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Received 21 January 2004; received in revised form 19 March 2004; accepted 10 May 2004
Abstract
Throughout history, the heart has been associated not only with its life-sustaining function but also with its close ties to the human
emotions. In this literature and Internet review, we attempt to gather and organize information from both of these perspectives as they relate to
the heart in the following 11 categories: (1) fun facts, (2) medical photography, (3) history, (4) languages (etymology), (5) nonmedical
English expressions, (6) death, (7) the arts, (8) movie titles, (9) song titles, (10) Shakespeare, and (11) the Bible. Part 1 will cover the first five
topics, and Part 2 will cover the last six topics. These data may be useful to those who are engaged in teaching about the cardiovascular
system. D 2004 Elsevier Inc. All rights reserved.
1054-8807/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.carpath.2004.05.001
M.J. Loe, W.D. Edwards / Cardiovascular Pathology 13 (2004) 282–292 283
Table 1
Cardiovascular fun facts [1–15]
Heart
Heart size is proportional to body size and is about the size of your clenched fist.
Heart weight is proportional to body size (about 25 g at birth, 50 g at age 2 years, 100 g at age 10 years, and 200 g at age 15 years).
In adults, the heart weighs 0.40% to 0.45% (or about 1/200th) of one’s total body weight.
The heart weighs about 300 g (10.5 oz) in adult women and 325 g (11.5 oz) in adult men.
The developing heart of a human embryo begins to beat 23 days after conception.
The cardiovascular system is the first organ system to become fully functional in utero, at approximately 8 weeks after conception.
Heart rate is inversely proportional to body size (140 beats per minute [bpm] in a fetus; 120 bpm in a neonate; and 90 bpm in a 7-year-old).
The normal resting heart rate in an adult is 60–90 bpm.
The normal resting heart rate is lowest in the morning and highest in the early afternoon.
In a well-trained endurance athlete, the resting heart rate may often only be 30–45 bpm.
The lowest recorded resting heart rate is 28 bpm (Miguel Induráin, Spanish cyclist).
In 1 day, the human heart beats approximately 100,000 times.
In 1 year, the heart beats approximately 37 million times.
In a 70-year lifetime, the heart will beat more than 2.5 billion times.
At rest, the heart pumps about 80 mL (3 oz) of blood per beat.
At rest, the heart pumps more than 1 L (more than 1 quart) every 10 s.
At rest, the heart pumps approximately 5 L (about 5 quarts) of blood per minute.
During the third trimester of pregnancy, the heart pumps 7–9 L/min.
At peak exertion, the heart can pump 20–35 L/min.
The heart pumps about 250 mL/min to the coronary circulation.
In 1 day, the heart pumps more than 7500 L (2000 gal) of blood.
In 1 day, the heart exerts enough power to lift a 1-ton weight 12.5 m (41 ft).
In 1 year, the heart will pump more than 2.5 million L (700,000 gal) of blood.
In 10 years, the heart will pump more than 25 million L (7 million gal) of blood.
In a 70-year lifetime, the heart will pump about 200 million L (more than 1 million barrels) of blood, or enough to fill three super tankers.
Vasculature
The blood vessels (arteries, capillaries, and veins), laid end-to-end, would measure about 100,000 km (60,000 miles), or approximately 2.5 times the
circumference of the earth.
Capillaries account for about 80,000 km (50,000 miles) of vasculature in an adult.
Capillaries average 0.5 mm (1/50th in.) in length.
Capillaries average 8 Am (1/3000th in.) in diameter.
It would take 50 capillaries to equal the diameter of one human hair.
Tissue the size of a pinhead contains 2000 to 3000 capillaries.
Blood travels 1000 times faster in the aorta (30 cm/s) than in the capillaries (0.03 cm/s).
Blood
The body of an average adult contains 5–6 L (6 quarts) of blood.
Blood accounts for about 7.5% (1/13th) of the body’s weight.
The entire blood volume circulates through the body about once per minute.
Every day, red blood cells travel approximately 19,000 km (12,000 miles) or about four times the distance from New York to Los Angeles.
Red blood cells are the most abundant cell in the human body.
In an average adult, the blood contains 25–30 trillion red blood cells (51012/L).
The bone marrow makes about 2 million red blood cells every second.
Stacked atop one another, the body’s red blood cells would span 50,000 km (30,000 miles).
U.S. cardiovascular statistics
Cardiology is the most popular nonprimary care, nonsurgical discipline (20,000 members).
One in every five adults has a cardiovascular disorder.
Cardiovascular disease has been the number one killer every year since 1900, except 1918 (the year of the influenza epidemic).
Cardiovascular disease is the number one killer of women as well as men.
Every day, more than 2600 U.S. citizens die of cardiovascular disease.
Nearly every 30 s, a U.S. citizen dies of cardiovascular disease.
Myocardial ischemia kills more U.S. citizens in one day than handguns kill in a year.
The annual estimated cost of heart disease in the United States is more than USD 285 billion.
Other cardiovascular trivia
The smallest reported tumor (2 mm) to cause sudden death is a mesothelioma of the AV node.
The lowest reported serum cholesterol level is 3 mg/dL for HDL and 9 mg/dL for LDL.
The highest reported total serum cholesterol level is 980 mg/dL.
The highest reported serum triglyceride level is 5880 mg/dL.
The highest reported creatine kinase MB fraction (CK-MB) is 530 U/L (27% of total).
The longest reported cardiac arrest before beginning successful resuscitation is 4 h (in a Norwegian hypothermia victim).
284 M.J. Loe, W.D. Edwards / Cardiovascular Pathology 13 (2004) 282–292
has a heart rate of 1260 bpm during flight but only 36 bpm increase heart weight by 2.5–3.0 times its expected mean
during torpor (nighttime cooling), when its body temper- value, but generally no more than this. Similar limits
ature drops by as much as 208C (358F). appear to exist for dilatation, as determined by the short-
The heart has a great but limited capacity for axis diameter of the left ventricle. As atherosclerosis
enlargement in various disease states. Hypertrophy can develops, coronary arteries can remodel and dilate to
about twice their normal diameter, but expansion beyond
this constitutes an aneurysm.
Table 2
Average heart rates for various animals [15–17]
Animal Heart rate (bpm) 3. The heart in medical photography
Mammals
Blue whale 5 Photographs of the heart and vessels may appear
Elephant 30 abstract to medical students and others. To relate disease
Camel 30 states to commonly encountered objects, pathologists
Lion 40 traditionally have made food analogies, such as bbread-
Horse 45
Pig 65
and-butterQ pericarditis (Fig. 1). A nonfood analogy is the
Cow 65 bfishmouth deformityQ of rheumatic mitral stenosis
Giraffe 65 (Fig. 2). Such photographs have great teaching value
Sheep 75 and are often long remembered by students [18,19].
Human 75 Topics are limited only by one’s imagination. For
Goat 90
Dog 100
example, to emphasize short-axis ventricular shapes, a
Seal 120 cross-section could be shown beside a croissant and a
Cat 130 bagel or doughnut (Fig. 3).
Skunk 170
Monkey 190
Rabbit 210
Squirrel 250
Guinea pig 280 4. The heart in history
Rat 360
Hamster 450 The history of cardiovascular discoveries may be appro-
Mouse 550 priate to include in our lectures (Table 3) [10,13,14,20–37].
Bat 750
Shrew 1000
More than 1800 years ago, Galen concluded that the heart
pumped blood throughout the body, although he did not
Birds recognize that blood was contained within vessels. Over
Ostrich or emu 45 1400 years elapsed before William Harvey, in 1628,
Turkey 100 demonstrated the circulation of blood within the cardiovas-
Herring gull 130
Blue jay 165
cular system.
Parrot 275 Other important events include the description of cardiac
Chicken 300 anatomy by Vieussens (1706), the invention of the
Crow 345 stethoscope by LaJnnec (1816), and the development of
Sparrow 460 electrocardiography by Einthoven (1903). The 20th
Robin 550
Canary 600
century was characterized by a virtual explosion of
Blue-winged teal 1000 exciting cardiovascular discoveries and developments.
Hummingbird Since 1987, the Society for Cardiovascular Pathology
Ruby-throated 600 has recognized 23 investigators with Distinguished
At rest 250 Achievement Awards for their outstanding contributions
In flight 1220
Blue-throated 600
toward an understanding of cardiovascular diseases
In torpor 36 (Table 4).
In flight 1260
Fig. 1. Bread-and-butter pericarditis. (A) Heart and parietal pericardium, showing severe diffuse fibrinous pericarditis. (B) Two pieces of buttered bread that
have been pulled apart from one another. (Reproduced with permission [18].)
Fig. 2. Mitral fishmouth deformity. (A) Rheumatic mitral stenosis (short-axis view). (B) Fish (anterior view) showing actual shape of fishmouth. (Reproduced
with permission [18].)
286 M.J. Loe, W.D. Edwards / Cardiovascular Pathology 13 (2004) 282–292
Table 3
Historical landmarks for cardiovascular descriptions, discoveries, and developments [10,13,20–37]
Yeara Person Countrya Description, discovery, or development
2980 bc Imhotep Egypt Observation of the pulse
1500 bc (Ebers papyrus) Egypt Relationship between heart and pulse
1000 bc (Canon of Medicine) China Heart is a repository for the pulse
~400 bc Hippocrates Greece Heart related to flow of blood
~350 bc Herophilus (Greek) Egypt Heart has chambers and valves
~300 bc Erasistratus (Greek) Egypt Heart pumps blood throughout body
~175 Galen Greeceb Heart pumps blood throughout body
1242 Ibn an-Nafis Egypt Aeration of blood occurs in the lungs
1519c Leonardo da Vinci Italy Cardiac valves ensure unidirectional flow
1543 Andreas Vesalius Italy Anatomy of cardiovascular system
1554 Ambrose Paré France Syphilitic aortic aneurysms
1594 Girolamo Fabrici Italy Venous valves ensure unidirectional flow
1628 William Harvey England Circulation of blood occurs within vessels
1640 Pierre Gassendi France Patent foramen ovale
1661 Marcello Malpighi Italy Microscopic capillary circulation (in lungs)
1664 Niels Stensen Denmark Heart consists primarily of muscle
1669 Richard Lower England Cardiac structure; blood transfusion
1671 Niels Stensen Denmark First description of tetralogy
1705 William Cowper England Aortic insufficiency
1706 Raymond de Vieussens France Structure of heart, coronary circulation
1708 Anton van Leeuwenhoek Holland Concept of the pulse
1728 Giovanni M. Lancisi Italy Cardiomegaly and congestive heart failure
1733 Stephen Hales England Measured blood pressure in animals
1749 Jean-Baptiste de Sénac France Quinidine for arrhythmias
1755 Albrecht von Haller Switzerland Calcified pericardium
1761 Leopold Auenbrugger Austria Thoracic percussion
1761 Giovanni B. Morgagni Italy Aortic and mitral stenosis; aortic aneurysm;
coronary calcification; heart block
1770 John Hunter England Valve disease; coronary calcification
1772 William Heberden England Angina pectoris
1785 William Withering England Digitalis (foxglove) for heart failure
1786 Edward Jenner England Coronary theory of angina pectoris
1793 Everard Home England Calcific coronary artery disease
1799 Caleb H. Parry England Coronary artery disease and its prevention
1804 Antonio Scarpa Italy Atherosclerosis and aneurysms
1806 Jean-Nicolas Corvisart France Signs of valvular stenosis
1812 William C. Wells United States Heart disease due to rheumatic fever
1816 René T. H. LaJnnec France Stethoscope
1818 James Blundell England Blood transfusion, human to human
1819 René T. H. LaJnnec France Cardiac auscultation
1827 Robert Adams Ireland Heart block
1830 George J. Guthrie England Arterial aneurysms and dissections
1832 Dominic J. Corrigan Ireland Signs of aortic regurgitation
1839 Jan E. Purkinje Czechoslovakia Bundle branches (Purkinje fibers)
1840 Jean-Baptiste Bouillaud France Rheumatic fever and endocarditis
1841 Carl von Rokitanski Austria Thrombotic theory of atherosclerosis
1842 Christian Doppler Austria Doppler effect
1844 Claude Bernard France Cardiac catheterization in animals
1845 Rudolph L. C. Virchow Germany Inflammatory theory of atherosclerosis
1846 Henry I. Bowditch England Cardiac auscultation and murmurs
1850 Joseph Skoda Czechoslovakia Cardiac sounds and murmurs
1854 William Stokes Ireland Stokes–Adams syndrome
1854 Armand Trousseau France Pericardiocentesis
1856 Rudolf von Koelliker and Heinrich Mqller Germany Heart generates electricity
1858 Thomas B. Peacock England Congenital heart disease
1862 Austin Flint United States Murmur of aortic insufficiency
1866 Wilhelm Ebstein Germany Tricuspid anomaly; metabolic diseases
1867 Pierre-Carl E. Potain France Jugular venous pulse
1867 Thomas L. Brunton England Amyl nitrate for angina pectoris
1868 Heinrich Quincke Germany Venous and capillary pulse
1869 Alexander Muirhead England Capillary electrometer for ECG
1870 Samuel Wilks England Bacterial endocarditis
(continued on next page)
288 M.J. Loe, W.D. Edwards / Cardiovascular Pathology 13 (2004) 282–292
Table 3 (continued )
Yeara Person Countrya Description, discovery, or development
1870 Adolf Fick Germany Measurement of cardiac output
1873 Adolf Kussmaul Germany Pericardial constriction and paradoxical pulse
1875 Carl von Rokitanski Austria Congenital heart disease
1876 Sigmund R. von Basch Austria Early sphygmomanometer
1878 Adam Hammer United States Coronary thrombosis (debatable)
1881 William R. Gowers England Hypertensive retinopathy
1885 William Osler United States Bacterial endocarditis
1888 Graham Steell England Murmur of pulmonary insufficiency
1891 Friedrich Maass Germany External cardiac massage
1893 Wilhelm His, Jr Germany Atrioventricular (His) bundle
1896 Scipione Riva-Rocci Italy Modern mercury sphygmomanometer
1896 Francis H. Williams United States Cardiac fluoroscopy
1888 Étienne-Louis A. Fallot France Tetralogy of Fallot
1897 Victor Eisenmenger Germany Congenital shunts and Eisenmenger complex
1897 William H. Broadbent England Pericarditis
1897 Ludwig Rehn Germany Surgical repair of cardiac laceration
1901 Luis Morquio Uruguay Congenital heart block; Morquio syndrome
1903 Willem Einthoven Holland String galvanometer for ECG
1904 Ludwig Aschoff Germany Microscopy of rheumatic myocarditis
1906 Sunao Tawara Germany Atrioventricular node
1907 Arthur Keith and Martin Flack England Sinus node and prediction as pacemaker
1908 James Mackenzie England Atrial fibrillation
1908 Leo Buerger United States Thromboangiitis obliterans
1910 Henri Vaquez France Left and right heart failure
1912 Ernest H. Starling England Cardiac physiology; Starling’s law
1912 Nikolai Anitschoff Russia Atherosclerosis
1912 James B. Herrick United States Coronary thrombosis and acute MI
1919 Adolf Spitzer Austria Pathogenesis of congenital heart disease
1923 Elliott C. Cutler and Samuel A. Levine United States Valvulotome for rheumatic mitral stenosis
1924 Carey F. Coombs England Murmur of acute rheumatic mitral valvulitis
1925 Nikolai Anitschoff Russia Myocarditis
1929 Werner Forssmann Germany X-ray of catheter (within his own heart)
1930 Frank N. Wilson United States Modern electrocardiography
1932 Albert S. Hyman United States Transthoracic electrical stimulation
1933 William S. Tillet United States Streptokinase (streptococcal fibrinolysin)
1936 Maude E. Abbott Canada Categorized 1000 malformed hearts
1939 Robert E. Gross United States Closure of patent ductal artery
1941 André Cournand and Dickinson W. Richards United States Catheterization of right heart
1944 Leo Loewe United States Penicillin for subacute bacterial endocarditis
1944 Clarence Crafoord Sweden Repair of coarctation of aorta (at two
Robert E. Gross United States separate institutions)
1945 Alfred Blalock and Helen B. Taussig United States Subclavian to pulmonary artery shunt for
tetralogy of Fallot
1945 L. Royal Christensen United States Mechanism of streptokinase
1946 Arthur M. Vineberg Canada IMA inserted directly into myocardium
1947 Claude Beck United States Open-chest resuscitation with defibrillator
1948 Dwight E. Harken United States Closed mitral commissurotomy (at three
Charles P. Bailey United States separate institutions)
Sir Russel C. Brock England
1948 Thomas H. Sellers England Closed pulmonary valvotomy (at two
Sir Russell C. Brock England separate institutions)
1949 Paul Dudley White United States Development of National Heart Institute;
"father of American cardiology"
1949 Thomas R. Dawber and William B. Kannel United States Framingham Heart Study begun
1950 Ignacio Chávez Mexico Founded International Society of Cardiology
1952 Charles Hufnagel United States Descending aortic ball-valve for chronic AI
1952 F. John Lewis United States Open heart surgery (well technique), with
repair of atrial septal defect
1952 Charles Dubost France Repair of abdominal aortic aneurysm
1953 John H. Gibbon, Jr United States Open heart surgery (pump-oxygenator), with
repair of atrial septal defect
1953 Inge Edler and C. Hellmuth Hertz Sweden Trans-thoracic M-mode echocardiography
(continued on next page)
M.J. Loe, W.D. Edwards / Cardiovascular Pathology 13 (2004) 282–292 289
Table 3 (continued )
Yeara Person Countrya Description, discovery, or development
1954 Sol Sherry United States Mechanism of streptokinase
1955 C. Walton Lillihei United States Closure of ventricular septal defect
1955 C. Walton Lillihei United States Repair of complete AV septal defect
1955 John W. Kirklin United States Repair of tetralogy of Fallot
1956 Michael E. DeBakey United States Repair of abdominal aortic aneurysm
1956 Don C. Sutton United States Transthoracic needle biopsy of heart
1956 Paul M. Zoll United States External cardiac defibrillation
1956 Shigeo Satomura Japan CW Doppler echocardiography
1958 F. Mason Sones, Jr United States Selective coronary angiography
1958 Anthony P. Fletcher United States Intravenous streptokinase for acute MI
1958 Dennis Melrose England Cold cardioplegia during heart surgery
1958 Donald Teare England Hypertrophic cardiomyopathy
1958 Michel Fernex and Claude Fernex Switzerland Mitral valve prolapse
1958 Rune Elmqvist and 2ke Senning Sweden External implantable pacemaker
1958 Seymour Furman and John B. Schwedel United States Internal implantable pacemaker (lead)
1959 Shigeo Satomura Japan CW Doppler vascular sonography
1960 William Chardack and Wilson Greatbatch United States Implantable pacemaker (lead and battery)
1960 Albert Starr United States Mechanical prosthetic mitral valve
1960 Dwight E. Harkin United States Mechanical prosthetic aortic valve
1960 Robert H. Goetz United States IMA graft to LAD (ring anastomosis)
1960 Norman E. Shumway and Richard Lower United States Successful canine cardiac transplantation
1961 Desmond G. Julian England Concept of coronary care unit
1961 Masamichi Oka and Alfred Angrist United States Mitral valve prolapse
1961 James R. Jude, G. Guy Knickerbocker and United States External cardiopulmonary resuscitation
William B. Kouwenhoven
1962 Bernard Lown United States Electric shock cardioversion
1962 Sigeru Sakakibara and Souji Konno Japan Transvenous endomyocardial biopsy
1962 Donald Ross England Homograft prosthetic aortic valve
1964 William T. Mustard Canada Intraatrial baffle repair for transposition
1964 Carlos Duran and Alfred Gunning England Xenograft prosthetic valve
1964 Vasilii I. Kolesov Russia IMA graft to LAD (suture anastomosis)
1965 Gian C. Rastelli United States Conduit repair of PA-VSD
1965 Michael B. DeBakey and Adrian Kantrowitz United States Mechanical left ventricular assist device
(LVAD)
1966 William J. Rashkind United States Balloon atrial septostomy
1967 Christiaan N. Barnard South Africa Cardiac allotransplantation in human
1967 René G. Favaloro United States Saphenous vein graft to RCA
1967 Bernard Lown United States Drug therapy (lidocaine) for arrhythmias
1967 Eugene Strandness United States Sonography for peripheral vascular flow
1968 Will C. Sealy United States Surgical ablation of WPW pathway
1968 Francis Fontan France Repair of single functional ventricle
1969 Peter N. T. Wells England PW Doppler echocardiography (three
Pierre Péronneau France separate institutions)
Donald W. Baker United States
1970 Barouh V. Berkovits Israel Dual-chamber pacemaker
1973 Nicolaas Bom Netherlands Linear array 2-D echocardiography
Donald L. King United States (two separate institutions)
1974 Christiaan N. Barnard South Africa Cardiac piggy-back implantation
1974 Leon J. Frazin United States Transesophageal echocardiography
1975 Adib D. Jatene Brazil Arterial switch repair for transposition
1976 Olaf T. von Ramm United States Phased array 2-D echocardiography
1976 Eugene I. Chazov Russia Intracoronary streptokinase for acute MI
1977 Andreas R. Grqentzig Switzerland Percutaneous transluminal coronary
angioplasty (PTCA)
1978 Guy Fontaine France Arrhythmogenic RV cardiomyopathy
1979 Peter Rentrop Germany Intracoronary streptokinase for acute MI
1980 Michel Mirowski United States Implantation of AICD in human
1981 Masayuki Matsumoto Japan Three-dimensional echocardiography
1982 Mark I. Singer United States Balloon angioplasty for coarctation
1982 Willem DeVries and Robert Jarvik United States Permanent artificial heart (implanted into
Barney Clarke)
1982 James J. Gallagher United States Catheter ablation of AV junction for SVT
(continued on next page)
290 M.J. Loe, W.D. Edwards / Cardiovascular Pathology 13 (2004) 282–292
Table 3 (continued )
Yeara Person Countrya Description, discovery, or development
1983 William I. Norwood United States Repair of aortic valve atresia (HLHS)
1984 Leonard L. Bailey United States Cardiac xeno-transplantation in human
1991 Juan C. Parodi Argentina Endovascular repair of aortic aneurysm
1994 Randas Batista Brazil Left ventriculoplasty
1998 Michel HaRssaguerre France Pulmonary veins as source of AF
2003 (FDA approval) United States Drug-eluting coronary artery stents
Abbreviations: AF = atrial fibrillation; AI = aortic insufficiency; AICD = automatic implantable cardiac defibrillator; AV = atrioventricular; CW = continuous
wave; 2-D = two-dimensional; ECG = electrocardiogram; FDA = Food and Drug Administration; HLHS = hypoplastic left heart syndrome; IMA = internal
mammary (thoracic) artery; LAD = left anterior descending coronary artery; MI = myocardial infarction; PA-VSD = pulmonary atresia with ventricular septal
defect; PW = pulsed wave; RCA = right coronary artery; RV = right ventricle; SVT = supraventricular tachycardia; WPW = Wolff–Parkinson–White syndrome.
a
bYearQ indicates the year of publication, not the year of accomplishment. bCountryQ indicates the place of the accomplishment, not the national origin of
the individual.
b
Galen (c 129–199) was born in Pergamum, a city then within the Roman Empire and now called Bergama in modern-day Turkey. Nevertheless,
Galen is generally considered Greek. During his lifetime, he taught in Turkey, Greece, Egypt (Alexandria), and Italy (Rome). His Latin name is
Claudius Galenus.
c
Da Vinci studied human anatomy from 1485 until this activity was banned in Italy in 1513. Although he completed over 600 folios containing thousands
of drawings, they were never published during his lifetime. Only after his death in 1519 did his pupil, Francesco Melzi, release them. Many are now housed at
the Royal Library at Windsor Castle in England.
blight-heartedQ, bbrokenheartedQ, bsweetheartQ, and byoung photography, (3) history, (4) language (etymology), and (5)
at heartQ. nonmedical English expressions. Part 2 will review six
additional topics: (1) death, (2) the arts, (3) movie titles, (4)
song titles, (5) Shakespeare, and (6) the Bible.
7. Summary
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