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When most people hear the term cardiovascular system, they immediately think of the heart.
We all felt our own heart ͞pound͟ from time to time, and we tend to get a bit nervous when this
happens. The crucial importance of heart has been recognized for ages.

The modest size and weight of the heart give few hints of its incredible strength. Approximately
the size of the person͛s fist, this hallow, cone-shaped heart weighs less than a pound. Snugly enclosed
within the inferior  , the medial cavity of the thorax, the heart is flanked on each side by the
lungs. Its more pointed  is directed toward the left hip and rests on the diaphragm, approximately
at level of the fifth intercostals space. Its broad posterosuperior aspect, or , from which the great
vessels of the body emerge, points toward the right shoulder and lies beneath the second rib.

The heart is enclosed by a double-walled sac called the   The loosely fitting
superficial part of this sac is referred to as the  . Deep to the fibrous pericardium is
the slippery, two layer   . At the superior aspect of the heart, this  

attaches to the large arteries leaving the heart and then makes a U-turn and continuous inferiorly over
the heart surface as the 
 , which is actually part of the heart wall. The heart
walls are composing of three layers: the outer  , the
  and the innermost
 

The heart has four hollow chambers- two  and two . The atria are primarily
@


@ The thick-walled ventricles are the discharging chambers, or actual pump of the
heart. Although it is a single organ, the heart functions as a double pump. The right side works as a
pulmonary circuit pump. It receives relatively oxygen-poor blood from the veins of the body through
 and pumps it out through the  
 The pulmonary trunk
splits into the   
, which carry blood to the lungs, where oxygen is picked
up and carbon dioxide is unloaded. Oxygen rich blood returned to the left side of the heart through the
four  
   
  Blood returned to the left side of the heart is pumped
out of the heart into the  from which the systemic arteries branch to supply essentially all body
tissues. Oxygen-poor blood circulates from the tissues back to the right atrium via the systemic veins
which finally empty their cargo into either the superior or inferior vena cava 
 
 The heart is equipped with four valves, which allow the blood to flow in only one direction
through the heart chambers. The 
 prevent backflow into the atria when the
ventricles contract. The left AV valve- the     consists of two flaps. The 
 has three flaps. Tiny white cords, the    anchor the flaps to walls of the
ventricles. The second set of valves, the  , guards the basis of two large arteries leaving
the ventricular chambers. Thus they are known as the pulmonary and aortic semilunar valves.

Although the heart chambers are bath with blood almost continuously, the blood contained in
heart does not nourish the myocardium. The blood supply that oxygenates and nourishes the heart is
provided by the right and left coronary arteries and their branches. These arteries originate from the
aorta just above the aortic valve leaflets. The heart has large metabolic requirements, extracting
approximately 70% to 80% of the oxygen delivered (other organs extract, on average 25%). Unlike other
arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole
and can decreased myocardial perfusion. The left coronary artery has three branches. The artery from
the point of origin to the first major branch is called the  

Two branches arise
off the left main coronary artery: the 
which courses down the anterior
wall of the heart and the circumflex artery, which circles around to the lateral left wall of the heart. The
right side of the heart is supplied by the  

which progresses around to the bottom or
inferior wall of the heart. The posterior wall of the heart receives its blood supply by an additional
branch from the right coronary artery. Superficial to coronary arteries are coronary veins. Venous blood
from these veins returns to the heart primarily through the coronary sinus, which is located posteriorly
then empties to the right atrium.

The cardiac conduction system generates and transmits electrical impulses that stimulate
contraction of the myocardium. Under normal circumstances, the conduction system first stimulates
contraction of the atria and then the ventricles. The synchronization of the atrial and ventricular events
allows the ventricles to fill completely before ventricular ejection, thereby maximizing cardiac output.

Both the  (SA)  and the  (AV)  are composed of nodal cells. The
electrical impulses initiated by the SA node are conducted along the myocardial cells of the atria via
specialized tracts called internodal pathways. The impulse cause electrical stimulation and subsequent
contraction of the atria. The impulses are then conducted to the AV node. T he AV nodes coordinates
the incoming electrical impulses from the atria and after a slight delay allowing the atria time to contract
and complete ventricular filling) relays the impulse to the ventricles. Initially, the impulse is conducted
through a bundle of specialized conducting tissue, referred to as the   which then divides
into right bundle branch (conducting impulse to right ventricle) and the left bundle branch (conducting
impulse to the left ventricle). To transmit impulses to the left ventricle, the left bundle branch divides
into left anterior and left posterior bundle branches. Impulses travel through the bundle branches to
reach the terminal point in the conduction system, called the  . These fibers are
composed of purkinje fibers, specialized to rapidly conduct the impulses through the thick walls of the
ventricles. This is the point at which the myocardial cells are stimulated, causing ventricular contraction.

Cardiac output is the amount of blood pumped out by each ventricle in a minute. It is the product of the
  and the    In general the stroke volume increases as the force of ventricular
contraction increases. Cardiac output must be responsive to changes in metabolic demands of the
tissues. Changes in heart rate are accomplished by reflex controls mediated by the autonomic nervous
system, including its sympathetic and parasympathetic divisions. The parasympathetic impulses, which
travel to the heart through the vagus nerve, can slow the cardiac rate, whereas sympathetic impulses
increase it. These effects on heart rate result from action on the SA node, to either increase or decrease
its inherent rate. The balance between these two reflex control systems normally determines the heart
rate. The heart is stimulated also by the increase level of circulating catecholamines and by excess
thyroid hormone.
According to ï @      @
 the critical factor controlling stroke volume is how much the
cardiac muscle cells are stretched just before they contract. The important factor stretching the heart
muscle is  @ @, the amount of blood entering the heart and distending its ventricles.