1. Angiology 脉管学

2. Angiology 脉管学 Composition Cardiovascular system 心血管系统
Lymphatic system 淋巴系统

3. The cardiovascular system 心血管系统
Organization
Heart 心
A muscle pump to maintain the flow of blood.
Consist of four chambers (right and left atria, right and left ventricles).
Artery (A)动脉
carry blood away from the heart.
Veins (V)静脉
carry blood back to the heart
Capillary (Cap)毛细血管
microscopic vessels, the area of exchange between blood and tissue fluid.

4. The cardiovascular system心血管系统
Blood circulation
Systemic circulation 体循环 left ventricle→aorta and its branches→capillaries of body→superior and inferior vena cava→right atrium
Pulmonary circulation 肺循环right ventricle→pulmonary A→ capillaries of lung → pulmonary V →left atrium

5. The cardiovascular system心血管系统
Vascular anastomosis 血管吻合
Anastomosis between A
Anastomosis between V
Arteriolovenular anastomosis 动静脉吻合
Collateral vessels 侧副管
Collateral circulation 侧支循环

6. The Heart

7. The heart Position Lies within the pericardium in middle mediastinum.
Behind the body of sternum and 2th. to 6th. coastal cartilages.
In front of 5th. to 8th. thoracic vertebrae.
One third of it lies to the right of median plan and 2/3 to the left.

8. Surfaces of the heart
Pyramidal in shape, somewhat larger than a closed fist.
One apex
One base
Two surface
Three borders
Four sulcuses

9. Cardiac apex 心尖 Formed by left ventricle
Directed downwards, forward, and to the left
Lies at the level of the 5th left intercostal space, 1~2 cm medial to the left midclavicular line (9cm from the midline) .

10. Cardiac base 心底
Formed by the left atrium and to a small extent by the right atrium.
Faces backward, upward and to the right.

11. Sternocostal surface 胸肋面
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.

12. Diaphragmatic surface 膈面
Formed the ventricles－chiefly the left ventricle.
Directed backwards and downwards, and rest upon the central tendon of the diaphragm.

13. Borders of the heart Right border 右缘 Left border 左缘 Inferior border 下缘
Vertical
Formed entirely by right atrium
Left border 左缘
Round
Mainly formed by the left ventricle and partly by the left auricle
Inferior border 下缘
Horizontal
Formed by the right ventricle and cardiac apex

14. Sulcuses of the heart
Coronary sulcus 冠状沟(circular sulcus) which marks the division between atrium and ventricles, contains the trunks of the coronary vessels and completely encircles the heart.
Interatrial sulcus 房间沟 －separates the two atrium and is hidden by pulmonary trunk and aorta in front.

15. Sulcuses of the heart Anterior interventricular groove 前室间沟
Posterior interventricular groove 后室间沟
Mark the division between ventricles (which separates the R from the L ventricle)
Cardiac apical incisure 心尖切迹
Atrioventricular crux 房室交点

16. Chambers of the heart 心 腔

17. Chambers of the heart 心腔
Consists of four chambers
Left and right atria
左、右心房
Left and right auricle
左、右心耳
Left and right ventricles
左、右心室

18. Right atrium 右心房 Three inlets
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 coronary sinus 冠状窦口
returns blood to the heart from the cardiac muscle.
One outlet －right atrioventricular orifice
右房室口

19. Right atrium 右心房
Crista terminalis 界嵴－vertical ridge that from superior vena cave to inferior vena cave.
Sulcus terminalis界沟－groove on exterior of heart that corresponds (一致)to crista terminalis.
Two parts －separated externally by sulcus terminalis and internally by the crista terminalis.
Atrium proper 固有心房
Sinus venarum cavarum 腔静脉窦

20. Right atrium 右心房 Atrium proper 固有心房 Sinus venarum cavarum 腔静脉窦
In front of the ridge
Pectinate muscles in wall
Sinus venarum cavarum 腔静脉窦
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)-房间隔缺损.

21. Right ventricle 右心室 One inlet －right atrioventricular orifice 右房室口
One outlet 　　－orifice of pulmonary trunk 肺动脉口

22. Right ventricle 右心室
Supraventricular crest 室上嵴 (a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk )
Two parts
Inflow tract 流入道
Outflow tract 流出道

23. Right ventricle 右心室 Inflow tract
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
Three: anterior, posterior and septal.

24. Right ventricle 右心室 Outflow tract —Conus arteriosus 动脉圆锥
Cone-shape , smooth area leading upward to orifice of pulmonary trunk
Pumps blood through pulmonary orifice to pulmonary trunk.

25. Tricuspid valve 三尖瓣 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 腱索, which connect the cusps to the papillary muscles.

26. Tricuspid valve 三尖瓣

27. Tricuspid complex 三尖瓣复合体
Tricuspid ring 三尖瓣环
Tricuspid valve 三尖瓣
Chordae tendineae 腱索
Papillary muscles 乳头肌

28. 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

29. Valve of pulmonary trunk 肺动脉瓣
three semilunar cusps which guards the orifice of pulmonary trunk

30. Function of pulmonary valves
Opening during systole(心脏收缩) , with cusps pressed toward wall of vessel as blood is forced upward.
Closed during diastole(心脏舒张)
Ventricular pressure drops in diastole.
Floating together of valve cusps, with free borders meeting, thus closing the valve.

31. Left atrium 左心房 Four inlets－four orifices of pulmonary veins 肺静脉口
One outlet－left atrioventricular orifice 左房室口

32. Left ventricle 左心室 One inlet left atrioventricular orifice 左房室口
One outlet － aortic orifice 主动脉口
Two parts－divided by anterior cusps of mitral valve.
Inflow tract－rough walls
Outflow tract
Aortic vestibule 主动脉前庭
Smooth area leading to aortic orifice

33. Mitral valve 二尖瓣 Guards left atrioventricular orifice
Two triangular cusps－anterior and posterior with commissural cusps between them.

34. Mitral complex 二尖瓣复合体 Mitral ring 二尖瓣环 Mitral valve 二尖瓣
Chordae tendineae 腱索
Papillary muscles 乳头肌

35. 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

36. Aortic valve 主动脉瓣 Guards the aortic orifice
Three semilunar cusps (right, left and posterior)
Aortic sinus 主动脉窦 – 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

37. 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

38. Structures of the heart
Walls of heart
Endocardium 心内膜
Inner coat of the heart wall
Continuous with the valve flaps
Myocardium 心肌
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 心外膜
Outer
Visceral layer of serous pericardium

39. Structures of the heart
Interatrial septum 房间隔
Located between right and left atria
Contains fossa ovalis
Interventricular septum 室间隔
Located between right and left ventricles
Has upper membranous part
Has thick lower muscular part
Atrioventricular septum 房室隔

40. Membranous part of interventricular septum

42. Fibrous skeleton of heart 纤维骨骼
Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices.
Left and right fibrous trigones.

43. Conduction system of heart 心传导系统

44. Conduction system of heart 心传导系统
Composed of specialized myocardial cells.
Sinuatrial node 窦房结
Internodal tract 结间束
Atrioventricular node 房室结
Atrioventricular bundle 房室束
Right and left bundle branches 左、右束支
Purkinje network 普肯野氏纤维网

45. Conduction system of heart 心传导系统
Sinuatrial node 窦房结
Called the pacemaker cell. Located at the upper part of the sulcus terminalis close to the superior vena cava, under the epicardium.

46. Conduction system of heart 心传导系统
Atrioventricular node (AV node) 房室结
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.

47. Conduction system of heart 心传导系统
Atrioventricular bundle (AV bundle)房室束
Passes forward through right fibrous trigone to reach inferior border of membranous part.
Divides into right and left bundle branches at upper border of muscular part of interve ntricular septum.

48. Conduction system of heart 心传导系统
Right and left bundle branches 左、右束支
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 普肯野氏纤维网 continuous with myocardium.

49. Atrioventricular bundle Atrioventricular node
★心传导系统
Sinatrial node
Atrioventricular bundle
Right and left bundle branches
Atrioventricular node
Purkinje network

50. Arterial supply of the heart
Left coronary artery 左冠状动脉
Course
Arises from left aortic sinus
Runs between pulmonary trunk and left auricle into coronary sulcus.
Branches
Anterior interventricular branch 前室间支－runs 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.

51. Arterial supply of the heart
Right coronary artery 右冠状动脉
Course
Arises from the right aortic sinus
Runs forward between right auricle and pulmonary trunk into coronary sulcus.
Branches
Right marginal branch 右缘支－ travels along inferior border.
Posteror interventricular branch 后室间支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.

52. Coronary artery bypass grafting (CABG)
Precutaneous translaminal
coronary angioplasty (PTCA)
Stent in an artery

53. Venous drainage of the heart
Coronary sinus 冠状窦
Lies in posterior part of coronary sulcus.
Carries most of venous blood from myocardium to right atrium.
Tributaries
Great cardiac vein 心大静脉
Middle cardiac vein 心中静脉
Small cardiac vein 心小静脉

54. Venous drainage of heart
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.

55. Pericardium 心包 Fibrous pericardium 纤维心包 Serous pericardium 浆膜心包
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.

56. 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.

57. Pericardium sinus
Oblique sinus of pericardium 心包斜窦－cul-de-sac(死胡同), posterior to heart, bounded by pulmonary veins on either side.
Anterior inferior sinus of pericardium 心包前下窦

58. 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