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Some cardiomyopathies such as hypertrophic cardiomopathy are linked to a higher risk of sudden cardiac death, particularly in athletes.

Healthy heart valves allow blood to flow easily in one direction, but prevent it from flowing in the other direction.

Diseased heart valves may have a narrow opening and therefore restrict the flow of blood in the forward direction referred to as a stenotic valve , or may allow blood to leak in the reverse direction referred to as valvular regurgitation.

Valvular heart disease may cause breathlessness, blackouts, or chest pain, but may be asymptomatic and only detected on a routine examination by hearing abnormal heart sounds or a heart murmur.

In the developed world, valvular heart disease is most commonly caused by degeneration secondary to old age, but may also be caused by infection of the heart valves endocarditis.

In some parts of the world rheumatic heart disease is a major cause of valvular heart disease, typically leading to mitral or aortic stenosis and caused by the body's immune system reacting to a streptococcal throat infection.

While in the healthy heart, waves of electrical impulses originate in the sinus node before spreading to the rest of the atria, the atrioventricular node , and finally the ventricles referred to as a normal sinus rhythm , this normal rhythm can be disrupted.

Abnormal heart rhythms or arrhythmias may be asymptomatic or may cause palpitations, blackouts, or breathlessness. Some types of arrhythmia such as atrial fibrillation increase the long term risk of stroke.

Some arrhythmias cause the heart to beat abnormally slowly, referred to as a bradycardia or bradyarrhythmia.

This may be caused by an abnormally slow sinus node or damage within the cardiac conduction system heart block.

These arrhythmias can take many forms and can originate from different structures within the heart—some arise from the atria e. AV nodal re-entrant tachycardia whilst others arise from the ventricles e.

Some tachyarrhythmias are caused by scarring within the heart e. Wolff-Parkinson-White syndrome. The most dangerous form of heart racing is ventricular fibrillation , in which the ventricles quiver rather than contract, and which if untreated is rapidly fatal.

The sack which surrounds the heart, called the pericardium, can become inflamed in a condition known as pericarditis.

This condition typically causes chest pain that may spread to the back, and is often caused by a viral infection glandular fever , cytomegalovirus , or coxsackievirus.

Fluid can build up within the pericardial sack, referred to as a pericardial effusion. Pericardial effusions often occur secondary to pericarditis, kidney failure, or tumours, and frequently do not cause any symptoms.

However, large effusions or effusions which accumulate rapidly can compress the heart in a condition known as cardiac tamponade , causing breathlessness and potentially fatal low blood pressure.

Fluid can be removed from the pericardial space for diagnosis or to relieve tamponade using a syringe in a procedure called pericardiocentesis.

Some people are born with hearts that are abnormal and these abnormalities are known as congenital heart defects. They may range from the relatively minor e.

Common abnormalities include those that affect the heart muscle that separates the two side of the heart a 'hole in the heart' e.

Other defects include those affecting the heart valves e. More complex syndromes are seen that affect more than one part of the heart e. Tetralogy of Fallot.

Some congenital heart defects allow blood that is low in oxygen that would normally be returned to the lungs to instead be pumped back to the rest of the body.

These are known as cyanotic congenital heart defects and are often more serious. Major congenital heart defects are often picked up in childhood, shortly after birth, or even before a child is born e.

More minor forms of congenital heart disease may remain undetected for many years and only reveal themselves in adult life e. Heart disease is diagnosed by the taking of a medical history , a cardiac examination , and further investigations, including blood tests , echocardiograms , ECGs and imaging.

Other invasive procedures such as cardiac catheterisation can also play a role. The cardiac examination includes inspection, feeling the chest with the hands palpation and listening with a stethoscope auscultation.

A person's pulse is taken, usually at the radial artery near the wrist, in order to assess for the rhythm and strength of the pulse. The blood pressure is taken, using either a manual or automatic sphygmomanometer or using a more invasive measurement from within the artery.

Any elevation of the jugular venous pulse is noted. A person's chest is felt for any transmitted vibrations from the heart, and then listened to with a stethoscope.

Typically, healthy hearts have only two audible heart sounds , called S1 and S2. The first heart sound S1, is the sound created by the closing of the atrioventricular valves during ventricular contraction and is normally described as "lub".

The second heart sound, S2, is the sound of the semilunar valves closing during ventricular diastole and is described as "dub". A third heart sound , S3 usually indicates an increase in ventricular blood volume.

A fourth heart sound S4 is referred to as an atrial gallop and is produced by the sound of blood being forced into a stiff ventricle. The combined presence of S3 and S4 give a quadruple gallop.

Heart murmurs are abnormal heart sounds which can be either related to disease or benign, and there are several kinds.

Murmurs are graded by volume, from 1 the quietest , to 6 the loudest , and evaluated by their relationship to the heart sounds, position in the cardiac cycle, and additional features such as their radiation to other sites, changes with a person's position, the frequency of the sound as determined by the side of the stethoscope by which they are heard, and site at which they are heard loudest.

A different type of sound, a pericardial friction rub can be heard in cases of pericarditis where the inflamed membranes can rub together.

Blood tests play an important role in the diagnosis and treatment of many cardiovascular conditions. Troponin is a sensitive biomarker for a heart with insufficient blood supply.

It is released 4—6 hours after injury, and usually peaks at about 12—24 hours. A test for brain natriuretic peptide BNP can be used to evaluate for the presence of heart failure, and rises when there is increased demand on the left ventricle.

These tests are considered biomarkers because they are highly specific for cardiac disease. Other blood tests are often taken to help understand a person's general health and risk factors that may contribute to heart disease.

These often include a full blood count investigating for anaemia , and basic metabolic panel that may reveal any disturbances in electrolytes.

A coagulation screen is often required to ensure that the right level of anticoagulation is given. Fasting lipids and fasting blood glucose or an HbA1c level are often ordered to evaluate a person's cholesterol and diabetes status, respectively.

Using surface electrodes on the body, it is possible to record the electrical activity of the heart. An ECG is a bedside test and involves the placement of ten leads on the body.

This produces a "12 lead" ECG three extra leads are calculated mathematically, and one lead is a ground. There are five prominent features on the ECG: the P wave atrial depolarisation , the QRS complex ventricular depolarisation [h] and the T wave ventricular repolarisation.

A downward deflection on the ECG implies cells are becoming more positive in charge "depolarising" in the direction of that lead, whereas an upward inflection implies cells are becoming more negative "repolarising" in the direction of the lead.

This depends on the position of the lead, so if a wave of depolarising moved from left to right, a lead on the left would show a negative deflection, and a lead on the right would show a positive deflection.

The ECG is a useful tool in detecting rhythm disturbances and in detecting insufficient blood supply to the heart.

Testing when exercising can be used to provoke an abnormality, or an ECG can be worn for a longer period such as a hour Holter monitor if a suspected rhythm abnormality is not present at the time of assessment.

Several imaging methods can be used to assess the anatomy and function of the heart, including ultrasound echocardiography , angiography , CT scans , MRI and PET.

An echocardiogram is an ultrasound of the heart used to measure the heart's function, assess for valve disease, and look for any abnormalities. Echocardiography can be conducted by a probe on the chest "transthoracic" or by a probe in the esophagus "transoesophageal".

A typical echocardiography report will include information about the width of the valves noting any stenosis , whether there is any backflow of blood regurgitation and information about the blood volumes at the end of systole and diastole, including an ejection fraction , which describes how much blood is ejected from the left and right ventricles after systole.

Ejection fraction can then be obtained by dividing the volume ejected by the heart stroke volume by the volume of the filled heart end-diastolic volume.

This cardiac stress test involves either direct exercise, or where this is not possible, injection of a drug such as dobutamine.

CT scans, chest X-rays and other forms of imaging can help evaluate the heart's size, evaluate for signs of pulmonary oedema , and indicate whether there is fluid around the heart.

They are also useful for evaluating the aorta, the major blood vessel which leaves the heart. Diseases affecting the heart can be treated by a variety of methods including lifestyle modification, drug treatment, and surgery.

Narrowings of the coronary arteries ischaemic heart disease are treated to relieve symptoms of chest pain caused by a partially narrowed artery angina pectoris , to minimise heart muscle damage when an artery is completely occluded myocardial infarction , or to prevent a myocardial infarction from occurring.

Medications to improve angina symptoms include nitroglycerin , beta blockers , and calcium channel blockers, while preventative treatments include antiplatelets such as aspirin and statins , lifestyle measures such as stopping smoking and weight loss, and treatment of risk factors such as high blood pressure and diabetes.

In addition to using medications, narrowed heart arteries can be treated by expanding the narrowings or redirecting the flow of blood to bypass an obstruction.

This may be performed using a percutaneous coronary intervention , during which narrowings can be expanded by passing small balloon-tipped wires into the coronary arteries, inflating the balloon to expand the narrowing, and sometimes leaving behind a metal scaffold known as a stent to keep the artery open.

If the narrowings in coronary arteries are unsuitable for treatment with a percutaneous coronary intervention, open surgery may be required.

A coronary artery bypass graft can be performed, whereby a blood vessel from another part of the body the saphenous vein , radial artery , or internal mammary artery is used to redirect blood from a point before the narrowing typically the aorta to a point beyond the obstruction.

Diseased heart valves that have become abnormally narrow or abnormally leaky may require surgery. This is traditionally performed as an open surgical procedure to replace the damaged heart valve with a tissue or metallic prosthetic valve.

In some circumstances, the tricuspid or mitral valves can be repaired surgically , avoiding the need for a valve replacement.

Heart valves can also be treated percutaneously, using techniques that share many similarities with percutaneous coronary intervention. Transcatheter aortic valve replacement is increasingly used for patients consider very high risk for open valve replacement.

Abnormal heart rhythms arrhythmias can be treated using antiarrhythmic drugs. These may work by manipulating the flow of electrolytes across the cell membrane such as calcium channel blockers , sodium channel blockers , amiodarone , or digoxin , or modify the autonomic nervous system's effect on the heart beta blockers and atropine.

In some arrhythmias such as atrial fibrillation which increase the risk of stroke, this risk can be reduced using anticoagulants such as warfarin or novel oral anticoagualants.

If medications fail to control an arrhythmia, another treatment option may be catheter ablation. In these procedures, wires are passed from a vein or artery in the leg to the heart to find the abnormal area of tissue that is causing the arrhythmia.

The abnormal tissue can be intentionally damaged, or ablated, by heating or freezing to prevent further heart rhythm disturbances. Whilst the majority of arrhythmias can be treated using minimally invasive catheter techniques, some arrhythmias particularly atrial fibrillation can also be treated using open or thoracoscopic surgery, either at the time of other cardiac surgery or as a standalone procedure.

A cardioversion , whereby an electric shock is used to stun the heart out of an abnormal rhythm, may also be used.

Cardiac devices in the form of pacemakers or implantable defibrillators may also be required to treat arrhythmias. Pacemakers, comprising a small battery powered generator implanted under the skin and one or more leads that extend to the heart, are most commonly used to treat abnormally slow heart rhythms.

These devices monitor the heart, and if dangerous heart racing is detected can automatically deliver a shock to restore the heart to a normal rhythm.

Implantable defibrillators are most commonly used in patients with heart failure , cardiomyopathies , or inherited arrhythmia syndromes.

As well as addressing the underlying cause for a patient's heart failure most commonly ischaemic heart disease or hypertension , the mainstay of heart failure treatment is with medication.

These include drugs to prevent fluid from accumulating in the lungs by increasing the amount of urine a patient produces diuretics , and drugs that attempt to preserve the pumping function of the heart beta blockers , ACE inhibitors and mineralocorticoid receptor antagonists.

In some patients with heart failure, a specialised pacemaker known as cardiac resynchronisation therapy can be used to improve the heart's pumping efficiency.

In very severe cases of heart failure, a small pump called a ventricular assist device may be implanted which supplements the heart's own pumping ability.

In the most severe cases, a cardiac transplant may be considered. Humans have known about the heart since ancient times, although its precise function and anatomy were not clearly understood.

He also discovered the heart valves. The Greek physician Galen 2nd century CE knew blood vessels carried blood and identified venous dark red and arterial brighter and thinner blood, each with distinct and separate functions.

These ideas went unchallenged for almost a thousand years. The earliest descriptions of the coronary and pulmonary circulation systems can be found in the Commentary on Anatomy in Avicenna's Canon , published in by Ibn al-Nafis.

In Europe, the teachings of Galen continued to dominate the academic community and his doctrines were adopted as the official canon of the Church.

Andreas Vesalius questioned some of Galen's beliefs of the heart in De humani corporis fabrica , but his magnum opus was interpreted as a challenge to the authorities and he was subjected to a number of attacks.

A breakthrough in understanding the flow of blood through the heart and body came with the publication of De Motu Cordis by the English physician William Harvey.

Harvey's book completely describes the systemic circulation and the mechanical force of the heart, leading to an overhaul of the Galenic doctrines.

Ernest Starling — was an important English physiologist who also studied the heart. Although they worked largely independently, their combined efforts and similar conclusions have been recognized in the name " Frank—Starling mechanism ".

Although Purkinje fibers and the bundle of His were discovered as early as the 19th century, their specific role in the electrical conduction system of the heart remained unknown until Sunao Tawara published his monograph, titled Das Reizleitungssystem des Säugetierherzens , in Tawara's discovery of the atrioventricular node prompted Arthur Keith and Martin Flack to look for similar structures in the heart, leading to their discovery of the sinoatrial node several months later.

These structures form the anatomical basis of the electrocardiogram , whose inventor, Willem Einthoven , was awarded the Nobel Prize in Medicine or Physiology in This marked an important milestone in cardiac surgery , capturing the attention of both the medical profession and the world at large.

However, long-term survival rates of patients were initially very low. Louis Washkansky , the first recipient of a donated heart, died 18 days after the operation while other patients did not survive for more than a few weeks.

As of March , more than 55, heart transplantations have been performed worldwide. By the middle of the 20th century, heart disease had surpassed infectious disease as the leading cause of death in the United States, and it is currently the leading cause of deaths worldwide.

Since , the ongoing Framingham Heart Study has shed light on the effects of various influences on the heart, including diet, exercise, and common medications such as aspirin.

As one of the vital organs, the heart was long identified as the center of the entire body, the seat of life, or emotion, or reason, will, intellect, purpose or the mind.

In the Hebrew Bible , the word for heart, lev , is used in these meanings, as the seat of emotion, the mind, and referring to the anatomical organ.

It is also connected in function and symbolism to the stomach. An important part of the concept of the soul in Ancient Egyptian religion was thought to be the heart, or ib.

The ib or metaphysical heart was believed to be formed from one drop of blood from the child's mother's heart, taken at conception. This is evidenced by Egyptian expressions which incorporate the word ib , such as Awi-ib for "happy" literally, "long of heart" , Xak-ib for "estranged" literally, "truncated of heart".

It was conceived as surviving death in the nether world, where it gave evidence for, or against, its possessor.

It was thought that the heart was examined by Anubis and a variety of deities during the Weighing of the Heart ceremony. If the heart weighed more than the feather of Maat , which symbolized the ideal standard of behavior.

If the scales balanced, it meant the heart's possessor had lived a just life and could enter the afterlife; if the heart was heavier, it would be devoured by the monster Ammit.

In Sanskrit, it may mean both the anatomical object and "mind" or "soul", representing the seat of emotion. Hrd may be a cognate of the word for heart in Greek, Latin, and English.

Many classical philosophers and scientists, including Aristotle , considered the heart the seat of thought, reason , or emotion, often disregarding the brain as contributing to those functions.

The heart also played a role in the Aztec system of belief. The most common form of human sacrifice practiced by the Aztecs was heart-extraction.

The Aztec believed that the heart tona was both the seat of the individual and a fragment of the Sun's heat istli.

To this day, the Nahua consider the Sun to be a heart-soul tona-tiuh : "round, hot, pulsating". In Catholicism , there has been a long tradition of veneration of the heart, stemming from worship of the wounds of Jesus Christ which gained prominence from the mid sixteenth century.

The expression of a broken heart is a cross-cultural reference to grief for a lost one or to unfulfilled romantic love. The notion of " Cupid 's arrows" is ancient, due to Ovid , but while Ovid describes Cupid as wounding his victims with his arrows, it is not made explicit that it is the heart that is wounded.

The familiar iconography of Cupid shooting little heart symbols is a Renaissance theme that became tied to Valentine's day. Animal hearts are widely consumed as food.

As they are almost entirely muscle, they are high in protein. They are often included in dishes with other offal , for example in the pan-Ottoman kokoretsi.

In Egyptian cuisine , they can be used, finely chopped, as part of stuffing for chicken. The hearts of beef, pork, and mutton can generally be interchanged in recipes.

As heart is a hard-working muscle, it makes for "firm and rather dry" meat, [] so is generally slow-cooked. Another way of dealing with toughness is to julienne the meat, as in Chinese stir-fried heart.

Beef heart may be grilled or braised. An Australian recipe for "mock goose" is actually braised stuffed beef heart.

Pig heart is stewed, poached, braised, [] or made into sausage. The Balinese oret is a sort of blood sausage made with pig heart and blood.

The SA node is found in all amniotes but not in more primitive vertebrates. In these animals, the muscles of the heart are relatively continuous, and the sinus venosus coordinates the beat, which passes in a wave through the remaining chambers.

Indeed, since the sinus venosus is incorporated into the right atrium in amniotes, it is likely homologous with the SA node.

In teleosts, with their vestigial sinus venosus, the main centre of coordination is, instead, in the atrium. The rate of heartbeat varies enormously between different species, ranging from around 20 beats per minute in codfish to around in hummingbirds [] and up to bpm in the ruby-throated hummingbird.

Adult amphibians and most reptiles have a double circulatory system , meaning a circulatory system divided into arterial and venous parts.

However, the heart itself is not completely separated into two sides. Instead, it is separated into three chambers—two atria and one ventricle.

Blood returning from both the systemic circulation and the lungs is returned, and blood is pumped simultaneously into the systemic circulation and the lungs.

The double system allows blood to circulate to and from the lungs which deliver oxygenated blood directly to the heart. In reptiles, the heart is usually situated around the middle of the thorax, and in snakes, usually between the junction of the upper first and second third.

There is a heart with three chambers: two atria and one ventricle. The form and function of these hearts are different than mammalian hearts due to the fact that snakes have an elongated body, and thus are affected by different environmental factors.

In particular, the snake's heart relative to the position in their body has been influenced greatly by gravity. Therefore, snakes that are larger in size tend to have a higher blood pressure due to gravitational change.

This results in the heart being located in different regions of the body that is relative to the snake's body length. In most reptilian species, there appears to be little, if any, mixing between the bloodstreams, so the aorta receives, essentially, only oxygenated blood.

In the heart of lungfish , the septum extends part-way into the ventricle. This allows for some degree of separation between the de-oxygenated bloodstream destined for the lungs and the oxygenated stream that is delivered to the rest of the body.

The absence of such a division in living amphibian species may be partly due to the amount of respiration that occurs through the skin; thus, the blood returned to the heart through the venae cavae is already partially oxygenated.

As a result, there may be less need for a finer division between the two bloodstreams than in lungfish or other tetrapods. Nonetheless, in at least some species of amphibian, the spongy nature of the ventricle does seem to maintain more of a separation between the bloodstreams.

Also, the original valves of the conus arteriosus have been replaced by a spiral valve that divides it into two parallel parts, thereby helping to keep the two bloodstreams separate.

Archosaurs crocodilians and birds and mammals show complete separation of the heart into two pumps for a total of four heart chambers ; it is thought that the four-chambered heart of archosaurs evolved independently from that of mammals.

In crocodilians, there is a small opening, the foramen of Panizza , at the base of the arterial trunks and there is some degree of mixing between the blood in each side of the heart, during a dive underwater; [] [] thus, only in birds and mammals are the two streams of blood—those to the pulmonary and systemic circulations—permanently kept entirely separate by a physical barrier.

Fish have what is often described as a two-chambered heart, [] consisting of one atrium to receive blood and one ventricle to pump it.

The atrium and ventricle are sometimes considered "true chambers", while the others are considered "accessory chambers".

Primitive fish have a four-chambered heart, but the chambers are arranged sequentially so that this primitive heart is quite unlike the four-chambered hearts of mammals and birds.

The first chamber is the sinus venosus , which collects deoxygenated blood from the body through the hepatic and cardinal veins.

From here, blood flows into the atrium and then to the powerful muscular ventricle where the main pumping action will take place.

The fourth and final chamber is the conus arteriosus , which contains several valves and sends blood to the ventral aorta. The ventral aorta delivers blood to the gills where it is oxygenated and flows, through the dorsal aorta , into the rest of the body.

In tetrapods , the ventral aorta has divided in two; one half forms the ascending aorta , while the other forms the pulmonary artery.

In the adult fish, the four chambers are not arranged in a straight row but instead form an S-shape, with the latter two chambers lying above the former two.

This relatively simple pattern is found in cartilaginous fish and in the ray-finned fish. In teleosts , the conus arteriosus is very small and can more accurately be described as part of the aorta rather than of the heart proper.

The conus arteriosus is not present in any amniotes , presumably having been absorbed into the ventricles over the course of evolution. Similarly, while the sinus venosus is present as a vestigial structure in some reptiles and birds, it is otherwise absorbed into the right atrium and is no longer distinguishable.

Arthropods and most mollusks have an open circulatory system. In this system, deoxygenated blood collects around the heart in cavities sinuses.

This blood slowly permeates the heart through many small one-way channels. The heart then pumps the blood into the hemocoel , a cavity between the organs.

The heart in arthropods is typically a muscular tube that runs the length of the body, under the back and from the base of the head. Instead of blood the circulatory fluid is haemolymph which carries the most commonly used respiratory pigment , copper-based haemocyanin as the oxygen transporter.

Haemoglobin is only used by a few arthropods. In some other invertebrates such as earthworms , the circulatory system is not used to transport oxygen and so is much reduced, having no veins or arteries and consisting of two connected tubes.

Oxygen travels by diffusion and there are five small muscular vessels that connect these vessels that contract at the front of the animals that can be thought of as "hearts".

Squids and other cephalopods have two "gill hearts" also known as branchial hearts , and one "systemic heart". The branchial hearts have two atria and one ventricle each, and pump to the gills , whereas the systemic heart pumps to the body.

OpenStax CNX. From Wikipedia, the free encyclopedia. This article is about the internal organ. For other uses, see Heart disambiguation.

For the comics character, see Cardiac comics. Muscular organ responsible for pumping blood through the circulatory system in most animals.

Healthy resting heart sounds. Auscultation of a healthy 15 year old's heart beating with no abnormalities. Play media. Main article: Heart valves.

With the atria and major vessels removed, all four valves are clearly visible. The heart, showing valves, arteries and veins. The white arrows show the normal direction of blood flow.

Further information: Cardiac muscle. Main article: Coronary circulation. Main articles: Heart development and Human embryogenesis. Main article: Cardiac physiology.

Main articles: Cardiac cycle , Systole , and Diastole. Main article: Cardiac output. Main articles: Electrical conduction system of the heart and Heart rate.

Main article: Heart rate. Auscultation of student's racing heart after exercise. Recorded heart sounds of a year-old girl immediately after running, and the following recovery of heart rate.

The stethoscope is used for auscultation of the heart, and is one of the most iconic symbols for medicine. A number of diseases can be detected primarily by listening for heart murmurs.

Atherosclerosis is a condition affecting the circulatory system. If the coronary arteries are affected, angina pectoris may result or at worse a heart attack.

Main article: Coronary artery disease. Main article: heart failure. Main article: Cardiomyopathy. Main article: Valvular heart disease.

Main article: Heart arrhythmia. An irregular heartbeat. Recording of heart sounds from a year-old girl with a cardiac arrhythmia.

Main article: Congenital heart defect. Main articles: Cardiac examination and Heart sounds. Normal heart sounds.

Normal heart sounds as heard with a stethoscope. Main article: Electrocardiography. Main article: Cardiac imaging.

Main articles: Coronary artery disease , Coronary artery bypass surgery , and Coronary stent. Main article: Artificial heart valve.

Main articles: Heart arrhythmia , Radiofrequency ablation , and Artificial cardiac pacemaker. Main article: Heart failure.

Common heart symbol. The seal script glyph for "heart" Middle Chinese sim. See also: Circulatory system. Blood flow through the fish heart: sinus venosus, atrium, ventricle, and outflow tract.

The coronary circulation. The pressure difference between the blood in the atria and the ventricles does this.

Taber's cyclopedic medical dictionary. Davis Co. Clinically Oriented Anatomy. Biology: Today and Tomorrow With Physiology. Cengage Learning.

Archived from the original on 2 May New York: Kaplan Pub. Archived from the original on 4 May Gordon Retrieved 11 August World Health Organization.

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McGraw-Hill Professional. European Heart Journal. Surface Markings of the Thorax". Archived from the original on 20 November Retrieved 18 October Dorland's Illustrated Medical Dictionary 32nd ed.

Archived from the original on 29 July Retrieved 14 August Cardiovascular Pathology. Human Physiology. Oxford University Press. Atlas of Human Cardiac Anatomy.

Archived from the original on 17 March Retrieved 7 March The Free Dictionary. Retrieved 31 July Retrieved 29 September BMC Genomics.

Principles of human anatomy. Nielsen, Mark T. Mark Thomas 11th ed. Hoboken, NJ: J. Archived from the original on 16 November Retrieved 17 October J Diagn Med Sonography.

Clinical Pharmacist. Archived from the original on 28 November Oh's Intensive Care Manual 7. London: Elsevier Health Sciences.

Human Physiology Third ed. Journal of Cardiovascular Electrophysiology. Archived from the original on 1 August Retrieved 7 June Archived from the original on 14 April Cardiovascular Research.

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He moves with his mother to meet her boyfriend Dave, with whom he does not get along, due to Dave's being mean to him.

They move to North Carolina to Dave's home. In the second story, he is in the fourth grade where he makes a lot of friends. His mother is now married to Dave, but Asa has difficulty accepting Dave as his stepfather.

He does not like the poem, so he plans to recite " The Highwayman. At first, Joel is excited, but he has difficulty remembering the lines.

Joel's mother and Asa agree on Asa's reciting the poem alone while Joel's mother takes him away, unaware of Asa's solo recitation.

Joel shows up on the day of the recital, and Asa, for sake of his friendship, switches back to "Little Blue Boy," which Joel remembers perfectly.

Another turning point takes place when Asa is eleven. He tries out for Little League Baseball after practicing with his stepfather and his mother for weeks.

A day before his tryout, his mother has an accident with pills. It is later revealed that his mother is suffering from depression.

The family moves to Raleigh , and Asa misses his chance to play baseball. In the fourth story, Asa is in love with Jean, his classmate since the fifth grade whom he finally befriends in the seventh grade.

Asa confesses his love to Jean and just as he reaches home that day, he learns that he and his mother are moving, due to his mother's separation from Dave.

The next day, Jean confesses her love to Asa by giving him two candy hearts that say "I love you, I love you," only to find out that Asa would no longer be with her.

Asa later calls Jean on the phone but Jean pretends as if nothing has happened between them. When Asa mentions the heart candies, Jean asks, "What Hearts?

Asa : Asa is the main character, going through different turning points as he learns to move with the changes. Asa's Mother : Asa's mother has a difficult relationship with Asa's father, and later with Dave, Asa's stepfather.

She falls into depression because of this.

Ace of Hearts (English Edition) eBook: Goode, Ella: footballensalle.be: Kindle-Shop. Ace of Hearts: Suit Up (English Edition) eBook: Scott, P.D.: footballensalle.be: Kindle-​Shop. Schau dir unsere Auswahl an ace of hearts an, um die tollsten einzigartigen oder spezialgefertigten, handgemachten Stücke aus unseren Shops zu finden.

A Of Hearts -

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Rate This. When compulsive gambler Sir Giles Staverley Christopher Plummer has lost his estate and all of his money playing dice, he realizes that he only has one thing left of value: his daughter Director: John Hough.

Writers: Barbara Cartland novel , Terence Feely screenplay. Available on Amazon. Added to Watchlist. High School Icons, Then and Now.

The Best Period Dramas. Use the HTML below. You must be a registered user to use the IMDb rating plugin. Edit Cast Cast overview, first billed only: Diana Rigg Lady Harriet Vulcan Edward Fox Serena Staverley Fiona Fullerton Lady Isabel Gillingham Neil Dickson Nicholas Christopher Plummer Sir Giles Staverley Stewart Granger Old Vulcan Anna Massey Eudora Eileen Atkins Lady Harriet's Maid Gareth Hunt Joker Marcus Gilbert Lord Justin Vulcan Robert Addie Lord Peter Gillingham James Gaddas Lord John Burley Christopher Villiers Captain Jackson Ben Aris Edit Storyline When compulsive gambler Sir Giles Staverley Christopher Plummer has lost his estate and all of his money playing dice, he realizes that he only has one thing left of value: his daughter Serena Helena Bonham Carter.

Edit Did You Know? Goofs Just after Justin asks Serena to marry him for the first time and he then walks toward the window, you can see a thin microphone being poked towards him as the walks away - the sound guy then realises it's in shot and pulls it back.

Was this review helpful to you? Yes No Report this. Add the first question. Edit Details Country: UK. Language: English.

The pulmonary valve lies between the right heart and the pulmonary trunk. The left heart has two chambers: the left atrium and the left ventricle, separated by the mitral valve.

The left atrium receives oxygenated blood back from the lungs via one of the four pulmonary veins.

The left atrium has an outpouching called the left atrial appendage. Like the right atrium, the left atrium is lined by pectinate muscles.

The left ventricle is much thicker as compared with the right, due to the greater force needed to pump blood to the entire body.

Like the right ventricle, the left also has trabeculae carneae , but there is no moderator band. The left ventricle pumps blood to the body through the aortic valve and into the aorta.

Two small openings above the aortic valve carry blood to the heart itself, the left main coronary artery and the right coronary artery. The heart wall is made up of three layers: the inner endocardium , middle myocardium and outer epicardium.

These are surrounded by a double-membraned sac called the pericardium. The innermost layer of the heart is called the endocardium.

It is made up of a lining of simple squamous epithelium and covers heart chambers and valves. It is continuous with the endothelium of the veins and arteries of the heart, and is joined to the myocardium with a thin layer of connective tissue.

The middle layer of the heart wall is the myocardium, which is the cardiac muscle —a layer of involuntary striated muscle tissue surrounded by a framework of collagen.

The cardiac muscle pattern is elegant and complex, as the muscle cells swirl and spiral around the chambers of the heart, with the outer muscles forming a figure 8 pattern around the atria and around the bases of the great vessels and the inner muscles, forming a figure 8 around the two ventricles and proceeding toward the apex.

This complex swirling pattern allows the heart to pump blood more effectively. There are two types of cells in cardiac muscle: muscle cells which have the ability to contract easily, and pacemaker cells of the conducting system.

These contractile cells are connected by intercalated discs which allow a rapid response to impulses of action potential from the pacemaker cells.

The intercalated discs allow the cells to act as a syncytium and enable the contractions that pump blood through the heart and into the major arteries.

They are generally much smaller than the contractile cells and have few myofibrils which gives them limited contractibility. Their function is similar in many respects to neurons.

There are specific proteins expressed in cardiac muscle cells. The pericardium is the sack that surrounds the heart. The tough outer surface of the pericardium is called the fibrous membrane.

This is lined by a double inner membrane called the serous membrane that produces pericardial fluid to lubricate the surface of the heart.

The pericardium is present in order to lubricate its movement against other structures within the chest, to keep the heart's position stabilised within the chest, and to protect the heart from infection.

Heart tissue, like all cells in the body, needs to be supplied with oxygen , nutrients and a way of removing metabolic wastes.

This is achieved by the coronary circulation , which includes arteries , veins , and lymphatic vessels. Blood flow through the coronary vessels occurs in peaks and troughs relating to the heart muscle's relaxation or contraction.

Heart tissue receives blood from two arteries which arise just above the aortic valve. These are the left main coronary artery and the right coronary artery.

The left main coronary artery splits shortly after leaving the aorta into two vessels, the left anterior descending and the left circumflex artery.

The left anterior descending artery supplies heart tissue and the front, outer side, and the septum of the left ventricle.

It does this by branching into smaller arteries—diagonal and septal branches. The left circumflex supplies the back and underneath of the left ventricle.

The right coronary artery supplies the right atrium, right ventricle, and lower posterior sections of the left ventricle. The right coronary artery runs in a groove at the back of the heart and the left anterior descending artery runs in a groove at the front.

There is significant variation between people in the anatomy of the arteries that supply the heart [30] The arteries divide at their furtherst reaches into smaller branches that join together at the edges of each arterial distribution.

The coronary sinus is a large vein that drains into the right atrium, and receives most of the venous drainage of the heart. It receives blood from the great cardiac vein receiving the left atrium and both ventricles , the posterior cardiac vein draining the back of the left ventricle , the middle cardiac vein draining the bottom of the left and right ventricles , and small cardiac veins.

Small lymphatic networks called plexuses exist beneath each of the three layers of the heart. These networks collect into a main left and a main right trunk, which travel up the groove between the ventricles that exists on the heart's surface, receiving smaller vessels as they travel up.

These vessels then travel into the atrioventricular groove, and receive a third vessel which drains the section of the left ventricle sitting on the diaphragm.

The left vessel joins with this third vessel, and travels along the pulmonary artery and left atrium, ending in the inferior tracheobronchial node.

The right vessel travels along the right atrium and the part of the right ventricle sitting on the diaphragm.

It usually then travels in front of the ascending aorta and then ends in a brachiocephalic node. The heart receives nerve signals from the vagus nerve and from nerves arising from the sympathetic trunk.

These nerves act to influence, but not control, the heart rate. Sympathetic nerves also influence the force of heart contraction. The vagus nerve of the parasympathetic nervous system acts to decrease the heart rate, and nerves from the sympathetic trunk act to increase the heart rate.

The vagus nerve is a long, wandering nerve that emerges from the brainstem and provides parasympathetic stimulation to a large number of organs in the thorax and abdomen, including the heart.

The ventricles are more richly innervated by sympathetic fibers than parasympathetic fibers. Sympathetic stimulation causes the release of the neurotransmitter norepinephrine also known as noradrenaline at the neuromuscular junction of the cardiac nerves.

This shortens the repolarization period, thus speeding the rate of depolarization and contraction, which results in an increased heart rate. It opens chemical or ligand-gated sodium and calcium ion channels, allowing an influx of positively charged ions.

The heart is the first functional organ to develop and starts to beat and pump blood at about three weeks into embryogenesis.

This early start is crucial for subsequent embryonic and prenatal development. The heart derives from splanchnopleuric mesenchyme in the neural plate which forms the cardiogenic region.

Two endocardial tubes form here that fuse to form a primitive heart tube known as the tubular heart. This places the chambers and major vessels into the correct alignment for the developed heart.

Further development will include the septa and valves formation and remodelling of the heart chambers. By the end of the fifth week the septa are complete and the heart valves are completed by the ninth week.

Before the fifth week, there is an opening in the fetal heart known as the foramen ovale. The foramen ovale allowed blood in the fetal heart to pass directly from the right atrium to the left atrium, allowing some blood to bypass the lungs.

Within seconds after birth, a flap of tissue known as the septum primum that previously acted as a valve closes the foramen ovale and establishes the typical cardiac circulation pattern.

A depression in the surface of the right atrium remains where the foramen ovale was, called the fossa ovalis. The embryonic heart begins beating at around 22 days after conception 5 weeks after the last normal menstrual period, LMP.

It starts to beat at a rate near to the mother's which is about 75—80 beats per minute bpm. The embryonic heart rate then accelerates and reaches a peak rate of — bpm early in the early 7th week early 9th week after the LMP.

There is no difference in female and male heart rates before birth. The heart functions as a pump in the circulatory system to provide a continuous flow of blood throughout the body.

This circulation consists of the systemic circulation to and from the body and the pulmonary circulation to and from the lungs. Blood in the pulmonary circulation exchanges carbon dioxide for oxygen in the lungs through the process of respiration.

The systemic circulation then transports oxygen to the body and returns carbon dioxide and relatively deoxygenated blood to the heart for transfer to the lungs.

The right heart collects deoxygenated blood from two large veins, the superior and inferior venae cavae.

Blood collects in the right and left atrium continuously. The inferior vena cava drains the blood from below the diaphragm and empties into the back part of the atrium below the opening for the superior vena cava.

Immediately above and to the middle of the opening of the inferior vena cava is the opening of the thin-walled coronary sinus.

The blood collects in the right atrium. When the right atrium contracts, the blood is pumped through the tricuspid valve into the right ventricle.

As the right ventricle contracts, the tricuspid valve closes and the blood is pumped into the pulmonary trunk through the pulmonary valve.

The pulmonary trunk divides into pulmonary arteries and progressively smaller arteries throughout the lungs, until it reaches capillaries.

As these pass by alveoli carbon dioxide is exchanged for oxygen. This happens through the passive process of diffusion. In the left heart , oxygenated blood is returned to the left atrium via the pulmonary veins.

It is then pumped into the left ventricle through the mitral valve and into the aorta through the aortic valve for systemic circulation.

The aorta is a large artery that branches into many smaller arteries, arterioles , and ultimately capillaries.

In the capillaries, oxygen and nutrients from blood are supplied to body cells for metabolism, and exchanged for carbon dioxide and waste products.

The cardiac cycle refers to the sequence of events in which the heart contracts and relaxes with every heartbeat.

The atria and ventricles work in concert, so in systole when the ventricles are contracting, the atria are relaxed and collecting blood.

When the ventricles are relaxed in diastole, the atria contract to pump blood to the ventricles. This coordination ensures blood is pumped efficiently to the body.

At the beginning of the cardiac cycle, the ventricles are relaxing. As they do so, they are filled by blood passing through the open mitral and tricuspid valves.

After the ventricles have completed most of their filling, the atria contract, forcing further blood into the ventricles and priming the pump.

Next, the ventricles start to contract. As the pressure rises within the cavities of the ventricles, the mitral and tricuspid valves are forced shut.

As the pressure within the ventricles rises further, exceeding the pressure with the aorta and pulmonary arteries, the aortic and pulmonary valves open.

Blood is ejected from the heart, causing the pressure within the ventricles to fall. Simultaneously, the atria refill as blood flows into the right atrium through the superior and inferior vena cavae , and into the left atrium through the pulmonary veins.

Finally, when the pressure within the ventricles falls below the pressure within the aorta and pulmonary arteries, the aortic and pulmonary valves close.

The ventricles start to relax, the mitral and tricuspid valves open, and the cycle begins again.

Cardiac output CO is a measurement of the amount of blood pumped by each ventricle stroke volume in one minute. This is calculated by multiplying the stroke volume SV by the beats per minute of the heart rate HR.

The average cardiac output, using an average stroke volume of about 70mL, is 5. Preload refers to the filling pressure of the atria at the end of diastole, when the ventricles are at their fullest.

A main factor is how long it takes the ventricles to fill: if the ventricles contract more frequently, then there is less time to fill and the preload will be less.

The force of each contraction of the heart muscle is proportional to the preload, described as the Frank-Starling mechanism.

This states that the force of contraction is directly proportional to the initial length of muscle fiber, meaning a ventricle will contract more forcefully, the more it is stretched.

Afterload , or how much pressure the heart must generate to eject blood at systole, is influenced by vascular resistance. It can be influenced by narrowing of the heart valves stenosis or contraction or relaxation of the peripheral blood vessels.

The strength of heart muscle contractions controls the stroke volume. This can be influenced positively or negatively by agents termed inotropes.

Inotropes that increase the force of contraction are "positive" inotropes, and include sympathetic agents such as adrenaline , noradrenaline and dopamine.

The normal rhythmical heart beat, called sinus rhythm , is established by the heart's own pacemaker, the sinoatrial node also known as the sinus node or the SA node.

Here an electrical signal is created that travels through the heart, causing the heart muscle to contract. The sinoatrial node is found in the upper part of the right atrium near to the junction with the superior vena cava.

It travels to the left atrium via Bachmann's bundle , such that the muscles of the left and right atria contract together. This is found at the bottom of the right atrium in the atrioventricular septum —the boundary between the right atrium and the left ventricle.

The septum is part of the cardiac skeleton , tissue within the heart that the electrical signal cannot pass through, which forces the signal to pass through the atrioventricular node only.

In the ventricles the signal is carried by specialized tissue called the Purkinje fibers which then transmit the electric charge to the heart muscle.

The normal resting heart rate is called the sinus rhythm , created and sustained by the sinoatrial node , a group of pacemaking cells found in the wall of the right atrium.

Cells in the sinoatrial node do this by creating an action potential. The cardiac action potential is created by the movement of specific electrolytes into and out of the pacemaker cells.

The action potential then spreads to nearby cells. When the sinoatrial cells are resting, they have a negative charge on their membranes.

However a rapid influx of sodium ions causes the membrane's charge to become positive. This is called depolarisation and occurs spontaneously.

All the ions travel through ion channels in the membrane of the sinoatrial cells. The potassium and calcium start to move out of and into the cell only once it has a sufficiently high charge, and so are called voltage-gated.

Shortly after this, the calcium channels close and potassium channels open, allowing potassium to leave the cell. This causes the cell to have a negative resting charge and is called repolarization.

The ions move from areas where they are concentrated to where they are not. For this reason sodium moves into the cell from outside, and potassium moves from within the cell to outside the cell.

Calcium also plays a critical role. Their influx through slow channels means that the sinoatrial cells have a prolonged "plateau" phase when they have a positive charge.

A part of this is called the absolute refractory period. Calcium ions also combine with the regulatory protein troponin C in the troponin complex to enable contraction of the cardiac muscle, and separate from the protein to allow relaxation.

The adult resting heart rate ranges from 60 to bpm. The resting heart rate of a newborn can be beats per minute bpm and this gradually decreases until maturity.

During exercise the rate can be bpm with maximum rates reaching from to bpm. The normal sinus rhythm of the heart, giving the resting heart rate , is influenced by a number of factors.

The cardiovascular centres in the brainstem that control the sympathetic and parasympathetic influences to the heart through the vagus nerve and sympathetic trunk.

Through a series of reflexes these help regulate and sustain blood flow. Baroreceptors are stretch receptors located in the aortic sinus , carotid bodies , the venae cavae, and other locations, including pulmonary vessels and the right side of the heart itself.

Baroreceptors fire at a rate determined by how much they are stretched, [51] which is influenced by blood pressure, level of physical activity, and the relative distribution of blood.

With increased pressure and stretch, the rate of baroreceptor firing increases, and the cardiac centers decrease sympathetic stimulation and increase parasympathetic stimulation.

As pressure and stretch decrease, the rate of baroreceptor firing decreases, and the cardiac centers increase sympathetic stimulation and decrease parasympathetic stimulation.

Increased venous return stretches the walls of the atria where specialized baroreceptors are located.

However, as the atrial baroreceptors increase their rate of firing and as they stretch due to the increased blood pressure, the cardiac center responds by increasing sympathetic stimulation and inhibiting parasympathetic stimulation to increase heart rate.

The opposite is also true. Low oxygen or high carbon dioxide will stimulate firing of the receptors. Exercise and fitness levels, age, body temperature, basal metabolic rate , and even a person's emotional state can all affect the heart rate.

High levels of the hormones epinephrine , norepinephrine, and thyroid hormones can increase the heart rate. The levels of electrolytes including calcium, potassium, and sodium can also influence the speed and regularity of the heart rate; low blood oxygen , low blood pressure and dehydration may increase it.

Cardiovascular diseases , which include diseases of the heart, are the leading cause of death worldwide. Many other medical professionals are involved in treating diseases of the heart, including doctors such as general practitioners , cardiothoracic surgeons and intensivists , and allied health practitioners including physiotherapists and dieticians.

Coronary artery disease , also known as ischaemic heart disease, is caused by atherosclerosis —a build-up of fatty material along the inner walls of the arteries.

These fatty deposits known as atherosclerotic plaques narrow the coronary arteries, and if severe may reduce blood flow to the heart. Severe narrowings may cause chest pain angina or breathlessness during exercise or even at rest.

The thin covering of an atherosclerotic plaque can rupture, exposing the fatty centre to the circulating blood. In this case a clot or thrombus can form, blocking the artery, and restricting blood flow to an area of heart muscle causing a myocardial infarction a heart attack or unstable angina.

Heart failure is defined as a condition in which the heart is unable to pump enough blood to meet the demands of the body. Heart failure is the end result of many diseases affecting the heart, but is most commonly associated with ischaemic heart disease , valvular heart disease , or high blood pressure.

Less common causes include various cardiomyopathies. Heart failure is frequently associated with weakness of the heart muscle in the ventricles systolic heart failure , but can also be seen in patients with heart muscle that is strong but stiff diastolic heart failure.

The condition may affect the left ventricle causing predominantly breathlessness , the right ventricle causing predominantly swelling of the legs and an elevated jugular venous pressure , or both ventricles.

Patients with heart failure are at higher risk of developing dangerous heart rhythm disturbances or arrhythmias. Cardiomyopathies are diseases affecting the muscle of the heart.

Some cause abnormal thickening of the heart muscle hypertrophic cardiomyopathy , some cause the heart to abnormally expand and weaken dilated cardiomyopathy , some cause the heart muscle to become stiff and unable to fully relax between contractions restrictive cardiomyopathy and some make the heart prone to abnormal heart rhythms arrhythmogenic cardiomyopathy.

These conditions are often genetic and can be inherited , but some such as dilated cardiomyopathy may be caused by damage from toxins such as alcohol.

Some cardiomyopathies such as hypertrophic cardiomopathy are linked to a higher risk of sudden cardiac death, particularly in athletes. Healthy heart valves allow blood to flow easily in one direction, but prevent it from flowing in the other direction.

Diseased heart valves may have a narrow opening and therefore restrict the flow of blood in the forward direction referred to as a stenotic valve , or may allow blood to leak in the reverse direction referred to as valvular regurgitation.

Valvular heart disease may cause breathlessness, blackouts, or chest pain, but may be asymptomatic and only detected on a routine examination by hearing abnormal heart sounds or a heart murmur.

In the developed world, valvular heart disease is most commonly caused by degeneration secondary to old age, but may also be caused by infection of the heart valves endocarditis.

In some parts of the world rheumatic heart disease is a major cause of valvular heart disease, typically leading to mitral or aortic stenosis and caused by the body's immune system reacting to a streptococcal throat infection.

While in the healthy heart, waves of electrical impulses originate in the sinus node before spreading to the rest of the atria, the atrioventricular node , and finally the ventricles referred to as a normal sinus rhythm , this normal rhythm can be disrupted.

Abnormal heart rhythms or arrhythmias may be asymptomatic or may cause palpitations, blackouts, or breathlessness. Some types of arrhythmia such as atrial fibrillation increase the long term risk of stroke.

Some arrhythmias cause the heart to beat abnormally slowly, referred to as a bradycardia or bradyarrhythmia. This may be caused by an abnormally slow sinus node or damage within the cardiac conduction system heart block.

These arrhythmias can take many forms and can originate from different structures within the heart—some arise from the atria e. AV nodal re-entrant tachycardia whilst others arise from the ventricles e.

Some tachyarrhythmias are caused by scarring within the heart e. Wolff-Parkinson-White syndrome. The most dangerous form of heart racing is ventricular fibrillation , in which the ventricles quiver rather than contract, and which if untreated is rapidly fatal.

The sack which surrounds the heart, called the pericardium, can become inflamed in a condition known as pericarditis. This condition typically causes chest pain that may spread to the back, and is often caused by a viral infection glandular fever , cytomegalovirus , or coxsackievirus.

Fluid can build up within the pericardial sack, referred to as a pericardial effusion. Pericardial effusions often occur secondary to pericarditis, kidney failure, or tumours, and frequently do not cause any symptoms.

However, large effusions or effusions which accumulate rapidly can compress the heart in a condition known as cardiac tamponade , causing breathlessness and potentially fatal low blood pressure.

Fluid can be removed from the pericardial space for diagnosis or to relieve tamponade using a syringe in a procedure called pericardiocentesis.

Some people are born with hearts that are abnormal and these abnormalities are known as congenital heart defects. They may range from the relatively minor e.

Common abnormalities include those that affect the heart muscle that separates the two side of the heart a 'hole in the heart' e. Other defects include those affecting the heart valves e.

More complex syndromes are seen that affect more than one part of the heart e. Tetralogy of Fallot. Some congenital heart defects allow blood that is low in oxygen that would normally be returned to the lungs to instead be pumped back to the rest of the body.

These are known as cyanotic congenital heart defects and are often more serious. Major congenital heart defects are often picked up in childhood, shortly after birth, or even before a child is born e.

More minor forms of congenital heart disease may remain undetected for many years and only reveal themselves in adult life e. Heart disease is diagnosed by the taking of a medical history , a cardiac examination , and further investigations, including blood tests , echocardiograms , ECGs and imaging.

Other invasive procedures such as cardiac catheterisation can also play a role. The cardiac examination includes inspection, feeling the chest with the hands palpation and listening with a stethoscope auscultation.

A person's pulse is taken, usually at the radial artery near the wrist, in order to assess for the rhythm and strength of the pulse.

The blood pressure is taken, using either a manual or automatic sphygmomanometer or using a more invasive measurement from within the artery. Any elevation of the jugular venous pulse is noted.

A person's chest is felt for any transmitted vibrations from the heart, and then listened to with a stethoscope.

Typically, healthy hearts have only two audible heart sounds , called S1 and S2. The first heart sound S1, is the sound created by the closing of the atrioventricular valves during ventricular contraction and is normally described as "lub".

The second heart sound, S2, is the sound of the semilunar valves closing during ventricular diastole and is described as "dub".

A third heart sound , S3 usually indicates an increase in ventricular blood volume. A fourth heart sound S4 is referred to as an atrial gallop and is produced by the sound of blood being forced into a stiff ventricle.

The combined presence of S3 and S4 give a quadruple gallop. Heart murmurs are abnormal heart sounds which can be either related to disease or benign, and there are several kinds.

Murmurs are graded by volume, from 1 the quietest , to 6 the loudest , and evaluated by their relationship to the heart sounds, position in the cardiac cycle, and additional features such as their radiation to other sites, changes with a person's position, the frequency of the sound as determined by the side of the stethoscope by which they are heard, and site at which they are heard loudest.

A different type of sound, a pericardial friction rub can be heard in cases of pericarditis where the inflamed membranes can rub together.

Blood tests play an important role in the diagnosis and treatment of many cardiovascular conditions. Troponin is a sensitive biomarker for a heart with insufficient blood supply.

It is released 4—6 hours after injury, and usually peaks at about 12—24 hours. A test for brain natriuretic peptide BNP can be used to evaluate for the presence of heart failure, and rises when there is increased demand on the left ventricle.

These tests are considered biomarkers because they are highly specific for cardiac disease. Other blood tests are often taken to help understand a person's general health and risk factors that may contribute to heart disease.

These often include a full blood count investigating for anaemia , and basic metabolic panel that may reveal any disturbances in electrolytes.

A coagulation screen is often required to ensure that the right level of anticoagulation is given. Fasting lipids and fasting blood glucose or an HbA1c level are often ordered to evaluate a person's cholesterol and diabetes status, respectively.

Using surface electrodes on the body, it is possible to record the electrical activity of the heart. An ECG is a bedside test and involves the placement of ten leads on the body.

This produces a "12 lead" ECG three extra leads are calculated mathematically, and one lead is a ground. There are five prominent features on the ECG: the P wave atrial depolarisation , the QRS complex ventricular depolarisation [h] and the T wave ventricular repolarisation.

A downward deflection on the ECG implies cells are becoming more positive in charge "depolarising" in the direction of that lead, whereas an upward inflection implies cells are becoming more negative "repolarising" in the direction of the lead.

This depends on the position of the lead, so if a wave of depolarising moved from left to right, a lead on the left would show a negative deflection, and a lead on the right would show a positive deflection.

The ECG is a useful tool in detecting rhythm disturbances and in detecting insufficient blood supply to the heart. Testing when exercising can be used to provoke an abnormality, or an ECG can be worn for a longer period such as a hour Holter monitor if a suspected rhythm abnormality is not present at the time of assessment.

Several imaging methods can be used to assess the anatomy and function of the heart, including ultrasound echocardiography , angiography , CT scans , MRI and PET.

An echocardiogram is an ultrasound of the heart used to measure the heart's function, assess for valve disease, and look for any abnormalities.

Echocardiography can be conducted by a probe on the chest "transthoracic" or by a probe in the esophagus "transoesophageal".

A typical echocardiography report will include information about the width of the valves noting any stenosis , whether there is any backflow of blood regurgitation and information about the blood volumes at the end of systole and diastole, including an ejection fraction , which describes how much blood is ejected from the left and right ventricles after systole.

Ejection fraction can then be obtained by dividing the volume ejected by the heart stroke volume by the volume of the filled heart end-diastolic volume.

This cardiac stress test involves either direct exercise, or where this is not possible, injection of a drug such as dobutamine.

CT scans, chest X-rays and other forms of imaging can help evaluate the heart's size, evaluate for signs of pulmonary oedema , and indicate whether there is fluid around the heart.

They are also useful for evaluating the aorta, the major blood vessel which leaves the heart. Diseases affecting the heart can be treated by a variety of methods including lifestyle modification, drug treatment, and surgery.

Narrowings of the coronary arteries ischaemic heart disease are treated to relieve symptoms of chest pain caused by a partially narrowed artery angina pectoris , to minimise heart muscle damage when an artery is completely occluded myocardial infarction , or to prevent a myocardial infarction from occurring.

Medications to improve angina symptoms include nitroglycerin , beta blockers , and calcium channel blockers, while preventative treatments include antiplatelets such as aspirin and statins , lifestyle measures such as stopping smoking and weight loss, and treatment of risk factors such as high blood pressure and diabetes.

In addition to using medications, narrowed heart arteries can be treated by expanding the narrowings or redirecting the flow of blood to bypass an obstruction.

This may be performed using a percutaneous coronary intervention , during which narrowings can be expanded by passing small balloon-tipped wires into the coronary arteries, inflating the balloon to expand the narrowing, and sometimes leaving behind a metal scaffold known as a stent to keep the artery open.

If the narrowings in coronary arteries are unsuitable for treatment with a percutaneous coronary intervention, open surgery may be required.

A coronary artery bypass graft can be performed, whereby a blood vessel from another part of the body the saphenous vein , radial artery , or internal mammary artery is used to redirect blood from a point before the narrowing typically the aorta to a point beyond the obstruction.

Diseased heart valves that have become abnormally narrow or abnormally leaky may require surgery. This is traditionally performed as an open surgical procedure to replace the damaged heart valve with a tissue or metallic prosthetic valve.

In some circumstances, the tricuspid or mitral valves can be repaired surgically , avoiding the need for a valve replacement. Heart valves can also be treated percutaneously, using techniques that share many similarities with percutaneous coronary intervention.

Transcatheter aortic valve replacement is increasingly used for patients consider very high risk for open valve replacement. Abnormal heart rhythms arrhythmias can be treated using antiarrhythmic drugs.

These may work by manipulating the flow of electrolytes across the cell membrane such as calcium channel blockers , sodium channel blockers , amiodarone , or digoxin , or modify the autonomic nervous system's effect on the heart beta blockers and atropine.

In some arrhythmias such as atrial fibrillation which increase the risk of stroke, this risk can be reduced using anticoagulants such as warfarin or novel oral anticoagualants.

If medications fail to control an arrhythmia, another treatment option may be catheter ablation. In these procedures, wires are passed from a vein or artery in the leg to the heart to find the abnormal area of tissue that is causing the arrhythmia.

The abnormal tissue can be intentionally damaged, or ablated, by heating or freezing to prevent further heart rhythm disturbances.

Whilst the majority of arrhythmias can be treated using minimally invasive catheter techniques, some arrhythmias particularly atrial fibrillation can also be treated using open or thoracoscopic surgery, either at the time of other cardiac surgery or as a standalone procedure.

A cardioversion , whereby an electric shock is used to stun the heart out of an abnormal rhythm, may also be used. Cardiac devices in the form of pacemakers or implantable defibrillators may also be required to treat arrhythmias.

Pacemakers, comprising a small battery powered generator implanted under the skin and one or more leads that extend to the heart, are most commonly used to treat abnormally slow heart rhythms.

These devices monitor the heart, and if dangerous heart racing is detected can automatically deliver a shock to restore the heart to a normal rhythm.

Implantable defibrillators are most commonly used in patients with heart failure , cardiomyopathies , or inherited arrhythmia syndromes.

As well as addressing the underlying cause for a patient's heart failure most commonly ischaemic heart disease or hypertension , the mainstay of heart failure treatment is with medication.

These include drugs to prevent fluid from accumulating in the lungs by increasing the amount of urine a patient produces diuretics , and drugs that attempt to preserve the pumping function of the heart beta blockers , ACE inhibitors and mineralocorticoid receptor antagonists.

In some patients with heart failure, a specialised pacemaker known as cardiac resynchronisation therapy can be used to improve the heart's pumping efficiency.

In very severe cases of heart failure, a small pump called a ventricular assist device may be implanted which supplements the heart's own pumping ability.

In the most severe cases, a cardiac transplant may be considered. Humans have known about the heart since ancient times, although its precise function and anatomy were not clearly understood.

He also discovered the heart valves. The Greek physician Galen 2nd century CE knew blood vessels carried blood and identified venous dark red and arterial brighter and thinner blood, each with distinct and separate functions.

These ideas went unchallenged for almost a thousand years. The earliest descriptions of the coronary and pulmonary circulation systems can be found in the Commentary on Anatomy in Avicenna's Canon , published in by Ibn al-Nafis.

In Europe, the teachings of Galen continued to dominate the academic community and his doctrines were adopted as the official canon of the Church.

Andreas Vesalius questioned some of Galen's beliefs of the heart in De humani corporis fabrica , but his magnum opus was interpreted as a challenge to the authorities and he was subjected to a number of attacks.

A breakthrough in understanding the flow of blood through the heart and body came with the publication of De Motu Cordis by the English physician William Harvey.

Harvey's book completely describes the systemic circulation and the mechanical force of the heart, leading to an overhaul of the Galenic doctrines.

Ernest Starling — was an important English physiologist who also studied the heart. Although they worked largely independently, their combined efforts and similar conclusions have been recognized in the name " Frank—Starling mechanism ".

Although Purkinje fibers and the bundle of His were discovered as early as the 19th century, their specific role in the electrical conduction system of the heart remained unknown until Sunao Tawara published his monograph, titled Das Reizleitungssystem des Säugetierherzens , in Tawara's discovery of the atrioventricular node prompted Arthur Keith and Martin Flack to look for similar structures in the heart, leading to their discovery of the sinoatrial node several months later.

These structures form the anatomical basis of the electrocardiogram , whose inventor, Willem Einthoven , was awarded the Nobel Prize in Medicine or Physiology in This marked an important milestone in cardiac surgery , capturing the attention of both the medical profession and the world at large.

However, long-term survival rates of patients were initially very low. Louis Washkansky , the first recipient of a donated heart, died 18 days after the operation while other patients did not survive for more than a few weeks.

As of March , more than 55, heart transplantations have been performed worldwide. By the middle of the 20th century, heart disease had surpassed infectious disease as the leading cause of death in the United States, and it is currently the leading cause of deaths worldwide.

Since , the ongoing Framingham Heart Study has shed light on the effects of various influences on the heart, including diet, exercise, and common medications such as aspirin.

As one of the vital organs, the heart was long identified as the center of the entire body, the seat of life, or emotion, or reason, will, intellect, purpose or the mind.

In the Hebrew Bible , the word for heart, lev , is used in these meanings, as the seat of emotion, the mind, and referring to the anatomical organ.

It is also connected in function and symbolism to the stomach. An important part of the concept of the soul in Ancient Egyptian religion was thought to be the heart, or ib.

The ib or metaphysical heart was believed to be formed from one drop of blood from the child's mother's heart, taken at conception. This is evidenced by Egyptian expressions which incorporate the word ib , such as Awi-ib for "happy" literally, "long of heart" , Xak-ib for "estranged" literally, "truncated of heart".

It was conceived as surviving death in the nether world, where it gave evidence for, or against, its possessor. It was thought that the heart was examined by Anubis and a variety of deities during the Weighing of the Heart ceremony.

If the heart weighed more than the feather of Maat , which symbolized the ideal standard of behavior. If the scales balanced, it meant the heart's possessor had lived a just life and could enter the afterlife; if the heart was heavier, it would be devoured by the monster Ammit.

In Sanskrit, it may mean both the anatomical object and "mind" or "soul", representing the seat of emotion. Hrd may be a cognate of the word for heart in Greek, Latin, and English.

Many classical philosophers and scientists, including Aristotle , considered the heart the seat of thought, reason , or emotion, often disregarding the brain as contributing to those functions.

The heart also played a role in the Aztec system of belief. The most common form of human sacrifice practiced by the Aztecs was heart-extraction.

The Aztec believed that the heart tona was both the seat of the individual and a fragment of the Sun's heat istli.

To this day, the Nahua consider the Sun to be a heart-soul tona-tiuh : "round, hot, pulsating". In Catholicism , there has been a long tradition of veneration of the heart, stemming from worship of the wounds of Jesus Christ which gained prominence from the mid sixteenth century.

The expression of a broken heart is a cross-cultural reference to grief for a lost one or to unfulfilled romantic love.

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