The healthy heart

Structure and mode of operation

The heart is a pump made of muscles, more precisely, it is two muscle pumps side by side. That is why we speak of two halves of the heart, namely the left and the right.

Each half of the heart is divided into a ventricleLower chamber of the heart. A healthy heart has two ventricles (right and left). and an atriumTerm for the uppermost chambers of the heart. There is a left atrium and a right atrium. The right atrium collects the oxygen-poor blood that flows back from the body to the heart; the left atrium collects the oxygen-rich blood that comes from the lungs. From the atria, the blood continues to the respective ventricles..
There are heart valves between the ventricles and the atria. They function like valves, letting blood through in only one direction – from the atria into the ventricles and from the ventricles into the two large arteries.

Both halves of the heart pump the same amount of blood at the same time, but into different vessels: the right ventricle into the pulmonary arteryArtery supplying the lungs. and thus into the lungs, the left into the aortaThe main major artery in the body. Leads from the left ventricle via an arch in the thoracic cavity to the abdominal cavity. There it splits into two large iliac arteries., thus into the rest of the body.

To prevent the blood that has just been pumped on from flowing back into the respective heart chambers, there are, as I said, heart valves also between the large vessels and the heart chambers.

Direction of blood flow

Right half of the heart
Body Right atrium Right ventricle PulmonaryBelonging to the lungs. arteryA blood vessel leading away from the heart that transports oxygenated blood to the organs. Arteries pulsate and can be palpated on the wrist, for example (pulse). The aorta is the main artery of the body. Lungs

Left half of the heart
Lungs Left atrium Left ventricle Aorta Body

SystoleActive section of the heart’s activity. During systole, the ventricles contract and pump blood into the arteries. – DiastoleThe relaxation phase of the ventricles (main chambers) of the heart after a pumping action. During this phase, the heart fills up with blood again.

When the heart chambers contract, they force blood into the arteries; this is called systole and lasts about a third of a second. When the heart chambers go slack, they fill with blood; this takes about two-thirds of a second. So we can say that the human heart works eight hours a day and rests 16 hours.

Numbers & Effort

The heart beats 60-70 times every minute, day and night, throughout life, without pauses, up to 100,000 times in 24 hours, pumping every minute:

• 5-6 l of blood into the lungs (pulmonary circulationBlood circulation leading from the right ventricle via the pulmonary artery into the lungs and via the pulmonary veins into the left heart. Gas exchange takes place via this circuit, oxygen is supplied to the blood.) and
• 5-6 litres of blood into the body (systemic circulationLarge, arterial blood circulation.).

in 24 hours so 2 x 8,000 litres = 16,000 litres at rest!
The heart is able to do five times as much during exertion

Size

The heart is about the size of your own clenched fist and weighs about 300 g.

Coronary vesselsCoronary arteries. The left and right coronary arteries originate above the aortic valve from the aortic root and initially run along the outside of the heart muscle before branching out into many sub-branches and dipping into the heart muscle tissue as fine arterioles.

The coronaryConcerning the coronary vessels that supply blood to the heart muscle. vessels supply the heart with oxygen and nutrients. The human heart has two main vessels that give off secondary branches. These main branches originate at the large body artery and lead from there to the heart chambers.

Heart valves

How do the heart valves work?

The heart has four valves. Two of them are located between the atria and the main chambers (tricuspid valve and mitral valve). The other two (pulmonary valve and aortic valve) are located at the junction of the main chambers with the large blood vessels, the pulmonary artery and the coronary artery respectively. The valves control the flow of blood from the atria into the main chambers and from the main chambers into the large arteries by opening and closing in a timed manner.

What causes heart valve disease?

In some cases, a malformation or dysfunction of a heart valve already exists at birth. Some valve diseases only develop in adulthood, especially following certain infectious diseases or inflammations of a rheumatic nature, which may also have occurred many years before valve disease.

The first sign of valve disease is usually a decrease in physical performance or shortness of breath, especially during exertion such as climbing stairs. In more advanced stages of valve disease, there may be heart pain or blood pooling in front of the heart, which can lead to fluid build-up in the lungs, liver or lower legs. Patients usually report swollen legs, especially in the evening.

A bluish discolouration of the lips during exertion or even at rest can also be a sign of insufficient heart activity or an overload of the heart muscle. Many of these symptoms can increase in severity as heart valve disease progresses.

Which heart valve diseases are there?

There are two main types of dysfunctionMalfunction, impaired function.:

• When the valveValve. is narrowed, it does not open wide enough to let the normal amount of blood through. The heart can only pump the normal amount of blood if it does extra work.
• In the case of valve regurgitationInability of the heart valve to close. Inflammation or calcification can cause the leaflets of the heart valves to shrink, or the increase in size of the heart can cause the valve ring to widen. When closed, small gaps remain between the leaflets through which the blood flows back into the chamber., the valve does not close completely. This creates a leak where blood also flows back against the desired direction of flow. With normal blood inflow together with this backflow, the heart has to do more work.

What are the risks without heart valve surgery?

With both valve dysfunctions, the heart has to do more work to supply the body with sufficient blood. This extra work can cause damage to the heart muscle in the long term. The heart muscle is then no longer able to do the necessary extra work. Heart failure occurs. The incoming blood is no longer pumped into the body by the heart and collects in the pulmonary vessels. High pressure builds up there, which on the one hand damages the lung vessels and on the other presses water into the lung tissue. Since the damage to the pulmonary vessels cannot be reversed, the operation should be performed before this damage has occurred.

Are there other treatment options?

Medication can be used to improve the symptoms, e.g. diuretic medication can be used to reduce the accumulation of fluid in the lungs or lower legs and relieve the heart. Other medicines can also be used to temporarily treat arrhythmias. However, all these medicinal measures do not lead to a cure of the underlying disease; only valve surgery can do this.

How is the operation performed?

For more information about surgery, please visit our heart valveIn the inflow and outflow area of the heart chambers there are valves which prevent the blood from flowing back in the wrong direction. Each heart half has a sail valve and a pocket valve: 1. Tricuspid valve (between the right atrium and right ventricle) 2. Pulmonary valve (between the right ventricle and pulmonary artery) 3. Mitral valve (between the left atrium and left ventricle) 4. Aortic valve (between the left ventricle and the aorta). page:

Heart Valve Centre

Heart diseases

Coronary heart disease (CHD)

Definition: Coronary heart disease (CHD)Heart disease caused by narrowing of the coronary arteries. Cause: progressive calcium deposits on the inner lining of the coronary arteries lead to narrowing of the coronary vessels and thus to a reduced supply of oxygen to the heart muscle. The symptoms first appear in the form of chest pain during exertion (angina pectoris). is defined as the manifestation of arteriosclerosisArteriosclerosis, also called atheromatosis. Vascular disease in which fat is stored and the subsequent calcification of the vessel walls leads to internal narrowing of the vessels. The consequences range from circulatory disorders to heart attacks. (hardening of the arteries) in the coronary vessels. Arteriosclerosis leads to deposits of blood fats, thrombi, connective tissue and, in smaller quantities, calcium in the vessel walls.

Epidemiology: Cardiovascular diseases, which include coronary heart disease, are by far the most common cause of death in industrialised nations. About 1 million people in Germany suffer from coronary heart disease (CHD).

Causes: 

• High blood pressureIncreased pressure within the arterial system. The limit value is 140/90 mmHg (see Hypertension).
• High cholesterolFat-like substance formed in the liver, which is the basic substance of various hormones. Every cell in the body contains cholesterol, which is mainly stored in the cell membranes. Cholesterol is partly taken from food, partly synthesised by the body.  Pathological proliferation, e.g. in the case of cholesterol metabolism disorders, leads to arteriosclerosis, among other things. level
• DiabetesSee Diabetes mellitus. mellitus (diabetes)
• Stress
• Being overweight
• Smoking
• Family history

Symptoms: In the advanced stages of coronary artery disease, blood flow can then become obstructed. Due to the reduced blood supply, the heart muscle is not supplied with enough oxygen, especially during exertion. This insufficient supply often makes itself felt in the form of pain behind the sternumBreastbone., which can also radiate to other parts of the body (often to the left arm or shoulder). This typical form of pain is called angina pectorisSevere pain in the left side of the chest ( stenocardia). The pain radiates to the left arm, neck or upper abdomen. The attacks are usually triggered by exertion, but they can also occur at rest. The cause is almost always a pathological narrowing of the coronary vessels.. In the case of a complete blockage of a coronary vessel, a heart attack, the area behind the blockage is no longer supplied with blood and perishes.

What other treatment options are there?

Various methods are available to improve blood flow to the heart:

• MedicationAdministration and dosage of a medicine. (e.g. to promote blood flow to the heart).
• Removal of the narrowing by dilating it with a catheter (balloon dilatation1. Dilatation of the ventricles or aorta. 2. Widening of constrictions in vessels and valves.), possibly wall stabilisation with the help of a wire mesh (stentSpiral-shaped, lattice-like vessel supports, usually made of a precious metal. Used when balloon dilatation has not produced the desired results or to close off aneurysms of the great vessels.) after dilatation.
• Bypass operationBypass surgery on the heart uses the patient’s own veins or arteries. Prostheses made of plastic tissue are also used for operations on the vascular system. Bypass operations are performed in large numbers for narrowed coronary arteries, but also for narrowing in the area of the pelvic and leg arteries.; (the following link refers you to our info page: Coronary bypass surgery)