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HEART PHYSIOLOGY

BY DR. MUDASSAR ALI ROOMI (MBBS, M. PHIL)

March 21, 2013

SA nodal action potential


Resting membrane potential of the SA nodal fiber is -55 to -60 mvolts. The cause of this lesser negativity is that the cell membranes of the sinus fibers are naturally leaky to Na+ and Ca++ ions and entry of these ions neutralize much of the intracellular negativity. The RMP of the SA nodal fibers is not stable. It drifts slowly to the threshold value. March 21, 2013

IMPORTANCE OF PRE-POTENTIAL
The unstable RMP of SA nodal fibers is called as PACEMAKER POTENTIAL or PRE-POTENTIAL. the inherent leakiness of the sinusnodal fibers to Na+ and Ca++ ions causes their self-excitation.*** Therefore, pre-potential is responsible for the automaticity of the SA nodal fibers.

THE MECHANISM OF PRE POTENTIAL SLOPE:


The early portion of the RMP is due to natural leakiness of the membrane to sodium (funny current) The last of portion of pre-potential is due to activation of (transient) T -Type of calcium channels.

SA nodal action potential


At -55 mvolts, the fast Na+ channels become inactivated. So these channels are not important in the depolarization of the SA nodal fibers. Therefore, only the slow sodiumcalcium channels (L-type) can open and cause depolarization. As a result, the SA nodal action potential is slower to develop than the that of the ventricular muscle.

March 21, 2013

SA nodal action potential (cont)


Note: There is no phase 1 and 2 in the action potential of SA nodal fibers.

Rhythmical Discharge of Sinus Nodal Fiber


Sinus Nodal Fiber Slow Ca++ Channels Open Ventricular Muscle fiber

+20

K+ Channels Open more


Threshold

Membrane Potential (mV)

0 -20 -40 -60 -80 -100 0

Na+ Leak

2 Seconds

March 21, 2013

WHAT DETERMINES THE HEART RATE?


Slope of pre potential determines the heart rate. More Steeper the slope- increased heart rate.** Less steeper the slope- decreased heart rate.** On sympathetic stimulation, there is increase in heart rate. Norepinephrine released from sympathetic fibers, increases the permeability of SA nodal fibers membrane to sodium and calcium. On vagal stimulation there is slowing of heart rate. There is release of acetylcholine which acts on SA nodal fibers to increase its permeability for potassium. Which causes hyperpolarization and less steep of prepotential.

Effects of Sympathetic stimulation on Heart


Nor-epinephrine is released at sympathetic nerve endings Norepinephrine increases the permeability of SA nodal fibers to sodium and calcium which increases the slope of the pre-potential. It causes increased sinus node discharge with increase Heart Rate (+ve chronotropic effect) Increases force of contraction in atria and ventricles (+ve inotropic effect) It also Increases rate of conduction of impulse (+ve dromotropic effect) Increased excitability of heart (+ve bathmotropic effect)
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Parasympathetic Effects on Heart


Parasympathetic (vagal) nerves, which release acetylcholine at their endings, innervate SA node and A-V node. Mechanism: Causes hyperpolarization because of increased K+ permeability in response to acetylcholine. This causes Decreased heart rate by decreasing the frequency of impulse generation (-ve chronotropic effect) Minimal decrease of force of contraction (-ve inotropic effects) decreased transmission of impulses (ve dromotropic effect). It may temporarily stop the heart. decreased excitability of heart (-ve bathmotropic effect).

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