THE HEART’S

ELECTROPHYSIOLOGY
Action Potential of the Heart
Action Potential of the Heart
• At resting condition, inner side is more
negative than outer side. This polarity is kept
by the sodium-potasium pump
 Action Potential of the Heart
• Ionic basis of cardiac electrical activity

Ccaused by movement of ions from
outside the cell into the cell or vice
versa. The movement of ions occurs due
to differences of ion concentration
between inner and outer side
Remember !!!
Depolarization is when a cell membrane's
charge becomes positive to generate an
action potential. This is usually caused by
positive sodium and calcium ions going into
the cell.
Repolarization is when a cell membrane's
charge returns to negative after
depolarization. This is caused by positive
potassium ions moving out of the cell.
Phase
Phase00(upstroke,
(upstroke,rapid
rapiddepolarization)
depolarization)
 Under normal conditions, the ventricular
muscle fibers are activated between 60 and
100 times/min by an electrical impulse
initiated by the sinoatrial (SA) node.
 This action allows a rapid inward flow of
Na into the cell through specific Na
channels.
 This process causes the inside of the cell to
become positively charged. The voltage
inside the cell at the end of depolarization
is about 30 mV.
 This electrophysiology event produces a
rapid up-stroke in the action potential
Phase
Phase11(early
(earlyrapid
rapidrepolarization)
repolarization)
• Immediately after phase 0,
the channels for K open
and permit K to flow out
of the cell, an action which
produces an early, but
incomplete repolarization

• (repolarization is slowed
by the Phase 2 influx of Ca
ions).
Phase
Phase22(plateau)
(plateau)
• During this period,
there is slow inward
flow of Ca, which in
turn significantly slows
the outward flow of K.
• The plateau phase
prolongs the
contraction of the
myocardial cells
Phase 3 (fast repolarization)
Phase 3 (fast repolarization)
 The longest phase
 This phase happen when sodium
ions that going out from the cell
more than calcium ions going
into the cell
 During this period, the inward
flow of Ca stops, the outward
flow of K is again accelerated,
and the rate of repolarization
accelerates
Phase
Phase44(Resting
(RestingMembrane
MembranePotential)
Potential)
 During this period, the voltage-sensitive
ion channels return to their pre-
depolarization permeability.

 The excess Na inside the cell (that

occurred during depolarization) and the
loss of K (that occurred during
repolarization) are returned to normal
by the Na and K ion pumps. An
additional Na and Ca pump removes the
excess of Ca from the cell
ELECTROCARDIOGRAM/ECG
TEMPAT PELETAKAN SADAPAN ECG
(PRECORDIAL LEADS)
 INDIKASI MELAKUKAN ECG
• Gangguan irama jantung
• Sesak napas dan nyeri dada
• Dicurigai PJK (penyakit jantung kongenital)
• Hipertensi berat
• Tx: memantau aktifitas obat pada jantung
THE SEGMENTS OF ECG
• P wave : atrial depolarization
• 2. QRS complex : ventricular
depolarization
- Q : septum interventricular
- R : apex
- S : postero-basal
• 3. T wave : ventricular repolarization
• 4. U wave : late ventricular
depolarization
THE REAL ECG READING
Heart Rate
(usually in Lead II)
>100x/ mnt
Normal= Takikardi

60-100x/mnt <60x/ mnt

Bradikardi

1) 1500 2) 300
 small  large