circulatorysystem循环系统英文课件

1、Logo Anatomy Contents1 Etiology 2 Diagnosis3 Treatment 4Hypertension5第1页，共45页。AnatomyThe circulatory system consists of the heart、vessels and neurohumoral adjustable devices of blood circulation. The hearta four-chambered pump. Its pumping action creates the pressure needed to push blood in the vess

2、els to the lungs as well as to the rest of the body cells.Location of the heartThe heart lies obliquely in the mediastinum, between the lungs, inside the thoracic cavity. About 2/3 of the heart is located to the left of the midline. Shape of the heartThe heart is a hollow,four chambered muscular org

3、an, which is approximately the size and shape of a clenched fist and weighs about 250-350g in adults.第2页，共45页。第3页，共45页。General description of the heart The heart looks like flattened and rounded pyramid that has an apex, a base,two surfaces and three borders(margins).Cardiac apex The cardiac apex is

4、 a free, cone-shaped end, which is made up only by the left ventricle.The cardiac apex is located at the level of the left 5thintercostal space and 0.5-1cm medial to the midclavicular line. This location is an important one for clinical purposes；for auscultation as well as for palpation.第4页，共45页。Log

5、oCardiac base The cardiac base is primarily made up by the left atrium with a lesser contribution of the right atrium. Grooves There are three grooves on the surface of heart:the coronary sulcus, the anterior interventricular groove, the posterior interventricular groove.第5页，共45页。Chambers of the hea

6、rt The heart is a four-chambered,double pump,consisting of the right and left atria above and the right and left ventricles below.Right atrium From the right margin of the heart. Receives blood from the superior vena cava, inferior vena cava and coronary sinus.Right ventricle Blood from the right at

7、rium passes thought the tricuspid valve to fill the right ventricle.Left atrium located on the posterior aspect of the heart，receives blood from the pulmonary veinLeft ventricle The left ventricle receives the blood from the left atrium. These two chambers are separated by the bicuspid (mitral) valv

8、e. 第6页，共45页。第7页，共45页。 Structure of the heartStructure of the heart wallendocardium located in the interial surface heart atrium and ventricle wall.consist of every valve of the heart. The place is easily invased by Rheumatic diseases.myocardium the majority of the heart wall,contains myocardioventri

9、cle and myocardiatrium .the former is thicker than the latter,especially left myocardioventricle.they dont continue each other.epicardium Atrial septal ventrial septal pericardium fibrous pericardium and serous pericardium 第8页，共45页。第9页，共45页。Conduction system of the heart It consists of special myoca

10、rdial fibers, forms a knot or bundle, locates in the heart wall. The system has the character of generating excitement, conducting impulse and maintaining normal rhythm of the heart beat. sinuatrial node locates in the epicardial deep surface between superior vena cava and right auricle, normal hear

11、t pacemaker. atrioventricular node locates in the endocardial deep surface between coronary sinus and right atrioventricular orifice,conducts impulse from sinuatrial node into cardioventricle from . atrioventricular bundle the only important way of linking the heart atrium with ventrile. its branche

12、s.第10页，共45页。第11页，共45页。Heart VesselsArteries and Veins Ascending aorta Source, left ventricle of the heart; branches:left and right coronary artery, continues as aortic arch;.Left coronary artery Source, ascending aorta; branches：anterior interventricular branches and circumflex branches.Right corona

13、ry artery Source, ascending aorta；branches：sinoatrial nodal branches, right marginal branches, posterior interventricular branches, atrioventricular nodal branches.Coronary sinus formed by union of great cardiac vein and oblique vein of left atrium; tributaries:middle cardiac vein, small cardiac vei

14、n.第12页，共45页。Pathway of blood circulationsystemic circulation left ventricle contract and eject arterial blood into aorta,pass away its branches into capillaries,exchange with substances and gases by production of different tissues or cells, then transform into vein blood and return the right atrium.

15、pulmonary circulation right ventricle contract and eject phelbial blood into pulmonary artery,pass away its branches into capillaries,exchange with oxygen from lung alveoluses, then transform into arterial blood and return the left atrium.第13页，共45页。第14页，共45页。Risk factors or causes for heart diseaseS

16、moking/intemperance High cholesterol klestrl hyperlipidemiaDiabetesObesity/mal-nutrition exercise too little第15页，共45页。Family history Hypertension/hypotentionCongenital malformationPeripheral artery disease virus or bacterial infectionpoisoningAge/sexPhysiological degeneration第16页，共45页。Chronic sympto

17、mscardic symptoms chest distress palpitation angina pectorispulmonary circulation cough expectoration Hemoptysis cyanosis dyspneasystemic circulation faintness abdominal distension and pain vomiting oliguria edama headache dizziness twitching第17页，共45页。Physiological examination the most basic examina

18、tion method.the doctors get patients relative datas by their eyes，ears，noses，hands and some simple tools,such as stethoscope,thermometer,tentionmeter.1.Vital Signs heart rate , pulse, respiration, blood pressure 2.inspection Observed in patients with skin color , pay attention to whether patients wi

19、th hypopnea and other symptoms. Such as angina may be cyanotic lips , and hypertension , may appear red face . Observe whether there have precardial prominence or precardial has some abnormal cardioc apex beat.(Apex beat in the left midclavicular line at the fifth intercostal space inside 0.5 cm , p

20、ulsatility range diameter of about 2.0cm.)第18页，共45页。3.palpation Touch at the apex beat , record whether the enhanced and weakened apex beat , with or without tremor , pericardial friction sensitivity .Touch the radial artery , record pulse rate , judgement if the arterial pulsation is powerful or no

21、t, including the rhythm is or not in the low ,and comparing both sides are symmetrical ,Determine whether there is pulsus paradoxus , alternating pulse or sign of capillary pulsation,etc.第19页，共45页。4、Percussion Draw the relative cardiac dullness by the percussion of chest ,in order to determine wheth

22、er the increase or decrease of heart.第20页，共45页。5、auscultation Listen to the cardiechema of these valves by the stethooscope to determine if the rhythm is neat or not and the abnormal cardiechema.第21页，共45页。第22页，共45页。some important signs1.Cardiac enlargement2.Abnormal heart sounds and pulse beat3.Arrh

23、ythmia 4.abnormal breath sounds5.Pulmonary rales6.hepatomegaly7.Jugular vein distention8.lower extremity edema第23页，共45页。Laboratory testsThe doctors use physical , chemical and biological laboratory technology to test patients blood,fluid,secretion and tissue ,so as to obtain data and assist diagnosi

24、s and treatment.Routine conventional tests blood,urine,faece routine examinationSpecial tests 1.microbial culture: infectious heart disease 2.ASO/ESR/CRP: rheumatic heart disease 3.lipids tests : coronary atherosclerotic heart disease 4.CK/CK-MB/cTnT/cTnI : myocardial infarction and angina pectoris第

25、24页，共45页。Equipment inspectionElectrocardiogram put the electrode onto the special regions of body surface,record out continuous curve about electricardia charges with the machine. mainly diagnose : Arrhythmia and Myocardial infarction 24-hour Holter 24-hour ambulatory blood pressure第25页，共45页。Echocar

26、diography move the prode onto the heart surface regions,observe the cardiography charges of computer.mainly diagnose cardiovalvularopathy.第26页，共45页。angiocardiogram胸片Selective coronary angiography-gold standard第27页，共45页。Classfication of the heart Etiology Congenital Acquired1.Atherosclerosis2.Rheumat

27、ic3.primary hypertention4.pulmonary 5.inflectious 6.endocrinopathic7.hematopathic8.Nutritional and metabolic9.Cardiac neurosis第28页，共45页。Pathological anatomy 1.Endocardium disease(endocarditis )2.Myocardosis (myocardial ischemia )Arrhythmia(tachycardia )3.pericardial disease (hydropericardium )4.Macr

28、ovascular disease (aortic stenosis )5.congenital malformation(Congenital heart disease)第29页，共45页。Pathophysiology 1.heart failure2.shock3.dysfunction of coronary circulation4.dysfunction of Papillary muscle 5.Hyperdynamic circulation6.Cardiac tamponade第30页，共45页。DiagnosisEtiologyPathological anatomyPa

29、thophysiologyeg:Rheumatic valvular heart disease1.Rheumatic heart disease2.bicuspid valve stenosis or incompetence3.heart failure4.atrial fibrillation第31页，共45页。Prevention1.stop per rest3.more movement4.lose weight5.decompression6.controll diets7.health education8.steady emotion 第32页，共45页

30、。Treatment1.release symptoms(1)deal with the emergency conditions acute myocardial infarction, acute left heart failure (2)keep a balance of life sign (3)relieve pain 心痛定,硝酸甘油含化片 (4)swelling 速尿，螺内酯，氢氯噻嗪第33页，共45页。2.remove etiology (1)control infection antibiotic 抗生素 NSAID非甾体类抗炎药(2)control high hypert

31、ention ACEI,ARB,CCB, Diuretic drugs(3)control high cholesterol 立普妥 Inhibition of platelet aggregation drugs 阿司匹林 氯吡格雷Anticoagulant drugs 华法林Thrombolytic drugs 尿激酶(4)control high blood sugar oral medication 二甲双胍 insulin 优泌林第34页，共45页。3.intervention(1)Artificial pacemaker4.surgical operation第35页，共45页。(

32、2)The percutaneous coronary artery bypass grafting第36页，共45页。5.rehabilitation-exercise(1)ensure the indications and contraindications (2)choose suitable exercise methods: medium or low intensity aerobic exercise, such as walking, jogging, swimming,tai chi chuan and so on. (3)master exercise intensity

33、: target heart rate is often used as an evaluation index, its definition:in exercise test, by heart rate monitor machine or touching the pulse beating,we can get 60% to 80% of maximum heart rate.But if the patient cant exercise, target heart rate=170 - Age.Commonly when the patient stop motion,the d

34、octor or theorpist touches the pulse besting immediately and lists 10 seconds (radial artery / ear artery / temporal artery), then6 represents one minute pulse rate, the result is close to the heart rate of moving exercise.第37页，共45页。 (4)master exercise time: 1 to 3 hours after a meal, ready time for

35、 10 minutes, training time for 20 to 30 minutes,and finally relaxing time for 10 minutes. (5)master exercise frequency: Weekly exercise for 3 to 5 times .第38页，共45页。clinical aspect of the circulatory systermatherosclerosis The accumulation of fatty deposits within the lining of an artery is termed at

36、herosclerosis. This type of deposit ,called a laque, begins to form when a vessel receives tiny injuries, usually at a point of branching. A majoy risk factor for the development of atherosclerosis is dyslipidemia, abnormally high levels or imbalance in lipoproteins that are carried in the blood, es

37、pecially high levels of cholesterol-containing low-density lipoproteins(LDL). Other risk factors for atherosclerosis include smoking, hypertension, poor diet, inactivity, stress, and family history. Atherosclerosis may involve any arteries,but most of its effects are seen in the cornary vessels of t

38、he heart, the aorta, the crotid arteries in the neck, and vessles in the brain.第39页，共45页。thrombosis and embolism Atherosclerosis predisposes a person to thrombosis, the formation of thrombus within a vessle. Usually the mass is a blood clot that breaks loose from the wall of a vessle, but it may also be air, fat, bacteria or other solid materials. Often a verous thrombus will travel through the heart and then lodge in an artery of the lungs, resulting in a life-threatening embolism. An thrombus from a carotid artery often blocks a cerebral vessles, causing a cerebrovascula