UNIT 4

CIRCULATORY SYSTEM
 Introduction:-
The circulatory system is transport system
carry oxygen, nutrient, hormones and other
substance to the tissue and conveying carbon
dioxide to the lungs and other waste product
to the kidney.
The cardiovascular system consists of
cardiac (heart), blood and vascular (blood
vessels).
The circulatory system is discovered by
William Harvey .
 Heart
The heart is a hollow muscular organ which
lies obliquely in thorax, in the medistrnum
between the lungs and immediately above
the diaphragm.
In, adult , its average weight is 300gm in
male and 250gm in female.
The adult heart is approximately 12cm
long, 9cm broad and 6cm thick.
4 chambers (2 Atrium and 2 Ventricles)
4 valves
Right side receives blood from the body
and send it to the lungs (pulmonary)
Left side receives blood from lungs and
sends it to the body (systemic)
Chamber of the heart:-
 Right atrium
 Right ventricle
 Left atrium
 Left ventricle
 Internal structure of the heart is divided into a
right and left sided by the septum, a portion consisting
of myocardium covered by atrioventricular valve into
four chamber, the atrium and a lower chamber the
ventricle.
The atria serve as a receiving chambers. The right
sided of the heart pump venous blood into the
pulmonary circulation and the left sided pump atrial
blood into the systemic circulation.
Atrial
Features:- Small, thin – walled chambers
Functions:-
 Receiving chambers for blood returning to the
heart from the circulation.
 Push the blood into the adjacent ventricles.

• Receive blood from

 Right side:- Deoxygenated blood from Superior
and inferior venacava
 Left side:- Oxygenated blood from four
Pulmonary vein
Ventricles
Features:-
 Make up most of the mass of the heart
 The walls of the left ventricle are 3x thicker
than those of the right

• Ventricles:-
 Discharging chambers of the heart
 Propel blood to pulmonary trunk(Right
ventricle), Aorta (Left ventricle)
Receive blood from:-
 Right Ventricle:- Receive blood from the
right atrium through the tricuspid
 Left Ventricle:- Oxygenated blood from
the left atrium to the left ventricles
through mitral(Bicuspid)
The wall of the left ventricles is thicker
than the right ventricle but the structure is
similar.
The thick wall is necessary to pump
oxygenated blood at high pressure
through the systemic circulation.
 Position of the heart:-
The heart is in the thoracic cavity between
the lungs, behind the sternum and between
second to the sixth ribs.
Approximately 2/3 of the heart lies on the
left to the midline. Posteriorly the heart rests
on the bodies of the fifth to eight thoracic
vertebrae.
It lies obliquely , a little more to the right
and present a base above and on apex below.
Organ associated with heart:-
Superiorly:- The great blood vessels ie the aorta,
superior venacava , pulmonary artery and pulmonary
veins.
Inferiorly:- The apex rests on the central tendon of the
diaphragm.
Anteriorly:- The sternum, ribs and intercostals muscle.
Posteriorly:- The esophagus, trachea, left and right
bronchi, descending aorta, inferior venacava and
thoracic vertebra.
Laterally:-The lungs, the left lungs overlaps the left
side of the heart.
Structure of the heart :-
The heart is composed of three layer of
tissue
Pericardium
Myocardium
Endocardium
A. Pericardium :- The pericardium is the outer most layer and
made of two layer. The outer sac consists of Fibrous tissue
and inner of continuous double layer of serous membrane.
It enclosed the pericardial cavity which contain pericardial
fluid.
 Fibrous pericardium:- It is the most superficial layer of the
pericardium . It is made up of dense and loose connective
tissue.
 Serious pericardium:- It is divided into two layer visceral
and parietal pericardial layer , there is a potential space
called pericardial cavity which contain a supply of
lubricating serous fluid known as pericardial fluid.
Function:-
 Fixes heart in mediastrnum and limits its motion.
 Protect it from infection.
 Lubricates the heart.
 Prevents excessive dilatation of the heart.
 Pericardial arteries supply blood to the dorsal portion of
pericardium.
B. Myocardium:- The myocardium is the muscular wall of
the heart (cardiac muscle)(or the heart muscle) and forms a
thick middle layer between the outer epicardium layer and
the inner Endocardium layer. The myocardial muscle is
similar to the skeletal muscle in that it is striated and is not
under voluntary control.
 The myocardium is stimulated by the action of SA node
without nerve stimulus. The muscular layer is thicker in the
left ventricle as it has to pump more blood to the aorta
where as in the right ventricle, it is thinner because it only
drives the blood to the lungs. Myocardium gets the blood
supply from the left and right coronary arteries.
C. Endocardium:- The endocardium is the innermost layer of
tissue that lies the chamber of the heart. It consists of single
layer of epithelium, which provides a smooth lining for the
blood to flow over. It continuous with the valves of the heart
and blood vessels.

Function:-
 The endocardium provides smooth muscle for the inside of
the heart. The smooth surface of wall allows blood to freely
flow along the tissue.
 The endocardium plays a role in the heart beat by containing
the purkinging fibres. The purkinging fibres in endicardium
helps to relay an electrical signal through the heart. The
electricity is cause the heart muscle to move, which causes
the heart to beat.
Properties of cardiac muscle:-
Excitability
Contractility
Autorhythmicity
Valves of the heart:-
 The heart valves open and close permitting blood to flow
in one direction only. The valves allow the blood to flow
from the atria into the ventricles and from ventricles to
arteries. These valves prevents a back flow from
ventricles to the atria and from artery to ventricles. There
are four types of valve present in the heart:-

 Bicuspid valve(two flaps)

 Tricuspid valve (three flap) Atrioventricular valve
 
 Aortic valve
 Pulmonary valve Semilunar valve
Arterial supply of the heart
The arterial supply of the heart is
provided by the right and left coronary
arteries, which arise from the ascending
aorta immediately above the aortic valve
Venous drainage of the heart
Most blood from the heart wall drains
into the right atrium through the coronary
sinus.
Function of Heart
Circulation forward:. Blood transporting A) Oxygen
B) Nutrients C) Hormones/Chemical messengers to
all tissues
Circulates return for Execretion, collects blood on
return from body circulate thru lungs to excrete
Carbon Dioxide and other Nitrogen wastes thru urine.
Circulates blood to peripheral tissues to maintain body
temperature regulating heating and cooling
Circulates Immune cells - White blood cells to fight
infections
Circulates platelets and clotting factors to seal off
wounds
Different kinds of circulation:-
 Pulmonary circulation
 Systemic circulation
 Portal circulation
 Fetal circulation
Pulmonary circulation:- The pulmonary circulation consists of
the circulation of blood from the right ventricle of the heart to
the lungs and back to the left atrium during which CO2 is
excreted and O2 is absorbed.
 The pulmonary artery, carrying deoxygenated blood, leaves the
right ventricles of the heart. The pulmonary artery divides into
left and right pulmonary artery. The left pulmonary artery runs
to the root of the left lungs and right pulmonary artery runs to
the root of the right lungs. Within the lungs these arteries
subsequently becoming arterioles and the lungs tissue that the
interchange of gases occurs. The capillary now containing
oxygenated blood join up with one another and eventually from
two veins.
 Two pulmonary veins leave from each lungs. Therefore , four
pulmonary veins carrying oxygenated blood enter the left
atrium of the heart. During atrial systole this blood passes into
the left ventricles and during ventricular systole , it is forced
into the aorta and goes to the general circulation.
 Systemic circulation:- The general or systemic circulation
involved the circulation in which the blood pumped out
from the left ventricle is carried by the branches of the aorta
around the body and is returned to the right atrium of the
heart by the superior or inferior.
 The circulation of blood to the different parts of the body
will be described in the order in which their arteries branch
off from the aorta which is the first artery of general
circulation.
Portal circulation:- The portal circulation , blood passes from the
abdominal part of the digestive system and the spleen via the
liver and the inferior venacava to the heart.
 The liver is unusual in that it has a double blood supply , the right
and left hepatic arteries carry oxygenated blood to the liver , and
the portal vein carries venous blood from the GI tract to the liver.
 The hepatic portal system collects nutrients rich venous blood
draining from the digestive viscera and delivers it to liver. The
livers collects the absorbed nutrients for metabolic processing or
for storage before releasing them back to the blood stream to
general cellular use.
 The hepatic portal system is very important for two reasons one
is that it provides a major source of blood supply to the liver. The
other reason is that blood drained from the intestines carry toxins
absorbed from the GI tract. Many of these toxins are metabolites
produced by bacteria within the gastrointestinal system. The liver
these toxins in such a way to make them less harm full to other
organ of the body.
This is formed by following veins forming together:-
 Inferior mesenteric vein(Rectum, pelvic, descending colon )
 Superior mesenteric vein(Small intestine)
 Gastric veins(Stomach)
 Cystic vein(Gall bladder)

  Through portal vein(Nutrition)

 Hepatic artery
O2 Liver
 
Aorta Hepatic vein
 
Inferior venacava

Deoxygenated blood
Heart
 
Fig :-Hepatic portal circulation
Fetal circulation:- In utero , mother and fetal blood nerve mix
unless there is pathological condition . There is only the
exchange of CO2, O2 and nutrition occur within the capillaries
inside the placenta.
 From the placenta , blood passes along the umbilical vein
through abdominal wall to the liver. This is only vessels which
carries purely oxygenated blood .
 In abdominal area , where one branch supply blood to liver and
other branches ductus venosus mixed with inferior venecava,
which collected impure blood from lower limbs.
 From there the blood passes into the right atrium and directed
across through the foramen ovale into the left atrium.
 It enter left ventricle through mitral valve and pump into aorta
through aortic valve . The brain, heart, upper and lower limbs
supply oxygenated blood from its branches.
Fetal circulation:-
In utero , mother and fetal blood nerve
mix unless there is pathological
condition . There is only the
exchange of CO2, O2 and nutrition
occur within the capillaries inside
the placenta.
 From the placenta , blood passes
along the umbilical vein through
abdominal wall to the liver. This is
only vessels which carries purely
oxygenated blood .
 In abdominal area , where one
branch supply blood to liver and
other branches ductus venosus
mixed with inferior venecava, which
collected impure blood from lower
limbs.
 From there the blood passes into
the right atrium and directed across
through the foramen ovale into the
left atrium.
 It enter left ventricle through mitral
valve and pump into aorta through
aortic valve . The brain, heart,
upper and lower limbs supply
oxygenated blood from its
branches.
 Blood collected from upper part of
the body returns to the right atrium
by superior venacava. This stream
of blood is depleted of oxygen and
nutrients. This stream of blood
cross the stream entering from
inferior venecava and reaches right
ventricle , then it is pumped into
pulmonary artery. It supplies blood
to the lungs for the development.
The remaining pass into
aorta through temporary
structure ductus
arteriousus then , it
descends and branches
off into iliac arteries
which goes to placenta.
These are called
hypogastric arteries.
They carry deoxygenated
blood from the fetus .
The blood is again
oxygenated by placenta
and continues circulation
occurs. This is called
fetal circulation.
There are four temporary structures which initiate the fetal
circulation or differentiate between adult and fetal
circulation, these are:-
 Ductus venosus
 Foramen ovale
 Ductus arteriosus
 Umbilical arteries(Hypogastric arteries)
At birth:-
Umbilical cord is clamped
 
First breath Closure of ductus venosus
(Blood transport to liver
Lungs expands and fluid is expelled and
portal system)
 

Pulmonary resistance Ligamentum venosum

 
Increase pressure of left atrium
 
Closure of foramen oval
 
Fossa ovalis
In fetus After birth
Ductus venosus Ligamentum venosum

(closing within 1 week)

Foramen ovale Fossa ovalis
(colsing after 1 year)
Ductus arteriosus Ligamentum arterisum
(clossing after 1-3 month)
Umbilical arteries Umbilical ligamentum
Umbilical vein Ligamentum arteriosum
Cardiac Conduction system
Cardiac conduction is the rate at which the
heart conducts electrical impulses. These
impulses cause the heart to contract and then
relax. The constant cycle of heart muscle
contraction followed by relaxation causes
blood to be pumped throughout the body .
Cardiac conduction can be influenced by
various factors including exercise,
temperature, and endocrine system hormones.
Step 1: Sinoatrial (SA) node (Pacemaker Impulse
Generation)
The sinoatrial (SA) node (also referred to as the pacemaker of
the heart) contracts generating nerve impulses that travel
throughout the heart wall. This causes both atria to contract.
The SA node is located in the upper wall of the right atrium. It
is composed of nodal tissue that has characteristics of both
muscle and nervous tissue.

Step 2: AV Node Impulse Conduction

The atrioventricular (AV) node lies on the right side of the
partition that divides the atria, near the bottom of the right
atrium. When the impulses from the SA node reach the AV
node they are delayed for about a tenth of a second. This delay
allows the atria to contract and empty their contents first.
Step 3: Atrioventricular Bundle
The impulses are then sent down the atrioventricular bundle.
It is originates from AV node and extends to the
introventricular septum. This bundle of fibers branches off
into two bundles and the impulses are carried down the
center of the heart to the left and right ventricles.

Step 4: Purkinje Fibers (bundle of his)

At the base of the heart the atrioventricular bundles start to
divide further into Purkinje fibers. When the impulses reach
these fibers they trigger the muscle fibers in the ventricles to
contract. The right ventricle sends blood to the lungs via the
pulmonary artery. The left ventricle pumps blood to the
aorta.
 Cardiac Cycle
Cardiac cycle means a complete heartbeat that consist
of contraction(systole) and relaxation(diastole) of both
atria plus contraction and relaxation of both ventricles .
The normal cardiac per minute is range from 60-80.

 Atrial Systole- Contraction of the atria (0.1 Sec)

 Ventricular Systole –Contraction of the Ventricles (0.3 sec)
 Complete Cardiac Diastole – Relaxation of the atria and
Ventricles
(0.4 sec)
The cardiac cycle refers to a complete heartbeat from its
generation to the beginning of the next beat, and so includes the
diastole, the systole, and the intervening pause.
The frequency of the cardiac cycle is described by the heart
rate, which is typically expressed as beats per minute.
Each beat of the heart involves five major stages.
The first two stages, often considered together as the
"ventricular filling" stage, involve the movement of blood from
the atria into the ventricles.
The next three stages involve the movement of blood from
the ventricles to the pulmonary artery (in the case of the right
ventricle) and the aorta (in the case of the left ventricle).
The first stage, " diastole," is when the semilunar valves (the pulmonary
valve and the aortic valve) close, the atrioventricular (AV) valves (the mitral
valve and the tricuspid valve) open, and the whole heart is relaxed.

The second stage, "atrial systole," is when the atrium contracts, and blood
flows from atrium to the ventricle.

The third stage, "isovolumic contraction" is when the ventricles begin to

contract, the AV and semilunar valves close, and there is no change in
volume.

The fourth stage, "ventricular systole," is when the ventricles are

contracting and emptying, and the semilunar valves are open.

During the fifth stage, "isovolumic relaxation time", pressure decreases,

no blood enters the ventricles, the ventricles stop contracting and begin to
relax, and the semilunar valves close due to the pressure of blood in the aorta.
Isovolumic relaxation time (IVRT) is an interval in the
cardiac cycle, from the aortic component of the second
heart sound, that is, closure of the aortic valve, to onset
of filling by opening of the mitral valve.

Isovolumetric contraction is a term used in cardiac

physiology to refer to an event occurring in early
systole, during which the ventricles contract with no
corresponding volume change. This short-lasting event
takes place when both the AV valve and SL valve are
closed.
 Heart Sound
 Heart sounds are the noises generated by the beating heart
and the resultant flow of blood through it. In cardiac
auscultation, an examiner may use a stethoscope to listen
for these unique and distinct sounds that provide
important auditory data regarding the condition of the
heart.
 In healthy adults, there are two normal heart sounds often
described as a lub and a dub (or dup), that occur in
sequence with each heartbeat. These are the first heart
sound (S1) and second heart sound (S2), produced by the
closing of the AV valves and semilunar valves,
 The closing of the mitral and tricuspid valves (known
together as the atrioventricular valves) at the beginning
of ventricular systole cause the first part (the lubb) of
the "lubb-dubb" sound made by the heart as it beats.
Formally, this sound is known as the first heart sound, or
S1.
 The second part (the dubb) of the "lubb-dubb" (the
second heart sound, or S2), is caused by the closure of
the aortic and pulmonary valves at the end of ventricular
systole.
Ventricular diastole is the period during which the
ventricles are filling and relaxing, while atrial
diastole is the period during which the atria are
relaxing.

Ventricular systole is the period of contraction of the

ventricles and Atrial systole is period of contraction
Of atria.
 Stroke volume (SV) is the amount of blood pumped out of
the heart (left ventricle - to the body) during each
contraction measured in mL/beat (millilitres per beat). It is
about 70 ml.

 Strokevolume is equal to different between End diastolic

volume(EDV) and End systolic volume(ESV). Stroke
volume = EDV-ESV
 End diastolic volume(EDV) is the volume of the blood
which remains in the ventricle at the end of ventricular
diastole. It is about 110-120 ml.

 End systolic volume(ESV) is the volume of the blood

which remains in the ventricle at the end of ventricular
systole. It is about 40-50 ml.

 cardiac output (CO), the amount of blood that is ejected by

each ventricle in each minute is called cardiac output,
measured in L/minute, can be calculated by multiplying
stroke volume by heart rate (CO = SV x HR).Normal
cardiac output is about 5 lit/min.
BLOOD
Blood is a liquid Connective tissue that is
ubiquitous in the body. It consists of the cell and
fluid within the closed circulatory system that
flow in a regular unidirectional movement
propelled mainly by the rhythmic contraction of
the heart.
Blood is the fluid that circulates through
the heart , arteries , capillaries and vein, carrying
nutrient materials and O2 to the tissues and
removing waste product and CO2 from tissue.
Characteristics of Blood
 It is thick red fluid . It is bright red in arteries due to
presence of O2 (pure blood)and dark purplish red in
vein due to presence of CO2 (impure blood).
 Slightly alkaline in reaction - PH 7.35-7.45.
 Volume - 5-6 liters (7.8%of total body weight)
 Specific gravity - 1.052-1.060
 Viscosity - 4.5 times more than water
 Temperature – 36 -38 deg C
 Osmotic pressure – 25 mm of Hg
 Taste - Salty
 Normal output from heart in one contraction - 70-80
ml
Function of blood
 Transportation
 Regulation
 Protection
 Transportation :-
- It carries oxygen from the lungs to the
body tissue and CO2 from tissue to lungs
for excretion.
- It transports nutrients materials from the
digestive tract to the cell and remove waste
products from there.
- It carries hormones, enzymes, vitamin
and other chemical to target organ or tissue.
 Regulation
- It distribute the heat and regulates the
body temperature.
- It maintain water and electrolyte
balance.
- It maintain acid base balance.
 Protection
- It carries materials (Platelets) that clot
blood, preventing its loss from a rupture blood
vessels.
- It contains agent (WBC) which protect
against the infection.
- It passes through monitoring organ and
enables the detection of variation in hormone
level, osmotic pressure, PH , temperature,
Blood pressure.
Composition of blood

BLOOD

BLOOD CELLS BLOOD PLASMA

45% 55%

RED BLOOD CEEL WHITE BLOOD CEEL PLATELETS

(RBC) ERYTHROCYTES (WBC) LEUCOCYTES OR THROMBOCYTES PR OTEIN,
M INERALS SALT,
ORGANIC WASTE PR ODUC T,
GASES, ENZYM ES, ANTIB ODIES AND ANTITOXIN, ENDOCR INEHOR M ONES, OTHER S
 WBC
LEUKOCYTES

GRANULOCYTES AGRANULOCYTES

NEUTOPHILLS EOSINOPHILLS BASOPHILS LYMPHOCYTES

(20-25%) MONOCYTES
(60-70%) (2-4%) (1%) A)T-LYMPHOCYTES
B)B-LYMPHOCYTES (3-8%)
RED BLOOD CEEL
(RBC)
ERYTHROCYTES
 These are shaped like a small wheel and are biconcave
on both side.
 The central part of the red corpuscle is thinness than the
circumference.
 They are correctly called corpuscle rather than cell
because they have no nucleus.
 This non- nucleated discs diameter is about 7 microns .
 They are 500-600 times more than WBC.
 Life span :- 120 days.
 Male :- 4.5-6.5 million/mm3.
Female:- 4.5- 5 million/mm3.
 They helps transport of respiratory gases.
 It helps to maintain acid base balance , iron balance and
maintaince of blood viscosity.
 It also bears surface antigen used to detect blood grouping.
 In embroyonic stage the RBC are formed in liver and
spleen but after birth they are formed in the red bone
marrow. This process of formation of RBC is known as
erythropoiesis.
FUNCTIONS:-
The main function of RBC to carry
oxygen from the lungs to tissue and CO2
from tissue to lungs.
The antigens on the plasma membrane of
RBCs determine the person’s blood
group.
RBC also has a role in the iron balance
WHITE BLOOD CEEL
(WBC)
LEUCOCYTES
They are colourless cells containing nuclei .
They are little larger in size than the RBC.
Normal leucocytes count:- 4000-11000 per cu mm.
Life span :-13-21 days.

 Functions of WBC:-
 To fight with bacterial infection .
 To ingest and digest dead tissue called
phagocytosis.
 Leucocytes are divided into two types:- (Based on
presence of granules)

 Granulocytes (Polymorphonuclear):- Its nucleus is irregular

and variables in shapes its cytoplasm contains granules. Its
forms about 75% of total WBC.

 A granulocytes(Mononuclear) :- These are non granular

cells and constitute about 25% of total number of WBC .
They are distinguished from the polymorphonuclear cells by
having a large nucleus.
Neutrophils :-
 They defend against bacterial or fungal infection. They are
usually the first responders to microbial infection; In viral
infections, neutrophils stimulates the production of
interferon (it inhibits replication of virus).
 Neutrophils are the most abundant white blood cell,
constituting 60-70% of the circulating leukocytes. They
defend against bacterial or fungal infection. They are
usually first responders to microbial infection; their activity
and death in large numbers forms pus.
 Neutrophils are active in phagocytosing bacteria and are
present in large amount in the pus of wounds.
 The life span of a circulating human neutrophil is about 5.4
days.
Function:-
Phagocytosis of bacteria.
Release of antimicrobial chemicals.
Initiation of inflammatory response by
activation of the complementary system.
Neutrophils seem to be especially
important for preventing infections of the
skin and mucosal surface.
Eosinophils

 The primarily deal with parasitic infections. They are

also the predominant inflammatory cells in allergic
reactions.
 Eosinophils compose about 2-4% of the WBC total. This
count fluctuates throughout the day, seasonally, and
during menstruation.
 It rises in response to allergies, parasitic infections, They
are rare in the blood, but increased in allergic condition
such as asthma ,hay fever, and during sensitivity and
skin condition.
Function:-
Phagocytosis of antigen – antibody
complexes, allergens and inflammatory
chemicals
Release enzymes that weaken or destroy
parasites such as worms.
Eosinophils also degrade histamine and
decrease the allergic reaction
 Basophils
 Basophils are chiefly responsible for allergic and antigen
 response by releasing the chemical histamine, which causes
dilation of the blood vessels.
 Because they are the rarest of the white blood cells (less than
0.5% of the total count.
 They excrete two chemicals that aid in the body's defenses:
histamine and heparin.
 Histamine is responsible for widening blood vessels and
increasing the flow of blood to injured tissue. It also makes
blood vessels more permeable so neutrophils and clotting
proteins can get into connective tissue more easily.
 Heparin is an anticoagulant that inhibits blood clotting and
promotes the movement of white blood cells into an area.
 Basophils can also release chemical signals that attract
eosinophils and neutrophils to an infection site. 
Function:-
Secrete histamine which increase blood
flow to a tissue.
Secrete heparine which promotes mobility
of other WBCs by preventing clotting.
Basophils possible play a role in the onset
of certain allergic reaction.
They may also protect us from some
parasitic infection:- Scabies
 Lymphocytes : : Lymphocytes are associated with
the protection of the body against foreign materials.

B-lymphocyte:-They arises from bone marrow ,gut and

lymphnoids. .They are defense against viruses and bacteria
that the blood and lymph. They donot moves to site of
infection and donot react against the transplants and cancer
cells
T-lymphocytes :- They arises from bone marrow and
thymus. They are defense against protists and fungi that the
cell. It moves to site of infection and react against the
transplants and cancer cells
Monocytes:-
These are large cell with a large nucleus that originate in red bone
marrow. They are amoeboid in shape. It main function is phagocytsis,
antigen production and cytokine production(are the proteins produced
by cells that serve as molecular messenger between cells). It helps to
increase temperature during microbial infection.

Cytokines are a category of
signaling molecules that mediate
and regulate immunity,
inflammation and hematopoiesis.
PLATELETS OR THROMBOCYTES
 Platelets, also called thrombocytes, are a component of
blood whose function (along with the coagulation factors) is
stop to bleeding by clotting blood in injuries blood vessels. 
 Platelets have no cell nucleus ,That are derived from the 
bone marrow, and then enter the circulation. These are
granulated dics. These unactivated platelets are biconvex
discoid (lens-shaped) structures. They are found only in
mammals.
 Men as a group have slightly higher mean value the women.
 Old platelets are destroyed by phagocytosis in liver.
 Normal platelets counts:-1,50000-3,00,000 mm3
 Life span:- 7-10 days.
 The main function of platelets is to contribute to hemostasis:
the process of stopping bleeding at the site of interrupted.
Function:-
The functions of platelets are primarily related to
hemostasis.
They secrete procoagulants or clotting factors, which
promotes blood clotting.
They secret vasoconstrictors which cause vascular spasm in
broken vessels.
 They form temporary platelet plug to stop bleeding.
They dissolve blood clot that have out lasted their
usefulness.
They secrete chemicals that attract neutrophils and
monocytes to the site of inflammation.
They secrete growth factors that simulate mitosis in the
vascular wall. These factors help to maintaining the lining
of damaged blood vessel.
Plasma
 Plasma is a pale yellow , water solution .It makes up
about 55% ot the total volume of our blood (6.4-
8.4gm/100ml)
 It acts as a solvent for important proteins, nutrients,
electrolytes, gases and other substances which is
essential to life.
 It has composition of
 Water (90- 92 %)
 Solid (8- 10 %)
 Solid plasma :-
 Plasma protein(Albumin, globulin, fibrinogen,
prothrombin)
 Mineral salt :- Sodium, potassium, calcium, magnesium,
sodium bicarbonate, phosphorus, iron, iodine, copper
cobalt, chloride.
 Nutrient material:- Vitamins, Carbohydrates(amino
acids), protein, fatty acid and fats
 Organic waste product: Urea, uric acid, creatinine.
 Gases:- Oxygen, carbon dioxide , nitrogen
 Enzyme:-Pepsinogen, trypsinogen, amylage
 Antibodies and antotoxine:- Different types
immunoglobin eg:- IgG, IgM, IgA
 Different endocrinal hormones:- Tsh, T3, T4.
Main function
 Albumins helps to maintain the correct amount of fluid
circulation in the body.
 It helps to control bleeding and work together with platelets
to ensure the blood clot effectively.
 Immunoglobulins are part of the immune system.
 They produce variety of antibodies that they fight against
infection.
Cells Decrease count Increase count

RBC Anaemia Polycythemia or

erythrocytes

WBC Leukopenia Leukocytes/

leukemia

PLATELETS Thrombocytopenia Thrombocytosis

Antigen:- A substance that
stimulates the production of an antibody. 
Antigens include
toxins, bacteria, foreign blood cells, and the cells 
of transplanted organs.
Antibody:- A Y-shaped protein that is secreted
into the blood or lymph in response to an antigeni
c stimulus,
such as a bacterium, virus, parasite, or transplante
d organ, and
that neutralizes the antigen by binding specifically
 to it.
Coagulation factors
Haemostasis:-
It is a series of responses that stop the
blood flow when blood vessels are
ruptured.
This response is fast, localized and
carefully controlled.
It involves many blood coagulation
factors present in plasma and other
substances released by platelets and
injured tissues.
 There are three mechanism of
haemostatic mechanism:
Vascular spasm(Vasoconstriction)
Platelet plug formation
Blood clotting(Coagulation)
i. Vascular Spasm:
The smooth muscle in blood vessel walls
contracts immediately the blood vessel is broken.
This response reduces blood loss for some time,
while the other haemostatic mechanisms become
active.

ii. Platelet Plug Formation:

When blood platelets encounter a damaged blood
vessel they form a “platelet plug” to help to close
the gap in the broken blood vessel. (The key
stages of this process are called platelet adhesion,
platelet release reaction, and platelet aggregation)
iii. Coagulation:
Following damage to a blood vessel, vascular spasm occurs to
reduce blood loss while other mechanisms also take effect.
Blood platelets congregate at the site of damage and a mass to
form a platelet plug. This is the beginning of the process of the
blood “breaking down” from its usual liquid form in such a
way that its constituents play their own parts in processes to
minimize blood loss.
Blood normally remains in its liquid state while it is within the
blood vessels but when it leaves them the blood may thicken
and form a gel (coagulation). Blood clotting (technically
“blood coagulation”) is the process by which (liquid) blood is
transformed into a solid state.
This blood clotting is a complex process involving many
clotting factors (incl. calcium ions, enzymes, platelets,
damaged tissues) activating each other.
Blood clotting(Coagulation)
 Coagulation(clotting) of the blood is the last but most
effective defense against bleeding, Coagulation is the process
by which a liquid blood is transformed to a gel. It is
important for the blood to clot quickly when a vessels has
been broken, but equally important for it not to clot in the
absence of vessels damage. It is most complex process in the
body, involving 30 chemical reactions.
 Many substances necessary for clotting are normally inactive
in the blood stream. These factors include calcium ions,
several inactive enzymes and other molecules released by the
platelets or damaged tissues. Factors that enhance clot
formation are called procoagulants, those that inhibit clotting
are called anticoagulations.
 A balance is maintained between procoagulants and
anticoagulants. Most procoagulants are proteins
produced by the liver. They are always present in plasma
in inactive form.
 When an injury occurs, the procoagulants(clotting
factors) are activated. When one factors is activated, it
functions as an enzyme that activates the next one in the
clotting pathway and finally a clot is formed
Blood clotting involves a series of reactions in which each
clotting factors depends on the activation of the preceding
one. Mainly three critical events are involves in
coagulation;
1. Two reaction pathways to coagulation called the extrinsic
and intrinsic pathway work simultaneously to form a
complex substance called prothrombin
activator(prothrombinase). From this point on, the clotting
mechanism have a common pathway.
2. Prothrombin activators converts a plasma protein called
prothrombin into thrombin.
3. Thrombin converts fibrinogen(a plasma protein) into
fibrin mesh, which traps blood cells and seals the hole.
 Blood clotting factors
Number Name Origin
I Fibrinogen Liver
II Prothrombin Liver
III Tissue thromboplastin Perivascular tissue
IV Calcium ions Diet, bones, and platelets
V Proaccelerin, Labile factors Liver, Platetets and endothelial cell
VII Proconvertin, stable factors Liver
VIII Antihemphilic factor A Liver
IX Antihemphilic factor A , Liver
Christmas factor
X Thrombokinnase, stuart factors Liver
XI Antihemophilic factor C Liver
XII Hageman factor, Liver, Platelets
Antihemoplilic factor D
XIII Fibrin stabilizing factors Platelets, Plasma
 BLOOD GROUPING
 A blood type (also called a blood group) is a classification of 
blood based on the presence or absence of antigenic substances
on the surface of red blood cells (RBCs).
 Blood group A individuals have the A antigen on the
surface of their RBCs, and blood serum containing IgM
antibodies against the B antigen. Therefore, a group A
individual can receive blood only from individuals of
groups A or, and can donate blood to individuals with
type A or AB.
 Blood group B individuals have the B antigen on the
surface of their RBCs, and blood serum containing IgM
antibodies against the A antigen. Therefore, a group B
individual can receive blood only from individuals of
groups B or, and can donate blood to individuals with
type B or AB.
 Blood group AB individuals have both A and B antigens on
the surface of their RBCs, and their blood plasma does not
contain any antibodies against either A or B antigen.
Therefore, an individual with type AB blood can receive
blood from any group but cannot donate blood to any group
other than AB. They are known as universal recipients.
 Blood group O individuals do not have either A or B
antigens on the surface of their RBCs, and their blood
serum contains IgM anti-A and anti-B antibodies against the
A and B blood group antigens. Therefore, a group O
individual can receive blood only from a group O
individual, but can donate blood to individuals of any ABO
blood group (i.e., A, B, O or AB).It is Universal donar.
The Rheus Factor:-
 The RH Factor named for the rheus monkey because it
was first studies using the blood of this animal.
 Beside from the antigen of the ABO system, those of the
RH system are of the greatest clinical important.
 Each blood type is also grouped by its rheus factos or RH
factor. Blood is either RH positive(RH +) or RH
negative(RH -) .
 Rheus refers to another type of antigen or protein on the
surface of red blood cells. The rheus comes from
RHEUSES MONKEY, in which protein was discovered.
RH Incompatibility
 Rh incompatibility is a condition that develops when a
pregnant woman has Rh-negative blood and the baby in her
womb has Rh-positive blood.
 If the blood of a person , who is RH positive ,is transfused to
a person who is RH negative the recipient slowly produces
an antibody against this agglutinogen. This antibody is
called anti RH factor.
 If the mother is Rh-negative, and her immune system treats
Rh-positive fetal cells as if they were a foreign substance.
The mother's body makes antibodies against the fetal blood
cells. These antibodies may cross back through the placenta
during delivery. Stimulating the mother to produce the anti
rheuses factor against the RH positive blood . No reaction
occur during first child but when the mother become
pregnant in second time, the anti RH factor able to destroy
the baby's circulating red blood cells. They cause severe
anemia to fetus, even it is also cause fetal death.
Firstborn infants are often not affected unless
the mother had past miscarriages or abortions
that sensitized her immune system. This
because it takes time for the mother to develop
antibodies. However, all children she has later
who are also Rh-positive may be affected.
To prevent such occurrence it is now
recommended to give special anti D
immunoglobulin injection to mother who is
RH negative within 72 hours of delivery.
HEAMOGLOBIN(HB%)
 Hemoglobin  also spelled haemoglobin and
abbreviated Hb or Hgb, is the iron -containing oxygen-
transport metalloprotein in the red blood cells of
all vertebrates.
  The main function of hemoglobin is to transport
oxygen from the lungs to the tissues and then transport
CO2 back from the tissues to the lungs.
Hemoglobin level:-
Male:- 14-18 gram/dl
Female :- 12-16 gram/dl
Newborn:-20-22 gram/dl
( dl=100ml)
The BLOOD VESSELS
The blood vessels are the part of the circulatory system that
transports blood throughout the human body.
The word vascular, meaning relating to the blood vessels, is
derived from the Latin vas, meaning vessel.
There are three major types of blood vessels: the arteries, which
carry the blood away from the heart; the capillaries, which
enable the actual exchange of water and chemicals between the
blood and the tissues; and the veins, which carry blood from the
capillaries back toward the heart.
 Classification of blood vessels
A. Anatomical
B. Functional

Anatomical
 Artery
 Vein
 Capillary
Functional
 Distributing vessels:-Arteries
 Resistance vessels:-Arterioles and pre-
capillary spinctures.
 Exchange vessels:-Capillaries
 Capacitance vessels:-Veins and venacava
 Conducting vessels:-Aortra and its
branches
 Artery:- Arteries are the blood vessels that transport away from
the heart. It always carries pure blood except pulmonary artery.
The size of artery is vary according to the site but but have the
same structure.

 Vein:- The vein are the blood vessels that transport blood to the
heart. It always carries deoxygenated blood except pulmonary
vein in adult and umbilical vein in fetal circulation..

 Capillaries are the smallest of a body's blood vessels (and lymph

vessels) that make up the microcirculation. Their endothelial
linings are only one cell layer thick. These micro vessels,
measuring around 5 to 10 micrometers (µm) in diameter, connect
arterioles and venules, and they help to enable the exchange of
water, oxygen, carbon dioxide, and many other nutrients and
waste substances between the blood and the tissues.
The arteries and veins have three layers, but the
middle layer is thicker in the arteries than it is in
the veins:
Tunica intima
Tunica media
Tunica adventitia
 Tunica intima (the inner layer): The inner coat of blood vessels
is called tunica intima . It consist of single layer of simple
squamous endothelial cells called endothelium, which line the
artery and separated from the middle muscular coat by a layer
of elastic fiber.

 Tunica media (the thickest layer in arteries): The middle coat

of blood vessels is called tunica media. It consists of elastic
fiber and connective tissue. The tunica media may (especially
in arteries) be rich in vascular smooth muscle, and arranged in
a circular manner which controls the caliber of the vessel.

 Tunica adventitia: (the thickest layer in veins) It is composed

of connective tissue. It also contains nerves that supply the
vessel as well as nutrient capillaries in the larger blood vessels.
Function of the blood vessels
 Arteries transport the oxygen rich blood away from the
heart to the all body tissues.
(with the exception of the pulmonary arteries, it carries
oxygen poor blood to the lungs)
 Vein carry the oxygen poor blood from the body tissues
back to the heart.(But pulmonary veins carry oxygenated
blood from the lungs to the left atrium)
 Vein also carry waste products away from the organs and
tissues, while the veins associated with the small intestine
carry digested food via the liver to the inferior venacava.
 The capillaries allow for gaseous exchange to take place
between the capillaries and the tissue fluids.
 Venules collect blood from the capillaries and deliver it to
veins.
Main blood vessels and their branches
Blood pressure
Pulse
Location of the common Arteries and Vein

Names of Systemic Arteries

 The Aorta and its branches
 The ascending aorta
 The arch of aorta
 The thoracic aorta
 The abdominal aorta
 The Aorta and its branches

 The ascending aorta:- It is the first portion of the aorta. It

begins at the aortic valve.
 The arch of aorta:- It is located immediately beyond the
ascending aorta.
 The thoracic aorta:- It is continuation of the arch of the
aorta. It is also called descending aorta.
 The abdominal aorta:- It is a continuation of the thoracic
aorta in the abdominal cavity. It is the section between the
diaphragm and the common iliac arteteries.
 The ascending aorta
 The ascending aorta has two branches near the heart that
supply the all parts of the myocardium. They are:-
 The left coronary arteries
 The right coronary arteries
 The arch of aorta
 The arch of aorta gives off three large branches: the
brachiocephalic trunk, the left common carotid and the left
subclavican.
 The brachiocephalic trunk:-It is a short artery. Its names means
that is supplies the head and the arm.
 After extending upward, it divided inti the right subclavical artery
and the right common carotid artery.
 The right subclavical artery supplies the right uper extremity and
the right side of the head and neck.
 The right common carotid artery supplies the right side of the
head and the neck.
 The left common carotid artery is the second branch which
extends upward from the highest part of the aortic arch. It
supplies the left side of the neck and the head.
 The left subclavian artery extends under the left collar bone
(Clavical) and supplies the left upper extremity.
 The thoracic aorta

The third part of the aorta, the thoracic, consists of parietal and
visceral branches . They supply branches to the chest wall, to the
esophagus, and to the bronchi and their treelike subdivision in the
lungs.
 Parietal branches of the thoracic aorta include:-
o Posterior intercostals arteries supply the intercostals and deep muscle
of the back.
o Subcostal arteries supply the same region of the posterior intercostals
arteries
o Superior phrenic arteries supply the posterior part of the diaphragm
 The visceral branches of the thoracic aorta include:-
o Pericardial arteries supply the pericardium of the heart.
o Bronchial arteries supply the lungs, bronchi and pleurae.
o Esophageal arteries supply the oesophagus.
o Mediastinal areteries supply the posterior mediastinum.
 The abdominal aorta

 The abdominal aorta also consists of parietal and visceral

branches that supply the abdominal viscera.
 The visceral branches consists of
o The celiac trunk that subdivides into three branches; the left
gastric artery goes to the stomach, the splenic artery goes to
the spleen, and the hepatic artery carries oxygenated blood to
the liver.
o The superior mesenteric artery, the largest of these branches,
carries blood to most of the small intestine as well as to the
first half of the large intestine.
 The much smaller inferior mesenteric artery supplies the
second one half of the large intestine.
 The suprarenal arteries supply the adrenal(Suprarenal)
glands.
 The renal arteries, the largest in this group, carry blood
to the kidney.
 The gonadal arteries(ovarian arteries in the female and
testicular arteries in the male), Supply the sex glands
 The parietal branches consists of:-
o Inferior phrenic arteries supply the diaphragm
o Four pairs of lumber arteries supply the lumber
vertebrae, spinal cord and muscle and skin of the lumber
region of the back.
o Median sacreal arteries supply the sacrum and coccyx.
Arteries of the pelvis and lower limbs
 The abdominal aorta finally divided into two common iliac
arteries. Both of these vessels extend into the pelvis, where
each one subdivided into an internal and an external iliac
artery.
 The internal iliac vessels then send branches to the pelvic
organ, including the urinary bladder, the rectum, and some
of the reproductive organs.
 The external iliac arteries continue into the thigh as the
femoral arteries. These vessels gives off branches in the
thigh and then become the popliteal arteries, which
subdivide below the knee. The subdivisions include the
tibial arteries, fibular arteries, and dorsalis pedis, which
supply the leg and the foot.
Other sub – branches of systemic Arteries
 Hundreds of names might be included, but we shall mention
only a few. For example;-
 Each common carotid artery gives off branches to the thyroid
gland and other structures in the neck before dividing into the
external and internal carotid artery, which supplies parts of
the head.
 The hand receives blood from the subclavian artery, which
becomes the axillary in the axilla.
 The longest part of this vessel, the brachial artery, is in the
arm proper. It subdivides into two branches near the elbow;
the radial artery, which continues down the thumb side of the
forearm and wrist, and the ulnar artery, which extends along
the medial or little finger side into the hand.
Major veins of the systemic circulation
 Two terminal systemic veins, the superior and inferior
venacava, along with their other veins, drain blood and return
to the heart.
 The superior Venacava:- The superior venacava receives blood
from the regions superior to the diaphragm except from the
pulmonary circuit. It is formed by the union of the right and left
brachiocephalic veins and empties into the right atrium . It drains
the head, neck, chest and upper limbs. The largest veins of the
upper limbs are the cephalic, the basilic and the median cubital
veins.
 The inferior venacava:- The inferior venacava , which is much
longer than the superior venacava returns the blood to the heart
from all body regions below the diaphragm. It begins in the
lower abdomen the by the union of the two common iliac veins.
It then ascends along the back wall of the abdomen, receiving
venous blood draining from the pelvis, kidney and lower limbs.
Just before it penetrates the diaphragm, it is joined by the hepatic
veins, which transport blood from the liver, and then it enters the
inferior aspect of the right atruim of the heart. The saphenous
veins of the lower extremities are the longest veins of the body.
 Drainage into the inferior venacave is more complicated than
drainage into the superior venacave. The large veins below the
diaphragm may be divided into two group:-
 The right and left veins that drain paired parts and organs.
 They include the iliac veins from near the groin, four pairs of
lumber veins from the dorsal part of the trunk and from the
spinal cord, the testicular veins from the testes of the male and
the ovarian vein from the ovaries of the female, the renal and
suprarenal veins from the kidneys and adrenal glands near the
kidneys, and finally the large hepatic veins from the liver.
 For the most part, these vessels empty directly into the inferior
venacava.
 The left testicular in the male and the left ovarian in female
empty in to the left renal vein, which then take this blood to
the inferior venacava ; these veins thus constitute exceptions
to the rule that the paired veins empty directly into venacava.
 Unpaired veins that come from the spleen and from
parts of the digestive tract(stomach and intestine)and
empty into a vein called the portal vein.
 Unlike other veins, which empty into inferior venacava ,
the hepatic portal vein is part of a special system that
enable blood to circulate through the liver before
returning to the heart.
Important questions of circulatory system:-
 Draw a well label diagram of the heart and describe the function of heat.
 Explain the pulmonary and systemic circulation with diagram.
 Describe the anatomy of heart and describe the flow of blood through the heart
with well label diagram.
 Write the composition and function of blood.
 Explain the portal circulation with well label diagram.
 Explain the fetal circulation with well label diagram.
 Define blood vessels and describe the structure and function of blood vessels.
 Define blood grouping and describe types of blood.
 Define pulse and list the sites of taking pulse.
 Define blood pressure and describe the types of blood pressure.
 Discuss the mechanism of blood coagulation/ clotting
 Write short notes:-
◦ Cardiac cycle
◦ Conduction system
◦ Heart sound
◦ Different between arteries , vein , capillaries