Fragile Lives

mitral valve 二尖瓣。得名于其形状与主教的法冠(mitre)像。是一对位于左心房和左心室之间，可上下拍动的心瓣。
在心舒期(the heart's illing phase, or diastole)，正常工作的二尖瓣因左心房充血加压而打开。左心房压高过左心室压的时候二尖瓣开启，使血液被动流入左心室。
心舒期结束于心房收缩(entricular contraction, or systole)，最终从心房喷出20%的血液到心室。同时二尖瓣关闭防止心房收缩后血液回流。

ventricular septum ((左、右心室之间)室间隔)

8-9 ‘’Tis bitter cold,/And I am sick at heart’ – Shakespeare adds to the atmosphere. Francisco simply means that he is in low spirits, but his ‘sick at heart’ is the first indication that something is wrong more generally: a more serious ‘sickness’ or ‘disease.’

Grim Reaper: a personification of death. 死神。

left ventricle -> body
right ventricle -> lung

Charing Cross Hospital Medical School. 查靈十字醫院。校友包括：
托马斯·亨利·赫胥黎
戴维·利文斯通 David Livingstone。19世纪英国探险家、传教士，维多利亚瀑布和马拉维湖的发现者，非洲探险的最伟大人物之一。

Lord Brock 英国手术医师。现代心脏外科手术的先驱者。

右心房接受上下腔静脉的含氧量低的静脉血。心脏收缩泵出右心室中的血液后舒张，会造成右心室（左心房和左心室一样）负压，使得右心房的血液通过三尖瓣流入右心室。这些血液在然后在心脏收缩的时候被射到肺动脉，进入肺循环。肺动脉瓣会防止血液倒流。在肺进行过气体交换后，含氧量高的血液会顺着肺静脉流到左心房。然后经过二尖瓣流入左心室。左心室内的血液会在心脏收缩时被射到主动脉，进入体循环。

心脏负责了全身的血液循环，循环又分为体循环和肺循环两种。静脉运输血液到心脏，而动脉则运输血液离开心脏。

肺循环：上下腔静脉(latin: Venae cavae)的含氧量低的静脉血 -> 右心房(right atrium) -三尖瓣(tricuspid valve)-> 右心室(right ventricle) -> 肺动脉(pulmonary artery) -> 肺循环(氧合) ->
体循环：肺静脉的含氧量高的静脉血 -> 左心房(left atrium) -二尖瓣(mitral valve) -> 左心室(left ventricle) (射血) -主动脉瓣(Aortic valve)> 主动脉(Aorta) -> 全身

Great vessels: 大血管
* 上腔靜脈 (latin: superior vena cava) 将无氧血从身体上半部分(上肢、眼睛和颈部)运输至右心房。
* 下腔靜脈 (french: Inferior vena cava) 连接身体的中部和下半部分与右心房。
* 肺動脈(pulmonary artery)。分叉为左、右两支：left / right pulmonary arteries
* 肺静脉(pulmonary vein)：共4条。血液从肺部流向心脏。
* 主動脈(Aorta)

valves: 心脏有4个
When the heart squeezes (contracts), the valves opens and lets blood flow. When the heart relaxes, the aortic valve closes to prevent blood from moving backward.

补充说明：
* 左、右心房合称 atria
* 冠状动脉 (coronary arteries)：分左、右冠状动脉，由主动脉的根部发出。为心肌自身供血。
* atrial septum 心房中隔。隔开左、右心房。

* diastole 扩张期。心室血液充盈。
* systole 收缩期。心室收缩排出血液。

Viral myocarditis 病毒性心肌炎
myocardial 心肌（相关的）


患者是 Julie Mills。 设备 AB-180
当时的新闻报道：New Artificial Heart Saves Lives (1998-11-03)

ALCAPA: 左冠状动脉起源于肺动脉。是一种非常少见的先天性心脏病，发病率为1/30万，占先天性心脏病的0.26-0.50%，90%的患儿在1岁内死亡。诊断本病的金标准为经心脏导管插入(Cardiac catheterization)的心血管造影，

患者是 Kirsty Collier。
当时的新闻(2008，手术9年后): The heart that grew back: ‘Miracle’ of girl whose heart healed itself after a third was removed in emergency operation

Kirsty was linked up to a heart lung bypass machine for the surgery – and when the surgical team attempted to get the heart to take over once again, they found it was so badly damaged that it was unable to pump blood again.

'We felt there was no hope at all,' Professor Westaby told Sky News.

A message was even sent to Kirsty's parents to warn them 'it was not going well'.

'She was essentially dead and was only resurrected by what I regarded at the time as a completely bizarre operation,' added Professor Westaby.

However, the surgeon had a hunch that reducing the size of Kirsty's heart would ease the pressure on the muscle, allowing it to contract properly.

And using scissors, he removed a large section of the muscle wall, stitched it back together, and hoped for the best.

'I have to confess I never thought it would work. It was an awful lot smaller.' But the baby's heart began beating again.

heart-lung transplant

终末期心脏病典型症状(心脏超声(echo))
* left ventricle was massively distended and barely moving. 左心室肥大
* The mitral valve was held open by the stretched heart 二尖瓣关闭不全 (二尖瓣反流)

患者是 Peter Houghton

ABC: ‘Airway, breathing, circulation’ is the rescue mnemonic, the medical ABC.

angioplasty  血管成形术
angioplasty balloons 血管成形术气囊
stent 支架

sternotomy 胸骨切开

cardiac tamponade. 心包填塞
Air embolism 空氣栓塞,气体形成气泡进入循环系统(血液)中。空气栓塞属于栓子（血液中游离的固体，液体或气体团块）
若空气栓塞出现在动脉，称为动脉空气栓塞（arterial gas embolism，AGE）。动脉空气栓塞比静脉空气栓塞要严重的多，因为会直接影响身体某个部位的供血。动脉空气栓塞的症状和其影响供血的部位有关，若影响到大脑或是心脏，也可能造成中风或是心肌梗死。随着部位不同，会产生动脉空气栓塞症状的气体量也会不同，在脑血管2 mL的空气就可以致命，而在冠状动脉中，0.5 mL的空气就会造成心搏停止。

ventricular fibrillation (VF, 心室颤动) - random electrical activity, with the heart squirming aimlessly and not pumping.
defibrillator
a ‘Lucas’ chest compression machine.
pupils still reacted to light 有瞳孔反应确认大脑没有死亡

Advanced Life Support approach:
1. First, defibrillation with high electrical charge – 150 joules then 200 joules on multiple occasions using the original electrodes
2. then,after repeated failure with this and persistent fibrillation, continuous cardiac compression by the machine and adrenaline injected into a vein. The adrenaline would have been potentially useful had the heart been contracting, but it worsens muscle irritability and predisposes the patient to more ventricular fibrillation.

ventricular dysrhythmia 心室心律不整

blood chemistry: acid levels 等指标
  acid 由缺乏供氧的肌肉组织释放( muscles starved of oxygen)
idiopathic ventricular fibrillation 非特异性心室颤动。找不到明显诱因
beta-blocker

circulatory support： a ventricular assist device to take over the circulation。The sort of pumps. eg:
ECMO (extracorporeal membrane oxygenation). This combines a centrifugal blood pump with an oxygenator and is similar to the oxygenator in the heart–lung machine, except that it’s engineered for long-term use and is safe for days or weeks until the heart gets better.
  * 通过两侧腹股沟部位(groin)血管接入身体。在超声指引下将长导管引导至右心房
  * 最常见致命并发症：Bleeding (血液凝血(clot)能力下降)
standard cardiopulmonary bypass: conventional heart-lung machine.

limb 供血不足: cold and white

Bleep Test: The 20m multistage fitness test (MSFT) is a commonly used maximal running aerobic fitness test. It is also known as the 20 meter shuttle run test, beep or bleep test among other names. It is a maximal test involving continuous running between two lines 20m apart in time to recorded beeps. 测量心肺功能。

left ventricular hypertrophy 左心室肥大
aortic stenosis 主动脉瓣狭窄:先天性或由于年老退化

怀孕12-36周阶段，心脏泵血量开始逐渐增加到正常水平的150%

Henry Marsh (neurosurgeon)

Do No Harm: Stories of Life, Death, and Brain Surgery Paperback (2014)
Admissions: A life in Brain Surgery. Weidenfeld & Nicolson (2017)

Cheshire Cat. 柴郡貓（英语：The Cheshire Cat），又译作歙縣貓、笑脸猫或妙妙貓，是英國作家路易斯·卡罗文學作品《爱丽丝梦游仙境》中的貓，以特殊的笑容著稱。1865年版的柴郡貓插圖常常作為愛麗絲系列的代表圖樣。即使牠身體消失，仍能在空氣中留下一抹露齒的笑容。

BBC documentary YourLife in Their Hands (2004)

John Hunter  18世纪英国传奇的外科医生。

Roses are red, Violets are blue.
Sorry you’re dead, What can I do?

cardiac catheterisation 心脏导管插入术
angiogram 血管造影(图)
cardiomyopathy 心肌病
Cardioplegia 心脏手术时注入冠状动脉，使心脏麻痹的溶液(4°C)
chronic heart failure: 慢性心衰。最常见原因是冠状动脉疾病(coronary artery disease)。
oronary artery bypass grafts 冠状动脉搭桥
coronary artery disease: 由动脉壁上聚集的 atheroma 引起的动脉狭窄

left ventricular assist device
* CentriMag or Berlin Heart: weeks
* Jarvik 2000 : years. expensive, need external battery

mitral stenosis:二尖瓣狭窄。风湿病(rheumatic fever, 由链球菌(streptococcus)引起)导致
myocardial infarction (MI)心肌梗塞。即 heart attack, 心脏病发作。冠状动脉堵塞导致心肌组织缺血死亡、瘢痕(scar)化。
  infarct: n. a small localized area of dead tissue caused by an inadequate blood suppy.
myocarditis 心肌炎。通常是病毒性
pericardium 心包；心包膜。 Fibrous sac that surrounds the heart. Can be used as patch material in the heart. Calf pericardium is used to make bioprosthetic heart valves.
pulmonary oedema: 肺水肿。左心室射血功能衰退时出现