CHAPTER I

INTRODUCTION
A. Background
The cardiovascular is a system that responsible for transporting nutrients and
removing gaseous waste from the body. This system is comprised of the heart and the
circulatory system. Structures of the cardiovascular system include the heart, blood vessels,
and blood.
The cardiovascular system permits blood to circulate and transport nutrients (such as
amino acids and electrolytes), oxygen, carbon dioxide, hormones, and blood cells to and
from cells in the body to nourish it and help to fight diseases, stabilize body temperature and
pH, and to maintain homeostasis.
The circulation will be successfully happens if heart functioned as a pump (pulsatile
pump). Good condition of heart pumps if:
1. If the valve works well
2. Atrium and ventricle filling are optimum
3. Strength of contraction is optimum
4. The frequency is normal, atrium and ventricle contraction alternately
changes.
As we know, heart has four chambers, two at the top (the atrium) and two at the
bottom (the ventricles). Heart has cone-like-shape and it determined in two parts. The first
basis cordis (base), the second one, apex cordis (apex).
Heart is consists of the smallest functional units called cells and they are combine, to
forming muscles. In common with other muscle tissue, the heart muscle cell membrane is an
excitable membrane (self-excitable or auto-rhythmic), it is capable of transmitting an action
potential. Also in common with other muscle tissue, the depolarisation is due to the opening
of the fast sodium channels. These cells generate an action potential that spreads throughout
the myocardium, causing the heart to contract as a single unit.
As we discuss about heart, we also know that heart has four properties. Below are the
following properties that we can found in heart:
1. Bathmotropic (excitability)
2. Dromotropic (conductivity)
3. Inotropic (contractility)
4. Chronotropic (rhythmicity)

The heart performance is strongly influenced by three main elements, namely

pacemaker cells, conduction cells and heart muscle cells, they are SA node, AV node,
Purkinje fibers. But SA node is the one which has perfect capability to make an action
potential. So that we only discuss about SA node as the pacemaker and out of four hearts
properties, only Bathmotropic and Chronotropic that related with SA node. We would like to
discuss about both of them also and their relation with SA node in in this paper.

B. Problems
1. What is SA node and how is its mechanism as the hearts pacemaker?
2. How is the relation between SA node and hearts properties?
3. How is the relation between SA node, contraction frequency, action potential frequency
and ventricle filling?

CHAPTER II
DISCUSSION
A. SA node and its mechanism as the hearts pacemaker
Out of three elements that important in heart performance, namely pacemaker cells,
conduction cells and heart muscle cells, SA node is the one with high excitability compare to
AV junction and Purkinje fibers. Here we will talk about SA node components.
The SA node is a bundle of nerve tissue found in the heart. This tissue acts as a
natural pacemaker and is called by other names as well. Some other words for this node
include sinoatrial node, sinus node, or SAN. This node works by generating nerve impulses
at regular intervals, thus causing the heart to beat at the same intervals.
When the SA node sends out electrical impulses, a series of electrical events are
triggered in the heart. Therefore, this node is a crucial part of the nervous system as well as
the circulatory system.
Along with the other components of the electrical system of the heart, the SA node
produces voltage changes within the heart. These voltage changes can be measured by
placing electrodes on the skin and performing a test known as an electrocardiogram, often
referred to as an ECG. This test is beneficial in detecting abnormalities in electrical activity,
often helping to diagnose and treat problems before they become life-threatening.
Normally, nerve cells need some sort of external stimulus in order to fire, or send out
electrical impulses. This is not the case with the SA node, as it has the capacity to fire on its
own. This ability contributes to the reasons the SA node is often referred to as the primary
pacemaker of the heart. If, for some reason, the SA node becomes damaged or otherwise
stops functioning properly, there are other cells in the heart that will begin to take over the
pacemaker role.
There are a number of medical conditions that can cause the sinus node to stop
functioning normally, including diabetes or any condition affecting the heart. While many
patients will not experience any negative side effects at all, others may experience a variety
of unpleasant side effects. Some of these symptoms include heart palpitations, chest pain or
discomfort, or difficulty breathing. In some cases, cardiac arrest may occur.
An ECG can often detect minor problems before something as severe as cardiac arrest
occurs. Therefore, it is important to take any unusual symptoms seriously. Prompt medical
attention is crucial to the health and well-being of the patient.

B. SA node relation with the hearts properties

SA node working mechanism relates with hearts properties. As we know, there are
four properties of heart such as, Bathmotropic, Dromotropic, Chronotropic, and Inotropic.
But only two of them that closely related with SA node mechanism. They are Bathmotropic
and Chronotropic. Below are some reason why both of those hearts properties are related to
SA node working mechanism:
1. Bathmotropic (excitability)
Bathmotropic is the knack of cardiac cells to respond to a suitable
amount of stimuli and produce an electric potential, also called electrical
impulse. This electrical impulse spreads across the heart, causing it to beat.
Before its beating, there are some processes in the heart (like channel) from
the SA node until it causing a contraction.
Firstly, it started by an electrical signal generated by the SA node.
Then, it moves from cell to cell, down through the heart, until it reaches the
AV node; a cluster of cells situated in the center of the heart, between the atria
and ventricles. The AV node serves as a gate, slowing the electrical current
before the signal is permitted to pass down to the ventricles. This delay
ensures that the atrium have a chance to fully contract before the ventricles are
stimulated. After passing the AV node, the electrical current travels to the
ventricles along special fibers embedded in the walls of the lower part of the
heart. The autonomic nervous system controls the firing of the SA node to
trigger the start of this cardiac cycle. The autonomic nervous system can
transmit a message quickly to the SA node, so it in turn can increase the heart
rate to twice the normal rate within only 3 to 5 seconds.
2. Chronotropic (rythmicity):
Chronotropic is a property of cardiac muscle cells which describes
their ability to contract regularly without the involvement of any nerves. Here,
talking about SA node as the pacemaker, which means the starting point of the
heart rhythm, is on the SA node.
The SA node normally produces 60-100 electrical signals per minute
this is your heart rate, or pulse. With each pulse, signals from the SA node
follow a natural electrical pathway through your heart walls. The movement
of the electrical signals causes your heart's chambers to contract and relax. We

called it as systole and diastole. Systole refers to the contraction of heart while
diastole refers to the relaxation. Both systole and diastole combine together to
help the heart pump blood to the entire body.
In a healthy heart, the chambers contract and relax in a coordinated
way, or in rhythm. When your heart beats in rhythm at a normal rate, it is
called sinus rhythm.
In a healthy heart, the chambers contract and relax in a coordinated
way, or in rhythm. When your heart beats in rhythm at a normal rate, it is
called sinus rhythm, which is moves from basis to the apex. This will related
with contraction frequency and action potential frequency that will discus
next.
Perfect heart cycle movement can cause cardiac output to reach the
target which is needed by the body.

C. SA node relations with contraction frequency, action potential frequency,

and ventricle filling
Action potential frequency and contraction frequency are closely related with
ventricle filling time. This means, SA node as the trigger of action potential also takes role in
ventricle filling.
Before talking about ventricular filling, heart has cone-like-shape and it determined in
two parts. The first basis cordis (base), directed upward, backward, and to the right. It is form
mainly by the left atrium, and to a small extent, by the part of the right atrium. The second
one, apex cordis (apex), is directed downward, forward, and to the left, and is overlapped by
the left lung and pleura.
SA node as the action potential trigger will make an electrical signal and then it sent
to the apex from basis. The excitability in the apex is lower than in the basis. This means, that
in the apex the action potential frequency is lower than the basis.
It also affected to the contraction frequency, because contraction occurs depends on
action potential. We can know when the contraction reaches the apex from the graphic at
kymograph or Electrocardiograph, which the interval of one contraction to another will be
longer than the basis, so that it will take long time for relaxation. Also, the contraction flow
from atrium to ventricle will take more time.
If the contraction flow from atrium to ventricle takes more time, the ventricle will
reaches it optimum volume. So, that only with a small trigger of electrical sign from the SA
node heart will work normally without any hard work or too much contraction.

This means that the SA node makes the process of blood pump takes longer time but
less energy waste.

CHAPTER III
CONCLUSION

SOURCES
Meshell Powell & Melissa Wiley. 2003. What Is the SA Node? http://www.wisegeek.com/whatis-the-sa-node.htm
Heart Smart How Your Heart Works http://www.bostonscientific.com/lifebeat-online/heartsmart/electrical-system.html
Dr. Ngakan Made Rai Widjaja, drh., MS. Kardiovaskular S1 FKH (slide 7)