Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010...

30
2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout ・このハンドアウトは教科書やアトラスの代わりになるものではありません。 ・単に講義中にスライドで提示される図譜を集めたものです。 ・ただしハンドアウト中のほぼすべての図に出典が示してあります。不明な点があれば原著の記述を読んでください。 Goals of the Course 医学教育モデル・コア・カリキュラム中の『循環器系』から解剖学領域のものを抜粋 一般目標: 循環器系の構造と機能を理解し、主な循環器疾患の病因、病態生理、症候、診断と治療を学ぶ。 項目別の到達目標: 【構造と機能】 ・心臓の構造と分布する血管・神経を説明できる。 ・心筋細胞の微細構造と機能を説明できる。 ・心筋細胞の電気現象と心臓の興奮(刺激)伝導系を説明できる。 ・興奮収縮連関を概説できる。 ・体循環、肺循環と胎児循環を説明できる。 ・大動脈の枝を図示し、分布領域を概説できる。 ・頭頸部と四肢の主な動脈を図示し、分布域を概説できる。 ・主な静脈を図示し、門脈系と大静脈系の吻合部を説明できる。 ・毛細血管における物質・水分交換を説明できる。 ・胸管を経由するリンパの流れを概説できる。 ・心周期にともなう血行動態を説明できる。 【診断と検査の基本】 ・胸部エックス線写真と断層心エコー図から心臓・大血管の画像診断を説明できる。 【疾患:先天性心疾患】 ・主な先天性心疾患(心房中隔欠損、心室中隔欠損、動脈管開存、ファロー四徴)の病態生理、症候 と診断を説明し、治療概説できる(診断と治療は卒業時点での到達点)。 ・上記の先天性心疾患の発生機序を理解する。 Course Menu 1) Heart Let's make a heart! General organization Chambers and valves Structure of the cardiac wall Conducting system Innervation of the heart Vascular supply Cardiac cycle Diagnostic imaging 2) Blood vessels Major blood vessels Branches of aorta Arteries in various regions Veins Histology of blood vessels Unique circulation 3) Lymphatic vessel system Lymphatic vessels and lymph nodes Lymphatic tissues and organs (tonsils, thymus,,,) 4) Mediastinum 5) Development of the cardiovascular system Early development Vasculogenesis Heart tube formation Cardiac loop formation Septum formation Outflow formation Valve formation Formation of the smooth-wall parts of the atrium Arterial system Fetal circulation Congenital heat disease 6) Clinical correlations Palpable arteries Medication route Heart sound ECG (Electrocardiogram) Chest X-ray Echocardiography CT (Computed tomography)

Transcript of Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010...

Page 1: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1

About this handout ・このハンドアウトは教科書やアトラスの代わりになるものではありません。

・単に講義中にスライドで提示される図譜を集めたものです。

・ただしハンドアウト中のほぼすべての図に出典が示してあります。不明な点があれば原著の記述を読んでください。

Goals of the Course (医学教育モデル・コア・カリキュラム中の『循環器系』から解剖学領域のものを抜粋) 一般目標: ・循環器系の構造と機能を理解し、主な循環器疾患の病因、病態生理、症候、診断と治療を学ぶ。 項目別の到達目標: 【構造と機能】

・心臓の構造と分布する血管・神経を説明できる。 ・心筋細胞の微細構造と機能を説明できる。 ・心筋細胞の電気現象と心臓の興奮(刺激)伝導系を説明できる。 ・興奮収縮連関を概説できる。 ・体循環、肺循環と胎児循環を説明できる。 ・大動脈の枝を図示し、分布領域を概説できる。 ・頭頸部と四肢の主な動脈を図示し、分布域を概説できる。 ・主な静脈を図示し、門脈系と大静脈系の吻合部を説明できる。 ・毛細血管における物質・水分交換を説明できる。 ・胸管を経由するリンパの流れを概説できる。 ・心周期にともなう血行動態を説明できる。 【診断と検査の基本】

・胸部エックス線写真と断層心エコー図から心臓・大血管の画像診断を説明できる。 【疾患:先天性心疾患】

・主な先天性心疾患(心房中隔欠損、心室中隔欠損、動脈管開存、ファロー四徴)の病態生理、症候と診断を説明し、治療概説できる(診断と治療は卒業時点での到達点)。 ・上記の先天性心疾患の発生機序を理解する。

Course Menu 1) Heart

Let's make a heart! General organization Chambers and valves Structure of the cardiac wall Conducting system Innervation of the heart Vascular supply Cardiac cycle Diagnostic imaging

2) Blood vessels Major blood vessels Branches of aorta Arteries in various regions Veins Histology of blood vessels

Unique circulation 3) Lymphatic vessel system

Lymphatic vessels and lymph nodes Lymphatic tissues and organs

(tonsils, thymus,,,) 4) Mediastinum 5) Development of the

cardiovascular system Early development Vasculogenesis Heart tube formation Cardiac loop formation Septum formation Outflow formation

Valve formation Formation of the smooth-wall parts

of the atrium Arterial system Fetal circulation Congenital heat disease

6) Clinical correlations

Palpable arteries Medication route Heart sound ECG (Electrocardiogram) Chest X-ray Echocardiography CT (Computed tomography)

Page 2: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-2

Heart Let's make a heart!

General organization of the heart

Fig. 2[解剖学アトラス(第 3版) p 215]

Fig. 1[Aimi original]

Page 3: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-3

Chambers

From 解剖学アトラス

Fig. 6[解剖学アトラス(第 3版) p 216]

Fig. 3[イラスト解剖学 (第 4版) p 250]

Fig. 4[Gray's Anatomy for Students p 154] Fig. 5[Essentials of Human Anatomy & Physiology (7th ed.) p313]

Page 4: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-4

Valves

Fig. 8[解剖学アトラス(第 3版) p 217]

Fig. 7[Gray's Anatomy (39th ed.) p1002]

Page 5: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-5

Structure of the cardiac wall

Fig. 12[Basic Histology (7th ed.) p208] Fig. 13[Color Atlas of Histology (2nd ed.) p117]

Fig. 9[イラスト解剖学(第 4版) p 253]

Fig. 11[解剖学アトラス(第 3版) p 218]

Fig. 10[イラスト解剖学(第 4版) p

255]

Page 6: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-6

Fig. 14 [解剖学アトラス

(第 3版) p 223]

Fig. 15 [Essentials of Human Anatomy & Physiology (7th ed.) p1015] Fig. 16

[ゼッタイわかる心電図・ 心エコー図の読み方 p 9]

Fig. 17[イラスト解剖学(第 4版) p 261] Fig. 18[イラスト解剖学(第 4版) p 263]

Conducting system Innervation of the heart

Page 7: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-7

Vascular supply

Fig. 19[解剖学アトラス(第 3版) p 222] Fig. 20[解剖学講義(第 2版) p 296]

Fig. 21[Gray's Anatomy (39th ed.) p1015]

Fig. 22[Gray's Anatomy (39th ed.) p1015]

Fig. 24[Step循環器 p 11]

Fig. 23[イラスト解剖学(第 4版) p 268]

Page 8: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-8

Cardiac cycle

Fig. 25[Gray's Anatomy (39th ed.) p1006]

Page 9: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-9

Diagnostic imaging of the heart

Fig. 26[解剖学アトラス(第 3版) p 226]

Fig. 27[解剖学アトラス(第 3版) p 226]

Page 10: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-10

Blood vessels Major blood vessels

Branches of aorta, arteries in various regions

Fig. 28[Gray's Anatomy

(39th ed.) p1075]

Fig. 29- glossary

Fig. 29[解剖学アトラス(第 3版) p 236] Fig. 30[解剖学アトラス(第 3版) p 239]

Fig. 30- glossary

Page 11: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-11

Fig. 31[解剖学アトラス(第 3版) p 245] Fig. 32[解剖学アトラス(第 3版) p 246]

Fig. 31- glossary

Fig. 32- glossary

Page 12: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-12

Fig. 33[解剖学アトラス(第 3版) p 248] Fig. 34[解剖学アトラス(第 3版) p 249]

Fig. 33- glossary

Fig. 34- glossary

Page 13: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-13

Fig. 36[Gray's Anatomy for Students p 295] Fig. 37[Gray's Anatomy for Students p 296]

Fig. 38[Gray's Anatomy for Students p 300]

Fig. 39[Gray's Anatomy for Students p 301]

Fig. 35[分担解剖学2巻 (第 11版) p 33]

Page 14: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-14

Veins

Fig. 40[解剖学アトラス

(第 3版) p 237]

Fig. 41[Gray's anatomy for Students p 304]

Fig. 42[解剖学アトラス(第 3版) p 250]

2:浅腹壁静脈 5:大伏在静脈

7:胸腹壁静脈 13:腋窩静脈 14:正中皮静脈

Page 15: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-15

Histology of blood vessels

Fig. 43[Essentials of Human Anatomy & Physiology (7th ed.) p340]

Fig. 44[分冊解剖学アトラスⅡ (第 5版) p 89]

Fig. 45[標準組織学各論 (第 2版) p 9]

Fig. 46[標準組織学各論 (第 2版) p 9] Fig. 47[標準組織学各論 (第 2版) p 11] Fig. 48[標準組織学各論 (第 2版) p 12]

Page 16: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-16

Fig. 50[分冊解剖学アトラスⅡ (第 5版) p 89] Fig. 51[分冊解剖学アトラスⅡ (第 5版) p 91]

Fig. 53[from a page in the internet]

Fig. 52[イラスト解剖学 (第 4版) p 216]

Fig. 49[イラスト解剖学 (第 4版) p 178]

Page 17: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-17

Unique Circulation

Lymphatic vessel system Lymphatic vessels and lymph nodes

Fig. 54[解剖学アトラス(第 3版) p 241] Fig. 55[分冊解剖学アトラスⅡ (第 5版) p 217]

Fig. 54- glossary

Fig. 55- glossary

Fig. 56[イラスト解剖学 (第 4版) p 228]

Fig. 57[イラスト解剖学 (第 4版) p 229]

Page 18: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-18

Lymphatic tissues and organs

Fig. 58[分冊解剖学アトラスⅡ (第 5版) p 81] Fig. 59[同左 p 81] Fig. 60[同左 p 81]

Fig. 61[分冊解剖学アトラスⅡ (第 5版) p 85]

Fig. 65[分冊解剖学アトラスⅡ (第 5版) p 363]

Fig. 64[分冊解剖学アトラスⅡ (第 5版) p 369]

Fig. 62[同左 p 83]

Fig. 63[同左 p 83]

Fig. 66[Gray's Anatomy for Students p 183]

Page 19: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-19

Fig. 67[Gray's Anatomy for Students p 185]

Fig. 68[Gray's Anatomy for Students p 189]

Fig. 69[Gray's Anatomy for Students p 107]

Fig. 70[Gray's Anatomy for Students p 130]

Fig. 71[Gray's Anatomy for Students p 131]

Fig. 72[Gray's Anatomy for Students p 132]

Mediastinum

Page 20: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-20

Development of the cardiovascular system Early development

Fig. 76[ラングマン人体発生学 (第 8版) p 60]

Fig. 73[イラスト解剖学 (第 4版) p 12]

Fig. 74[Langman's Medical Embryology (9th ed.) p 196]

Fig. 75[ラングマン人体発生学 (第 8版) p 197]

Page 21: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-21

Vasculogenesis, Heart tube formation

Cardiac loop formation

Septum formation

Fig. 41 Fig. 77[Langman's Medical Embryology (9th ed.) p 101]

Fig. 80[Langman's Medical Embryology (9th ed.) p 238]

Fig. 79[Langman's Medical Embryology (9th ed.) p 230+231]

Fig. 78[Langman's Medical Embryology (9th ed.) p 224]

Page 22: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-22

Outflow formation

Valve formation

Fig. 81[Langman's Medical Embryology (9th ed.) p 248]

Fig. 82[Langman's Medical Embryology (9th ed.) p 250]

Fig. 83[Langman's Medical Embryology (9th ed.) p 242]

Page 23: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-23

Formation of the smooth-walled parts of the atrium

Arterial system

Fig. 84[Langman's Medical Embryology (9th ed.) p 239]

Fig. 85[Langman's Medical Embryology

(9th ed.) p 255]

Fig. 86[Langman's Medical Embryology

(9th ed.) p 256]

Page 24: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-24

Fetal Circulation

Fig. 88[Langman's Medical Embryology (9th ed.) p 268+270]

Fig. 87[Langman's Medical Embryology

(9th ed.) p 257]

Page 25: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-25

Congenital heart disease

VSD ASD

PDA TF

Fig.89[イラスト解剖学 (第 4版) p 285]

Fig. 90[イラスト解剖学 (第 4版) p 283]

Fig. 91[イラスト解剖学 (第 4版) p 287]

Fig. 92[イラスト解剖学 (第 4版) p 282]

Page 26: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-26

Clinical correlations

Fig. 93[Essentials of Human Anatomy & Physiology (7th ed.) p351]

Fig. 94[分冊解剖学アトラスⅡ p 73]

Page 27: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-27

Fig. 95[図解日常診療手技ガイド p 58]

Fig. 96[図解日常診療手技ガイド p 65] Fig. 97[図解日常診療手技ガイド p 61]

Fig. 98[from a page in the internet]

Page 28: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-28

Fig. 99[ゼッタイわかる心電図・心エコー図の読み方 p 81]

Fig. 100[出典不明 m(_ _)m]

Fig. 101[超音波アトラス(?) p 25]

Page 29: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-29

Mediastinum: CT of the chest

Fig. 102[胸部の CT、医学書院]

Page 30: Goals of the Course - Shiga University of Medical …lec-anatomy/2010CardiovascularCPD.pdf2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-1 About this handout

2010 Cardiovascular system handout By Yoshinari AIMI, Dept. Anatomy page-30

AA Ascending aorta

ARCH Aortic arch

Az Azygos v.

AzAr Azgos arch

BcA Brachiocephalic a.

CA Coronary a.

CS Coronary sinus

CV Coronary v.

DA Descending aorta

HAz Hemiazygos v.

ImBr Intermediate bronchus

IVC Inferior vena cava

IVS Interventricular septum

LA L. atrium

LAApp L. auricle

LBcV L. brachiocephalic v.

LCA L. common carotid a.

LIPV L. inferior pulmonary v.

LJV L. jugular v.

LMPA L. main pulmonary a.

LScA L. subclavian a.

LScV L. subclavian v.

LSPV L. superior pulmonary v.

LV L. ventricle

LVA L. vertebral a.

LVV L. vertebral v.

MBr Main branchus

PA Pulmonary a.

PATr Pulmonary a. trunk

PV Pulmonary v.

RA R. atrium

RAApp R. auricle

RBcV R. brachiocephalic v.

RCA (図 K中) R. coronary a.

RCA (図 A-C) R. common carotid a.

RIPV R. inferior pulmonary v.

RJV R. jugular v.

RMPA R. main pulmonary a.

RScA R. subclavian a.

RScV R. subclavian v.

RSPV R. superior pulmonary v.

RV R. ventricle

RVA R. vertebral a.

RVV R. vertebral v.

SIcV Superior intercostal v.

SPS Superior pericardial sinus

SVC Superior vena cava

Thy Thyroid

Tr Trachea

TrPS Transverse pericardial sinus