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Angiology

Angiology. SHANDONG UNIVERSITY Liu Zhiyu. Angiology. Composition Cardiovascular system Lymphatic system. The cardiovascular system. Organization Heart A muscle pump to maintain the flow of blood

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Angiology

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  1. Angiology SHANDONG UNIVERSITY Liu Zhiyu

  2. Angiology Composition • Cardiovascular system • Lymphatic system

  3. 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

  4. The cardiovascular system 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. →left atrium

  5. The cardiovascular system Vascular anastomosis • Anastomosis between a. • Anastomosis between v. • Arteriolovenular anastomosis • Collateral vessels • Collateral circulation

  6. The Heart

  7. The heart Position • 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

  8. Surfaces of the heart

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

  10. Cardiac apex • 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)

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

  12. Sternocostal 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

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

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

  15. Sulcuses of the heart • 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

  16. Sulcuses of the heart • Anterior interventricular groove • Posterior interventricular groove • Mark the division between ventricles (which separates the RV from the LV) • Cardiac apical incisure • Atrioventricular crux

  17. Chambers of the heart

  18. Chambers of the heart Consists of four chambers • Left and right atria • Left and right auricle • Left and right ventricles

  19. Right atrium (RA) • Three inlets • Orifice of superior vena cava returns blood to the heart from the upper half of the body • Orifice of inferior vena cavareturns 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 outlet－right atrioventricular orifice

  20. Right atrium (RA) • 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

  21. Right atrium (RA) • Atrium proper • In front of the ridge • Pectinate muscles in wall • Sinus venarum cavarum • 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) • Aortic mound

  22. Right ventricle (RV) • One inlet 　　－right atrioventricular orifice • One outlet 　　－orifice of pulmonary trunk

  23. Right ventricle (RV) • Supraventricular crest (a muscular ridge between right atrioventricular orifice and orifice of pulmonary trunk ) • Two parts • Inflow tract • Outflow tract

  24. Right ventricle (RV) • Inflow tract • Trabeculae carneaeirregularly 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

  25. Right ventricle (RV) • Outflow tract —Conus arteriosus • Cone-shape , smooth area leading upward to orifice of pulmonary trunk • Pumps blood through pulmonary orifice to pulmonary trunk

  26. Tricuspid valve • 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,which connect the cusps to the papillary muscles.

  27. Tricuspid valve

  28. Tricuspid complex • Tricuspid ring • Tricuspid valve • Chordae tendineae • Papillary muscles

  29. Chordae tendineae Papillary muscles

  30. 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

  31. Valve of pulmonary trunk • Guards the orifice of pulmonary trunk • Has three semilunar cusps – each with free border that has central modulescalled nodules of semilunar valve • Has three pulmonary sinuses —bulges in wall of pulmonary trunk at level of valve that correspond to cusps

  32. Function of pulmonary 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

  33. Left atrium (LA) • Four inlets－four orifices of pulmonary veins • One outlet－left atrioventricular orifice

  34. Left ventricle (LV) • 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

  35. Mitral valve • Guards left atrioventricular orifice • Two triangular cusps－anterior and posterior with commissural cusps between them (posteromedial and anterolateral commissures)

  36. Mirtal complex • Mitral ring • Mitral valve • Chordae tendineae • Papillary muscles

  37. 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

  38. Aortic valve • 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

  39. 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

  40. Structures of the heart

  41. Structures of the heart Walls of heart • 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

  42. Structures of the heart • Interatrial septum • Located between right and left atria • Contains fossa ovalis • Interventricular septum • Located between right and left ventricles • Has upper membranous part • Has thick lower muscular part • Atrioventricular septum

  43. Membranous part of interventricular septum

  44. Ventricular Septal Defect

  45. Fibrous skeleton of heart • Fibrous rings that surround the atrioventricular, pulmonary, and aortic orifices • Left and right fibrous trigones

  46. Conduction system of heart

  47. Conduction system of heart Composed of specialized myocardial cells • Sinuatrial node • Internodal tract • Atrioventricular node • Atrioventricular bundle • Right and left bundle branches • Purkinje network

  48. Conduction system of heart Sinuatrial node (SA node) • Called the pacemaker cell (P cell) • Located at the upper part of the sulcus terminalis close to the superior vena cava, under the epicardium.

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