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Physiology of Cardiac Conduction and Contractility: Shoaib Alam

The document summarizes the physiology of cardiac conduction and contractility. It describes the cardiac conducting system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers. It then explains the five phases of the cardiac action potential and the roles of sodium, potassium, and calcium ions in depolarization and repolarization. Finally, it discusses the refractory period and its subdivisions that allow the heart to contract efficiently.

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Uzma Khan
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30 views16 pages

Physiology of Cardiac Conduction and Contractility: Shoaib Alam

The document summarizes the physiology of cardiac conduction and contractility. It describes the cardiac conducting system including the sinoatrial node, atrioventricular node, bundle of His, and Purkinje fibers. It then explains the five phases of the cardiac action potential and the roles of sodium, potassium, and calcium ions in depolarization and repolarization. Finally, it discusses the refractory period and its subdivisions that allow the heart to contract efficiently.

Uploaded by

Uzma Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Physiology of cardiac

conduction and contractility

Shoaib Alam
Cardiac conducting system
• Sinoatrial (SA) node normally generates
the action potential
• The SA node excites the right atrium
(RA), travels through Bachmann’s
bundle to excite left atrium (LA).
• The impulse travels through internodal
pathways in RA to the atrioventricular
(AV) node.
Cardiac conducting
system(cont.)
• From the AV node, the impulse then
travels through the bundle of His
• Right bundle branch (RBB)
depolarizes the right ventricle (RV).
• Left bundle branch (LBB) depolarizes
the left ventricle (LV) and
interventricular septum.
• Both bundle branches terminate in
Purkinje fibers, millions of small fibers
projecting throughout the myocardium.
Pacemaker
• The cells which rhythmically generates
impulses is called as PACEMAKER.
Action potentials and impulse
conduction
• The action potential in typical
cardiomyocytes is composed of 5 phases:
• Phase 0
• Phase 1
• Phase 2
• Phase 3
• Phase 4
Action potentials and impulse
conduction(cont.)
• Phase 4: The resting phase:
• The resting potential in a cardiomyocyte is
−90 mV due to a constant outward leak of
K+ through inward rectifier channels.
• Na+ and Ca 2+ channels are closed at
resting membrane potential
Action potentials and impulse
conduction(cont.)
• Phase 0: Depolarization:
• Na+ channels start to open one by one
and Na + leaks into the cell, further
raising the membrane potential.
• Membrane potential when approaches
from -90 mV to -70 mV, then fast Na-
channels opens leading to rapid
sodium influx depolarizing to 0 mV.
• L-type (“long-opening”) Ca 2+ channels
open when the membrane potential is
greater than −40 mV.
Action potentials and impulse
conduction(cont.)
• Phase 1: Early repolarization:
• Some of the Potassium-channels open,
causing efflux of potassium ion, and which
maintains the membrane potential to 0 mV.
Action potentials and impulse
conduction(cont.)
Phase 2: The plateau phase:
• Ca 2+ from outside enters the cytosol of the muscle cell
through calcium channel(t-tubules and L-type) or calcium/
sodium channels.
• Ca 2+ enters from the sarcoplasmic reticulum within the
cell which is induced by entering of Ca 2+ from outside the
cell & it is called CALCIUM INDUCED CALCIUM
RELEASE.
• Within the cell, Ca 2+ binds to troponin, which in turn
triggers the cross‐bridge binding that leads to the sliding of
actin filaments past myosin filaments.
• The decrease in cardiac permeability for potassium is the
reason for plateau which is because of open calcium
Action potentials and impulse
conduction(cont.)
• Phase 3: Repolarization
• Ca2+ channels are gradually inactivated.
• Potassium channels opens and diffuses
potassium out of the cell.
• Membrane potential returns to normal i.e
-90 mV.
• The pumps involved include Na+-Ca2+
exchanger, Ca2+-ATPase and Na+-K+-
ATPase.
Refractory Period
• Defined as the time from phase 0 until the
next possible depolarization of a cardiac cell.
• Cardiomyocytes have a longer refractory
period than other muscle cells given the long
plateau from slow Ca 2+ channels (phase 2).
• This is a physiological mechanism allowing
sufficient time for the ventricles to empty and
refill prior to the next contraction.
Refractory Period(cont.)
• Absolute refractory period (ARP):
• the cell is completely unexcitable to a new stimulus.

• Effective refractory period (ERP):


• ARP + short segment of phase 3 during which a
stimulus may cause the cell to depolarize minimally
but will not result in a propagated action potential (i.
e. neighbouring cells will not depolarize).
• Relative refractory period (RRP):
• a greater than normal stimulus will depolarize the
cell and cause an action potential.
• Supranormal period:
• a hyperexcitable period during which a weaker
than normal stimulus will depolarize the cells and
cause an action potential.
• Cells in this phase are particularly susceptible to
arrhythmias

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