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Illustration A shows cardiac diastole. The cardiac muscle is relaxed, and blood flows into the heart atria and into the ventricles. Illustration B shows atrial systole; the atria contract, pushing blood into the ventricles, which are relaxed. Illustration C shows atrial diastole; after the atria relax, the ventricles contract, pushing blood out of the heart.
During (a) cardiac diastole, the heart muscle is relaxed and blood flows into the heart. During (b) atrial systole, the atria contract, pushing blood into the ventricles. During (c) atrial diastole, the ventricles contract, forcing blood out of the heart.

The pumping of the heart is a function of the cardiac muscle cells, or cardiomyocytes, that make up the heart muscle. Cardiomyocytes , shown in [link] , are distinctive muscle cells that are striated like skeletal muscle but pump rhythmically and involuntarily like smooth muscle; they are connected by intercalated disks exclusive to cardiac muscle. They are self-stimulated for a period of time and isolated cardiomyocytes will beat if given the correct balance of nutrients and electrolytes.

Micrograph shows cardiac muscle cells, which are oblong and have prominent striations.
Cardiomyocytes are striated muscle cells found in cardiac tissue. (credit: modification of work by Dr. S. Girod, Anton Becker; scale-bar data from Matt Russell)

The autonomous beating of cardiac muscle cells is regulated by the heart’s internal pacemaker that uses electrical signals to time the beating of the heart. The electrical signals and mechanical actions, illustrated in [link] , are intimately intertwined. The internal pacemaker starts at the sinoatrial (SA) node    , which is located near the wall of the right atrium. Electrical charges spontaneously pulse from the SA node causing the two atria to contract in unison. The pulse reaches a second node, called the atrioventricular (AV) node, between the right atrium and right ventricle where it pauses for approximately 0.1 second before spreading to the walls of the ventricles. From the AV node, the electrical impulse enters the bundle of His, then to the left and right bundle branches extending through the interventricular septum. Finally, the Purkinje fibers conduct the impulse from the apex of the heart up the ventricular myocardium, and then the ventricles contract. This pause allows the atria to empty completely into the ventricles before the ventricles pump out the blood. The electrical impulses in the heart produce electrical currents that flow through the body and can be measured on the skin using electrodes. This information can be observed as an electrocardiogram (ECG)    —a recording of the electrical impulses of the cardiac muscle.

 The sinoatrial node is located at the top of the right atrium, and the atrioventricular node is located between the right atrium and right ventricle. The heart beat begins with an electrical impulse at the sinoatrial node, which spreads throughout the walls of the atria, resulting in a bump in the ECG reading. The signal then coalesces at the atrioventricular node, causing the ECG reading to flat-line briefly. Next, the signal passes from the atrioventricular node to the Purkinje fibers, which travel from the atriovenricular node and down the middle of the heart, between the two ventricles, then ups the sides of the ventricles. As the signal passes down the Purkinje fibers the ECG reading falls. The signal then spreads throughout the ventricle walls, and the ventricles contract, resulting in a sharp spike in the ECG. The spike is followed by a flat-line, longer than the first then a bump.
The beating of the heart is regulated by an electrical impulse that causes the characteristic reading of an ECG. The signal is initiated at the sinoatrial valve. The signal then (a) spreads to the atria, causing them to contract. The signal is (b) delayed at the atrioventricular node before it is passed on to the (c) heart apex. The delay allows the atria to relax before the (d) ventricles contract. The final part of the ECG cycle prepares the heart for the next beat.

Visit this site to see the heart’s “pacemaker” in action.

Arteries, veins, and capillaries

The blood from the heart is carried through the body by a complex network of blood vessels ( [link] ). Arteries take blood away from the heart. The main artery is the aorta that branches into major arteries that take blood to different limbs and organs. These major arteries include the carotid artery that takes blood to the brain, the brachial arteries that take blood to the arms, and the thoracic artery that takes blood to the thorax and then into the hepatic, renal, and gastric arteries for the liver, kidney, and stomach, respectively. The iliac artery takes blood to the lower limbs. The major arteries diverge into minor arteries, and then smaller vessels called arterioles , to reach more deeply into the muscles and organs of the body.

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