9 Cardiovascular System – Heart

Cardiovascular System – Heart Word Parts

Click on prefixes, combining forms, and suffixes to reveal a list of word parts to memorize for the cardiovascular system – Heart.

Introduction to the Heart

The heart is a fist-sized vital organ that has one job: to pump blood. If one assumes an average heart rate of 75 beats per minute, a human heart would beat approximately 108,000 times in one day, more than 39 million times in one year, and nearly 3 billion times during a 75-year lifespan. At rest, each of the major pumping chambers of the heart ejects approximately 70 mL blood per contraction in an adult. This would be equal to 5.25 liters of blood per minute and approximately 14,000 liters per day. Over one year, that would equal 10,000,000 liters of blood sent through roughly 100,000 km of blood vessels. In order to understand how that happens, it is necessary to understand the anatomy and physiology of the heart.

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Cardiovascular System – Heart Medical Terms

Anatomy of the Heart

Location

The human heart is located within the thoracic cavity, between the lungs in the space known as the mediastinum. Figure 9.1 shows the position of the heart within the thoracic cavity. Within the mediastinum, the heart is separated from the other mediastinal structures by a tough membrane known as the pericardium, or pericardial sac, and sits in its own space called the pericardial cavity. The great vessels, which carry blood to and from the heart, are attached to the superior surface of the heart, which is called the base. The base of the heart is located at the level of the third costal cartilage. The inferior tip of the heart, the apex, lies just to the left of the sternum between the junction of the fourth and fifth ribs.

Concept Check

• On the diagram below (Figure 9.1), locate the mediastinum, the pericardial cavity, the base of the heart and the apex of the heart.
• Locate the largest vein in the body superior vena cava.

Membranes and Layers of the Heart Walls

The heart and the roots of the great vessels are surrounded by a membrane known as the pericardium or pericardial sac. The pericardium consists of two distinct sub layers:

• The sturdy outer fibrous pericardium is made of tough, dense connective tissue that protects the heart and holds it in position.
• Separated by the pericardial cavity and containing pericardial fluid the inner serous pericardium consists of two layers:
  • the outer parietal pericardium, which is fused to the fibrous pericardium.
  • the inner visceral pericardium, or epicardium, which is fused to the heart and forms the outer layer of the heart wall.

The walls of the heart consist of three layers:

• The outer epicardium, which is another name for the visceral pericardium mentioned above.
• The thick, middle myocardium, which is made of muscle tissue and gives the heart its ability to contract.
• The inner endocardium, which lines the heart chambers and is the main component of the heart valves.

Concept Check

• Look at Figure 9.2 below, and name the layers of the heart wall and surrounding membranes, starting with the innermost layer.
• As shown on the diagram, suggest why is the myocardium layer is thicker than the endocardium layer?

Internal Structures of the Heart

The heart consists of four chambers:

• The upper chambers are the right and left atria (singular: atrium).
• The lower chambers are the right and left ventricles.

The interventricular septum is a muscular wall that separates the right and left ventricles. The interatrial septum separates the right and left atria.

The atrium and ventricle on each side of the heart are separated by an atrioventricular (AV) valve:

• The right AV valve, or tricuspid valve, separates the right atrium and right ventricle.
• The left AV valve, or bicuspid valve, separates the left ventricle and the left atrium. This valve is also called the mitral valve.

There are also two semilunar valves:

• The pulmonary valve separates the right ventricle from the pulmonary trunk.
• The aortic valve separates the left ventricle from the aorta.

Anatomy Labeling Activity

Physiology of the Heart

Pulmonary Circuit

Blood exiting from the right ventricle flows into the pulmonary trunk, which bifurcates into the two pulmonary arteries. These vessels branch to supply blood to the pulmonary capillaries, where gas exchange occurs within the lung alveoli. Blood returns via the pulmonary veins to the left atrium.

Concept Check

• On Figure 9.3 below, use your finger to trace the pathway of blood flowing through the left side of the heart, naming each of the following structures as you encounter them: right and left pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta.

Cardiac Cycle

The process of pumping and circulating blood is active, coordinated and rhythmic. Each heartbeat represents one cycle of the heart receiving blood and ejecting blood.

• Diastole is the portion of the cycle in which the heart is relaxed and the atria and ventricles are filling with blood. The AV valves are open, so that blood can move from the atria to the ventricles.
• Systole is the portion of the cycle in which the heart contracts, AV valves slam shut, and the ventricles eject blood to the lungs and to the body through the open semilunar valves. Once this phase ends, the semilunar valves close, in preparation for another filling phase.

Heart Terms not Easily Broken into Word Parts

Heart Abbreviations

Many terms and phrases related to the cardiovascular system- heart are abbreviated.
Learn these common abbreviations by expanding the list below.

Diseases and Disorders

Cardiomyopathy

The heart of a well-trained athlete can be considerably larger than the average person’s heart. This is because exercise results in an increase in muscle cells called hypertrophy . Hearts of athletes can pump blood more effectively at lower rates than those of non-athletes. However, when an enlarged heart is not the result of exercise, it may be due to hypertrophic cardiomyopathy. The cause of an abnormally enlarged heart muscle is unknown, but the condition is often undiagnosed and can cause sudden death in apparently otherwise healthy young people (Betts, et al., 2021).

Other types of cardiomyopathy include:

• Dilated cardiomyopathy, which also has an unknown cause and is seen in people of any age. In this disorder, one of the ventricles of the heart is larger than normal.
• Arrhythmogenic cardiomyopathy, an inherited condition which results in irregular heart rhythms.
• Restrictive cardiomyopathy, which is a complication of other conditions which cause the myocardium to scar or stiffen (Centers for Disease Control and Prevention, 2019).

Cardiomyopathy may also be caused by myocardial infarctions, myocardial infections, pregnancy, alcohol or cocaine abuse, autoimmune and endocrine diseases. Because the myocardium is responsible for contracting and pumping blood, patients with cardiomyopathy experience impaired heart function which may lead to heart failure. (Centers for Disease Control and Prevention, 2019). To learn more about cardiomyopathy visit the CDC’s cardiomyopathy web page.

Heart Failure

Heart failure is defined as the inability of the heart to pump enough blood to meet the needs of the body. It is also called congestive heart failure (CHF). This condition causes swelling in the lower extremities and shortness of breath, due to a buildup of fluid in the lungs. It may be caused by cardiomyopathy and it may lead to hypertension and heart valve disorders (Heart & Stroke, n.d.). To learn more, visit the Heart & Stroke’s congestive heart failure web page.

Valvular Heart Disease

The four heart valves open and close at specific times during the cardiac cycle, in order to ensure that blood flows in only one direction through the heart. This requires that these valves open and close completely. Infections such as rheumatic disease or bacterial endocarditis can affect the heart valves and result in scar tissue formation which interferes with valve function. Other causes of heart valve disease include: congenitally malformed valves, autoimmune diseases, and other cardiovascular diseases such as aortic aneurysms and atherosclerosis (Centers for Disease Control and Prevention, 2019a).

Heart valve disease may be asymptomatic, or cause dyspnea, arrhythmias, fatigue and other symptoms. It is often detected when a heart murmur is heard through a stethoscope (Centers for Disease Control and Prevention, 2019a).

• Mitral Valve Prolaspse
  • The mitral (bicuspid) valve is diseased or malformed and is not able to close completely, allowing the regurgitation of blood back into the left atrium during systole. Because some of the blood goes back into the atrium, insufficient blood is pumped out of the ventricle into the systemic circulation. This inability to close properly and the resulting regurgitation may also be found in other heart valves (Centers for Disease Control and Prevention, 2019a).
• Aortic Stenosis
  • The aortic valve is narrowed and hardened, preventing it from opening fully and allowing sufficient blood to travel to the systemic circulation. Any heart valve can be stenosed, but this disorder most often affects the aortic valve (Centers for Disease Control and Prevention, 2019a).

Visit the CDC’s page on valvular heart disease to learn more.

Aneurysms

An aneurysm is a defect in the wall of an artery in which the wall becomes thin and weak and starts to balloon out as blood pulses against the vessel wall. This can happen to any artery and even to the myocardial walls. Aneurysms sometimes occur in the portion of the aorta that is in the thorax (see Figure 9.4). If these aneurysms start to leak between layers of the vessel wall, the condition is known as aortic dissection. If an aortic or cardiac aneurysm bursts, there is sudden, massive internal bleeding (Centers for Disease Control and Prevention, 2019b).

People who smoke, have hypertension, hypercholesterolemia, and/or atherosclerosis have an increased risk of developing aneurysms. Having a family history of aneurysms or certain genetic diseases may also increase a person’s risk of developing an aneurysm.

Aneurysms are often asymptomatic and may be detected incidentally during diagnostic tests that are being done for other reasons. They are sometimes repaired surgically and sometimes treated with medications such as antihypertensives (Centers for Disease Control and Prevention, 2019b; Tittley, n.d.). Visit the Society for Vascular Surgery’s page on thoracic aortic aneurysms to learn more.

Heart Defects

Fetal circulation is different from postnatal circulation. There are 2 extra openings in the fetal heart, the foramen ovale and the ductus arteriosus, which allow blood circulation that bypasses the immature fetal lungs. The fetal blood is reoxygenated by the mother’s lungs and transported between mother and fetus via the placenta. These two openings usually close around the time of birth (Betts, et al., 2021).

Septal defects are commonly first detected through auscultation. Unusual heart sounds may be detected because blood is not flowing and valves are not closing correctly. Medical imaging is ordered to confirm or rule out a diagnosis. In many cases, treatment may not be needed.

• Patent ductus arteriosus is a congenital condition in which the ductus arteriosus fails to close.  If untreated, the condition can result in congestive heart failure.
• Patent foramen ovale is one type of atrial septal defect (ASD), due to a failure of the hole in the interatrial septum to close at birth.
  • As much as 20 – 25 percent of the general population may have a patent foramen ovale, most have the benign, asymptomatic version but in extreme cases a surgical repair is required to close the opening permanently.
• Tetralogy of Fallot is a congenital condition that may also occur from exposure to unknown environmental factors; it occurs when there is an opening in the interventricular septum caused by blockage of the pulmonary trunk, normally at the pulmonary semilunar valve. This allows blood that is relatively low in oxygen from the right ventricle to flow into the left ventricle and mix with the blood that is relatively high in oxygen.
  • Symptoms include a distinct heart murmur, low blood oxygen percent saturation, dyspnea, polycythemia,  clubbing of the fingers and toes, and in children, difficulty in feeding or failure to grow and develop.
  • It is the most common cause of cyanosis following birth. Other heart defects may also accompany this condition, which is typically confirmed by echocardiography imaging.
• In the case of severe septal defects, including both tetralogy of fallot and patent foramen ovale, failure of the heart to develop properly can lead to a condition commonly known as a blue baby. Regardless of normal skin pigmentation, individuals with this condition have an insufficient supply of oxygenated blood, which leads to cyanosis, especially when active (Betts, et al., 2021).

Diseases of the Coronary Circulation

Coronary Artery Disease (CAD)

Coronary artery disease occurs when the buildup of plaque in the coronary arteries obstructs the flow of blood and decreases compliance of the vessels. This condition is called atherosclerosis. As the disease progresses and coronary blood vessels become more and more narrow, cells of the myocardium become ischemic, which causes symptoms of angina pectoris, in some patients. If untreated, coronary artery disease can lead to MI.

The image below shows the blockage of coronary arteries on an angiogram (Betts, et al., 2021).

 

CAD is progressive and chronic. Risk factors include smoking, family history, hypertension, obesity, diabetes, high alcohol consumption, lack of exercise, stress, and hyperlipidemia. Treatments may include medication, changes to diet and exercise, angioplasty with a balloon catheter, insertion of a stent, or coronary artery bypass graft (CABG) (Betts, et al., 2021).

• Angioplasty is a procedure in which the occlusion is mechanically widened with a balloon. A specialized catheter with an expandable tip is inserted into a blood vessel in the arm or leg, and then directed to the site of the occlusion. At this point, the balloon is inflated to compress the plaque material and to open the vessel to increase blood flow. Once the balloon is deflated and retracted, a stent consisting of a specialized mesh is typically inserted at the site of occlusion to reinforce the weakened and damaged walls and prevent re-occlusion.

• Coronary bypass surgery (Coronary artery bypass graft CABG) is a surgical procedure which grafts a replacement vessel obtained from another part of the body to bypass the occluded area. (Betts, et al., 2021).

Myocardial Infarction

Myocardial infarction (MI) is the medical term for a heart attack.

An MI normally results from a lack of blood flow to a region of the heart, resulting in death of the cardiac muscle cells. An MI often occurs when a coronary artery is blocked by the buildup of atherosclerotic plaque. It can also occur when a piece of an atherosclerotic plaque breaks off and travels through the coronary arterial system until it lodges in one of the smaller vessels. MIs may be triggered by excessive exercise, in which the partially occluded artery is no longer able to pump sufficient quantities of blood, or severe stress, which may induce spasm of the smooth muscle in the walls of the vessel (Betts, et al., 2021).

In the case of acute MI (AMI), there is often sudden pain beneath the sternum (retrosternal pain) called angina pectoris, often radiating down the left arm in males but not in female patients. Other common symptoms include dyspnea, palpitations, nausea and vomiting, diaphoresis, anxiety, and syncope. Many of the symptoms are shared with other medical conditions, including anxiety attacks and simple indigestion, so differential diagnosis is critical (Betts, et al., 2021).

An MI can be confirmed by examining the patient’s ECG.

Other diagnostic tests include:

• echocardiography.
• CT.
• MRI.
• Common blood tests indicating an MI include elevated levels of creatine kinase MB and cardiac troponin, both of which are released by damaged cardiac muscle cells (Betts, et al., 2021).

MIs may induce dangerous heart rhythms and even cardiac arrest. Important risk factors for MI include coronary artery disease, age, smoking, high blood levels of LDL, low levels of HDL, hypertension, diabetes mellitus, obesity, lack of physical exercise, chronic kidney disease, excessive alcohol consumption, and use of illegal drugs (Betts, et al., 2021).

Diseases of the (Electrical) Conduction System

Arrhythmia

The heart’s natural pacemaker, the sinoatrial (SA) node initiates an electrical impulse 60-90 times per minute in a resting adult. This impulse travels through the heart’s conduction system in order to ensure a smooth, coordinated pumping action. This electrical activity can be detected and recorded through the skin using an electrocardiograph. Arrhyhmias may occur when the SA node fails to initiate an impulse, or when the conduction system fails to transmit that impulse through the heart.

In the event that the electrical activity of the heart is severely disrupted, cessation of electrical activity or fibrillation may occur. In fibrillation, the heart beats in a wild, uncontrolled manner, which prevents it from being able to pump effectively.

• Atrial fibrillation is a serious condition, but as long as the ventricles continue to pump blood, the patient’s life may not be in immediate danger.
• Ventrical fibrillation is a medical emergency that requires life support, because the ventricles are not effectively pumping blood, left untreated ventricular fibrillation may lead to brain death.

The most common treatment is defibrillation which uses special paddles to apply a charge to the heart from an external electrical source in an attempt to establish a normal sinus rhythm. A defibrillator effectively stops the heart so that the SA node can trigger a normal conduction cycle. External automated defibrillators (EADs) are being placed in areas frequented by large numbers of people, such as schools, restaurants, and airports. These devices contain simple and direct verbal instructions that can be followed by non-medical personnel in an attempt to save a life (Betts, et al., 2021).

Abnormal Heart Rates

Bradycardia is the condition in which resting adult heart rate drops below 60 bpm. a client exhibiting symptoms such as weakness, fatigue, dizziness, syncope, chest discomfort, palpitations or respiratory distress may indicate that the heart is not providing sufficient oxygenated blood to the tissues. If the patient is not exhibiting symptoms then bradycardia is not considered clinically significant. The term relative bradycardia may be used with a patient who has a HR in the normal range but is still suffering from these symptoms.  Most patients remain asymptomatic as long as the HR remains above 50 bpm.

Tachycardia is the condition in which the resting rate is above 100 bpm. Tachycardia is not normal in a resting patient and may be detected in pregnant women or individuals experiencing extreme stress. Some individuals may remain asymptomatic, but when present, symptoms may include dizziness, shortness of breath, rapid pulse, heart palpitations, chest pain, or syncope. Treatment depends upon the underlying cause but may include medications, implantable cardioverter defibrillators, ablation, or surgery (Betts, et al., 2021).

Heart Block

A heart block refers to an interruption in the normal conduction pathway. Heart blocks are generally named after the part of the conduction system that is causing the problem. For example, bundle branch blocks occur within either the left or right atrioventricular bundle branches.

Medical Terms in Context

Medical Specialties and Procedures Related to the Heart

Cardiologists and Cardiovascular Surgeons

Cardiologists are medical doctors that specialize in diagnosing and treating heart disease non-invasively. Cardiovascular/thoracic surgeons provide surgical treatments for the heart and other thoracic organs (American Medical Association, 2020). To learn more about these specialists please visit the AMA’s Specialty Profiles web page.

Cardiology Technologists

Cardiology Technologists complete a college training program and perform diagnostic tests such as electrocardiography, stress testing, Holter monitor testing, ambulatory blood pressure testing, as well as pacemaker monitoring and programming (American College of Cardiology). Please visit the American College of Cardiology webpage for more information.

Cardiovascular Perfusionists

Cardiovascular perfusionists complete a college training program and are responsible for operation of the heart-lung bypass machine during open heart surgery. They also monitor the patient’s vitals, administering IV fluids, and other drugs (Mayo Clinic). Please visit the Mayo Clinic: Cardiovascular Perfusion page for more information.

Test Yourself

References

American Medical Association. (2020). Specialty Profiles. https://freida.ama-assn.org/specialty/cardiovascular-disease-im

American College of Cardiology (2020). Home. https://www.acc.org/#sort=%40commonsortdate%20descending

Centers for Disease Control and Prevention. (2019). Cardiomyopathy. CDC. https://www.cdc.gov/heartdisease/cardiomyopathy.htm

Centers for Disease Control and Prevention. (2019a). Valvular heart disease. CDC. https://www.cdc.gov/heartdisease/valvular_disease.htm

Centers for Disease Control and Prevention. (2019b). Aortic aneurysm. CDC. https://www.cdc.gov/heartdisease/aortic_aneurysm.htm

[CrashCourse]. (2015, July 6). The heart, part 1 – under pressure: Crash course A&P #25 [Video]. YouTube. https://youtu.be/X9ZZ6tcxArI

Heart & Stroke. (n.d.). Heart failure. Heart and Stroke Foundation. https://www.heartandstroke.ca/heart/conditions/heart-failure

Mayo Clinic. (n.d.). Cardiovascular perfusion. Mayo Clinic. https://college.mayo.edu/academics/explore-health-care-careers/careers-a-z/cardiovascular-perfusionist/#:~:text=Cardiovascular%20perfusionists%20are%20responsible%20for,patient’s%20circulatory%20or%20respiratory%20function

Eagleton, M. J. (n.d.). Thoracic aortic aneurysms. Retrieved from Society for Vascular Surgery: https://vascular.org/

Unless otherwise indicated, this chapter contains material adapted from Anatomy and Physiology (on OpenStax), by Betts, et al. and is used under a a CC BY 4.0 international license. Download and access this book for free at https://openstax.org/books/anatomy-and-physiology/pages/1-introduction.