The Heart – Cardiology

To look at it simply, the heart is just a mechanical pump, made up of very powerful muscles. Its job is to pumps blood around your body constantly every day of your life. Like any muscle in your body, it requires its own blood supply which brings it oxygen and nutrients to keep it alive, and able to do its job.

Cardiac muscle is self-exciting. This is in contrast with skeletal muscle, which requires either conscious or reflex nervous stimuli. The heart’s rhythmic contractions occur spontaneously, although the frequency or heart rate can be changed by nervous or hormonal influences such as exercise or the perception of danger.

The rhythmic sequence of contractions is coordinated by the sinoatrial and atrioventricular nodes. The sinoatrial node, often known as the cardiac pacemaker, is located in the upper wall of the right atrium and is responsible for the wave of electrical stimulation that initiates atria contraction. Once the wave reaches the atrioventricular node, situated in the lower right atrium, it is conducted through the bundles of His and causes contraction of the ventricles. The time taken for the wave to reach this node from the sinoatrial nerve creates a delay between contraction of the two chambers and ensures that each contraction is coordinated simultaneously throughout all of the heart. In the event of severe pathology, the Purkinje fibers can also act as a pacemaker; this is usually not the case because their rate of spontaneous firing is considerably lower than that of the other pacemakers and hence is overridden.

Diagram of the Heart

The blood supply travels to the heart muscle by way of small coronary arteries. These are normally able to respond to varying demands which the heart muscle makes by dilating (opening wider) or constricting (narrowing). When the heart speeds up, it requires more energy to do the extra work; so the coronary arteries dilate and deliver more oxygen to the heart muscles.

As the heart returns to its resting mode, less oxygen is required and the coronary arteries constrict to their original size. However, things sometimes go wrong with the coronary arteries, and the outcome can be either angina or a heart attack.

The heart also secretes ANF (atrial natriuretic factor), a powerful peptide hormone, that affects the blood vessels, the adrenal glands, the kidneys and the regulatory regions of the brain to regulate blood pressure and volume.

In the human body, the heart is normally situated slightly to the left of the middle of the thorax, underneath the sternum (breastbone). It is enclosed by a sac known as the pericardium and is surrounded by the lungs. The apex is the blunt point at the base of the heart. A stethoscope can be placed directly over the apex and count the beats. In normal adults, its mass is 250-350 g, but extremely diseased hearts can be up to 1000 g in mass. It consists of four chambers, the two upper atria (singular: atrium) and the two lower ventricles.

A septum divides the right atrium and ventricle from the left atrium and ventricle, preventing blood from passing between them. Valves between the atria and ventricles (atrioventricular valves) maintain coordinated unidirectional flow of blood from the atria to the ventricles.The ventricular systole consists of the contraction of the ventricles and flow of blood into the circulatory system. Again, once all the blood empties from the ventricles, the pulmonary and aortic semilunar valves close. Finally complete cardiac diastole involves relaxation of the atria and ventricles in preparation for refilling with circulating blood.

The function of the right side of the heart is to collect deoxygenated blood from the body and pump it into the lungs so that carbon dioxide can be dropped off and oxygen picked up. this happens through a process called diffusion. The left side collects oxygenated blood from the lungs and pumps it out to the body. On both sides, the lower ventricles are thicker than the upper atria.