Transcript The Heart - 山东大学医学院人体解剖学教研室

The Heart
山东大学医学院 解剖教研室
李振华
Position
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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
External characteristics－a
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hollow muscular organ, pyramidal
in shape , somewhat larger than
a closed fist; consists of four
chanbers (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, 1~2cm
medial to the left midclavicular
line (9cm from the midline)
Cardiac base is formed by the
left atrium and to a small extent
by the right atrium. It faces
backward, upward and to the
right
Two surface
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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
Diaphragmatic surface
is formed the ventricles－
chiefly the left ventricle,
directed backwards and
downwards, and rest upon
the central tendon of the
diaphragm
Three borders
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Right border－vertical, is
formed entirely by right
atrium
Left border－round, is
mainly formed by the left
ventricle and partly by the
left auricle
Inferior border－
horizontal, 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
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Interatrial sulcus 房间沟－separates the
two atria and is hidden by pulmonary
trunk and aorta in front
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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 apical
incisure 心尖切迹
Atrioventricular crux 房室交点－a junction
of the posterior interventricular groove
and coronary sulcus
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Chambers of the heart
Right atrium 右心房 (RA)
Three inlets
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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 coronar sinus 冠状窦口
－returns blood to the heart from the
cardiac muscle
One outle
－right atrioventricular orifice 右房室口
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Crista terminalis界嵴
－vertical ridge thatjfrom superior
vena cave to inferior vena cave
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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
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Atrium proper 固有心房
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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 root of
superior vena cava, pectinate
muscles in wall
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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 fossae ovalis 卵圆窝缘
– prominent margin of fossa
ovalis
 Torus aortious 主动脉隆凸
Right ventricle (RV) 右心室
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Receives deoxygenated blood
from right atrium through right
atrioventricular orifice
One inlet－right artrioventricular
orifice 右房室口
One outlet－orifice of pulmonary
trunk 肺动脉口
Two parts－divided by the
supraventricular crest 室上嵴, a
muscular ridge between right
atrioventricular orifice and orifice
of pulmonary trunk
Inflow tract－rough walls
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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,
contains right bundle branch
Papillary muscles乳头肌－
conical-shaped , anterior,
posterior and septal
Out flow tract
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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
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Left auricle左心耳－projecting to
the right, pectinate muscles in wall
Four inlets－four orifices of
pulmonary veins 肺静脉口open
through the posterior wall
One outlet－left atrioventricular
orifice左房室口, blood leaves
through left atrioventricular orifice
to left ventricle
Left ventricle (LV) 左心室
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Has wall three times thicker
than that of right ventricle
One inlet－left atrioventricular
orifice 左房室口
One outlet－aortic orifice
主动脉口
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Two parts－divided by anterior
cusps of mitral valve
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Inflow tract－rough walls
Outflow tract – aortic vestibule
主动脉前庭, smooth area leading to
aortic orifice
Valves
Tricuspid valve 三尖瓣
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Guards right atrioventricular
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
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Guards left atrioventricular
orifice
Two triangular cusps－anterior
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
atria
 Closed during systole to prevent regurgitation of blood into
atria
Valve of pulmonary trunk
肺动脉瓣
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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
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Guards the aortic orifice
Three semilunar cusps (right,
left and post)
Three aortic sinuses – bulges
in aortic wall at level of valve
that correspond to cusps
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Right－contains opening
of right coronary artery
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Left－contains opening of
left coronary artery
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Posterior－no opening
Similar functions for
pulmonary and aortic
valves
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Opening during systole,
with cusps pressed
toward wall of vessel as
blood is forced upward
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Closed during diastole
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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
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Endocardium心内膜－inner
coat of the heart wall, and
continuous 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
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室间隔
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Located between right and
left ventricles
Has upper membranous
part
Has thick lower muscular
part
Fibrous skeleton 纤维骨骼
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Fibrous rings that surround
the atrioventricular,
pulmonary, and aortic
orifices
Left and right fibrous trigons
Conduction system of heart心传导系
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Consists of specialized
myocardial cells
Sinuatrial node 窦房结
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(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
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(AV node)
Located in the lower part of interatrial
septum just above the orifice of
coronary sinus, under the
endocardium
Lower part related to membranous
part of interventricular septum
Atrioventricular bundle 房室束
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(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
Right and left bundle
branches 左、右束支
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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 fibers 普肯野氏纤维
－continuous with myocardium
Arterial supply
Left coronary artery 左冠状动脉
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Arises from left aortic sinus
Runs between pulmonary trunk and left
auricle into coronary sulcus
Branches
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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 posterior aspect
Distribution－supplies 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
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Arises from the right aortic sinus
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Runs forward between right auricle
and pulmonary trunk into coronary
sulcus
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Branches
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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
ventricle, posterior 1/3 of
interventricular septum, posterior wall
of left ventricle, the sinuatrial node
and atrioventricular node
Venous drainage
Coronary sinus 冠状窦
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Located in posterior part
of coronary sinus
Carries most of venous
blood from myocardium to
right atrium
Tributaries
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Great cardiac vein 心大静脉
Middle cardiac vein 心中静脉
Small cardiac vein 心小静脉
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Anterior cardiac veins
心前静脉－3~4 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
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Attached to central tendon of
diaphragm inferiorly
Blends with outer coat of great
vessels superiorly
Serous pericardium 浆膜心包
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Visceral pericardium (epicardium)
Parietal pericardium
Pericardial cavity 心包腔
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Potential space between visceral
and parietal pericardium
Contains film of pericardium fluid
Pericardium sinus
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Transverse sinus of pericardium 心包横窦－posterior to
ascending 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
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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
Dissection of the heart