Angiology circulatory sysem

Angiology 脉管学
华北理工大学解剖学教研室
司道文
Daowen Si
In the previous study we have learnd
Locomoter system
Splanchnology
Today we are going to learn

Angiology
circulatory sysem
Plan in this term
（ 4-11 week ）
 Heart 心
 Artery (a.) 动脉
 Veins ( v.) 静脉
 Lymphatic system

Angiology 脉管学 circulatory sysem
Composition
 Cardiovascular
system 心血管系统
 Lymphatic
system 淋巴系统
Lymphatic nodes
Lymphatic vessels
Cardiovascular system
Organization
The cardiovascular system 心血管系统
Organization
 Heart 心
muscular pump
 Artery (a.) 动脉
blood vessel carry blood away
from the heart
 Veins ( v.) 静脉
carry blood back to the heart

 Capillary 毛细血管
This system is a continual, closed and
tubular system, and is filled with blood
The Capillaries
 The capillary lies between the arteries and veins.
 Their wall is very thin and favors the material exchange
between blood and tissue fluid.
 Capillary beds are present in all regions of the body.
 Substance exchange
 oxygen carbon dioxide
 nutrient
 metabolite （ waste ）
Respiratory system 呼吸系统 Oxygen
carbon dioxide
Composition
 Respiratory tract 呼吸道
 Nose
 Pharynx
 Larynx
 Trachea

Bronchi
 Lungs 肺　
Function
supply the body with oxygen and to get
rid of excess carbon dioxide resulting
from cell metabolism
Alimentary system 消化系统
nutrient substance
Major salivary glands
Mouth Pharynx
Esophagus
Stomach
Liver
Duodenum Pancreas
Large intestine
Ileum
Jejunum
Urinary system 泌尿系统
Metabolic waste
Composition
 Kidney 肾
 Ureter 输尿管
 Bladder 膀胱
 Urethra 尿道
The Heart
The heart is a muscular pump,

slightly larger than your closed
fist.
The heart is the hardest-working

organ , never rests, to keep
everybody alive.
The Heart
 A muscle pump to maintain the flow of
blood
 Consist of four chambers
 right atrium , left atrium,
 right ventricle , left ventricle
 Septum separates heart into four
chambers.
 interatrial septum
 interventricular septum
 Big blood vessel
 aorta and its branches
 superior and inferior vena cava
 pulmonary a.
 pulmonary v.
Two septum
four chambers
interatrial septum
interventricular
septum
left atrium
right atrium
left ventricle
right ventricle
the heart
aorta left atrium
superior vena cava
pulmonary a.
pulmonary v.
right atrium
left ventricle
right ventricle
inferior vena cava

the heart
the pulmonary trunk ------- right ventricle
the the aorta ------- left ventricle
superior inferior vena cava ------- right atrium
pulmonary v ------- left atrium
arises from ， connect with ， link

Blood circulation
Blood circulation
 Systemic circulation (big) 体循环
left ventricle→aorta and its
branches→capillaries of body→superior and
inferior vena cava→right atrium
 Pulmonary circulation (small) 肺循环
right ventricle→pulmonary a.→capillaries of
lung → pulmonary v. →left atrium
Begins from , flow , go though ,enter, return
Substance exchange
 systemic circulation
 pulmonary circulation
pulmonary Lung blood capillary pulmonary
artery vein
pulmonary RV LA
pulmonary
circulation
circulation
systemic
systemic
circulation
circulation
RA LV
vena cava body blood capillary aorta

color
 Usually, we use the blue color to
express the oxygen-poor blood, also
called the venous blood; red express
the oxygen-rich blood called the arterial
blood.
 Generally speaking, the blood of the

right half of heart is oxygen-poor, on the
other hand, the left half of the heart
contains the oxygen-rich blood.
Angiology 脉管学
Upper part of body
Respiratory system
Alimentary system
Urinary system
lower part of body

Function --- transportation

 Systemic circulation 体循环
nutriment and metabolite, oxygen and
carbon dioxide exchange between
blood and cells
 Pulmonary circulation 肺循环
oxygen and carbon dioxide exchange
between the blood and air, at this time,
blue blood becomes red blood
 Alimentary System
 Respiratory System
 Urinary system
Function --- transportation
 transport different substances from

the other system to the organs all
over the body,to cells,tissues
 Waste produced by the cell to Urinary
system
Here we can see this

picture shows
Alimentary System
Respiratory System
Urinary system
Angiology 脉管学
Upper part of body
Oxygen
carbon Respiratory system
dioxide
nutrient substance Alimentary system
metabolic waste Urinary system
lower part of body
Function ------Transportation
Vascular anastomosis
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
The Heart
The heart
Position
 in middle mediastinum
,between the two lungs, cover
by membrane called
pericardium
 Situate on the diaphragm
 Behind the body of sternum
and coastal cartilages 2 to 6
 In front of thoracic vertebrae 5
to 8
Surfaces of the heart
 Pyramidal in shape, somewhat larger
than a closed fist
 One apex
 One base
 Two surfaces
 Three borders
 Four sulcuses
Cardiac apex 心尖
 Directed downwards, forward,

and to the left
 Formed by left ventricle
 Lies at the level of the fifth left
intercostal space, 1~2 cm
medial to the left midclavicular
line (9cm from the midline)
 Heartbeat can be observed in
this position
Cardiac base 心底
 Formed by the left atrium and

to a small part by the right
atrium.
 Faces backward, upward and
to the right
Sternocostal surface 胸肋面
 Anterior surface
 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 膈面
 inferior surface
 Formed the ventricles － chiefly
the left ventricle and small part
by the right ventricle.
 Directed backwards and
downwards, and rest upon the
central tendon of the diaphragm
Borders of the heart
 Right border 右缘
 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
Sulcuses of the heart
 Coronary sulcus 冠状沟

encircles between the atria and
ventricles, the atria and
ventricles can be distinguished
by this groove, so also called
atrioventricular groove.
 Cross by pulmonary trunk

 Blood vessle
 The anterior interventricular
groove descends from the
coronary groove to the cardiac
apical incisure on the sternocostal
surface, corresponding to the
anterior margin of interventricular
septum.
 The posterior interventricualr

groove
these interventricular grooves can

separate the right and left
ventricles on the surface of the
heart.
 The interatrial groove
corresponds to the interatrial
septum and separates the left and
right atria ， between the two atria.
 The atrioventricular crux is the

point of junction of the three
grooves.
.
Rotation to the left
During development, the heart undergoes a slight rotation to the left.
Therefore, the right half of the heart is anterior to the left half of the
heart.
A third of it lies to the right of median plan and 2/3 to the left
Chambers of the heart 心腔
Consists of four chambers

 Left and right atria 左、右心房
 Left and right ventricles 左、右心室

 during diastole ， blood

flow from atrium into
ventricles
 during systole ， blood flow
from ventricles into artery
atrium → ventricle → artery
Because of valve
Right atrium (RA) 右心房
 Crista terminalis 界嵴－ vertical
ridge that from superior vena cave to
inferior vena cave
 Sulcus terminalis 界沟－ groove
on surface of heart that corresponds
to crista terminalis
 Two parts － separated externally
by crest ， can be divided into two
parts
 Atrium proper 固有心房
 anterior muscular protrusion

 Sinus venarum cavarum 腔静脉窦
 posterior smooth
 Atrium proper 固有心房
 Right auricle
 projects anteriorly from the root of superior vena cava and
covers the root of the ascending aorta （ internal clot
block ）
 Pectinate muscles in wall
 parallel muscular ridges
 right atrioventricualr orifice
 outlet communicates with the right ventricle by the orifice.
 Sinus venarum cavarum
腔静脉窦
 three inlets
 one fossa
 Sinus venarum cavarum
 three inlets
 the orifice of superior vena cava
 orifice of inferior vena cava
 orifice of coronary sinus
The orifice of coronary sinus lies between the
orifice of inferior vena cava and the right
atrioventricular orifice, and has a valve of
coronary sinus to prevent the backflow of
bloodstream.
 Sinus venarum cavarum 腔静脉窦
 Fossa ovalis 卵圆窝－ lies near

the center of the interatrial
septum, is very thin. Therefore,
the interatrial septal defect often
occurs at this position.
(position clinical significance )
 during fetus Blood from the superior and

inferior vena cava pass directly through the
oval foramen into the left atrium
 after birth, the pulmonary circulation is
established and the oval foramen is closed
to form a remnant called oval fossa.
Summary
 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
Right ventricle (RV) 右心室
 One inlet 　　
－ right atrioventricular orifice 右房室口
 One outlet 　　
－ orifice of pulmonary trunk 肺动脉口
 Supraventricular crest 室上嵴
(a muscular ridge between right
atrioventricular orifice and orifice of
pulmonary trunk )
 Two parts
 Inflow tract (sinous part) 流入道
 Outflow tract （ Infundibular part ）
流出道
Demarcation By dividing line can be devided

two parts
 Inflow tract (sinous
part)
 Trabeculae carneae 肉
柱 irregular
muscular ridges
 Papillary muscles 乳头
肌
 fingerlike muscles
project from the
ventricular wall into
the ventricular cavity
 Conical-shaped
 Three: anterior,
posterior and septal
On the inner wall of the RV,
there are some special type muscle
 Inflow tract (sinous part)
 Septomarginal trabecula 隔
缘肉柱
 larger and more important
 extends from interventricular
septum to base of anterior
papillary muscle,
 prevent overdistension of
the ventricle (so also called
moderator band)
 Right bundle branch （ a
part of conduction system ）
passes through it
we should prevent the damage of it in

the operation to avoid the
conduction block 。
Tricuspid complex 三尖瓣复合体
 tricuspid annulus
 a fibrous ring, and lies around the right
atrioventricular orifice
 tricuspid valve
 attaches to the tricuspid annulus ，
anterior, septal and posterior leaflets
 The base of them is connected one
another to form the commissure
 Papillary muscles
 anterior, posterior and septal papillary
muscles ， corresponding to valve.
 chordae tendineae
 Connect the valve with muscle
 damage of anyone of the complex may cause

the tricuspid valve dysfunction.
Tricuspid complex 三尖瓣复合体
 Tricuspid annulus 三尖瓣环
 Tricuspid valve 三尖瓣
 Chordae tendineae 腱索
 Papillary muscles 乳头肌
valve stenosis
valve incompetence
tricuspid valve
chordae tendineae
papillary muscles
Function of tricuspid complex
 when the ventricle diastoles, the valves open ， blood flows from the
atrium to ventricle
 When the ventricle systoles, the valves close ， prevent the backflow of
bloodstream.
Chordae tendineae
Papillary muscles
 Outflow tract （ Infundibular part
）
 Conus arteriosus 　　　　　　　　
Cone-shape , smooth area
 Pumps blood through pulmonary
orifice to pulmonary trunk
 pulmonary valve
 valve has semilunar valve, favors
theleft,valve
anterior, right to close completely
Function of pulmonary valves
 Has three valve
 Opening during systole
 with cusps pressed toward wall of
vessel as blood is forced upward
 Closed during diastole
 Floating together of valve cusps, with
free borders meeting, thus closing the
valve
Prevents back-flow of blood from the pulmonary artery
into the right ventricle
pulmonary trunk
valve of pulmonary trunk

Left atrium (LA) 左心房
 Four inlets － four orifices of pulmonary veins 肺静脉口
 One outlet － left atrioventricular orifice 左房室口
 The structures of the left atrium are the same as those of the right
atrium basically
Similar with
Left ventricle (LV) 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 (sinous part)
 rough walls
 Outflow tract (aortic vestibule) 主动脉前庭
 Smooth area leading to aortic orifice
Thick supply blood to whole body

Mirtal complex 二尖瓣复合体
 Mitral annulus 二尖瓣环
 The mitral annulus is a fibrous
structure, and lies around the
right atrioventricular orifice
 Mitral valve 二尖瓣
 mitral valve attaches to the mitral
annulus. The mitral valve consists
of the anterior, and posterior
leaflets
 papillary muscle gives off the
chordae tendineae to the
adjacent leaflets
The damage of anyone of the complex may

also cause the mitral valve dysfunction
bicuspid valve all together

Mirtal complex 二尖瓣复合体
 Mitral annulus 二尖瓣环

 Mitral valve 二尖瓣
valve stenosis
valve incompetence
Function of mitral complex
 Open during diastole to allow blood to enter ventricles from atrium
 Closed during systole to prevent blood into atrium
Left ventricle (LV) 左心室
 Outflow tract
 Aortic vestibule 主动脉前庭
 Smooth area leading to aortic orifice
 The structures are similar with the structures of

the right ventricle
 The outlet is the aortic orifice.
 aortic valve is around the orifice

Aortic valve 主动脉瓣
 Three semilunar cusps (right,

left and posterior)
 Each with free border that has
nodules of semilunar valve
半月瓣小结
 Aortic sinus 主动脉窦 – The
cavity between the valves and
the corresponding wall of the
aorta
Aortic valve 主动脉瓣
 Aortic sinus 主动脉窦

– The cavity between the
valves and the corresponding
wall of the aorta
 Right － contains
opening of right
coronary artery
 Left － contains opening of
left coronary artery

Posterior － no opening
On the right and left side of aortic sinus

There are two opening for the coronary artery
Supply the heart, comes from here
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
4 Opening summary
4 valve
 right atrioventricular orifice
 Tricuspid valve
 orifice of pulmonary trunk

 pulmonary valve
 left atrioventricular orifice

 Mirtal valve
 aortic orifice
 aortic valve
Atrioventricular valves between atria and ventricles.
Semilunar valves between ventricles and artery
close Tricuspid valve Mirtal valve
systole open pulmonary valve aortic valve
close pulmonary valve aortic valve

diastole open Tricuspid valve Mirtal valve
during
stethoscope
Structures of the heart
Walls of heart layers
 Endocardium 心内膜
 Inner coat of the heart wall

 Myocardium 心肌
 Formed by muscles
 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
 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
The interventricular septal defect often

takes place in the membranous part.
Membranous part of
interventricular septum
Fibrous skeleton of heart 纤维骨骼
 Fibrous rings that surround the
atrioventricular, pulmonary, and
aortic orifices
 Left and right fibrous trigones
 right atrioventricular orifice

 Tricuspid valve
 orifice of pulmonary trunk
 pulmonary valve
 left atrioventricular orifice
 Mirtal valve
 aortic orifice
 aortic valve
Conduction system of heart
心传导系统
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
gives off impulse

conduct impulse
conduction system ★ 心传导系统
gives off the impulse about
60 to 100 times per minute
Internodal atrial
pathway
Sinuatrial node
Atrioventricular bundle
left bundle
branches
Atrioventricular node
Purkinje network
Right bundle
branches
统
Sinuatrial node (SA node) 窦房结
 the normal pacemaker of the heart,
gives off the impulse about 60 to
100 times per minute in most
people.
 located at the junction of the SVC
and the right atrium, under the
epicardium
统
Internodal tract 结间束
 whether the tracts exist or not
remains controversial
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
统
Atrioventricular bundle (AV
bundle) 房室束
 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 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 three branches,
which eventually become
continuous with the Purkinje fibers
 Purkinje network 普肯野氏纤维网
continuous with myocardium
Conduction system of heart 心传导系统
Arterial supply of the heart
The vessels of heart includes the
arteries and veins, the right and left
coronary arteries are the source of
the blood supply of the heart,
The venous blood of the heart

returns mainly to the right atrium by
the coronary sinus.
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
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
Right coronary artery 右冠状动脉
 Course
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 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

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
Pericardium 心包
Pericardium 心包
 Fibrous pericardium 纤维心包
 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
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.
Pericardium sinus
 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
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
 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
Cardiac anatomy shown by transthoracic echocardiography.
Four-chamber view.
Cardiac anatomy shown by transthoracic echocardiography.
Short-axis view at aortic valve level.
Dissection of the heart
★You must identify follow structures ！
Vessels of heart
Shape of heart
 Left coronary artery
 Cardiac apex
 Anterior interventricular branch
 Cardiac base
 Right coronary artery
 Coronary sulcus
 Posteror interventricular branch
 Anterior interventricular
 coronary sinus
groove
 Posterior interventricular
Right atrium
 Orifice of superior vena cava
groove  Orifice of inferior vena cava
 Cardiac apical incisure  Orifice of coronary sinus
 Atrioventricular crux  Sulcus terminalis
 Right and left auricle  Fossa ovalis
 Pulmonary trunk  Pectinate muscles

★You must identify follow structures ！
Right ventricle Left atrium

 Right atrioventricular orifice
 Orifices of pulmonary veins
 Left atrioventricular orifice
 Tricuspid valve
Left ventricle
 Chordae tendineae
 Aortic vestibule
 Papillary muscles
 Mitral valve
 Supraventricular crest  Aortic vavle
 Trabeculae carneae  Aortic sinus
 Septomarginal trabecula
 Conus arteriosus
 Valve of pulmonary trunk

Angiology circulatory sysem

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Angiology circulatory sysem

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Angiology 脉管学

Today we are going to learn

carry blood back to the heart

The heart is a muscular pump,

The heart is the hardest-working

inferior vena cava

the pulmonary trunk ------- right ventricle

the the aorta ------- left ventricle

superior inferior vena cava ------- right atrium

pulmonary v ------- left atrium

arises from ， connect with ， link

Begins from , flow , go though ,enter, return

vena cava body blood capillary aorta

 Generally speaking, the blood of the

lower part of body

Function --- transportation

Function --- transportation

 transport different substances from

Here we can see this

nutrient substance Alimentary system

metabolic waste Urinary system

lower part of body

 Directed downwards, forward,

 Formed by the left atrium and

 Coronary sulcus 冠状沟

 Cross by pulmonary trunk

 The posterior interventricualr

these interventricular grooves can

 The atrioventricular crux is the

Consists of four chambers

 Left and right ventricles 左、右心室

 during diastole ， blood

atrium → ventricle → artery

 anterior muscular protrusion

 Fossa ovalis 卵圆窝－ lies near

 during fetus Blood from the superior and

Demarcation By dividing line can be devided

we should prevent the damage of it in

 damage of anyone of the complex may cause

valve of pulmonary trunk

 Two parts － divided by anterior cusps of

Thick supply blood to whole body

The damage of anyone of the complex may

bicuspid valve all together

 Mitral annulus 二尖瓣环

 Smooth area leading to aortic orifice

 The structures are similar with the structures of

 aortic valve is around the orifice

 Three semilunar cusps (right,

 Aortic sinus 主动脉窦

On the right and left side of aortic sinus

 orifice of pulmonary trunk

 left atrioventricular orifice

close pulmonary valve aortic valve

 Inner coat of the heart wall

 Attached to fibrous rings

surrouding the four orifices of

about three times thicker than

The interventricular septal defect often

 right atrioventricular orifice

 Sinuatrial node 窦房结

gives off impulse

 Located in the lower part of interatrial