the differences between
elastic and muscle arteries
4/ Define an arteriole and describe its particularities in relation to artery
5/ Describe the different types of arterial endings
6/ Describe the different types of block devices: give examples
7/ Describe the histological structure of a vein and explain the difference between the
arterial wall
8/ Describe structural differences between a propellant and a receptive vein
9/ Define a venule and explain these histological differences with the veins
10/ Describe the different types of blood capillaries and their structural and functional
characteristics
11/ Describe the different particular sequences of blood circulation: venous portal
system, admirable system, neuro-vascular glomus
12/ Describe the different tunics of the heart wall
13/ Define lymphatic circulation and explain structural features of lymphatic vessels
14/ Describe the functional features of blood and lymphatic vessels (valves)

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PLAN

I. Introduction
II. Blood vascular system
A- Arteries
1- General structure
2- Classification
3- Arterioles
4- Artery termination mode
5- Histophysiology
B. Veins
1- Structure
2- Classification
3- Very small venules and veins
C. Special vascular devices
1- Simple arteriovenous anastomosis
2- Portal systems and rete mirabile networks
3- neuro-vascular glomus
4- Block devices
5- Erectile tissue
D. Capillaries
1- Structure
2- Classification
3- Capillary network
E. Heart
1- Endocard
2- Myocardium
3- Pericardium
4- Vascularization and innervation
5- Nodal tissue
III. Lymphatic system
A. Lymphatic capillaries
B. Collector lymphatics

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Preamble

"For centuries, people have been wondered about the organ that constantly beats in the
hollow of their chests. The Greeks of Antiquity believed that the heart was the seat of
intelligence, while others saw it as the source of emotions. These theories have long since
fallen into disuse, but it is true that emotions affect heart rate. When your heart is racing, you
suddenly realize that your whole life depends on the beating of this organ. The blood
vessels are compared to a road network and the cells of the body are compared to the
inhabitants of the city served by this network. These cells depend on the movements of a
transporter, blood. The latter is propelled through the network of VESSELS by a pump, the
HEART".

The structure of the HEART and VESSELS is the subject of this minimodule.

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I. INTRODUCTION

The circulatory system is the main fluid transport route for the body.
Its main functions are the transport of oxygen and nutrients to tissues, and the transport
of carbon dioxide and metabolic waste from tissues.
The circulatory system has two functional components: blood and lymphatic vasculature.
The blood vasculature includes:
- The heart: driving element
- The arteries: lead blood to the capillaries
- Capillaries: wide network, place of exchange between blood and tissues
- The veins: receive the blood from the capillaries and bring it back to the heart
The lymphatic vascular system includes:
- Capillaries and lymphatic ducts (collectors) that drain the lymph and discharge it
into the venous circulation.

II. BLOOD VASCULAR SYSTEM

It includes macrocirculation (vessel diameter > 0.1 mm) and microcirculation (vessels
visible only in EM)

A. Arteries

1- General structure

The wall of the arteries comprises three layers or tunics (FIG. 1):
- Tunica Intima: inner layer, includes:
o an Endothelium
o a sub endothelial connective layer

- Tunica Media: intermediate layer

o mainly composed of smooth muscle cells and elastic blades
o particularly developed in arteries

- Tunica Adventitia: outer layer, includes

o conjunctivo-elastic tissue
o small blood vessels: vasa-vasorum
o nerve nets

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 Figure 1: General structure of artery wall

The vascularization of the media and adventitia of medium and large-caliber arteries is
ensured by collateral branches from the vasa-vasorum. The intima is fed by imbibition from the
blood of the vascular lumen (FIG. 2).
The wall of the small arteries is fed by imbibition from the blood of the vascular lumen.
The innervation of the arteries is ensured by the nerve fibers in the adventitia.

The
vasa-
vasorum

Figure 2: Vascularization of an artery

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 2- Classification

Depending on their structure, there are two types of arteries:

➔ Elastic arteries (Fig 3):

- Large arteries near the heart: aorta, subclavian, primary carotid artery, pulmonary artery
- Intima: relatively thick, includes
o an endothelium
o a subendothelial layer
o an internal elastic lamina: indistinguishable from the elastic strips of the
medium
- Media: very thick, includes:
o abundant elastic laminae, organized in concentric layers, with circular
arrangement. Their number varies and can reach 60 to 70 at the aorta. The
first lamina and the last elastic lamina respectively constitute the equivalent
of the internal and external elastic laminae
o smooth muscle cells between the elastic laminae: obliquely oriented rowing
cells
o poor connective tissue
- Adventitia: relatively thin, includes connectivo-elastic tissue, vasa-vasorum and nerve
fibers

Figure 3: Wall structure of an elastic artery

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 ➔ Muscle arteries (Fig 4):

- The most widespread

- Relatively thick wall
- Represented by small (< 2mm) and medium-sized arteries
- Intima: thin, includes:
o an endothelium
o a connnectivo-elastic subendothelial layer
 an Inner Elastic Lamina: thick elastic blade lamina, very refractive, generally
continuous, strongly pleated
- Media: thick, includes
o smooth muscle fibers with circular arrangement
o moderate elastic component
o some collagen fibers and rare fibroblasts
- Adventitia: has
o elastic fibers and laminae which can constitute an External Elastic Lamina in
contact with the media
o collagen, nerve fibers and vasa-vasorum

Intima Internal elastic lamina

Media

Adventitia

Figure 4: Structure of the wall of a muscle artery

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 3- Arterioles (Fig 5)

- They are characterized by a diameter of < 100 microns and reduced lumen
- The intima is thin and has no internal elastic lamina
- The media is formed from one to two layers of circularly arranged muscle cells. From
arteriole to capillary, this layer becomes discontinuous
- The adventitia forms a thin layer of collagen, rich in nerve fibers

A B

Figure 5: Schematic representation of the wall of an arteriole (A) and that of a venule (B).

4- Artery termination mode

- Anastomotic arterial network (Fig 6):

The arteries, in this case, form anastomotic networks or plexus, thus providing
possibilities of replacement when a branch is obstructed. Example: skin, mucous membranes,
brain...

Figure 6: Anastomotic arterial network

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 - Terminal arteries (Fig 7):

In this case, there are no anastomoses between the arteries that irrigate the neighboring
territories.
If a terminal artery is blocked, no circulatory replacement is possible and the territory
normally irrigated by this artery is necrotic.
Example: Myocardial infarction

Figure 7: Terminal arteries

5- Histophysiology

- Muscular Arteries and arterioles:

○ Offer resistance to blood pressure and absorb shock waves due to the tonicity of
their walls
○ Regulate blood flow in microcirculatory networks, through their wealth of smooth
muscle cells, by contracting (vasoconstriction) or by expanding (vasodilatation)

- Elastic arteries:

○ The blood flow is pulsed when leaving the heart; it is conditioned by the rhythmic
activity of the heart:
○ The elastic wall allows, thanks to its distension, to absorb the shock wave during
ventricular ejection
○ During diastole, the elastic system returns to the initial state. Energy accumulated
during distension is released to move ahead the blood column in these arteries.

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 B. Veins

1- Structure (Fig 8)

The structure of the veins varies considerably depending on its location.

- Intima: thin, includes:
o an endothelium and a subendothelial connective layer
o The internal elastic lamina is usually absent (if it exists it is thin and
discontinuous)
- Media: undeveloped, made of circular smooth muscle layers and elastic fibers in varying
proportions depending on the thickness of the vein wall
- Adventitia: predominant layer
o formed of collagen fibers, elastic fibers and some smooth muscle cells
o External elastic lamina is inconsistent
The veins are generally richer than the adventitia in vasa vasorum arteries and the
capillaries penetrate deeper into the wall.
The venous wall contains lymphatic vessels.
Innervation is represented by amyelinic nerve fibers.
By comparison:
- the wall width of a vein is thinner than that of an artery of equivalent size
- With the exception of some large-caliber veins, there is no internal elastic lamina at the
venous wall
- Circular smooth muscle formations are less developed than muscle arteries
- The adventitia is the thickest layer in a vein
- Longitudinal collagen formations are more developed in the venous walls
The result of all these differences is that the tone of the venous wall is low compared to
the arterial equivalent; a vein emptied of its blood flattens.

Figure 8: Schematic representation of the wall of an artery and that of a vein

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 2- Classification

The veins are divided into two groups:

- Receptive veins :
o Supra-cardiac topography veins
o At their level, blood return is passive
o Fibrous veins: the wall is formed of dense fibrous tissue (exp: venous sinus of
dura mater)
o Fibro-elastic veins: the wall is poor in muscle component, rich in fibro-elastic
component (exp: jugular and axillary veins)

- Propellant veins:
o Sub-cardiac topography veins
o Ensure return circulation slowed down by gravity
o Present two types of characteristic formations (Fig 9):
* Valves: mainly in the veins of the lower limbs, usually arranged in pairs.
Each valve is formed by a fold of the intima, consisting of a thin
connectivo-elastic axis and lined with an endothelium.
Above the valves, the vein is slightly dilated.
* A circular muscle layer: oblique or plexiform, especially in the media.

Venous wall
(Intima, Media, Adventice)

Valves

Direction of venous
blood circulation
(venous return)

Figure 9: Schematic section at a propellant vein

In the lower vena cava and other large vena cava, the media is relatively developed and
the adventitia contains longitudinal muscle bundles.

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 3- Very small venules and veins (FIG. 5)
- Ensure the connection of the veins to the capillary network
- Diameter greater than that of capillaries
- The postcapillary venules are provided with an endothelium surrounded by a
connectivo-elastic thin layer
- Gradually and as the caliber increases, appear some smooth muscle fibers with
circular arrangement

C. Special vascular devices

1- Simple arteriovenous anastomoses (or arteriovenous shunts)

Artery and vein are connected by an intermediate segment of structure close to the
artery, the transition to the vein is rapid.

2- Portal systems and rete mirabile networks

- A portal system is formed by a capillary network fed by an afferent vein and drained by
an efferent vein. Example: hepatic portal system

- An rete mirabile network is formed by a capillary network fed by an afferent artery and
drained by an efferent artery. Example: renal glomerulus

3- Neurovascular glomus (fig 10)

- Encapsulated ovoid formation of 0.1 to 0.3˚m comprising an anastomotic vessel between
an arterial branch and a venous branch
- Their role in controlling local traffic is essential. They are essentially involved in
thermoregulation phenomena
- Observe at skin level, fingers, nail beds, lips, nose, ears.

Figure 10: Neurovascular Glomus

(1: artery, 2: anastomotic vessel, 3: media, 4: adventitia, 5: vein)

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 4- Block devices
- Occurs in small arteries, arterioles, small veins and arteriovenous anastomoses
- These vessels comprise in particular reinforcements of smooth muscle beams at the
level of the intima or the media which, by contracting, lead to partial or total
occlusion of the light

5- Erectile tissue
- Formed by a set of intercommunicating vascular cavities, irregularly dilated,
separated by connective spans which comprise smooth muscle fibers.
- Irrigated by arteries and arterioles with numerous block devices. These arteries are
very sinuous at rest, they are called: helicine arteries
- Circulation is normally reduced in erectile tissue. When the block devices relax, there
is a rush of blood into the erectile tissue which then becomes turgid.

D. Capillaries
1- Structure

The capillary wall has three elements:

- An endothelium:
o OM: more or less flattened endothelial cells stretched in the direction of the
blood stream with an oval nucleus projecting from the luminal side
o EM: endothelial cells contain cytoplasmic organelles and micropinocytosis
vesicles. They can be connected by different junction systems

- A basal lamina

- +/- a pericyte:
o An elongated, inconstant cell on the basal side of the endothelium
o Included in basal lamina splitting
o Has ultrastructural similarities with smooth muscle cell

2- Classification

- Continuous capillaries (Fig 11)

o Most common
o Present in many organs: skeletal muscle, heart, lung, skin...
o Endothelium is continued: the endothelial cells are contiguous
o The basal lamina is continuous

- The Fenestrated capillaries (FIG. 11)

o Mainly present in endocrine glands, digestive mucosa and renal glomeruli
o The cytoplasm of endothelial cells is provided with pores. These pores may be
permeable or closed by a diaphragm
o The pores allow the free diffusion of substances from the light of the vessel to
the tissues
 The basal lamina is continued

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 A

Figure 11: Schematic cross-section at a continuous type capillary and a

windowed capillary (A) structure, (B) ultrastructure.

- Discontinuous (or sinusoidal) capillaries

o Present in liver, spleen and bone marrow
o Their path is often winding
o Endothelium is discontinued. The endothelial cells are separated by spaces
which allow, in particular, the passage of blood cells.
o The basal lamina is discontinued, or even absent
Cells have macrophagic activity at their walls

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 o Devoid of pericytes

3- Capillary network

- Represents a very large area

- Density varies according to tissues and organs (Exp: tendons: few capillaries,
myocardium: rich in capillaries)
- Architecture adapted to organ structure
- Normally located between the arterial and venous tree except the arterial and venous
portal systems
- There are two varieties of capillaries that differ in structure and function:
● Direct (or junction) capillaries: they directly prolong the arterioles that give
birth to them and continue directly through a venule. They ensure
permanent circulation between the arteriole and the venule
● True (or nutritious) capillaries: do not directly prolong the vessels that give
birth to them, they make a right or acute angle and are initially driven by a
precapillary sphincter. They are the seat of intermittent circulation.

E. Heart

Includes 3 tunics: endocardium, myocardium and pericardium

1- Endocard (Fig 12)

- Lines endocardial cavities, valves and cords
- Thicker in the atria than in the ventricles
- Includes 2 layers:
o An endothelium
o A subendothelial layer: rich in elastic fibers
- Connected to the myocardium by sub-endocardial connective tissue which
comprises, at the ventricles, Purkinje cells of the nodal tissue
· The valves
- The atrial-ventricular and sigmoid valves (aortic and pulmonary) are folds of the
endocardium around a dense connective axis
- This connective axis is in continuity with that of the ropes and with the fibrous rings
surrounding the atrio-ventricular, aortic and pulmonary orifices

2- Myocardium (Fig 12)

- Consisting essentially of a three-dimensional network of cardiac muscle cells
- The papillary muscles or pillars of the heart are conical projections of the
myocardium that are connected to one or more tendon cords.
- The connective frame of the myocardium includes fibro-elastic spans surrounding the
vessels and nerves

3- Pericardium (Fig 12)

Includes two layers: visceral (epicardium) and parietal

- The epicardium comprise:

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 o A mesothelium
o A submesothelial connective layer
o It is separated from the myocardium by a subepicardial layer of connective
tissue containing fat cells, coronary vessels and nerve fibers
- The parietal layer has the same elements as the visceral layer but is reinforced in
its surface part by thick collagen bundles constituting the pericardial fibrous bag.

Figure 12: Schematic cut at heart wall

4- Vascularization and innervation

- The myocardium is one of the most irrigated organs in the body

- Coronary arteries and veins form an important network that travels through the
connective component
- Vascularization is terminal: coronary anastomoses are few.
- Innervation is essentially sympathetic and parasympathetic
- The nerve fibers form three plexuses: sub-pericardial, myocardial and sub-
endocardial
- Sensitive fibers are of particular interest to the pericardium

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 5- Nodal tissue

- Consisting of specific myocardial cells, includes:

o A sinus node: located in the sub-epicardial connective tissue of the right
atrium wall
o An atrio-ventricular node: located in the sub-endocardial connective tissue of
the right atrium
o A bundle of His: consisting of nodal cells
o A network of Purkinje: whose nodal cells are located in the sub-endocardial
layer and are in contact with the myocardial cells of the two ventricles

III. LYMPHATIC SYSTEM

- Collects part of the interstitial lymph and discharges it into the venous system
- Begins with capillaries closed at their ends
- Lymphatic vessels gather in ascending-caliber lymphatic trunks that end in two
collecting trunks: right lymphatic canal and left thoracic canal

A. Lymphatic capillaries

- Start with a bag bottom (blind end), of very irregular caliber

- Anastomose and form a network in connective tissue
- Present in many organs
- Absent in the central nervous system, bone marrow and endocrine glands (except
thyroid)
- Wall made of a simple endothelium without basal lamina, the junctions between the
endothelial cells are inconsistent

B. Collector lymphatics

- Characterized by the existence of numerous valves (intima folds arranged in pairs)

and a large and irregular lumen, expanded above the valves. Their wall is
comparable to that of a vein of an equivalent size
- The intima: includes an endothelium covering a thin layer of fibro-elastic connective
tissue
- Media: is connectivo-muscular, consisting of smooth muscle cells, with circular
arrangement, intertwined with some elastic fibers
The high blood pressure intended to ensure sufficient oxygenation of the tissues,
promotes the transsudation of interstitial fluid through the wall of the blood capillaries, thus
contributing to the formation of the interstitial lymph.
The lymphatics drain the interstitial lymph and ensure that adequate pressure is
maintained in the interstitial spaces and normal plasma volume is maintained.

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POST-TEST

1- The wall of the muscular arteries

a- Does not contain elastic laminae
b- Includes thick media
c- Contains erectile tissue block devices
d- Contains valves to prevent blood return
e- Has fenestrated pores at its endothelium

2- In the fenestrated capillaries:

a- The cytoplasm of endothelial cells is provided with pores
b- The basal blade is discontinuous
c- Molecular exchanges are important
d- Are present in the endocrine glands
e- Their path is very sinuous

3- Propellant veins:
a- Have discontinuous type endothelium
b- Have valves
c- Have a circular muscle layer in the media
d- Do not contain vasa vasorum in their adventitia
e- Are subcardiac veins

4- The endocardium
a- Contains a simple squamous epithelium
b- lines the heart cavities
c- binds the heart valves
d- Includes 2 layers
e- Connected to the myocardium by sub-endocardial connective tissue

5- List three components of the media of an elastic artery

............................................................................................................

6- Cite the three layers of the epicardium (visceral pericardium):

.............................................................................................................

7- List two organs containing discontinuous type capillaries (sinusoids)

.............................................................................................................

8- Define a portal type circulation

.............................................................................................................

9- What is the role of the vascular glomus?

.............................................................................................................

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PRACTICAL WORK

Slide N 5/2F: AORTA (H.P)

The wall of this artery consists of three layers:

- Intima: It consists of an endothelium and a thin and essentially connective
subendothelial layer.
The internal elastic lamina appears little different from the elastic laminae of the media.

- Media: Very thick with:

- Elastic, corrugated laminae colored in red
- Smooth muscle cells (rowing cells)
- Collagen fibers

- Adventice: Less thick than media

It contains collagen fibers, adipose tissue and vasa-vasorum

Slide N 5/3a: MEDIUM CALIBER VEIN (H.E.S)

Note that the wall of this vein is thinner than that of the arteries.
- Intima: It consists of an endothelium and a subendothelial layer containing longitudinally
arranged smooth muscle fibers and collagen fibers.
- Media: It consists of a set of circular fibers, both connective and muscle.
- Adventice: It's pretty thick. It consists mainly of collagen fibers, some longitudinal
smooth muscle cells and vascular elements (Vasa-Vasorum).

Slide N 5/1a: HEART (H.P.O)

The wall of the heart has a structure schematically similar to that of the blood vessels. The
following equivalency is generally established:
Endocard — Intima
Myocardium — Media
Epicarde — Adventice

- The endocardium: On this slide, it is often reduced to the endothelium and the thin sub-
endothelial layer.
- The myocardium: myocardial cell
- The pericardium: On this slide, it is represented only by its visceral leaf called
epicardium. It consists of:
- Mesothelium
- A thin submesothelial layer
- Thick, connectivo-adipose sub-epicardial layer

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