Heart Matters

HEART, in cinema, is often given, taken and even broken. What about it in science?
Heart transplant, even though rare, is a distinct possibility and heart surgery often
becomes a necessity. But the general knowledge of most people about heart matters is
most often poor. A dangerous symptom, especially when heart diseases are becoming
rather common. So, let’s learn something about heart, through the queries that we
have received from our curious readers.

 If heart is a pump, what is its horsepower?

 How many chambers does human heart contain and what are their functions?
 What is the difference between the right and left halves of a human heart?
 In human body heart is at right side only, why not on the left side?
 Why our heart becomes fast whenever we become excited over any matter such as in the
examination hall or at the climax of a cricket match?

Heart and blood are closely related. To sustain life the blood has to be constantly in
motion. Heart provides the energy for this motion. Besides, it also directs its flow to
different organs, lungs to replenish the oxygen content and discard carbon dioxide, to
kidneys to remove the toxic wastes and so on. No wonder, almost all animals, which
have blood, have a heart too.
Human heart is a large, hollow, muscular organ. Each person's heart is about
the same size as that person's fist. A newborn baby's heart weighs only about 20
grams. An adult's heart weighs as much as 250 to 320 grams. It can be considered as
two pumps that propel blood through two different circuits. It is located near the
middle of the chest, between the lungs, closer to the front of the chest than to the back
and slightly to the left side. The location of heart in the human body, slightly towards
the left, is a result of the overall design of the body. Thus the query, why it is not
towards the right, is similar to the query, why is the engine in a particular brand of
cars located in the boot and not in the dickey? A design of human body in which heart
is located towards the right side may be possible, but it does not occur in Nature.
The heart cavity is divided down the middle into a right and a left heart, which
in turn are subdivided into two chambers. Thus a human heart has four chambers. A
upper chamber is called an atrium (or auricle), and a lower chamber is called a
ventricle. The two atria (plural of atrium) act as receiving chambers for blood
entering the heart. The ventricles are a bit more muscular, they pump the blood out
of the heart. There are two kinds of capilliaries that facilitata the transport of blood
from and to the heart, the veins and the arteries. Veins transport blood from
throughout the body to the right-ventricle (which in turn sends the blood to the lungs,
where it picks up oxygen and loses carbon dioxide). The oxygenated blood then
flows to the left side of the heart, which pumps it through arteries to the rest of the
body. Valves control the flow of blood through the heart. The left-sided pump is
larger and stronger than the right-sided pump. There are several valves in the heart
that allow blood to flow in one direction only and help maintain the pressure required
to pump the blood. These valves have flaps that open as blood pours from a chamber.
When the flaps close, they prevent blood from flowing back into the chamber. Two
valves separate the atria and the ventricles. They are called the atrioventricular valves
or AV valves.
The heart has a built-in power supply, in addition it has a delicate regulatory
mechanism that permits it to perform efficiently under a wide range of demands. The
nervous system regulates the heart and other parts of the circulatory system. A
division of the nervous system called the autonomic nervous system, automatically
controls the heart rate making it faster or slower, depending on the body's needs. For
example, the heart pumps slowly while a person sleep, providing relatively small
amounts of oxygen to the body. But the heart rate can be quickly speeded up again
and so increase the oxygen output enormously. This happens when a person
exercises, becomes frightened, or needs to fight or run. During moments of fear,
passion, or violent exercise, the heart rate increases greatly, and the contractions
become more forceful, so that the pumping of the blood intrudes on the
consciousness. This is experienced by the individual as palpitations.
Although heart is like a pump indicating its power in terms of horsepower is
seldom necessary. As we all know, horsepower is a unit used for indicating the power
of motors or engines, that is, machines that move heavy objects through a distance (It
is the force required to raise 33,000 pounds of matter at the rate of one foot per
minute). In the context of heart this unit is of no relevance. The pumping power of a
normal adult man heart can be gauged from the fact that it pumps about 5 liters of
blood per minute through a myriad network of arteries, veins and very fine capillaries.

Heart Beat
 Why is the heartbeat of children faster than adults, and that of adults faster than that of an
old person?
 What is the relation between heart beat and age?
 Why does the heartbeat increase if we do anything fast?
 Why does our heart beat fast when we are tense or are afraid?
 What makes our heart to beat and from where does it get energy to beat?
 Can systole and diastole be controlled by an external medium?

Let us first understand the heartbeat? Both sides of heart pump blood at the
same time. As the right ventricle contracts and sends blood to the lungs, the left
ventricle contracts and squeezes blood out to the body. The two periods of the heart's
cycle are known as systole and diastole. When the ventricles contract systole occurs,
and when they relax, diastole. One complete cycle of contraction and relaxation of
the heart muscle makes up one heartbeat. Diastole is the longer of the two phases so
that the heart can rest between contractions.
In general, the rate of heartbeat varies inversely with the size of the animal. In
elephants it averages 25 beats per minute, in canaries about 1,000. In humans the rate
diminishes progressively from birth (when it averages 130) to adolescence but
increases slightly in old age; the average adult rate is 70 beats at rest. This is because
an infant body is growing faster than the body of an adult, and as a human being ages
its rate of growth and hence metabolic requirements diminish. The rate increases
temporarily during exercise, emotional excitement, and fever because the body needs
more oxygen for the enhanced metabolism during such conditions. Similarly it
decreases during sleep. However, athletic training enlarges the heart and slows the
heartbeat. Many well-trained athletes have resting rates from 40 to 60 beats per
minute.
How does the heart beat? The exact mechanism is yet unknown but broadly
the process can be summed up as follows. A healthy human heart contains its own
electrical conducting system capable of controlling both the rate and the order of
cardiac contractions. Electrical impulses are generated at the sinoatrial (S-A) node
embedded in the right atrium. The sinoatrial node is a mass of specialized heart tissue
often called the pacemaker of the heart because it establishes the basic rhythm at
which the heart beats. The electrical impulses then pass through the muscles of both
atria to trigger the contraction of those two chambers, which force blood into the
ventricles. The wave of atrial electrical activity activates a second patch of conductive
tissue, the atrioventricular (A-V) node, initiating a second discharge along an
assembly of conductive fibres called the bundle of His, which induces the contraction
of the ventricles.
Energy for heartbeats, as for any movement in a biological organism, comes
from the rearrangement of chemical bonds in various metabolic reactions. Specifically
a compound known as adenosine triphosphate (ATP) is usually ascribed the major role
in making available chemical energy for various biochemical reactions.
The condition when electrical conduction through this system is interrupted, as is
the case in a number of diseases including congestive heart failure and as an
aftereffect of heart surgery, is called heart block. An artificial pacemaker is a device
that is often used in such cases. It comprises a pulse generator connected to the heart
by wire or electrode. The pulse generator has a battery power source and electronic
circuitry that can generate an artificial stimulus at a predetermined rate. It is often
employed temporarily until normal conduction returns, or permanently to overcome
the block. In temporary pacing, a miniature electrode attached to fine wires is
introduced into the heart through a vein, usually in the arm. The pacing device, an
electric generator, remains outside the body and produces regular pulses of electric
charge to maintain the heartbeat. In permanent pacing, the electrode may again be
passed into the heart through a vein or it may be surgically implanted on the heart's
surface; in either case the electrode is generally located in the right ventricle. The
electric generator is placed just beneath the skin, usually in a surgically created pocket
below the collarbone. The first pacemakers were of a type called asynchronous, or
fixed, and they generated regular discharges that overrode the natural pacemaker.
Most pacemakers are set at 70 to 75 beats per minute. More recent pacemakers,
known as synchronous, or demand devices trigger heart contractions only when the
normal beat is interrupted. Most pacemakers of this type are designed to generate a
pulse when the natural heart rate falls below 68 beats per minute. These instruments
have a sensing electrode that detects the pulse rate in the arteries. Once in place, the
electrode and wires of the pacemaker usually require almost no further attention. The
power source of the implanted pulse generator is most often a battery that requires
replacement at regular intervals, generally every four to five years.
Although the sinoarterial node (pacemaker) sets the basic rhythm of the heart,
the rate and strength of beating can be modified by other factors. Located in the
medulla of the brain (the widening continuation of the spinal cord, forming the
lowest part of the brain and containing nerve centers that control breathing,
circulation, etc.) are two control centers. They can initiate pulses that travel to the
heart by way of accelerator nerves causing an increase in the heartbeat and hence
the rate of flow of blood through the body. These impulses arise when the
individual is subject to some stress such as fear or violent physical exertion. The
heartbeat can thus increase to 140, or even more, beats per minute. The total
quantity of blood pumped by heart may thus increase upto 35-40 liters per minute.
Vigorous exercise accelerates heartbeat in two ways. As cellular respiration
increases, so does the carbon dioxide content of the blood. This stimulates special
carbon dioxide receptor located in carotid arteries (two principal arteries, one on
each side of the neck, which convey the blood from the aorta to the head) and
aorta, and these transmit impulses to the medulla for relay, by way of the
accelerator nerves, to the nerves. Similarly, stretch receptors located in the walls
of atrium are simulated by the increased flow of blood. These too send impulses to
the medulla to be relayed to the heart. Working together these two mechanisms
ensure that the increased demand of the oxygen by various muscle tissues are met
by increasing the heartbeat during vigorous exercise.

Blood Pressure

 What is blood pressure, how does it become high or low?

 Why do doctors always measure blood pressure on our arms not on any other part?
 How is blood pressure measured with a sphygmomanometer?
 What is heart attack and what is the cause of it?

Blood pressure is the force exerted by the blood against the walls of the blood
vessels, originating in the pumping action of the heart. Blood in the circulatory
system, like water in the pipes of a water system, is always under pressure. Thus
blood pressure refers to the force with which the blood pushes against the walls of the
arteries. That force drives blood from the heart to all parts of the body. Each person's
blood pressure reflects the amount of blood in the body, the strength and rate of the
heart's contractions, and the elasticity of the arteries. Because the heart pumps in
cycles, pressure in the arteries rises and falls during systole and diastole. Contraction
of the heart produces systolic blood pressure, and relaxation produces diastolic blood
pressure. Lasting usually 0.3 to 0.4 second, ventricular systole is introduced by a very
brief period of contraction, followed by the ejection phase, during which 80 to 100 cc
of blood leave each ventricle.
In human beings, the highest (systolic) pressure, normally about 120 (100 to
140) millimeters of mercury, occurs during contraction of the ventricles; the lowest
(diastolic) pressure, normally about 80 (60 to 100) millimeters, occurs during
ventricular relaxation. (Normal atmospheric pressure is equivalent to 760 millimetres
of mercury).
 Blood pressure is measured indirectly with a device called a
sphygmomanometer, over a brachial or femoral artery. The pressure of blood within
the artery is balanced by an external pressure exerted by air contained in a cuff
applied externally around the arm. Actually, it is the pressure within the cuff that is
measured. Thus it is not really necessary that the cuff be wound around the arm only.
It can be wound around any part of a limb. Around the limb is more convenient for the
doctor as well as the patient.
The steps employed in determining blood pressure with a sphygmomanometer
are:
1. The cuff is wrapped securely around the arm above the elbow.
2. Air is pumped into the cuff with a rubber bulb until pressure is sufficient to stop
the flow of blood in the brachial artery (the principal artery of the upper arm).
Pressure within the cuff is shown on the scale of the sphygmomanometer.
3. The observer places a stethoscope over the brachial artery just below the elbow
and gradually releases the air from within the cuff. The decreased air pressure
permits the blood to flow, filling the artery below the cuff. Faint tapping sounds
corresponding to the heartbeat are heard. When the sound is first noted, the air
pressure within the cuff is recorded on the scale. This pressure is equal to the
systolic blood pressure.
4. As the air in the cuff is further released, the sounds become progressively louder,
until the sounds change in quality from loud to soft and finally disappear. The
point at which the sound completely disappears should be recorded as diastolic
blood pressure.

Changes in blood pressure may depend on several regulating mechanisms.

(any of the smaller blood vessels intermediate in size and position between
arteries and capillaries) are the main source of resistance to blood flow. Blood
pressure, therefore, can be affected if the resistance of the arterioles does not keep
pace with the cardiac output. Arterial pressure is also affected by the chemical
composition of the blood. A decreased oxygen or increased carbon dioxide tension
(partial pressure) causes a reflex elevation of blood pressure. Thus the respiratory
activity is also an important regulator of arterial pressure.
Heart attacks, invariably, occur when a blood clot suddenly and completely blocks
a coronary (heart) artery. The condition is called a coronary thrombosis, or simply a
coronary. The heart muscle supplied by the blocked artery becomes damaged because
it receives too little oxygen. Unless blood flow returns within minutes, muscle
damage increases. The heart cells begin to die after four to six hours without blood.
The damage can affect the heart's ability to pump and cause the death of the victim.
The body reacts to a heart attack with its own defences. Substances in the blood can
dissolve clots and permit blood to flow freely again. If the clot is dissolved within
four to six hours of the attack, the heart suffers less damage.

Heart and other animals

 Is it possible to transplant monkey's heart to human or vise-versa?
 How heavy is an elephant’s heart? How large is it?
 Do animals have heart attack like human beings?
 Do snakes have heart?

No, it is not possible to transplant a monkey’s heart to a human being. The heart of an
animal is tailored according to the needs of its body. The requirements of the
circulatory system of a monkey’s body are different from those of a human body
hence a monkeys heart will not be accepted in a human body.
Elephants’ heart weighs around 12 Kgs. Its volume is around 12-13 liters for a
typical adult elephant. Yes, many animals can suffer a heart attack, because a heart
attack is a systemic failure, which can occur in the organ of any animal. Snakes do
have heart. Except for crocodilians which have a four chambered heart all reptiles
(under which snakes also come) have a three chambered heart. It comprises of two
atria and one ventricle. The chamber called the right atrium receives deoxygenated or
impure blood returning from the body tissue. It then passes this blood to the lungs for
oxygenation and to other body organs. The oxygenated blood from the lungs returns
to the left atrium and once again enters the same ventricle, from which it is pumped
again. There is no mixing of oxygenated and deoxygenated blood in the ventricle, as
there is an incomplete partition in the ventricle. In normal four chambered hearts this
partition is complete.