《心脏血管系统》演示PPT

1、1 The Heart and Angiology 同济大学医学院同济大学医学院 解剖教研室解剖教研室孙红斌孙红斌2Composition Cardiovascular system心血管系统心血管系统 Lymphatic system 淋巴系统淋巴系统3The cardiovascular systemOrganization Heart 心心 A muscle pump to maintain the flow of blood, Consist of four chambers (right and left atria, right and left ventricles) Arter

2、y 动脉动脉 a. carry blood away from the heart Veins 静脉静脉 v. carry blood back to the heart Capillary 毛细血管毛细血管microscopic vessels, the area of exchange between blood and tissue fluid 4Blood circulation Systemic circulation 体循体循环环 left ventricleaorta and its branchescapillaries of bodysuperior and inferior

3、 vena cavaright atrium Pulmonary circulation 肺循肺循环环right ventriclepulmonary a.capillaries of lungpulmonary v.right atrium5 Vascular anastomosis 血管吻血管吻合合 Anastomosis between a. Anastomosis between v. Arteriolovenular anastomosis 动静脉吻合 Collateral vessels侧副管 Circulation侧支循环6Rectal venous plexus7Positio

4、n Lies within the pericardium in middle mediastinum Behind the body of sternum and coastal cartilages 2 to 6 In front of thoracic vertebrae 5 to 8 A third of it lies to the right of median plan and 2/3 to the left89External characteristicsa hollow muscular organ, pyramidal in shape , somewhat larger

5、 than a closed fist; consists of four chanbers (right and left atria, right and left ventricles) Cardiac apex is formed by left ventricle and is directed downwards and forwards to the left. It lies at the level of the fifth left intercostal space, 12cm medial to the left midclavicular line (9cm from

6、 the midline) Cardiac base is formed by the left atrium and to a small extent by the right atrium. It faces backward, upward and to the right 10Two surface Sternocostal surface is formed mainly by the right atrium and right ventricle, and a lesser portion of its left is formed by the left auricle an

7、d ventricle. It is directed forwards and upwards Diaphragmatic surface is formed the ventricleschiefly the left ventricle, directed backwards and downwards, and rest upon the central tendon of the diaphragm11Three borders Right bordervertical, is formed entirely by right atrium Left borderround, is

8、mainly formed by the left ventricle and partly by the left auricle Inferior borderhorizontal, is formed by the right ventricle and cardiac apex12Four groovesCoronary sulcus 冠状沟冠状沟(circular sulcus) which marks the division between atria and ventricles, contains the trunks of the coronary vessels and

9、completely encircles the heartInteratrial sulcus 房间沟房间沟separates the two atria and is hidden by pulmonary trunk and aorta in frontInterventricular grooves 室间沟室间沟anterior and posterior, mark the division between ventricles (which separates the RV from the LV), the two grooves extend from the base of

10、the ventricular potion to a notch called: the cardiac apical incisure 心尖切迹心尖切迹Atrioventricular crux 房室交点房室交点a junction of the posterior interventricular groove and coronary sulcus 13Chambers of the heartRight atrium 右心房右心房 (RA)Three inletsOrifice of superior vena cava 上腔静脉口上腔静脉口returns blood to the

11、heart from the upper half of the bodyOrifice of inferior vena cava 下腔静脉口下腔静脉口 returns blood to the heart from the lower half of the bodyOrifice of coronar sinus 冠状窦口冠状窦口 returns blood to the heart from the cardiac muscle One outle right atrioventricular orifice 右房室口右房室口14 Crista terminalis界嵴界嵴 verti

12、cal ridge thatjfrom superior vena cave to inferior vena cave Sulcus terminalis 界沟界沟 groove on exterior of heart that corresponds to crista terminalisTwo partsseparated externally by sulcus terminalis and internally by the crista terminalis Atrium proper 固有心房固有心房 In front of the ridge Pectinate muscl

13、es in wall Right auricle 右心耳右心耳a small conical muscular pouch, projects to the left from the root of superior vena cava, pectinate muscles in wall15 Sinus venarum cavarum 腔静脉窦腔静脉窦 Lies posterior to the ridge Smooth walls Fossa ovalis 卵圆窝卵圆窝an oval depression, a remnant of the fetal foramen ovale, on

14、 the lower part of interatrial septum, the most common location of atrial septal defects (ASD) Limbus fossae ovalis 卵圆窝卵圆窝缘缘 prominent margin of fossa ovalis Torus aortious 主动脉隆凸主动脉隆凸1617Right ventricle (RV) 右心室右心室 Receives deoxygenated blood from right atrium through right atrioventricular orifice

15、One inletright artrioventricular orifice 右房室右房室口口 One outletorifice of pulmonary trunk 肺动脉口肺动脉口 Two partsdivided by the supraventricular crest 室上嵴室上嵴, a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk 18Inflow tractrough walls Trabeculae carneae肉柱肉柱 irregularly a

16、rranged bundles of myocardium Septomarginal trabecula 隔缘肉柱隔缘肉柱extends from interventricular septum to base of anterior papillary muscle, contains right bundle branch Papillary muscles乳头肌乳头肌conical-shaped , anterior, posterior and septalOut flow tract Conus arteriosus 动脉圆锥动脉圆锥 cone-shaped, smooth are

17、a leading upward to orifice of pulmonary trunk Pumps blood through pulmonary orifice to pulmonary trunk19 Left atrium (LA) 左心房左心房 Left auricle左心耳左心耳projecting to the right, pectinate muscles in wall Four inletsfour orifices of pulmonary veins 肺静脉口肺静脉口open through the posterior wall One outletleft at

18、rioventricular orifice左房室口左房室口, blood leaves through left atrioventricular orifice to left ventricle20Left ventricle (LV) 左心室左心室 Has wall three times thicker than that of right ventricle One inletleft atrioventricular orifice 左房左房室口室口 One outletaortic orifice 主动脉口主动脉口 Two partsdivided by anterior cu

19、sps of mitral valve Inflow tractrough walls Outflow tract aortic vestibule 主动脉前庭主动脉前庭, smooth area leading to aortic orifice21Valves Tricuspid valve 三尖瓣三尖瓣Guards right atrioventricular orifice Three triangular cusps: anterior, posterior and septal, the base of cusps are attached to fibrous ring surr

20、ounding the atrioventricular orificeChordae tendineae 腱索腱索fine, white, connective tissue cords, attach margin of cusps to papillary muscles 乳头肌乳头肌22Mitral valve 二尖瓣二尖瓣Guards left atrioventricular orifice Two triangular cuspsanterior and posterior with commissural cusps between them (posteromedial an

21、d anterolateral commissures)Similar structures to those of right 2324Valve of pulmonary trunk 肺动脉瓣肺动脉瓣Guards the orifice of pulmonary trunkHas three semilunar cusps each with free border that has central nodules of semilunar valve 半月瓣小结半月瓣小结25Aorti vavle 主动脉瓣主动脉瓣Guards the aortic orificeThree semilu

22、nar cusps (right, left and post)Three aortic sinuses bulges in aortic wall at level of valve that correspond to cuspsRightcontains opening of right coronary arteryLeftcontains opening of left coronary arteryPosteriorno opening 26Similar functions for pulmonary and aortic valvesOpening during systole

23、, 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 27Structure of the heartWalls of heart Endocardium心内膜心内膜inner coat of the heart wall,

24、and continuous with the valve flaps Myocardium 心肌心肌 Arranged spirally Attached to fibrous rings surrouding the four orifices of heart Epicardium 心外膜心外膜serous membrane (visceral pericardium)28Interatrial septum 房间隔房间隔 Located between right and left atria Contains fossa ovalis and limbusInterventricul

25、ar septum 室间隔室间隔 Located between right and left ventricles Has upper membranous part Has thick lower muscular part 29Fibrous skeleton 纤维骨纤维骨骼骼 Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices Left and right fibrous trigons30Conduction system of heart心传导心传导系系 Consists

26、of specialized myocardial cellsSinuatrial node 窦房结窦房结(SA node) Called the pacemaker cell (P cell) Located at the junction of right atrium and superior vena cava, upper part of the sulcus terminalis, under the epicardium31Atrioventricular node 房室结房室结 (AV node) Located in the lower part of interatrial

27、 septum just above the orifice of coronary sinus, under the endocardium Lower part related to membranous part of interventricular septumAtrioventricular bundle 房室束房室束 (AV bundle) Passes forward through right fibrous trigon to reach inferior border of membranous part Divides into right and left bundl

28、e branches at upper border of muscular part of interventricular septum 32Right and left bundle branches 左、右束支左、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

29、with the fibers of Purkinje fibres Left 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 fibers 普肯野氏纤维普肯野氏纤维 continuous with myocardium33 Arterial supply

30、Left coronary artery 左冠状动左冠状动脉脉 Arises from left aortic sinus Runs between pulmonary trunk and left auricle into coronary sulcus BranchesAnterior interventricular branch 前室间支前室间支travels downward in anterior interventricular groove around inferior margin of heart to posterior interventricular grooveC

31、ircumflex branch 旋支旋支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 34Right coronary artery 右冠状动脉右冠状动脉Arises from the right aortic sinus Runs forwar

32、d between right auricle and pulmonary trunk into coronary sulcus BranchesRight marginal branch 右缘支右缘支 travels along inferior bord Posteror interventricular branch 后室间支后室间支travels downward in posterior interventricular groove, it anastomosises near the apex with the anteriorinterventricular branch of

33、 the left coronary arteryDistribution: supplies right atrium and ventricle, posterior 1/3 of interventricular septum, posterior wall of left ventricle, the sinuatrial node and atrioventricular node3536Venous drainage Coronary sinus 冠状冠状窦窦 Located in posterior part of coronary sinus Carries most of v

34、enous blood from myocardium to right atrium Tributaries Great cardiac vein 心大静心大静脉脉 Middle cardiac vein 心中心中静脉静脉 Small cardiac vein 心小静心小静脉脉37Anterior cardiac veins 心前静脉心前静脉34 small vessels, drain into right atrium Smallest cardiac veins 心最小静脉心最小静脉drain into all chambers, mainly atria38Pericardium 心

35、包心包Fibrous pericardium 纤维心纤维心包包 Attached to central tendon of diaphragm inferiorly Blends with outer coat of great vessels superiorlySerous pericardium 浆膜心浆膜心包包 Visceral pericardium (epicardium) Parietal pericardiumPericardial cavity 心包腔心包腔 Potential space between visceral and parietal pericardium C

36、ontains film of pericardium fluid 39Pericardium sinusTransverse sinus of pericardium 心包横窦心包横窦posterior to ascending aorta and pulmonary trunk, anterior to superior vena cava and left atrium.Oblique sinus of pericardium 心包斜窦心包斜窦cul-de-sac , posterior to heart, bounded by pulmonary veins on either sid

37、e40Surface markings of heart Right bordercorresponds to a line running from the upper border of right third costal cartilage 1.2cm from the margin of sternum, downwards to sixth sternocostal joint Apexin the fifth left intercostal space 79cm from the midline Left borderrepresented by a line running

38、from apex upwards and medially to a point on lower border of left second costal cartilage 1.2cm from sternal margin Lower borderrepresented by a line joint the lower end of right border to apex 41Dissection of the heart42The ArteriesCharacteristicsSymmetry 对称In the trunk of the body consist parietal

39、 and visceral branches 壁支和脏支Shortest possible course Run on flexor surfaces Usually do not pass directly through muscles, avoiding compressionTogether with the veins and nerves in a sheath of fascia to form neurovascular bundle 血管神经束43Arteries of pulmonary circulation 肺循环的动脉Pulmonary trunk 肺动脉肺动脉干干A

40、rises from right ventricle Runs up, back ,and to the leftBifurcates inferior to aortic arch into right and left pulmonary arteries, one for each lung 44Arteries of systemic circulation 体循环的动脉体循环的动脉Aorta 主动脉主动脉 Ascending aorta 升主动脉升主动脉 Aortic arch 主动脉弓主动脉弓 Brachiocephalic trunk 头臂干头臂干 right common ca

41、rotid a. 右颈总动右颈总动脉脉 right subclavian a. 右锁骨下动脉右锁骨下动脉 Left common carotid a. 左颈总动左颈总动脉脉 Left subclavian a. 左锁骨下动脉左锁骨下动脉 Descending aorta 降主动脉降主动脉 Thoracic aorta 胸主动脉胸主动脉 Abdominal aorta 腹主动脉腹主动脉45Arteries of head and neck Common carotid a.颈总动颈总动脉脉 External carotid a. 颈外动脉颈外动脉 Internal carotid a. 颈内动脉

42、颈内动脉 Subclavian a. 锁骨下动脉锁骨下动脉 46Arteries of upper limb Axillary a. 腋动脉腋动脉 Brachial a. 肱动脉肱动脉 Radial a. 桡动脉桡动脉 Ulnar a. 尺动脉尺动脉 Superficial palmar arch 掌浅弓掌浅弓 deep palmar arc 掌深掌深弓弓47Thoracic aorta 胸主动脉胸主动脉Parietal branches 壁支 Nine pairs posterior intercostals arteries 肋间后动肋间后动脉脉 One pair subcostal 肋下

43、动脉肋下动脉Visceral branches 脏支48Abdominal aorta 腹主动脉腹主动脉Visceral branches 脏支脏支 Paired branches Middle suprarenal artery 肾上腺中动脉肾上腺中动脉 Renal artery 肾动脉肾动脉 Testicular (ovarian) artery 睾丸（卵巢）动脉睾丸（卵巢）动脉 Unpaired branches Celiac trunk 腹腔干腹腔干 Superior mesenteric a. 肠系膜上动脉肠系膜上动脉 Inferior mesenteric a. 肠系膜下动脉肠系膜

44、下动脉Parietal branches49Arteries of pelvis Common iliac a. 髂总动髂总动脉脉 Internal iliac a. 髂内动脉髂内动脉 External iliac a. 髂外动脉髂外动脉50Arteries of lower limb Femoral a. 股动脉股动脉 Popliteal a. 腘动脉腘动脉 Posterior tibial a. 胫后动脉胫后动脉 Anterior tibial a. 胫前动脉胫前动脉 dorsal a. of foot 足背动脉足背动脉51The Veins 静脉静脉General feature Thin walls, larger lumens, veno