心脏起搏器培训资料：心脏的解剖和生理

1、1 Cardiac Anatomy & Physiology 2 心脏的解剖和生理 3 Reference Points Anatomical locations Lateral Side Lateral Side Posterior Back Midline Medial Inferior Bottom Superior Top Distal Farthest Anterior Front Proximal Nearest 4 观察点 解剖位置解剖位置 侧面侧面 Side 侧面侧面 Side 后面后面 Back Midline 中间中间 下面下面 Bottom 上面上面 Top 远端远端 F

2、arthest 前面前面 Front 近端近端 Nearest 5 Location Midline Apex Between the lungs and behind the sternum 6 位置 中线中线 心尖部心尖部 心脏在两肺之间，胸骨的后面心脏在两肺之间，胸骨的后面 7 Wall & Covering Endocardium Myocardium Pericardial Sac Epicardium Coronary Artery Tissue surrounding the heart 8 心脏壁和遮盖物 心内膜心内膜 心肌心肌 心包心包 心外膜心外膜 冠状冠状 动脉动脉 围绕

3、着心脏的组织围绕着心脏的组织 9 Chambers 4 chambers Right Atrium Right Ventricle Left Atrium Left Ventricle 10 心腔 4个心腔个心腔 右心房右心房 右心室右心室 左心房左心房 左心室左心室 11 Valves Right Atrium Right Ventricle Left Atrium Left Ventricle 4 sets of valves Pulmonic Valve Mitral Valve Aortic Valve Tricuspid Valve 12 瓣膜 右心房 右心室 左心房 左心室 4个瓣

4、膜个瓣膜 肺动脉瓣肺动脉瓣 二尖瓣二尖瓣 主动脉瓣主动脉瓣 三尖瓣三尖瓣 13 Interior View Arteries to Head & Arms Superior Vena Cava Pulmonary Valve Left Coronary Artery Aortic Valve Mitral Valve Aortic Arch Tricuspid Valve Right Coronary Artery A look inside 14 内部观 至头和手臂的动脉至头和手臂的动脉 上腔静脉上腔静脉 肺动脉瓣肺动脉瓣 左冠状动脉左冠状动脉 主动脉瓣主动脉瓣 二尖瓣二尖瓣 主动脉弓主动脉

5、弓 三尖瓣三尖瓣 右冠状动脉右冠状动脉 从内部看从内部看 15 Anterior View Right Coronary Artery Right VentricleLeft Ventricle Left Coronary Artery Left Atrium Great Cardiac Vein Right Atrium Anterior / Exterior 16 前面观 右冠状动脉右冠状动脉 右心室右心室左心室左心室 左冠状动脉左冠状动脉 左心房左心房 心大静脉心大静脉 右心房右心房 从前面看从前面看 17 Posterior View Backside Left Circumflex

6、Coronary Artery Coronary Sinus Interior Vena Cava Left Ventricle Right Ventricle Right Coronary Artery Pulmonary Veins Aortic Arch Superior Vena Cava 18 后面观 左冠状动脉回旋支左冠状动脉回旋支 冠状静脉窦冠状静脉窦 下腔静脉下腔静脉 左心室左心室右心室右心室 右冠状动脉右冠状动脉 肺静脉肺静脉 主动脉弓主动脉弓 上腔静脉上腔静脉 从后面看从后面看 19 Superior View Tricuspid ValvePulmonary Veins

7、Right Atrium Aortic Valve Pulmonary Valve Left Atrium Mitral Valve Looking down at the valves 20 上面观 三尖瓣三尖瓣 肺静脉肺静脉 右心房右心房 主动脉瓣主动脉瓣 肺动脉瓣肺动脉瓣 左心房左心房 二尖瓣二尖瓣 从上往下看瓣膜从上往下看瓣膜 21 Fluoroscopic Imaging Anterior Posterior view (AP) AP (also sometimes called PA) is a straight-down view into the heart. The x-ra

8、y tube and intensifier line up directly over the spine and sternum. Spine is slightly left of the heart on the image Sternum is directly over the spine Ribs angle downward Silhouette of heart is right of center on image 22 透视影像 前后位前后位(AP) AP (有时也称作PA) 是心脏的正面观，X线球管和影 像增强仪与脊柱和胸骨在一条直 线上 影像上脊柱在心脏的稍左侧 胸骨

9、在脊柱的正上方 肋骨的角度向下 心脏的轮廓在影像中心偏右侧 23 24右心室 左心室 右心房 左心耳 二尖瓣环 三尖瓣环 主动脉瓣环 肺动脉瓣环 右肺静脉 右肺动脉 上腔静脉 左肺静脉 肺动脉干 下腔静脉 膈肌 主动脉 25 Right Anterior Oblique View Right anterior oblique (RAO) view: Long axis view of the heart Spine to the left Sternum to the right Perpendicular to the intraventricular septum 26 右前斜位 右前斜位

10、(RAO): 观察心脏“长轴” 脊柱在左侧 胸骨在右侧 垂直于室间隔 27 28 二尖瓣环 三尖瓣环 左心室 右心室 主动脉瓣环 主动脉 右心 房 肺动脉瓣环 肺动脉干 29 Right Anterior Oblique View RA RV IVC SVC 30 右前斜位 RA RV IVC SVC 31 Left Anterior Oblique View In the LAO view, you will see: The spine rightward of the heart The sternum to the left The ribs angled downward to th

11、e left The short axis silhouette of the heart In LAO, the left ventricle will have: The septal wall to the left of the image The lateral wall to the right of the image 32 左前斜位(LAO) 在LAO位, 可见到: 脊柱在心脏的右侧 胸骨在左侧 肋骨角度向左向下 心脏的短轴轮廓 在LAO位, 左心室: 间隔壁在影像的左侧 侧壁在影像的右侧 33 Left Anterior Oblique view 34 左前斜位 35 Lef

12、t Anterior Oblique View TVMV CS 36 左前斜位 TVMV CS 37 Veins & Arteries Arteries High- pressure system moves blood from heart Smooth muscle in vessel walls facilitates perfusion Arterioles connect to capillaries Veins Low- pressure system returns blood to heart Intravascular valves facilitate return of

13、blood Venules connect to capillaries End-to-end a 5,000 mile span 38 静脉和动脉 动脉 高压系统，将 心脏的血液运 送至全身 血管壁上的平 滑肌有利于灌 注 小动脉与毛细 血管连接 静脉 低压系统，回 收血液至心脏 血管内的瓣膜 有利于血液回 收 小静脉与毛细 血管连接 起始到结束的距离约起始到结束的距离约5000英里英里 39 Capillaries CapillariesTissue Cells VenuleArteriole Artery From heart Vein To heart The connection b

14、etween arteries & veins 40 毛细血管 毛细血管毛细血管组织细胞组织细胞 小静脉小静脉小动脉小动脉 动脉动脉 从心脏 静脉静脉 至心脏 动脉和静脉之间的连接动脉和静脉之间的连接 41 Rhythmic Cycle Contraction / Relaxation Valves play key roles in the hearts one-way blood flow Pressure changes in the chambers and vessels facilitate the valves to open and close tightly, prevent

15、ing the backflow of blood Systole contraction occurs Diastole rest between contractions 42 有节奏的周期 收缩收缩/舒张舒张 在心脏单向血流中，瓣膜起到了关键作用 心腔和血管内压力的变化有利于瓣膜打开和紧密关闭，阻止血液 倒流 收缩期收缩期 发生收缩 舒张期舒张期 收缩之间 的休息 43 Right Heart Right Pulmonary Artery Right Atrium Lobar Branches to Right Lung Right Ventricle Left Ventricle Le

16、ft Atrium Pulmonary Vein Lobar Branches to Left Lung Tricuspid Valve Left Pulmonary Artery Pulmonary Vein Aortic Arch Lung Pump Superior Vena Cava Inferior Vena Cava Superior Vena Cava Inferior Vena Cava Right Pulmonary Artery 44 右心 右心房右心房 右肺动脉分支右肺动脉分支 右心室右心室 左心室 左心房 肺静脉 三尖瓣三尖瓣 左肺动脉 肺静脉肺静脉 主动脉弓 肺泵肺泵

17、 上腔静脉上腔静脉 下腔静脉下腔静脉 右肺动脉右肺动脉 左肺动脉分支左肺动脉分支 45 Left Heart Right Pulmonary Artery Superior Vena Cava Inferior Vena Cava Right Atrium Lobar Branches to Right Lung Right Ventricle Left Ventricle Left Atrium Pulmonary Vein Lobar Branches to Left Lung Tricuspid Valve Left Pulmonary Artery Pulmonary Vein Aor

18、ta Aorta Arch Body Pump Left Atrium Left Ventricle Aorta 46 左心 右肺动脉 上腔静脉 下腔静脉 右心房 右肺动脉分支 右心室 肺静脉肺静脉 左肺动脉分支左肺动脉分支 三尖瓣 左肺动脉左肺动脉 肺静脉 Aorta 主动脉弓主动脉弓 体泵体泵 左心房左心房 左心室左心室 主动脉主动脉 47 Systemic & Pulmonary Circulation Head & Upper Limbs Arms Heart Digestive Tract Kidneys Lungs Trunk & Upper Limbs Systemic Circ

19、ulation Systemic Circulation Pulmonary Circulation How blood flows through the body 48 体循环和肺循环 头和上肢头和上肢 手臂手臂 心脏心脏 消化道消化道 肾脏肾脏 肺肺 躯干和上肢躯干和上肢 体循环体循环 体循环体循环 肺循环肺循环 血液是如何流向身体的血液是如何流向身体的 49 Myocardial Infarction What happens during a heart attack Damaged Heart Muscle Occluded Coronary Artery Ischemia dec

20、rease in blood supply leading to hypoxia Infarction tissue death caused by lack of oxygen Arrhythmias force or rhythm irregularities When a coronary artery is blocked, oxygenated blood cant reach cells downstream 50 心肌梗死 心肌梗死时发生了什么心肌梗死时发生了什么 坏死的心肌坏死的心肌 阻塞的冠状动脉阻塞的冠状动脉 缺血 血液供应减 少，导致组织缺氧 坏死 由于缺氧导 致组织死亡

21、 心律失常 使节律不规则 当冠状动脉被阻塞时，含氧的血液不能到达下游细胞 51 Ejection Fraction Cardiac OutputStroke Volume Heart RateHR EF Performance 4 key measurements (CO, SV, HR, EF) Volume of blood pumped from the heart in a minute Volume of blood pumped from the heart during a single contraction Number of heartbeats per minute Percent of blood pumped from the heart per stroke CO = HR x SV Normal = 4-8 L/minute EF = Volume Ejected Total Volume Normal = 50-60% Systolic Heart Failure = EF of 40% COSV 52 射血分数射血分数 心输出量心输出量每搏输出量每搏输出量 心率心率 HREF 评估指标 4个主要评估指标个主要评估指标 (CO, SV, HR, EF