Since many human heart diseases involve both the intrinsic cardiac neurons and nerves, their detailed
normal ultrastructure was examined in material from autopsy cases without cardiac complications obtained
no more than 8 h after death. Many intracardiac nerves were covered by epineurium, the thickness of which
was related to nerve diameter. The perineurial sheath varied from nerve to nerve and, depending on nerve
diameter, contained up to 12 layers of perineurial cells. The sheaths of the intracardiac nerves therefore
become progressively attenuated during their course in the heart. The intraneural capillaries of the human
heart differ from those in animals in possessing an increased number of endothelial cells. A proportion of
the intraneural capillaries were fenestrated. The number of unmyelinated axons within unmyelinated nerve
fibres was related to nerve diameter, thin cardiac nerves possessing fewer axons. The most distinctive feature
was the presence of stacks of laminated Schwann cell processes unassociated with axons that were more
frequent in older subjects. Most unmyelinated and myelinated nerve fibres showed normal ultrastructure,
although a number of profiles displayed a variety of different axoplasmic contents. Collectively, the data
provide baseline information on the normal structure of intracardiac nerves in healthy humans which may
be useful for assessing the degree of nerve damage both in autonomic and sensory neuropathies in the
human heart.