ANGIOLOGY

Erial Bahar2014

ANATOMY OF HUMAN BLOOD VESSELS

Lecture outline

1. Overview of the cardiovascular system2. Blood circuit3. Structure of blood vessels4. Distribution of the blood vessels5. Clinical anatomy of cardiovascular system

OVERVIEW OF THE CARDIOVASCULAR SYSTEM

The Human Cardiovascular System

1. The Heart2. Vascular system:

1. Arterial system2. Venous system3. Lymphatic system

3. Blood circulation1. Pulmonary circulation2. Systemic circulation

BLOOD VESSELS1. ARTERIES carry blood away from the heart and toward the

tissues. The heart’s ventricles pump blood into the arteries.2. ARTERIOLES are small subdivisions of the arteries. They

carry blood into the capillaries.3. CAPILLARIES are tiny, thin-walled vessels that allow for

exchanges between systems. These exchanges occur between the blood and the body cells and between the blood and the air in the lung tissues. The capillaries connect the arterioles and venules.

4. VENULES are small vessels that receive blood from the capillaries and begin its transport back toward the heart.

5. VEINS are vessels formed by the merger of venules. They continue the transport of blood until it is returned to the heart

Blood circuitsA. Pulmonary circuit—carries blood to and

from lungsB. Systemic circuit—carries blood to and from

rest of body

STRUCTURE OF THE BLOOD VESSELS

a. Artery walls—layers (tunics)1. Tunica intima = Endothelium; Innermost—single layer of

flat epithelial cells.2. Tunica media; Middle—thicker layer of smooth muscle

and elastic connective tissue.3. Tunica adventitia; Outer—connective tissue

b. Arterioles—thinner walls, less elastic tissue, more smooth muscle

c. Capillaries—only endothelium; single layer of cellsd. Venules—wall slightly thicker than capillary walle. Veins—all three layers; thinner walls than arteries,

less elastic tissuePictures

Interconnection between arterial system and venous system

DISTRIBUTION OF THE BLOOD VESSELS

Distribution of Blood Vessels

1. Arterial system2. Venous system

Systemic arteriesA. The aorta and its parts

a. Ascending aorta• Left and right coronary arteries

b. Aortic arch1. Brachiocephalic artery—branches to arm and head on right2. Left common carotid artery—supplies left side of neck and the head3. Left subclavian artery—supplies left arm

c. Descending aorta1. Thoracic aorta—branches to chest wall, esophagus, bronchi2. Abdominal aorta—supplies abdominal viscera

B. Iliac arteries and their subdivisions– Final divisions of aorta– Branch to pelvis and legs

C. Arteries that branch to the arm and head—common carotid, subclavian, brachial

D. Anastomoses—communications between vessels

ARTERIES OF THE THORACIC CAVITY AND WALLS

Aortic arch = Arcus aorta

Thoracic Aortaa. Visceral branches : supplying thoracic organs

1. Bronchial : Lung tissue2. Esophageal : Esophagus

b. Parietal branches : supplying thoracic wall1. Intercostal :Thoracic wall2. Superior phrenic :Superior surface of diaphragm

Blood Suppy to Thoracic Wall

• The walls of the thorax are supplied with blood by :1. the anterior intercostals : The anterior intercostals are derived

from the internal thoracic arteries, which are branches of the subclavian arteries and lie on the inner surface of the anterior thoracic wall.

2. the posterior intercostals. . The posterior intercostals are derived as bilateral branches directly from the descending aorta.

3. Superior phrenic arteries supply blood to the diaphragm• The anterior and posterior intercostal arteries lie along the

inferior margin of each rib and anastomose with each other approximately midway between the ends of the ribs.

ARTERIES OF THE ABDOMINAL CAVITY AND WALL

Abdominal Aorta1. Inferior phrenic : Adrenal gland and inferior surface of diaphragm2. Celiac trunk

1. Left gastric : Stomach and esophagus2. Common hepatic :

1. Gastroduodenal : Stomach and duodenum2. Right gastric : Stomach3. Hepatic : Liver

3. Splenic : Spleen and pancreas1. Left gastroepiploic : Stomach

3. Lumbar : Lumbar vertebrae and back muscles 4. Suprarenal : Adrenal gland5. Superior mesenteric :Pancreas, small intestine, and colon6. Renal : Kidney7. Gonadal

1. Testicular (male) : Testis and ureter2. Ovarian (female) : Ovary, ureter, and uterine tube

8. Inferior mesenteric :Descending colon and rectum

9. Median sacral : Inferior vertebrae

10. Common iliac1. External iliac : Lower limb2. Internal iliac : Lower back, hip, pelvis, urinary bladder, vagina, uterus, rectum, and external genitalia

1. Common Iliac Arteries 1. Internal Iliac Arteries (Hypogastric Arteries)

1. Superior gluteal : Hip muscles and joint2. Internal pudendal : Rectum, anus, perineal

muscles, external genitalia.3. Obturator4. Lateral sacral

2. External Iliac artery go to lower extremities

ARTERIES OF THE PELVIC CAVITY

ARTERIES OF NECK AND HEAD

ARTERIES OF THE HEAD AND NECK• Aortic arch

1. Brachiocephalic trunk1. Right common carotid a. to the right side of neck and

head2. Right subclavian a.

1. Right axillary a. to the right arm2. Right vertebral a. to the brain

2. Left common carotid a. to left side of neck and head

3. Left subclavian a. 1. Axillary a. to the left arm2. Vertebral a. to the brain

Common carotid artery1. External carotid artery

1. Superior thyroid 2. Lingual 3. Facial 4. Occipital 5. Posterior auricular 6. Ascending pharyngeal 7. Superficial temporal 8. Maxillary

2. Internal carotid artery1. Posterior communicating 2. Anterior cerebral 3. Middle cerebral

1. External Carotid1. Superior thyroid 2. Lingual 3. Facial 4. Occipital 5. Posterior auricular 6. Ascending pharyngeal 7. Superficial temporal 8. Maxillary

2. Internal Carotid1. Posterior communicating 2. Anterior cerebral 3. Middle cerebral

3. Vertebral Arteries (branches of the subclavian arteries)1. Anterior spinal 2. Posterior inferior cerebellar

4. Basilar Artery (formed by junction of vertebral arteries)1. Anterior inferior cerebellar 2. Superior cerebellar 3. Posterior cerebral

SUMMARY OF THE ARTERIES OF THE HEAD AND NECK

Systemic veins

A. Superficial—near surfaceB. Deep—usually parallel to arteries with same

names as corresponding arteries1. The venae cavae and their tributaries

a. Superior vena cava—drains upper part of bodya) Jugular veins drain head and neckb) Brachiocephalic veins empty into superior vena cava

b. Inferior vena cava—drains lower part of body

2. Venous sinuses—enlarged venous channels3. Hepatic portal system—carries blood from

abdominal organs to liver, where it is processed before returning to heart

The physiology of circulation• A. Capillary exchange

o Primary method—diffusiono Blood pressure—drives fluid into tissueso Osmotic pressure—pulls fluid into capillary

• B. Dynamics of blood flowo Vasomotor activities

• Vasodilation—increase in diameter of blood vessel• Vasoconstriction—decrease in diameter of blood vessel• Vasomotor center—in medulla; controls contraction and relaxation

of smooth muscle in vessel wallo Precapillary sphincter—regulates blood flow into capillaryo Return of blood to heart

1. Pumping action of heart2. Pressure of skeletal muscles on veins3. Valves in veins4. Breathing—changes in pressure move blood toward heart

BLOOD VESSEL DISORDERSA. Arteriosclerosis—hardening of arteries with scar tissue, calcium salts, or fatty deposits

– 1. Atherosclerosis—deposits of fatty material (plaque) in vessels– 2. Possible results—pain, breathing problems, angina pectoris, thrombosis (blood clot),

tissue necrosis, gangrene

B. Aneurysm—weakness and bulging of a vessel; may burst

C. Vasospastic Conditions:1. Raynaud’s disease2. Raynaud’s phenomenon

D. Arterial inflammation:– Thromboangiitis obliterans (Burger's disease): an inflammatory disorder that can

affect the aorta or peripheral arteries. It occurs most often in young men who are heavy cigarette smokers

E. Embolus—piece of a clot traveling in circulation• Pulmonary embolism—clot lodged in lung

F. Phlebitis—inflammation of a vein; may lead to thrombophlebitis

G. Varicose veins —swelling and loss of function in superficial veins, usually in legs and rectum (hemorrhoids)

Thank you

Cardiovascular system diagram. The blue-colored vessels carry O2-poor blood, and the red-colored vessels carry O2-rich blood; the arrows indicate the flow of blood.

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Internal RespirationAt systemic capillaries, HbO2 inside red blood cellsbecomes Hb and O2. Hb now combines with H+ toform HHb. O2 leaves red blood cells and capillaries.

External RespirationAt pulmonary capillaries, HCO3–is converted inside red blood cellsto H2O and CO2. CO2 leaves redblood cells and capillaries.

External RespirationAt pulmonary capillaries, O2enters red blood cells where itcombines with Hb to form HbO2 .

Internal RespirationAt systemic capillaries, CO2 enters red blood cells. Some combines with Hb to form HbCO2. Most is converted to HCO3 –, which is carried in the plasma

External and internal respiration.During external respiration in the lungs, CO2 leaves blood and O2 enters blood. During internal respiration in the tissues, O2 leaves blood and CO2 enters blood.

Mader: Human Biology 7th ed.BACK

ARTERIAL SYSTEM VENOUS SYSTEM

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PRINCIPAL SYSTEMIC ARTERIES

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Principal systemic veins

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The aorta and its branches. BACK

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Blood vessels.The walls of arteries and veins have three layers. The inner layer is composed largely of endothelium with a basement membrane that has elastic fibers; the middle layer is smooth muscle tissue; the outer layer is connective tissue (largely collagen fibers). a. Arteries have a thicker wall than veins because they have a larger middle layer than veins. b. Capillary walls are one-cell-thick endothelium. c. Veins are larger in diameter than arteries, so that collectively veins have a larger holding capacity than arteries. d. Light micrograph of an artery and a vein.

Mader: Human Biology 7th ed.

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Internal RespirationAt systemic capillaries, HbO2 inside red blood cellsbecomes Hb and O2. Hb now combines with H+ toform HHb. O2 leaves red blood cells and capillaries.

External RespirationAt pulmonary capillaries, HCO3–is converted inside red blood cellsto H2O and CO2. CO2 leaves redblood cells and capillaries.

External RespirationAt pulmonary capillaries, O2enters red blood cells where itcombines with Hb to form HbO2 .

Internal RespirationAt systemic capillaries, CO2 enters red blood cells. Some combines with Hb to form HbCO2. Most is converted to HCO3 –, which is carried in the plasma

External and internal respiration.During external respiration in the lungs, CO2 leaves blood and O2 enters blood. During internal respiration in the tissues, O2 leaves blood and CO2 enters blood.

Mader: Human Biology 7th ed.BACK

BLOOD VESSEL STRUCTURE

Sections of small blood vessels. Drawings show the thick wall of an artery, the thin wall of a vein, and the single-layered wall of a capillary. A venous valve also is shown. The arrow indicates the direction of blood flow. BACK

BLOOD VESSEL STRUCTUREThe three layers (tunics), innervation and vascularization of the blood vessel

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The relationship of an intercostal space.

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The thoracic aorta.

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Abdominal Aorta & External Iliac Artery BACK

Celiac Trunk

i. Arises from the anterior aspect of the abdominal aorta at the level of the lower border of T12.

ii. Branches:i. Left gastric artery

i. Oeshophageal brii. Splenic arteryiii. Common hepatic artery

i. Right gastricii. Gastroduodenali. Superior

pancreaticoduodenalii. Right gastroepiploiciii. Hepatic

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1. Cystic artery2. Hepatic proper artery3. Celiac trunk4. Right gastric artery5. Common hepatic artery6. Gastroduodenal artery7. Superior mesenteric artery8. Superior posterior

pancreaticoduodenal9. Body of pancreas10. Superior anterior

pancreaticoduodenal artery11. Right gastro-omental

(gastroepiploic) artery12. Duodenum13. Short gastric arteries14. Spleen15. Left gastric artery16. Splenic artery17. Posterior pancreatic branch

of splenic artery18. Tail of pancreas19. Left gastro-omental

(gastroepiploic) artery20. Inferior pancreatico-

duodenal artery21. Middle colic artery22. Superior mesenteric artery23. Jejunal arteries

Blood supply of upper abdominal organs (branches of the celiac trunk and superior mesenteric artery).

(Schematic drawing.)

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Branches of celiac trunk (Schematic drawing.)

1. Liver (visceral surface)2. Gallbladder3. Cystic duct and artery4. Right branch of hepatic

artery proper5. Right gastric artery6. Gastroduodenal artery7. Duodenum8. Superior

pancreaticoduodenal artery

9. Right gastro-omental (gastroepiploic) artery

10. Common hepatic artery11. Aorta12. Celiac trunk13. Spleen14. Short gastric arteries15. Left gastric artery16. Splenic artery17. Left gastro-omental

(gastroepiploic) artery

Main branches of superior and inferior mesenteric arteries. (Schematic drawing.)

1. Pancreas2. Middle colic artery3. Duodenum4. Right colic artery5. Jejunal arteries6. Iliocolic artery7. Appendicular artery8. Transverse mesocolon9. Superior mesenteric artery10.Duodenojejunal flexure11.Inferior mesenteric artery12.Left colic artery13.Sigmoid arteries14.Superior rectal artery

The superior and inferior mesenteric arteries and their branches.

1. Superior suprarenal artery2. Upper capsular artery3. Anterior branch of renal artery4. Perforating artery5. Lower capsular artery6. Ureter7. Right inferior phrenic artery8. Left inferior phrenic artery9. Middle suprarenal artery10. Celiac trunk11. Inferior suprarenal artery12. Superior mesenteric artery13. Right renal artery14. Posterior branch of renal artery15. Left testicular (or ovarian) artery16. Inferior mesenteric artery

Arteries of kidney and suprarenal gland. (Schematic drawing.)

Blood Supply of the kidney. A longitudinal section of the kidney showing the blood supply. Note that the renal artery divides into smaller arteries, and these divide into arterioles. Venules join to form small veins, which join to form the renal vein.

Mader: Human Biology 7th ed.

Glomerular FiltrationWater, salts, nutrient molecules, and waste molecules move from the glomerulus to the inside of the glomerular capsule. These small molecules are called the glomerular filtrate.

Tubular ReabsorptionNutrient and salt molecules areactively reabsorbed from theproximal convoluted tubule into the peritubular capillary network, and water flows passively.

Tubular SecretionCertain molecules are actively secreted from the peritubular capillary network into the distal convoluted tubule.

Steps in urine formation. The three main steps in urine formation are color-coded to arrows that show the movement of molecules into or out of the nephron at specific locations. In the end, urine is composed of the substances within the collecting duct (see gray arrow).

Mader: Human Biology 7th ed.

Bifurcation of the aorta and branches of the internal iliac artery.BACK

Arterial supply to the rectum, posterior viewBACK

1. Right ureter2. Right common iliac artery3. Right external iliac artery4. Umbilical artery5. Right ductus deferens6. Medial umbilical ligament with

obliterated umbilical artery7. Superior vesical artery and branch to the

ductus deferens8. Left ureter9. Urinary bladder10. Prostate11. Urogenital diaphragm12. Deep artery of penis13. Dorsal artery of penis14. Penis15. Testis16. Left common iliac artery17. Right internal iliac artery18. Iliolumbar artery19. Lateral sacral artery20. Superior gluteal artery and sacral spinal

nerve21. Obturator artery22. Inferior gluteal artery23. Middle rectal artery24. Internal pudendal artery25. Levator ani muscle26. Inferior rectal artery

Main branches of internal iliac artery in the male. (Schematic drawing

1. Testicular vein2. Testicular artery3. Deep dorsal vein of penis4. Dorsal artery of penis5. Pampiniform venous plexus6. Helicine arteries7. Prepuce8. Glans penis9. Testis with tunica albuginea10. Ductus deferens11. Ureter12. Urinary bladder13. Seminal vesicle14. Prostate15. Vesicoprostatic venous plexus16. Deep artery of, penis17. Artery of bulb of penis18. Internal pudendal artery19. Corpus spongiosum of penis20. Corpus cavernosum of penis21. Superficial dorsal vein of penis22. Urethra

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1. Infundibulum of uterine tube2. Ovary3. Fundus of uterus4. Uterine tube5. Round ligament of uterus6. Vaginal portion of cervix of uterus7. Vagina8. Clitoris9. Corpus cavernosum of clitoris10. Bulb of vestibule11. Vaginal orifice12. Greater vestibular gland13. Ovarian artery14. Suspensory ligament of ovary15. Internal iliac artery16. Tubal branch of ovarian artery17. Ovarian branch of ovarian artery18. Uterine artery19. Ovarian branch of uterine artery

(anastomoses with ovarian artery)20. Artery of round ligament21. Internal pudendal artery22. Vaginal artery

Arteries of female genital organs. (Schematic drawing.)BACK

Arteries of the Head and NeckThe brachiocephalic artery, the right common carotid artery, the right subclavian artery, and their branches. The major arteries to the head are the common carotid and vertebral arteries.

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The carotid arteries, their branches and their related nerves.BACK

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Lateral view of a schematic drawing of the carotid arteries, vertebral arteries, and intracranial vessels and their relationships in the neck and brain.

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Schematic drawing of the relationships with the skull of the external carotid artery and branches, in the lateral view.

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1 Superficial temporal arteryBranches of the first part2 Deep auricular artery and anterior tympanic artery3 Middle meningeal artery4 Inferior alveolar arteryBranches of the second part5 Deep temporal branches6 Pterygoid branches7 Masseteric artery8 Buccal arteryBranches of the third part9 Posterior superior alveolar artery10 Infraorbital artery11 Sphenopalatine artery and branches to the nasal cavity12 Descending palatine artery13 Artery of the pterygoid canal

Main branches of maxillary artery

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Blood Supply to the BrainBACK

Arteries on the base of the brainBACK

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1. Anterior communicating artery2. Left anterior cerebral artery3. Internal carotid artery4. Pons and left superior cerebellar artery5. Anterior inferior cerebellar artery6. Posterior inferior cerebellar artery7. Medulla oblongata8. Right anterior cerebral artery9. Olfactory tract10. Optic nerve11. Middle cerebral artery12. Infundibulum13. Oculomotor nerve and posterior

communicating artery14. Posterior cerebral artery15. Basilar artery and abducens nerve (n. VI)16. Anterior spinal artery17. Vertebral artery18. Cerebellum19. Labyrinthine arteries20. Posterior spinal artery21. Right superior cerebellar artery22. Olfactory bulb

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1. A.cerebralis anterior2. A.cerebralis media3. A.ophthalmica4. A.carotis interna5. A.basilaris6. Ramus temporalis

a.cerebralis media7. Ramus temporalis

a.cerebralis media8. A.communicantes

posterior9. A.cerebralis posterior10. A.cerebellaris

superior11. A.cerebellaris inferior

anterior12. A.cerebellaris inferior

posterior13. A.vertebralis

Arteries of the brain

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Schematic drawing showing the distribution of the peripheral branches of the middle cerebral artery and territories.

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1. Insula2. A.cerebralis

media3. A.basilaris4. A.vertebralis5. Sulcus centralis6. Lobus occipitalis7. A.cebellaris

superior8. Cerebellum

1. Interventricular foramen

2. Septum pellueidum3. Frontal lobe4. Anterior cerebral

artery5. Anterior commissure6. Optic chiasma and

infundibulum7. Mamillary body8. Oculomotor nerve (n.

III)9. Pons10. Basilar artery11. Corpus callosum12. Fornix13. Choroid plexus14. Third ventricle15. Pineal body16. Tectum and cerebral

aqueduct17. Fourth ventricle18. Cerebellum (arbor

vitae. vermis)19. Median aperture of

Magendie20. Medulla oblongata

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1. Anterior communicating artery

2. Left anterior cerebral artery

3. Internal carotid artery4. -5. Anterior inferior

cerebellar artery6. Posterior inferior

cerebellar artery7. -8. -9. -10. Optic nerve11. Middle cerebral artery12. -13. Oculomotor nerve and

posterior communicating artery

14. Posterior cerebral artery15. Basilar artery and

abducens nerve (n. VI)16. Anterior spinal artery17. Vertebral artery18. -19. -20. Posterior spinal artery21. Right superior cerebellar

artery22. Olfactory bulb

Arteries of the base of the brain, arterial circle of Willis.(Schematic drawing.)

1. Anterior cerebral artery2. Anterior communicating artery3. Middle cerebral artery4. Posterior communicating artery5. Oculomotor nerve6. Trochlear nerve7. Posterior cerebral artery8. Trigeminal nerve9. Internal auditory artery10. Facial nerve and vestibulocochlear nerve11. Glossopharyngeal nerve and vagus nerve12. Hypoglossal nerve13. Accessory nerve14. Anterior inferior cerebellar artery15. Falx cerebri16. Optic nerve17. Optic chiasma18. Infundibulum and pituitary gland19. Anterior choroidal artery and choroid plexus20. Basilar artery21. Abducens nerve22. Vertebral arteries23. Medulla oblongata24. Inferior sagittal sinus25. Tentorium cerebelli26. Superior sagittal sinus and confluence of

sinuses27. Anterior spinal artery28. Internal carotid artery29. Superior cerebellar artery30. Anterior inferior cerebellar artery31. Posterior inferior cerebellar artery32. Posterior spinal artery33. Ophthalmic artery

Arterial circle of Willis (superior aspect).(Schematic drawing.)

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Principal systemic veins

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The venous dural sinuses. Superior view.

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The usual arrangement of the veins in the neck.

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Hepatic portal system. This system provides venous drainage of the digestive organs and takes venous blood to the liver.

Mader: Understanding Human Anatomy & Physiology, Fifth Edition

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The composition of the portal system

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Skeletal muscle contraction moves blood in veins.a. Muscle contraction exerts pressure against the vein, and

blood moves past the valve. b. Blood cannot flow back once it has moved past the valve.

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External heart anatomy.A. The superior vena cava and the pulmonary trunk are attached to the right side of the heart.

The aorta and pulmonary veins are attached to the left side of the heart. The right ventricle forms most of the ventral surface of the heart, and the left ventricle forms most of the dorsal surface.

B. The coronary arteries and cardiac veins pervade cardiac muscle. The coronary arteries bring oxygen and nutrients to cardiac cells, which derive no benefit from blood coursing through the heart.

Mader: Human Biology 7th ed.

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Sites of coronary artery occlusion, in order of frequency (1-6)

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Mader: Understanding Human Anatomy & Physiology, Fifth Edition

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Aortic dissection. • Type A (proximal dissection) involves the ascending

aorta or ascending and descending aorta. • Type B (distal dissection) does not involve the

ascending aorta.BACK

Aneurysms of the abdominal aorta below the level of the renal arteries, may extend inferiorly to involve the common iliac arteries.

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Surface landmarks on the right side of the head. The relations of the middle meningeal artery and the brain to the surface of the skull are shown.BACK

Surface landmarks for a temporal burr hole. The vertical incision passes through the temporalis muscle down to bone. The middle meningeal artery lies between the endosteal and meningeal layers of dura and is embedded in the endosteal layer of dura or lies in a bony tunnel.

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Catheterization of the right external jugular vein. A. Surface marking of the vein. B. Site of catheterization. Note how the external jugular vein joins the subclavian vein at a right angle. C. Cross section of the neck showing the relationships of the external jugular vein as it crosses the posterior triangle of the neck.BACK

Interconnection between arterial system and venous system

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Major Arteries of the Abdomen and Pelvis

Anatomy and Physiology, Seeley

CAPILLARY