Cardiovascular physiology

Origin of the Heartbeat and the Electrical

Activity of the Heart

Dr Muma
 Objectives
• After studying this chapter, you should be able
to:
– Describe the structure and function of the
conduction system of the heart
– Describe the action potential of the heart
– Describe the normal ECG
– Name the common arrhythmias
Histology of Cardiac Muscle Tissue
 The Conducting System
(Autorhythmic Fibers)

Internodal pathway
• A network of specialized
SA node AV node
cardiac muscle fibers that
provide a path for each Bundle
Of His
cycle of cardiac excitation
Bundle
to progress through the branches
heart.
– These are self-excitable
• Repeatedly generate
action potentials
• Ensures heart chambers
are stimulated to contract
in a coordinated manner.
Purkinje fibers
 Sequence of action potential conduction
1. SA node (located in right
atrium)
– Cells of SA node have unstable
resting potentials
– They repeatedly depolarize
triggering action potential
– Each action potential from SA
node propagates throughout both
atria and causes them to contract
2. AV node
– Action potential from SA node
conducts through the atrial
(internodal pathway) to reach the
AV node
3. AV Bundle ( bundle of His)
– From AV node the action potential
enters the bundle of His
– This is the only site where action
potention can conduct from atria to
ventricles.
4. Bundle branches
– Extend into the interventricular
septum towards the apex
5. The Purkinje fibers
– Rapid conducting of action
potential occurs in these fibers
– Contraction starts from the apex
upward pushing blood towards the
semilunar valves
 Action Potential and Contraction of
Contractile Fibers
• Action potential is
initiated by SA node and
spread to the rest of
cardiac fibers
(contractile fibers)
• Contractile fibers have
stable resting
membrane potential
close to -90 mV
 Action Potential and Contraction of
Contractile Fibers
Phases of Action Potential
1. Depolarization phase
– When contractile fibers are
stimulated to threshhold
• The voltage-gated fast Na+
channels open
• This leads to influx of Na+
• Na+ influx produces rapid
depolarization
– Within few milliseconds the
Na+ channels inactivates and
Na+ influx decreases
2. Plateau phase
3. Repolarization phase
 Action Potential and Contraction of
Contractile Fibers
2. Plateau phase
– This is a period of maintained
depolarization. It is due to:
1. Opening of voltage-gated slow
Ca2+ channels
• Influx (inflow) of Ca2+ ions
• More Ca2+ ions released from
sarcoplasmic reticulum
• This results in contraction of the
muscles
2. Opening of voltage-gated K+
channels
• This leads to K+ efflux (outflow)
• Because Ca2+ influx balances K+
efflux the depolarization is maintained
3. Repolarization phase
 Action Potential and Contraction of
Contractile Fibers
3. Repolarization phase
– This is a period of recovery
of resting membrane
potential. It is due to;
1. Additional voltage-gated
K+ channels
• The efflux (outflow) of K+ ions
restores the negative resting
membrane potential
2. Calcium channels are
closing which also
contributes to the
repolarization
Refractory period
• Time interval during which a second contraction cannot be triggered
• The refractory period for the cardiac muscle lasts longer than the contraction
• This is beneficial. It means that tetanus can not occur in cardiac muscle.
 Electrocardiogram
(ECG or EKG)
• Action potentials generate
electrical currents that can
be recorded on the surface
of the body
• An ECG is a recording of
these electrical signals
– it is a record of all action
potentials produced by the
heart during each heartbeat.
– An instrument used to record
these changes is called an
electrocardiograph
 Electrocardiogram
(ECG or EKG)
• By careful examination
of the ECG we are able
to determine
1. if the conducting
pathway is abnormal
2. if the heart is enlarged
3. if certain regions of the
heart are damaged
4. Cause of the chest pain
 ECG Waves
• P wave
– First wave of the ECG
– Represents atrial
depolarization
• QRS complex
– Represents rapid
ventricular depolarization
• T wave
– Represents ventricular
repolarization
 Common Arrhythmias
• Arrhythmias simply • Ventricular tachycardia
means abnormal • Ventricular fibrillation
rhythm of the heart.
• Normal heart rate is 60
– 90 beats/min
• Slow rate is bradycardia
• Fast rate is tachycardia
• Atrial fibrillation
Thank you.