The job description for the heart is pretty impressive!

I was watching a show on television recently when one of the characters said that the heart is an organ.  Someone else replied, "No, the heart is a muscle."  I found that response to be confusing because I would think that the term “organ donor” (which includes heart donors) means that the heart is an organ.  So what is the correct answer?

I googled the question:  Is the heart an organ?  The answers that came back reaffirmed the complexity of the heart and suggested that the heart performs a number of functions.  I continued to ask google similar questions over the next few days and confirmed the importance of each of the multiple roles the heart performs in our lives.
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Some say the heart is an organ.  Some say the heart is a muscle.  Some talk about the tissues in the heart.  So is it all three of the above, or none of the above, or a combination of the three?  And if the answer is all three of the above, can I be blamed for coming close to burning out with my workaholic habits when my heart apparently is the greatest multi-tasker of all time?  Perhaps the heart is even more type A than the most driven being on this planet.

According to the American Heart Association (which I would argue is a definitive authority) the heart is a muscular organ that is made of tissues.  So the three most common explanations regarding what the heart is seem to peacefully co-exist together.  And maybe that is a good thing, as it might explain how the heart has the power to set the bar for multi-tasking. 

So let’s turn to the numerous articles on the roles that this tissue laden muscular organ performs each day.  Is it a pump?  The answer would be not only yes but double yes.  The heart is essentially two distinct, but anatomically connected pumps.  Here is a description of the functions of each pump from the website heartfailure.org:

     Right side – Receives blood from body and pumps blood into lungs to gather oxygen
     Left side – Receives oxygenated blood from lungs and sends out to body     
     The pulmonary circulation is responsible for taking up oxygen and releasing carbon dioxide.
     The Systemic circulation delivers the oxygenated blood to our tissues.
 
Here is what the Cleveland Clinic says about the heart’s pump:  The heart is located under the rib cage, to the left of the breastbone (sternum) and between the lungs. Your heart is an amazing organ. Shaped like an upside-down pear, this fist-sized powerhouse pumps five or six quarts of blood each minute to all parts of your body.

But you are probably thinking that there has to be something else going on that helps the pump maintain operations.  And you would be correct. 

Just like the pump in your HVAC system needs power to operate, so does your heart.  This is accomplished by the heart’s electrical system, which is responsible for making and conducting signals that trigger the heart to beat. These signals cause the heart’s muscle to contract. With each contraction, blood is pumped throughout the body. The process begins in the upper chambers of the heart (atria), which pump blood into the lower chambers (ventricles). The ventricles then pump blood to the body and lungs. This coordinated action occurs because the heart is "wired" to send electrical signals that tell the chambers of the heart when to contract.

So what happens to someone like me who has a heart electrical system that crashed?  I know some people who live in houses that have back-up generators in case the electrical system goes down so that there is still power coming into the house.  Obviously, my heart did not entirely shut down or I would be dead.  But it is weakened and damaged.  I like to think of my Implantable Cardioverter Defibrillator (ICD) as a generator-type device that assists my electrical system in delivering power to pace my heart.  It also has the power to become a defibrillator and shock my heart into beating normally if the need ever arises (although I am obviously hoping that this never happens.  This device has a battery that provides the power and can last for a number of years.      

The information I have related so far is about as scientific and technical as I get.  I’m a lawyer and I am also a storyteller.  So I am more comfortable in telling the story of the role of the heart, using more familiar, straightforward terms.  So below are a few more imaginative examples I found on-line.

The Franklin Institute is a center of science education and development (and a museum) in Philadelphia.  It is named after America’s first scientist, Benjamin Franklin.  The Franklin Institute in Philadelphia, Pennsylvania discusses the role of the heart in everyday terms.  The Institute’s website compares the heart’s operations to the assembly line operations of a car factory.  The Franklin Institute says:  "Your body operates in much the same way. Different systems within your body are responsible for different jobs, yet they all share the common goal of keeping you alive.  At the center of all of this activity is the heart. You could say it acts as the factory “foreman” to set the pace and regulate all of the other body systems."

If the car factory analogy is too commercial for your tastes, you might like the more domestic comparison from the American College of Cardology.  I found it on their website, Cardiosmart:

• The heart is divided into four chambers or "rooms". You can compare it to a duplex apartment that is made up of a right and a left unit, separated from each other by a partition wall known as a septum (pronounced SEP-tum).
• Each "duplex" is subdivided into an upper and a lower chamber. The upper chamber is known as the atrium (pronounced AY-tree-yum) while the lower chamber is referred to as the ventricle(pronounced VEN-trickle). The right atrium (RA) sits on top of the right ventricle (RV) on the right side of the heart while the left atrium (LA) sits atop the left ventricle (LV) on the left side.
• The right side of the heart (RA and RV) is responsible for pumping blood to the lungs, where the blood cells pick up fresh oxygen. This oxygenated blood is then returned to the left side of the heart (LA and LV). From here the oxygenated blood is pumped out to the rest of the body supplying the fuel that the body cells need to function. The cells of the body remove oxygen from the blood, and the oxygen-poor blood is returned to the RA, where the journey began. This round trip is known as the circulation of blood.

So we all periodically want to renovate our residences.  Who wants to have the same furniture and paintings in place forever?  Maybe we want a bigger sofa, or a more dramatic painting.  Are there similar activities occurring inside the residence of your heart?  Well, maybe but these may not be constructive activities.  I recently have come across the term “remodeling” used in context with the heart. 

I wasn’t sure this was a positive term as it relates to heart failure.  So I asked my heart failure doctor if remodeling is a good thing, a bad thing, or just is what it is.  He told me that remodeling is a bad thing.  An example of remodeling would be when my left ventricle became dilated.  In essence, the left ventricle remodeled itself to be able to help the pumping function.  

So what I take away from his explanation is that a large sofa may be a great improvement for your home, but a larger, remodeled heart is not a great improvement for your heart.  Now, reverse remodeling might be a different story.   An example of this would be when my left ventricle returned to a more normal size for a while.   Living in a prosperous country like the United States, it is hard to comprehend that bigger is not always better.  But in this particular instance, I would be happy to have my old worn-out but smaller size sofa back in my heart residence.

To continue with the residence analogy, I believe every residence in the United States is required to have a smoke detector in place to alert the owner or tenant to the fact that a fire is occurring.  Well if you have a heart that is assisted by a pacemaker device like I do, you may also have an alert system to let you know that the battery is running down.  The alert is to let you know that it needs to be replaced or your body’s electrical system will suffer.  According to the Boston Scientific website, there may be a feature that makes a device beep when replacement time is near, and the patient is supposed to call the doctor immediately if the device beeps.  So in this respect, it sounds like the device is similar to a battery operated smoke detector, although the battery replacement for the ICD is a little more complicated.

I will let you decide which you prefer, the scientific or the home/factory descriptions of what your heart does each day.  To be honest, I often find the scientific explanations to be interesting.  But then when I remember it is my living heart in my body that we’re talking about, well that is when I like to make the discussion of the heart something that is easier, less emotional and less scary for me to process! 

​But regardless of which explanations you prefer, I think we all have to agree that the heart is an awesome multi-tasker!