II.

ANATOMY AND PHYSIOLOGY

The Circulatory System The Circulatory System is designed to deliver oxygen and nutrients to all parts of the body and pick up waste materials and toxins for elimination. This system is made up of the heart, the veins, the arteries, and the capillaries. Circulation is achieved by a continuous one-way movement of blood throughout the body. The network of blood vessels that flow through the body is so extensive that blood flows within close proximity to almost every cell. Heart The heart is a muscular pump that propels blood throughout the body. The heart is located between the lungs, slightly to the left of center in the chest. The heart is broken down into four chambers including:

The right atrium, which is a chamber which receives oxygenpoor blood from the veins. The right ventricle which pumps the oxygen-poor blood from the right atrium to the lungs. The left atrium which receives the now oxygen-rich blood that is returning from the lungs. The left ventricle, which pumps the oxygenated blood

through the arteries to the rest of the body. This process occurs about 72 times per minute, every day of our lives. Blood Vessels Blood vessels are broken down into three groups: the

arteries which carry blood out of the heart to the capillaries, the veins which transport oxygen-poor blood back to the heart, and the capillaries which transfer oxygen and other nutrients into the cells and removes carbon dioxide and other metabolic waste from these body tissues.

Blood Pressure Blood pressure is the force exerted by the blood against the walls of the blood vessels. The output or direct pumping of the heart and the resistance to blood is flow in the vessels by blood determines blood Blood pressure = blood flow x resistance. HUMAN CARDIOVASCULAR SYSTEM The main components of the human cardiovascular system are the heart, blood, and blood vessels. It includes: the pulmonary circulation, a "loop" through the lungs where blood is oxygenated; and the systemic circulation, a "loop" through the rest of the body to provideoxygenated blood. An average adult contains five to six quarts (roughly 4.7 to 5.7 liters) of blood, which consists of plasma, red blood cells, white blood blood pressure. Resistance determined

viscosity and by friction between the blood and the wall of the vessel.

cells, and platelets. Also, thedigestive system works with the circulatory system to provide the nutrients the system needs to keep the heart pumping. Pulmonary circulation The pulmonary circulatory in system is the portion of the

cardiovascular

system

whichoxygen-depleted blood is

pumped

away from the heart, via the pulmonary artery, to the lungsand returned, oxygenated, to the heart via the pulmonary vein. Oxygen deprived blood from the vena cava, enters the right atrium of the heart and flows through the tricuspid valve (right atrioventricular valve) into the right ventricle, from which it is then pumped through the pulmonary semilunar valve into the pulmonary artery to the lungs. Gas exchange occurs in the lungs, whereby CO2 is released from the blood, and oxygen is absorbed. The pulmonary vein returns heart. Systemic circulation Systemic circulation is the portion of the cardiovascular system which transports oxygenated blood away from the heart, to the now oxygen-rich blood to the

the rest of the body, and returns oxygen-depleted blood back to the heart. Systemic circulation is, distance-wise, much longer than pulmonary circulation, transporting blood to every part of the body. Coronary circulation The coronary circulatory system provides a blood supply to the heart. As it provides oxygenated blood to the heart, it is by definition a part of the systemic circulatory system. The Blood Supply of the Brain and Spinal Cord The entire on blood two sets supply of of the from brain and spinal cord depends branches the dorsal aorta.

The vertebral arteries arise from the subclavian arteries, and the internal carotid arteries are branches of the common carotid arteries. The vertebral arteries and the ten medullary arteries that arise from segmental branches of the aorta provide the primary vascularization of the spinal cord. These medullary arteries damaged join (during to form the anterior and posterior spinal surgery, for example), the blood arteries. If any of the medullary arteries are obstructed or abdominal supply to specific parts of the spinal cord may be compromised. The pattern of resulting neurological damage differs according to whether the As supply might to be the posterior or anterior artery expected neural from the in arrangement the spinal leads to pathways generally is of interrupted. ascending loss of and

descending

cord, loss

the posterior supply

of sensory functions, whereas loss of the anterior supply more often causes motor deficits. The brain receives blood from two sources: the internal carotid arteries, which arise at the point in the neck where the common carotid arteries bifurcate, and the vertebral arteries. The internal carotid arteries branch to form two major cerebral arteries, the anterior and middle cerebral arteries. The right and left vertebral arteries The the come of together artery of at the to level form the of the the pons on the ventral surface artery. (in the brainstem

midline basilar base of the

basilar vicinity the

joins

blood

supply from the internal carotids in an arterial ring at the brain the hypothalamus and of Willis. cerebral peduncles) called circle

The posterior cerebral arteries arise at this confluence, as do two small bridging arteries. arteries, Conjoining the anterior and posterior communicating

the two major sources of cerebral vascular supply via the circle of Willis presumably improves the chances of any region of the brain continuing to receive blood if one of the major arteries becomes occluded The major arteries of the brain. (A) Ventral view (compare with Figure 1.13B). The enlargement of the boxed area shows the circle of Willis. Lateral (B) and (C) midsagittal views showing anterior. The major branches that arise from the internal carotid arterythe anterior and middle cerebral arteriesform These that deep the anterior circulation that rise to branches the such as that supplies the forebrain. branches supplying

arteries also originate from the circle of Willis. Each gives supply of the cortex and the are brain, the penetrate structures capsule. arteries arteries basal surface the basal from the

ganglia, thalamus, middle the cerebral brain and

and internal artery. These

Particularly that branch supply

prominent the basal the

lenticulostriate

ganglia and thalamus. supplies it from The the the all the brainstem; arising arteries. for similar Midline arteries arteries (also

The posterior circulation of the posteriorcortex, comprises pattern of arterial arterial of

midbrain, branches is

the posterior cerebral,basilar, subdivisions

and vertebral

distribution lateral

thebrainstem: and dorsal-lateral arteries

arteries supply

supply medial structures, lateral brainstem,

supply dorsalcalled long cerebellar regions of

lateral brainstem structures and the cerebellum. Among the most important dorsal-lateral artery (PICA) artery (AICA), and which circumferential arteries) are the posterior inferior cerebellar the anterior inferior supply distinct

the medulla and pons. These arteries, as well as branches of the basilar artery that penetrate the brainstem from its ventral and lateral surfaces are (called paramedian and short especially common sites of circumferential arteries),

occlusion

and

result

in

specific

functional

deficits

of

cranial nerve, somatic sensory, and motor function. Blood supply of the three subdivisions of the brainstem. (A) Diagram of major supply. (B) Sections through different levels of the brainstem. The physiological demands served by the blood supply of the brain are particularly significant because neurons are more sensitive to oxygen deprivation than other kinds of cells with lower rates of metabolism. In addition, the brain is at risk from circulating toxins, and is specifically protected in this respect by the blood-brain barrier. As a result of the high metabolic rate of neurons, brain tissue deprived of oxygen and glucose as a result of compromised blood supply is likely to sustain supply which, transient (referred if not or to permanent as ischemia) reversed, damage. can can Brief lead loss to of blood death. cause cellular cell changes,

quickly

Sustained loss of blood supply leads much more directly to death and degeneration of the deprived cells. Strokesan anachronistic term that refers to the death or dysfunction of brain tissue due to vascular diseaseoften follow the occlusion of (or hemorrhage from) the brain's arteries. of the in Historically, and brain and spinal studies cord, of the to functional vascular consequences strokes, their relation

territories

provided

information about the location of various brain functions. The location of the major language functions in the left hemisphere, for instance, was discovered in this way in the latter part of the nineteenth based century. on Now, noninvasive have functional imaging the techniques blood flow largely supplanted

correlation of clinical signs and symptoms with the location of tissue damage observed at autopsy.