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Electrical conduction in the

Heart
• The Sinoatrial node (SA node), is a group of autorhythmic cells (main
pacemaker of the heart) in the right atrium near the entry of the superior
vena cava.
• An internodal pathway connects the SA node to the atrioventricular
node (AV node), a group of autorhythmic cells found near the floor of
the right atrium.
• From the AV node action potentials move into fiber known as the
bundles of his or atrioventricular bundle. The bundle passes from the
AV node into the wall of the septum between the ventricles.
• A short way down the septum the bundle divides into left and right
bundle branches.
• These fibers continue downward to the apex where they divide into many
small purkinje fibers that spread outward among the contractile cells.
• If the electrical signals from the atria were conducted directly
into the ventricles, the ventricles would start to contraction at
the top. Then the blood would be squeezed downward and
trapped at the bottom of the ventricle.

• The apex to base contraction squeezes blood toward the
arterial opening at the base of the heart.

• The AV node also delays the transmission of action
potentials slightly, allowing the atria to complete their
contraction before the ventricles begin their contraction.
This AV node delay is accomplished by slowing conduction
through the AV node cells.
Electrocardiogram (ECG)
• Composite of all action potentials of nodal and
myocardial cells detected, amplified and recorded
by electrodes on arms, legs and chest
ECG
• P wave
– SA node fires, atrial depolarization
– atrial systole
• QRS complex
– atrial repolarization and diastole (signal
obscured)
– AV node fires, ventricular depolarization
– ventricular systole
• T wave
– ventricular repolarization
Normal Electrocardiogram (ECG)
Electrical Activity of Myocardium
1)atria begin to
depolarize
2) atria depolarize
3)ventricles begin to
depolarize at apex;
atria repolarize
4)ventricles depolarize
5) ventricles begin to
repolarize at apex
6) ventricles repolarize
Diagnostic Value of ECG
• Invaluable for diagnosing abnormalities in
conduction pathways, MI, heart
enlargement and electrolyte and hormone
imbalances
ECGs, Normal & Abnormal

No P waves
ECGs, Abnormal

Arrhythmia: conduction failure at AV node

No pumping action occurs
Cardiac Cycle
• One complete contraction and relaxation
of heart
• Atrial systole
• Atrial diastole
• Ventricle systole
• Ventricle diastole
• Quiescent period
Principles of Pressure and Flow
• Measurement: compared to force
generated by column of mercury (mmHg)
- sphygmomanometer
• Change in volume creates a pressure
gradient

• Opposing pressures
– always positive blood
pressure in aorta, holds
aortic valve closed
– ventricular pressure must
rise above aortic pressure
forcing open the valve
Heart Sounds
• Auscultation - listening to sounds made by
body
• First heart sound (S1), louder and longer
“lubb”, occurs with closure of AV valves
• Second heart sound (S2), softer and
sharper “dupp” occurs with closure of
semilunar valves
• S3 - rarely heard in people > 30
Phases of Cardiac Cycle
• Quiescent period
– all chambers relaxed
– AV valves open
– blood flowing into ventricles
• Atrial systole
– SA node fires, atria depolarize
– P wave appears on ECG
– atria contract, force additional blood into
ventricles
– ventricles now contain end-diastolic
volume (EDV) of about 130 ml of blood
Isovolumetric Contraction of
Ventricles
• Atria repolarize and relax
• Ventricles depolarize
• QRS complex appears in ECG
• Ventricles contract
• Rising pressure closes AV valves
• Heart sound S1 occurs
• No ejection of blood yet (no change in
volume)
Ventricular Ejection
• Rising pressure opens semilunar valves
• Rapid ejection of blood
• Reduced ejection of blood (less pressure)
• Stroke volume: amount ejected, about 70 ml
• SV/EDV= ejection fraction, at rest ~ 54%, during
vigorous exercise as high as 90%, diseased heart <
50%
• End-systolic volume: amount left in heart
Isovolumetric Relaxation of
Ventricles
• T wave appears in ECG
• Ventricles repolarize and relax (begin to
expand)
• Semilunar valves close (dicrotic notch of
aortic press. curve)
• AV valves remain closed
• Ventricles expand but do not fill
• Heart sound S2 occurs
Ventricular Filling
• AV valves open
• Ventricles fill with blood - 3 phases
– rapid ventricular filling - high pressure
– diastasis - sustained lower pressure
– filling completed by atrial systole
• Heart sound S3 may occur
Major Events of Cardiac Cycle

• Quiescent period
• Atrial systole
• Isovolumetric
contraction
• Ventricular
ejection
• Isovolumetric
relaxation
• Ventricular filling
Rate of Cardiac Cycle
• Atrial systole, 0.1 sec
• Ventricular systole, 0.3 sec
• Quiescent period, 0.4 sec
• Total 0.8 sec, heart rate 75 bpm
Overview of Volume Changes
End-systolic volume (ESV) 60 ml
Passively added to ventricle
during atrial diastole 30 ml
Added by atrial systole 40 ml
Total: end-diastolic volume (EDV) 130 ml
Stoke volume (SV) ejected
by ventricular systole -70 ml
End-systolic volume (ESV) 60 ml
Both ventricles must eject same amount of
blood
Unbalanced Ventricular
Output
Unbalanced Ventricular
Output
Cardiac Output (CO)
• Amount ejected by each ventricle in 1
minute
• CO = HR x SV
• Resting values, CO = 75 beats/min x70
ml/beat = 5,250 ml/min, usually about 4 to
6L/min
• Vigorous exercise ↑ CO to 21 L/min for fit
person and up to 35 L/min for world class
athlete
• Cardiac reserve: difference between
maximum and resting CO
Diastole and Systole
• Diastole - the time during which cardiac muscle relaxes.
• Systole - the time in which cardiac muscle is contracting.

I - The Heart at Rest : Atrial and Ventricular Diastole
– While both atria and ventricles are relaxing, the atria begin filing with
blood from the veins while the ventricles have just completed a
contraction
– As the ventricles relax the AV valves between the atria and ventricles
open, and blood flows from the atria to the ventricles.
II - Completion of Ventricular Filling : Atrial Systole
– The last 20% of the filling of the ventricles is accomplished when the atria
contract. Atrial systole begins following depolarization of the SA node.
– Atrial contraction can aid filling of the ventricles in stenosis of the AV valves.
– The force of atrial contraction can also push blood back into the vein. This can
be observed by the pulse in jugular vein of a normal person lying w/ the head
and chest elevated about 30 degrees. If there is an observable jugular pulse
higher on the neck of a person sitting upright, it is indication that the pressure in
the atria is higher than normal.

III- Early Ventricular Contraction and the 1st Heart Sound
– Ventricular Systole begins at the apex of the heart as spiral bands of muscle
squeeze the blood upward toward the base. Blood pushing upward on the
underside of the AV valve forces them closed so that blood cannot flow back
into the atria.
– Vibrations following closure of the AV valves creates the 1st heart sound, the
“lub” of “lub-dup”.
IV - The heart pumps: Ventricular Ejection
– As the ventricles contract, they generate enough pressure to open the semilunar
valves and the blood is pushed into the arteries.
– The pressure created by ventricular contraction becomes the driving force for
blood flow.

V - Ventricular Relaxation and the 2nd Heart Sound
– As the ventricles begin to relax, ventricular pressure decreases.
– Once ventricular pressure falls below the pressure in the arteries blood starts to
flow backward into the heart. This backflow fills the cusps of the semilunar
valves, forcing them together into the closed position.
– The vibrations of the semilunar valve closure is the 2nd heart sound, the “dup” of
“lub-dup”.
– The AV valves open once the pressure in the ventricles falls below the pressure in
the atria and the cycle starts again.