香港中文大学：心脏 The Heart

The heart YC Wong,PhD王雲川 The University of Hong Kong wong@hku. hk

The Heart YC Wong, PhD 王雲川 The University of Hong Kong ycwong@hku.hk

Scope Overview of anatomy of the heart Surface markings and gross anatomica structure Vascular system of the heart mpule conducting system Histology of the heart

Scope • Overview of anatomy of the heart • Surface markings and gross anatomical structure • Vascular system of the heart • Impulse conducting system • Histology of the heart

Location and surface markings ocated in middle mediastinum纵隔 ocate the sternal angle Point one: right 3rd costal cartilage 1 cm from sternum border Point 2 6th costal cartilage 1 cm from sternum Point 3 5th left intercostal space just medial to mid clavicular line Point 4: 2nd left intercostal space at Sternal the border of sternum angle Join the 4 points to mark the outer shape of the heart

• Located in middle mediastinum 纵隔 • Locate the sternal angle • Point one: right 3rd costal cartilage 1 cm from sternum border • Point 2: 6th costal cartilage, 1 cm from sternum • Point 3: 5th left intercostal space just medial to mid clavicular line • Point 4: 2nd left intercostal space at the border of sternum • Join the 4 points to mark the outer shape of the heart Location and surface markings Sternal angle

The pericardium心包膜 Fibrous capsule enclosing the heart Separated by pericardial cavity filled with fluid To reduce the friction of heart during pumping Lined by serous pericardium浆膜心包 Subdivided into parietal and visceral layers 心包: the visceral layer reflected on the outer surface The parietal layer closely adheres to fibrous pericardium 4Ts heart, the external limit of epicardium心外膜, lined by mesothelium间皮 Perforated only at the roots of major vessels Reflections of serous pericardium forms transverse sinus ta and oblique sinus斜窦

The Pericardium 心包膜 • Fibrous capsule enclosing the heart • Separated by pericardial cavity filled with fluid • To reduce the friction of heart during pumping • Lined by serous pericardium 浆膜心包 • Subdivided into parietal and visceral layers • The parietal layer closely adheres to fibrous pericardium 纤维 心包; the visceral layer reflected on the outer surface of heart, the external limit of epicardium 心外膜, lined by mesothelium 间皮 • Perforated only at the roots of major vessels • Reflections of serous pericardium forms transverse sinus 横窦 and oblique sinus 斜窦

The pericardium心包膜 R. common arotid a L comnmon aroud a L. subclavian a atria Parietal pericardium(cut) Cut edges of serous Visceral pericardium(cut)Sup. wean caua Trans Sinus R Pulmonary V Pulmonary Ventricles Oblique Sinus Pericardial fluid DIAPHRAGM Pericardial sac

The Pericardium 心包膜 R. Pulmonary V L pulmonary V Trans Sinus Oblique Sinus

Anatomy of the Heart Located in middle mediastinum Brachiocephalic artery Surrounded by pericardium Left subclavian artery Apart from attachment to Superior vena cava Arch of aorta major vessels the rest is Ascending aorta Pulmonary trunkey Left pulmonary basically free within pericardia Right pulmonary artery Left auricle cavity Right atrium Three surfaces: sternocostal Left ventricle surface, diaphramatic surface and base, i. e. the posterior surtace Inferior vena cava Right ventricle The apex心尖 of the heart is directed forward downward Apex and to the left

Anatomy of the Heart • Located in middle mediastinum • Surrounded by pericardium • Apart from attachment to major vessels, the rest is basically free within pericardial cavity • Three surfaces: sternocostal surface, diaphramatic surface and base, i.e. the posterior surface • The apex 心尖 of the heart is directed forward, downward and to the left Right ventricle Left ventricle Right atrium Left auricle Apex

Four Chambers Divided by vertical septa to form 4 chambers Right atrium and left atrium, separated by interatrial septum Right ventricle and left ventricle, separated by Right Atrium Left atrium interventricularseptum Supenor vena ca Right atrium and right ventricle is guarded by a Ascending aorta valve, the tricuspid valve,三尖瓣 Pulmonary trunk Left atrium and left ventricle is guarded by puimonary vean Pulmonary v Aortic v mitral va|ve二尖瓣 Mitral v Deoxygenated blood returns to right atrium then to right ventricle which is pumped to the Tricuspid V lungs via pulmonary trunk guarded by Rightventricular wall pulmonary valve肺动脉瓣 Oxygenated blood from the lungs enters the vena cava left atrium then to left ventricle Right ventricle Left ventricle This blood is pumped through aorta guarded by aortic valve主动脉瓣

Four Chambers • Divided by vertical septa to form 4 chambers • Right atrium and left atrium, separated by interatrial septum • Right ventricle and left ventricle, separated by interventricular septum • Right atrium and right ventricle is guarded by a valve, the tricuspid valve, 三尖瓣 • Left atrium and left ventricle is guarded by mitral valve 二尖瓣 • Deoxygenated blood returns to right atrium then to right ventricle which is pumped to the lungs via pulmonary trunk, guarded by pulmonary valve 肺动脉瓣 • Oxygenated blood from the lungs enters the left atrium, then to left ventricle • This blood is pumped through aorta guarded by aortic valve 主动脉瓣 Right Atrium Right ventricle Left atrium Left ventricle Tricuspid v Mitral v Pulmonary v Aortic v

Right atrium右心房 Receive blood from superior Aorta Right auricle vena cava上腔靜脈 · Inferior vena cava下腔靜脈 Superior vena cava Venous blood from the heart the coronary sinus冠状窦 Musculi pectinati Interior surface, musculi Limbus fossae pectinati梳状肌 ovals Fossa Fossa ovale卵圆窝,on ovale interatrial septum Crista Ria. Crista terminalis界嵴 Right auricle心耳,an Valve of corona extension from atrium cava with valve irregular surtace · Location of sinoatrial node竇 厉結 at junction with superior vena cava

Right atrium 右心房 • Receive blood from superior vena cava 上腔靜脈 • Inferior vena cava 下腔靜脈 • Venous blood from the heart, the coronary sinus 冠状窦 • Interior surface, musculi pectinati 梳状肌 • Fossa ovale 卵圆窝, on interatrial septum • Crista terminalis 界嵴 • Right auricle 心耳, an extension from atrium, irregular surface • Location of sinoatrial node 竇 房結at junction with superior vena cava Superior vena cava Inferior vena cava with valve Fossa ovale Right auricle Musculi pectinati

Patent foramen ovale atent fairly common foramen ovale Hidden condition Left No obvious symptoms atrium Riaht Left atrium pressure higher atrium than right, the potent opening is physiological closed Reason for the opening to stay patent, and not fused afterbirth remains unclear No treatment is needed in most cases

• Fairly common • Hidden condition • No obvious symptoms • Left atrium pressure higher than right, the potent opening is physiologically closed • Reason for the opening to stay patent, and not fused afterbirth remains unclear. • No treatment is needed in most cases Patent foramen ovale

Atrial Septal Defect (ASD) Hole in interatrial septum Allow left atrial blood atrium (oxygenated to enter right Atrial septal atrium(lower pressure defect Increased work load of right Right ventricle atrium Small hole no significant effect Mixing blood from left (oxygenated Medium or large hole may and right (deoxygenated) atria require surgical repair

Atrial Septal Defect (ASD) • Hole in interatrial septum • Allow left atrial blood (oxygenated) to enter right atrium (lower pressure) • Increased work load of right ventricle • Small hole, no significant effect • Medium or large hole may require surgical repair