ANATOMY AND PHYSIOLOGY OF THE HEART

Heart is a hollow muscular organ that pumps blood through the body. The heart,
blood, and blood vessels make up the circulatory system, which is responsible for
distributing oxygen and nutrients to the body and carrying away carbon dioxide and
other waste products. The heart is the circulatory system's power supply. It must beat
ceaselessly because the body's tissues-especially the brain and the heart itself-depend
on a constant supply of oxygen and nutrients delivered by the flowing blood. If the heart
stops pumping blood for more than a few minutes, death will result.
The human heart is shaped like an upside-down pear and is located slightly to
the left of center inside the chest cavity. About the size of a closed fist, the heart is
made primarily of muscle tissue that contracts rhythmically to propel blood to all parts of
the body. This rhythmic contraction begins in the developing embryo about three weeks
after conception and continues throughout an individual's life. The muscle rests only for
a fraction of a second between beats. Over a typical life span of 76 years, the heart will
beat nearly 2.8 billion times and move 169 million liters (179 million quarts) of blood.
The human heart has four chambers. The upper two chambers, the right and left atria,
are receiving chambers for blood. The atria are sometimes known as auricles. They
collect blood that pours in from veins, blood vessels that return blood to the heart. The
heart's lower two chambers, the right and left ventricles, are the powerful pumping
chambers. The ventricles propel blood into arteries, blood vessels that carry blood away
from the heart.
A wall of tissue separates the right and left sides of the heart. Each side pumps
blood through a different circuit of blood vessels: The right side of the heart pumps
oxygen-poor blood to the lungs, while the left side of the heart pumps oxygen-rich blood
to the body. Blood returning from a trip around the body has given up most of its oxygen
and picked up carbon dioxide in the body's tissues. This oxygen-poor blood feeds into
two large veins, the superior vena cava and inferior vena cava, which empty into the
right atrium of the heart.
The right atrium conducts blood to the right ventricle, and the right ventricle
pumps blood into the pulmonary artery. The pulmonary artery carries the blood to the
lungs, where it picks up a fresh supply of oxygen and eliminates carbon dioxide. The
blood that is oxygen-rich returns to the heart through the pulmonary veins, which empty
into the left atrium. Blood passes from the left atrium into the left ventricle, from where it
is pumped out of the heart into the aorta, the body's largest artery. Smaller arteries that
branch off the aorta distribute blood to various parts of the body.
Four valves within the heart prevent blood from flowing backward in the heart.
The valves open easily in the direction of blood flow, but when blood pushes against the
valves in the opposite direction, the valves close. Two valves, known as atrioventricular
valves, are located between the atria and ventricles. The right atrioventricular valve is
formed from three flaps of tissue and is called the tricuspid valve. The left
atrioventricular valve has two flaps and is called the bicuspid or mitral valve. The other
two heart valves are located between the ventricles and arteries. They are called
semilunar valves because they each consist of three half-moon-shaped flaps of tissue.
The right semilunar valve, between the right ventricle and pulmonary artery, is also
called the pulmonary valve. The left semilunar valve, between the left ventricle and
aorta, is also called the aortic valve.
Muscle tissue, known as myocardium or cardiac muscle, wraps around a
scaffolding of tough connective tissue to form the walls of the heart's chambers. The
atria, the receiving chambers of the heart, have relatively thin walls compared to the
ventricles, the pumping chambers. The left ventricle has the thickest walls-nearly 1 cm
(0.5 in) thick in an adult-because it must work the hardest to propel blood to the farthest
reaches of the body.
A tough, double-layered sac known as the pericardium surrounds the heart. The
inner layer of the pericardium, known as the epicardium, rests directly on top of the
heart muscle. The outer layer of the pericardium attaches to the breastbone and other
structures in the chest cavity and helps hold the heart in place. Between the two layers
of the pericardium is a thin space filled with a watery fluid that helps prevent these
layers from rubbing against each other when the heart beats. The inner surfaces of the
heart's chambers are lined with a thin sheet of shiny, white tissue known as the
endocardium. The same type of tissue, more broadly referred to as endothelium, also
lines the body's blood vessels, forming one continuous lining throughout the circulatory
system. This lining helps blood flow smoothly and prevents blood clots from forming
inside the circulatory system.
The heart is nourished not by the blood passing through its chambers but by a
specialized network of blood vessels. Known as the coronary arteries, these blood
vessels encircle the heart like a crown. About 5 percent of the blood pumped to the
body enters the coronary arteries, which branch from the aorta just above where it
emerges from the left ventricle. Three main coronary arteries-the right, the left
circumflex, and the left anterior descending-nourish different regions of the heart
muscle. From these three arteries arise smaller branches that enter the muscular walls
of the heart to provide a constant supply of oxygen and nutrients. Veins running through
the heart muscle converge to form a large channel called the coronary sinus, which
returns blood to the right atrium.
The heart's duties are much broader than simply pumping blood continuously
throughout life. The heart must also respond to changes in the body's demand for
oxygen. Moreover, the heart and the rest of the circulatory system can respond almost
instantaneously to shifting situations-when a person stands up or lies down, for
example, or when a person is faced with a potentially dangerous situation. Although the
right and left halves of the heart are separate, they both contract in unison, producing a
single heartbeat. The sequence of events from the beginning of one heartbeat to the
beginning of the next is called the cardiac cycle. The cardiac cycle has two phases:
diastole, when the heart's chambers are relaxed, and systole, when the chambers
contract to move blood. During the systolic phase, the atria contract first, followed by
contraction of the ventricles. This sequential contraction ensures efficient movement of
blood from atria to ventricles and then into the arteries. If the atria and ventricles
contracted simultaneously, the heart would not be able to move as much blood with
each beat.
 During diastole, both atria and ventricles are relaxed, and the atrioventricular
valves are open. Blood pours from the veins into the atria, and from there into the
ventricles. In fact, most of the blood that enters the ventricles simply pours in during
diastole. Systole then begins as the atria contract to complete the filling of the
ventricles. Next, the ventricles contract, forcing blood out through the semilunar valves
and into the arteries, and the atrioventricular valves close to prevent blood from flowing
back into the atria. As pressure rises in the arteries, the semilunar valves snap shut to
prevent blood from flowing back into the ventricles. Diastole then begins again as the
heart muscle relaxes-the atria first, followed by the ventricles-and blood begins to pour
into the heart once more.
The characteristic heartbeat sounds are made by the valves in the heart-not by
the contraction of the heart muscle itself. The sound comes from the leaflets of the
valves slapping together. The closing of the atrioventricular valves, just before the
ventricles contract, makes the first heart sound. The second heart sound is made when
the semilunar valves snap closed. The first heart sound is generally longer and lower
than the second, producing a heartbeat that sounds like lub-dup, lub-dup, lub-dup.
Blood pressure, the pressure exerted on the walls of blood vessels by the flowing blood,
also varies during different phases of the cardiac cycle. Blood pressure in the arteries is
higher during systole, when the ventricles are contracting, and lower during diastole, as
the blood ejected during systole moves into the body's capillaries. A person's blood
pressure may increase for a short time during moments of stress or strong emotions.
However, a prolonged or constant elevation of blood pressure, a condition known as
hypertension, can increase a person's risk for heart attack, stroke, heart and kidney
failure, and other health problems.