The Nervous System and the Heart

pp 3-54

Neural Supply of the Heart

  • Simon J. Crick
  • , Mary N. Sheppard
  • , Robert H. Anderson

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The heart receives an extrinsic efferent (sympathetic and parasympathetic) and afferent innervation, as well as possessing an intrinsic (intracardiac) nerve supply. This intrinsic nervous system interacts with efferent nerve fibers in a complex fashion to help maintain adequate cardiac output. Intrinsic neurones also receive afferent inputs from mechanosensory and chemosensory nerve endings located in cardiovascular and pulmonary tissues, together with afferent fibers from centrally located neurones. The importance of the intrinsic nervous system is often overlooked. It is now thought that this system may even function as a “mini-brain” within the heart, where incoming neural information is processed and integrated, with the final outcome being an effective “fine-tuning” of cardiac dynamics. A description of all aspects of cardiac neuroanatomy will be reviewed, based on an account of the individual neural components, and their interaction with each other. Noradrenaline (NA) and acetylcholine (ACh) are the predominant “classical” transmitters utilized by the mammalian heart. Nevertheless, many other types of neurotransmitter or neuromodulator have been localized to cardiac nerves, many of which, but not all, have been found to coexist with either NA or ACh in the same nerve fibers. This review will characterize the plenitude of neurotransmitters and neuromodulators to be found in the mammalian heart, together with a brief account of their putative effects on cardiac dynamics. Finally, we will discuss the denervated cardiac transplant and its prospects for reinnervation.