Cardiovascular Physiology
The conducting system of the heart
Fall 2019-2020
Part 3-4
Dr. Khalid Maseer
Properties of the cardiac muscle
❑Cardiac muscle contraction is similar to skeletal muscle
contraction
❑The heart has four basic properties which are essential
for its functioning as the central pump of the CVS.
These are:
1. Autorhythmicity
2. Conductivity
3. Excitability
4. Contractility
1. Autorhythmicity
❑During embryonic development, about 1% of all of the
muscle cells of the heart form a network or pathway
called the cardiac conduction system.
❑This specialized group of myocytes called
Autorhythmic cells.
Autorhythmic Fibers
❑ They have the ability to
spontaneously depolarize (self-
excitable)
❑ Repeatedly generate action
potentials that trigger heart
contractions.
❑ The rhythmical electrical activity
they produce is called
autorhythmicity.
❑ Because heart muscle is
autorhythmic, it does not rely on
the central nervous system to
sustain a lifelong heartbeat.
Autorhythmic Fibers
❑ Autorhythmic cells spontaneously depolarize at a given rate,
some groups faster, some groups slower.
❑ Once a group of autorhythmic cells reaches threshold and starts
an action potential (AP), ions spread through gap junctions of the
Intercalated discs (I) to allows the AP to pass from cell to cell, so
all of the cells in that area of the heart also depolarize.
Autorhythmic Fibers
❑ The self-excitable myocytes that "act like nerves" have
the 2 important roles :
✓ Act as pacemaker within that system: setting the rhythm of
electrical excitation that causes contraction of the heart.
✓ Forming the conduction system: a network of specialized
cardiac muscle fibers that provide a path for each cycle of
cardiac excitation to progress through the heart, and ensures
that cardiac chambers become stimulated to contract in a
coordinated manner
2. Conductivity
❑ Conductivity: Impulses can spread easily between
cardiac muscle fibers.
❑ Yet, conduction in the heart is normally carried out by the
specialized conducting system to ensure the spread of the
excitation wave from the S-A node to all over the heart in
certain pattern.
The conducting system of the heart
Conduction system: Sequence of Excitation
❑ Sinoatrial (SA) node: located in the right atrial wall.
❑ Atrioventricular (AV) node: located in the interatrial septum,
just anterior to the opening of the coronary sinus
❑ Atrioventricular bundle (bundle of His):
✓ Only site where action potentials can conduct from atria to
ventricles due to fibrous skeleton
✓ AV bundle splits into two pathways in the interventricular
septum:
1. Bundle branches which extends through interventricular
septum toward apex
2. Purkinje fibers
Conduction system: Sequence of Excitation
Cardiac Conduction (SA node)
❑ Because it has the fastest rate of
depolarization, the normal
pacemaker of the heart is the
sinoatrial (SA) node, located in the
right atrial wall just below where
the superior vena cava enters the
chamber.
Cardiac Conduction (SA node)
❑The pacemaker cells are characterized by having an
unstable membrane potential. This is the basis for
automaticity. SA node acts as natural pacemaker
✓ Faster than other autorhythmic fibers
❑After firing an action potential, the membrane potential
decreases i.e. the membrane depolarizes gradually from
a basal value of ~ -60mV to a critical firing level of –45
mV. At this level, an action potential is fired and the
cycle is repeated.
❑The gradual depolarization of the S-A nodal cells is
called the pacemaker potential or the prepotential.
Pacemaker Potentials of the Heart
The early part of the pacemaker potential is caused by a decrease in the
permeability of the membrane to K+. The late part is caused by Ca++ influx
through the transient (T-type) Ca++-channels.
Cardiac Conduction (SA node)
❑SA node generates impulses about every 0.6 second, or
100 action potential/minute.
✓ Propagates through atria via gap junctions
✓ Atria contact
❑ Nerve impulses from autonomic nervous system (ANS) and
hormones modify timing and strength of each heartbeat
✓ Do not establish fundamental rhythm
Cardiac Conduction (SA node)
Spontaneous depolarization of autorhythmic fibers in the SA node
firing about once every 0.6 seconds, or 100 action potentials per minute
Cardiac Conduction (AV node)
❑ The action potential generated from the SA
node reaches the next pacemaker by
propagating throughout the wall of the atria
to the AV node in the interatrial septum.
❑ At the AV node, the signal is slowed
approximately 0.1 second, allowing the
atrium a chance to mechanically move blood
into the ventricles.
Cardiac Conduction (Atrioventricular bundle )
❑ From the AV node, the action potential enters the
atrioventricular (AV) bundle. This bundle is the
only site where action potentials can conduct from
the atria to the ventricles.
❑ The A-V bundle conducts impulses only in one
direction. So impulse pass through the AV bundle
to the left and right bundle branches in the
interventricular septum towards the apex of the
heart.
❑ Finally, the Purkinje fibers rapidly conduct the
action potential throughout the ventricles (0.2
seconds after atrial contraction).
❑ Then the ventricles contract, pushing the blood
upward toward the semilunar valves.
Autonomic regulation (sympathetic)
❑ Heart is stimulated by the
sympathetic cardioacceleratory
center .
✓ Noreprinephrine has 2 separate
effects
In SA and AV node speeds rate
of spontaneous depolarization
In contractile fibers enhances
Ca2+ entry increasing
contractility
Autonomic regulation (parasympathetic)
❑ Heart is inhibited by the
parasympathetic
cardioinhibitory center.
✓ Parasympathetic nerves release
acetylcholine which decreases
heart rate by slowing rate of
spontaneous depolarization
3. Excitability
❑Excitability is the ability to respond to stimuli.
❑The resting membrane potential of the contractile fibers
is stable at about – 90 mV. When an effective stimulus is
applied, a propagated action potential is produced in
the cell membrane.
Action Potentials and Contraction
❑ Action potential initiated by SA node spreads out to
excite “working” fibers called contractile fibers.
❑ An action potential occurs in a contractile fiber as
follows:
1. Depolarization
2. Plateau
3. Repolarization
Action Potential of Contractile Cardiac Muscle Cell
Rapid depolarization
❑ Depolarization: It is caused by the rapid influx of Na+ into
the cell.
✓ Unlike autorhythmic fibers, contractile fibers have a stable
resting membrane potential that is close to -90 mV.
✓ When a contractile fiber is brought to threshold by an action
potential from neighboring fibers, its voltage-gated fast Na
channels open.
✓ These sodium ion channels are referred to as “fast” because
they open very rapidly in response to a threshold-level
depolarization.
Rapid depolarization
❑ Opening of these channels allows Na inflow because the
cytosol of contractile fibers is electrically more negative than
interstitial fluid and Na concentration is higher in interstitial
fluid.
❑ Inflow of Na down the electrochemical gradient produces a
rapid depolarization. Within a few milliseconds, the fast
Na channels automatically inactivate and Na inflow
decreases.
Plateau
❑ Plateau, a period of maintained depolarization.
❑ It is due in part to opening of voltage-gated slow Ca2+ channels
in the sarcolemma. The inward movement of Ca2+ and the
decreased efflux of K+ maintain the membrane potential near
zero during this phase of the action potential.
❑ The plateau phase lasts for about 0.25 seconds.
❑ By comparison, depolarization in a neuron or skeletal muscle
fiber is much briefer, about 1 msec (0.001 sec), because it lacks a
plateau phase.
Repolarization
❑Repolarization: due to a reduction of the inward Na+
and Ca2+ currents and a large increase in the
outward K+ current.
❑The membrane goes back to the resting level (- 90 mV).
❑ Na+-K+ pump works to drive the excess Na+ out and
the excess K+ in.
Differences between pacemaker and contractile cells
❑ The pacemaker action potential differs from the action
potential of the contractile myocardial cells in the
following:
❑ Depolarization phase is mainly due to Ca2+ influx through
long-lasting (L-type) Ca2+-channels.
❑ Depolarization phase is relatively slow to develop.
❑ There is no plateau phase. Repolarization immediately
follows depolarization.
Differences between pacemaker and contractile cells
VENTRICULULAR SAN
CELL
1
2
0 0
MEMBRANE POTENTIAL (mV)
0 3
0 3
-50 -50 4
-100 -100
Refractory periods
❑ In muscle, the refractory period is the time interval during which
a second contraction cannot be triggered.
❑ The refractory period of a cardiac muscle fiber lasts longer than
the contraction itself. As a result, another contraction cannot
begin until relaxation is well under way.
❑ This means that the ventricle would not respond to any stimulus
until it finishes with its systole and have some diastole.
❑ So refractory period protects the ventricle against tetnization if it
receives multiple successive stimuli.
Refractory periods
4. Contractility
❑Contractility is the ability of the muscle to
convert the potential energy into mechanical
energy.
ATP Production in Cardiac Muscle
Cardiac muscle relies almost exclusively on aerobic cellular
respiration in its numerous mitochondria.
The needed oxygen diffuses from blood in the coronary
circulation and is released from myoglobin inside cardiac
muscle fibers.
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