Cardiovascular Structure and Function: Outline
Cardiovascular Structure and Function: Outline
Cardiovascular Structure and Function: Outline
● Intrinsic circulation
Concerning functional ability and durability, the heart is
● Contractile elements
the major source of propulsion of blood* through an esti-
● Anatomical infrastructure of energy physiology
mated 60,000 miles of tubes that make up the closed blood
● Intrinsic conduction system vascular system. It pumps more than 5 L of blood every
● Normal physiology of cardiac output minute (about 30 times its own weight), or about 80 gallons
Heart Regulation every hour.† Over a period of a year, that would yield 70 rail-
● Neural mechanisms road tank cars at 10,000 gallons each! When the work per-
Summary formed over a lifetime is considered, one begins to realize
just why it is such an extraordinary organ.
This chapter provides appropriately detailed descriptions
of cardiac output, heart rate, and stroke volume; surface
The human heart, an incredibly efficient organ that never anatomy of the heart; gross anatomy of the pericardium and
rests, shows remarkable functional ability and extraordinary heart and its walls, chambers, valves, and intrinsic circula-
durability. A fibromuscular organ shaped like a hollow cone, tion; and microanatomy of the heart. The clinical signifi-
it weighs about 300 g (slightly more than 10 oz) in men and cance of anatomical abnormalities is used here to emphasize
about 250 g in women1; it approximates the size of the the relevance and importance of an understanding of car-
owner’s fist. The heart is located in the middle mediastinum. diac anatomy and physiology. The purpose of this chapter is
About two thirds of its mass lies to the left of midline; the to provide a basis for an understanding of normal and
entire heart is protected by the sternum and ribs anteriorly abnormal heart function. This understanding is used repeat-
and by the vertebral column and ribs posteriorly (Fig. 1-1). edly in subsequent chapters to provide the rationale for
Functionally, the heart is a pair of pumps (the “right” and appropriate physical therapy interventions for patients with
“left” hearts) arranged in series. Each pump comprises a pair compromised cardiac function.
of serial chambers separated by valves and guarded by
another set of valves at its ejection end. Furthermore, each
pump serves separate vascular circuits. However, because *
The propulsive sources largely responsible for venous return include
those circuits are unequal in size, volume, and resistance, the such phenomena as: the “milking” action of contracting skeletal mus-
thickness of the muscular walls of the two pumps is likewise cles on lower extremity deep veins (equipped with one-way valves);
unequal, which reflects the effort required to move blood compressive forces on the inferior vena cava associated with respiratory
through their respective circuits. The left ventricle is signifi- movements of the chest and abdomen; venous tone; and the facilitation
of gravity upon return of venous blood.
cantly larger and thicker than the right. It has to pump †
And that is while at rest! Because we are active for more than half of
against a systemic resistance that is 5 to 7 times as great each day and because our daily cardiac output increases accordingly,
as the pulmonic system resistance. Yet, because they are the actual amount is proportionately larger.