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Aus Dornheim Anatomy
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==Binnenräume==
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==Inner spaces==  
 
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<lightbox-embedding src="file:ArteriellerAusstrom.png" group="image-group-1" caption="Arterieller Ausstrom aus linken Herz" width="400" height="300" style="width:300px; height:300px;float:left;margin:1px;background-color:#fff;border:1px solid #c8ccd1;display: flex;justify-content: center;"/>
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<lightbox-embedding src="file:ArteriellerAusstrom.png" group="image-group-1" caption="Arterial outflow from left heart" width="400" height="300" style="width:300px; height:300px;float:left;margin:1px;background-color:#fff;border:1px solid #c8ccd1;display: flex;justify-content: center;"/>
 
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<lightbox-embedding src="file:ArteriellerZustrom.png" group="image-group-1" caption="Arterieller zustrom zum linken Herz"/> <lightbox-embedding src="file:BlutstromImLinkenHerz.png" group="image-group-1" caption="Blutstrom im linken Herz"/> <lightbox-embedding src="file:BlutstroemeLinkesHerz.png" group="image-group-1" caption="Blutströme am linken Herzen"/><lightbox-embedding src="file:BlutstromZurLunge.png" group="image-group-1" caption="Blutstrom zur Lunge"/>
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<lightbox-embedding src="file:ArteriellerZustrom.png" group="image-group-1" caption="Arterial flow to the left heart"/> <lightbox-embedding src="file:BlutstromImLinkenHerz.png" group="image-group-1" caption="Blood flow in the left heart"/> <lightbox-embedding src="file:BlutstroemeLinkesHerz.png" group="image-group-1" caption="Blood flows at the left heart"/><lightbox-embedding src="file:BlutstromZurLunge.png" group="image-group-1" caption="Blood flow to the lungs"/>
 
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<lightbox-embedding src="file:VenöserZustrom.png" group="image-group-1" caption="Venöser Zustrom zum linken Herz"/> <lightbox-embedding src="file:BlutstromImRechtenHerz.png" group="image-group-1" caption="Blutstrom im rechten Herz"/> <lightbox-embedding src="file:BlutstroemeRechtesHerz.png" group="image-group-1" caption="Blutströme am rechten Herz"/>
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<lightbox-embedding src="file:VenöserZustrom.png" group="image-group-1" caption="Venous inflow to the left heart"/> <lightbox-embedding src="file:BlutstromImRechtenHerz.png" group="image-group-1" caption="Blood flow in the right heart"/> <lightbox-embedding src="file:BlutstroemeRechtesHerz.png" group="image-group-1" caption="Blood flows at the right heart"/>
 
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blutströme am und im Herz</div>
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Blood flows at and in the heart</div>
 
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Im Herzen werden vier Binnenräume (jeweils links und rechts eine Kammer (Ventrikel) und ein Vorhof (Atrium)) unterschieden. Die Vorhöfe grenzen jeweils an die Ventrikel, die über ihre abgehenden Gefäße mit der Lunge oder den großen Körperarterien und -venen verbunden sind.
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In the heart, four internal spaces are distinguished (one chamber (ventricle) and one atrium (atrium) on the left and right respectively). The atria are adjacent to the ventricles, which are connected to the lungs or the major arteries and veins of the body by their outgoing vessels.
  
  
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===Binnenräume des linken Herzens===
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===Inner spaces of the left heart===
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Der linke Vorhof ist glattwandig zwischen den Einmündungen der vier Lungenvenen (Vv. pulmonales dextra/sinistra superior und inferior). Die Muskelwand des linken Vorhofs ist dünner als die des rechten, da er zum Niederdrucksystem gehört.  
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The <b>left atrium</b> has smooth walls between the openings of the four pulmonary veins (Vv. pulmonales dextra/sinistra superior and inferior). The muscle wall of the left atrium is thinner than that of the right atrium because it belongs to the low pressure system.  
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Die schmale Falte (Valvula foraminis ovalis) ist zeitweilig am Septum interatriale zu sehen. Sie entsteht durch emporragen der Fossa ovalis in den linken Vorhof.  
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The narrow fold (valvula foraminis ovalis) is temporarily visible at the septum interatriale. It is formed by raising the fossa ovalis into the left atrium.  
  
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<!--[segmenter_snapshot raum 4]-->Das Blut gelangt über das Ostium atrioventriculare sinistrum vom linken Vorhof in den <b>linken Ventrikel</b><!--[/]-->.
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<!--[segmenter_snapshot raum 4]-->Blood passes from the left atrium into the <b>left ventricle</b> via the ostium atrioventriculare sinistrum.<!--[/]-->.
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Das Ostium atrioventriculare kann dabei durch das Valva atrioventricularis sinistra verschlossen werden. <!--[segmenter_snapshot raum 5]--> Außerdem besitzt der linke Ventrikel eine Ein- und Ausstrombahn.<!--[/]--> Wobei der Einstrom entlang der Hinterwand, der linken Seitenwand wie auch des apikalen Abschnittes verläuft.
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The ostium atrioventriculare can be closed by the valva atrioventricularis sinistra. <!--[segmenter_snapshot raum 5]--> The left ventricle also has an inflow and outflow pathway.<!--[/]--> The inflow passes along the posterior wall, the left lateral wall as well as the apical section. The smooth-walled outflow tract is located near the  <!--[segmenter_snapshot raum 7]-->septum interventriculare<!--[/]--> and continues into the vestibulum aortae. It consists largely of musculature (pars muscularis). <!--[segmenter_snapshot raum 6]--> The ostium aortae is the opening between the aortic outflow tract of the left ventricle and the aorta.<!--[/]--> The wall of the left ventricle is about three times as thick as that of the right ventricle and thus belongs to the high-pressure system.
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Die glattwandige Ausstrombahn befindet sich in der Nähe vom <!--[segmenter_snapshot raum 7]--> Septum interventriculare<!--[/]--> und setzt sich in das Vestibulum aortae fort. Sie besteht größtenteils aus Muskulatur (Pars muscularis). <!--[segmenter_snapshot raum 6]--> Als Ostium aortae bezeichnet man die Öffnung zwischen der aortalen Ausstrombahn des linken Ventrikels  und der Aorta.<!--[/]--> Die Wand des linken Ventrikels ist ca. drei mal so dick, wie die des rechten Ventrikels und gehört somit zum Hochdrucksystem.
 
  
  
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===Binnenräume des rechten Herzens===
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===Inner spaces of the right heart===
  
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Der hintere Teil des rechten Vorhofs besteht aus dem Sinus venarum cavarum (Vorhofsinus).<!--[segmenter_snapshot raum 0]--> Am Ostium cavea superioris und inferioris münden die beiden Vv. cavae (superior und inferior).<!--[/]--> Von diesen kann das Blut nahtlos ohne dazwischenliegende Klappen in den Vorhof einfließen. Die Fossa ovalis befindet sich über dem Einmündungsort der V. cava inferior und wird vom Limbus fosssae ovalis umrandet. Die Crista terminalis grenzt den vorderen Teil (rechter Vorhof mit Herzohr) vom hinteren ab.<br>  
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The posterior part of the right atrium consists of the sinus venarum cavarum (atrial sinus).<!--[segmenter_snapshot raum 0]--> At the ostium cavea superioris and inferioris the two vv. cavae (superior and inferior) open.<!--[/]--> From these, blood can flow seamlessly into the atrium without intervening valves. The oval fossa is located above the confluence of the inferior vena cava and is surrounded by the oval fossa limbus. The crista terminalis separates the anterior part (right atrium with heart ear) from the posterior.<br>  
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Der rechte Vorhof ist größer als der linke und gehört ebenfalls zum Niederdrucksystem. Im Gegensatz zum glattwandigen vorderen Abschnitts des Vorhofs, weißt der hintere Teil deutlich mehr Struktur auf.
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The right atrium is larger than the left and also belongs to the low-pressure system. In contrast to the smooth-walled anterior section of the atrium, the posterior part has significantly more structure.
  
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Durch die Trabeculae carnea und die Crista supraventricularis lässt sich der rechte Ventrikel auch in zwei Teile trennen.<br>
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The right ventricle can also be separated into two parts by the trabeculae carnea and the crista supraventricularis.<br>
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<!--[segmenter_snapshot raum 1]-->Das Blut fließt über das Ostium atrioventriculare dextrum in die rechte Herzkammer.<!--[/]--> Auch hier erkennt man eine <!--[segmenter_snapshot raum 2]--> Ein- und Ausflussbahn<!--[/]-->. Im Einstrombereich befinden sich die Trabeculae carneae, dabei handelt es sich um kleine Muskelbälkchen. Auch hier sind die Mm. papillares über Chordae tendineae mit der Valva atrioventricularis (dextra) verbunden.<!--[segmenter_snapshot raum 3]--> Die Ausflussbahn setzt über dem Conus arteriosus fort.<!--[/]--> Als Conus arteriosus bezeichnet man den kegelförmigen Übergang der rechten Herzkammer in den Truncus pulmonalis. Dieser Bereich ist glattwandig und weist keine Trabeculae carneae auf. Das Blut fließt über die Pulmonalklappe (Valva trunci pulmonalis) durch das Ostium trunci pulmonalis in den Truncus pulmonalis. Auch der rechte Ventrikel gehört zum Niederdrucksystem.
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<!--[segmenter_snapshot raum 1]-->The blood flows via the ostium atrioventriculare dextrum into the right ventricle.<!--[/]--> Here, too, there is an <!--[segmenter_snapshot raum 2]-->inflow and outflow trajectory<!--[/]-->. In the inflow area are the trabeculae carneae, which are small muscle bulbs. Here too, the papillary muscles are connected to the valva atrioventricularis (dextra) via chordae tendineae.<!--[segmenter_snapshot raum 3]--> The outflow tract continues over the conus arteriosus.<!--[/]--> The conus arteriosus is the cone-shaped transition of the right ventricle into the truncus pulmonalis. This area is smooth-walled and has no trabeculae carneae. The blood flows over the pulmonary valve (valva trunci pulmonalis) through the ostium trunci pulmonalis into the truncus pulmonalis. The right ventricle also belongs to the low-pressure system.
  
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==Übersicht über die Herzklappen==
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==Overview of the heart valves==
  
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Es werden zwei Arten von Klappen im Herzen unterschieden: Vorhof-Kammer-Klappen und Gefäßklappen. Die vier Herzklappen dienen dazu den Blutfluss im Herzen nur in eine Richtung zu ermöglichen und dadurch einen Rückflusses des Blutes zu verhindern. Die Segelklappen befinden sich zwischen den Vorhöfen und den Ventrikeln. Zwischen dem Truncus pulmanis bzw. der Aorta liegen die Taschenklappen.
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There are two types of valves in the heart: atrioventricular valves and vascular valves. The four heart valves serve to allow blood to flow in the heart in only one direction and thus prevent backflow of blood. The leaflet valves are located between the atria and the ventricles. The pocket valves are located between the pulmonary trunk and the aorta.
  
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===Segelklappen (Valvae atrioventriculares)===
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===Sail valves (Valvae atrioventriculares)===
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Die Segelklappen (Valvae atrioventriculares) werden auch Atrioventrikularklappen (AV-Klappen) genannt. Zu ihnen gehören die Trikuspidalklappe (Valva atrioventricularis dextra) und die Bikuspidalklappe (Valva atrioventricularis sinistra). Durch diese Klappen wird der Rückstrom des Blutes aus den Ventrikeln in die Vorhöfe während der Kontraktion des Herzens verhindert. Der Name der Klappen kommt von ihrer Form, die einem Segel ähnelt. Sie ragen dabei in das Ostium atrioventricularis dextrum sowie sinistrum. Die Segelklappen sind über das Chordae tendinae an der Musculi papillares befestigt. Diese sind eine besondere Ausprägung der Trabeculae carneae. So sind die Segelklappen mechanisch am Herzskelett befestigt.
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The sail valves (valvae atrioventriculares) are also called atrioventricular valves (AV valves). They include the tricuspid valve (valva atrioventricularis dextra) and the bicuspid valve (valva atrioventricularis sinistra). These valves prevent the backflow of blood from the ventricles into the atria during contraction of the heart. The name of the valves comes from their shape, which resembles a sail. They project into the ostium atrioventricularis dextrum as well as sinistrum. The sail valves are attached to the musculi papillares via the chordae tendinae. These are a special form of the trabeculae carneae. Thus, the leaflet valves are mechanically attached to the cardiac skeleton.
  
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Bei der Systole wird das Blut aus dem Ventrikel herausgepresst. Dabei blähen sich die Segelklappen auf und werden mit Blut gefüllt. Durch die Verankerung der Klappen an der Chordae tendinae sowie die Kontraktion der Mm. papillares wird die Öffnung der Klappen in den Vorhof verhindert. Die Segelklappen befinden sich auf Höhe des Ostiums, da die Aussackung der Segel in Richtung Vorhof durch den Rückzug der Papillarmuskeln aufgehoben wird.
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During systole, the blood is forced out of the ventricle. In the process, the leaflet valves inflate and are filled with blood. The anchoring of the valves to the chordae tendinae and the contraction of the papillary muscles prevent the valves from opening into the atrium. The leaflet valves are located at the level of the ostium because the bulging of the leaflets towards the atrium is cancelled by the retraction of the papillary muscles.
  
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'''Trikuspidalklappe'''<br>
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'''Tricuspid valve'''<br>
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Die Trikuspidalklappe befindet sich zwischen dem rechten Vorhof und Ventrikel. Sie verhindert den systolischen Rückfluss des Blutes vom rechten Ventrikel in den rechten Vorhof. Aufgebaut ist sie aus drei Segeln: Cuspis anterior, Cuspus posterior und Cuspus septalis.
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The tricuspid valve is located between the right atrium and ventricle. It prevents systolic backflow of blood from the right ventricle into the right atrium. It is made up of three leaflets: Cuspis anterior, cuspus posterior and cuspus septalis.
  
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'''Bikuspidalklappe'''<br>
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'''Bicuspid valve'''<br>
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Die Bikuspidalklappe liegt zwischen dem linken Vorhof und dem linken Ventrikel. Im Gegensatz zur Trikuspidalklappe besteht die Bikuspidalklappe nur aus zwei Segeln (Cuspis anterior und Cuspis posterior).
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The bicuspid valve is located between the left atrium and the left ventricle. Unlike the tricuspid valve, the bicuspid valve consists of only two leaflets (cuspis anterior and cuspis posterior).
  
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===Taschenklappen (Valvae semilunares)===
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===Semilunar valves (Valvae semilunares)===
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Zu den Taschenklappen zählen die Pulmonalklappe und die Aortenklappe. Ihre Struktur ist aus einem dünnen Bindegewebe mit einem Endokardüberzug aufgebaut. Die Klappen sind aus drei halbmondförmigen Taschen (Valvula semilunaris anterior, sinistra und dextra) aufgebaut und öffnen sich im Ostium aortae bzw. Ostium trunci pulmonalis in Richtung der Gefäße. Die einzelnen Klappen haben einen freien Rand (Lunula valvae semilunares), der sich in der Mitte zu einem kleinen bindegewebigen Knoten (Nodulus valvulae semilunaris) verdichtet. Wenn  sich die Klappe schließt, treffen die Noduli und Lunulae aufeinander. Auf diese Art und Weise wird das Ostium komplett abgedichtet. Der Rückfluss des Blutes wird durch das Füllen der Taschen verhindert. Dabei ist keine Muskelkontraktion notwenidig.
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The pulmonary valve and the aortic valve belong to the semilunar valves. Their structure is made up of a thin connective tissue with an endocardial covering. The valves are composed of three crescent-shaped pockets (valvula semilunaris anterior, sinistra and dextra) and open in the direction of the vessels in the ostium aortae or ostium trunci pulmonalis. The individual valves have a free edge (lunula valvae semilunares), which thickens in the middle to form a small connective tissue nodule (nodulus valvulae semilunaris). When the valve closes, the nodules and lunulae meet. In this way, the ostium is completely sealed. The backflow of blood is prevented by filling the pockets. No muscle contraction is necessary in this process.
  
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'''Pulmonalklappe (Valva trunci pulmonalis)'''<br>
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'''Pulmonary valve (valva trunci pulmonalis)'''<br>
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Durch die Pulmonalklappe wird der Rückfluss des Blutes in den rechten Ventrikel verhindert. Da diese Klappe zwischen zwei Niederdrucksystemen (venöser Schenkel des Körperkreislaufsystem und Pulmonalkreislauf) ist sie dünner ausgeprägt.
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The pulmonary valve prevents the backflow of blood into the right ventricle. Since this valve is located between two low-pressure systems (venous limb of the systemic circulation and pulmonary circulation), it is thinner.
  
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'''Aortenklappe (Valva aortae)'''<br>
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'''Aortic valve (valva aortae)'''<br>
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Durch die Aortenklappe wird der Rückfluss aus der Aorta in den linken Ventrikel verhindert. Sie hat eine leichte Auswölbung nach außen (Sinus aortae). Die Herzkranzgefäße (A. coronaria sinistra und dextra) entspringen im linken und rechten Sinus aortae, so dass das Herz mit Blut versorgt wird.
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The aortic valve prevents backflow from the aorta into the left ventricle. It has a slight outward bulge (sinus aortae). The coronary vessels ( a. coronaria sinistra and dextra) originate in the left and right sinus aortae, so that the heart is supplied with blood.
  
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==Herzauskultation==
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==Cardiac auscultation==
  
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Bei einer Funktionsstörung entstehen durch Wirbelbildungen des Blutes hörbare Strömungsgeräusche. Zur Erkennung dieser Geräusche ist die Herzauskultation eine alte, aber wichtige Methode. Sie dient sowohl der Ersterkennung als auch der Verlaufskontrolle von Funktionsstörungen. Die Grundlage ist, dass beim gesunden, erwachsenen Herzen zwei Töne zu hören sind. Dabei ist der erste Herzton (S1) am Beginn der Systole. Erzeugt wird der Ton durch die Blutsäule, die gegen die Segelklappen schlägt und nicht, wie häufig angenommen, durch den Schluss der Klappen. Der zweite Herzton (S2) wird durch den Verschluss der Taschenklappen am Ende der Systole erzegt. Er ist im Vergleich zum ersten Herzton deutlich heller. Die beiden Töne sind an unterschiedlichen Orten deutlich zu hören. Über der Herzspitze ist der erste Herzton deutlich zu hören, über der Herzbasis dagegen der zweite Herzton. Am Erb'schen Punkt, der links parasternal im dritten Interkostalraum liegt, können alle Herzklappen gleich gut erfasst werden. Für die Auskultation einzelner Herzklappen werden bestimmte Punkte am Brustkorb empfohlen, da die geräusche an diese Orte projiziert werden und so am lautesten zu hören sind:
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In the case of a malfunction, audible flow noises are caused by the formation of whirls in the blood. Cardiac auscultation is an old but important method for recognizing these sounds. It is used both for the initial detection and the follow-up of functional disorders. The basis is that two sounds can be heard in a healthy adult heart. The first heart sound (S1) is at the beginning of systole. The tone is produced by the blood column hitting the leaflet valves and not, as is often assumed, by the closure of the valves. The second heart sound (S2) is produced by the closure of the leaflet valves at the end of systole. It is much brighter than the first heart sound. The two sounds are clearly audible at different locations. The first heart sound is clearly heard above the apex of the heart, whereas the second heart sound is clearly heard above the base of the heart. At Erb's point, which is located on the left parasternal side in the third intercostal space, all heart valves can be detected equally well. Specific points on the chest are recommended for auscultation of individual heart valves, as the sounds are projected to these locations and can thus be heard loudest:
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* Aortenklappe: 2/3. Interkostalraum rechts parasternal
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* Aortic valve: 2/3rd intercostal space right parasternal.
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* Pulmonalklappe: 2. Interkostalraum links parasternal
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* Pulmonary valve: 2nd intercostal space left parasternal
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* Trikuspidalklappe: 4. Interkostalraum rechts parasternal
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* Tricuspid valve: 4th intercostal space right parasternal
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* Bikuspidalklappe: 5. Interkostalraum links medioklavikulär
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* Bicuspid valve: 5th intercostal space left medioclavicular
  
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==Erregungsbildungs- und Erregungsleitungssystem <i>(Demnächst)</i>==
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==Excitation formation and excitation conduction system <i>(Coming soon)</i>==
  
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Im Herzen gibt es ein autonomes Erregungsbildungssystem (Systema conducente cordis) und ein Erregungsleitungssystem (Systema conducente cordis). Es werden dabei vier Abschnitte unterschieden. Bei der Erregung des Herzen spannt sich die Vorhof- und Kammermuskulatur ca 100.000 Mal pro Tag. Dabei wird der Herzmuskel durch elektrische Impulse gesteuert. Die entstandenen Impulse verbreiten sich in einem speziellen Zellsystem des Herzmuskels.
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In the heart there is an autonomous excitation generation system (systema conducente cordis) and an excitation conduction system (systema conducente cordis). A distinction is made between four sections. When the heart is excited, the atrial and ventricular muscles contract about 100,000 times a day. The heart muscle is controlled by electrical impulses. The resulting impulses spread through a special cell system of the heart muscle.
  
  
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===Sinusknoten===   
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===Sinus node===   
  
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Der Sinusknoten wird auch Nodus sinuatrialis oder Keith-Flack-Knoten genannt. Er besteht makroskopisch aus einer muskulären Struktur, die etwa 3 mm dick und 10 mm lang ist. Die äußere Form ähnelt einem Komma. Er befindet sich an der Dorsalseite des rechten Herzens und ist dort subepikardial im Sulcus terminalis gelegen. Kranial vom Sinusknoten befindet sich die Einmündung der Vena cava superior. In manchen Fällen reicht der Sinusknoten bis in das rechte Herzohr hinein.
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The sinus node is also called the nodus sinuatrialis or Keith-Flack node. Macroscopically, it consists of a muscular structure that is about 3 mm thick and 10 mm long. The external shape resembles a comma. It is located on the dorsal side of the right heart, subepicardially in the terminal sulcus. Cranial to the sinus node is the junction of the superior vena cava. In some cases, the sinus node extends into the right heart ear.
  
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Funktionell gesehen, ist der Sinusknoten das primäre Schrittmacherzentrum des Herzens und ist damit an der komplexen Regulation der Herzfrequenz beteiligt. Dem Sinusknoten fällt die zentrale Rolle der Erregungsbildung zu. Es werden durch ihn Erregungssalven mit einer Ruhefrequenz von 60-70 Impulsen pro Minute erzeugt. Die Impulse werden für eine Erregung des Vorhofmyokards genutzt, da sich die Vorhoferregungswelle in Richtung der Kammern ausbreitet. Der Ramus nodi sinuatrialis sorgt für die Durchblutung des Sinusknoten. Angesteuert wird er durch den Sympathikus und Parasympathikus. De Sinuknoten besteht aus spezifischen Herzmuskelzellen:
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Functionally, the sinus node is the primary pacemaker centre of the heart and is therefore involved in the complex regulation of the heart rate. The sinus node has the central role of excitation formation. It generates excitation volleys with a resting frequency of 60-70 impulses per minute. The pulses are used to excite the atrial myocardium, as the atrial excitation wave propagates towards the ventricles. The sinuatrial ramus nodi provides blood flow to the sinus node. It is controlled by the sympathetic and parasympathetic nervous systems. The sinus node consists of specific heart muscle cells:
  
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'''P-Zellen'''<br>
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'''P cells'''<br>
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Die P-Zellen ("Pacemaker") sind rundliche, blasse Zellen, die meistens in Gruppen vorliegen. Sie sind untereinander durch Nexus und Desmosomen verbunden.
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The P cells (''pacemakers'') are roundish, pale cells that are usually present in groups. They are connected to each other by nexus and desmosomes.
  
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'''Transitionszellen'''<br>
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'''Transition cells'''<br>
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Transitionszellen sind elongierte und teilweise verzweigte Kardiomyozyten. In diesen sind sehr viele Myofibrillen enthalten. Durch die Transitionszellen werden die P-Zellen verbunden und eine Verbindung zum Arbeitsmyokard hergestellt.
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Transition cells are elongated and partially branched cardiomyocytes. They contain a large number of myofibrils. The transition cells connect the P cells and establish a connection to the working myocardium.
  
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===Atrioventrikularknoten===  
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===Atrioventricular node===  
  
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Der Atrioventrikularknoten wird auch Nodus atrioventricularis, AV-Knoten oder Aschoff-Tawara-Knoten genannt. Er ist das sekundäre Schrittmacherzentrum des Herzens. Der AV-Knoten ist 5 mm lang, 3 mm breit und 1 mm dick und ist im rechten Herzvorhof angesiedelt. Die genaue Position ist an der Basis des Vorhofseptums vor der Einmündung des Sinus coronarius. Dieser Bereich wird als Koch-Dreieck bezeichnet. Der Atrioventrikularknoten dient der Regulierung der Reizübertreibung über das nichtleitende Herzskelett. Er wird durch das His-Bündel fortgesetzt, welches in Richtung der Herzspitze weiter zieht. Angesteuert wird der AV-Knoten ebenfalls durch den Sympathikus und den Parasympathikus. Die Durchblutung findet durch den Ramus nodi atrioventricularis aus dem Arteria coronaria dextra statt. Die Hauptaufgabe liegt in der Verzögerung der Erregungsübertragung  auf die Kammern. So wird sichergestellt, dass die Vorhofkontraktion abgeschlossen ist, bevor die Kammerkontraktion beginnt. Durch den AV-Knoten können auch spontane Erregungen erzeugt werden. Diese haben aber eine deutlich geringere Frequenz (40-50 Depolarisationen pro Minute) als der Sinusknoten. Diese Impuls-Erregung findet nicht statt solange der Sinusknoten intakt ist.
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The atrioventricular node is also called the nodus atrioventricularis, AV node or Aschoff-Tawara node. It is the secondary pacemaker centre of the heart. The AV node is 5 mm long, 3 mm wide and 1 mm thick and is located in the right atrium. Its exact location is at the base of the atrial septum before the confluence of the coronary sinus. This area is called the triangle of Koch. The atrioventricular node serves to regulate stimulus exaggeration via the non-conducting cardiac skeleton. It is continued by the His bundle, which continues towards the apex of the heart. The AV node is also controlled by the sympathetic and parasympathetic nervous systems. Blood flow takes place through the ramus nodi atrioventricularis from the arteria coronaria dextra. Its main function is to delay the transmission of excitation to the ventricles. This ensures that the atrial contraction is completed before the ventricular contraction begins. Spontaneous excitations can also be generated by the AV node. However, these have a much lower frequency (40-50 depolarisations per minute) than the sinus node. This impulse excitation does not take place as long as the sinus node is intact.
  
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===Atrioventrikularbündel===  
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===Atrioventricular bundle===  
  
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Das Atrioventrikularbündel, auch Fasciculus atrioventricularis, AV-Bündel oder His-Bündel, ist ein Bestandteil des Erregungsleitungssystems des Herzens. Er ist 4 mm dick und 20 mm lang. Das AV-Bündel geht subendokardial im Vorhof vom AV-Knoten aus. Es durchdringt das Trigonum fibrosum dextrum und teilt sich danach in der Pars membranacea des Ventrikelseptums in die beiden Tawara-Schenkel. Die Funktion des AV-Bündels ist die Weiterleitung der Erregung von AV-Knoten bis zu den Kammerschenkeln.
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The atrioventricular bundle, also known as the fasciculus atrioventricularis, AV bundle or His bundle, is a component of the heart's conduction system. It is 4 mm thick and 20 mm long. The AV bundle originates subendocardially in the atrium from the AV node. It penetrates the trigonum fibrosum dextrum and then divides into the two tawara legs in the pars membranacea of the ventricular septum. The function of the AV bundle is to transmit excitation from the AV node to the ventricular legs.
  
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===Kammerschenkel===
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===Bundle branch===
  
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Die Kammerschenkel werden auch als Crus dextrum und sinistrum oder Tawara-Schenkel bezeichnet. Die Tawara-Schenkel teilen sich an dem AV-Bündel. Ihre Hauptaufgabe ist die Weiterleitung der Erregung aus dem His-Bündel über das Nexus in das Arbeitsmyokard. Der linke Tawara-Schenkel (Crus sinistrum) zweigt sich so gut wie senkrecht vom His-Bündel ab und fächert sich daraufhin auf. So werden folgende Strukturen erzeut: posteriorer faszikel, mittlerer Faszikel und anteriorer Faszikel. Der rechte Tawara-Schenkel (Crus dextrum) verläuft weiter nach vorne und tritt in das Myokard des Kammerseptums ein. Er verläuft weiter in Richtung Herzspitze. Im Kammermyokard wird die Erregung über die Purkinje Fasern weitergeleitet.
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The bundle branches are also called crus dextrum and sinistrum or tawara branches. The tawara legs divide at the AV bundle. Their main function is to transmit excitation from the His bundle via the nexus into the working myocardium. The left Tawara branch (crus sinistrum) branches off almost perpendicularly from the His bundle and then fans out. This creates the following structures: posterior fascicle, middle fascicle and anterior fascicle. The right tawara limb (crus dextrum) continues anteriorly and enters the myocardium of the ventricular septum. It continues towards the apex of the heart. In the ventricular myocardium, excitation is transmitted via the Purkinje fibres.
  
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==Erkrankungen==  
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==Diseases==  
  
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*[[Special:MyLanguage/Herzinfarkt|Herzinfarkt]]
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*[[Special:MyLanguage/Herzinfarkt|Myocardial infarction]]
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*[[Special:MyLanguage/Herzinsuffizienz|Herzinsuffizienz]]
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*[[Special:MyLanguage/Herzinsuffizienz|Cardiac Failure]]
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*[[Special:MyLanguage/Herzrhythmusstörung|Herzrhythmusstörung]]
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*[[Special:MyLanguage/Herzrhythmusstörung|Cardiac arrhythmia]]
  
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==Freies Explorieren==   
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==Free exploration==   
  
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{{Tab4|Button1=Herz|Button2=Herzgefäße|Button3=Binnenräume im Herz|Button4=Herz in situ|Segmenter1=<segmenter-embedding wsemb-id="herzteile" file="Herzteile.seg" height="300" width="500"/>|Inhalt1=<b>Aufbau des Herz</b><br>Schauen Sie sich das Herz in 3D an und explorieren Sie sie frei. Danach können Sie sich andere Fälle ansehen oder Ihr erlerntes Wissen durch die Übungsaufgaben überprüfen.|Segmenter2=<segmenter-embedding wsemb-id="Herzgefäße" file="Herzgefaesse.seg" height="300" width="500"/>|Inhalt2=<b>Herzgefäße</b><br>Schauen Sie sich die Gefäße an, welche das Herz mit dem Körper und Lungenkreislauf verbinden sowie einige Herzkranzgefäße.|Segmenter3=<segmenter-embedding wsemb-id="HerzBinnenraeume" file="HerzBinnenraeume.seg" height="300" width="500"/>|Inhalt3=<b>Binnenräume im Herz</b><br>Betrachten Sie die Binnenräume in den einzelnen Teilen des Herz.|Segmenter4=<segmenter-embedding wsemb-id="HerzInSitu" file="HerzInSitu.seg" height="300" width="500"/>|Inhalt4=<b>Herz in situ</b><br>Betrachten Sie das Herz in situ.}}
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{{Tab4|Button1=Heart|Button2=Heart vessels|Button3=Internal spaces in the heart|Button4=Heart in situ|Segmenter1=<segmenter-embedding public wsemb-id="herzteile" file="Herzteile.seg" height="300" width="500"/>|Inhalt1=<b>Structure of the heart</b><br>Look at the heart in 3D and explore it freely. Afterwards, you can look at other cases or check your acquired knowledge through the practice exercises.|Segmenter2=<segmenter-embedding public wsemb-id="Herzgefäße" file="Herzgefaesse.seg" height="300" width="500"/>|Inhalt2=<b>Heart vessels</b><br>Look at the vessels that connect the heart to the body and pulmonary circulation as well as some coronary vessels.|Segmenter3=<segmenter-embedding public wsemb-id="HerzBinnenraeume" file="HerzBinnenraeume.seg" height="300" width="500"/>|Inhalt3=<b>Internal spaces in the heart</b><br>Look at the internal spaces in the individual parts of the heart.|Segmenter4=<segmenter-embedding public wsemb-id="HerzInSitu" file="HerzInSitu.seg" height="300" width="500"/>|Inhalt4=<b>Heart in situ</b><br>Look at the heart in situ.}}
  
  
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<div><li class="mw-ui-button button_new" >[[Special:MyLanguage/Übungsaufgaben|Exercises]]</li></div>
 
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<li class="mw-ui-button button_normal">[[Special:MyLanguage/Niere (Ren)|Niere]]</li>
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Aktuelle Version vom 11. Mai 2022, 07:24 Uhr

The heart (lat. cor) is a hollow muscle. Through its contractions the blood is pumped through the body. It is a vital organ that ensures the necessary supply of blood to the other organs.

Exercises
Exercises
Neighbouring structures
Neighbouring structures
Body regions
Body regions
Organ system
Organ system

Heart in situ

Anatomy of the heart in situ

The heart is located approximately in the middle of the thorax, which is called the mediastinum. The representation in the WebViewer is greatly simplified. In order to have a clear view of the heart, the thorax must be opened extensively and the connective tissue in the mediastinum anterius removed. Approximately two-thirds of the heart is located to the left of the breastbone and one-third to the right. The apex of the heart (apex cortis) points to the left front and lies on one level with the left nipple. Its contraction (the so-called cardiac apex thrust) can be felt as a tender beat through the chest wall. Viewed ventrally, the heart is located obliquely and turned counterclockwise in the thorax. At the front it reaches the sternum and at the back it is bounded by the trachea and oesophagus. On the left and right it is surrounded by the lungs. The right ventricle is clearly visible from the ventral view. The left ventricle is only partially visible. Even the large vessels are not all visible at the base of the heart. The vv. pulmonales lies on the flip side of the heart and merges in the left atrium, which is also dorsal. Clearly recognizable, however, are the two heart ears (auricula sinistra and dextra), each located on the periphery.


Form and structure

Antomy of the heart

Anatomie der Gefäße am Herz

View from ventral
The heart (Cor) has the shape of an obliquely inclined cone and is a muscular hollow organ. The following structures are differentiated in the heart:

  • a downward, left and ventrally inclined tip of the heart,
  • three areas, whose names are mostly based on the adjacent thorax walls
  • a heart base inclined upwards, to the right and dorsally

On the side of the heart that rests on the sternum and costae, you can see the right ventricle, which is separated from the left ventricle by the sulcus interventricularis anterior. From this angle, the left ventricle forms the left edge of the heart and the apex cordis.
The anterior interventricular groove (sulcus interventricularis anterior) contains the r. interventricularis anterior of the a. coronaria sinistra and the v. interventricularis anterior. The sulcus interventricularis anterior describes the course of the ventricular septum inside the heart.
The atria (atrium sinistrum and dextrum) are separated from the ventricles by the sulcus coronarius, which also contains coronary vessels.
The right atrium (auricle dextra) attaches to the base of the aorta (pars ascendens), the left atrium (auricle sinistra) to the base of the truncus pulmonalis. From this perspective, the aorta obscures the exit of the right pulmonary artery from the pulmonary trunk.


View from dorsal and caudal

By turning the heart ventrally, the side facing the diaphragm (Fascies diaphragmatica) becomes more visible. Exclusively from caudally from the viewing direction of the diaphragm it can be seen that the both Vv. cavae lie in one axis.


View from dorsal

From this perspectiveit is clearly visible how the Arcus aortae crosses the Truncus pulmonalis, where it divides into the A. pulmonalis sinistra and A. pulmonalis dextra. At this point the three major arteries branch off to the upper extremity and to the neck and skull: Truncus brachiocephalicus, A. carotis communis sinisra and A. subclavia sinistra. Also the orifices of the - usually four - Vv. pulmonales into the left atrium (Atrium sinistrum) and the two Vv. cavae into the right atrium (Atrium dextrum) are well visible. Also visible here is the sinus coronarius in the sulcus of the same name. This sinus is the collection vessel for the venous blood that is supplied to the heart via the Vv. cardiacae.


Inner spaces

Blood flows at and in the heart

In the heart, four internal spaces are distinguished (one chamber (ventricle) and one atrium (atrium) on the left and right respectively). The atria are adjacent to the ventricles, which are connected to the lungs or the major arteries and veins of the body by their outgoing vessels.


Inner spaces of the left heart

The left atrium has smooth walls between the openings of the four pulmonary veins (Vv. pulmonales dextra/sinistra superior and inferior). The muscle wall of the left atrium is thinner than that of the right atrium because it belongs to the low pressure system. The narrow fold (valvula foraminis ovalis) is temporarily visible at the septum interatriale. It is formed by raising the fossa ovalis into the left atrium.

Blood passes from the left atrium into the left ventricle via the ostium atrioventriculare sinistrum.. The ostium atrioventriculare can be closed by the valva atrioventricularis sinistra. The left ventricle also has an inflow and outflow pathway. The inflow passes along the posterior wall, the left lateral wall as well as the apical section. The smooth-walled outflow tract is located near the septum interventriculare and continues into the vestibulum aortae. It consists largely of musculature (pars muscularis). The ostium aortae is the opening between the aortic outflow tract of the left ventricle and the aorta. The wall of the left ventricle is about three times as thick as that of the right ventricle and thus belongs to the high-pressure system.


Inner spaces of the right heart

The posterior part of the right atrium consists of the sinus venarum cavarum (atrial sinus). At the ostium cavea superioris and inferioris the two vv. cavae (superior and inferior) open. From these, blood can flow seamlessly into the atrium without intervening valves. The oval fossa is located above the confluence of the inferior vena cava and is surrounded by the oval fossa limbus. The crista terminalis separates the anterior part (right atrium with heart ear) from the posterior.
The right atrium is larger than the left and also belongs to the low-pressure system. In contrast to the smooth-walled anterior section of the atrium, the posterior part has significantly more structure.

The right ventricle can also be separated into two parts by the trabeculae carnea and the crista supraventricularis.
The blood flows via the ostium atrioventriculare dextrum into the right ventricle. Here, too, there is an inflow and outflow trajectory. In the inflow area are the trabeculae carneae, which are small muscle bulbs. Here too, the papillary muscles are connected to the valva atrioventricularis (dextra) via chordae tendineae. The outflow tract continues over the conus arteriosus. The conus arteriosus is the cone-shaped transition of the right ventricle into the truncus pulmonalis. This area is smooth-walled and has no trabeculae carneae. The blood flows over the pulmonary valve (valva trunci pulmonalis) through the ostium trunci pulmonalis into the truncus pulmonalis. The right ventricle also belongs to the low-pressure system.

Overview of the heart valves

There are two types of valves in the heart: atrioventricular valves and vascular valves. The four heart valves serve to allow blood to flow in the heart in only one direction and thus prevent backflow of blood. The leaflet valves are located between the atria and the ventricles. The pocket valves are located between the pulmonary trunk and the aorta.

Sail valves (Valvae atrioventriculares)

The sail valves (valvae atrioventriculares) are also called atrioventricular valves (AV valves). They include the tricuspid valve (valva atrioventricularis dextra) and the bicuspid valve (valva atrioventricularis sinistra). These valves prevent the backflow of blood from the ventricles into the atria during contraction of the heart. The name of the valves comes from their shape, which resembles a sail. They project into the ostium atrioventricularis dextrum as well as sinistrum. The sail valves are attached to the musculi papillares via the chordae tendinae. These are a special form of the trabeculae carneae. Thus, the leaflet valves are mechanically attached to the cardiac skeleton.

During systole, the blood is forced out of the ventricle. In the process, the leaflet valves inflate and are filled with blood. The anchoring of the valves to the chordae tendinae and the contraction of the papillary muscles prevent the valves from opening into the atrium. The leaflet valves are located at the level of the ostium because the bulging of the leaflets towards the atrium is cancelled by the retraction of the papillary muscles.

Tricuspid valve
The tricuspid valve is located between the right atrium and ventricle. It prevents systolic backflow of blood from the right ventricle into the right atrium. It is made up of three leaflets: Cuspis anterior, cuspus posterior and cuspus septalis.

Bicuspid valve
The bicuspid valve is located between the left atrium and the left ventricle. Unlike the tricuspid valve, the bicuspid valve consists of only two leaflets (cuspis anterior and cuspis posterior).

Semilunar valves (Valvae semilunares)

The pulmonary valve and the aortic valve belong to the semilunar valves. Their structure is made up of a thin connective tissue with an endocardial covering. The valves are composed of three crescent-shaped pockets (valvula semilunaris anterior, sinistra and dextra) and open in the direction of the vessels in the ostium aortae or ostium trunci pulmonalis. The individual valves have a free edge (lunula valvae semilunares), which thickens in the middle to form a small connective tissue nodule (nodulus valvulae semilunaris). When the valve closes, the nodules and lunulae meet. In this way, the ostium is completely sealed. The backflow of blood is prevented by filling the pockets. No muscle contraction is necessary in this process.

Pulmonary valve (valva trunci pulmonalis)
The pulmonary valve prevents the backflow of blood into the right ventricle. Since this valve is located between two low-pressure systems (venous limb of the systemic circulation and pulmonary circulation), it is thinner.

Aortic valve (valva aortae)
The aortic valve prevents backflow from the aorta into the left ventricle. It has a slight outward bulge (sinus aortae). The coronary vessels ( a. coronaria sinistra and dextra) originate in the left and right sinus aortae, so that the heart is supplied with blood.

Cardiac auscultation

In the case of a malfunction, audible flow noises are caused by the formation of whirls in the blood. Cardiac auscultation is an old but important method for recognizing these sounds. It is used both for the initial detection and the follow-up of functional disorders. The basis is that two sounds can be heard in a healthy adult heart. The first heart sound (S1) is at the beginning of systole. The tone is produced by the blood column hitting the leaflet valves and not, as is often assumed, by the closure of the valves. The second heart sound (S2) is produced by the closure of the leaflet valves at the end of systole. It is much brighter than the first heart sound. The two sounds are clearly audible at different locations. The first heart sound is clearly heard above the apex of the heart, whereas the second heart sound is clearly heard above the base of the heart. At Erb's point, which is located on the left parasternal side in the third intercostal space, all heart valves can be detected equally well. Specific points on the chest are recommended for auscultation of individual heart valves, as the sounds are projected to these locations and can thus be heard loudest:

  • Aortic valve: 2/3rd intercostal space right parasternal.
  • Pulmonary valve: 2nd intercostal space left parasternal
  • Tricuspid valve: 4th intercostal space right parasternal
  • Bicuspid valve: 5th intercostal space left medioclavicular

Excitation formation and excitation conduction system (Coming soon)

In the heart there is an autonomous excitation generation system (systema conducente cordis) and an excitation conduction system (systema conducente cordis). A distinction is made between four sections. When the heart is excited, the atrial and ventricular muscles contract about 100,000 times a day. The heart muscle is controlled by electrical impulses. The resulting impulses spread through a special cell system of the heart muscle.


Sinus node

The sinus node is also called the nodus sinuatrialis or Keith-Flack node. Macroscopically, it consists of a muscular structure that is about 3 mm thick and 10 mm long. The external shape resembles a comma. It is located on the dorsal side of the right heart, subepicardially in the terminal sulcus. Cranial to the sinus node is the junction of the superior vena cava. In some cases, the sinus node extends into the right heart ear.

Functionally, the sinus node is the primary pacemaker centre of the heart and is therefore involved in the complex regulation of the heart rate. The sinus node has the central role of excitation formation. It generates excitation volleys with a resting frequency of 60-70 impulses per minute. The pulses are used to excite the atrial myocardium, as the atrial excitation wave propagates towards the ventricles. The sinuatrial ramus nodi provides blood flow to the sinus node. It is controlled by the sympathetic and parasympathetic nervous systems. The sinus node consists of specific heart muscle cells:

P cells
The P cells (pacemakers) are roundish, pale cells that are usually present in groups. They are connected to each other by nexus and desmosomes.

Transition cells
Transition cells are elongated and partially branched cardiomyocytes. They contain a large number of myofibrils. The transition cells connect the P cells and establish a connection to the working myocardium.

Atrioventricular node

The atrioventricular node is also called the nodus atrioventricularis, AV node or Aschoff-Tawara node. It is the secondary pacemaker centre of the heart. The AV node is 5 mm long, 3 mm wide and 1 mm thick and is located in the right atrium. Its exact location is at the base of the atrial septum before the confluence of the coronary sinus. This area is called the triangle of Koch. The atrioventricular node serves to regulate stimulus exaggeration via the non-conducting cardiac skeleton. It is continued by the His bundle, which continues towards the apex of the heart. The AV node is also controlled by the sympathetic and parasympathetic nervous systems. Blood flow takes place through the ramus nodi atrioventricularis from the arteria coronaria dextra. Its main function is to delay the transmission of excitation to the ventricles. This ensures that the atrial contraction is completed before the ventricular contraction begins. Spontaneous excitations can also be generated by the AV node. However, these have a much lower frequency (40-50 depolarisations per minute) than the sinus node. This impulse excitation does not take place as long as the sinus node is intact.

Atrioventricular bundle

The atrioventricular bundle, also known as the fasciculus atrioventricularis, AV bundle or His bundle, is a component of the heart's conduction system. It is 4 mm thick and 20 mm long. The AV bundle originates subendocardially in the atrium from the AV node. It penetrates the trigonum fibrosum dextrum and then divides into the two tawara legs in the pars membranacea of the ventricular septum. The function of the AV bundle is to transmit excitation from the AV node to the ventricular legs.

Bundle branch

The bundle branches are also called crus dextrum and sinistrum or tawara branches. The tawara legs divide at the AV bundle. Their main function is to transmit excitation from the His bundle via the nexus into the working myocardium. The left Tawara branch (crus sinistrum) branches off almost perpendicularly from the His bundle and then fans out. This creates the following structures: posterior fascicle, middle fascicle and anterior fascicle. The right tawara limb (crus dextrum) continues anteriorly and enters the myocardium of the ventricular septum. It continues towards the apex of the heart. In the ventricular myocardium, excitation is transmitted via the Purkinje fibres.

Diseases

Free exploration

  • Heart
  • Heart vessels
  • Internal spaces in the heart
  • Heart in situ
Structure of the heart
Look at the heart in 3D and explore it freely. Afterwards, you can look at other cases or check your acquired knowledge through the practice exercises.
Heart vessels
Look at the vessels that connect the heart to the body and pulmonary circulation as well as some coronary vessels.
Internal spaces in the heart
Look at the internal spaces in the individual parts of the heart.
Heart in situ
Look at the heart in situ.


  • Further article
  • Kidney
  • Humerus
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