Angiology脉管学专题知识.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Angiology,脉管学,Angiology脉管学专题知识,第1页,Angiology,脉管学,Composition,Cardiovascular system,心血管系统,Lymphatic system,淋巴系统,Angiology脉管学专题知识,第2页,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,动脉,blood vessels carring blood away from the heart,Vein,静脉,blood vessels carring blood towards the heart,Capillary,毛细血管,smallest blood vessels，exchange site of substances between blood and surrounding tissues,Angiology脉管学专题知识,第3页,The Hard Working Heart,LVSV 70 ml/beat,HMO 70 x70=5000ml,HHO 70 x70 x60=300000ml,HDO 70 x70 x60 x24=700ml,HAO 70 x70 x60 x24x365=2600000000ml,HLO 70 x70 x60 x24x365x70=210,000,000,000ml,210,000/50/50=84,Trains,Angiology脉管学专题知识,第4页,The cardiovascular system,心血管系统,Blood circulation,Systemic circulation,体循环,Left ventricle,aorta and its branches capillaries of bodysuperior and inferior vena cava,right atrium,Pulmonary circulation,肺循环,Right ventricle,pulmonary a.capillaries of lung pulmonary v.,left atrium,Angiology脉管学专题知识,第5页,The cardiovascular system,心血管系统,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,Angiology脉管学专题知识,第6页,H,ea,rt,丁兆习,山东大学医学院人体解剖教研室,Office:1205,dingzhaoxi,Angiology脉管学专题知识,第7页,Position of t,he hea,rt,Position of t,he hea,rt,Lies within the pericardium in middle mediastinum,Behind the body of sternum and coastal cartilages 2 to 6,In front and at the level of T5-8,A third of it lies to the right of median plan and 2/3 to the left,Angiology脉管学专题知识,第8页,Surfaces of the heart,Pyramidal in shape,somewhat larger than a closed fist,One apex-,Cardiac apex,One base-,Cardiac base,Two surface,Sternocostal surface,Diaphragmatic surface,Three borders,Right border,Left border,Inferior border,Four sulcuses,Coronary sulcus,Anterior interventricular groove,Posterior interventricular groove,Interatrial sulcus,Angiology脉管学专题知识,第9页,Cardiac apex,心尖,Formed by left ventricle,Directed downwards,forward,and to the left,Lies at the level of the fifth left intercostal space,1-2 cm medial to the left midclavicular line(9cm from the midline),Surfaces of the heart,Angiology脉管学专题知识,第10页,Surfaces of the heart,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,Continuous with the large vessels,Angiology脉管学专题知识,第11页,Surfaces of the heart,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,Left and right auricles,左、右心耳,Angiology脉管学专题知识,第12页,Surfaces of the heart,Diaphragmatic surface,膈面,Formed the ventricleschiefly the left ventricle,Directed backwards and downwards,and rest upon the central tendon of the diaphragm,Angiology脉管学专题知识,第13页,Surfaces of the heart,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 cardiac apex,Angiology脉管学专题知识,第14页,Surfaces of the heart,Sulci of the heart,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,房间沟,Separates the two atria and is hidden by pulmonary trunk and aorta in front,Angiology脉管学专题知识,第15页,Surfaces of the heart,Sulci of the heart,Anterior interventricular groove,前室间沟,Posterior interventricular groove,后室间沟,Mark the division between ventricles(which separates the RV from the LV),Cardiac apical incisure,心尖切迹,Atrioventricular crux,房室交点,Angiology脉管学专题知识,第16页,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 ventricles,左、右心室,Angiology脉管学专题知识,第17页,Right atrium,(RA),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,Angiology脉管学专题知识,第18页,Right atrium,(RA),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 to crista terminalis,Two parts,Separated externally by sulcus terminalis and internally by the crista terminalis,Atrium proper,固有心房,In front of the crista terminalis,Sinus venarum cavarum,腔静脉窦,Angiology脉管学专题知识,第19页,Right atrium,(RA),右心房,Atrium proper,固有心房,Right auricle-,心外科最惯用手术入路之一,Pectinate muscles,in wall,Sinus venarum cavarum,腔静脉窦,Fossa ovalis,卵圆窝,An oval depression,a remnant of the fetal,foramen ovale,Lies on the lower part of interatrial septum,The most common location of atrial septal defects(,ASD,),Limbus fossae ovalis 卵圆窝缘,Aortic mound 主动脉隆凸,Koch triangle Koch三角,Angiology脉管学专题知识,第20页,Right ventricle,(RV),右心室,One inlet,Right atrioventricular orifice,右房室口,One outlet,Orifice of pulmonary trunk,肺动脉口,Angiology脉管学专题知识,第21页,Right ventricle,(RV),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,(conus arteriosus动脉圆锥),Angiology脉管学专题知识,第22页,Right ventricle,(RV),右心室,Inflow tract,Tricuspid valve,三尖瓣,Guards right atrioventricular orifice,Three triangular cusps,:,anterior,posterior and septal,Base of cusps are attached to fibrous,Tricuspid ring,surrounding the atrioventricular orifice,Chordae tendineae,腱索,fibrous band that,Connect the f,ree edges and ventricular surfaces of cusps to the papillary muscles,Papillary muscles,乳头肌,Conical-shaped,Three,:anterior,posterior and septal,Angiology脉管学专题知识,第23页,Trabeculae carneae,肉柱,irregularly arranged bundles of myocardium,Septomarginal trabecula,隔缘肉柱/morderator band节制索,extends from interventricular septum to base of anterior papillary muscle,contains right bundle branch,Right ventricle,(RV),右心室,Angiology脉管学专题知识,第24页,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:,prevent the reflow of blood from the right ventricle into right atrium,Right ventricle,(RV),右心室,diastole,systole,Angiology脉管学专题知识,第25页,Ant.,Post.,septal,Tricuspid valve 三尖瓣,Right ventricle,(RV),右心室,Angiology脉管学专题知识,第26页,Chordae tendineae,Papillary muscles,Angiology脉管学专题知识,第27页,Right ventricle,(RV),右心室,Function of,tricuspid complex,Ventricles relax,blood returning to the heart fills atria,putting pressure against atrioventricular valves,atrioventricular vales forced open.,diastole,Angiology脉管学专题知识,第28页,Right ventricle,(RV),右心室,Function of,tricuspid complex,Ventricles contract,forcing blood against atrioventricular valve cusps.Atrioventricular valves closed.,Papillary muscles contract and chordae tendineae tighten,preventing valve flaps from everting into atria.,systole,Angiology脉管学专题知识,第29页,Right ventricle,(RV),右心室,Outflow tract-,Conus arteriosus,动脉圆锥,Cone-shape,smooth area leading upward to orifice of pulmonary trunk,Pumps blood through pulmonary orifice to pulmonary trunk,orifice of pulmonary trunk,肺动脉口,valve of pulmonary trunk,肺动脉瓣,Angiology脉管学专题知识,第30页,Right ventricle,(RV),右心室,Pulmonary Valve,肺动脉瓣,Guards the orifice of pulmonary trunk,Three semilunar cusps,each with free border that has central nodules called,nodules of semilunar valve 半月瓣小结,Pulmonary sinuses,肺动脉窦,Bulges in wall of pulmonary trunk at level of valve that correspond to cusps,Function,Prevent the reflow of blood from the pulmonary trunk to right ventricle,Angiology脉管学专题知识,第31页,Right ventricle,(RV),右心室,Function of pulmonary valves,As ventricles contract and intraventricular pressure rises,blood is pushed up against semilunar valves,forcing them open,Angiology脉管学专题知识,第32页,Right ventricle,(RV),右心室,Function of pulmonary valves,As ventricles relax and intraventricular pressure falls,blood flow back from arteries,filling the cusps of semilunar valves and forcing them to close,Angiology脉管学专题知识,第33页,Left atrium(LA),左心房,左心耳,Left auricles,-,心外科最惯用手术入路之一,左心房窦,left atrial sinus,Four inlets:,orifices of pulmonary veins,肺静脉口,One outlet:,left atrioventricular orifice,左房室口,Angiology脉管学专题知识,第34页,Left ventricle(LV),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 orifice,Angiology脉管学专题知识,第35页,Mitral valve,二尖瓣,Guards left atrioventricular orifice,Two triangular cusps:,Anterior,and,posterior,Function:,prevent the reflow of blood from the left ventricle into left atrium,Left ventricle(LV)左心室,Angiology脉管学专题知识,第36页,Mirtal 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：,prevent the reflow of blood from left ventricle into left atrium,Left ventricle(LV)左心室,Angiology脉管学专题知识,第37页,Left ventricle(LV)左心室,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,Angiology脉管学专题知识,第38页,Left ventricle(LV)左心室,Aortic valve,主动脉瓣,Guards the aortic orifice,Three semilunar cusps(right,left and posterior),Each with free border that has,nodules of semilunar valve,半月瓣小结,Aortic sinus,主动脉窦,Bulges in aortic wall at level of valve that correspond to cusps,Right,contains opening of right coronary artery,Left,contains opening of left coronary artery,Posterior,no opening,Function,：,prevent the reflow of blood from aorta into left ventricle,L,R,P,Angiology脉管学专题知识,第39页,Left ventricle(LV)左心室,Function of aortic valves,Opened,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,Angiology脉管学专题知识,第40页,Angiology脉管学专题知识,第41页,Angiology脉管学专题知识,第42页,Angiology脉管学专题知识,第43页,Structures of the heart,Endocardium,心内膜,Myocardium,心肌,Epicardium,心外膜,Angiology脉管学专题知识,第44页,Walls of the 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 surrounding the four orifices of heart,The walls of left ventricle are about three times thicker than that of right,Epicardium,心外膜,Outer,Visceral layer of serous pericardium,Angiology脉管学专题知识,第45页,Structures of the heart,Interatrial septum,房间隔,Located between right and left atria,Contains,fossa ovalis,ASD(,A,trial Septal Defect,),Interventricular septum,室间隔,Located between right and left ventricles,Has upper,membranous part,Has thick lower,muscular part,VSD(,Ventricular Septal Defect,),Atrioventricular septum,房室隔,Angiology脉管学专题知识,第46页,Membranous part of interventricular septum,Muscular part of interventricular septum,Angiology脉管学专题知识,第47页,Angiology脉管学专题知识,第48页,Ventricular Septal Defect,Angiology脉管学专题知识,第49页,Fibrous skeleton of heart,纤维骨骼,Fibrous rings,that surround the atrioventricular,pulmonary,and aortic orifices,Left and right,fibrous trigones,Angiology脉管学专题知识,第50页,Fibrous skeleton of heart,纤维骨骼,Angiology脉管学专题知识,第51页,Conduction system of heart,心传导系统,Angiology脉管学专题知识,第52页,Conduction system of heart,心传导系统,窦房结,房室结,房室束,左、右束支,Purkinje 纤维,Composed of specialized myocardial cells,Components,Sinoatrial node,窦房结,(pacemaker),Internodal tracts,结间束,Atrioventricular node,房室结,Atrioventricular bundle,房室束,Right and left bundle branches,左、右束支,Purkinje fibers(network),普肯野氏纤维网,Angiology脉管学专题知识,第53页,Conduction system of heart,心传导系统,Sinuatrial node(SA node),窦房结,Called the,pacemaker,(P cell)(60-100 pulses/min),Located at the upper part of the sulcus terminalis close to the superior vena cava,under the epicardium,窦房结,Clinical tip:,窦性心动过速 sinustachycardia,窦性心动过缓 sinus bradycardia,Angiology脉管学专题知识,第54页,Conduction system of heart,心传导系统,Atrioventricular node(AV node),房室结,Located in the Koch triangle,Under the endocardium,Lower part related to membranous part of interventricular septum,房室结,Angiology脉管学专题知识,第55页,Conduction system of heart,心传导系统,Atrioventricular bundle(AV bundle),房室束,Passes forward through right fibrous trigone to reach inferior border of membranous part of interventricular septum,Divides into right and left bundle branches at upper border of muscular part of interventricular septum,房室束,Angiology脉管学专题知识,第56页,Conduction system of heart,心传导系统,Right and left bundle branches,左、右束支,Right bundle branch,passes 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 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,左、右束支,Purkinje network,Angiology脉管学专题知识,第57页,Conduction system of heart,心传导系统,Angiology脉管学专题知识,第58页,Arterial supply of the heart,Arteries：,left coronary artery,right coronary artery,Angiology脉管学专题知识,第59页,Arterial supply of the heart,Left coronary artery 左冠状动脉,Course,Arises from left aortic sinus,Runs between pulmonary trunk and left auricle 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,Angiology脉管学专题知识,第60页,Arterial supply of the heart,Right coronary artery 右冠状动脉,Course,Arises from the right aortic sinus,Runs forward between right auricle and pulmonary trunk into coronary sulcus,Branches,Branch of sinoatrial node 窦房结支,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,Angiology脉管学专题知识,第61页,Arterial supply of the heart,Thrombus in Coronary Artery Angiogram,冠状动脉造影显示动脉血栓,Angiology脉管学专题知识,第62页,Arterial supply of the heart,Stent in an artery,Precutaneous translaminal,coronary angioplasty(PTCA),Coronary artery bypass grafting(CABG),Angiology脉管学专题知识,第63页,Venous drainage of the heart,Coronary sinus,冠状窦,Great cardiac vein,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,Smallest cardiac veins,心最小静脉,Angiology脉