《心臟血管系統(tǒng)》ppt課件

1、 The Heart and Angiology 同濟(jì)大學(xué)醫(yī)學(xué)院同濟(jì)大學(xué)醫(yī)學(xué)院 解剖教研室解剖教研室孫紅斌孫紅斌Composition Cardiovascular system心血管系統(tǒng)心血管系統(tǒng) Lymphatic system 淋巴系統(tǒng)淋巴系統(tǒng)The 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) Artery 動脈

2、動脈 a. carry blood away from the heart Veins 靜脈靜脈 v. carry blood back to the heartCapillary 毛細(xì)血管毛細(xì)血管microscopic vessels, the area of exchange between blood and tissue fluid Blood circulation Systemic circulation 體循體循環(huán)環(huán) left ventricleaorta and its branchescapillaries of bodysuperior and inferior vena

3、cavaright atrium Pulmonary circulation 肺肺循環(huán)循環(huán)right ventriclepulmonary a.capillaries of lungpulmonary v.right atrium Vascular anastomosis 血管吻血管吻合合 Anastomosis between a. Anastomosis between v. Arteriolovenular anastomosis 動靜脈吻合 Collateral vessels側(cè)副管 Circulation側(cè)支循環(huán)Rectal venous plexusPositionLies wit

4、hin 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 leftExternal characteristicsa hollow muscular organ, pyramidal in shape , somewhat larger than a clos

5、ed 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 the midline)

6、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 Two surfaceSternocostal surface is formed mainly by the right atrium and right ventricle, and a lesser portion of its left is formed by the left auricle and ventricle. It i

7、s directed forwards and upwardsDiaphragmatic surface is formed the ventricleschiefly the left ventricle, directed backwards and downwards, and rest upon the central tendon of the diaphragmThree bordersRight bordervertical, is formed entirely by right atrium Left borderround, is mainly formed by the

8、left ventricle and partly by the left auricle Inferior borderhorizontal, is formed by the right ventricle and cardiac apexFour groovesCoronary sulcus 冠狀溝冠狀溝(circular sulcus) which marks the division between atria and ventricles, contains the trunks of the coronary vessels and completely encircles th

9、e heartInteratrial sulcus 房間溝房間溝separates the two atria and is hidden by pulmonary trunk and aorta in frontInterventricular grooves 室間溝室間溝anterior and posterior, mark the division between ventricles (which separates the RV from the LV), the two grooves extend from the base of the ventricular potion

10、to a notch called: the cardiac apical incisure 心尖切跡心尖切跡Atrioventricular crux 房室交點房室交點a junction of the posterior interventricular groove and coronary sulcus Chambers of the heartRight atrium 右心房右心房 (RA)Three inletsOrifice of superior vena cava 上腔靜脈口上腔靜脈口returns blood to the heart from the upper half

11、 of the bodyOrifice of inferior vena cava 下腔靜脈口下腔靜脈口 returns blood to the heart from the lower half of the bodyOrifice of coronar sinus 冠冠狀竇口狀竇口 returns blood to the heart from the cardiac muscle One outle right atrioventricular orifice 右房室口右房室口 Crista terminalis界嵴界嵴 vertical ridge thatjfrom superio

12、r vena cave to inferior vena cave Sulcus terminalis 界溝界溝 groove on exterior of heart that corresponds to crista terminalis Two 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 muscles in wall Right auricle 右

13、心耳右心耳a small conical muscular pouch, projects to the left from the root of superior vena cava, pectinate muscles in wall Sinus venarum cavarum 腔靜脈竇腔靜脈竇 Lies posterior to the ridge Smooth walls Fossa ovalis 卵圓窩卵圓窩an oval depression, a remnant of the fetal foramen ovale, on the lower part of interatri

14、al septum, the most common location of atrial septal defects (ASD) Limbus fossae ovalis 卵圓卵圓窩緣窩緣 prominent margin of fossa ovalis Torus aortious 自動脈隆凸自動脈隆凸Right ventricle (RV) 右心室右心室 Receives deoxygenated blood from right atrium through right atrioventricular orificeOne inletright artrioventricular

15、orifice 右房室口One outletorifice of pulmonary trunk 肺動脈口Two partsdivided by the supraventricular crest 室上嵴, a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk Inflow tractrough wallsTrabeculae carneae肉柱肉柱 irregularly arranged bundles of myocardiumSeptomarginal trabec

16、ula 隔緣肉柱隔緣肉柱extends from interventricular septum to base of anterior papillary muscle, contains right bundle branch Papillary muscles乳頭肌乳頭肌conical-shaped , anterior, posterior and septalOut flow tractConus arteriosus 動脈圓錐動脈圓錐 cone-shaped, smooth area leading upward to orifice of pulmonary trunkPumps

17、 blood through pulmonary orifice to pulmonary trunk Left atrium (LA) 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 肺靜脈口肺靜脈口open through the posterior wall One outletleft atrioventricular orifice左房室口左房室口, blood leaves through left

18、 atrioventricular orifice to left ventricleLeft ventricle (LV) 左心室左心室 Has wall three times thicker than that of right ventricle One inletleft atrioventricular orifice 左房室口 One outletaortic orifice 自動脈口 Two partsdivided by anterior cusps of mitral valve Inflow tractrough walls Outflow tract aortic ve

19、stibule 自動脈前庭, smooth area leading to aortic orificeValves 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 surrounding the atrioventricular orificeChordae tendineae 腱索腱索fine, white, con

20、nective tissue cords, attach margin of cusps to papillary muscles 乳頭乳頭肌肌Mitral valve 二尖瓣二尖瓣Guards left atrioventricular orifice Two triangular cuspsanterior and posterior with commissural cusps between them (posteromedial and anterolateral commissures)Similar structures to those of right Similar fun

21、ctions for right and left atriventricular valvesOpen during diastole to allow blood to enter ventricles from atriaClosed during systole to prevent regurgitation of blood into atriaValve of pulmonary trunk 肺動脈瓣肺動脈瓣Guards the orifice of pulmonary trunkHas three semilunar cusps each with free border th

22、at has central nodules of semilunar valve 半月半月瓣小結(jié)瓣小結(jié)Aorti vavle 自動脈瓣自動脈瓣Guards the aortic orificeThree semilunar 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

23、 coronary arteryPosteriorno opening Similar functions for pulmonary and aortic valvesOpening 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, th

24、us closing the valve Structure of the heartWalls of heartEndocardium心內(nèi)膜心內(nèi)膜inner coat of the heart wall, and continuous with the valve flapsMyocardium 心肌心肌Arranged spirallyAttached to fibrous rings surrouding the four orifices of heartEpicardium 心外膜心外膜serous membrane (visceral pericardium)Interatrial

25、 septum 房間房間隔隔Located between right and left atria Contains fossa ovalis and limbusInterventricular septum 室間隔室間隔Located between right and left ventriclesHas upper membranous part Has thick lower muscular part Fibrous skeleton 纖維纖維骨骼骨骼 Fibrous rings that surround the atrioventricular, pulmonary, and

26、 aortic orificesLeft and right fibrous trigonsConduction system of heart心傳導(dǎo)心傳導(dǎo)系系 Consists of specialized myocardial cells Sinuatrial node 竇房結(jié)(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 epi

27、cardiumAtrioventricular node 房室結(jié)房室結(jié) (AV node)Located in the lower part of interatrial septum just above the orifice of coronary sinus, under the endocardiumLower part related to membranous part of interventricular septumAtrioventricular bundle 房室束房室束 (AV bundle)Passes forward through right fibrous t

28、rigon to reach inferior border of membranous part Divides into right and left bundle branches at upper border of muscular part of interventricular septum Right 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 trabec

29、ular 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

30、fibersPurkinje fibers 普肯野氏纖維普肯野氏纖維 continuous with myocardium Arterial supplyLeft coronary artery 左冠狀左冠狀動脈動脈Arises from left aortic sinusRuns between pulmonary trunk and left auricle into coronary sulcusBranchesAnterior interventricular branch 前室間支前室間支travels downward in anterior interventricular gr

31、oove around inferior margin of heart to posterior interventricular grooveCircumflex branch 旋支旋支travels to left in coronary sulcus to posterior aspectDistributionsupplies left atrium and ventricle, lesser portion of anterior wall of right ventricle, and anterior 2/3 of interventricular septum Right c

32、oronary artery 右冠狀動脈右冠狀動脈Arises from the right aortic sinus Runs forward between right auricle and pulmonary trunk into coronary sulcus BranchesRight marginal branch 右緣支右緣支 travels along inferior bord Posteror interventricular branch 后室間支后室間支travels downward in posterior interventricular groove, it

33、anastomosises near the apex with the anteriorinterventricular branch of 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 nodeVenous drainage Coronary sinus 冠

34、狀冠狀竇竇Located in posterior part of coronary sinus Carries most of venous blood from myocardium to right atrium Tributaries Great cardiac vein 心心大靜脈大靜脈Middle cardiac vein 心中靜脈心中靜脈Small cardiac vein 心心小靜脈小靜脈Anterior cardiac veins 心前靜脈心前靜脈34 small vessels, drain into right atrium Smallest cardiac veins

35、心最小靜脈心最小靜脈drain into all chambers, mainly atriaPericardium 心包心包Fibrous pericardium 纖維纖維心包心包Attached to central tendon of diaphragm inferiorlyBlends with outer coat of great vessels superiorlySerous pericardium 漿膜心漿膜心包包Visceral pericardium (epicardium)Parietal pericardiumPericardial cavity 心包腔心包腔Pote

36、ntial space between visceral and parietal pericardium Contains film of pericardium fluid Pericardium sinusTransverse sinus of pericardium 心包橫竇心包橫竇posterior to ascending aorta and pulmonary trunk, anterior to superior vena cava and left atrium.Oblique sinus of pericardium 心包斜竇心包斜竇cul-de-sac , posteri

37、or to heart, bounded by pulmonary veins on either sideSurface 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 th

38、e midline Left borderrepresented by a line running 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 Dissection of the heartThe ArteriesCharacteristicsSymme

39、try 對稱In the trunk of the body consist parietal and visceral branches 壁支和臟支Shortest possible courseRun on flexor surfacesUsually do not pass directly through muscles, avoiding compressionTogether with the veins and nerves in a sheath of fascia to form neurovascular bundle 血管神經(jīng)束Arteries of pulmonary

40、circulation 肺循環(huán)的動脈肺循環(huán)的動脈Pulmonary trunk 肺動脈肺動脈干干Arises from right ventricle Runs up, back ,and to the leftBifurcates inferior to aortic arch into right and left pulmonary arteries, one for each lung Arteries of systemic circulation 體循環(huán)的動脈體循環(huán)的動脈Aorta 自動脈自動脈Ascending aorta 升自動脈升自動脈Aortic arch 自動脈弓自動脈弓

41、Brachiocephalic trunk 頭臂干頭臂干right common carotid a. 右右頸總動脈頸總動脈right subclavian a. 右鎖骨下右鎖骨下動脈動脈Left common carotid a. 左頸左頸總動脈總動脈Left subclavian a. 左鎖骨下左鎖骨下動脈動脈Descending aorta 降自動脈降自動脈Thoracic aorta 胸自動脈胸自動脈Abdominal aorta 腹自動脈腹自動脈Arteries of head and neckCommon carotid a.頸總動頸總動脈脈External carotid a.

42、頸外動頸外動脈脈Internal carotid a. 頸內(nèi)動脈頸內(nèi)動脈Subclavian a. 鎖骨下動脈鎖骨下動脈 Arteries of upper limbAxillary a. 腋動脈腋動脈Brachial a. 肱動脈肱動脈Radial a. 橈動脈橈動脈Ulnar a. 尺動脈尺動脈Superficial palmar arch 掌淺弓掌淺弓deep palmar arc 掌深掌深弓弓Thoracic aorta 胸自動脈Parietal branches 壁支Nine pairs posterior intercostals arteries 肋間后動脈One pair su

43、bcostal 肋下動脈Visceral branches 臟支Abdominal aorta 腹自動脈腹自動脈Visceral branches 臟支臟支Paired branchesMiddle suprarenal artery 腎上腺中動脈腎上腺中動脈Renal artery 腎動脈腎動脈Testicular (ovarian) artery 睪丸卵巢睪丸卵巢動脈動脈Unpaired branchesCeliac trunk 腹腔干腹腔干Superior mesenteric a. 腸系膜上動脈腸系膜上動脈Inferior mesenteric a. 腸系膜下動脈腸系膜下動脈Parie

44、tal branchesArteries of pelvisCommon iliac a. 髂總動髂總動脈脈Internal iliac a. 髂內(nèi)動脈髂內(nèi)動脈External iliac a. 髂外動脈髂外動脈Arteries of lower limbFemoral a. 股動脈股動脈Popliteal a. 腘動脈腘動脈Posterior tibial a. 脛后動脈脛后動脈Anterior tibial a. 脛前動脈脛前動脈 dorsal a. of foot 足背動脈足背動脈The Veins 靜脈靜脈General featureThin walls, larger lumens, v