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Heart
FromWikipedia,thefreeencyclopedia

Theheartisamuscularorganinhumansandotheranimals,whichpumpsbloodthroughthebloodvesselsof
thecirculatorysystem.[1]Bloodprovidesthebodywithoxygenandnutrients,aswellasassistsintheremovalof
metabolicwastes.[2]Theheartislocatedinthemiddlecompartmentofthechest.[3]

Heart

Inhumans,othermammals,andbirds,theheartisdividedintofourchambers:upperleftandrightatriaand
lowerleftandrightventricles.[4][5]Commonlytherightatriumandventriclearereferredtogetherastheright
heartandtheirleftcounterpartsastheleftheart.[6]Fishincontrasthavetwochambers,anatriumanda
ventricle,whilereptileshavethreechambers.[5]Inahealthyheartbloodflowsonewaythroughtheheartdueto
heartvalves,whichpreventbackflow.[3]Theheartisenclosedinaprotectivesac,thepericardium,whichalso
containsasmallamountoffluid.Thewalloftheheartismadeupofthreelayers:epicardium,myocardium,and
endocardium.[7]
Theheartpumpsbloodwitharhythmdeterminedbyagroupofpacemakingcellsinthesinoatrialnode.These
generateacurrentthatcausescontractionoftheheart,travelingthroughtheatrioventricularnodeandalongthe
conductionsystemoftheheart.Theheartreceivesbloodlowinoxygenfromthesystemiccirculation,which
enterstherightatriumfromthesuperiorandinferiorvenaecavaeandpassestotherightventricle.Fromhereit
ispumpedintothepulmonarycirculation,throughthelungswhereitreceivesoxygenandgivesoffcarbon
dioxide.Oxygenatedbloodthenreturnstotheleftatrium,passesthroughtheleftventricleandispumpedout
throughtheaortatothesystemiccirculationwheretheoxygenisusedandmetabolizedtocarbondioxide.[8]
Theheartbeatsatarestingratecloseto72beatsperminute.[9]Exercisetemporarilyincreasestherate,but
lowersrestingheartrateinthelongterm,andisgoodforhearthealth.[10]
Cardiovasculardiseases(CVD)arethemostcommoncauseofdeathgloballyasof2008,accountingfor30%of
deaths.[11][12]Ofthesemorethanthreequartersarearesultofcoronaryarterydiseaseandstroke.[11]Riskfactors
include:smoking,beingoverweight,littleexercise,highcholesterol,highbloodpressure,andpoorlycontrolled
diabetes,amongothers.[13]Cardiovasculardiseasesfrequentlyhavenosymptomsormaycausechestpainor
shortnessofbreath.Diagnosisofheartdiseaseisoftendonebythetakingofamedicalhistory,listeningtothe
heartsoundswithastethoscope,ECG,andultrasound.[3]Specialistswhofocusondiseasesoftheheartare
calledcardiologists,althoughmanyspecialtiesofmedicinemaybeinvolvedintreatment.[12]
https://en.wikipedia.org/wiki/Heart

Thehumanheart
Details
System Circulatory
Artery Aorta, [a]pulmonarytrunkandrightand
leftpulmonaryarteries[b]Rightcoronary
artery,leftmaincoronaryartery[c]
Vein

Superiorvenacava,inferiorvenacava, [d]
rightandleftpulmonaryveins, [e]great
cardiacvein,middlecardiacvein,small
cardiacvein,anteriorcardiacveins. [f]

Nerve

Acceleransnerve,vagusnerve
Identifiers

Latin

cor
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Greek karda()

Contents
1 Structure
1.1 Locationandshape
1.2 Chambers
1.3 Heartwall
1.4 Coronarycirculation
1.5 Nervesupply
2 Development
3 Physiology
3.1 Bloodflow
3.2 Electricalconduction
3.3 Heartrate
3.4 Heartsounds
4 Clinicalsignificance
4.1 Disease
4.2 Diagnosis
4.3 Treatment
5 History
5.1 Ancient
5.2 Premodern
5.3 Modern
6 Societyandculture
6.1 Symbolism
6.2 Food
7 Otheranimals
7.1 Othervertebrates
7.2 Doublecirculatorysystems
7.3 Thefullydividedheart
7.4 Fish
7.5 Invertebrates
8 Additionalimages
9 Notes
10 References
11 Bibliography
12 Externallinks

https://en.wikipedia.org/wiki/Heart

MeSH A07.541(https://www.nlm.nih.gov/cgi/mes
h/2011/MB_cgi?mode=&term=Heart)
TA

A12.1.00.001(http://www.unifr.ch/ifaa/Pu
blic/EntryPage/TA98%20Tree/Entity%20T
A98%20EN/12.1.00.001%20Entity%20T
A98%20EN.htm)

FMA

7088(http://xiphoid.biostr.washington.ed
u/fma/fmabrowserhierarchy.html?fmaid=7
088)
Anatomicalterminology
[editonWikidata]

Normalheartsounds
0:00

MENU

Normalheartsoundsasheardwitha
stethoscope
Problemsplayingthisfile?Seemediahelp.

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Structure
Locationandshape
Thehumanheartissituatedinthemiddlemediastinum,atthelevelofthoracicvertebraeT5T8.Adoublemembranedsac
calledthepericardiumsurroundstheheartandattachestothemediastinum.[15]Thebacksurfaceoftheheartliesnearthe
vertebralcolumn,andthefrontsurfacesitsbehindtothesternumandribcartilages.[7]Theupperpartoftheheartisthe
attachmentpointforseverallargebloodvesselsthevenaecavae,aortaandpulmonarytrunk.Theupperpartoftheheartis
locatedatthelevelofthethirdcostalcartilage.[7]Thelowertipoftheheart,theapex,liestotheleftofthesternum(8to
9cmfromthemidsternalline)betweenthejunctionofthefourthandfifthribsneartheirarticulationwiththecostal
cartilages.[7]
Thelargestpartoftheheartisusuallyslightlyoffsettotheleftsideofthechest(thoughoccasionallyitmaybeoffsettothe
right)andisfelttobeontheleftbecausetheleftheartisstrongerandlarger,sinceitpumps
toallbodyparts.Becausetheheartisbetweenthelungs,theleftlungissmallerthanthe
rightlungandhasacardiacnotchinitsbordertoaccommodatetheheart.[7]Theheartis
coneshaped,withitsbasepositionedupwardsandtaperingdowntotheapex.[7]Anadult
hearthasamassof250350grams(912oz).[16]Theheartistypicallythesizeofafist:
12cm(5in)inlength,8cm(3.5in)wide,and6cm(2.5in)inthickness.[7]Welltrained
athletescanhavemuchlargerheartsduetotheeffectsofexerciseontheheartmuscle,
similartotheresponseofskeletalmuscle.[7]

Computergeneratedanimationofa
beatinghumanheart

Thehumanheartisinthe
middleofthethorax,withits
apexpointingtotheleft. [14]

RealtimeMRIofthehumanheart

Chambers
Thehearthasfourchambers,twoupperatria,thereceivingchambers,andtwolowerventricles,thedischargingchambers.Theatriaopenintotheventriclesvia
theatrioventricularvalves,presentintheatrioventricularseptum.Thisdistinctionisvisiblealsoonthesurfaceoftheheartasthecoronarysulcus.[17]Thereisan
earshapedstructureintheupperrightatriumcalledtherightatrialappendage,orauricle,andanotherintheupperleftatrium,theleftatrialappendage.[18]The
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rightatriumandtherightventricletogetheraresometimesreferredtoastherightheart.Similarly,theleftatriumandthe
leftventricletogetheraresometimesreferredtoastheleftheart.[6]Theventriclesareseparatedfromeachotherbythe
interventricularseptum,visibleonthesurfaceoftheheartastheanteriorlongitudinalsulcusandtheposterior
interventricularsulcus.[17]
Thecardiacskeletonismadeofdenseconnectivetissueandthisgivesstructuretotheheart.Itformstheatrioventricular
septumwhichseparatestheatriafromtheventricles,andthefibrousringswhichserveasbasesforthefourheartvalves.[19]
Thecardiacskeletonalsoprovidesanimportantboundaryintheheart'selectricalconductionsystemsincecollagencannot
conductelectricity.Theinteratrialseptumseparatestheatriaandtheinterventricularseptumseparatestheventricles.[7]The
interventricularseptumismuchthickerthantheinteratrialseptum,sincetheventriclesneedtogenerategreaterpressure
whentheycontract.[7]

Heartbeingdissectedshowingright
andleftventricles,fromabove

Valves
Thehearthasfourvalves,whichseparateitschambers.Onevalveliesbetweeneachatrium
andventricle,andonevalverestsattheexitofeachventricle.[7]
Thevalvesbetweentheatriaandventriclesarecalledtheatrioventricularvalves.Between
therightatriumandtherightventricleisthetricuspidvalve.Thetricuspidvalvehasthree
cusps,[20]whichconnecttochordaetendinaeandthreepapillarymusclesnamedtheanterior,
posterior,andseptalmuscles,aftertheirrelativepositions.[20]Themitralvalveliesbetween
theleftatriumandleftventricle.Itisalsoknownasthebicuspidvalveduetoitshavingtwo
cusps,ananteriorandaposteriorcusp.Thesecuspsarealsoattachedviachordaetendinae
totwopapillarymusclesprojectingfromtheventricularwall.[21]
Withtheatriaandmajorvessels

Theheart,showingvalves,

Thepapillarymusclesextendfromthewallsofthehearttovalvesbycartilaginous
removed,allfourvalvesareclearly
arteriesandveins.Thewhite
connectionscalledchordaetendinae.Thesemusclespreventthevalvesfromfallingtoofar
[7]
arrowsshowsthenormal
visible.
[22]
directionofbloodflow.
backwhentheyclose. Duringtherelaxationphaseofthecardiaccycle,thepapillary
musclesarealsorelaxedandthetensiononthechordaetendineaeisslight.Astheheart
chamberscontract,sodothepapillarymuscles.Thiscreatestensiononthechordaetendineae,helpingtoholdthecuspsoftheatrioventricularvalvesinplaceand
preventingthemfrombeingblownbackintotheatria.[7][g][20]
Twoadditionalsemilunarvalvessitattheexitofeachoftheventricles.Thepulmonaryvalveislocatedatthebaseofthepulmonaryartery.Thishasthreecusps
whicharenotattachedtoanypapillarymuscles.Whentheventriclerelaxesbloodflowsbackintotheventriclefromthearteryandthisflowofbloodfillsthe
pocketlikevalve,pressingagainstthecuspswhichclosetosealthevalve.Thesemilunaraorticvalveisatthebaseoftheaortaandalsoisnotattachedtopapillary
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muscles.Thistoohasthreecuspswhichclosewiththepressureofthebloodflowingbackfromtheaorta.[7]
Rightheart
Therightheartconsistsoftwochambers,therightatriumandtherightventricle,separatedbyavalve,thetricuspid
valve.[7]
Therightatriumreceivesbloodalmostcontinuouslyfromthebody'stwomajorveins,thesuperiorandinferiorvenae
cavae.Asmallamountofbloodfromthecoronarycirculationalsodrainsintotherightatriumviathecoronarysinus,which
isimmediatelyaboveandtothemiddleoftheopeningoftheinferiorvenacava.[7]Inthewalloftherightatriumisanoval
shapeddepressionknownasthefossaovalis,whichisaremnantofanopeninginthefetalheartknownastheforamen
ovale.[7]Mostoftheinternalsurfaceoftherightatriumissmooth,thedepressionofthefossaovalisismedial,andthe
anteriorsurfacehasprominentridgesofpectinatemuscles,whicharealsopresentintherightatrialappendage.[7]

Frontalsectionshowingpapillary
musclesattachedtothetricuspid
valveontherightandtothemitral
valveontheleftviachordae
tendineae. [7]

Therightatriumisconnectedtotherightventriclebythetricuspidvalve.[7]Thewallsoftherightventriclearelinedwith
trabeculaecarneae,ridgesofcardiacmusclecoveredbyendocardium.Inadditiontothesemuscularridges,abandofcardiacmuscle,alsocoveredby
endocardium,knownasthemoderatorbandreinforcesthethinwallsoftherightventricleandplaysacrucialroleincardiacconduction.Itarisesfromthelower
partoftheinterventricularseptumandcrossestheinteriorspaceoftherightventricletoconnectwiththeinferiorpapillarymuscle.[7]Therightventricletapersinto
thepulmonarytrunk,intowhichitejectsbloodwhencontracting.Thepulmonarytrunkbranchesintotheleftandrightpulmonaryarteriesthatcarrythebloodto
eachlung.Thepulmonaryvalveliesbetweentherightheartandthepulmonarytrunk.[7]
Leftheart
Thelefthearthastwochambers:theleftatrium,andtheleftventricle,separatedbythemitralvalve.[7]
Theleftatriumreceivesoxygenatedbloodbackfromthelungsviaoneofthefourpulmonaryveins.Theleftatriumhasanoutpouchingcalledtheleftatrial
appendage.Liketherightatrium,theleftatriumislinedbypectinatemuscles.[23]Theleftatriumisconnectedtotheleftventriclebythemitralvalve.[7]
Theleftventricleismuchthickerascomparedwiththeright,duetothegreaterforceneededtopumpbloodtotheentirebody.Liketherightventricle,theleftalso
hastrabeculaecarneae,butthereisnomoderatorband.Theleftventriclepumpsbloodtothebodythroughtheaorticvalveandintotheaorta.Twosmallopenings
abovetheaorticvalvecarrybloodtotheheartitself,theleftmaincoronaryarteryandtherightcoronaryartery.[7]

Heartwall

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Theheartwallismadeupofthreelayers:theinnerendocardium,middlemyocardiumandouterepicardium.Theseare
surroundedbyadoublemembranedsaccalledthepericardium.
Theinnermostlayeroftheheartiscalledtheendocardium.Itismadeupofaliningofsimplesquamousepithelium,and
coversheartchambersandvalves.Itiscontinuouswiththeendotheliumoftheveinsandarteriesoftheheart,andisjoined
tothemyocardiumwithathinlayerofconnectivetissue.[7]Theendocardium,bysecretingendothelins,mayalsoplaya
roleinregulatingthecontractionofthemyocardium.[7]
Themiddlelayeroftheheartwallisthemyocardium,whichisthecardiacmusclealayerofinvoluntarystriatedmuscle
tissuesurroundedbyaframeworkofcollagen.Thecardiacmusclepatterniselegantandcomplex,asthemusclecellsswirl
andspiralaroundthechambersoftheheart,withtheoutermusclesformingafigure8patternaroundtheatriaandaround
thebasesofthegreatvessels,andinnermusclesforminingafigure8aroundthetwoventriclesandproceedtowardthe
apex.Thiscomplexswirlingpatternallowsthehearttopumpbloodmoreeffectively.[7]
Therearetwotypesofcellsincardiacmuscle:musclecellswhichhavetheabilitytocontracteasily,andpacemakercellsof
theconductingsystem.Themusclecellsmakeupthebulk(99%)ofcellsintheatriaandventricles.Thesecontractilecellsare
connectedbyintercalateddiscswhichallowarapidresponsetoimpulsesofactionpotentialfromthepacemakercells.The
intercalateddiscsallowthecellstoactasasyncytiumandenablethecontractionsthatpumpbloodthroughtheheartandinto
themajorarteries.[7]Thepacemakercellsmakeup1%ofcellsandformtheconductionsystemoftheheart.Theyare
generallymuchsmallerthanthecontractilecellsandhavefewmyofibrilswhichgivesthemlimitedcontractibility.Their
functionissimilarinmanyrespectstoneurons.[7]Cardiacmuscletissuehasautorhythmicity,theuniqueabilitytoinitiatea
cardiacactionpotentialatafixedratespreadingtheimpulserapidlyfromcelltocelltotriggerthecontractionoftheentire
heart.[7]
Thepericardiumsurroundstheheart.Itconsistsoftwomembranes:aninnerserousmembranecalledtheepicardium,andan
outerfibrousmembrane.Bloodvesselsandnervesreachthecardiacmusclefromtheepicardium.[7]Thesehelpinfluencethe
heartrate.[7]Theseenclosethepericardialcavitywhichcontainsthepericardialfluidthatlubricatesthesurfaceoftheheart.[24]

Layersoftheheartwall,including
visceralandparietalpericardium.

Theswirlingpatternof
myocardiumhelpstheheartpump
effectively

Coronarycirculation
Hearttissue,likeallcellsinthebody,needstobesuppliedwithoxygen,nutrientsandawayofremovingmetabolicwastes.Thisisachievedbythecoronary
circulation,whichincludesarteries,veins,andlymphaticvessels,Bloodflowthroughthecoronaryvesselsoccursinpeaksandtroughsrelatingtotheheart
muscle'srelaxationorcontraction.[7]

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Hearttissuereceivesbloodfromtwoarterieswhicharisejustabovetheaorticvalve.Thesearetheleftmaincoronaryartery
andtherightcoronaryartery.Theleftmaincoronaryarterysplitsshortlyafterleavingtheaortaintotwovessels,theleft
anteriordescendingandtheleftcircumflexartery.Theleftanteriordescendingarterysupplieshearttissueandthefront,
outerside,andtheseptumoftheleftventricle.Itdoesthisbybranchingintosmallerarteriesdiagonalandseptalbranches.
Theleftcircumflexsuppliesthebackandunderneathoftheleftventricle.Therightcoronaryarterysuppliestheright
atrium,rightventricle,andlowerposteriorsectionsoftheleftventricle.Therightcoronaryarteryalsosuppliesbloodtothe
atrioventricularnode(inabout90%ofpeople)andthesinoatrialnode(inabout60%ofpeople).Therightcoronaryartery
runsinagrooveatthebackoftheheartandtheleftanteriordescendingarteryrunsinagrooveatthefront.Thereis
significantvariationbetweenpeopleintheanatomyofthearteriesthatsupplytheheart[25]Thearteriesdivideattheir
furtherstreachesintosmallerbranchesthatjointogetherattheedgesofeacharterialdistribution.[7]

Arterialsupplytotheheart(red),
withotherareaslabelled(blue).

Thecoronarysinusisalargeveinthatdrainsintotherightatrium,andreceivesmostofthevenousdrainageoftheheart.Itreceivesbloodfromthegreatcardiac
vein(receivingtheleftatriumandbothventricles),theposteriorcardiacvein(drainingthebackoftheleftventricle),themiddlecardiacvein(drainingthebottom
oftheleftandrightventricles),andsmallcardiacveins.[26]Theanteriorcardiacveinsdrainthefrontoftherightventricleanddraindirectlyintotherightatrium.[7]
Smalllymphaticnetworkscalledplexusesexistbeneatheachofthethreelayersoftheheart.Thesenetworkscollectintoamainleftandamainrighttrunk,which
travelupthegroovebetweentheventriclesthatexistsontheheart'ssurface,receivingsmallervesselsastheytravelup.Thesevesselsthentravelintothe
atrioventriculargroove,andreceiveathirdvesselwhichdrainsthesectionoftheleftventriclesittingonthediaphragm.Theleftvesseljoinswiththisthirdvessel,
andtravelsalongthepulmonaryarteryandleftatrium,endingintheinferiortracheobronchialnode.Therightvesseltravelsalongtherightatriumandthepartof
therightventriclesittingonthediaphragm.Itusuallythentravelsinfrontoftheascendingaortaandthenendsinabrachiocephalicnode.[27]

Nervesupply
Theheartreceivesnervesignalsfromthevagusnerveandfromnervesarisingfromthesympathetictrunk.Thesenervesacttoinfluence,butnotcontrol,theheart
rate.Sympatheticnervesalsoinfluencetheforceofheartcontraction.[28]Signalsthattravelalongthesenervesarisefromtwopairedcardiovascularcentresinthe
medullaoblongata.Thevagusnerveoftheparasympatheticnervoussystemactstodecreasetheheartrate,andnervesfromthesympathetictrunkacttoincrease
theheartrate.[7]Thesenervesformanetworkofnervesthatliesovertheheartcalledthecardiacplexus.[7][27]
Thevagusnerveisalong,wanderingnervethatemergesfromthebrainstemandprovidesparasympatheticstimulationtoalargenumberoforgansinthethorax
andabdomen,includingtheheart.[29]ThenervesfromthesympathetictrunkemergethroughtheT1T4thoracicgangliaandtraveltoboththesinoatrialand
atrioventricularnodes,aswellastotheatriaandventricles.Theventriclesaremorerichlyinnervatedbysympatheticfibersthanparasympatheticfibers.
Sympatheticstimulationcausesthereleaseoftheneurotransmitternorepinephrine(alsoknownasnoradrenaline)attheneuromuscularjunctionofthecardiac
nerves.Thisshortenstherepolarizationperiod,thusspeedingtherateofdepolarizationandcontraction,whichresultsinanincreasedheartrate.Itopenschemical
orligandgatedsodiumandcalciumionchannels,allowinganinfluxofpositivelychargedions.[7]Norepinephrinebindstothebeta1receptor.[7]

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Development
Theheartisthefirstfunctionalorgantodevelopandstartstobeatandpumpbloodataboutthreeweeksinto
embryogenesis.Thisearlystartiscrucialforsubsequentembryonicandprenataldevelopment.
Theheartderivesfromsplanchnopleuricmesenchymeintheneuralplatewhichformsthecardiogenicregion.Two
endocardialtubesformherethatfusetoformaprimitivehearttubeknownasthetubularheart.[30]Betweenthethirdand
fourthweek,thehearttubelengthens,andbeginstofoldtoformanSshapewithinthepericardium.Thisplacesthe
chambersandmajorvesselsintothecorrectalignmentforthedevelopedheart.Furtherdevelopmentwillincludethesepta
andvalvesformationandremodellingoftheheartchambers.Bytheendofthefifthweektheseptaarecompleteandthe
heartvalvesarecompletedbytheninthweek.[7]
Beforethefifthweek,thereisanopeninginthefetalheartknownastheforamenovale.Theforamenovaleallowedblood
inthefetalhearttopassdirectlyfromtherightatriumtotheleftatrium,allowingsomebloodtobypassthelungs.Within
secondsafterbirth,aflapoftissueknownastheseptumprimumthatpreviouslyactedasavalveclosestheforamenovale
andestablishesthetypicalcardiaccirculationpattern.Adepressioninthesurfaceoftherightatriumremainswherethe
foramenovaleoncewalls,calledthefossaovalis.[7]
Theembryonicheartbeginsbeatingataround22daysafterconception(5weeksafterthelastnormalmenstrualperiod,
LMP).Itstartstobeatatarateneartothemother'swhichisabout7580beatsperminute(bpm).Theembryonicheartrate
thenacceleratesandreachesapeakrateof165185bpmearlyintheearly7thweek(early9thweekaftertheLMP).[31][32]
After9weeks(startofthefetalstage)itstartstodecelerate,slowingtoaround145(25)bpmatbirth.Thereisno
differenceinfemaleandmaleheartratesbeforebirth.[33]
Autonomicinnervationoftheheart

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Developmentofthehumanheartduringthefirsteightweeks(top),andthe
formationoftheheartchambers(bottom). [7]

Physiology
Bloodflow
Theheartfunctionsasapumpinthecirculatorysystemtoprovideacontinuousflowofbloodthroughoutthebody.Thiscirculationconsistsofthesystemic
circulationtoandfromthebodyandthepulmonarycirculationtoandfromthelungs.Bloodinthepulmonarycirculationexchangescarbondioxideforoxygenin
thelungsthroughtheprocessofrespiration.Thesystemiccirculationthentransportsoxygentothebodyandreturnscarbondioxideandrelativelydeoxygenated
bloodtotheheartfortransfertothelungs.[7]

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Therightheartcollectsdeoxygenatedbloodfromtwolargeveins,thesuperiorand
inferiorvenaecavae.Bloodcollectsintherightandleftatriumcontinuously.[7]The
superiorvenacavadrainsbloodfromabovethediaphragmandemptiesintothe
upperbackpartoftherightatrium.Theinferiorvenacavadrainsthebloodfrom
belowthediaphragmandemptiesintothebackpartoftheatriumbelowtheopening
forthesuperiorvenacava.Immediatelyaboveandtothemiddleoftheopeningof
theinferiorvenacavaistheopeningofthethinwalledcoronarysinus.[7]
Bloodflowthroughtheheartfrom
Additionally,thecoronarysinusreturnsdeoxygenatedbloodfromthemyocardium
theKhanacademy
totherightatrium.Thebloodcollectsintherightatrium.Whentherightatrium
contracts,thebloodispumpedthroughthetricuspidvalveintotherightventricle.
Astherightventriclecontracts,thetricuspidvalveclosesandthebloodispumpedintothepulmonarytrunkthroughthe
pulmonaryvalve.Thepulmonarytrunkdividesintopulmonaryarteriesandprogressivelysmallerarteriesthroughoutthe
lungs,untilitreachescapillaries.Asthesepassbyalveolicarbondioxideisexchangedforoxygen.Thishappensthrough
thepassiveprocessofdiffusion.

Intheleftheart,oxygenatedbloodisreturnedtotheleftatriumviathepulmonaryveins.Itisthenpumpedintotheleftventriclethroughthemitralvalveandinto
theaortathroughtheaorticvalveforsystemiccirculation.Theaortaisalargearterythatbranchesintomanysmallerarteries,arterioles,andultimatelycapillaries.
Inthecapillaries,oxygenandnutrientsfrombloodaresuppliedtobodycellsformetabolism,andexchangedforcarbondioxideandwasteproducts.[7]Capillary
blood,nowdeoxygenated,travelsintovenulesandveinsthatultimatelycollectinthesuperiorandinferiorvenacavae,andintotherightheart.
Cardiaccycle
Thecardiaccyclereferstoacompleteheartbeatwhichincludessystoleanddiastoleandtheinterveningpause.[9]Thecyclebeginswithcontractionoftheatriaand
endswithrelaxationoftheventricles.Systolereferstocontractionoftheatriaorventriclesoftheheart.Diastoleiswhentheatriaorventriclesrelaxandfillwith
blood.Theatriaandventriclesworkinconcert,soinsystolewhentheventriclesarecontracting,theatriaarerelaxedandcollectingblood.Whentheventriclesare
relaxedindiastole,theatriacontracttopumpbloodtotheventricles.Thiscoordinationensuresbloodispumpedefficientlytothebody.[7]
Atthebeginningofthecardiaccycle,inearlydiastole,boththeatriaandventriclesarerelaxed.Sincebloodmovesfromareasofhighpressuretoareasoflow
pressure,whenthechambersarerelaxed,bloodwillflowintotheatria(throughthecoronarysinusandthepulmonaryveins).Astheatriabegintofill,thepressure
willrisesothatthebloodwillmovefromtheatriaintotheventricles.Inlatediastoletheatriacontract,pumpingmorebloodintotheventricles.Thiscausesarise
inpressureintheventricles.Astheventriclesreachsystole,bloodwillbepumpedintothepulmonaryartery(rightventricle)oraorta(leftventricle).[9]
Whentheatrioventricularvalves(tricuspidandmitral)areopen,duringbloodflowtotheventricles,theaorticandpulmonaryvalvesareclosedtoprevent
backflowintotheventricles.Whentheventricularpressureisgreaterthantheatrialpressurethetricuspidandmitralvalveswillshut.Whentheventriclescontract
thepressureforcestheaorticandpulmonaryvalvesopen.Astheventriclesrelax,theaorticandpulmonaryvalveswillcloseinresponsetodecreasedpressure.[9]
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Cardiacoutput
Cardiacoutput(CO)isameasurementoftheamountofbloodpumpedbyeachventricle(strokevolume)inoneminute.
Thisiscalculatedbymultiplyingthestrokevolume(SV)bythebeatsperminuteoftheheartrate(HR).Sothat:CO=SVx
HR.[7]Thecardiacoutputisnormalizedtobodysizethroughbodysurfaceareaandiscalledthecardiacindex.
Theaveragecardiacoutput,usinganaveragestrokevolumeofabout70mL,is5.25L/min,withanormalrangeof4.08.0
L/min.[7]Thestrokevolumeisnormallymeasuredusinganechocardiogramandcanbeinfluencedbythesizeoftheheart,
physicalandmentalconditionoftheindividual,sex,contractility,durationofcontraction,preloadandafterload.[7]
Preloadreferstothefillingpressureoftheatriaattheendofdiastole,whentheyareattheirfullest.Amainfactorishow
longittakestheventriclestofilliftheventriclescontractfaster,thenthereislesstimetofillandthepreloadwillbe
less.[7]Preloadcanalsobeaffectedbyaperson'sbloodvolume.Theforceofeachcontractionoftheheartmuscleis
proportionaltothepreload,describedastheFrankStarlingmechanism.Thisstatesthattheforceofcontractionisdirectly
proportionaltotheinitiallengthofmusclefiber,meaningaventriclewillcontractmoreforcefully,themoreitis
stretched.[7][34]

Thecardiaccycleascorrelatedtothe
ECG

Afterload,orhowmuchpressuretheheartmustgeneratetoejectbloodatsystole,isinfluencedbyvascularresistance.It
canbeinfluencedbynarrowingoftheheartvalves(stenosis)orcontractionorrelaxationoftheperipheralbloodvessels.[7]
Thestrengthofheartmusclecontractionscontrolsthestrokevolume.Thiscanbeinfluencedpositivelyornegativelyby
agentstermedinotropes.[35]Theseagentscanbearesultofchangeswithinthebody,orbegivenasdrugsaspartof
treatmentforamedicaldisorder,orasaformoflifesupport,particularlyinintensivecareunits.Inotropesthatincreasethe
forceofcontractionare"positive"inotropes,andincludesympatheticagentssuchasadrenaline,noradrenalineand
dopamine.[36]"Negative"inotropesdecreasetheforceofcontractionandincludecalciumchannelblockers.[35]

Electricalconduction
Thenormalrhythmicalheartbeat,calledsinusrhythm,isestablishedbythesinoatrialnode,theheart'spacemaker.Herean
electricalsignaliscreatedthattravelsthroughtheheart,causingtheheartmuscletocontract.

Thexaxisreflectstimewitha
recordingoftheheartsounds.They
axisrepresentspressure. [7]

Thesinoatrialnodeisfoundintheupperpartoftherightatriumneartothejunctionwiththesuperiorvenacava.[37]Theelectricalsignalgeneratedbythe
sinoatrialnodetravelsthroughtherightatriuminaradialwaythatisnotcompletelyunderstood.IttravelstotheleftatriumviaBachmann'sbundle,suchthatthe
musclesoftheleftandrightatriacontracttogether.[38][39][40]Thesignalthentravelstotheatrioventricularnode.Thisisfoundatthebottomoftherightatriumin
theatrioventricularseptumtheboundarybetweentherightatriumandtheleftventricle.Theseptumispartofthecardiacskeleton,tissuewithintheheartthatthe
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electricalsignalcannotpassthrough,whichforcesthesignaltopassthroughtheatrioventricularnodeonly.[7]The
signalthentravelsalongthebundleofHistoleftandrightbundlebranchesthroughtotheventriclesoftheheart.
IntheventriclesthesignaliscarriedbyspecializedtissuecalledthePurkinjefiberswhichthentransmittheelectric
chargetotheheartmuscle.[41]

Heartrate
Thenormalrestingheartrateiscalledthesinusrhythm,createdandsustainedbythesinoatrialnode,agroupof
pacemakingcellsfoundinthewalloftherightatrium.Cellsinthesinoatrialnodedothisbycreatinganaction
potential.Thecardiacactionpotentialiscreatedbythemovementofspecificelectrolytesintoandoutofthe
pacemakercells.Theactionpotentialthenspreadstonearbycells.[42]
Whenthesinoatrialcellsareresting,theyhaveanegativechargeontheirmembranes.Howeverarapidinfluxof
sodiumionscausesthemembrane'schargetobecomepositive.Thisiscalleddepolarisationandoccurs
spontaneously.[7]Oncethecellhasasufficientlyhighcharge,thesodiumchannelscloseandcalciumionsthen
begintoenterthecell,shortlyafterwhichpotassiumbeginstoleaveit.Alltheionstravelthroughionchannelsin
themembraneofthesinoatrialcells.Thepotassiumandcalciumonlystarttomoveoutofandintothecellonceit
hasasufficientlyhighcharge,andsoarecalledvoltagegated.Shortlyafterthis,thecalciumchannelscloseand
potassiumchannelsopen,allowingpotassiumtoleavethecell.Thiscausesthecelltohaveanegativeresting
chargeandiscalledrepolarization.Whenthemembranepotentialreachesapproximately60mV,thepotassium
channelscloseandtheprocessmaybeginagain.[7]

Transmissionofacardiacactionpotential
throughtheheart'sconductionsystem

Theionsmovefromareaswheretheyareconcentratedtowheretheyarenot.Forthisreasonsodiummovesinto
thecellfromoutside,andpotassiummovesfromwithinthecelltooutsidethecell.Calciumalsoplaysacritical
role.Theirinfluxthroughslowchannelsmeansthatthesinoatrialcellshaveaprolonged"plateau"phasewhen
theyhaveapositivecharge.Apartofthisiscalledtheabsoluterefractoryperiod.Calciumionsalsocombinewith
theregulatoryproteintroponinCinthetroponincomplextoenablecontractionofthecardiacmuscle,andseparate
fromtheproteintoallowrelaxation.[43]
Theadultrestingheartraterangesfrom60to100bpm.Therestingheartrateofanewborncanbe129beatsper
minute(bpm)andthisgraduallydecreasesuntilmaturity.[44]Anathlete'sheartratecanbelowerthan60bpm.
Duringexercisetheratecanbe150bpmwithmaximumratesreachingfrom200to220bpm.[7]

Conductionsystemoftheheart

Influences

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Thenormalsinusrhythmoftheheart,givingtherestingheartrate,isinfluencedanumberoffactors.Thecardiovascular
centresinthebrainstemthatcontrolthesympatheticandparasympatheticinfluencestotheheartthroughthevagusnerve
andsympathetictrunk.[45]Thesecardiovascularcentresreceiveinputfromaseriesofreceptorsincludingbaroreceptors,
sensingstretchthestretchingofbloodvesselsandchemoreceptors,sensingtheamountofoxygenandcarbondioxideinthe
bloodanditspH.Throughaseriesofreflexesthesehelpregulateandsustainbloodflow.[7]
Baroreceptorsarestretchreceptorslocatedintheaorticsinus,carotidbodies,thevenaecavae,andotherlocations,
includingpulmonaryvesselsandtherightsideoftheheartitself.Baroreceptorsfireataratedeterminedbyhowmuchthey
arestretched,[46]whichisinfluencedbybloodpressure,levelofphysicalactivity,andtherelativedistributionofblood.
Withincreasedpressureandstretch,therateofbaroreceptorfiringincreases,andthecardiaccentersdecreasesympathetic
stimulationandincreaseparasympatheticstimulation.Aspressureandstretchdecrease,therateofbaroreceptorfiring
decreases,andthecardiaccentersincreasesympatheticstimulationanddecreaseparasympatheticstimulation.[7]Thereisa
similarreflex,calledtheatrialreflexorBainbridgereflex,associatedwithvaryingratesofbloodflowtotheatria.Increased
venousreturnstretchesthewallsoftheatriawherespecializedbaroreceptorsarelocated.However,astheatrial
baroreceptorsincreasetheirrateoffiringandastheystretchduetotheincreasedbloodpressure,thecardiaccenter
respondsbyincreasingsympatheticstimulationandinhibitingparasympatheticstimulationtoincreaseheartrate.The
oppositeisalsotrue.[7]Chemoreceptorspresentinthecarotidbodyoradjacenttotheaortainanaorticbodyrespondtothe
blood'soxygen,carbondioxidelevels.Lowoxygenorhighcarbondioxidewillstimulatefiringofthereceptors.[47]

Theprepotentialisduetoaslow
influxofsodiumionsuntilthe
thresholdisreachedfollowedbya
rapiddepolarizationand
repolarization.Theprepotential
accountsforthemembranereaching
thresholdandinitiatesthe
spontaneousdepolarizationand
contractionofthecellthereisno
restingpotential. [7]

Exerciseandfitnesslevels,age,bodytemperature,basalmetabolicrate,andevenaperson'semotionalstatecanallaffecttheheartrate.Highlevelsofthe
hormonesepinephrine,norepinephrine,andthyroidhormonescanincreasetheheartrate.Thelevelsofelectrolytesincludingcalcium,potassium,andsodiumcan
alsoinfluencethespeedandregularityoftheheartratelowbloodoxygen,lowbloodpressureanddehydrationmayincreaseit.[7]

Heartsounds
Oneofthesimplestmethodsofassessingtheheart'sconditionistolistentoitusingastethoscope.[7]Typically,healthyheartshaveonlytwoaudibleheartsounds,
calledS1andS2.ThefirstheartsoundS1,isthesoundcreatedbytheclosingoftheatrioventricularvalvesduringventricularcontractionandisnormally
describedas"lub".Thesecondheartsound,S2,isthesoundofthesemilunarvalvesclosingduringventriculardiastoleandisdescribedas"dub".[7]Eachsound
consistsoftwocomponents,reflectingtheslightdifferenceintimeasthetwovalvesclose.[48]S2maysplitintotwodistinctsounds,eitherasaresultofinspiration
ordifferentvalvularorcardiacproblems.[48]Additionalheartsoundsmayalsobepresentandthesegiverisetogalloprhythms.Athirdheartsound,S3usually
indicatesanincreaseinventricularbloodvolume.AfourthheartsoundS4isreferredtoasanatrialgallopandisproducedbythesoundofbloodbeingforcedinto
astiffventricle.ThecombinedpresenceofS3andS4giveaquadruplegallop.[7]
Heartmurmursareabnormalheartsoundswhichcanbeeitherpathologicalorbenign.[49]OneexampleofamurmurisStill'smurmur,whichpresentsamusical
soundinchildren,hasnosymptomsanddisappearsinadolescence.[50]
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Adifferenttypeofsound,apericardialfrictionrubcanbeheardincasesofpericarditiswheretheinflamedmembranescan
rubtogether.[51]

Clinicalsignificance
Disease
Cardiovasculardiseases,whichincludediseasesoftheheart,aretheleadingcauseofdeathworldwide.[52]Themajorityof
cardiovasculardiseaseisnoncommunicableandrelatedtolifestyleandotherfactors,becomingmoreprevalentwith
ageing.[52]Heartdiseaseisamajorcauseofdeath,accountingforanaverageof30%ofalldeathsin2008,globally.[11]This
ratevariesfromalower28%toahigh40%inhighincomecountries.[12]Doctorsthatspecialiseintheheartarecalled
cardiologists.Manyothermedicalprofessionalsareinvolvedintreatingdiseasesoftheheart,includingdoctorssuchas
generalpractitioners,cardiothoracicsurgeonsandintensivists,andalliedhealthpractitionersincludingphysiotherapistsand
dieticians.[53]

3Dechocardiogramshowingthe
mitralvalve(right),tricuspidand
mitralvalves(topleft)andaortic
valve(topright).
Theclosureoftheheartvalvescauses
theheartsounds.

Coronaryarterydiseaseisalsoknownasischemicheartdisease,iscausedbyatherosclerosisabuildupofplaquealongtheinnerwallsofthearterieswhich
narrowsthem,reducingthebloodflowtotheheart.[54]Astableplaquemaycausechestpain(angina)orbreathlessnessduringexerciseoratrest,ornosymptoms
atall.Arupturedplaquecanblockabloodvesselandleadtoischaemiaoftheheartmuscle,causingunstableanginaoraheartattack.[55]Intheworstcasethis
maycausecardiacarrest,asuddenandutterlossofoutputfromtheheart.[56]Obesity,highbloodpressure,uncontrolleddiabetes,smokingandhighcholesterol
canallincreasetheriskofdevelopingatherosclerosisandcoronaryarterydisease.[52][54]
Heartfailureiswheretheheartcan'tbeatoutenoughbloodtomeettheneedsofthebody.[54]Itisgenerallyachroniccondition,associatedwithage,that
progressesgradually.[57]Eachsideoftheheartcanfailindependentlyoftheother,resultinginheartfailureoftherightheartortheleftheart.Leftheartfailurecan
alsoleadtorightheartfailure(corpulmonale)byincreasingstrainontherightheart.Iftheheartisunabletopumpsufficientblood,itmayaccumulatethroughout
thebody,causingbreathlessnessinthelungs(pulmonarycongestionpulmonaryedema),swelling(edema)ofthefeetorothergravitydependentareas,decrease
exercisetolerance,orcauseotherclinicalsignssuchasanenlargedliver,cardiacmurmurs,oraraisedjugularvenouspressure.Commoncausesofheartfailure
includecoronaryarterydisease,valvedisordersanddiseasesofcardiacmuscle.[58]
Cardiomyopathyisanoticeabledeteriorationoftheheartmuscle'sabilitytocontract,whichcanleadtoheartfailure.Thecausesofmanytypesofcardiomyopathy
arepoorlyunderstoodsomeidentifiedcausesincludealcohol,toxins,systemicdiseasesuchassarcoidosis,andcongenitalconditionssuchasHOCM.Thetypesof
cardiomyopathyaredescribedaccordingtohowtheyaffectheartmuscle.Cardiomyopathycancausethehearttobecomeenlarged(hypertrophiccardiomyopathy),
constricttheoutflowtractsoftheheart(restrictivecardiomyopathy),orcausethehearttodilateandimpacttheefficiencyofitsbeating(dilated
cardiomyopathy).[59]HOCMisoftenundiagnosedandcancausesuddendeathinyoungathletes.[7]
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Heartmurmursareabnormalheartsoundswhichcanbeeitherrelatedtodiseaseorbenign,andthereareseveralkinds.[60]
Therearenormallytwoheartsounds,andabnormalheartsoundscaneitherbeextrasounds,or"murmurs"relatedtothe
flowofbloodbetweenthesounds.Murmursaregradedbyvolume,from1(thequietest),to6(theloudest),andevaluated
bytheirrelationshiptotheheartsounds,positioninthecardiaccycle,andadditionalfeaturessuchastheirradiationto
othersites,changeswithaperson'sposition,thefrequencyofthesoundasdeterminedbythesideofthestethoscopeby
whichtheyareheard,andsiteatwhichtheyareheardloudest.[60]Phonocardiogramscanrecordthesesounds,[7]and
echocardiogramsaregenerallyrequiredfortheirdiagnosis.[61]Murmurscanresultfromvalvularheartdiseasesdueto
narrowing(stenosis),orregurgitationofanyofthemainheartvalves,suchasaorticstenosis,mitralregurgitationor
mitralvalveprolapse.Theycanalsoresultfromanumberofotherdisorders,includingatrialandventricularseptal
defects.[60]Twocommonandinfectivecausesofheartmurmursareinfectiveendocarditisandrheumaticfever,
particularlyindevelopingcountries.Infectiveendocarditisinvolvescolonisationofaheartvalve,[62]andrheumaticfever
involvesaninitialbacterialinfectionbyGroupAstreptococcusfollowedbyareactionagainsthearttissuethatresembles
thestreptococcalantigen.[63]
Abnormalitiesinthenormalsinusrhythmoftheheartcanpreventtheheartfromeffectivelypumpingblood,andare
generallyidentifiedbyECG.Thesecardiacarrhythmiascancauseanabnormalbutregularheartrhythm,suchasarapid
heartrate(tachycardia,classifiedasarisingfromabovetheventriclesorfromtheventricles)oraslowheartrate
(bradycardia)ormayresultinirregularrhythms.Tachycardiaisgenerallydefinedasaheartratefasterthan100beatsper
minute,andbradycardiaasaheartrateslowerthan60.[64]Asystoleisthecessationofheartrhythm.Arandomand
varyingrhythmisclassifiedasatrialorventricularfibrillationdependingiftheelectricalactivityoriginatesintheatriaor
theventricles.[64]Abnormalconductioncancauseadelayorunusualorderofcontractionoftheheartmuscle.Thiscanbe
aresultofadiseaseprocess,suchasheartblock,orcongenital,suchasWolffParkinsonWhitesyndrome.[64]

Thestethoscopeisusedforauscultation
oftheheart,andisoneofthemost
iconicsymbolsformedicine.Anumber
ofdiseasescanbedetectedprimarilyby
listeningforheartmurmurs.

Atherosclerosisisaconditionaffecting
thecirculatorysystem.Ifthecoronary
arteriesareaffectedanginapectoris
mayresultoratworseaheartattack.

Diseasesmayalsoaffectthepericardiumwhichsurroundstheheart,whichwheninflammediscalledpericarditis.This
mayresultfrominfectivecauses(suchasglandularfever,cytomegalovirus,coxsackievirus,tuberculosisorQfever),
systemicdisorderssuchasamyloidosisorsarcoidosis,tumours,highuricacidlevels,andothercauses.Thisinflammation
affectstheabilityofthehearttopumpeffectively.Whenfluidbuildsupinthepericardiumthisiscalledpericardialeffusion,whichwhenitcausesacuteheart
failureiscalledcardiactamponade.Thismaybebloodfromatraumaticinjuryorfluidfromaneffusion.[65]Thiscancompresstheheartandadverselyaffectthe
functionoftheheart.Thefluidcanberemovedfromthepericardialsacusingasyringeinaprocedurecalledpericardiocentesis.[66]

Theheartcanbeaffectedbycongenitaldiseases.Theseincludefailureofthedevelopmentalforamenovaletoclose,presentinupto25%ofpeople[67]ventricular
oratrialseptaldefects,congenitaldiseasesoftheheartvalves(e.g.congenitalaorticstenosis)ordiseaserelatingtobloodvesselsorbloodflowfromtheheart
(suchasapatentductusarteriosusoraorticcoarctation).[68][69]Thesemaycausesymptomsatavarietyofages.Ifunoxygenatedbloodtravelsdirectlyfromthe

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righttotheleftsideoftheheart,itmaybenoticedatbirth,asitmaycauseababytobecomeblue(cyanotic)suchasTetralogyofFallot.Aheartproblemmay
impactachild'sabilitytogrow.[68]Somecausesrectifywithtimeandareregardedasbenign.Othercausesmaybeincidentallydetectedonacardiacexamination.
Thesedisordersareoftendiagnosedonanechocardiogram.[69]

Diagnosis
Heartdiseaseisdiagnosedbythetakingofamedicalhistory,acardiacexamination,andfurtherinvestigations,includingbloodtests,echocardiograms,ECGsand
imaging.Otherinvasiveproceduressuchascardiaccatheterisationcanalsoplayarole.[70]
Examination
Thecardiacexaminationincludesinspection,feelingthechestwiththehands(palpation)andlisteningwithastethoscope(auscultation).[71][72]Itinvolves
assessmentofsignsthatmaybevisibleonaperson'shands(suchassplinterhaemorrhages),jointsandotherareas.Aperson'spulseistaken,usuallyattheradial
arterynearthewrist,inordertoassessfortherhythmandstrengthofthepulse.Thebloodpressureistaken,usingeitheramanualorautomatic
sphygmomanometerorusingamoreinvasivemeasurementfromwithintheartery.Anyelevationofthejugularvenouspulseisnoted.Aperson'schestisfeltfor
anytransmittedvibrationsfromtheheart,andthenlistenedtowithastethoscope.Anormalhearthastwoheartssoundsadditionalheartsoundsorheartmurmurs
mayalsobeabletobeheardandmaypointtodisease.Additionaltestsmaybeconductedtoassessaperson'sheartmurmursiftheyarepresent,andperipheral
signsofheartdiseasesuchasswollenfeetorfluidinthelungsmaybeassessed.[72]
Bloodtests
Bloodtestsplayanimportantroleinthediagnosisandtreatmentofmanycardiovascularconditions.
Troponinisasensitivebiomarkerforaheartwithinsufficientbloodsupply.Itisreleased46hoursafterinjury,andusuallypeaksatabout1224hours.[36]Two
testsoftroponinareoftentakenoneatthetimeofinitialpresentation,andanotherwithin36hours,[73]witheitherahighlevelorasignificantrisebeing
diagnostic.Atestforbrainnatriureticpeptide(BNP)canbeusedtoevaluateforthepresenceofheartfailure,andriseswhenthereisincreaseddemandontheleft
ventricle.Thesetestsareconsideredbiomarkersbecausetheyarehighlyspecificforcardiacdisease.[74]TestingfortheMBformofcreatinekinaseprovides
informationabouttheheart'sbloodsupply,butisusedlessfrequentlybecauseitislessspecificandsensitive.[75]
Otherbloodtestsareoftentakentohelpunderstandaperson'sgeneralhealthandriskfactorsthatmaycontributetoheartdisease.Theseoftenincludeafullblood
countinvestigatingforanaemia,andbasicmetabolicpanelthatmayrevealanydisturbancesinelectrolytes.Acoagulationscreenisoftenrequiredtoensurethat
therightlevelofanticoagulationisgiven.Fastinglipidsandfastingbloodglucose(oranHbA1clevel)areoftenorderedtoevaluateaperson'scholesteroland
diabetesstatus,respectively.[76]
Electrocardiogram
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Usingsurfaceelectrodesonthebody,itispossibletorecordtheelectricalactivityoftheheart.Thistracingoftheelectrical
signalistheelectrocardiogram(ECG)or(EKG).AnECGisabedsidetestandinvolvestheplacementoftenleadsonthe
body.Thisproducesa"12lead"ECG(threeextraleadsarecalculatedmathematically,andoneleadisaground).[77]
TherearefiveprominentfeaturesontheECG:thePwave(atrialdepolarisation),theQRScomplex(ventricular
depolarisation[h])andtheTwave(ventricularrepolarisation).[7]Astheheartcellscontract,theycreateacurrentthattravels
throughtheheart.AdownwarddeflectionontheECGimpliescellsarebecomingmorepositiveincharge("depolarising")
CardiaccycleshownagainstECG
inthedirectionofthatlead,whereasanupwardinflectionimpliescellsarebecomingmorenegative("repolarising")inthe
directionofthelead.Thisdependsonthepositionofthelead,soifawaveofdepolarisingmovedfromlefttoright,alead
ontheleftwouldshowanegativedeflection,andaleadontherightwouldshowapositivedeflection.TheECGisausefultoolindetectingrhythmdisturbances
andindetectinginsufficientbloodsupplytotheheart.[77]Sometimesabnormalitiesaresuspected,butnotimmediatelyvisibleontheECG.Testingwhen
exercisingcanbeusedtoprovokeanabnormality,oranECGcanbewornforalongerperiodsuchasa24hourHoltermonitorifasuspectedrhythmabnormality
isnotpresentatthetimeofassessment.[77]
Imaging
Severalimagingmethodscanbeusedtoassesstheanatomyandfunctionoftheheart,includingultrasound(echocardiography),angiography,CTscans,MRIand
PET.Anechocardiogramisanultrasoundoftheheartusedtomeasuretheheart'sfunction,assessforvalvedisease,andlookforanyabnormalities.
Echocardiographycanbeconductedbyaprobeonthechest("transthoracic")orbyaprobeintheesophagus("transoesophageal").Atypicalechocardiography
reportwillincludeinformationaboutthewidthofthevalvesnotinganystenosis,whetherthereisanybackflowofblood(regurgitation)andinformationaboutthe
bloodvolumesattheendofsystoleanddiastole,includinganejectionfraction,whichdescribeshowmuchbloodisejectedfromtheleftandrightventriclesafter
systole.Ejectionfractioncanthenbeobtainedbydividingthevolumeejectedbytheheart(strokevolume)bythevolumeofthefilledheart(enddiastolic
volume).[78]Echocardiogramscanalsobeconductedundercircumstanceswhenthebodyismorestressed,inordertoexamineforsignsoflackofbloodsupply.
Thiscardiacstresstestinvolveseitherdirectexercise,orwherethisisnotpossible,injectionofadrugsuchasdobutamine.[72]
CTscans,chestXraysandotherformsofimagingcanhelpevaluatetheheart'ssize,evaluateforsignsofpulmonaryoedema,andindicatewhetherthereisfluid
aroundtheheart.Theyarealsousefulforevaluatingtheaorta,themajorbloodvesselwhichleavestheheart.[72]

Treatment
Anumberofmedicationsareusedtotreatdiseasesoftheheart,oramelioratesymptoms.
Fordiseasesoftheheartrateorrhythm,anumberofdifferentantiarrhythmicagentsareused.Thesemayinterferewithelectrolytechannelsandthusthecardiac
actionpotential(suchascalciumchannelblockers,sodiumchannelblockers),interferewithstimulationoftheheartbythesympatheticnervoussystem(beta
blockers),orinterferewiththemovementofsodiumandpotassiumacrossthecellmembrane,suchasdigoxin.[79]Otherexamplesincludeatropineforslow
rhythms,andamiodaroneforirregularrhythms.Suchmedicationsarenottheonlywayoftreatingdiseasesofheartrateorrhythm.Inthecontextofanewonset
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irregularheartrhythm(atrialfibrillation),immediateelectricalcardioversionmaybeattempted.Foraslowheartbeatorheartblock,apacemakerordefibrillator
maybeinserted.[76]Theacuityofonsetoftenaffectshowarhythmdisturbanceismanaged,asdoeswhetherarhythmcauseshemodynamicinstability,suchaslow
bloodpressureorsymptoms.Aninstigatingcauseisinvestigatedfor,suchasaheartattack,medication,ormetabolicproblem.[76]
Forischaemicheartdisease,treatmentalsoincludesameliorationofsymptoms.Thisincludesnitroglycerin,betablockersand,inthecontextofanacuteevent,
strongerpainreliefsuchasmorphineandotheropiates.Manyofthesedrugshaveadditionalprotectivebenefits,bydecreasingthesympathetictoneontheheart
thatoccurswiththepain,orbydilatingbloodvessels(GTN).[76]
Treatmentofheartdiseaseincludesprimaryandsecondarypreventiontopreventtheoccurrenceorworseningofsymptomsandatherosclerosis.Thisincludes
recommendationstoceasesmoking,decreasealcoholconsumption,increaseexercise,andmakemodificationstotheirdiettodecreasetheconsumptionoffatsand
sugars.Medicationsmayalsobegiventohelpbettercontrolconcurrentdiabetes.Statinsorotherdrugssuchasfibratesmayalsobegiventodecreaseaperson's
cholesterollevels.Bloodpressuremedicationmayalsobecommencedormodified.[76]
Formanydiseasesoftheheart,includingatrialfibrillationandvalvulardisease,andafteraheartoperation,anticoagulationintheformofaspirin,warfarin,
clopidogrelornoveloralanticoagulantsisoftengivensimultaneously,becauseofanincreasedriskofstrokeor,inthecontextofaclottedheartvessel,
rethrombosis.[76]
Surgery
Surgery,whenconsiderednecessaryfordiseasesoftheheart,cantakeplaceviaanopenoperationorviasmallguidewiresinsertedviaperipheralarteries
("percutaneouscoronaryintervention").Percutaneouscoronaryinterventionisusuallyusedinthecontextofanacutecoronarysyndrome,andmaybeusedto
insertastent.[80]
Coronaryarterybypasssurgeryisonesuchoperation.Inthisoperation,oneormorearteriessurroundingtheheartthathavebecomenarrowedarebypassed.This
isdonebytakingbloodvesselsharvestedfromanotherpartofthebody.Commonlyharvestedveinsincludethesaphenousveinsortheinternalmammaryartery.
Becausethisoperationinvolvesthehearttissue,amachineisusedsothatbloodcanbypasstheheartduringtheoperation.[80]
Heartvalverepairorvalvereplacementareoptionsfordiseasesoftheheartvalves.[80]

History
Ancient

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Humanshaveknownabouttheheartsinceancienttimes,althoughitsprecisefunctionandanatomywerenotclearly
understood.[81]Fromtheprimarilyreligiousviewsofearliersocietiestowardstheheart,ancientGreeksareconsideredto
havebeentheprimaryseatofscientificunderstandingoftheheartintheancientworld.[82][83][84]Aristotleconsideredthe
hearttobeorganresponsibleforcreatingbloodPlatoconsideredtheheartasthesourceofcirculatingbloodand
Hippocratesnotedbloodcirculatingcyclicallyfromthebodythroughthehearttothelungs.[82][84]Erasistratos(304250
BCE)notedtheheartasapump,causingdilationofbloodvessels,andnotedthatarteriesandveinsbothradiatefromthe
heart,becomingprogressivelysmallerwithdistance,althoughhebelievedtheywerefilledwithairandnotblood.Healso
discoveredtheheartvalves.[82]
TheGreekphysicianGalen(2ndcenturyCE)knewbloodvesselscarriedbloodandidentifiedvenous(darkred)andarterial
(brighterandthinner)blood,eachwithdistinctandseparatefunctions.[82]Galen,notingtheheartasthehottestorganinthe
body,concludedthatitprovidedheattothebody.[84]Theheartdidnotpumpbloodaround,theheart'smotionsuckedblood
induringdiastoleandthebloodmovedbythepulsationofthearteriesthemselves.[84]Galenbelievedthearterialbloodwas
createdbyvenousbloodpassingfromtheleftventricletotherightthrough'pores'betweentheventricles.[81]Airfromthe
lungspassedfromthelungsviathepulmonaryarterytotheleftsideoftheheartandcreatedarterialblood.[84]

Heartanditsbloodvessels,by
LeonardodaVinci,15thcentury

Theseideaswentunchallengedforalmostathousandyears.[81][84]

Premodern
TheearliestdescriptionsofthecoronaryandpulmonarycirculationsystemscanbefoundintheCommentaryonAnatomyinAvicenna'sCanon,publishedin1242
byIbnalNafis.[85]Inhismanuscript,alNafiswrotethatbloodpassesthroughthepulmonarycirculationinsteadofmovingfromtherighttotheleftventricleas
previouslybelievedbyGalen.[86]HisworkwaslatertranslatedintoLatinbyAndreaAlpago.[87]
InEurope,theteachingsofGalencontinuedtodominatetheacademiccommunityandhisdoctrineswereadoptedastheofficialcanonoftheChurch.Andreas
VesaliusquestionedsomeofGalen'sbeliefsoftheheartinDehumanicorporisfabrica(1543),buthismagnumopuswasinterpretedasachallengetothe
authoritiesandhewassubjectedtoanumberofattacks.[88]MichaelServetuswroteinChristianismiRestitutio(1553)thatbloodflowsfromonesideoftheheartto
theotherviathelungs.[88]

Modern
AbreakthroughinunderstandingtheflowofbloodthroughtheheartandbodycamewiththepublicationofDeMotuCordis(1628)bytheEnglishphysician
WilliamHarvey.Harvey'sbookcompletelydescribesthesystemiccirculationandthemechanicalforceoftheheart,leadingtoanoverhauloftheGalenic
doctrines.[89]OttoFrank(18651944)wasaGermanphysiologistamonghismanypublishedworksaredetailedstudiesofthisimportantheartrelationship.
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ErnestStarling(18661927)wasanimportantEnglishphysiologistwhoalsostudiedtheheart.Althoughtheyworkedlargelyindependently,theircombined
effortsandsimilarconclusionshavebeenrecognizedinthename"FrankStarlingmechanism".[7]
AlthoughPurkinjefibersandthebundleofHiswerediscoveredasearlyasthe19thcentury,theirspecificroleintheelectricalconductionsystemoftheheart
remainedunknownuntilSunaoTawarapublishedhismonograph,titledDasReizleitungssystemdesSugetierherzens,in1906.Tawara'sdiscoveryofthe
atrioventricularnodepromptedArthurKeithandMartinFlacktolookforsimilarstructuresintheheart,leadingtotheirdiscoveryofthesinoatrialnodeseveral
monthslater.Thesestructuresformtheanatomicalbasisoftheelectrocardiogram,whoseinventor,WillemEinthoven,wasawardedtheNobelPrizeinMedicineor
Physiologyin1924.[90]
Thefirstsuccessfulhearttransplantationwasperformedin1967bytheSouthAfricansurgeonChristiaanBarnardatGrooteSchuurHospitalinCapeTown.This
markedanimportantmilestoneincardiacsurgery,capturingtheattentionofboththemedicalprofessionandtheworldatlarge.However,longtermsurvivalrates
ofpatientswereinitiallyverylow.LouisWashkansky,thefirstrecipientofadonatedheart,died18daysaftertheoperationwhileotherpatientsdidnotsurvivefor
morethanafewweeks.[91]TheAmericansurgeonNormanShumwayhasbeencreditedforhiseffortstoimprovetransplantationtechniques,alongwithpioneers
RichardLower,VladimirDemikhovandAdrianKantrowitz.AsofMarch2000,morethan55,000hearttransplantationshavebeenperformedworldwide.[92]
Bythemiddleofthe20thcentury,heartdiseasehadsurpassedinfectiousdiseaseastheleadingcauseofdeathintheUnitedStates,anditiscurrentlytheleading
causeofdeathsworldwide.Since1948,theongoingFraminghamHeartStudyhasshedlightontheeffectsofvariousinfluencesontheheart,includingdiet,
exercise,andcommonmedicationssuchasaspirin.AlthoughtheintroductionofACEinhibitorsandbetablockershasimprovedthemanagementofchronicheart
failure,thediseasecontinuestobeanenormousmedicalandsocietalburden,with30to40%ofpatientsdyingwithinayearofreceivingthediagnosis.[93]

Societyandculture
Symbolism
Asoneofthevitalorgans,theheartwaslongidentifiedasthecenteroftheentirebody,theseatoflife,oremotion,orreason,will,intellect,
purposeorthemind.[94]Theheartisanemblematicsymbolinmanyreligions,signifying"truth,conscienceormoralcourageinmany
religionsthetempleorthroneofGodinIslamicandJudeoChristianthoughtthedivinecentre,oratman,andthethirdeyeoftranscendent
wisdominHinduismthediamondofpurityandessenceoftheBuddhatheTaoistcentreofunderstanding."[94]

jb(F34)"heart"
inhieroglyphs

IntheHebrewBible,thewordforheart,lev,isusedinthesemeanings,astheseatofemotion,themind,andreferringtotheanatomicalorgan.Itisalsoconnected
infunctionandsymbolismtothestomach.[95]
AnimportantpartoftheconceptofthesoulinAncientEgyptianreligionwasthoughttobetheheart,orib.Theibormetaphysicalheartwasbelievedtobeformed
fromonedropofbloodfromthechild'smother'sheart,takenatconception.[96]ToancientEgyptians,theheartwastheseatofemotion,thought,will,and
intention.ThisisevidencedbyEgyptianexpressionswhichincorporatethewordib,suchasAwiibfor"happy"(literally,"longofheart"),Xakibfor"estranged"
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(literally,"truncatedofheart").[97]InEgyptianreligion,theheartwasthekeytotheafterlife.Itwasconceivedassurviving
deathinthenetherworld,whereitgaveevidencefor,oragainst,itspossessor.Itwasthoughtthattheheartwasexaminedby
AnubisandavarietyofdeitiesduringtheWeighingoftheHeartceremony.Iftheheartweighedmorethanthefeatherof
Maat,whichsymbolizedtheidealstandardofbehavior.Ifthescalesbalanced,itmeanttheheart'spossessorhadlivedajust
lifeandcouldentertheafterlifeiftheheartwasheavier,itwouldbedevouredbythemonsterAmmit.[98]
TheChinesecharacterfor"heart",,derivesfromacomparativelyrealisticdepictionofaheart(indicatingtheheart
chambers)insealscript.[99]TheChinesewordxnalsotakesthemetaphoricalmeaningsof"mind","intention",or"core".[100]
InChinesemedicine,theheartisseenasthecenterofshn"spirit,consciousness".[101]Theheartisassociatedwiththe
smallintestine,tongue,governsthesixorgansandfiveviscera,andbelongstofireinthefiveelements.[102]

Letterofthe
Georgianscript
isoftenusedasa
"heart"symbol.

Thesealscript
glyphfor
"heart"(Middle
Chinesesim)

TheSanskritwordforheartishdorhdaya,foundintheoldestsurvivingSanskrittext,theRigveda.InSanskrit,itmaymeanboththeanatomicalobjectand
"mind"or"soul",representingtheseatofemotion.HrdmaybeacognateofthewordforheartinGreek,Latin,andEnglish.[103][104]
Manyclassicalphilosophersandscientists,includingAristotle,consideredthehearttheseatofthought,reason,oremotion,oftendisregardingthebrainas
contributingtothosefunctions.[105]TheidentificationoftheheartastheseatofemotionsinparticularisduetotheRomanphysicianGalen,whoalsolocatedthe
seatofthepassionsintheliver,andtheseatofreasoninthebrain.[106]
TheheartalsoplayedaroleintheAztecsystemofbelief.ThemostcommonformofhumansacrificepracticedbytheAztecswasheartextraction.TheAztec
believedthattheheart(tona)wasboththeseatoftheindividualandafragmentoftheSun'sheat(istli).Tothisday,theNahuaconsidertheSuntobeaheartsoul
(tonatiuh):"round,hot,pulsating".[107]
InCatholicism,therehasbeenalongtraditionofvenerationoftheheart,stemmingfromworshipofthewoundsofJesusChristwhichgainedprominencefromthe
midsixteenthcentury.[108]ThistraditioninfluencedthedevelopmentofthemedievalChristiandevotiontotheSacredHeartofJesusandtheparallelworshipof
ImmaculateHeartofMary,madepopularbyJohnEudes.[109]
Theexpressionofabrokenheartisacrossculturalreferencetogriefforalostoneortounfulfilledromanticlove.
Thenotionof"Cupid'sarrows"isancient,duetoOvid,butwhileOviddescribesCupidaswoundinghisvictimswithhisarrows,itisnotmadeexplicitthatitis
theheartthatiswounded.ThefamiliariconographyofCupidshootinglittleheartsymbolsisaRenaissancethemethatbecametiedtoValentine'sday.[94]

Food
Animalheartsarewidelyconsumedasfood.Astheyarealmostentirelymuscle,theyarehighinprotein.Theyareoftenincludedindisheswithotheroffal,for
exampleinthepanOttomankokoretsi.
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Chickenheartsareconsideredtobegiblets,andareoftengrilledonskewers:Japanesehtoyakitori,Brazilianchurrascodecorao,Indonesianchickenheart
satay.[110]Theycanalsobepanfried,asinJerusalemmixedgrill.InEgyptiancuisine,theycanbeused,finelychopped,aspartofstuffingforchicken.[111]Many
recipescombinedthemwithothergiblets,suchastheMexicanpolloenmenudencias[112]andtheRussianraguizkurinyikhpotrokhov.[113]
Theheartsofbeef,pork,andmuttoncangenerallybeinterchangedinrecipes.Asheartisahardworkingmuscle,itmakesfor"firmandratherdry"meat,[114]sois
generallyslowcooked.Anotherwayofdealingwithtoughnessistojuliennethemeat,asinChinesestirfriedheart.[115]
Beefheartmaybegrilledorbraised.[116]InthePeruviananticuchosdecorazn,barbecuedbeefheartsaregrilledafterbeingtenderizedthroughlongmarinationin
aspiceandvinegarmixture.AnAustralianrecipefor"mockgoose"isactuallybraisedstuffedbeefheart.[117]
Pigheartisstewed,poached,braised,[118]ormadeintosausage.TheBalineseoretisasortofbloodsausagemadewithpigheartandblood.AFrenchrecipefor
curdeporcl'orangeismadeofbraisedheartwithanorangesauce.

Otheranimals
Othervertebrates
Thesizeoftheheartvariesamongthedifferentanimalgroups,withheartsinvertebratesrangingfromthoseofthesmallestmice(12mg)tothebluewhale
(600kg).[119]Invertebrates,theheartliesinthemiddleoftheventralpartofthebody,surroundedbyapericardium.,[120]whichinsomefishmaybeconnectedto
theperitoneum.[121]
TheSAnodeisfoundinallamniotesbutnotinmoreprimitivevertebrates.Intheseanimals,themusclesoftheheartarerelativelycontinuousandthesinus
venosuscoordinatesthebeatwhichpassesinawavethroughtheremainingchambers.Indeed,sincethesinusvenosusisincorporatedintotherightatriumin
amniotes,itislikelyhomologouswiththeSAnode.Inteleosts,withtheirvestigialsinusvenosus,themaincentreofcoordinationis,instead,intheatrium.The
rateofheartbeatvariesenormouslybetweendifferentspecies,rangingfromaround20beatsperminuteincodfishtoaround600inhummingbirds[122]andupto
1200bpmintherubythroatedhummingbird.[123]

Doublecirculatorysystems
Adultamphibiansandmostreptileshaveadoublecirculatorysystem,meaningacirculatorysystemdividedintoarterialandvenousparts.However,theheartitself
isnotcompletelyseparatedintotwosides.Instead,itisseparatedintothreechamberstwoatriaandoneventricle.Bloodreturningfromboththesystemic
circulationandthelungsisreturned,andbloodispumpedsimultaneouslyintothesystemiccirculationandthelungs.Thedoublesystemallowsbloodtocirculate
toandfromlungswhichdeliveroxygenatedblooddirectlytotheheart.[124]

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Inreptiles,theheartisusuallysituatedaroundthemiddleofthethorax,andinsnakes,usuallybetweenthejunctionofthe
upperfirstandsecondthird.Thereisaheartwiththreechambers:twoatriaandoneventricle.Theventricleisincompletely
separatedintotwohalvesbyawall(septum),withaconsiderablegapnearthepulmonaryarteryandaorticopenings.In
mostreptilianspecies,thereappearstobelittle,ifany,mixingbetweenthebloodstreams,sotheaortareceives,essentially,
onlyoxygenatedblood.[122][124]Theexceptiontothisruleiscrocodiles,whichhaveafourchamberedheart.[125]
Intheheartoflungfish,theseptumextendspartwayintotheventricle.Thisallowsforsomedegreeofseparationbetween
thedeoxygenatedbloodstreamdestinedforthelungsandtheoxygenatedstreamthatisdeliveredtotherestofthebody.
Theabsenceofsuchadivisioninlivingamphibianspeciesmaybepartlyduetotheamountofrespirationthatoccurs
throughtheskinthus,thebloodreturnedtotheheartthroughthevenaecavaeisalreadypartiallyoxygenated.Asaresult,
theremaybelessneedforafinerdivisionbetweenthetwobloodstreamsthaninlungfishorothertetrapods.Nonetheless,
inatleastsomespeciesofamphibian,thespongynatureoftheventricledoesseemtomaintainmoreofaseparation
betweenthebloodstreams.Also,theoriginalvalvesoftheconusarteriosushavebeenreplacedbyaspiralvalvethatdivides
itintotwoparallelparts,therebyhelpingtokeepthetwobloodstreamsseparate.[122]

Thefullydividedheart
Archosaurs(crocodiliansandbirds)andmammalsshowcompleteseparationoftheheartintotwopumpsforatotaloffour
heartchambersitisthoughtthatthefourchamberedheartofarchosaursevolvedindependentlyfromthatofmammals.In
crocodilians,thereisasmallopening,theforamenofPanizza,atthebaseofthearterialtrunksandthereissomedegreeof
mixingbetweenthebloodineachsideoftheheart,duringadiveunderwater[126][127]thus,onlyinbirdsandmammalsare
thetwostreamsofbloodthosetothepulmonaryandsystemiccirculationspermanentlykeptentirelyseparatebya
physicalbarrier.[122]

Acrosssectionofathreechambered
adultamphibianheart,notethesingle
ventricle.Thepurpleregions
representareaswheremixingof
oxygenatedanddeoxygenatedblood
occurs.
1.PulmonaryVein
2.LeftAtrium
3.RightAtrium
4.Ventricle
5.Conusarteriosus
6.Sinusvenosus

Fish
Fishhavewhatisoftendescribedasatwochamberedheart,[128]consistingofoneatriumtoreceivebloodandoneventricle
topumpit,[129]However,thefishhearthasentryandexitcompartmentsthatmaybecalledchambers,soitisalso
sometimesdescribedasthreechambered[129]orfourchambered,[130]dependingonwhatiscountedasachamber.The
atriumandventriclearesometimesconsideredtruechambers,whiletheothersareconsideredaccessorychambers.[131]
Primitivefishhaveafourchamberedheart,butthechambersarearrangedsequentiallysothatthisprimitiveheartisquite
unlikethefourchamberedheartsofmammalsandbirds.Thefirstchamberisthesinusvenosus,whichcollects
deoxygenatedblood,fromthebody,throughthehepaticandcardinalveins.Fromhere,bloodflowsintotheatriumand
thentothepowerfulmuscularventriclewherethemainpumpingactionwilltakeplace.Thefourthandfinalchamberisthe
https://en.wikipedia.org/wiki/Heart

Bloodflowthroughthefishheart:
sinusvenosus,atrium,ventricle,and
outflowtract
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conusarteriosuswhichcontainsseveralvalvesandsendsbloodtotheventralaorta.Theventralaortadeliversbloodtothegillswhereitisoxygenatedandflows,
throughthedorsalaorta,intotherestofthebody.(Intetrapods,theventralaortahasdividedintwoonehalfformstheascendingaorta,whiletheotherformsthe
pulmonaryartery).[122]
Intheadultfish,thefourchambersarenotarrangedinastraightrowbut,insteadformanSshapewiththelattertwochamberslyingabovetheformertwo.This
relativelysimplerpatternisfoundincartilaginousfishandintherayfinnedfish.Inteleosts,theconusarteriosusisverysmallandcanmoreaccuratelybe
describedaspartoftheaortaratherthanoftheheartproper.Theconusarteriosusisnotpresentinanyamniotes,presumablyhavingbeenabsorbedintothe
ventriclesoverthecourseofevolution.Similarly,whilethesinusvenosusispresentasavestigialstructureinsomereptilesandbirds,itisotherwiseabsorbedinto
therightatriumandisnolongerdistinguishable.[122]

Invertebrates

Basicarthropodbodystructure
heartshowninred

Arthropodsandmostmolluskshaveanopencirculatorysystem.Inthissystem,
deoxygenatedbloodcollectsaroundtheheartincavities(sinuses).Thisbloodslowly
permeatestheheartthroughmanysmallonewaychannels.Theheartthenpumpsthe
bloodintothehemocoel,acavitybetweentheorgans.Theheartinarthropodsis
typicallyamusculartubethatrunsthelengthofthebody,underthebackandfromthe
baseofthehead.Insteadofbloodthecirculatoryfluidishaemolymphwhichcarriesthe
mostcommonlyusedrespiratorypigment,copperbasedhaemocyaninastheoxygen
transporterironbasedhaemoglobinisusedbyonlyafewarthropods.[132]

Inotherinsectssuchasearthworms,thecirculatorysystemisnotusedtotransportoxygenandsoismuchreduced,having
noveinsorarteriesandconsistingofatwoconnectedtubes.Oxygentravelsbydiffusionandtherearefivesmallmuscular
vesselsthatconnectthesevesselsthatcontractatthefrontoftheanimalsthatcanbethoughtofas"hearts".[132]
Squidsandothercephalopodshavetwo"gillhearts"alsoknownasbranchialhearts,andone"systemicheart".Thebrachial
heartshavetwoatriaandoneventricleeach,andpumptothegills,whereasthesystemicheartpumpstothebody.[133][134]

Thetubelikeheart(green)ofthe
mosquitoAnophelesgambiaeextends
horizontallyacrossthebody,
interlinkedwiththediamondshaped
wingmuscles(alsogreen)and
surroundedbypericardialcells(red).
Bluedepictscellnuclei.

Additionalimages
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Thehumanheart
viewedfromthefront

Thehumanheart
viewedfrombehind

Thecoronary
circulation

Ananatomical
specimenoftheheart

HeartIllustrationwith
circulatorysystem

Notes
a.Fromthehearttothebody
b.Arteriesthatcontaindeoxygenatedblood,fromthehearttothelungs
c.Supplyingbloodtotheheartitself
d.Fromthebodytotheheart
e.Veinscontainingoxygenatedbloodfromthelungstotheheart
f.Veinsthatdrainbloodfromthecardiactissueitself
g.Notethemusclesdonotcausethevalvestoopen.Thepressuredifferencebetweenthebloodintheatriaandtheventriclesdoesthis.
h.Depolarisationoftheventriclesoccursconcurrently,butisnotsignificantenoughtobedetectedonanECG.[77]

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Externallinks
WhatIstheHeart?(http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw_pumping.html)NIH
AtlasofHumanCardiacAnatomy(http://www.vhlab.umn.edu/atlas/index.shtml)
DissectionreviewoftheanatomyoftheHumanHeartincludingvessels,internalandexternalfeatures(http://anatomyguy.com/middlemediastinumandhea
rtreview/)
Prenatalhumanheartdevelopment(http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/thorax0/heartdev/main_fra.html)
Animalhearts:fish,squid(http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/A/AnimalHearts.html)
Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Heart&oldid=747964542"
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