RYTHMICAL EXCITATION OF HEART

1. SPECIALIZED EXCITTORY AND CONDUCTION SYSTEM OF HEART

2. CONTROL OF EXCITATION AND CONDUCTION OF HEART
1. СПЕЦИЈАЛИЗИРАН ЕКСЦИТАТОРЕН И СПРОВОДЕН СИСТЕМ НА
СРЦЕТО - This system has two characteristics: self-
generation of rhythmical electrical impulses,
that initiate rhythmical conatractions of
cardiac muscle and fast conduction of impulses
through heart.
- With normally functioning of this system,
atriums contract for 1/6 of second earlier than
contraction of ventricles, contributing for
completely filling of ventricles before its
contraction, and a synchronized contraction of
all parts of ventricles, enabling generation of
effective pressure in ventricles.
- With dysfunction of this system (ischemia),
abnormal rhythm and contractions occur, that
decrease the effectiveness of heart and could
lead to death.
 1.1. SINOATRIAL NODE (SA)
SA node is located in upper, posterior-lateral part od right atrium, nearby below and laterally from opening of vena cava
superior. Its fibbers (thinner than other musculature and al most uncontactable) bind directly to muscle fibers of atrium,
contributing for fast spreading of impulse (generated from it) through atriums.

- The mebrane potential at rest of feibers in SA node is -55 до -60 mV (in ventricle
fibers is -85 до -90 mV), that is result of naturally permeability of these fibers for
Na+ и Са++ (this permeability makes this node self-excitating),neutralized some of
intracellular negativity.
- This potential at rest provokes closing of inactivated gates of fast Na+ voltage gated
channels inside the cell.
- When potential of -40 мV would be reached (due to natural permeability of
membrane for Na+ и Са++), actually, the threshold of stimulus is reached, opening
the slow L-channels of Са++ and an action potential occurs (slowly developing,
with longer duration and slowly return to membrane potential at rest)

Closing of slow L-channels of Са++ after100-150 msec and increasing opening of К+

channels, return potential backward (
repolarization), with hyperpolarization due to condition of prolonged opened К+
channels

With closing of К+ channles, hyperpolarization finishes and self-regenerative process of excitation occurs again, due to natural
permeability for Na+ and Са++.
1.2. INTERNODAL AND INTRAATRIAL PATHWAYS

Action potential of SA node spreads directly

into muscle fibbers of atriums with velocity of
0.3 м/sec

There are specialized conductive fibers that

originate from SA node, but conduct action
potential with velocity of1 м/sec – these are
interatrial pathway that connects both
atriums, and 3 internodal pathways (anterior,
medial and posterior) that connect SA node
with AV node
 1.3. ATRIOVENTRICULAR (AV) NODE
AV node slows down conduction of impulse, obtaining an emptying of atriums before contraction of ventricles.

AV node is located in posterior wall of right atrium, nearby

posterior of tricuspid valve.
AV чвор
- From SA node to AV node, impulse travel for 0.03 sec, but, there is a
slowing down of 0.09 sec in AV node, before its entering in
penetrating part of AV bundle. There is more 0.04 sec slowing down
in this penetrating part (containing small fascicles that pass through
fibrous tissue which separates atriums from ventricles).
- Slowing down or delay in AV node and AV bundle is 0.13 sec.
- From appearing of impulse in SA node to finaly its reaching in
contractile fibers of ventricles, the period of 0.16 sec is necessary

Decreasing of number of tight junctions between celss is the main

reason for slowing down in transitory fibers, AV node and
penetrating part of AV bundle, at the same time, increasing the
resistance of conduction of excitatory ions from one to another fiber.
 1.4. PURKINJE FIBERS
Purkinje fibers have opposite characteristics than fibers of AV node - thicker, longer (than fibers of ventricular musculature), with velocity
of conductance of 1.5-4 м/sec (6 times higher than in ventricular fibers, but 150 times than in AV node) and with promptly spreading of
impulse in ventricles.
The fast conduction is due to high permeability od tight junctions
in intercalated disks (ions pass rapidly through membranes) and
there are almost no contractile myofibrils

AV bundle has two characteristics:

- Action potentials are conducted only toward ventricles (there
is exception in pathological conditions)
- Fibrous ring on the place of AV bundle separates atriums
from ventricles (when there are abnormal fibers that pass out
of AV bundle, re-entry mechanism could occur and impulse
could spread backward in atriums, that could provoke
serious arrythmia).

After entering in interventricular septum, АV bundle divide on left and
right branch that pass under endocardium of septum toward apex of
heart, dividing on smaller branches that pass backward to base of
heart, ending directly on muscle fibers of 1/3 of thickness of myocardium
– this process last 0.03 sec.
The velocity of spreading through ventricle fibers is slower (0.3-
0.5 м/sec), so more 0.03 sec are necessary for depolarization
of all muscle fibers – this is due to double spirals of ventricle
fibers (separated with septum) and impulse spread angularly
(not directly from inside to outside)
1.5. SUMMARY OF SPREADING OF IMNPULSE THROUGH HEART
2. CONTROL OF EXCIATATION AND SPREADING OF IMPULSE THROUGH
HEART
Although all СРЦЕТО
parts of conductive system produce impulses, SA node is pacemaker of
cardiac rhythm due to production of impulses with the highest frequency (60-100
b/miin).

Ectopic pacemaker – pacemaker of heart rhythm could be any other part of

conduction system (AV node, branches of bundle, Pyrkinje fibers), but in some
pathological conditions, ventricular musculature too

If there is block in conduction from atriums in ventricles (AV block), AV node

and AV bundle, the most frequently Purkinje system, take over rhythm in
ventriclesго, so atriums contract with 60-100 b/min (impulses from SA
node), but ventricles contract with15-40 b/min (impulses from Purkinje
system).

After suddenly block of AV bundle, 5-20 sec are necessary for taking over the
rhythm from Purkinje system, due to refractory period of ventricle fibers
from previous impulse from SA node, so, after 4-5 sec without blood in
brain, loss of consciousness happens – Adams-Stokes syndrome.
40-60

If there is any slowing down of impulses through ventricles (that contract

15-40
synchrony due to fast spreading), one part of the musculature would
contract ahead other and effectiveness of ventricles would decrease for 20-
30%.
 2.1. AUTONOMIC NERVOUS SYTEM CONTROLS RHYTMICITY AND CONDUCTION OF IMPULSES
2. AUTONOMIC NERVOUS SYSTEM

A) Sympathic stimulation – increase frequency from 70 to 180-200-250 , како b/min, and increases the ejection fraction and pressure for 2-
3 times, respectively, cardiac output for 2-3 times.
- During inhibition of sympathicus, the pump function of heart decreases for 30% - in normal conditions, there is continuous sending of
sympathic impulses that increase the heart pump function for 30% - sympathetic nerve fibers are distributed the most in ventricle muscles
(although there are few in both nodes)
Б) Parasympathetic stimulation (vagi) – during strong stimulation, the heart stops
(but, after time, ventricular escape occurs with ventricular contractions of 20-40
b/min) and could decrease the force for 20-30 %.
- Vagal fibers are situated mainly in atriums and that is why vagal stimulation
predominantly influence on heart rate
- Combination of strong decreasing of frequency and weak decreasing of
strength of contraction, decrease the ventricular pump function for 50%

INFLUENCE ON HEART sumpathicus parasympathicus

Bathmotropic +
-
Dromotropic + -
Chronotropic + -
Inotropic + -
Tonotropic + -