人體解剖學(xué)教學(xué)課件：heart

ANGIOLOGYIntroductionCardiovascularSystem(blood)LymphaticSystem(lymph)TheCardiovascularsystem

Heart：powerorgan.Arteries：carrybloodawayfromtheheart.Veins：returnbloodtotheheart.Capillaries：exchangeofmaterial.Systemiccirculation(leftventricletorightatrium)Pulmonarycirculation(rightventricletoleftatrium)BloodcirculationVascularAnastomoses

Arterialcircle/arch/networkArteriovenousanastomosesVenousplexusCollateralcirculationEnd-arteryHeartConeshape,fistsize,300gNormalheartEnlargedheartLocationLieswithinthemiddlemediastinum

Two-thirdsliesontheleftOne-thirdliesontherightpericardiumAnteriorlyborderedbysternumandcoastalcartilages2to6Posteriorlyborderedbythoracicvertebrae5to8TheexternalfeatureoftheheartCardiacapex

formedbyleftventricleandisdirecteddownwards,forwardsandtotheleft.Cardiacapexliesatthelevelofthefifthleftintercostalspace,nearoralittlemedialtotheleftmidclavicularline.Cardiacbase

formedmainlybytheleftatrium,andasmallportionoftherightatrium.Facesbackward,upwardandtotheright.RightatriumRightventricleLeftatriumLeftventricleTwosurfacesSternocostalsurface

formedmainlybytherightatriumandrightventricle,andalesserportionisformedbytheleftauricleandleftventricle.Mostpartiscoveredbythepleuralmembranesandtheedgesoflungsexceptthe“bareareaofpericardium”

.Intracardiacinjection

Diaphragmaticsurface

formedbytwoventricles(chieflytheleft),restuponthecentraltendonofthediaphragm.ThreebordersRightborderformedentirelybyrightatriumLeftbordermainlyformedbytheleftventricleandpartlybytheleftauricleInferiorbordersharp,horizontal,isformedbytherightventricleandcardiacapexFourgroovesCoronarygrooveringlike,separatestheatriafromtheventricles,containsthetrunksofthecoronaryvesselsandcompletelyencirclestheheartCoronarygrooveInteratrialgroove

separatesthetwoatria,nostructuresinthisgrooveInteratrialgrooveInterventriculargrooves

anteriorandposterior,markthedivisionbetweenventricles

cardiacapicalincisureAnteriorinterventriculargroovePosteriorinterventriculargrooveCardiacapicalincisureAtrioventricularcrux

ajunctionoftheinteratrialgroove,posteriorinterventriculargrooveandcoronarygroove

ChambersoftheheartThoracicvertebraLeftatriumRightatriumLeftventricleRightventricleSternumRightatrium(RA)AtriumproperSinusvenarumcavarumSulcusterminalis

grooveontheoutersurfaceoftherightatriumthatcorrespondstoterminalcrestTerminalcrestExtendsfromtheorificeofthesuperiorvenacavatotheorificeoftheinferiorvenacava.ThreeinletsOneoutletOrificeofinferiorvenacavaValveofinferiorvenacavaOrificeofcoronarysinusAtrioventricularorificeOrificeofsuperiorvenacavaTendonofTodaro

TriangleofKochattachmentoftheseptalleafletofthetricuspidvalveanteromedialmarginoftheorificeofthecoronarysinustendonofTodaroPectinatemusclesParallelmuscularridges,arisefromtheterminalcrest,towardstheright

atrioventricularorifice.RightauricleAsmallconicalmuscularpouch,projectstotheleftfromtherootofsuperiorvenacava,pectinatemusclesinwallTerminalcrestFossaovalisAremnantofthefetalforamenovale,themostcommonlocationofatrialseptaldefects(ASD)FossaovalisRightventricle(RV)Trabeculaecarneae

Papillarymuscles

TendinouscordsTricuspidvalve

SupraventricularcrestSeptomarginaltrabecula

Inflowtract(sinuspart)TricuspidvalvecomplexAnnulusofthetricuspidvalvetricuspidvalve(anterior,posterior,septal)TendinouscordsPapillarymuscle(anterior,posterior,septal)Outflowtract(infundibularpart)Conusarteriosus

funnel-like,smoothwalls,leadingupwardtopulmonaryorificePulmonaryorificePulmonaryvalvethreesemilunarcuspsConusarteriosus

SupraventricularcrestPulmonaryvalve

Leftatrium(LA)Leftauricle:pectinatemusclesFourinlets:orificesofpulmonaryveinsOneoutlet:leftatrioventricularorificeLeftauricle

orificeofthepulmonaryvein

Leftatrioventricularorifice

Leftventricle(LV)Twoparts－dividedbyanteriorcuspofmitralvalveInflowtract(sinouspart)Trabeculaecarneae

Papillarymuscle

Tendinouscords

Mitralvalve

Leftventricularbands(Purkinjefibers)MitralvalvecomplexAnnulusofmitralvalveMitralvalve(anterior,posterior)TendinouscordsPapillarymuscle(anterior,posterior)Outflowtract(aorticvestibule)AorticorificeAorticvalveAorticsinusesAorticvalve

Aorticsinus

OpeningofleftcoronaryarteryOpeningofrightcoronaryarteryWallsofheartThestructureoftheheartEndocardiumthinandsmoothcontinuouswiththelargebloodvesselsconstitutethevalves

NormalaorticvalveRheumaticendocarditis(valvularstenosis/valvularinadequacy)Myocardiumartium:superficialanddeeplayersventricle:superficial,middleanddeeplayersattachedtofibrousringsEpicardiumserousmembrane(visceralpericardium)InteratrialseptumbetweenrightandleftatriafossaovalisInterventricularseptumcorrespondstointerventriculargroovesuppermembranouspart(thin,ovalorroundsmallarea)lowermuscularpart(thick,myocardium)Fibrousskeleton

providestablebaseforvalvesandmusclesensureelectrophysiologicaldiscontinuity(insulation)LeftfibroustrigoneRight

fibroustrigone(centralfibrousbody):strongestConductionsystemofheartSpecializedmyocardialcellsInitiateandmaintainthenormalcardiacrhythmEnsurethepropercoordinationoftheatrialandventricularcontractionsSinoatrialnode(SAnode)pacemakercell(Pcell)atthejunctionofrightatriumandsuperiorvenacavaundertheepicardiumSinusrhythm(60-100bpm)Atrioventricularnode(AVnode)inthelowerpartofinteratrialseptum,undertheendocardiumInternodaltracts(presumption?)Atrioventricularbundle(Hisbundle)passthroughcentralfibrousbodytoreachposteriorborderofmembranouspartDividesintorightandleftbundlebranchesRightbundlebranchentertheseptomarginaltrabecularreachtheanteriorpapillarymuscleLeftbundlebranchtheanteriorgroupdistributestoanteriorpapillarymuscles,anteriorpartoftheinterventricularseptum,anteriorandlateralwalloftheleftventricletheposteriorgroupdistributestotheseptalwalloftheleftventricle,middleandposteriorpartoftheinterventricularseptum,posteriorpapillarymuscles.PurkinjefibersSubendocardialplexus,reachallpartsoftheventricle,continuouswithmyocardiumContractionpassesfromtheapexoftheventricletotheoutflowtract.ArterialsupplyLeftcoronaryarteryArisesfromleftaorticsinusDividesintotheanteriorinterventricularbranch(leftanteriordescending

artery)andtheleftcircumflexartery(circumflexbranch)

.Anteriorinterventricularbranch

downwardinanteriorinterventriculargroovesupplytheanteriorwallsofthebothventriclesandtheanteriortwo-thirdsoftheinterventricularseptum.Circumflexbranchtravelstoleftincoronarygroovetoposteriorpartramiincludestheleftatrialbranch,leftmarginalbranchsuppliesleftatrium,lateralwallandposteriorwalloftherightventricle.Rightcoronaryarteryarisesfromtherightaorticsinus,passeswithinthecoronarygroove,towardsthecruxoftheheart.terminatesbyanastomosingwiththecircumflexbranchBranchesrightmarginalbranchposteriorbranchoftheleftventricleposterorinterventricularbranch(posteriordescendingartery)

suppliesrightatriumandventricle,posterior1/3ofinterventricularseptum,posteriorwallofleftventricleSinoatrialnodalarteryarisesfromtherightcoronaryartery(60%)orthecircumflexbranchofleftcoronaryartery(40%).Atrioventricularnodalarterymainlyarisesfromtherightcoronaryartery(93%).69%Right-dominantequalleft-dominant65.7%28.7%5.6%VenousdrainageCoronarysinusLocatedinposteriorpartofcoronarygrooveCarriesmostofvenousbloodfrommyocardiumtorightatriumMiddlecardiacveinSmallcardiacveinGreatcardiacveinCoronarysinusAnteriorcardiacveins3~4smallvessels,collectbloodfromtheanteriorpartoftherightventricle,openintorightatriumSmallestcardiacveinsArisefromthecapillariesinmyocardium,verysmall,drainintoallchambersdirectlyThesy