Angiology 脉管学

Angiology 脉管学

Angiology 脉管学Composition Cardiovascular system

心血管系统 Lymphatic system

淋巴系统

The cardiovascular system 心血管系统

Organization Heart 心

A muscle pump to maintain the flow of blood.

Consist of four chambers (right and left atria, right and left ventricles).

Artery (A) 动脉 carry blood away from the heart. Veins (V) 静脉 carry blood back to the heart Capillary (Cap) 毛细血管 microscopic vessels, the area of exch

ange between blood and tissue fluid.


Blood circulation Systemic circulation 体循环 l

eft ventricle→aorta and its branches→capillaries of body→superior and inferior vena cava→right atrium

Pulmonary circulation 肺循环 right ventricle→pulmonary A→ capillaries of lung → pulmonary V →left atrium


Vascular anastomosis 血管吻合

Anastomosis between A Anastomosis between V Arteriolovenular anastomosis

动静脉吻合 Collateral vessels 侧副管 Collateral circulation 侧支循环

The Heart

The heartPosition Lies within the pericardium in mid

dle mediastinum. Behind the body of sternum and 2t

h. to 6th. coastal cartilages. In front of 5th. to 8th. thoracic vert

ebrae. One third of it lies to the right of m

edian plan and 2/3 to the left.

Surfaces of the heart

Pyramidal in shape, somewhat larger than a closed fist.

One apex One base Two surface Three borders Four sulcuses

Formed by left ventricle Directed downwards, for

ward, and to the left Lies at the level of the 5th

left intercostal space, 1~2 cm medial to the left midclavicular line (9cm from the midline) .

Cardiac apex 心尖

Cardiac base 心底 Formed by the left

atrium and to a small extent by the right atrium.

Faces backward, upward and to the right.

Sternocostal surface 胸肋面

Formed mainly by the right atrium and right ventricle, and a lesser portion of its left is formed by the left auricle and ventricle.

Directed forwards and upwards.

Diaphragmatic surface 膈面 Formed the ventricles － c

hiefly the left ventricle. Directed backwards and d

ownwards, and rest upon the central tendon of the diaphragm.

Borders of the heart Right border 右缘

Vertical Formed entirely by right atrium

Left border 左缘 Round Mainly formed by the left ventricle

and partly by the left auricle

Inferior border 下缘 Horizontal Formed by the right ventricle and c

ardiac apex

Sulcuses of the heart

Coronary sulcus 冠状沟 (circular sulcus) which marks the division between atrium and ventricles, contains the trunks of the coronary vessels and completely encircles the heart.

Interatrial sulcus 房间沟－ separates the two atrium and is hidden by pulmonary trunk and aorta in front.

Sulcuses of the heart Anterior interventricular groove

前室间沟 Posterior interventricular groove

后室间沟 Mark the division between ventricle

s (which separates the R from the L ventricle)

Cardiac apical incisure 心尖切迹 Atrioventricular crux 房室交点

Chambers of the heart 心腔

Chambers of the heart 心腔

Consists of four chambers Left and right atria

左、右心房 Left and right auricle

左、右心耳 Left and right ventricles

左、右心室

Right atrium 右心房 Three inlets

Orifice of superior vena cava 上腔静脉口

returns blood to the heart from the upper half of the body.

Orifice of inferior vena cava 下腔静脉口

returns blood to the heart from the lower half of the body.

Orifice of coronary sinus 冠状窦口

returns blood to the heart from the cardiac muscle.

One outlet － right atrioventricular orifice

右房室口

Right atrium 右心房 Crista terminalis 界嵴－ vertical ridge

that from superior vena cave to inferior vena cave.

Sulcus terminalis 界沟－ groove on exterior of heart that corresponds ( 一致 )to crista terminalis.

Two parts － separated externally by sulcus terminalis and internally by the crista terminalis. Atrium proper 固有心房 Sinus venarum cavarum 腔静脉窦

Right atrium 右心房 Atrium proper 固有心房

In front of the ridge Pectinate muscles in wall

Sinus venarum cavarum 腔静脉窦 Smooth walls Fossa ovalis 卵圆窝－ an oval

depression, a remnant of the fetal foramen ovale, on the lower part of interatrial septum, the most common location of atrial septal defects (ASD)- 房间隔缺损 .

Right ventricle 右心室

One inlet 　　－ right atrioventricular orifice 右房室口

One outlet 　　－ orifice of pulmonary trunk 肺动脉口

Right ventricle 右心室 Supraventricular crest 室上嵴

(a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk )

Two parts Inflow tract 流入道 Outflow tract 流出道

Right ventricle 右心室 Inflow tract

Trabeculae carneae 肉柱 irregularly arranged bundles of myocardium.

Septomarginal trabecula 隔缘肉柱－ extends from interventricular septum to base of anterior papillary muscle, contains right bundle branch.

Papillary muscles 乳头肌 Conical-shaped Three: anterior, posterior

and septal.

Right ventricle 右心室

Outflow tract —Conus arteriosus 　　　　　　　　　　　动脉圆锥 Cone-shape , smooth area leadi

ng upward to orifice of pulmonary trunk

Pumps blood through pulmonary orifice to pulmonary trunk.

Tricuspid valve 三尖瓣 Guards right atrioventricular orifice Three triangular cusps:

anterior, posterior and septal Base of cusps are attached to fi

brous ring surrounding the atrioventricular orifice.

To their free edges and ventricular surfaces are attached chordae tendineae 腱索 , which connect the cusps to the papillary muscles.

Tricuspid valve 三尖瓣

Tricuspid complex 三尖瓣复合体

Tricuspid ring 三尖瓣环 Tricuspid valve 三尖瓣 Chordae tendineae 腱索 Papillary muscles 乳头肌

Function of tricuspid complex Open during diastole to allow blood to enter ventricles from atria

Closed during systole to prevent regurgitation of blood into atria

Valve of pulmonary trunk 肺动脉瓣

three semilunar cusps which guards the orifice of pulmonary trunk

Function of pulmonary valves

Opening during systole( 心脏收缩 ) , with cusps pressed toward wall of vessel as blood is forced upward.

Closed during diastole( 心脏舒张 ) Ventricular pressure drops in dia

stole. Floating together of valve cusps,

with free borders meeting, thus closing the valve.

Left atrium 左心房 Four inlets － four orifices of pulmonary veins 肺静脉口 One outlet － left atrioventricular orifice 左房室口

Left ventricle 左心室 One inlet

left atrioventricular orifice 左房室口

One outlet － aortic orifice 主动脉口 Two parts － divided by anterior cusps

of mitral valve. Inflow tract － rough walls Outflow tract

Aortic vestibule 主动脉前庭 Smooth area leading to aortic orific

e

Mitral valve 二尖瓣 Guards left atrioventricular orifice Two triangular cusps － anterior a

nd posterior with commissural cusps between them.

Mitral complex 二尖瓣复合体

Mitral ring 二尖瓣环 Mitral valve 二尖瓣 Chordae tendineae 腱索 Papillary muscles 乳头肌

Function of mitral complex Open during diastole to allow blood to enter ventricles from atria

Closed during systole to prevent regurgitation of blood into atria

Aortic valve 主动脉瓣 Guards the aortic orifice Three semilunar cusps (right, le

ft and posterior) Aortic sinus 主动脉窦 – bulges i

n aortic wall at level of valve that correspond to cusps. Right － contains opening of

right coronary artery. Left － contains opening of le

ft coronary artery. Posterior － no opening

Function of aortic valves

Opening during systole, with cusps pressed toward wall of vessel as blood is forced upward

Closed during diastole Ventricular pressure drops in diastole Floating together of valve cusps, with

free borders meeting, thus closing the valve

Structures of the heart

Walls of heart Endocardium 心内膜

Inner coat of the heart wall Continuous with the valve flaps

Myocardium 心肌 Arranged spirally Attached to fibrous rings surrouding t

he four orifices of heart The walls of left ventricle are about th

ree times thicker than that of right Epicardium 心外膜

Outer Visceral layer of serous pericardium

Structures of the heart

Interatrial septum 房间隔 Located between right and left atria Contains fossa ovalis

Interventricular septum 室间隔 Located between right and left ventri

cles Has upper membranous part Has thick lower muscular part

Atrioventricular septum 房室隔

Membranous part of interventricular septum

Fibrous skeleton of heart 纤维骨骼

Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices.

Left and right fibrous trigones.

Conduction system of heart 心传导系统

Conduction system of heart 心传导系统Composed of specialized myocardial cells.

Sinuatrial node 窦房结 Internodal tract 结间束 Atrioventricular node 房室结 Atrioventricular bundle 房室束 Right and left bundle branches 左、右束支 Purkinje network 普肯野氏纤维网

Conduction system of heart 心传导系统

Sinuatrial node 窦房结 Called the pacemaker cell. Loc

ated at the upper part of the sul

cus terminalis close to the supe

rior vena cava, under the epicar

dium.

Conduction system of heart 心传导系统Atrioventricular node (AV node) 房室结

Located in the lower part of interatri

al septum, near orifice of coronary sinus and base of tricuspid valve.

Under the endocardium Lower part related to membranous

part of interventricular septum.

Conduction system of heart 心传导系统Atrioventricular bundle (AV bundle)

房室束 Passes forward through right fibr

ous trigone to reach inferior border of membranous part.

Divides into right and left bundle branches at upper border of muscular part of interve ntricular septum.

Conduction system of heart 心传导系统 Right and left bundle branches

左、右束支 Right bundle branch － passes dow

n on right side of interventricular septum to reach the septomarginal trabecular and into the base of anterior papillary muscle. Here it becomes continuous with the fibers of Purkinje fibres.

Left bundle branch － passes down on left side of interventricular septum beneath the endocardium. It usually divides into two branches, which eventually become continuous with the Purkinje fibers.

Purkinje network 普肯野氏纤维网 continuous with myocardium.

★ 心传导系统

Sinatrial node

Atrioventricular node

Atrioventricular bundle

Right and left bundle branches

Purkinje network

Arterial supply of the heartLeft coronary artery 左冠状动脉 Course

Arises from left aortic sinus Runs between pulmonary trunk and left au

ricle into coronary sulcus. Branches

Anterior interventricular branch 前室间支－ runs downward in anterior interventricular groove around inferior margin of heart to posterior interventricular groove.

Circumflex branch 旋支－ travels to left in coronary sulcus to posterior aspect.

Distribution － supplies left atrium and ventricle, lesser portion of anterior wall of right ventricle, and anterior 2/3 of interventricular septum.

Arterial supply of the heartRight coronary artery 右冠状动脉 Course

Arises from the right aortic sinus Runs forward between right auricle and pulmo

nary trunk into coronary sulcus. Branches

Right marginal branch 右缘支－ travels along inferior border.

Posteror interventricular branch 后室间支 travels downward in posterior interventricular groove, it anastomosises near the apex with the anterior interventricular branch of the left coronary artery.

Distribution: supplies right atrium and ventricle, posterioinferior 1/3 of interventricular septum, posterior wall of left ventricle, the sinuatrial node and atrioventricular node.

Stent in an artery

Precutaneous translaminal coronary angioplasty (PTCA)

Coronary artery bypass grafting (CABG)

Venous drainage of the heart

Coronary sinus 冠状窦 Lies in posterior part of coronary

sulcus. Carries most of venous blood fr

om myocardium to right atrium. Tributaries

Great cardiac vein 心大静脉 Middle cardiac vein 心中静脉 Small cardiac vein 心小静脉

Venous drainage of heart

Anterior cardiac veins 心前静脉－ 3~4 small vessels, drain into right atrium.

Smallest cardiac veins 心最小静脉－ drain into all chambers, mainly atria.

Pericardium 心包 Fibrous pericardium 纤维心包

Attached to central tendon of diaphragm inferiorly

Blends with outer coat of great vessels superiorly

Serous pericardium 浆膜心包 Visceral layer (epicardium) Parietal layer

Pericardial cavity 心包腔 Potential space between visceral and

parietal layes. Contains film of pericardium fluid as a

lubricant to facilitate cardiac movements.

Pericardium 心包

Pericardium sinus Formed by reflection of serous peric

ardium. Transverse sinus of pericardium

心包横窦 Posterior to ascending aorta and pul

monary trunk Anterior to superior vena cava and le

ft atrium.

Pericardium sinus

Oblique sinus of pericardium 心包斜窦－ cul-de-sac( 死胡同 ), posterior to heart, bounded by pulmonary veins on either side.

Anterior inferior sinus of pericardium 心包前下窦

Surface markings of heart

R. superior point － lies on the upper border of right third costal cartilage ±1.2cm from the margin of sternum

R. inferior point － lies on the sixth sternocostal joint

L. superior point － lies on lower border of left second costal cartilage ±1.2cm from sternal margin

Cardiac apex － in the fifth left intercostal space 7~9cm from the midline

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Angiology 脉管学