Electrical properties of the Heart – Lecture PPYT (10/30/19)

Pericardium
- Thin sac that surrounds the heart
- Parietal and visceral pericardium
- Attached to diaphragm, sternum and vertebrae
- Main function: to make the heart stay in its position even if there is activity (contraction of the heart)
- In between parietal and visceral pericardium is a small amount of fluid (50 to 150 mL) → Pericardial fluid
- Pericardial fluid: filled with phospholipids; important in preventing or diminishing friction while the heart is in activity;
protection against infection

Four chambers of the heart

- L and R atrium
- L and R ventricle
o Left ventricle is bigger and thicker than that of the R ventricle because it has to produce a lot of pressure in order
to push the blood into the peripheral circulation
o Right ventricle is thinner because it has to bring the blood to the lungs for oxygenation (lungs: low pressure type of
circulation)
- The chambers are guarded by the valves
o Left: Aortic and Mitral valve
o Right: Tricuspid and Pulmonary valve
 The clinical valvular areas will be different to the anatomical valvular areas

When you stimulate your excitable cells, we have two responses to stimulation:
- Electrical response
o ECG – shows the electrical activity of the heart as taken from the surface of the body (electrical response of the
heart)
- Mechanical response
o Events that will happen in systole (contraction) and diastole (relaxation period of heart)

Types of cells in the heart:

- Conducting cells
o Purkinje fibers – responsible for the initiation of the electrical event or action potential
o Sinoatrial node
- Contractile cells
o Actively contracting cells
o Responsible for the pumping action of the heart
o Cardiac muscle, cardiac myocyte

Automaticity
- Spontaneous generation of action potential
o This potential is expressed by conducting cells – SA node, Atrioventricular (AV) node, Purkinje fibers
o Spontaneous: we don’t need any outside stimulus in order to initiate the action potential
o Action potential exhibited by the cell would be much shorter in duration and slower
- Ion channels responsible for the different phases of your slow response action potentials are:
o Selective
o voltage sensitive
o Time-dependent

Different phases of action potential: Slow Response Action Potential (SRAP)

- Phase 4: resting membrane potential
o Occurs right after phase 3 of the previous action potential
o No straight line – primarily because of opening of special channels which allow sodium to enter the cells
 o Pre-potential → joined by another group of Ca ions before it reaches the threshold potential → which is due to the
opening of transient Ca channels
o When it reaches the threshold potential, these channels will close and only the Ca channel will remain open to
cause the depolarization or phase 0
- Phase 0: depolarization phase
o Due to the opening L-type calcium channels – allow calcium to go inside which causes depolarization
- Phase 3: repolarization phase
o After depolarization, calcium channels start to close
o Potassium channels open, allowing the efflux of K from cell causing the downslope or repolarization phase
o K channels do not close easily – some of them are still open or they will remain open until the equilibrium potential
is reached
- Note: Even if they exhibit automaticity, or capability to initiate action potential, it can be modified by certain factors:
presence of drugs, stimulation of autonomic NS

Two branches of Autonomic NS

- Sympathetic stimulation
o there is a change in the slope in the RMP
o Instead of a long line, it is shorter and steeper slope for RMP
o Depolarization and repolarization phase
o Conc: Faster heart rate
- Parasympathetic stimulation (violet line)
o Slope is much longer
o “mas tulog siya”
o Conc: Slower heart rate

Sympathetic Activity
- Increases the firing of the SA node through your B1 Adrenergic receptors
- If you use β-adrenergic agonist
o Agonist: substance which will mimic the effect of the substance which you find intracellularly
o Adrenergic: Increase in sympathetic activity = increase in heart rate
 RECALL:
 Muscarinic: parasympathetic receptor
 Antagonist: substance that will block or propel the action of the drug
o Hypokalemia – increase sympathetic response = increase heart rate

Parasympathetic Activity
- Vagus nerve
- Decreases the firing rate of SA node, decreasing the heart rate
- We can use the β-blockers to block the effect of the receptor = decrease in heart rate
- Hyperkalemia = decrease heart rate

Why is SA node the primary pacemaker?

- If the other cells in the conducting system will be firing beyond their natural firing rate, what will happen is that it will
increase will increase Na/K ATPase activity hyperpolarizing the cell
o SA node will be left alone which will cause the SA node to fire alone (Overdrive Suppression)

NOTE: Atrioventricular Septum – separates the atrium and ventricle

Atrioventricular Node (AV Node)

- The only portion which separates the atrium from the ventricle
- The only normal conducting pathway from SA node to ventricle
- “AV delay”
o Delay is important in order to assure that the ventricles are already filled before it will contract
o Enough time for ventricular volume in order to have sufficient cardiac output
 - Presence of AV node will limit the number of atrial cells conducted from atrium to ventricle
o “ayaw ng masyadong mabilis”

Summary: Slow Response Action Potential Characteristics

- No constant RMP
- Depolarization: Calcium influx
- Repolarization: Potassium efflux
- Refracting period is time-dependent
o Time-dependent: Conducting cells even if they are in their normal state, they should
wait for some more time before you can stimulate again
o Hindi ibig sabihin na nakabalik na siya sa normal state niya, pwede niyo na siya i-
stimulate agad.. Maghintay.

Fast Response Action Potentials

- Exhibited by ventricular muscles
- During the RMP:
o Potassium channels are open
o Sodium and Calcium channels are closed

Phases of Fast Response Action Potentials:

- Phase 0: Depolarization phase
o Opening of the voltage-gated sodium channel
o Sudden influx of Sodium into the cell
o Maximum rise of upstroke reflects the magnitude of sodium conductance into your cell
o “Mas maraming sodium, mas mabilis, mas mataas yung upstroke”
- Phase 1: Initial Repolarization Phase
o Some of the potassium channels will open so that the there would be an efflux of some of the potassium ions
which causes downstroke
o Downstroke = slight repolarization
- Phase 2: Plateau
o Opening of the calcium channels resulting to the influx of Ca
 Some potassium channels will open to produce the repolarization → opening of calcium channels
 Some potassium channels will remain open with the potassium exiting the cell
 We have initially for the plateau, more calcium entering the cell than potassium exiting the cell
- Phase 3: Rapid Repolarization
o After the plateau phase, the calcium channels now will start to close
o There will be more potassium exiting the cell, then calcium will get inside the cell → returning the cell into its RMP
- Phase 4: Resting Membrane Potential
o Due to permeability to potassium
 Summary: Fast Response Action Potential Characteristics
- RMP: Due to permeability to potassium
- Depolarization: Opening of sodium channels causing sodium to enter the cell
- Repolarization (Initial): Inactivation of sodium channels but opening of potassium channels
- Plateau: Calcium channels open; “calcium producing phase”
- Repolarization (Rapid): Inactivation of calcium channels, opening of more potassium
channels
- Back to RMP phase

Fast Response Action Potential: observed in ventricular muscles

Slow Response Action Potential: conducting cells, SA node
Ions responsible for each phase of action potential: Sodium, Potassium, Calcium

Refractoriness
- The inability to respond to another stimulus
- Refractory period: From the upstroke until the RMP
- Absolute refractory period: period where no amount of stimulus strength will elicit another response
o Contraction phase of skeletal muscle: way beyond the absolute refractory period
o If I will re-stimulate this muscle, I will get another contraction which can be summated or added to the previous
contraction (seen in Tetanus)
o Cardiac myocyte: fast response action potential; contraction period is overlapping the absolute refractory period
 Reason why you cannot re-stimulate your cell, and have another contraction to summate the previous
one
 You cannot tetanize your cardiac muscle because of the absolute refractory period
- Why is there a period of refractoriness?
o Because the ion channels have not yet recovered from the previous activity
o Fast response action potential: ion channels are voltage-dependent
 If they’re able to go back to their normal state, you can re-stimulate them
o Slow response action potential (conducting cells): they still need time before re-stimulation even if they have
gone to their normal or basal state
- Absolute refractory period: Time where you cannot re-stimulate because the conducting cells need some more time before
having another action potential → Effective Refractory Period
o Some of the channels (sodium and calcium) will be opened but if you stimulate them, we get a local response and
not a propagated response

Arrythmia
- Irregular heartbeat of cardiac
- Normal: 60-100 bpm

Summary: Electrophysiologic Properties of Cardiac Tissues

- Automaticity: spontaneous generation of the action potential
- Excitability: ability to respond to stimulus by generating an action potential
- Refractoriness: following an action potential, the cell is unable to initiate another due to the
inactivation of the ion channels
o “after the event, pagod na”
- Conduction: spread of the impulse from cell to cell
o Cardiac muscle
- Rhythmicity: spontaneous depolarization and repolarization that happens repeatedly and in
a stable manner

Note: Unidirectional flow of impulses (atrium to ventricle)