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Chapter 16: Elements of Cardiac Function

Electrical Properties of the Heart

Cells of the heart are excitable and generate action potential that
initiate contraction and determine heart rate.
The Cardiac Action Potential
The heart consists of two kinds of muscle cells
o Contractile cells
o Conducting cells
Two main types of action potentials occur in the heart
o The fast response
Occurs in normal atrial and ventricular myocytes and
in the specialized conducting fibers (Purkinje fibers of
the heart)
Divided into five phases:
1. Rapid upstroke of action potential
2. Early repolarization
3. Plateau that persists 0.1-0.2 sec
4. Membrane then repolarizes
5. The resting state of polarization
Phase 3 or final repolarization develops more slowly
than depolarization or phase 0
Resting membrane potential (phase 4) of fastresponse cells is more negative
Upstroke, amplitude, and overshoot are greater in
fast-response cells
o The slow response
Occurs in SA node (natural pacemaker of heart and
AV node (specialized tissue that conducts the cardiac
impulse from the atria to the ventricles)
No phase 1
Action potential is propagated more slowly and
conduction is more likely to be blocked
Rapid depolarization precedes the development of force, and
completion of repolarization occurs at peak force
Relaxation of the muscle takes place mainly during phase 4 of
action potential
The various phases of the cardiac action potential are associated
with changes in cell membrane permeability, mainly to Na+, K+,
and Ca++
Permeability is changed by the opening and closing of ion
channels that are specific for individual ions. These changes of
membrane permeability alter the rate of movement of these ions
across the membrane and change the membrane voltage.

Resting Membrane Voltage

Resting cell membrane has relatively high permeability to K+;
permeability to Na+ and Ca++ is much less
K+ diffuses from inside to outside of cell
Potassium channels take potassium out. There are several types
of K+ channels in cardiac cell membranes; soe are controlled by
a chemical signal and others are regulated the membrane
o Inwardly rectifying K+
Voltage-regulated channel
open at rest when K+ conductance is high and are
closed by depolarization
K+ passes through during phase 4
o In a resting cardiac cell conductance to K+ is 100 times
greater than conductance to Na+
o Alterations in extracellular [K+] can change membrane
Hypokalemia= hyperpolarization
Hyperkalemia = depolarization
Fast-Response Action Potentials
Genesis of the Upstroke (Phase 0)

Any stimulus that abruptly depolarizes membrane voltage (Vm) to

threshold elicits an action potential
Upstroke is a phase of rapid depolarization that commences the
action potential
The upstroke is caused by a transient increase in Na+
conductance produced by depolarization-induced opening of
activation gates on the Na+ channels
o Na+ enters the myocyte through specific fast voltageactivated Na+ that exist in the membrane.
Na+ channels open briefly and the close (slower than they open)
o Na+ channels activate (open) very rapidly, causing an
abrupt increase Na+ conductance, which drives the
membrane potential toward Na+ equilibrium.
o The membrane does not quite reach Na+ equilibrium
because the inactivation gates close on Na+ channels
close in response to depolarization (but slower than the
when the gates open)
In graph, action potential amplitude is dependent on [Na+]o
o When [Na+]o is decreased, amplitude of action potential

o When [Na+]o is reduced from its normal value the cell is no

longer excitable
Na+ channels remain inactivated until membrane begins to
o With repolarization, the channel transitions to the closed
state, form which it can then be reopend by another
depolarization for membrane voltage to threshold
Effective refractory period or absolute refractory period:
When Na+ channels are in the inactivated state, they cannot be
reopen, and another action potential cannot be generated
o Prevents tetanic contraction of cardiac muscle
Relative refractory period: As cell repolarizes (phase 3), the
inactivated channels begin to transition to the closed state.
Another action potential can be generated during this period, but
it requires a larger than normal depolarization
Only when membrane voltage has returned to the resting level
(phase 4) are all the Na+ channels closed and thus able to be
reactivated by normal depolarization

Genesis of Early Repolarization (Phase 1)

Repolarization is brief becasuse of activation of a transient

outward current carried mainly by K+
Activation of K+ channels during phase 1 causes a brief efflux of
K+ from the cell because the cell interior is positively charged
and [K+] greatly exceeds [K+]0. This causes the cell to be briefly
and partially repolarized
Size of phase 1 notch between the end of upstroke and
beginning of plateau varies among cardiac cells
o Prominent in myocytes in the epicardial and midmyocardial
regions of the left ventricular wall and in ventricular
Purkinje fibers
o Notch is negligible in myocytes from the endocardial region
of the left ventricle

Genesis of the Plateau