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Meet the heart

I really like this picture that I found. It actually shows you really neatly where the heart sits in our
body so you can see the heart is surrounded, on both sides, by ribs, right? And in fact, I didn't draw it
in yet, but let me show you where the lungs would be. This is the right lung and on this side you'd
have the left lung. So this is where your heart sits: between two lungs. And I'm saying left and right
from the perspective of the the person who owns this heart. So this is their left and right, which is
the opposite of us if we're looking at it. The heart is actually sitting between the two lungs within
this protective casing that the ribs are basically there to keep all these important organs safe. And
then below them, so if you draw this here. Or if I draw it, you can see now that below all this stuff is
a really really important muscle. So this muscle people don't talk about this muscle, or this is not the
kind of muscle that you usually see people working on at the gym, but this muscle is called the
diaphragm. So your diaphragm muscle and your ribs are enclosing a space, right? The diaphragm
becomes the floor, and the ribs are kind of the ceiling and the walls of this space. And if you look at
the contents of this space, you'd have your lung and you'd have your heart. So, this entire space
then is called your thorax. So what exactly does the heart do? Let's actually make a little bit of space
now, and bring up a zoomed in version of the heart. Let me start by orienting you to the heart. This
is our right lung and on the other side we have our left lung. And all this would be inside of the rib
cage, but I'm not going to draw that now, because that would make it harder to see the heart itself.
So to think about exactly what the heart does, I think one, kind of neat way to do it is to actually
imagine that you're a cell. So put yourself in the perspective of a cell, and let's say you're a cell
hanging out over here. This is you. And you can think about any part of the body that you could be.
Let's say a little toe cell. So let's say you're a toe cell and your job, of course, is to live and be
happy,and you've got near by, a little blood vessel. And in fact, every cell in our body has a little
blood vessel that's near by. And this toe cell is just trying to make a living. And toe cells need certain
things, right? They need, for example, let's say oxygen. I'll write it in white so it's very clear. They
need oxygen and they need nutrients, right? So cells need certain things to live and be happy. And
on the flip-side, they also make waste. They're in a sense just like us, they make waste. And that
waste could be all sorts of things, and one that kind of jumps to mind is carbon dioxide (CO2). So
carbon dioxide is waste for this cell. So it's making some waste and for the moment let's imagine
that there's no blood flow. So, even though there's a blood vessel near by, really, no flow is
happening, so I'll just write "no flow". So as the little cell makes waste. That waste, let's draw a little
ball right here, it's going to start accumulating, you're going to start collecting more and more of it
since the blood is not really flowing. And it might kind of end up getting all the way around our toe
cell. So our toe cell is getting swamped, literally getting kind of covered by its own waste. And on the
flip-side, is it getting oxygen or nutrients? No. It's not getting either of these things. So, before very
long, I would say within minutes, our toe cell is thinking, "Well this is not a very happy way to live!"
this is actually really very sad, this is awful. And if this continues the toe cell would die. So, what a
toe cell needs, and what every cell needs, and that could be a finger cell or a skin cell, or really any
cell that's living, needs flow. Right? It needs this blood to be flowing nicely and smoothly. And if
there is flow then you get a very different picture, right? If there's flow then all the sudden all the
waste product is actually now lifted and taken away. It's flowing away, and it's a little bit like having
someone come by and pick up the trash, then you don't have trash all over the house. So then you
have nice flow, and in return, oxygen and nutrients are delivered. So this stuff gets delivered as well.
So, all of the sudden the cell is going to be very, very happy, and is going to be living just fine. So,
really if you want all of the cells in your body to be living just fine like this cell here, you really want
good flow throughout the body. And so this is really point number one. Is that you really need,
somehow, to have blood flow moving and pushing blood constantly through the body. So, to do this
for billions and billions of cells you would need a pretty powerful pump, right? Something that's
going to be able to pull in all the blood from the body, and then push it back out. And that's what the
heart is. I mean at its core, that's exactly what the heart is doing. It's an amazing pump, pushing
blood, so that you have good blood flow. And so I'm going to write that on the side as kind of job
number one. These are the jobs of the heart. So jobs, and number one, would be blood flow. And I'll
write systemic flow. Systemic flow. And all that systemic means is that I'm refering to the entire
body. So systemic when I say that word, I just mean the entire body. All the cells in the body. Now,
exactly how that happens actually you can see on this picture. So, here you have a giant vein, this is
a vein, and you have an artery. This is an artery. And blood is actually going through the artery, that
way. And it's actually coming into two veins, the one at the top, this is called the superior, superior
just kind of means at the top. Superior vena cava. That's the name of the vein. And at the bottom
here, you can't see it because it's on the other side of the heart, but there's another vein called the
inferior vena cava. And these two veins, this is also a vein, these two veins are actually dragging
blood in from all over the body, into the heart. And then, when the heart is ready to pump it back
out, it goes into this artery, and the name of it is the aorta. So if you've heard of the aorta, this is the
artery that people are talking about. So this is how blood comes and gets pumped around. But this
isn't actually the only job of the heart. The job, the second job of the heart, is actually also in this
picture, and it's called pulmonary flow. Pulmonary flow. So, what does that mean? Well, we know
that cells are expecting oxygen, right? We know this. And that they have a lot of carbon dioxide
waste. Well, it's good to move things around. It's good to move blood around. But if you actually
never got rid of that carbon dioxide or brought in new oxygen, then a cell is not going to be very
happy either. I mean, you can have blood flow, but at some point it's also going to want some
oxygen. And it's going to want to get rid of that carbon dioxide. So, that's where the lungs come in.
So what happens is that the heart, before sending blood out the aorta, before just dishing it out back
into the body, it actually sends the blood over to the lungs. And it goes over to the left lung, and
over to the right lung. And the blood comes back from the right lung and the left lung, and gets
pushed back into the heart, and then gets squeezed through the aorta. So there's this actual extra
little step here, where blood is going to and from the lungs, and that's the pulmonary flow. So the
final thing you'll notice, if you look at this picture it's hard not to notice, is that there are these, kind
of wriggly looking little blood vessels all over the heart. And what are these exactly? I mean, you've
got red ones, and blue ones, and the blue ones are the veins, and the red ones are the arteries but
are they part of the systemic flow, or pulmonary flow, or something else? Well, these vessels, all of
them, together are called coronary vessels. And so specifically you might hear about a coronary
artery, or a coronary vein, but together you can call them coronary blood vessels. I'll add the word
blood here. So these coronary blood vessels are actually serving the heart muscle itself. I mean
remember, the heart is made up of thousands and thousands, actually tens of thousands of cells and
those cells, just like our toe cell that we drew, they also need oxygen, nutrients, and have waste. So,
those cells are going to need blood vessels supplying them as well. So, that's what the coronary
blood vessels are. They're literally the blood vessels that go to and serve the heart. So these are the
ones that serve the heart. Now, if they're serving the heart muscles and the heart cells, then, think
about it, would they fit under the systemic flow, or pulmonary flow? Well if the main job is to serve
the needs of cells, then the coronary vessels fall under the systemic flow.
Flow Through The Heart

So what you're looking at is one of the most amazing organs in your body. This is the human heart.
And it's shown with all the vessels on it. And you can see the vessels coming into it and out of it. But
the heart, at its core, is a pump. And this pump is why we call it the hardest working organ in our
body. Because it starts pumping blood from the point where you're a little fetus, maybe about eight
weeks old, all the way until the point where you die. And so this organ, I think, would be really cool
to look at in a little bit more detail. But it's hard to do that looking just at the outside. So what I did is
I actually drew what it might look like on the inside. So let me actually just show you that now. And
we'll follow the path of blood through the heart using this diagram. Let me start with a little picture
in the corner. So let's say we have a person here. And this is their face, and this is their neck. I'm
going to draw their arms. And they have, in the middle of their chest, their heart. And so the whole
goal is to make sure that blood from all parts of their body, including their legs, can make its way
back to the heart, first of all, and then get pumped back out to the body. So blood is going to come
up from this arm, let's say, and dump into there. And the same on this side. And it's going to come
from their head. And all three sources, the two arms and the head, are going to come together into
one big vein. And that's going to be dumping into the top of the heart. And then separately, you've
got veins from the legs meeting up with veins from the belly, coming into another opening into the
heart. So that's how the blood gets back to the heart. And any time I mention the word vein, I just
want you to make sure you think of blood going towards the heart. Now if blood is going towards
the heart, then after the blood is pumped by the heart, it's going to have to go out to the heart. It's
going to have to go away from the heart. So that's the aorta. And the aorta actually has a little arch,
like that. We call it the aortic arch. And it sends off one vessel to the arm, one vessel up this way, a
vessel over this way. And then this arch kind of goes down, down, down and splits like that. So this is
kind of a simplified version of it. But you can see how there are definitely some parallels between
how the veins and the arteries are set up. And arteries, anytime I mention the word artery, I want
you to think of blood going away from the heart. And an easy way to remember that is that they
both start with the letter A. So going to our big diagram now. We can see that blood coming in this
way and blood coming in this way is ending up at the same spot. It's going to end up at the-- actually,
maybe I'll draw it here-- is ending up at the right atrium. That's just the name of the chamber that
the blood ends up in. And it came into the right atrium from a giant vessel up top called the superior
vena cava. And this is a vein, of course, because it's bringing blood towards the heart. And down
here, the inferior vena cava. So these are the two directions that blood is going to be flowing. And
once blood is in the right atrium, it's going to head down into the right ventricle. So this is the right
ventricle, down here. This is the second chamber of the heart. And it gets there by passing through a
valve. And this valve, and all valves in the heart, are basically there to keep blood moving in the right
direction. So it doesn't go in the backwards direction. So this valve is called the tricuspid valve. And
it's called that because it's basically got three little flaps. That's why they call it tri. And I know you
can only see two in my drawing, and that's just because my drawing is not perfect. And it's hard to
show a flap coming out at you, but you can imagine it. So blood goes into the right ventricle. And
where does it go next? Well after that, it's going to go this way. It's going to go into this vessel, and
it's going to split. But before it goes there, it has to pass through another valve. So this is a valve,
right here, called the pulmonary valve. And it gives you a clue as to where things are going to go
next. Right? Because the word pulmonary means lungs. And so, if this is my lung, on this side, this is
my left lung. And this is my right lung, on this side. Then these vessels-- and I'll let you try to guess
what they would be called-- these vessels. This would be my-- I want to make sure I get my right and
left straight. This is my left pulmonary artery. And I hesitated there just to make sure you got that
because it's taking blood away from the heart. And this is my right pulmonary artery. So this is my
right and left pulmonary artery. And so blood goes, now, into my lungs. These are the lungs that are
kind of nestled into my thorax, where my heart is sitting. It goes into my lungs. And remember, this
blood is blue. Why is it blue? Well, it's blue because it doesn't have very much oxygen. And so one
thing that I need to pick up is oxygen. And so that's one thing that the lungs are going to help me
pick up. And I'm going to write O2 for oxygen. And it's also blue. And that reminds us that it's full of
carbon dioxide. It's full of waste because it's coming from the body. And the body's made a lot of
carbon dioxide that it's trying to get rid of. So in the lungs, you get rid of your carbon dioxide and
you pick up oxygen. So that's why I switch, at this point, from a blue-colored vessel to a red-colored
vessel. So now blood comes back in this way and this way and dumps into this chamber. So what is
that? This is our left atrium. So just like our right atrium, we have one on the left. And it goes down
into-- and you can probably guess what this one is called-- it's our left ventricle. So just like before,
where it went from the right atrium to the right ventricle, now we're going from the left atrium to
the left ventricle. And it passes through a valve here. So this valve is called the mitral valve. And its
job is, of course, to make sure that blood does not go from the left ventricle back to the left atrium
by accident. It wants to make sure that there's forward flow. And then the final valve-- I have to find
a nice spot to write it, maybe right here. This final valve that it passes through is called the aortic
valve. And the aortic valve is going to be what divides the left ventricle from this giant vessel that we
talked about earlier. And this is, of course, the aorta. This is my aorta. So now blood is going to go
through the aorta to the rest of the body. So you can see how blood now flows from the body into
the four chambers. First into the right atrium-- this is chamber number one. And then it goes into the
right ventricle. This is chamber number two. It goes to the lungs and then back out to the left atrium.
So this is chamber number three. And then the left ventricle. And this happens every moment of
every day. Every time you hear your heart beating, this process is going on.
Two Circulating in the body

So what you're looking at is basically kind of a mechanistic way of thinking about the heart, almost as
if it's a couple of pumps with pipes attached to the pumps. And in a way, that's not a bad way to
think about the heart. In fact, we're going to kind of move through this diagram. And I realize it looks
a little bit scary. But once I start labeling stuff, you'll start seeing that it's actually not as bad as it
seems. So let's get started in the upper part of the heart. The right atrium is right there, and then
blood goes down into the right ventricle. And then on the other side, I'm going to label the last two
chambers, the left atrium and the left ventricle. And we're going to actually follow the path of blood
after it leaves the right ventricle. We're going to start our journey here at the right ventricle. So
what's the first thing that kind of comes across? Well, blood leaves the right ventricle, goes through
a valve. And after, on the other side, you've got this area right here. And I've drawn it as one tube
with no split, and this is the pulmonary trunk. So blood is headed towards the lungs, going first
through the trunk. And of course, after the trunk there's a left and right. So I'll write that up here.
The pulmonary arteries are next. And remember, I call them arteries because they're going away
from the heart. And there are two arteries. So pulmonary arteries, left and right pulmonary arteries.
And that's why you see two things here. One here, and you see one here. And those are basically
tubes. So it's going from the pulmonary trunk. It's splitting into one of the two tubes. And now I'm
drawing the left and right lung up top. And of course, you know that the lungs are actually not going
to look this way. So this is not anatomically correct. But this is not, as I said in the beginning, a bad
way of thinking about it. So blood goes through the lungs and then comes out on the other side. And
there we're going to talk about left and right pulmonary veins. And actually, here I'm going to make
the point that there aren't just two pulmonary veins, one for each lung. Actually, there are usually
more than that. And so when I draw this, too, I really want you to just think of the two sides, veins
coming from both sides. But the actual number could be a few pulmonary veins in total. The
pulmonary veins drain blood, then, into the left atrium, right? So now we're on the other side of the
heart. And for the moment, I'm going to kind of pause the journey here. So we've gone from the
right ventricle, around to the lungs, back again in the left atrium. And this is kind of the first part of
our journey. And this part of the journey is called the pulmonary circulation. I'm actually just going to
write that here. Pulmonary circulation. So the fact that this part is going-- starting from the heart
and going back to the heart is one circuit, and our heart actually has two circuits. But I want to point
out the circuits one at a time, and we've already kind of completed one circuit. So I'm going to take
some blue paint to indicate deoxygenated blood, or blood without oxygen. I'm going to paint in how
it would look. And actually, it stopped there because my arrows. But you can actually see now the
deoxygenated blood kind of goes from the right ventricle, through the pulmonary trunk, through the
arteries, and into the left and right lung. And once it's there, it's going to kind of mix in with the
capillaries. And it's going to start getting oxygen, and then it's going to come out on the other side in
the pulmonary veins. And it's again stopped a little bit there, but I can fill it in. And the pulmonary
veins are going to deliver that oxygenated blood to the left atrium. So what you see kind of colored
in now is the pulmonary circulation. That's the first part of our circuit. But let's now keep going and
now talk about the second part of the circulatory system, which is the systemic circulation. So now
the journey starts with the left ventricle, so let me start there. So for the systemic circulation, I'm
going to start the left ventricle. And it's going to go around to the body, right? The body is kind of the
thing that's going to be receiving all of the blood. And when I say body, I really mean lots of things. I
mean things like the brain, so it could be an organ like the brain or the liver. It could also be maybe
things like bones, if you have bones in your fingers. Could be the toes. Could be any part of your
body that you can think of, right? So all these different organs and tissues are going to be getting
blood from the left ventricle. It's going to be going initially through a giant vessel. This vessel I'm
going to label it say, here, as the aorta. So this large vessel is the aorta. And of course, it branches
and splits. And I haven't shown all the branches that come off the aorta. But there are many, many
of them. It goes to the various tissues and organs, and then it comes back out on the other side. And
at the end, kind of somewhere up here, it's going to go back to the right atrium. And it generally
travels through two major kind of vessels. One is the inferior, and the other is the superior, meaning
lower and upper. And they're both called vena cava. So superior vena cava and inferior vena cava. I'll
just write that here. So these are the two major veins that are bringing back blood from all the
different parts of the body. And so now you've actually seen the second circulation, because it all
ends at the right atrium. And this is the systemic circulation. I'm going to write systemic circulation
here. So now you can see that the heart is really two different systems-- or let's say two different
circuits, rather. And the first one, the pulmonary circulation, is really kind of relying on the right
ventricle as the pump. And the second one is relying on the left ventricle as the pump. And actually,
now that you've seen it, I can now color it in. There it would kind of deliver all the blood to the
various organs, and then the organs would use up the oxygen. So let me show it kind of now going
back to blue just to indicate deoxygenated blood, and it goes back to the right atrium as
deoxygenated blood. So this is kind of how we sometimes see it. And again, this doesn't show you or
give you an appreciation for the anatomy exactly, where things branch off and where the different
names make sense. But you get a kind of overall feel for the fact that we have two different
circulations, and you can see where the blood is going for the two different circuits. Now, when you
look at this picture, you could say, well, OK, I guess you can see where all the different tissues are
getting the blood. Basically sounds like everything is coming from the oxygenated blood coming out
of the left ventricle. But some tissues always kind of trip people up or kind of spark a question, and
I'm just going to kind of try to target a couple of the tissues that I think people sometimes might
have questions about. And one of them-- wouldn't really call it a tissue, but you could definitely call
it a cell type. It's the RBC, and RBC just stands for red blood cell. So people sometimes wonder if the
red blood cells are carrying blood to other parts of the body, then how do they themselves get
oxygen? Do they just kind of use up some of the oxygen that they're carrying, or what exactly? And
to answer this question, I would have to remind you that a red blood cell basically looks a little bit
like this in cross-section. And it doesn't have any mitochondria. No mitochondria. So it has no
mitochondria. And remember, mitochondria are these tiny little organelles inside of cells that are
using oxygen. So if it has no mitochondria, then it is not really using oxygen. So it's not using oxygen.
And really, these cells-- we call them cells, and they are in many senses of the word. But they don't
really have mitochondria. They also don't have a nucleus. I mean, these are, literally, these
amazingly designed cells that are made for the purpose of carrying around oxygen to the body,
because they literally are bags of hemoglobin. So just remember, red blood cells don't really need
oxygen. They simply carry it around. Another tissue or organ that makes people kind of wonder is
the heart. The heart is pumping all the blood around. But does it actually get oxygen from vessels
that are in the pulmonary circulation or from the systemic circulation or what? And here, the short
answer is systemic circulation. That's kind of the quick answer. And let me actually show you where
the blood vessels come from. These are called coronary vessels. I'll just write the word coronary
here, coronary vessels. So coronary artery and vein. And these coronary vessels, they actually come
right off the aorta here and here. So they kind of come off of the aorta right away. They're the first
branches off the aorta, actually. So the first branches go and serve the heart, so it's kind of the first
to get systemic circulation blood. And the veins actually drain into a spot directly into the right
atrium, so there's actually a little spot right there that they drain into. So the blood from the arterial
side is coming from the aorta. And on the venous side, it's actually not even dumping into the
inferior or superior vena cava. Kind of a little known fact, it's going directly into the right atrium. And
finally, kind of a tricky one, but the lungs. Where do the lungs get their oxygen from? And this is, I
say, tricky. And I kind of saved this for last, because there are actually blood vessels. And again, don't
worry so much about the anatomy in terms of where is it coming off of exactly? But it's coming off of
the systemic circulation, and you've got a vessel going to the right lung. Let's say something like that.
And you've got another vessel going-- I'll just draw it kind of going-- to the left lung like that. So
you've got a couple of arteries that are branching off, and these are also part of the systemic
circulation. And these are called the bronchial arteries. And these bronchial arteries bring then really
wonderful oxygenated blood, right? These are the bronchial arteries. And you might say, well, that
wasn't so difficult. I'll say bronchial vessels, because there are also some veins coming off. Actually,
let me draw the veins now for you, so you can see how those kind of end up. And these veins, they
come from, of course, the right lung. And they actually end up dumping in here. You can't really
show blue on blue, but just trust they go there. And you've got another vein from the other lung,
kind of following a parallel path and going into the veins as well. And so they don't dump necessarily
directly into the inferior or superior vena cava, but I just want to show that they go into the venous
side on the systemic circulation. So if that was it, that would be really simple. But actually, lungs are
kind of interesting in the sense that there is a lot of mixing going on. So you've got pulmonary
arteries carrying blood. You've got bronchial arteries carrying blood, and that blood mixes. And then
you've got-- at the capillaries, you've got some blood kind of from both places, the pulmonary
circulation and blood from the systemic circulation again mixing. And then on the other side, where
the veins are bringing blood back to the heart, most of the blood-- as it turns out, most of the blood
actually goes this way, into the pulmonary veins. So even though you have bronchial arteries
bringing blood in-- that would be right here-- you only have bronchial arteries bringing blood in, a lot
of that blood ends up going into the pulmonary circulation. So that's kind of an interesting fact, that
not as much goes this way directly into that systemic circulation. So it's kind of a tricky thing to keep
in mind. But the lungs, then, technically really are getting blood both from the systemic circulation,
but also they're kind of mixing blood. And they're mixing blood with the pulmonary circulation. We'll
talk a little bit more about this in another video. I don't want you to feel like this kind of got too
confusing. But I just want you to be aware that there is mixing going on in the lungs with the
systemic and pulmonary circulation, kind of a neat organ in that sense.

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