The human heart is a pear-shaped structure about the size of a fist. It lies obliquely within the chest cavity just left of center, with the apex pointing downward. The heart is constructed of a special kind of muscle called myocardium or cardiac muscle, and is enclosed in a double-layered, membranous sac known as the pericardium. A wall of muscle divides the heart into two cavities: the left cavity pumps blood throughout the body, while the right cavity pumps blood only through the lungs. Each cavity is in turn divided into two chambers, the upper ones called atria, the lower ones ventricles. Venous blood from the body, containing large amounts of carbon dioxide, returns to the right atrium. It enters the right ventricle, which contracts, pumping blood through the pulmonary artery to the lungs. Oxygenated blood returns from the lungs to the left atrium and enters the left ventricle, which contracts, forcing the blood into the aorta, from which it is distributed throughout the body. In addition, the heart employs a separate vascular system to obtain blood for its own nourishment. Two major coronary arteries regulate this blood supply.
Blood flows through the heart in one direction only. It is prevented from backing up by a series of valves at various openings: the tricuspid valve between the right atrium and right ventricle; the bicuspid, or mitral, valve between the left atrium and left ventricle; and the semilunar valves in the aorta and the pulmonary artery. Each heartbeat, or cardiac cycle, is divided into two phases. In the first phase, a short period of ventricular contraction known as the systole, the tricuspid and mitral valves snap shut, producing the familiar "lub" sound heard in the physician's stethoscope. In the second phase, a slightly longer period of ventricular relaxation known as the diastole, the pulmonary and aortic valves close up, producing the characteristic "dub" sound. Both sides of the heart contract, empty, relax, and fill simultaneously; therefore, only one systole and one diastole are felt. The normal heart has a rate of 72 beats per minute, but in infants the rate may be as high as 120 beats, and in children about 90 beats, per minute. Each heartbeat is stimulated by an electrical impulse that originates in a small strip of heart tissue known as the sinoatrial (S-A) node, or pacemaker.
One of the important advances in cardiology is the artificial pacemaker used to electrically initiate a normal heartbeat when the patient's own pacemaker is defective (see arrhythmia); it may be surgically implanted in the patient's body. Similarly, an internal defibrillator may be implanted to deliver an electrical shock to the heart in order to stop certain forms of rapid heart rhythm disturbances. Another familiar tool of the cardiologist is the electrocardiograph (EKG), which is used to detect abnormalities that are not evident from a physical examination (see electrocardiography).
One of the most important advances in heart surgery during the 1960s was the transplantation of the healthy heart immediately after the death of an individual (the donor) to a recipient suffering from incurable heart disease (see transplantation, medical). In the 1980s new advances in the design and construction of an artificial heart—both the entire organ and such parts as the valves and large blood vessels—showed some promise in treating cardiovascular disease (see heart, artificial), but the limited success that has characterized artificial heart implantation thus far has led many experts to question the efficacy of such measures. Although the artificial heart has often been used as a temporary measure until a permanent human donor heart can be located, a number of recipients have not fared well, even for a limited duration. In addition, it is often unclear how long the recipient will have to wait for a donor. Proponents of the artificial heart hope that technological advances will allow the permanent replacement of human hearts with artificial ones.
See J. Peto, The Heart (2005).
Beginning 2001, however, a second type of artificial heart, the AbioCor, was implanted in a number of patients. Unlike the Jarvik-7, the AbioCor is powered by electrical energy that is transmitted from a battery across the skin to an internal coil and backup battery. Because an opening in the skin is not needed to allow passage for tubes or wires, the risk of infection is greatly reduced. In addition, the external battery pack is designed to worn on a belt or suspenders, enabling the patient to be mobile. On average, the patients who received the heart from 2001 to 2004 and survived the operation lived for five months; the longest lived not quite 17 months. In 2006 the AbioCor was approved for use in patients who do not qualify for a heart transplant if their life expectancy as a result of heart failure is less than month; the device is also approved as a temporary measure for patients awaiting a transplant.
A related device, the ventricular assist device (VAD), or "artificial ventricle," is an internally implanted pump designed to aid a person with a failing left ventricle; unlike an artificial heart, it does not require removal of the patient's heart. A version for temporary use was developed in 1964. In 1991 doctors implanted the first portable VAD; it was powered by a battery pack. Its pump used a special interior lining to promote the growth of a surface similar to that which lines the blood vessels, reducing the risk of the formation of blood clots, which can cause stroke.
Any surgical procedure opening the heart and exposing one or more of its chambers, most often to repair valve disease or correct congenital heart malformations (see congenital heart disease). Invention of the heart-lung machine (see artificial heart), which allows the heart to be stopped during surgery, made it possible. The first successful open-heart surgery was performed in the U.S. in 1953 by John H. Gibbon, Jr., to close an atrial septal defect.
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Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). Short-term oxygen deprivation can cause angina pectoris. Long-term, severe oxygen depletion causes a heart attack. Coronary bypass or angioplasty is needed if medication and diet do not control the disease.
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Procedure to remove a diseased heart and replace it with a healthy one from a legally dead donor. The first was performed in 1967 by Christiaan Barnard. The diseased heart is removed (except for some atrial tissue to preserve nerve connections to the natural pacemaker). The new heart is put in place and connected to the recipient's blood vessels. Patients and donors are matched for tissue type, but the patient's immune system must still be suppressed to prevent rejection (see immunosuppression). A successful transplant can enable the recipient to have an active life for many years.
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Inability of one or both sides of the heart to pump enough blood for the body. Causes include pulmonary heart disease, hypertension, and coronary atherosclerosis. A person with left-sided heart failure experiences shortness of breath after exertion, difficulty in breathing while lying down and night breathlessness, and abnormally high pressure in the pulmonary veins. A person with right-sided failure experiences abnormally high pressure in the systemic veins, liver enlargement, and accumulation of fluid in the legs. A person with failure of both ventricles has an enlarged heart and a three-beat heartbeat. Treatment includes bed rest, medications such as digitalis, control of excess salt and water retention, and elimination of the underlying cause. Seealso congestive heart failure.
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Death of a section of heart muscle when its blood supply is cut off, usually by a blood clot in a coronary artery narrowed by atherosclerosis. Hypertension, diabetes mellitus, high cholesterol, cigarette smoking, and coronary heart disease increase the risk. Symptoms include severe chest pain, often radiating to the left arm, and shortness of breath. Up to 20percnt of victims die before reaching the hospital. Diagnosis is done by electrocardiography and by analysis for enzymes in the blood. Treatment aims to limit the area of tissue death (infarct) and prevent and treat complications. Thrombolytic (clot-dissolving) drugs may be administered. Beta-blockers alleviate pain and slow the heart rate. Angioplasty or coronary bypass restores blood flow to heart muscle. Follow-up may include drugs, exercise programs, and counseling on diet and lifestyle changes.
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Structure of the human heart. Oxygen-rich blood from the lungs enters the heart through the elipsis
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Deformity of the heart. Examples include septal defect (opening in the septum between the sides of the heart), atresia (absence) or stenosis (narrowing) of one or more valves, tetralogy of Fallot (with four components: ventricular septal defect, pulmonary valve stenosis, right ventricular enlargement, and positioning of the aorta so that it receives blood from both ventricles), and transposition of the great vessels (so the pulmonary and systemic circulations each receive blood from the wrong side of the heart). Such defects can prevent enough oxygen from reaching the tissues, so the skin has a bluish cast. Many are fatal if not corrected surgically soon after birth—or, rarely, before birth, if detected prenatally. Abnormalities of the large vessels are usually less serious (see aorta, coarctation of; ductus arteriosus).
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Bleeding heart (Dicentra spectabilis)
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Machine or mechanical pump that maintains blood circulation in the human body. The heart-lung machine, a mechanical pump, can maintain circulation for a few hours while the heart is stopped for surgery. It shunts blood away from the heart, oxygenates it, and returns it to the body. No device has yet been developed for total, long-term replacement of the heart; existing artificial hearts reduce the heart's workload by pumping between beats or acting as an auxiliary ventricle and are suitable only as temporary replacements in patients awaiting transplant. Seealso pacemaker.
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The heart is a muscular organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods. The term cardiac (as in cardiology) means "related to the heart" and comes from the Greek καρδιά, kardia, for "heart."
The heart of a vertebrate is composed of cardiac muscle, an involuntary muscle tissue which is found only within this organ. The average human heart beating at 72 BPM, will beat approximately 2.5 billion times during a lifetime spanning 66 years.
The animal heart is derived from embryonic mesoderm germ-layer cells that differentiate after gastrulation into mesothelium, endothelium, and myocardium. Mesothelial pericardium forms the outer lining of the heart. The inner lining of the heart, lymphatic and blood vessels develop from endothelium. Myocardium develops into heart muscle
From splachnopleuric mesoderm tissue, the cardiogenic plate develops cranially and laterally to the neural plate. In the cardiogenic plate, two separate angiogenic cell clusters form on either side of the embryo. Each cell cluster coalesces to form an endocardial tube continuous with a dorsal aorta and a vitteloumbilical vein. As embryonic tissue continues to fold, the two endocardial tubes are pushed into the thoracic cavity and begin to fuse together and are completely fused at approximately 21 days.
The human embryonic heart begins beating around 21 days after conception, or five weeks after the last normal menstrual period (LMP), which is the date normally used to date pregnancy. It is unknown how blood in the human embryo circulates for the first 21 days in the absence of a functioning heart. The human heart begins beating at a rate near the mother’s, about 75-80 beats per minute (BPM). The embryonic heart rate (EHR) then accelerates linearly for the first month of beating, peaking at 165-185 BPM during the early 7th week, (early 9th week after the LMP). This acceleration is approximately 3.3 BPM per day, or about 10 BPM every three days, an increase of 100 BPM in the first month.
After peaking at about 9.2 weeks after the LMP, it decelerates to about 152 BPM (+/-25 BPM) during the 15th week after the LMP. After the 15th week the deceleration slows reaching an average rate of about 145 (+/-25 BPM) BPM at term. The regression formula which describes this acceleration before the embryo reaches 25 mm in crown-rump length or 9.2 LMP weeks is Age in days = EHR(0.3)+6
There is no difference in male and female heart rates before birth.
The structure of the heart varies among the different branches of the animal kingdom. (See Circulatory system.) Cephalopods have two "gill hearts" and one "systemic heart". Fish have a two-chambered heart that pumps the blood to the gills and from there it goes on to the rest of the body. In amphibians and most reptiles, a double circulatory system is used, but the heart is not always completely separated into two pumps. Amphibians have a three-chambered heart.
Birds and mammals show complete separation of the heart into two pumps, for a total of four heart chambers; it is thought that the four-chambered heart of birds evolved independently from that of mammals.
In the human body, the heart is usually situated in the middle of the thorax with the largest part of the heart slightly offset to the left (although sometimes it is on the right, see dextrocardia), underneath the breastbone (see diagrams). The heart is usually felt to be on the left side because the left heart (left ventricle) is stronger (it pumps to all body parts). The left lung is smaller than the right lung because the heart occupies more of the left hemithorax. The heart is enclosed by a sac known as the pericardium and is surrounded by the lungs. The pericardium comprises two parts: the fibrous pericardium, made of dense fibrous connective tissue; and a double membrane structure containing a serous fluid to reduce friction during heart contractions (the serious pericardium). The mediastinum, a subdivision of the thoracic cavity, is the name of the heart cavity.
The apex is the blunt point situated in an inferior (pointing down and left) direction. A stethoscope can be placed directly over the apex so that the beats can be counted. It is located posterior to the 5th intercostal space in the left mid-clavicular line. In normal adults, the mass of the heart is 250-350 g (9-12 oz), or about three quarters the size of a clenched fist, but extremely diseased hearts can be up to 1000 g (2 lb) in mass due to hypertrophy. It consists of four chambers, the two upper atria (singular: atrium ) and the two lower ventricles.
Starting in the right atrium, the blood flows through the tricuspid valve to the right ventricle. Here it is pumped out the pulmonary semilunar valve and travels through the pulmonary artery to the lungs. From there, blood flows back through the pulmonary vein to the left atrium. It then travels through the mitral valve to the left ventricle, from where it is pumped through the aortic semilunar valve to the aorta. The aorta forks, and the blood is divided between major arteries which supply the upper and lower body. The blood travels in the arteries to the smaller arterioles, then finally to the tiny capillaries which feed each cell. The (relatively) deoxygenated blood then travels to the venules, which coalesce into veins, then to the inferior and superior venae cavae and finally back to the right atrium where the process began.
The heart is effectively a syncytium, a meshwork of cardiac muscle cells interconnected by contiguous cytoplasmic bridges. This relates to electrical stimulation of one cell spreading to neighboring cells.
The heart is one of the critical organs of an animal's body, as it pumps oxygenated blood to feed the body's biological functions. The cessation of the heartbeat, referred to as cardiac arrest, is a critical emergency. Without intervention, death can occur within minutes of cardiac arrest since the brain requires a continuous supply of oxygen and cannot survive for long if that supply is cut off.
If a person is encountered in cardiac arrest, cardiopulmonary resuscitation (CPR) should be started and help called. Use of a defibrillator is preferred, if available, to attempt to restore a normal heartbeat; many public areas have portable defibrillators available for such emergencies. Usually, if there is enough time, the person can be rushed to the hospital where he or she will be resuscitated in the Emergency Department.
Electrical innervation of the heart in health is supplied by two closely intertwined mechanisms. The first mechanism is well demonstrated in electrical coil systole (interpreted by the electrocardiogram as QRS) as an individualized myocardial electrical tree initiated by the sinoatrial node. Secondary diastolic electrical control is posited to represent autonomic recoil control from the vagus nerve and cardiac branches and the thoracic ganglia.
Philosophers distinguished veins from arteries but thought that the pulse was a property of arteries themselves. Erasistratos observed that arteries that were cut during life bleed. He ascribed the fact to the phenomenon that air escaping from an artery is replaced with blood that entered by very small vessels between veins and arteries. Thus he apparently postulated capillaries but with reversed flow of blood.
The 2nd century AD, Greek physician Galenos (Galen) knew that blood vessels carried blood and identified venous (dark red) and arterial (brighter and thinner) blood, each with distinct and separate functions. Growth and energy were derived from venous blood created in the liver from chyle, while arterial blood gave vitality by containing pneuma (air) and originated in the heart. Blood flowed from both creating organs to all parts of the body where it was consumed and there was no return of blood to the heart or liver. The heart did not pump blood around, the heart's motion sucked blood in during diastole and the blood moved by the pulsation of the arteries themselves.
Galen believed that the arterial blood was created by venous blood passing from the left ventricle to the right by passing through 'pores' in the inter ventricular septum, air passed from the lungs via the pulmonary artery to the left side of the heart. As the arterial blood was created 'sooty' vapors were created and passed to the lungs also via the pulmonary artery to be exhaled.