Describe the electrical conduction of the heart.

SA Node Atrial Muscle AV node Bundle of His

Left & Right Bundle Branches Purkinje Fibers Ventricular
Muscle

What is the function of the SA node?

Sino Atrial node is the pacemaker of the heart because of its
ability to spontaneously generate AP without stimulation.
Which other part of the heart can spontaneously generate AP?
Atrio Ventricular node (AV node), Bundle of His, and the Purkinje
Fibers
Compare the rate of fire between SA node and that of AV node,
Bundle of His, and Purkinje Fibers.
The rate of fire of AV node, Bundle of His, and Purkinje Fibers is
slower than SA node; SA node sets the pace of the heart.
What is the role of AV node and Purkinje Fibers?
They conduct electrical current between Atria and Ventricles; the
Purkinje Fibers specifically branches off AP to all cardiac tissue in
ventricle
Why is there a delay in the conduction at AV-node?

(Why is electrical conduction slowest at the AV node?)

In order for the atria to empty out blood into ventricle
Which part of the heart has a high rate of electrical conduction?
The Purkinje Fibers and Bundle of His

State some characteristics of cardiac muscle.

Striated

(has sarcomere),
Gap Junction)

Nucleated, and Intercalated Disk

(contains

What is an artery?
Blood vessel that carries blood away from the heart
What is a vein?
Blood vessel that blood to the heart
What is the tricuspid valve? What is its function?
Valve between right atrium and right ventricle
It prevents backflow of blood into right atrium
What is the pulmonary semi lunar valve?
Valve between right ventricle and pulmonary artery
What is the bicuspid or mitral valve? What is its function?
Valve between left atrium and left ventricle
It prevents backflow of blood into right atrium

What is the aortic semi lunar valve?

Valve between left ventricle and the aorta
Describe the flow of blood in the heart.
Deoxygenated blood returns to heart via the VENA CAVA
SUPERIOR and VENA CAVA INFERIOR.
Blood enters RIGHT ATRIA, and then flows to RIGHT
VENTRICULE via TRICUSPID VALVE.
Ventricle pushes blood to into PULMANORY ARTERY (or
Pulmonary Trunk) via PULMONARY SEMI LUNAR VALVE
Blood gets oxygenated in the lung, and returns to the heart via
PULMONARY VEIN
Blood enters LEFT ATRIA, and then flows to LEFT VENTRICLE
via MITRAL VALVE (BICUSPID VALVE)
Ventricle pushes blood into AORTA via AORTIC SEMI LUNAR
VALVE.

Name all 12 channels on the cardiac muscle.

Gap Junctions
Ca2+ DHP
Ryanodine ligand gated Ca2+ channels
Norepinephrine Receptors (sympathetic NS)
Acetyl Choline Receptors (PARASYMPATHETIC NS)
Na+ voltage channel
Ca2+ ATPase

Ca2+ /Na+ exchanger

Na+/K+ ATPase
K+ leak channel
Na+ Funny channel
K+ Funny channel
What is an EKG or ECG?
EKG electrocardiogram is a recording of the electrical activity of
the heart made on the surface of the body.
What are 5 things an EKG tells us about the heart?
1.
2.
3.
4.
5.

Heart Rate
Size of heart chambers
If ventricles are damaged
Orientation of the heart in chest
Conduction of excitation between parts of the heart

What are the different components of an EKG?

P wave: atrial depolarization
PR-Interval: conduction time from SA node through Purkinje to
ventricle
QRS-complex: beginning of ventricular depolarization
ST-segment: ventricle completely depolarized
T-wave: ventricular repolarization
QT-interval: beginning of ventricular depolarization to end of
ventricular repolarization

What is the RR interval?

Interval between 2 R waves used to calculate heart rate.

What does the R wave help us detect?

R wave allows us to detect heart arrhythmias
What does the Q wave help us detect?
Q wave is a marker for previous myocardial infarction
For the EKG below each RR interval (1 to 2; 2 to 3; and 3 to 4)
represent a heart rate. Calculate HR for each RR interval?

Answer: Each red box in EKG represents 0.2 seconds

RR interval 1 to 2

4 boxes; 4 x 0.2 = 0.8 seconds;

That means 1 beat/0.8 second.

1 beat
60 second

0.8 second 1 minute

RR interval 2 to 3

75 beats/minute

3 boxes; 3 x 0.2 = 0.6 seconds;

That means 1 beat/0.6 second.

1 beat
60 second

0.6 second 1 minute

RR interval 3 to 4

100 beats/minute

6 boxes; 6 x 0.2 = 1.2 seconds;

That means 1 beat/1.2 second.

1 beat
60 second

1.2 second 1 minute

50 beats/minute

What is a normal heart rate?

60-100 bpm
What is tachycardia? How would the RR interval look like?
Heart rate above 100 bpm; RR interval would be shorter than
normal
What is bradycardia? How would the RR interval look like?
Heart rate below 60 bpm; RR interval would be longer than
normal

Normal EKG, HR = 75 bpm

Tachycardia EKG, HR = 300 bpm, RR interval is shorter than

normal

Brachycardia EKG, HR = 50 bpm, RR interval is longer than

normal

For each of the RR intervals below, state the HR

What is HR if RR interval is 1 block apart? HR = 300 bpm
What is HR if RR interval is 2 blocks apart? HR = 150 bpm

What is HR if RR interval is 3 blocks apart? HR = 100 bpm

What is HR if RR interval is 4 blocks apart? HR = 75 bpm
What is HR if RR interval is 5 blocks apart? HR = 60 bpm
What are the 2 broad groups of cardiac action potentials?
Fast response cells and slow response cells
What are fast response cells?
Cardiac muscle cells that make up the atria and ventricles
What are slow response cells?
SA and AV nodes
What do fast response and slow response refer to?
Rate of depolarization
Compared to skeletal muscle, are cardiac action potential longer
or faster in duration?
Action potential last longer
State all 9 channels are involved in production of cardiac action
potentials and what their functions are?
GAP junction, Ryanodine Ca2+channels, DHP Ca2+ voltage channel,
Na+ voltage channel, Na+ funny channel, K+ leakage channel,
Na+/K+ ATPase, Ca2+ T voltage channel, K+S

For each of the channels involved in production of cardiac action

potentials state their functions?
GAP junction?

Spread depolarization between cardiac myocytes

Na+ funny channel, Na+F?
Found only in SA and AV node, spontaneously open at -40mV
Na+ voltage channel, Na+v?
Everywhere in heart, depolarizes cells
DHP receptor or Ca2+L voltage channel?
Voltage gated channel depolarizes cell
Ca2+T?
Found in SA and AV node - voltage gated calcium channel
Ryanodine Receptor - RyR?
Found in SR of cardiac cell, induce by Ca2+ and is Ca2+ ligand
gated channel.
K+s or delayed rectifying K+ channel?
Contributes to repolarization
K+ leakage channel?
Always open, contributes to RMP
Na+/K+ ATPase?
Maintains chemical gradient of sodium and potassium

Describe the graph of fast response action potential.

Fast response graph has 5 phases Phase 0, Phase 1, Phase 2,
Phase 3, and Phase 4.

Phase 0: Depolarization Voltage Na+ gated channel open

Phase 1: PEAK; Voltage Na+ gated channel closes, and Ca2+
voltage channel open, KS channel open
Phase 2: DHP channel (Ca2+L voltage channel) open, RyR
activated, KS channel open
Phase 3: KS channel still open; DHP channel (Ca2+L voltage
channel) close
Phase 4: KS channel close; RMP

Describe the graph of slow response action potential.

Slow response graph has 3 phases Phase 0, Phase 3, and Phase
4.
Phase 0: (SA & AV node) Ca2+T voltage channel Ca2+L
voltage channel =
Depolarization
Phase 3: KS channel open; DHP channel (Ca2+L voltage channel)
close
Phase 4: RMP

Na+F OPEN

What initiates slow response action potential?

SA and AV nodes
How is the spontaneous generation of slow response action
potential initiated?
Activation of Na+F (Sodium Funny Channel)
Followed by activation of Na+ voltage channel.
What does the depolarization trigger?
Activation of Ca2+T (calcium T type voltage channel) in SA and AV
node
Followed by activation of Ca2+L (calcium L type voltage channelDHP receptor)
What 4 channels are open in slow response action potential when
AP is triggered?
Na+F (Sodium Funny Channel)
Na+ voltage channel
Ca2+T (calcium T type voltage channel)
Ca2+L (calcium L type voltage channel- DHP receptor)
What happens to the concentration of sodium when calcium
levels rise?
Sodium levels diminish

What does the influx of Ca2+ trigger? Why?

Activation of RyR; calcium already in the cell is a ligand for
ryanodine receptors.
Does RyR need ATP to allow calcium in? Why?
No because Ca2+ is moves down its gradient concentration
When Ca2+T and Ca2+L close, what occurs?
Delayed rectifying K+ channels that were open return the cell to
RMP
Why can an action potential be triggered at RMP in slow response
action potential?
RMP is about -50mV, and sodium funny channels can open to
trigger another AP around that voltage
After the slow response action potential is completed, what
happens next?
Cardiac muscle fire FAST RESPONSE ACTION POTENTIALS
What triggers depolarization in fast response action potential?
Spontaneous opening of sodium funny channel and sodium
voltage channels
What occurs at Phase 1 of fast response action potential?
Na+V channels close, KS channel open, Ca2+L open
During Phase 2, why does a plateau exist?
Ca2+ influx balances out the efflux of K+
During Phase 3, why does repolarization occur?
Ca2+L close and KS stays open bringing cell back to RMP

How is RMP maintained in fast response action potential?

K+ leakage channel and Na+/K+ ATPase
What are the 3 mechanism to remove Ca2+?
SR Ca2+ ATPase
Cell membrane Ca2+ ATPase
Na+/Ca2+ exchanger (3 sodium in: 1 calcium out)
When viewing an EKG, state which interval or wave corresponds
to:
Fast response action potential Phase 0 and Phase 1?
QRS complex
Fast response action potential Phase 2?
ST segment
Fast response action potential Phase 3?
T wave

On the fast response action potential graph, what phases

corresponds to ABSOLUTE REFRACTORY PERIOD?
Phase 0 to Phase 3

On the fast response action potential graph, what phases

corresponds to RELATIVE REFRACTORY PERIOD?
Phase 3

Why cant there be spatial or temporal summation for ventricular

contraction?
2 reasons:
1. Long duration of action potential = no temporal summation
2. Excitation of heart is independent of nerve stimulation = no
spatial summation
Which subunit of autonomic nervous system increase heart rate?
Sympathetic NS
Describe how Sympathetic NS stimulates increase in HR?
Norepinephrine/epinephrine binds to 1 receptors
1 receptors activates G protein that stimulates adenylyl cyclase
to produce cAMP
cAMP targets Na+F and Na+V to open longer and sooner =
faster and sustained AP
cAMP also targets PKA which activate DHP (Ca2+L channel) adds
more to depolarization
PKA also targets KS to repolarize cell faster

How can a quick repolarization of the cardiac cell help increase

heart rate?
Shorter absolute refractory period
What increases the contractibility force of the heart rate?
Availability of Ca2+
Describe how parasympathetic NS stimulates decrease in HR?
Acetylcholine binds to M2 receptors
M2 inhibits adenylyl cyclase
M2 also stimulates KS decreasing contractibility force and heart
rate