the hollow muscular organ lying slightly to the left of the midline of the chest. The heart serves as a pump controlling the blood flow in two circuits, the pulmonary and the systemic. See also
circulatory system, and see Plates.
Divisions of the Heart. The
septum, a thick muscular wall, divides the heart into right and left halves. Each half is again divided into upper and lower quarters or chambers. The lower chambers are called
ventricles and the upper chambers are called
atria. The right side of the heart, consisting of the right atrium and right ventricle, receives deoxygenated blood and sends it into the pulmonary circuit. The left side, consisting of the left atrium and left ventricle, receives oxygenated blood and sends it into the systemic circuit.
Valves of the Heart. The
atrioventricular valves connect an atrium and a ventricle: between the right atrium and right ventricle is the
tricuspid valve and between the left atrium and left ventricle is the
mitral valve. The
semilunar valves are valves at the blood's exit points from the heart: the
pulmonary valve opens from the right ventricle into the pulmonary artery, and the
aortic valve opens from the left ventricle into the aorta. These valves, both within the heart and leading out of it, open and shut in such a way as to keep the blood flowing in one direction through the heart's two separate pairs of chambers: fro atrium to ventricle and out through its appropriate artery.
Layers of the Heart. The heart wall is composed of three layers of tissues. Its chambers are lined by a delicate membrane, the
endocardium. The thick muscular wall essential to normal pumping action of the heart is called the
myocardium. The thin but sturdy membranous sac surrounding the exterior of the heart is called the
pericardium.
The Heart's Pacemaker. The heart is made up of special muscle tissue, capable of continuous rhythmic contraction without tiring. The impulse that starts the contraction of the heart has its origin in an area of the right atrium called the
sinoatrial node; it is this special tissue that acts as the normal
pacemaker for the heart. The impulse is transmitted in a fraction of a second through the atria to another group of similarly sensitive fibers called the
atrioventricular node, through the
bundle of his, down the
bundle branches, and to the
Purkinje fibers, resulting in contraction of the ventricles.
Pumping Action. Although the right and left sides of the heart serve two separate branches of the circulation, each with its distinct function, they are coordinated so that the heart efficiently serves both sides with a single pumping action. The valve action on both sides is also coordinated with the two phases of the pumping action. Thus during
diastole, the relaxation phase, oxygen-poor blood returning from the systemic circulation and accumulated in the right atrium pours into the right ventricle. At the same time, the oxygen-rich blood that has accumulated in the left atrium returning from the pulmonary circulation pours into the left ventricle. The walls of both atria contract to press blood into the relaxed ventricles. In the next contraction phase (
systole), the valves between the atria and ventricles close and the ventricles contract, forcing the blood through the pulmonary artery and the aorta. At the end of the contraction the pulmonary and aortic valves snap shut, preventing any backward flow of the blood into the ventricles. Diastole follows, the ventricles again filling with the blood from their respective atria, and the cycle is repeated.
Disorders of the Heart. The heart is subject to a variety of disorders. Among them are
congenital heart defects, which begin or exist at the time of birth. Disorders of this nature may interfere with the flow of the blood both within the heart and from the heart to the lungs.
tetralogy of fallot and
patent ductus arteriosus are examples of congenital heart defects. Rheumatic heart disease may be associated with
rheumatic fever. Other disorders of the heart include
angina pectoris, which is caused by coronary insufficiency;
myocardial infarction, which results from formation of a blood clot in a coronary artery and death of myocardial tissue; and
heart failure. Cardiac
arrhythmias are disturbances in the normal rate and rhythm of the heartbeat.
Diagnostic Tests. Many different diagnostic procedures are available for the examination of the heart. Along with a history and physical examination, an
electrocardiogram (ECG) is routinely obtained. It shows a tracing of the electrical excitation that spreads through the heart during each beat. It is the definitive source of information about cardiac arrhythmias, and also gives diagnostic information about myocardial infarctions.
Exercise stress testing is a valuable tool for detecting persons who have some degree of coronary heart disease. The test subject performs maximal exercise while being monitored by ECG. A positive stress test occurs when the subject cannot sustain the exercise for the duration of the test, cannot attain a normal maximal heart rate, or shows ECG changes indicative of ischemia. When stress testing is used for screening purposes, it is not diagnostic. However, persons with a positive stress test are 13 times more likely to develop significant coronary artery or heart disease and should work to reduce their risk factors. Stress testing is also used to evaluate the severity of known coronary disease and to guide the rehabilitation of a patient with coronary disease.
Phonocardiography is the recording of heart sounds and murmurs. It is more precise than
auscultation with a stethoscope because it provides a permanent visual record that can be used to obtain precise timing information and can be used as baseline data for comparison with later findings.
Echocardiography is a type of diagnostic
ultrasonography that provides information about the structure and function of the heart. It is a comfortable technique for the patient and is capable of establishing a diagnosis for several types of heart disease, especially those involving the valves. Types include
M-mode, Doppler, and
transesophageal echocardiography.Several types of
radioisotope examination are used to detect heart disease. A radioisotope imaging agent is injected into the patient, and a scintillation camera is then used to make an image of the distribution of radioactivity.
Thallium 201 has an affinity for heart tissue; when injected intravenously, it is carried to areas with adequate perfusion. Myocardial infarcts and areas of acute ischemia or scarring appear as “cold spots” (areas of no uptake of thallium) on the
scintigram. When the isotope is injected during maximal exercise in an exercise stress test, the scan shows areas of inadequate perfusion and is a better indicator of coronary disease than a stress test alone.
Radiopharmaceuticals that label the blood pool can be used with a computerized scintillation camera to evaluate ventricular performance. Images of the first pass of the radioisotope through the heart can be used to determine the cardiac output and ejection fraction, the size of the ventricles, and regional wall motion.
The imaging agents used for bone scans, such as
technetium 99m pyrophosphate or diphosphonate, also have an affinity for areas of acute ischemic tissue damage. “Hot spots” on the scintigram (areas of isotope uptake) show areas of acute infarction. The scan is usually negative by approximately 6 days after an infarction.
Cardiac catheterization is an invasive technique used when definitive data are required to decide whether heart disease should be treated medically, surgically, or through interventional cardiology techniques such as
percutaneous transluminal angioplasty,
stents, or
valvuloplasty. A catheter is inserted into a vein or artery, usually the brachial artery or the femoral vein or artery, and guided into the heart. Tracings of the pressure pulses within the chambers during the heart cycle are obtained. Cardiac output, pulmonary artery pressures, the orifice area of valves, and the degree of left-to-right shunting can be determined.
Angiocardiography is the x-ray examination of the heart after injection of a radiopaque contrast medium through a catheter at various locations in the heart. The films show the size and motion of the heart chambers and can demonstrate
aortic or
mitral regurgitation. In
coronary arteriography the contrast medium is injected through a catheter into the orifice of each coronary artery. The films show atherosclerotic obstructions of the arteries and are useful in planning coronary bypass surgery, percutaneous transluminal angioplasty, or stents.
Prevention of Heart Disease. Although heart disease remains the leading cause of death in industrialized countries, its mortality rate has steadily declined since the early 1970s. A major factor in this decline is the development of more effective preventive measures and modes of treatment for ischemic heart disease. These advances include open heart surgery to repair congenital defects and replace malfunctioning valves; vascular surgery to repair or bypass obstructions in the coronary arteries and aorta; newer and more accurate diagnostic tests and procedures for detecting problems involving the heart and blood vessels; antimicrobial therapy for the treatment of rheumatic fever, syphilis, and other infectious diseases that are damaging to the heart; more sophisticated monitoring equipment and intensive care units; and aggressive medical treatment and management of heart disease and hypertension.
All these contributions to the control and correction of cardiovascular diseases are important in the reduction of mortality rates and improvement in patients' quality of life. Nevertheless, it is also important for prevention that there be an improvement of the general public's awareness of the causes and risk factors of cardiac disorders. Major risk factors that can be avoided, modified, or corrected include cigarette
smoking, elevated blood lipids,
obesity, habitual dietary excesses, lack of exercise,
hypertension, and excessive
stress. Health professionals can promote reduction in the incidence of heart disease by educating the public about these risk factors and by encouraging active participation in preventive measures, particularly in those that involve changes in lifestyle.

Blood enters the right atrium from the body and then passes into the right ventricle, where it is pumped into the lungs. It returns from the lungs into the right atrium. It enters the left ventricle and then is pumped to the body via the aorta.