1. 21-1
The Heart & The Blood Pipes
Our heart is one of the hardest
working organs in our body. It is
that organ which beats many times
each and every second of our life.
They do their work and make sure
that we are able to live and enjoy
life too.
The moment our heart stops work-
ing. We are dead.
In this chapter, let us learn all
about this important organ in our
body. The heart works along with
a complicated system of pipes
that runs through our body.

2. 21-2
Heart
The heart is a precious organ inside the chest
slightly to the right of the midline. It is about
the size of the person’s closed fist and the heart
beats without a break throughout the life of
the heart
the person.
The heart is like an automatic pump. Made of
special muscle, its walls first squeeze the blood
out of its pipes. It then waits for a while for
blood to rush into it from distant parts of the the heart
body and from the lungs. Then again, it pipes
squeezes the blood out, pumps in blood from
other parts and the cycle continues.
What is the pulse?
Each time the heart beats, the wave
A hard working pump
is carried to the last parts of the Imagine how hard working the
blood pipes and is called pulse. The heart is? Whenever the heart
pulse just like the heart should also beats, it is pumping blood. The
record sixty to eighty per minute. heart beats, or in other words
Usually we measure the pulse in the pipe in the wrist on the squeezes the blood out sixty to
side of the thumb where it can be felt easily. eighty times every minute! When
exercising or when we have fever
Each time the heart squeezes, about eighty to hundred ml of and some diseases, the heart may
blood is sent out. Since each of us has nearly eighty ml of have to squeeze much more often
blood for each kilo of weight we can easily see that almost all to meet the higher oxygen and
the blood is passed through the heart and lungs at least once other demands of the body.
a minute
Rush a Bleeding Child to Hospital
An average adult with sixty kilo weight will have 80 ml x 60kgs i.e. 4800 ml of blood or
nearly five litres of blood. A child with ten kilo weight will have only 80 ml x 10 kgs, that
is less than one litre of blood.
Hence, in an accident where an adult and a child are bleeding, the child is more likely to
die from losing just half litre loss of blood. Rush children with bleeding to the hospital!

3. 21-3
How our heart works
Our heart has four
compartments.
Two of the compartments
(the right side of the heart)
receive blood from differ-
ent parts of the body and
pump it to the lungs
where it gets fresh
oxygen.
From the lungs, the blood
with fresh oxygen goes
back to the heart (the left
side) and from there it
gets pumped to different
parts of the body.
It works some-
thing like this:
The first (I) is called the
Right Atrium(at-ri-
yum). This is where
blood is brought from all
parts of the body
AORTA
through the Vena Cava
Takes Fresh (or big veins).
Blood to rest
of Body From here , the blood
flows to the second
compartment (II), the
Right Ventricle.
The blood gets squeezed
out to the lungs from
here.
The lungs put fresh
oxygen into the blood
and now send it to the
left side of the heart (Part
III).
It first goes to the left atrium (Part III) and then to the left ventricle (Part IV) where it gets pumped
to other parts of the body.
A large artery called the aorta takes the fresh blood from the left ventricle (Part IV) for giving it to all
parts of the body.

4. 21-4
Parts of the Heart
Heart Valves
The valves of the heart make sure that Repairing Heart Valves
blood flows down only in one direction People whose valves are
in the pipe. damaged permanently
because of repeated sore
Damaged Valves throat infections or by birth,
Sometimes these valves can get dam- may need operation to repair
aged. Some children are born with the valves or to replace them
damaged valves. Sometimes, repeated with artificial ones. Replac-
throat infections can damage the valves. ing heart valves is more ex-
The heart has to beat more and the load pensive than operating the
on the heart increases. heart to repair them.
If the heart does not work well , the lungs get full of water because there is a backlog that cannot be
pushed out. Such patients get breathless very easily and if the illness gets serious, they cannot breathe
properly even while sitting or lying down. Gradually, the heart weakens and could cause heart fail-
ure.
Pacemaker & ECG
Pacemaker (pase-may-ker) is a part of the heart. It sends weak currents at regular intervals to help the heart
squeeze and maintain the regular beating rhythm. In case of a heart attack affecting the area of the pacemaker, the
regular beat may be lost. Unless such patients get a artificial pacemaker, they are not likely to survive long.ECG
Our Heart Can Change Its Beat What are heart attacks?
Does our heart not beat faster when we are From the heart, the aorta collects blood to give to
angry or scared or anxious or even very ex- other parts through a sys-
cited or happy? Nerve connections to the brain tem of blood pipes.
make the pacemaker beat at a faster or a slower
pace. The body prepares to react and face emer- But like how drain pipe or
gencies when it senses strong feelings. It gets water pipes in our own
ready to give more food and oxy- homes get blocked with
gen and so pumps faster to get the dirt, blood pipes can also
blood moving. get blocked.
Don’t we feel our heart beating Older people and people
hard when we do some exercise? who eat very oily and greasy food could have their
Every time the body exercises and blood pipes blocked. Those who take meat, eggs
there is more blood coming back to and fried things very often are more likely to have
the heart, the heart muscle stretches out wider. this problem.
In response to the stretch, it tends to beat
stronger so that instead of the normal 80 to If a pipe is completely blocked, blood and hence
100 ml per squeeze, it now throws out 100 to oxygen cannot reach one or more parts of the heart.
150 ml per squeeze. But this cannot happen This is what is meant by a heart attack. If too large
for long. If such conditions continue too long, an area is affected, the heart may no longer be able
it shows on the performance of the heart and it to squeeze out blood properly and heart may fail
may fail. completely. The person would die.

5. 21-5
The Blood Pipes
Pipes throughout the body carry blood from and to the heart. One set of pipes carries the blood to
the heart (veins) and another set of pipes (arteries) takes it away from the heart. Another set of
pipes that are very thin and allow things to pass out from their walls are called capillaries.
1. Arteries 2. Veins
Any pipe that carries blood Veins carry blood back to the
away from the heart is called heart from the diffrent parts of
an artery. The biggest artery is the body. The process is oppsite
Network of Veins & Arteries
the Aorta, that comes directly are like roads on which the from the arteries. Here, tiny cap-
from the heart. blood travels carrying illaries join together to form
oxygen & food for all body veins.
Most organs like the brain, parts!
heart, liver, kidneys and Small narrow veins, starting
stomach have one or more ar- from far off capillaries, keep join-
teries supplying blood to ing into larger ones. Blood has
them. to be brought to the heart both
from the top of the body and
The walls of these pipes are from the bottom.
thick and strong so that they
can take the force of the push Veins from the upper part of the
made by the heart. body end in the Superior Vena
Cava and those from the lower
Each artery keeps giving rise parts of the body end in the Infe-
to smaller and smaller rior Vena Cava. Both these veins
branches until they become pour blood into the Right Atrium
very narrow and the wall (compartment I) of the heart.
thickness also lessens. The
smallest arteries end in a loose Veins have thin walls and hence
web of pipes that have very the blood can be seen through
thin walls through which them. As they have no heart like
many substances can pass pump that keeps pushing the
through. These webs are blood, there is a chance that the
called capillaries and allow blood may flow back. Veins have
oxygen and other small nutri- valves that allow the flow only
ents to pass through its walls. towards the heart.
3. Capillaries : The Smallest Blood Pipes
The smallest arteries end in a loose web of pipes that have very thin walls. Through
these walls many substances can pass leave and also enter. These webs are called
capillaries and allow oxygen and other small nutrients to pass through its walls.
For example, such capillaries in the brain or in the leg muscles will allow the oxygen to
slip out and be available to the organ there. At the same time, the thin walls allow the
waste carbon dioxide to slip into the blood. This is carried back to the heart through
the veins. Form the heart they go to the lungs and oxygen is put into them.

6. 21-6
Learning To Find Our Arteries & Veins
Finding Arteries Finding Veins
Take your friend’s hand. Lightly
press your middle three fingers –
Tie a thin string or a
not hard – against the bone just
shoelace just above
above the wrist on the side of the
your elbow. It should be
thumb. Turn the hand down and
loose enough to allow
let the wrist hang loose. Do you
your little finger to pass
feel the throb of the artery? Count
through. Soon you will
it. This is the artery that brings blood from the heart to the hand.
see the veins of your
forearm and hand very
Another artery that can be easily felt
clearly. Why do they
takes blood to the brain. For this,
look blue or green when
look straight and try to feel the hard
the blood inside them is
cartilage of the voice box in your
red in colour?
neck. Reach its upper end and go one
finger width above. Now take your
Block the upper end of
finger to the side of the neck - one
a small vein, and
side at a time - till it reaches the mus-
squeeze out the blood
cle. Press lightly. You will feel the throb of the artery. In uncon-
to the lower end. Does
scious people, if this artery is not throbbing, it tells us that blood
the blood fill up again
is no longer going to the brain and the person may have died
very quickly? Now
already!
block it at the lower end and squeeze it the
upper way? Does the blood fill up as
You may feel another artery ‘one in the middle of the elbow. Try
quickly? Why?
to feel other arteries in the body.
BLOOD PRESSURE
What is What is the
Blood Pressure? “Normal Pressure”?
In normal people of young age,
The heart has to pump blood the blood pressure ranges from
non-stop every single second 100 to 140 mm of Hg (mercury)
as it has to reach food for the when the heart is squeezing
body (oxygen, glucose and (called systolic BP) and between
many things) from the head 60 and 90 mm of Hg when the
to the toes. If blood fails to reach heart is relaxing (also called
it would would mean certain diastolic BP).
death. This is because the brain cannot stay without oxygen for
more than three minutes while the heart muscles themselves would It is the pressure in the arteries
die in less than five minutes. Therefore it is crucial that the heart that the heart has to overcome to
makes sure blood reaches till the very last and the very smallest get the blood across. The higher
capillary. the pressure in the arteries, the
stronger the heart has to pump.
To do this, it will require some pressure to push the blood In old age, and in those who have
through these pipes. Some ‘pressure’ or ‘tension’ has to be high levels of cholesterol, the
maintained by the arteries so that the blood reaches unto walls of the pipe become rigid
the farthest capillaries. This tension or pressure is called and hard. This causes the pres-
blood pressure. sure in the blood pipes to rise.

7. 21-7
High B.P & Low B.P
High Blood Pressure Low Blood Pressure
If the blood pressure is above 160 mm Hg while the On the other hand, blood pressure
heart is squeezing and above 95 mm Hg when resting below 100 mm Hg while the heart is
(we measure it early morning for three days continously), squeezing, and below 60 mm Hg
then we call it as hypertension or high blood pres- when it is relaxing is also not normal.
sure. But low blood pressure is not a dis-
ease by itself unlike high blood pres-
The term Hypertension simply means more tension (or sure.
pressure) in the wall of the arteries. It has nothing to
do with mental tension, though also, that can contrib- Whenever low blood pressure is de-
ute to high blood pressure! High B.P may be due to tected, it is a sign of an underlying
some kidney diseases, but usually we cannot find any illness that must be treated to raise
other disease with it. the blood pressure back to normal.
Look for any cause that may have
Treating High B.P caused bleeding : like accidents, frac-
Pumping blood at pressures above 160/95 mm Hg results tures, piles, childbirth, etc. It may also
in the heart getting little rest and hence getting tired. High be the effect of severe loss of water –
blood pressure can cause heart disease and later heart dehydration – that may happen in
failure. It can also lead to some artery in the brain or diarrhoea or burns. People with low
another part of the body to burst out and cause bleed- nutrition levels and with mental de-
ing. Less salt in the diet and good exercise may prevent pression are also found to have blood
one from taking medicines altogether. pressures below normal.
Learn to Measure Blood Pressure
Find your friend’s blood pressure by using a blood pressure
machine.
Go Step By Step
1 Get familiar with the parts of the BP machine like cuff,
tube, rubber bulb, valve etc. Also get familiar with the
stethoscope, its earpieces, tube, diaphragm and bell.
2 Wrap the cuff of the blood pressure machine above your
friend’s elbow, taking care that the rubber cuff covers
the front of the elbow.
3 Pump the rubber bulb after closing its valve while ob
serving the meter (gauge). Keep pumping the bulb until
the meter shows 200 mm Hg.
4 Keeping the diaphragm of the stethoscope on the front
of the elbow – a little towards the inner side – slowly start releasing the cuff by opening the valve of the
rubber bulb.
5 Note the meter reading – say ‘X’ – when you start hearing the regular beat of the heart (or pulse).
6 Once again, note the meter reading when the sound can no longer be held – say ‘Y’.
7 The first is the pressure when the heart is squeezing and the second reading tells us the pressure
when the heart is at rest. Write your friend’s blood pressure as X / Y mm Hg. Isn’t it simple?

8. 21-8
Know the Answers
The Heart & Blood Pipes
a. Please Mark if “right” or “wrong”:
1. The normal pulse rate is between 18 and 20 per minute.
2. A child with 10 kilo weight will have 80 ml X 10 kilo or 800 ml of blood in the body.
3. Blood from the legs reaches the left side of the heart before going to the lungs.
4. Our heart beats slower and harder when we exercise.
5. The arteries carry blood with oxygen and take them to far off parts of the body.
6. The veins carry blood from the heart to the lungs.
7. Capillaries are small nerves that carry blood.
b. Please fill in the blanks:
1. Normal B.P ranges from _____ to _______ / ________ to ________ mm Hg.
2. Arteries end in a web of small tubes called ________________.
3. The biggest artery is called ___________.
4. The blood goes from Chamber ____ to Chamber _____ before going to the lungs. From the lungs
it comes to Chamber ______ to Chamber _____ from where it is pumped out to the rest of the
body.

9. 21-9
HEART DISEASES heart valves
Mainly three common heart diseases need to be kept in mind. They are:
1. Rheumatic Heart Disease (RHD)
2. Heart Failure
3. Heart Attack
1. Rheumatic Heart Disease (RHD)
RHD is a common heart problem in our place. Caused by bacteria, the disease spoils the valves of
the heart. The opening of the valves becomes so small that they block the blood being pumped.
Or, the valves have started leaking and the blood instead of getting pumped out, comes back into
the chamber (II or IV).
What Happens In RHD? Sore Throats Can Damage
Once the valves of the heart have been dam- Heart Valves In Children
aged, they may worsen with every new at- RHD is basically caused by bacteria that also
tack of the sore throat bacteria. If valves are cause sore throat in children and young
damaged, the blood is unable to be pumped adults. While the body tries to make antibod-
out of the heart and hence a backlog keeps ies against the germ, by mistake the anitibodies
collecting. This causes the heart to increase attack the person’s own heart valves or her
in size so that it has problems beating prop- joints.
erly.
This illness starts with what we call Rheumatic
The blood also gets stuck in veins of the (Ryoo- ma-tik) Fever in which we have a
lungs, so that water collects in the lungs and history of sore throat, joint swell-
hence oxygen cannot be absorbed. If the ing and high heart rate (pulse). If
heart disease is serious, RHD patients feel not treated quickly with antibiotics
weak, have a bulged out chest on the left like PENICILLIN,
side, may feel bad palpitations and get blue. COTRIMOXAZOLE OR DOXYCYCLINE,
As the heart has problems in beating, they the illness may worsen and go on to damage
may be seen with swelling of legs and face the heart valves. Highest possible doses of AS-
and ultimately die of heart failure. PIRIN – as much as 3 to 6 tablets four times a
day with food - are also allowed during the at-
tack for Rheumatic Fever.
Treating RHD
The RHD keeps worsening if the person gets sore throat repeatedly. It is advised that such
patients should get Injection Penicillin every month from a doctor, or take
COTRIMOXAZOLE daily until five years of the last attack OR till the person becomes
20 years of age, whichever is later. It is rare to see the germ troubling people beyond this
age, although the effect on the heart will be there for life.
Once RHD has affected the heart, regular treatment from a doctor is needed to avoid
further strain on the heart. Any load of pregnancy, an operation or even something simple
like getting a tooth removed can put the life of a RHD patient in danger. Persons’ with
RHD should avoid getting pregnant and inform the surgeon/doctor about RHD before
operation is performed.
Valve damage can be operated upon or by replacing the defective valves with artificial valves,
but the treatment is costly and available only in very big hospitals.

10. 21-10
2. Heart Attack
The term means that there is a sudden blocking of the blood supply to a
portion of the heart and it has stopped functioning properly. Seen in death
scenes in many films, the signals are known to many :
· sudden squeezing pain in the chest continuing for more than half
an hour
· pain spreading to the left arm or neck
· feeling of “ end of this world,”
· cold sweat on the forehead.
Who Gets Heart Attacks ? Why Heart Attacks Happen?
People who get heart attacks are usually be- It is mainly because of a clot blocking one or more of the three
yond 45 years of age, but not always. Many arteries supplying blood to the heart. Until the blood supply
would have been on treatment for high B.P. can be arranged from the other arteries, some parts of heart
or for heart disease due to repeated pain in muscle get no oxygen and pain a lot.
the heart (that lasts for a few minute at a time
and worsens with exertion). Yet, in many the If a large part of the heart muscle is affected, the heart may
illness is a first ‘attack’ on the heart. not be able to pump sufficient amount of blood. In such cases,
the heart fails and the person may even die.
What To Do In Heart Attacks ?
Refer to a hospital immediately any such patient that you suspect has suffered
a HEART ATTACK ! But give an ASPIRIN tablet with something to eat
before you send her. It can make the difference between living and dying as
ASPIRIN decreases the ability of blood to clot.
3. Heart Failure
The heart may fail if there is too much of pressure in the arteries to pump
across – as in high B.P. - or if there is too much to pump that the heart
muscles cannot cope. This is what is called Heart Failure. It may also hap-
pen if a Heart Attack (see above) damages too large a part of the heart
muscle that it cannot pump effectively.
Heart failure of the Left side of the heart causes Heart Failure of the Right side may cause
breathlessness (that may worsen to such a level swelling of the legs and face. The liver also
that it is not possible to lie down also), pain in the enlarges to press on the stomach, and the
chest and dry cough with a wheeze. If severe, blood patient feels heavy in the stomach.
may be thrown out with cough.
The only way to help the heart is to help improve the underlying reason for heart failure. Lowering
the blood pressure and decreasing fluids helps, but under the monitoring eyes of a doctor. RHD
can be corrected by heart operation, but has its own problems.
Where nothing much can be done to help, decreasing the activity to match the heart’s capacity is the only
way to a longer life.
Refer any patient to a doctor for regular, long term treatment
of s/he shows signs of heart failure

11. 21-11
Know the Answers
The Heart & Heart Diseases
a. Please Fill in the blanks:
1. Germs that cause sore throat in children may be responsible for a disease of the ________ of the
heart. This is called ____________ Heart Disease.
2. Children with RHD should be given germ killer medicines regularly until ______ years og age.
3. Signs of serious RHD are _______________, ______________ and ____________________.
4. The first aid for heart attack is to give ______________ tablet before sending to a hospital.
5. Signs of heart attack seen commonly in people above 45 years of age are ___________,
________________, _____________________ and __________________________.
6. Heart Failure of the left side causes _____________ and ____________________.
7. Heart failure of the right side causes __________________ and ____________________.

12. 21-12
My Notes