1、The Heart and Angiology,同济大学医学院 解剖教研室 孙红斌,Composition,Cardiovascular system心血管系统 Lymphatic system 淋巴系统,The cardiovascular system,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 动脉 a. carry blood away
2、from the heart Veins 静脉 v. carry blood back to the heart Capillary 毛细血管microscopic vessels, the area of exchange between blood and tissue fluid,Blood circulation,Systemic circulation 体循环 left ventricleaorta and its branchescapillaries of bodysuperior and inferior vena cavaright atrium Pulmonary circ
3、ulation 肺循环right ventriclepulmonary a.capillaries of lungpulmonary v.right 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 Circulation侧支循环,Rectal venous plexus,Position Lies within the pericardium in middle media
4、stinum 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 left,External characteristicsa hollow muscular organ, pyramidal in shape , somewhat larger than a closed fist; consists of four chanbers
5、 (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) Cardiac base is formed by the le
6、ft atrium and to a small extent by the right atrium. It faces backward, upward and to the right,Two 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 and ventricle. It is directed forwards and upwards
7、 Diaphragmatic surface is formed the ventricleschiefly the left ventricle, directed backwards and downwards, and rest upon the central tendon of the diaphragm,Three borders Right bordervertical, is formed entirely by right atrium Left borderround, is mainly formed by the left ventricle and partly by
8、 the left auricle Inferior borderhorizontal, is formed by the right ventricle and cardiac apex,Four grooves Coronary sulcus 冠状沟(circular sulcus) which marks the division between atria and ventricles, contains the trunks of the coronary vessels and completely encircles the heart Interatrial sulcus 房间
9、沟separates the two atria and is hidden by pulmonary trunk and aorta in front Interventricular grooves 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 notch called: the cardiac ap
10、ical incisure 心尖切迹 Atrioventricular crux 房室交点a junction of the posterior interventricular groove and coronary sulcus,Chambers of the heart,Right atrium 右心房 (RA)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
11、脉口 returns blood to the heart from the lower half of the body Orifice of coronar sinus 冠状窦口 returns blood to the heart from the cardiac muscleOne outle right atrioventricular orifice 右房室口,Crista terminalis界嵴 vertical ridge thatjfrom superior vena cave to inferior vena cave Sulcus terminalis 界沟 groov
12、e 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 In front of the ridge Pectinate muscles in wall Right auricle 右心耳a small conical muscular pouch, projects to the left from the ro
13、ot of superior vena cava, pectinate muscles in wall,Sinus venarum cavarum 腔静脉窦 Lies posterior to the ridge 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) Limbus fo
14、ssae ovalis 卵圆窝缘 prominent margin of fossa ovalis Torus aortious 主动脉隆凸,Right ventricle (RV) 右心室,Receives deoxygenated blood from right atrium through right atrioventricular orifice One inletright artrioventricular orifice 右房室口 One outletorifice of pulmonary trunk 肺动脉口 Two partsdivided by the suprave
15、ntricular crest 室上嵴, a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk,Inflow tractrough walls 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, c
16、ontains right bundle branch Papillary muscles乳头肌conical-shaped , anterior, posterior and septal Out flow tract Conus arteriosus 动脉圆锥 cone-shaped, smooth area leading upward to orifice of pulmonary trunk Pumps blood through pulmonary orifice to pulmonary trunk,Left atrium (LA) 左心房,Left auricle左心耳proj
17、ecting to the right, pectinate muscles in wall Four inletsfour orifices of pulmonary veins 肺静脉口open through the posterior wall One outletleft atrioventricular orifice左房室口, blood leaves through left atrioventricular orifice to left ventricle,Left ventricle (LV) 左心室,Has wall three times thicker than t
18、hat of right ventricle One inletleft atrioventricular orifice 左房室口 One outletaortic orifice 主动脉口 Two partsdivided by anterior cusps of mitral valve Inflow tractrough walls Outflow tract aortic vestibule 主动脉前庭, smooth area leading to aortic orifice,Valves,Tricuspid valve 三尖瓣 Guards right atrioventric
19、ular orifice Three triangular cusps: anterior, posterior and septal, the base of cusps are attached to fibrous ring surrounding the atrioventricular orifice Chordae tendineae 腱索fine, white, connective tissue cords, attach margin of cusps to papillary muscles 乳头肌,Mitral valve 二尖瓣 Guards left atrioven
20、tricular orifice Two triangular cuspsanterior and posterior with commissural cusps between them (posteromedial and anterolateral commissures) Similar structures to those of right,Similar functions for right and left atriventricular valves Open during diastole to allow blood to enter ventricles from
21、atria Closed during systole to prevent regurgitation of blood into atria,Valve of pulmonary trunk 肺动脉瓣 Guards the orifice of pulmonary trunk Has three semilunar cusps each with free border that has central nodules of semilunar valve 半月瓣小结,Aorti vavle 主动脉瓣 Guards the aortic orifice Three semilunar cu
22、sps (right, left and post) Three aortic sinuses bulges in aortic wall at level of valve that correspond to cusps Rightcontains opening of right coronary artery Leftcontains opening of left coronary artery Posteriorno opening,Similar functions for pulmonary and aortic valves Opening during systole, w
23、ith 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,Structure of the heart,Walls of heart Endocardium心内膜inner coat of the heart wall, and co
24、ntinuous with the valve flaps Myocardium 心肌 Arranged spirally Attached to fibrous rings surrouding the four orifices of heart Epicardium 心外膜serous membrane (visceral pericardium),Interatrial septum 房间隔 Located between right and left atria Contains fossa ovalis and limbus Interventricular septum 室间隔
25、Located between right and left ventricles Has upper membranous part Has thick lower muscular part,Fibrous skeleton 纤维骨骼 Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices Left and right fibrous trigons,Conduction system of heart心传导系,Consists of specialized myocardial ce
26、lls Sinuatrial node 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 epicardium,Atrioventricular node 房室结 (AV node) Located in the lower part of interatrial septum just above the orifice of
27、coronary sinus, under the endocardium Lower part related to membranous part of interventricular septum Atrioventricular bundle 房室束 (AV bundle) Passes forward through right fibrous trigon to reach inferior border of membranous part Divides into right and left bundle branches at upper border of muscul
28、ar part of interventricular septum,Right and left bundle branches 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 with the fibers of Purkinje fibres Left bun
29、dle branchpasses 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 fibers 普肯野氏纤维 continuous with myocardium,Arterial supply,Left coronary artery 左冠状动脉 Arises from left aorti
30、c sinus Runs between pulmonary trunk and left auricle into coronary sulcus Branches Anterior interventricular branch 前室间支travels 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
31、 posterior aspect Distributionsupplies left atrium and ventricle, lesser portion of anterior wall of right ventricle, and anterior 2/3 of interventricular septum,Right coronary artery 右冠状动脉 Arises from the right aortic sinus Runs forward between right auricle and pulmonary trunk into coronary sulcus
32、 Branches Right marginal branch 右缘支 travels along inferior bord Posteror interventricular branch 后室间支travels downward in posterior interventricular groove, it anastomosises near the apex with the anteriorinterventricular branch of the left coronary artery Distribution: supplies right atrium and vent
33、ricle, posterior 1/3 of interventricular septum, posterior wall of left ventricle, the sinuatrial node and atrioventricular node,Venous drainage,Coronary sinus 冠状窦 Located in posterior part of coronary sinus Carries most of venous blood from myocardium to right atrium Tributaries Great cardiac vein
34、心大静脉 Middle cardiac vein 心中静脉 Small cardiac vein 心小静脉,Anterior cardiac veins 心前静脉34 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 co
35、at of great vessels superiorly Serous pericardium 浆膜心包 Visceral pericardium (epicardium) Parietal pericardium Pericardial cavity 心包腔 Potential space between visceral and parietal pericardium Contains film of pericardium fluid,Pericardium sinus Transverse sinus of pericardium 心包横窦posterior to ascendi
36、ng aorta and pulmonary trunk, anterior to superior vena cava and left atrium. Oblique sinus of pericardium 心包斜窦cul-de-sac , posterior to heart, bounded by pulmonary veins on either side,Surface markings of heart,Right bordercorresponds to a line running from the upper border of right third costal ca
37、rtilage 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 from apex upwards and medially to a point on lower border of left second costal cartilage 1.2cm from sternal margin L
38、ower borderrepresented by a line joint the lower end of right border to apex,Dissection of the heart,The Arteries,Characteristics Symmetry 对称 In the trunk of the body consist parietal and visceral branches 壁支和脏支 Shortest possible course Run on flexor surfaces Usually do not pass directly through mus
39、cles, avoiding compression Together with the veins and nerves in a sheath of fascia to form neurovascular bundle 血管神经束,Arteries of pulmonary circulation 肺循环的动脉,Pulmonary trunk 肺动脉干 Arises from right ventricle Runs up, back ,and to the left Bifurcates inferior to aortic arch into right and left pulmo
40、nary arteries, one for each lung,Arteries of systemic circulation 体循环的动脉,Aorta 主动脉 Ascending aorta 升主动脉 Aortic arch 主动脉弓 Brachiocephalic trunk 头臂干 right common carotid a. 右颈总动脉 right subclavian a. 右锁骨下动脉 Left common carotid a. 左颈总动脉 Left subclavian a. 左锁骨下动脉 Descending aorta 降主动脉 Thoracic aorta 胸主动脉
41、 Abdominal aorta 腹主动脉,Arteries of head and neck Common carotid a.颈总动脉 External carotid a. 颈外动脉 Internal carotid a. 颈内动脉 Subclavian a. 锁骨下动脉,Arteries of upper limb Axillary a. 腋动脉 Brachial a. 肱动脉 Radial a. 桡动脉 Ulnar a. 尺动脉 Superficial palmar arch 掌浅弓 deep palmar arc 掌深弓,Thoracic aorta 胸主动脉 Parietal b
42、ranches 壁支 Nine pairs posterior intercostals arteries 肋间后动脉 One pair subcostal 肋下动脉 Visceral branches 脏支,Abdominal aorta 腹主动脉,Visceral branches 脏支 Paired branches Middle suprarenal artery 肾上腺中动脉 Renal artery 肾动脉 Testicular (ovarian) artery 睾丸（卵巢）动脉 Unpaired branches Celiac trunk 腹腔干 Superior mesente
43、ric a. 肠系膜上动脉 Inferior mesenteric a. 肠系膜下动脉 Parietal branches,Arteries of pelvis Common iliac a. 髂总动脉 Internal iliac a. 髂内动脉 External iliac a. 髂外动脉,Arteries of lower limb Femoral a. 股动脉 Popliteal a. 腘动脉 Posterior tibial a. 胫后动脉 Anterior tibial a. 胫前动脉dorsal a. of foot 足背动脉,The Veins 静脉,General featu
44、re Thin walls, larger lumens, venous valves, venous plexus, venous rete Two setsSuperficial veinDeep veins Special structures: sinuses of dura mater 硬脑膜窦 diploic veins 板障静脉,Venous valve,Diploic veins,Sinuses of dura mater,Superior vena cava and its tributaries,Veins of head and neck Internal jugular
45、 vein External jugular vein Brachiocephalic vein: venous angle,Veins of upper limb Deep vein: have the same names as their companion arteries Superficial veins: cephalic v. 头静脉 basilica v. 贵要静脉 median cubital v. 肘正中静脉,Veins of thorax Superior vena cava 上腔静脉 Azygos v. 奇静脉Hemiazygos v. 半奇静脉 accessory
46、hemiazygos v.副半奇静脉Veins of vertebral column 椎静脉丛,Inferior vena cava systemVeins of lower limb Deep vein: have the same names as their companion arteries Superficial veins: great saphenous v. 大隐静脉small saphenous 小隐静脉,Veins of pelvis Internal iliac v. 髂内静脉 External iliac v.髂外静脉 Common iliac v.髂总静脉,Inf
47、erior vena cava and its tributariesHepatic portal v.,The Lymphatic System,Heart,Artery,Capillaries,Vein,Cell,Tissue fluid,Lymphatic capillary,Lymphatic vessel,Lymphatic node,Lymphatic trunk,Lymphatic duct,Composition Lymphatic vessel Lymphatic capillary Lymphatic vessels: two sets, superficial and deep Lymphatic trunks: nine Lymphatic ducts: thoracic duct, right lymphatic duck Lymphatic organ Lymphatic nodes Tonsil, spleen, thymusLymphatic tissue,Lymphatic capillary,Lymphatic node,Afferent vessels,Afferent vessels,Thoracic duct Right lymphatic duck,Lymphatic vessels,
