The heart is a pear shaped, muscular organ in vertebrates, responsible for pumping blood

through the blood vessels by repeated, rhythmic contractions, or a similar structure in

annelids, mollusks, and arthropods The term cardiac (as in cardiology) means "related to

the heart" and comes from the Greek καρδία, kardia, for ‘heart.’ The heart is composed

of cardiac muscle, an involuntary muscle tissue which is found only within this muscle.

Early development

At 21 days after conception, the human heart begins beating at 70 to 80 beats per minute

and accelerates linearly for the first month of beating. The human heart beats more than

2.5 billion times in an average lifetime.

The human embryonic heart begins beating approximately 21 days after conception, or

five weeks after the last normal menstrual period (LMP), which is the date normally used

to date pregnancy. The human heart begins beating at a rate near the mother’s, about 75-

80 beats per minute (BPM). The embryonic heart rate (EHR) then accelerates linearly for

the first month of beating, peaking at 165-185 BPM during the early 7th week, (early 9th

week after the LMP). This acceleration is approximately 3.3 BPM per day, or about 10

BPM every three days, an increase of 100 BPM in the first month.

After peaking at about 9.2 weeks after the LMP, it decelerates to about 150 BPM (+/-25

BPM) during the 15th week after the LMP. After the 15th week the deceleration slows

reaching an average rate of about 145 (+/-25 BPM) BPM at term. The regression formula

which describes this acceleration before the embryo reaches 25 mm in crown-rump

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length or 9.2 LMP weeks is: Age in days = EHR(0.3)+6. There is no difference in male

and female heart rates before birth.

Structure

Anterior (frontal) view of the opened heart. Arrows indicate normal blood flow. In the

human body, the heart is usually situated to the left of the middle of the thorax,

underneath the breastbone. The heart is usually felt to be on the left side because the left

heart (left ventricle) is stronger (it pumps to all body parts). The left lung is smaller than

the right lung because the heart occupies more of the left hemithorax. The heart is

enclosed by a sac known as the pericardium and is surrounded by the lungs. The

pericardium is a double membrane structure containing a serous fluid to reduce friction

during heart contractions. The mediastinum, a subdivision of the thoracic cavity, is the

name of the heart cavity.

The apex is the blunt point situated in an inferior (pointing down and left) direction. A

stethoscope can be placed directly over the apex so that the beats can be counted. This

physical location is between the sixth and seventh rib, just to the left of the sternum. In

normal adults, the mass of the heart is 250-350 g (9-12 oz), or about three fourths the size

of a clenched fist, but extremely diseased hearts can be up to 1000 g (2 lb) in mass due to

hypertrophy. It consists of four chambers, the two upper atria (singular: atrium ) and the

two lower ventricles. On the left is a picture of a fresh human heart which was removed

from a 64-year-old British female.

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Human heart

The function of the right side of the heart is to collect de-oxygenated blood, in the right

atrium, from the body and pump it, via the right ventricle, into the lungs (pulmonary

circulation) so that carbon dioxide can be dropped off and oxygen picked up (gas

exchange). This happens through a passive process called diffusion. The left side collects

oxygenated blood from the lungs into the left atrium. From the left atrium the blood

moves to the left ventricle which pumps it out to the body. On both sides, the lower

ventricles are thicker and stronger than the upper atria. The muscle wall surrounding the

left ventricle is thicker than the wall surrounding the right ventricle due to the higher

force needed to pump the blood through the systemic circulation.

The blood flows through a system, starting in the right atrium, the blood flows to the

tricuspid valve, then to the right ventricles that pump blood out, to the pulmonary

semilunar valve [psv], and on to the pulmonary artery which delivers blood to the lungs.

From there, blood flows back to the pulmonary vein to the left atrium, then the bicuspid

valve, and to the left ventricle, then on to the aortic semilunar valve. Then the blood

"forks off" and is delivered to the rest of your body through your aorta, then the arteries,

to the arterioles, and to cappilaries where they go back to the heart to the venuoles, to the

veins, to the inferior/superior vena cava, and starts all over again.

The heart is effectively a syncytium, a meshwork of cardiac muscle cells interconnected

by contiguous cytoplasmic bridges. This relates to electrical stimulatoin of one cell

spreading to neighboring cells.

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First aid

If a person is encountered in cardiac arrest (no heartbeat), cardiopulmonary resuscitation

(CPR) should be started, and help called. If an automated external defibrillator is

available, this device may automatically administer defibrillation if this is indicated.

Often, if there is enough time, the victim can be rushed to the hospital where he or she

will be placed in the care of a cardiologist, which is a doctor specializing in the heart and

lungs.

Food use

The hearts of cattle, sheep, pigs, chickens and certain fowl are consumed as food in many

countries. They are counted among offal, but being a muscle, the taste of heart is much

more like regular meat than that of other offal. It resembles venison in structure and taste.

As a symbol

The heart was historically seen by some as the seat of the soul and the organ responsible

for human thought. Even though it is now known that the heart has nothing to do with

thought or love, people still carry on using the term ‘heart’ metaphorically when talking

about love. When used in this metaphorical sense, the heart is often illustrated as an icon

(♥).

The term ‘heart’ can also refer to the core or center of anything e.g. “The heart of the

matter”.

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There has been some recent research on the Cellular memory of the heart, particularly

with heart transplant patients. This study shows how the heart contains thinking and

memory skills, interacting heavily with the brain. This, though, is not widely accepted by

the scientific community.

Heart cancer

Heart cancer is an extremely rare form of cancer of the heart. Heart cancer is divided into

primary tumors of the heart and secondary tumors of the heart. Most heart cancers are

benign myxomas, fibromas, rhabdomyomas and hamartomas, although malignant

sarcomas (such as angiosarcoma or cardiac sarcoma) have been known to occur. In a

study of 12,487 autopsies performed in Hong Kong seven cardiac tumors were found,

most of which were benign. Cancer, however, can also spread to heart from other parts of

the body. In addition the heart can be affected by treatment for cancer in other parts of the

body.

Congenital heart defect

A congenital heart defect (CHD) is a defect in the structure of the heart and great vessels

of the newborn. Most heart defects either obstruct blood flow in the heart or vessels near

it or cause blood to flow through the heart in an abnormal pattern, although other defects

affecting heart rhythm (such as long QT syndrome) can also occur. Heart defects are

among the most common birth defects, and are the leading cause of birth defect-related

deaths.

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Overview

Congenital heart defects can be broadly categorised into two groups, acyanotic heart

defects (‘pink’ babies) and cyanotic heart defects (‘blue’ babies).

Epidemiology

Slightly less than 1% of all newborn infants have congenital heart disease. Eight defects

are more common than all others and make up 80% of all congenital heart diseases,

whereas the remaining 20% consist of many independently infrequent conditions or

combinations of several defects. Ventricular septal defect (VSD) is generally considered

to be the most common type of malformation, accounting for about 1/3 of all congenital

heart defects.

The incidence is higher when a parent or a sibling has a heart defect (4-5%), in stillborns

(3-4%), abortuses (10-25%), and premature infants (2%). The number of adults with

problems connected to a congenital heart defect is rising and is passing the number of

children with congenital heart defects in most western countries. This group is called

GUCH patients.

Etiology

The cause of most congenital heart defects is unknown. Where a cause is known, it may

be of a multifactorial origin and/or a result of genetic predisposition and environmental

factors.

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Known genetic causes of heart disease includes chromosomal abnormalities such as

trisomies 21, 13, and 18, as well as a range of newly recognised genetic point mutations,

point deletions and other genetic abnormalities as seen in syndromes such as CATCH 22,

familial ASD with heart block, Alagille syndrome, Noonan syndrome, and many more.

Known antenatal environmental factors include maternal infections (Rubella), drugs

(alcohol, hydantoin, lithium and thalidomide) and maternal illness (diabetes mellitus,

phenylketonuria, and systemic lupus erythematosus).

Other congenital heart defects are of a neutral type. The frequency of occurrence is about

the same for both sexes. Among them it is also possible to allocate simple

(Potts/Waterston-Cooley shunt and ostium primum) and complex (partial and full

atrioventricular canal, Ebstain’s anomaly and tricuspid atresia) defects. Simple defects of

this group, as well as female defects, can be considered atavistic. The difference between

them is that these defects contrary to female ones represent a return to the past far in

onthogenetic and phylogenetic sense. They can be considered as consequence of a block

in heart development at early stages of embriogenesis (the first 2-3 months of embryo's

life during which the anatomic formation of the heart occurs), and on earlier in

comparison to female defects stages of phylogenesis. For complex defects of neutral

group the sex ratio depends on which of their components prevail, female or male.

Rokitansky (1875) explained congenital heart defects as breaks in heart development at

various ontogenesis stages. Spitzer (1923) treats them as returns to one of the

phylogenesis stages. Krimsky (1963), synthesizing two previous points of view,

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considered congenital heart diseases as a stop of development at the certain stage of

ontogenesis, corresponding to this or that stage of the phylogenesis. Hence these theories

can explain atavistic heart diseases only (feminine and neutral, according to our

classification), and all group of men’s defects does not find an explanation.

The concept allows considering sex of the patient as a diagnostic symptom. This

symptom is stable, cheap and does not harm the patient compare to some invasive

diagnostic procedures.

Major categories

Patent ductus arteriosus

The ductus arteriosus is a temporary pathway in the foetal heart between the pulmonary

artery and aorta, which allows blood to bypass the fetus' nonfunctioning lungs until birth.

Normally, the ductus closes within a few hours or days of birth; when it does not, the

result is patent ductus arteriosus. This defect is common in premature infants but rare in

full-term infants.

Hypoplasia

Hypoplasia can affect the heart, which typically results in the failure of either the right

ventricle or the left ventricle to adequately develop, leaving only one side of the heart

capable of pumping blood to the body and lungs. Hypoplasia of the heart is rare but is the

most serious form of CHD; it is called hypoplastic left heart syndrome when it affects the

left side of the heart and hypoplastic right heart syndrome when it affects the right side of

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the heart. In both conditions, the presence of a patent ductus arteriosus (and, when

hypoplasia affects the right side of the heart, a patent foramen ovale) is vital to the

infant's ability to survive until emergency heart surgery can be performed, since without

these pathways blood cannot circulate to the body (or lungs, depending on which side of

the heart is defective). Hypoplasia of the heart is generally a cyanotic heart defect.

Obstruction defects

Obstruction defects occur when heart valves, arteries, or veins are abnormally narrow or

blocked. Common obstruction defects include pulmonary valve stenosis, aortic valve

stenosis, and coarctation of the aorta, with other types such as bicuspid aortic valve

stenosis and subaortic stenosis being comparatively rare. Any narrowing or blockage can

cause heart enlargement or hypertension.

Septal defects

The septum is a wall of tissue which separates the left heart from the right heart. It is

comparatively common for defects to exist in the interatrial septum or the interventricular

septum, allowing blood to flow from the left side of the heart to the right, reducing the

heart's efficiency. Ventricular septal defects are collectively the most common type of

CHD, although approximately 30% of adults have a type of atrial septal defect called

patent foramen ovale. Septal defects may or may not cause cyanosis depending on the

severity of the defect.

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Cyanotic defects

Cyanotic heart defects are called such because they result in cyanosis, a bluish-grey

discoloration of the skin due to a lack of oxygen in the body. Such defects include

persistent truncus arteriosus, total anomalous pulmonary venous connection, tetralogy of

Fallot, transposition of the great vessels, and tricuspid atresia.

Other defects

 Ebstein's anomaly

 Brugada syndrome

 Marfan syndrome

 DiGeorge Syndrome

Signs and Symptoms

Symptoms and signs are related to the type and severity of the heart defects. Some

children have no signs while others may exhibit shortness of breath, cyanosis, chest pain,

syncope, sweating, heart murmur, respiratory infections, underdeveloping of limbs and

muscles, poor feeding, or poor growth. Most defects cause a whispering sound, or

murmur, as blood moves through the heart causing some of these symptoms. All of these

symptoms occur at a young age of a child or infant which is typically found during a

physical examination.

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Treatment

Sometimes CHD improves with no treatment necessary. At other times the defect is so

small and does not require any treatment. Most of the time CHD is serious and requires

surgery and/or medications. Medications include diuretics which aid the baby in

eliminating water, salts, and digoxin, which aids in strengthening the contraction of the

heart. This slows the heartbeat and removes some fluid from tissues. Some defects

require surgical procedures to repair as much as possible to restore circulation back to

normal. In some cases, multiple surgeries are needed to be performed to help balance the

circulation. Interventional cardiology now offers patients minimally invasive alternatives

to surgery. Device closures can now be treated with a standard transcatheter procedure

using a closure device mounted on a balloon catheter. Equally stenosis can be treated

using a balloon dilation procedure to dilate the obstruction during cardiac catheterization.

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REFERENCES

1. Geodakyan V. A., Sherman A. L. (1970). “Eksperimental’naja hirurgija i

anesteziologija (Experimental surgery and anesthesiology) ” 32 N 2, 18–23.

2. Geodakyan V. A., Sherman A. L. (1971). Svjaz' vrozdennych anomalij razvitija s

polom (Relation of congenital anomalies with the development of sex). “Zh.

Obsh. Biol.” 32 N 4, 417–424.

3. Rokitarisky K. E. (1875) Die defecte der Scheidewande des Herzens. Wien.

4. Spitzer A. (1923) Arch. Pathol. Anat. 243, 81–272.

5. Krimski L. D. (1963) Pathological anatomy of congenital heart defects and

complications after their surgical treatment. M., Medicine.

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