三、心脏 Third, the heart

（一）心的位置 Position (a) heart  

心位于胸腔中纵隔内。 Located in the heart of mediastinal chest. 2/3位于正中线左侧，1/3位于正中线右侧。 Located on the left side of the midline 2/3, 1/3 located on the right of midline.

心的前面大部分被肺和胸膜所遮盖，只有一小部分借心包与胸骨下份和左侧4~6肋软骨相邻，此区称心包裸区。 In front of the heart of most of the lung and pleura are covered by only a small portion of the adjacent parts of the pericardium and left under the sternum cartilage 4-6, this area of the Heart package bare area. 临床心内注射应选择胸骨左缘第4肋间处进针，可不伤及肺和胸膜。 Injection should choose the 4th intercostal space left sternal border at the clinical center within the needle, do not hurt the lung and pleura.

心的位置 Position of the heart

心脏位于中纵隔 Located in the heart of the mediastinum     前面大部被肺遮 Front cover most of the lungs

胸骨左缘四肋间 Fourth intercostal left sternal     急救药物可注射 Emergency injectable drugs

（二）心的外形 (B) the shape of heart  

心呈倒置圆锥形，纵轴斜向左前下方。 Heart was inverted conical bottom left anterior oblique vertical axis. 心的外形可归纳为一 尖、一底、两面、三缘、三沟 。 Heart shape can be summarized as a tip, a bottom, two, three edge, three ditch.

1． 1. 心尖 Apical

指向左前下方，在第5肋间隙、左锁骨中线内侧1~2cm处可触及心尖的搏动。 Pointing down the left front, in the fifth intercostal space, left medial clavicular line 1 ~ 2cm at the apex of a palpable pulse.

2． 2. 心底 Heart

指向右后上方，连有出入心的大血管。 Refers to the top of the post to the right, even the big discrepancy vessels of the heart.

3． 3. 两面 Both sides

(1)前面：与胸骨和肋软骨相对，称胸肋面。 (1) front: the sternum and rib cartilage relative, said Sternocostal surface.

(2)后面（下面）：与膈相邻，称膈面。 (2) back (below): the diaphragm adjacent to said diaphragm surface.

4． 4. 三缘 Three edge

(1)左缘：主要由左心室构成。 (1) Left edge: mainly composed of the left ventricle.

(2)右缘：主要由右心房构成。 (2) the right edge: mainly composed of the right atrium.

(3)下缘：主要由右心室和心尖构成。 (3) lower edge: mainly composed of the right ventricle and apex.

5． 5. 三沟 Tricolpate

(1)冠状沟：心表面的环形沟，是心房和心室的心表分界。 (A) Coronal: annular groove surface of the heart, atrial and ventricular epicardial boundaries.

(2)前室间沟：左、右心室在心前面的分界线。 (2) the anterior sulcus: left and right ventricles of the heart in front of the line.

(3)后室间沟：左、右心室在心后面的分界线。 Room (3) Room ditch: the left and right ventricles of the heart behind the line.

心的外形 Heart shape

右上心底左下尖 Right upper left heart tip     前胸后膈两个面 After two chest diaphragmatic surface

左右下，三个缘 Around, the three edge     表面三沟分界线 Tricolpate boundary surface

（三）心腔的结构 Structure (three) of the heart chamber  

心有四个腔，分别是左、右心房和左、右心室。 Heart has four chambers, namely the right and left atrium and the left and right ventricle. 心房间有房间隔，心室间有室间隔。 The rooms have atrial septal heart, between ventricular septal there.

1． 1. 右心房 Right atrium

位于心的右上份，腔大壁薄，主要结构有右心耳、梳状肌、卵圆窝等。 Located in the heart of the right upper parts of large thin-walled chamber, the main structure of the right atrial appendage, comb muscle, oval fossa.

(1)入口：有三个，即上、下腔静脉口和冠状窦口，分别导入上、下半身和心本身的静脉血。 (1) Entrance: There are three, namely, the inferior vena cava and coronary sinus orifice, were introduced into the body, lower body and mind their own blood.

(2)出口：一个，即右房室口，通向右心室。 (2) Export: one, that the right atrioventricular mouth, through the right ventricle.

2． 2. 右心室 Right ventricle

位于右心房左前下，分流入道和流出道。 Located under the front left and right atrium shunt humanely and outflow tract.

(1)流入道：入口为右房室口，口周有纤维环，环上附三片瓣膜，称右房室瓣（三尖瓣）。 (1) into the channel: the entrance is right atrioventricular mouth, perioral there annulus, ring attached three valves, said the right atrioventricular valve (tricuspid). 瓣膜借腱索与乳头肌相连，作用为防止进入右心室的血液再返流入右心房。 Valve chordae and papillary muscles by connecting role to prevent blood into the right ventricle and then back into the right atrium.

(2)流出道：是右心室向左上延伸的部分，呈漏斗形又称动脉圆锥。 (2) outflow tract: It is part of the extension of the right ventricle to the left, also known as arterial cone funnel-shaped. 出口为肺动脉口，口周纤维环上附有三个半月形的袋状瓣膜，称肺动脉瓣，作用是防止进入肺动脉的血液再返流回右心室。 Export pulmonary mouth, with three half-moon on the perioral pouch valve annulus, said the pulmonary valve, is to prevent the blood into the pulmonary artery and then back to the right ventricle regurgitation.

3． 3. 左心房 Left atrium

构成心底的大部，主要结构有左心耳等。 Constitute the heart of most of the main structure of the left atrial appendage and so on.

(1)入口：共四个，即左、右各二个肺静脉口，分别导入左、右肺的静脉血。 (1) Entrance: A total of four, that is right, and left two pulmonary vein, were introduced into the left and right lung blood.

(2)出口：一个，即左房室口，通向左心室。 (2) Export: one, that left atrioventricular orifice, leading to the left ventricle.

4． 4. 左心室 Left ventricular

也分为流入道和流出道。 Also divided into inflow and outflow tract.

(1)流入道：有一入口，即左房室口，口周有纤维环上附二片瓣膜，称左房室瓣（二尖瓣）。 (1) inflow tract: a portal, left atrioventricular mouth, a mouth piece attached to two weeks on the valve annulus, said the left atrioventricular valve (mitral valve). 瓣膜借腱索与乳头肌相连，作用为防止进入左心室的血液再返流回左心房。 Valve chordae and papillary muscles by connecting role to prevent reflux into the left ventricle of the blood and then back to the left atrium.

(2)流出道：有一出口为主动脉口，口周纤维环上也附有三个半月形的袋状瓣膜，称主动脉瓣，作用是防止进入主动脉的血液再返流回左心室。 (2) outflow tract: an outlet port of the aorta, the opening weeks of the annulus is also accompanied by three half-moon pouch valve, called the aortic valve into the aorta is to prevent blood reflux and then back to the left ventricle.

心腔内瓣膜位置及作用总结如表9-1： Intracardiac valve position and role are summarized in Table 9-1:

表9-1 Table 9-1   心瓣膜位置及作用 Heart valve position and role

（四）心壁的构造 (D) the heart wall construction  

心壁由心内膜、心肌层、心外膜组成。 Heart wall from endocardium, myocardium, epicardium components.

1． 1. 心内膜 Endocardial

是心腔面一层光滑的薄膜，心的瓣膜就是由心内膜折叠而成。 Heart cavity surface layer of smooth film, the heart valve is folded by endocardial.

2． 2. 心肌层 Myocardium

主要由心肌构成，心室肌比心房肌厚，左心室肌又比右心室肌厚。 Composed mainly of cardiac ventricular muscle thicker than the atria, left ventricle and right ventricle muscle off than thick. 心房肌和心室肌均附着于纤维环上，互不传导。 Atrial and ventricular muscle are attached to the annulus, and do not transfer.

3． 3. 心外膜 Epicardial

属浆膜，覆盖于心肌层的表面。 Genus serous covering the surface of the myocardium. 同时也是浆膜性心包的脏层。 Also serous pericardial visceral.

（五）心的传导系 Conduction system (five) heart

心的传导系是由特殊分化的心肌细胞组成。 Cardiac conduction system is differentiated by a special cardiac cells. 主要作用是产生并传导冲动，以维持心脏的正常节律。 The main role is to generate and conduct impulses, in order to maintain a normal heart rhythm. 主要包括窦房结、房室结、房室束及其分支。 Including sinus node, atrioventricular node, atrioventricular bundle and its branches.

1． 1. 窦房结 Sinus

是心的正常起搏点，位于上腔静脉入口与右心房交界处的心外膜深面。 It is normal pacemaker of the heart, epicardial surface located deep superior vena cava and right atrium entrance junction.

2． 2. 房室结 Atrioventricular node

位于冠状窦口上方的心内膜深面。 Located above the coronary sinus deep endocardial surface. 接受窦房结的控制。 Accept the sinus node control.

3． 3. 房室束及其分支 Atrioventricular bundle and its branches

由房室结发出，在室间隔上部分为左、右束支，最后延为浦肯野纤维，与心室肌纤维接触，将冲动传递给心室肌。 Issued by the atrioventricular node, the septal portion of the left and right bundle branch, the last extension of Purkinje fibers in contact with the ventricular muscle fibers, the impulse delivered to the ventricular myocardium.

（六）心的血管（图见上） (Vi) the heart blood vessels (Figure above)

1． 1. 动脉 Artery

营养心的动脉为左、右冠状动脉。 Nutrition heart artery to the left and right coronary arteries.

(1)左冠状动脉：起自主动脉根部左侧，从左心耳与肺动脉干之间穿出，分为两支。 (1) the left coronary artery: starting from the left side of the aortic root, between the left atrial appendage and the pulmonary trunk piercing, divided into two.

1)前室间支：沿前室间沟下降，布于室间隔前2/3、左心室前壁及右心室前壁的少部。 1) the anterior branch: ditch the falling edge of the anterior chamber, distributed in two-thirds of the anterior wall of the left ventricle and a small portion of the right ventricular septal anterior wall of the former.

2)旋支：沿冠状沟左行，布于左心室侧壁、后壁和左心房。 2) circumflex branch: Coronal left along the line, distributed in the left ventricular lateral, posterior and left atrium.

(2)右冠状动脉：起自主动脉根部右侧，从右心耳与肺动脉干之间穿出，沿冠状沟向右下行，发出后室间支，沿后室间沟下降。 (2) the right coronary artery: the right of self from the aortic root, between the right atrial appendage and the pulmonary trunk piercing, downward to the right along the Coronal, after the issue of inter-room units were down along the posterior interventricular sulcus. 右冠状动脉主要布于室间隔后1/3、右心室、右心房及左心室后壁的少部。 Mainly distributed in 1/3 of the right coronary artery, the right ventricle and right atrium and left ventricular posterior wall of the small posterior interventricular septum.

2． 2. 静脉 Vein

心的静脉主要有心大静脉、心中静脉和心小静脉，它们先汇入冠状窦，再经冠状窦口入右心房。 Mainly determined cardiac vein vein, veins and heart hearts small veins, coronary sinus import them first, and then the coronary sinus into the right atrium.

（七）心包和心包腔 (Vii) the pericardium and pericardial

1． 1. 心包 Pericardium

心包是包在心和大血管根部的膜性囊，分为纤维性心包和浆膜性心包。 Pericardium is the heart and great vessels root package membranous sac, into fibrous pericardium and the serous pericardium.

(1)纤维性心包：位于最外层，厚而无弹性。 (1) fibrous pericardium: Located in the outermost layer, thick inelastic.

(2)浆膜性心包：位于纤维性心包内面，分脏、壁两层，脏层即心外膜。 (2) serous pericardial: Located on the inner surface of the fibrous pericardium, sub dirty wall layers, namely, the epicardium visceral.

2． 2. 心包腔：是浆膜性心包脏、壁两层间形成的间隙。 Pericardial cavity: a serous pericardial dirty, the gap formed between the two walls. 内有少量浆液。 Within a small amount of slurry.

心包和心包腔 Pericardium and pericardial

纤维心包最外层 Fibrous pericardium outermost     厚而坚韧无弹性 Thick and tough inelastic

浆膜心包围成腔 Heart surrounded by a serous cavities     脏壁两层相移行 Two-phase migration of the dirty wall

（八）心的体表投影 (Viii) the surface projection of the heart

1． 1. 左上点：左侧第二肋软骨下缘，距胸骨左缘1.2cm处。 Left point: the lower edge of the left side of the second costal cartilage from 1.2cm at the left sternal border.

2． 2. 右上点：右侧第三肋软骨上缘，距胸骨右缘1cm处。 Upper right: the right of the third costal margin from 1cm at the right edge of the sternum.  

3． 3. 右下点：右侧第六胸肋关节处。 Right point: the right of the sixth Sternocostal joints.

4． 4. 左下点：左侧第五肋间隙，距前正中线7cm~9cm处。 Left point: the left fifth intercostal space, anterior midline 7cm ~ 9cm place.

    心的体表投影 Heart of the surface projection

心脏体表有投影 Heart body surface projection     四点四弧可围成 Four four arcs can be enclosed

左右上点二肋间 The point about two intercostal     胸骨旁距略不同 Slightly different from the parasternal

右下第六胸肋处 Right at the sixth Sternocostal     左下心尖见搏动 See left apex beat

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