muscle • The basic structural unit is the sarcomere. • Tight and gab junctions. – the gab junctions act as a low resistance bridges that allow spread of excitation wave between cardiac cells – The tight juctions exert mechanical connection between cardiac muscle fibers. • It contains actin and myosin with striations of dark A-bands and light I- bands. • each transverse tubule is surrounded by cisternae of sarcoplasmic reticulum. • Most of the energy of the heart is derived from aerobic oxidation The cardiac muscle differs from skeletal muscle in:
being not dependent on central nervous
system. having no neuromuscular junctions. acting as a single unit or functional syncitium. Functional division: • Nodal or pacemaker tissue – It is the tissue that is able to initiate nerve impulse in an automatic and regular manner, examples : SAN (sinoatrial node) and AVN (atrio-ventricular node). • Junctional (Conductive tissue) : this system conducts nerve impulse from site of initiation to all parts of the heart as fast as possible. • Contractile (muscular) tissue : It is the issue that is able to contract and act as a pump. Properties of cardiac muscle Autorhythmicity Conductivity Excitability Contractility Autorhythmicity
It is the ability of autorhythmic cells
present in the heart to generate nerve impulses in regular and independent manner. Autorhythmic cells ◦ SAN Its rhythm is 100 impulse / minute ◦ AVN.: Its rhythm is 50 imulse/ minute ◦ Purkinje fibers: Its rhythm is 25 impulse / minute Autorhythmic cells have unstable resting membrane potential at – 60 mv resting level, there is spontaneous depolarization due to decrease in K+ and increase in Na+ and Ca+ permeability SAN is the pacemaker of the heart because it discharge nerve impulses at the highest rhythm about 100 impulse / minute. Factors affecting Autorhythmicity Sympathetic stimulation increases autorhythmicity by decreasing membrane permeability to K+ Parasympathetic stimulation decreases automaticity due to increase in K+ permeability Increase in body temperature by 1o C increases heart rate by 20 bpm Mechanical stretch of right atrium stimulates SAN Catecholamines also stimulate SAN. • Chrotropic effect: – It is the increase of rate of discharge of SAN and hence increase heart rate. • Positive chronotropic effect : Increase of HR – Examples • Sympathetic stimulation • Catecholamines (adrenaline and noradrenaline) • Negative chronotropic effect: Decrease of HR – Examples • Parasympathetic (vagal) stimulation • Acetylcholine. Conductivity:
It is the ability of the heart to conduct
nerve impulses from the site of initiation to all parts of the ventricles through a specialized conductive system as fast as possible. Importance of AVN • It acts as one way conduction of nerve impulse from atrium to ventricle • It delays the nerve impulse for about 0.1 second to allow atrial excitation to be completed before the start of ventricular excitation • AVN also has a long absolute refractory period to protect the ventricle from high atrial rhythms • AVN act as a latent pacemakerin case of damage of SAN The highest conductive velocity occurs in Purkinje fibers while the highest rate of discharge occurs in SAN Excitability It is the ability of cardiac muscle to respond to stimulation by producing action potential. Two types of electrical responses. ◦ Fast response is recorded from fast response fibers or contractile fibers ◦ slow response recorded from slow response fibers or autorhythmic cells. Slow Response • It is the action potential recorded from SAN or AVN. It is formed from the following phases: – Prepotential : it is the unstable resting membrane potential of the slow fibers. • The membrane potential changes from -60 mv to the firing level of – 45 mv. • is due to decrease potassium efflux and increase sodium and calcium influx. – Depolarization of action potential occurs by calcium influx – Repolarization occurs by potassium efflux. Fast response • It is the action potential recorded from contractile cells.It is formed of the following phases : – Phase 4 : resting state -90 mv. – Phase 0 : fast depolarization from -90 mv to + 30 mv it is due to sodium influx through fast volt- sensitive sodium channels. – Phase 1 : rapid small repolarization : It is due to potassium efflux. – Phase 2 : Plateau : It is a plateau phase and is due to both calcium influx and potassium efflux. – Phase 3 : rapid repolarization : It is due to potassium efflux. During which phase of the ventricular action potential is the conductance to Ca2+ highest? (A) Phase 0 (B) Phase 1 (C) Phase 2 (D) Phase 3 (E) Phase 4 Contractility It is the intrinsic ability of cardiac muscle to generate force at a constant length. Excitation contraction coupling ◦ depolarization of cardiac muscle cells will lead to opening of volt sensitive calcium channels in the sarcolemma causing calcium influx. ◦ The increased intracellular calcium will activate another calcium sensitive calcium channels in the cisternae of sarcoplasmic reticulum ◦ release of calcium from sarcoplasmic reticulum to the cytoplasm Contractility Excitation contraction coupling ◦ increase intracellular calcium will bind troponin c ◦ this will cause binding of actin to myosin with sliding of actinover myosin. ◦ shortening of sarcomeres and so muscle contraction ◦ Relaxation of cardiac muscle occurs by decreasing cytosolic calcium ◦ pumping calcium to extracellular fluid or to cisternae of sarcoplasmic reticulumby active mechanism. Ion movements during the contraction of cardiac muscle. ATPase = adenosine triphosphatase Factors affecting cardiac muscle contractility Intrinsic: ◦ Preload ◦ Afterload ◦ Heart Rate Extrinsic ◦ Nervous Sympathetic Parasympathetic ◦ Humoral Hormones Chemixcals and drugs Intrinsic regulation of Contractility Preload ◦ Its effect is determined by Starling law ◦ It is a direct relationship within limit . So ◦ Increase VR (venous return) will cause stretch of the muscle of ventricle and this leads to increase preload so force of contraction increases. ◦ If the ventricle is overstretched, force of contraction will decrease. Intrinsic regulation of Contractility Afterload ◦ it is defined as the load imposed on the muscle during contraction or the force against which the heart pumps blood ◦ The high arterial blood pressure and aortic stenosis are examples of afterloads. ◦ Increase afterload is inversely proportional to the velocity of shortening. Effect of heart rate on contraction ◦ Increase HR increases force of contraction Extrinsic regulation of Contractility Nervous factors ◦ Sympathetic stimulation has a positive inotropic effect by increasing availability of calcium ◦ Parasympathetic stimulation has negative inotropic effect by decreasing calcium but this effect is exerted only on the atria Humoral factors ◦ Catecholamines have a positive inotropic ◦ Calcium may stop the heart in systole ◦ potassium stops the heart in diastole. ◦ Digitalis has a positive inotropic effect by increasing calcium inside the cardiac cells. ◦ Calcium channel blockers (nefidipine) : has a negative inotropic effect
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