Nerve & Cardiac Impulse

Neural zone
 Electrical Signals in Neurons
Neurons have a resting membrane potential (like
all cells)
Neurons are excitable; can rapidly change their
membrane potential
Changes in membrane potential act as electrical
signals
 Membrane Potential
Three factors contribute to the membrane potential

•The distribution of ions across the plasma membrane

•The relative permeability of the membrane to these ions
•The charges of the ions
Resting potential

Nernst equation
predicts membrane
potential for a single
ion
Goldman equation for
the membrane
potential : predicts the
membrane potential
using multiple ions
 Action Potentials (AP)

Occurs only when the membrane

potential at the axon hillock
reaches threshold
Three phases
Depolarization
Repolarization
Hyperpolarization
Absolute refractory period –
incapable of generating a new AP
Relative refractory period – more
difficult to generate a new AP``````
Positive feedback, e.g., influx of Na+ →  local
depolarization →  number of open Na+ channels
Na+ channels open first (depolarization)
K+ channels open more slowly (repolarization)
Na+ channels close
K+ channels close slowly (relative refractory period)
 EEG(Electroencephalogram)
•The electroencephalogram (EEG) is a
electrophysiological monitoring method to record the
electrical activity of the brain ( superficial layer i.e. the
dendrites of pyramidal cells) by placing the electrodes on
the scalp.

•EEG measures voltage fluctuations resulting from ionic

current within the neurons of the brain.
 Mechanism of EEG
• Brain’s electrical charge is maintained by billions of
neurons.
• Neurons are electrically charged or polarised by
membrane transport proteins that pump ions across
their membranes.
• Neurons are constantly exchanging ions with the
extracellular medium for example to maintain resting
potential and to propagate action potentials.
• Ions of similar charge repel each other and when many
ions are pushed out of many neurons at the same time,
they can repel their neighbouring ions, which in turn
repel their neighbouring ions and so on in a wave.
• This process is called volume conduction
 Mechanism contd.
• When thousands of neurons fire in sync, they generate
an electric field which is strong enough to spread
through tissue, bone and skull and eventually can be
measured on the surface of the head.
• EEG measures the electrical activity in volts generated
by the synchronised activity of thousands or millions of
neurons that have similar spatial orientation.
• As the voltage fluctuations measured at the electrodes
are very small, the recorded data is digitised and sent
to an amplifier.
• The amplified data is displayed as a sequence of
voltage values.
 Electroencephalogram
EEG is the record of electrical activity of brain(
superficial layer i.e. the dendrites of pyramidal
cells) by placing the electrodes on the scalp.
• The first recordings were made by Hans Berger in 1929
•In conventional scalp EEG, the recording is obtained by
placing electrodes on the scalp with a conductive gel or
paste after preparing the scalp area by light abrasion to
reduce impedence due to dead skin cells.
•Each electrode is attached to an individual wire.
•Some systems use caps or nets into which electrodes are
embedded.
•Each electrode is connected to one input of a differential
amplifier(one amplifier per pair of electrodes.
•These amplifiers amplify the voltage between the active
electrode and reference electrode.
•Amplified signal is digitised via an analog to digital converter
Origin of EEG waves
 EEG Waves
Alpha wave -- 8 – 13 Hz.
Beta wave -- >13 Hz. (14 – 30 Hz.)
Theta wave -- 4 – 7.5 Hz.
Delta waves – 1 – 3.5 Hz.

DTAB
 EEG

EEG rhythms correlate with patterns of behavior (level of

attentiveness, sleeping, waking, seizures, coma).
Rhythms occur in distinct frequency ranges:
Gamma: 20-60 Hz (“cognitive” frequency band)
Beta: 14-20 Hz (activated cortex)
Alpha: 8-13 Hz (quiet waking)
Theta: 4-7 Hz (sleep stages)
Delta: less than 4 Hz (sleep stages, especially “deep
sleep”)
Higher frequencies: active processing, relatively de-
synchronized activity (alert wakefulness, dream sleep).
Lower frequencies: strongly synchronized activity
(nondreaming sleep, coma).
Different types of brain waves in normal EEG
 Alpha wave
• rhythmic, 8-13 Hz
• mostly on occipital lobe
• 20-200 μ V
• Normal
• Are seen when we close our eyes and are in a calm
state
• Increased when in a state of relaxed wakefulness
 Beta wave
• Irregular
• 14-30 Hz
• mostly on temporal and frontal lobe
• mental activity
• Excitement
• Motor regions : stronger when we execute body
movements
 Theta wave
• Rhythmic
• 4-7 Hz
• Drowsy, sleep
• Associated with fatigue
 Delta wave
• Slow
• < 3.5 Hz
• Adult slow wave sleep
• normal sleep rhythm in babies
• Assess the depth of sleep
 Different types of brain waves in normal
EEG
Rhythm Frequenc Amplitude Recording
y (uV) & Location
(Hz)
Alpha(α) 8 – 13 50 – 100 Adults, rest, eyes closed.
Occipital region

Beta(β) 14 - 30 20 Adult, mental activity

Frontal region

Theta(θ) 5–7 Above 50 Children, drowsy adult,

emotional distress
Occipital
Delta(δ) 2–4 Above 50 Children in sleep

DTAB
 Requirements
EEG machine (8/16 channels).
Silver cup electrodes/metallic bridge electrodes.
Electrode jelly.
Rubber cap.
Quiet dark comfortable room.
Skin pencil & measuring tape.
Computerized EEG Machine
 EEG Electrodes

Sliver Electrodes Electrodes Cap

 Procedure of EEG recording
A standard EEG makes use of 21 electrodes
linked in various ways (Montage).
Apply electrode according to 10/20% system.
Check the impedance of the electrodes.
 EEG

Standard placements of electrodes on the human scalp: A, auricle; C, central;

F, frontal; Fp, frontal pole; O, occipital; P, parietal; T, temporal.
10 /20 % system of EEG electrode
placement
 EEG Electrodes

Each electrode site is labeled with a letter and a

number.
The letter refers to the area of brain underlying the
electrode
e.g. F - Frontal lobe and T - Temporal lobe.
Even numbers denote the right side of the head and
Odd numbers the left side of the head.
 Two types of recording

Bipolar – both the electrodes are at active site

Bipolar montage are parasagital montage.
Unipolar – one electrode is active and the other
is indifferent kept at ear lobe.
 Analysis
Electrical activity from the brain consist of
primarily of rhythms.
They are named according to their frequencies
(Hz) and amplitude in micro volt (μv).
Different rhythms at different ages and different
conditions (level of consciousness)
Usually one dominant frequency (background
rhythm)
 Factor influencing EEG
Age
Infant – theta, delta wave
Child – alpha formation.
Adult – all four waves.
Level of consciousness (sleep)
Hypocapnia(hyperventilation) slow & high amplitude
waves.
Hypoglycemia
Hypothermia Slow waves

Low glucocorticoids
EEG potentials are good indicators of global
brain state. They often display rhythmic
patterns at characteristic frequencies
 Use of EEG
Epilepsy
Generalized (grandmal) seizures.
Absence (petitmal) seizures.
Localize brain tumors.
Sleep disorders (Polysomnography)
Narcolepsy
Sleep apnea syndrome
Insomnia and parasomnia
Helpful in knowing the cortical activity, toxicity,
hypoxia and encephalopathy &
Determination of brain death.
Flat EEG(absence of electrical activity) on two records run 24
hrs apart.
Conductive System of the Heart
 Conduction system
The specialized heart cells of the cardiac conduction
system generate and coordinate the transmission of
electrical impulses to myocardial cells

The result is sequential atrioventricular contraction which

provides for the most effective flow of blood , thereby
optimizing cardiac out put
 Characteristics of Cardiac Conduction
Cells
Automaticity: ability to initiate an electrical
impulse

Excitability: ability to respond to an electrical

impulse

Conductivity: ability to transmit an electrical

impulse from one cell to another
 Conduction system

The sinoatrial (SA) node: a

primary pacemaker of the heart

The electrical impulses initiated

by the SA node are conducted
along the myocardial cells of the
atria via specialized tracts

The impulses cause electrical

stimulation and subsequent
contraction of the atria
 Conduction System

The impulses are then conducted to atrioventricular(AV) node

The AV node consist of specialized muscle cells

The AV node coordinate the incoming electrical impulses from atria and
after a slight delay (allowing the atria time to contract and complete
ventricular filling) relays the impulses to the ventricles
The impulse is then conducted through a bundle of specialized conduction
cells (bundle- His ) that travel in the septum separating the left and right
ventricles

The bundle of His divides into the right bundle branch (conducting
impulses to the right ventricle )
The left bundle branch (conducting impulses to the left ventricle )

Impulses travel through bundle branches to reach terminal point in the

conduction system called the purkinjie fiber this is the point at which
myocardial cell at stimulated causing ventricular contraction
 Physiology of cardiac conduction
⚫ Cardiac electrical activity is result of the movement of ions (charged
particles such as sodium, potassium and calcium) across to cell
membrane

⚫ In the resting state cardiac muscle cells are polarized, which means
an electrical difference exists between the negatively charged inside
and the positively charged outside of the cell membrane

⚫ As soon as an electrical impulses is initiated,cell membrane

permeability changes and sodium move rapidly into the cell while
potassium exits the cell

⚫ This ionic exchange begins depolarization (electrical activation of the

cell) converting the internal charge of the cell to a positive one

⚫ The repolarization is return of the cell to its resting state occurs as the
cell returns to its baseline. This corresponds to relaxation of
myocardial muscle
After the rapid influx of sodium into the cell during depolarization the
permeability of cell membrane to calcium is changed calcium enters the cell
and is released from intracellular calcium stores

There are two phases of refractory period refered to as the:

absolute refractory period

relative refractory period
The absolute refractory period is the time during which the heart can not
be restimulated to contract regardless of strength of electrical stimulus. This
period corresponds with depolarization and the early part of repolarization

During the later part of repolarization , if the electrical stimulus is stronger

than normal the myocardium can be stimulated to contract
This short period at the end of repolarization is called the relative
refractory period
 Initiation of the electric impulse
• Pacemaker cells will slowly depolarize by themselves and do not
need any outside innervation from the autonomic nervous
system to fire action potentials.
• The resting potential of a pacemaker cell (-60mV to -70mV) is
caused by a continuous outflow or "leak" of potassium ions
through ion channel proteins in the membrane that surrounds
the cells
• In pacemaker cells, this potassium permeability (efflux)
decreases as time goes on, causing a slow depolarization. In
addition, there is a slow, continuous inward flow of sodium
called the funny current
• These two relative ion concentration changes slowly depolarize
(make more positive) the inside membrane potential (voltage) of
the cell, giving these cells their pacemaker potential.
• When the membrane potential gets depolarized to about -40mV
it has reached threshold allowing an action potential to be
generated.
• The sequence of events for pacemaker action potential:
• Automaticity: unlike other cardiomyocytes, pacemaker cells do
not require external stimulation to initiate their action potential;
they are capable of self-initiated depolarization in a rhythmic
fashion. This property is known as automaticity, whereby the
cells undergo spontaneous depolarization and an action
potential is triggered when threshold voltage is reached.
• Spontaneous flow of ions mainly through slow Na+ channels
slowly depolarizes TMP above −60 mV. This is called the funny
current (also known as pacemaker current); it is active at
TMPs of less than −55 mV.
• At TMP −55 mV, T-type Ca2+ channels open and continue slow
depolarization.
• TMP −40 mV is the threshold potential for pacemaker cells. L-
type Ca2+ channels open and depolarize cell to 0 mV, then
overshoot to +40 mV.
Delayed rectifier K+ channels counteract the L-
type Ca2+ channels for a brief plateau phase and
then return the TMP back to −60 mV as
Ca2+ channels close.

Synchronous contraction: all cardiomyocytes

(including pacemaker cells) are electrically
coupled through gap junctions. An action
potential in one cell will cause all neighbouring
cells to depolarize, allowing the heart chambers to
act as a unit.
Refractoriness protects the heart from sustained
contraction (tetany) which would result in sudden cardiac
death

change in serum calcium contraction may alter the

contraction of the heart muscle fibers

change in serum potassium concentration is also

important because potassium affects the normal
electrical voltage of the cell
 ECG(Electrocardiogram)
• ECG is the process of recording the electrical activity
of the heart over a period of time using electrodes
placed over the skin.
• These electrodes detect the tiny electrical changes on
the skin that arise from the heart muscle’s
electrophysiologic pattern of depolarising and
repolarizing during each heartbeat.
• In a conventional 12 lead ECG, 10 electrodes are
placed on the chest and limbs and the heart’s electric
potential is measured from twelve different leads and is
recorded over a period of time (10 sec).
• The graph of voltage versus time is called ECG
P wave : depolarisation of atria
QRS complex: Depolarisation of
ventricles
T wave: repolarisation of ventricles
Further split up:
P: atrial systole contraction pulse
Q: downward deflection preceding
ventricular contraction
R: peak of ventricular contraction
S: downward deflection after
ventricular contraction
T: recovery of ventricles
Recording of the ECG:Leads used:
• Limb leads are I, II, II. Socalled because at one time subjects
had to literally place arms and legs in buckets of salt water.
• Each of the leads are bipolar; i.e., it requires two sensors on the
skin to make a lead.
• If one connects a line between two sensors, one has a vector.
• There will be a positive end at one electrode and negative at
the other.
• The positioning for leads I, II, and III were first given by
Einthoven. Form the basis of Einthoven’s triangle.
 Types of ECG Recordings

Bipolar leads record voltage

between electrodes placed on
wrists & legs (right leg is
ground)
Lead I records between right
arm & left arm
Lead II: right arm & left leg
Lead III: left arm & left leg

Fig 13.23

13-61
 ECG
3 distinct waves are
produced during
cardiac cycle
P wave caused by
atrial depolarization
QRS complex
caused by ventricular
depolarization
T wave results from
ventricular
repolarization

Fig 13.24
13-63
Elements of the ECG:

• P wave
• Depolarization of both atria;
• Relationship between P and QRS helps
distinguish various cardiac arrhythmias
• Shape and duration of P may indicate atrial
enlargement
•QRS complex:
• Represents ventricular depolarization
• Larger than P wave because of greater muscle
mass of ventricles
• Normal duration = 0.08-0.12 seconds
• Its duration, amplitude, and morphology are useful
in diagnosing cardiac arrhythmias, ventricular
hypertrophy, MI, electrolyte derangement, etc.
• Q wave greater than 1/3 the height of the R wave,
greater than 0.04 sec are abnormal and may
represent MI
• PR interval:
• From onset of P wave to onset of QRS
• Normal duration = 0.12-2.0 sec (120-200
ms) (3-4 horizontal boxes)
• Represents atria to ventricular conduction
time (through His bundle)
• Prolonged PR interval may indicate a 1st
degree heart block
T wave:
• Represents repolarization or recovery of
ventricles
• Interval from beginning of QRS to apex of T is
referred to as the absolute refractory period
ST segment:
• Connects the QRS complex and T wave
• Duration of 0.08-0.12 sec (80-120 msec)

QT Interval
• Measured from beginning of QRS to the
end of the T wave
• Normal QT is usually about 0.40 sec
• QT interval varies based on heart rate
 Rule of 300
Take the number of “big boxes” between
neighboring QRS complexes, and divide this into
300. The result will be approximately equal to the
rate

Although fast, this method only works for regular

rhythms.
What is the heart rate?

www.uptodate.com

(300 / 6) = 50 bpm
What is the heart rate?

www.uptodate.com

(300 / ~ 4) = ~ 75 bpm
What is the heart rate?

(300 / 1.5) = 200 bpm

Abnormal ECG Deflection Wave Patterns