1 Cardiovascular Structure and Function
Robert J.Laird and Scot Irwin
Outline
General Organization, Spatial Orientation and Surface Anatomy
Essential Gross Anatomy, Microanatomy and Physiology of Cardiac Output
● Pericardium
● General myology
● Myocardial connective tissue and architecture
● Chambers and valves of the heart
● Intrinsic circulation
● Contractile elements
● Anatomical infrastructure of energy physiology
● Intrinsic conduction system
● Normal physiology of cardiac output
Heart Regulation
● Neural mechanisms
Summary
The human heart, an incredibly efficient organ that never
rests, shows remarkable functional ability and extraordinary
durability. A fibromuscular organ shaped like a hollow cone,
it weighs about 300 g (slightly more than 10 oz) in men and
about 250 g in women1; it approximates the size of the
owner’s fist. The heart is located in the middle mediastinum.
About two thirds of its mass lies to the left of midline; the
entire heart is protected by the sternum and ribs anteriorly
and by the vertebral column and ribs posteriorly (Fig. 1-1).
Functionally, the heart is a pair of pumps (the “right” and
“left” hearts) arranged in series. Each pump comprises a pair
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
those circuits are unequal in size, volume, and resistance, the
thickness of the muscular walls of the two pumps is likewise
unequal, which reflects the effort required to move blood
through their respective circuits. The left ventricle is signifi-
cantly larger and thicker than the right. It has to pump
against a systemic resistance that is 5 to 7 times as great
as the pulmonic system resistance. Yet, because they are
arranged in series instead of in parallel, the two pumps are
obliged to pump equal volumes of blood as a function of
time. This necessary accommodation for proper functioning
of the system is a design feature responsible for significant
clinical consequences when parts of either pump become
compromised through disease, and the delicate balance
between them is disturbed.
Concerning functional ability and durability, the heart is
the major source of propulsion of blood* through an esti-
mated 60,000 miles of tubes that make up the closed blood
vascular system. It pumps more than 5 L of blood every
minute (about 30 times its own weight), or about 80 gallons
every hour.† Over a period of a year, that would yield 70 rail-
road tank cars at 10,000 gallons each! When the work per-
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
anatomy of the heart; gross anatomy of the pericardium and
heart and its walls, chambers, valves, and intrinsic circula-
tion; and microanatomy of the heart. The clinical signifi-
cance of anatomical abnormalities is used here to emphasize
the relevance and importance of an understanding of car-
diac anatomy and physiology. The purpose of this chapter is
to provide a basis for an understanding of normal and
abnormal heart function. This understanding is used repeat-
edly in subsequent chapters to provide the rationale for
appropriate physical therapy interventions for patients with
compromised cardiac function.
*
The propulsive sources largely responsible for venous return include
such phenomena as: the “milking” action of contracting skeletal mus-
cles on lower extremity deep veins (equipped with one-way valves);
compressive forces on the inferior vena cava associated with respiratory
movements of the chest and abdomen; venous tone; and the facilitation
of gravity upon return of venous blood.
†
And that is while at rest! Because we are active for more than half of
each day and because our daily cardiac output increases accordingly,
the actual amount is proportionately larger.