Last edited: 8/13/2021

1. EXTRINSIC CARDIAC CONDUCTION SYSTEM

Cardiovascular | Electrophysiology | Extrinsic Cardiac Conduction System Medical Editor: Dr. Sofia Centenaro

OUTLINE

I) DEFINITION
II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)
III) SYMPATHETIC NERVOUS SYSTEM (SNS)
IV) REFRACTORY PERIOD
V) REVIEW QUESTIONS
VI) REFERENCES

I) DEFINITION
Definition: The Autonomic Nervous System modifies the
intrinsic Cardiac Conduction and Contractility based on
body’s needs
System Innervation of Heart (SNS & PSNS)

II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)

(A) ANATOMY
1) Anterior Hypothalamus
2) ↑ Cardiac Inhibitory Center in Medulla
3) ↑ Preganglionic Vagus Nerve fibers
4) ↑ Postganglionic Vagus nerve fibers in Intramural
Ganglia
5) ↑ Cervical and Thoracic Cardiac nerves
6) Heart Figure 1. Mechanism of action of SNS and PSNS on nodal cells

(B) FUNCTION
↓Heart Rate III) SYMPATHETIC NERVOUS SYSTEM (SNS)
o ↓Chronotropy (keeps the sinus rhythm)
o slow depolarization → decreased rate of action (A) ANATOMY
potentials (APs) 1) Posterior Hypothalamus
whenever HR< 60 bpm → Bradycardia 2) ↑ Cardioacceleratory Center in the Medulla
3) ↑ Preganglionic Fibers in T1-T5 region of spinal cord
↓Conduction 4) ↑ Postganglionic Fibers in Sympathetic Chain
o ↓ Dromotropy Ganglia
No effect on Contractility 5) ↑ Superior, Middle and Inferior cardiac nerves
6) Heart
(C) INTRACELLULAR MECHANISM OF ACTION
(B) FUNCTION
PSNS fibers
↑ Acetylcholine (Ach) release ↑ Increases Heart Rate
↑ Muscarinic Type 2 receptors activity o ↑ Chronotropy
↑ Gs inhibitory protein activity o more rapid depolarization
↑ dissociation of alpha (𝛼𝛼) subunit from beta (𝛽𝛽) and o → ↑ increased rate of action potentials (Aps)
gamma (𝛾𝛾) whenever HR >100 bpm → Tachycardia
o ↑ beta/gamma activity
 → ↑ binding to K+ channels ↑Increases conduction
 → ↑ K+ efflux o ↑ Dromotropy
 → ↑ hyperpolarization of cells ↑Increases Contractility
 → ↓ AP’s o ↑ Inotropy
 → ↓ HR & ↓Conduction
o ↑ alpha activity
 → ↓ AC activity
 → ↓ cAMP
 → ↓ PKA
 → ↓ phosphorylation of L-type Ca++ channels
 → ↓Calcium influx in nodal cells
 → ↓AP’s
 → ↓HR

Figure 2. Effects of SNS and PSNS on HR

extrinsic cardiac conduction system CARDIOVASCULAR PHYSIOLOGY : Note #1. 1 of 2

 (C) INTRACELLULAR MECHANISM OF ACTION IV) REFRACTORY PERIOD
(1) on nodal cells: During phases 3 and 4 (repolarization and RMP)
SNS fibers absolute, relative, super
↑ release NE and Epi normal heart is resting
↑ 𝛽𝛽1 adrenergic receptor activity 250 ms
↑ Gs protein activity In the relative refractory period if you provide enough
↑ AC activity stimulus to the heart, you can take it out of refraction and
↑ cAMP trigger another action potential – but you want to obey the
↑ PKA absolute refractory period
↑ phosphorylate proteins:
o ↑ phosphorylation of L type Ca++ channels
 → ↑ Calcium influx in nodal cells
 → ↑ depolarization rate
 → ↑ AP’s
 → ↑ HR & ↑Conduction & ↑Contractility
(2) on contractile cells:
SNS fibers
↑ release NE and Epi (from adrenal medulla)
↑ Beta 1 adrenergic receptor activity
↑ CAMP
↑ PKA
↑phosphorylate proteins: Figure 3. Phases of cardiac action potentials in a myocyte
o ↑ phosphorylation of Phospholamban
 → ↑influx of Ca++ back into Sarcoplasmic
V) REVIEW QUESTIONS
reticulum
 → ↑ speed of relaxation Bradycardia occurs when HR is:
• so it can be stimulated again quickly a. < 60 bpm
o ↑ phosphorylation of L-type Ca++ channels b. > 60 bpm
 → ↑ Calcium influx contractile cells c. <100 bpm
 → ↑ Ryr-2 activity d. Equal to 60 bpm
 → ↑ Ca++ in the SR
 → ↑↑ Ca++ released into the sarcoplasm Tachycardia occurs when HR is:
a. > 120 bpm
 → ↑ interactions with troponin
b. < 100 bpm
 → ↑ cross-bridge formation (interaction actin-
c. > 100 bpm
myosin)
d. > 60 bpm
 → contraction rate and speed → ↑ heart pumping
 → ↑ SV → ↑ CO The refractory period lasts about:
a. 150 ms
Definitions: b. 250 ms
Stroke volume (SV) = volume of blood pumped out of the c. 50 ms
ventricle in one heartbeat d. 500 ms
Cardiac Output (CO) = amount of blood pumped out of the
ventricle in one minute Which type of channels are phosphorylated by
stimulation of the SNS?
Remember: a. L- type Ca++ channels
CO = HR x SV b. T- type Ca++ channels
BP = CO x TPR (total peripheral resistance) c. K+ channels
↑HR  ↑CO  ↑BP d. Na+ channels
↓HR ↓ CO  ↓BP
The PSNS can affect the contractility of the heart.
a. True
b. False

The SNS has a positive chronotropic action.

a. True
b. False

During the relative refractory period APs can be

triggered.
a. True
b. False

CHECK YOUR ANSWERS

VI) REFERENCES
• Guyton and Hall, Textbook of Medical Physiology,
Edra, 2021

Figure 1.1. MoA of PSNS & SNS on contractile cells

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