Beyond the pump: integrating the heart's endocrine function into early medical education.

摘要

BACKGROUND: The heart is commonly introduced in early medical education through its structural, mechanical, and electrophysiological roles. Although this framing remains foundational, it may underemphasize the heart's endocrine functions. Cardiac endocrine signaling, particularly natriuretic peptide physiology, offers a concise structure-function example linking anatomy, histology, cardiovascular physiology, and clinical biomarker interpretation. OBJECTIVE: To synthesize scientific and educational principles of cardiac endocrine function and propose an anatomy-anchored framework for integration into pre-clerkship medical education. METHODS: A librarian-assisted narrative review was conducted in May 2025 using representative literature from PubMed, Google Scholar, and Scopus, supplemented by historical, molecular, physiological, anatomical, and medical education sources. The search focused on cardiac endocrine function, natriuretic peptides, and medical education and yielded 23 abstracts. The aim was conceptual synthesis rather than systematic or exhaustive retrieval. RESULTS: The discovery of atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) established the heart as an endocrine organ influencing renal, and cardiovascular homeostasis. The available medical education literature provides limited explicit guidance on how this topic should be introduced, and reinforced in early curricula. Integration of cardiac endocrine biology aligns with principles of cognitive integration, spiral curriculum design, and authentic learning. ANP and BNP/NT-proBNP are proposed as high-yield teaching examples: ANP links atrial structure and stretch to volume regulation, whereas BNP/NT-proBNP links ventricular wall stress to heart failure evaluation. CONCLUSIONS: Early integration of the heart's endocrine function into medical curricula may fortify structure-function reasoning, enhance systems thinking, and support mechanistic clinical reasoning. Rather than adding a separate curricular block, cardiac endocrine signaling can be incorporated through anatomy and histology, then reinforced in cardiovascular physiology, renal physiology, biochemistry, pharmacology, and clinical reasoning. Aligning foundational instruction with modern cardiovascular science can improve learners' conceptual frameworks and better prepare them for clinical decision making.