Chapter IV

Cardiovascular Physiology (1)

Components of the cardiovascular system heart vascular system blood

Anatomy of the heart

Intercalated discs

Desmosome

Lungs Pulmonory capillaries

Pulmonory circulation

The heart is the pump that propels the blood through the systemic and pulmonary circuits.

Right atrium Right ventricle Systemic circulation

Left atrium Left ventricle

Section A Electrical activity of the heart

types of cardiac muscle

Non-autorhythmic cells
(Cardiac working cells) Contractility Conductivity Excitability
Atrial muscle Ventricular muscle

Autorhythmic cells
Autorhythmicity Conductivity Excitability

Specialized excitatory and conductive muscle

I.Bioelectricity of myocardial cells

1. Bioelectricity of Working Cells

A. Resting potential (RP) -90 mV (K+ equilibrium potential)

Ionic basis: K+ efflux

Factors affecting the membrane potential

Ionic concentration gradients across the cell membrane. Permeability of the membrane to each ion.

B. Action potential (AP)

1
0 0 2 0

Em (mV)
-90 4 0

3
4

Em (mV)
-70

Time (ms)

250

Time (ms)

a. Phase 0 (rapid depolarization phase)

Characteristics:
-90 to +30 mV To last for 1-2ms Vmax: 200-300V/Sec TP: -60-70mV

Ionic basis:
Fast Na+ channel (voltage-gated) Na+ influx Blocker: tetrodotoxin (TTX)

Phase 0
stimulation RP TP Na+ Channels Na+ Influx Na+ EP

Extracellular fluid

Intracellular fluid

b. Phase 1 (rapid early repolarization )

1 Characteristics: +30 to 0 mV To last for about 10 ms Ionic basis: Na+ Channel inactivated, K+ efflux (Itotransient outward current)

Phase 1
Fast Na+ Ch inactivated + K+ Ch activated K+ Efflux Rapid Repolarization

Extracellular fluid

Intracellular fluid

c. Phase 2 (plateau phase )

Characteristics: 2 0 mV To last for 100-150 ms Ionic basis: L-type Ca2+ channel (voltage gated, slow) Ca2+ + Na+ influx Blocker: Mn2+, verapamil Decreased K+ efflux

Phase 2 Ca2+ Ch activated + IK activated Balance between Ca2+ + Na+ influx and K+ efflux Plateau

Extracellular fluid

Intracellular fluid

d. Phase 3 (rapid final repolarization )

Characteristics: 0 mV to -90mV To last for 100-150 ms
3

Ionic basis: L-type Ca2+ channel inactivated, K+ Efflux

Phase 3
Ca2+ Ch inactivated + IK K+ efflux Rapid repolarization

Extracellular fluid

Intracellular fluid

e. Phase 4 (resting phase )

Characteristics:
The membrane potential maintains at RP

Ionic basis:
Eliminate the excess Na+ ,Ca2+
4

Uptake K+
(Na+-K+pump, Na+-Ca2+ exchanger, Ca2+ pump)

2. Bioelectricity of Autorhythmic Cells

Characteristics of autorhythmic cells AP

1. There is a spontaneous depolarization in phase 4. It is the mechanism of autorhythmicity. 2. The repolarization reaches its maximum at the end of phase 3. Maximal repolarization potential, MRP Maximal diastolic potential, MDP

A. Purkinje cells
Characteristics: AP also has five phases. What happened in phases 012, and 3, is the same as that in working cells.

The repolarization reaches its maximum at the end of phase 3. MRP: -90mV.
There is a spontaneous depolarization in phase 4.

Mechanism of spontaneous depolarization in Purkinje cells :

(1) Outward current of K+ (Ik) decreases. (2) Inward current of Na+ (If) increases gradually. (Pacemaker current) (F-type Na+ Ch is different from fast Na+ Ch, its blocker is Cs2+, but not TTX

X: Ik, current of K+ ;

Y: If, Current of Na+

B. Pacemaker cells in SA node

Characteristics: MRP 70mV TP 40mV A slow upstroke in phase 0 (10V/s)

Altitude of depolarization is lower (70mV) Duration of depolarization is longer (7ms)

A fast spontaneous depolarization in phase 4 (0.1V/s) Only three phases:0, 3, 4

0
Em (mV)

0
-40

4
spontaneous depolarization

-80

250

Time (ms)

Ionic basis of AP in SA node cells

Phase 0Inward Ca2+ Current

(L-type Ca2+ Ch)

Extracellular fluid

Intracellular fluid

Phase 3:

Ik: Outward K+ Current

Inactivated Ca2+ current
Extracellular fluid

Intracellular fluid

Phase 4
progressive reduction of Ik Steady increase of inward current of Ca2+ (T-type Ca2+ channel) If (F-type Na+ channel)

II. Electrophysiological Properties of Cardiac Cells

Physiological properties of myocardium Excitability Autorhythmicity

(automaticity)

Electrophysiological

Conductivity Contractility

properties

Mechanical property

1.Excitability
The excitability can be evaluated by threshold intensity or threshold.

A. Periodic changes in excitability during cardiac cycle

(1)Effective refractory period (ERP)
i. Absolute refractory period From the onset of phase 0 to 55mV in phase 3. (no any response) ii. Local response period -55-60mV in phase 3 (local response, no AP)

iii. Effective refractory period

ERP is a period in the cardiac cycle during which a stimulus, no matter how strong, fails to produce a propagated AP.
From the onset of phase 0 to 60mV in phase 3.

(2)Relative refractory period (RRP)

-60-80mV in phase 3

Need a stronger stimulus to evoke an AP

(3)Supranormal period (SNP)

-80-90mV in phase 3 A subthreshold stimulus can evoke an AP

The ERP of the heart is much longer than ARP in skeletal muscle or neuron. The heart unlike skeletal muscle can not be completely tetanized.

The ventricular systole and diastole can occur alternately. It is very important for filling of the ventricles and pumping blood to arteries.

B. Extrasystole and compensatory pause

ERP

(1) Extrasystole (premature contraction)

Concept: it is a contraction of the heart before the time that normal contraction would have been expected. It is caused mainly by ectopic foci (ectopic pacemaker cells) in human.

(2) Compensatory pause

Concept: the interval between the premature contraction and the next succeeding contraction.

2. Autorhythmicity (Automaticity)
Concept: Ability to produce spontaneous
rhythmic self-excitation without

external stimulus is auto rhythmicity.

The autorhythmicity of a tissue or cell can be evaluated by the frequency of the self-excitations.

A. Graded autorhythmicity
SA node:
AV node: AV bundle:

100 /min
50 / min 40 / min

Purkinje cell: 25 / min

B. Normal pacemaker and sinus rhythm

The normal pacemaker is the SA node. The rhythm of the heartbeat controlled by normal pacemaker in the SA node is called sinus rhythm.

C. Latent pacemaker and ectopic pacemaker

A pacemaker elsewhere than the SA node is called a latent pacemaker . When the latent pacemakers become pacemakers controlling the heartbeats, they are ectopic pacemakers or ectopic foci.

3. Conductivity
Concept:
Ability of the cardiac cells to conduct excitation is called conductivity.

A. Specialized conducting system of heart

SA node

Internodal pathways (preferential pathways) AV node AV bundle (bundle of His)

Left and right bundle branches

Purkinje System

B. Conducting of cardiac impulses

SA node Atria

Internodal pathways (preferential pathways)

AV node AV bundle (bundle of His) Left and right bundle branches Purkinje System Ventricles

C. velocity of conduction
Atrial muscle : 0.3m/sec Internodal pathway : 1.0 - 1.2m/sec AV node : 0.02m/sec three functional regions: A-N region N region N-H region Purkinje fibers : 2 4 m/sec Ventricular muscle : 1.0 m/sec

Characteristics of the conducting system

i. The conduction velocity in AV node is slow.

Atrioventricular delay: The delay of impulse conduction through AV node is called AV delay (0.1S).
Physiologic importance: This delay causes the atria to contract before ventricles to contract, which allows the atria to empty their blood into the ventricles before ventricular contraction begins.

ii. Rapid transmission in the Purkinje fibers causes the ventricular muscle fibers to excite and contract almost synchronously.

III. Electrocardiogram
The electrical activity
recorded by electrodes placed

on the body skin on opposite

sides of the heart is known as an electrocardiogram (ECG or EKG).

P wave
It is caused by electrical potentials generated as the atria depolarize before atrial contraction.

QRS complex
It is caused by potentials generated when the ventricles depolarize before their contraction.

T wave
It is caused by potentials generated as the ventricles recover from the state of depolarization.

P-R (P-Q) interval

a. The duration of time between the beginning of the P wave and the beginning of the QRS complex. It indicates the time between the beginning of electrical excitation of the atria and the beginning of excitation of ventricles Normal range: 0.12-0.20s.

b.

c.

Q-T interval
a.The interval from the beginning of the Q wave to the end of the T wave is Q-T interval. b.This interval averages 0.35 second for the normal Q-T interval. c.It corresponds to the time required for complete electrical excitation and recovery of the ventricles.

S-T segment
It is the time from the end of the S wave to the beginning of the T wave. It represents the time when the ventricular fibers are depolarized during the plateau phase of the action potential.

ERP

RS RN PP