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13 - Heart Phys

13 - Heart Phys

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Published by: sanwel on Feb 14, 2010
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05/18/2012

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Lecture: Heart PhysiologyI. Cardiac Muscle (compare to Skeletal Muscle)
Cardiac Muscle Cellsfairly shortsemi-spindle shape branched, interconnectedconnected (intercalated discs)electrical link (gap junction)common contraction (syncytium)1 or 2 central nucleidense "endomysium"high vasculatureMANY mitochondria
25
%
space)almost all AEROBIC (oxygen)myofibers fuse at endsT tubules wider, fewer Skeletal Muscle Cellsvery longcylindrical shapeside-by-sideno tight bindingno gap junctionsindependent contractmultinucleatedlight "endomysium"medium vasculatureless mitochondria (2%)aerobic & anaerobicmyofibers not fusedT tubules at A/I spot
II. Mechanism of Contraction of Contractile Cardiac Muscle Fibers
1.Na
+
influx from extracellular space, causes positive feedback opening of voltage-gated Na
+
channels; membrane potential quickly depolarizes (-90 to +30 mV); Na
+
channels close within 3 ms of opening.2.Depolarization causes release of Ca
++
from sarcoplasmic reticulum (as in skeletalmuscle), allowing sliding actin and myosin to proceed.3.Depolarization ALSO causes opening of slow Ca
++
channels on the membrane(special to cardiac muscle), further increasing Ca
++
influx and activation of filaments. This causes more prolonged depolarization than in skeletal muscle,resulting in a plateau action potential, rather than a "spiked" action potential (as inskeletal muscle cells).Differences Between Skeletal & Cardiac MUSCLE Contraction1.All-or-None Law - Gap junctions allow all cardiac muscle cells to be linkedelectrochemically, so that activation of a small group of cells spreads like a wavethroughout the entire heart. This is essential for "synchronistic" contraction of the heart asopposed to skeletal muscle.2.Automicity (Autorhythmicity) - some cardiac muscle cells are "self-excitable" allowingfor rhythmic waves of contraction to adjacent cells throughout the heart. Skeletal musclecells must be stimulated by independent motor neurons as part of a motor unit.1
 
3.Length of Absolute Refractory Period - The absolute refractory period of cardiac musclecells is much longer than skeletal muscle cells
250
 
ms vs. 2-3 ms), preventing wavesummation and tetanic contractions which would cause the heart to stop pumpingrhythmically.
III.Internal Conduction (Stimulation) System of the Heart
A.General Properties of Conduction1.heart can beat rhythmically without nervous input2.nodal system (cardiac conduction system) - special autorhythmic cells of heart that initiate impulses for wave-like contraction of entire heart (nonervous stimulation needed for these)3.gap junctions - electrically couple all cardiac muscle cells so thatdepolarization sweeps across heart in sequential fashion from atria toventriclesB."Pacemaker" Features of Autorhythmic Cells1.pacemaker potentials - "autorhythmic cells" of heart muscle create action potentials in rhythmic fashion; this is due to unstable resting potentialswhich slowly drift back toward threshold voltage after repolarization froma previous cycle.Theoretical Mechanism of Pacemaker Potential:a.
+
leak channels allow K 
+
OUT of the cell more slowly than in skeletal muscle b.Na
+
slowly leaks into cell, causing membrane potential to slowly drift up to the thresholdto trigger Ca
++
influx from outside (-40 mV)c.when threshold for voltage-gated Ca
++
channels is reached (-40 mV), fast calciumchannels open, permitting explosive entry of Ca
++
from of the cell, causing sharp rise inlevel of depolarizationd.when peak depolarization is achieved, voltage-gated
+
channels open, causingrepolarization to the "unstable resting potential"e.cycle begins again at step a.C.Anatomical Sequence of Excitation of the Heart1. Autorhythmic Cell Location & Order of Impulses(right atrium)sinoatrial node (SA) ->(right AV valve)atrioventricular node (AV) ->2
 
atrioventricular bundle (bundle of His) ->right & left bundle of His branches ->Purkinje fibers of ventricular walls(from SA through complete heart contraction = 220 ms = 0.22 s)a.sinoatrial node (SA node) "the pacemaker" - has the fastest autorhythmic rate (70-80 peminute), and sets the pace for the entire heart; this rhythm is called the sinus rhythm;located in right atrial wall, just inferior to the superior vena cava b.atrioventricular node (AV node) - impulses pass from SA via gap junctions in about 40ms.; impulses are delayed about 100 ms to allow completion of the contraction of bothatria; located just above tricuspid valve (between right atrium & ventricle)c.atrioventricular bundle (bundle of His) - in the interATRIAL septum (connects L and R atria)d.L and R bundle of His branches - within the interVENTRICULAR septum (between Land R ventricles)e.Purkinje fibers - within the lateral walls of both the L and R ventricles; since left ventriclemuch larger, Purkinjes more elaborate here; Purkinje fibers innervate “papillary muscles” before ventricle walls so AV can valves prevent backflowD. Special Considerations of Wave of Excitation1.initial SA node excitation causes contraction of both the R and L atria2.contraction of R and L ventricles begins at APEX of heart (inferior point),ejecting blood superiorly to aorta and pulmonary artery3.the bundle of His is the ONLY link between atrial contraction and ventricular contraction; AV node and bundle must work for ventricular contractions4.since cells in the SA node has the fastest autorhythmic rate (70-80 per minute), itdrives all other autorhythmic centers in a normal heart5.arrhythmias - uncoordinated heart contractions6.fibrillation - rapid and irregular contractions of the heart chambers; reducesefficiency of heart7.defibrillation - application of electric shock to heart in attempt to retain normalSA node rate8.ectopic focus - autorhythmic cells other than SA node take over heart rhythm9.nodal rhythm - when AV node takes over pacemaker function (40-60 per minute)10.extrasystole - when outside influence (such as drugs) leads to prematurecontraction11.heart block - when AV node or bundle of His is not transmitting sinus rhythm toventricles3

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