ABIA STATE UNIVERSITY UTURU

PMB…………..

A REPORT ON

THE ELECTRIC ACTIVITY OF THE HEART

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 Table of Contents

INTRODUCTION .......................................................................................................................... 3

1.0 How the Heart Beats ........................................................................................................ 3

2.0 Electrical Activity of the Heart ........................................................................................ 4

3.0 Heart Conduction Disorders ............................................................................................. 6

3.1 Bundle Branch Block.................................................................................................... 6

3.2 Heart Block arrhythmia ............................................................................................... 7

3.3 Long QT Syndrome (LQTS) ...................................................................................... 10

REFERENCES ............................................................................................................................. 12

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INTRODUCTION
In the simplest terms, the heart is a pump made up of muscle tissue. Like all muscle, the heart
needs a source of energy and oxygen to function. The heart's pumping action is regulated by an
electrical conduction system that coordinates the contraction of the various chambers of the heart.

1.0 HOW THE HEART BEATS

The heart beats when an electrical stimulus is generated by the sinus node (also called the
sinoatrial node, or SA node). This is a small mass of specialized tissue located in the right upper
chamber (atria) of the heart. The sinus node generates an electrical stimulus regularly, 60 to 100
times per minute under normal conditions. The atria are then activated. The electrical stimulus
travels down through the conduction pathways and causes the heart's ventricles to contract and
pump out blood. The 2 upper chambers of the heart (atria) are stimulated first and contract for a
short period of time before the 2 lower chambers of the heart (ventricles).

The electrical impulse travels from the sinus node to the atrioventricular node (also called AV
node). There, impulses are slowed down for a very short period, then continue down the
conduction pathway via the bundle of His into the ventricles. The bundle of His divides into right
and left pathways, called bundle branches, to stimulate the right and left ventricles.

Normally at rest, as the electrical impulse moves through the heart, the heart contracts about 60
to 100 times a minute, depending on a person's age.

Each contraction of the ventricles represents one heartbeat. The atria contract a fraction of a
second before the ventricles so their blood empties into the ventricles before the ventricles
contract. (johnhopkinsmedicine.org, 2019)

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2.0 Electrical Activity of the Heart
The parts of the heart normally beat in orderly sequence: Contraction of the atria (atrial systole)
is followed by contraction of the ventricles (ventricular systole), and during diastole all four
chambers are relaxed. The heartbeat originates in a specialized cardiac conduction system and
spreads via this system to all parts of the myocardium. The structures that make up the
conduction system are the sinoatrial node (SA node), the internodal atrial pathways, the
atrioventricular node (AV node), the bundle of His and its branches, and the Purkinje system.
The various parts of the conduction system and, under abnormal conditions, parts of the
myocardium, are capable of spontaneous discharge. However, the SA node normally discharges
most rapidly, with depolarization spreading from it to the other regions before they discharge
spontaneously. The SA node is therefore the normal cardiac pacemaker, with its rate of discharge
determining the rate at which the heart beats. Impulses generated in the SA node pass through
the atrial pathways to the AV node, through this node to the bundle of His, and through the
branches of the bundle of His via the Purkinje system to the ventricular muscle. Each of the cell
types in the heart contains a unique electrical discharge pattern; the sum of these electrical
discharges can be recorded as the electrocardiogram (ECG). (Accessmedicine, 2019)

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Diagrams of the heart's electrical system (Fig. 1, 2, 3)

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The cardiac conduction system is a group of specialized cardiac muscle cells in the walls of the
heart that send signals to the heart muscle causing it to contract. The main components of the
cardiac conduction system are the SA node, AV node, bundle of His, bundle branches, and
Purkinje fibers. The SA node (anatomical pacemaker) starts the sequence by causing the atrial
muscles to contract. From there, the signal travels to the AV node, through the bundle of His,
down the bundle branches, and through the Purkinje fibers, causing the ventricles to contract.
This signal creates an electrical current that can be seen on a graph called an Electrocardiogram
(EKG or ECG). Doctors use an EKG to monitor the cardiac conduction system's electrical
activity in the heart. (Medlineplus.gov.us, 2019)

3.0 Heart Conduction Disorders

Rhythm versus conduction

Heart rhythm is the way the heart beats. Conduction is how electrical impulses travel through the
heart, which causes it to beat. Some conduction disorders can cause arrhythmias, or irregular
heartbeats.

Three common conduction disorders are:

3.1 Bundle branch block

Normally, electrical impulses travel down the right and left branches of the ventricles at the same
speed. This allows both ventricles to contract simultaneously. But when there’s a “block” in one
of the branches, electrical signals have to take a different path through the ventricle. This detour
means that one ventricle contracts a fraction of a second slower than the other, causing an
arrhythmia.

Symptoms and diagnosis

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A person with bundle branch block may experience no symptoms, especially in the absence of
any other problems. In such cases, bundle branch block is usually first identified by testing for
some other reason, such as a routine physical. An electrocardiogram (EKG or ECG) reveals
bundle branch block when it measures the heart’s electrical impulses.

Treatment

Often, no treatment is required for bundle branch block. But regular checkups are necessary.
This is because a doctor will have to monitor the condition to make sure that no other changes
occur.

3.2 Heart block arrhythmia

In cases of heart block, the electrical signals that progress from the heart’s upper chambers (atria)
to its lower chambers (ventricles) are impaired. When those signals don’t transmit properly, the
heart beats irregularly.

There are several degrees of heart block.

1. First-degree heart block

First-degree heart block occurs when the electrical impulse moves through the heart’s AV node
more slowly than normal. This usually results in a slower heart rate. The condition may cause
dizziness or lightheadedness, or it may cause no symptoms at all. First-degree heart block may
not require specific treatment.

Certain medications can cause first-degree heart block as a side effect. Eg.:

Digitalis: This medication is commonly used to slow down the heart rate. If it’s taken in high
dosages or for a long period, digitalis can cause first-degree heart block.

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Beta blockers: These drugs inhibit the part of the nervous system that speeds up the heart. This
can have the side effect of delaying electrical conduction within the heart, which can cause first-
degree heart block.

Calcium channel blockers: Among their other effects, calcium channel blockers can slow down
the conduction within the heart’s AV node, resulting in first-degree heart block.

2. Second-degree heart block

Second-degree heart block occurs when electrical signals from the heart’s upper chambers (atria)
don’t reach the lower chambers (ventricles). This can result in “dropped beats.”

Symptoms of second-degree heart block include:

 Chest pain

 Fainting (syncope)

 Heart palpitations

 Breathing difficulties, such as shortness of breath (during exertion)

 Rapid breathing

 Nausea

 Excessive fatigue

 Second-degree heart block can be classified in two ways:

Mobitz Type 1: Commonly referred to as Wenckebach block , Mobitz Type 1 may not cause
noticeable symptoms. Still, it can be a forerunner for the more serious type of second-degree
heart block, Mobitz Type 2.

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Mobitz Type 2: In this type of second-degree heart block, the heart doesn’t beat effectively. It
impacts the heart’s ability to pump blood throughout the body. Often, a pacemaker is necessary
to ensure that the heart will continue to beat regularly and efficiently.

3.0 Third-degree heart block

Third-degree, or complete, heart block means that electrical signals can’t pass at all from the
heart’s upper chambers (atria) to its lower chambers (ventricles). In the absence of electrical
impulses from the sinoatrial node, the ventricles will still contract and pump blood, but at a
slower rate than usual. With third-degree heart block, the heart does not contract properly, and it
can’t pump blood out to the body effectively.

Symptoms for third-degree heart block include:

 Chest pain

 Fainting (syncope)

 Dizziness

 Excessive fatigue

 Shortness of breath

Heart conditions can cause third-degree heart block, as can certain medications in extreme cases.
An injury to the heart’s electrical conduction system during surgery can also cause third-degree
heart block.

People with third-degree heart block require immediate medical attention. Their irregular and
unreliable heartbeats heighten the risk of cardiac arrest.

A temporary or permanent pacemaker is used to treat third-degree heart block, providing a

carefully timed electrical impulse to the heart muscle.

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3.3 Long QT Syndrome (LQTS)
Long QT Syndrome, also called LQTS, is a disorder of the heart’s electrical system, like other
arrhythmias.

In LQTS, the lower chambers of the heart (ventricles) take too long to contract and release. The
gap of time needed to complete a cycle can be measured and compared to normal averages.

The name for the condition comes from letters associated with the waveform created by the
heart’s electrical signals. The interval between the letters Q and T defines the action of the
ventricles. Hence, Long QT Syndrome means that time period is too long, even if by fractions of
a second.

An occasional prolonged QT interval can be precipitated by everyday circumstances, including:

 When startled by a noise

 Physical activity or exercise

 Intense emotion (such as fright, anger or pain)

In these instances, the heartbeat usually regains its normal contraction rhythm quickly.

 Both hereditary and acquired

LQTS can be hereditary, appearing in otherwise healthy people. (Although this happens
infrequently.) When this occurs, it usually affects children or young adults.

Some people acquire LQTS, sometimes as a side effect of medications. It’s also possible for
someone to have both the hereditary and acquired forms of LQTS.

Medications that can cause LQTS

Several types of medications can cause LQTS, including:

 Antihistamines and decongestants

 Diuretics (such as potassium or sodium)

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  Certain antibiotics

 Antiarrhythmic medicines (meds that regulate heartbeat)

 Antidepressant and antipsychotic medicines

 Cholesterol-lowering medicines

 Certain diabetes medicines

Symptoms of LQTS

People with LQTS may not have any symptoms. Those who do may experience:

 Fainting (syncope)

 Fluttering in the chest

 Abnormal heart rate or rhythm (arrhythmia)

Studies of otherwise healthy people with LQTS indicate that they had at least one episode of
fainting by age 10. The majority also had a family member with LQTS.

Unexplained fainting episodes or a family history of heart-related death may warrant

electrocardiogram (EKG or ECG) testing.

Consequences of LQTS

Some arrhythmias related to LQTS are potentially fatal and can cause sudden cardiac arrest.
Deafness may also occur with one type of inherited LQTS. In some cases, exercise can bring
about fatal arrhythmias in those with LQTS.

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Treatment for LQTS

Treatment options for LQTS include:

 Medications, such as beta blockers

 Surgical procedures

 Implantable cardioverter defibrillator (ICD) or pacemaker. (Heart.org, 2019)

REFERENCES
Hopkinsmedicine (n.d.) Anatomy and Function of the Heart's Electrical System, Johns Hopkins Medicine
Health Library, [online] Available from: https://www.hopkinsmedicine.org/health/conditions-and-
diseases/anatomy-and-function-of-the-hearts-electrical-system (Accessed 16 April 2019).

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Medlineplus (n.d.) Cardiac conduction system - Health Video: MedlinePlus Medical Encyclopedia,
MedlinePlus, U.S. National Library of Medicine, [online] Available from:
https://medlineplus.gov/ency/anatomyvideos/000021.htm (Accessed 16 April 2019).

Heart.org https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/conduction-disorders

(n.d.) Conduction Disorders, www.heart.org, [online] Available from: https://www.heart.org/en/health-

topics/arrhythmia/about-arrhythmia/conduction-disorders (Accessed 16 April 2019).

Accessmedicine (n.d.) Ganong's Review of Medical Physiology, 25e, AccessMedicine, [online] Available
from: https://accessmedicine.mhmedical.com/content.aspx?bookid=1587 (Accessed 16 April 2019).

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