HEART PHYSIOLOGY

(ARRYTHMIAS)
BY
DR. MUDASSAR ALI ROOMI (MBBS, M. PHIL)
Assistant Professor Physiology
ARRYTHMIAS
Definition of arrythmia:
variation from the normal
rhythm of the heart beat,
encompassing abnormalities
of the rate, regularity, site of
impulse origin and sequence
of activation.
There are two main types of
arrythmias:
1. Normotropic arrythmias:
when SA node is still the
pacemaker of heart.
2. Ectopic arrythmias: when SA
node is no more the
pacemaker of heart.

ARRYTHMIAS
NORMOTROPIC ARRYTHMIAS
SINUS TACHYCARDIA
SINUS BRADYCARDIA
SINUS ARRYTHMIAS
ECTOPIC ARRYTHMIAS
HEART BLOCKS:
SA nodal BLOCKS
AV nodal BLOCKS(1
st
,2
nd,
3
rd

degree).
EXTRASYSTOLE ( atrial, AV
nodal and ventricular).
PAROXYSMAL TACHYCARDIA
( atrial, AV nodal, ventricular ).
OTHERS ( atrial flutter, atrial
fibrillation, ventricular
fibrillation).
SINUS TACHYCARDIA
Normal heart rate
(normocardia) = 60-100
beats/min.
In this case heart rate is
greater than 100 beats/min
Causes:
Exercise (physiological)
emotional states (physiological)
anxiety (physiological)
hyperthyroidism (pathological)
Epinephrine
Sympathetic stimulation
(physiological)
Atropine (anticholinergic drug)
Increased body temperature
e.g. fever (pathological)

Calculate the heart rate by the
formulae:
HR = 1500 ss/no. of smallest squares
between two successive R waves.
(OR)
HR= 300 big squares/ no. of big
squares b/w two successive R waves.

SINUS TACHYCARDIA (cont..)
Effect of temperature on heart rate: With each degree Fahrenheit, heart rate
increases by 10 beat/min (18 beat/min for each degree Celsius) upto 105 F.
beyond 105 F, the heart rate may decrease because of progressive debility of the
heart muscle as a result of the fever.
MECHANISM: Fever causes tachycardia because increased temperature increases
the rate of metabolism of the sinus node, which in turn directly increases its
excitability and rate of rhythm.

increased temperature
Increase in the rate of metabolism of the sinus
node
Increase in excitability
SINUS BRADYCARDIA
It means a slow heart rate usually
less than 60 beats /min.
Causes of sinus bradycardia:
Bradycardia in athletes (physiological)
***
Carotid sinus syndrome (pathological)
Vagal stimulation such as during
vomiting,
cholinergic drugs e.g. pilocarpine.
Hypothyroidism (pathological)
hypothermia,
severe depression, (pathological)
raised intracranial pressure
(pathological)
In some infections e.g. enteric fever
(typhoid fever) there is relative
bradycardia.***
Antiadrenergic (propranolol)

Calculate the heart rate by the
formula:
HR = 1500/no. of smallest
squares between two successive
R waves.

SINUS BRADYCARDIA (cont..)
Bradycardia In athletes:
Cardiac output (C.O) =
stroke volume (S.V)*
heart rate (H.R).
In athletes, there is
physiological hypertrophy
of heart (forceful heart).
stroke volume (SV) is
permanently increased.
So, at rest the cardiac
output is maintained at
5.5 L/min by decreasing
heart rate.

SINUS BRADYCARDIA (cont..)
Carotid sinus syndrome:
In some individuals if we
apply slight pressure on
carotid sinus, it causes
bradycardia.
It is due to arteriosclerosis
or calcification of carotid
sinus which increases the
sensitivity of baroreceptors
and thus causing
bradycardia.
When we perform carotid
massage there is slowing
of heart rate.

SINUS ARRHYTHMIA
It is a physiological
condition i.e.
heart rate increases during
inspiration and
decreases during expiration.
This variation of heart rate
becomes more marked
during deep breathing.
This variation can be
recorded by
cardiotachometer.

SINUS ARRHYTHMIA
(cont..)
Mechanism of sinus arrythmia: it
involves three possible mechanisims:
1. There is spread of excitation from the
inspiratory neurons to nearby
vasomotor center to increase heart
rate during inspiration.
2. Impulses from stretch receptors in
the lungs go to vasomotor centre to
increase heart rate when lungs
expand during inspiration.
3. Bainbridge reflex: during inspiration
there is more negative intrathoracic
pressure, so venous return increases
to the right atrium. Impulses
originate from the low pressure
stretch receptors in the wall of atria
and large vessels and these impulses
go along the sensory fibers in vagus
nerve to vasomotor centre to
increase heart rate during
inspiration.