解剖学_心血管

心血管

heart
- Location
  - In the mediastinum
    - Between the lungs
    - Mediastinum 纵隔 is a region that extends from sternum to vertebral column and from 1st rib to diaphragm
  - 2/3 of the mass of the heart lies to the left of the body’s midline.
  - Visualizes as a cone lying on its side
- 外观
  - Apex
    - formed by the tip of LV and rests on the diaphragm
    - directed anteriorly, inferiorly, and to the left
  - Base
    - opposite the apex
    - formed by the atria, mostly the LA
  - Anterior surface
    - deep to the sternum and ribs
  - Inferior/diaphragmatic surface
    - rests on the diaphragm
  - Right surface
    - faces the right lung
  - Left surface
    - faces the left lung
  - Auricle 心耳
    - resembles a dog’s ear
    - on the anterior surface of each atrium
  - Sulci
    - a series of grooves沟 on heart surface
    - contain coronary blood vessels and fat
    - external boundary for 4 chambers
      - coronary sulcus 冠状沟
        
        分隔 atria and ventricles
      - anterior interventricular sulcus 前室间沟
        
        分隔 RV and LV on the anterior surface
      - posterior interventricular sulcus 后室间沟
        
        分隔 RV and LV on the posterior surface
  - 图
- Right atrium
  - Entry
    - Superior vena cava
    - Inferior vena cava
    - Coronary sinus 冠状窦
      - opening of deoxygenated blood from the myocardium
  - Exit
    - Tricuspid valve
  - 结构
    - Smooth posterior wall of the inner layer
    - Rough anterior wall of the inner layer due to pectinate muscles 梳状肌//左边掀起来的
    - Pectinate muscles extend into the auricle
    - Interatrial septum (septum = a dividing wall)
    - fossa ovalis - oval depression 卵圆窝
  - 图
- Right ventricle
  - Exit
    - pulmonary valve into pulmonary trunk 肺动脉干
    - pulmonary trunk divides into right and left pulmonary arteries
  - 结构
    - forms most of the anterior surface of the heart
    - inside of the RV contains trabeculae carneae 肉柱
    - cusps of the tricuspid valve connect to chordae tendineae 腱索
    - chordae tendineae connect to papillary muscles 乳头肌
    - RV separated from LV by interventricular septum
  - 图
- Operation of tricuspid and bicuspid
  - ventricles relax → papillary muscles relax → chordae tendineae are slack → blood flows from a higher pressure in the atria to a lower pressure in the ventricles through open valves
  - ventricles contract → pressure of the blood drives the cusps upward and close the opening → papillary muscles contract → pulls on chordae tendineae → prevents the backflow of blood
  - 图
- Left atrium
  - Entry
    - four pulmonary veins
  - Exit
    - bicuspid valve
  - forms most of the base of the heart
  - smooth inner layer as pectinate muscles only in the auricle of the LA
  - 后面看, 左右肺静脉流入左心房
- Left ventricle
  - Thickest chamber
  - Forms the apex of the heart
  - Contains trabeculae carneae and chordae tendineae
  - Exit
    - aortic valve into the ascending aorta
      - ascending aorta
      - arch of the aorta
      - descending aorta (thoracic aorta and abdominal aorta)
  - ligamentum arteriosum 动脉韧带 connects the pulmonary trunk and the aorta
- Fibrous rings
  - Four dense connective tissue rings surround the valves of the heart
  - form a structural foundation for the heart valves
  - prevent overstretching of the valves as blood passes through them
  - acts as an electrical insulator between the atria and ventricles
  - 图
conduction sysytem
- Autorhythmic fibers - specialized cardiac muscle fibers
- Self-excitable - act as a pacemaker, generate AP
- Cardiac chambers contract in a coordinated manner
- 兴奋过程
  - Cardiac excitation begins in the sinoatrial node
  - AP propagates through both atria via intercalated discs
  - Both atria contract
  - AP reaches the atrioventricular node
  - AP enters the atrioventricular bundle 房室束(希氏束)
  - AP enters both the right and left bundle branches 右束支和左束支
  - AP propagates along Purkinje fibers
  - Both ventricles contract
- 图
Coronary Circulation
- Coronary arteries
  - branch from the ascending aorta
  - supply oxygenated blood to the myocardium
  - left coronary artery - passes inferior to the left auricle
  - right coronary artery - passes inferior to the right auricle
  - 图
  - 图
- Left coronary artery
  - passes inferior to the left auricle and divides into
    - Left anterior descending (LAD)
      - in the anterior interventricular sulcus 走行于前室间沟内
      - supplies both ventricles
    - Circumflex branch 旋支
      - in the coronary sulcus 走行于冠状沟内
      - supplies both atria
  - 图
- Right coronary artery
  - passes inferior to the right auricle and divides into
    - marginal branch 右缘支
      - runs along the right margin of the heart 走行于心脏右缘
      - supplies RV
      - 图
    - posterior descending of right coronary A 后降支
      - in the posterior interventricular sulcus 走行于后室间沟
      - supplies both ventricles
      - 图
Pericardium
- Pericardium is triple-layered membrane that surrounds the heart
- 分为
  - the fibrous pericardium 纤维性心包
    - 在浆膜性心包外面
  - the serous pericardium 浆膜性心包
    - 2层
      - parietal layer
      - visceral layer, AKA epicardium 心外膜
    - pericardial cavity - cavity b/t the parietal and visceral layers 心包腔
    - pericardial fluid - lubricating serous fluid 心包液
    - 图
Heart Wall
- Epicardium (external layer)
- Myocardium (middle layer)
  - composed of cardiac muscle tissue
  - makes up approximately 95% of the heart wall
  - responsible for the pumping action
- Endocardium (inner layer)
  - thin layer of connective tissue
  - minimizes the surface friction as blood passes through the heart
Aorta
- Ascending aorta
  - locates posterior to the pulmonary trunk
  - gives off 2 coronary arteries
  - arches to the left
- Arch of the aorta
  - 左右在刚开始不相同分支
    - brachiocephalic trunk
      - right common carotid A
      - right subclavian A
      - right vertebral A
        
        横突孔在颈椎上
      - 图
    - left common carotid
    - left subclavian
      - left vertebral
    - 先分成三个分支
    - 图
  - 在后面左右对称
    - Common carotid A
      - Ascending aorta → brachiocephalic trunk → right common carotid
      - Ascending aorta → left common carotid
      - Carotid sheath颈动脉鞘 contains the common carotid A, internal jugular V, and vagus N.
      - common carotid A在颈动脉窦部分分成internal carotid A与external carotid A
      - pressure-monitoring receptors in the carotid sinus 颈动脉窦
      - chemoreceptors (receptors that monitor blood levels of oxygen and carbon dioxide) in the carotid bodies 颈动脉小球
      - 分叉的点在喉结高度的地方
    - Arteries of the upper limbs
      - Subclavian A
      - Axillary A 腋动脉
      - Brachial A 肱动脉
      - Radial A 桡动脉
      - Ulnar A 尺动脉
      - Deep palmar arch 掌深弓
      - Superficial palmar arch 掌浅弓
      - 左右对称
- Descending aorta
  - Thoracic aorta
    - Parietal branches 壁支
      - Posterior intercostal A (9 pairs) 肋间后动脉
        
        arise from posterolateral aspect of thoracic aorta
        
        Start inferior to 3rd rib
        
        run through intercostal space
        
        supply intercostal and chest muscles
      - Subcostal A (1 pair) 肋下动脉
        
        inferior to 12th rib
        
        supply upper abdominal muscles
      - Superior phrenic A (1 pair) 膈上动脉
        
        supply diaphragm
    - Visceral branches 脏支
      - Bronchials 支气管支
      - Esophageals 食管支
      - Pericardials 心包支
    - 图
  - Abdominal aorta
    - Unpaired visceral branches
      - Celiac trunk 腹腔干
        
        Splenic artery
        
        Common hepatic artery
        
        Left gastric artery
        
        没胃
        
        有胃
      - Superior mesenteric A 肠系膜上动脉
        
        between pancreas and duodenum
        
        supplies from duodenum to transverse colon
      - Inferior mesenteric A 肠系膜下动脉
        
        Inferior to duodenum
        
        supplies from transverse colon to rectum
      - 图
    - Paired visceral branches
      - Middle suprarenal A 肾上腺中动脉
      - Renal A 肾动脉
      - Testicular A/Ovarian A 睾丸、卵巢动脉
    - Unpaired parietal branch
      - Median sacral A 骶正中动脉
    - Paired parietal branch
      - Inferior phrenic A (1 pair) 膈下动脉
      - Lumbar A (4 pairs) 腰动脉
  - Arteries of the pelvis and lower limbs
    - right and left common iliac A
      - internal iliac A
      - external iliac A
        
        femoral A
        
        popliteal A 腘动脉
        
        anterior and posterior tibial A 胫前动脉和胫后动脉
    - 图
    - Femoral triangle
      - SAIL - Sartorius + Adductor longus 长收肌+ Inguinal Ligament 腹股沟韧带
      - 这个区域有动脉, 静脉, 神经
Pulmonary circulation
- deoxygenated blood
  - RV → pulmonary trunk →
    - right pulmonary artery → right lung
    - left pulmonary artery → left lung
- oxygenated blood
  - ① Left upper lobe
  - ② Left lower lobe
  - ③ Right upper and middle lobe
  - ④ Right lower lobe
  - 图
Veins
- 基础
  - Venous valves
    - Valve cusps point toward heart
      - allow one-way flow toward the heart
    - Prevent the backflow of blood when muscles relax
  - Mechanisms of venous return
    - Venous return - the flow of blood from the periphery back to the RA
    - Mechanisms
      - Pressure gradient
      - Skeletal muscle pump
      - e.g. contraction of gastrocnemius腓肠肌 prompts venous return
  - Artery vs. Vein
    - 单词的区别
      - Artery 叫 Branch
      - Vein 叫 Tributary - smaller veins draining into larger veins
      - Carotid 颈动脉的
        
        Common carotid A
        
        External carotid A
        
        Internal carotid A
      - Jugular 颈静脉的
        
        External jugular V
        
        Internal jugular V
    - arteries are deep, veins may be superficial or deep, deep veins go alongside arteries
- three systemic veins into RA
  - coronary sinus
  - superior vena cava
    - Azygos system
      - Azygos V
        
        only on the right side of the vertebral column
        
        begins at junction of right ascending lumbar V右腰升静脉 and right subcostal V右肋下静脉 near diaphragm
        
        right ascending lumber V 右腰升静脉 is a tributary of common iliac V
        
        穿过diaphragm
      - Hemiazygos V
      - Accessory hemiazygos V
    - Brachiocephalic veins
      - 分为 Right Brachiocephalic veins(3cm) 与 Left Brachiocephalic veins(6cm)
      - Subclavian V + Internal jugular V → brachiocephalic V → superior vena cava 都由两个静脉汇入
      - Subclavian V
        
        位置
        
        inferior to minor pectoral muscle
        
        inferior to clavicle
        
        superior to 1st rib
        
        External jugular veins 颈外静脉
        
        Across sternocleidomastoid 胸锁乳突肌
        
        External jugular vein → subclavian V
        
        Become very prominent凸显 along side of neck when venous pressure rises
        
        Axillary vein 腋静脉
        
        位置
        
        Axillary vein → Subclavian V
        
        Starts at border of the teres major 大圆肌边缘
        
        Ends at subclavian V
        
        Veins of the Upper Limbs
        
        Deep veins
        
        特点
        
        Locate deep in the body
        
        Follow the course of the arteries
        
        Two veins accompany one artery
        
        Have the same names as the corresponding arteries
        
        Brachial veins 肱静脉
        
        Two brachial veins
        
        起点 - cubital fossa
        
        终点 - distal border of teres major m
        
        图
        
        Ulnar veins
        
        Radial veins
        
        Deep venous palmar arch
        
        Superficial veins
        
        特点
        
        locate just deep to the skin and are often visible
        
        do not accompany arteries
        
        Basilic vein 贵要静脉
        
        Starts at the dorsal venous network
        
        Courses on the medial side of the forearm
        
        Basilic vein → the brachial V → Axillary vein
        
        红色这段
        
        Cephalic vein 头静脉
        
        Starts at the dorsal venous network
        
        Courses on the lateral side of the forearm
        
        Cephalic vein → Axillary V
        
        红色这段
        
        Median cubital vein
        
        Connects cephalic V and basilic V in cubital fossa 肘窝
        
        Commonly used for venipuncture 静脉穿刺
        
        Intercaptitular vein
        
        Dorsal venous network of hand
        
        Venous network on the dorsum of the hand
        
        lateral aspect of dorsal venous network → Cephalic V (radial side of forearm) 头静脉
        
        medial aspect of dorsal venous network → Basilic V (ulnar side of forearm) 贵要静脉
        
        图
      - Internal jugular V
        
        facial vein
        
        Ophthalmic V 眼静脉
        
        路径
        
        图
        
        Deep facial V
        
        Deep facial V → Pterygoid plexus 翼静脉丛 → Cavernous sinus
        
        Cavernous sinus 海绵窦
        
        连着许多静脉,动脉,神经感染会有危险
        
        病-CVC
        
        Central Venous Catheter 中心静脉导管
        
        IJV是CVC最常见的穿刺部位之一
    - 总结
      - 从手背静脉注射的路径
      - 图
  - inferior vena cava
    - 基础
      - Blood from abdominal and pelvic viscera returns to inferior vena cava. 下腔静脉的属支
      - Bood from GI tract, spleen, pancreas, and gallbladder return to hepatic portal vein. 肝门静脉系
      - Collects blood from the lower half of the body (below the diaphragm)
      - No valves
      - Starts at the junction of the right and left common iliac V
      - Runs on the right side of the vertebral column
      - Runs on the right of the abdominal aorta
    - Visceral tributaries
      - Hepatic V
      - Left renal V
        
        Left suprarenal V
        
        Left ovarian/testicular V
      - Right renal V
      - Right suprarenal V
      - Right ovarian/testicular V
    - Parietal tributaries
      - Lumbar V (4 pairs)
      - Inferior phrenic V
    - Veins of the lower limbs
      - 分类
        
        Superficial veins
        
        In subcutaneous layer
        
        Anastomose with one another and with deep veins
        
        Do not go with arteries
        
        Deep veins
        
        Go with arteries
        
        Have the same names as corresponding arteries
        
        All veins of the lower limbs have valves, which are more numerous than in veins of the upper limbs.
      - Veins of thigh
        
        Femoral V
        
        Accompany femoral A
        
        Extends from external iliac V at the region of the inguinal ligament 腹股沟韧带
        
        Femoral V → external iliac V → common iliac V → inferior vena cava → right atrium
        
        Deep vein of thigh
        
        a tributary of femoral V 股深静脉
        
        Popliteal V
        
        continuation of femoral V
        
        Femoral V goes through adductor hiatus into popliteal V.
        
        紫色Deep vein of thigh,浅蓝色Femoral V
        
        图
      - Veins of legs
        
        Anterior tibial V 胫前静脉
        
        Posterior Tibial V 胫后静脉
        
        Lies posterior to the medial malleolus in the ankle and ascends 内踝后侧上行
        
        Fibular V
        
        Lies posterior to the lateral malleolus in the ankle and ascends to empty into the posterior tibial V 外踝后侧上行
      - Superficial veins
        
        Great saphenous veins
        
        Just deep to skin
        
        Begin at medial end of dorsal venous arch
        
        Pass anterior to medial malleolus of tibia 内踝前
        
        Ascends along medial side of leg and thigh
        
        Empty into femoral vein
        
        Have 10-20 valves, with more located in leg than thigh
        
        Varicose veins: enlarged, twisted veins
        
        Longest veins in body
        
        Small saphenous V
        
        Deep to skin
        
        Begin at lateral aspect of dorsal venous arch
        
        Ascend along posterior aspect of leg
        
        Empty into popliteal V, posterior to knee
        
        Have 9-12 valves
        
        图
        
        足背
        
        dorsal digital V → dorsal metatarsal V → dorsal venous arches
        
        外侧Small saphenous V,Begin at lateral aspect of dorsal venous arch足背静脉弓
        
        内侧Great saphenous V,Begin at medial end of dorsal venous arch
        
        图
      - 总结
        
        图
    - 总结
      - 图