INTRODUCTION

The heart is a muscular organ in most animals. This organ

pumps blood through the blood vessels of the circulatory
system. The pumped blood carries oxygen and nutrients to the
body, while carrying metabolic waste such as carbon dioxide to
the lungs. I humans, the heart is approximately the size of a
closed fist and is located between the lungs, in the middle
compartment of the chest, called the mediastinum.

In humans, other mammals, and birds, the heart is divided into four
chambers: upper left and right atria and lower left and
right ventricles. Commonly the right atrium and ventricle are referred together as the right
heart and their left counterparts as the left heart. Fish, in contrast, have two chambers, an
atrium and a ventricle, while most reptiles have three chambers. In a healthy heart blood
flows one way through the heart due to heart valves, which prevent backflow. The heart is
enclosed in a protective sac, the pericardium, which also contains a small amount of fluid.
The wall of the heart is made up of three layers: epicardium, myocardium, and endocardium.

The heart pumps blood with a rhythm determined by a group of pacemaker cells in
the sinoatrial node. These generate an electric current that causes the heart to contract,
traveling through the atrioventricular node and along the conduction system of the heart. In
humans, deoxygenated blood enters the heart through the right atrium from
the superior and inferior venae cavae and passes to the right ventricle. From here it is pumped
into pulmonary circulation to the lungs, where it receives oxygen and gives off carbon
dioxide. Oxygenated blood then returns to the left atrium, passes through the left ventricle
and is pumped out through the aorta into systemic circulation, traveling
through arteries, arterioles, and capillaries—where nutrients and other substances are
exchanged between blood vessels and cells, losing oxygen and gaining carbon dioxide—
before being returned to the heart through venules and veins. The heart beats at a resting
rate close to 72 beats per minute. Exercise temporarily increases the rate, but lowers it in the
long term, and is good for heart health.

Dept. of Mechanical Engineering, SCE

LOCATION AND SHAPE

The human heart is situated in

the mediastinum, at the level of thoracic
vertebrae T5-T8. A double-membraned sac
called the pericardium surrounds the heart and
attaches to the mediastinum. The back surface
of the heart lies near the vertebral column,
and the front surface known as the
sternocostal surface sits behind
the sternum and rib cartilages. The upper part
of the heart is the attachment point for several large blood vessels the venae
cavae, aorta and pulmonary trunk. The upper part of the heart is located at the level of the
third costal cartilage. The lower tip of the heart, the apex, lies to the left of the sternum (8 to
9 cm from the midsternal line) between the junction of the fourth and fifth ribs near
their articulation with the costal cartilages.

The largest part of the heart is usually slightly offset to the left side of the chest (though
occasionally it may be offset to the right) and is felt to be on the left because the left heart is
stronger and larger, since it pumps to all body parts. Because the heart is between the lungs,
the left lung is smaller than the right lung and has a cardiac notch in its border to
accommodate the heart. The heart is cone-shaped, with its base positioned upwards and
tapering down to the apex. An adult heart has a mass of 250–350 grams. The heart is often
described as the size of a fist: 12 cm (5 in) in length, 8 cm (3.5 in) wide, and 6 cm (2.5 in) in
thickness, although this description is disputed, as the heart is likely to be slightly
larger. Well-trained athletes can have much larger hearts due to the effects of exercise on the
heart muscle, similar to the response of skeletal muscle.

VALVES

The heart has four valves, which separate its chambers. One valve lies between each atrium
and ventricle, and one valve rests at the exit of each ventricle.

The valves between the atria and ventricles are called the atrioventricular valves. Between the
right atrium and the right ventricle is the tricuspid valve. The tricuspid valve has three
cusps, which connect to chordae tendinae and three papillary muscles named the anterior,

Dept. of Mechanical Engineering, SCE

posterior, and septal muscles, after their relative positions. The mitral valve lies between the
left atrium and left ventricle. It is also known as the bicuspid valve due to its having two
cusps, an anterior and a posterior cusp. These cusps are also attached via chordae tendinae to
two papillary muscles projecting from the ventricular wall.

The papillary muscles extend from the walls of the heart to valves by cartilaginous
connections called chordae tendinae. These muscles prevent the valves from falling too far
back when they close. During the relaxation phase of the cardiac cycle, the papillary muscles
are also relaxed and the tension on the chordae tendineae is slight. As the heart chambers
contract, so do the papillary muscles. This creates tension on the chordae tendineae, helping
to hold the cusps of the atrioventricular valves in place and preventing them from being
blown back into the atria.

Two additional semilunar valves sit at the exit of each of the ventricles. The pulmonary
valve is located at the base of the pulmonary artery. This has three cusps which are not
attached to any papillary muscles. When the ventricle relaxes blood flows back into the
ventricle from the artery and this flow of blood fills the pocket-like valve, pressing against
the cusps which close to seal the valve. The semilunar aortic valve is at the base of
the aorta and also is not attached to papillary muscles. This too has three cusps which close
with the pressure of the blood flowing back from the aorta.

 The tricuspid valve connects your right atrium and right ventricle.
 The pulmonary valve connects your right ventricle and main pulmonary artery (large
artery that carries blood to your lungs).
 The mitral valve connects your left atrium and left ventricle.
 The aortic valve connects your left ventricle and aorta (large artery that carries blood
away from your heart to the rest of your body).

Dept. of Mechanical Engineering, SCE

PHYSIOLOGY

Blood flow

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 superior vena cava drains blood from above the diaphragm and empties into the upper
back part of the right atrium. 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. Additionally, the coronary sinus returns
deoxygenated blood from the myocardium to the right atrium. 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

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waste products. Capillary blood, now deoxygenated, travels into venules and veins that
ultimately collect in the superior and inferior vena cavae, and into the right heart.

Cardiac cycle

The cardiac cycle is the sequence of events in which the heart contracts and relaxes with
every heartbeat. The period of time during which the ventricles contract, forcing blood out
into the aorta and main pulmonary artery, is known as systole, while the period during which
the ventricles relax and refill with blood is known as diastole. 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.

Dept. of Mechanical Engineering, SCE

Cardiac output

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). So that: CO = SV x HR. The cardiac output is
normalized to body size through body surface area and is called the cardiac index.

The average cardiac output, using an average stroke volume of about 70mL, is 5.25 L/min,
with a normal range of 4.0–8.0 L/min. The stroke volume is normally measured using
an echocardiogram and can be influenced by the size of the heart, physical and mental
condition of the individual, sex, contractility, duration of contraction, preload and afterload.

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. Preload can also be
affected by a person's blood
volume. 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. These agents can be a result of changes
within the body, or be given as drugs as part of treatment for a medical disorder, or as a form
of life support, particularly in intensive care units. Inotropes that increase the force of
contraction are "positive" inotropes, and include sympathetic agents such

Dept. of Mechanical Engineering, SCE

as adrenaline, noradrenaline and dopamine. "Negative" inotropes decrease the force of
contraction and include calcium channel blockers.

Dept. of Mechanical Engineering, SCE