Nerve supply to heart

ambiguus
Nerve supply to heart
• Sympathetic innervation
• Parasympathetic innervation

Origin of sympathetic nerves supplying heart

Intermediolateral horn of spinal segments T1-T5

Distribution of sympathetic innervation in heart

All parts of heart receive sympathetic innervation

In atria,
• Sympathetic innervation on the right side is distributed primarily
to the SA node

• Sympathetic innervation on the left side is distributed primarily

to the AV node
Origin of parasympathetic (vagal) nerves supplying heart
Nucleus ambiguus in medulla oblongata

Distribution of parasympathetic innervation in heart

Right vagus nerve is distributed mainly to SA node

Left vagus nerve is distributed mainly to AV node

Effect of sympathetic stimulation on heart

increase in force of cardiac contraction (+ve ionotropic effect)
increase in heart rate (Positive chronotropic effect)

Effect of parasympathetic stimulation on heart

Decrease in heart rate (negative chronotropic effect)
Resting heart is predominantly under vagal control

Properties of cardiac muscles

• Excitability
• Autorhythmicity
• Conductivity
• Contractility

Excitability
Ability of a tissue to give response to a stimulus

Stimulus
Action potential
Physiological action in the form of contraction
Phases of action potential of cardiac muscles
• A rapid depolarization
• Initial repolarization
• Plateau
• Final repolarizattion
Resting membrane potential of heart muscles
SA node: -55 to -60 mV
Ventricular muscles: -85 to -90 mV

Autorhythmicity
Ability of a tissue to produce its own impulse at a regular interval

Rhythmicity of different parts of the heart

SA node: 70 - 80/min
AV node: 40 – 60/min
Atrial muscles: 40 – 60/min
Purkinje fibers: 35 – 40/min
Ventricular fibers: 20 – 40/min
Conductivity
Ability to transmit impulse from one place to another
The conductive system of heart comprises

Conductive tissues of the

heart= junctional tissues
Contractility
Ability of a tissue to shorten in length after receiving a stimulus

Pacemaker
Structure in the heart that generates impulses for heartbeat

In human heart, SA node acts as a pacemaker

However, AV node, bundle of His and Purkinje system can

function as pacemakers

SA node
A small strip of modified cardiac muscle situated in the superior
part of lateral wall of right atrium, just below the opening of
Superior venacava

Features of muscle fibers in SA node

Do not possess contractile elements
These fibers are continuous with fibers of atrial muscle, so that the
impulses from SA node spread rapidly thru the atria

Why is SA node called pacemaker of the heart?

The rate at which SA node fires (generate impusles) determines the
heart rate
An impulse originating in SA node spreads thruout the heart by
means of the conduction system and results in sequential
contraction of different chambers of the heart
Before an impulse from AV node or any other part of the conduction
system can initiate an impulse, the next impulse from the SA node is
discharged because its rate of firing is the highest
Conductive system of heart
Velocity of impulses at different
parts of conductive system
SA node = 0.05 m/s

Internodal pathways = 1 m/s

Atrial muscle = 0.30 m/s

AV node = 0.05 m/s

Bundle of His = 1m/s

Purkinje fibers = 4 m/s

Ventricular muscle = 0.3 to 0.5 m/s

Electrocardiogram (ECG/EKG)
Record or graphical registration of the electrical activities of the
heart.
Electrocardiograph
Instrument(machine) by which electrical activities of the heart
are recorded

Electrocardiography
Technique by which electrical activities of the heart is recorded

Recording of ECF
By placing electrodes on the arms and legs (limb leads) and at six
positions on the chest (chest leads)
Uses of ECG
To determine if the conducting pathway is abnormal
To determine if the heart is enlarged
To determine if certain regions of the heart are damaged
To determine the cause of chest pain
Amplitude of ECG waves
Denoted by horizontal lines
Interval between two thick lines (5 mm) = 0.5 mV
Interval between two thin lines (1mm) = 0.1 mV

Duration of ECG waves

Denoted by vertical lines
Interval between two thick lines (5mm) = 0.2 sec
Interval between two thin lines (1 mm) = 0.04 sec

Waves of ECG
P wave
QRS complex
T wave
P wave
First wave of ECG
Small upward deflection on the ECG

Cause of P wave
Due to depolarization of atrial muscles

Duration of P wave