Chapter 15 Structured Notes

Cardiovascular System:

• Consists of the heart and blood vessels:

• Heart is a hollow, cone-shaped, muscular pump; generates force to transport respiratory
gases, nutrients, and wastes through body
• Blood vessels transport blood throughout the body:
• Arteries transport blood away from heart
• Veins transport blood toward heart
• Capillaries transport blood between arteries and veins, and perform nutrient, gas, and waste
exchange

Overview of the Cardiovascular System

• Two closed circuits (pathways) are included in Cardiovascular System:

• Pulmonary circuit: Carries oxygen-poor blood from heart to lungs, drops off carbon dioxide,
picks up oxygen, flows back to heart
• Systemic circuit: Transports oxygen-rich blood and nutrients to body cells, removes wastes
from cells, flows back to heart
• Organization of the heart:
• Right side pumps to pulmonary circuit, blood returns to the left of the heart
• Left side pumps to systemic circuit, blood returns to the right side of the heart

Structure of the Heart

Size and location of heart:
• Size of fist, varies with body size, averages 14 cm long, 9 cm wide
• Located in inside thoracic cavity, in mediastinum, behind sternum, above diaphragm, near
lungs
• Broad base lies beneath the 2nd rib
• Pointed apex lies at the 5th intercostal space
• Hollow, cone-shaped organ, containing double pump
• Divided into left and right halves

Coverings of the Heart

Pericardium (pericardial sac):
• Covering over heart and proximal ends of large blood vessels
• Portions of the pericardium:
• Fibrous pericardium:
Tough outer layer, that surrounds double-layered serous membrane
• Parietal pericardium:
Deep to fibrous pericardium; outer layer of serous membrane
• Visceral pericardium:
Inner layer of serous membrane; attached to surface of heart; also called the
epicardium
• Pericardial cavity:
Space between visceral and parietal layers of ___________

Wall of the Heart

The heart wall has 3 distinct layers:
• Epicardium:
• Outer layer, thin
• Also called visceral pericardium
• Reduces friction
• Myocardium:
• Middle layer; thickest layer • Composed of cardiac muscle tissue
• Endocardium:
• Inner layer, thin
• Forms inner lining of all heart chambers

Heart Chambers and Valves

• Heart chambers:
• Atria: Thin-walled upper chambers; receive blood returning to heart
• Auricles: Flap-like projections from atria, which allow atrial expansion
• Ventricles: Thick-walled lower chambers; pump blood into arteries
• 4 chambers of the heart:
• Right atrium Receives blood returning from systemic circuit (from the superior and inferior
vena cavae and coronary sinus); pumps blood to right ventricle
• Right ventricle Receives blood from the right atrium; pumps blood to lungs
• Left atrium: Receives blood from the pulmonary veins; pumps blood to left ventricle
• Left ventricle Receives blood from the left atrium; pumps blood to systemic circuit
• Structures associated with the Heart:
• Interatrial septum separates left and right atria
• Interventricular septum separates left and right ventricles
• Superior and inferior venae cavae return oxygen-poor blood to heart
• Tricuspid valve separates right atrium from right ventricle
 • Pulmonary semilunar valve separates right ventricle from pulmonary trunk
• Mitral (bicuspid) valve separates left atrium from left ventricle
• Aortic semilunar valve separates left ventricle from aorta
• Chordae tendineae are fibrous strings that attach cusps of tricuspid and mitral valves to
papillary muscles in wall of heart
• Pulmonary veins (4) return oxygen-rich blood from lungs to atrium

Skeleton of the Heart

• Rings of dense connective tissue surround origins of pulmonary trunk and aorta, and orifices
between atria and ventricles.
• Provide attachments for heart valves and muscle fibers
• Prevent excess dilation of heart chambers during contraction
• These rings, along with other fibrous masses in the interventricular septum, make up the
skeleton of the heart.

Blood Flow Through the Heart, Lungs, and Tissues

• Oxygen-poor blood from venae cavae and coronary sinus enter right atrium
• Blood flows from right atrium, through tricuspid valve, into right ventricle
• Right atrium contracts, sending remaining blood into right ventricle
• Right ventricle contracts
• Tricuspid valve closes right atrioventricular orifice
• As pressure rises in right ventricle, atrioventricular semilunar valve opens
• Blood flows into pulmonary trunk
• Blood flows to lungs, drops off carbon dioxide, picks up oxygen
• Blood returns to left atrium via pulmonary veins
• Blood flows from left atrium, though mitral valve, into left ventricle
• Left atrium contracts, sending remaining blood into left ventricle • Left ventricle contracts
• Mitral valve closes left atrioventricular orifice
• As pressure rises in left ventricle, aortic semilunar valve opens
• Blood flows into aorta, transporting oxygen-rich blood to body cells

Blood Supply to the Heart

Left and right coronary arteries supply blood to tissues of the heart • The
coronary arteries are first 2 branches of the aorta
• Branches of right coronary artery:
• Posterior interventricular artery: Supplies posterior ventricles
• Right marginal branch: Supplies right atrium and ventricle
• Branches of left coronary artery:
• Circumflex branch: Supplies left atrium and ventricle
• Anterior interventricular (left anterior descending) artery: Supplies walls of ventricles
Cardiac veins drain blood from myocardium
• Paths of veins lie nearly parallel to those of coronary arteries
• Coronary sinus: Enlarged vein into which other cardiac veins drain; drains into right atrium

Heart Actions:

Systole: Contraction of a heart chamber

• Diastole: Relaxation of a heart chamber
• The heart chambers function in regulated, coordinated manner
• Cardiac Cycle (the events that occur during a heartbeat):
• Atria contract (atrial systole) while ventricles relax
(Ventricular diasole)
• Then ventricles contract ( ventricular systole) while atria relax
(Atrial distole)
• Then both chambers relax briefly

Cardiac Muscle Cells

Characteristics of cardiac muscle cells:
• Have 1 central nucleus, and form branching networks
• Intercalated between cells contain desmosomes for structural support, and gap junctions to
spread action potentials through a network of cells
• Form a functional syncytium, mass of merging cells that function as a unit:
2 such masses exist in the heart:
• In the atrial walls; called the atrial syncytium
• In the ventricular walls; called the ventricular syncytium

Cardiac Conduction System:

• Specialized group of cardiac muscle cells, which initiate and distribute cardiac action potentials
through myocardium
• Major Components of the Cardiac Conduction System:
• SA (Sinoatrail) Node: Pacemaker; initiates rhythmic contractions of the heart
• Internodal Atrial Muscle: Conducts impulses from SA node to atria
• Junctional Fibers: Conduct impulses from SA node to AV node
• AV (Atrioventricular) Node: Conducts impulses to AV bundle delays impulse, so that atria
finish contracting before ventricles contract
• AV (Atrioventricular) Bundle (of his): Conducts impulses rapidly between SA node and
bundle branches
• Left and Right bundle branches: Split off from AV bundle, conduct impulses to Purkinje
fibers on both sides of heart
• Purkinje Fibers: Large fibers that conduct impulses to ventricular myocardium; conduct
impulses to apex first; whorled pattern of muscle in ventricles contract with twisting motion

Electrocardiogram (ECG, EKG):

• A recording of electric changes that occur in the myocardium during the cardiac cycle
• Used to assess ability of heart to conduct impulses
• The deflections in the normal ECG, or waves, include:
• P wave: Atrial depolarization; occurs just prior to atrial contraction
• QRS complex (3 waves): Ventricular depolarization; occurs just prior to ventricular
contraction
• Record of atrial repolarization is “hidden” in the QRS complex, since ventricular
depolarization is a much larger event
• T wave: Ventricular repolarization; occurs just prior to ventricular relaxation

Heart Sounds

• A heartbeat through a stethoscope sounds like “lubb-dupp”

• Sounds are due to closing of heart valves, and vibrations associated with a sudden slowing of
blood flow during contraction/relaxation of chambers
• Heart sounds:
• “Lubb”:
• The first heart sound (S1)
• Occurs during ventricular systole • Associated with closing of the AV valves
• • “Dupp”:
• The second heart sound (S2)
• Occurs during ventricular diastole
• Associated with closing of the closing of the pulmonary and semilunar valves
• Murmur: Abnormal heart sound derived from incomplete closure of cusps of a valve

Pressure and Volume Changes of a Cardiac Cycle

• During a cardiac cycle, the pressure in the heart chambers rises and falls • Pressure changes
open and close the valves
• Early in ventricular diastole:
• Ventricular pressure is lower than atrial pressure
• Atria and ventricles are relaxed
• AV valves open, and semilunar valves are closed
• About 70% of blood flows passively from atria into ventricles
• During atrial systole and ventricular diastole:
• Atria contract and ventricles are relaxed
• The AV valves open and the semilunar valves close
• Atrial systole pushes remaining 30% of blood into the ventricles, causing ventricular
pressure to increase
• During ventricular systole and atrial diastole:
• When ventricular pressure rises above atrial pressure, AV valves close
• Chordae tendineae prevent the cusps of the valves from bulging too far backward into the
atria
• Atria relax
• Blood flows into atria from venae cavae and pulmonary veins
• Ventricular pressure continues to increase and opens the semilunar valves
• Blood flows into the pulmonary trunk and aorta.

Regulation of the Cardiac Cycle

• Heart rate and volume of blood pumped change to meet requirements

• Cardiac center in medulla oblongata performs neural regulation of heart
• SA node (pacemaker) normally controls the heart rate , and heart rate changes occur due
to factors that influence the SA node
• Sympathetic and parasympathetic fibers modify the heart rate in response to changing
condition such as:
• Physical exercise
• Body temperature
• Fight-or-flight response
• Concentration of various ions, such as K+ and Ca+2
• Parasympathetic impulses that innervate heart:
• Reach heart via vagus nerves
• Lower SA node rate of 100 beats/min to 60 to 80 beats/min
• Decrease heart rate, due to influence on SA and AV nodes
• Sympathetic impulses that innervate heart:
• SternReach heart on accelerator nerves
• Increase heart rate, due to influence on SA and AV nodes, atrial and ventricular myocardium
• Baroreceptor reflexes:
• Involve cardiac control center in medulla oblongata
• Balance inhibitory and excitatory effects of parasympathetic and sympathetic fibers
• Contains cardioinhibitor reflex center and a cardio accelerator • Example of
baroreceptor reflex response:
• Baroreceptors in aortic arch and carotid artery detect blood pressure
• Increased pressure stretches receptors
• Parasympathetic cardioinhibitory reflex lowers heart rate and blood pressure
• Stretch Receptors in venae cavae:
• Increase in blood pressure stretches receptors
• Sympathetic cardioaccelerator reflex increases heart rate and force of contraction, to lower
venous pressure
• Other factors that affect heart rate:
• Impulses from hypothalamus and cerebrum
• Body temperature
• Levels of K+ and Ca+2

Arrhythmias
Arrhythmias: Altered heart rhythms; several types:
• Fibrillation:
• Uncoordinated, chaotic contraction of small areas of myocardium
• Atrial fibrillation not life-threatening; ventricular fibrillation is often fatal
• Tachycardia:Abnormally fast heartbeat, >100 beats/min at rest
• Bradycardia: Abnormally slow heartbeat, <60 beats/min at rest
• Flutter: Rapid, regular contraction of a heart chamber, 250 to 350 beats/min.
• Premature Beat: Beat that occurs before expected in normal cardiac cycle; often originates
from ectopic regions of heart (other than SA node)
• Ectopic Pacemaker: Damage to SA node may lead to AV node taking over, and act as
secondary pacemaker; 40 to 60/min, instead of 70 to 80
• Artificial Pacemaker: Device used to treat disorders of cardiac conduction system;
implantable and battery-powered

Blood Vessels
Blood vessels are organs of the cardiovascular system
• Blood vessels form a closed circuit, transporting blood from heart to body cells (or lungs) and
back to the heart
• Types of blood vessels:
• Arteries: Carry blood away from the ventricles of the heart
Arterioles: Receive blood from the arteries, and carry it to the capillaries
• Capillaries: Sites of exchange of substances between the blood and the body cells
• Venues: Receive blood from the capillaries, and conduct it to veins
• Veins: Receive blood from venules, and carry it back to the atria of the heart

Arteries and Arterioles

• Arteries:
• Thick, strong wall, thicker than walls of veins
• 3 layers or tunics:
• Tunica interna (intima): innermost layer, endothelium
• Tunica media: smooth muscle and elastic tissue
• Tunica externa (adventitia): outer layer, connective tissue
• Transport blood under high blood pressure
• Give rise to smaller arterioles • Arterioles:
• Smaller and thinner-walled than arteries (same 3 layers or tunics)
• Walls of middle and outer layers become thinner as arterioles become smaller
• Both arteries and arterioles can undergo vasoconstriction and vasodilation Capillaries:
• Smallest-diameter blood vessels
• Connect the smallest arteroles and the smallest venules
• Extensions of the inner lining of arterioles
• Walls consist of endothelium (simple squamous epithelium) only
• Semipermeable; exchange substances between blood and tissue fluid
• Capillary blood flow regulated mainly by precapillary: smooth muscle surrounding capillary
when it branches off arteriole or metarteriole

Capillary Permeability

• Openings in walls of capillaries are thin slits found where endothelial cells overlap • Sizes of
openings vary among tissues; permeability varies with size or slits
• Types of capillaries:
• Continuous capillaries:
• Have small openings
• Found in muscle, connective and nervous tissues, and skin
• Fenestrated capillaries:
• Have large openings in cell membranes and between endothelial cells
• Found in endocrine glands, kidneys, small intestine • Sinusoidal capillaries:
• Have largest openings; spaces between cells are small cavities
• Discontinuous
• Found in liver, spleen, and red bone marrow

Capillary Arrangement

• Higher the metabolic rate in a tissue, the denser its capillary networks
• Rich capillary supply in muscle and nerve tissue, since they use a large amount of O 2 and
nutrients
• Tissues with lower metabolic rate, such as cartilage, have fewer capillaries
• Capillary patterns differ; some directly connect arterioles to venules, others branch out into
complex networks
• Blood flow distribution to capillaries can change with situation:
• During exercise, muscle capillaries receive more blood flow, and digestive system capillaries
receive less
• After a meal, digestive system capillaries receive more blood flow, and muscles receive less
• Precapillary Sphincter: Band of smooth muscle that wraps around beginning of capillary, to
regulate blood flow

Exchanges in the Capillaries

• Capillaries exchange gases, nutrients, and metabolic byproducts between blood and tissue
around cells. Exchange occurs by these 4 methods:
• Diffusion:
• Most important method of transfer
• Lipid-soluble substances diffuse through cell menbrane; water-soluble substances
diffuse through membrane channels and slits
• Filtration:
• Hydrostatic pressure forces molecules through membrane
• Pressure is derived from ventricular contraction • Osmosis:
• Presence of impermeant solute, such as plasma proteins, inside capillaries creates osmotic
pressure
• Osmotic pressure draws water into capillaries, opposing filtration
• Colloid osmotic pressure refers to pressure due to plasma proteins
• At arteriolar end of capillary H2O and other substances leave capillary by filtration because
hydrostatic pressure > colloid osmotic pressure
• At venular end of capillary, H2O is reaborbed into capillary, because colloid osmotic pressure
> hydrostatic pressure
• More fluid leaves capillaries at arteriolar end than returns at venous end
• Lymphatic vessels return excess fluid through the lymphatic system to the venous blood
• Transcytosis:
• Large substances (antibodies and lipoproteins) use this method
• Substances enter endothelial cell by endocytosis and leave other side of cell by exocytosis

Venules and Veins

Venules:
• Microscopic vessels that transport blood from the capillaries to the veins.
• Thinner walls and less smooth muscle than arterioles. Veins:
• Thinner walls than arteries, but still have 3 layers (tunics)
• Tunica media less developed than in arteries
• Carry blood under relatively low pressure
• Function as blood reservoirs
•
Many have one way valves to help with blood flow

Blood Vessel Disorders

• Atherosclerosis: Deposits of cholesterol plaque form in inner lining of walls of

arteries
• Aneurysm: A bulge in the wall of an artery, formed when blood pressure
dilates a weakened area of the vessel; can burst wall of artery
• Phlebitis: Inflammation of a vein; common disorder
• Varicose Veins: Abnormal and irregular dilations in superficial veins; most
common in legs

Blood pressure:
• The force the blood exerts against the inner walls of the blood vessels
• Circulates the blood
• “Blood pressure” usually refers to pressure in systemic arteries
• Exists throughout the vascular system
• Blood moves from higher to lower pressure throughout the system

Arterial blood pressure:

• Rises when the ventricles contract
• Falls when the ventricles relax
• Arterial systolic pressure (SP): The maximum pressure reached during
ventricular contraction.
• Arterial diastole pressure (DP): The minimum pressure remaining before
next ventricular contraction.
• Pulse pressure (PP):
Difference between systolic and diastolic blood pressures (SP DP).

• Mean arterial pressure (MAP): Average pressure in arterial system;

represents average force driving blood to the tissues:
• (DP + 1/3 PP)
• Blood pressure is stated as a fraction: SP/DP, as in 120/80
• Blood pressure is stated in units of mm Hg, and is typically measured with a
sphygmomanometer (blood pressure cuff).

Cardiac Output
• Stroke volume (SV): Volume of blood that enters the arteries with each
ventricular contraction (70 mL/beat)
•
• Cardiac output (CO): Volume of blood discharged from a ventricle each
minute; blood pressure varies with cardiac output.
• Cardiac output = stroke volume X heart rate
• CO= SV x HR
• Normal CO: 70 mL x 72 beats/min = 5,040 mL/min
Increase in SV or HR causes increases in CO, which increases the blood
pressure (BP)

Blood Volume:
• Sum of volumes of plasma and formed elements
• Varies with age, body size, gender
• Usually about 5 L for adults (about 4 to 5 liters in a female and 5 to 6 liters in a
male)
• 8% of body weight
• Blood pressure (BP) is directly proportional to blood volume
• Any factor that changes blood volume can change BP
• Example: Decreased blood volume, due to hemorrhage, decreases BP

Peripheral Resistance (PR):

• Force of friction between blood and walls of blood vesseels
• Blood pressure must overcome PR in order to flow
• Factors that change PR also change blood pressure
• Vasoconstriction of arterioles increases PR, which increases the blood
pressure
• When blood is pumped out of ventricles arteries swell; rapid
Elastic recoil sends the blood through the arteries, against PR in arterioles
and capillaries

Viscosity:
• Difficulty with which molecules of fluid flow past each other
• Greater the viscosity, the greater the resistance to blood flow
• Blood cells and plasma proteins increase the viscosity of the blood
•
Greater the resistance to flow greater the force necessary to transport the blood greater the blood pressur

• Any factor that alters concentration of blood cells or plasma proteins also alters
blood viscosity
•
Example: Anemia lowers concentration of blood cells lowers blood viscosity lowers the blood pressure
•

Control of Blood Pressure

• Blood pressure (BP): Product of cardiac output (CO) and peripheral
resistance (PR): BP = CO × PR
• Maintenance of blood pressure requires regulation of these 2 factors
• Cardiac output (CO): Product of Heart Rate (HR) and Stroke Volume (SV)
• Stroke volume: Difference between end-diastolic volume (EDV) and
endsystolic volume (ESV)
• End-diastolic Volume: Volume of blood in each ventricle at end of ventricular
diastole End-systolic : Volume of blood remaining in each ventricle at end of
ventricular systole
• Several mechanical, neural, and chemical factors influence stroke volume and
heart rate
• Cardiac output is limited by venous return (volume of blood returning to
ventricles)
• Stroke volume can be increased by sympathetic stimulation
• Preload can increase stroke volume: Higher the EDV, the greater the
mechanical stretch of ventricular myocardial cells (preload), and greater the
force of contraction that will follow (Frank-Starling Law of the Heart)
• ESV is affected by these factors:
• Preload
• Contractility: Strength of contraction at a specific preload (EDV)
• After load: Force that ventricles must provide to open semilunar valves to eject
blood
• Cardiac output, peripheral resistance, and therefore blood pressure are also
regulated by baroreceptor (cardioaccelerator and cardioinhibitory reflexes)
• Epinephrine a hormone from adrenal medulla, increases heart rate, cardiac
output, blood pressure
• Peripheral resistance (PR), derived from changing arteriole diameter, also
regulates blood pressure:
• Vasoconstriction reduces arteriole diameter, increases PR, and increases blood
pressure
• Vasodilation increases arteriole diameter, decreases PR, and decreases blood
pressure
• Vasomotor center in medulla oblongata regulates diameter of arterioles
and therefore PR, by changing sympathetic stimulation of muscle in walls of
arterioles
•
Hypertension (high blood pressure):
• Long-lasting elevated arterial blood pressure
• Causes: unknown cause, increased Na+ intake, psychological stress that activates
the sympathetic nervous system, obesity (by increasing the peripheral
resistance), kidney disease (via renin-angiotensin response)
• “Silent killer,” because it may not cause any direct symptoms
• Contributes to formation of atherosclerosis
• May lead to coronary thrombosis or embolism
• May lead to cerebral thrombosis, embolism, or hemorrhage, perhaps resulting in
a transient ischemic attack (TIA, ministroke) or a cerebral vascular accident
(CVA, stroke)
• Prevention: healthy diet and weight, regular exercise, limiting Na + intake
• Treatments: diuretics, sympathetic inhibitors
Venous Blood Flow:
• Blood pressure decreases as the blood moves through the arterial system and
into the capillary network, so very little pressure remains at the venous ends of
the capillaries
• Only partly a direct result of heart action • Also dependent on:
• Skeletal muscle contraction: When muscle contract, they squeeze veins, and
help move blood back toward heart
• Respiratory movements: During inspiration, as thoracic cavity enlarges,
pressure falls below abdominal pressure; this helps blood flow upward toward
heart
• Vasoconstriction of veins (venoconstriction) Under conditions of low blood
pressure, sympathetic reflexes cause contraction of smooth muscle in walls of
veins
• Veins act as blood reservoir, which can alter its capacity in response to
changes in blood volume

Central Venous Pressure

• All veins, except those returning to the heart from the lungs, drain into right
atrium
• Pressure in the right atrium is called central venous pressure
• Factors that influence it alter flow of blood into the right atrium
• It affects pressure within the peripheral veins
• A weakly beating heart incentral venous pressure
• An increase in central venous pressure causes blood to back up into the
peripheral veins
• This can lead to peripheral edema
• Increase in blood volume or venoconstriction increases blood flow to right
atrium, which increases central venous pressure

Paths of Circulation

Pulmonary circuit:
• Right ventricle pulmonary trunk right and left pulmonary arteries
lobar branches, repeated divisions pulmonary
arterioles alveolar capillaries
pulmonary venules and veins left atrium
• Blood in pulmonary arteries and arterioles is low in O2 and high lol.in CO2
• Gas exchange occurs in pulmonary (alveolar) capillaries • Blood in pulmonary
venules and veins is rich in O2 and low in CO2 Systemic circuit:
• Oxygen-rich blood moves from left atrium to left ventricle
• Contraction of left ventricle sends blood into systemic circuit
•
Left ventricle aorta all arteries and arterioles leading to body tissues systemic capillaries systemic venu

Arterial System

Aorta:
• Largest diameter artery in body
• Portion attached to heart is aortic root
• Main portions include ascending aorta arch, descending aorta
(which contains the thoracic aorta and the abdominal aorta)
• Aortic semilunar valve lies at root
• Swellings near valve cusps are aortic sinuses
• Left and right coronary arteries begin at aortic sinuses
• Aortic bodies: baroreceptors in aortic arch that monitor blood pressure
• Major branches of aortic arch:
• Brachiocephalic trunk: Supplies right side of head and upper limb; splits into
right common carotid and right subclavian arteries
• Left common artery: Supplies left side of head and neck
• Left subclavain artery: Supplies left arm
• Aorta eventually branches into the 2 Common iliac arteries
• Cerebral arterial circle (circle of willis):
• System which supplies blood to the brain
• Formed by merging of the internal carotid arteries and basilar artery
(formed by 2 vertebral arteries uniting inside cranial cavity)

Venous Pathways: Characteristics of Venous Pathways

• Systemic venous circulation returns blood to heart after exchange of gases,
nutrients, and wastes between blood and cells
• Vessels of the venous system originate from the merging of capillaries into
venules, venules into small veins, and small veins into larger ones
• Unlike arterial pathways, those of the venous system are difficult to follow, due
to irregular networks and unnamed tributaries
• Pathways of larger veins usually parallel arteries of the same name
 • All systemic veins converge into the superior and inferior venae cavae, and
return to the heart through the right atrium

Veins from the Abdominal Viscera

Portal veins:
• Unusual, in that they do not transport blood directly to the heart
• Filter blood through 2 sets of capillaries, instead of the usual 1 set
• One set of capillaries performs a unique function in the body
• Examples: Hepatic Portal System and the Renal Portal System Hepatic portal
system:
• Unique venous pathway that drains abdominal viscera
• Blood from capillaries in the stomach, intestines, pancreas, and spleen drain into
the hepatic portal vein, which transports it to the liver for processing, before
it is delivered to inferior vena cava
• Liver adjusts nutrient concentrations before blood enters general circulation
• After passing through the hepatic portal system, blood drains out of liver though
hepatic veins and enters inferior vena cava
• Other veins drain directly into inferior vena cava

Life-Span Changes
• Cholesterol deposition in the blood vessels
• Narrowed coronary arteries
• Heart may shrink slightly, or enlarge due to disease
• Proportion of heart consisting of cardiac muscle declines
• Increase in fibrous connective tissue of the heart
• Increase in adipose tissue of the heart
• Heart valves and left ventricular wall may thicken
• Increase in systolic blood pressure
• Decrease in resting heart rate
• Lumens of large arteries narrow, as arterial walls thicken
• Decrease in arterial elasticity