Transcript Angiology_SLDC

Angiology
• Angiology: The study of the anatomy, physiology and
related diseases of blood vessels.
Anatomy of an Artery
• Tunica Adventitia/Externa: Anchors artery
along its proper course (connective tissue).
• Tunica Musculosa/Media: Smooth Muscle
controls blood pressure.
• Tunica Intima/Interna: Essentially composed of
a single layer of endothelial cells.
Anatomy of an Artery
ANATOMY OF AN ARTERY
Capillary Beds
Figure 19.4a
Capillary Beds
Figure 19.4b
Typical Artery and Vein
Atherosclerosis and
Arteriosclerosis
• Atherosclerosis - the process through
which cholesterol plaques form on the
arterial walls.
• Arteriosclerosis - The process through
which cholesterol plaques become
infiltrated with calcium resulting in
hardening of the arteries.
Pathophysiology
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1. Vascular irritants irritate the tunica interna of the blood vessel.
Vascular Irritants:
a. Smoking
b. Alcohol
c. Fried foods
d. Chemical produced during stress
e. Caffeine
f. Physical trauma
g. Normal wear and tear (aging) (anti-oxidant vitamins improve circulation)
h. Environmental toxins
I. Homocysteine: intermediate chemical substance in the metabolism of the
amino acid cysteine that is a strong vascular irritant. Folic acid, vitamin B12
and vitamin B6 will prevent the build up of homocysteine in the blood.
Homocysteine
Folic B12 B6
Acid
Cysteine
Methionine
Normal Artery VS
Atherosclerotic Artery
Protrusion of Tunica Musculosa
Cells Into the Arterial Lumen
• 2. Tunica intima cells die and cells from
the tunica musculosa protrude
through into the lumen (hole)
Pathophysiological Progression
of Atherosclerosis
Macrophages
• 3. Macrophages (a type of white blood
cell) infiltrate the smooth muscle cells
with oxidized LDL cholesterol. As the
smooth muscle cells become infiltrated
with cholesterol, they die and form a
cholesterol plaque resulting in
atherosclerosis.
Infiltration of LDL Cholesterol
Into the Arterial Wall
Foam Cell
Arteriosclerosis
• 4. A calcification of the cholesterol plaque
leads to hardening of the arteries
resulting in arteriosclerosis
Collateral Circulation
• Alternate routes of blood flow developed
primarily within the
arterial system which help to compensate
for atherosclerosis and
arteriosclerosis in the body. Collateral
circulation develops
with time and exercise.
Hypercholesterolemia
• Hypercholesterolemia is a term describing high
serum concentrations of cholesterol. The
serum concentrations of cholesterol which have
been used to diagnose hypercholesterolemia
have been reduced since 1980. In 1980 a
serum cholesterol concentration of 220 mg of
blood would have been diagnostic of
hypercholesterolemia. In 1984 the level
was reduced to 200mg, and in 1986 it was again
reduced to 180mg.
Types of Cholesterol
• Exogenous Cholesterol: dietary
cholesterol
• Endogenous Cholesterol: the amount of
cholesterol produced daily by the liver
Variables Affecting Serum
Cholesterol
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1. Genetics
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2. Diet (+/- cholesterol level 15%)
a. Saturated fat increases serum cholesterol levels
b. Unsaturated fat decreases serum cholesterol levels
c. Fiber decreases cholesterol levels
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3. Sex
a. Males -------> testosterone increases cholesterol
b. Females -----> estrogen decreases cholesterol
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4. Thyroid Function a. Hyperactive thyroid - decreases serum cholesterol levels
b. Hypoactive thyroid - increases serum cholesterol levels
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5. Diabetes increases cholesterol
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6. Liver Function a. the liver produces endogenous cholesterol
b. the liver produces the lipoproteins
High Density Lipoproteins
• High Density Lipoproteins/ HDL’s
(Good)
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cholesterol
Tissues --------------> Liver
Low Density Lipoproteins
• Low Density Lipoproteins/ LDL’s (Bad)
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cholesterol
Liver -----------------> Tissues
Lipoprotein Profile
• The lipoprotein profile provides a health
care practitioner with the ratio of LDL
cholesterol (Bad) to HDL cholesterol
(Good) and translates this ratio into a
percentage risk factor for developing
cardiovascular disease for the patient.
Most progressive nutritionists believe
that a LDL to HDL ratio of 4 : 1 is
optimal.
Major Arteries
Major Arteries
Aortic Arch
• The aortic arch has three major branches:
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Right Brachiocephalic Artery
Left Common Carotid
Left Subclavian
Aorta Arch and It’s Major
Branches
Aorta and Its Superior Branches
• Aorta is largest artery of the body
– ascending aorta
• 2 coronary arteries supply myocardium
– arch of aorta -- branches to the arms & head
• brachiocephalic trunk branches into right common carotid and
right subclavian
• left subclavian & left carotid arise independently
– thoracic aorta supplies branches to pericardium,
esophagus, bronchi, diaphragm, intercostal & chest
muscles, mammary gland, skin, vertebrae and spinal cord
Coronary Circulation
• Right & left coronary
arteries branch to
supply heart muscle
– anterior & posterior
interventricular aa.
Thoracic Aorta
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Artery
• Rt/Left Anterior/Posterior
Intercostal Arteries
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Supplies
• Supplies blood to the anterior
and posterior aspects of the
ribs, intercostal muscles and
associated tissues
• Supplies blood to the superior
surface of the diaphragm
• Rt/Left Phrenic Arteries
Abdominal Aorta
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Artery
• Rt/Left Inferior Phrenic Artery
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Supplies
• Supplies blood to the inferior
surface of the diaphragm
Abdominal Aorta and Its Branches
• Supplies abdominal & pelvic viscera & lower
extremities
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celiac aa. supplies liver, stomach, spleen & pancreas
superior & inferior mesenteric aa. supply intestines
renal aa supply kidneys
gonadal aa. supply ovaries
and testes
• Splits into common iliac
aa at 4th lumbar vertebrae
– external iliac aa supply
lower extremity
– internal iliac aa supply
pelvic viscera
Visceral Branches off Abdominal Aorta
• Celiac artery is first branch inferior to diaphragm
– left gastric artery, splenic artery, common hepatic artery
• Superior mesenteric artery lies in mesentery
– pancreaticoduodenal, jejunal, ileocolic, ascending &
middle colic aa.
• Inferior mesenteric artery
– descending colon, sigmoid colon & rectal aa
Celiac Trunk
• Celiac Trunk:
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Artery
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• Common Hepatic Artery
• Supplies blood to the liver
• Left Gastric Artery
• Supplies blood to the stomach
• Splenic Artery
• Supplies blood to the spleen
Supplies
Celiac Trunk
Visceral Branches of the
Abdominal Aorta
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Arteries
• Superior Mesenteric Artery
• Rt/left Suprarenal Arteries
• Rt/left Renal Arteries
• Inferior Mesenteric Artery
• Rt/left Gonadal Arteries
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Supplies
• Supplies blood to the small
intestine
• Supplies blood to the rt/left
suprarenal (adrenal) glands
• Supplies blood to the rt/left
kidneys
• Supplies blood to the large
intestine
• Supplies blood to gonads
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Arteries of the Abdomen
Liver (cut)
Inferior vena cava
Celiac trunk
Hepatic artery
proper
Common hepatic
artery
Right gastric artery
Gallbladder
Gastroduodenal
artery
Right gastroepiploic
artery
Duodenum
Abdominal aorta
(b)
Diaphragm
Esophagus
Left gastric
artery
Left gastroepiploic
artery
Splenic artery
Spleen
Stomach
Pancreas
(major portion
lies posterior
to stomach)
Superior
mesenteric
artery
Figure 19.23b
Arteries of the Abdomen
Opening
for inferior
vena cava
Hiatus (opening)
for esophagus
Celiac trunk
Diaphragm
Inferior phrenic
artery
Middle suprarenal
artery
Renal artery
Kidney
Superior
mesenteric artery
Lumbar arteries
Abdominal aorta
Median sacral
artery
Gonadal (testicular
or ovarian) artery
Inferior
mesenteric artery
Common iliac artery
Ureter
(c)
Figure 19.23c
Arteries of the Abdomen
Celiac trunk
Middle colic artery
Right colic artery
Ileocolic artery
Ascending colon
Ileum
Superior rectal
artery
Cecum
Appendix
Transverse colon
Superior
mesenteric artery
Intestinal arteries
Left colic artery
Inferior
mesenteric artery
Aorta
Sigmoidal arteries
Descending colon
Left common
iliac artery
Sigmoid colon
Rectum
(d)
Figure 19.23d
Arteries of the Abdominal Cavity
Arteries of the Abdominal Cavity
Arteries of the Right Upper Extremity
Peripheral Arteries:
Upper Extremities
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Artery
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Supplies
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Right Brachiocephalic Artery
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Supplies blood to the right subclavian artery
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Rt/Left Subclavian Arteries
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Supplies blood to the clavicles and surrounding
soft tissue
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Rt/left Axillary Arteries
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Supplies blood to the axillary regions
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Rt/left Brachial Arteries
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Supplies blood to the rt/left humerus, biceps
muscles, and surrounding soft tissue
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Rt/left Radial Arteries
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Supplies blood to the lateral aspects of the
rt/left forearms
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Rt/left Ulnar Arteries
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Supplies blood to the medical aspects of the
rt/left forearms
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Rt/left Deep Palmar Arch
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Supplies blood to the digital arteries
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Rt/left Digital Arteries
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Supplies blood to the digits (fingers) of the
rt/left hands
Arteries of the Lower Extremities
Peripheral Arteries
Lower Extremities
Artery
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Rt/left Common Iliac Arteries
Rt/left Internal Iliac Arteries
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Rt/left External Iliac Arteries
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Rt/left Femoral Arteries
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Rt/left Popliteal Arteries
Supplies
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Supplies blood to the rt/left
internal and external iliac arteries
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Supplies blood to the pelvic
muscles and organs
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Supplies blood to the external
structures of the pelvis (hip, etc.)
and femoral arteries
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Supplies blood to the femur, thigh
muscles and skin over the thigh
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Supplies blood to the rt/left knees
and surrounding soft tissues
Arteries of the Lower Leg
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Artery
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Supplies
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Rt/left Posterior Tibial Arteries
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Supplies blood to the rt/left calf
muscles (soleus/gastrocnemius)
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Rt/left Anterior Tibial Arteries
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Supplies blood to the rt/left tibialis
anterior muscles and the soft tissue of
the anterior aspects of the legs
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Rt/left Peroneal Arteries
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Supplies blood to the rt/left peroneal
muscle groups and the soft tissue of
the lateral aspects of the legs
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Rt/left Deep Plantar Archers
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Supplies blood to the digital arteries of
the rt/left feet
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Rt/left Digital Arteries
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Supplies blood to the digits (toes) of
the rt/left feet
Blood Supply to the Brain
The Circle of Willis
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The brain is supplied with blood by a vascular network referred to as the Circle of
Willis. The right and left vertebral arteries originate at the right and left subclavian
arteries respectively, and travel cephalad towards the brain through the transverse
foramen of the cervical vertebrae. At the base of the brain, the right and left vertebral
arteries converge to form the basilar artery. The basilar artery divides at the base
of the brain to form a right and left posterior communicating artery. These
arteries form the posterior loop of the Circle of Willis.
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The right carotid artery arises from the right brachiocephalic artery and travels
cephalad towards the brain along the right side of the neck. The left common
carotid artery arises from the aortic arch and travels cephalad towards the
brain along the left side of the neck. The right and left common carotid arteries
will each divide into an external and internal carotid artery. The right and left
external carotids will supply the structures of the head and face, while the right
and left internal carotid arteries will supply the brain. When the right and left
internal carotid arteries reach the base of the brain, they give rise to a
respective right and left anterior communicating artery. The right and left
anterior communicating arteries form the anterior loop of the Circle of Willis.
When the anterior and posterior loops join, they form a complete circle at the
base of the brain known as the Circle of Willis. The Circle of Willis provides all parts
of the brain with a constant, and uniform blood supply
Blood Supply to the Brain:
Carotid and Vertebral Arteries
Angiogram of Carotid and Vertebral
Arteries
Circle of Willis
Circle of Willis
Vertebral Arteries Taveling Through the
Transverse Foramen of the Cervical Vertebrae
Three Dimensional Axial CT
Scan of the Cervical Spine
Closing of a Vertebral Artery As The
Head/Cervical Spine is Rotated
Palpated Pulse
Figure 19.11
Pulse Points
The Major Veins
Major Veins
Drainage of Blood From the
Head and Brain
• Rt/left External Jugular Veins
• Rt/left Internal Jugular Veins
Drain blood from the structures of
the head and face
Drain blood from the brain
Veins of the Head and Brain
Drainage of Blood From the
Upper Extremities
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Rt./Left Brachial Veins
Drain blood from the rt/left humeri, the
biceps and surrounding soft tissues
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Rt./Left Axillary Veins
Drains blood from the axillary region
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Rt./Left Subclavian Veins
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Rt./Left Brachiocephalic Veins
Drains blood from the rt./left clavicles and
surrounding soft tissues
Receives blood from the rt./left
internal jugular veins, and the
rt./left subclavian veins. The rt./left
brachiocephalic veins eventually drain into
the superior vena cava. The superior
vena cava drains blood into the right
atrium of the heart.
Veins of the Right Upper
Extremity
Drainage of Blood From the
Internal Organs
• Rt./Left Anterior/Posterior
Intercostal Veins
• Rt./Left Superior Phrenic Veins
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Rt./Left Inferior Phrenic Veins
Gastric Veins
Hepatic Veins
Superior Mesenteric Vein
Rt./Left Suprarenal Veins
• Drain blood from the
anterior/posterior aspects of
the ribs, intercostal muscles
and associated soft tissues
• Drains blood from the superior
surface of the diaphragm
• Drains blood from the inferior
surface of the diaphragm
• Drains blood from the stomach
• Drain blood from the liver
• Drains blood from the small
intestine
• Drain blood from the rt./left
suprarenal glands
Veins of the Abdominal Cavity
Drainage of Blood From the
Internal Organs (continued)
• Rt./Left Renal Veins
• Inferior Mesenteric
Vein
• Rt./Left Gonadal
Veins
• Drain blood from the rt./left
kidneys
• Drains blood from the large
intestine
• Drain blood from the gonads
(ovaries/testes)
Veins of the Abdominal Cavity
Drainage of Blood From the
Lower Extremities
• Rt./Left Great Saphenous Vein
• Rt./Left Small Saphenous Vein
• Rt./Left Posterior Tibial Veins
• Rt./Left Popliteal Veins
• Drain blood from the medial
aspects of the rt./left legs and
thighs
• Drain blood from the lateral
aspects of the rt./left legs
• Drains blood from the posterior
aspects of the rt./left legs and
calf muscles
(soleus/gastrocnemeus)
• Drains blood from the rt./left
knee joints and surrounding
soft tissues
Drainage of Blood From the
Lower Extremities
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Rt./Left Femoral Veins
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Rt./Left External Iliac Veins
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Rt./Left Internal Iliac Veins
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***All of the blood drained from the
internal organs, lower extremities
and hepatic portal circulation
eventually drains into the inferior
vena cava which in turn empties
into the right atrium of the heart
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Drain blood from the rt./left
femurs, thigh muscles and
surrounding tissues
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Drains blood from the rt./left legs
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Drain blood from the pelvic organs
and muscles
Veins of the Right Lower
Extremity
Hepatic Portal Circulation
• The hepatic portal circulation is designed
to divert blood from the digestive system
to the liver before it (and the nutrients it
carries) enters the general circulation.
The hepatic portal vein is formed from the
joining of the superior mesenteric vein and
splenic vein. The hepatic portal circulatory
route is referred to as a “portal” system
because the blood contained within it
travels from one capillary bed to another.
Hepatic Portal Circulation
Factors Assisting the Return of
Venous Blood Back to the Heart
• Skeletal muscle contraction and one way
valves in the veins
• Respiratory movements (Diaphragmatic)
• Decreasing surface area of venous blood
vessel
Skeletal Muscles and Valves of
the Veins