The Heart

1 of 24 © Boardworks Ltd 2008
Task:
1) Draw and label a diagram of the heart – no
help.
2) Compare the diagram with the one you have
drawn. Compare labels. Draw the correct
structure.
3) Cover this up. Re-draw and label the heart.

The human heart
The heart is a muscular
organ located between the
lungs in the centre of the
chest (thorax), and is about
the size of a fist.
It pumps blood continuously
around the body. An organism
can lose conscious within just
a few seconds if the brain is
deprived of blood.
In foetuses, the heart begins

beating about 5–6 weeks after
conception.

Cardiac muscle
The heart mainly consists of cardiac muscle tissue, which
like smooth muscle (but not skeletal muscle), contracts
involuntarily.
Cardiac muscle is
made up of cells that
are connected by
cytoplasmic bridges.
This enables electrical
impulses to pass
through the tissue.
It contains large numbers of mitochondria and myoglobin

molecules.

Structure of the heart

What structure?

Blood flow through the heart

The cardiac cycle

Interactive heart

Cardiac output
The amount of blood pumped around the body is called the
cardiac output, and depends on two factors:
 the stroke volume – the volume of blood pumped by the

left ventricle in each heart beat. A typical value for an
adult at rest is 75 ml.
 the heart rate – the number of times the heart beats per
minute. A typical value for an adult at rest is 70 bpm.
cardiac output = stroke volume × heart rate
A typical resting cardiac output is 4–6 litres per minute.

This can rise to as much as 40 litres per minute in highly
trained endurance athletes.

Pacemaker cells of the heart
The heart can beat without any input from the nervous
system as longs as its cells stay alive. This is due to
myogenic contraction.
Muscle cells (myocytes) in the heart have a slight

electrical charge across their membrane. They are
polarized. When the charge is reversed, they are said to
be depolarized and this causes them to contract.
Depolarization is initiated in a region of the heart called the

sinoatrial node (SAN) – also known as the pacemaker –
which is in the wall of the right atrium.

Myogenic stimulation of the heart

Interactive heart

Artificial pacemakers
Artificial pacemakers are devices implanted in people whose
heart’s electrical conduction system is not working properly.
Problems include the SAN not firing, and the blockage or

disruption of impulses between the SAN and AVN, or in the
bundle of His.
Pacemakers monitor the

heart’s electrical activity and
stimulate the ventricles or atria
to contract when necessary.
Impulses are transmitted
down electrodes implanted in
the muscular walls.

The cardiac cycle

What are electrocardiograms?
The electrical activity of the heart can be monitored by
an electrocardiograph.
Several electrodes are

attached to specific places
on a person’s chest and
limbs. These detect
changes in polarization in
the heart by measuring
current at the skin surface.
The leads are connected to

a machine that draws an
electrocardiogram (ECG).

Components of an ECG trace

ECG in diagnosis
ECGs are used to diagnose problems with the heart, as
variations in different components of the trace can
indicate a disease or other abnormality.
An ECG may be taken

while the patient is relaxed
or it may be taken before,
during and after exercise.
This is called a ‘stress test’

and usually involves the
patient exercising on a
treadmill while attached to
an ECG machine.

Abnormal ECGs

Glossary

What’s the keyword?

Multiple-choice quiz

Worldwide deaths due to CVD, 2002

What is coronary heart disease?
Coronary heart disease (CHD) is a disease of the arteries
supplying the heart (coronary arteries). Almost one-fifth of
all deaths in the UK in 2005 were due to CHD.
The major cause of CHD is

atherosclerosis: a thickening of
arteries caused by a build-up of
fatty plaques (atheromas) on the
inside walls.
Atherosclerosis can eventually

lead to a reduced blood supply
(ischaemia) to tissues, with
potentially fatal consequences.

Trends in CVD death rates

Gender, age, CHD and stroke

Scientist case study

Development of atherosclerosis

CHD risk factors
Hundreds of risk factors for CHD and stroke have been
identified. The major ones are:
Modifiable Non-modifiable
high blood pressure advancing age
high blood cholesterol male gender
tobacco smoking family history of the disease
physical inactivity ethnicity/race
obesity
diabetes mellitus
others: stress, alcohol

Hypertension and CHD
High blood pressure (hypertension) is a major risk factor for
CHD and other cardiovascular diseases.
Hypertension is defined as
systolic blood pressure above
140 mmHg and/or diastolic
blood pressure above 90 mmHg.
Hypertension puts strain on the

heart and blood vessels,
increasing the risk of
aneurysm or thrombosis. It is
sometimes called the ‘silent
killer’ because it can develop
without symptoms.

Hypertension and CHD

Cholesterol and lipoproteins
Cholesterol is a soft waxy lipid that has a vital role as a
component of cell membranes, where it regulates fluidity.
Cholesterol is insoluble in blood, so
it is transported by lipoproteins.
These are spherical complexes
consisting of:
 an outer layer of phospholipids,

studded with proteins
 an inner core of trigylcerides
and cholesterol.
Two major types of lipoprotein are low-density lipoprotein

(LDL) and high-density lipoprotein (HDL).

High blood cholesterol levels and CHD
LDLs generally transport cholesterol from the
liver to body tissues, depositing it on the
walls of blood vessels. In high levels,
it contributes to atherosclerosis.
Eating a diet high in saturated fat

is the biggest cause of elevated LDL cholesterol levels.
LDL cholesterol levels can be reduced by regular exercise,

eating plenty of fibre and a diet rich in polyunsatured fats.
HDLs generally transport cholesterol away from the tissues

to the liver, where the cholesterol is metabolized. High levels
of HDL cholesterol are linked to a reduced risk of CHD.

Smoking and CHD
Smoking tobacco is a major cause of CHD, and smokers are
at a higher risk of developing CVD than lung cancer.
Smoking increases the risk of CHD in several ways:

 it damages and weakens the endothelial lining of blood
vessels
 it increases clotting and the development of atheromas
 it lowers HDL cholesterol and raises LDL cholesterol levels
 nicotine increases blood pressure and heart rate, and
constricts blood vessels
 carbon monoxide reduces the amount of oxygen that
blood can carry.

Effects of CHD: heart attack
The most dangerous symptom/result of CHD is a heart attack,
known as a myocardial infarction (MI).
An MI occurs when the blood

supply to part of the heart muscle
(myocardium) is interrupted.
This causes oxygen deprivation
and subsequent tissue damage.
The most common symptom is

chest pain, but shortness of breath,
excessive sweating, nausea and
weakness may also be present. Loss
of consciousness and death can occur.

Effects of CHD: angina
A less severe symptom of
CHD is angina pectoris.
This is a tight, gripping
chest pain or ache, similar
to indigestion, which
commonly occurs during
physical activity.
The narrowing of the coronary arteries results in inadequate

blood and oxygen supply, forcing the heart to respire
anaerobically, and causing a build-up of lactic acid.
The pain normally subsides with rest, once the demand on

the heart has dropped and it can respire aerobically.

Diagnosing heart disease

How does CHD develop?

Identifying CHD risk factors

Reducing the risk of CHD
Ensuring a healthy lifestyle can make a significant difference
to a person’s risk of developing CHD.
These changes aim to reduce blood pressure and blood
cholesterol, and reduce weight if overweight or obese. Key
steps include:
 stopping smoking
 regular cardiovascular exercise – about 30 mins of
moderate exercise several times a week
 a healthy diet – low in saturated fats (including trans fats)
and salt, high in fibre, fresh fruit/vegetables, and
moderate mono/polunsaturated fats
 reducing alcohol intake.

Treating CHD: medication

Treating CHD: surgery
Surgery is used in the treatment or prevention of CHD, stroke
or MI. The type of operation depends on the severity and
location of atherosclerosis, and factors such as whether the
patient has diabetes.
A coronary artery bypass

graft (CABG) is an operation
in which arteries from
elsewhere in the body (e.g.
legs or chest) are grafted on
to coronary arteries to
bypass blocked regions.
Single, double, triple bypass refers to the number of coronary

arteries that are bypassed.

Treating CHD: coronary angioplasty

Respiratory diseases
Respiratory diseases are one of the biggest causes of death
worldwide.
Respiratory diseases affect the lungs, bronchi, trachea and

throat. They can be mild (e.g. cold) or life-threatening (e.g.
pneumonia, lung cancer).
Chronic obstructive pulmonary disorder (COPD) is a
term for a group of diseases that cause a reduction in the
airflow in the lungs and which are not fully reversible.
Two of the more serious types of COPD are chronic

bronchitis and emphysema, and are both usually caused
by smoking.

COPD: chronic bronchitis
Chronic bronchitis is a bronchi
narrowing of the bronchi. It
is characterized by: normal
airway
 a persistent cough that
produces phlegm - due
to an increased number mucus
and size of goblet cells inflammed
airway
 shortness of breath and wheezing - irritants in cigarette
smoke cause inflammation in the lining of the bronchioles.
Over time this leads to scarring and narrowing of the
bronchioles, reducing airflow.

COPD: emphysema
Emphysema is a gradual breakdown of alveolar walls and
damage to terminal bronchioles and alveolar capillaries.
This reduces the efficiency of gas exchange, causing

chronic breathlessness and hyperventilation.
Using this photo of

healthy lung tissue
(left) and emphysema
lung tissue (right), can
you explain why gas
exchange is less
efficient in
emphysema?

Diagnosing COPD
There is no one single test for COPD. Diagnosis depends
on taking into account a patient’s risk factors (e.g. whether
they smoke, their age), their symptoms and clinical tests.
Testing the patient’s lung

function using spirometry
is essential. It can
determine whether there is
airway obstruction and can
help exclude the possibility
of other respiratory
diseases, such as asthma
or lung cancer.

Determining lung function

Treating COPD
Stopping smoking is the single most important step in
slowing the decline in lung function in people with COPD.
Medicines commonly prescribed to treat COPD include

bronchodilators, which widen the airways by relaxing
smooth muscles, and corticosteroids, which act as anti-
inflammatories.
Oxygen therapy,
especially for people
with emphysema, may
be required for most of
each day.

What is asthma?
Asthma is a chronic condition in which the airways
occasionally narrow and become inflamed, limiting airflow.
Asthma causes difficulty

breathing, wheezing and
chest tightness, and can
be mild or life-threatening.
Asthma is triggered by a
range of stimuli, such as
allergens, dust, exercise,
stress and infections.
Treatment is with bronchodilators, corticosteroids, or a

combination of the two.

Lung cancer
Lung cancer is the biggest cause of cancer-related deaths in
men and second-biggest cause in women. About 90% of
cases are caused by smoking.
Most incidences of lung

cancer are due to
uncontrolled growth of
epithelial cells lining the
airways. Cancers arising
from these cells are
called carcinomas.
Symptoms include shortness of breath, coughing (including

coughing up blood) and loss of weight.

Lung cancer
Lung cancer generally develops quite slowly. By the time it
has been diagnosed, the cancer may have spread to other
areas of the body. This is called metastasis, and makes it
difficult to treat successfully.
Lung cancer can be seen

on an X-ray or a CT scan,
and diagnosis is usually
confirmed after a small
sample of tissue is taken
(a biopsy) and analysed.
Like many other cancers, lung cancer is treated by surgery,

chemotherapy and/or radiotherapy.

Cancer statistics

Smoking and lung cancer

Smoking and lung cancer: epidemiology
The first solid epidemiological evidence that smoking
increased the risk of lung cancer came from a 1950 study by
Richard Doll, a British doctor and epidemiologist, and Austin
Bradford Hill, a British epidemiologist and statistician.
Before their study, it was unclear whether the rapid rise in

lung cancer was due to smoking or other atmospheric
pollution, such as exhaust fumes, industrial plants or tarmac.
Their study of over 1,700 men and women in London

concluded that: “The risk of developing the disease
increases in proportion to the amount smoked. It may be
50 times as great among those who smoke 25 or more
cigarettes a day as among non-smokers.”

Smoking and health: epidemiology
Following Doll and Hill’s research, a large-scale study into the
health and smoking habits of British male doctors began in
1950, continuing with periodic updates until 2001.
Two of the main findings of this British Doctors Study were:
 life-long smokers died, on average, 10 years earlier than

non-smokers
 the earlier smokers stop smoking, the more chance they

have of avoiding reduced life expectancy.

Which respiratory disease?

Glossary

What’s the keyword?

Multiple-choice quiz

The Heart

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1 of 24 © Boardworks Ltd 2008

2 of 24 © Boardworks Ltd 2008

In foetuses, the heart begins

6 of 24 © Boardworks Ltd 2008

It contains large numbers of mitochondria and myoglobin

7 of 24 © Boardworks Ltd 2008

8 of 24 © Boardworks Ltd 2008

9 of 24 © Boardworks Ltd 2008

10 of 24 © Boardworks Ltd 2008

12 of 24 © Boardworks Ltd 2008

13 of 24 © Boardworks Ltd 2008

 the stroke volume – the volume of blood pumped by the

cardiac output = stroke volume × heart rate

A typical resting cardiac output is 4–6 litres per minute.

14 of 24 © Boardworks Ltd 2008

Muscle cells (myocytes) in the heart have a slight

Depolarization is initiated in a region of the heart called the

15 of 24 © Boardworks Ltd 2008

16 of 24 © Boardworks Ltd 2008

17 of 24 © Boardworks Ltd 2008

Problems include the SAN not firing, and the blockage or

Pacemakers monitor the

18 of 24 © Boardworks Ltd 2008

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Several electrodes are

The leads are connected to

20 of 24 © Boardworks Ltd 2008

21 of 24 © Boardworks Ltd 2008

An ECG may be taken

This is called a ‘stress test’

22 of 24 © Boardworks Ltd 2008

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25 of 24 © Boardworks Ltd 2008

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The major cause of CHD is

Atherosclerosis can eventually

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Hypertension puts strain on the

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 an outer layer of phospholipids,

Two major types of lipoprotein are low-density lipoprotein

38 of 52 © Boardworks Ltd 2008

Eating a diet high in saturated fat

LDL cholesterol levels can be reduced by regular exercise,

HDLs generally transport cholesterol away from the tissues

39 of 52 © Boardworks Ltd 2008

Smoking increases the risk of CHD in several ways:

40 of 52 © Boardworks Ltd 2008

An MI occurs when the blood

The most common symptom is

41 of 52 © Boardworks Ltd 2008

The narrowing of the coronary arteries results in inadequate

The pain normally subsides with rest, once the demand on

42 of 52 © Boardworks Ltd 2008

43 of 52 © Boardworks Ltd 2008