Objectives for today: describe how heart action is coordinated with reference to the sinoatrial node (SAN), the

e atrioventricular node (AVN) and the Purkyne tissue. interpret and explain electrocardiogram (ECG) traces, with reference to normal and abnormal heart activity.

Syllabus: 1.2.2 g & h

Homework: continue revising for your January exam! Now: match up the questions and answers on the dominoes. They should go in a big loop.
http://www.youtube.com/watch?v=AAe3cabBLaM http://www.nhlbi.nih.gov/health/dci/animate/electrical.swf

Purkyne fibres: British poor-kin-yuh Purkinje fibres: American poor-kin-jee

Control of heartbeat 1. The heart beat is initiated by the SAN (the pacemaker). It initiates a wave of depolarisation: also often called a wave of excitation. This is a change in the distribution of charges on either side of cell membranes like a nervous impulse. 2. The wave of depolarisation spreads over the 2 atria, causing them to contract. 3. The wave of depolarisation reaches the AVN, but is delayed before being relayed down the bundle of His and the Purkyne tissue. This delay ensures that the ventricles contract after the atria. 4. This wave of depolarisation then spreads through the walls of the ventricles... making them contract upwards, away from the apex (the pointy bit at the bottom of the heart).

The ECG displays voltage changes against time. Voltage (mV)

Time (s)
ECGs show the changes in charge distribution in the heart tissue. Depolarisation (the charge differences decrease) causes contraction. Repolarisation (the charge differences are re-established) causes relaxation. Patients with heart problems will have a different ECG trace.

P wave: atrial depolarisation. P-Q interval: time delay for at depolarisation to travel from SAN to bundle of His. Q wave: depolarisation of bundle of His. R wave: depolarisation of ventricles. This starts contraction, beginning with the left ventricle. S wave: final depolarization of the ventricles. S-T segment: both ventricles depolarised and starting to relax. T wave: ventricular repolarisation. The ventricles are in diastole.

And now:

1. Read p.70-72 in the green books and p.58-59 in the purple books.
2. Annotate your ECG trace to say what is happening at each point. 3. Do the Diagnosing heart problems from ECG traces sheet. Extension: 1. Try SAQ6 on p.71 of the green books. Answers on p.246. 2. Try Qs 1, 2, 3 & 5 (not Q4) on p.59 of the purple books. Answers on p.238.

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