E - Book Cadiovascular System

E - Book
E - Book






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Cardiovascular System
Cardiovascular System


























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ÃкºäËÅàÇÕ¹âÅËÔµ »ÃСͺ仴ŒÇ 3 ʋǹ ¤×Í àÅ×Í´ ËÑÇ㨠áÅÐËÅÍ´àÅ×Í´

àÅ×Í´ (Blood)
àÅ×Í´ (Blood)





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à«ÅÅàÁ´àÅÍ´á´§ (Red blood cell or erythrocyte)
ÅѡɳТͧà«ÅŏàÁç´àÅ×Í´á´§ ໚¹áºº Biconcave shape ·Õè·íÒãˌÃٻËҧÊÒÁÒö

à»ÅÕè¹䴌ÁÒ¡ â´ÂäÁ‹·íÒãˌ»ÃÔÁÒµÃà»ÅÕè¹ ÁÕ¡ÒäǺ¤ØÁ¡ÒÃÊÌҧÎÍÏâÁ¹ÍÕÃÔâ·Ã¾ÍÂÍÕµÔ¹

(Erythropoietin) ÁÕÍÒÂØ 120 Çѹ ¶Ù¡·íÒÅÒÂã¹ÁŒÒÁ µÑº áÅÐ䢡Ãд١ «Öè§ÀÒÂã¹ àÁç´àÅ×Í´

á´§»ÃСͺ仴ŒÇ ÎÕâÁâ¡ÅºÔ¹ (Hemoglobin) à͹ä«Á (enzyme) áÅÐÍÔÍ͹ (ion) µ‹Ò§æ

·íÒ˹ŒÒ·Õè㹡Ò⹶‹ÒÂÍÍ¡«ÔਹáÅФÒϺ͹ä´ÍÍ¡ä«´ÃÐËNjҧ»Í´¡Ñºà¹×éÍàÂ×èÍ áÅзíÒ

˹ŒÒ·Õè໚¹ºÑ¿à¿ÍÏ·Õè»ÃѺ¤ÇÒÁÊÁ´ØŢͧ¡Ã´áÅд‹Ò§ (acid-base buffer) ¢Í§àÅ×Í´ «Öè§ÎÕâÁ


â¡ÅºÔ¹ (Hemoglobin,Hb) ໚¹â»ÃµÕ¹·ÕèÍÂًã¹àÁç´àÅ×Í´á´§ ᵋÅÐâÁàÅ¡ØŢͧÎÕâÁºÔ¹
»ÃСͺ´ŒÇ 4 ˹‹Ç‹͠ᵋÅÐ˹‹Ç»ÃСͺ´ŒÇ 1 ÎÕÁ (heme) 1 ÊÒÂ໻䷴


(polypeptide) 1 ÍеÍÁ¸ÒµØàËÅç¡ (Fe)

















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à«ÅÅàÁ´àÅÍ´¢ÒÇ (White blood cell , Leukocyte)
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à«ÅŏàÁç´àÅ×Í´¢ÒÇ ·íÒ˹ŒÒ·Õè㹡Òû‡Í§¡Ñ¹áÅзíÒÅÒÂÊÔè§á»Å¡»ÅÍÁ·ÕèࢌÒÊًËҧ¡ÒÂ

«Öè§ÊÒÁÒöẋ§à«ÅŏàÁç´àÅ×Í´¢ÒÇ䴌໚¹ 2 ª¹Ô´ãË­‹æ ¤×Í

ª¹Ô´ÁÕá¡Ã¹ÙÅËÃ×ÍÁÕ¹ÔÇà¤ÅÕÂÊËÅÒÂẺ (Granulocytic or polymorphonuclear cell)













ª¹Ô´äÁ‹ÁÕá¡Ã¹ÙÅËÃ×ÍÁÕ¹ÔÇà¤ÅÕÂÊà´ÕÂÇ (Agranulocytic or monouclear cell)














à«ÅŏàÁç´àÅ×Í´¢ÒÇÁդسÊÁºÑµÔÊíҤѭ 3 »ÃСÒà ¤×Í

1. àÁç´àÅ×Í´¢ÒÇÊÒÁÒöà¤Å×è͹·Õ輋ҹ¼¹Ñ§ËÅÍ´àÅ×Í´½ÍÂÊًà¹×éÍàÂ×èÍä»ÂѧºÃÔàdz·ÕèÁÕàª×éÍâä

àÃÕ¡¡Ãкǹ¡ÒùÕéÇ‹Ò Diapedesis

2. àÁç´àÅ×Í´¢ÒÇÊÒÁÒöà¤Å×è͹·ÕèࢌÒä»ËÒàª×éÍâä â´Â¡Òô֧´Ù´¢Í§ÊÒÃà¤ÁÕ

(Chemotaxis) ·Õè¶Ù¡»Å‹ÍÂÍÍ¡¨Ò¡àª×éÍâä ઋ¹ Ấ·ÕàÃÕÂ

3. àÁç´àÅ×Í´¢ÒÇÊÒÁÒö¨Ñº¡Ô¹ÊÔè§á»Å¡»ÅÍÁâ´ÂÇÔ¸Õ¡ÒÃࢌÒâͺŌÍÁáÅЋÍÂàª×éÍâäËÃ×Í

ÊÔè§á»Å¡»ÅÍÁ¹Ñé¹ àÃÕ¡¡Ãкǹ¡ÒùÕéÇ‹Ò Phagocytosis























3

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à«ÅÅàÁ´àÅÍ´¢ÒÇ (White blood cell , Leukocyte)





















¡Ãкǹ¡Òà Phagocytosis ໚¹¡Ãкǹ¡Ò÷íÒÅÒÂÊÔè§á»Å¡»ÅÍÁ â´Â¡ÒÃâͺŌÍÁ

ÊÔè§á»Å¡»ÅÍÁࢌÒÊًà«ÅŏàÁç´àÅ×Í´¢ÒÇ «Öè§ÀÒÂã¹ÁÕ lysosome ·íÒ˹ŒÒ·ÕèËÅÑè§à͹ä«ÁÁÒ

·íÒÅÒÂÊÔè§á»Å¡»ÅÍÁ áŌǢѺÍÍ¡Áҹ͡à«Åŏ






àÅ×Í´ (Blood)
àÅ×Í´ (Blood)



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à¡Å´àÅÍ´ (Platelet , Thrombocyte)



















à¡Åç´àÅ×Í´»š¹Í§¤»ÃСͺ¢Í§àÅ×Í´·ÕèÁÕ¢¹Ò´àÅç¡·ÕèÊØ´»ÃÐÁÒ³ 2-4 äÁ¤Ã͹


äÁ‹ÁÕ¹ÔÇà¤ÅÕÂÊ Ê‹Ç¹ãË­‹¨ÐÁÕÃٻËҧ¡ÅÁ ẹ ËÃ×ÍÃٻ䢋 «Öè§ÁÕµŒ¹¡íÒà¹Ô´ÁÒ¨Ò¡à«ÅŏàÁ¡Ð¤ÒÃÔ
âÍ䫵 (megakaryocyte) ·íÒ˹ŒÒ·ÕèÊíҤѭà¡ÕèÂǡѺ¡ÒÃá¢ç§µÑǢͧàÅ×Í´ áÅзíÒãˌàÅ×Í´ËÂØ´


äËÅËÃ×ÍˌÒÁàÅ×Í´àÁ×èÍà¡Ô´ºÒ´á¼Å



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¾ÅÒÊÁÒ à»š¹¢Í§àËÅÇãÊ ÊÕàËÅ×ͧ͋͹ «Öè§ÀÒÂã¹»ÃСͺ仴ŒÇ¹íéÒ 90% ÊÒÃÍÒËÒÃ

áË¸ÒµØ ¡Ò«¤ÒϺ͹ä´ÍÍ¡ä«´ ÂÙàÃÕ áÅлÃСͺ仴ŒÇÂâ»ÃµÕ¹ÊíҤѭ ઋ¹

俺ÃÔâ¹à¨¹ (Fibrinogen) : ª‹ÇÂ㹡Ãкǹ¡ÒÃá¢ç§µÑǢͧàÅ×Í´

ÍÑźÙÁÔ¹ (Albumin) : ¶Ù¡ÊÌҧ¢Ö鹨ҡµÑº ·íÒ˹ŒÒ·Õ誋ǨѺÊÒÃÍÒËÒà ÎÍÏâÁ¹µ‹Ò§æ

áÅЪ‹ÇÂÃÑ¡ÉÒ¹íéÒã¹ËÅÍ´àÅ×Í´äÁ‹ãˌ«ÖÁÍÍ¡¹Í¡ËÅÍ¡Å×Í´

â¡ÅºÙÅÔ¹ (Globulin) : ª‹ÇÂ㹡ÒÃÊÌҧ antibody

«Ö觾ÅÒÊÁÒ ·íÒ˹ŒÒ·Õè㹡ÒÃÅíÒàÅÕ§ÊÒÃÍÒËÒõ‹Ò§æ ·ÕèÍÂً㹾ÅÒÊÁÒʋ§ä»Âѧʋǹµ‹Ò§æ

¢Í§Ã‹Ò§¡Ò áÅÐÃÑ¡ÉÒ¤ÊÒÁÊÁ´ØÅã¹Ã‹Ò§¡ÒÂ




















Serum : àÅ×Í´·ÕèäÁ‹ãʋÊÒáѹàÅ×Í´á¢ç§ àÁ×èÍà¨ÒÐàÅ×Í´·Ôé§änj¹Ò¹æ ¨ÐÁÕ¡ÒèѺµÑÇ

¡Ñ¹à»š¹ blood clot

Plasma : àÅ×Í´·ÕèÁÕÊÒáѹàÅ×Í´á¢ç§








5

Heart








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ËÑÇ㨠·íÒ˹ŒÒ·ÕèÊÙº©Õ´àÅ×Í´ä»àÅÕé§ʋǹµ‹Ò§æ ¢Í§Ã‹Ò§¡Ò »ÃСͺ´ŒÇ ¡ÅŒÒÁ

à¹×éÍËÑÇ㨠(cardiac muscle) ·íÒ§Ò¹â´ÂÍѵÔâ¹ÁÑµÔ ÁÕ¤ÇÒÁÊÒÁÒö㹡ÒÃÊÌҧ¡ÃÐáÊä¿¿‡Ò

áÅÐË´µÑÇ䴌àͧ â´ÂÍÂً㹪‹Í§Í¡ (pericardial cavity) ÁբͧàËÅÇËŋÍàÅÕé§ÍÂً à¾×èÍËŋÍ

Å×è¹ààÅЪ‹ÇÂÅ´¡ÒÃàÊÕ´ÊÕÃÐËNjҧËÑÇ㨡Ѻ»Í´ ÃÐËNjҧ»Í´·Ñé§Êͧ¢ŒÒ§¤‹Í¹ä»·Ò§«ŒÒÂ

àÅ硹ŒÍ ÁÕËÅÍ´àÅ×Í´ coronary artery 2 àʌ¹¹íÒàÅ×Í´ÁÒàÅÕé§ËÑÇã¨


Coronary circulation


¤×Í¡Ò÷ÕèËÅÍ´àÅ×ʹʋ§àÅ×Í´ÁÒàÅÕ駺ÃÔàdz·ÕèÃͺ æ ËÑÇã¨

â´ÂÁÕàʌ¹àÅ×Í´·Õèà¡ÕèÂÇ¢ŒÍ§¡ÑºËÑÇ㨠¤×Í


1) Coronary artery 2 àʌ¹ «Öè§á¡ÍÍ¡¨Ò¡ Aorta

·íÒ˹ŒÒ·Õè¹íÒàÅ×Í´ÁÒàÅÕé§ËÑÇã¨

2) Coronary vein ·íÒ˹ŒÒ·ÕèÅíÒàÅÕ§àÅ×Í´´íÒÍÍ¡¨Ò¡

¡ÅŒÒÁà¹×éÍËÑÇã¨Ê‹Ç¹µ‹Ò§æ ࢌÒÊً coronary sinus «Öè§à»š¹

àʌ¹àÅ×Í´´íÒ·ÕèÍÂً·Õè¼ÔÇ·Ò§´ŒÒ¹ËÅѧ¢Í§ËÑÇã¨áŌǹíÒàÅ×ʹࢌÒÊً

ËÑÇã¨ËŒÍ§º¹¢ÇÒâ´ÂµÃ§ (äÁ‹ÃÇÁ¡Ñºàʌ¹àÅ×Í´ vena cava)




ËéͧËÑÇ㨠(Heart Chambers)



ËÑÇã¨Á¹ØɏÁÕ 4 ˌͧ «Öè§ÊÒÁÒöà຋§ä´Œ


2 atria áÅÐ 2 ventricle »ÃСͺ仴ŒÇÂÃкº

ÊíҤѭ 2 Ãкºã¹¡Ò÷íÒ§Ò¹ ¤×Í

1) pulmonary system ໚¹¡ÒùíÒàÅ×Í´¨Ò¡ËÑÇã¨

·ÕèÁÕÍÍ¡«ÔਹµíèÒ仿͡·Õè»Í´

2) systemic system ໚¹¡ÒùíÒàÅ×Í´·ÕèÁÕ

ÍÍ¡«ÔਹÊÙ§ä»àÅÕé§ʋǹµ‹Ò§ æ ¢Í§Ã‹Ò§¡ÒÂ










7

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ËÑÇ㨠(Heart) ค ํํานํา
ËÑÇ㨠(Heart)


ËéͧËÑÇ㨠(Heart Chambers)


1.right atrium (RA) ËÑÇã¨Ëéͧº¹¢ÇÒ

¼¹Ñ§ºÒ§ÊØ´ ÁÕáç´Ñ¹¹ŒÍ·ÕèÊØ´

ÃѺàÅ×Í´·ÕèÁÕÍÍ¡«ÔਹµíèÒ

¨Ò¡Ã‹Ò§¡ÒÂʋǹº¹ ¼‹Ò¹ Superior vena cava

¨Ò¡Ã‹Ò§¡ÒÂʋǹŋҧ ¼‹Ò¹ Inferior vena cava

ʋ§àÅ×Í´·ÕèÁÕÍÍ¡«ÔਹµíèÒãˌ Right ventricle (RA)

ÅÔé¹»ÃШíÒˌͧ¤×Í Tricuspid valve





2.right ventricle(RV) ËÑÇã¨ËéͧÅèÒ§¢ÇÒ

¼¹Ñ§Ë¹Ò໚¹Íѹ´Ñº 2

ÃѺàÅ×Í´ÍÍ¡«ÔਹµíèÒ¨Ò¡ right atrium(RA) ¼‹Ò¹ÅÔé¹ tricuspid valve

ʋ§àÅ×Í´·ÕèÁÕÍÍ¡«ÔਹµíèÒ仿͡·Õè»Í´¼‹Ò¹·Ò§àʌ¹àÅ×Í´ Pulmonary artery

ÅÔé¹»ÃШíÒˌͧ¤×Í pulmonary semilunar valve




3.left atrium ËÑÇã¨Ëéͧº¹«éÒÂ

¼¹Ñ§Ë¹Ò໚¹Íѹ´Ñº 3

ÃѺàÅ×Í´·ÕèÁÕÍÍ¡«ÔਹÊÙ§¨Ò¡»Í´¼‹Ò¹·Ò§àʌ¹àÅ×Í´ pulmonary vein

ʋ§àÅ×Í´·ÕèÁÕÍÍ¡«ÔਹÊÙ§ãˌ left ventricle (LV)


ÅÔé¹»ÃШíÒˌͧ¤×Í Bicuspid valve




4.left ventricle ËÑÇã¨ËéͧÅèÒ§«éÒÂ

¼¹Ñ§Ë¹Ò·ÕèÊØ´à¾ÃÒÐÃѺáç´Ñ¹ÁÒ¡·ÕèÊØ´

ÃѺàÅ×Í´·ÕèÁÕÍÍ¡«ÔਹÊÙ§¨Ò¡ left atrium (LA) ¼‹Ò¹ÅÔé¹ bicuspid valve

ʋ§àÅ×Í´·ÕèÁÕÍÍ¡«ÔਹÊÙ§ä»àÅÕé§ËÑèÇËҧ¡Ò¼‹Ò¹àʌ¹àÅ×Í´ Aorta

ÅÔé¹»ÃШíÒˌͧ¤×Í Aortic semilunar valve





8

ค ํํานํา
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ËÑÇ㨠(Heart)
ËÑÇ㨠(Heart)



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àÂÍËØéÁËÑÇ㨠(Pericardial layers of the heart)



























ºÃÔàdzËÑÇ㨨ÐÁÕª‹Í§ pericardial cavity ໚¹ª‹Í§Ç‹Ò§´ŒÒ¹¹Í¡à¾×èͺÃÃ¨Ø pericardial

fluid «Öè§à»š¹¢Í§àËÅÇ·íÒ˹ŒÒ·Õè㹡ÒÃÅ´ààç¡ÃÐàà·¡ààÅзíÒãˌËÑÇã¨Â×´ËÂ؋¹ â´ÂàÂ×èÍË،Á

ËÑÇã¨ÁÕ˹ŒÒ·Õè㹡Òû‡Í§¡Ñ¹ààÅзíÒãˌËÑÇã¨á¢Ç¹ÍÂً䴌Í‹ҧ໚¹ÍÔÊÃÐ ¤Çº¤ØÁãˌàÅ×ʹࢌÒ

ËÑÇã¨Í‹ҧ¨íÒ¡Ñ´ áÅСÒÃÂ×´Ë´-¤ÅÒÂÍ‹ҧ໚¹ÍÔÊÃÐ









































9

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ËÑÇ㨠(Heart) ค ํํานํา
ËÑÇ㨠(Heart)




Ôé
ŹËÑÇ㨠(Heart valves)






ÁÕ˹ŒÒ·ÕèºÑ§¤Ñº·ÔÈ·Ò§ãˌàÅ×Í´äËÅä»ã¹·ÔÈ·Ò§à´ÕÂǡѹ »‡Í§¡Ñ¹¡ÒÃäËÅŒ͹¡ÅѺ «Öè§

»ÃСͺ仴ŒÇÂ

1.Atrioventricular (AV) valves ¡Ñé¹ÃÐËNjҧËÑÇã¨ËŒÍ§ atrium ¡Ñº ventricle ÁÕ˹ŒÒ·Õè

»‡Í§¡Ñ¹àÅ×Í´äËÅŒ͹¡ÅѺˌͧ atria ¢³Ð ventricles ºÕºµÑÇ à຋§ä´Œà»š¹

Tricuspid valve ¡Ñé¹ËÑÇã¨ÃÐËNjҧˌͧº¹¢ÇÒààÅÐŋҧ¢ÇÒ

Bicuspid valve/Mitral valve ¡Ñé¹ËÑÇã¨ÃÐËNjҧˌͧº¹«ŒÒÂààÅÐŋҧ«ŒÒÂ



2. Semilunar valve ¡Ñé¹ÃÐËNjҧËÑÇã¨ËŒÍ§ ventricles ¡ÑºÃ‹Ò§¡ÒÂààÅлʹ

ÁÕ˹ŒÒ·Õ軇ͧ¡Ñ¹àÅ×Í´äËÅŒ͹¡ÅѺä»Âѧˌͧ ventricles

Aortic semilunar valve ¡Ñé¹ËÑÇã¨ÃÐËNjҧˌͧ left ventricle ¡ÑºËÅÍ´àÅ×Í´

aorta 㹡ÒÃʋ§àÅ×Í´ä»Âѧʋǹµ‹Ò§æ¢Í§Ã‹Ò§¡ÒÂ

Pulmonary semilunar valve ¡Ñé¹ËÑÇã¨ÃÐËNjҧˌͧ right ventricle ¡Ñº

pulmonary trunk 㹡ÒÃʋ§àÅ×ʹ仿͡·Õè»Í´





































10

คานา
ํ
ËÑÇ㨠(Heart) ค ํํานํา
ËÑÇ㨠(Heart)




Pathway of blood through the heart and lung







right atrium








tricuspid valve










right ventricle








pulmonary semilunar


valve








pulmonary arteries









lung














11

คานา
ํ
ËÑÇ㨠(Heart) ค ํํานํา
ËÑÇ㨠(Heart)


Pathway of blood through the heart and lung






lung








pulmonary vein







left atrium






bicuspid valve








left ventricle







aortic


semilunar valve





Aorta






systemic circulation










12

คานา
ํ
ËÑÇ㨠(Heart) ค ํํานํา
ËÑÇ㨠(Heart)




Pathway of blood through the heart and lung











systemic circulation

















Superior and

Inferior vena cava

















Right atrium


























13

Blood Vessel







×
ËÅÍ´àÅÍ´

ค ํํานํา
ํ
คานา
ËÅÍ´àÅ×Í´ (Blood vessels)
ËÅÍ´àÅ×Í´ (Blood vessels)





×
ËÅÍ´àÅÍ´àà´§(Artery)




















ËÅÍ´àÅ×Í´·Õè¹íÒàÅ×Í´ÍÍ¡¨Ò¡ËÑÇ㨠«Ö觨Ð໚¹àÅ×Í´·ÕèÁÕ»ÃÔÁÒ³ÍÍ¡«ÔਹÊ٧໚¹àÅ×Í´·Õè

ÁÕÊÕᴧʴ ä»àÅÕé§ÍÇÑÂÇе‹Ò§æ ·ÑèÇËҧ¡Ò ( ¡ànj¹ËÅÍ´àÅ×Í´·Õèä»Êً»Í´ª×èÍ pulmonary


artery «Ö觨йíÒàÅ×Í´´íÒ¨Ò¡ËÑÇ㨷ÕèÁÕ¤ÒϺ͹ä´ÍÍ¡ä«´Ê٧仿͡·Õè»Í´ )






ËÅÍ´àÅ×Í´ (Blood vessels)
ËÅÍ´àÅ×Í´ (Blood vessels)





×
ËÅÍ´àÅÍ´´íÒ (vein)



















ËÅÍ´àÅ×Í´·Õè¹íÒàÅ×Í´·ÕèÁբͧàÊÕ áÅФÒϺ͹ä´ÍÍ¡ä«´ ( àÅ×Í´´íÒ ) ·ÕèËҧ¡ÒÂ

㪌áŌǨҡʋǹµ‹Ò§æ ¢Í§Ã‹Ò§¡Ò¡ÅѺࢌÒÊًËÑÇã¨ËŒÍ§º¹¢ÇÒ ( Right atrium ) à¾×è͹íÒ¡ÅѺ

仿͡·Õè»Í´ ( ¡ànj¹ËÅÍ´àÅ×Í´´íһʹ·Õèª×èÍ pulmonary vein )





15

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ËÅÍ´àÅ×Í´ (Blood vessels)
ËÅÍ´àÅ×Í´ (Blood vessels)







ËÅÍ´àÅÍ´½ÍÂ(Capillary)
×



































ËÅÍ´àÅ×Í´·Õèàª×èÍÁµ‹ÍÃÐËNjҧËÅÍ´àÅ×Í´á´§¢¹Ò´àÅç¡ ä»ÂѧËÅÍ´àÅ×Í´´íÒ¢¹Ò´àÅç¡


â´Â¨Ðá·Ã¡ÍÂًã¹à¹×éÍàÂ×è͵‹Ò§æ ¢Í§Ã‹Ò§¡ÒÂ



































16

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ËÅÍ´àÅ×Í´ (Blood vessels)
ËÅÍ´àÅ×Í´ (Blood vessels)



ÅѡɳТͧËÅÍ´àÅ×Í´àà´§ (Artery)


¼¹Ñ§¢Í§ËÅÍ´àÅ×Í´àà´§à˹ÕÂÇ ààÅÐÂ×´ËÂ؋¹ä´Œ´Õ àÁ×èÍäÁ‹ÁÕàÅ×Í´ÍÂًÀÒÂã¹

ËÅÍ´àÅ×Í´¨ÐäÁ‹à࿺ à¹×èͧ¨Ò¡µŒÍ§ÃͧÃѺàÅ×Í´·ÕèÁÕ¤ÇÒÁ´Ñ¹ÊÙ§·íÒãˌ¼¹Ñ§¢Í§ËÅÍ´

àÅ×Í´àà´§àà¢ç§ààç ÀÒÂã¹äÁ‹ÁÕÅÔé¹ (Valve) ÁÕ¼¹Ñ§ 3 ªÑé¹





























ÅѡɳТͧËÅÍ´àÅ×Í´´íÒ(Vein)


¼¹Ñ§¢Í§ËÅÍ´àÅ×Í´´íÒºÒ§¡Ç‹ÒËÅÍ´àÅ×Í´àà´§ ÁÕ¤ÇÒÁÂ×´ËÂ؋¹¹ŒÍÂ¡Ç‹Ò ààÅÐ

àÁ×èÍäÁ‹ÁÕàÅ×Í´ÍÂًÀÒÂã¹ ËÅÍ´àÅ×Í´¨Ðà࿺àູ ÍÕ¡·Ñé§ÁÕÅÔé¹ (Valve) ÍÂًÀÒÂã¹

à¹×èͧ¨Ò¡àÅ×Í´ã¹ËÅÍ´àÅ×Í´´íÒ¤ÇÒÁ´Ñ¹µíèÒ ¨Ö§µŒÍ§ÁÕÅÔé¹à¾×èÍ»‡Í§¡Ñ¹¡ÒÃäËÅŒ͹¡ÅѺ

¢Í§àÅ×Í´ ààÅÐ㪌¡ÒÃË´µÑǢͧ¡ÅŒÒÁà¹×éÍ㹡Òê‹ÇÂÅíÒàÅÕ§àÅ×Í´ ÁÕ¼¹Ñ§ 3 ªÑé¹



























18

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ËÅÍ´àÅ×Í´ (Blood vessels)
ËÅÍ´àÅ×Í´ (Blood vessels)







â¤Ã§ÊÃéÒ§¢Í§ËÅÍ´àÅ×Í´


ËÅÍ´àÅ×Í´àà´§

ËÅÍ´àÅ×Í´á´§ãË­‹ (Aorta) ËÅÍ´àÅ×Í´á´§¢¹Ò´ãË­‹ÊØ´ ·íÒ˹ŒÒ·ÕèÅíÒàÅÕ§àÅ×Í´

á´§·Õè¶Ù¡ÊÙº©Õ´ÍÍ¡¨Ò¡ËÑÇã¨ËŒÍ§Å‹Ò§«ŒÒÂ⤌§ä»·Ò§´ŒÒ¹ËÅѧ ·Í´¼‹Ò¹ª‹Í§Í¡áÅÐ

ª‹Í§·ŒÍ§ ¢¹Ò´ãË­‹ÊØ´ÁÕàʌ¹¼‹Ò¹Èٹ¡ÅÒ§»ÃÐÁÒ³ 1 ¹ÔéÇ

ËÅÍ´àÅ×Í´àà´§¡ÅÒ§ ÍÒÏà·ÍÃÕ (Artery) ·íÒ˹ŒÒ·Õè¹íÒàÅ×Í´ä»àÅÕé§ʋǹµ‹Ò§æ ¢Í§

Ëҧ¡Ò ËÅÍ´àÅ×Í´ÁÕ¼¹Ñ§¡ÅŒÒÁà¹×éÍ˹Òà¾×èÍãˌ·¹µ‹Íáç´Ñ¹àÅ×Í´

ËÅÍ´àÅ×Í´á´§àÅç¡ ÍÒÏà·ÍÃÔâÍÅ (Arteriole) ÊÒÁÒö¨Ð¢ÂÒµÑÇËÃ×ÍË´µÑÇ䴌 à¾×èÍ

ºÑ§¤Ñº¡ÒÃäËŢͧàÅ×Í´


ËÅÍ´àÅ×Í´àà´§½Í ¤Ò¾ÔÅÅÒÃÕè (Capillary)



ËÅÍ´àÅ×Í´´íÒ

ËÅÍ´àÅ×Í´´íÒãË­‹ àǹҤÒÇÒ (Vena cava) ·ÕèÁÕ˹ŒÒ·ÕèÃѺàÅ×Í´àÊÕ¨ҡʋǹµ‹Ò§æ ¢Í§

Ëҧ¡ÒÂࢌÒÊًËÑÇã¨ËŒÍ§¢ÇÒà¾×èÍʋ§µ‹Íä»Âѧ»Í´

ËÅÍ´àÅ×Í´´íÒ¡ÅÒ§ àǹ (vein)

ËÅÍ´àÅ×Í´´íÒàÅç¡ àǹÙÅ (Venule)

ËÅÍ´àÅ×Í´´íҽ͠¤Ò¾ÔÅÅÒÃÕ (Capillary)



















17

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ËÅÍ´àÅ×Í´ (Blood vessels)
ËÅÍ´àÅ×Í´ (Blood vessels)






ÅѡɳТͧËÅÍ´àÅ×Í´½Í (Capillary)

ÁÕ¼¹Ñ§ºÒ§ºÒ§à¾Õ§ªÑé¹à´ÕÂÇ à¾×èÍÊдǡ㹡ÒÃààÅ¡à»ÅÕ蹡Ò« ÍÍ¡«Ôਹ ÍÒËÒÃ

ààÅТͧàÊÕ§ÃÐËNjҧàÅ×Í´¡Ñºà«ÅŏËÃ×Íà¹×éÍàÂ×è͵‹Ò§æ ÁÕ¡ÒûÃÐÊÒ¹¡Ñ¹à»š¹µÒ¢‹Ò ÍÂًÃÐËNjҧ

ËÅÍ´àÅ×Í´àà´§àÅç¡ààÅÐËÅÍ´àÅ×Í´´íÒàÅç¡ àÁç´àÅ×Í´¢ÒǨ֧ÊÒÁÒöÅÍ´¼‹Ò¹¼¹Ñ§ËÅÍ´àÅ×Í´

½ÍÂÍÍ¡ÁÒ䴌 à¾×è͵‹ÍµŒÒ¹ËÃ×Í¡íҨѴÊÔè§àà»Å¡»ÅÍÁ·ÕèࢌÒÁÒã¹Ã‹Ò§¡Ò ààÅÐÁÕàʌ¹¼‹Ò¹

Èٹ¡ÅÒ§ 7-8 äÁ¤Ã͹ à¾×èÍãˌàÁç´àÅ×Í´àà´§äËÅä»Í‹ҧªŒÒæ




























































19

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ËÅÍ´àÅ×Í´ (Blood vessels)
ËÅÍ´àÅ×Í´ (Blood vessels)















à»ÃÕºà·Õº¤ÇÒÁ´Ñ¹àÅ×Í´ÀÒÂã¹ËÅÍ´àÅ×Í´

(ËÅÍ´àÅ×Í´·ÕèÂÔè§ÍÂًä¡ÅÍ͡仨ҡ¡ÒúպµÑǢͧËÑÇã¨ÁÕ¤ÇÒÁ´Ñ¹Å´Å§)


Aorta > artery >arteriole >capillary >venule >vein>vena cava















à»ÃÕºà·Õº¤ÇÒÁàÃçÇ㹡ÒÃäËŢͧàÅ×Í´ã¹ËÅÍ´àÅ×Í´

(¤ÇÒÁàÃçÇá»Ã¼¡¼Ñ¹¡Ñº¢¹Ò´¾×é¹·Õè˹ŒÒµÑ´ÃÇÁ¢Í§ËÅÍ´àÅ×Í´)

Aorta > artery >arteriole > vena cava >vein>venule >capillary




























20

¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨





Cardiovascular system

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨




àÊÕ§¢Í§ËÑÇ㨠(Heart sound)



ÊÒÁÒö㪌 Stethoscope ¿˜§àÊÕ§ËÑÇã¨ä´Œ â´Â¨Ð䴌ÂÔ¹àÊÕ§ lub-dup, lub-dup, lub-dup

lub : ໚¹àÊÕ§¢Í§àÅ×Í´·Õè¡ÃÐá·¡ Atrioventricular valve àÁ×èÍËÑÇã¨ËŒÍ§Å‹Ò§ºÕºµÑÇ

dup : ໚¹àÊÕ§¢Í§àÅ×Í´·Õè¡ÃÐá·¡ semilunar valve àÁ×èÍËÑÇã¨ËŒÍ§Å‹Ò§¤ÅÒµÑÇ

ÊÀÒÇзÕè valve ¼Ô´»¡µÔ àÃÕ¡ heart murmur à¡Ô´¨Ò¡ÅÔé¹ËÑÇã¨ÃÑèÇ ¨ÐÁÕàÊÕ§¿Ù†æ áÅÐàÅ×Í´

ÍÒ¨¨ÐäËÅŒ͹¡ÅѺ䴌




























Ñ
ǯ¨Ñ¡ÃËÑÇ㨠(cardiac cycle)



Çѯ¨Ñ¡ÃËÑÇ㨠: ¡ÒúպáÅФÅÒµÑǢͧËÑÇã¨à»š¹Ãͺæ

ÃÐÂзÕèÁÕ¡ÒúպµÑÇàÃÕÂ¡Ç‹Ò Systole

ÃÐÂзÕèÁÕ¡ÒäÅÒµÑÇàÃÕÂ¡Ç‹Ò Diastole

1. Atrial and ventricular diastole : ˌͧº¹ - ŋҧ¤ÅÒµÑÇ ÃÐÂÐàÇÅÒ 0.4 s

2. Atrial systole, Ventricular diastole : ˌͧº¹ºÕºµÑÇ ËŒÍ§Å‹Ò§¤ÅÒµÑÇÃѺ

àÅ×Í´·ÕèºÕºÁҨҡˌͧº¹ ÃÐÂÐàÇÅÒ 0.1 s


3. Ventricular systole, Atrial diastole : ˌͧŋҧºÕºµÑÇ ËŒÍ§º¹¤ÅÒµÑÇ

ÃÐÂÐàÇÅÒ 0.3 s






22

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨






Ñ
ǯ¨Ñ¡ÃËÑÇ㨠(cardiac cycle)




































¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨
¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨




Cardiac out put


ËÁÒ¶֧ »ÃÔÁÒ³àÅ×Í´·Õ軘Á¨Ò¡ËÑÇã¨ËŒÍ§Å‹Ò§«ŒÒÂä»àÅÕé§ʋǹµ‹Ò§æ ¢Í§Ã‹Ò§¡ÒÂ

µ‹Í¹Ò·Õ



Cardiac out put (vol/min)




heart rate (no./min) X stroke volume (vol/no.)




Stroke volume : »ÃÔÁÒµÃàÅ×Í´·ÕèÍÍ¡¨Ò¡ËÑÇã¨ËŒÍ§Å‹Ò§«ŒÒ¨ҡ¡ÒúպµÑÇ 1 ¤ÃÑé§

= 75 ml/1 ¤ÃÑé§






23

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨






¨Ñ§ËÇСÒÃàµé¹¢Í§ËÑÇ㨠(heart’s rhythmic beat)





































ÊÁͧʋ§ÊÑ­­Ò³ä¿¿‡ÒÁÒÂѧËÑÇ㨠>>> Sinoatrial (SA) node «Öè§ÍÂًº¹¼¹Ñ§ËŒÍ§

º¹¢ÇÒã¡ÅŒ¡Ñº Superior vena cava ¨Ð¡ÃШÒÂÊÑ­­Ò³ä»·ÑèÇˌͧº¹ ·íÒãˌˌͧº¹

à¡Ô´¡ÒúպµÑÇ >>> Atroventricular (AV) node ·ÕèÍÂًÃÐËNjҧˌͧº¹áÅÐˌͧŋҧ

¢ÇÒ áµ¡á¢¹§ bundle branches ä»Âѧˌͧŋҧ«ŒÒÂ-¢ÇÒ ÁÒ¨¹¶Ö§ heart apex >>>


áÅÐÊÑ­­Ò³¡ÃШÒ·ÑèÇˌͧŋҧ ·íÒãˌˌͧŋҧà¡Ô´¡ÒúպµÑÇ

*** SA node ¤Çº¤ØÁÍѵÃÒáÅÐàÇÅÒ㹡ÒúպµÑǢͧËÑÇ㨠***
























24

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨






¤Å¹ä¿¿éÒËÑÇ㨠(Electrocardiogram : EKG)
×è


¤×Í ¤Å×è¹ä¿¿‡Ò·Õèà¡Ô´¨Ò¡¡ÒÃäËŢͧ¡ÃÐáÊä¿¿‡Òã¹ËÑÇ㨠໚¹¼Å·Õè䴌¨Ò¡¡ÒÃ

ºÑ¹·Ö¡¡ÒÃà»ÅÕè¹á»Å§¢Í§Èѡ俿‡Ò¹Í¡à«Åŏ «Öè§à¡Ô´¨Ò¡¡ÒÃʋ§¼‹Ò¹ÊÑ­­Ò³


ä¿¿‡Ò¢Í§à«ÅŏËÑÇã¨

¡Òúѹ·Ö¡ electrocardiogram àÃÕÂ¡Ç‹Ò electrocardiography ¹ÔÂÁ·íÒ¡ÒÃ

µÃǨÇÑ´¤ÇÒÁµ‹Ò§Èѡ俿‡ÒÃÐËNjҧ¨Ø´ 2 ¨Ø´º¹¼ÔÇ¡ÒÂ

EKG ÁÕ»ÃÐ⪹ã¹¡ÒõÃǨÍѵÃÒ¡ÒÃൌ¹áÅШѧËÇСÒÃൌ¹¢Í§ËÑÇ㨡ÒÃ

à»ÅÕè¹á»Å§¢Í§Èѡ俿‡ÒÀÒ¹͡à«ÅŏËÑÇã¨

EKG ·Õèà¡Ô´¢Öé¹ã¹ª‹Ç§ËÑÇ㨷íҧҹ໚¹»¡µÔ¨Ðµ‹Ò§¡ÑºàÁ×èÍà¡Ô´¾ÂÒ¸ÔÊÀÒ¾



































P : ºÃÔàdz·ÕèËÑÇã¨ËŒÍ§º¹ºÕºµÑÇ

R : ºÃÔàdz·ÕèËÑÇã¨ËŒÍ§Å‹Ò§ºÕºµÑÇ

T : ºÃÔàdz·ÕèËÑÇã¨ËŒÍ§Å‹Ò§¤ÅÒµÑÇ









25

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨






Ñ
Ñ
¡ÒÃǴ͵ÃÒ¡ÒÃàµé¹¢Í§ËÑÇã¨

ÊÒÁÒöẋ§¡ÒÃÇÑ´Í͡䴌 2 Ẻ ¤×Í áºº Normal EKG áÅÐ Abnormal EKG



Normal EKG

R R

1 2 3 4







ÍѵÃÒ¡ÒÃൌ¹¢Í§ËÑÇ㨠(¤ÃÑé§/¹Ò·Õ) = 300/¨íҹǹª‹Í§ãË­‹ (¨íҹǹª‹Í§ãË­‹¨Ò¡ R ¶Ö§ R)

µÑÇÍ‹ҧ¡Òäíҹdz¨Ò¡ÀÒ¾ : ÍѵÃÒ¡ÒÃൌ¹¢Í§ËÑÇ㨠= 300/4 = 75 ¤ÃÑé§/¹Ò·Õ




Abnormal EKG



1 2 3 4 5 6 7 8 9 10 11 12








ÍѵÃÒ¡ÒÃൌ¹¢Í§ËÑÇ㨠(¤ÃÑé§/¹Ò·Õ) = R x 10 (¹Ñº¨íҹǹ R ¨Ò¡ 30 ª‹Í§ãË­‹)

µÑÇÍ‹ҧ : ÍѵÃÒ¡ÒÃൌ¹¢Í§ËÑÇ㨠= 12 x 10 = 120 ¤ÃÑé§/¹Ò·Õ



























26

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨






¡ÒÃäËÅáÅФÇÒÁ´¹àÅÍ´
Ñ
×
(blood flow and blood pressure )



































¡ÒÃäËŢͧàÅ×Í´ã¹ËÅÍ´àÅ×Í´¢Ö鹡Ѻ

Law of continuity : ¡ÒÃäËŢͧæ àËÅÇã¹·‹Í·ÕèÁÕ¾×é¹·Õè˹ŒÒµÑ´¹ŒÍ¡NjҨÐäËÅ

àÃçÇ¡Ç‹Ò ´Ñ§¹Ñé¹ ¡ÒÃäËŢͧàÅ×Í´ã¹ capillary ¨ÐªŒÒ¡Ç‹Ò artery áÅÐ aorta µÒÁ

ÅíҴѺ à¾ÃÒо×é¹·Õè˹ŒÒµÑ´ÃÇÁ¢Í§ capillary ÁÒ¡¡Ç‹Ò áÅСÒÃäËŢͧàÅ×Í´·Õ誌Òæ ã¹

capillary ·íÒãˌà¡Ô´¡ÒÃáÅ¡à»ÅÕè¹ÊÒÃ䴌´Õ

¤ÇÒÁ´Ñ¹àÅ×Í´ «Ö觤ÇÒÁ´Ñ¹¨Ð¢Öé¹ÍÂً¡Ñº»ÃÔÁÒµÃàÅ×Í´·Õèʋ§ÍÍ¡¨Ò¡ËÑÇ㨠¡ÒÃÍØ´

µÑ¹¢Í§àËÅ×Í´ áÅÐáç⹌Á¶‹Ç§ â´Â¤ÇÒÁ´Ñ¹àÅ×Í´ã¹ aorta > artery > arteriole >

capillary > venule > vein > vena cava


















27

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨
¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨






Ñ
×
Ñ
¡ÒÃÇ´¤ÇÒÁ´¹àÅÍ´




























¤ÇÒÁ´Ñ¹àÅ×Í´»¡µÔ㹤¹ÍÒÂØ 20 »‚ = 120/70 (Systolic/Diastolic)

à¤Ã×èͧ·Õè㪌ÇÑ´¤ÇÒÁ´Ñ¹¤×Í Sphygmomanometer

ÇÔ¸Õ¡ÒÃÇÑ´ : ¾Ñ¹ arm cuff Ãͺ⤹ᢹ ºÕºãˌÅÁࢌÒä»ã¹ cuff ¨¹¡ÃзÑè§

¤ÇÒÁ´Ñ¹ã¹ cuff ÊÙ§¡Ç‹Ò¤ÇÒÁ´Ñ¹àÅ×Í´ã¹ artery àÅ×Í´ËÂØ´äËÅáŌÇ㪌

Stethoscope ¿˜§àÊÕ§¡ÒÃäËŢͧàÅ×Í´ ¤‹ÍÂæ »Å‹ÍÂãˌÅÁÍÍ¡¨Ò¡ cuff àÁ×èÍ

¤ÇÒÁ´Ñ¹ã¹ artery ÊÙ§¡Ç‹Òã¹ cuff ¨Ð䴌ÂÔ¹àÊÕ§¡ÒÃäËŢͧàÅ×Í´ àÃÕ¡NjÒ


Systolic pressure áÅФ‹ÍÂæ »Å‹ÍÂÅÁã¹ cuff ÍÍ¡àÃ×èÍÂæ ¨¹¡ÃзÑè§äÁ‹ä´ŒÂÔ¹

àÊÕ§¡ÒÃäËŢͧàÅ×Í´ àÃÕÂ¡Ç‹Ò Diastolic pressure
























28

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¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨









¡ÒÃàÊÕÂàÅÍ´
×








»ÃÔÁÒ³àÅ×ʹŴŧ

¤ÇÒÁ´Ñ¹àÅ×ʹŴŧ ¡ÒÃà»ÅÕè¹á»Å§¢Í§á¡Ê










Baroreceptor Reflex Chemoreceptors Reflex











·íÒãˌà¡Ô´¡ÒÃË´µÑǢͧËÅÍ´àÅ×Í´

·íÒãˌ¡ÒÃäËŢͧàÅ×Í´ªŒÒŧ


































29

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Ø
ì
Ñ
Ç·ÂÒžÂÒºÒźÃÁÃÒªª¹¹Õ ÊÃÒɮøҹÕ
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