Cardiovascular

Anatomy-Histology Correlate

By: Michael Lu, Class of 07

Heart in Situ

NOTE:
-

Visceral pleura is in direct contact with the lungs,

while parietal pleura is everything else. The same
applies to pericardium and the heart.

4 sections of parietal pleura: cupola, costal,

diaphragmatic, and mediastinal.

Potential spaces of the costomediastinal and

costodiaphragmatic recesses, where there is no
lung tissue.

Mediastinum located between the lungs extending

from the sternum anteriorly to vertebrae posteriorly.
a) superior bounded by horizontal line through
sternal angle below and rib 1 above
b) anterior bounded by sternum in front and
pericardium in back
c) middle includes heart and pericardium
d) posterior bounded by pericardium in front and
vertebral bodies in back; includes esophagus and
aorta

Phrenic nerves (right and left) motor nerves to

diaphragm that travel along the side of the heart in
the pericardium in front of the root of the lung

Pericacardiacophrenic arteries and veins

traveling with the phrenic nerves.

Thymus gland immune tissue, becomes fatty

tissue with age

Heart Anterior Pericardial

Sac Removed

NOTE:
-

The superior vena cava, aortic arch, and

pulmonary trunk exiting the base of the heart.

The internal and external jugular veins joining

the subclavian vein to become the
brachiocephalic veins that drain into the superior
vena cava.

Since the superior vena cava is on the right, the

left brachiocephalic vein is longer than the right
brachiocephalic vein and crosses midline.

The aorta bending left and inferiorly, its arch giving

off 3 main branches:
a) brachiocephalic trunk, which gives off right
subclavian and right common carotid arteries
b) left common carotid artery directly off aorta
c) left subclavian artery directly off aorta

The veins are situated anterior to the arteries.

The pulmonary trunk giving off right and left

pulmonary arteries to the lungs.

Ligamentum arteriosum attached between the

aortic arch and left pulmonary artery.

Vagus n. running in the mediastinum behind the

lung root, giving off the recurrent laryngeal n. on
the left side under the aortic arch.

Right ventricle of the heart is situated most

NOTE:
-

With the heart removed, the openings of the great

vessels at the base of the heart: superior and
inferior vena cava, pulmonary trunk bifurcating
into left and right pulmonary arteries, left and
right pulmonary veins, and ascending aorta.

Once again, the phrenic nerves running anterior

to the roots of the lungs and the vagus nerves
(not shown here) running posterior.

The transverse pericardial sinus situated behind

the pulmonary trunk and ascending aorta (easily
felt by inserting a finger from behind these great
vessels from the left with heart in situ).

The oblique pericardial sinus behind the

diaphragmatic surface up to the base of the heart
(easily felt by lifting the apex and sliding fingers
behind the heart).

Throughout the cardiovascular system, like all

other organ systems in the body, structure
correlates with function. This is true from the heart
all the way down to the capillary. In the following
slides, we will look closely at the histological
details of arteries and veins, starting with the great
vessels.

AORTA (intima)
-

All vessel walls are divided into 3 tunica (starting

from inside): intima, media, and adventitia.

The inner intima layer consists of simple

squamous epithelium and underlying connective
tissue.

The border between the tunica intima and tunica

media may not be easy to recognize. As a general
rule of thumb, the intima ends and the media
begins where the first distinct elastic sheet or
lamella is located.

In the figure below, the elastic sheet is indicated by

arrowheads, and the intima is indicated by the
bracket.

Thickening of Tunica Intima

Thickening of the tunica intima may occur in 2 ways arteriosclerosis and atherosclerosis.
Arteriosclerosis is a part of normal aging. There is an increase in connective tissue,
fibrosis, and fragmentation of elastic lamellae. Atherosclerosis, on the other hand, is a
pathological process involving eccentric fibrous intimal thickening, lipid deposition, and
dystrophic calcification. Intima thickening within coronary arteries, which nourish the
myocardium of the heart, is a major cause for myocardial infarcts. Shown below are
examples of tunica intima thickening. As a reminder, the presence of elastic lamellae, or in
this case a distinct internal elastic membrane, separates the tunica intima from the tunica
media.

AORTA (media)
-

The tunica media consists of circularly arranged

smooth muscle and abundant elastic tissue. In
the H&E stain below, the arrows point to a smooth
muscle cell nucleus and elastic lamella (E).

The Masson-aldehyde fuchsin stain accentuates

the abundance of elastic lamellae within the tunica
media.

The smooth muscle cells, not fibroblasts,

synthesize the elastic fibers, in addition to
collagen and various proteoglycans.

AORTA (adventitia)
-

The outermost layer of the vessel wall, the tunica

adventitia, is mainly a connective tissue sheath
surrounding the vessel.

The media ends and adventitia begins where the

elastic lamellae are not found.

The H&E stain below shows the border between

the media and adventitia. In larger vessels, such
as the aorta in this case, the adventitia contains
small arteries and veins, also called vasa
vasorum, and their smaller branches (arrowheads)
that supply nourishment to the outer half of the
media.

Adventitia of vein

Comparison of Artery and Vein

There are several criteria that can help you distinguish
between arteries and veins.
-

Arteries experience a much higher blood pressure

than veins and therefore have a much higher wallto-lumen ratio (structure correlates with function).
On the other hand, venous pressure is much lower
and thus veins have a lower wall-to-lumen ratio,
or wider lumen and thin wall.

Veins are more variably shaped than arteries.

Most arteries contain a distinct internal elastic

membrane (labeled as iem), while veins do not.

In an artery, the media is thicker than the

adventitia. Once again, the media contains
abundant smooth muscle and elastic fibers. The
adventitia does not contain any muscle.

In a vein, the adventitia is thicker than the

media. The media consists of circumferentially
oriented smooth muscle fibers, while the adventitia
contains longitudinal smooth muscle fibers. The
adventitia is the thickest layer.

NOTE:
-

The heart serves as a mechanical pump to supply

the entire body with blood, both providing nutrients
and removing waste products.

The great vessels exit the base of the heart.

Blood flow: bodyvena cavaright atriumright

ventriclelungsleft atriumleft ventriclebody

The heart consists of 3 layers the endocardium,

myocardium, and epicardium. The epicardium
(bottom left) consists of arteries, veins, nerves,
connective tissue, and variable amounts of fat.

The myocardium contains branching, striated

muscle cells with centrally located nuclei. They
are connected by intercalated disks
(arrowheads).

-Coronary arteries and cardiac veins supply the muscular tissue of the heart. The left and right coronary
arteries immediately branch off of the ascending aorta and further give off the left anterior descending (LAD),
circumflex, SA nodal, right marginal, posterior descending, and atrial branches.
-The small cardiac, middle cardiac, and great cardiac veins all drain into the coronary sinus, which wraps
around the heart and drains into the right atrium.
-The following slide details the 4 chambers of the heart left and right atria and ventricles. Two features to notice
are the fossa ovalis and the ligamentum arteriosum, which are remnants of shunts that were open during
circulation through the fetal heart in order to bypass the lungs.

Right Atrium

Left Atrium

Right Ventricle

Left Ventricle

Endocardium of Atrium and Ventricle

-

These sections of heart are both taken near the

atrio-ventricular sulcus that contains a coronary
artery and cardiac vein. They also exhibit all 3
layers of the heart wall epicardium, myocardium,
and endocardium.

Notice (both here and in the previous slide) that

the myocardium in the ventricle is much thicker
than that in the atrium.

The endocardium (marked by the black bracket)

is magnified in the lower panel and compared
between the atrium and the ventricle.

The atrial endocardium is much thicker than

the ventricular endocardium and contains a welldeveloped network of elastic fibers.

Right beneath the ventricular endocardium are

conducting fibers that will be covered in the next 2
slides.

Conducting System of the Heart

-

The heart continuously pumps

blood to the entire body without
input from elsewhere.

Nerve impulses initiate from the

sinoatrial (SA) node and travel
down to the atrioventricular
(AV) node. They continue down
the bundle of His and spread
out among the Purkinje fibers
towards the apex of the heart.
This mechanism provides
regular, synchronous
contractions of the
myocardium.

The Purkinje fibers can be

found immediately beneath the
endocardium of the ventricular
papillary muscle or in other
regions immediately
underneath the ventricular
endocardium.

The Purkinje conducting fibers

are modified cardiac muscle
cells, specialized for the
conduction of electrochemical
impulses. They appear much
larger and paler than cardiac
muscle fibers.

- This section was taken near the interventricular septum. The nerve tissue of the AV bundle, or bundle of His
(lighter staining enclosed in bracket), must travel through the cardiac skeleton down a small fascicle of muscle
fibers. The nerve fibers then travel down the interventricular septum towards the apex of the heart as Purkinje
fibers.
- The cardiac skeleton consists of dense connective tissue surrounding the cardiac valves, on which all the
muscle fibers of the heart insert. When the cardiac muscles contract, they pull toward these insertion points and
empty the atria and ventricles.

Cardiac Valves
-

As shown in the previous slide, the heart contains

4 valves the tricuspid, pulmonary, mitral, and
aortic valves. The valves prevent regurgitation of
blood flow.

The cardiac valves are essentially plates of dense

connective tissue extending from the cardiac
skeleton covered with endothelium. They are
avascular.

The side of the valve that faces oncoming blood

flow exhibits an extensive elastic fiber network.
As the blood is squeezed out of the heart chamber,
the increased blood pressure pushes the valve
open. As the blood flows past the valve and the
pressure drops, the elastic fibers recoil and help
the valve to close. The other side of the valve
contains abundant collagen fibers.

Both atrial valves, the tricuspid and mitral valves,

are attached to papillary muscles in the ventricles
via chordae tendineae. The papillary muscles and
chordae tendineae do NOT pull open the valves.
All valves open and close passively. Instead, these
structures hold the tricuspid and mitral valves shut
to prevent regurgitation of blood back into the atria
when the ventricles contract. The blood exits the
ventricles via the pulmonary and aortic valves.