The heart is a roughly cone-shaped hollow muscular organ.

It is about 10 cm long and is about the size of

the owner's fist. It weighs about 225 g in women and is heavier in men (about 310 g).

Position
The heart lies in the thoracic cavity between the lungs. It lies obliquely, a little more to the left than the right,
and presents a base above, and an apex below. The apex is about 9 cm to the left of the midline at the level of
the 5th intercostal space. The base extends to the level of the 2nd rib.

Organs associated with the heart

Inferiorly — the apex rests on the central tendon of the diaphragm
Superiorly — the great blood vessels, i.e. the aorta, superior vena cava, pulmonary artery and pulmonary veins
Posteriorly — the oesophagus, trachea, left and right bronchus, descending aorta, inferior vena cava and
thoracic vertebrae
Laterally — the lungs — the left lung overlaps the left side of the heart
Anteriorly — the sternum, ribs and intercostal muscles
Structure
The heart is composed of three layers of tissue: pericardium,
myocardium and endocardium.
Pericardium The pericardium is made up of two sacs. The outer sac
consists of fibrous tissue and the inner of a continuous double layer of
serous membrane. The outer fibrous sac is continuous with the tunica
adventitia (The outermost coat, or tunica adventitia, is a tough layer
consisting mainly of collagen fibres that act as a supportive element. The
large arteries differ structurally from the medium-sized arteries in that they
have a much thicker tunica media and a somewhat thicker tunica
adventitia) of the great blood vessels above and is adherent to the
diaphragm below. Its inelastic, fibrous nature prevents overdistension of
the heart. The outer layer of the serous membrane, the parietal
pericardium, lines the fibrous sac. The inner layer, the visceral pericardium,
or epicardium is adherent to the heart muscle. A similar arrangement of a
double membrane forming a closed space is seen also with the pleura, the
membrane enclosing the lungs. The serous membrane consists of flattened
epithelial cells. It secretes serous fluid (is any of various body fluids
resembling serum, that are typically pale yellow and transparent and of a
benign nature. ) into the space between the visceral and parietal layers
which allows smooth movement between them when the heart beats.
Myocardium The myocardium is composed of specialised
cardiac muscle found only in the heart. It is not under voluntary
control but, like skeletal muscle, cross-stripes are seen on
microscopic examination. Each fibre (cell) has a nucleus and
one or more branches. The ends of the cells and their branches
are in very close contact with the ends and branches of
adjacent cells. Microscopically these 'joints', or intercalated
discs, can be seen as thicker, darker lines than the ordinary
cross-stripes. This arrangement gives cardiac muscle the
appearance of being a sheet of muscle rather than a very large
number of individual cells. Because of the end-to-end
continuity of the fibres, each one does not need to have a
separate nerve supply. When an impulse is initiated it spreads
from cell to cell via the branches and intercalated discs over the
whole 'sheet‘ of muscle, causing contraction. The 'sheet'
arrangement of the myocardium enables the atria and
ventricles to contract in a coordinated and efficient manner.
The myocardium is thickest at the apex and thins out towards
the base. This reflects the amount of work each chamber
contributes to the pumping of blood. It is thickest in the left
ventricle.
Endocardium
This forms the lining of the myocardium and the heart valves. It is a thin, smooth, glistening
membrane which permits smooth flow of blood inside the heart. It consists of flattened epithelial
cells, continuous with the endothelium that lines the blood vessels.

Interior of the heart

The heart is divided into a right and left side by the septum (Fig. 5.14), a partition consisting of
myocardium covered by endocardium. After birth blood cannot cross the septum from one side to
the other. Each side is divided by an atrioventricular valve into an upper chamber, the atrium, and a
lower chamber, the ventricle (Fig. 5.15). The atrioventricular valves are formed by double folds of
endocardium strengthened by a little fibrous tissue. The right atrioventricular valve (tricuspid valve)
has three flaps or cusps and the left atrioventricular valve (mitral valve) has two cusps. The valves
between the atria and ventricles open and close passively according to changes in pressure in the
chambers. They open when the pressure in the atria is greater than that in the ventricles. During
ventricular systole (contraction) the pressure in the ventricles rises above that in the atria and the
valves snap shut preventing backward flow of blood. The valves are prevented from opening
upwards into the atria by tendinous cords, called chordae tendineae, which extend from the inferior
surface of the cusps to little projections of myocardium covered with endothelium, called papillary
muscles.
Flow of blood through the heart
The two largest veins of the body, the superior
and inferior venae cavae, empty their contents
into the right atrium. This blood passes via the
right atrioventricular valve into the right
ventricle, and from there it is pumped into the
pulmonary artery or trunk (the only artery in the
body which carries deoxygenated blood). The
opening of the pulmonary artery is guarded by
the pulmonary valve, formed by three semilunar
cusps. This valve prevents the back flow of blood
into the right ventricle when the ventricular
muscle relaxes. After leaving the heart the
pulmonary artery divides into left and right
pulmonary arteries, which carry the venous
blood to the lungs where exchange of gases
takes place: carbon dioxide is excreted
and oxygen is absorbed.

Interior of heart
Two pulmonary veins from each lung carry oxygenated blood back to the left atrium. Blood then passes through
the left atrioventricular valve into the left ventricle, and from there it is pumped into the aorta, the first artery of
the general circulation. The opening of the aorta is guarded by the aortic valve, formed by three semilunar cusps.
Blood supply to the heart
Arterial supply The heart is supplied with arterial blood by the right and left coronary arteries which branch from
the aorta immediately distal to the aortic valve. The coronary arteries receive about 5% of the blood pumped
from the heart, although the heart comprises a small proportion of body weight. This large blood supply,
especially to the left ventricle,
highlights the importance of the heart to body function. The coronary arteries traverse the heart, eventually
forming
a vast network of capillaries.
Venous drainage. Most of the venous blood is collected into several small veins that join to form the coronary
sinus which opens into the right atrium. The remainder passes directly into the heart chambers through little
venous channels.
Conducting system of the heart There are small groups of specialised neuromuscular cells in
the myocardium which initiate and conduct impulses causing coordinated and synchronised
contraction of the heart muscle.

Sinoatrial node (SA node) This small mass of specialised cells is in the wall of the right atrium
near the opening of the superior vena cava. The SA node is the 'pace-maker' of the heart
because it normally initiates impulses more rapidly than other groups of neuromuscular cells.

Atrioventricular node (AV node) This small mass of neuromuscular tissue is situated in the wall
of the atrial septum near the atrioventricular valves. Normally the AV node is stimulated by
impulses that sweep over the atrial myocardium. However, it too is capable of initiating
impulses that cause contraction but at a slower rate than the SA node.

Atrioventricular bundle (AV bundle or bundle of His)

This is a mass of specialised fibres that originate from the AV node. The AV bundle crosses the
fibrous ring that separates
atria and ventricles then, at the upper end of the ventricular septum, it divides into right and
left bundle branches. Within the ventricular myocardium the branches break up into fine fibres,
called the Purkinje fibres. The AV bundle, bundle branches and Purkinje fibres convey electrical
impulses from the AV node to the apex of the myocardium where the wave of ventricular
contraction begins, then sweeps upwards and outwards, pumping blood into pulmonary artery
and aorta.