Heart Decks Flashcards
made of desmosomes that connect the cells to each other and gap junctions that allow for the movement of ions
intercalated discs
What are intercalated discs made of?
desmosomes that connect the cells to each other and gap junctions that allow for the movement of ions
What makes the heart behave as a single unit (functional syncytium)?
gap junctionsthey coordinate the movement of ions through the heart
Does cardiac muscle need neuronal stimulation?
no
What are the 2 main types of cells cardiac muscle contains?
cardiac pacemaker cells (aka autorhythmic cells) contractile cardiac muscle cells
these cells make up the intrinsic conduction system of the heart and do not contract
cardiac pacemaker cells (autorhythmic cells)
do cardiac pacemaker cell contract?
no
these cells do contract
contractile cardiac muscle cells
can alter the heart rate but if disconnected the heart still beats
ANS
3 facts about the cardiac pacemaker cells
- do not have stable resting potential 2. set the rhythm 3.form a conduction pathway
Cardiac pacemaker cells: 1. Do not have stable resting potential.
The are always close to threshold with a changing membrane potential (pacemaker potential)
Cardiac pacemaker cells: 2. set the rhythm
they set the rhythm of the heart, they are the pacemaker
Cardiac pacemaker cells: 3. Form a conduction pathway…..
that propagates the action potential of the heart from one area to another
What are the 5 steps of the intrinsic cardiac conduction system in order of propagation.
- sinoatrial (SA) node 2. atrioventricular (AV) node 3. AV bundle (bundle of His) 4. right and left bundle branches 5. subendocardial conduction network (Purkinje fibers)
Intrinsic cardiac conduction system (in order of propagation):located in the right atrium just below the superior vena cava
- sinoatrial (SA) node aka natural pacemaker
Intrinsic cardiac conduction system (in order of propagation):Where is the sinoatrial (SA) node aka natural pacemaker located?
right atrium just below the superior vena cava
Intrinsic cardiac conduction system (in order of propagation):Where does the action potential normally start?
sinoatrial (SA) node aka natural pacemaker
Intrinsic cardiac conduction system (in order of propagation):Where does the action potential go after its start at the sinoatrial (SA) node?
it travels to both atriathe atria contract as a result of this action potential
Intrinsic cardiac conduction system (in order of propagation):The atria contracts as a result of the action potential that starts at the SA node. How many action potential (AP’s) are initiated per minute?
90-100 at rest 75 at rest
Intrinsic cardiac conduction system (in order of propagation):Normally the action potentials from the SA node are about 90-100 per minute whereas at rest they are about 75 per minute, why is this?
because the heart rate is decreased due to the effects of the parasympathetic NS
Intrinsic cardiac conduction system (in order of propagation):located in the lower portion of the interatrial septum. The impules travels via the internodal pathway and is momentarily delayed at this point.
- atrioventricular (AV) node
Intrinsic cardiac conduction system (in order of propagation):Where is the atrioventricular (AV) node located?
in the lower portion of the interatrial septum
Intrinsic cardiac conduction system (in order of propagation):In 2. where does the impulse travel and where is it delayed?
the impulse travels via the internodal pathways and is momentarily delayed at the AV node
Intrinsic cardiac conduction system (in order of propagation):What is the rate of action potentials at the AV node?
50-60 action potentials per minute
Intrinsic cardiac conduction system (in order of propagation):located in the upper portion of the interventricular septum. This part of the conduction pathway connects the atria to the ventricles.
- AV bundle (bundle of His)
Intrinsic cardiac conduction system (in order of propagation):Where is the 3. AV bundle (bundle of His) located?
in the upper portion of the interventricular septum
Intrinsic cardiac conduction system (in order of propagation):What does the 3. AV bundle (bundle of His) connect?
the atria to the ventricles
Intrinsic cardiac conduction system (in order of propagation):located in the respective sides of the interventricular septum, conduct the action potentials from the interventricular septum to the apex of the heart.
- right and left bundle branches
Intrinsic cardiac conduction system (in order of propagation):Where is the 4. right and left bundle branches located?
in the respective sides of the interventricular septum
Intrinsic cardiac conduction system (in order of propagation):Where does the 4. right and left bundle branches conduct action potentials?
from the interventricular septum to the apex of the heart
Intrinsic cardiac conduction system (in order of propagation):branches that are located in the lateral sides of the ventricles, conducts impulses to the ventricles
- subendocardial conduction network (Purkinje fibers)
Intrinsic cardiac conduction system (in order of propagation):Where are 5. subendocardial conduction network (Purkinje fibers) located and where do they conduct impulses?
located in the lateral sides of the ventricles conducts impulses to the ventricles
sometimes there is an extra bundle of cardiac pacemaker cells (an extra node) that can produce occasional extra beats or even take over the SA nodes natural rhythm.
ectopic pacemaker
What triggers the ectopic pacemaker?
caffeine, nicotine, hypoxia, and electrolyte imbalances
Where do the action potentials propegate fastest and then where do they get slower?
fastest from SA node to the AV nodeand then slower after that due to smaller diameter of fibers past AV node
What results from the faster propagation from SA node to AV node then slower after AV node?
atria contracts fully before the ventricles are stimulated to contract
What happens if the SA node quits working?
another node bundle can take over at a lower rate (slower than normal) so then an artificial pacemaker will need to be put in place to return the heart back to a normal higher pace
What is an ECG/EKG?
a means of recording all of the action potentials of the heart
What in our tissues is used for the ECG/EKG?
electrolytes in our tissues carry the charges to the surface where they can be measured
How many leads are used and why?
12 leads each in a slightly different position relative to the heart
What 5 things can the ECG/EKG be used to diagnose?
-if the intrinsic conduction pathway is working -if the heart is enlarged -if the heart is damaged -if there is an electrolyte imbalance -if there are arrhythmias (irregular rhythms)
What does each wave in the tracing represent?
an event
PQRST completion time =
one heart beat
atrial depolarization, the atria usually contracts shortly after the P wave begins (enlarged P indicates enlarged atria)
P wave
What is the P wave?
atrial depolarization
In P wave when does the atria usually contract?
shortly after the P wave begins
What does an enlarged P wave indicate?
enlarged atria
ventricular depolarization; atria repolarization is occurring but is masked, the ventricles contract shortly after the depolarization
QRS complex
What does the QRS complex indicate?
ventricular depolarization
In the QRS complex when do the ventricles contract?
shortly after the depolarization
What is happening with the atria in the QRS complex?
the atria is repolarizing but it’s masked
ventricular repolarization
T wave
What is the T wave?
ventricular repolarization
When an ECG is performed during exercise, increasing the demand for oxygen makes it easier to detect blockages and changes in the tracing.
stress test
Why is an ECG performed during exercise for a stress test?
because increasing the demand for oxygen makes it easier to detect blockages and changes in the tracing
abnormal rhythm, can be too slow or too fast or erratic
arrhythmia (dysrhythmia)
What is arrhythmia (dysrhythmia)?
abnormal rhythm can be too fast, slow, or erratic
too slow (less than 60 bpm)
bradycardia
too fast (greater than 100bpm)
tachycardia
What is bradycardia?
too slow less than 60 bpm
What is tachycardia?
too fast greater than 100 bpm
an interruption in the conduction system, AV block is most common
heart block
What is a heart block?
an interruption in the conduction system
What is the most common heart block?
AV block
What are the 5 types of heart blocks?
1st degree 2nd degree 3rd degree atrial fibrillation (AFib) ventricular fibrillation (VF)
delay in propagation of the action potential from the SA node to AV node, detected as an increase in the P-R interval.
1st degree
1st degree is a delay in the propagation of the action potential from the ___ node to ___ node.
SA to AV node
Where in the interval is the 1st degree block detected?
P-R interval
sometimes the action potential gets to the AV node and sometimes it doesn’t. The ratio of P:QRS is 2:1 or 3:1 or 4:1
2nd degree
What is a 2nd degree heart block?
sometimes the action potential gets to the AV node and sometimes it doesn’t
What is the ratio of P:QRS for a 2nd degree heart block?
2:1, 3:1, or 4:1
complete heart block, the AP ventricles and atria do not contract in the proper sequence
3rd degree
complete heart block
3rd degree
What happens with a 3rd degree heart block?
the AP ventricles and atria do not contract in the proper sequence
cardiac muscle within the atria are not contracting in sync. (This is usually seen as a missing P wave for one heart beat.)
atrial fibrillation (AFib)
What is happening with the cardiac muscles with atrial fibrillation?
the cardiac muscle within the atria are not contracting in sync
How is AFib usually seen?
as a missing P wave for one heart beat
cardiac muscle within the ventricles is not contracting in sync
ventricular fibrillation (VF)
What is ventricular fibrillation (VF)
cardiac muscle within the ventricles is not contracting in sync
Where does the cardiac action potential start and spread?
starts in the SA node and the action potential spreads form one contractile cell to another via gap junctions
What are the 4 key differences between cardiac action potential and the skeletal muscle action potential? (shortened)
- cardiac muscles don’t require outside innervation 2. cardiac muscles contract as an entire unit 3. cardiac action potential typically 15-300 msec 4. very long absolute refractory period
- Why don’t cardiac muscles require outside innervation?
they are self-stimulatory aka they have automaticity or autorhythmicity provided by the pace maker cells
- The cardiac muscles of the heart contract as an entire unit (a functional syncytium) rather than what?
rather than as a motor unit
- How does the cardiac action potential differ from the skeletal muscle action potential?
cardiac action potential = 15 to 300 msec in length skeletal muscle action potential = 1-5 msec in length