Transcript The Heart

Angiology
SHANDONG UNIVERSITY
Liu Zhiyu
Angiology
Composition
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Cardiovascular
system
Lymphatic system
The cardiovascular system
Organization
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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
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Pulmonary circulation
left ventricle→aorta and its
branches→capillaries of
body→superior and inferior
vena cava→right atrium
right ventricle→pulmonary
a.→capillaries of lung →
pulmonary v. →left atrium
The cardiovascular system
Vascular
anastomosis
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Anastomosis between a.
Anastomosis between v.
Arteriolovenular
anastomosis
Collateral vessels
Collateral circulation
The Heart
The heart
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
Surfaces of the heart
Surfaces of the heart
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Pyramidal in shape, somewhat larger
than a closed fist
One apex
One base
Two surface
Three borders
Four sulcuses
Cardiac apex
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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 base
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Formed by the left atrium and
to a small extent by the right
atrium.
Faces backward, upward and
to the right
Sternocostal surface
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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
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Formed the ventricles－chiefly
the left ventricle
Directed backwards and
downwards, and rest upon the
central tendon of the diaphragm
Borders of the heart
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Right border
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Left border
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Vertical
Formed entirely by right
atrium
Round
Mainly formed by the left
ventricle and partly by the left
auricle
Inferior border
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Horizontal
Formed by the right ventricle
and cardiac apex
Sulcuses of the heart
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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
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Anterior interventricular
groove
Posterior interventricular
groove
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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
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Left and right atria
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Left and right auricle
Left and right ventricles
Right atrium (RA)
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Three inlets
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Orifice of superior vena
cava returns blood to the heart
from the upper half of the body
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Orifice of inferior vena
cava
returns blood to the
heart from the lower half of the
body
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Orifice of coronary sinus
returns blood to the heart from
the cardiac muscle
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One outlet
－right atrioventricular
orifice
Right atrium (RA)
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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)
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Atrium proper
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In front of the ridge
Pectinate muscles in wall
Sinus venarum cavarum
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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)
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Aortic mound
Right ventricle (RV)
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One inlet
－right atrioventricular orifice
One outlet
－orifice of pulmonary trunk
Right ventricle (RV)
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Supraventricular crest
(a muscular ridge between
right atrioventricular orifice
and orifice of pulmonary
trunk )
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Two parts
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Inflow tract
Outflow tract
Right ventricle (RV)
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Inflow tract
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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)
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Outflow tract —Conus
arteriosus
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Cone-shape , smooth area
leading upward to orifice of
pulmonary trunk
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Pumps blood through pulmonary
orifice to pulmonary trunk
Tricuspid valve
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Guards right atrioventricular
orifice
Three triangular cusps:
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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
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Tricuspid ring
Tricuspid valve
Chordae tendineae
Papillary muscles
Chordae tendineae
Papillary muscles
Function of tricuspid complex
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Open during diastole to allow blood to enter ventricles from atria
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Closed during systole to prevent regurgitation of blood into atria
Valve of pulmonary trunk
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Guards the orifice of
pulmonary trunk
Has three semilunar
cusps – each with free
border that has central
modules called nodules
of semilunar valve
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Has three pulmonary
sinuses —bulges in wall
of pulmonary trunk at level
of valve that correspond to
cusps
Function of pulmonary valves
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Opening during systole, with cusps
pressed toward wall of vessel as
blood is forced upward
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
Left atrium (LA)
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Four inlets－four orifices of pulmonary veins
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One outlet－left atrioventricular orifice
Left ventricle (LV)
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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
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Guards left atrioventricular orifice
Two triangular cusps－anterior and
posterior with commissural cusps between
them (posteromedial and anterolateral
commissures)
Mirtal complex
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Mitral ring
Mitral valve
Chordae tendineae
Papillary muscles
Function of mitral complex
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Open during diastole to allow blood to enter ventricles from atria
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Closed during systole to prevent regurgitation of blood into atria
Aortic valve
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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
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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
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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
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Interatrial septum
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Interventricular septum
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Located between right and left
atria
Contains fossa ovalis
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
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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
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Sinuatrial node
Internodal tract
Atrioventricular node
Atrioventricular bundle
Right and left bundle branches
Purkinje network
Conduction system of heart
Sinuatrial node (SA node)
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Called the pacemaker cell
(P cell)
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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
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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
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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
Conduction system of heart
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Right and left bundle branches
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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 network continuous with
myocardium
★
Sinuatrial node
Atrioventricular bundle
Right and left
bundle branches
Atrioventricular node
Purkinje network
Arterial supply of the heart
Arterial supply of the heart
Left coronary artery
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Course
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Arises from left aortic sinus
Runs between pulmonary trunk and left
auricle into coronary sulcus
Branches
 Anterior interventricular branch
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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
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Arterial supply of the heart
Right coronary artery
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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
Coronary artery bypass
grafting (CABG)
Precutaneous translaminal
coronary angioplasty (PTCA)
Stent in an artery
Venous drainage of the heart
Venous drainage of the heart
Coronary sinus
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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
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Fibrous pericardium 纤维心包
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Serous pericardium 浆膜心包
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Attached to central tendon of
diaphragm inferiorly
Blends with outer coat of great
vessels superiorly
Visceral layer (epicardium)
Parietal layer
Pericardial cavity 心包腔
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Potential space between visceral and
parietal layes
Contains film of pericardium fluid as a
lubricant to facilitate cardiac
movements
Pericardium 心包
Pericardium sinus
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Formed by reflection of serous
pericardium
Transverse sinus of pericardium
心包横窦
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Posterior to ascending aorta and
pulmonary trunk
Anterior to superior vena cava and
left atrium.
Pericardium sinus
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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
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Anterior cardiac
veins －3~4 small
vessels, drain into
right atrium
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Smallest cardiac
veins －drain into all
chambers, mainly
atria
Surface markings of heart
Surface markings of heart
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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
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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
★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 orifice
Left ventricle
 Aortic vestibule
 Mitral valve
 Aortic vavle
 Aortic sinus
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