5.心臟解剖課件

心臟解剖&心臟傳導系統(tǒng)華東醫(yī)院周雯華東醫(yī)院周雯5.心臟解剖位置位于縱隔腔內(nèi)左右肺之間2/3在中線左側方向：右后上－左前下MidLine5.心臟解剖概述：心房為薄壁，低壓心腔左右心房以房間隔分隔導管從右心房到左心房，需行房間隔穿刺術，經(jīng)卵圓窩通路進入左心房右心房：在右心室收縮期充盈接受來自于SVC，IVC，CS的血液靜脈血右心房5.心臟解剖IVC右心房5.心臟解剖IVCSuperiorVenaCavaInferiorVenaCavaCoronarySinus右心房5.心臟解剖IVCTricuspidValveAnnulus(TVA)5.心臟解剖IVCRightAuricle(or)RightAtrialAppendage5.心臟解剖IVCCristaTerminalisTendonofTodaroEustachianRidge5.心臟解剖柯氏三角點CS竇口His束邊緣Todaro氏腱三尖瓣環(huán)5.心臟解剖IVCFossaOvalis5.心臟解剖左心房左心房在左心室收縮期充盈接受來自肺靜脈的血液動脈血5.心臟解剖肺靜脈RightSuperiorRightInferiorLeftSuperiorLeftInferior5.心臟解剖5.心臟解剖LeftAtrialAppendage5.心臟解剖GreatCardiacVeinCoronarySinus5.心臟解剖FossaOvalis5.心臟解剖心室概述左右心室間以室間隔相隔分流入道和流出道左心室

接受來自左心房的血液將血液泵入主動脈(Ao)，至全身組織左心室室壁厚于右心室右心室接受來自右心房的血液將血液泵入肺動脈5.心臟解剖Viewedfromabove左右心室橫截面5.心臟解剖右心室5.心臟解剖TricuspidValve5.心臟解剖RightVentricularOutflowTract(RVOT)PulmonicValve5.心臟解剖ModeratorBand5.心臟解剖Bicuspid/MitralValve5.心臟解剖5.心臟解剖AorticValve5.心臟解剖心壁結構心外膜最外層Outermostlayer薄層，漿膜Thin,serousmembrane心肌層Myocardium中層Middlelayer工作心肌Workingmuscleofheart心內(nèi)膜Endocardium最內(nèi)層InnermostlayerLinesmyocardium心包Pericardium心包腔PericardialSac內(nèi)含少量漿膜液Smallamountofliquid5.心臟解剖纖維骨架纖維骨架分離心房和心室為心臟瓣膜提供框架5.心臟解剖心臟瓣膜(房室瓣)只允許血液從心房單向流向心室三尖瓣連接RA和RV二尖瓣連接LA和LV心室壓力低于心房壓力時，房室瓣開放5.心臟解剖心臟收縮期

心臟瓣膜5.心臟解剖心臟瓣膜心臟舒張期5.心臟解剖心臟瓣膜（半月瓣）肺動脈瓣：連接RV與PA主動脈瓣：連接LV與AoPulmonicValveAorticValve5.心臟解剖心臟瓣膜在心動周期中的作用5.心臟解剖腱索與乳頭肌腱索腱索連接房室瓣和乳頭肌乳頭肌發(fā)自心內(nèi)膜,連接于腱索作用心室收縮迫使房室瓣關閉乳頭肌收縮引起腱索緊張預防血液從動脈逆向回流至心室5.心臟解剖心臟傳導系統(tǒng)

ConductionSystem5.心臟解剖心臟傳導系統(tǒng)組成竇房結（SANode）Theheart’smainPacemakerLocatednearjunctionofRAandSVCBachman’sBundleconductsactivationfromSAnodetoLA結間束（InternodalTracts）ConductsactivationfromSAnodeacrossatria纖維骨架（FibrousSkeleton）

barriertoconductionfromatriatoventricles5.心臟解剖房室結房室結(AVnode)位于三尖瓣上方，CS開口前方激動從心房經(jīng)AV傳導到His束(bundleofHis)TrafficCopSecondarypacemakeroftheheart5.心臟解剖AVDelay的作用Iftheventriclescontractwhenthemitralandtricuspidvalvesareopen,bloodtendstogobackwardsinsteadofforwardsBydelayingit120to150milliseconds,thatallowstheatriatoemptyandthentheventriclestocontractagainstclosedvalves.5.心臟解剖希氏束希氏束（BundleHis）StartofVentricularConductionSystemConductsimpulsesthroughseptumtobundlebranchesNormallythesoleelectricalconnectionbetweenatriaandventricles5.心臟解剖束支（BundleBranches）DownSeptumWallTransmitsimpulsesfromthebundleofHistobothventricles浦氏纖維網(wǎng)（PurkinjeFibers）

SpecialcellsofconductionthroughouttheventriclesTertiarypacemakeroftheheart20-40bpm5.心臟解剖His-PurkinjeSystemTheseareliketheAutobahn.SinusnodeandAVnodehavespeedlimitsofaboutabout25mphAtriumandventricularmuscleis70or75mphHis-PurkinjesystemisliketheAutobahnat150mph.ItallowsveryrapidconductiondowntotheapexoftheheartLargecellsandallowcontractiondowntotheapexsotheheartsqueezesapexbacktobase.5.心臟解剖心臟電傳導的組成SANodeInternodalTractsandBachman’sBundleAVNodeBundleofHisBundleBranchesPurkinjeFibers5.心臟解剖CardiacAnatomyQuizPleaseidentifythefollowinganatomicpoints.SANodeBachman’sBundleInternodalTractsAVNodeBundleofHisBundleBranchesPurkinjeFibers1.2.3.4.5.6.7.8.9.10.11.12.13.SuperiorVenaCavaOSofSuperiorVenaCavaRightAtriumOSofInferior