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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Composition Cardiovascular system心血管系统心血管系统 Lymphatic system 淋巴系统淋巴系统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 动脉
2、动脉 a. carry blood away from the heart Veins 静脉静脉 v. carry blood back to the heartCapillary 毛细血管毛细血管microscopic vessels, the area of exchange between blood and tissue fluid Blood circulationSystemic circulation 体循体循环环 left ventricleaorta and its branchescapillaries of bodysuperior and inferior vena c
3、avaright atriumPulmonary circulation 肺循肺循环环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 动静脉吻合Collateral vessels侧副管 Circulation侧支循环Rectal venous plexusPositionLies within th
4、e 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 closed fis
5、t; 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)Cardia
6、c 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 is dire
7、cted 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 left v
8、entricle and partly by the left auricle Inferior borderhorizontal, is formed by the right ventricle and cardiac apexFour 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 completely encircles the hear
9、tInteratrial 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 the ventricular potion to a n
10、otch 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 Chambers 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 heart from the upper half of th
11、e 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Crista terminalis界嵴界嵴 vertical ridge thatjfrom superior vena
12、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 terminalisAtrium proper 固有心房固有心房In front of the ridgePectinate muscles in wallRight auricle 右心耳右心耳a small
13、 conical muscular pouch, projects to the left from the root of superior vena cava, pectinate muscles in wallSinus venarum cavarum 腔静脉窦腔静脉窦Lies posterior to the ridgeSmooth wallsFossa ovalis 卵圆窝卵圆窝an oval depression, a remnant of the fetal foramen ovale, on the lower part of interatrial septum, the m
14、ost 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Right ventricle (RV) 右心室右心室 Receives deoxygenated blood from right atrium through right atrioventricular orificeOne inletright artrioventricular orifice 右房室右房室口口O
15、ne 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 Inflow tractrough wallsTrabeculae carneae肉柱肉柱 irregularly arranged bundles of myocardiumSeptomarginal trabecula 隔缘
16、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 tractConus arteriosus 动脉圆锥动脉圆锥 cone-shaped, smooth area leading upward to orifice of pulmonary trunkPumps blood
17、 through pulmonary orifice to pulmonary trunk Left atrium (LA) 左心房左心房Left auricle左心耳左心耳projecting to the right, pectinate muscles in wallFour inletsfour orifices of pulmonary veins 肺静脉口肺静脉口open through the posterior wallOne outletleft atrioventricular orifice左房室口左房室口, blood leaves through left atrio
18、ventricular 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 左房左房室口室口One outletaortic orifice 主动脉口主动脉口Two partsdivided by anterior cusps of mitral valveInflow tractrough wallsOutflow tract aortic vesti
19、bule 主动脉前庭主动脉前庭, 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, c
20、onnective tissue cords, attach margin of cusps to papillary muscles 乳头肌乳头肌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 f
21、unctions 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 肺动脉瓣肺动脉瓣Guards the orifice of pulmonary trunkHas three semilunar cusps each with free border
22、that has central nodules of semilunar valve 半月瓣小结半月瓣小结Aorti vavle 主动脉瓣主动脉瓣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 le
23、ft 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,
24、thus closing the valve Structure of the heartWalls of heartEndocardium心内膜心内膜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)Interatri
25、al septum 房间隔房间隔Located between right and left atria Contains fossa ovalis and limbusInterventricular septum 室间隔室间隔Located between right and left ventriclesHas upper membranous part Has thick lower muscular part Fibrous skeleton 纤维骨纤维骨骼骼 Fibrous rings that surround the atrioventricular, pulmonary, a
26、nd aortic orificesLeft and right fibrous trigonsConduction system of heart心传导心传导系系 Consists 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 e
27、picardiumAtrioventricular node 房室结房室结 (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
28、 trigon 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 trab
29、ecular 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 Purkinj
30、e fibersPurkinje fibers 普肯野氏纤维普肯野氏纤维 continuous with myocardium Arterial supplyLeft coronary artery 左冠状动左冠状动脉脉Arises from left aortic sinusRuns between pulmonary trunk and left auricle into coronary sulcusBranchesAnterior interventricular branch 前室间支前室间支travels downward in anterior interventricular
31、groove 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
32、 coronary artery 右冠状动脉右冠状动脉Arises from the right aortic sinus Runs forward 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, i
33、t 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
34、 冠状冠状窦窦Located in posterior part of coronary sinus Carries most of venous 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Anterior cardiac veins 心前静脉心前静脉34 small vessels, drain into right atrium Smallest cardiac vein
35、s 心最小静脉心最小静脉drain into all chambers, mainly atriaPericardium 心包心包Fibrous pericardium 纤维心纤维心包包Attached to central tendon of diaphragm inferiorlyBlends 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Po
36、tential space between visceral and parietal pericardium Contains film of pericardium fluid Pericardium 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 , poste
37、rior 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
38、the midlineLeft 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 ArteriesCharacteristicsSymm
39、etry 对称In the trunk of the body consist parietal and visceral branches 壁支和脏支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 血管神经束Arteries of pulmonary
40、 circulation 肺循环的动脉Pulmonary trunk 肺动脉肺动脉干干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 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Brach
41、iocephalic trunk 头臂干头臂干right common carotid 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Arteries of head and neckCommon carotid a.颈总动颈总动脉脉External carotid a. 颈外动脉颈
42、外动脉Internal carotid a. 颈内动脉颈内动脉Subclavian a. 锁骨下动脉锁骨下动脉 Arteries of upper limbAxillary 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Thoracic 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 pai
43、r subcostal 肋下动脉肋下动脉Visceral branches 脏支Abdominal aorta 腹主动脉腹主动脉Visceral branches 脏支脏支Paired branchesMiddle 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 branchesCeliac 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
44、脉肠系膜下动脉Parietal branchesArteries of pelvisCommon 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Arteries of lower limbFemoral 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The Veins 静脉静脉General featureThin walls, l
45、arger lumens, venous valves, venous plexus, venous reteTwo sets Superficial vein Deep veinsSpecial structures: sinuses of dura mater 硬硬脑膜窦脑膜窦diploic veins 板障静脉板障静脉Venous valveDiploic veinsSinuses of dura materSuperior vena cava and its tributariesVeins of head and neckInternal jugular veinExternal j
46、ugular veinBrachiocephalic vein: venous angleVeins of upper limbDeep vein: have the same names as their companion arteriesSuperficial veins: cephalic v. 头静脉头静脉basilica v. 贵要静脉贵要静脉median cubital v. 肘正中静脉肘正中静脉Veins of thoraxSuperior vena cava 上腔静脉Azygos v. 奇静脉 Hemiazygos v. 半奇静脉accessory hemiazygos v.
47、副半奇静脉 Veins of vertebral column 椎静脉丛Inferior vena cava system Veins of lower limbDeep vein: have the same names as their companion arteriesSuperficial veins: great saphenous v. 大隐静脉 small saphenous 小隐静脉Veins of pelvisInternal iliac v. 髂内静脉External iliac v.髂外静脉Common iliac v.髂总静脉 Inferior vena cava a
48、nd its tributaries Hepatic portal v.The Lymphatic SystemHeart Artery Capillaries Vein Cell Tissue fluidLymphatic capillaryLymphatic vesselLymphatic nodeLymphatic trunkLymphatic ductCompositionLymphatic vesselLymphatic capillaryLymphatic vessels: two sets, superficial and deepLymphatic trunks: nine Lymphatic ducts: thoracic duct, right lymphatic duckLymphatic organLymphatic nodesTonsil, spleen, thymus Lymphatic tissueLymphatic capillaryLymphatic nodeAfferent vessels Afferent vessels Thoracic ductRight lymphatic duckLymphatic vessels
