***By the NAME OF ALLAH***

SA-Node is the pace maker of the heart

What makes the SA-Node the pace maker of the heart?

1) It is leaky to sodium ions (but this is not enough)Æsince other parts of the cardiac
muscle are also leaky to sodium ions.
2) It gives the highest heart beat (the fastest one). Æmajor distinguishing point
3) Slow depolarization(related to point 1)
4) Self-excited

2 4

1 RMP(polarized)Æslight leakage of Na+

2 DepolarizationÆ Na+/Ca++ influx through
slow Na-Ca slow channel
3 Platue(narrow range)ÆNa+/Ca++ influx
through slow Na-Ca slow channel
4 RepolarizationÆK+ outflux

*Cardiac cycle duration*

0.8 second

-50
m.v

-60

t
From this figure we can see :
1) Heart beat rate = 60/0.8= 72 bpm
0.8 S: time between first beat and second beat.

2) The time taken for depolarization and repolarization is shorter than the one required to
reach the threshold .

3) We can reduce the time to reach the threshold by increase the slope (increase the
angle). Slope=tan (α) α: the angle between slope and X-axis.
This happens in cell by:
• Increase the conc. Of Na+.
• Increase the conc. Of Ca++.
• Decrease the conc. Of K+.
Thus, we can increase the heart beat by reducing the time to reach the threshold:
eg: if the time of Cardiac cycle duration = 0.5 then,
Heart beat= 60/0.5=120 bpm.
(This happen by sympathetic stimulation which occurs on fear, running……)

* The normal heart beat in ADULTS ranges from 60-100.

ParaSympathetic: if it is near to 60.
Sympathetic: if it is near to 100.
Both Sympathetic and parasympathetic can be controlled by drugs:
1) Sympathetic: by using sympathagonist .
2) Parasympathetic: by using sympathoantagonist.
To produce parasympathetic control we must:
• Decrease the conc. Of Na+
• Decrease the conc. Of Ca++
• Increase the conc. Of K+
Thus, Cardiac cycle duration will take more time.
* If the heart beat >100 then the patient has Tachicardia.
*If the heart beat <60 then the patient has Bradicardia .

SA-node has its common intrinsic …….. which means if we cut nervous supply either
Parasympathetic or sympathetic SA-node will expert itself without the nervous supply
but it become more faster.

Can AV-node become pace maker?

AV-node is unable to expert is self because it is suppressed by another more active
node(SA), BUT since it is leaky to Na+ but much lower than SA-node , it can become a
pace maker with less activity.
(with slower heart beat 42-55).

Cases of AV-node become pace maker:

1) Sick sinus syndrome
2) Myocardial in fraction.
3) Complete ischemia.(atrioventricular block ,so no communication between atria and
ventricles because of blockage of valves between them.)
4) roumatic fever(can defect SA-node, AV-node, endocardiac cell)

SA-node AV-node

-50

-60
-65

Why we call AV-node latent pacemaker?

From this figure we can see that the RMP of SA-node is not equal to AV-node but the
slope of SA-node will reach the threshold earlier than AV-node because ignition of
stimulant will reach after SA-node the AV-node and then continue to AV-bundle ….. so
AV is supresteared(first to receive) by external stimulation.

What will occur in case of AV-node defection?

Purkinje cell will take the responsibility as pacemaker but the heart beat will be decreased
(20-40) due to very low leakage for Na+, so in this case we must put artificial pacemaker
in right atrium.(and it is very dangerous to expose the patient for x-ray radiations if an
artificial pacemaker is fixed in the human body).

SA- AV-
node node Purkinje fiber
-50

-60
-65
 Ectopic pacemaker
-Ventricular cell’s are not leaky to Na+(because sodium channels are inactivated at it’s
RMP) so it can’t act as a normal pace maker but it will act as an ectopic pacemaker (i.e
outside of its normal route)-‫مھاجرة‬Æ under special conditions(diseases/defects…)

-If we have patient with M.I Æ this will cause ischemia of heart tissues Ælead to death in
3min. Æ because only ventricular fibers will work as an Ectopic pacemaker and this will
cause only contraction of ventricles Æ ventricular fibrillation.

A case in which heart We must apply to him dc-shock

can not relax and (2000 v) to inactivate SA node till
continues to contract it works again normally.
without relaxing.

***we conclude that SA-node/AV-node/AV bundle/purkinje fibers all act as pacemakers

but with different permeabilities to Na+(leakages) so the one with the highest leakage
ability (fastest to reach threshold value) will predominate and act as a main(normal)
pacemaker and the rest will act as latent pacemakers

The end
Mohammad Al-Assaf
Tamer batsh

We congratulate the new daughter “Rayat AL_noor” for prince

Hashim Ibn AL-Hussien

●Correction for sheet#5:

-cell membrane is asymmetrical
-capillary membrane is symmetrical

●Correction for sheet#10:

 -the heart(cardiac muscle fibers) consist of myofibrils of Actin
& Myosine opposite to the Sa-node.