5.心脏解剖

心脏解剖&心脏传导系统华东医院周雯华东医院周雯位置•位于纵隔腔内•左右肺之间•2/3在中线左侧•方向：右后上－左前下MidLine•概述：–心房为薄壁，低压心腔–左右心房以房间隔分隔–导管从右心房到左心房，需行房间隔穿刺术，经卵圆窝通路进入左心房•右心房：–在右心室收缩期充盈–接受来自于SVC，IVC，CS的血液–静脉血右心房IVC右心房IVC右心房IVCTricuspidValveAnnulus(TVA)IVCRightAuricle(or)RightAtrialAppendageIVC柯氏三角•点•CS窦口•His束•边缘•Todaro氏腱•三尖瓣环IVC左心房•左心房•在左心室收缩期充盈•接受来自肺静脉的血液•动脉血肺静脉LeftAtrialAppendageGreatCardiacVeinCoronarySinus心室•概述•左右心室间以室间隔相隔•分流入道和流出道•左心室•接受来自左心房的血液•将血液泵入主动脉(Ao)，至全身组织•左心室室壁厚于右心室•右心室•接受来自右心房的血液•将血液泵入肺动脉Viewedfromabove左右心室横截面右心室Bicuspid/MitralValve心壁结构•心外膜•最外层Outermostlayer•薄层，浆膜Thin,serousmembrane•心肌层Myocardium•中层Middlelayer•工作心肌Workingmuscleofheart•心内膜Endocardium•最内层Innermostlayer•Linesmyocardium•心包Pericardium•心包腔PericardialSac•内含少量浆膜液Smallamountofliquid纤维骨架•纤维骨架•分离心房和心室•为心脏瓣膜提供框架心脏瓣膜(房室瓣)•只允许血液从心房单向流向心室•三尖瓣连接RA和RV•二尖瓣连接LA和LV•心室压力低于心房压力时，房室瓣开放心脏瓣膜心脏舒张期心脏瓣膜（半月瓣）•肺动脉瓣：连接RV与PA•主动脉瓣：连接LV与AoPulmonicValveAorticValve心脏瓣膜在心动周期中的作用腱索与乳头肌•腱索•腱索连接房室瓣和乳头肌•乳头肌•发自心内膜,连接于腱索•作用•心室收缩迫使房室瓣关闭•乳头肌收缩引起腱索紧张•预防血液从动脉逆向回流至心室心脏传导系统ConductionSystem心脏传导系统组成•窦房结（SANode）•Theheart’smainPacemaker•LocatednearjunctionofRAandSVC•Bachman’sBundle•conductsactivationfromSAnodetoLA•结间束（InternodalTracts）•ConductsactivationfromSAnodeacrossatria•纤维骨架（FibrousSkeleton）•barriertoconductionfromatriatoventricles房室结•房室结(AVnode)•位于三尖瓣上方，CS开口前方•激动从心房经AV传导到His束(bundleofHis)•TrafficCop•Secondarypacemakeroftheheart希氏束•希氏束（BundleHis）•StartofVentricularConductionSystem•Conductsimpulsesthroughseptumtobundlebranches•Normallythesoleelectricalconnectionbetweenatriaandventricles•束支（BundleBranches）•DownSeptumWall•TransmitsimpulsesfromthebundleofHistobothventricles•浦氏纤维网（PurkinjeFibers）•Specialcellsofconductionthroughouttheventricles•Tertiarypacemakeroftheheart•20-40bpm心脏电传导的组成•SANode•InternodalTractsandBachman’sBundle•AVNode•BundleofHis•BundleBranches•PurkinjeFibersCardiacAnatomyQuizPleaseidentifythefollowinganatomicpoints.SANodeBachman’sBundleInternodalTractsAVNodeBundleofHisBundleBranchesPurkinjeFibers1.2.3.4.5.6.7.8.9.10.11.12.13.SuperiorVenaCavaOSofSuperiorVenaCavaRightAtriumOSofInferiorVenaCavaCoronarySinusInferiorVenaCavaTricuspidValveRightVentricleIntraatrialSeptumIntraventricularSeptumLeftAtriumMitralValveLeftVentricleReview