Angiology

Composition

• Cardiovascular
system
• Lymphatic system
The cardiovascular system
Organization
• 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
 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.→right
atrium
 Vascular anastomosis
• Anastomosis between a.
• Anastomosis between v.
• Arteriolovenular anastomosis
• Collateral vessels
• Collateral Circulation
• Anastomosis between v.
• Collateral vessels
• Collateral Circulation
The Heart
 Position
• Lies within the pericardiu
m in middle mediastinum
• Behind the body of stern
um and coastal cartilage
s 2 to 6
• In front of thoracic verteb
rae 5 to 8
• A third of it lies to the rig
ht of median plan and 2/
3 to the left
External characteristics
A hollow muscular organ,
pyramidal in shape , some
what larger than a closed f
ist;consists of four chambe
rs (right and left atria, right
and left ventricles).
The heart has an apex,
a base, two surfaces, thr
ee borders,four grooves
exist on the surface of the
heart.
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 spac
e, 1~2cm medial to the left
midclavicular line (9cm fro
m the midline).
we can touch the beating heart
at the left fifth intercostal spac
e 1~2cm medial to the midcla
vicular line.
Cardiac base is for
med by the left atriu
m and to a small ext
ent by the right atriu
m. It faces backwar
d, upward and to the
right .
 Two surface
• Sternocostal surface
is formed mainly by the ri
ght atrium and right ventri
cle, and a lesser portion o
f its left is formed by the l
eft auricle and ventricle. It
is directed forwards and u
pwards
• Diaphragmatic surface
is formed by the ventricles
－ chiefly the left ventricle, d
irected backwards and down
wards, and rest upon the cent
ral tendon of the diaphragm.
 Three borders
• Right border － vertical
, is formed entirely by ri
ght atrium.
• Left border － round, is
mainly formed by the lef
t ventricle and partly by t
he left auricle.
• Inferior border － horiz
ontal, is formed by the ri
ght ventricle and cardiac
apex.
 Four grooves
• Coronary sulcus
(circular sulcus) which mar
ks the division between atri
a and ventricles, contains t
he trunks of the coronary v
essels and completely enci
rcles the heart
• Interatrial sulcus
－ separates the two atria
and is hidden by pulmonary
trunk and aorta in front
• Interventricular grooves
－ anterior and posterio
r, mark the division betwee
n ventricles (which separate
s the RV from the LV), the t
wo grooves extend from the
base of the ventricular potio
n to a notch called: the card
iac apical incisure Atriove
ntricular crux
－ a junction of the post
erior interventricular groove
and coronary sulcus
 Chambers of the heart
The interior of the
heart is divided into
four chambers:
upper right and left
atria and lower right
and left ventricles.
 • Sulcus terminalis
Right atrium (RA) － groove on exterior of he
art that corresponds to crista
terminalis
• Crista terminalis
－ vertical ridge that go fr
om superior vena cave to inf
erior vena cave
• Two parts
－ separated externally by s
ulcus terminalis and internall
y by the crista terminalis
• Atrium proper
– In front of the ridge
– Pectinate muscles in wall
– Right auricle 右心耳－ a small conical muscular pouc
h, projects to the left from the root of superior vena c
ava, pectinate muscles in wall
• Sinus venarum cavarum
– 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 l
ocation of atrial septal defects (ASD)
Limbus fossae ovalis 卵圆窝缘
– prominent margin of fossa ovalis
Torus aortious 主动脉隆凸
Three inlets
• Orifice of superior vena cava
－ returns blood to the heart fr
om 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 outle
－ right atrioventricular orifice
Triangle of Koch is located between the anteromedial
margin of the orifice of the coronary sinus, the attachme
nt of the septal cusp (leaflet) of the tricuspid valve and t
he upper margin of tendon of Todaro
 Right ventricle (RV)
Receives deoxygenated blood f
rom right atrium through right at
rioventricular orifice
• One inlet － right artrioventric
ular orifice
右房室口
• One outlet － orifice of pulmo
nary trunk 肺动脉口
• Two parts － divided by the su
praventricular crest 室上嵴 , a
muscular ridge between right atr
ioventricular orifice and orifice o
f pulmonary trunk
Inflow tract
－ rough walls
• Trabeculae carneae 肉柱
－ irregularly arrang
ed bundles of myocardium
• Septomarginal trabecula
隔缘肉柱－ extends from
interventricular septum to
base of anterior papillary m
uscle, contains right bundle
branch
• Papillary muscles 乳头肌
－ conical-shaped , ante
rior, posterior and septal
Outflow tract
• Conus arteriosus
动脉圆锥
cone-shaped, smoo
th area leading upw
ard to orifice of pul
monary trunk
• Pumps blood throu
gh pulmonary orific
e to pulmonary trun
k
 Left atrium (LA)
• Left auricle 左心耳－ projec
ting to the right, pectinate m
uscles in wall
• Four inlets － four orifices
of pulmonary veins
肺静脉口 open through the
posterior wall
• One outlet － left atriovent
ricular orifice
左房室口 , blood leaves thr
ough left atrioventricular orif
ice to left ventricle
 Left ventricle (LV)
• 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
• 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
 Valves
Tricuspid valve 三尖瓣
• Guards right atrioventricular ori
fice
• Three triangular cusps: anterio
r, posterior and septal, the bas
e of cusps are attached to fibro
us ring surrounding the atriove
ntricular orifice
• Chordae tendineae 腱索－ fin
e, white, connective tissue cor
ds, attach margin of cusps to p
apillary muscles 乳头肌
Mitral valve 二尖瓣
• Guards left atrioventricular or
ifice
• Two triangular cusps
－ anterior and posterior
with commissural cusps betw
een 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 fro
m atria
• Closed during systole to prevent regurgitation of blood int
o atria
Valve of pulmonary t
runk 肺动脉瓣
• Guards the orifice of
pulmonary trunk
• Has three semilunar c
usps – each with free
border that has centr
al nodules of semilu
nar valve
半月瓣小结
 Aortic valve 主动脉瓣
• Guards the aortic orifice
• Three semilunar cusps (right, l
eft and post)
• Three aortic sinuses – bulges
in aortic wall at level of valve t
hat correspond to cusps
– Right － contains opening o
f right coronary artery
– Left － contains opening of
left coronary artery
– Posterior － no opening
 Similar functions for
pulmonary and 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
 Structure of the heart
Walls of heart
• Endocardium 心内膜
－ inner coat of the heart wall,
and continuous with the valve fl
aps
• Myocardium 心肌
– Arranged spirally
– Attached to fibrous rings surr
ouding the four orifices of he
art
• Epicardium 心外膜－ serous m
embrane (visceral pericardium)
Interatrial septum 房间隔
• Located between right and l
eft atria
• Contains fossa ovalis and li
mbus
Interventricular septum
室间隔
• Located between right and l
eft ventricles
• Has upper membranous p
art and thick lower muscul
ar part
Fibrous skeleton 纤维骨骼
• Fibrous rings that surround the atrioventricular
, pulmonary, and aortic orifices
• Left and right fibrous trigons
 Conduction system of heart
The conduction system consists of specialized tissues that
generate and distribute electrical impulses through the heart
The components of the co
nduction system are the si
noatrial node (SA node), i
nternodal bundles ， atrio
ventricular node (AV nod
e), atrioventricular bundle
(bundle of His), and Purki
nje fibers
• Sinuatrial node 窦房结
(SA node)
• Have the pacemaker cell
(P cell)
• Located at the junction of rig
ht atrium and superior vena
cava, upper part of the sulcu
s terminalis, under the epicar
dium
Internodal tract
atrioventricular junction
atrioventricular bundle
Atrioventricular node
房室结
(AV node)
• Located in the lower part
of interatrial septum just
above the orifice of coro
nary sinus, under the en
docardium
• Lower part related to me
mbranous part of interve
ntricular septum
Atrioventricular bundle
房室束 (AV bundle)
• Passes forward through
right fibrous trigon to rea
ch inferior border of me
mbranous part
• Divides into right and left
bundle branches at uppe
r border of muscular part
of interventricular septu
m
 Right and left bundle branches
左、右束支
• Right bundle branch
－ passes down on righ
t side of interventricular s
eptum to reach the septo
marginal trabecular and i
nto the base of anterior p
apillary muscle. Here it b
ecomes continuous with t
he fibers of Purkinje fibre
s
• Left bundle branch
－ passes down on left sid
e of interventricular septum
beneath the endocardium.
It usually divides into two br
anches, which eventually b
ecome 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
• Arises from left aortic
sinus
• Runs between pulmo
nary trunk and left auri
cle into coronary sulc
us
• Branches
– Anterior interventricular
branch 前室间支
－ travels downward in anteri
or interventricular groove a
round inferior margin of he
art to posterior interventric
ular groove
– Circumflex branch 旋支
－ travels to left in coronary s
ulcus to posterior aspect

Distribution － supplies left atrium and ventricl

e, lesser portion of anterior wall of right ventri
cle, and anterior 2/3 of interventricular septum
.
Right coronary artery
右冠状动脉
• Arises from the right
aortic sinus.
• Runs forward betwee
n right auricle and pul
monary trunk into cor
onary sulcus.
Branches
– Right marginal branch
右缘支
－ travels along inferior borde
r
– Posteror interventricular bran
ch 后室间支
－ travels downward in poste
rior interventricular groove, it an
astomosises near the apex with
the anterior interventricular bra
nch of the left coronary artery
Distribution: supplies right atrium and ventricle, pos
terior 1/3 of interventricular septum, posterior wall
of left ventricle, the sinuatrial node and atrioventric
ular node.
 Venous drainage
Coronary sinus 冠状窦
• Located in posterior part of
coronary sulcus
• Carries most of venous bloo
d from myocardium to right
atrium
• Tributaries
– Great cardiac vein
– Middle cardiac vein
– Small cardiac vein
• Anterior cardiac veins
心前静脉
－ 3~4 small vessels
, drain into right atrium
• Smallest cardiac vein
s 心最小静脉
－ drain into all cha
mbers, mainly atria
 Pericardium 心包
Fibrous pericardium
纤维心包
• Attached to central tendon
of diaphragm inferiorly
• Blends with outer coat of gr
eat vessels superiorly
Serous pericardium
浆膜心包
• Visceral pericardium (epica
rdium)
• Parietal pericardium
Pericardial cavity 心包腔
• Potential space between visceral and parietal peric
ardium
• Contains pericardium fluid
 Pericardium sinus
• Transverse sinus of pericardium
－ posterior to ascending aorta and pulmonary trunk,
anterior to superior vena cava and left atrium.
• Oblique sinus of pericardium
－ posterior to heart, bounded by pulmonary veins on
either side
That’s
over,
thank
you!
 Surface markings of heart
• Right border － corresponds t
o a line running from the upper
border of right third costal cartil
age ±1.2cm from the margin of
sternum, downwards to sixth st
ernocostal joint
• Apex － in the fifth left intercos
tal space 7~9cm from the midli
ne
• Left border － represented by
a line running from apex upwar
ds and medially to a point on lo
wer border of left second costa
l 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