Ahmad Aulia Jusuf, Histology FMUI

CARDIOVASCULAR SYSTEM
A View From Histological Aspect
Ahmad Aulia Jusuf, MD, PhD
Department of Histology Faculty of Medicine University of Indonesia
2!
INTRODUCTION
"he ciculation system is composed of cardiovascular system and the lymphatic
vascular system# "he cardiovascular system is to carry $lood in $oth directions $et%een
heart and the tissue# "he lymphatic vascular system is to collect the lymph, the e&cess
e&tracellular tissue fluid and deliver it $ac' into the cardiovascular system#
"he $lood from the heart is pumped out
into t%o separated circuits( the pulmonary
circuit %hich carries $lood to and from
lungs and the systemic circuit %hich
distri$utes the $lood to and from all of the
organ and tiussues of the $ody# "he $lood
from the heart %ill circulate into aorta, the
largest artery that continue draining into
the medium and small arteries#
"he $lood then enters the e&tracellular
tissue fluid to give the o&ygen and nutrient
for the cells# "hen the %aste of meta$olism
and car$ondio&yde %ill $e drained into the
small vein )venue*, medium vein and large
veins# From the large vein the $lood is
circulated $ac' into the heart
Figure+, An -vervie% of cardiovascular
system
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Ahmad Aulia Jusuf, Histology FMUI
THE LOOD VESSEL
In general the structure of $lood vessel is composed of . tunics or layers
,# "he tunica intima
"he most internal layer is composed of a single layer of flattened, s/uamous
endothelial cells# "he other structures are the su$endotelial loose connective tisue
and the internal elastic tunic
2# "he tunica media
"his medial layer is composed of concentric smooth muscle layer, elastic fi$ers,
type III collagen fi$ers and proteoglycan
.# "he e&ternal elastic lamina
"he e&ternal elastic lamina is more delicate than the internal elastic lamina and
separates the tunica media from overlaying tunica adventisia#
0# "unica Adventisia
"his layer covers the outside surface of $lood vessel, and msotly composed of
type I collagen fi$ers# In this part the vasa vasorum, the small arteries that enter
the vessel %alls to give the nutrient for the %all of $lood vessel#
Figure+2 1tructure of $lood vessel
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Ahmad Aulia Jusuf, Histology FMUI
ARTERY
Arteries are efferent vessels that transport $lood a%ay from the heart to the
capillary $ed# "hey can $e classify into . types
,# 2arge artery )elastic artery, conducting artery*
"he arteries $elongs to this type are aorta, inominate artery, carotic communis
artery, su$clavia artery, iliac artery
"he tunica intima of elastic artery contains an endothelium, supported $y the
narro% layer of underlying connective tissue# "he endothelial c&ells contain
3ei$el+Palade $odies, an mem$rane inclusion that have a dense matri& containg
glycoprotein von 3illi$rand factor# "hin laminae of elastic fi$er, the internal
elstic lamina are also present# "he tunica media consists of many fenestrated
Figure+. "he histological appearance of aorta
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Ahmad Aulia Jusuf, Histology FMUI
lamellae of elastin fi$ers and a fe% amount of smooth muscle# "he e&ternal elastic
laminae is also present in the tunica media# "unica adeventisia is relatively thin,
composed of loose fi$roelastic connective tissue# "he tunica adventisia contains
the vasavasorum# 4asa 4asorum is the small $lood vessel located in the %all of
large artery or medium artery that functions in supplying the nutrient and o&ygen
to that tissue
"he function of large artery is to drainage the $lood to the medium artery, to 'eep
the systolic pressure in the constan condition and to avoid the flunctuation of
$lood flo%#
2# Medium artery )muscular artery, distri$uting artery*
Figure+0 "he Medium artery
"he e&ample of this type are $rachialis artery, ulnar artery, femoral artery,
poplitea artery, coronary artery, um$ilical artery and arteries located in the $rain
"he tunica intima in muscular artery is thinner than in the elastic arteries# "he
internal elastic laminae is prominent and displays an undulating surface# "he
tunica media is composed predominantly of smooth muscle cells# "he e&ternal
elastic lamina is identifia$le in histological sections as several layers of thin
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Ahmad Aulia Jusuf, Histology FMUI
elastic sheets# "he tunica adventisia consist of elastic fi$ers, collagen fi$ers and a
ground su$stance composed mostly of dermatan sulfate and heparan sulfate#
"he function of medium artery is to distri$ute the $lood to the atrget organ or
tissue#
.# 1mall artery )Arteriol*
Figure+5 "he small artery
"he endothelium of tunica intima is supported $y a thin su$endothelium layer
consisting of type III collagen and a fe% elasticfi$ers em$edded in ground
su$stance# An internal elastic lamina is a$sent in small and terminal arterioles#
"he tunica media is composed of a single smooth muscle cell layer# "he tunica
adventisia is scant and is represented $y fi$roelastic connective tissue#
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1mall artery )arteriol* is one component of microvascular sistem# "his system
consists of arteriole, metarteriole, capillary and venule#
4asoconstriction of arteriole %ill increase the peripheral resistency, resulting in
the increasing of systemic $lood pressure
0# Metarteriol
A metarteriol is an artery that supply $lood to capillary $eds# "he smooth muscle
layer is not continuous $ut spaced apart# It is thought that this arrangement
permits these smooth muscle cells to function as a sphincter upon contraction,
thus controlling $lood flo% into the capillary $ed#
Figure+6 "he capillary $ed
"he $lood vessel is controlled $y sympathetic and parasympathetic nerve system# "he
sympathetic nerve system through adrenalin stimulates vasoconstriction, %hile the
parasympathetic through the acetylcholine stimulatse the vasodilation of vessel#
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CA!ILLARIES
"he smallest $lod vessels arising from the terminal ends of the arterioles %hich
form, $y $ranching and anastomosing, a capillary $ed )net%or'* $et%een the arterioles
and venules#
7apillary has the diameter a$out 8+,2 micrometer# 7apillaries are formed $y a
single layer of s/uamous endothelial cells 'no%n as endothel that is lined $y $asal
mem$rane# Pericytesare located along the outside of the capillaries and small venules#
"hese cells are flatenned in shape and contain tropomyosin isomyosin and protein 'inase
%hich are all related to contraction that regulate the $lood flo%#
Figure+8 "he capillary
"here are . types of capillary
,# 7ontinuous capillaries
"he contonuous capillaries have no interruptions )pore or fenestrated* in their
%all# "his type of capillary is present in the muscle, nervous and connective
tissues
2# Fenestrated capillaries
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"he fenestrated capillaries have pore or fenestrae in their %all# "his type of
capillary is present in the pancreas, intestines, endocrine and 'idney
.# 1inusoidal capilaries
"he sinusoidal capillaries, also 'no%n as sinusoids, have irregular shape
%hich conform to the shape of the structure in %hich they are located# "his
capillaries can $e found in the hemopoeitic tissue such as $one marro% and
spleen, liver, corte& of adrenal and adenohipophysis#
VEINS
"he vein is afferent vessel that collect and transport the $lood $ac' to the heart#
"he veins is characteri9ed into . types $ased on si9e ( small, medium and large veins#
2i'e artery veins is also characteri9ed into . types
Figure+: "he small )left side* and medium )right side* veins
,# 1mall vein
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"he shape of small venule is irregular, %hile the arteriole is round# "unica intima
of venule is lined $y a single flattened cells 'no%n as andothelial cells#
2# Medium veins
"he histological apperance of medium vein is similar to medium artery $ut the
medium vein has no internal elastic lamina
.# 2arge veins
"he tunica intima of large vein is similar to medium vein e&cept the large veins
have a thic' su$endothelial connective tissue layer#
Many medium veins have valves that function to prevent the $ac' flo% of $lood # A
venous valve is composed of t%o leaflets each composed of a thin fold of the intima
;utting out from the %all into the lumen
Arterio"e#o$s a#astomoses
"erminal of most arteries end in capillary $eds, %hich deliver their $lood to
venules for the return $ac' to the venous side of the cardiovascular system# In many part
of our $ody ho%ever the artery simpley ;oins %ith a venous channel, forming an
arteriovenous anastomoses )A4A*# "his shunt is useful in thermoregulation and found
a$undant in the s'in# "his segmen is innervated %ith adrenergc and cholinergic nerves#
THE LYM!HATIC SYSTEM
"he lymphatic vascular system is a series of vessels that remove e&cess tissue
fluid )lymph* from the interstitial tissue spaces and return it to the cardiovascular system#
2ympahtic vessel are found throughout the $ody e&cept in the central nervous system and
fe% other ares including cartilage, $one, $one marro%, thymus, teeth, internal ear and
placenta#
"he lymphatic system is an open system in that there is no pump and no
circulation of fluid# "he lymphatic vascular system $egins in the tissue of the $ody as
$lind ended lymphatic capillaries# "he e&cess fluid in the e&tracelluar space enters the
lymphatic capillaries # "he lymphatic capillaries empty their contents into lymphatic
vessels %hich empty into successively larger vessels until one of the t%o lymphatic duct
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Ahmad Aulia Jusuf, Histology FMUI
Figure+! "he lymphatic vessel
is reached# "hese t%o lymphatic duct are right lymphatic duct and thoracic duct# "he
right lymphatic duct collects lymph from the upper right /uadrant of $ody, %hile the
thoracic duct collect lymph from the remainder of the $ody# "he right lymphatic duct
empties its contents into the venous system at the ;unction of right internal ;ugular and
su$clavian vein %hile the thoracic duct empties its contents at the ;unction of the left
internal ;ugular and su$clavian veins
"he lymphatic capillaries are composed of a single layer of endothelial cells %ith
an incomplete $asal lamina# "he small and medium lymphatic vessels are characteri9ed
$y closely space valves# 2arge lymphatic vessels resem$le small vein structurally , e&cept
their lumen are larger and their %all thinner# "he smooth muscles in the tunica media are
arranged in the regular manner#
HEART
"he heart is the pump for the cardiovascular system# Its muscular %all
)myocardium* is composed of cardiac muscle# "he heart consists of four cham$ers t%o
atria %hich receive the $lood and t%o ventricles %hich discharge $lood from the heart#
"he %all of heart is composed $y . layers that are homologous to the tunica
intima, tunica media, and tunica adventitia respectively in the $lood vessels# "hey are
,# <ndocardium that lining the heart lumen and direct contact to the $lood
2# myocardium, located in the middle part that contains the cardiac muscle cells
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.# epicardium, also called as visceral layer of pericardium that covers the
myocardium
Figure+ , the layers of heart
E#%ocar%i$m
"he endocardium %ill continuous %ith the tunica intima of the $lood vessel entering and
leaving the heart# "he endocardium is made up of
,# An endothelium composed of simple s/uamous epithelium
2# 1u$endothelium %hich contains the collagenous and elastic fi$ers
.# 1u$endocardium, a layer %hich is consists of loose connective tissue# "he
su$endocardium of ventricle and interventricular septum contain the Pur'in;e
fi$ers, the modified myocardium that functions in nerve conducting system# "he
su$endocardium layer is a$sent in the papilaris muscle and corda tendinae#
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Figure+,, <ndocardium
Figure+,2 "he Pur'in;e fi$ers in su$endocardium
M&ocar%i$m
Myocardium contains the cardiac muscle cells, %hich are arranged in comple&
spirals around the orifices of cham$ers# "he cardiac muscle consists of separate cellular
units and is uni=nucleate# Furthermore cardiac muscle is characteri9ed $y rhythmic,
involuntary contractions controlled $y autonomic innervation#
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"he cardiac muscle cells have . speciali9ed properties# "hey are contraction,
endocrine secretion and impulse generation or impulse conduction#
"he speciali9ed cardiac muscle cells located primarily in the atrial %all and in the
interventricular septum produce an array of small secreted peptides# "hese include
atriopeptin, atrial natriuretic polypeptide, cardiodilatin and cardionatrin %hich are
released into the surrounding capillaries# "hese hormones aid fluid maintenance and
electrolyte $alance and decreased $lood pressure#
Figure+,. "he path%ays of nerve impulse in the heart
"he heart rate is controlled $y the sinoatrial node, a pacema'er located at the ;unction
of the superior vena cava and the right atrium# "hese speciali9ed nodal cardiac muscle
cells can spontaneously create an impulse that spreads over the atrial cham$er %all $y
internodal path%ays to the atrioventricular node, located in the septal %all ;ust a$ove the
tricuspid valve# Modified cardiac muscle cells of the atrioventricular node transmits
signals to the myocardium of atria via the atrioventricular $undle $undle of His*# Fi$ers
from the atrioventricular $undle pass do%n the interventricular septum to conduct the
impulse to the cardiac muscle through the modified cardiac muscle cells located in the
su$endocardial connective tissue of right and left ventricle, 'no%n as Pur'in;e fi$ers#
Pur'in;e fi$ers also can $e found in a fe% num$ers in the limited area of right atrium and
in the interventricular septum
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E!ICARDIUM
Figure+,0 <picardium
"he epicardium , also 'no%n as visceral layer of the pericardium is composed of a
simpler s/uamous epithelium# "he su$epicardial layer of loose connective tissue contain
the coronary vessels, nerves and ganglia and an adipose tissue#
At the roots of the vessels entering and leaving the heart, the visceral pericardium
$ecomes continuous %ith the serous layer of the parietal pericardium# "hese t%o layers of
the pericardium enclose the pericardial cavity, a space containing a small amount of
serous fluid for lu$ricating the serous layer of the pericardium and the visceral
pericardium#
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Figure+,5 "he Pericardium
CARDIAC S'ELETON
7ardiac s'eleton is a structure that provide the structural frame%or' for heart and
attachment sites for cardiac muscle and cardiac valve# "he cardiac s'eleton composed of
dense connective tissue includes three main components
,# septum mem$ranaceum, that constituting the upper portion of the interventricular
septum, the atrioventricular foramina and atrial foramina#
2# trigonum fi$rosum, that constituting some of cuspal area of the aortic valve
.# annuli fi$rosi that formed around the $ase of the aorta, pulmonary artery, and
atrioventricular orifices#
"he cardiac valve is a leaf li'e structure made $y dense connective tissue that is
attached to the annuli fi$rosi# "here are 0 cardiac valve (
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Figure+,6 "he Heart 4alves
,# Mitral or $icuspid valve consists of 2 leafs located $et%een left atrium and left
ventricle
2# "ricuspid valve consists of . leafs located $et%een right atrium and right
ventricle
.# "he semilunar aortic valve consists of . leafs located $et%een aorta and left
ventricle
0# "he semilunar pulmonal valve consists of . leafs located $et%een pulmonal and
right ventricle
"he surface of cardiac valve is continuation of atrial and ventricle endocardium# "he
edge of cardiac valve contains the corda tendinae, a fi$er li'e structure composed $y
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collagen fi$ers# "he atrioventricular valve contains the small $lood vessel, $ut the
semilunar valves are avascular#
Figure+,8 "he 1ection of Heart
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