PART

Ⅲ
Circulatory
system
Department of Human Anatomy,
Medical School of Nantong University
Xinhua Zhang
 Introduction
Cardiovascular system

Circulatory system
Lymphatic system

Function:
transporting materials needed by cells
Remove waste materials from cells
Cardiovascular
System
Heart
Atria
ventricles

Large artery (elastic

artery)
Arteries Medium-sized artery
(muscular artery)
Arterioles

CapillarieExchange matter
s Tributaries

Veins
 Circuit
Pulmonary circulation
right atrium right
ventricle left atrium

Systemic circulation
left atrium left
ventricle right atrium
 Vascular Anastomoses

Arterial
Anastomoses

Arterial networks

Arterial arches

Arterial circle
 Vascular Anastomoses

Venous
Anastomoses

Venous plexuse


Venous network

 Vascular Anastomoses

Arteriovenous
Anastomoses

Arterioles communicate directly with venules

In the skin of the terminal phalanges, lips, nose and in the nail bed
It’s funtion is regulating the local blood flow
 Vascular Anastomoses

Collateral Anastomoses
Collateral circulation
The Heart
Position
 Lies within the pericardium
in middle mediastinum
between the pleurae and
lungs.
 Behind the body of sternum
and coastal cartilages 2 to 6
 In front of thoracic vertebra
4 to 8
 Rests upon the diaphragm,
large blood vessels enter or
leave its upper extremity
 A third of it lies to the right
of median plan and 2/3 to
the left
Position
 Lies within the pericardium
in middle mediastinum
between the pleurae and
lungs.
 Behind the body of sternum
and coastal cartilages 2 to 6
 In front of thoracic vertebra
4 to 8
 Rests upon the diaphragm,
large blood vessels enter or
leave its upper extremity
 A third of it lies to the right
of median plan and 2/3 to
the left
External Features
hollow muscular organ, conical or
pyramidal in shape , about the
size of a closed fist; consists of
four chambers (right and left
atria, right and left ventricles)
an apex, a base, three surfaces,
three borders, five grooves
 Cardiac apex is formed by left
ventricle and is directed
downwards and forwards to the
left. It lies at the level of the left
fifth intercostal space, 1~2cm
medial to the left midclavicular
line (9cm from the midline).
 Cardiac base is formed mainly
by the left atrium and to a small
extent by the right atrium. It faces
backward, upward and to the
right, pulmonary veins open into
the left atrium, superior and
inferior venae cavae open into
the right atrium
Three surfaces
 Sternocostal surface (anterior
surface) is formed mainly by
the right atrium and right ventricle,
and a lesser portion of its left is
formed by the left auricle and
ventricle. It faces forward and
upward
large part is covered by pleura
and the anterior edges of the
lungs
small part is separated from the
lower part of sternum and the left
fourth to sixth costal cartilages by
the pericardium
intracardiac injection performed at
the left 4 intercostal space near
sternum to avoid the damage of
the pleura and lung
pulmonary trunk and ascending
aorta arise from the upper part of
it
Three surfaces

 Diaphragmatic surface
(inferior surface)
faces the diaphragm
2/3 is maded up by the left
ventricle and 1/3 by the
right ventricle
it is largely horizontal,
sloping down and forwards
a little towards the apex
 Three surfaces

 left surface
consists mainly of the left
ventricle, a small part of the
left atrium
faces up, back and to the
left
Three borders
 Left border － round, separates
the sternocostal and left
surfaces, is mainly formed by
the left ventricle and partly by
the left auricle, descends from
the left auricle to the cardiac
apex.
 Right border － vertical,
separates the sternocostal
surface and cardiac base, is
formed entirely by right atrium
 Inferior border － sharp and
nearly horizontal, separates the
sternocostal and diaphragmatic
surfaces, is formed by the right
ventricle and partly by the left
ventricle near the apex
Five grooves
 Coronary sulcus (atrioventricular
groove) which marks the division
between atria and ventricles, contains
the trunks of the coronary vessels and
completely encircles the heart.
 Anterior interventricular groove
seen on sternocostal surface, is almost
paralled to the left border, descends from
the coronary groove to the cardiac apical
incisure, 2cm to right of apex
 posterior interventricular groove
seen on diaphragmatic surface, extends
from coronary groove to the cardiac
apical incisure

corresponding to the interventricular

septum, two interventricular grooves
separate left and right ventricles

contain blood vessels and adipose tissue

 Five grooves
 Interatrial groove
is verticle and right ro orifices of the
right pulmonary veins, hidden by
pulmonary trunk and aorta in front,
separates the two atria, corresponds
to the interatial septum
 Sulcus terminalis
is shallow and verticle, extending
between the right sides of openings
of the superior and inferior venae
cavae
Atrioventricular crux
a point of junction of the posterior
interventricular groove and coronary
groove , interatrial groove. Internally,
the interatrial septum joins the
interventricular septum. at the crux,
the middle and small cardiac veins
join the coronary sinus
 Chambers of the heart
Right atrium (RA)
Sinus venarum cavarum
Atrium proper
separated externally by sulcus
terminalis and internally by the crista
terminalis
 Crista terminalis
smooth, muscular vertical ridge
passing anterior to the orifice of the
superior vena cave to right side of the
orifice of inferior vena cava,
corresponds externally to sulcus
terminalis
 Sulcus terminalis
groove on exterior of heart that
corresponds to crista terminalis
 Sinus venarum cavarum
 Lies posterior to the atrium proper
 Smooth walls

 Three inlets
 Orifice of superior vena cava
returns blood to the heart from the upper
half of the body, has no valve
 Orifice of inferior vena cava
returns blood to the heart from the lower
half of the body
valve of inferior vena cava passes in the
front of it, continues with crista terminalis
laterally and with valve of coronary sinus
medially
 Orifice of coronary sinus
returns blood to the heart from the
cardiac muscle, lies between the orifice of
inferior vena cava and the right
atrioventricular orifice
valve of coronary sinus lies below it
 Atrium proper
 Lies in front of the crista terminalis
 Right auricle － a small conical
muscular pouch, projects to the left
from the root of superior vena cava
and overlaps the aortic root
 Pectinate muscles － inner surface
is trabeculated, pectinate muscles
extend anterolaterally from the
crista terminalis and reach into the
auricle, form multiple trabeculations
 One outlet
right atrioventricular orifice,
lies on the anterior wall of it,
through which right atrium
communicates with the right
ventricle
 Interatrial septum – medial wall
 Oval fossa － on the lower part of
interatrial septum, above and to the
left of the orifice of inferior vena
cava, an oval depression, a remnant
of the fetal foramen ovale, the most
common location of atrial septal
defects (ASD).
 Tendon of Todaro
from the valve of inferior vena cava, runs
into the atrial septum between orifice of
coronary sinus and oval fossa
 Triangle of Koch
between septal leaflet of tricuspid valve,
anteromedial margin of orifice of
coronary sinus , and endocardial tendon
of Todaro
atrioventicular node is located under
triangle of Koch
Function
 Venous blood returning.
 Store Venous blood when
right ventricle systole.
 Blood flows from the right
atrium to right ventricle
when ventricular diastole
Right ventricle (RV)
Conical, receives deoxygenated
blood from right atrium through
right atrioventricular orifice
 Two parts
sinous part (inflow tract)
infundibular part (outflow tract)
divided by the supraventricular
crest, a muscular ridge arches
between right atrioventricular
orifice and orifice of pulmonary
trunk
 One inlet － right
artrioventricular orifice, is
guraded by the tricuspid valve
 One outlet － orifice of
pulmonary trunk, is guraded by
the pulmonary valve
Sinous part － extends from
the right atrioventricular orifice
nearly to the cardiac apex,
rough walls
 Trabeculae carnae 肉柱
the trabeculated appearance
due to irregular muscular ridges
and protrusions, which are
know collectively as
 Septomarginal trabecula
extends from interventricular
septum to base of anterior
papillary muscle on the anterior
wall, through which the right
bundle branch passes, also
termed moderator band, can
prevent overdistension of the
ventricle
 Papillary muscles
conical-shaped, finger-like
muscles project from the
ventricular wall.
anterior-originates from the
septomarginal trabecula as well
as from the anterolateral wall
posterior-lies beneath the
junction of the posterior and
septal leaflets of the tricuspid
valve
septal-arises from the septal
wall
Each papillary muscle connects
the adjacent corresponding
leaflets of tricuspid valve
through chordae tendineae
 Tricuspid valve (right
atrioventricular valve)
• attaches to the tricuspid annulus
at the right atrioventricular orifice,
annulus is a fibrous structure
supporting the valve
• consists of anterior, posterior,
septal leaflet. The base of the
leaflets are connected each other
forming the anteroseptal,
posteroseptal, antero-posterior
commissure

tricuspid complex
tricuspid annulus, valve, chordae
tendineae, papillary muscles to
prevent venous blood regurgitation
to right atrium when the right
ventricle ejects blood. Alterations of
anyone of these structures can
cause tricuspid valve dysfunction
Infundibular part
 Ascends to the left to become the
Conus arteriosus 动脉圆锥 , cone-
shaped, smooth area leading upward
to orifice of pulmonary trunk
 Pumps blood to pulmonary trunk
through pulmonary orifice, which is
supported by the annulus of pulmonary
valve
 Pulmonary valve
 attaches to the annulus of pulmonary
valve, three leaflets
 includes anterior, left, right vavles.
Central thickening in the free margin of
each valve is named the nodule of
the semilunar vavle
 each valve and corresponding wall of
pulmonary trunck form pulmonary sinus
 preventing blood regurgitation from
pulmonary trunck
 Funtion of RV
 Receives blood during ventricle
diastole
 Propels blood when ventricle systole
Chambers of Heart

LA
RA
LV
RV
 Left atrium (LA)
 Left auricle
－ projecting to the right, is longer,
narrower and more hooked than the
right auricle.
 Four inlets
－ orifices of pulmonary veins
 One outlet
Left auricle
－ left atrioventricular orifice
 Function
－ receives blood from pulmonary veins;
serves as reservoir during left ventricle
systole and a conduit during left
ventricular filling
Left ventricle (LV)
 One inlet
－ left atrioventricular orifice
 One outlet
－ aortic orifice
 Two parts
－ divided by anterior leaflet of
mitral valve
 Inflow tract (sinous part)
 Outflow tract (aortic vestibule)
Sinous part
 Trabeculae carneae
 Papillary muscles
 Anterior group
 Posterior group
 Mitral valve
attaches to the mitral annulus at the left
atrioventricular orifice.
 Mitral complex
 Mitral annulus
 Mitral valve
 Chordae tendineae
 Papillary muscles
 Function: when left ventricle ejects blood,
the mitral valve closes to prevent blood
regurgitation to left atrium.
Aortic vestibule
 Communicates with the aorta through
the aortic orifice.
 Aortic vavle
 Guards the aortic orifice, attaches to
annulus of the aortic valve.
 Semilunar valves (right, left and
posterior), each valve has a nodule of
the semilunar valve.
 Aortic sinus (left, right and posterior),
formed by valve and corresponding
wall of aorta.
 Function: prevents backflow of blood
into the left ventricle from aorta
Functions of valves
 During diastole of ventricle, Atrioventricular valves open to allow
blood to enter ventricles from atria, but aortic and pulmonary
valves close prevent backflow from aorta and pulmonary artery.
 During systole of ventricle, Atrioventricular valves close to
prevent backflow of blood into atria, and aortic and pulmonary
valves open to allow blood to enter aorta and pulmonary artery.
 Structure of heart

 Fibrous skeleton of heart

 Architecture of myocardium
 Interatrial and interventricular septum
Fibrous skeleton of heart
 For attachment of cardiac muscles and
valves
 Membranous part of the interventricular
septum
 Fibrous trigones

right fibrous trigone
lies between tricuspid annulus, mitral
annulus and the fibrous ring of aortic
valve.

left fibrous trigone
is located between the mitral annulus and
the fibrous ring of aortic valve.
 Fibrous annuli

Fibrous rings that surround the
atrioventricular, pulmonary, and aortic
orifices.

Serve as attachment for the vavles and
atrial, ventricular muscles.
Architecture of myocardium
The heart walls consist of
 Endocardium
is inner coat of the heart wall.
 Epicardium
is outer coat of heart wall.
 Myocardium
 includes atrial and ventricular muscle
fibers which are separated by fibrous
skeleton
 Myocardium of atria
Two layers: superficial layer and deep layer.
 Myocardium of ventricles
Three layers: superficial layer, middle layer and
deep layer
Interatrial septum
 Is located between right and left atria,
posterior margin of the septum
corresponds to atrioventricular groove. Is
thin, especially at the oval fossa
 Made up of endocardium and a few
myocardium fibers

Interventricular septum
 Is located between right and left
ventricles.
 Membranous part
– located superiorly just below the right and
posterior leaflets of aortic valve. with
attachment of septal leaflet of the
tricuspid valve, it is divided into
atrioventricular and interventricular parts.
 Muscular part
– is convex to the right, the upper third is
smooth, lower two thirds is ridged by
trabeculae carneae.
Conduction system of heart
 Specialized myocytes:
autorhythmic cells
 initiate and conduct action
potential
 Sinuatrial node
 Internodal tracts
 Atrioventricular node
 Atrioventricular bundle
 Right and left bundle branches
 Plexus of Purkinje fibers
Conduction system of heart
Sino-atrial node (SA node)
 Shape: Spindle.
 Location:
 at the junction of right atrium and
superior vena cava
 Function:
 Generate action potentials to initiate
heartbeat.
 Frequency: 70-80/min
Conduction system of heart
Internodal tracts
 Anterior internodal tract
 superior internodal tract –to left atrium
 descending branch –to atrioventricular
node
 Middle internodal tract
 goes round superior vena cava and
descends anterior to the oval fossa.
 Posterior internodal tract
 runs through crista terminalis and valve of
the inferior vena cava above the orifice of
the coronary sinus, goes to atrioventricular
node.
Conduction system of heart
Atrioventricular node (AV node)
 Location: Situated in the triangle of Koch.
 Funtion: receive and convey the impulses
from SA node, and deliver to
atrioventricular bundle.

Atrioventricular bundle (His bundle)

 Location: Extends from AV node, reaches
inferior border of membranous part of the
interventricular septum.
 Division: Right and Left branches at
upper border of muscular part of the
interventricular septum.
Conduction system of heart
Right and left bundle branches
 Right bundle branch
 passes down on right side of interventricular
septum and originates branches to reach right
ventricle
 Left bundle branch
 passes down on left side of interventricular septum
and reaches all parts of the left ventricle.

Purkinje fibers
 connects with the ends of bundle branches to form
networks which enter into the myocardium.
Vessels of heart
Arteries
Right coronary artery
 Arises from the right aortic sinus
 Branches
 Posterior branch of left ventricle
— runs in coronary sulcus, meets circumflex
branch of left coronary artery, supplies the
diaphragmatic wall of the left ventricle.
 Posterior interventricular branch
— travels downward in posterior interventricular
groove, and supplies the posterior one third
of the interventricular septum and the
diaphragmatic wall of ventricles.
Vessels of heart
Arteries
Left coronary artery
 Arises from left aortic sinus
 Branches
 Anterior interventricular branch
— descends in anterior interventricular groove to
cardiac apex, and supplies the anterior wall of
left ventricle, a part of anterior wall of right
ventricle and the anterior 2/3 of the
interventricular septum.
 Circumflex branch
— travels left in coronary sulcus and then turns
around the left margin of the heart into
posterior part of the sulcus, supplies the left
atrium, the left and diaphragmatic walls of left
ventricle.
Vessels of heart
Cardiac veins
Coronary sinus
 About 2-3 cm long, located in posterior
part of coronary.
 Tributaries
 Great cardiac vein
 lies in anterior interventricular groove
 Middle cardiac vein
 lies in posterior interventricular groove
 Small cardiac vein
 lies posterior of the coronary sulcus
Vessels of heart
Cardiac veins
 Anterior cardiac veins
 2~3 small vessels pass from the
front of the right ventricle, and
open directly into the right
atrium.
 Smallest cardiac veins
 begin in the heart wall and open
directly into the cardiac cavities.
Pericardium
Fibrous pericardium
 Made of tough connective tissue
 Attaches to central tendon of diaphragm
inferiorly
 Is securely anchored and maintains the
general thoracic position of the heart

Serous pericardium
 A closed sac within fibrous pericardium
 Two layers
 Visceral layer
 Parietal layer
Pericardium
Pericardial cavity
 Space between visceral and
parietal layers of the serous
pericardium
 Contains serous fluid, which
provides lubrication to prevent
friction between the layers of
serous pericardium when heart
beats
Pericardium
Pericardium sinus
 Transverse sinus of pericardium
－ lies posterior to ascending aorta and
pulmonary trunk, anterior to superior vena
cava and left atrium.
 Oblique sinus of pericardium
－ lies between posterior wall of the left atrium
and the posterior part of the pericardium.
 Anterioinferior sinus of pericardium
－ lies the anteroinferior part of the pericardial
cavity, formed by the reflexion of the
anterior wall into the inferior wall of parietal
layer of serous pericardium.