CARDIAC ACTION POTENTIAL
HAMDAN IBRAHIM
The heart has Cardiac Myocytes (muscle cells). The contraction of
these cells is initiated by electrical impulses known as “Action
Potential”
Impulses start from small group of myocytes called Pacemaker cells
and responsibility for initiating & conduction action potential
Various states of membrane action potential and recording of
depolarization and repolarization as waveform.
The movement of ions across the myocardium cell can be
described using two terms :
Depolarization – myocardial contraction
Repolarization – myocardial relaxation
RE polarization = RE laxation
Electrical activity occurs in the body as the result of movement of
positive and negative ions cell
The hearts conduction system produces systolic contraction and
diastolic relaxation of myocardium.
The electrical activity of the heart can be graphically on an
ELECTROCARDIOGRAM (ECG).
4 steps of cardiac conduction
6
Step 1 : Pacemaker Impulse Generation
SA Node contracts, generating nerve impulses travel to the heart cause both
atria contract.
Step 2 : AV node Impulse Conduction
Impulse reach AV Node, delayed for about 0.10 sec to allows atria to
contract and empty blood into the ventricle.
Step 3 : AV Bundle Impulse Conduction
Impulses are carried down the center of the heart to left & right ventricle
Step 4 : Purkinje fibers Impulse Conduction
Impulses reach these fibers & trigger the muscle fibers in the ventricle to
contract
Anatomy of the Action Potential in the heart
Mechanical events of the heart triggered by changes in the
electrical of the cardiac cells.
Under normal circumstances, electric impulse generated
spontaneously via conduction system of the heart
Surface of ECG can be simply described as P,QRS and T waves
and its summation action potential event.
Cells are stimulated by the impulses and electric potential of cell
membrane drastically changed
This change in the membrane potential is termed “action
potential”
EXCITATION-CONTRACTION COUPLING
9
Process by which an electrical action potential leads to
contraction of cardiac muscle cells
Converting a chemical signal into mechanical energy via
the action of “contractile proteins”
Calcium is the mediator couples electrical excitation to
physical contraction by cycling in and out myocytes
cytosol.
10 CONTRACTILE PROTEINS
Main contractile elements:-
a)Myosin – thick filaments contains myosin ATPase
b)Actin –thin filaments
Regulatory elements
a)Tropomyosin – prevents contraction resting state
b)Troponin – have 3 subunits
- troponin T TnT (ties troponin to actin)
- troponin I TnI (inhibits activity ATPase)
- troponin C TnC (binds calcium ions)
11
CALCIUM-INDUCED CALCIUM RELEASE (CICR)
Initial influx of Ca+ into myocytes during phase 2 is
insufficient to trigger contraction
This signal amplified by the CICR mechanism which
triggers much greater.
12
CONTRACTILE CYCLE
Ca+ binds to Tnc – TnI is inhibit – conformational change
tropomyosin
MYOCYTE RELAXATION
Ca+ channels inactivate end of phase 2
Ca+ ions dissociate from TnC
Action potential follows a fixed time and voltage
Changes in cardiac action potential may induce cardiac
arrhythmias
Ion channel Syndrome Arrythmias
Natrium N+ Brugada VF
Natrium N+ Long QT 3 Torsades de Pointes
Kalium K+ Short QT syndrome Atrial arrhythmias
Long QT 1 Torsades de Pointes
Long QT 2
Calcium C+ Cathecolaminergic Bidirectional VT
Ventricular Tachycardia
The action potential in typical cardiomyocytes composed of 5 phases (0-4) , beginning and ending with phase 4
PHASE 0 – Upstroke of rapid depolarization
Voltage gated Na+ channels open reponse to depolarization
Positive feedback mechanism cause fast and step depolarization
Very rapid and it lasts for about 2m/sec (0.002 sec)
PHASE 1 – Early repolarization
Immediately after depolarization
The end of rapid repolarization represented “notch”
K+ ion channel open rapidly repolarize the cell
PHASE 2 – Plateau
C+ ion channel open and excitation contraction coupling process is balance
Correlated with S-T segment on ECG
PHASE 3 – Final rapid repolarization
C+ ion channel close but K+ ion channel remain open
Correlated with T wave on ECG
Prepare cell for new cycle of depolarization
PHASE 4 – Resting membrane
N+ and C+ ions channel are closed
K+ ions channel keeps membrane positive outside and negative charge
inside the cell
17
Thank you
