1、Angiology 脉管学,Angiology 脉管学,Composition Cardiovascular system 心血管系统 Lymphatic system 淋巴系统,The cardiovascular system 心血管系统,Organization Heart 心A muscle pump to maintain the flow of blood.Consist of four chambers (right and left atria, right and left ventricles). Artery (A)动脉 carry blood away from the
2、 heart. Veins (V)静脉 carry blood back to the heartCapillary (Cap)毛细血管 microscopic vessels, the area of exchange between blood and tissue fluid.,The cardiovascular system心血管系统,Blood circulationSystemic circulation 体循环 left ventricleaorta and its branchescapillaries of bodysuperior and inferior vena ca
3、varight atriumPulmonary circulation 肺循环right ventriclepulmonary A capillaries of lung pulmonary V left atrium,The cardiovascular system心血管系统,Vascular anastomosis 血管吻合Anastomosis between AAnastomosis between VArteriolovenular anastomosis 动静脉吻合Collateral vessels 侧副管 Collateral circulation 侧支循环,The Hea
4、rt,The heart,Position Lies within the pericardium in middle mediastinum. Behind the body of sternum and 2th. to 6th. coastal cartilages.In front of 5th. to 8th. thoracic vertebrae.One third of it lies to the right of median plan and 2/3 to the left.,Surfaces of the heart,Pyramidal in shape, somewhat
5、 larger than a closed fist.One apexOne baseTwo surfaceThree bordersFour sulcuses,Formed by left ventricle Directed downwards, forward, and to the leftLies at the level of the 5th left intercostal space, 12 cm medial to the left midclavicular line (9cm from the midline) .,Cardiac apex 心尖,Cardiac base
6、 心底,Formed by the left atrium and to a small extent by the right atrium. Faces backward, upward and to the right.,Sternocostal surface 胸肋面,Formed mainly by the right atrium and right ventricle, and a lesser portion of its left is formed by the left auricle and ventricle.Directed forwards and upwards
7、.,Diaphragmatic surface 膈面,Formed the ventricleschiefly the left ventricle.Directed backwards and downwards, and rest upon the central tendon of the diaphragm.,Borders of the heart,Right border 右缘VerticalFormed entirely by right atrium Left border 左缘 Round Mainly formed by the left ventricle and par
8、tly by the left auricle Inferior border 下缘HorizontalFormed by the right ventricle and cardiac apex,Sulcuses of the heart,Coronary sulcus 冠状沟(circular sulcus) which marks the division between atrium and ventricles, contains the trunks of the coronary vessels and completely encircles the heart.Interat
9、rial sulcus 房间沟 separates the two atrium and is hidden by pulmonary trunk and aorta in front.,Sulcuses of the heart,Anterior interventricular groove 前室间沟Posterior interventricular groove 后室间沟Mark the division between ventricles (which separates the R from the L ventricle)Cardiac apical incisure 心尖切迹
10、Atrioventricular crux 房室交点,Chambers of the heart 心 腔,Chambers of the heart 心腔,Consists of four chambers Left and right atria 左、右心房Left and right auricle 左、右心耳Left and right ventricles 左、右心室,Right atrium 右心房,Three inletsOrifice of superior vena cava 上腔静脉口 returns blood to the heart from the upper hal
11、f of the body.Orifice of inferior vena cava 下腔静脉口 returns blood to the heart from the lower half of the body.Orifice of coronary sinus 冠状窦口 returns blood to the heart from the cardiac muscle.One outlet right atrioventricular orifice 右房室口,Right atrium 右心房,Crista terminalis 界嵴vertical ridge that from
12、superior vena cave to inferior vena cave. Sulcus terminalis界沟groove on exterior of heart that corresponds (一致)to crista terminalis.Two parts separated externally by sulcus terminalis and internally by the crista terminalis.Atrium proper 固有心房Sinus venarum cavarum 腔静脉窦,Right atrium 右心房,Atrium proper 固
13、有心房In front of the ridgePectinate muscles in wallSinus venarum cavarum 腔静脉窦Smooth wallsFossa ovalis 卵圆窝 an oval depression, a remnant of the fetal foramen ovale, on the lower part of interatrial septum, the most common location of atrial septal defects (ASD)-房间隔缺损.,Right ventricle 右心室,One inlet righ
14、t atrioventricular orifice 右房室口One outlet orifice of pulmonary trunk 肺动脉口,Right ventricle 右心室,Supraventricular crest 室上嵴 (a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk ) Two partsInflow tract 流入道Outflow tract 流出道,Right ventricle 右心室,Inflow tractTrabeculae car
15、neae 肉柱 irregularly arranged bundles of myocardium.Septomarginal trabecula 隔缘肉柱extends from interventricular septum to base of anterior papillary muscle, contains right bundle branch. Papillary muscles 乳头肌Conical-shaped Three: anterior, posterior and septal.,Right ventricle 右心室,Outflow tract Conus a
16、rteriosus 动脉圆锥 Cone-shape , smooth area leading upward to orifice of pulmonary trunkPumps blood through pulmonary orifice to pulmonary trunk.,Tricuspid valve 三尖瓣,Guards right atrioventricular orifice Three triangular cusps: anterior, posterior and septalBase of cusps are attached to fibrous ring sur
17、rounding the atrioventricular orifice. To their free edges and ventricular surfaces are attached chordae tendineae 腱索, which connect the cusps to the papillary muscles.,Tricuspid valve 三尖瓣,Tricuspid complex 三尖瓣复合体,Tricuspid ring 三尖瓣环Tricuspid valve 三尖瓣Chordae tendineae 腱索Papillary muscles 乳头肌,Functi
18、on of tricuspid complex,Open during diastole to allow blood to enter ventricles from atriaClosed during systole to prevent regurgitation of blood into atria,Valve of pulmonary trunk 肺动脉瓣,three semilunar cusps which guards the orifice of pulmonary trunk,Function of pulmonary valves,Opening during sys
19、tole(心脏收缩) , with cusps pressed toward wall of vessel as blood is forced upward. Closed during diastole(心脏舒张) Ventricular pressure drops in diastole.Floating together of valve cusps, with free borders meeting, thus closing the valve.,Left atrium 左心房,Four inletsfour orifices of pulmonary veins 肺静脉口On
20、e outletleft atrioventricular orifice 左房室口,Left ventricle 左心室,One inlet left atrioventricular orifice 左房室口One outlet aortic orifice 主动脉口Two partsdivided by anterior cusps of mitral valve.Inflow tractrough wallsOutflow tract Aortic vestibule 主动脉前庭Smooth area leading to aortic orifice,Mitral valve 二尖瓣
21、,Guards left atrioventricular orifice Two triangular cuspsanterior and posterior with commissural cusps between them.,Mitral complex 二尖瓣复合体,Mitral ring 二尖瓣环Mitral valve 二尖瓣Chordae tendineae 腱索Papillary muscles 乳头肌,Function of mitral complex,Open during diastole to allow blood to enter ventricles fro
22、m atriaClosed during systole to prevent regurgitation of blood into atria,Aortic valve 主动脉瓣,Guards the aortic orificeThree semilunar cusps (right, left and posterior)Aortic sinus 主动脉窦 bulges in aortic wall at level of valve that correspond to cusps.Rightcontains opening of right coronary artery.Left
23、contains opening of left coronary artery.Posteriorno opening,Function of aortic valves,Opening during systole, with cusps pressed toward wall of vessel as blood is forced upward Closed during diastole Ventricular pressure drops in diastoleFloating together of valve cusps, with free borders meeting,
24、thus closing the valve,Structures of the heart,Walls of heartEndocardium 心内膜 Inner coat of the heart wall Continuous with the valve flaps Myocardium 心肌Arranged spirallyAttached to fibrous rings surrouding the four orifices of heartThe walls of left ventricle are about three times thicker than that o
25、f right Epicardium 心外膜 OuterVisceral layer of serous pericardium,Structures of the heart,Interatrial septum 房间隔Located between right and left atria Contains fossa ovalisInterventricular septum 室间隔Located between right and left ventriclesHas upper membranous part Has thick lower muscular partAtrioven
26、tricular septum 房室隔,Membranous part of interventricular septum,Fibrous skeleton of heart 纤维骨骼,Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices.Left and right fibrous trigones.,Conduction system of heart 心传导系统,Conduction system of heart 心传导系统,Composed of specialized my
27、ocardial cells.Sinuatrial node 窦房结Internodal tract 结间束Atrioventricular node 房室结Atrioventricular bundle 房室束Right and left bundle branches 左、右束支Purkinje network 普肯野氏纤维网,Conduction system of heart 心传导系统,Sinuatrial node 窦房结 Called the pacemaker cell. Located at the upper part of the sulcus terminalis cl
28、ose to the superior vena cava, under the epicardium.,Conduction system of heart 心传导系统,Atrioventricular node (AV node) 房室结 Located in the lower part of interatrial septum, near orifice of coronary sinus and base of tricuspid valve.Under the endocardiumLower part related to membranous part of interven
29、tricular septum.,Conduction system of heart 心传导系统,Atrioventricular bundle (AV bundle)房室束 Passes forward through right fibrous trigone to reach inferior border of membranous part. Divides into right and left bundle branches at upper border of muscular part of interve ntricular septum.,Conduction syst
30、em of heart 心传导系统,Right and left bundle branches 左、右束支Right bundle branchpasses down on right side of interventricular septum to reach the septomarginal trabecular and into the base of anterior papillary muscle. Here it becomes continuous with the fibers of Purkinje fibres.Left bundle branchpasses d
31、own on left side of interventricular septum beneath the endocardium. It usually divides into two branches, which eventually become continuous with the Purkinje fibers.Purkinje network 普肯野氏纤维网 continuous with myocardium.,心传导系统,Sinatrial node,Atrioventricular node,Atrioventricular bundle,Right and lef
32、t bundle branches,Purkinje network,Arterial supply of the heart,Left coronary artery 左冠状动脉Course Arises from left aortic sinusRuns between pulmonary trunk and left auricle into coronary sulcus.BranchesAnterior interventricular branch 前室间支runs downward in anterior interventricular groove around infer
33、ior margin of heart to posterior interventricular groove.Circumflex branch 旋支travels to left in coronary sulcus to posterior aspect.Distributionsupplies left atrium and ventricle, lesser portion of anterior wall of right ventricle, and anterior 2/3 of interventricular septum.,Arterial supply of the
34、heart,Right coronary artery 右冠状动脉CourseArises from the right aortic sinus Runs forward between right auricle and pulmonary trunk into coronary sulcus. BranchesRight marginal branch 右缘支 travels along inferior border. Posteror interventricular branch 后室间支travels downward in posterior interventricular
35、groove, it anastomosises near the apex with the anterior interventricular branch of the left coronary artery.Distribution: supplies right atrium and ventricle, posterioinferior 1/3 of interventricular septum, posterior wall of left ventricle, the sinuatrial node and atrioventricular node.,Stent in a
36、n artery,Precutaneous translaminal coronary angioplasty (PTCA),Coronary artery bypass grafting (CABG),Venous drainage of the heart,Coronary sinus 冠状窦Lies in posterior part of coronary sulcus. Carries most of venous blood from myocardium to right atrium. Tributaries Great cardiac vein 心大静脉Middle card
37、iac vein 心中静脉Small cardiac vein 心小静脉,Venous drainage of heart,Anterior cardiac veins 心前静脉34 small vessels, drain into right atrium. Smallest cardiac veins 心最小静脉drain into all chambers, mainly atria.,Pericardium 心包,Fibrous pericardium 纤维心包Attached to central tendon of diaphragm inferiorlyBlends with
38、outer coat of great vessels superiorlySerous pericardium 浆膜心包Visceral layer (epicardium)Parietal layer Pericardial cavity 心包腔Potential space between visceral and parietal layes.Contains film of pericardium fluid as a lubricant to facilitate cardiac movements.,Pericardium 心包,Pericardium sinus Formed
39、by reflection of serous pericardium. Transverse sinus of pericardium 心包横窦Posterior to ascending aorta and pulmonary trunk Anterior to superior vena cava and left atrium.,Pericardium sinus,Oblique sinus of pericardium 心包斜窦cul-de-sac(死胡同), posterior to heart, bounded by pulmonary veins on either side.
40、Anterior inferior sinus of pericardium 心包前下窦,Surface markings of heart,R. superior point lies on the upper border of right third costal cartilage 1.2cm from the margin of sternum R. inferior point lies on the sixth sternocostal joint L. superior point lies on lower border of left second costal cartilage 1.2cm from sternal margin Cardiac apexin the fifth left intercostal space 79cm from the midline,
