Electrical Properties of the Heart drsherwanshal@gmail.

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The Conducting System of the Heart Cardiac muscle cells, like other electrically excitable cells such as neurons and skeletal muscle fibers, have a resting membrane potential (RMP). The RMP depends on a low permeability of the cell membrane to Na+ and Ca++ ions and a higher permeability to K+ ions.

The Conducting System of the Heart It is a network of specialized cardiac muscle cells that (1) initiates and (2) distributes electrical impulses. It is composed of the following: • 1- Sinoatrial (SA) node, • 2- Atrioventricular (AV) node, • 3- Conducting cells,

1- Sinoatrial (SA) node, located in the junction between SVC and posterior wall of Rt atrium. 2- Atrioventricular (AV) node, located in the membranous part of interventricular septum. 3- Conducting cells, which interconnect the two nodes and distribute the contractile stimulus throughout the

AP is the reverse of RMP and it is the change in the permeability of the cell membrane that produces AP. The differences in AP between myocardium and skeletal muscle fibers are: (A) AP in cardiac muscle last longer (200-500 milli-seconds to complete) than in skeletal muscle cells (2 milli-seconds). (B) AP in skeletal muscle fibers is conducted along the length of a single muscle fiber and not from fiber to fiber, whereas ion cardiac muscle

Action Potentials (AP)

• Also the rate of AP propagation is slower in cardiac muscle than in skeletal muscle because cardiac muscle cells are smaller in diameter and much shorter than skeletal muscle fibers. Although the gap junction of intercalated disks allows transfer of AP between

(D) In contrast to skeletal muscle fibers, cardiac muscle cells contract on its own, in the absence of any neural or hormonal stimulation. This property is called “Automaticity” or Autorhythmicity. (E) The resting potential of a ventricular contractile cell is approximately -90 mV,

Autorhythmicity of Cardiac Muscle:
• The heart is said to be autorhythmic because it stimulate itself (auto) to contract at regular intervals (rhythmic). • If the heart is removed from the body and maintained under physiologic conditions with proper nutrients and temperature, it will continue to

• In the sino-atrial (SA) node, specialized cardiac muscle cells, called pacemaker cells, generate AP spontaneously and at regular intervals. • These AP spread through the conducting system of the heart to other cardiac muscle cells, causing voltage-gated Na+ ion channels to open. • As a result, AP are produced and the cardiac muscle cells contract.

• The generation of AP in SA node results when a spontaneous developing local potential, called prepotential, reaches threshold. • The prepotential is caused by changes in ion movement into and out of

• Unlike other cardiac muscle cells, the movement of Ca++ ions to the pacemaker cells is primarily responsible for the depolarization phase of the AP. • Repolarization occurs, as in other cardiac muscle cells, when the voltage-gated Ca++ ion channels close and the voltage­ gated K+ ion channels open. • After the RMP is reestablished, production of prepotential starts the generation of a next AP.

An AP begins when the membrane of the ventricular muscle cell is brought to threshold, usually at about -75 mV. • Threshold is normally reached in a portion of the membrane next to an intercalated disc. • The typical stimulus is the excitation of an adjacent

Step 1: The stage of rapid depolarization in cardiac muscle cell resembles that in skeletal muscle fiber. At threshold, voltage-regulated sodium channels open and the membrane suddenly becomes permeable to Na+. The result is rapid depolarization of the sarcolemma. The channels involved are called “fast channels”, because they open quickly and remain open fore only few milliseconds.

Step 2: The plateau: As the transmembrane potential approaches +30 mV, the voltage-regulated sodium channels close. They will remain close and inactivated until the membrane potential reaches -60 mV. As the sodium channels are closing, voltage regulated

• These channels are called “slow calcium channels” because they open slowly and remain open foe a relatively long period. This portion of AP curve is called the plateau. • The presence of a plateau is the major difference between APs in cardiac muscle cells and skeletal muscle fibers. In skeletal muscle fibers, rapid depolarization is

Step 3: Repolarization: As the plateau continues, slow calcium channels begin closing and slow potassium channels begins opening. The result is a period of rapid repolarization that restores the resting AP.

The refractory period (The

period of unresponsiveness): As with skeletal muscle conduction, for same time after an AP begins the membrane will not respond normally to a second stimulus. This time is called

In the absolute RP, the

membrane cannot respond at all, because the sodium channels are either already open or closed and inactivated. In a ventricular muscle cell, the absolute RP lasts approximately 200 msec, spanning the duration of the

The absolute RP is followed by a shorter (50 msec) relatively RP. During this period, the voltage-regulated sodium channels are closed but can open. The membrane will respond to a stronger-than-normal stimulus by initiating another AP.

Note that:
I: Features of cells of conducting system: 2. Smaller in size than the contractile cells. 3. Contain very few myofibrils. 4. Cannot maintain a stable resting potential. II: Rate of spontaneous depolarization differs in different areas of the conducting system of the heart: At SA node is about 80 to 100 beat per minute (contraction). At AV node 40 to 60 beat per minute

• III: SA node is regarded as a natural or cardiac pacemaker. • IV: The RMP for the SA cells is around -60 mV, so they can be more easily stimulated since they are in more critical state than other cells of the conducting system of the heart, and this is part of the explanation why these cells have automatic discharge of AP (Autorhythmicity).

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