Cardiac Action Potentials

Reading:
Klabunde, Cardiovascular Physiology Concepts
Chapter 2 (Electrical Activity of the Heart) pages 18-26

The Cardiac Action Potential Types Are Either Fast Or Slow Response
Fast-response action potentials
Atrial myocardial fibers Ventricular myocardial fibers Purkinje fibers

Slow-response action potentials

Sinoatrial node Atrioventricular node

Differences between fast and slow cardiac action potentials:

RMP Slope of upstroke
Amplitude of action potential Overshoot of action potential

Slow > Fast Fast > Slow

Fast > Slow Fast > Slow

Fast Response Action Potential

Phases of the Fast Response Action Potential

Phase 0 = Depolarization Phase 1 = Partial Repolarization

Phase 2 = Plateau
Phase 3 = Repolarization Phase 4 = Resting Membrane Potential

Phase 0
The characteristics of the upstroke of the action potential depend almost entirely on inward movement of Na+

Phase 0
Fast Na+ Current

Phase 1
Inactivation of Na+ channels ends Transient outward K+ current

Na+ current ends

Na+ Current

Outward K+ current

Phase 2 (Plateau)
What produces the plateau? Slow inward Ca++ currents (L-type calcium channels) Counterbalanced by: Outward K+ currents

Action potential and ionic fluxes

Phase 2 (Plateau)
Ventricular contraction persists throughout the action potential, so the long plateau produces a long action potential to ensure forceful contraction of substantial duration

Calcium-Induced Calcium Release

When the myocyte is depolarized calcium enters the cell via L-type calcium channels. The amount of calcium that enters the cell is small, but this triggers the release of a large amount of calcium into the cytosol from the sarcoplasmic reticulum which results in binding of myosin to actin and contraction of the myocyte.

Phase 3
Outward K+ current is mainly responsible for repolarization Na+ channel recovery begins during Relative Refractory Period

= Outward K+ Current

Na+ Channel Recovery

Na+ Channel Configuration Change

Phase 4
Restoration of ionic concentrations
Na+,K+-ATPase Na+-Ca++ Exchanger ATP-driven Ca++ Pump

Restoration of Ionic Gradients

Na/Ca Exchanger

Na+ In

Cell ECF
Excess Ca++ ions from CICR Excess Ca++ ions from actinmyosin dissociation

Ca++ Out

Resting Membrane Potential in Cardiac Cells

Depends mainly on the conductance of K+ Determined mainly by the ratio of intracellular to extracellular concentration of K+ Measured value is slightly less negative than predicted because of small but finite conductance of Na+ Na+,K+-ATPase

Slow Response Action Potentials

Slow Response Action Potential

Phase 0 Phase 2
Very brief 0 3

Phase 3
Not separated clearly from phase 2 4

Phase 4 Note: Phase 1 is absent

Slow Response Action Potential: Phase 0

Depolarization is mainly by Ca++ influx

Cations from an adjacent depolarizing cell or diastolic depolarization

K+ efflux causes repolarization

Ca++ channel recovery

Relative Refractory Period Ca++ channels activated

Refractory Periods:
Effective (ERP) and Relative (RRP)

Automaticity (Pacemaker Cells)

Diastolic Depolarization
Inward Na+ (not via typical Na+ channels) Ca++ influx K+ efflux (opposes effects of other ions)

Autonomic neurotransmitters

Autonomic neurotransmitters

SA Node

Right Atrial Tracts*

Anterior Internodal Pathway*

Middle Internodal Pathway*

Posterior Internodal Pathway*

Anterior interatrial myocardial band (Bachmanns Bundle)

AV Node

AN Region N Region NH Region Bundle of His

Left Atrium

Right Bundle Branch

Left Bundle Branch

Anterior Division

Posterior Division

Conduction System

Sinus Rhythm
The SA (Sinus) Node is the hearts dominant pacemaker. The ability of a focal area of the heart to generate pacemaking stimuli is known as Automaticity.

The depolarization wave flows from the SA Node in all directions.

Overdrive Suppression

Overdrive Suppression
SA Node

Overdrive Suppression
Atrial Foci (60-80 bpm) Junctional Foci (40-60 bpm) Ventricular Foci (20-40 bpm)

Overdrive Suppression
Automaticity of pacemaker cells becomes depressed after a period of excitation at a high frequency
Due to activity of Na+, K+-ATPase. At higher heart rates more Na+ is extruded than K+ enters the cell > tends to hyperpolarize the cells Slow diastolic depolarization requires more time to reach threshold

THE END