系统解剖脉管学英文版课件.ppt

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 bloodConsist of four chambers(right and left atria,right and left ventricles)Artery 动脉 blood vessels carring blood away from the heart Vein 静脉 blood vessels carring blood towards the heartCapillary 毛细血管 smallest blood vessels，exchange site of substances between blood and surrounding tissues,The Hard Working Heart,LVSV 70 ml/beatHMO 70 x70=5000mlHHO 70 x70 x60=300000mlHDO 70 x70 x60 x24=7200000mlHAO 70 x70 x60 x24x365=2600000000mlHLO 70 x70 x60 x24x365x70=210,000,000,000ml,210,000/50/50=84,Trains,The cardiovascular system心血管系统,Blood circulationSystemic circulation 体循环 Left ventricleaorta and its branches capillaries of bodysuperior and inferior vena cavaright 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 a.Anastomosis between v.Arteriolovenular anastomosis 动静脉吻合Collateral vessels 侧副管 Collateral circulation 侧支循环,Heart,丁兆习山东大学医学院人体解剖教研室Office:,Position of the heart,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 of the heart,Pyramidal in shape,somewhat larger than a closed fistOne apex-Cardiac apex One base-Cardiac base Two surfaceSternocostal surfaceDiaphragmatic surfaceThree bordersRight borderLeft borderInferior borderFour sulcusesCoronary sulcusAnterior interventricular groovePosterior interventricular groove Interatrial sulcus,Cardiac apex 心尖Formed by left ventricle Directed downwards,forward,and to the leftLies 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 heart,Cardiac base 心底Formed by the left atrium and to a small extent by the right atrium Faces backward,upward and to the right Continuous with the large vessels,Surfaces of the heart,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 ventricleDirected forwards and upwardsLeft and right auricles 左、右心耳,Surfaces of the heart,Diaphragmatic surface 膈面Formed the ventricleschiefly the left ventricleDirected backwards and downwards,and rest upon the central tendon of the diaphragm,Surfaces of the heart,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 partly by the left auricle Inferior border 下缘HorizontalFormed by the right ventricle and cardiac apex,Surfaces of the heart,Sulci of the heart Coronary sulcus 冠状沟(circular sulcus)which marks the division between atria and ventricles,contains the trunks of the coronary vessels and completely encircles the heartInteratrial sulcus 房间沟 Separates the two atria and is hidden by pulmonary trunk and aorta in front,Surfaces of the heart,Sulci 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 RV from the LV)Cardiac apical incisure 心尖切迹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 ventricles 左、右心室,Right atrium(RA)右心房,Three inletsOrifice of superior vena cava 上腔静脉口 returns blood to the heart from the upper half of the bodyOrifice of inferior vena cava 下腔静脉口 returns blood to the heart from the lower half of the bodyOrifice of coronary sinus 冠状窦口 returns blood to the heart from the cardiac muscleOne outlet Right atrioventricular orifice 右房室口,Right atrium(RA)右心房,Crista terminalis 界嵴 Vertical ridge that from superior vena cave to inferior vena cave Sulcus terminalis界沟 Groove on exterior of heart that corresponds to crista terminalisTwo parts Separated externally by sulcus terminalis and internally by the crista terminalisAtrium proper 固有心房 In front of the crista terminalis Sinus venarum cavarum 腔静脉窦,Right atrium(RA)右心房,Atrium proper 固有心房Right auricle-心外科最常用手术入路之一Pectinate muscles in wallSinus venarum cavarum 腔静脉窦Fossa ovalis 卵圆窝An oval depression,a remnant of the fetal foramen ovaleLies on the lower part of interatrial septumThe most common location of atrial septal defects(ASD)Limbus fossae ovalis 卵圆窝缘Aortic mound 主动脉隆凸Koch triangle Koch三角,Right ventricle(RV)右心室,One inlet Right atrioventricular orifice 右房室口One outlet Orifice of pulmonary trunk 肺动脉口,Right ventricle(RV)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(conus arteriosus动脉圆锥),Right ventricle(RV)右心室,Inflow tract Tricuspid valve 三尖瓣Guards right atrioventricular orifice Three triangular cusps:anterior,posterior and septalBase of cusps are attached to fibrous Tricuspid ring surrounding the atrioventricular orifice Chordae tendineae 腱索 fibrous band that Connect the free edges and ventricular surfaces of cusps to the papillary muscles Papillary muscles 乳头肌Conical-shaped Three:anterior,posterior and septal,Trabeculae carneae 肉柱 irregularly arranged bundles of myocardium Septomarginal trabecula 隔缘肉柱/morderator band节制索extends from interventricular septum to base of anterior papillary muscle,contains right bundle branch,Right ventricle(RV)右心室,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 Function:prevent the reflow of blood from the right ventricle into right atrium,Right ventricle(RV)右心室,diastole,systole,Ant.,Post.,septal,Tricuspid valve 三尖瓣,Right ventricle(RV)右心室,Chordae tendineae,Papillary muscles,Right ventricle(RV)右心室,Function of tricuspid complexVentricles relax,blood returning to the heart fills atria,putting pressure against atrioventricular valves,atrioventricular vales forced open.,diastole,Right ventricle(RV)右心室,Function of tricuspid complex Ventricles contract,forcing blood against atrioventricular valve cusps.Atrioventricular valves closed.Papillary muscles contract and chordae tendineae tighten,preventing valve flaps from everting into atria.,systole,Right ventricle(RV)右心室,Outflow tract-Conus arteriosus 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valve of pulmonary trunk 肺动脉瓣,Right ventricle(RV)右心室,Pulmonary Valve 肺动脉瓣Guards the orifice of pulmonary trunkThree semilunar cusps each with free border that has central nodules called nodules of semilunar valve 半月瓣小结Pulmonary sinuses 肺动脉窦Bulges in wall of pulmonary trunk at level of valve that correspond to cusps FunctionPrevent the reflow of blood from the pulmonary trunk to right ventricle,Right ventricle(RV)右心室,Function of pulmonary valves As ventricles contract and intraventricular pressure rises,blood is pushed up against semilunar valves,forcing them open,Right ventricle(RV)右心室,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,左心耳Left auricles-心外科最常用手术入路之一左心房窦left atrial sinus Four inlets:orifices of pulmonary veins 肺静脉口One outlet:left atrioventricular orifice 左房室口,Left ventricle(LV)左心室,One inlet:left atrioventricular orifice 左房室口One outlet:Aortic orifice 主动脉口Two parts:Divided by anterior cusps of mitral valveInflow tractrough wallsOutflow tract Aortic vestibule 主动脉前庭Smooth area leading to aortic orifice,Mitral valve 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,Mirtal 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：prevent the reflow of blood from left ventricle into left atrium,Left ventricle(LV)左心室,Left ventricle(LV)左心室,Function of mitral complexOpen during diastole to allow blood to enter ventricles from atriaClosed during systole to prevent regurgitation of blood into atria,Left ventricle(LV)左心室,Aortic valve 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 Aortic sinus 主动脉窦 Bulges in aortic wall at level of valve that correspond to cuspsRightcontains opening of right coronary arteryLeftcontains opening of left coronary arteryPosteriorno opening Function：prevent the reflow of blood from aorta into left ventricle,L,R,P,Left ventricle(LV)左心室,Function of aortic valves Opened 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,thus closing the valve,Structures of the heart,Endocardium 心内膜 Myocardium 心肌Epicardium 心外膜,Walls of the heart,Endocardium 心内膜 Inner coat of the heart wall Continuous with the valve flaps Myocardium 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 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 ovalisASD(Atrial Septal Defect)Interventricular septum 室间隔Located between right and left ventriclesHas upper membranous part Has thick lower muscular partVSD(Ventricular Septal Defect)Atrioventricular septum 房室隔,Membranous part of interventricular septum,Muscular part of interventricular septum,Ventricular Septal Defect,Fibrous skeleton of heart 纤维骨骼,Fibrous rings that surround the atrioventricular,pulmonary,and aortic orificesLeft and right fibrous trigones,Fibrous skeleton of heart 纤维骨骼,Conduction system of heart 心传导系统,Conduction system of heart 心传导系统,窦房结,房室结,房室束,左、右束支,Purkinje 纤维,Composed of specialized myocardial cells Components Sinoatrial node 窦房结(pacemaker)Internodal tracts 结间束Atrioventricular node 房室结Atrioventricular bundle 房室束Right and left bundle branches 左、右束支Purkinje fibers(network)普肯野氏纤维网,Conduction system of heart 心传导系统,Sinuatrial node(SA node)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,Clinical tip:窦性心动过速 sinustachycardia 窦性心动过缓 sinus bradycardia,Conduction system of heart 心传导系统,Atrioventricular node(AV node)房室结 Located in the Koch triangle Under the endocardiumLower part related to membranous part of interventricular septum,房室结,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 of interventricular septum Divides into right and left bundle branches at upper border of muscular part of interventricular septum,房室束,Conduction system 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 fibresLeft bundle branchpasses down on left side of interventricular septum beneath the endocardium It usually divides into two branches,which eventually become continuous with the Purkinje fibersPurkinje network 普肯野氏纤维网 Continuous with myocardium,左、右束支,Purkinje network,Conduction system of heart 心传导系统,Arterial supply of the heart,Arteries：left coronary arteryright coronary artery,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 inferior margin of heart to posterior interventricular grooveCircumflex branch 旋支Travels to left in coronary sulcus to posterior aspect,Distribution supplies left atrium and ventricle,lesser portion of anterior wall of right ventricle,and anterior 2/3 of interventricular septum,Arterial supply of the 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 BranchesBranch of sinoatrial node 窦房结支Right marginal branch 右缘支 travels along inferior border Posteror interventricular branch 后室间支travels downward in posterior interventricular grooveit anastomosises near the apex with the anterior interventricular branch of the left coronary artery,Distributionsupplies right atrium and ventricle,posterioinferior 1/3 of interventricular septum,posterior wall of left ventricle,the sinuatrial node and atrioventricular node,Arterial supply of the heart,Thrombus in Coronary Artery Angiogram冠状动脉造影显示动脉血栓,Arterial supply of the heart,Stent in an artery,Precutaneous translaminal coronary angioplasty(PTCA),Coronary artery bypass grafting(CABG),Venous drainage of the heart,Coronary sinus 冠状窦Great cardiac vein 心大静脉Middle cardiac vein 心中静脉Small cardiac vein 心小静脉Anterior cardiac veins 心前静脉Smallest cardiac veins 心最小静脉,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 cardiac 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Serous pericardium 浆膜心包Pericardial cavity 心包腔,Pericardium 心包,Fibrous pericardium 纤维心包Attached to central tendon of diaphragm inferiorlyBlends with 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 layersContains film of pericardium fluid as a lubricant to facilitate cardiac movements,Pericardium 心包,Pericardium sinus 心包窦Formed 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 心包,Oblique sinus of pericardium 心包斜窦Cul-de-sac,posterior to heart,bounded by pulmonary veins on either sideAnterior inferior sinus of pericardium 心包前下窦,Surface markings of heart,R.superior pointLies on the upper border of right third costal cartilage 1.0cm from the margin of sternum R.inferior point Lies on the 7th 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 7-9cm from the midline,Surface markings of the Heart Valves,Tricuspid valve Lies behind the right half of the sternum opposites the fourth inter