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Angiology
SHANDONG UNIVERSITY
Liu Zhiyu
Angiology
Composition Cardiovascular
system Lymphatic system
The cardiovascular systemOrganization Heart
A muscle pump to maintain the flow of blood
Consist of four chambers (right and
left atria, right and left ventricles) Artery (a.) carry blood away from the heart Veins ( v.) carry blood back to the heart Capillary microscopic vessels, the area of
exchange between blood and tissue fluid
The cardiovascular system
Blood circulation Systemic circulation
left ventricle→aorta and its branches→capillaries of body→superior and inferior vena cava→right atrium
Pulmonary circulation right ventricle→pulmonary a.→capillaries of lung → pulmonary v. →left atrium
The cardiovascular system
Vascular anastomosis
Anastomosis between a. Anastomosis between v. Arteriolovenular
anastomosis Collateral vessels Collateral circulation
The Heart
The heart
Position Lies within the pericardium in
middle mediastinum 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
Surfaces of the heart
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, 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)
Cardiac apex
Cardiac base
Formed by the left atrium and to a small extent by the right atrium.
Faces backward, upward and
to the right
Sternocostal surface
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
Formed the ventricles - chiefly the left ventricle
Directed backwards and downwards, and rest upon the central tendon of the diaphragm
Borders of the heart
Right border Vertical Formed entirely by right
atrium Left border
Round Mainly formed by the left
ventricle and partly by the left auricle
Inferior border Horizontal Formed by the right ventricle
and cardiac apex
Sulcuses of the heart
Coronary sulcus (circular sulcus) which marks the division between atria and ventricles, contains the trunks of the coronary vessels and completely encircles the heart
Interatrial sulcus -separates the two atria and is hidden by pulmonary trunk and aorta in front
Sulcuses of the heart Anterior interventricular
groove Posterior interventricular
groove Mark the division between
ventricles (which separates the RV from the LV)
Cardiac apical incisure Atrioventricular crux
Chambers of the heart
Chambers of the heart
Consists of four chambers
Left and right atria Left and right auricle
Left and right ventricles
Right atrium (RA) Three inlets
Orifice of superior vena cava returns blood to the heart from the upper half of the body
Orifice of inferior vena cava returns blood to the heart from the lower half of the body
Orifice of coronary sinus returns blood to the heart from the cardiac muscle
One outlet - right atrioventricular orifice
Right atrium (RA) Crista terminalis - vertical
ridge that from superior vena cave to inferior vena cave
Sulcus terminalis - 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 Sinus venarum cavarum
Right atrium (RA) Atrium proper
In front of the ridge Pectinate muscles in wall
Sinus venarum cavarum Smooth walls Fossa ovalis - 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)
Aortic mound
Right ventricle (RV)
One inlet - right atrioventricular orifice
One outlet - orifice of pulmonary trunk
Right ventricle (RV)
Supraventricular crest (a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk )
Two parts Inflow tract Outflow tract
Right ventricle (RV)
Inflow tract Trabeculae carneae
irregularly arranged bundles of myocardium
Septomarginal trabecula - extends from interventricular septum to base of anterior papillary muscle, contains right bundle branch
Papillary muscles Conical-shaped Three: anterior, posterior
and septal
Right ventricle (RV)
Outflow tract —Conus
arteriosus Cone-shape , smooth area
leading upward to orifice of pulmonary trunk
Pumps blood through pulmonary orifice to pulmonary trunk
Tricuspid valve Guards right atrioventricular
orifice Three triangular cusps:
anterior, posterior and septal Base of cusps are attached to
fibrous ring surrounding the atrioventricular orifice.
To their free edges and ventricular surfaces are attached chordae tendineae , which connect the cusps to the papillary muscles.
Tricuspid valve
Tricuspid complex
Tricuspid ring Tricuspid valve Chordae tendineae Papillary muscles
Chordae tendineae
Papillary muscles
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
Guards the orifice of pulmonary trunk
Has three semilunar cusps – each with free border that has central modules called nodules of semilunar valve
Has three pulmonary sinuses —bulges in wall of pulmonary trunk at level of valve that correspond to cusps
Function of pulmonary 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
Left atrium (LA) Four inlets - four orifices of pulmonary veins One outlet - left atrioventricular orifice
Left ventricle (LV)
One inlet left atrioventricular orifice
One outlet - aortic orifice Two parts - divided by anterior cusps of
mitral valve Inflow tract - rough walls Outflow tract
Aortic vestibule Smooth area leading to aortic orifice
Mitral valve
Guards left atrioventricular orifice Two triangular cusps - anterior and
posterior with commissural cusps between them (posteromedial and anterolateral commissures)
Mirtal complex
Mitral ring Mitral valve Chordae tendineae Papillary muscles
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
Guards the aortic orifice Three semilunar cusps (right, left and
posterior) Each with free border that has
nodules of semilunar valve Aortic sinus – 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 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
Structures of the heart
Walls of heart Endocardium
Inner coat of the heart wall Continuous with the valve flaps
Myocardium Arranged spirally Attached to fibrous rings surrouding
the four orifices of heart The walls of left ventricle are about
three times thicker than that of right Epicardium
Outer Visceral layer of serous pericardium
Structures of the heart Interatrial septum
Located between right and left atria
Contains fossa ovalis Interventricular septum
Located between right and left ventricles
Has upper membranous part Has thick lower muscular part
Atrioventricular septum
Membranous part of interventricular septum
Ventricular Septal Defect
Fibrous skeleton of heart
Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices
Left and right fibrous trigones
Conduction system of heart
Conduction system of heart Composed of specialized myocardial
cells
Sinuatrial node Internodal tract Atrioventricular node Atrioventricular bundle Right and left bundle branches Purkinje network
Conduction system of heart
Sinuatrial node (SA node)
Called the pacemaker cell
(P cell)
Located at the upper part of
the sulcus terminalis close
to the superior vena cava,
under the epicardium.
Conduction system of heart
Atrioventricular node (AV node)
Located in the lower part of interatrial 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 Atrioventricular bundle
(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 muscular part of interventricular septum
Conduction system of heart Right and left bundle branches
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 continuous with myocardium
★
Sinuatrial node
Atrioventricular node
Atrioventricular bundle
Right and left bundle branches
Purkinje network
Arterial supply of the heart
Arterial supply of the heart
Left coronary artery Course
Arises from left aortic sinus Runs between pulmonary trunk and left
auricle into coronary sulcus Branches
Anterior interventricular branch -runs downward in anterior interventricular groove around inferior margin of heart to posterior interventricular groove
Circumflex branch - 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 Course
Arises from the right aortic sinus Runs forward between right auricle and
pulmonary trunk into coronary sulcus Branches
Right marginal branch travels along inferior border
Posteror interventricular branch - 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
Thrombus in Coronary Artery Angiogram冠状动脉造影显示动脉血栓
Stent in an artery
Precutaneous translaminal coronary angioplasty (PTCA)
Coronary artery bypass grafting (CABG)
Venous drainage of the heart
Venous drainage of the heart
Coronary sinus Lies in posterior part of
coronary sulcus Carries most of venous
blood from myocardium to right atrium
Tributaries Great cardiac vein Middle cardiac vein Small cardiac vein
Pericardium 心包
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
pericardium Transverse sinus of pericardium 心包横窦 Posterior to ascending aorta and
pulmonary trunk Anterior to superior vena cava and
left atrium.
Pericardium sinus
Oblique sinus of pericardium 心包斜窦- cul-de-sac , posterior to heart, bounded by pulmonary veins on either side
Anterior inferior sinus of pericardium 心包前下窦
Venous drainage of heart
Anterior cardiac veins - 3~4 small vessels, drain into right atrium
Smallest cardiac veins - drain into all chambers, mainly atria
Surface markings of heart
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
Surface markings of heart
Right border - corresponds to a line running from the upper border of right third costal cartilage ±1.2cm from the margin of sternum, downwards to sixth sternocostal joint
Apex - in the fifth left intercostal space 7~9cm from the midline
Left border - represented 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
Lower border - represented by a line joint the lower end of right border to apex
★You must identify follow structures!
Shape of heart Cardiac apex Cardiac base Coronary sulcus Anterior interventricular
groove Posterior interventricular
groove Cardiac apical incisure Atrioventricular crux Right and left auricle Pulmonary trunk
Vessels of heart Left coronary artery Anterior interventricular branch Right coronary artery Posteror interventricular branch coronary sinus Right atrium Orifice of superior vena cava Orifice of inferior vena cava Orifice of coronary sinus Sulcus terminalis Fossa ovalis Pectinate muscles
★You must identify follow structures!
Right ventricle Right atrioventricular orifice Tricuspid valve Chordae tendineae Papillary muscles Supraventricular crest Trabeculae carneae Septomarginal trabecula Conus arteriosus Valve of pulmonary trunk
Left atrium Orifices of pulmonary veins Left atrioventricular orificeLeft ventricle Aortic vestibule Mitral valve Aortic vavle Aortic sinus