HUMAN ANATOMY AND PHYSIOLOGY

NERVOUS SYSTEM

The nervous system is a complex network of nerves and nerve cells (neurons) that carry signals
or messages to and from the brain and spinal cord to different parts of the body. It is made up
of the central nervous system and the peripheral nervous system.
The CENTRAL NERVOUS SYSTEM (CNS) is made up of the brain and spinal cord. The brain
controls most body functions, including awareness, movements, sensations, thoughts, speech
and memory. The spinal cord is connected to the brain at the brain stem and is covered by the
vertebrae of the spine. Nerves exit the spinal cord to both sides of the body. The spinal cord
carries signals back and forth between the brain and the nerves in the rest of the body.

What Does the Central Nervous System Do?

The brain is like a central computer that controls all the body's functions. It is in charge of what
we think and feel, how we learn and remember, and the way we move and talk. It also controls
things we're less aware of — like the beating of our hearts and the digestion of our food. The
brain sends messages back and forth with the body. These messages travel through the spinal
cord.
A. BRAIN
The brain structure is composed of three main parts: the forebrain, midbrain and
hindbrain, each with multiple parts.

1. FOREBRAIN
The Cerebrum: Also known as the cerebral cortex, the cerebrum is the largest part of the
human brain, and it is associated with higher brain function such as thought and action. Nerve
cells make up the gray surface, which is a little thicker than our thumb. White nerve fibers
beneath the surface carry signals between nerve cells in other parts of the brain and body . Its
wrinkled surface increases the surface area, and is a six-layered structure found in mammals,
called the neocortex. It is divided into four sections, called “lobes”. They are; the frontal lobe,
the parietal lobe, the occipital lobe and the temporal lobe.

Functions Of The Lobes:

Frontal Lobe – The frontal lobe lies just beneath our forehead and is associated with our brain’s
ability to reason, organize, plan, speak, move, make facial expressions, serial task, problem
solve, control inhibition, spontaneity, initiate and self-regulate behaviors, pay attention,
remember and control emotions.
Parietal Lobe – The parietal lobe is located at the upper rear of our brain, and controls our
complex behaviors, including senses such as vision, touch, body awareness and spatial
orientation. It plays important roles in integrating sensory information from various parts of our
body, knowledge of numbers and their relations, and in the manipulation of objects. Portions
are involved with our visuospatial processing, language comprehension, the ability to construct,
body positioning and movement, neglect/inattention, left-right differentiation and self-
awareness/insight.
Occipital Lobe – The occipital lobe is located at the back of our brain, and is associated with our
visual processing, such as visual recognition, visual attention, spatial analysis (moving in a 3-D
world) and visual perception of body language; such as postures, expressions and gestures.
Temporal Lobe – The temporal lobe is located near our ears, and is associated with processing
our perception and recognition of auditory stimuli (including our ability to focus on one sound
among many, like listening to one voice among many at a party), comprehending spoken
language, verbal memory, visual memory and language production (including fluency and word-
finding), general knowledge and autobiographical memories.
A deep furrow divides the cerebrum into two halves, known as the left and right hemispheres.
And, while the two hemispheres look almost symmetrical, each side seems to function
differently. The right hemisphere is considered our creative side, and the left hemisphere is
considered our logical side. A bundle of axons, called the corpus callosum, connects the two
hemispheres.

2. MIDBRAIN
The midbrain is located below the cerebral cortex, and above the hindbrain placing it near the
center of the brain. It is comprised of the tectum, tegmentum, cerebral aqueduct, cerebral
peduncles and several nuclei and fasciculi. The primary role of the midbrain is to act as a sort of
relay station for our visual and auditory systems. Portions of the midbrain called the red
nucleus and the substantia nigra are involved in the control of body movement, and contain a
large number of dopamine-producing neurons. The degeneration of neurons in the substantia
nigra is associated with Parkinson’s disease. The midbrain is the smallest region of the brain,
and is located most centrally within the cranial cavity.

Limbic System – the limbic system is often referred to as our “emotional brain”, or ‘childish
brain’. It is found buried within the cerebrum and contains the thalamus, hypothalamus,
amygdala and hippocampus.
Thalamus – the primary role of the thalamus is to relay sensory information from other parts of
the brain to the cerebral cortex
Hypothalamus – the primary role of the hypothalamus is to regulate various functions of the
pituitary gland and endocrine activity, as well as somatic functions e.g.body temperature, sleep,
appetite.
Amygdala – the primary role of the amygdala is to be a critical processor for the senses.
Connected to the hippocampus, it plays a role in emotionally laden memories and contains a
huge number of opiate receptor sites that are implicated in rage, fear and sexual feelings.
Hippocampus – the primary role of the hippocampus is memory forming, organizing and storing
information. It is particularly important in forming new memories, and connecting emotions
and senses, such as smell and sound, to memories.
Pituitary Gland – the primary role of the pituitary gland is an important link between the
nervous system and the endocrine system. It releases many hormones which affect growth,
metabolism, sexual development and the reproduction system. It is connected to the
hypothalamus and is about the size of a pea. It is located in the center of the skull, just behind
the bridge of the nose.
 3. HINDBRAIN

The Cerebellum – The cerebellum, or “little brain”, is similar to the cerebrum with its two
hemispheres and highly folded surface. It is associated with regulation and coordination of
movement, posture, balance and cardiac, respiratory and vasomotor centers.
Brain Stem – The brain stem is located beneath the limbic system. It is responsible for vital life
functions such as breathing, heartbeat, and blood pressure. The brain stem is made of the
midbrain, pons, and medulla.
 Pons – The primary role of the pons is to serve as a bridge between various parts of
the nervous system, including the cerebellum and cerebrum. Many important nerves
that originate in the pons, such as the trigeminal nerve, responsible for feeling in the
face, as well as controlling the muscles that are responsible for biting, chewing, and
swallowing. It also contains the abducens nerve, which allows us to look from side to
side and the vestibular-cochlear nerve, which allows to hear. As part of the
brainstem, a section of the lower pons stimulates and controls the intensity of
breathing, while a section of the upper pons decreases the depth and frequency of
breaths. The pons is also associated with the control of sleep cycles, and controls
respiration and reflexes. It is located above the medulla, below the midbrain, and
just in front of the cerebellum.
 Medulla – The primary role of the medulla is regulating our involuntary life
sustaining functions such as breathing, swallowing and heart rate. As part of the
brain stem, it also helps transfer neural messages to and from the brain and spinal
cord. It is located at the junction of the spinal cord and brain.

B. The Spinal Cord

The spinal cord is the extension of nervous tissue in the vertebral column contained within the
vertebral cavity. As the spinal cord continues to develop in the newborn, anatomical features
mark its surface. For instance, the anterior midline is marked by the anterior median fissure,
and the posterior midline is marked by the posterior median sulcus.
Spinal Cord Anatomy
The length of the spinal cord is divided into regions that correspond to the regions of the
vertebral column. The name of a spinal cord region corresponds to the level at which spinal
nerves pass through the intervertebral foramina. Immediately inferior to the brain stem is the
cervical region, followed by the thoracic, then the lumbar, and finally the sacral region. The
spinal cord is not the full length of the vertebral column because the spinal cord does not grow
significantly longer after the first or second year, but the skeleton continues to grow. The
nerves that emerge from the lower spinal cord pass through the intervertebral formina at the
respective levels. As the vertebral column grows, these nerves grow with it and result in a long
bundle of nerves that resembles a horse's tail and is named the cauda equina. The sacral spinal
cord is at the level of the upper lumbar vertebral bones. The spinal nerves extend from their
various levels to the proper level of the vertebral column.

In adults, the spinal cord is usually 40cm long and 2cm wide. It forms a vital link between the
brain and the body.

The spinal cord is divided into five different parts.

 Sacral cord
 Lumbar cord
 Thoracic cord
 Cervical cord
 Coccygeal
 Several spinal nerves emerge out of each segment of the spinal cord. There are 8 pairs
of cervical, 5 lumbar, 12 thoracics, 5 sacral and 1 coccygeal pair of spinal nerves
  It performs the primary processing of information as it carries sensory signals from all parts of
the body to the Central Nervous System through afferent fibres.
 Nerve tissue consists of the grey and white matter spread across uniformly.
 The tissue called "gray matter" in the brain and spinal cord is also known as substantia grisea,
and is made up of cell bodies. "White matter", or substantia alba, is composed of nerve
fibers. Gray matter consists of cell bodies and unmyelinated neural processes, whereas
white matter consists of myelinated fibers. Hence, gray matter processes information, and
white matter transmits neural signals from one area to another.

SPINAL CORD NERVES

The spinal nerves consist of a group of 31 nerves. These nerves are attached to the spinal cord by two
roots- dorsal sensory root and ventral motor root.

The sensory root fibres carry sensory impulses to the spinal cord. The motor roots, on the
contrary, carry impulses from the spinal cord.

The spinal nerves carry messages to and from the skin of specific regions of the body called
dermatomes.

The spinal cord nerves can be grouped as:

 Cervical
 Thoracic
 Sacral
 Lumbar
 Coccygeal

Cervical Nerves

Cervical means of the neck. There are 8 cervical nerves that emerge from the cervical spine (C1-
C8).

Thoracic Nerves

Thoracic means of the chest. There are 12 thoracic nerves that emerge from the thoracic spine
(T1-T12).
Lumbar Nerves

Lumbar means from the lower back region. There are 5 lumbar nerves that emerge from the
lumbar spine (L1-L5).

Sacral Nerves

Sacral means of the sacrum. The sacrum is a bony plate at the base of the vertebral column.

There are 5 sacral nerves that emerge from the sacral bone (S1-S5).

Coccygeal Nerves

Coccygeal means of the tailbone. There is 1 nerve that emerges from the coccygeal bone.

Function Of Spinal Cord

Important functions of Spinal Cord are mentioned below:

 Forms a connecting link between the brain and the PNS

 Provides structural support and builds a body posture
 Facilitates flexible movements
 Myelin present in the white matter acts as an electrical insulation
 Communicates messages from the brain to different parts of the body
 Coordinates reflexes
 Receives sensory information from receptors and approaches towards the brain for
processing.
Structure Of Spinal Cord

The Spinal cord runs through a hollow case from the skull enclosed within the vertebral column.
Spinal nerves arise from different regions of the vertebral column and are named accordingly,
the regions are – Neck, chest, pelvic and abdominal.

Cross-section of spinal cord displays grey matter shaped like a butterfly surrounded by a white
matter.
Grey matter consists of the central canal at the centre and is filled with a fluid called CSF
(Cerebrospinal fluid). It consists of horns (four projections) and forms the core mainly
containing neurons and cells of the CNS. There are two dorsal and two ventral horns.

The white matter consists of a collection of axons permitting communication between different
layers of CNS. A tract is a collection of axons and carries specialized information. Ascending
tracts and descending tracts send and transmit signals from the brain respectively to various
nerve cells across the body.

Spinal nerves act as mediators, communicating information to and from the rest of the body
and the spinal cord. We have 31 pairs of spinal nerves.

Three layers of meninges surround the spinal cord and spinal nerve roots.

 Dura mater
 Arachnoid mater
 Pia mater

Dura mater consists of two layers- periosteal and meningeal. Epidural space is present between
the two layers. Subarachnoid space lies between the arachnoid mater and pia mater. It is filled
with cerebrospinal fluid.

Spinal Cord Injuries

Damage to any part of the spinal cord or spinal nerves results in permanent and life-long
damage to the spinal cord affecting the normal functioning of the spinal cord without any
replacements.

It often causes long-term changes in the strength, body posture and reflexing of the body.
Voluntary control of limbs post an injury depends on the severity and location of the injury.

One has a complete injury when he loses the ability to move or sense below the injury. The
incomplete injury allows the injured to perform some sensory and motor functions.

Spinal cord injury not only has an impact on the spinal nerves and the vertebral column but
affects other muscles and vital organs as well.

Paralysis from an injury can be of two types:

 Tetraplegic
 Paraplegic
Tetraplegia is a paralysis that results in total or partial loss of use of all four limbs and torso.

Paraplegia, on the other hand, is similar to tetraplegia, except it doesn’t affect the arms.

These injuries result in the inability to voluntarily move limbs, lose sensation, delayed or
exaggerated reflexes, changes in sexual functions, intense shooting pain due to damaged nerve
fibres. It also causes shortness of breath, cough and muscle spasms.

PERIPHERAL NERVOUS SYSTEM

Your peripheral nervous system (PNS) is that part of your nervous system that lies outside
your brain and spinal cord. It plays key role in both sending information from different areas of
your body back to your brain, as well as carrying out commands from your brain to various
parts of your body.
Some of those signals, like the ones to your heart and gut, are automatic. Others, like the ones
that control movement, are under your control.
Your peripheral nervous system is everything else and includes nerves that travel from your
spinal cord and brain to supply your face and the rest of your body. The term “peripheral” is
from the Greek word that means around or outside the center.
What does the peripheral nervous system do?
Your peripheral nervous system has two main subsystems: autonomic and somatic.
Autonomic: These are nervous system processes your brain runs automatically and without you
thinking about them.
Somatic: These are functions you manage by thinking about them.
Those two subsystems are how your peripheral nervous system does its three main jobs:
1. Senses: Your PNS is a key part of how your brain gets information about the world
around you. This job falls under the somatic nervous system.
2. Movement: Your peripheral nerves deliver command signals to all the muscles in your
body that you can consciously control. This job also falls under the somatic nervous
system.
3. Unconscious processes: This is how your brain runs critical processes that don’t depend
on your thinking about them. Examples of this include heartbeat and blood pressure.
This job depends on your autonomic nervous system.
Senses
Your brain is like a powerful supercomputer. However, it knows nothing about the world
outside your body without outside input. That’s why your peripheral nervous system is so
important. A computer needs peripheral devices like a camera, microphone or keyboard to give
it information from outside itself, and your brain is the same.
Your peripheral nervous system is how your brain gets information about the outside world.
Most of your peripheral nervous system travel to the rest of your body by exiting or entering
your spinal cord. Your cranial nerves are unlike other peripheral nerves in that these very
special nerves connect directly to your brain. These nerves carry signals from your nose, ears
and mouth, as well as many other organs. Your cranial nerves also give you a sense of touch in
the skin of your face, head and neck.
Other peripheral nerves intertwine throughout every part of your body. They stretch out
everywhere, including to the tips of your fingers and toes. The sensory nerves in your hands
and feet are also part of your brain’s ability to get information from the outside world. The
motor nerves allow you to move various parts of your body.
Movement
Your peripheral nerves that branch outward throughout your body deliver command signals
from your brain to your muscles. That allows you to move around and do all kinds of tasks,
ranging from simple ones, like scratching your nose, to complicated ones, like juggling.
Unconscious processes
Your autonomic nervous system functions without you thinking about it. Part of your brain is
always working, managing processes that keep you alive. Your brain needs your peripheral
nervous system to control those functions. Examples of these processes include your heart rate,
breathing, blood pressure and your gut’s digestion of food.
Types of nerve signals
Your nerves consist of bundles of nerve cells, which have long, arm-like extensions called axons.
The nerve cells and their axons twist and intertwine together to form nerve fibers. This is
similar to how multiple strands of spun cloth fibers twist together to form sewing thread. Some
of the nerves in that bundle carry information into your brain, while others carry information
out of your brain.

 Sensory: These nerves carry information to your brain and spinal cord. They either
connect directly to your brain through your cranial nerves or carry information to your
spinal nerves, which then feed into your spinal cord. The sensory nerve connections to
your spinal cord are on the back of your spinal cord.
  Motor: These nerves carry command signals from your brain to various parts of your
body. They only carry information away from your brain. The motor nerve connections
are on the front of your spinal cord; meaning, these nerves are for sending muscle
movement commands only.
 Autonomic: These nerves control the automatic functions of the organs and systems in
your body. Your autonomic nerves often involve mixed nerve fibers, some of which carry
commands from your brain to their destination, and others that carry information about
an organ’s function back to your brain.

Where is the peripheral nervous system located?

Your peripheral nervous system extends everywhere in your body that isn’t your spinal cord or
brain. It includes:
Cranial nerves: There are 12 pairs of nerves that connect directly to your brain, and 11 of them
are part of your peripheral nervous system (the second cranial nerve, which controls your
vision, is part of your central nervous system). These 11 nerves are part of your senses of smell,
sound, taste, and the sense of touch you have in the skin on your head, face and neck. One of
the 11, the vagus nerve, extends down and attaches to all vital organs from your neck to your
colon.
Spinal nerves: These are 31 pairs of nerves that attach to your spine at about the same level as
each segment bone (vertebra) in your spine.
What is it made of?
Your peripheral nervous system consists of various types of nerve cells and structures.
Peripheral nerves and cranial nerves have command centers that are neurons as well as
highways that send information called axons and dendrites. The cell types are as follows, with
more about them listed below:
Neurons
Neurons are the cells that send and relay signals through your nervous system, using both
electrical and chemical signals. Each neuron consists of:
Cell body: This is the main part of the cell.
Axon: This is a long, arm-like part that extends outward from the cell body. At the end of the
axon are several finger-like extensions where the electrical signal in the neuron becomes a
chemical signal. These extensions, known as synapses, lead to nearby nerve cells.
Dendrites: These are small branch-like extensions (their name comes from a Latin word that
means “tree-like”) on the cell body. Dendrites are the receiving point for chemical signals from
the synapses of other nearby neurons.
Myelin: This is a thin layer composed of fatty chemical compounds. Myelin surrounds the axon
of many neurons and acts as a protective covering.
Neuron connections are incredibly complex, and the dendrites on a single neuron may connect
to thousands of other synapses. Some neurons are longer or shorter, depending on their
location in your body and what they do.
GLIAL CELLS
Glial (pronounced glee-uhl) cells have many different purposes, helping develop and maintain
neurons when you’re young and managing how the neurons work throughout your entire life.
They also protect your nervous system from infections, control the chemical balance in your
nervous system and create the myelin coating on the neurons’ axons. Your nervous system has
10 times more glial cells than neurons.

 Oligodendrocytes are the myelinating cells of the central nervous system (CNS). They
are the end product of a cell lineage which has to undergo a complex and precisely
timed program of proliferation, migration, differentiation, and myelination to finally
produce the insulating sheath of axons.
 Astrocytes are a subtype of glial cells that make up the majority of cells in the human
central nervous system (CNS). They perform metabolic, structural, homeostatic, and
neuroprotective tasks such as clearing excess neurotransmitters, stabilizing and
regulating the blood-brain barrier, and promoting synapse formation.
 Microglia are resident cells of the brain that regulate brain development, maintenance
of neuronal networks, and injury repair.

The Autonomic Nervous System

The autonomic nervous system controls specific body processes, such as blood circulation,
digestion, breathing, urination, heartbeat, etc. The autonomic nervous system is named so
because it works autonomously, i.e., without a person’s conscious effort.
The primary function of the autonomic nervous system is homeostasis. Apart from maintaining
the body’s internal environment, it is also involved in controlling and maintaining the following
life processes:

 Digestion
 Metabolism
 Urination
 Defecation
 Blood pressure
 Sexual response
 Body temperature
 Heartbeat
 Breathing rate
 Fluid balance
There are two types of the autonomic nervous system:

1. Sympathetic autonomic nervous system

2. Parasympathetic autonomic nervous system

What Is the Sympathetic and Parasympathetic Nervous System?

Sympathetic Autonomic Nervous System: It is the part of the autonomic nervous system
located near the thoracic and lumbar regions in the spinal cord. Its primary function is to
stimulate the body’s fight-or-flight response. It does this by regulating the heart rate, rate of
respiration, pupillary response and more.

Parasympathetic Autonomic Nervous System: It is located in between the spinal cord and the
medulla. It primarily stimulates the body’s “rest and digest” and “feed and breed” responses.

Difference between Sympathetic and Parasympathetic Nervous System

The sympathetic nervous system prepares the body for the “fight or flight” response during any
potential danger. On the other hand, the parasympathetic nervous system inhibits the body
from overworking and restores the body to a calm and composed state. The sympathetic and
parasympathetic nervous systems are differentiated based on how the body responds to
environmental stimuli.
SOMATIC NERVOUS SYSTEM

The somatic nervous system (SNS) is also known as the voluntary nervous system.

It contains both afferent nerves (which send information to the brain and spinal cord), made of
sensory neurons that inform the central nervous system about our five senses; and efferent
nerves (which send information from the brain), which contain motor neurons responsible
for voluntary movements, such as walking or lifting an object.

The nerves in the somatic nervous system are classified based on their location, either in the
head regions or in the spine region. There are 12 pairs of cranial nerves, which send
information to the brain stem (base of the brain where the spinal cord connects) or from the
brain stem to the periphery.
These nerves are required for the five senses and for the movement of head, neck and tongue.
The spinal nerves are 31 pairs of nerves that send sensory information from the periphery to
the spinal cord and muscle commands from the spinal cord to the skeletal muscles.

It’s interesting to note that while the neurotransmitter acetylcholine has an excitatory effect in
the somatic nervous system (ramps up a response), in the autonomic nervous system (the
involuntary nervous system), it has an opposite inhibitory function (dampens a response).

Several diseases affecting motor neurons, for example motor neurone disease (MND), result in
death of the neurons (neurodegeneration) and eventually muscle wasting and loss of functions.
Work at QBI is being conducted to understand the genetics and the molecular mechanisms
responsible for MND.

Reflexes: involuntary movements

In addition to regulating the voluntary movements of the body, the somatic nervous system is
also responsible for a specific type of involuntary muscle responses known as reflexes,
controlled by a neural pathway known as the reflex arc.

A reflex arc includes a sensory neuron that sends a signal straight to the spinal cord (bypassing
the brain) which in turn generates a response such as a quick muscle contraction so fast that it’s
subconscious. One common example is the knee reflex: hitting the patellar tendon just below
the knee cap with a reflex hammer leads to an automatic contraction of the quadriceps – which
results in the lower leg kicking out.
Cardiovascular System
Your body's circulatory system, also known as your cardiovascular system, is made up of
numerous blood vessels and your heart. Your body needs oxygen and other essentials, which
your heart provides through the vast and complex network of blood vessels throughout your
body. Additionally, this network eliminates unnecessary items from your body and transfers
them to organs that can dispose of waste. Your body's entire system depends on your blood to
carry waste, nutrition, and oxygen.
The purpose of the cardiovascular system is to ensure that your body eliminates unnecessary
substances and receives the oxygen, nutrients, and other things it requires.
Your heart beats throughout the day and even while you sleep, pumping blood throughout your
body. Your doctor can hear your heartbeat because of this. That sound is your heart beating
normally. Approximately 2,000 gallons of blood are circulated daily by your heart.

Two important circulation processes

Pulmonary circulation
Blood without oxygen comes into the right side of your heart and is sent to the lungs to get
oxygen and get rid of carbon dioxide. Then the oxygenated blood comes back through the left
side of your heart.
Systemic circulation
Blood that has just gotten oxygen from the lungs and returned through your heart’s left side is
pushed out to the rest of your body’s cells so they can receive oxygen and nutrients. The cycle
starts again when blood without oxygen goes to the right side of your heart.

Where is the cardiovascular system located?

Your heart is located in the middle of your chest. It connects to your blood vessels. They go
everywhere throughout your body so they can get oxygen and nutrients to every part of your
body. They also take waste away from all the cells in your body. They connect to smaller and
smaller blood vessels as they get farther away from your heart to deliver oxygen and remove
waste throughout your entire body. Capillaries, the tiniest of blood vessels, transfer oxygen,
nutrients and waste between your blood vessels and your tissue cells.

Functions of the Heart

The functions of the heart are as follows:

1. Managing blood supply. Variations in the rate and force of heart contraction
match blood flow to the changing metabolic needs of the tissues during rest,
exercise, and changes in body position.
2. Producing blood pressure. Contractions of the heart produce blood pressure,
which is needed for blood flow through the blood vessels.
3. Securing one-way blood flow. The valves of the heart secure a one-way blood
flow through the heart and blood vessels.
4. Transmitting blood. The heart separates the pulmonary and systemic
circulations, which ensures the flow of oxygenated blood to tissues.
Anatomy of the Heart

The cardiovascular system can be compared to a muscular pump equipped with one-way valves
and a system of large and small plumbing tubes within which the blood travels.

Heart Structure and Functions

The modest size and weight of the heart give few hints of its incredible strength.
 Weight. Approximately the size of a person’s fist, the hollow, cone-shaped heart
weighs less than a pound.
 Mediastinum. Snugly enclosed within the inferior mediastinum, the medial
cavity of the thorax, the heart is flanked on each side by the lungs.
 Apex. Its more pointed apex is directed toward the left hip and rests on the
diaphragm, approximately at the level of the fifth intercostal space.
 Base. Its broad posterosuperior aspect, or base, from which the great vessels of
the body emerge, points toward the right shoulder and lies beneath the second
rib.
 Pericardium. The heart is enclosed in a double-walled sac called the pericardium
which is the outermost layer of the heart.
 Fibrous pericardium. The loosely fitting superficial part of this sac is referred to
as the fibrous pericardium, which helps protect the heart and anchors it to
surrounding structures such as the diaphragm and sternum.
 Serous pericardium. Deep to the fibrous pericardium is the slippery, two-layer
serous pericardium, where its parietal layer lines the interior of the fibrous
pericardium.
Layers of the Heart

The heart muscle has three layers and they are as follows:

 Epicardium. The epicardium or the visceral and outermost layer is actually a part
of the heart wall.
 Myocardium. The myocardium consists of thick bundles of cardiac muscle
twisted and whirled into ringlike arrangements and it is the layer that actually
contracts.
 Endocardium. The endocardium is the innermost layer of the heart and is a thin,
glistening sheet of endothelium hat lines the heart chambers.
Chambers of the Heart

The heart has four hollow chambers, or cavities: two atria and two ventricles.

 Receiving chambers. The two superior atria are primarily the receiving
chambers, they play a lighter role in the pumping activity of the heart.
 Discharging chambers. The two inferior, thick-walled ventricles are the
discharging chambers, or actual pumps of the heart wherein when they contract,
blood is propelled out of the heart and into circulation.
 Septum. The septum that divides the heart longitudinally is referred to as either
the interventricular septum or the interatrial septum, depending on which
chamber it separates.
Associated Great Vessels

The great blood vessels provide a pathway for the entire cardiac circulation to proceed.

 Superior and inferior vena cava. The heart receives relatively oxygen-poor
blood from the veins of the body through the large superior and inferior vena
cava and pumps it through the pulmonary trunk.
 Pulmonary arteries. The pulmonary trunk splits into the right and left pulmonary
arteries, which carry blood to the lungs, where oxygen is picked up and carbon
dioxide is unloaded.
 Pulmonary veins. Oxygen-rich blood drains from the lungs and is returned to
the left side of the heart through the four pulmonary veins.
 Aorta. Blood returned to the left side of the heart is pumped out of the heart
into the aorta from which the systemic arteries branch to supply essentially all
body tissues.
Heart Valves

The heart is equipped with four valves, which allow blood to flow in only one direction through
the heart chambers.
  Atrioventricular valves. Atrioventricular or AV valves are located between the
atrial and ventricular chambers on each side, and they prevent backflow into the
atria when the ventricles contract.
 Bicuspid valves. The left AV valve- the bicuspid or mitral valve, consists of two
flaps, or cusps, of the endocardium.
 Tricuspid valve. The right AV valve, the tricuspid valve, has three flaps.
 Semilunar valve. The second set of valves, the semilunar valves, guards the
bases of the two large arteries leaving the ventricular chambers, thus they are
known as the pulmonary and aortic semilunar valves.
Cardiac Circulation Vessels

Although the heart chambers are bathed with blood almost continuously, the blood contained
in the heart does not nourish the myocardium.

 Coronary arteries. The coronary arteries branch from the base of the aorta and
encircle the heart in the coronary sulcus (atrioventricular groove) at the
junction of the atria and ventricles, and these arteries are compressed when the
ventricles are contract and fill when the heart is relaxed.
 Cardiac veins. The myocardium is drained by several cardiac veins, which empty
into an enlarged vessel on the posterior of the heart called the coronary sinus.
Blood Vessels

Blood circulates inside the blood vessels, which form a closed transport system, the so-called
vascular system.

 Arteries. As the heart beats, blood is propelled into large arteries leaving the
heart.
 Arterioles. It then moves into successively smaller and smaller arteries and then
into arterioles, which feed the capillary beds in the tissues.
 Veins. Capillary beds are drained by venules, which in turn empty into veins that
finally empty into the great veins entering the heart.
Tunics

Except for the microscopic capillaries, the walls of the blood vessels have three coats or tunics.
  Tunica intima. The tunica intima, which lines the lumen, or interior, of the
vessels, is a thin layer of endothelium resting on a basement membrane and
decreases friction as blood flows through the vessel lumen.
 Tunica media. The tunica media is the bulky middle coat which mostly consists
of smooth muscle and elastic fibers that constrict or dilate, making the blood
pressure increase or decrease.
 Tunica externa. The tunica externa is the outermost tunic composed largely of
fibrous connective tissue, and its function is basically to support and protect the
vessels.
Major Arteries of the Systemic Circulation

The major branches of the aorta and the organs they serve are listed next in the sequence from
the heart.

Arterial Branches of the Ascending Aorta

The aorta springs upward from the left ventricle of the heart as the ascending aorta.

 Coronary arteries. The only branches of the ascending aorta are the right and
left coronary arteries, which serve the heart.
Arterial Branches of the Aortic Arch

The aorta arches to the left as the aortic arch.

 Brachiocephalic trunk. The brachiocephalic trunk, the first branch off the aortic
arch, splits into the right common carotid artery and right subclavian artery.
 Left common carotid artery. The left common carotid artery is the second
branch of the aortic arch and it divides, forming the left internal carotid, which
serves the brain, and the left external carotid, which serves the skin and muscles
of the head and neck.
 Left subclavian artery. The third branch of the aortic arch, the left subclavian
artery, gives off an important branch- the vertebral artery, which serves as part
of the brain.
 Axillary artery. In the axilla, the subclavian artery becomes the axillary artery.
 Brachial artery. the subclavian artery continues into the arm as the brachial
artery, which supplies the arm.
 Radial and ulnar arteries. At the elbow, the brachial artery splits to form the
radial and ulnar arteries, which serve the forearm.
Arterial Branches of the Thoracic Aorta

The aorta plunges downward through the thorax, following the spine as the thoracic aorta.
  Intercostal arteries. Ten pairs of intercostal arteries supply the muscles of the
thorax wall.
Arterial Branches of the Abdominal Aorta

Finally, the aorta passes through the diaphragm into the abdominopelvic cavity, where it
becomes the abdominal aorta.

 Celiac trunk. The celiac trunk is the first branch of the abdominal aorta and has
three branches: the left gastric artery supplies the stomach; the splenic
artery supplies the spleen, and the common hepatic artery supplies the liver.
 Superior mesenteric artery. The unpaired superior mesenteric artery supplies
most of the small intestine and the first half of the large intestine or colon.
 Renal arteries. The renal arteries serve the kidneys.
 Gonadal arteries. The gonadal arteries supply the gonads, and they are
called ovarian arteries in females while in males they are testicular arteries.
 Lumbar arteries. The lumbar arteries are several pairs of arteries serving the
heavy muscles of the abdomen and trunk walls.
 Inferior mesenteric artery. The inferior mesenteric artery is a small, unpaired
artery supplying the second half of the large intestine.
 Common iliac arteries. The common iliac arteries are the final branches of the
abdominal aorta.
Major Veins of the Systemic Circulation

Major veins converge on the venae cavae, which enter the right atrium of the heart.
Veins Draining into the Superior Vena Cava

Veins draining into the superior vena cava are named in a distal-to-proximal direction; that is, in
the same direction the blood flows into the superior vena cava.

 Radial and ulnar veins. The radial and ulnar veins are deep veins draining the
forearm; they unite to form the deep brachial vein, which drains the arm and
empties into the axillary vein in the axillary region.
 Cephalic vein. The cephalic vein provides for the superficial drainage of
the lateral aspect of the arm and empties into the axillary vein.
 Basilic vein. The basilic vein is a superficial vein that drains the medial aspect of
the arm and empties into the brachial vein proximally.
 Median cubital vein. The basilic and cephalic veins are joined at the anterior
aspect of the elbow by the median cubital vein, often chosen as the site for
blood removal for the purpose of blood testing.
 Subclavian vein. The subclavian vein receives venous blood from the arm
through the axillary vein and from the skin and muscles of the head through
the external jugular vein.
 Vertebral vein. The vertebral vein drains the posterior part of the head.
 Internal jugular vein. The internal jugular vein drains the dural sinuses of the
brain.
 Brachiocephalic veins. The right and left brachiocephalic veins are large veins
that receive venous drainage from the subclavian, vertebral, and internal jugular
veins on their respective sides.
 Azygos vein. The azygos vein is a single vein that drains the thorax and enters
the superior vena cava just before it joins the heart.
Veins Draining into the Inferior Vena Cava

The inferior vena cava, which is much longer than the superior vena cava, returns blood to the
heart from all body regions below the diaphragm.

 Tibial veins. The anterior and posterior tibial veins and the fibular vein drain the
leg; the posterior tibial veins become the popliteal vein at the knee and then
the femoral vein in the thigh; the femoral vein becomes the external iliac vein as
it enters the pelvis.
 Great saphenous veins. The great saphenous veins are the longest veins in the
body; they begin at the dorsal venous arch in the foot and travel up the medial
aspect of the leg to empty into the femoral vein in the thigh.
 Common iliac vein. Each common iliac vein is formed by the union of the
external iliac vein and the internal iliac vein which drains the pelvis.
 Gonadal vein. The right gonadal vein drains the right ovary in females and the
right testicles in males; the left gonadal vein empties into the left renal veins
superiorly.
  Renal veins. The right and left renal veins drain the kidneys.
 Hepatic portal vein. The hepatic portal vein is a single vein that drains the
digestive tract organs and carries this blood through the liver before it enters the
systemic circulation.
 Hepatic veins. The hepatic veins drain the liver.
Physiology of the Heart

As the heart beats or contracts, the blood makes continuous round trips- into and out of the
heart, through the rest of the body, and then back to the heart- only to be sent out again.

Intrinsic Conduction System of the Heart

The spontaneous contractions of the cardiac muscle cells occurs in a regular and continuous
way, giving rhythm to the heart.

 Cardiac muscle cells. Cardiac muscle cells can and do contract spontaneously
and independently, even if all nervous connections are severed.
 Rhythms. Although cardiac muscles can beat independently, the muscle cells in
the different areas of the heart have different rhythms.
 Intrinsic conduction system. The intrinsic conduction system, or the nodal
system, that is built into the heart tissue sets the basic rhythm.
 Composition. The intrinsic conduction system is composed of a special tissue
found nowhere else in the body; it is much like a cross between a muscle and
nervous tissue.
 Function. This system causes heart muscle depolarization in only one direction-
from the atria to the ventricles; it enforces a contraction rate of approximately
75 beats per minute on the heart, thus the heart beats as a coordinated unit.
 Sinoatrial (SA) node. The SA node has the highest rate of depolarization in the
whole system, so it can start the beat and set the pace for the whole heart; thus
the term “pacemaker“.
 Atrial contraction. From the SA node, the impulse spread through the atria to
the AV node, and then the atria contract.
 Ventricular contraction. It then passes through the AV bundle, the bundle
branches, and the Purkinje fibers, resulting in a “wringing” contraction of the
ventricles that begins at the heart apex and moves toward the atria.
 Ejection. This contraction effectively ejects blood superiorly into the large
arteries leaving the heart.
The Pathway of the Conduction System

The conduction system occurs systematically through:

  SA node. The depolarization wave is initiated by the sinoatrial node.
 Atrial myocardium. The wave then successively passes through the atrial
myocardium.
 Atrioventricular node. The depolarization wave then spreads to the AV node,
and then the atria contract.
 AV bundle. It then passes rapidly through the AV bundle.
 Bundle branches and Purkinje fibers. The wave then continues on through the
right and left bundle branches, and then to the Purkinje fibers in the ventricular
walls, resulting in a contraction that ejects blood, leaving the heart.
Cardiac Cycle and Heart Sounds

In a healthy heart, the atria contract simultaneously, then, as they start to relax, contraction of
the ventricles begins.

 Systole. Systole means heart contraction.

 Diastole. Diastole means heart relaxation.
 Cardiac cycle. The term cardiac cycle refers to the events of one complete
heartbeat, during which both atria and ventricles contract and then relax.
 Length. The average heart beats approximately 75 times per minute, so the
length of the cardiac cycle is normally about 0.8 seconds.
 Mid-to-late diastole. The cycle starts with the heart in complete relaxation; the
pressure in the heart is low, and blood is flowing passively into and through the
atria into the ventricles from the pulmonary and systemic circulations; the
semilunar valves are closed, and the AV valves are open; then the atria contract
and force the blood remaining in their chambers into the ventricles.
 Ventricular systole. Shortly after, the ventricular contraction begins, and the
pressure within the ventricles increases rapidly, closing the AV valves; when
the intraventricular pressure is higher than the pressure in the large arteries
leaving the heart, the semilunar valves are forced open, and blood rushes
through them out of the ventricles; the atria are relaxed, and their chambers are
again filling with blood.
 Early diastole. At the end of systole, the ventricles relax, the semilunar valves
snap shut, and for a moment the ventricles are completely closed chambers; the
intraventricular pressure drops and the AV valves are forced open; the ventricles
again begin refilling rapidly with blood, completing the cycle.
 First heart sound. The first heart sound, “lub”, is caused by the closing of the AV
valves.
 Second heart sound. The second heart sound, “dub”, occurs when the
semilunar valves close at the end of systole.
Cardiac Output

Cardiac output is the amount of blood pumped out by each side of the heart in one minute. It is
the product of the heart rate and the stroke volume.
  Stroke volume. Stroke volume is the volume of blood pumped out by a ventricle
with each heartbeat.
 Regulation of stroke volume. According to Starling’s law of the heart, the
critical factor controlling stroke volume is how much the cardiac muscle cells are
stretched just before they contract; the more they are stretched, the stronger
the contraction will be; and anything that increases the volume or speed of
venous return also increases stroke volume and force of contraction.
 Factors modifying basic heart rate. The most important external influence on
heart rate is the activity of the autonomic nervous system, as well as physical
factors (age, gender, exercise, and body temperature).
Physiology of Circulation

A fairly good indication of the efficiency of a person’s circulatory system can be obtained by
taking arterial blood and blood pressure measurements.

Cardiovascular Vital Signs

Arterial pulse pressure and blood pressure measurements, along with those of respiratory rate
and body temperature, are referred to collectively as vital signs in clinical settings.

 Arterial pulse. The alternating expansion and recoil of an artery that occurs with
each beat of the left ventricle create a pressure wave-a pulse- that travels
through the entire arterial system.
 Normal pulse rate. Normally, the pulse rate (pressure surges per minute) equals
the heart rate, so the pulse averages 70 to 76 beats per minute in a normal
resting person.
 Pressure points. There are several clinically important arterial pulse points, and
these are the same points that are compressed to stop blood flow into distal
tissues during hemorrhage, referred to as pressure points.
 Blood pressure. Blood pressure is the pressure the blood exerts against the inner
walls of the blood vessels, and it is the force that keeps blood circulating
continuously even between heartbeats.
 Blood pressure gradient. The pressure is highest in the large arteries and
continues to drop throughout the systemic and pulmonary pathways, reaching
either zero or negative pressure at the venae cavae.
 Measuring blood pressure. Because the heart alternately contracts and relaxes,
the off-and-on flow of the blood into the arteries causes the blood pressure to
rise and fall during each beat, thus, two arterial blood pressure measurements
are usually made: systolic pressure (the pressure in the arteries at the peak of
ventricular contraction) and diastolic pressure (the pressure when the ventricles
are relaxing).
 Peripheral resistance. Peripheral resistance is the amount of friction the blood
encounters as it flows through the blood vessels.
  Neural factors. The parasympathetic division of the autonomic nervous system
has little or no effect on blood pressure, but the sympathetic division has the
major action of causing vasoconstriction or narrowing of the blood vessels,
which increases blood pressure.
 Renal factors. The kidneys play a major role in regulating arterial blood pressure
by altering blood volume, so when blood pressure increases beyond normal, the
kidneys allow more water to leave the body in the urine, then blood volume
decreases which in turn decreases blood pressure.
 Temperature. In general, cold has a vasoconstricting effect, while heat has a
vasodilating effect.
 Chemicals. Epinephrine increases both heart rate and blood
pressure; nicotine increases blood pressure by causing vasoconstriction; alcohol
and histamine cause vasodilation and decreased blood pressure.
 Diet. Although medical opinions tend to change and are at odds from time to
time, it is generally believed that a diet low in salt, saturated fats,
and cholesterol help to prevent hypertension, or high blood pressure.
Blood Circulation Through the Heart

The right and left sides of the heart work together in achieving a smooth-flowing blood
circulation.
  Entrance to the heart. Blood enters the heart through two large veins, the
inferior and superior vena cava, emptying oxygen-poor blood from the body into
the right atrium of the heart.
 Atrial contraction. As the atrium contracts, blood flows from the right atrium to
the right ventricle through the open tricuspid valve.
 Closure of the tricuspid valve. When the ventricle is full, the tricuspid valve
shuts to prevent blood from flowing backward into the atria while the ventricle
contracts.
 Ventricle contraction. As the ventricle contracts, blood leaves the heart through
the pulmonic valve, into the pulmonary artery, and to the lungs where it is
oxygenated.
 Oxygen-rich blood circulates. The pulmonary vein empties oxygen-rich blood
from the lungs into the left atrium of the heart.
 Opening of the mitral valve. As the atrium contracts, blood flows from your left
atrium into your left ventricle through the open mitral valve.
 Prevention of backflow. When the ventricle is full, the mitral valve shuts. This
prevents blood from flowing backward into the atrium while the ventricle
contracts.
 Blood flow to the systemic circulation. As the ventricle contracts, blood leaves
the heart through the aortic valve, into the aorta, and to the body.
Capillary Exchange of Gases and Nutrients

Substances tend to move to and from the body cells according to their concentration gradients.

 Capillary network. Capillaries form an intricate network among the body’s cells
such that no substance has to diffuse very far to enter or leave a cell.
 Routes. Basically, substances leaving or entering the blood may take one of four
routes across the plasma membranes of the single layer of endothelial cells
forming the capillary wall.
 Lipid-soluble substances. As with all cells, substances can
diffuse directly through their plasma membranes if the substances are lipid-
soluble.
 Lipid-insoluble substances. Certain lipid-insoluble substances may enter or leave
the blood and/or pass through the plasma membranes within vesicles, that is,
by endocytosis or exocytosis.
 Intercellular clefts. Limited passage of fluid and small solutes is allowed by
intercellular clefts (gaps or areas of plasma membrane not joined by tight
junctions), so most of our capillaries have intercellular clefts.
 Fenestrated capillaries. Very free passage of small solutes and fluid is allowed by
fenestrated capillaries, and these unique capillaries are found where absorption
is a priority or where filtration occurs.
INTEGRATION OF NERVOUS SYSTEM AND CIRCULATORY SYSTEM
Heart rate is controlled by the two branches of the autonomic (involuntary) nervous system.
The sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The
sympathetic nervous system (SNS) releases the hormones (catecholamines - epinephrine and
norepinephrine) to accelerate the heart rate.
The regulation of the heart and peripheral circulation by the nervous system is accomplished by
control centers in the medulla that receive descending input from higher neural areas in the
brain and afferent input from mechanically and chemically sensitive receptors located
throughout the body.
Brain Circulation

The brain derives its arterial supply from the paired carotid and vertebral arteries. Every
minute, about 600-700 ml of blood flow through the carotid arteries and their branches while
about 100-200 ml flow through the vertebral-basilar system.

The carotid and vertebral arteries begin extracranially, and course through the neck and base of
the skull to reach the cranial cavity. The internal carotid arteries and their branches supply the
anterior 2/3 of the cerebral hemispheres, including its deep white matter and the basal ganglia.
The vertebral arteries and basilar artery, with their branches, supply the remaining posterior
and medial regions of the hemispheres, most of the diencephalon, the brainstem, cerebellum,
and cervical spinal cord.

The carotid and vertebral-basilar circulations are anatomically interconnected with each other,
and with their counterparts in the opposite hemisphere, through the circle of Willis. However,
these connections usually cannot carry enough blood flow to maintain adequate cerebral
circulation if either a carotid or a vertebral artery is suddenly blocked. This is because in most
cases the connecting vessels have small diameters, and pressure differences between the two
circulations are usually too small to drive much blood flow through them.

WHAT IS THE CIRCLE OF WILLIS?

The circle of Willis is a junction of several important arteries at the bottom part of the brain. It
helps blood flow from both the front and back sections of the brain. The circle of Willis gets its
name from the physician Thomas Willis, who described this part of the anatomy in 1664.
It may play a passive role in protecting a person from some health issues, such as stroke.
However, it has an association with intracranial aneurysms.

The circle of Willis is an important junction of arteries at the base of the brain. The structure
encircles the middle area of the brain, including the stalk of the pituitary gland and other
important structures.

Two arteries, called the carotid arteries, supply blood to the brain. They run along either side of
the neck and lead directly to the circle of Willis.

Each carotid artery branches into an internal and external carotid artery. The internal carotid
artery then branches into the cerebral arteries. This structure allows all of the blood from the
two internal carotid arteries to pass through the circle of Willis.

The structure of the circle of Willis includes:

 left and right internal carotid arteries

 left and right anterior cerebral arteries

 left and right posterior cerebral arteries

  left and right posterior communicating arteries

 basilar artery

 anterior communicating artery

The circle of Willis is critical, as it is the meeting point of many important arteries supplying
blood to the brain. The internal carotid arteries branch off from here into smaller arteries,
which deliver much of the brain’s blood supply.

ASSOCIATED CONDITIONS

Several diseases and conditions have an association with the circle of Willis, including:

Stroke

The structure and function of the circle of Willis may protect against stroke in people who have
a complete circle of Willis. The complete circle allows blood to go from one side of the brain to
the other, even when blockages or thinning vessels occur.

The change in pressure from a blockage or thinning vessel could cause blood to flow backward
through the circle of Willis and still reach similar areas of the brain or other important
structures. This process is called collateral circulation, and it may protect a person from major
events or a lack of oxygen in the brain due to impaired blood flow.

However, collateral circulation is not a guaranteed effect, and it may only occur in people with a
mostly or fully complete circle of Willis.

Aneurysms

The circle of Willis is a very common place for intracranial aneurysms to occur.

Aneurysms refer to arteries that bulge or balloon out. The major risk with aneurysms is
rupturing, which causes bleeding in the brain. A ruptured aneurysm can cause an extremely
severe headache alongside other symptoms, such as vision problems, light sensitivity, and a stiff
neck.

SUBCLAVIAN STEAL SYNDROME

Subclavian steal syndrome is a rare condition that may go unnoticed, as it is largely

asymptomatic.

It occurs when there is not enough blood supply to an arm through the subclavian artery. When
this happens, extra blood flows through the circle of Willis to make up for the lack of blood
supply, but this may result in insufficient blood going to the brain.

If symptoms do occur, they may appear due to an ischemic event. Some possible symptoms of
subclavian steal syndrome include:
 a numb arm or arm pain
 general fatigue
 cold skin from lack of blood supply
 dizziness when exercising

SUMMARY

The circle of Willis is an important juncture in the body. As the carotid arteries travel up to the
base of the brain, they branch into the circle of Willis. From there, other smaller arteries that
stem off from the circle supply much of the blood to the brain.

The circle of Willis may also play a passive role in protecting against stroke in people who have
a complete circle of Willis. However, a complete circle of Willis is less common than other
variants.

Many aneurysms also occur within the circle of Willis, although the risk of rupture may be less
than it would be in smaller arteries.

WHAT IS THE MOST COMMON ANOMALY OF THE CIRCLE OF WILLIS?--------------------------

The most common anomaly of the circle of Willis in normal brains was hypoplasia of one or
other components of the circle. Arteries of less than 1 mm in external diameter were
considered hypoplastic, except for the communicating arteries, where less than 0.5 mm was
considered hypoplastic.

Predisposing Factors Present/Absent Justification

The older you are, the more likely
you are to have a stroke. The
chance of having a stroke about
doubles every 10 years after age
Age Present 55. Although stroke is common
among older adults, many people
younger than 65 years also have
strokes. In fact, about one in
seven strokes occur in adolescents
and young adults ages 15 to
49. Experts think younger people
are having more strokes because
more young people have obesity,
high blood pressure, and diabetes.

Men are more likely than women

to drink too much alcohol. Not
enough physical activity. Not
getting enough physical activity
Gender Present can lead to other health
conditions that can raise the risk
for stroke. In 2017, about half of
men met the guidelines for
aerobics and muscle
strengthening.
African Americans are 50 percent
more likely to have a stroke
Race Absent (cerebrovascular disease), as
compared to their white adult
counterparts. Black men are 70
percent more likely to die from a
stroke as compared to non-
 Hispanic whites.

The chance of stroke is greater in

Hereditary Absent people with a family history of
stroke.