The Cardiovascular The Cardiovascular SystemSystem

Anatomy LectureAnatomy LectureLectured by Bien Nillos, MDLectured by Bien Nillos, MD

Reference: Gray’s Anatomy and Ellis Clinical Anatomy 11Reference: Gray’s Anatomy and Ellis Clinical Anatomy 11thth edition edition

The Vascular SystemThe Vascular System

((aa) the ) the blood vascular system -blood vascular system - comprises comprises the heart and blood vessels for the the heart and blood vessels for the circulation of the blood.circulation of the blood.

((bb) the ) the lymph vascular system - lymph vascular system - consisting of lymph glands and lymphatic consisting of lymph glands and lymphatic vessels, through which a colorless fluid, vessels, through which a colorless fluid, the the lymph,lymph, circulates.  circulates.

It must be noted, however, that the two It must be noted, however, that the two systems communicate with each other and systems communicate with each other and are intimately associated developmentally. are intimately associated developmentally.

The HeartThe Heart

the central organ of the blood vascular system, and the central organ of the blood vascular system, and consists of a hollow muscle; by its contraction the consists of a hollow muscle; by its contraction the blood is pumped to all parts of the body through a blood is pumped to all parts of the body through a complicated series of tubes, termed complicated series of tubes, termed arteries arteries arterioles arterioles capillaries capillaries venules venules veins veins Back to the heartBack to the heart

The HeartThe Heart The human heart is divided by septa into The human heart is divided by septa into

right and left halves, and each half is further right and left halves, and each half is further divided into two cavities, an upper termed divided into two cavities, an upper termed the the atriumatrium and a lower the  and a lower the ventricle.ventricle.  

The heart therefore consists of four The heart therefore consists of four chambers: two, the right atrium and right chambers: two, the right atrium and right ventricle, forming the right half, and two, ventricle, forming the right half, and two, the left atrium and left ventricle the left half. the left atrium and left ventricle the left half.

The right half of the heart contains venous The right half of the heart contains venous blood; the left, arterial blood. blood; the left, arterial blood.

The Circulation SystemThe Circulation System The atria are receiving chambers, and the ventricles The atria are receiving chambers, and the ventricles

distributing ones.distributing ones. From the cavity of the left ventricle the pure blood is From the cavity of the left ventricle the pure blood is

carried into a large artery, the carried into a large artery, the aorta,aorta,  is distributed   is distributed to all parts of the body, with the exception of the to all parts of the body, with the exception of the lungs. lungs.

changed from arterial into venous blood, which is changed from arterial into venous blood, which is collected by the veins and through them returned to collected by the veins and through them returned to the right atrium of the heart. the right atrium of the heart.

From this cavity the venous blood passes into the From this cavity the venous blood passes into the right ventricle, and is conveyed through right ventricle, and is conveyed through the the pulmonary arteriespulmonary arteries to the lungs.  to the lungs.

In the capillaries of the lungs it again becomes In the capillaries of the lungs it again becomes arterialized, and is then carried to the left atrium by arterialized, and is then carried to the left atrium by the the pulmonary veins.pulmonary veins.  

From the left atrium it passes into the left ventricle, From the left atrium it passes into the left ventricle, from which the cycle once more begins. from which the cycle once more begins.

The course of the blood from the left The course of the blood from the left ventricle through the body generally ventricle through the body generally to the right side of the heart to the right side of the heart constitutes the greater or constitutes the greater or systemic systemic circulation,circulation,  

Its passage from the right ventricle Its passage from the right ventricle through the lungs to the left side of through the lungs to the left side of the heart is termed the lesser the heart is termed the lesser or or pulmonary circulation.pulmonary circulation.

Portal CirculationPortal Circulation The blood which circulates through the spleen, The blood which circulates through the spleen,

pancreas, stomach, small intestine, and the pancreas, stomach, small intestine, and the greater part of the large intestine is not greater part of the large intestine is not returned directly from these organs to the returned directly from these organs to the heart, but is conveyed by the heart, but is conveyed by the portal veinportal vein to  to the liver. the liver.

In the liver this vein divides, like an artery, and In the liver this vein divides, like an artery, and ultimately ends in capillary-like vessels ultimately ends in capillary-like vessels ((sinusoidssinusoids), from which the rootlets of a series ), from which the rootlets of a series of veins, called the of veins, called the hepatic veins,hepatic veins, arise;  arise;

these carry the blood into the inferior vena these carry the blood into the inferior vena cava, whence it is conveyed to the right atrium cava, whence it is conveyed to the right atrium

The blood in the portal vein carries The blood in the portal vein carries certain of the products of digestion: certain of the products of digestion: the carbohydrates, which are mostly the carbohydrates, which are mostly taken up by the liver cells and stored taken up by the liver cells and stored as glycogen, and the protein as glycogen, and the protein products which remain in solution products which remain in solution and are carried into the general and are carried into the general circulation to the various tissues and circulation to the various tissues and organs of the body. organs of the body.

The heart is irregularly conical in shape, and it The heart is irregularly conical in shape, and it is placed obliquely in the middle mediastinum. is placed obliquely in the middle mediastinum.

Viewed from the front, portions of all the heart Viewed from the front, portions of all the heart chambers can be seen. The right border is chambers can be seen. The right border is formed entirely by the right atrium, the left formed entirely by the right atrium, the left border partly by the auricular appendage of the border partly by the auricular appendage of the left atrium but mainly by the left ventricle, and left atrium but mainly by the left ventricle, and the inferior border chiefly by the right ventricle the inferior border chiefly by the right ventricle but also by the lower part of the right atrium but also by the lower part of the right atrium and the apex of the left ventricle.and the apex of the left ventricle.

Anterior Surface – Right Ventricle and Anterior Surface – Right Ventricle and Right AtriumRight Atrium

Diaphragmatic Surface – Right and Diaphragmatic Surface – Right and Left VentriclesLeft Ventricles

Posterior Surface – Left Atrium and, Posterior Surface – Left Atrium and, to a lesser extent, the Right Atriumto a lesser extent, the Right Atrium

The Chambers of the HeartThe Chambers of the Heart

The Right AtriumThe Right Atrium– receives the superior vena cava in its upper and receives the superior vena cava in its upper and

posterior part, the inferior vena cava and coronary posterior part, the inferior vena cava and coronary sinus in its lower part, and the anterior cardiac sinus in its lower part, and the anterior cardiac vein (draining much of the front of the heart) vein (draining much of the front of the heart) anteriorly.anteriorly.

– The openings of the inferior vena cava and the The openings of the inferior vena cava and the coronary sinus are guarded by rudimentary valves; coronary sinus are guarded by rudimentary valves; that of the inferior vena cava being continuous that of the inferior vena cava being continuous with the annulus ovalis around the shallow with the annulus ovalis around the shallow depression on the atrial septum, the fossa ovalis, depression on the atrial septum, the fossa ovalis, which marks the site of the fetal foramen ovale.which marks the site of the fetal foramen ovale.

Right VentricleRight Ventricle– joined to the right atrium by the way of joined to the right atrium by the way of

the vertically disposed the vertically disposed tricuspid valvetricuspid valve, , and with the pulmonary trunk through and with the pulmonary trunk through the the pulmonary valvepulmonary valve. .

– A muscular ridge, the A muscular ridge, the infundibuloventricular crest, between infundibuloventricular crest, between the atrioventricular and pulmonary the atrioventricular and pulmonary orifices, separates the ‘inflow’ and orifices, separates the ‘inflow’ and ‘outflow’ tracts of the ventricle. ‘outflow’ tracts of the ventricle.

– The outflow tract of the ventricle or infundibulum is The outflow tract of the ventricle or infundibulum is smooth-walled and is directed upwards and to the smooth-walled and is directed upwards and to the right towards the pulmonary trunk. right towards the pulmonary trunk.

– The pulmonary orifice is guarded by the pulmonary The pulmonary orifice is guarded by the pulmonary valves, comprising three semilunar cuspsvalves, comprising three semilunar cusps

Left AtriumLeft Atrium– rather smaller than the right but has somewhat rather smaller than the right but has somewhat

thicker walls. thicker walls. – On the upper part of its posterior wall it On the upper part of its posterior wall it

presents the openings of the four pulmonary presents the openings of the four pulmonary veins and on its septal surface there is a veins and on its septal surface there is a shallow depression corresponding to the fossa shallow depression corresponding to the fossa ovalis of the right atrium. ovalis of the right atrium.

– As on the right side, the main part of the cavity As on the right side, the main part of the cavity is smooth-walled but the surface of the auricle is smooth-walled but the surface of the auricle is marked by a number of ridges due to the is marked by a number of ridges due to the underlying pectinate muscles.underlying pectinate muscles.

The Left VentricleThe Left Ventricle– communicates with the left atrium by way communicates with the left atrium by way

of the mitral valve which possesses a large of the mitral valve which possesses a large anterior and a smaller posterior cusp anterior and a smaller posterior cusp attached to papillary muscles by chordae attached to papillary muscles by chordae tendineae. tendineae.

– the wall of the left ventricle is marked by the wall of the left ventricle is marked by thick trabeculae carneae.thick trabeculae carneae.

– The aortic orifice is guarded by the three The aortic orifice is guarded by the three semilunar cusps of the aortic valve, semilunar cusps of the aortic valve, immediately above which are the dilated immediately above which are the dilated aortic sinuses. aortic sinuses.

– The mouths of the right and left coronary The mouths of the right and left coronary arteries are seen in the anterior and left arteries are seen in the anterior and left posterior sinus respectively.posterior sinus respectively.

Blood Supply to the HeartBlood Supply to the Heart

derived from the right and left coronary derived from the right and left coronary arteries whose main branches lie in the arteries whose main branches lie in the interventricular and atrioventricular groovesinterventricular and atrioventricular grooves

Right Coronary ArteryRight Coronary Artery Arises from the anterior aortic sinus and Arises from the anterior aortic sinus and

passes forwards between the pulmonary passes forwards between the pulmonary trunk and the right atrium to descend in trunk and the right atrium to descend in the right part of the atrioventricular groove. the right part of the atrioventricular groove.

At the inferior border of the heart it At the inferior border of the heart it continues along the atrioventricular groove continues along the atrioventricular groove to anastomose with the left coronary at the to anastomose with the left coronary at the posterior interventricular groove. posterior interventricular groove.

It gives off a It gives off a marginal branchmarginal branch along the along the lower border of the heart and the lower border of the heart and the posterior interventricular branchposterior interventricular branch which which runs forward in the inferior interventricular runs forward in the inferior interventricular groove and to anastomose near the apex of groove and to anastomose near the apex of the heart with the corresponding branch of the heart with the corresponding branch of the left coronary artery.the left coronary artery.

Left Coronary ArteryLeft Coronary Artery is larger than the right, rises from the left is larger than the right, rises from the left

posterior aortic sinus. Passing first behind posterior aortic sinus. Passing first behind and then to the left of the pulmonary trunk, and then to the left of the pulmonary trunk, it reaches the left part of atrioventricular it reaches the left part of atrioventricular groove in which it runs laterally round the groove in which it runs laterally round the left border of the heart as the left border of the heart as the circumflex circumflex arteryartery to reach the posterior interatrial to reach the posterior interatrial groove. groove.

Its most important branch - Its most important branch - anterior anterior interventricular arteryinterventricular artery = supplies the = supplies the anterior aspect of both ventricles, passes anterior aspect of both ventricles, passes around the apex of the heart to anastomose around the apex of the heart to anastomose with the posterior interventricular branch of with the posterior interventricular branch of the right coronary. the right coronary.

Venous Drainage of the Venous Drainage of the HeartHeart

The bulk of the venous drainage of the heart The bulk of the venous drainage of the heart is achieved by veins which accompany the is achieved by veins which accompany the coronary arteries and which open into the coronary arteries and which open into the right atrium. The rest of the blood drains by right atrium. The rest of the blood drains by means of small veins (venae cordis means of small veins (venae cordis minimae) directly into the cardiac cavity.minimae) directly into the cardiac cavity.

The coronary sinus lies in the posterior The coronary sinus lies in the posterior atrioventricular groove and opens into the atrioventricular groove and opens into the right atrium just to the left of the mouth of right atrium just to the left of the mouth of the inferior vena cava.the inferior vena cava.

Coronary SinusCoronary Sinus

It receives:It receives:1.1. the great cardiac vein in the anterior the great cardiac vein in the anterior

interventricular groove;interventricular groove;2.2. the middle cardiac vein the inferior the middle cardiac vein the inferior

interventricular grooveinterventricular groove3.3. the small cardiac vein — accompanying the small cardiac vein — accompanying

the marginal artery along the lower the marginal artery along the lower border of the heart;border of the heart;

4.4. the oblique vein— descends obliquely on the oblique vein— descends obliquely on the posterior aspect of the left atrium.the posterior aspect of the left atrium.

The Nerve Supply of the The Nerve Supply of the HeartHeart

The nerve supply of the heart is The nerve supply of the heart is derived from the vagus (cardio-derived from the vagus (cardio-inhibitor) and the cervical and upper inhibitor) and the cervical and upper 5 thoracic sympathetic ganglia 5 thoracic sympathetic ganglia (cardioaccelerator) by way of (cardioaccelerator) by way of superficial and deep cardiac superficial and deep cardiac plexuses.plexuses.

Surface Anatomy of the Surface Anatomy of the HeartHeart

1.1. the 2nd left costal cartilage 0.5in the 2nd left costal cartilage 0.5in (12mm) from the edge of the (12mm) from the edge of the sternum;sternum;

2.2. the 3rd right costal cartilage 0.5in the 3rd right costal cartilage 0.5in (12mm) from the sternal edge;(12mm) from the sternal edge;

3.3. the 6th right costal cartilage 0.5in the 6th right costal cartilage 0.5in (12mm) from the sternum; (12mm) from the sternum;

4.4. the 5th left intercostal space 3.5in the 5th left intercostal space 3.5in (9cm) from the midline (9cm) from the midline (corresponding to the apex beat).(corresponding to the apex beat).

The The left borderleft border of the heart (indicated by of the heart (indicated by the curved line joining points 1 and 4) is the curved line joining points 1 and 4) is formed almost entirely by the left ventricle formed almost entirely by the left ventricle (the auricular appendage of the left atrium (the auricular appendage of the left atrium peeping around this border superiorly)peeping around this border superiorly)

The The lower borderlower border (the horizontal line joining (the horizontal line joining points 3 and 4) corresponds to the right points 3 and 4) corresponds to the right ventricle and the apical part of the left ventricle and the apical part of the left ventricle.ventricle.

the the right borderright border (marked by the line joining (marked by the line joining points 2 and 3) is formed by the right atriumpoints 2 and 3) is formed by the right atrium

End of Part OneEnd of Part One““The heart has reasons that reason The heart has reasons that reason

does not understand.” - Jacques does not understand.” - Jacques Benigne Bossuel  Benigne Bossuel 

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No. 10

Start of Part TwoStart of Part TwoThe Cardiovascular SystemThe Cardiovascular System

(Hingagaw Session)(Hingagaw Session)

““THE DISTRIBUTION of the systematic arteries is like a THE DISTRIBUTION of the systematic arteries is like a highly ramified tree, the common trunk of which, highly ramified tree, the common trunk of which, formed by the aorta, commences at the left ventricle, formed by the aorta, commences at the left ventricle, while the smallest ramifications extend to the while the smallest ramifications extend to the peripheral parts of the body and the contained peripheral parts of the body and the contained organs.” – Henri Grayorgans.” – Henri Gray

  The arteries, in their distribution, The arteries, in their distribution, communicate with one another, communicate with one another, forming what are called forming what are called anastomosesanastomoses,, and these  and these communications are very free communications are very free between the large as well as between the large as well as between the smaller branches. between the smaller branches.

The AortaThe Aorta the main trunk of a series of the main trunk of a series of

vessels which convey the vessels which convey the oxygenated blood to the tissues oxygenated blood to the tissues of the body for their nutrition. of the body for their nutrition.

begins at the upper part of the begins at the upper part of the left ventricleleft ventricle

after ascending for a short after ascending for a short distance, arches backward and distance, arches backward and to the left sideto the left side

descends within the thorax on descends within the thorax on the left side of the vertebral the left side of the vertebral columncolumn

passes into the abdominal cavity passes into the abdominal cavity through the aortic hiatus in the through the aortic hiatus in the diaphragm, diaphragm,

ends opposite the lower border ends opposite the lower border of the fourth lumbar vertebra, by of the fourth lumbar vertebra, by dividing into the right and left dividing into the right and left common iliac arteries.  common iliac arteries. 

Parts of the AortaParts of the Aorta

ascending aortaascending aorta   arch of the aortaarch of the aorta   descending aortadescending aorta  

– thoracicthoracic  – abdominal aortaabdominal aorta

Ascending AortaAscending Aorta

Branches.Branches.—The only branches of —The only branches of the ascending aorta are the two the ascending aorta are the two coronary arteries which supply the coronary arteries which supply the heart; they arise near the heart; they arise near the commencement of the aorta commencement of the aorta immediately above the attached immediately above the attached margins of the semilunar valves. margins of the semilunar valves.

Arch of the AortaArch of the Aorta

The branches given off from the arch The branches given off from the arch of the aorta are three in number: of the aorta are three in number: the the innominate innominate (brachiocephalic),(brachiocephalic), the  the left left common carotid,common carotid, and the  and the left left subclavian.subclavian.

The The innominate arteryinnominate artery is the largest  is the largest branch of the arch of the aortabranch of the arch of the aorta

It divides into the It divides into the right common right common carotidcarotid and and right subclavian right subclavian arteriesarteries. .

occasionally a small branch, occasionally a small branch, the the thyreoidea imathyreoidea ima,, arises from it.  arises from it.

sometimes it gives off sometimes it gives off a a thymicthymic or  or bronchial branch.bronchial branch.

The innominate artery sometimes The innominate artery sometimes divides above the level of the divides above the level of the sternoclavicular joint, less frequently sternoclavicular joint, less frequently below it. below it.

When the aortic arch is on the right When the aortic arch is on the right side, the innominate is directed to side, the innominate is directed to the left side of the neck. the left side of the neck.

The Common CarotidsThe Common Carotids

The principal arteries of supply to the The principal arteries of supply to the head and neck head and neck

each divides into two branches:each divides into two branches:(1) the (1) the external carotid,external carotid, supplying  supplying

the exterior of the head, the face, the exterior of the head, the face, and the greater part of the neckand the greater part of the neck

(2) the (2) the internal carotid, internal carotid, supplying to supplying to a great extent the parts within the a great extent the parts within the cranial and orbital cavities. cranial and orbital cavities.

The The rightright begins at the bifurcation of  begins at the bifurcation of the innominate artery behind the the innominate artery behind the sternoclavicular joint and is confined sternoclavicular joint and is confined to the neck. to the neck.

The The leftleft springs from the  springs from the highest highest partpart of the arch of the aorta to the of the arch of the aorta to the left of, and on a plane posterior to left of, and on a plane posterior to the innominate artery, and therefore the innominate artery, and therefore consists of a thoracic and a cervical consists of a thoracic and a cervical portion. portion.

The common carotid usually gives off The common carotid usually gives off no branch previous to its bifurcation, no branch previous to its bifurcation, but it occasionally gives origin to the but it occasionally gives origin to the superior thyroid or its laryngeal superior thyroid or its laryngeal branch, the ascending pharyngeal, branch, the ascending pharyngeal, the inferior thyroid, or, more rarely, the inferior thyroid, or, more rarely, the vertebral artery. the vertebral artery.

The External Carotid ArteryThe External Carotid Artery

begins opposite the upper border of begins opposite the upper border of the thyroid cartilage, and, taking a the thyroid cartilage, and, taking a slightly curved course, passes slightly curved course, passes upward and forward, and then upward and forward, and then inclines backward to the space inclines backward to the space behind the neck of the mandiblebehind the neck of the mandible

it divides into the it divides into the superficial superficial temporaltemporal and and internal maxillaryinternal maxillary arteries arteries

Branches of the External Branches of the External CarotidCarotid

Anterior Group: Superior Thyroid, Anterior Group: Superior Thyroid, Lingual, External MaxillaryLingual, External Maxillary

Posterior Group: Occipital, Posterior Posterior Group: Occipital, Posterior AuricularAuricular

Ascending Group: Ascending Ascending Group: Ascending PharyngealPharyngeal

Terminal GroupTerminal Group* * : Superficial : Superficial Temporal, Internal Maxillary Temporal, Internal Maxillary

Internal Carotid ArteryInternal Carotid Artery

supplies the anterior part of the supplies the anterior part of the brain, the eye and its appendages, brain, the eye and its appendages, and sends branches to the forehead and sends branches to the forehead and nose. and nose.

Its size, in the adult, is equal to that Its size, in the adult, is equal to that of the external carotid, though, in the of the external carotid, though, in the child, it is larger than that vessel.  child, it is larger than that vessel. 

In considering the course and In considering the course and relations of this vessel it may be relations of this vessel it may be divided into four portions: divided into four portions: – cervical - cervical - The cervical portion of the The cervical portion of the

internal carotid gives off no branches. internal carotid gives off no branches. – petrouspetrous– Cavernous - Cavernous - Ophthalmic. Ophthalmic. – cerebralcerebral - Anterior Cerebral, Middle - Anterior Cerebral, Middle

Cerebral, Posterior Communicating.Cerebral, Posterior Communicating.

Circle of WillisCircle of Willis The cerebral arteries are derived from the The cerebral arteries are derived from the

internal carotid and vertebral, which at the internal carotid and vertebral, which at the base of the brain form a remarkable base of the brain form a remarkable anastomosis anastomosis

formed in front by the formed in front by the anterior cerebralanterior cerebral arteries, branches of the internal carotid, arteries, branches of the internal carotid, which are connected together by the which are connected together by the anterior communicatinganterior communicating; behind by the ; behind by the two two posterior cerebral arteriesposterior cerebral arteries, branches , branches of the of the basilarbasilar, which are connected on , which are connected on either side with the internal carotid by the either side with the internal carotid by the posterior communicatingposterior communicating

The Subclavian ArteriesThe Subclavian Arteries The artery which supplies the upper The artery which supplies the upper

extremity continues as a single trunk from extremity continues as a single trunk from its commencement down to the elbow its commencement down to the elbow

That part of the vessel which extends from its That part of the vessel which extends from its origin to the outer border of the first rib is origin to the outer border of the first rib is termed the termed the subclaviansubclavian;;  

beyond this point to the lower border of the axilla beyond this point to the lower border of the axilla it is named theit is named the  axillaryaxillary;;  

and from the lower margin of the axillary space and from the lower margin of the axillary space to the bend of the elbow it is termedto the bend of the elbow it is termed  brachialbrachial;;  

here the trunk ends by dividing into two here the trunk ends by dividing into two branches: branches: the the radialradial and  and ulnarulnar..

branches of the branches of the subclavian artery are:subclavian artery are:– Vertebral*Vertebral*– Internal mammary Internal mammary

(thoracic)(thoracic)– ThyrocervicalThyrocervical– Costocervical.Costocervical.

*union forms Basilar *union forms Basilar ArteryArtery

Basilar ArteryBasilar Artery

named from its position at the base of named from its position at the base of the skull, is a single trunk formed by the the skull, is a single trunk formed by the junction of the two vertebral arteriesjunction of the two vertebral arteries

It ends by dividing into the two posterior It ends by dividing into the two posterior cerebral arteries. cerebral arteries.

Branches: Pontine, Anterior Inferior Branches: Pontine, Anterior Inferior Cerebellar, Internal Auditory, Superior Cerebellar, Internal Auditory, Superior Cerebellar, Posterior Cerebral.Cerebellar, Posterior Cerebral.

The Axillary ArteryThe Axillary Artery

the continuation of the subclavian, the continuation of the subclavian, commences at the outer border of commences at the outer border of the first rib, and ends at the lower the first rib, and ends at the lower border of the tendon of the border of the tendon of the Teres Teres majormajor, where it takes the name of , where it takes the name of brachial. brachial.

3 portions3 portions

first portionfirst portion of the axillary artery is  of the axillary artery is covered covered anteriorlyanteriorly by the clavicular  by the clavicular portion of the Pectoralis major and the portion of the Pectoralis major and the coracoclavicular fascia, and is crossed by coracoclavicular fascia, and is crossed by the lateral anterior thoracic nerve the lateral anterior thoracic nerve

second portionsecond portion of the axillary artery is  of the axillary artery is covered, covered, anteriorly,anteriorly, by the Pectorales  by the Pectorales major and minor; major and minor;

third portionthird portion of the axillary artery  of the axillary artery extends from the lower border of the extends from the lower border of the Pectoralis minor to the lower border of the Pectoralis minor to the lower border of the tendon of the Teres major. tendon of the Teres major.

Branches of the Axillary Branches of the Axillary ArteryArtery

FirstFirst Portion : Highest Thoracic Portion : Highest Thoracic ArteryArtery

SecondSecond Portion : Thoracoacromial, Portion : Thoracoacromial, Lateral ThoracicLateral Thoracic

ThirdThird Portion : Subscapular, Portion : Subscapular, Posterior Humeral Circumflex, Posterior Humeral Circumflex, Anterior Humeral Circumflex.Anterior Humeral Circumflex.

Brachial ArteryBrachial Artery

commences at the lower margin of the commences at the lower margin of the tendon of the Teres major, and, passing tendon of the Teres major, and, passing down the arm, ends about 1 cm. below the down the arm, ends about 1 cm. below the bend of the elbow, where it divides into bend of the elbow, where it divides into the the radialradial and  and ulnar* arteries.ulnar* arteries.

At first the brachial artery lies medial to At first the brachial artery lies medial to the humerus; but as it runs down the arm the humerus; but as it runs down the arm it gradually gets in front of the bone, and it gradually gets in front of the bone, and at the bend of the elbow it lies midway at the bend of the elbow it lies midway between its two epicondyles. between its two epicondyles.

* Ulnar is larger than the radial artery* Ulnar is larger than the radial artery

Branches of the Brachial Branches of the Brachial ArteryArtery

Profunda Brachii Profunda Brachii Superior Ulnar CollateralSuperior Ulnar Collateral NutrientNutrient Inferior Ulnar CollateralInferior Ulnar Collateral MuscularMuscular

Descending AortaDescending Aorta

Two parts: Two parts: Thoracic part and Thoracic part and Abdominal partAbdominal part

Remember at what level Remember at what level the aorta pierces through the aorta pierces through the diaphragmthe diaphragm

Thoracic AortaThoracic Aorta

contained in the posterior mediastinal contained in the posterior mediastinal cavity. cavity.

begins at the lower border of the T4 begins at the lower border of the T4 where it is continuous with the aortic where it is continuous with the aortic arch, and ends in front of the lower arch, and ends in front of the lower border of T12 at the aortic hiatus in border of T12 at the aortic hiatus in the diaphragmthe diaphragm

Branch groups: Visceral group and Branch groups: Visceral group and Parietal Group Parietal Group

Visceral Branches: Pericardial, Visceral Branches: Pericardial, Bronchial, Esophageal, MediastinalBronchial, Esophageal, Mediastinal

Parietal Branches: Intercostal, Parietal Branches: Intercostal, Subcostal, Superior PhrenicSubcostal, Superior Phrenic

A small A small aberrant arteryaberrant artery is sometimes found arising from  is sometimes found arising from the right side of the thoracic aorta near the origin of the the right side of the thoracic aorta near the origin of the right bronchial.  right bronchial. 

The Abdominal AortaThe Abdominal Aorta

begins at the aortic hiatus of the begins at the aortic hiatus of the diaphragm, in front of the lower diaphragm, in front of the lower border of the body of the last border of the body of the last thoracic vertebra, and, descending in thoracic vertebra, and, descending in front of the vertebral column, ends front of the vertebral column, ends on the body of the fourth lumbar on the body of the fourth lumbar vertebra, by dividing into the two vertebra, by dividing into the two common iliac arteries. common iliac arteries.

Visceral BranchesVisceral Branches

CeliacCeliac Superior Superior

MesentericMesenteric Inferior Inferior

MesentericMesenteric Middle Middle

SuprarenalsSuprarenals RenalsRenals Internal Internal

SpermaticSpermatic OvarianOvarian

Parietal BranchesParietal Branches

Inferior PhrenicsInferior Phrenics LumbarLumbar Middle SacralMiddle Sacral

* Terminal branches – Left and Right * Terminal branches – Left and Right Common Iliac ArteriesCommon Iliac Arteries

Celiac ArteryCeliac Artery

a short thick trunk, about 1.25 cm. in a short thick trunk, about 1.25 cm. in length, which length, which arisesarises from the front of  from the front of the aorta, just below the aortic hiatus the aorta, just below the aortic hiatus of the diaphragm, and, passing nearly of the diaphragm, and, passing nearly horizontally forward, divides into three horizontally forward, divides into three large branches:large branches:

left gastric,left gastric, the  the hepatic,hepatic, and  and the the splenicsplenic

Left Gastric ArteryLeft Gastric Artery   smallest of the three branches of the celiac smallest of the three branches of the celiac

artery artery distributes branches to the esophagus; distributes branches to the esophagus; others supply the cardiac part of the stomachothers supply the cardiac part of the stomach It then runs from left to right, along the lesser It then runs from left to right, along the lesser

curvature of the stomach to the pylorus, curvature of the stomach to the pylorus, between the layers of the lesser omentum; between the layers of the lesser omentum;

it gives branches to both surfaces of the it gives branches to both surfaces of the stomach and anastomoses with the right stomach and anastomoses with the right gastric artery. gastric artery.

Hepatic ArteryHepatic Artery

in the fetus, it is the largest of the in the fetus, it is the largest of the three branches of the celiac artery.  three branches of the celiac artery. 

divides into two branches, right and divides into two branches, right and left.left.

Branches: Branches: – Right GastricRight Gastric– Gastroduodenal - Gastroduodenal - right gastroepiploicright gastroepiploic and  and

the the superior pancreaticoduodenal.superior pancreaticoduodenal.   – CysticCystic

Splenic Artery (Lienal)Splenic Artery (Lienal)

the largest branch of the celiac the largest branch of the celiac artery artery

Branches: Branches: – PancreaticPancreatic– Short Gastric.Short Gastric.– Left Gastroepiploic.Left Gastroepiploic.

Common Iliac ArteriesCommon Iliac Arteries

They diverge from the termination of They diverge from the termination of the aorta, pass downward and the aorta, pass downward and lateralward, and divide, opposite the lateralward, and divide, opposite the intervertebral fibrocartilage between intervertebral fibrocartilage between the last lumbar vertebra and the the last lumbar vertebra and the sacrum, into two branches, sacrum, into two branches, the the external external iliac*iliac* and  and hypogastric arterieshypogastric arteries *external iliac artery is larger than the hypogastric artery*external iliac artery is larger than the hypogastric artery

External Iliac ArteryExternal Iliac Artery

passes obliquely downward and passes obliquely downward and lateralward along the medial border of lateralward along the medial border of the Psoas major, from the bifurcation the Psoas major, from the bifurcation of the common iliac to a point of the common iliac to a point beneath the inguinal ligament, beneath the inguinal ligament, midway between the anterior superior midway between the anterior superior spine of the ilium and the symphysis spine of the ilium and the symphysis pubis, where it enters the thigh and pubis, where it enters the thigh and becomes the becomes the femoral arteryfemoral artery. .

Branches:Branches:– Inferior Inferior

epigastricepigastric– Deep iliac Deep iliac

circumflecircumflexx

Femoral ArteryFemoral Artery

begins immediately behind the begins immediately behind the inguinal ligament, midway between inguinal ligament, midway between the ASIS and the symphysis pubis, the ASIS and the symphysis pubis, and passes down the front and and passes down the front and medial side of the thigh. medial side of the thigh.

It ends at the junction of the middle It ends at the junction of the middle with the lower third of the thigh, with the lower third of the thigh, where it passes through an opening where it passes through an opening in the in the Adductor magnusAdductor magnus to become to become the the popliteal arterypopliteal artery. .

The first 4 cm. of the vessel is enclosed, The first 4 cm. of the vessel is enclosed, together with the femoral vein, in a together with the femoral vein, in a fibrous sheath—thefibrous sheath—thefemoral sheath.femoral sheath.  

In the upper third of the thigh the In the upper third of the thigh the femoral artery is contained in femoral artery is contained in the the femoral trianglefemoral triangle ( (Scarpa’s Scarpa’s triangletriangle), and in the middle third of the ), and in the middle third of the thigh, in the thigh, in the adductor canal adductor canal ((Hunter’s Hunter’s canalcanal). ).

Femoral Femoral TriangleTriangle

  Its apex is directed Its apex is directed downward, and the downward, and the sides are formed sides are formed laterally by the laterally by the medial margin of medial margin of the Sartorius, the Sartorius, medially by the medially by the medial margin of medial margin of the Adductor longus, the Adductor longus, and above by the and above by the inguinal ligament. inguinal ligament.

Hunter’s CanalHunter’s Canal an aponeurotic tunnel an aponeurotic tunnel

in the middle third of in the middle third of the thigh, extending the thigh, extending from the apex of the from the apex of the femoral triangle to the femoral triangle to the opening in the opening in the Adductor magnus. It is Adductor magnus. It is bounded, in front and bounded, in front and laterally, by the Vastus laterally, by the Vastus medialis; behind by medialis; behind by the Adductores longus the Adductores longus and magnus and magnus

Branches of the Femoral Branches of the Femoral ArteryArtery

Superficial EpigastricSuperficial Epigastric Deep External PudendalDeep External Pudendal Superficial Iliac CircumflexSuperficial Iliac Circumflex MuscularMuscular Superficial External Pudendal.Superficial External Pudendal. Profunda Femoris.Profunda Femoris. Highest Genicular.Highest Genicular.

Popliteal ArteryPopliteal Artery

  the continuation of the femoral, and the continuation of the femoral, and courses through the courses through the popliteal fossapopliteal fossa..

It extends from the opening in the It extends from the opening in the Adductor magnus, at the junction of the Adductor magnus, at the junction of the middle and lower thirds of the thigh, middle and lower thirds of the thigh, downward and lateralward to the downward and lateralward to the intercondyloid fossa of the femur, and intercondyloid fossa of the femur, and then vertically downward to the lower then vertically downward to the lower border of the Popliteusborder of the Popliteus

divides into divides into anterioranterior and  and posterior tibial posterior tibial arteries.arteries.

Popliteal FossaPopliteal Fossa lozenge-shaped space, lozenge-shaped space,

at the back of the at the back of the knee-joint. Laterally it knee-joint. Laterally it is bounded by the is bounded by the Biceps femoris above, Biceps femoris above, and by the Plantaris and by the Plantaris and the lateral head of and the lateral head of the Gastrocnemius the Gastrocnemius below; medially it is below; medially it is limited by the limited by the Semitendinous and Semitendinous and Semimembranosus Semimembranosus above, and by the above, and by the medial head of the medial head of the Gastrocnemius below. Gastrocnemius below.

Anterior Tibial ArteryAnterior Tibial Artery

commences at the bifurcation of the commences at the bifurcation of the popliteal, at the lower border of the popliteal, at the lower border of the Popliteus, passes forward between the two Popliteus, passes forward between the two heads of the Tibialis posterior, and through heads of the Tibialis posterior, and through the aperture above the upper border of the aperture above the upper border of the interosseous membrane, to the deep the interosseous membrane, to the deep part of the front of the leg: it here lies part of the front of the leg: it here lies close to the medial side of the neck of the close to the medial side of the neck of the fibula. fibula.

becomes the becomes the dorsalis pedis.dorsalis pedis.

Posterior Tibial ArteryPosterior Tibial Artery

divides beneath the origin of the divides beneath the origin of the Adductor hallucis into Adductor hallucis into the the medialmedial and  and lateral plantar lateral plantar arteries.arteries.    

Lateral Lateral is much larger than the is much larger than the medialmedial plantar artery. plantar artery.

Take HomeTake Home

Study the Major Veins of the Neck, Study the Major Veins of the Neck, Thorax, Abdomen, Upper and Lower Thorax, Abdomen, Upper and Lower Extremity and trace their tributariesExtremity and trace their tributaries

Study the difference between an Study the difference between an artery and a vein.artery and a vein.

Group PaperGroup Paper Group 1: Atherosclerosis, Arteriosclerosis: Group 1: Atherosclerosis, Arteriosclerosis:

Causes, how they develop, Symptoms and Causes, how they develop, Symptoms and how they are diagnosed and treatedhow they are diagnosed and treated

Group 2: Varicose Veins: Causes, how they Group 2: Varicose Veins: Causes, how they develop, treatment.develop, treatment.

Group 3: The Fetal Circulation. Trace the Group 3: The Fetal Circulation. Trace the circulation of blood inside a Fetus, take note circulation of blood inside a Fetus, take note the differences in an adult circulationthe differences in an adult circulation

Group 4: Different Problems of Heart Group 4: Different Problems of Heart Valves. How are they different from each Valves. How are they different from each other. Causes. Treatment?other. Causes. Treatment?

Group 5: Blood and Blood Components. Group 5: Blood and Blood Components.

““I do not hold the key to our liberation, I do not know I do not hold the key to our liberation, I do not know all the solutions to our many problems. All I know is all the solutions to our many problems. All I know is

that if the situation continues in the Philippines, then that if the situation continues in the Philippines, then blood will flow, and when blood flows, there will be no blood will flow, and when blood flows, there will be no victor and there will be no vanquished because all of victor and there will be no vanquished because all of

us will be a victim of our folly” – Ninoy Aquinous will be a victim of our folly” – Ninoy Aquino