The Circulatory System

(Anatomy and Physiology)

The circulatory system is responsible for the transport of water and dissolved materials throughout the
body, including oxygen, carbon dioxide, nutrients, and waste. The circulatory system transports oxygen
from the lungs and nutrients from the digestive tract to every cell in the body, allowing for the
continuation of cell metabolism. The circulatory system also transports the waste products of cell
metabolism to the lungs and kidneys where they can be expelled from the body. Without this important
function toxic substances would quickly build up in the body.

Anatomy of the Circulatory System

The human circulatory system is organized into two major circulations. Each has its own pump with both
pumps being incorporated into a single organ—the heart. The two sides of the human heart are separated
by partitions, the interatrial septum and the interventricular septum. Both septa are complete so that the
two sides are anatomically and functionally separate pumping units. The right side of the heart pumps
blood through the pulmonary circulation (the lungs) while the left side of the heart pumps blood through
the systemic circulation (the body).

The human heart is a specialized, four-chambered muscle that maintains the blood flow in the circulatory
system. It lies immediately behind the sternum, or breastbone, and between the lungs. The apex, or
bottom of the heart, is tilted to the left side. At rest, the heart pumps about 59 cc (2 oz) of blood per beat
and 5 l (5 qt) per minute. During exercise it pumps 120-220 cc (4-7.3 oz) of blood per beat and 20-30 l (21-
32 qt) per minute. The adult human heart is about the size of a fist and weighs about 250-350 gm (9 oz).

The human heart begins beating early in fetal life and continues regular beating throughout the life span of
the individual. If the heart stops beating for more than 3 or 4 minutes permanent brain damage may occur.
Blood flow to the heart muscle itself also depends on the continued beating of the heart and if this flow is
stopped for more than a few minutes, as in a heart attack, the heart muscle may be damaged to such a
great extent that it may be irreversibly stopped.

The heart is made up of two muscle masses. One of these forms the two atria (the upper chambers) of the
heart, and the other forms the two ventricles (the lower chambers). Both atria contract or relax at the
same time, as do both ventricles.

An electrical impulse called an action potential is generated at regular intervals in a specialized region of
the right atrium called the sinoauricular (or sinoatrial, or SA) node. Since the two atria form a single
muscular unit, the action potential will spread over the atria. A fraction of a second later, having been
triggered by the action potential, the atrial muscle contracts.

The ventricles form a single muscle mass separate from the atria. When the atrial action potential reaches
the juncture of the atria and the ventricles, the atrioventricular or AV node (another specialized region for
conduction) conducts the impulse. After a slight delay, the impulse is passed by way of yet another bundle
of muscle fibers (the Bundle of His and the Purkinje system.) Contraction of the ventricle quickly follows
the onset of its action potential. From this pattern it can be seen that both atria will contract
simultaneously and that both ventricles will contract simultaneously, with a brief delay between the
contraction of the two parts of the heart.

The electrical stimulus that leads to contraction of the heart muscle thus originates in the heart itself, in
the sinoatrial node (SA node), which is also known as the heart's pacemaker. This node, which lies just in
front of the opening of the superior vena cava, measures no more than a few millimeters. It consists of
heart cells that emit regular impulses. Because of this spontaneous discharge of the sinoatrial node, the
heart muscle is automated. A completely isolated heart can contract on its own as long as its metabolic
processes remain intact.

The rate at which the cells of the SA node discharge is externally influenced through the autonomic
nervous system, which sends nerve branches to the heart. Through their stimulatory and inhibitory
influences they determine the resultant heart rate. In adults at rest this is between 60 and 74 beats a
minute. In infants and young children it may be between 100 and 120 beats a minute. Tension, exertion, or
fever may cause the rate of the heart to vary between 55 and 200 beats a minute.

The Heart Sounds

The closure of the heart valves and the contraction of the heart muscle produce sounds that can be heard
through the thoracic wall by the unaided ear, although they can be heard better when amplified by a
stethoscope. The sounds of the heart may be represented as lubb-dubb-pause-lubb-dubb-pause. The lubb
sound indicates the closing of the valves between the atria and ventricles and the contracting ventricles;
the dubb sound indicates the closing of the semilunar valves. In addition, there may also be cardiac
murmurs, especially when the valves are abnormal. Some heart murmurs, however, may also occur in
healthy persons, mainly during rapid or pronounced cardiac action. The study of heart sounds and
murmurs furnishes valuable information to physicians regarding the condition of the heart muscle and
valves.

Coronary Circulation

The coronary arteries supply blood to the heart muscle. These vessels originate from the aorta
immediately after the aortic valve and branch out through the heart muscle. The coronary veins transport
the deoxygenated blood from the heart muscle to the right atrium. The heart's energy supply is almost
completely dependent on these coronary vessels. When the coronary vessels become blocked, as
in arteriosclerosis or hardening of the arteries, blood flow to the cardiac muscle is compromised. This is
when the common "bypass surgery" is performed where the coronary arteries are "bypassed" by replacing
them with, for example, a vein from the leg. A "double bypass" is when two coronary arteries are
bypassed. A "triple bypass" is when three are bypassed, etc.

The Heartbeat

The heart muscle pumps the blood through the body by means of rhythmical contractions (systole) and
relaxations or dilations (diastole). The heart's left and right halves work almost synchronously. When the
ventricles contract (systole), the valves between the atria and the ventricles close as the result of
increasing pressure, and the valves to the pulmonary artery and the aorta open. When the ventricles
become flaccid during diastole, and the pressure decreases, the reverse process takes place.

The Pulmonary Circulation

From the right atrium the blood passes to the right ventricle through the tricuspid valve, which consists of
three flaps (or cusps) of tissue. The tricuspid valve remains open during diastole, or ventricular filling.
When the ventricle contracts, the valve closes, sealing the opening and preventing backflow into the right
atrium. Five cords attached to small muscles, called papillary muscles, on the ventricles' inner surface
prevent the valves' flaps from being forced backward.

From the right ventricle blood is pumped through the pulmonary or semilunar valve, which has three half-
moon-shaped flaps, into the pulmonary artery. This valve prevents backflow from the artery into the right
ventricle. From the pulmonary artery blood is pumped to the lungs where it releases carbon dioxide and
picks up oxygen.
The Systemic Circulation

From the lungs, the blood is returned to the heart through pulmonary veins, two from each lung. From the
pulmonary veins the blood enters the left atrium and then passes through the mitral valve to the left
ventricle. As the ventricles contract, the mitral valve prevents backflow of blood into the left atrium, and
blood is driven through the aortic valve into the aorta, the major artery that supplies blood to the
entire body. The aortic valve, like the pulmonary valve, has a semilunar shape.

The aorta has many branches, which carry the blood to various parts of the body. Each of these branches
in turn has branches, and these branches divide, and so on until there are literally millions of small blood
vessels. The smallest of these on the arterial side of the circulation are called arterioles. They contain a
great deal of smooth muscle, and because of their ability to constrict or dilate, they play a major role in
regulating blood flow through the tissues.

The blood passing through the arterioles passes through a bed of minute vessels called capillaries, which
are a single cell thick. These capillaries are so small that the red blood cells must line up single file to pass
through. The exchange of nutrients and waste products takes place between the capillary blood and the
tissue fluids. The arterialized blood that enters the capillaries thus becomes venous blood as it passes
through them.

The capillaries empty the venous blood into collecting tubes called venules, and these in turn empty into
small veins, which empty into larger veins, and so on until finally all the blood returns to the heart through
two large veins, the superior and inferior vena cavae. These terminate in the right atrium, and the
systemic circulation is complete.

A one-way flow of blood in this system is maintained by valves located, not only in the heart, but in the
veins as well. Some veins also have semilunar valves and the pressure of contracting muscles against the
veins works with the action of these valves to increase the venous return to the heart. This is the reason
that exercise is so important for the circulation.

The Lymphatic System

An often overlooked part of the circulatory system is the lymphatic system. As blood passes through the
capillaries, some of the fluid diffuses into the surrounding tissues. One function of the lymphatic system is
to collect and recycle this fluid (called lymph). Lymph passes from capillaries to lymph vessels and flows
through lymph nodes that are located along the course of these vessels. Cells of the lymph
nodes phagocytize, or ingest, impurities such as bacteria, old red blood cells, and toxic and cellular waste.
Finally, lymph flows into the thoracic duct, a large vessel that runs parallel to the spinal column, or into the
right lymphatic duct, both of which transport the lymph back into veins of the shoulder areas where is
mixes with blood and is returned to the heart. All lymph vessels contain one-way valves, like the veins, to
prevent backflow.

The tissues of the lymphatic system include the spleen. The spleen serves as a reservoir for blood,
releasing additional blood into the circulatory system as needed. It is also involved with destruction of old
cells and other substances by phagocytosis. The lymphatic system is also responsible for collecting
nutrients that the digestive system has extracted from our foods, and is a very important part of the
immune system. We will cover the lymphatic system in detail in the lesson on the immune system.
The Blood

The blood transports life-supporting food and oxygen to every cell of the body and removes their waste
products. It also helps to maintain body temperature, transports hormones, and fights infections. The brain
cells in particular are very dependent on a constant supply of oxygen. If the circulation to the brain is
stopped, death shortly follows.

Blood has two main constituents. The cells, or corpuscles, comprise about 45 percent, and the liquid
portion, or plasma, in which the cells are suspended comprises 55 percent. The blood cells comprise three
main types: red blood cells, or erythrocytes; white blood cells, or leukocytes, which in turn are of many
different types; and platelets, or thrombocytes. Each type of cell has its own individual functions in the
body. The plasma is a complex colorless solution, about 90 percent water, that carries different ions and
molecules including proteins, enzymes, hormones, nutrients, waste materials such as urea, and fibrinogen,
the protein that aids in clotting.

A. Red Blood Cells

The red blood cells are tiny, round, biconcave disks, averaging about 7.5 microns (0.003 in) in diameter. A
normal-sized man has about 5 l (5.3 qt) of blood in his body, containing more than 25 trillion red cells.
Because the normal life span of red cells in the circulation is only about 120 days, more than 200 billion
cells are normally destroyed each day by the spleen and must be replaced. Red blood cells, as well as
most white cells and platelets, are made by the bone marrow.

The main function of the red blood cells is to transport oxygen from the lungs to the tissues and to
transport carbon dioxide, one of the chief waste products, it to the lungs for release from the body.

The substance in the red blood cells that is largely responsible for their ability to carry oxygen and carbon
dioxide is hemoglobin, the material that gives the cells their red color. It is a protein complex comprising
many linked amino acids, and occupies almost the entire volume of a red blood cell. Essential to its
structure and function is the mineral iron.

B. White Blood Cells

The leukocytes, or white blood cells, are of three types; granulocytes, lymphocytes, and monocytes. All
are involved in defending the body against foreign organisms.

There are three types of granulocytes: neutrophils, eosinophils, and basophils, with neutrophils the most
abundant. Neutrophils seek out bacteria andphagocytize, or engulf, them.

The lymphocytes' chief function is to migrate into the connective tissue and build antibodies against
bacteria and viruses. Leukocytes are almost colorless, considerably larger than red cells, have a nucleus,
and are much less numerous; only one or two exist for every 1,000 red cells. The number increases in the
presence of infection.

Monocytes, representing only 4 to 8 percent of white cells, attack organisms not destroyed by
granulocytes and leukocytes.

The granulocytes, accounting for about 70 percent of all white blood cells, are formed in the bone marrow.
The lymphocytes on the other hand are produced primarily by the lymphoid tissues of the body—the
spleen and lymph nodes. They are usually smaller than the granulocytes. Monocytes are believed to
originate from lymphocytes. Just as the oxygen-carrying function of red cells is necessary for our survival,
so are normal numbers of leukocytes, which protect us against infection.

C. Platelets
Platelets, or thrombocytes, are much smaller than the red blood cells. They are round or biconcave disks
and are normally about 30 to 40 times more numerous than the white blood cells. The platelets' primary
function is to stop bleeding. When tissue is damaged, the platelets aggregate in clumps to obstruct blood
flow.

D. Plasma

The plasma is more than 90 percent water and contains a large number of substances, many essential to
life. Its major solute is a mixture of proteins. The most abundant plasma protein is albumin. The globulins
are even larger protein molecules than albumin and are of many chemical structures and functions. The
antibodies, produced by lymphocytes, are globulins and are carried throughout the body, where many of
them fight bacteria and viruses.

An important function of plasma is to transport nutrients to the tissues. Glucose, for example, absorbed
from the intestines, constitutes a major source of body energy. Some of the plasma proteins and fats, or
lipids, are also used by the tissues for cell growth and energy. Minerals essential to body function,
although present only in trace amounts, are other important elements of the plasma. The calcium ion, for
example, is essential to the building of bone, as is phosphorus. Calcium is also essential to the clotting of
blood. Copper is another necessary component of the plasma.