What do you see?

What do you see?

 Monday – Cardiac Conduction System

Technology Theme

1. All technologies have costs .. Benefits and detriments .

2. We are tools of our tools. Henry David Thoreau
1. Car
2.Mobile Phone
3.Pain pills
4.Food preservatives
Pacemaker Technology
• Is there a downside to pacemakers?
• Health
• Jobs
• Any down side?
Earl Bakken and Medtronic
The Frist Pacemakers - Medtronic
A Medtronic Micra pacemaker
Heart Block …
• Key term: heart block
• Key anatomy: cardiac conduction system
• Key physiology: electrical events precede mechanical events

Other terms: systole vs. diastole, cardiac cycle, stroke volume, heart
rate, cardiac output.
The Conducting System of the Heart.
Sinoatrial
(SA) node

Internodal
pathways

Atrioventricular
(AV) node
AV bundle

Bundle
branches
Purkinje
fibers

a Components of the conducting system.

© 2017 Pearson Education, Inc.
Page 119. Electrical Activity in the Heart
The Conducting System of the Heart.
1 SA node activity and
atrial activation begin. SA node

Time = 0

2
Stimulus spreads across the
atrial surfaces and reaches
the AV node.
AV node

Elapsed time = 50 msec

3
There is a 100-msec delay
at the AV node. Atrial
contraction begins.
AV
bundle

Bundle
branches

Elapsed time = 150 msec

4
The impulse travels along the
interventricular septum within
the AV bundle and the bundle
branches to the Purkinje fibers.

Elapsed time = 175 msec

5
The impulse is distributed by
Purkinje fibers and relayed
throughout the ventricular
myocardium. Atrial contraction
is completed, and ventricular
contraction begins.

Elapsed time = 225 msec Purkinje fibers

b The stimulus for contraction is conducted through the heart in a

predictable sequence of events (steps 1–5).
© 2017 Pearson Education, Inc.
Figure 12-10 An Electrocardiogram. 800 msec
+1

Millivolts
0

ECG rhythm strip

a Electrode placement
for recording a The small P wave accompanies the The QRS complex appears as the The smaller T wave coincides
standard ECG. depolarization of the atria. The ventricles depolarize. The ventricles with ventricular repolarization.
impulse spreads across atria, begin contracting shortly after the
triggering atrial peak of the
contractions. R wave.

b An ECG printout is a strip of graph paper

containing a record of the electrical events
T
monitored by the electrodes. The placement P
of electrodes on the body surface affects the
size and shape of the waves recorded. The
example is a normal ECG. The enlarged Q S
section at right indicates the major compo-
nents of the ECG and the measurements
P–R interval Q–T interval
most often taken during © clinical
2017 analysis.
Pearson Education, Inc.
Figure 12-10a An Electrocardiogram.

800 msec
+1

Millivolts
0

ECG rhythm strip

a Electrode placement for recording

a standard ECG.

© 2017 Pearson Education, Inc.

Figure 12-10b An Electrocardiogram.
The small P wave accompanies the
depolarization of the atria. The impulse
spreads across atria, triggering atrial
contractions.
The QRS complex appears as the The smaller T wave coincides
ventricles depolarize. The ventricles begin with ventricular repolarization.
contracting shortly after the
peak of the
R wave.

b An ECG printout is a strip of graph paper

containing a record of the electrical events
T
monitored by the electrodes. The placement P
of electrodes on the body surface affects the
size and shape of the waves recorded. The
example is a normal ECG. The enlarged Q S
section at right indicates the major compo-
nents of the ECG and the measurements
most often taken during clinical analysis. P–R interval Q–T interval

© 2017 Pearson Education, Inc.

Figure 12-11 The Cardiac Cycle.
Start
a Atrial systole begins:
Atrial contraction forces a small amount of
additional blood into relaxed ventricles.

b Atrial systole ends,

atrial diastole begins

0 100
800
msec msec
msec

Cardiac
f Ventricular
diastole—late: cycle c Ventricular systole—
first phase: Ventricular
All chambers are relaxed. contraction pushes AV
Ventricles fill passively. valves closed but does
370
not create enough
msec
pressure to open
semilunar valves.

d Ventricular systole—second
phase: As ventricular pressure
e Ventricular diastole—early: rises and exceeds pressure
As ventricles relax, pressure in in the arteries, the semi-
ventricles drops; blood flows back lunar valves open
against cusps of semilunar valves and blood is
and forces them closed. Blood flows ejected.
into the relaxed atria.

© 2017 Pearson Education, Inc.

Figure 12-12 Heart Sounds.

Sounds heard Aortic

Valve location valve 120
Semilunar Semilunar
Valve location Pulmonary valves open valves close
Sounds heard valve
90

Pressure
(mm Hg)
60
Left
ventricle

Left AV valves AV valves

30 atrium close open

Left
Sounds heard 0
AV
Valve location S1
valve S2
S4 S3 S4
Valve location Right Heart sounds
AV
Sounds heard
valve “Lubb” “Dupp”

a Placements of a stethoscope for listening to the b The relationship between heart sounds and key events in the cardiac cycle
different sounds produced by individual valves

© 2017 Pearson Education, Inc.