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The CardiovascularThe Cardiovascular

SystemSystemAnatomy LectureAnatomy Lecture

Lectured by Bien Nillos, MDLectured by Bien Nillos, MDReference: Grays Anatomy and Ellis Clinical Anatomy 11Reference: Grays Anatomy and Ellis Clinical Anatomy 11thth editionedition

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The Vascular SystemThe Vascular System

((aa) the) the blood vascular systemblood vascular system -- comprises thecomprises theheart and blood vessels for the circulation of theheart and blood vessels for the circulation of theblood.blood.

((bb) the) the lymph vascular systemlymph vascular system -- consisting ofconsisting oflymph glands and lymphatic vessels, throughlymph glands and lymphatic vessels, throughwhich a colorless fluid, thewhich a colorless fluid, the lymph,lymph, circulates.circulates.

It must be noted, however, that the two systemsIt must be noted, however, that the two systemscommunicate with each other and are intimatelycommunicate with each other and are intimatelyassociated developmentally.associated developmentally.

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The HeartThe Heart

the central organ of the blood vascular system, andthe central organ of the blood vascular system, andconsists of a hollow muscle; by its contraction the bloodconsists of a hollow muscle; by its contraction the bloodis pumped to all parts of the body through a complicatedis pumped to all parts of the body through a complicatedseries of tubes, termedseries of tubes, termed arteriesarteries arteriolesarterioles capillariescapillaries venulesvenules veinsveins Back to the heartBack to the heart

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The HeartThe Heart

The human heart is divided by septa into rightThe human heart is divided by septa into rightand left halves, and each half is further dividedand left halves, and each half is further dividedinto two cavities, an upper termedinto two cavities, an upper termed

thethe atriumatrium and a lower theand a lower the ventricle.ventricle. The heart therefore consists of four chambers:The heart therefore consists of four chambers:

two, the right atrium and right ventricle, formingtwo, the right atrium and right ventricle, formingthe right half, and two, the left atrium and leftthe right half, and two, the left atrium and left

ventricle the left half.ventricle the left half. The right half of the heart contains venousThe right half of the heart contains venous

blood; the left, arterial blood.blood; the left, arterial blood.

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The Circulation SystemThe Circulation System

The atria are receiving chambers, and the ventriclesThe atria are receiving chambers, and the ventriclesdistributing ones.distributing ones.

From the cavity of the left ventricle the pure blood isFrom the cavity of the left ventricle the pure blood iscarried into a large artery, thecarried into a large artery, the aorta,aorta, is distributed to allis distributed to all

parts of the body, with the exception of the lungs.parts of the body, with the exception of the lungs. changed from arterial into venous blood, which ischanged from arterial into venous blood, which is

collected by the veins and through them returned to thecollected by the veins and through them returned to theright atrium of the heart.right atrium of the heart.

From this cavity the venous blood passes into the rightFrom this cavity the venous blood passes into the right

ventricle, and is conveyed through theventricle, and is conveyed through the pulmonarypulmonaryarteriesarteries to the lungs.to the lungs. In the capillaries of the lungs it again becomesIn the capillaries of the lungs it again becomes

arterialized, and is then carried to the left atrium byarterialized, and is then carried to the left atrium bythethe pulmonary veins.pulmonary veins.

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

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The course of the blood from the leftThe course of the blood from the leftventricle through the body generally toventricle through the body generally to

the right side of the heart constitutes thethe right side of the heart constitutes thegreater orgreater or systemic circulation,systemic circulation,

Its passage from the right ventricleIts passage from the right ventriclethrough the lungs to the left side of thethrough the lungs to the left side of the

heart is termed the lesser orheart is termed the lesser or pulmonarypulmonarycirculation.circulation.

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Portal CirculationPortal Circulation

The blood which circulates through the spleen,The blood which circulates through the spleen,pancreas, stomach, small intestine, and thepancreas, stomach, small intestine, and thegreater part of the large intestine is not returnedgreater part of the large intestine is not returned

directly from these organs to the heart, but isdirectly from these organs to the heart, but isconveyed by theconveyed by the portal veinportal vein to the liver.to the liver.

In the liver this vein divides, like an artery, andIn the liver this vein divides, like an artery, andultimately ends in capillaryultimately ends in capillary--like vesselslike vessels

((sinusoidssinusoids), from which the rootlets of a series), from which the rootlets of a seriesof veins, called theof veins, called the hepatic veins,hepatic veins, arise;arise;

these carry the blood into the inferior venathese carry the blood into the inferior venacava,cava, whence it is conveyed to the right atriumwhence it is conveyed to the right atrium

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

Viewed from the front, portions of all the heartViewed from the front, portions of all the heart

chambers can be seen. The right border ischambers can be seen. The right border isformed entirely by the right atrium, the leftformed entirely by the right atrium, the leftborder partly by the auricular appendage of theborder partly by the auricular appendage of theleft atrium but mainly by the left ventricle, andleft atrium but mainly by the left ventricle, andthe inferior border chiey by the right ventriclethe inferior border chiey by the right ventriclebut also by the lower part of the right atriumbut also by the lower part of the right atriumand the apex of the left ventricle.and the apex of the left ventricle.

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Anterior SurfaceAnterior Surface Right Ventricle andRight Ventricle andRight AtriumRight Atrium

Diaphragmatic SurfaceDiaphragmatic Surface Right and LeftRight and LeftVentriclesVentricles

Posterior SurfacePosterior Surface Left Atrium and, to aLeft Atrium and, to alesser extent, the Right Atriumlesser extent, the Right Atrium

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The Chambers of the HeartThe Chambers of the Heart

The Right AtriumThe Right Atrium

receives the superior vena cava in its upper andreceives the superior vena cava in its upper andposterior part, the inferior vena cava and coronaryposterior part, the inferior vena cava and coronary

sinus in its lower part, and the anterior cardiac veinsinus in its lower part, and the anterior cardiac vein(draining much of the front of the heart) anteriorly.(draining much of the front of the heart) anteriorly.

The openings of the inferior vena cava and theThe openings of the inferior vena cava and thecoronary sinus are guarded by rudimentary valves;coronary sinus are guarded by rudimentary valves;that of the inferior vena cava being continuous withthat of the inferior vena cava being continuous withthe annulus ovalis around the shallow depression onthe annulus ovalis around the shallow depression onthe atrial septum, the fossa ovalis, which marks thethe atrial septum, the fossa ovalis, which marks thesite of the fetal foramen ovale.site of the fetal foramen ovale.

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Right VentricleRight Ventricle

joined to the right atrium by the way of thejoined to the right atrium by the way of thevertically disposedvertically disposed tricuspidvalvetricuspidvalve, and with, and withthe pulmonary trunk through thethe pulmonary trunk through the pulmonarypulmonaryvalvevalve..

A muscular ridge, the infundibuloventricularA muscular ridge, the infundibuloventricular

crest, between the atrioventricular andcrest, between the atrioventricular andpulmonary orices, separates the inow andpulmonary orices, separates the inow andoutow tracts of the ventricle.outow tracts of the ventricle.

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The outow tract of the ventricle or infundibulum isThe outow tract of the ventricle or infundibulum issmoothsmooth--walled and is directed upwards and to thewalled and is directed upwards and to theright towards the pulmonary trunk.right towards the pulmonary trunk.

The pulmonary orice is guarded by the pulmonaryThe pulmonary orice is guarded by the pulmonary

valves, comprising three semilunar cuspsvalves, comprising three semilunar cusps

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

thicker walls.thicker walls.

On the upper part of its posterior wall it presents theOn the upper part of its posterior wall it presents the

openings of the four pulmonary veins and on itsopenings of the four pulmonary veins and on itsseptal surface there is a shallow depressionseptal surface there is a shallow depressioncorresponding to the fossa ovalis of the right atrium.corresponding to the fossa ovalis of the right atrium.

As on the right side, the main part of the cavity isAs on the right side, the main part of the cavity issmoothsmooth--walled but the surface of the auricle iswalled but the surface of the auricle ismarked by a number of ridges due to the underlyingmarked by a number of ridges due to the underlyingpectinate muscles.pectinate muscles.

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The Left VentricleThe Left Ventricle

communicates with the left atrium by way ofcommunicates with the left atrium by way ofthe mitral valve which possesses a largethe mitral valve which possesses a largeanterior and a smaller posterior cusp attachedanterior and a smaller posterior cusp attachedto papillary muscles by chordae tendineae.to papillary muscles by chordae tendineae.

the wall of the left ventricle is marked by thickthe wall of the left ventricle is marked by thicktrabeculae carneae.trabeculae carneae.

The aortic orice is guarded by the threeThe aortic orice is guarded by the threesemilunar cusps of the aortic valve,semilunar cusps of the aortic valve,

immediately above which are the dilatedimmediately above which are the dilatedaortic sinuses.aortic sinuses.

The mouths of the right and left coronaryThe mouths of the right and left coronaryarteries are seen in the anterior and leftarteries are seen in the anterior and left

posterior sinus respectively.posterior sinus respectively.

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Blood Supply to the HeartBlood Supply to the Heart

derived from the right and left coronary arteriesderived from the right and left coronary arterieswhose main branches lie in the interventricularwhose main branches lie in the interventricular

and atrioventricular groovesand atrioventricular grooves

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Right Coronary ArteryRight Coronary Artery

Arises from the anterior aortic sinus and passesArises from the anterior aortic sinus and passesforwards between the pulmonary trunk and theforwards between the pulmonary trunk and theright atrium to descend in the right part of theright atrium to descend in the right part of theatrioventricular groove.atrioventricular groove.

At the inferior border of the heart it continuesAt the inferior border of the heart it continuesalong the atrioventricular groove to anastomosealong the atrioventricular groove to anastomosewith the left coronary at the posteriorwith the left coronary at the posteriorinterventricular groove.interventricular groove.

It gives off aIt gives off a marginalbranchmarginalbranch along the loweralong the lower

border of the heart and theborder of the heart and the posteriorposteriorinterventricularbranchinterventricularbranch which runs forward inwhich runs forward inthe inferior interventricular groove and tothe inferior interventricular groove and toanastomose near the apex of the heart with theanastomose near the apex of the heart with thecorresponding branch of the left coronary artery.corresponding branch of the left coronary artery.

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Left Coronary ArteryLeft Coronary Artery

is larger than the right, rises from the leftis larger than the right, rises from the leftposterior aortic sinus. Passing rst behind andposterior aortic sinus. Passing rst behind andthen to the left of the pulmonary trunk, itthen to the left of the pulmonary trunk, it

reaches the left part of atrioventricular groove inreaches the left part of atrioventricular groove inwhich it runs laterally round the left border ofwhich it runs laterally round the left border ofthe heart as thethe heart as the circumexarterycircumexartery to reach theto reach theposterior interatrial groove.posterior interatrial groove.

Its most important branchIts most important branch -- anterioranteriorinterventriculararteryinterventricularartery= supplies the anterior= supplies the anterioraspect of both ventricles, passes around theaspect of both ventricles, passes around theapex of the heart to anastomose with theapex of the heart to anastomose with theposterior interventricular branch of the rightposterior interventricular branch of the right

coronary.coronary.

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Venous Drainage of the HeartVenous Drainage of the Heart

The bulk of the venous drainage of the heart isThe bulk of the venous drainage of the heart isachieved by veins which accompany theachieved by veins which accompany thecoronary arteries and which open into the rightcoronary arteries and which open into the right

atrium. The rest of the blood drains by means ofatrium. The rest of the blood drains by means ofsmall veins (venae cordis minimae) directly intosmall veins (venae cordis minimae) directly intothe cardiac cavity.the cardiac cavity.

The coronary sinus lies in the posteriorThe coronary sinus lies in the posterior

atrioventricular groove and opens into the rightatrioventricular groove and opens into the rightatrium just to the left of the mouth of theatrium just to the left of the mouth of theinferior vena cava.inferior vena cava.

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Coronary SinusCoronary Sinus

It receives:It receives:

1.1. the great cardiac vein in the anteriorthe great cardiac vein in the anteriorinterventricular groove;interventricular groove;

2.2. the middle cardiac vein the inferiorthe middle cardiac vein the inferiorinterventricular grooveinterventricular groove

3.3. the small cardiac veinthe small cardiac vein accompanying theaccompanying themarginal artery along the lower border of themarginal artery along the lower border of the

heart;heart;4.4. the oblique veinthe oblique vein descends obliquely on thedescends obliquely on the

posterior aspect of the left atrium.posterior aspect of the left atrium.

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The Nerve Supply of the HeartThe Nerve Supply of the Heart

The nerve supply of the heart is derivedThe nerve supply of the heart is derivedfrom the vagus (cardiofrom the vagus (cardio--inhibitor) and theinhibitor) and thecervical and upper 5 thoracic sympatheticcervical and upper 5 thoracic sympatheticganglia (cardioaccelerator) by way ofganglia (cardioaccelerator) by way ofsupercial and deep cardiac plexuses.supercial and deep cardiac plexuses.

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Surface Anatomy of the HeartSurface Anatomy of the Heart

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

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

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

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

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TheThe left borderleft border of the heart (indicated by theof the heart (indicated by thecurved line joining points 1 and 4) is formedcurved line joining points 1 and 4) is formedalmost entirely by the left ventricle (the auricularalmost entirely by the left ventricle (the auricular

appendage of the left atrium peeping aroundappendage of the left atrium peeping aroundthis border superiorly)this border superiorly)

TheThe lower borderlower border (the horizontal line joining(the horizontal line joiningpoints 3 and 4) corresponds to the rightpoints 3 and 4) corresponds to the rightventricle and the apical part of the left ventricle.ventricle and the apical part of the left ventricle.

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

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End ofPart OneEnd ofPart OneThe heart has reasons that reason does notThe heart has reasons that reason does notunderstand.understand. -- Jacques Benigne BossuelJacques Benigne Bossuel

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No. 1

No. 2

No. 3

No. 4

No. 5 No. 6 No. 7

No. 8

No. 9

No. 10

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Start ofPart TwoStart ofPart TwoThe Cardiovascular SystemThe Cardiovascular System

(Hingagaw Session)(Hingagaw Session)

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THE DISTRIBUTIONTHE DISTRIBUTION of the systematic arteries is like aof the systematic arteries is like ahighly ramified tree, the common trunk of which, formedhighly ramified tree, the common trunk of which, formedby the aorta, commences at the left ventricle, while theby the aorta, commences at the left ventricle, while thesmallest ramifications extend to the peripheral parts ofsmallest ramifications extend to the peripheral parts ofthe body and the contained organs.the body and the contained organs. Henri GrayHenri Gray

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The arteries, in their distribution,The arteries, in their distribution,communicate with one another, formingcommunicate with one another, formingwhat are calledwhat are called anastomosesanastomoses,, and theseand thesecommunications are very free between thecommunications are very free between thelarge as well as between the smallerlarge as well as between the smallerbranches.branches.

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The AortaThe Aorta

the main trunk of a series of vesselsthe main trunk of a series of vesselswhich convey the oxygenated bloodwhich convey the oxygenated bloodto the tissues of the body for theirto the tissues of the body for theirnutrition.nutrition.

begins at the upper part of the leftbegins at the upper part of the leftventricleventricle

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

descends within the thorax on thedescends within the thorax on theleft side of the vertebral columnleft side of the vertebral column

passes into the abdominal cavitypasses into the abdominal cavitythrough the aortic hiatus in thethrough the aortic hiatus in thediaphragm,diaphragm,

ends opposite the lower border ofends opposite the lower border ofthe fourth lumbar vertebra, bythe fourth lumbar vertebra, bydividing into the right and leftdividing into the right and leftcommon iliac arteries.common iliac arteries.

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Parts of the AortaParts of the Aorta

ascending aortaascending aorta

arch of the aortaarch of the aorta

descending aortadescending aorta thoracicthoracic

abdominal aortaabdominal aorta

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Ascending AortaAscending Aorta

Branches.Branches.The only branches of theThe only branches of theascending aorta are the two coronaryascending aorta are the two coronaryarteries which supply the heart; they arisearteries which supply the heart; they arisenear the commencement of the aortanear the commencement of the aortaimmediately above the attached marginsimmediately above the attached marginsof the semilunar valves.of the semilunar valves.

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Arch of the AortaArch of the Aorta

The branches given off from the arch ofThe branches given off from the arch ofthe aorta are three in number:the aorta are three in number:thethe innominateinnominate(brachiocephalic),(brachiocephalic), thethe left commonleft commoncarotid,carotid, and theand the left subclavian.left subclavian.

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TheThe innominate arteryinnominate artery is the largestis the largestbranch of the arch of the aortabranch of the arch of the aorta

It divides into theIt divides into the right common carotidright common carotidandand right subclavian arteriesright subclavian arteries..

occasionally a small branch,occasionally a small branch,thethe thyreoideaimathyreoideaima,, arises from it.arises from it.

sometimes it gives offsometimes it gives offaa thymicthymic oror bronchial branch.bronchial branch.

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The innominate artery sometimes dividesThe innominate artery sometimes dividesabove the level of the sternoclavicularabove the level of the sternoclavicularjoint, less frequently below it.joint, less frequently below it.

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

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The Common CarotidsThe Common Carotids

The principal arteries of supply to theThe principal arteries of supply to thehead and neckhead and neck

each divides into two branches:each divides into two branches:

(1) the(1) the external carotid,external carotid, supplying thesupplying theexterior of the head, the face, and theexterior of the head, the face, and thegreater part of the neckgreater part of the neck

(2) the(2) the internal carotid,internal carotid, supplying to asupplying to agreat extent the parts within the cranialgreat extent the parts within the cranialand orbital cavities.and orbital cavities.

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TheThe rightright begins at the bifurcation of thebegins at the bifurcation of theinnominate artery behind theinnominate artery behind thesternoclavicular joint and is confined tosternoclavicular joint and is confined to

the neck.the neck. TheThe leftleft springs from thesprings from the highest parthighest part ofof

the arch of the aorta to the left of, and onthe arch of the aorta to the left of, and ona plane posterior to the innominate artery,a plane posterior to the innominate artery,and therefore consists of a thoracic and aand therefore consists of a thoracic and acervical portion.cervical portion.

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The common carotid usually gives off noThe common carotid usually gives off nobranch previous to its bifurcation, but itbranch previous to its bifurcation, but itoccasionally gives origin to the superioroccasionally gives origin to the superiorthyroid or its laryngeal branch, thethyroid or its laryngeal branch, theascending pharyngeal, the inferior thyroid,ascending pharyngeal, the inferior thyroid,or, more rarely, the vertebral artery.or, more rarely, the vertebral artery.

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The External Carotid ArteryThe External Carotid Artery

begins opposite the upper border of thebegins opposite the upper border of thethyroid cartilage, and, taking a slightlythyroid cartilage, and, taking a slightlycurved course, passes upward andcurved course, passes upward andforward, and then inclines backward toforward, and then inclines backward tothe space behind the neck of the mandiblethe space behind the neck of the mandible

it divides into theit divides into the superficial temporalsuperficial temporal

andand internal maxillaryinternal maxillary arteriesarteries

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Branches of the External CarotidBranches of the External Carotid

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

Posterior Group: Occipital,

Posterior

Posterior Group: Occipital,

PosteriorAuricularAuricular

Ascending Group: Ascending PharyngealAscending Group: Ascending Pharyngeal

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

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Internal Carotid ArteryInternal Carotid Artery

supplies the anterior part of the brain, thesupplies the anterior part of the brain, theeye and its appendages, and sendseye and its appendages, and sendsbranches to the forehead and nose.branches to the forehead and nose.

Its size, in the adult, is equal to that of theIts size, in the adult, is equal to that of theexternal carotid, though, in the child, it isexternal carotid, though, in the child, it islarger than that vessel.larger than that vessel.

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In considering the course and relations ofIn considering the course and relations ofthis vessel it may be divided into fourthis vessel it may be divided into fourportions:portions:

cervicalcervical -- The cervical portion of the internalThe cervical portion of the internalcarotid gives off no branches.carotid gives off no branches.

petrouspetrous

CavernousCavernous -- Ophthalmic.Ophthalmic. cerebralcerebral -- Anterior Cerebral, Middle Cerebral,Anterior Cerebral, Middle Cerebral,Posterior Communicating.Posterior Communicating.

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Circle of WillisCircle of Willis

The cerebral arteries are derived from theThe cerebral arteries are derived from theinternal carotid and vertebral, which at the baseinternal carotid and vertebral, which at the baseof the brain form a remarkable anastomosisof the brain form a remarkable anastomosis

formed in front by theformed in front by the anterior cerebralanterior cerebralarteries, branches of the internal carotid, whicharteries, branches of the internal carotid, whichare connected together by theare connected together by the anterioranteriorcommunicatingcommunicating; behind by the two; behind by the two posteriorposteriorcerebral arteriescerebral arteries, branches of the, branches of the basilarbasilar,,which are connected on either side with thewhich are connected on either side with theinternal carotid by theinternal carotid by the posteriorposteriorcommunicatingcommunicating

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The Subclavian ArteriesThe Subclavian Arteries

The artery which supplies the upper extremityThe artery which supplies the upper extremitycontinues as a single trunk from itscontinues as a single trunk from itscommencement down to the elbowcommencement down to the elbow

That part of the vessel which extends from its origin toThat part of the vessel which extends from its origin tothe outer border of the first rib is termedthe outer border of the first rib is termedthethe subclaviansubclavian;;

beyond this point to the lower border of the axilla it isbeyond this point to the lower border of the axilla it isnamed thenamed the axillaryaxillary;;

and from the lower margin of the axillary space to theand from the lower margin of the axillary space to thebend of the elbow it is termedbend of the elbow it is termed brachialbrachial;;

here the trunk ends by dividing into two branches:here the trunk ends by dividing into two branches:thethe radialradialandand ulnarulnar..

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branches of thebranches of thesubclavian artery are:subclavian artery are:

Vertebral*Vertebral*

Internal mammaryInternal mammary(thoracic)(thoracic)

ThyrocervicalThyrocervical

Costocervical.Costocervical.

*union forms Basilar Artery*union forms Basilar Artery

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Basilar ArteryBasilar Artery

named from its position at the base of thenamed from its position at the base of theskull, is a single trunk formed by theskull, is a single trunk formed by thejunction of the two vertebral arteriesjunction of the two vertebral arteries

It ends by dividing into the two posteriorIt ends by dividing into the two posteriorcerebral arteries.cerebral arteries.

Branches: Pontine, Anterior InferiorBranches: Pontine, Anterior Inferior

Cerebellar, Internal Auditory, SuperiorCerebellar, Internal Auditory, SuperiorCerebellar, Posterior Cerebral.Cerebellar, Posterior Cerebral.

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The Axillary ArteryThe Axillary Artery

the continuation of the subclavian,the continuation of the subclavian,commences at the outer border of the firstcommences at the outer border of the firstrib, and ends at the lower border of therib, and ends at the lower border of the

tendon of thetendon of the Teres majorTeres major, where it, where ittakes the name of brachial.takes the name of brachial.

3 portions3 portions

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first portionfirst portion of the axillary artery isof the axillary artery is

coveredcovered anteriorlyanteriorly by the clavicular portion ofby the clavicular portion ofthe Pectoralis major and the coracoclavicularthe Pectoralis major and the coracoclavicularfascia, and is crossed by the lateral anteriorfascia, and is crossed by the lateral anteriorthoracic nervethoracic nerve

second portionsecond portion of the axillary artery isof the axillary artery iscovered,covered, anteriorly,anteriorly, by the Pectorales major andby the Pectorales major andminor;minor;

third portionthird portion of the axillary artery extendsof the axillary artery extends

from the lower border of the Pectoralis minor tofrom the lower border of the Pectoralis minor tothe lower border of the tendon of the Teresthe lower border of the tendon of the Teresmajor.major.

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Branches of the Axillary ArteryBranches of the Axillary Artery

FirstFirst Portion : Highest Thoracic ArteryPortion : Highest Thoracic Artery

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

ThirdThird Portion : Subscapular, PosteriorPortion : Subscapular, PosteriorHumeral Circumflex, Anterior HumeralHumeral Circumflex, Anterior HumeralCircumflex.Circumflex.

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Brachial ArteryBrachial Artery

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

At first the brachial artery lies medial to theAt first the brachial artery lies medial to thehumerus; but as it runs down the arm ithumerus; but as it runs down the arm itgradually gets in front of the bone, and at thegradually gets in front of the bone, and at the

bend of the elbow it lies midway between its twobend of the elbow it lies midway between its twoepicondyles.epicondyles.

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

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Branches of the Brachial ArteryBranches of the Brachial Artery

Profunda BrachiiProfunda Brachii

Superior Ulnar CollateralSuperior Ulnar Collateral

NutrientNutrient Inferior Ulnar CollateralInferior Ulnar Collateral

MuscularMuscular

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Descending AortaDescending Aorta

Two parts:Two parts:

Thoracic part andThoracic part andAbdominal partAbdominal part

Remember at what level theRemember at what level theaorta pierces through theaorta pierces through the

diaphragmdiaphragm

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Thoracic AortaThoracic Aorta

contained in the posterior mediastinalcontained in the posterior mediastinalcavity.cavity.

begins at the lower border of the T4begins at the lower border of the T4where it is continuous with the aortic arch,where it is continuous with the aortic arch,and ends in front of the lower border ofand ends in front of the lower border ofT12 at the aorticT12 at the aortic hiatus in the diaphragmhiatus in the diaphragm

Branch groups: Visceral group and ParietalBranch groups: Visceral group and ParietalGroupGroup

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

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

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

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The Abdominal AortaThe Abdominal Aorta

begins at the aortic hiatus of thebegins at the aortic hiatus of thediaphragm, in front of the lower border ofdiaphragm, in front of the lower border ofthe body of the last thoracic vertebra,the body of the last thoracic vertebra,

and, descending in front of the vertebraland, descending in front of the vertebralcolumn, ends on the body of the fourthcolumn, ends on the body of the fourthlumbar vertebra, by dividing into the twolumbar vertebra, by dividing into the two

common iliac arteries.common iliac arteries.

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Visceral BranchesVisceral Branches

CeliacCeliac SuperiorSuperior

MesentericMesenteric InferiorInferior

MesentericMesenteric MiddleMiddle

SuprarenalsSuprarenals RenalsRenals

InternalInternalSpermaticSpermatic

OvarianOvarian

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Parietal BranchesParietal Branches

Inferior PhrenicsInferior Phrenics

LumbarLumbar

Middle SacralMiddle Sacral

* Terminal branches* Terminal branches Left and RightLeft and RightCommon Iliac ArteriesCommon Iliac Arteries

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Celiac ArteryCeliac Artery

a short thick trunk, about 1.25 cm. ina short thick trunk, about 1.25 cm. inlength, whichlength, which arisesarises from the front of thefrom the front of theaorta, just below the aortic hiatus of theaorta, just below the aortic hiatus of the

diaphragm, and, passing nearly horizontallydiaphragm, and, passing nearly horizontallyforward, divides into three large branches:forward, divides into three large branches:

left gastric,left gastric, thethe hepatic,hepatic, andand

thethe splenicsplenic

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Left Gastric ArteryLeft Gastric Artery

smallest of the three branches of the celiacsmallest of the three branches of the celiacarteryartery

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 lesserIt 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 theit gives branches to both surfaces of thestomach and anastomoses with the right gastricstomach and anastomoses with the right gastricartery.artery.

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Hepatic ArteryHepatic Artery

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

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

Branches:Branches:

Right GastricRight Gastric

GastroduodenalGastroduodenal -- right gastroepiploicright gastroepiploic and theand the superiorsuperiorpancreaticoduodenal.pancreaticoduodenal.

CysticCystic

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Splenic Artery (Lienal)Splenic Artery (Lienal)

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

Branches:Branches:

PancreaticPancreatic

Short Gastric.Short Gastric.

Left Gastroepiploic.Left Gastroepiploic.

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Common Iliac ArteriesCommon Iliac Arteries

They diverge from the termination of theThey diverge from the termination of theaorta, pass downward and lateralward,aorta, pass downward and lateralward,and divide, opposite the intervertebraland divide, opposite the intervertebral

fibrocartilage between the last lumbarfibrocartilage between the last lumbarvertebra and the sacrum, into twovertebra and the sacrum, into twobranches, thebranches, the externalexternal

iliac*iliac*andand hypogastric arterieshypogastric arteries*external iliac artery is larger than the hypogastric artery*external iliac artery is larger than the hypogastric artery

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External Iliac ArteryExternal Iliac Artery

passes obliquely downward andpasses obliquely downward andlateralward along the medial border of thelateralward along the medial border of thePsoas major, from the bifurcation of thePsoas major, from the bifurcation of the

common iliac to a point beneath thecommon iliac to a point beneath theinguinal ligament, midway between theinguinal ligament, midway between theanterior superior spine of the ilium and theanterior superior spine of the ilium and the

symphysis pubis, where it enters the thighsymphysis pubis, where it enters the thighand becomes theand becomes the femoral arteryfemoral artery..

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Branches:Branches:

InferiorInferiorepigastricepigastric

Deep iliacDeep iliaccircumflexcircumflex

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Femoral ArteryFemoral Artery

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begins immediately behind the inguinalbegins immediately behind the inguinalligament, midway between the ASIS andligament, midway between the ASIS andthe symphysis pubis, andthe symphysis pubis, and passes down thepasses down the

front and medial side of the thigh.front and medial side of the thigh. It ends at the junction of the middle withIt ends at the junction of the middle with

the lower third of the thigh, where itthe lower third of the thigh, where itpasses through an opening in thepasses through an opening in the

Adductor magnusAdductor magnus to become theto become thepoplitealarterypoplitealartery..

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The first 4 cm. of the vessel is enclosed,The first 4 cm. of the vessel is enclosed,together with the femoral vein, in atogether with the femoral vein, in afibrous sheathfibrous sheaththethefemoral sheath.femoral sheath.

In the upper third of the thigh the femoralIn the upper third of the thigh the femoralartery is contained in theartery is contained in the femoralfemoraltriangletriangle ((Scarpas triangleScarpas triangle), and in the), and in the

middle third of the thigh, in themiddle third of the thigh, in the adductoradductorcanalcanal ((Hunters canalHunters canal).).

FemoralFemoral

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FemoralFemoralTriangleTriangle

Its apex is directedIts apex is directeddownward, and thedownward, and thesides are formedsides are formed

laterally by thelaterally by themedial margin of themedial margin of theSartorius, medially bySartorius, medially bythe medial margin ofthe medial margin of

the Adductor longus,the Adductor longus,and above by theand above by theinguinal ligament.inguinal ligament.

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Hunters CanalHunters Canal

an aponeurotic tunnel inan aponeurotic tunnel inthe middle third of thethe middle third of thethigh, extending fromthigh, extending fromthe apex of the femoralthe apex of the femoral

triangle to the openingtriangle to the openingin the Adductor magnus.in the Adductor magnus.It is bounded, in frontIt is bounded, in frontand laterally, by theand laterally, by the

Vastus medialis; behindVastus medialis; behindby the Adductoresby the Adductoreslongus and magnuslongus and magnus

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Branches of the Femoral ArteryBranches of the Femoral Artery

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.

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Popliteal ArteryPopliteal Artery

the continuation of the femoral, and coursesthe continuation of the femoral, and coursesthrough thethrough the poplitealfossapoplitealfossa..

It extends from the opening in the AdductorIt extends from the opening in the Adductormagnus, at the junction of the middle and lowermagnus, at the junction of the middle and lowerthirds of the thigh, downward and lateralward tothirds of the thigh, downward and lateralward tothe intercondyloid fossa of the femur, and thenthe intercondyloid fossa of the femur, and thenvertically downward to the lower border of thevertically downward to the lower border of thePopliteusPopliteus

divides intodivides into anterioranterior andand posterior tibialposterior tibialarteries.arteries.

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Popliteal FossaPopliteal Fossa

lozengelozenge--shaped space,shaped space,at the back of the kneeat the back of the knee--joint. Laterally it isjoint. Laterally it isbounded by the Bicepsbounded by the Biceps

femoris above, and byfemoris above, and bythe Plantaris and thethe Plantaris and thelateral head of thelateral head of theGastrocnemius below;Gastrocnemius below;medially it is limited bymedially it is limited by

the Semitendinous andthe Semitendinous andSemimembranosusSemimembranosusabove, and by theabove, and by themedial head of themedial head of theGastrocnemius below.Gastrocnemius below.

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Anterior Tibial ArteryAnterior Tibial Artery

commences at the bifurcation of the popliteal, atcommences at the bifurcation of the popliteal, atthe lower border of the Popliteus, passesthe lower border of the Popliteus, passesforward between the two heads of theforward between the two heads of the

TibialisTibialis posterior, and through the apertureposterior, and through the apertureabove the upper border of the interosseousabove the upper border of the interosseousmembrane, to the deep part of the front of themembrane, to the deep part of the front of theleg: it here lies close to the medial side of theleg: it here lies close to the medial side of the

neck of the fibula.neck of the fibula. becomes thebecomes the dorsalis pedis.dorsalis pedis.

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Posterior Tibial ArteryPosterior Tibial Artery

divides beneath the origin of the Adductordivides beneath the origin of the Adductorhallucis into thehallucis into the medialmedial andand laterallateralplantar arteries.plantar arteries.

LateralLateral is much largerthan theis much largerthan the medialmedialplantarartery.plantarartery.

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Take HomeTake Home

Study the Major Veins of the Neck,Study the Major Veins of the Neck,Thorax, Abdomen, Upper and LowerThorax, Abdomen, Upper and LowerExtremity and trace their tributariesExtremity and trace their tributaries

Study the difference between an arteryStudy the difference between an arteryand a vein.and a vein.

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Group PaperGroup Paper

Group 1: Atherosclerosis, Arteriosclerosis: Causes,Group 1: Atherosclerosis, Arteriosclerosis: Causes,how they develop, Symptoms and how they arehow they develop, Symptoms and how they arediagnosed and treateddiagnosed and treated

Group 2: Varicose Veins: Causes, how theyGroup 2: Varicose Veins: Causes, how they

develop, treatment.develop, treatment. Group 3: The Fetal Circulation. Trace theGroup 3: The Fetal Circulation. Trace the

circulation of blood inside a Fetus, take note thecirculation of blood inside a Fetus, take note thedifferences in an adult circulationdifferences in an adult circulation

Group 4: DifferentProblems of Heart Valves. HowGroup 4: DifferentProblems of Heart Valves. Howare they different from each other. Causes.are they different from each other. Causes.Treatment?Treatment?

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

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I do not hold the key to our liberation, I do not know all theI do not hold the key to our liberation, I do not know all thesolutions to our many problems. All I know is that if thesolutions to our many problems. All I know is that if the

situation continues in the Philippines, then blood will flow,situation continues in the Philippines, then blood will flow,and when blood flows, there will be no victor and there will beand when blood flows, there will be no victor and there will beno vanquished because all of us will be a victim of our follyno vanquished because all of us will be a victim of our folly

Ninoy AquinoNinoy Aquino