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Transcript
00:00Hey, how are you doing? I did three hours of teaching, it wasn't even me doing all the
00:05teaching this morning, in fact hardly any of it, but we did three hours to a camera
00:10live over Zoom because of the whole Covid thing. But I'm going to do a bit more video
00:16and it's going to be a nice relaxed chilled out look at the cardiovascular system. So the aim is,
00:22hey let's start at the heart, let's follow the blood vessels out from the heart, follow them
00:28out to the upper limbs, lower limbs, up into the head, just like a general overview of where they
00:33go, what they do, and then we'll look at some of the veins as they come back again and how they
00:40get back to the heart. I'm going to do all the veins because there's a lot, but okay, is that
00:45okay? Yeah, right, good, let's do that. Now this might not actually be the best model for this.
01:04Yeah, no, it's probably fine, it's probably fine. Aren't these things beautiful? I mean,
01:09the human body is beautiful and they're a very pretty rendition of them. Okay,
01:14the heart. So the heart is the pump of the circulatory system and the circulatory system
01:20is essentially a closed loop. So the heart receives blood and then pumps it back out again.
01:26It's not just a single pump really, it's kind of two pumps in one. One side, the right side,
01:33is pumping blood to the lungs and the left side then is pumping blood all around the body. So the
01:39left side tends to be a bit thicker. The muscle is thicker here, it's got a bigger job to do.
01:46So let's just do the lungs first, I guess. So actually, see this here. So the right ventricle
01:52of the heart is here and it's pushing blood out through this large tube here. This is the
01:58pulmonary trunk. Now it's blue, but it's an artery because the right side of the heart has received
02:05blood from the body. So that blood is poorly oxygenated. So it's blue, kind of a dark red,
02:12anyway. We won't get into that argument. But this blue vessel then is the pulmonary trunk. So
02:17arteries leave the heart and veins return to the heart. Their content, you know, whether their
02:24blood is oxygenated or deoxygenated is irrelevant. It's an anatomical thing of whether they're going
02:29to or from the heart. This is why we're starting from the heart. So the vessels leaving the heart
02:34are arteries. So the pulmonary trunk then takes the blood and then it splits into left. We can
02:41see that this is the left side of the body. We can see the left pulmonary artery here.
02:46And actually we have to look around there to see the right pulmonary artery. So the two pulmonary
02:52arteries send blood to the lungs. And those, they branch, branch, branch, branch throughout the lungs
02:59and blood. So it sends its carbon dioxide and what have you out through the lungs.
03:08So you exhale carbon dioxide and then you inhale air and the oxygen from the air is taken
03:16through from the gas, from the air to the capillaries of the lungs. And then these red
03:22vessels then, they're carrying well-oxygenated blood, which is painted red. And these are
03:29actually pulmonary veins, red pulmonary veins, draining blood from the lungs back to the heart.
03:36And these pulmonary veins enter the left side of the heart, the left atrium, and then the
03:41left ventricle. So that's why they're red. And now we're back in the heart
03:47and the left ventricle then, this is going to send blood out through this huge great big blood
03:55vessel here, the aorta. A really big, a really important blood vessel. And the aorta is going
04:02to ascend. Now its first branches are actually, we haven't, still haven't left the heart yet,
04:08its first branches are the coronary arteries. We have right and left coronary arteries.
04:14So the coronary arteries supply the muscle of the heart with blood because they're very active,
04:22they need a lot of oxygen and glucose and what have you, and they're working literally all day
04:26long for your entire life. So the coronary arteries branch from the aorta and go around the heart.
04:34Now as the aorta continues, so it ascends superiorly, it actually ascends and then loops
04:42posteriorly and to the left. So if I take the heart out, you can see the aorta curving around
04:52there posteriorly and to the left. So it's going to run along the posterior thoracic wall, just to
04:58the left of the vertebrae. But before it gets there, it gives off three major branches. So this
05:07is the arch of the, we have the ascending aorta, the arch of the aorta and then the descending
05:13thoracic aorta, because it's in the thorax. The first branch then of the thoracic, of the,
05:21the first branch of the arch of the aorta is the brachiocephalic trunk.
05:27Maybe called the innominate artery by elderly surgeons that you might speak to, but it's not
05:32a word I come across very often in different parts of the world, that might be different.
05:37But the brachiocephalic artery extends superiorly and to the right. Brachiocephalic, cephalic
05:46head, brachium, arm or upper limb. So the brachiocephalic artery is going to send blood
05:54to the upper limb and to the head. Which one should we do first? Let's do the upper limb.
06:03The upper limb. So the brachiocephalic artery, brachiocephalic trunk, is going to give off
06:12the subclavian artery. So this is the clavicle here, here's the clavicle. So the subclavian
06:20artery is going to run sub the clavicle, it's going to run inferior to the clavicle. And then
06:26essentially we have one artery running out through the first part of the upper limb.
06:32But we change its name as we go along. So we have the subclavian artery then becomes the
06:38axillary artery as it runs through the axilla. The axilla is your armpit. And then the axillary
06:45artery becomes the brachial artery when it's in the brachium. This being the brachium here,
06:50the upper arm. So you can probably actually, so here's bicep and triceps. If you feel around in
06:56there, you can find, ooh, you can feel some things, some long structures. You've got some
07:03nerves in there and you've got some blood vessels. And if you're careful and you get
07:07your fingertips in the right place, you will feel the pulse of the brachial artery.
07:12So the subclavian artery becomes the axillary artery, becomes the brachial artery,
07:20and then as we get to the elbow, it splits. So it runs anterior to the elbow,
07:29protected by some muscles, which is sensible, and then it divides into two.
07:36Kind of like this. Now in the forearm, or the antebrachium, we have two bones. We have the
07:45radius and the ulna. The radius is on your thumb side. So the arteries take on the names of the
07:53bones. So the radial artery runs here and the ulnar artery runs here. So the radial artery
08:03runs to your thumb. So this is the pulse that you can palpate if you put your fingers there,
08:08that's the radial artery. Now the ulnar artery runs essentially towards the little finger,
08:14and you can, you can find the ulnar pulse, but it's harder because it tends to be covered by
08:20more muscles and connected tissues and that sort of thing. And then in the hands they,
08:27we have these arcades, these palmar arcades, but that's it. So brachial artery, ulnar and radial
08:33arteries to the hands. So that's where the subclavian artery goes. That's the upper limb
08:39done. Right, let's get rid of this one. Brachiocephalic. We've done the brachio bit,
08:48what about the cephalic bit? All right, can you see it?
08:55This is the cephalic bit. This is the common carotid artery. Now when we think about the
09:01carotid arteries, because there are a few of them, we never say that's the carotid artery.
09:06There is a common carotid artery, there is an internal carotid artery, there is an external
09:11carotid artery, but there's not a carotid artery, anatomically speaking, right? Because anatomy is
09:17about being accurate. So this is the common carotid artery, and the common carotid artery
09:23extends up to the neck and then kind of just beneath the jaw there, if you, you can palpate
09:31your pulse in there, the pulse that you're feeling there is actually the external carotid artery.
09:37So the common carotid artery ascends and then splits into two. The external carotid artery
09:42is going to supply blood to the face and the internal carotid artery goes into the skull
09:47and is going to be one of the arteries that supplies blood to the brain.
09:51The other artery that supplies blood to the brain actually comes from the subclavian artery and runs
09:56up the cervical vertebrae to get into the skull.
10:06Vertebral arteries come from the subclavian artery and go to the brain.
10:13The common carotid artery on the right comes from the brachiocephalic trunk.
10:20Are we still keeping it simple? I don't know, I think it's okay.
10:23All right, so that's the brachiocephalic trunk. Two more arteries come from the arch of the aorta,
10:30but now that we've looked at some stuff this will get a lot easier. So the second branch
10:34from the arch of the aorta is the left common carotid artery. And you know where that goes and
10:39what that does because we just described what the right one did, the left one does the same thing.
10:44So that's the left common carotid artery. And then the third branch from the arch of the aorta
10:50is the left subclavian artery. So that again is going to loop over, it's going to dive deep to the
10:57clavicle and it's going to supply blood to the left upper limb. All right, so we're done with
11:08these. These get called some of the great vessels. Now the aorta, as I said, it descends within the
11:14thorax. As it descends it gives off intercostal arteries which run around with the ribs to supply
11:22blood to the thoracic cage and various other bits and bobs. But in terms of major vessels
11:28we're now going to take out all of the abdominal viscera, most of the abdominal viscera maybe,
11:39transverse colon, see what we can see. Okay, so the thoracic aorta passes through the diaphragm,
11:46there's kind of a gap at the back of the diaphragm and runs through that gap to get to the abdomen.
11:52And if I take this off we can now see the abdominal aorta. So it changes its name from,
12:00well it's still the aorta, but you just describe this bit of the aorta as the abdominal aorta.
12:07And again it's on the posterior abdominal wall, but can you see it's pretty much
12:11lying anterior to the vertebrae. As the abdominal aorta descends it gives off one, two, three
12:19anterior branches. So these are running anteriorly and they supply blood to the gut
12:28and other viscera associated with the gut. So we have the first branch is the celiac trunk,
12:35the second branch is the superior mesenteric artery, and the third branch is the inferior
12:41mesenteric artery. And they will all supply the stomach, or rather each one will supply,
12:47they will all supply parts of the gastrointestinal tract. So they will supply organs such as the
12:53spleen, the pancreas, the liver, the stomach, the small intestine, the large intestine,
13:07and whatnot. All right, so those are the three major branches, those are the three anterior
13:12branches of the abdominal aorta. And you may well have noticed, if you were looking carefully,
13:18there are also some lateral branches. Now there are pairs of lateral branches.
13:25These are the kidneys here, and you can see some arteries here which are a little bit hidden by
13:29the veins, but these then are the renal arteries, the left and right renal arteries are lateral
13:35branches of the abdominal aorta carrying blood to the kidneys. The kidneys, like the lungs,
13:42are organs that process blood. So they see a lot of blood, they don't need a lot of blood to
13:46survive, they process that blood, so they have a high throughput of blood. But we can't see the
13:52whole thing there, you can see how big the veins are, the renal veins, and the renal arteries are
13:55kind of similar. As we descend, there, see these? So these are arteries that are running, they're
14:08descending down towards the pelvis. And they'll take slightly different paths in male and female
14:15pelvises. These are running through the inguinal ligament, I can see, so this would be a male
14:20pelvis, I think. Although, yeah, well, we haven't got a uterus, which is always a good sign of a
14:25male pelvis, isn't it? These lateral branches then are gonadal arteries. In this case, testicular
14:33arteries, but in the female anatomy, these would be ovarian arteries. So you can see why they get
14:41called gonadal arteries as well, because that's a catch-all for both terms. So those are two pairs
14:47of lateral arteries from the abdominal aorta. And it's also sending off other segmental branches to
14:55the posterior abdominal wall and bits and bobs, but those aren't major. OK? Still with me? Right.
15:03Let's have another closer look down here. We're now at the end of the aorta. This huge,
15:10great big blood vessel comes to an end by dividing into two other arteries. These are the
15:16common iliac arteries. We might say this is a final bifurcation, a terminal bifurcation of the
15:24aorta into left and right common iliac arteries. And these are going to descend down and give off
15:31branches to supply blood to the pelvis and to the lower limbs. So in fact, the common iliac artery
15:38isn't very long. Can you see how here it divides again? So the common iliac artery runs from here
15:46to here, and then it divides to give off an internal iliac artery and an external iliac
15:53artery. The internal iliac artery, and there's a left one and a right one, those are going to dive
15:59into the pelvis and will give off a number of branches that supply blood to the viscera,
16:05to the organs inside the pelvis. Whereas the external iliac artery will... So what we've got
16:13here is we've got the inguinal ligament. There's a ligament running across here.
16:16The external iliac artery will run deep to this inguinal ligament. And when it passes the
16:22inguinal ligament, we change its name because we like to do that. When it passes into the lower
16:28limb, it becomes the femoral artery. So it's the same blood vessel. It's continuing down.
16:33We just change its name at that point and it becomes the femoral artery. And the femoral artery
16:39is the artery supplying blood to the lower limb. And we're going to change its name a couple more
16:45times. Right, I'm going to need a lower limb, aren't I? Okay, so when we get down to the foot,
16:51we'll have finished our overview of the arteries. So here's the inguinal ligament I was talking
16:57about, and here's the femoral artery. And look, it disappears. So you can palpate your femoral artery
17:04the pulse of it, if you're careful. But it disappears deep to these muscles. Let's take
17:08these muscles off. And it's going to run that away. It gives off a deep branch to this big muscle,
17:19the quadriceps muscle. But essentially, the femoral artery runs distally, or inferiorly,
17:26and medially, so towards the inside of your leg. There's the big toe there.
17:32And there's a gap in the muscles. And it runs through that gap in the muscles to get
17:39to the back of your knee, the popliteal fossa. See, there it is there. So the femoral artery,
17:47when it passes through that gap in the muscle to enter the popliteal fossa, we change its name,
17:52and it becomes the popliteal artery. You can palpate the pulse of that as well. It might
17:59take a bit of a while to find that. And as it descends, so here's the popliteal artery here.
18:07And as it runs through the popliteal fossa, you can see it giving off a number of branches. These
18:12are to the knee. But as we pass the knee, as we pass the knee joint in the popliteal fossa,
18:19the popliteal artery continues as the posterior tibial artery. And the posterior tibial artery
18:26then is the artery of the calf. So it's running down deep to these big calf muscles, and it's
18:34going to eventually run medially around the ankle to form the plantar arteries of the sole of the
18:41foot. Now, the reason it changes its name and becomes the posterior tibial artery is because
18:47we have an anterior tibial artery forming here. So look, there's the shin, top of the foot,
18:52shin, pop that muscle, and now in there we can see the anterior tibial artery. So you could say
19:01that the popliteal artery divides into posterior and anterior tibial arteries. When we actually
19:06look at the anatomy, it's a little bit more awkward than that, but that's the best way of
19:09thinking about it. So the anterior tibial artery is the artery of the shin. The posterior tibial
19:15artery is the artery of the calf. And the anterior tibial artery will run down to the
19:23the dorsum of the foot, and those arteries will actually communicate a little bit. But that's it,
19:29that's the overview of the arterial supply throughout the human body, up to the brain, down
19:35to the big toe. Not so bad, we can add a lot of detail to that, but we're not going to do that
19:41today because this is an introduction. We'll do that as we look at each area. What we will do now
19:46is consider the veins on their way back up, which are not on these models. So
19:53first rule, veins tend to follow the artery. So there are veins that match the arteries that
20:01we've talked about. But whilst we have one nice neat artery, when we're looking at the body,
20:11we often find that a pair of veins run with them and they interconnect and what have you.
20:15So that's the first bit of complexity. The other thing is that we tend to have not just
20:21the veins matching the artery, some of which we've seen, but we also have superficial veins
20:29in the skin, a whole bunch of other veins of which there are not arteries matching them.
20:35For example, in the lower limb, we have the great saphenous vein, or the long saphenous vein,
20:43and the short saphenous vein. These are very superficial, you see them in the skin. Those
20:48are the veins that tend to give rise to varicose veins. They're very, very superficial. Otherwise
20:52though, we have, you can see there's a popliteal vein. And as it passes through that gap in the
20:58muscle, it becomes, I shouldn't have put this back together, it becomes, what does it become?
21:05The femoral vein. Yeah. So the femoral vein runs up here. There's the inguinal ligament again.
21:11When the femoral vein runs deep to the inguinal ligament, we change its name to the
21:18external iliac vein. Very good. Very good. And that follows up. So the great saphenous vein,
21:26for example, it stays within the skin. That's why we can't see on this model, because the skin has
21:30been removed, so the superficial veins have been removed. So the great saphenous vein actually
21:37runs all the way up the lower limb and drains its blood back into the femoral vein up here.
21:43So, you know, you might have heard of deep vein thrombosis, a clot forming in the deep veins of
21:49the leg. This is what we're talking about. These deep veins covered by muscle in the lower limb,
21:55not the superficial veins. The superficial veins are the ones that become varicose.
21:59I'm getting a bit confused. I've got way too much stuff out here. Okay. So then the external
22:09iliac vein joins with the internal iliac vein, draining blood from the pelvis, and they become
22:15the common iliac vein. The left and right common iliac veins come together and form the inferior
22:21vena cava. The inferior vena cava ascends through the abdomen. And look, we see a pair of lateral
22:30gonadal veins draining into them. And we see a pair of renal veins draining into the inferior
22:36vena cava. But we don't see any anterior veins draining back into the vena cava. And the reason
22:44for that is that all the blood from the gastrointestinal tract drains to the liver.
22:51So the purpose of that is that the small intestine absorbs nutrients, for example,
22:57into the blood. That blood is then passed to the liver, essentially for processing and management.
23:03Do you see? So there's no point sending the blood from the GI tract back to the inferior
23:09vena cava. No. You've got to send it back to the liver first. And you do that through the portal
23:14vein. And then the liver surrounds the inferior vena cava. So the blood passes through the liver.
23:21The hepatocytes perform hundreds of functions on all of that stuff that you've been absorbing.
23:27And then it passes that blood into the inferior vena cava. And then the inferior vena cava passes
23:34up through the diaphragm. And then we're back to the heart. The inferior vena cava drains
23:41directly back into the right atrium, the right side of the heart. So that blood will then be
23:48passed to the lungs. And round and round we go. Now what about the upper part, the superior part?
23:53Well, I said that this was the inferior vena cava. This is the superior vena cava. So now we've got
24:01to think about blood going in that direction, because it's draining into the heart. And the
24:05superior vena cava is also draining into the right atrium, the right side of the heart.
24:12So the superior and inferior vena cava both come up and drain into the right atrium.
24:18Now the superior vena cava then, all right, we have two brachiocephalic veins. We saw only one
24:26brachiocephalic artery, right? Just one brachiocephalic trunk. But we have two brachiocephalic
24:33veins. They're a little bit superficial to the arteries. So those two brachiocephalic veins,
24:38left and right, come together to form the superior vena cava. Now what forms the brachiocephalic
24:43veins? Again, brachiocephalic. So we have a subclavian vein here, coming from the upper limb.
24:49So the blood from the upper limb drains in here. And then here, this isn't a carotid vein, this is
24:56a jugular vein. And again, we don't have a jugular vein, we have an internal jugular vein and an
25:03external jugular vein. And this is the internal jugular vein. So the internal jugular vein is
25:09draining most of the blood from the brain and the face. And the internal jugular vein meets the
25:16subclavian vein. Those two come together and become the brachiocephalic vein. That happens
25:21on both sides. And as I said, the two brachiocephalic veins come together, form the superior
25:26vena cava and drain all that blood to the heart. The external jugular vein, again, it's a very
25:32superficial one. You might see it in my neck here while I'm talking, because when you use the muscles
25:37in your face a great deal, you're passing more blood through them and it kind of pops up and
25:41that sort of thing. But really, that's kind of for a neck or jugular vein general video
25:46when we look at internal and external. Anyway, upper limb.
25:54You can't see any veins at all, but they are here in you. So again, we have ulnar and radial veins.
26:00We have deep veins which match the arteries that we talked about. Ulnar and radial veins become
26:07a brachial vein, becomes an axillary vein, becomes a subclavian vein. Those are the deep veins.
26:15And then we also have superficial veins, which I don't think we can see very well on me. Anyway,
26:22there's a basilic vein which runs over here, a cephalic vein that runs over there,
26:28a median cubital vein linking them together. And those two will drain back to the brachial or
26:36subclavian, brachial and axillary or subclavian. Anyway, they'll drain back to this major deep vein
26:44draining blood from the upper limb at some point. And we have covered that elsewhere if you want
26:49more detail. Is that it? That is it, I think. That is an overview of the entire cardiovascular
26:59system, anatomically speaking, from the heart, following the blood out to the extremities,
27:06hands and feet, up to the brain, and then following the blood back again. It's an overview.
27:13But honestly, we covered pretty much most of all of the major vessels that
27:21someone might need to know about. There is more detail. There's a lot more detail,
27:25and you can look at that detail as you look at each region in more detail. But that's it.
27:30Wow, how long is this video going to be? I don't want to know. Anyway, I hope that was useful.
27:35Um, like I say, if you want to find more detail, just search, you know, you know, YouTube's built
27:42on Google, right? And Google are quite good at search. If you want to find any of these topics,
27:46just search my name, Sam Webster, and whatever thing you're looking for in Google,
27:52in YouTube, rather, and should show you videos if I've ever made them.
27:57I think it, I think YouTube listens to what I'm saying, and then like,
28:01create, search things from what I've said, because I don't bother typing much in,
28:05but it still works. Anyway, enough of that. Oh, all right, time to tidy up,
28:11and have another cup of coffee, and I'll see you guys, um, next week, no doubt.