Topic: circulatory system

The blood circulatory system is a system of organs that includes the heart, blood vessels, and
blood which is circulated throughout the entire body of a human or other vertebrate. It
includes the cardiovascular system, or vascular system, that consists of the heart and blood
vessels (from Greek kardia meaning heart, and from Latin vascula meaning vessels). The
circulatory system has two divisions, a systemic circulation or circuit, and a pulmonary
circulation or circuit. Some sources use the terms cardiovascular system and vascular system
interchangeably with the circulatory system.The network of blood vessels are the great
vessels of the heart including large elastic arteries, and large veins; other arteries, smaller
arterioles, capillaries that join with venules (small veins), and other veins. The circulatory
system is closed in vertebrates, which means that the blood never leaves the network of blood
vessels. Some invertebrates such as arthropods have an open circulatory system. Diploblasts
such as sponges, and comb jellies lack a circulatory system.

Blood is a fluid consisting of plasma, red blood cells, white blood cells, and platelets that is
circulated around the body carrying oxygen and nutrients to the tissues, and waste materials
away. Circulated nutrients include proteins and minerals, other components transported are
gases such as oxygen, and carbon dioxide, hormones, and hemoglobin; providing
nourishment, help in the immune system to fight diseases, and in maintaining homeostasis by
stabilizing temperature and natural pH.

In vertebrates, complementary to the circulatory system is the lymphatic system. This system
carries excess plasma filtered from the capillaries as interstitial fluid between cells, away
from the body tissues in an accessory route to return the excess fluid back to the blood
circulation as lymph. The passage of lymph takes much longer than that of blood. The
lymphatic system is a subsystem that is essential for the functioning of the blood circulatory
system; without it the blood would become depleted of fluid. The lymphatic system works
together with the immune system. Unlike the closed circulatory system, the lymphatic system
is an open system. Some sources describe it as a secondary circulatory system.

The circulatory system can be affected by many cardiovascular diseases. Cardiologists are
medical professionals which specialise in the heart, and cardiothoracic surgeons specialise in
operating on the heart and its surrounding areas. Vascular surgeons focus on disorders of the
blood vessels, and lymphatic vessels.

Structure
The circulatory system includes the heart, blood vessels, and blood. The cardiovascular
system in all vertebrates, consists of the heart and blood vessels. The circulatory system is
further divided into two major circuits – a pulmonary circulation, and a systemic circulation.
The pulmonary circulation is a circuit loop from the right heart taking deoxygenated blood to
the lungs where it is oxygenated and returned to the left heart. The systemic circulation is a
circuit loop that delivers oxygenated blood from the left heart to the rest of the body, and
returns deoxygenated blood back to the right heart via large veins known as the venae cavae.
The systemic circulation can also be defined as two parts – a macrocirculation and a
microcirculation. An average adult contains five to six quarts (roughly 4.7 to 5.7 liters) of
blood, accounting for approximately 7% of their total body weight. Blood consists of plasma,
red blood cells, white blood cells, and platelets. The digestive system also works with the
circulatory system to provide the nutrients the system needs to keep the heart
pumping.Further circulatory routes are associated, such as the coronary circulation to the
heart itself, the cerebral circulation to the brain, renal circulation to the kidneys, and
bronchial circulation to the bronchi in the lungs.

The human circulatory system is closed, meaning that the blood is contained within the
vascular network. Nutrients travel through tiny blood vessels of the microcirculation to reach
organs. The lymphatic system is an essential subsystem of the circulatory system consisting
of a network of lymphatic vessels, lymph nodes, organs, tissues and circulating lymph. This
subsystem is an open system. A major function is to carry the lymph, draining and returning
interstitial fluid into the lymphatic ducts back to the heart for return to the circulatory system.
Another major function is working together with the immune system to provide defense
against pathogens.

Heart

The heart pumps blood to all parts of the body providing nutrients and oxygen to every cell,
and removing waste products. The left heart pumps oxygenated blood returned from the lungs
to the rest of the body in the systemic circulation. The right heart pumps deoxygenated blood
to the lungs in the pulmonary circulation. In the human heart there is one atrium and one
ventricle for each circulation, and with both a systemic and a pulmonary circulation there are
four chambers in total: left atrium, left ventricle, right atrium and right ventricle. The right
atrium is the upper chamber of the right side of the heart. The blood that is returned to the
right atrium is deoxygenated (poor in oxygen) and passed into the right ventricle to be
pumped through the pulmonary artery to the lungs for re-oxygenation and removal of carbon
dioxide. The left atrium receives newly oxygenated blood from the lungs as well as the
pulmonary vein which is passed into the strong left ventricle to be pumped through the aorta
to the different organs of the body.

Pulmonary circulation

The pulmonary circulation is the portion of the cardiovascular system in which oxygen-
depleted blood is pumped away from the heart, via the pulmonary artery, to the lungs and
returned, oxygenated, to the heart via the pulmonary vein.

Oxygen-deprived blood from the superior and inferior 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 the now oxygen-rich
blood to the left atrium.A separate system known as the bronchial circulation supplies blood
to the tissue of the larger airways of the lung.

Systemic circulation

The systemic circulation is a circuit loop that delivers oxygenated blood from the left heart to
the rest of the body through the aorta. Deoxygenated blood is returned in the systemic
circulation to the right heart via two large veins, the inferior vena cava and superior vena
cava, where it is pumped from the right atrium into the pulmonary circulation for
oxygenation. The systemic circulation can also be defined as having two parts – a
macrocirculation and a microcirculation.

Blood vessels

The blood vessels of the circulatory system are the arteries, veins, and capillaries. The large
arteries and veins that take blood to, and away from the heart are known as the great vessels.

Arteries

Oxygenated blood enters the systemic circulation when leaving the left ventricle, via the
aortic semilunar valve. The first part of the systemic circulation is the aorta, a massive and
thick-walled artery. The aorta arches and gives branches supplying the upper part of the body
after passing through the aortic opening of the diaphragm at the level of thoracic ten vertebra,
it enters the abdomen. Later, it descends down and supplies branches to abdomen, pelvis,
perineum and the lower limbs.The walls of the aorta are elastic. This elasticity helps to
maintain the blood pressure throughout the body. When the aorta receives almost five litres
of blood from the heart, it recoils and is responsible for pulsating blood pressure. As the aorta
branches into smaller arteries, their elasticity goes on decreasing and their compliance goes
on increasing.

Capillaries

Arteries branch into small passages called arterioles and then into the capillaries. The
capillaries merge to bring blood into the venous system.

Veins

Capillaries merge into venules, which merge into veins. The venous system feeds into the two
major veins: the superior vena cava – which mainly drains tissues above the heart – and the
inferior vena cava – which mainly drains tissues below the heart. These two large veins
empty into the right atrium of the heart.

Portal veins

The general rule is that arteries from the heart branch out into capillaries, which collect into
veins leading back to the heart. Portal veins are a slight exception to this. In humans the only
significant example is the hepatic portal vein which combines from capillaries around the
gastrointestinal tract where the blood absorbs the various products of digestion; rather than
leading directly back to the heart, the hepatic portal vein branches into a second capillary
system in the liver.

Coronary circulation

The heart itself is supplied with oxygen and nutrients through a small "loop" of the systemic
circulation and derives very little from the blood contained within the four chambers.

The coronary circulation system provides a blood supply to the heart muscle itself. The
coronary circulation begins near the origin of the aorta by two coronary arteries: the right
coronary artery and the left coronary artery. After nourishing the heart muscle, blood returns
through the coronary veins into the coronary sinus and from this one into the right atrium.
Backflow of blood through its opening during atrial systole is prevented by the Thebesian
valve. The smallest cardiac veins drain directly into the heart chambers.

Cerebral circulation

The brain has a dual blood supply, an anterior and a posterior circulation from arteries at its
front and back. The anterior circulation arises from the internal carotid arteries to supply the
front of the brain. The posterior circulation arises from the vertebral arteries, to supply the
back of the brain and brainstem. The circulation from the front and the back join (anastomise)
at the circle of Willis.

Renal circulation

The renal circulation is the blood supply to the kidneys, contains many specialized blood
vessels and receives around 20% of the cardiac output. It branches from the abdominal aorta
and returns blood to the ascending vena cava.

Development
The development of the circulatory system starts with vasculogenesis in the embryo. The
human arterial and venous systems develop from different areas in the embryo. The arterial
system develops mainly from the aortic arches, six pairs of arches that develop on the upper
part of the embryo. The venous system arises from three bilateral veins during weeks 4 – 8 of
embryogenesis. Fetal circulation begins within the 8th week of development. Fetal circulation
does not include the lungs, which are bypassed via the truncus arteriosus. Before birth the
fetus obtains oxygen (and nutrients) from the mother through the placenta and the umbilical
cord.

Arteries

The human arterial system originates from the aortic arches and from the dorsal aortae
starting from week 4 of embryonic life. The first and second aortic arches regress and form
only the maxillary arteries and stapedial arteries respectively. The arterial system itself arises
from aortic arches 3, 4 and 6 (aortic arch 5 completely regresses).

The dorsal aortae, present on the dorsal side of the embryo, are initially present on both sides
of the embryo. They later fuse to form the basis for the aorta itself. Approximately thirty
smaller arteries branch from this at the back and sides. These branches form the intercostal
arteries, arteries of the arms and legs, lumbar arteries and the lateral sacral arteries. Branches
to the sides of the aorta will form the definitive renal, suprarenal and gonadal arteries.
Finally, branches at the front of the aorta consist of the vitelline arteries and umbilical
arteries. The vitelline arteries form the celiac, superior and inferior mesenteric arteries of the
gastrointestinal tract. After birth, the umbilical arteries will form the internal iliac arteries.

Veins

The human venous system develops mainly from the vitelline veins, the umbilical veins and
the cardinal veins, all of which empty into the sinus venosus.
Function
About 98.5% of the oxygen in a sample of arterial blood in a healthy human, breathing air at
sea-level pressure, is chemically combined with hemoglobin molecules. About 1.5% is
physically dissolved in the other blood liquids and not connected to hemoglobin. The
hemoglobin molecule is the primary transporter of oxygen in vertebrates.

Clinical significance
Many diseases affect the circulatory system. These include a number of cardiovascular
diseases, affecting the heart and blood vessels; hematologic diseases that affect the blood,
such as anemia, and lymphatic diseases affecting the lymphatic system. Cardiologists are
medical professionals which specialise in the heart, and cardiothoracic surgeons specialise in
operating on the heart and its surrounding areas. Vascular surgeons focus on the blood
vessels.

Cardiovascular disease

Diseases affecting the cardiovascular system are called cardiovascular disease.

Many of these diseases are called "lifestyle diseases" because they develop over time and are
related to a person's exercise habits, diet, whether they smoke, and other lifestyle choices a
person makes. Atherosclerosis is the precursor to many of these diseases. It is where small
atheromatous plaques build up in the walls of medium and large arteries. This may eventually
grow or rupture to occlude the arteries. It is also a risk factor for acute coronary syndromes,
which are diseases that are characterised by a sudden deficit of oxygenated blood to the heart
tissue. Atherosclerosis is also associated with problems such as aneurysm formation or
splitting ("dissection") of arteries.

Another major cardiovascular disease involves the creation of a clot, called a "thrombus".
These can originate in veins or arteries. Deep venous thrombosis, which mostly occurs in the
legs, is one cause of clots in the veins of the legs, particularly when a person has been
stationary for a long time. These clots may embolise, meaning travel to another location in
the body. The results of this may include pulmonary embolus, transient ischaemic attacks, or
stroke.

Cardiovascular diseases may also be congenital in nature, such as heart defects or persistent
fetal circulation, where the circulatory changes that are supposed to happen after birth do not.
Not all congenital changes to the circulatory system are associated with diseases, a large
number are anatomical variations.

Investigations

The function and health of the circulatory system and its parts are measured in a variety of
manual and automated ways. These include simple methods such as those that are part of the
cardiovascular examination, including the taking of a person's pulse as an indicator of a
person's heart rate, the taking of blood pressure through a sphygmomanometer or the use of a
stethoscope to listen to the heart for murmurs which may indicate problems with the heart's
valves. An electrocardiogram can also be used to evaluate the way in which electricity is
conducted through the heart.

Other more invasive means can also be used. A cannula or catheter inserted into an artery
may be used to measure pulse pressure or pulmonary wedge pressures. Angiography, which
involves injecting a dye into an artery to visualise an arterial tree, can be used in the heart
(coronary angiography) or brain. At the same time as the arteries are visualised, blockages or
narrowings may be fixed through the insertion of stents, and active bleeds may be managed
by the insertion of coils. An MRI may be used to image arteries, called an MRI angiogram.
For evaluation of the blood supply to the lungs a CT pulmonary angiogram may be used.
Vascular ultrasonography may be used to investigate vascular diseases affecting the venous
system and the arterial system including the diagnosis of stenosis, thrombosis or venous
insufficiency. An intravascular ultrasound using a catheter is also an option.

Surgery

There are a number of surgical procedures performed on the circulatory system:

Coronary artery bypass surgery

Coronary stent used in angioplasty

Vascular surgery

Vein stripping

Cosmetic proceduresCardiovascular procedures are more likely to be performed in an

Other animals
While humans, as well as other vertebrates, have a closed blood circulatory system (meaning
that the blood never leaves the network of arteries, veins and capillaries), some invertebrate
groups have an open circulatory system containing a heart but limited blood vessels. The
most primitive, diploblastic animal phyla lack circulatory systems.

An additional transport system, the lymphatic system, which is only found in animals with a
closed blood circulation, is an open system providing an accessory route for excess interstitial
fluid to be returned to the blood.The blood vascular system first appeared probably in an
ancestor of the triploblasts over 600 million years ago, overcoming the time-distance
constraints of diffusion, while endothelium evolved in an ancestral vertebrate some 540–510
million years ago.

Open circulatory system

In arthropods, the open circulatory system is a system in which a fluid in a cavity called the
hemocoel bathes the organs directly with oxygen and nutrients, with there being no
distinction between blood and interstitial fluid; this combined fluid is called hemolymph or
haemolymph. Muscular movements by the animal during locomotion can facilitate
hemolymph movement, but diverting flow from one area to another is limited. When the
heart relaxes, blood is drawn back toward the heart through open-ended pores (ostia).

Hemolymph fills all of the interior hemocoel of the body and surrounds all cells. Hemolymph
is composed of water, inorganic salts (mostly sodium, chloride, potassium, magnesium, and
calcium), and organic compounds (mostly carbohydrates, proteins, and lipids). The primary
oxygen transporter molecule is hemocyanin.

There are free-floating cells, the hemocytes, within the hemolymph. They play a role in the
arthropod immune system.

Closed circulatory system

The circulatory systems of all vertebrates, as well as of annelids (for example, earthworms)
and cephalopods (squids, octopuses and relatives) always keep their circulating blood
enclosed within heart chambers or blood vessels and are classified as closed, just as in
humans. Still, the systems of fish, amphibians, reptiles, and birds show various stages of the
evolution of the circulatory system. Closed systems permit blood to be directed to the organs
that require it.

In fish, the system has only one circuit, with the blood being pumped through the capillaries
of the gills and on to the capillaries of the body tissues. This is known as single cycle
circulation. The heart of fish is, therefore, only a single pump (consisting of two chambers).

In amphibians and most reptiles, a double circulatory system is used, but the heart is not
always completely separated into two pumps. Amphibians have a three-chambered heart.

In reptiles, the ventricular septum of the heart is incomplete and the pulmonary artery is
equipped with a sphincter muscle. This allows a second possible route of blood flow. Instead
of blood flowing through the pulmonary artery to the lungs, the sphincter may be contracted
to divert this blood flow through the incomplete ventricular septum into the left ventricle and
out through the aorta. This means the blood flows from the capillaries to the heart and back to
the capillaries instead of to the lungs. This process is useful to ectothermic (cold-blooded)
animals in the regulation of their body temperature.

Mammals, birds and crocodilians show complete separation of the heart into two pumps, for a
total of four heart chambers; it is thought that the four-chambered heart of birds and
crocodilians evolved independently from that of mammals. Double circulatory systems
permit blood to be repressurized after returning from the lungs, speeding up delivery of
oxygen to tissues.

No circulatory system

Circulatory systems are absent in some animals, including flatworms. Their body cavity has
no lining or enclosed fluid. Instead, a muscular pharynx leads to an extensively branched
digestive system that facilitates direct diffusion of nutrients to all cells. The flatworm's dorso-
ventrally flattened body shape also restricts the distance of any cell from the digestive system
or the exterior of the organism. Oxygen can diffuse from the surrounding water into the cells,
and carbon dioxide can diffuse out. Consequently, every cell is able to obtain nutrients, water
and oxygen without the need of a transport system.

Some animals, such as jellyfish, have more extensive branching from their gastrovascular
cavity (which functions as both a place of digestion and a form of circulation), this branching
allows for bodily fluids to reach the outer layers, since the digestion begins in the inner
layers.

History
The earliest known writings on the circulatory system are found in the Ebers Papyrus (16th
century BCE), an ancient Egyptian medical papyrus containing over 700 prescriptions and
remedies, both physical and spiritual. In the papyrus, it acknowledges the connection of the
heart to the arteries. The Egyptians thought air came in through the mouth and into the lungs
and heart. From the heart, the air travelled to every member through the arteries. Although
this concept of the circulatory system is only partially correct, it represents one of the earliest
accounts of scientific thought.

In the 6th century BCE, the knowledge of circulation of vital fluids through the body was
known to the Ayurvedic physician Sushruta in ancient India. He also seems to have possessed
knowledge of the arteries, described as 'channels' by Dwivedi & Dwivedi (2007). The valves
of the heart were discovered by a physician of the Hippocratean school around the 4th
century BCE. However, their function was not properly understood then. Because blood
pools in the veins after death, arteries look empty. Ancient anatomists assumed they were
filled with air and that they were for the transport of air.

The Greek physician, Herophilus, distinguished veins from arteries but thought that the pulse
was a property of arteries themselves. Greek anatomist Erasistratus observed that arteries that
were cut during life bleed. He ascribed the fact to the phenomenon that air escaping from an
artery is replaced with blood that enters between veins and arteries by very small vessels.
Thus he apparently postulated capillaries but with reversed flow of blood.In 2nd-century AD
Rome, the Greek physician Galen knew that blood vessels carried blood and identified
venous (dark red) and arterial (brighter and thinner) blood, each with distinct and separate
functions. Growth and energy were derived from venous blood created in the liver from
chyle, while arterial blood gave vitality by containing pneuma (air) and originated in the
heart. Blood flowed from both creating organs to all parts of the body where it was consumed
and there was no return of blood to the heart or liver. The heart did not pump blood around,
the heart's motion sucked blood in during diastole and the blood moved by the pulsation of
the arteries themselves.

Galen believed that the arterial blood was created by venous blood passing from the left
ventricle to the right by passing through 'pores' in the interventricular septum, air passed from
the lungs via the pulmonary artery to the left side of the heart. As the arterial blood was
created 'sooty' vapors were created and passed to the lungs also via the pulmonary artery to
be exhaled.

In 1025, The Canon of Medicine by the Persian physician, Avicenna, "erroneously accepted
the Greek notion regarding the existence of a hole in the ventricular septum by which the
blood traveled between the ventricles." Despite this, Avicenna "correctly wrote on the cardiac
cycles and valvular function", and "had a vision of blood circulation" in his Treatise on Pulse.
While also refining Galen's erroneous theory of the pulse, Avicenna provided the first correct
explanation of pulsation: "Every beat of the pulse comprises two movements and two pauses.
Thus, expansion : pause : contraction : pause. [...] The pulse is a movement in the heart and
arteries ... which takes the form of alternate expansion and contraction."In 1242, the Arabian
physician, Ibn al-Nafis described the process of pulmonary circulation in greater, more
accurate detail than his predecessors, though he believed, as they did, in the notion of vital
spirit (pneuma), which he believed was formed in the left ventricle. Ibn al-Nafis stated in his
Commentary on Anatomy in Avicenna's Canon:

...the blood from the right chamber of the heart must arrive at the left chamber but there is no
direct pathway between them. The thick septum of the heart is not perforated and does not
have visible pores as some people thought or invisible pores as Galen thought. The blood
from the right chamber must flow through the vena arteriosa (pulmonary artery) to the lungs,
spread through its substances, be mingled there with air, pass through the arteria venosa
(pulmonary vein) to reach the left chamber of the heart and there form the vital spirit...

In addition, Ibn al-Nafis had an insight into what would become a larger theory of the
capillary circulation. He stated that "there must be small communications or pores (manafidh
in Arabic) between the pulmonary artery and vein," a prediction that preceded the discovery
of the capillary system by more than 400 years. Ibn al-Nafis' theory, however, was confined
to blood transit in the lungs and did not extend to the entire body.

Michael Servetus was the first European to describe the function of pulmonary circulation,
although his achievement was not widely recognized at the time, for a few reasons. He firstly
described it in the "Manuscript of Paris" (near 1546), but this work was never published. And
later he published this description, but in a theological treatise, Christianismi Restitutio, not
in a book on medicine. Only three copies of the book survived but these remained hidden for
decades, the rest were burned shortly after its publication in 1553 because of persecution of
Servetus by religious authorities.

A better known discovery of pulmonary circulation was by Vesalius's successor at Padua,

Finally, the English physician William Harvey, a pupil of Hieronymus Fabricius (who had
earlier described the valves of the veins without recognizing their function), performed a
sequence of experiments and published his Exercitatio Anatomica de Motu Cordis et
Sanguinis in Animalibus in 1628, which "demonstrated that there had to be a direct
connection between the venous and arterial systems throughout the body, and not just the
lungs. Most importantly, he argued that the beat of the heart produced a continuous
circulation of blood through minute connections at the extremities of the body. This is a
conceptual leap that was quite different from Ibn al-Nafis' refinement of the anatomy and
bloodflow in the heart and lungs." This work, with its essentially correct exposition, slowly
convinced the medical world. However, Harvey was not able to identify the capillary system
connecting arteries and veins; these were later discovered by Marcello Malpighi in 1661.

In 1956, André Frédéric Cournand, Werner Forssmann and Dickinson W. Richards were
awarded the Nobel Prize in Medicine "for their discoveries concerning heart catheterization
and pathological changes in the circulatory system."
In his Nobel lecture, Forssmann credits Harvey as birthing cardiology with the publication of
his book in 1628.In the 1970s, Diana McSherry developed computer-based systems to create
images of the circulatory system and heart without the need for surgery.