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Heart and lungs picture: Lungs (Human Anatomy): Picture, Function, Definition, Conditions


Lungs (Human Anatomy): Picture, Function, Definition, Conditions

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The lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). The trachea (windpipe) conducts inhaled air into the lungs through its tubular branches, called bronchi. The bronchi then divide into smaller and smaller branches (bronchioles), finally becoming microscopic.

The bronchioles eventually end in clusters of microscopic air sacs called alveoli. In the alveoli, oxygen from the air is absorbed into the blood. Carbon dioxide, a waste product of metabolism, travels from the blood to the alveoli, where it can be exhaled. Between the alveoli is a thin layer of cells called the interstitium, which contains blood vessels and cells that help support the alveoli.

The lungs are covered by a thin tissue layer called the pleura. The same kind of thin tissue lines the inside of the chest cavity — also called pleura. A thin layer of fluid acts as a lubricant allowing the lungs to slip smoothly as they expand and contract with each breath.

Lung Conditions

  • Chronic obstructive pulmonary disease (COPD): Damage to the lungs results in difficulty blowing air out, causing shortness of breath. Smoking is by far the most common cause of COPD.
    • Emphysema: A form of COPD usually caused by smoking. The fragile walls between the lungs’ air sacs (alveoli) are damaged, trapping air in the lungs and making breathing difficult.
    • Chronic bronchitis: Repeated, frequent episodes of productive cough, usually caused by smoking. Breathing also becomes difficult in this form of COPD.
  • Pneumonia: Infection in one or both lungs. Bacteria, especially Streptococcus pneumoniae, are the most common cause, but pneumonia may also be caused by a virus. 
  • Asthma: The lungs’ airways (bronchi) become inflamed and can spasm, causing shortness of breath and wheezing. Allergies, viral infections, or air pollution often trigger asthma symptoms.
  • Acute bronchitis: An infection of the lungs’ large airways (bronchi), usually caused by a virus. Cough is the main symptom of acute bronchitis.
  • Pulmonary fibrosis: A form of interstitial lung disease. The interstitium (walls between air sacs) become scarred, making the lungs stiff and causing shortness of breath.
  • Sarcoidosis: Tiny areas of inflammation can affect all organs in the body, with the lungs involved most of the time. The symptoms are usually mild; sarcoidosis is usually found when X-rays are done for other reasons.
  • Obesity hypoventilation syndrome: Extra weight makes it difficult to expand the chest when breathing. This can lead to long-term breathing problems.
  • Pleural effusion: Fluid builds up in the normally tiny space between the lung and the inside of the chest wall (the pleural space). If large, pleural effusions can cause problems with breathing.
  • Pleurisy: Inflammation of the lining of the lung (pleura), which often causes pain when breathing in. Autoimmune conditions, infections, or a pulmonary embolism may cause pleurisy.
  • Bronchiectasis: The airways (bronchi) become inflamed and expand abnormally, usually after repeated infections. Coughing, with large amounts of mucus, is the main symptom of bronchiectasis.
  • Lymphangioleiomyomatosis (LAM): A rare condition in which cysts form throughout the lungs, causing breathing problems similar to emphysema. LAM occurs almost exclusively in women of childbearing age.
  • Cystic fibrosis: A genetic condition in which mucus does not clear easily from the airways. The excess mucus causes repeated episodes of bronchitis and pneumonia throughout life.
  • Interstitial lung disease: A collection of conditions in which the interstitium (lining between the air sacs) becomes diseased. Fibrosis (scarring) of the interstitium eventually results, if the process can’t be stopped.
  • Lung cancer: Cancer may affect almost any part of the lung. Most lung cancer is caused by smoking.
  • Tuberculosis: A slowly progressive pneumonia caused by the bacteria Mycobacterium tuberculosis. Chronic cough, fever, weight loss, and night sweats are common symptoms of tuberculosis.
  • Acute respiratory distress syndrome (ARDS): Severe, sudden injury to the lungs caused by a serious illness. Life support with mechanical ventilation is usually needed to survive until the lungs recover.
  • Coccidioidomycosis: A pneumonia caused by Coccidioides, a fungus found in the soil in the southwestern U.S. Most people experience no symptoms, or a flu-like illness with complete recovery.
  • Histoplasmosis: An infection caused by inhaling Histoplasma capsulatum, a fungus found in the soil in the eastern and central U.S. Most Histoplasma pneumonias are mild, causing only a short-lived cough and flu-like symptoms.
  • Hypersensitivity pneumonitis (allergic alveolitis): Inhaled dust and other substances cause an allergic reaction in the lungs. Usually this occurs in farmers or others who work with dried, dusty plant material.
  • Influenza (flu): An infection by one or more flu viruses causes fever, body aches, and coughing lasting a week or more. Influenza can progress to life-threatening pneumonia, especially in older people with medical problems.
  • Mesothelioma: A rare form of cancer that forms from the cells lining various organs of the body with the lungs being the most common. Mesothelioma tends to emerge several decades after asbestos exposure.
  • Pertussis (whooping cough): A highly contagious infection of the airways (bronchi) by Bordetella pertussis, causing persistent cough. A booster vaccine (Tdap) is recommended for adolescents and adults to prevent pertussis.
  • Pulmonary hypertension: Many conditions can lead to high blood pressure in the arteries leading from the heart to the lungs. If no cause can be identified, the condition is called idiopathic pulmonary arterial hypertension.
  • Pulmonary embolism: A blood clot (usually from a vein in the leg) may break off and travel to the heart, which pumps the clot (embolus) into the lungs. Sudden shortness of breath is the most common symptom of a pulmonary embolism.
  • Severe acute respiratory syndrome (SARS): A severe pneumonia caused by a specific virus first discovered in Asia in 2002. Worldwide prevention measures seem to have controlled SARS, which has caused no deaths in the U.S.
  • SARS-CoV-2/COVID-19: The coronavirus that led to a worldwide pandemic beginning in 2019 can lead to pneumonia that affects both lungs, filling them with fluid and making it difficult to breathe. COVID-19 can lead to long-term lung damage and other respiratory conditions such as acute respiratory distress syndrome. 
  • Pneumothorax: Air in the chest; it occurs when air enters the area around the lung (the pleural space) abnormally. Pneumothorax can be caused by an injury or may happen spontaneously.

Congenital Heart Defects – Facts about Pulmonary Atresia

Pulmonary atresia is a birth defect (pronounced PULL-mun-airy ah-TREE-sha) of the heart where the valve that controls blood flow from the heart to the lungs doesn’t form at all. In babies with this defect, blood has trouble flowing to the lungs to pick up oxygen for the body.

What is Pulmonary Atresia?

Pulmonary atresia is a birth defect of the pulmonary valve, which is the valve that controls blood flow from the right ventricle (lower right chamber of the heart) to the main pulmonary artery (the blood vessel that carries blood from the heart to the lungs). Pulmonary atresia is when this valve didn’t form at all, and no blood can go from the right ventricle of the heart out to the lungs. Because a baby with pulmonary atresia may need surgery or other procedures soon after birth, this birth defect is considered a critical congenital heart defect (critical CHD). Congenital means present at birth.

In a baby without a congenital heart defect, the right side of the heart pumps oxygen-poor blood from the heart to the lungs through the pulmonary artery. The blood that comes back from the lungs is oxygen-rich and can then be pumped to the rest of the body. In babies with pulmonary atresia, the pulmonary valve that usually controls the blood flowing through the pulmonary artery is not formed, so blood is unable to get directly from the right ventricle to the lungs.

In pulmonary atresia, since blood cannot directly flow from the right ventricle of the heart out to the pulmonary artery, blood must use other routes to bypass the unformed pulmonary valve. The foramen ovale, a natural opening between the right and left upper chambers of the heart during pregnancy that usually closes after the baby is born, often remains open to allow blood flow to the lungs. Additionally, doctors may give medicine to the baby to keep the baby’s patent ductus arteriosus open after the baby’s birth. The patent ductus arteriosus is the blood vessel that allows blood to move around the baby’s lungs before the baby is born and it also usually closes after birth.

Learn more about how the heart works »

Types of Pulmonary Atresia

There are typically two types of pulmonary atresia, according to whether or not a baby also has a ventricular septal defect (a hole in the wall that separates the two lower chambers, or ventricles, of the heart):

  • Pulmonary atresia with an intact ventricular septum: In this form of pulmonary atresia, the wall, or septum, between the ventricles remains complete and intact. During pregnancy when the heart is developing, very little blood flows into or out of the right ventricle (RV), and therefore the RV doesn’t fully develop and remains very small. If the RV is under-developed, the heart can have problems pumping blood to the lungs and the body. The artery which usually carries blood out of the right ventricle, the main pulmonary artery (MPA), remains very small, since the pulmonary valve (PV) doesn’t form.
  • Pulmonary atresia with a ventricular septal defect: In this form of pulmonary atresia, a ventricular septal defect (VSD) allows blood to flow into and out of the right ventricle (RV). Therefore, blood flowing into the RV can help the ventricle develop during pregnancy, so it is typically not as small as in pulmonary atresia with an intact ventricular septum. Pulmonary atresia with a VSD is similar to another condition called tetralogy of Fallot. However, in tetralogy of Fallot, the pulmonary valve (PV) does form, although it is small and blood has trouble flowing through it – this is called pulmonary valve stenosis. Thus, pulmonary atresia with a VSD is like a very severe form of tetralogy of Fallot.


A 2019 study using 2010-2014 data from birth defects surveillance systems across the United States, researchers estimated that each year about 550 babies in the United States are born with pulmonary atresia. In other words, about 1 in every 7,100 babies born in the United States each year are born with pulmonary atresia.

Causes and Risk Factors

The causes of heart defects, such as pulmonary atresia, among most babies are unknown. Some babies have heart defects because of changes in their genes or chromosomes. Heart defects also are thought to be caused by a combination of genes and other factors, such as the things the mother comes in contact with in the environment, or what the mother eats or drinks, or certain medicines she uses.

Read more about CDC’s work on causes and risk factors »


Pulmonary atresia may be diagnosed during pregnancy or soon after a baby is born.

During Pregnancy

During pregnancy, there are screening tests (also called prenatal tests) to check for birth defects and other conditions. Pulmonary atresia might be seen during an ultrasound (which creates pictures of the body). Some findings from the ultrasound may make the healthcare provider suspect a baby may have pulmonary atresia. If so, the healthcare provider can request a fetal echocardiogram to confirm the diagnosis. A fetal echocardiogram is an ultrasound specifically of the baby’s heart and major blood vessels that is performed during the pregnancy. This test can show problems with the structure of the heart and how well the heart is working.

After the Baby is Born

Babies born with pulmonary atresia will show symptoms at birth or very soon afterwards. They may have a bluish looking skin color, called cyanosis, because their blood doesn’t carry enough oxygen. Infants with pulmonary atresia can have additional symptoms such as:

  • Problems breathing
  • Ashen or bluish skin color
  • Poor feeding
  • Extreme sleepiness

During a physical examination, a doctor can see the symptoms, such as bluish skin or problems breathing. Using a stethoscope, a doctor will check for a heart murmur (an abnormal “whooshing” sound caused by blood not flowing properly). However, it is not uncommon for a heart murmur to be absent right at birth.

If a doctor suspects that there might be a problem, the doctor can request one or more tests to confirm the diagnosis of pulmonary atresia. The most common test is an echocardiogram. This test is an ultrasound of the baby’s heart that can show problems with the structure of the heart, like holes in the walls between the chambers, and any irregular blood flow. Cardiac catheterization (inserting a thin tube into a blood vessel and guiding it to the heart) also can confirm the diagnosis by looking at the inside of the heart and measuring the blood pressure and oxygen levels. An electrocardiogram (EKG), which measures the electrical activity of the heart, and other medical tests may also be used to make the diagnosis.

Pulmonary atresia is a critical congenital heart defect (critical CHD) that may be detected with newborn screening using pulse oximetry (also known as pulse ox). Pulse oximetry is a simple bedside test to estimate the amount of oxygen in a baby’s blood. Low levels of oxygen in the blood can be a sign of a critical CHD. Newborn screening using pulse oximetry can identify some infants with a critical CHD, like pulmonary atresia, before they show any symptoms.


Most babies with pulmonary atresia will need medication to keep the ductus arteriosus open after birth. Keeping this blood vessel open will help with blood flow to the lungs until the pulmonary valve can be repaired.

Treatment for pulmonary atresia depends on its severity.

  • In some cases, blood flow can be improved by using cardiac catheterization (inserting a thin tube into a blood vessel and guiding it to the heart). During this procedure, doctors can expand the valve using a balloon or they may need to place a stent (a small tube) to keep the ductus arteriosus open.
  • In most cases of pulmonary atresia, a baby may need surgery soon after birth. During surgery, doctors widen or replace the pulmonary valve and enlarge the passage to the pulmonary artery. If a baby has a ventricular septal defect, the doctor also will place a patch over the ventricular septal defect to close the hole between the two lower chambers of the heart. These actions will improve blood flow to the lungs and the rest of the body. If a baby with pulmonary atresia has an underdeveloped right ventricle, he or she might need staged surgical procedures, similar to surgical repairs for hypoplastic left heart syndrome.

Most babies with pulmonary atresia will need regular follow-up visits with a cardiologist (a heart doctor) to monitor their progress and check for other health conditions that might develop as they get older. As adults, they may need more surgery or medical care for other possible problems.


  1. Cara T. Mai, Jennifer L. Isenburg, Mark A. Canfield, Robert E. Meyer, Adolfo Correa, Clinton J. Alverson, Philip J. Lupo, Tiffany Riehle‐Colarusso, Sook Ja Cho, Deepa Aggarwal, Russell S. Kirby.  National population‐based estimates for major birth defects, 2010–2014. BDR Oct 2019.

The images are in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider (Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities) be credited and notified in any public or private usage of this image.

The images are in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider (Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities) be credited and notified in any public or private usage of this image.

The images are in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider (Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities) be credited and notified in any public or private usage of this image.

Heart Information Center: Heart Anatomy

Your heart is located between your lungs in the middle of your chest, behind and slightly to the left of your breastbone (sternum). A double-layered membrane called the pericardium surrounds your heart like a sac. The outer layer of the pericardium surrounds the roots of your heart’s major blood vessels and is attached by ligaments to your spinal column, diaphragm, and other parts of your body

The heart weighs between 7 and 15 ounces (200 to 425 grams) and is a little larger than the size of your fist. By the end of a long life, a person’s heart may have beat (expanded and contracted) more than 3.5 billion times. In fact, each day, the average heart beats 100,000 times, pumping about 2,000 gallons (7,571 liters) of blood.

Your heart is located between your lungs in the middle of your chest, behind and slightly to the left of your breastbone (sternum). A double-layered membrane called the pericardium surrounds your heart like a sac. The outer layer of the pericardium surrounds the roots of your heart’s major blood vessels and is attached by ligaments to your spinal column, diaphragm, and other parts of your body. The inner layer of the pericardium is attached to the heart muscle. A coating of fluid separates the two layers of membrane, letting the heart move as it beats.

Your heart has 4 chambers. The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. A wall of muscle called the septum separates the left and right atria and the left and right ventricles. The left ventricle is the largest and strongest chamber in your heart. The left ventricle’s chamber walls are only about a half-inch thick, but they have enough force to push blood through the aortic valve and into your body.

The Heart Valves

Four valves regulate blood flow through your heart:

  • The tricuspid valve regulates blood flow between the right atrium and right ventricle.
  • The pulmonary valve controls blood flow from the right ventricle into the pulmonary arteries, which carry blood to your lungs to pick up oxygen.
  • The mitral valve lets oxygen-rich blood from your lungs pass from the left atrium into the left ventricle.
  • The aortic valve opens the way for oxygen-rich blood to pass from the left ventricle into the aorta, your body’s largest artery.
The Conduction System

Electrical impulses from your heart muscle (the myocardium) cause your heart to contract. This electrical signal begins in the sinoatrial (SA) node, located at the top of the right atrium. The SA node is sometimes called the heart’s “natural pacemaker.” An electrical impulse from this natural pacemaker travels through the muscle fibers of the atria and ventricles, causing them to contract. Although the SA node sends electrical impulses at a certain rate, your heart rate may still change depending on physical demands, stress, or hormonal factors.

The Circulatory System

The heart and circulatory system make up your cardiovascular system. Your heart works as a pump that pushes blood to the organs, tissues, and cells of your body. Blood delivers oxygen and nutrients to every cell and removes the carbon dioxide and waste products made by those cells. Blood is carried from your heart to the rest of your body through a complex network of arteries, arterioles, and capillaries. Blood is returned to your heart through venules and veins. If all the vessels of this network in your body were laid end-to-end, they would extend for about 60,000 miles (more than 96,500 kilometers), which is far enough to circle the earth more than twice!

Heart Information, Facts, Photos | National Geographic

The heart is the body’s engine room, responsible for pumping life-sustaining blood via a 60,000-mile-long (97,000-kilometer-long) network of vessels. The organ works ceaselessly, beating 100,000 times a day, 40 million times a year—in total clocking up three billion heartbeats over an average lifetime. It keeps the body freshly supplied with oxygen and nutrients, while clearing away harmful waste matter.

The fetal heart evolves through several different stages inside the womb, first resembling a fish’s heart, then a frog’s, which has two chambers, then a snake’s, with three, before finally adopting the four-chambered structure of the human heart.


About the size of its owner’s clenched fist, the organ sits in the middle of the chest, behind the breastbone and between the lungs, in a moistened chamber that is protected all round by the rib cage. It’s made up of a special kind of muscle (cardiac muscle) that works involuntarily, so we don’t have to think about it. The heart speeds up or slow downs automatically in response to nerve signals from the brain that tell it how much the body is being exerted. Normally the heart contracts and relaxes between 70 and 80 times per minute, each heartbeat filling the four chambers inside with a fresh round of blood.

These cavities form two separate pumps on each side of the heart, which are divided by a wall of muscle called the septum. The upper chamber on each side is called the atrium. This is connected via a sealing valve to the larger, more powerful lower chamber, or ventricle. The left ventricle pumps most forcefully, which is why a person’s heartbeat is felt more on the left side of the chest.

When the heart contracts, the chambers become smaller, forcing blood first out of the atria into the ventricles, then from each ventricle into a large blood vessel connected to the top of the heart. These vessels are the two main arteries. One of them, the pulmonary artery, takes blood to the lungs to receive oxygen. The other, the aorta, transports freshly oxygenated blood to the rest of the body. The vessels that bring blood to the heart are the veins. The two main veins that connect to the heart are called the vena cava.

Blood Delivery

Since the heart lies at the center of the blood delivery system, it is also central to life. Blood both supplies oxygen from the lungs to the other organs and tissues and removes carbon dioxide to the lungs, where the gas is breathed out. Blood also distributes nourishment from the digestive system and hormones from glands. Likewise our immune system cells travel in the bloodstream, seeking out infection, and blood takes the body’s waste products to the kidneys and liver to be sorted out and trashed.

Given the heart’s many essential functions, it seems wise to take care of it. Yet heart disease has risen steadily over the last century, especially in industrialized countries, largely due to changes in diet and lifestyle. It has become the leading cause of death for both men and women in the United States, claiming almost 700,000 lives a year, or 29 percent of the annual total. Worldwide, 7.2 million people die from heart disease every year.

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<p>The picture of health, an angiogram of a human heart shows blood vessels in sharp detail. To take an angiogram, or arteriogram x-ray, doctors must first inject the patient with a special opaque dye that allows a clear view of the heart’s blood vessels, including the large left and right coronary arteries. Narrowed arteries indicate the presence of coronary artery disease. Blockages of either of the coronary arteries could lead to a heart attack. Such x-rays help doctors determine a course of treatment.</p>

Angiogram of Healthy Heart

The picture of health, an angiogram of a human heart shows blood vessels in sharp detail. To take an angiogram, or arteriogram x-ray, doctors must first inject the patient with a special opaque dye that allows a clear view of the heart’s blood vessels, including the large left and right coronary arteries. Narrowed arteries indicate the presence of coronary artery disease. Blockages of either of the coronary arteries could lead to a heart attack. Such x-rays help doctors determine a course of treatment.

Photograph by SPL/Photo Researchers, Inc.

How the Heart Works | NHLBI, NIH

Oxygen-poor blood from the body enters your heart through two large veins called the superior and inferior vena cava. The blood enters the heart’s right atrium and is pumped to your right ventricle, which in turn pumps the blood to your lungs.

The pulmonary artery then carries the oxygen-poor blood from your heart to the lungs. Your lungs add oxygen to your blood. The oxygen-rich blood returns to your heart through the pulmonary veins. Visit our How the Lungs Work Health Topic to learn more about what happens to the blood in the lungs.

The oxygen-rich blood from the lungs then enters the left atrium and is pumped to the left ventricle. The left ventricle generates the high pressure needed to pump the blood to your whole body through your blood vessels.

When blood leaves the heart to go to the rest of the body, it travels through a large artery called the aorta. A balloon-like bulge, called an aortic aneurysm, can sometimes occur in the aorta.

Circulation and the heart. Your heart is divided into left and right halves, which work together like a dual pump. On the right side of your heart, oxygen-poor blood from your body’s tissues flows through large veins, called the superior and inferior vena cava, into your right atrium. Next, the blood moves into your right ventricle, which contracts and sends blood out of your heart to your lungs, to gather oxygen and get rid of carbon dioxide. On the left side of your heart, oxygen-rich blood from your lungs flows through your pulmonary veins into your left atrium. The blood then moves into your left ventricle, which contracts and sends blood out of your heart through the aorta to feed your cells and tissues. Medical Animation Copyright © 2019 Nucleus Medical Media, All rights reserved.

Anatomy, how it works, and more

The human heart is a finely-tuned instrument that serves the whole body. It is a muscular organ around the size of a closed fist, and it sits in the chest, slightly to the left of center.

The heart beats around 100,000 times a day, pumping approximately 8 pints of blood throughout the body 24/7. This delivers oxygen- and nutrient-rich blood to tissues and organs and carries away waste.

The heart sends deoxygenated blood to the lungs, where the blood loads up with oxygen and unloads carbon dioxide, a waste product of metabolism.

Together, the heart, blood, and blood vessels — arteries, capillaries, and veins — make up the circulatory system.

In this article, we explore the structure of the heart, how it pumps blood around the body, and the electrical system that controls it.

Below is an interactive 3D model of the heart. Explore the model using your mouse pad or touchscreen to learn more.

The heart consists of four chambers:

  • The atria: These are the two upper chambers, which receive blood.
  • The ventricles: These are the two lower chambers, which discharge blood.

A wall of tissue called the septum separates the left and right atria and the left and right ventricle. Valves separate the atria from the ventricles.

The heart’s walls consist of three layers of tissue:

  • Myocardium: This is the muscular tissue of the heart.
  • Endocardium: This tissue lines the inside of the heart and protects the valves and chambers.
  • Pericardium: This is a thin protective coating that surrounds the other parts.
  • Epicardium: This protective layer consists mostly of connective tissue and forms the innermost layer of the pericardium.

The rate at which the heart contracts depends on many factors, such as:

  • activity and exercise
  • emotional factors
  • some medical conditions
  • a fever
  • some medications
  • dehydration

At rest, the heart might beat around 60 times each minute. But this can increase to 100 beats per minute (bpm) or more.

Learn more information about a “normal” heart rate here.

Left and right sides

The left and right sides of the heart work in unison. The atria and ventricles contract and relax in turn, producing a rhythmic heartbeat.

Right side

The right side of the heart receives deoxygenated blood and sends it to the lungs.

  • The right atrium receives deoxygenated blood from the body through veins called the superior and inferior vena cava. These are the largest veins in the body.
  • The right atrium contracts, and blood passes to the right ventricle.
  • Once the right ventricle is full, it contracts and pumps the blood to the lungs via the pulmonary artery. In the lungs, the blood picks up oxygen and offloads carbon dioxide.

Left side

The left side of the heart receives blood from the lungs and pumps it to the rest of the body.

  • Newly oxygenated blood returns to the left atrium via the pulmonary veins.
  • The left atrium contracts, pushing the blood into the left ventricle.
  • Once the left ventricle is full, it contracts and pushes the blood back out to the body via the aorta.

Diastole, systole, and blood pressure

Each heartbeat has two parts:

Diastole: The ventricles relax and fill with blood as the atria contract, emptying all blood into the ventricles.

Systole: The ventricles contract and pump blood out of the heart as the atria relax, filling with blood again.

When a person takes their blood pressure, the machine will give a high and a low number. The high number is the systolic blood pressure, and the lower number is the diastolic blood pressure.

Systolic pressure: This shows how much pressure the blood creates against the artery walls during systole.

Diastolic pressure: This shows how much pressure is in the arteries during diastole.

Gas exchange

When blood travels through the pulmonary artery to the lungs, it passes through tiny capillaries that connect on the surface of the lung’s air sacs, called the alveoli.

The body’s cells need oxygen to function, and they produce carbon dioxide as a waste product. The heart enables the body to eliminate the unwanted carbon dioxide.

Oxygen enters the blood and carbon dioxide leaves it through the capillaries of the alveoli.

The coronary arteries on the surface of the heart supply oxygenated blood to the heart muscle.


A person can feel their pulse at points where arteries pass close to the skin’s surface, such as on the wrist or neck. The pulse is the same as the heart rate. When you feel your pulse, you feel the rush of blood as the heart pumps it through the body.

A healthy pulse is usually 60–100 bpm, and what is normal can vary from person to person.

A very active person may have a pulse as low as 40 bpm. People with a larger body size tend to have a faster pulse, but it is not usually over 100 bpm.

Learn how to take the pulse here.

Share on PinterestA diagram of the heart’s valves.
Image credit: OpenStax College, Anatomy & Physiology, 2013

The heart has four valves to ensure that blood only flows in one direction:

  • Aortic valve: This is between the left ventricle and the aorta.
  • Mitral valve: This is between the left atrium and the left ventricle.
  • Pulmonary valve: This is between the right ventricle and the pulmonary artery.
  • Tricuspid valve: This is between the right atrium and right ventricle.

Most people are familiar with the sound of the heart. In fact, the heart makes many types of sound, and doctors can distinguish these to monitor the health of the heart.

The opening and closing of the valves are key contributors to the sound of the heartbeat. If there is leaking or a blockage of the heart valves, it can create sounds called “murmurs.”

To pump blood throughout the body, the muscles of the heart must work together to squeeze the blood in the right direction, at the right time, and with the right force. Electrical impulses coordinate this activity.

The electrical signal begins at the sino-atrial node, sometimes called the sinus, or SA, node. This is the heart’s pacemaker, and it sits at the top of the right atrium. The signal causes the atria to contract, pushing blood down into the ventricles.

The electrical impulse then travels to an area of cells at the bottom of the right atrium, between the atria and ventricles, called the atrioventricular, or AV, node.

These cells act as a gatekeeper. They coordinate the signal so that the atria and ventricles do not contract at the same time. There needs to be a slight delay.

From here, the signal travels along fibers, called Purkinje fibers, within the ventricle walls. The fibers pass the impulse to the heart muscle, causing the ventricles to contract.

There are three types of blood vessels:

Arteries: These carry oxygenated blood from the heart to the rest of the body. The arteries are strong, muscular, and stretchy, which helps push blood through the circulatory system, and they also help regulate blood pressure. The arteries branch into smaller vessels called arterioles.

Veins: These carry deoxygenated blood back to the heart, and they increase in size as they get closer to the heart. Veins have thinner walls than arteries.

Capillaries: These connect the smallest arteries to the smallest veins. They have very thin walls, which allow them to exchange compounds such as carbon dioxide, water, oxygen, waste, and nutrients with surrounding tissues.

The heart, blood, and blood vessels make up the circulatory, or cardiovascular, system.

Here, learn about some diseases that can affect this system.

The heart is essential to life — if it stops beating, blood will not reach the brain and other organs, and the person can die within minutes. This is called cardiac arrest.

If a person experiences cardiac arrest, they will be unable to speak or breathe, and they will have no heartbeat.

Anyone nearby should call 911 immediately and start cardiopulmonary resuscitation (CPR), pressing hard and fast with locked hands on the center of the person’s chest.

According to the Centers for Disease Control and Prevention (CDC), CPR can double or triple a person’s chance of survival after their heart stops.

Here, learn how to do CPR.

Heart-lung transplant – NHS – NHS

A heart-lung transplant is a major operation to replace a person’s diseased heart and lungs with those from a donor.

It’s offered to people with both heart and lung failure when all other treatment options have failed.

Very few suitable donor organs are available for this operation, and priority is generally given to people who only need a heart transplant.

Assessment and suitability

Heart-lung transplants are only recommended after very careful consideration and an in-depth assessment. The assessment will be done at your nearest transplant centre.

The aim of the assessment is to build a detailed picture of your current health and to check for underlying problems that could make you unsuitable for a transplant.

You’ll have several tests, which may include blood tests, urine tests, blood pressure tests, lung and heart function tests, X-rays and scans.

The decision about whether you’re suitable for a heart-lung transplant is not made by 1 person. An agreement is reached by members of the transplant team.

If a heart-lung transplant is recommended, you’ll be put on the transplant waiting list until suitable donor organs become available. This can take several months or even years.

While on the waiting list, your condition will be regularly monitored. During this time, your transplant team will be able to offer any information, support, or guidance you need.

The transplant operation

When a donated heart and pair of lungs becomes available, your transplant team will contact you to arrange transport to take you to the transplant centre as quickly as possible.

After being admitted, you’ll be quickly re-assessed to check you have not developed any new medical problems that could make the transplant less likely to be successful.

At the same time, another surgical team will check the donated heart and lungs to make sure they’re in good condition and suitable for transplantation.

If your transplant team is happy with your current health and the donated organs, you’ll be taken to the operating theatre and given a general anaesthetic so that you’re unconscious during the operation.

You’ll be connected to a heart-lung bypass machine using tubes that are inserted into your blood vessels. This machine pumps oxygen-rich blood around your body until the operation is complete.

A cut (incision) will be made in your chest so the surgeon can remove your heart and lungs. The donated heart and lungs will be put in place and connected to the surrounding blood vessels and your windpipe.

As a heart-lung transplant is a complex operation, it usually takes between 4 and 6 hours to complete.

After the operation

After the incision in your chest is closed with stitches, you’ll be transferred to an intensive care unit (ICU) for a few days, so you can be closely monitored.

It’s likely you’ll be in some pain after the transplant, so you’ll be given pain relief as and when you need it.

After a few days, you’ll be transferred to a general ward, where your health will be monitored.

Most people who have a heart-lung transplant are well enough to leave hospital after a few weeks.


Soon after your operation you’ll be given immunosuppressant medicine, which you’ll need to take for the rest of your life.

Immunosuppressants are powerful medicines that suppress your immune system, so it does not attack (reject) the newly transplanted organs.

Rejection can happen at any time, but the risk is highest during the first few months of having an organ transplant, so you’ll be given a fairly high dose of immunosuppressants at the start.

You might not know if your body is rejecting the new organs because symptoms are not always obvious. Typical symptoms can include tiredness, a high temperature (fever), swelling of your arms and legs (lymphoedema), weight gain, heart palpitations, shortness of breath and coughing and wheezing.

Contact your transplant team as soon as possible if you have any worrying symptoms. You may need to have some special tests and your dose of immunosuppressant medicine might need to be changed.

You may also get side effects from the immunosuppressants. These can include high blood pressure, diabetes, high cholesterol and kidney problems.

Although these are serious side effects, you should never stop taking immunosuppressants or reduce the recommended dose. If you do, it could lead to your heart and lungs being rejected, which can be fatal.

Extra treatments may be recommended to help reduce any side effects you experience while taking immunosuppressants.


Fully recovering from a transplant can be a long and frustrating process.

You may be referred to a physiotherapist who will teach you exercises to strengthen your new heart and lungs. This is known as cardiopulmonary rehabilitation.

It may be several months before you’re well enough to return to your normal daily activities.

During your recovery, you’ll need frequent hospital visits and sometimes you may need to stay overnight. It’s likely you’ll have several check-ups a week during the first few weeks, but these appointments will become less frequent if you make good progress.

Even when you’ve made a full recovery, you’ll still need regular check-ups. These can range from once every 3 months to once a year.


A heart-lung transplant is a major operation that has a high risk of complications, some of which can be fatal.

This is why it’s usually only considered when all other treatment options have been exhausted and it’s thought the potential benefits outweigh the risks.

As well as the risk of rejection and infection, there’s also a chance your new heart and lungs will not work properly.

Bronchiolitis obliterans syndrome

Bronchiolitis obliterans syndrome (BOS) is a fairly common form of lung rejection that can happen in the years after a heart-lung transplant.

In BOS, the immune system causes the airways inside the lungs to become inflamed, blocking the flow of air through the lungs.

Symptoms of BOS include shortness of breath, a dry cough and wheezing. In some people, this can be treated with additional immunosuppressants. However, not all cases of BOS respond to treatment.


As immunosuppressants weaken your immune system, you’ll be more vulnerable to infections, including bacterial, fungal and cytomegalovirus (CMV) infections.

Signs of a possible infection include:

  • a high temperature (fever)
  • breathing problems, such as shortness of breath and wheezing
  • generally feeling unwell
  • sweating and shivering
  • loss of appetite
  • diarrhoea
  • chest pain
  • coughing up thick mucus that may be yellow, green, brown or bloodstained
  • a rapid heartbeat
  • dizziness
  • a change in mental behaviour, such as confusion or disorientation

Contact a GP or your transplant team if you think you have an infection. Depending on the type of infection you have, you may need treatment with antibiotics, antifungals or antivirals.

As a precaution, you may be given these medicines for a few months after your transplant to protect you from serious infections.

Try to reduce your risk of getting an infection, particularly in the early stages of recovery. For example, avoid crowds and close contact with anyone who you know has an infection. You should also avoid substances that can irritate your lungs, such as smoke or chemical sprays.

Narrowing of the heart arteries

Sometimes, the blood vessels connected to the donor heart can become narrowed and hardened. This is known as cardiac allograft vasculopathy or coronary artery vasculopathy (CAV).

It’s a common long-term complication after a heart transplant, but it tends to be less common following a heart-lung transplant.

CAV can be serious because it can restrict the blood supply to the heart, which can sometimes trigger a heart attack or lead to heart failure.

Because of this risk, your new heart will be regularly checked to make sure it’s receiving enough blood.

Treatment options for CAV are limited, but may include medicine to help widen blood vessels, such as statins and calcium channel blockers.


The outlook for people who have a heart-lung transplant is reasonably good, with about 50% of people surviving more than 5 years.

However, survival rates are only a general guide. Many things could influence your own survival, such as your age and lifestyle.

Help and support

Finding out that you need a transplant, waiting for suitable donor organs to become available, and actually having the transplant can be emotionally demanding for both you and your family. Most transplant teams are able to offer counselling to support you.

Alternatively, a GP may be able to refer you to a counsellor and provide you with information and advice about joining a support group in your area.

Several organisations offer support and advice, including:

NHS Organ Donor Register

Because of the limited availability of suitable organs, there’s a need for members of the public to join the NHS Organ Donor Register.

You can register your details online or call the NHS Donor Line on 0300 123 23 23.

Page last reviewed: 15 April 2020
Next review due: 15 April 2023

Pulmonary embolism

Pulmonary embolism

Pulmonary embolism is a blockage (blockage) of one or more arteries in the lungs. In most cases, pulmonary embolism is caused by blood clots (thrombi) that travel from other parts of the body, most often from the lower extremities.

Pulmonary embolism (PE) is predominantly a complication of deep vein thrombosis.

PE can occur in relatively healthy people.Common symptoms include sudden and unexplained shortness of breath, chest pain, and cough, which may be accompanied by bloody sputum.

PE can be a life-threatening condition, but immediate treatment with antithrombotic drugs can reduce the risk of death to a minimum. Taking steps to prevent blood clots in your lower extremities can also protect you from thromboembolism.


Symptoms of thromboembolism can vary depending on the number of arteries involved, the size of the clot, and overall health.

Main symptoms:

  • Shortness of breath. This symptom usually comes on suddenly, regardless of physical activity.
  • Chest pain , similar to a heart attack. The pain is worse with deep breathing, coughing, bending over or eating. The pains are aggravated by exertion and do not go away with relaxation.
  • Cough. Cough may be accompanied by bloody sputum.

Other symptoms that may accompany PE

90,018 90,019 wheezing;

  • edema of the lower limbs, usually of one lower limb;
  • cyanosis of the skin;
  • sweating;
  • fast and irregular heartbeat;
  • weak pulse;
  • dizziness or fainting.
  • Reasons

    Thromboembolism occurs when a pulmonary artery is blocked by a blood clot (thrombus). These blood clots usually form in the deep veins of the lower extremities, although embolism from other parts of the body is possible. This condition is called deep vein thrombosis (DVT). However, not all DVTs result in pulmonary embolism.

    Sometimes pulmonary embolism occurs due to:

    • adipose tissue, with bone fractures;
    • 90,019 air bubbles;

    • parts of a disintegrating tumor.

    The lesion is rarely solitary, as a rule, blockage occurs with several clots at the same time. Lung tissue supplied by a blocked artery is deprived of nutrients, which can lead to its death. This, in turn, creates difficulties in supplying oxygen to other parts of the body.

    Risk factors

    Anyone can develop a thrombosis leading to PE, but certain factors increase the risk of this disease.


    Prolonged immobilization. Blood clots are more likely to form in the lower extremities during periods of inactivity, such as:

    • Prolonged bed rest. By being bedridden for a long period after surgery, heart attack, broken leg, or any other serious medical condition, you become more prone to blood clots in your lower extremities.
    • Long journeys. Sitting in a cramped position during long flights or travel by car slows down the blood flow in the veins, this contributes to thrombus formation in the vessels of the lower extremities.

    Age. Older people are more prone to blood clots.

    Varicose veins. Thin valves located inside the large veins allow blood to flow in the correct direction. However, these valves are prone to deterioration with age. If their work is disrupted, the blood stagnates in the legs, which leads to thrombosis.

    Dehydration. Older people are at higher risk of dehydration, which increases the risk of thrombosis.

    Other diseases. Older people are also prone to other comorbidities that can increase the risk of blood clots, such as joint replacements, tumors, or heart disease.

    Heredity. High risk of thrombosis if you or your next of kin have had this disease in the past. So inherited disorders of the blood coagulation system can manifest themselves, which can be detected in special laboratories.Be sure to tell your doctor if your family member has a medical condition in order to perform certain tests.

    Surgical treatment. Surgery is one of the most important causes of blood clots, especially knee or hip replacement. During the preparation of bones for artificial joints, the surrounding tissue is damaged and can enter the bloodstream and stimulate blood clots. Prolonged immobilization after any surgery can contribute to thrombosis.Also, the risk increases depending on the duration of the anesthesia.

    The risk of thrombosis is higher at:

    • Heart disease. High blood pressure and other cardiovascular diseases contribute to thrombosis.
    • Pregnancy. The weight of a child compressing the veins of the pelvis can slow down blood flow in the veins of the lower extremities, which increases the risk of thrombosis.
    • Tumor. Certain tumors, in particular cancer of the pancreas, ovaries and lungs, increase the concentration of substances in the blood that stimulate thrombosis, which is also aggravated by subsequent chemotherapy.
    • Recurrent cases of thrombosis. If you have had deep vein thrombosis in the past, then you are at an increased risk of blood clots.


    The risk of thrombosis is increased:

    • Smoking. Tobacco smoking predisposes to increased blood clotting, which in turn can lead to thrombosis.
    • Overweight. Being overweight increases the risk of thrombosis, especially in hypertensive women who smoke.
    • Estrogen preparations. Estrogen in oral contraceptives and substitution medications increases the risk of thrombosis, especially if you smoke or are obese.

    Diagnostic Methods

    PE can be difficult to diagnose, especially in patients with heart or lung disease. This may require research such as:

    Chest X-ray. This non-invasive examination allows you to assess the condition of the lungs and heart in the image. Although a chest radiograph cannot be used to diagnose PE and may even look normal if present, radiography is necessary to rule out diseases that mimic embolism.

    Spiral computed tomography. Conventional computed tomography records X-rays from different angles and then compares them into a two-dimensional image of internal organs.With spiral CT, the scanner rotates around your body to create a 3D image. This type of CT can detect abnormalities with much greater accuracy and speed than conventional CT. If PE is suspected, an intravenous injection of contrast agent is usually given and a spiral CT scan is taken immediately.

    Angiography of the pulmonary arteries. During this test, a soft tube (catheter) is inserted into a large vein — usually in the groin — and passed through the right atrium and ventricle into the pulmonary arteries.Then a special dye is injected into the catheter, the movements of which are recorded on X-rays. During angiography of the pulmonary arteries, it is possible to measure the pressure in the right heart, where, in the case of pulmonary embolism, it will be increased. This test is highly skilled and carries potential risks, so it is usually done when other testing methods have not provided the necessary information.

    Blood test for D-dimer. This test identifies a protein that is synthesized when a blood clot breaks loose from anywhere in the body.A negative result is a good marker that the thrombus is not fresh. A positive result suggests a fresh embolism, but more research is needed for a definitive diagnosis.

    Ultrasound examination. This non-invasive test, known as a duplex vein scan, uses high-frequency sound waves to detect blood clots in the veins. During this exam, the doctor uses a device called a transducer that emits sound waves to visualize the veins.These waves are reflected and translated into a moving picture using a computer.

    Magnetic resonance imaging (MRI) . MRI uses radio waves and a powerful magnetic field to produce detailed images of internal organs. MRI is indicated for pregnant women to minimize exposure to the fetus and in patients with renal failure.


    Immediate treatment of pulmonary embolism is essential to prevent serious complications and even death.


    Drugs for the treatment of PE include:

    Anticoagulants. Heparin works quickly when given intravenously. Warfarin and rivaroxaban are available in tablet form. These drugs prevent new blood clots from forming, but they take several days before they take effect.

    Thrombolytics. While blood clots usually resolve on their own, there are drugs that speed up this process.Since these drugs can cause sudden and severe bleeding, they are only used in life-threatening situations.

    Surgical and other procedures

    In some cases, the doctor may decide to carry out one of the following procedures:

    Removal of thrombus. If you have a large blood clot in your pulmonary artery, your doctor may pass a thin tube (catheter) through the blood vessels and aspirate (extract) the clot. It can be difficult to remove a blood clot, thus, and this procedure is not always successful.

    Installation of a filter in the inferior vena cava. The catheter can also be used to place a filter in the main vein — the inferior vena cava — that carries blood from the lower extremities to the right heart. This filter catches blood clots that travel to the lungs.

    Surgical treatment. If you have shock and thrombolytic therapy does not work, you may need emergency surgery. The goal of the surgery is to remove as many blood clots as possible, especially if there is a large clot in the main pulmonary artery.


    Prevention of PE includes the prevention of deep vein thrombosis.

    Tactics for preventing thrombosis in the hospital include:

    Anticoagulant therapy. An anticoagulant such as heparin is given to anyone at risk of clotting after surgery, as well as to people with certain heart conditions, heart attacks, complications of tumors, or burns. You may be given warfarin by mouth for a few days before major surgery to reduce the risk of blood clots.

    Compression jersey

    Compression jersey. Compression stockings constantly compress the legs, helping the veins and muscles move blood more efficiently. It is a safe, simple, and inexpensive way to prevent blood stasis.

    Pneumatic compressors. This treatment includes a thigh or calf cuff that automatically inflates every few minutes to massage and compress the veins in the lower extremities to improve blood flow.

    Physical activity. Early activation after surgery helps prevent PE and accelerates overall recovery. This is one of the main reasons the nurse takes you for a walk as soon as possible after surgery.

    Travel prophylaxis. Prolonged sitting during a flight or car trip increases the risk of developing thrombosis of the veins of the lower extremities. To prevent this:

    Take a walk. Walk along the plane once an hour. If you are driving, make stops at the same frequency. Do some deep squats.

    Seated exercises. Bend, unbend and rotate the ankle, press your feet on the seat opposite you, raise and lower your feet on your toes. Do not sit cross-legged for long periods of time.

    Anticoagulants , as recommended by a physician. If you have a history of deep vein thrombosis, talk to your doctor about long-term travel options, for which you can self-administer long-acting heparin the day before your trip.Also talk with your doctor about the need for heparin on the way back.

    Drink plenty of water. Water is the best fluid to prevent dehydration, which promotes blood clots. Avoid drinking alcohol and caffeine, which can lead to fluid loss.

    How to check the lungs: types of diagnostics

    Many of us are confronted with a respiratory test only in the form of an annual snapshot for admission to work or study. But if you are concerned about chest pains, coughing and shortness of breath, you need to think about how to check the lungs and bronchi for diseases.

    When Should You Consider a Chest Exam?

    An ordinary person needs to do fluorography and check the condition of the lungs once a year. For some categories of citizens, for example, those working in educational institutions with children, they are required to do this twice a year. This is necessary for the early detection of patients with tuberculosis, a disease that is rapidly spreading in the collective.

    In addition to prevention, it is also necessary to check the lungs at the first signs of illness. These include:

    • dyspnea at rest,
    • long bouts of coughing: dry or with blood and pus in the sputum,
    • wheezing and whistling when breathing,
    • feeling of heaviness in the chest,
    • fever, general deterioration of health, loss of appetite …

    Usually, a lung examination is ordered by the attending physician. Only a specialist will be able to assess the symptoms and determine which type of diagnosis is suitable for your case. But there are cases in which doctors can be visited with ready-made materials:

    • You have had a relapse of an illness that you already know about.
    • Symptoms are not pronounced, there is no acute pain syndrome.

    In any case, if you show the doctor the already taken pictures, it will speed up the diagnosis.

    A lung check is part of a complete examination of the body.

    Options for diagnostics of the chest organs

    Diagnostics available without referral are limited to non-invasive methods. You will not be able to perform an endoscopy without a doctor’s opinion.But even so, there are a lot of types of diagnostics:

    • Ultrasound will not show you lung disease. It is usually used to detect fluid in the pleural cavity, therefore, if you do not know your diagnosis, it makes no sense to go for an ultrasound scan .
    • Fluorography : The fastest way to examine the lungs. During the procedure, the chest is illuminated with a low dose of X-rays. The image is printed on film or displayed on the monitor.Its undoubted plus is in safety: FLH for prevention is done to children from 14 years old. However, in the resulting image, pathology can be detected, but cannot be considered in detail. Most likely, after fluorography, the doctor will refer you to a more detailed study – CT of the lungs.
    • Radiography means higher radiation doses. The X-ray will give a high-quality image in which all the details can be clearly seen. The result will be printed on the film. But doctors do not recommend that such an examination be carried out often, since a large dose of radiation can be received.

    Tomography as a way to check the lungs

    Tomography is a more accurate and safer way to check the lungs. It gives a highly accurate result on the state of the lung tissue and mediastinal organs.

    The study LDCT of lungs – low-dose computed tomography – is gaining more and more credibility. This study is tens of times superior to fluorography and X-ray in terms of information content, and the radiation dose is lower.

    Multispiral computed tomography of the lungs also works with X-rays and should therefore not be performed on pregnant or lactating women.MSCT is prescribed to prepare the patient for surgery or to evaluate the results of surgery. It can be carried out both without contrast and with contrast enhancement.

    With this type of examination, you can track abnormalities, identify chest injuries, neoplasms in the early stages and inflammatory diseases. With this method, you can see pathological changes in the lungs, bronchi and trachea in a 3D image. A detailed picture helps the doctor to make an unmistakable diagnosis.

    Computed tomography is prescribed to detect:

    • tuberculosis,
    • sarcoidosis,
    • lung abscess,
    • lung cancer,
    • inflammatory diseases of the lungs, bronchi, pleura,
    • foreign bodies,
    • lymphoproliferative diseases,
    • pathologies of the mediastinal organs.

    CT is also monitored to monitor the postoperative and preoperative state of the problem organ.

    Invasive lung examinations

    There are a number of studies that, even in paid centers, are performed only for their intended purpose.These are endoscopic methods. Thanks to them, you can examine organs in detail and take tissue samples for analysis, and in some cases, immediately carry out treatment. Such surveys include:

    • Bronchoscopy : The endoscope is inserted through the nasopharynx. You can examine the trachea and bronchi.
    • Thoracoscopy is the insertion of a transducer directly into the lungs through punctures in the chest. This study is performed only under general anesthesia.
    • Thoracotomy – An incision in the chest so that the doctor can independently examine all organs.
    • Puncture of the pleural cavity and biopsy of pleura will help to find the cause of the inflammation, make tests for antibodies to malignant tumors and determine the infection.

    Your doctor will refer you to these tests, if necessary. However, such examinations are referred only in rather severe cases, therefore, most likely, if you have problems with the lungs, you will need fluorography, an X-ray or tomography.

    Chronic obstructive pulmonary disease (COPD)

    Key facts

    • Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, from which in 2019. died 3.23 million people. [1]
    • More than 80% of these deaths occur in low- and middle-income countries (LMICs).
    • COPD causes persistent and progressive respiratory symptoms, which include shortness of breath, coughing and / or sputum production.
    • COPD is caused by chronic exposure to harmful gases and fine particulate matter in combination with individual factors, including circumstances that affect lung development in childhood, as well as genetic factors.
    • Important risk factors for COPD are exposure to tobacco smoke, indoor air pollution, and inhalation of dust, smoke and chemicals in the workplace.

    Early diagnosis and treatment, including smoking cessation assistance, is needed to slow the progression of symptoms and reduce the frequency of exacerbations.

    What is COPD?

    COPD is a common, preventable and treatable chronic lung disease that affects both men and women around the world.

    The defeat of the small airways in the lungs leads to a violation of the incoming and outgoing air flow. The narrowing of the airway is a consequence of a number of processes. Partial destruction of lung tissue may occur, obliteration
    respiratory tract sputum, inflammation and swelling of the mucous membrane of the respiratory tract.

    Sometimes the terms “emphysema” or “chronic bronchitis” are used to refer to COPD. As a rule, the term “emphysema” means the destruction of the small air cavities of the lung, which end in the airways.Chronic
    bronchitis is a chronic sputum-producing cough caused by inflammation of the airways.

    COPD and asthma have a number of common symptoms (cough, wheezing and shortness of breath), and both can run in parallel.

    Impact of COPD on quality of life

    Common symptoms of COPD begin in middle age and include:

    • shortness of breath or shortness of breath;
    • chronic cough, often with expectoration; and / or
    • fatigue.

    As COPD progresses, it becomes more difficult for the person to carry out normal daily activities, often due to shortness of breath. The associated decrease in labor productivity and household restrictions, as well as the cost of treatment, lead to a significant
    financial burden.

    During an exacerbation, COPD symptoms become much more severe and may require additional home treatment or hospitalization for emergency care.Severe exacerbations can be life threatening.

    People with COPD often have comorbidities such as cardiovascular disease, osteoporosis, musculoskeletal disorders, lung cancer, depression and anxiety disorders.

    Causes of COPD

    COPD is characterized by gradual development, often as a result of exposure to a combination of risk factors:

    • inhalation of tobacco smoke during active and passive smoking;
    • Occupational inhalation exposure to dust, smoke or chemicals;
    • Indoor air pollution: In low- and middle-income countries, biomass fuels (wood, dung, crop residues) or coal are often used for cooking or heating, with high exposure
      smoke in living quarters;
    • features of the first years of life, for example, intrauterine growth disorders, prematurity, as well as frequent or severe respiratory infections in childhood, which prevent the full growth and development of the lungs;
    • childhood asthma; and / or
    • a rare genetic disorder – alpha-1-antitrypsin deficiency – can lead to the development of COPD at an early age.

    Reducing the burden of COPD

    COPD is not curable, but early diagnosis and treatment is important and can help slow the progression of symptoms and reduce the risk of exacerbations.

    Disease can be suspected when there are characteristic symptoms, and a functional breathing test called spirometry, which measures lung function, is done to confirm the diagnosis. In low- and middle-income countries, it is often
    there are no opportunities for spirometry, as a result of which the disease may remain undiagnosed.

    COPD patients can take a number of measures to improve their general condition and curb the progression of the disease:

    • smoking cessation – people with COPD should be provided with help to quit smoking;
    • regular physical activity; and
    • vaccinations against pneumonia, influenza and coronavirus infection.

    Inhaled medications may be given to relieve symptoms and relieve flare-ups. There are many different inhaled drugs with different mechanisms of action, some of which can be combined.

    Certain inhaled medications dilate the airways; they can be prescribed on a regular basis to prevent or alleviate symptoms, or to relieve symptoms during severe exacerbations. Sometimes to decline
    inflammation of the lung tissue in combination with these drugs, inhaled corticosteroids are prescribed.

    The use of inhaled drugs requires the correct technique, and in some cases, so-called spacer devices are used to more efficiently deliver the drug to the respiratory tract.In many low and medium countries
    income is limited; access to inhaled drugs is limited; for example, in 2019, inhaled salbutamol was available in primary health care settings in only half of the low-income countries [2].

    Often, exacerbations are triggered by a respiratory infection; in these cases, antibiotics and / or oral steroids may be prescribed in addition to inhaled drugs or nebulizers as needed.

    People living with COPD should be provided with information about their condition, the treatment they need, and self-care guidelines to help them lead the most active and healthy lives.

    WHO strategy for prevention and control COPD

    COPD is reflected in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) and the United Nations 2030 Agenda for Sustainable Development

    WHO is taking a number of steps to expand the diagnosis and treatment of COPD.

    To help tackle NCDs at the primary health care level in resource-limited settings, WHO has developed a set of essential responses to noncommunicable diseases.This complex includes protocols for the assessment, diagnosis and management of
    chronic respiratory disease (asthma and chronic obstructive pulmonary disease); and modules related to health counseling, including smoking cessation and self-help.

    Rehabilitation 2030 is a new strategic approach to prioritize the development and strengthening of rehabilitation services within health systems. WHO is currently developing
    a set of rehabilitation measures, which, among other things, includes pulmonary rehabilitation for COPD.

    Reducing exposure to tobacco smoke is essential both for the primary prevention of COPD and in the context of case management. Progress in this area is facilitated by the Framework Convention on Tobacco Control, as well as WHO initiatives such as MPOWER and mTobacco

    Other prevention activities include the development of the Clean Energy Homes Toolbox (CHEST), which aims to promote clean and safe household energy technologies and support policy development,
    promoting the introduction of clean energy sources in the home at the local, program and national levels.

    Global Alliance Against Chronic Respiratory Diseases

    The Global Alliance Against Chronic Respiratory Diseases (GARD) supports WHO’s work on the prevention and control of chronic respiratory diseases. GARD is a broad voluntary alliance of national and international organizations
    and agencies working towards the common goal of reducing the global burden of chronic respiratory diseases.

    Without heart and lungs.How earthworms live. Society news

    Divide and Conquer

    “If you cut an earthworm in two, will they be friends? – With you no”. This anecdote best describes the most famous feature of the earthworm – its ability to regenerate.

    “Some suggest that if you chop the unfortunate worm, each of its parts will become independent. This is not so, the biologist dispels the myth.- Only the part that remains with the head will survive. The severed tail will die. The fact is that the front part is more complex: the mouth, pharynx, intestines – everything is there. There are also calcareous glands that help the worm to neutralize humic acids from the soil. ”

    This is an earthworm for us – “phew, what disgusting.” And for moles – a favorite delicacy.

    However, as for rats, birds, toads, fish and other representatives of the fauna. After all, the worm is 82% pure protein! “Gourmets” are also among people.OBZH teacher Alexey Grigoriev knows perfectly well what will help you survive in the forest if you get lost:

    “One handful of these live spaghetti a day will help a person to survive without other food for a whole month! I read that they even lower the level of cholesterol in the blood, but I didn’t measure it myself ”.

    Two in one

    Each earthworm is both male and female, that is, hermaphrodite. But he cannot fertilize himself, because he transforms into a girl, then into a boy at different periods of time.

    The process is quite funny: first, two individuals meet in the male hypostasis, gallantly exchange male cells and diverge. And after a while, the feminine principle wakes up in everyone. The cells of different sexes are mixed in a sleeve (a dense ring on the body of the worm). During his movement, she slides and forms a cocoon, similar to a tiny lemon. The worm throws it into the ground, where it will ripen. Each of the cocoons contains from 1 to 5 embryos.

    “They don’t have a larval stage,” the biologist emphasizes.“Therefore, small, but already completely independent individuals hatch from it at once”.

    They will reach full size in about a year.

    Photo: shutterstock.com

    90,000 “I spend my last moments with those dying of coronavirus”: a nurse’s confession

    Photo author, AFP

    Photo caption,

    Doctors in the intensive care unit often have to make difficult decisions, including who to disconnect from ventilator

    For many patients with acute Covid-19, being connected to a ventilator in a timely manner is often a matter of life and death.

    However, even this device does not guarantee salvation, and doctors around the world have to make a difficult choice, turning off ventilators when there is no more hope.

    “Turning off the device is emotionally very difficult and very painful. Sometimes it even seems that I am personally responsible for someone’s death,” admits Juanita Nittla.

    Juanita was born in southern India but has worked for the UK National Health Service (NHS) for the past 16 years.

    She is the head nurse in the intensive care unit of the Royal Free Hospital, London.

    42-year-old Nittla often finds herself in situations where doctors have no choice but to stop supporting the patient’s life with mechanical ventilation devices (ventilators).

    To view this content, you must enable JavaScript or use another browser

    Video caption,

    One day in intensive care in London

    Photo author, Getty Images

    Photo caption,

    Ventilators help maintain breathing of critically ill patients diagnosed with Covid- 19

    Will of the dying person

    One day in early April, when Juanita came to her morning shift, the head of the department announced that she would have to interrupt the treatment of a patient with Covid-19.

    The patient was also a nurse, a woman in her 50s. Juanita had to explain to her daughter what the procedure would be.

    “I tried to assure the girl that her mother was not in pain and felt quite comfortable, and also asked if the patient had any last wishes, including those of a religious nature.”

    In the intensive care unit, the beds are next to each other, and in addition to the dying patient Nittla there were other patients who were also unconscious.

    “She was lying in a box with eight beds, everyone is seriously ill. I drew the curtain and turned off the sound notification of the devices.”

    Author of the photo, Juanita Nittla

    Caption to the photo,

    Nurses in the intensive care unit rarely manage to even sit down during a shift.

    All the staff in the ward froze for several minutes.

    “The nurses are silent, because human dignity and patient comfort are our first priority,” says Nittla.

    Then she lifted the telephone receiver to the patient’s ear and gave her daughter the opportunity to say her mother’s farewell words.

    “For me it was just a phone call, but for her family it made a huge difference. Of course, they would like to be able to make a video call, but unfortunately it is forbidden to use mobile phones in intensive care.”

    At the request of the relatives of the dying Juanita, she turned on the music video of their choice on the computer, and then turned off the ventilator.

    “I sat next to her and held her hands until she passed away,” says the nurse.

    Photo author, Juanita Nittla

    Photo caption,

    Many hospitals, including London’s Royal Free, were forced to increase the number of beds in intensive care units

    The decision to stop treatment and disconnect from the equipment is made by a group of doctors only after a thorough assessment of the condition patient, age, medical history, response to treatment and chances of recovery.

    In Nittla’s case, her ward died five minutes after the ventilator was turned off.

    “I saw alarm signals flashing on the monitor, and then the cardiogram showed a solid straight line on the screen – the heart stopped beating.”

    Death in loneliness

    After that, the nurse disconnected the droppers, which supplied sedatives to the patient’s blood.

    At the same time, the patient’s daughter, not knowing what was happening in the ward, continued to talk to her mother on the phone and read prayers.With a heavy heart, Nittle was forced to pick up the phone and tell her that it was all over.

    Photo author, AFP

    Photo caption,

    Many hospital patients die alone, because their relatives are not allowed to see them due to quarantine.

    However, according to Juanita, her duties do not stop with the death of the patient.

    “With the help of my colleagues, I washed her, wrapped her in a white shroud and put the body in a special bag, but first I put a cross on her forehead,” the nurse explains.

    Before the coronavirus epidemic, relatives personally discussed with doctors the procedure for stopping therapy.

    Previously, relatives were also allowed to be present in the intensive care unit when the life-supporting equipment was turned off. However, due to the current situation in most countries of the world, this practice has now been canceled.

    “It’s sad to see people die alone,” says Nittla and admits that she’s better at helping the dying.

    Photo author, Getty Images

    Photo caption,

    New coronavirus patients continue to arrive at hospitals

    Bed shortage

    Due to the large influx of patients, the hospital’s intensive care unit has been expanded from 34 to 60 beds.They are all busy now.

    A whole army of 175 nurses is working in the intensive care unit.

    “Usually in intensive care the ratio is one to one, but now there are three patients for each nurse. And if the situation continues to worsen, then there will be six patients for each nurse.”

    Photo by Juanita Nittla

    Some nurses showed symptoms of coronavirus and went into self-isolation. I had to re-profile nurses from other specialties to work in intensive care.

    “Before each shift, we hold hands and say like a mantra:“ Let everything be fine. ”We look after each other, making sure everyone is wearing gloves, masks and other protective equipment,” says Nittla.

    Photo author, Juanita Nittla


    Juanita (center) with two colleagues in the intensive care unit

    The hospital lacks ventilators, infusion pumps (for dosed administration of drugs to patients), oxygen cylinders and many essential medicines.

    Fortunately, Royal Free has sufficient personal protective equipment for all staff.

    The intensive care unit has an average of one death per day, well above the pre-pandemic average.

    “It is very depressing, – admits Nittle, – I have nightmares, I cannot sleep, I think that I will get infected, I communicate a lot with colleagues, and they are all afraid.”

    Last year she fell ill with tuberculosis for several months and knows very well that the capacity of her lungs is severely limited.But she, as the head nurse, sometimes has to suppress her own fears.

    “I am often told that I should not go to work, but now there is a pandemic, and I have to forget about everything and do my job.”

    “At the end of my shift, I always think about the patients who passed away that day, but I try to switch to something else when I leave the hospital.”

    Prone position (face down) with artificial ventilation in adults with acute respiratory failure

    Review Question

    The purpose of the review is to study the effect of the technology “artificial ventilation of the lungs (ALV) in the prone position” in the intensive care unit on one of the endpoints – the risk of death (mortality).We also wanted to identify the negative consequences and complications associated with mechanical ventilation in the prone position, as well as the long-term benefits.


    Patients admitted to the intensive care unit (intensive care unit) and requiring mechanical ventilation due to lung damage due to disease have a high risk of death. If the lungs are involved in the process of a disease, for example, with pneumonia, then they consist of normal and affected areas.It takes time to restore normal airiness and the patient may require mechanical support from a ventilator. Ventilation is a potentially lifesaving measure as it maintains proper oxygen levels in the blood and removes carbon dioxide. However, the very use of a ventilator can cause inflammation and thus lead to additional lung complications. The harder the ventilator has to work to achieve normal oxygenation and removal of carbon dioxide, the more likely it is that healthy parts of the lungs can be damaged and the person’s condition deteriorated.A prone position of a face-down (prone) ventilator instead of a supine ventilator can improve the ventilator’s performance, thereby reducing these unwanted side effects.

    Search date

    The evidence is current as of May 01, 2020.

    Characteristics of research

    We identified and included in this review randomized controlled trials in adults that compared conventional supine ventilation with prone ventilation.

    Main results

    Reports from nine studies involving 2,165 people (12 publications) show that recumbent ventilation did not benefit all participants requiring ventilation. The findings suggest some situations in which it can improve survival. In one group of patients with extremely severe lung disease, a decrease in mortality was found, as well as in patients in whom treatment was started early and continued for a long period of time.Complications have been described. The most common of these were pressure sores and tracheal tube blockages or obstruction. Low blood pressure and cardiac arrhythmias were also found. The use of a recumbent position for all low-oxygen intensive care participants has not been supported by the evidence identified, but certain specific groups of participants, such as those with particularly low oxygen levels, may benefit from a recumbent position. Further clinical trials would help to identify potential benefits for these patient populations, but further trials may not be carried out due to the observed very large benefits of treatment in patients with very low oxygen levels.In the absence of new studies, meta-analysis of individual patient data may facilitate further evaluation as well as further observational studies in risk groups.

    Quality of evidence

    The quality of the evidence for the primary outcomes in this systematic review was low as a result of severe inconsistency (study inconsistency) and serious potential bias.

    Harm of smoking on the human body

    Nervous system

    The nervous system controls all processes in our body.She is responsible for the connection of the body with the external and internal environment. And first of all, it is the nervous system that suffers from poisoning with tobacco poisons. One of the first signs of tobacco poisoning of the nervous system is dizziness. Dizziness is usually accompanied by seizures, and sometimes a series of seizures of great intensity. Initially, a feeling of emptiness appears, a person cannot concentrate, a feeling of loss of consciousness appears. It seems that all objects are moving, and if a person closes his eyes, there is a feeling of his own body spinning.Over time, smokers develop symptoms characteristic of a neurotic state: fatigue, irritability, memory impairment, nervousness, headaches.

    Respiratory organs

    Respiratory organs – take the very first blow from tobacco poisons. Dense soot particles and the “bouquet” that is part of tobacco smoke products irritate the mucous membrane of the larynx, trachea, bronchi, tiny bronchioles and pulmonary vesicles – alveoli.As a result of exposure, chronic inflammation of the airways develops. Smokers often suffer from bronchitis, they are constantly tormented by a cough, especially worse in the morning.

    The cough is accompanied by copious expectoration of dirty gray phlegm. Constant irritation of the vocal cords, which is often found in smokers, makes his voice rough, hoarse, unpleasant. That, in turn, can become an obstacle for professional activities, for example (singer, teacher).

    In one year, about 800 g of tobacco tar passes through the lungs of a smoker.Therefore, the lungs of a smoker become darker than the lungs of a non-smoker. A persistent painful cough entails a decrease in the elasticity of the lung tissue, causes stretching of the alveoli and the development of pulmonary emphysema. Scientists have shown that in smokers, lung function becomes less complete in all respects. The resistance of the lungs to infectious diseases is significantly reduced.

    Doctors have established a direct link between smoking and tuberculosis. Tuberculosis is twice as common in smokers as in non-smokers.Smoking is one of the first causes of lung cancer. Statistics are stubborn things, and they say that smokers are 10 times more likely to develop lung cancer than non-smokers. Studies in the United States and Europe have shown that the risk of lung cancer increases in direct proportion to the number of cigarettes smoked. The possibility of getting sick is especially increased in those who are used to using half-smoked cigarettes and taking deeper puffs of smoke.

    Cardiovascular system

    The harm of tobacco smoking on the cardiovascular system is complex and diverse.When you smoke, your heart rate increases, and this happens after the first puff. In a completely healthy person, the heart beats 70 times per minute, and during smoking 80-90 times. In one contraction, the heart distills 60-70 milliliters of blood, at 70 contractions per minute, the heart pumps 4-6 liters of blood, in 1 hour this figure will be equal to 300 liters, and in 24 hours over 7000 liters. Now imagine that the heart is not beating 70 times, but 85 times per minute, that is, 21% more often.

    By simple calculations, it can be determined that in 24 hours the heart should not pump 7000, but 8470 liters of blood, which is almost 1500 liters more than under normal conditions.

    This is the extra burden our heart has!

    If a person is healthy, this load on the heart is not very great, and if a person has a sick heart, then this load is difficult to bear. Experiments have shown that when smoking, the adrenal glands secrete hormonal substances that can cause an increase in blood pressure. This, in turn, further increases the burden on the heart.

    The heart expends more energy to drive blood through the significantly reduced vascular lumen.With a decrease in the diameter of the vessels, the blood supply to the organs worsens, the temperature of the skin decreases. Inhalation of carbon monoxide in smokers increases the content of carboxyhemoglobin in the blood, which impairs the supply of oxygen to the heart muscle.

    Poor blood supply to the heart gradually leads to its fatty degeneration. Thus, smoking can cause the development of atherosclerosis, and atherosclerosis, in turn, can lead to an increase in the incidence of coronary heart disease, which is often called now “disease of the century.”Ischemic disease includes all heart diseases and disorders of its activity associated with a sharp decrease (general or localized) in the flow of blood into the vessels that feed the heart.

    In the development of hypertension and atherosclerosis, smoking is assigned one of the first roles. WHO data show that mortality from coronary heart disease occurs more often in smokers and decreases in those who quit smoking. Sudden death attacks are four times more common in smokers than in non-smokers.

    Harm of smoking on the digestive organs

    Getting into the oral cavity, the smoke from cigarettes irritates the tongue, gums, pharynx, it has a negative effect on the tooth enamel and it begins to crack.Very often the mouth of a smoker smells unpleasant. Smoke from cigarettes irritates the salivary glands, resulting in profuse salivation. Scientists have found that smoking is a direct route to lip and tongue cancer.

    According to a study by the World Health Organization, cancer of the oral cavity and esophagus is four times more common among smokers than non-smokers. The toxic role of tobacco smoke is associated with mechanical, thermal and chemical influences. In various ways, toxic substances from tobacco smoke enter the digestive system.Poisons enter the digestive system through the central nervous system, with saliva, and also through the circulatory system.

    Statistics show a direct link between smoking and stomach and duodenal ulcers. The mortality rate from these diseases is 3-4 times higher among smokers than non-smokers. Tobacco smoke irritates the gastric mucosa and causes an increased secretion of gastric juice with high acidity. Constant stomach irritation can cause chronic gastritis.Nicotine inhibits contraction (peristalsis) of the stomach and intestines. Doctors, studying this phenomenon, found that a smoked cigarette slows down the contractions of the stomach, and sometimes stops completely. Thus, smoking inhibits the motor action of intestinal functions.

    This explains poor appetite and poor digestion in smokers. Smoking causes invaluable harm to the liver. People who smoke often experience liver enlargement, which goes away if the person quits smoking. Smoking also harms the pancreas.Smokers have twice the risk of cancer than non-smokers. If a non-smoker is constantly in a smoky room, he is at risk of getting chronic gastrointestinal diseases.

    Endocrine system

    Numerous studies of scientists have shown that smoking has a detrimental effect on the endocrine glands. The sex glands are especially affected by tobacco. Toxic substances from cigarette smoke poison the sex glands, which is associated with the occurrence of sexual impotence in men.Observing women working in tobacco processing factories, the teachings revealed the harmful effects of harmful substances on their bodies. The observed women experienced menstrual irregularities, toxicosis increased during pregnancy, and miscarriages were more common.


    In a smoker, the tongue is constantly covered with viscous thick mucus, which makes it difficult for food to contact the tongue, and those nerve endings that perceive taste sensations. Many smokers, for example, do not like sweets….

    This fact can be explained: tobacco inhibits the activity of nerve endings located in the oral cavity. Such an experiment was carried out more than once: a smoker and a non-smoker was given a taste of slightly sweetened and slightly salted water. A non-smoker could easily distinguish the taste of water, while a smoker could not understand the difference. Often, due to a decrease in taste, the smoker’s appetite deteriorates.

    Harmfulness of smoking to the sense of smell. People who smoke cease to perceive shades of odors.Constant smoking causes chronic inflammation of the nasal mucosa, which leads to chronic rhinitis. The influence of tobacco poisons has adverse changes in the optic nerve. The eyes of a smoking person are always red, watery, the edges of the eyelids swell. This leads to a change in visual perception, and can lead to complete blindness. It is not uncommon for smokers to have normal color perception.

    Harm of smoking on hearing organs

    Many smokers experience hearing loss.From constant exposure to toxic substances, chronic inflammation of the nasopharynx begins, turning into passages connecting the nasopharynx with the tympanic cavity. At the same time, there is a thickening of the tympanic membrane and a decrease in the mobility of the auditory ossicles. All this taken together impairs hearing.

    This is an incomplete picture of the harm smoking causes to our body. It is known that a dose of 0.1 g of nicotine is fatal to humans. It is contained in 20 cigarettes. Scientists have calculated that with an average of 20 cigarettes a day, a smoker will smoke over 200,000 cigarettes containing 160 kg of tobacco for 30 years.

    This amount of tobacco contains approximately 800 grams of nicotine – 8000 lethal doses of this poison. A person who daily injects one lethal dose of nicotine into his body does not die just because this dose does not come immediately, but gradually. The choice is yours to smoke and take a lethal dose of nicotine every day or get rid of this addiction.

    Passive smoking

    People around who inhale the smoke of a smoker are just as susceptible to all the same diseases as the martyr himself, since most of the smoke with its harmful substances is not inhaled by the smoker, but is scattered in the surrounding air, and non-smokers inhaling this air receive their dose of poison, which contributes to the development of various diseases and they.