The
Cardiovascular
System


S04:

Histology
of
the
Heart
and
Blood
Vessels


Introduction


You
will
remember
that
you
studied
the
micro‐anatomical
appearance
of
skeletal,
cardiac
and
smooth
muscle
last

year
(in
NAS),
and
you
will
need
to
revise
that
session
and
others
considering
the
autonomic
nervous
system
(NAS)

and
loose
connective
tissues
(MTM)
prior
to
this
session.




Cardiac
muscle
is
a
unique
type
of
muscle
found
in
the
walls
of
the
heart
and
at
the
point
of
entry
of
the
caval
veins.


Like
skeletal
muscle,
it
is
striated
and
has
a
T‐tubule
system
in
close
proximity
to
the
sarcoplasmic
reticulum,
but
with

fewer
T‐tubules
often
characterised
by
a
diad
system
rather
than
the
triad
system
associated
with
skeletal
muscle.



Unlike
skeletal
muscle
however,
cardiac
myocytes
are
short,
branched
and
are
joined
to
other
myocytes
to
be
finally

arranged
in
a
whorled
manner
that
optimises
the
wringing
of
blood
from
the
ventricles
to
the
pulmonary
trunk
and

aorta
during
ventricular
contraction.

The
join
between
the
individual
cells
is
the
intercalated
disc
which
contains
gap,

adherens
and
desmosmal
junctions.

Unlike
skeletal
muscle,
cardiac
muscle
is
not
supplied
by
the
somatic
nervous

system,
and
therefore
does
not
have
neuromuscular
junctions.


Rather,
it
is
supplied
by
the
autonomic
nervous

system
that
influences
(but
does
not
initiate)
rate
and
strength
of
contraction.


The
similarities
with
smooth
muscle
have
led
anatomists
to
believe
that
cardiac
muscle
has
evolved
toward
skeletal

muscle
from
the
smooth
muscle
of
primitive
circulatory
systems.


It
is
clear
therefore
that
in
many
ways,
cardiac
muscle
has
far
more
similarities
with
smooth
muscle:



• Cardiac
muscle
is
formed
from
individual
mono‐nucleated
cells
joined
together;

• Individual
cardiac
myocytes
are
in
direct
communication
with
adjacent
cells
via
gap
junctions
–
allowing
the

passage
of
small
ions;

• The
nuclei
of
cardiac
muscle
cells
are
centrally
placed;

• Cardiac
muscle
cells
contract
spontaneously
–
they
are
myogenic;

• Autonomic
innervation
modifies
the
intrinsic
rate
of
cardiac
muscle
contraction,
and
the
sympathetic
system
can

increase
the
strength
of
the
contraction.




The
primary
function
of
the
conducting
blood
vessels
–
arteries
and
veins
–
is
to
move
blood
quickly
and
efficiently
to

the
capillary
beds
of
tissues,
and
to
return
that
modified
blood
to
the
heart.

The
primary
function
of
capillaries
is
to

allow
exchange
of
metabolic
substrates
and
oxygen
to
tissues,
and
to
remove
their
waste
products
‐
all
done
by

diffusion
which
is
very
rapid
over
short
distances.

Fluid
usually
leaves
the
blood
system
at
capillaries,
whereas
cells

can
if
necessary
leave
at
the
postcapillary
venules,
the
remainder
of
the
vascular
tree
is
impermeable.

Lymphatic

vessels
carry
excess
water
failing
to
return
to
the
pre‐venular
capillary
and
some
tissue‐derived
fluid,
now
termed

lymph
back
to
the
blood
vascular
system.


Most
blood
vessels
are
composed
of
three
major
layers
(tunica),
simply
the
tunica
intima,
tunica
media
and
tunica

externa.

The
innermost
tunica
intima
is
made
up
of
endothelial
and
their
basement
membrane,
and
a
thin
layer
of

connective
tissue,
particularly
fibres,
the
tunica
media
is
dominated
by
smooth
muscle
arranged
circumferentially,

and
the
outermost
tunica
adventitia
dominated
by
collagen
fibres.

The
central
layer
of
most
arteries
and
arterioles
is

dominated
by
a
thick
smooth
muscle,
whilst
even
the
largest
veins
have
little
muscle
in
their
walls.

On
the
other
hand

the
outermost
layer
is
the
thickest
layer
of
veins
where
collagen
prevents
overdistension.


Despite
carrying
highly
oxygenated
blood,
the
wall
of
arteries
is
so
thick
that
diffusion
would
not
be
rapid
enough
to

supply
the
cells
forming
their
walls
to
be
adequately
perfused,
therefore
the
vasa
vasorum,
vessels
of
vessels
supply

them.

The
vasa
vasorum
can
be
seen
with
the
naked
eye
in
cadavers,
although
it
is
often
only
the
venous
vessels
on

large
arteries
that
are
easily
visualised.


Red
blood
cells,
like
the
other
cellular
constituents
of
blood
are
produced
in
bone
marrow.

They
are
anuclear
and

have
a
characteristic
biconcave
disc
appearance
in
blood
smears,
although
they
are
very
deformable
and
elastic,
as

they
must
be
in
order
to
pass
through
capillaries
of
very
small
diameter.


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Histology
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2012

Objectives


When
you
have
prepared
for
this
small
group
session,
and
following
it,
completed
any
follow‐up
work
required,
you

should
be
able
to:


• Discuss
the
structural
and
functional
differences
between
different
categories
of
arteries,
veins
and
capillaries.

• Describe
the
structural
and
functional
features
that
distinguish
cardiac
muscle
from
other
basic
muscle
types
at
a

macroscopic
and
microscopic
level
and
identify
them
in
histological
sections.

• Identify
and
describe
the
functional
microanatomy
of
the
heart.

• Draw
and
label
diagrams
summarising
the
histological
features
of
each
classification
of
blood
vessel
type
and

relate
this
to
their
functional
anatomy.

• Distinguish
between
arterial
and
venous
vessels
in
histological
sections.

• Describe
the
appearance
of
the
different
categories
of
capillaries
and
sinusoids
under
electron
microscopy,
and

relate
this
to
their
function.

• Describe
the
histological
response
of
cardiac
muscle
and
blood
vessel
tissues
to
disease
and
trauma
and
describe

the
functional
effects
of
such
damage.

• Recognise
blood
cells
in
a
blood
smear
and
describe
the
population
and
basic
functions
of
those
cells
in
a
typical

specimen.




*
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*
*
*
*
*
*
*
*
*
*


Suggested
Preparative
Reading


You
will
need
to
revise
appropriate
sessions
from
the
Molecules
to
Man
and
Neurones
and
Synapses
modules
you

studied
last
year,
particularly:



• Anatomy
and
histology
of
the
autonomic
nervous
system

• Histology
of
cardiac
and
smooth
muscle:


• Functional
(micro)anatomy
of
loose
and
dense
connective
tissues


Additionally
you
ought
to
refer
to
material
from
Integrated
Anatomy
Lecture
1
from
1st
October.


You
will
also
need
to
make
concise
notes
and
may
of
course
use
other
resources
you
discover
on
your
own.




You
are
expected
to
have
this
recommended
histological
textbook,
and
therefore
guidance
as
to
page
numbers
is

given.

You
may
have
chosen
another
text,
but
you
will
need
to
find
appropriate
sections
to
read
yourself.


Junqueira’s
Basic
Histology
(12th
edition)
 
 
 Chapter
11:
pages
185
‐
202

Anthony
L
Mescher

McGraw
Hill




There
will
be
a
short
video
presentation
during
this
session
–
you
may
choose
to
take
notes


Some
key
images
will
be
given
to
you
during
this
session
–
it
is
important
however
that
you
obtain
a
few
images
from

textbooks,
and
the
internet
that
you
source
yourself.


Extra
notes
and
questions
referring
to
the
coloured
sheet:


• How
would
you
differentiate
between
cardiac
and
smooth
muscle
in
microanatomical
sections?




2 CVS
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Histology
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2012

• Image
1
is
a
diagram
showing
the
general
structure
of
blood
vessels.

Identify
the
layers
arrowed
a
‐
d.





 



 Is
the
layer
arrowed
at
(b)
a
feature
of
all
blood
vessels?


• A
low
power
view
of
a
section
taken
through
the
ventricular
wall
of
the
heart
is
shown
in
Image
2.

Identify
the

tissue
arrowed
at
(a).





 Identify
the
tissues
which
cover
the
inner
and
outer
surfaces
of
the
ventricular
wall.



 Identify
the
impulse
conducting
fibres
arrowed
at
(b).


• Image
3
is
a
high
power
view
of
a
section
through
a
blood
capillary.

What
type
of
cell,
arrowed
at
(a),
forms
the

luminal
wall
of
capillaries?





 What
are
the
two
different
categories
of
blood
capillary
found
in
the
body?


• A
transmission
electronmicrograph
of
the
endothelial
wall
of
a
blood
capillary
is
shown
in
Image
4.

Name
the

subcellular
structure
arrowed
at
(a).





 What
type
of
junction
is
arrowed
at
(b)?



 Is
this
a
fenestrated
capillary?

Give
reasons
for
your
answer.



 


• Image
5
is
a
low
power
view
of
a
section
through
a
distributing
artery
indicated
by
an
arrow
at
(a)
and
a
vein

arrowed
at
(b).

List
the
principle
differences
in
the
structures
of
these
two
vessels.





 


• Image
6
shows
a
high
power
view
of
a
blood
vessel
stained
to
show
elastic
fibres
(black).

Name
the
layers
of

elastic
fibres
indicated
by
arrows
at
(a)
and
(b).





 Is
the
section
shown
an
artery
or
a
vein?

Give
a
reason
for
your
answer.


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2012

 • A
low
power
view
of
a
section
through
the
aorta
is
shown
in
Image
7.

The
section
has
been
stained
to
show

the
elastic
fibres
black.

Why
does
this
vessel
have
so
many
elastic
fibres?



 


• Image
8
shows
a
low
power
view
of
a
section
through
a
large
vein.

Describe
the
constituents
of
the
three
main

layers
in
this
vessel.


 



 


• Image
9
is
a
very
low
power
micrograph
of
a
section
taken
from
a
human
coronary
artery.

What
do
you
notice

about
this
section?


 



 What
functional
deficit
would
have
been
apparent
in
this
patient?



 


• Image
10
shows
a
very
high
power
electronmicrograph
of
the
liver.

Identify
the
structures
indicated
by
the

arrows
(a).

What
type
of
vessels
are
they
associated
with?





 What
are
the
features
arrowed
at
(b)?


• Image
11
shows
a
high
power
electronmicrograph
of
a
fenestrated
capillary
in
the
gastrointestinal
tract.


Identify
the
features
labelled
(a).



 Identify
the
feature
labelled
(b).



 Identify
structure
(c).

What
does
this
tell
you
about
the
dimensions
of
the
vessel?



 



 Other
cells
are
labelled
(L)
and
(M).

Identify
these
cells
and
comment
upon
their
functions.



 How
do
the
walls
of
the
vessel
in
this
Image
differ
from
that
shown
in
Image
10?

Why?


• Post
capillary
venules
are
the
likely
site
for
migration
of
immuno‐competent
cells
from
the
blood
to
the
tissues
–

why
these
vessels?




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Histology
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• In
order
to
allow
this
passage
of
cells
the
junctions
between
adjacent
cells
must
be
weakened.

This
reversible

process
occurs
under
the
influence
of
certain
factors,
for
example
histamine.

Which
cells
are
responsible
for
the

release
of
histamine,
and
where
are
they
located?




• Where
are
blood
cells
generated?

How
long
does
it
take
for
them
to
develop?






• What
is
the
typical
density
of
the
following
in
adult
blood?

And
in
a
normal
haematocrit?



a)
 Red
blood
cells
 


b)
 White
blood
cells
 


c)
 Platelets
 



 


• How
do
lymph
vessels
differ
from
those
carrying
blood?




• What
is
leukaemia?






Suggestions
of
clinical
correlations
for
discussion


• Apart
from
their
role
in
conduction
of
blood
to
the
capillary
bed,
what
are
the
functions
of
arterioles
and
how

does
this
relate
to
their
histological
appearance?

• Some
athletes
try
to
increase
their
oxygen
carrying
capacity
by
increasing
their
red
blood
cell
count.

How
might

this
be
done,
and
why
might
it
be
of
clinical
significance?

• What
are
thrombi,
emboli,
atherosclerotic
plaque,
and
why
are
they
important?

• What
are
the
relative
advantages
and
disadvantages
of
continuous,
fenestrated
and
sinusoidal
capillaries?

• What
is
the
relationship
between
radius
of
a
vessel
and
flow?

How
will
this
be
changed
by
atherosclerosis?


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Histology
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2012