Circulatory system

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This article is about the organ system. For transport in plants, see Vascular tissue.
It has been suggested that Systemic circulation be merged into this article. (Discuss)Proposed since
December 2014.

Circulatory system

The human circulatory system (simplified). Red indicates oxygenated

blood carried inarteries, blue indicates deoxygenated blood carried
in veins. Capillaries, which join the arteries and veins, and
the lymphatic vesselsare not shown.

Details

Latin

Systema cardiovasculare

Identifiers

TA

A12.0.00.000

FMA

7161

Anatomical terminology

The circulatory system, also called the cardiovascular system, is an organ system that
permits blood to circulate and transport nutrients (such as amino
acids and electrolytes), oxygen, carbon dioxide, hormones, and blood cells to and from the cells in
the body to provide nourishment and help in fighting diseases, stabilize temperature and pH, and
maintain homeostasis. The study of the blood flow is called hemodynamics. The study of the
properties of the blood flow is called hemorheology.
The circulatory system is often seen to comprise both the cardiovascular system, which distributes
blood, and the lymphatic system, which circulateslymph.[1] These are two separate systems. The
passage of lymph for example takes a lot longer than that of blood.[2] Blood is a fluid consisting
of plasma, red blood cells, white blood cells, and platelets that is circulated by the heartthrough the
vertebrate vascular system, carrying oxygen and nutrients to and waste materials away from all body
tissues. Lymph is essentially recycled excess blood plasma after it has been filtered from
the interstitial fluid (between cells) and returned to the lymphatic system. The cardiovascular (from
Latin words meaning 'heart'-'vessel') system comprises the blood, heart, and blood vessels.[3] The
lymph, lymph nodes, and lymph vessels form the lymphatic system, which returns filtered blood
plasma from the interstitial fluid (between cells) as lymph.
While humans, as well as other vertebrates, have a closed cardiovascular system (meaning that the
blood never leaves the network of arteries, veins andcapillaries), some invertebrate groups have an
open cardiovascular system. The lymphatic system, on the other hand, is an open system providing
an accessory route for excess interstitial fluid to get returned to the blood. [4] The more
primitive, diploblastic animal phyla lack circulatory systems.
Contents
[hide]

1 Structure
1.1 Cardiovascular system

1.1.1 Heart

1.1.2 Pulmonary circulation

1.1.3 Systemic circulation

1.1.4 Brain

1.1.5 Kidneys
1.2 Lymphatic system

1.3 Physiology
2 Development

2.1 Arterial development

2.2 Venous development

3 Clinical significance
o

3.1 Cardiovascular disease

3.2 Measurement techniques

3.3 Surgery

4 Society and culture

5 Other animals
o

5.1 Other vertebrates

5.2 Open circulatory system

5.3 Absence of circulatory system

6 History

7 See also

8 References

9 External links

Structure[edit]
Cardiovascular system[edit]

Depiction of the heart, major veins and arteries constructed from body scans.

Cross section of a human artery

The essential components of the human cardiovascular system are the heart,blood, and blood
vessels.[5] It includes the pulmonary circulation, a "loop" through the lungs where blood is
oxygenated; and the systemic circulation, a "loop" through the rest of the body to
provide oxygenated blood. The systemic circulation can also be seen to function in two parts
a macrocirculation and amicrocirculation. 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. [6] Blood consists
of plasma, red blood cells, white blood cells, and platelets. Also, the digestive system works with the
circulatory system to provide the nutrients the system needs to keep the heart pumping.[7]
The cardiovascular systems of humans are closed, meaning that the blood never leaves the network
of blood vessels. In contrast, oxygen and nutrients diffuse across the blood vessel layers and
enter interstitial fluid, which carries oxygen and nutrients to the target cells, and carbon dioxide and
wastes in the opposite direction. The other component of the circulatory system, the lymphatic
system, is open.
Heart[edit]
Main article: Heart

View from the front

The heart pumps oxygenated blood to the body and deoxygenated blood to the lungs. 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.
The coronary circulation system provides a blood supply to the heart muscleitself. The coronary
circulation begins near the origin of the aorta by two 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. Back flow of blood through its opening
during atrial systole is prevented by the Thebesian valve. The smallest cardiac veinsdrain directly
into the heart chambers.[7]
Pulmonary circulation[edit]

The pulmonary circulation as it passes from the heart. Showing both the pulmonary artery and bronchial arteries.

Main article: Pulmonary circulation

The circulatory system of the lungs is the portion of the cardiovascular system in which oxygendepleted blood is pumped away from the heart, via the pulmonary artery, to the lungs and returned,
oxygenated, to the heart via thepulmonary 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 thepulmonary 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.[7]
A separate system known as the bronchial circulation supplies blood to the tissue of the larger
airways of the lung.
Systemic circulation[edit]
Main article: Systemic circulation
The systemic circulation is the circulation of the blood to all parts of the body except the lungs.
Systemic circulation is the portion of the cardiovascular system which transports oxygenated blood
away from the heart through the aorta from the left ventricle where the blood has been previously
deposited from pulmonary circulation, to the rest of the body, and returns oxygen-depleted blood
back to the heart.[7]
Brain[edit]
Main article: Cerebral circulation
The brain has a dual blood supply that comes from arteries at its front and back. These are called
the "anterior" and "posterior" circulation respectively. The anterior circulation arises from the internal
carotid arteries and supplies the front of the brain. The posterior circulation arises from the vertebral
arteries, and supplies the back of the brain and brainstem. The circulation from the front and the
back join together (anastomise) at the Circle of Willis.
Kidneys[edit]
The renal circulation receives around 20% of the cardiac output. It branches from the abdominal
aorta and returns blood to the ascending vena cava. It is the blood supply to the kidneys, and
contains many specialized blood vessels.

Lymphatic system[edit]
The lymphatic system is part of the circulatory system. It is a network of lymphatic
vessels and lymph capillaries, lymph nodes and organs, and lymphatic tissues and circulating lymph.
One of its major functions is to carry the lymph, draining and returning interstitial fluid back towards
the heart for return to the cardiovascular system, by emptying into the lymphatic ducts. Its other main
function is in the immune system.

Physiology[edit]

An animation of a typical human red blood cell cycle in the circulatory system. This animation occurs at real time (20
seconds of cycle) and shows the red blood cell deform as it enters capillaries, as well as changing color as it
alternates in states of oxygenation along the circulatory system.

Main article: Blood Oxygen transport

About 98.5% of the oxygen in a sample of arterial blood in a healthy human, breathing air at sealevel pressure, is chemically combined with hemoglobinmolecules. 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 mammals and many other species.

Development[edit]
Main article: Fetal circulation
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 which 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 theplacenta and the umbilical cord.
[8]

Arterial development[edit]
Main article: Aortic arches
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 forms 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, suprarrenal 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 andinferior mesenteric arteries of the gastrointestinal tract. After birth, the
umbilical arteries will form the internal iliac arteries.

Venous development[edit]
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.

Clinical significance[edit]
Many diseases affect the circulatory system. This includes cardiovascular disease, affecting the
cardiovascular system, andlymphatic disease affecting the lymphatic system. Cardiologists are
medical professionals which specialise in the heart, andcardiothoracic surgeons specialise in
operating on the heart and its surrounding areas. Vascular surgeons focus on other parts of the
circulatory system.

Cardiovascular disease[edit]
Main article: 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 which
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.

Measurement techniques[edit]

Magnetic resonance angiography ofaberrant subclavian artery

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 pressurethrough a sphygmomanometer or the use of
a stethoscope to listen to the heart formurmurs which may indicate problems with the heart's valves.
An electrocardiogramcan 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.
Ultrasound can also be used, particularly to identify the health of blood vessels, and a Doppler
ultrasound of the carotid arteries or Doppler ultrasound of the lower limbs can be used to evaluate
for narrowing of the carotid arteries or thrombusformation in the legs, respectively.

Surgery[edit]
This section requires expansion.
(March 2015)

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 procedures

Cardiovascular procedures are more likely to performed in the inpatient setting than in an
ambulatory care setting; in the United States, only 28% of cardiovascular surgeries were performed
in the ambulatory care setting.[9]

Society and culture[edit]

This section requires expansion.
(March 2015)

A number of alternative medical systems such as Chinese medicine view the circulatory system in
different ways.

Other animals[edit]
Circulation in vertebrates

Fish, amphibians and mammals

1: heart
venous blood

2: systemic
arterial blood

3: pulmonary
mixed blood

Other vertebrates[edit]

Two-chambered heart of a fish

The circulatory systems of all vertebrates, as well as of annelids (for example,earthworms)

and cephalopods (squids,octopuses and relatives) are closed, just as in humans. Still, the systems
of fish,amphibians, reptiles, and birds show various stages of the evolution of the circulatory system.
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 assingle 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 toectothermic (cold-blooded) animals in the regulation of their body
temperature.
Birds and mammals show complete separation of the heart into two pumps, for a total of four heart
chambers; it is thought[citation needed] that the four-chambered heart of birds evolved independently from
that of mammals.

Open circulatory system[edit]

See also: Hemolymph
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 and there is no distinction between blood and interstitial
fluid; this combined fluid is called hemolymphor haemolymph.[10] 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, inorganicsalts (mostly Na+, Cl, K+, Mg2+, and Ca2+), 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.

Flatworms, such as thisPseudoceros bifurcus, lack specialized circulatory organs

Absence of circulatory system[edit]

Circulatory systems are absent in some animals, including flatworms (phylumPlatyhelminthes).
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,
andcarbon 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 theirgastrovascular
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[edit]
Human anatomical chart of blood vessels, with heart, lungs, liver and kidneys included. Other organs are numbered
and arranged around it. Before cutting out the figures on this page, Vesalius suggests that readers glue the page onto
parchment and gives instructions on how to assemble the pieces and paste the multilayered figure onto a base
"muscle man" illustration. "Epitome", fol.14a. HMD Collection, WZ 240 V575dhZ 1543.

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.[11] He also seems to have possessed knowledge of
the arteries, described as 'channels' by Dwivedi & Dwivedi (2007). [11] The valves of the heart were
discovered by a physician of theHippocratean 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 transport of
air.
The Greek physician, Herophilus, distinguished veins from arteries but thought that the pulse was a
property of arteries themselves. Greek anatomist Erasistratusobserved 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 entered by very small vessels between veins and arteries. Thus he
apparently postulated capillaries but with reversed flow of blood. [12]
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.[13][verification needed] 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."[14]

In 1242, the Arabian physician, Ibn al-Nafis, became the first person to accurately describe the
process of pulmonary circulation, for which he is sometimes considered the father of circulatory
physiology.[15][not in citation given] 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.[16] 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"[17][18] (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, the rest were burned shortly after its publication in 1553 because
of persecution of Servetus by religious authorities. Better known was its discovery by Vesalius's
successor atPadua, Realdo Colombo, in 1559.

Image of veins from William Harvey's Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus

Finally, 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 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."[19] 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, Andr Frdric 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."[20]