The Heart

Anatomy of the Heart

Your heart is located under the ribcage in the center of your chest between your right and left lungs. Its muscular walls beat, or contract, pumping blood continuously to all parts of your body. The size of your heart can vary depending on your age, size, and the condition of your heart. A normal, healthy, adult heart most often is the size of an average clenched adult fist. Some diseases of the heart can cause it to become larger.

The Exterior of the Heart

Below is a picture of the outside of a normal, healthy, human heart.

Heart Exterior

The illustration shows the front surface of a heart, including the coronary arteries and major blood vessels. The heart is the muscle in the lower half of the picture. The heart has four chambers. The right and left atria (AY-tree-uh) are shown in purple. The right and left ventricles (VEN-trih-kuls) are shown in red.

Some of the main blood vesselsarteries and veinsthat make up your blood circulatory system are directly connected to the heart. The ventricle on the right side of your heart pumps blood from your heart to your lungs. When you breathe air in, oxygen passes from your lungs through your blood vessels and into your blood. Carbon dioxide, a waste product, is passed from your blood through blood vessels to your lungs and is removed from your body when you breathe out. The left atrium receives oxygen-rich blood from your lungs. The pumping action of your left ventricle sends this oxygen-rich blood through the aorta (a main artery) to the rest of your body.

The Right Side of Your Heart

The superior and inferior vena cavae are in blue to the left of the heart muscle as you look at the picture. These veins are the largest veins in your body. After your body's organs and tissues have used the oxygen in your blood, the vena cavae carry the oxygen-poor blood back to the right atrium of your heart. The superior vena cava carries oxygen-poor blood from the upper parts of your body, including your head, chest, arms, and neck. The inferior vena cava carries oxygen-poor blood from the lower parts of your body. The oxygen-poor blood from the vena cavae flows into your heart's right atrium and then on to the right ventricle. From the right ventricle, the blood is pumped through the pulmonary (PULLmun-ary) arteries (in blue in the center of the picture) to your lungs. There, through many small, thin blood vessels called capillaries, the blood picks up more oxygen. The oxygen-rich blood passes from your lungs back to your heart through the pulmonary veins (in red to the left of the right atrium in the picture).

The Left Side of Your Heart

Oxygen-rich blood from your lungs passes through the pulmonary veins (in red to the right of the left atrium in the picture). It enters the left atrium and is pumped into the left ventricle. From the left ventricle, the oxygen-rich blood is pumped to the rest of your body through the aorta. Like all of your organs, your heart needs blood rich with oxygen. This oxygen is supplied through the coronary arteries as blood is pumped out of your heart's left ventricle. Your coronary arteries are located on your heart's surface at the beginning of the aorta. Your coronary arteries (shown in red in the drawing) carry oxygen-rich blood to all parts of your heart.

The Interior of the Heart

Below is a picture of the inside of a normal, healthy, human heart.

Heart Interior

The illustration shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows from the body to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs to the rest of the body.

The Septum
The right and left sides of your heart are divided by an internal wall of tissue called the septum. The area of the septum that divides the atria (the two upper chambers of your heart) is called the atrial or interatrial septum. The area of the septum that divides the ventricles (the two lower chambers of your heart) is called the ventricular or interventricular septum.

Heart Chambers
The picture shows the inside of your heart and how it's divided into four chambers. The two upper chambers of your heart are called atria. The atria receive and collect blood. The two lower chambers of your heart are called ventricles. The ventricles pump blood out of your heart into the circulatory system to other parts of your body.

Heart Valves

The picture shows your heart's four valves. Shown counterclockwise in the picture, the valves include the aortic (ay-OR-tik) valve, the tricuspid (tri-CUSS-pid) valve, the pulmonary valve, and the mitral (MI-trul) valve.

Blood Flow
The arrows in the drawing show the direction that blood flows through your heart. The light blue arrows show that blood enters the right atrium of your heart from the superior and inferior vena cavae. From the right atrium, blood is pumped into the right ventricle. From the right ventricle, blood is pumped to your lungs through the pulmonary arteries. The light red arrows show the oxygen-rich blood coming in from your lungs through the pulmonary veins into your heart's left atrium. From the left atrium, the blood is pumped into the left ventricle. The left ventricle pumps the blood to the rest of your body through the aorta. For the heart to work properly, your blood must flow in only one direction. Your heart's valves make this possible. Both of your heart's ventricles have an "in" (inlet) valve from the atria and an "out" (outlet) valve leading to your arteries. Healthy valves open and close in very exact coordination with the pumping action of your heart's atria and ventricles. Each valve has a set of flaps called leaflets or cusps that seal or open the valves. This allows pumped blood to pass through the chambers and into your arteries without backing up or flowing backward.

The Kidney

Capsule The renal capsule is the membranous covering of the kidney. It directly covers the renal cortex, which forms the outer stratum Cortex The cortex of the kidney is the outer section which covers the internal medulla. The cortex is visible near the outer edge of the cross-sectioned kidney. It is composedof blood vessels and urine tubes and is supported by a fibrous matrix. Calyx The calyces (plural for calyx) are the recesses in the internal medulla of the kidney which enclose the pyramids. They are used to subdivide the sections of the kidney anatomically, with distinction being made between major calyces and minor calyces. Renal Column

The renal columns are lines of the kidney matrix which support the cortex of the kidney. They are composed of lines of blood vessels and urinary tubes and a fibrous, cortical material. Pyramid The renal pyramids are conical segments within the internal medulla of the kidney. The pyramids contain the secreting apparatus and tubules and are also known as the malphighian pyramids. Renal Sinus The renal sinus is the cavity within the kidney which houses the renal pyramid. Nerves and blood vessels pass into the renal sinus through the hilus. Hilus The hilus is the slit-like opening in the middle of the concave medial border of the kidney. Nerves and blood vessels pass through the hilus into the renal sinus within. Renal Artery One quarter of the total blood output from the heart comes to the kidneys along the renal artery. Two renal arteries arise from the abdominal section of the aorta, each artery supplies a lobe of the kidney. The incoming artery divides into four or five branches, eventually forming arterioles, each of which leads to the compact ball of capillaries called the glomerulus. Renal Vein Cell waste is discharged in the veins for excretion through the kidneys. The body circulates about 425 gallons of blood through the kidneys on a daily basis, but only about a thousandth of this is converted in urine. The remainder goes back into circulation through the renal arteries. From the Bowman's capsule, the blood is carried through the compact network of capillaries that forms the glomerulus within the capsule. The capillaries eventually reconverge into small venules which lead to the larger renal veins. There are two renal veins, one extending from each lobe of the kidney, and opening into the vena cava. Formation and Elimination of Urine The formation of urine occurs in the basic units of the kidney, called nephrons. Each human kidney contains over 1 million nephrons. Nephrons consist of a network of capillaries (called a glomerulus), a renal tubule, and a membrane that surrounds the glomerulus and functions as a filter (called Bowman's capsule). The glomeruli are where urine production begins. Urine formation occurs in the renal tubules, which travel from the outer tissue of the kidney (called the cortex), to the inner tissue (called the medulla), and return to the cortex. Extensions of the cortex project into the medulla and divide the tissue into renal pyramids. The renal pyramids extend into funnel-like extensions (called calyces), where the collection of urine

occurs. Minor calyces merge to form major calyces and major calyces merge to form the renal pelvis, the upper portion of the ureter. Each section of the renal tubule performs a different function. As the tube leads away from Bowman's capsule into the cortex, it forms the proximal convoluted (highly coiled) tubule. In this section, waste products and toxic substances (e.g., ammonia, nicotine) are forced out of the blood through a permeable membrane and useful substances (e.g., glucose, amino acids, vitamins, minerals) are reabsorbed. Urine then travels through the loop of Henle, a long U-shaped extension of the proximal convoluted tubule. It consists of a descending limb and an ascending limb. Some sections of the loop are permeable to water and impermeable to substances in the urine (e.g., salt, ammonia), and some sections are impermeable to water and permeable to other substances. The next section is the distal convoluted tubule. Normally, this section is water permeable. Substances that remain in the urine are reabsorbed, increasing the concentration of the urine. After passing through the distal convoluted tubule, the urine consists almost entirely of waste products. Most of the water and other useful substances have been reabsorbed. Next, urine enters the collecting tubule. Urine from several nephrons empties into each collecting tubule. These tubules form the calyces, and the calyces form the renal pelvis (upper portion of the ureter). Urine travels from the kidneys through the ureters to the bladder, where it is stored until it is eliminated from the body through the urethra. Hormones The hypothalamus in the brain detects the level of substances in the blood and controls the secretion of hormones. Antidiuretic hormone, aldosterone, and atrial natriuretic factor are hormones that change the permeability of the distal convoluted tubule and the collecting tubule, regulating urine volume and helping to maintain blood pressure. For example, when water content in the blood is low (called dehydration), the secretion of antidiuretic hormone (ADH) increases and the kidneys reabsorb more water. This increases the concentration of the urine and decreases urine output. When water content in the blood is high, ADH production ceases and the kidneys reabsorb less water. This decreases the concentration of the urine and increases urine output. BUN and Creatinine The concentration in the blood (blood level) of blood urea nitrogen (BUN), known as urea, and creatinine (Cr) can be measured by routine laboratory tests. BUN and creatinine levels indicate the general function of the kidneys. BUN is a metabolic by-product of protein-rich food such as meat, poultry, and certain vegetables. BUN is filtered out of the blood by the kidneys and excreted in the urine. Creatinine is continuously generated by normal cell metabolism within the muscles. Creatinine is also filtered out of the blood by the kidneys and excreted in the urine. The amounts of BUN and creatinine in the blood are equal to the amount excreted by the kidneys. The blood levels of BUN and Cr remain unchanged unless there is sudden deterioration

of renal (i.e., kidney) function. If the kidneys are suddenly unable to function, BUN and Cr increase daily. This condition is known as acute renal failure. Chronic renal failure is a condition distinguished by a gradual increase in BUN and Cr over a long period of time. When renal function decreases, blood levels of Cr and BUN increase because the kidneys are unable to clean the blood effectively. Factors not related to the kidneys also impact BUN and Cr levels. Creatinine, in particular, is affected by age, sex, weight, and muscle mass.