Conduction of Impulses in the heart Flashcards

1
Q

What is unique about the heart’s nervous supply?

A

it exhibits autorhythmicity it triggers its own impulse from the SA node which will cause contraction independent of the wider nervous system

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2
Q

where does the excitation of the heart normally originate?

A

The sinoatrial SA node which is located in the right upper atrium where the superior vena cava enters the heart

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3
Q

when is the heart said to be in sinus rhythm?

A

when the heart beat is being controlled by the sinoatrial node

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4
Q

what is the resting membrane potential of the pacemaker cells in the SA node?

A

The pacemaker cells have no stable resting potential, they generate regular spontaneous pacemaker potentials

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5
Q

How is an action potential fired in the pacemaker cells of the SA node?

A

The pacemaker potential increases until the membrane potential reaches a threshold and an action potential is fired

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6
Q

The SA node generates

A

regular spontaneous action potentials

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7
Q

what is the pacemaker potential?

A

the slow depolarisation of a membrane potential to a threshold

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8
Q

the pacemaker potential is due to

A
  • decrease in K+ efflux
  • Na+ influx (the funny current)
  • transient Ca2+ influx (T-type channels)
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9
Q

What causes repolarisation of the SA node?

A
  • L-type Ca2+ channels are inactivated

- K+ channels are activated causing K+ efflux

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10
Q

How does cardiac excitation normally spread across the heart?

A
  • SA node
  • cell-to-cell conduction through the atria and to the AV node (although there are a few internodal pathways)
  • AV node to the bundle of His
  • Down the left and right fibres of the bundle to the Purkinje fibre
  • Purkinje fibres deliver the excitation to the ventricles
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11
Q

How does cell-to-cell spread of excitation occur?

A

The excitation spreads between cells through the desmosomes and the gap junctions

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12
Q

What it the atrioventricular AV node?

A
  • small bundle of specialised cardiac cells

- the only point of electrical conductivity between the atria and ventricles

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13
Q

Where is the AV node?

A

The base of the right atrium just above the atrioventricular junction

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14
Q

Why is conduction delayed in the AV node?

A
  • the cells are small in diameter and have slow conduction velocity
  • to allow atrial systole to precede ventricular systole
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15
Q

What is the resting membrane potential of the cardiac myocytes?

A

-90mV until the cell is excited

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16
Q

What causes depolarisation of the cardia myocytes?

A

fast Na+ influx

17
Q

What is Phase 0 of action potential in contractile cardiac muscle cells?

A

The rapid rising phase of the action potential, from -90mV to +20mV

18
Q

what are the phases of ventricular muscle action potential?

A
  • Phase 0 (fast Na+ influx)
  • Phase 1 (closure of Na+ channels and transient K+ efflux)
  • Phase 2 (mainly Ca++ influx)
  • Phase 3 (closure of Ca++ channels and K+ efflux)
  • Phase 4 (resting membrane potential)
19
Q

What is the Plateau Phase of Ventricular muscle action?

A
  • a unique characteristic of contractile cardiac muscle cells
  • it’s mainly due to the influx of Ca++ through L-type Ca++ channels balancing the efflux
20
Q

What causes repolarisation in cardiac muscle cells?

A
  • the inactivation of Ca++ channel and activation of K+ channels resulting in K+ efflux
21
Q

What is the part of the nervous system which influences heart rate?

A

The autonomic nervous system

22
Q

What is the effect of sympathetic stimulation on heart rate?

A

it increases heart rate

23
Q

What is the effect of parasympathetic stimulation on heart rate?

A

it decreases the heart rate

24
Q

What is the influence of the autonomic nervous system on heart rate under resting conditions?

A
  • vagus nerve (parasympathetic) exerts continuous influence on the SA node under resting conditions
  • vagal tone is dominant
  • slows the intrinsic heart rate from ~100bpm to normal resting heart rate of ~70 bpm
25
Q

What is considered normal heart rate?

A

Between 60 and 100 bpm

26
Q

What is bradycardia?

A

resting heart rate less than 60bpm

27
Q

What is tachycardia?

A

resting heart rate more than 100bpm

28
Q

What effect does the vagal nerve have?

A
  • supplies the SA and AV node
  • slows heart rate
  • increases AV nodal delay
29
Q

What is the mechanism of the parasympathetic effect on heart rate?

A
  • acetylcholine acting through muscarinic M2 receptors
30
Q

What effect does atropine have?

A

It is a competitive inhibitor of acetylcholine, so is used to speed up the heart rate in extreme bradycardia

31
Q

How does vagal stimulation effect the pacemaker potential?

A

it has a negative chronotropic effect - the slope of the potential decreases and hence it takes longer to reach the threshold

32
Q

What effect does sympathetic stimulation have on the heart?

A
  • sympathetic nerves supply SA node, AV node and the myocardium
  • increases heart rate
  • decreases AV nodal delay
  • increases force of contraction
33
Q

What is the neurotransmitter of the sympathetic supply?

A

noradrenaline acting on B1 adrenoreceptors

34
Q

What is the effect of noradrenaline in pacemaker potential?

A

Positive chronotropic effect

Slope of pacemaker potential increases, threshold is reached quicker

35
Q

Phases of action potential in a cardiac pacemaker myocyte

A
  • Phase 0 (Ca++ influx) not as steep as ventricular muscle action
  • Phase 3 (repolarisation)
  • Phase 4 (pacemaker potential)
36
Q

What is special about the refractory period of the heart?

A

Tetanic contraction isn’t possible each contraction of the heart is completely independent