系统解剖脉管学英文版Heart课件.ppt

1、Angiology 脉管学脉管学Composition qCardiovascular system 心血管系统心血管系统 qLymphatic system 淋巴系统淋巴系统The cardiovascular system 心血管系统心血管系统 Organization qHeart 心心A muscle pump to maintain the flow of bloodConsist of four chambers(right and left atria,right and left ventricles)qArtery 动脉动脉 blood vessels carring blo

2、od away from the heart qVein 静脉静脉 blood vessels carring blood towards the heartqCapillary 毛细血管毛细血管 smallest blood vessels，exchange site of substances between blood and surrounding tissues The Hard Working HeartqLVSV 70 ml/beatqHMO 70 x70=5000mlqHHO 70 x70 x60=300000mlqHDO 70 x70 x60 x24=7200000mlqHA

3、O 70 x70 x60 x24x365=2600000000mlqHLO 70 x70 x60 x24x365x70=210,000,000,000ml210,000/50/50=84TrainsThe cardiovascular system心血管系统心血管系统 Blood circulationqSystemic circulation 体循环体循环 Left ventricleaorta and its branches capillaries of bodysuperior and inferior vena cavaright atriumqPulmonary circulati

4、on 肺循环肺循环 Right ventriclepulmonary a.capillaries of lung pulmonary v.left atrium The cardiovascular system 心血管系统心血管系统Vascular anastomosis 血管吻合血管吻合qAnastomosis between a.qAnastomosis between v.qArteriolovenular anastomosis 动静脉吻合动静脉吻合qCollateral vessels 侧副管侧副管 qCollateral circulation 侧支循环侧支循环Heart丁兆习丁

5、兆习山东大学医学院人体解剖教研室山东大学医学院人体解剖教研室Office: Position of the heartq Position of the heartLies within the pericardium in middle mediastinum Behind the body of sternum and coastal cartilages 2 to 6 In front and at the level of T5-8 A third of it lies to the right of median plan and 2/3 to the left Surfaces o

6、f the heartqPyramidal in shape,somewhat larger than a closed fistqOne apex-Cardiac apex qOne base-Cardiac base qTwo surfaceSternocostal surfaceDiaphragmatic surfaceqThree bordersRight borderLeft borderInferior borderqFour sulcusesCoronary sulcusAnterior interventricular groovePosterior interventricu

7、lar groove Interatrial sulcusCardiac apex 心尖心尖qFormed by left ventricle qDirected downwards,forward,and to the leftqLies at the level of the fifth left intercostal space,1-2 cm medial to the left midclavicular line(9cm from the midline)Surfaces of the heart Surfaces of the heartCardiac base 心底心底qFor

8、med by the left atrium and to a small extent by the right atrium qFaces backward,upward and to the right qContinuous with the large vessels Surfaces of the heartSternocostal surface 胸肋面胸肋面qFormed mainly by the right atrium and right ventricle,and a lesser portion of its left is formed by the left au

9、ricle and ventricleqDirected forwards and upwardsqLeft and right auricles 左、左、右心耳右心耳 Surfaces of the heartDiaphragmatic surface 膈面膈面qFormed the ventricleschiefly the left ventricleqDirected backwards and downwards,and rest upon the central tendon of the diaphragm Surfaces of the heartBorders of the

10、heart qRight border 右缘右缘VerticalFormed entirely by right atrium qLeft border 左缘左缘 Round Mainly formed by the left ventricle and partly by the left auricle qInferior border 下缘下缘HorizontalFormed by the right ventricle and cardiac apex Surfaces of the heartSulci of the heart qCoronary sulcus 冠状沟冠状沟(cir

11、cular sulcus)which marks the division between atria and ventricles,contains the trunks of the coronary vessels and completely encircles the heartqInteratrial sulcus 房间沟房间沟 Separates the two atria and is hidden by pulmonary trunk and aorta in front Surfaces of the heartSulci of the heart qAnterior in

12、terventricular groove 前室间沟前室间沟qPosterior interventricular groove 后室间沟后室间沟Mark the division between ventricles(which separates the RV from the LV)qCardiac apical incisure 心尖切迹心尖切迹qAtrioventricular crux 房室交点房室交点 Chambers of the heart 心腔心腔qChambers of the heart 心腔心腔Consists of four chambers Left and ri

13、ght atria 左、右心房左、右心房Left and right ventricles 左、右心室左、右心室 Right atrium(RA)右心房右心房qThree inletsOrifice of superior vena cava 上腔静脉口上腔静脉口 lreturns blood to the heart from the upper half of the bodyOrifice of inferior vena cava 下腔静脉口下腔静脉口 lreturns blood to the heart from the lower half of the bodyOrifice

14、of coronary sinus 冠冠状窦口状窦口 lreturns blood to the heart from the cardiac muscleqOne outlet Right atrioventricular orifice 右房室口右房室口 Right atrium(RA)右心房右心房qCrista terminalis 界嵴界嵴 Vertical ridge that from superior vena cave to inferior vena cave qSulcus terminalis界沟界沟 Groove on exterior of heart that co

15、rresponds to crista terminalisqTwo parts Separated externally by sulcus terminalis and internally by the crista terminalisAtrium proper 固有心房固有心房 In front of the crista terminalis Sinus venarum cavarum 腔静腔静脉窦脉窦 Right atrium(RA)右心房右心房qAtrium proper 固有心房固有心房Right auricle-心外科最常用手术入路心外科最常用手术入路之一之一Pectina

16、te muscles in wallqSinus venarum cavarum 腔静脉窦腔静脉窦Fossa ovalis 卵圆窝卵圆窝lAn oval depression,a remnant of the fetal foramen ovalelLies on the lower part of interatrial septumlThe most common location of atrial septal defects(ASD)Limbus fossae ovalis 卵圆窝缘卵圆窝缘Aortic mound 主动脉隆凸主动脉隆凸Koch triangle Koch三角三角 R

17、ight ventricle(RV)右心室右心室qOne inlet Right atrioventricular orifice 右房室口右房室口qOne outlet Orifice of pulmonary trunk 肺动脉口肺动脉口 Right ventricle(RV)右心室右心室qSupraventricular crest 室上嵴室上嵴 A muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk qTwo partsInflow tract 流入道流入道Outflo

18、w tract 流出道流出道(conus arteriosus动脉圆锥动脉圆锥)Right ventricle(RV)右心室右心室qInflow tract Tricuspid valve 三尖瓣三尖瓣lGuards right atrioventricular orifice lThree triangular cusps:anterior,posterior and septallBase of cusps are attached to fibrous Tricuspid ring surrounding the atrioventricular orifice Chordae tend

19、ineae 腱索腱索 fibrous band that Connect the free edges and ventricular surfaces of cusps to the papillary muscles Papillary muscles 乳头肌乳头肌lConical-shaped lThree:anterior,posterior and septalTrabeculae carneae 肉柱肉柱 lirregularly arranged bundles of myocardium Septomarginal trabecula 隔缘隔缘肉柱肉柱/morderator b

20、and节制索节制索lextends from interventricular septum to base of anterior papillary muscle,contains right bundle branch Right ventricle(RV)右心室右心室q Tricuspid complex 三尖瓣复合体三尖瓣复合体Tricuspid ring 三尖瓣环三尖瓣环Tricuspid valve 三尖瓣三尖瓣Chordae tendineae 腱索腱索Papillary muscles 乳头肌乳头肌q Function:prevent the reflow of blood

21、from the right ventricle into right atriumRight ventricle(RV)右心室右心室diastole systoleAnt.Post.septalTricuspid valve 三尖瓣三尖瓣Right ventricle(RV)右心室右心室Chordae tendineaePapillary musclesRight ventricle(RV)右心室右心室q Function of tricuspid complexVentricles relax,blood returning to the heart fills atria,putting

22、 pressure against atrioventricular valves,atrioventricular vales forced open.diastoleRight ventricle(RV)右心室右心室q Function of tricuspid complex Ventricles contract,forcing blood against atrioventricular valve cusps.Atrioventricular valves closed.Papillary muscles contract and chordae tendineae tighten

23、,preventing valve flaps from everting into atria.systole Right ventricle(RV)右心室右心室qOutflow tract-Conus arteriosus 动脉圆锥动脉圆锥 Cone-shape,smooth area leading upward to orifice of pulmonary trunkPumps blood through pulmonary orifice to pulmonary trunkorifice of pulmonary trunk肺动脉口肺动脉口valve of pulmonary t

24、runk 肺动脉瓣肺动脉瓣 Right ventricle(RV)右心室右心室q Pulmonary Valve 肺动脉瓣肺动脉瓣Guards the orifice of pulmonary trunkThree semilunar cusps leach with free border that has central nodules called nodules of semilunar valve 半月瓣小结半月瓣小结Pulmonary sinuses 肺动脉窦肺动脉窦lBulges in wall of pulmonary trunk at level of valve that

25、correspond to cuspsq FunctionPrevent the reflow of blood from the pulmonary trunk to right ventricleRight ventricle(RV)右心室右心室q Function of pulmonary valves As ventricles contract and intraventricular pressure rises,blood is pushed up against semilunar valves,forcing them openRight ventricle(RV)右心室右心

26、室q Function of pulmonary valves As ventricles relax and intraventricular pressure falls,blood flow back from arteries,filling the cusps of semilunar valves and forcing them to close Left atrium(LA)左心房左心房q左心耳左心耳Left auricles-心外科最常用手术入路之一心外科最常用手术入路之一q左心房窦左心房窦left atrial sinus Four inlets:orifices of p

27、ulmonary veins 肺静脉口肺静脉口One outlet:left atrioventricular orifice 左房室口左房室口 Left ventricle(LV)左心室左心室qOne inlet:left atrioventricular orifice 左房室口左房室口qOne outlet:Aortic orifice 主动脉口主动脉口qTwo parts:Divided by anterior cusps of mitral valveInflow tractrough wallsOutflow tract lAortic vestibule 主动脉前庭主动脉前庭Sm

28、ooth area leading to aortic orificeq Mitral valve 二尖瓣二尖瓣Guards left atrioventricular orifice Two triangular cusps:Anterior and posteriorFunction:prevent the reflow of blood from the left ventricle into left atrium Left ventricle(LV)左心室左心室q Mirtal complex 二尖瓣复合体二尖瓣复合体Mitral ring 二尖瓣环二尖瓣环Mitral valve

29、二尖瓣二尖瓣Chordae tendineae 腱索腱索Papillary muscles 乳头肌乳头肌q Function：prevent the reflow of blood from left ventricle into left atrium Left ventricle(LV)左心室左心室Left ventricle(LV)左心室左心室qFunction of mitral complexOpen during diastole to allow blood to enter ventricles from atriaClosed during systole to preven

30、t regurgitation of blood into atriaLeft ventricle(LV)左心室左心室q Aortic valve 主动脉瓣主动脉瓣Guards the aortic orificeThree semilunar cusps(right,left and posterior)Each with free border that has nodules of semilunar valve 半月瓣小结半月瓣小结 Aortic sinus 主动脉窦主动脉窦 lBulges in aortic wall at level of valve that correspon

31、d to cuspslRightcontains opening of right coronary arterylLeftcontains opening of left coronary arterylPosteriorno opening q Function：prevent the reflow of blood from aorta into left ventricleLRPLeft ventricle(LV)左心室左心室 Function of aortic valves qOpened during systole,with cusps pressed toward wall

32、of vessel as blood is forced upward qClosed during diastole Ventricular pressure drops in diastoleFloating together of valve cusps,with free borders meeting,thus closing the valve Structures of the heartqEndocardium 心内膜心内膜 qMyocardium 心肌心肌qEpicardium 心外膜心外膜 Walls of the heartqEndocardium 心内膜心内膜 Inne

33、r coat of the heart wall Continuous with the valve flaps qMyocardium 心肌心肌Arranged spirallyAttached to fibrous rings surrounding the four orifices of heartThe walls of left ventricle are about three times thicker than that of right qEpicardium 心外膜心外膜 OuterVisceral layer of serous pericardiumStructure

34、s of the heartq Interatrial septum 房间隔房间隔Located between right and left atria Contains fossa ovalisASD(Atrial Septal Defect)q Interventricular septum 室间隔室间隔Located between right and left ventriclesHas upper membranous part Has thick lower muscular partVSD(Ventricular Septal Defect)qAtrioventricular

35、septum 房室隔房室隔Membranous part of interventricular septum Muscular part of interventricular septum Ventricular Septal DefectFibrous skeleton of heart 纤维骨骼纤维骨骼 qFibrous rings that surround the atrioventricular,pulmonary,and aortic orificesqLeft and right fibrous trigonesFibrous skeleton of heart 纤维骨骼纤维

36、骨骼 Conduction system of heart 心传导系统心传导系统Conduction system of heart 心传导系统心传导系统窦房结窦房结房室结房室结房室束房室束左、右束支左、右束支Purkinje 纤维纤维qComposed of specialized myocardial cellsq Components Sinoatrial node 窦房结窦房结 (pacemaker)Internodal tracts 结间束结间束Atrioventricular node 房室结房室结Atrioventricular bundle 房室束房室束Right and le

37、ft bundle branches 左、右束支左、右束支Purkinje fibers(network)普肯普肯野氏纤维网野氏纤维网Conduction system of heart 心传导系统心传导系统q Sinuatrial node(SA node)窦房结窦房结 Called the pacemaker (P cell)(60-100 pulses/min)Located at the upper part of the sulcus terminalis close to the superior vena cava,under the epicardium窦房结窦房结Clinic

38、al tip:窦性心动过速窦性心动过速 sinustachycardia 窦性心动过缓窦性心动过缓 sinus bradycardiaConduction system of heart 心传导系统心传导系统q Atrioventricular node(AV node)房室结房室结 Located in the Koch triangle Under the endocardiumLower part related to membranous part of interventricular septum房室结房室结Conduction system of heart 心传导系统心传导系统

39、q Atrioventricular bundle(AV bundle)房室束房室束 Passes forward through right fibrous trigone to reach inferior border of membranous part of interventricular septum Divides into right and left bundle branches at upper border of muscular part of interventricular septum 房室束房室束Conduction system of heart 心传导系

40、统心传导系统qRight and left bundle branches 左、右束支左、右束支Right bundle branchlpasses down on right side of interventricular septum to reach the septomarginal trabecular and into the base of anterior papillary muscle.lHere it becomes continuous with the fibers of Purkinje fibresLeft bundle branchlpasses down o

41、n left side of interventricular septum beneath the endocardium lIt usually divides into two branches,which eventually become continuous with the Purkinje fibersqPurkinje network 普肯野氏纤维普肯野氏纤维网网 Continuous with myocardium左、右束支左、右束支Purkinje networkConduction system of heart 心传导系统心传导系统Arterial supply of

42、 the heartqArteries：left coronary arteryright coronary arteryArterial supply of the heartqLeft coronary artery 左冠状动脉左冠状动脉 Course lArises from left aortic sinuslRuns between pulmonary trunk and left auricle into coronary sulcus BrancheslAnterior interventricular branch 前室间支前室间支 Runs downward in anter

43、ior interventricular groove around inferior margin of heart to posterior interventricular groovelCircumflex branch 旋支旋支Travels to left in coronary sulcus to posterior aspect Distribution lsupplies left atrium and ventricle,lesser portion of anterior wall of right ventricle,and anterior 2/3 of interv

44、entricular septum Arterial supply of the heart qRight coronary artery 右冠状动脉右冠状动脉 CourselArises from the right aortic sinus lRuns forward between right auricle and pulmonary trunk into coronary sulcus BrancheslBranch of sinoatrial node 窦房结支窦房结支lRight marginal branch 右缘支右缘支 travels along inferior bord

45、er lPosteror interventricular branch 后室后室间支间支travels downward in posterior interventricular grooveit anastomosises near the apex with the anterior interventricular branch of the left coronary artery Distributionlsupplies right atrium and ventricle,posterioinferior 1/3 of interventricular septum,post

46、erior wall of left ventricle,the sinuatrial node and atrioventricular nodeArterial supply of the heartThrombus in Coronary Artery Angiogram冠状动脉造影显示动脉血栓冠状动脉造影显示动脉血栓Arterial supply of the heartStent in an arteryPrecutaneous translaminal coronary angioplasty(PTCA)Coronary artery bypass grafting(CABG)Ve

47、nous drainage of the heartqCoronary sinus 冠状窦冠状窦Great cardiac vein 心大静脉心大静脉Middle cardiac vein 心中静脉心中静脉Small cardiac vein 心小静脉心小静脉qAnterior cardiac veins 心前静脉心前静脉qSmallest cardiac veins 心最小静脉心最小静脉Venous drainage of the heartq Coronary sinus 冠状窦冠状窦Lies in posterior part of coronary sulcus Carries mos

48、t of venous blood from myocardium to right atrium Tributaries lGreat cardiac vein 心大静脉心大静脉lMiddle cardiac vein 心中静脉心中静脉lSmall cardiac vein 心小静脉心小静脉Venous drainage of heartqAnterior cardiac veins 心前静脉心前静脉34 small vessels,drain into right atrium qSmallest cardiac veins 心最小静脉心最小静脉Drain into all chamber

49、s,mainly atriaPericardium 心包心包qFibrous pericardium 纤维心包纤维心包qSerous pericardium 浆膜心包浆膜心包qPericardial cavity 心包腔心包腔 Pericardium 心包心包qFibrous pericardium 纤维心包纤维心包Attached to central tendon of diaphragm inferiorlyBlends with outer coat of great vessels superiorlyqSerous pericardium 浆膜心包浆膜心包Visceral laye

50、r(epicardium)Parietal layer qPericardial cavity 心包腔心包腔Potential space between visceral and parietal layersContains film of pericardium fluid as a lubricant to facilitate cardiac movementsPericardium 心包心包qPericardium sinus 心包窦心包窦Formed by reflection of serous pericardium q Transverse sinus of pericar