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HEART
ANATOMY OF HEART

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 The heart is a muscular organ that pumps blood throughout the body. It is located in the
middle cavity of the chest, between the lungs. In most people, the heart is located on the left
side of the chest, beneath the breastbone.
The heart is composed of smooth muscle. It has four chambers which contract in a specific
order, allowing the human heart to pump blood from the body to the lungs and back again
with high efficiency. The heart also contains “pacemaker” cells which fire nerve impulses at
regular intervals, prompting the heart muscle to contract.

Heart structure
The heart’s unique design allows it to accomplish the incredible task of circulating blood
through the human body. Here we will review its essential components, and how and why
blood passes through them.

Layers of the Heart Wall

The heart has three layers of tissue, each of which serve a slightly different purpose. These
are:

The Epicardium. The epicardium is also sometimes considered a part of the protective
pericardial membrane around the heart. It helps to keep the heart lubricated and
protected.

The Myocardium. The myocardium is the muscle of the heart. You can remember this
because the root word “myo” comes from “muscle,” while “cardium” comes from
“heart.”The myocardium is an incredibly strong muscle that makes up most of the heart.
It is responsible for pumping blood throughout the body.

The Endocardium. The endocardium is a thin, protective layer on the inside of the
heart. It is made of smooth, slippery endothelial cells, which prevent blood from sticking
to the inside of the heart and forming deadly blood clots.

Chambers of the Heart

The heart has four chambers, which are designed to pump blood from the body to the lungs
and back again with extremely high efficiency. Here we’ll see what the four chambers are,
and how they do their jobs:

The Right Atrium. The right and left atria are the smaller chambers of the heart, and
they have thinner, less muscular walls. This is because they only receive blood from the
veins – they don’t have to pump it back out through the whole circulatory system!The

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 right atrium only has to receive blood from the body’s veins and pump it into the left
ventricle, where the real pumping action starts.

The Right Ventricle. The ventricles are larger chambers with stronger, thicker walls.
They are responsible for pumping blood to the organs at high pressures.There are two
ventricles because there are two circuits blood needs to be pumped through – the
pulmonary circuit, where blood receives oxygen from the lungs, and the body circuit,
where oxygen-filled blood travels to the rest of the body.

The left atrium receives oxygenated blood from the pulmonary veins. It pumps this
blood into the left ventricle, which…

The left ventricle pumps blood throughout the rest of the body.

Valves of heart
Tricuspid valve: This valve has three leaflets. They allow blood to flow from the right
atrium to the right ventricle. They also prevent blood from flowing backward from the
right ventricle to the right atrium.

Pulmonary valve: This valve also has three leaflets. They allow blood to pump from the
right ventricle to the pulmonary artery. This artery leads to the lungs, where blood picks
up oxygen. The pulmonary valve prevents blood from going backward from the
pulmonary artery to the right ventricle.

Mitral valve: This valve has two leaflets. They allow blood to flow from your left atrium
to your left ventricle. And they prevent backward flow from the left ventricle to the left
atrium.

Aortic valve: This valve has three leaflets. They open to let blood flow from your heart’s
left ventricle to the aorta. The aorta is the largest blood vessel in your body. It brings
oxygenated blood from your heart to the rest of your body. The aortic valve prevents
backward flow from the aorta into the left ventricle.

DOUBLE CIRCULATION
Double circulation refers to the system of blood flow in which blood passes through the
heart twice during a single complete circuit of the body. This process is essential for the
effective separation of oxygenated and deoxygenated blood, thereby enhancing the
efficiency of oxygen delivery to various tissues throughout the organism. This
characteristic is particularly prominent in mammals and birds, distinguishing them from
other vertebrates that utilize single circulation.

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 In the context of double circulation, the circulatory system fulfills several critical
functions, including the transportation of nutrients and gases, such as oxygen, to cells, as
well as the removal of metabolic waste products from the body. The heart plays a pivotal
role in this system, acting as the central pump that propels blood throughout the
organism. Blood circulation is closely tied to the respiratory system, specifically the
lungs, which facilitate the oxygenation of blood. However, it is important to note that
while the heart and lungs are key components in blood purification and circulation, other
organs and systems also contribute to these processes.

In contrast, single circulation, found in organisms such as fish, involves blood

passing through the heart only once per circuit. This system can be less efficient, as
it mixes oxygenated and deoxygenated blood, resulting in a lower overall oxygen
delivery to the body. Therefore, the evolution of double circulation represents a
significant advancement in the circulatory adaptations of certain vertebrate species,
allowing for more complex and active lifestyles.

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 BLOOD CIRCULATION
The blood circulatory system (cardiovascular system) delivers nutrients and oxygen to all
cells in the body. It consists of the heart and the blood vessels running through the entire

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 body. The arteries carry blood away from the heart; the veins carry it back to the heart. The
system of blood vessels resembles a tree: The “trunk” – the main artery (aorta) – branches
into large arteries, which lead to smaller and smaller vessels. The smallest arteries end in a
network of tiny vessels known as the capillary network.

There isn't only one blood circulatory system in the human body, but two, which are
connected: The systemic circulation provides organs, tissues and cells with blood so that they
get oxygen and other vital substances. The pulmonary circulation is where the fresh oxygen
we breathe in enters the blood. At the same time, carbon dioxide is released from the blood.

Blood vessels: Structure and function

The function of blood vessels is to deliver blood to the organs and tissues in your body. Blood
supplies them with the oxygen and nutrients they need to work. Blood vessels also carry
waste products and carbon dioxide away from your organs and tissues.

Each type of blood vessel serves a different function:

Arteries. These strong, muscular blood vessels carry oxygen-rich blood from your heart
to your body. This blood contains oxygen from your lungs.

Arterioles. Similar to arteries, arterioles are smaller branches that extend out from
arteries as they move toward your tissues. These smaller vessels are very flexible. They
get bigger or smaller to help maintain your body’s blood pressure.

Capillaries. Your smallest blood vessels, these connect arteries and veins. Because of
their thin walls, capillaries are transfer stations for oxygen, nutrients, carbon dioxide and
waste.

Venules. Venules (small veins) receive blood from capillaries and lead to veins.

Veins. These blood vessels carry oxygen-poor blood back to your heart. From there, it
goes to your lungs for more oxygen.

Where are blood vessels located?

Blood vessels run all through your body. Branches from large vessels get smaller and smaller,
reaching every organ in your body. You have billions of blood vessels in your body, and most
of them are capillaries, venules and arterioles. These smaller vessels connect to 160 arteries
and 200 veins.

Your most important blood vessel is your body’s main artery — your aorta. This is a large
artery that carries blood away from your heart and delivers oxygen-rich blood to your body.
Your aorta runs down through your chest, diaphragm and abdomen (belly), branching off in

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 many areas. Near your pelvis, this main artery branches into two arteries that supply blood to
your lower body and legs.

The main vein in your body is the vena cava. The superior vena cava is in the upper right part
of your chest. It takes blood from your head, neck, arms and chest back to your heart. The
inferior vena cava is near the right side of your diaphragm. It brings blood from your legs,
feet, abdomen and pelvis back to your heart.

What do blood vessels look like?

Blood vessels have a tube-like shape, but they rarely run in a straight line. Some are big
enough to see under your skin. If you’ve ever had your blood drawn, you may have noticed
veins on the inside of your arm. They might appear blue under your skin, even though your
blood is red.

CONDUCTION SYSTEM OF HEART

Elements of the conduction system
The cardiac conduction system is responsible for generating and transmitting electrical
impulses that stimulate the heart to contract. The system consists of several
components:

1. Sinoatrial Node: A collection of specialised cells located in the upper wall of the right
atrium that can spontaneously generate electrical impulses.

2. Atrioventricular Node: A node located in the lower part of the right atrium that receives
impulses from the sinoatrial node and transmits them to the atrioventricular bundle.

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 3. Atrioventricular Bundle: A bundle of specialized fibers that conducts the impulse from
the atrioventricular node to the ventricles.

4. Purkinje Fibers: Specialized fibers that distribute the impulse throughout the ventricles

REGULATION OF HEARTBEAT BY THE

ATONOMIC NERVOUS SYSTEM (ANS)
1. Sympathetic Nervous System (SNS):
• Role: Prepares the body for "fight or flight" responses.
• Effect on Heartbeat:– Increases heart rate (positive chronotropic effect).– Strengthens
the force of contraction (positive inotropic effect).
• Mechanism: Releases norepinephrine (noradrenaline), which binds to
beta-adrenergic receptors on the heart, enhancing its activity.

2. Parasympathetic Nervous System (PNS):

• Role: Encourages "rest and digest" states.

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 • Effect on Heartbeat:– Decreases heart rate (negative chronotropic effect).– Minimal
effect on contraction strength.
• Mechanism: The vagus nerve releases acetylcholine, which acts on
muscarinic receptors, reducing the pace set by the SA node.

Balance between SNS and PNS

• The cardiac center in the medulla oblongata monitors blood pressure, oxygen levels, and
other factors, adjusting SNS and PNS activity accordingly.
• During exercise or stress, the SNS dominates to meet the body's higher oxygen and energy
needs.
• During rest or sleep, the PNS ensures a slower, steady heartbeat

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 CARDIAC OUTPUT
Cardiac output (CO) is the amount of blood pumped by the heart minute and is the
mechanism whereby blood flows around the body, especially providing blood flow to the
brain and other vital organs. The body’s demand for oxygen changes, such as during exercise,
and the cardiac output is altered by modulating both heart rate (HR) and stroke volume (SV).
As a result, the regulation of cardiac output is subject to a complex mechanism involving the
autonomic nervous system, endocrine, and paracrine signaling pathways.[1]

Because every tissue in the body relies on the heart pumping blood for nourishment, any
cardiovascular dysfunction has the potential to result in significant morbidity and mortality.
Heart disease affects nearly 30 million Americans annually and is the number one cause of

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 death in the United States. The degree of functional impairment can be assessed by a variety
of methods that guides diagnosis, prognosis, and treatment. As a clinician, one will come
across heart disease in the course of practice and should be familiar with the basics of cardiac
function.

CO = Stroke Volume × Heart Rate

• Stroke Volume (SV): The amount of blood ejected by each ventricle per heartbeat (~70
mL in a healthy adult).
• Heart Rate (HR): Number of heartbeats per minute (~60-100 beats per minute in a
resting adult).
• Normal Range: For a healthy adult, cardiac output is approximately 4-8 liters per
minute

CARDIAC CYCLE
Overview of Cardiac Cycle

Cardiac Cycle

• The cardiac cycle is the sequence of events in one complete

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 heartbeat, consisting of systole (contraction) and diastole (relaxation).
Here’s a breakdown:
• Atrial Systole (0.1 seconds):– Atria contract, pushing blood into the ventricles.– AV valves
(tricuspid and mitral) open; semilunar valves (aortic and pulmonary) remain closed.
• Ventricular Systole (0.3 seconds):– Ventricles contract, ejecting blood into the arteries (aorta
and pulmonary artery).– Semilunar valves open; AV valves close to prevent backflow into
atria.
• Diastole (0.4 seconds):– Atria and ventricles relax, allowing blood to refill the heart.– AV
valves open; semilunar valves close.
• Total Duration: A complete cardiac cycle lasts about 0.8 seconds in a person with a heart
rate of 75 beats per minute

BLOOD PRESSURE
Blood pressure refers to the force exerted by circulating blood on the walls of blood
vessels as the heart pumps it throughout the body. It's an essential measure of overall
health, and maintaining it within a healthy range is crucial.
• There are two key measurements:
• Systolic Pressure: The pressure when your heart beats and pushes blood.
• Diastolic Pressure: The pressure when your heart is at rest between beats.
• A normal blood pressure reading is typically around 120/80 mmHg. High blood
pressure (hypertension) and low blood pressure (hypotension) can lead to health
complications if
not managed properly.

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 REGULATION OF BLOOD PRESSURE
Blood pressure regulation is crucial for maintaining proper blood flow through
the body. The following mechanisms are involved:
• Nervous Regulation:– Baroreceptors: These pressure-sensitive receptors in the carotid
arteries and aorta
detect changes in blood pressure and send signals to the brain (medulla oblongata).–
Autonomic Nervous System (ANS):
• Sympathetic Nervous System (SNS): Raises blood pressure by increasing heart rate and
vasoconstriction (narrowing blood vessels).
• Parasympathetic Nervous System (PNS): Lowers blood pressure by decreasing heart
rate and promoting vasodilation.
• Hormonal Regulation:– Renin-Angiotensin-Aldosterone System (RAAS): Increases
blood pressure by promoting vasoconstriction and sodium retention.– Antidiuretic

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 Hormone (ADH): Helps the kidneys retain water, increasing blood pressure.– Atrial
Natriuretic Peptide (ANP): Reduces blood pressure by promoting sodium excretion and
vasodilation.
• Local Regulation:– Vasodilation and Vasoconstriction: Local factors like nitric oxide
(dilates vessels) and endothelins (constrict vessels) help adjust blood flow to tissues.

PULSE
Your pulse is a way of counting heartbeats per minute. You can feel your pulse in various
parts of your body.
What you feel when you take your pulse is the pressure in your arteries going up briefly as
your heart pushes out more blood. Every time your heart beats, it squeezes and propels blood
through the network of arteries in your body.
Between beats, your heart relaxes, which brings the pressure back down again. That’s why
each heartbeat feels like a single push rather than a constant flow of pressure like water
through a hose.

The pulse is the rhythmic expansion and recoil of arteries due to the beating of the heart.
It
provides information about:
• Rate: Heartbeats per minute (normal range: 60-100 bpm in adults).
• Rhythm:Regular or irregular pattern.
• Strength: Strong, weak, or bounding, indicating blood flow dynamics.
• Pulse is commonly checked at locations such as the radial artery (wrist), carotid artery
(neck), or brachial artery (arm)

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 ELECTROCARDIOGRAM (ECG/EKG)
An electrocardiogram (ECG or EKG) is a simple and painless test that measures the
electrical activity of your heart. It involves placing sticky patches called electrodes on the
chest, arms, or legs, which connect to a computer that records the heart's electrical signals.
The ECG provides important information about the heart's rhythm and can help diagnose
various heart conditions, such as arrhythmias or heart disease. The test is quick and typically
takes only a few minutes to complete.

P Wave: Atrial depolarization (contraction of atria).

• QRS Complex: Ventricular depolarization (contraction of ventricles).
• T Wave: Ventricular repolarization (relaxation of ventricles).
• Irregularities in the ECG can indicate arrhythmias, ischemia, or other heart issues

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 DISORDERS OF THE HEART
1. Coronary Artery Disease (CAD): The most common type of heart disease, CAD occurs
when the coronary arteries become narrowed or blocked due to plaque buildup
(atherosclerosis). This can lead to chest pain (angina) or heart attacks due to reduced
blood flow to the heart muscle.

2. Arrhythmias: These are irregular heartbeats that can be too fast, too slow, or erratic.
Atrial fibrillation is a common type of arrhythmia that can increase the risk of stroke and
heart failure.

3. Heart Failure: This condition occurs when the heart cannot pump enough blood to meet
the body's needs. It can result from various heart disorders, including CAD and high
blood pressure.

4. Heart Valve Disease: This involves damage to one or more of the heart's valves, which
can disrupt blood flow within the heart. Conditions can include stenosis (narrowing of
the valve) or regurgitation (leaking of the valve).

5. Congenital Heart Defects: These are structural problems with the heart present at birth.
They can affect the heart's walls, valves, or blood vessels.

6. Peripheral Artery Disease (PAD): This condition affects blood flow to the limbs and is
often caused by atherosclerosis, leading to pain and mobility issues.

Causes and Risk Factors

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 Atherosclerosis: The buildup of fats, cholesterol, and other substances in and on artery
walls is a primary cause of many heart disorders.

High Blood Pressure: This can damage arteries and lead to heart disease over time.

Diabetes: Increases the risk of heart disease due to its effects on blood vessels and nerves
that control the heart.

Lifestyle Factors: Poor diet, lack of physical activity, smoking, and excessive alcohol
consumption can significantly increase the risk of heart disorders.

Prevention and Treatment

Many heart disorders can be prevented or managed through lifestyle changes such as:

Eating a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins.

Regular physical activity.

Maintaining a healthy weight.

Avoiding tobacco and limiting alcohol intake.Treatment options may include

medications, lifestyle changes, and in some cases, surgical procedures to repair or replace
damaged heart structures.

Understanding these disorders is crucial for maintaining heart health and preventing
serious complications. Regular check-ups and awareness of risk factors can help in early
detection and management of heart disease.

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