Action Potential & ECG

Prof.Lammers CVS Module/ Week 2

Action potential of the cardiac muscles

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The cardiac action potential is made of 3 phases: Depolarization: caused by the opening of Fast Na channels & slow Ca channels Plateau: remaining of slow Ca channels open for several seconds, drawing large amount of Ca inside which prolong depolarization Replarization: Opening of potassium channels

The plateau phase

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The plateau phase is explained by: Opening of the slow Ca channel prolong depolarization After the onset of action potential the permeability to potassium channels decreases prevent rapid return of action potential to resting membrane potential.

Tissues of the heart

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There are three main tissues in the heart: Atrium and ventricular muscle: moderate conducting velocity and AP needs to return to reach threshold. Nodal tissue ( SA, AV, bundle of His): slow conducting velocity and could be pace makers Purkinji fibers: has the fastest conducting velocity.

Conducting system of the heart

The conducting system of the heart is responsible for generating rhythmical impulses through the heart to cause rhythmical contrition. It is made of: SA node: where the normal impulse is generated as they have the capacity of self-excitation AV node: in which impulses is delayed before it reaches the ventricles, to allow it to fill.

Conducting system of the heart

AV bundle: that conduct impulses from the atrium to the ventricle Rt-Lt Bundle branches & purkinji fibers: that conduct impulses to all parts of the ventricles. * AV bundle is the only way in which impulses could be conducted from the atrium to the ventricles. Because the atria is separated from the ventricles by fibrous tissue that surround the AV valvular opening.

ECG waves
A normal ECG is made of:
P wave: that present atrial depolarization QRS complex: that present ventricular depolarization T wave: that present ventricular repolarization PQ interval: no electrical signal ( transmission of impulses from Atrium to ventricles) ST segment: present the platue phase. In ischemic heart disease, ST segment is elevated due to the absence of the platue.

ECG leads

Three bipolar leads: record impulses from 2 electrodes located on different sides. Lead I: (+) Left limb (-) right limb. Lead II: (+) left foot (-) right limb. Lead III: (+) left foot (-) left limb. These 3 leads for Einthowens triangle in which the heart is located in the middle. Einthowens law: if electrical potential of 2 leads was known, we can know the 3rd by summation of the 2.

ECG leads

Chest leads ( Precordial leads): Placing the electrodes on the anterior surface of the chest: V1 4th intercostal space ( Right sternal border). V2 4th intercostal space ( left sternal border). V3 Between V2 and V4. V4 5th intercostal space in the mid clavicle line. V5 5th intercostal space in the anterior axillary line. V6 5th intercostal space in the mid axillary line.

Augmented Voltage Leads

Unipolar leads because there is 1 positive electrode in combination with the ground that is considered. AVL: Left arm. AVR: Right arm. AVF: Left foot.