HEART PHYSIOLOGY

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

ARRYTHMIAS
Definition of arrythmia: variation from the normal rhythm of the heart beat, encompassing abnormalities of the rate, regularity, site of impulse origin and sequence of activation. There are two main types of arrythmias: Normotropic arrythmias: when SA node is still the pacemaker of heart. Ectopic arrythmias: when SA node is no more the pacemaker of heart.

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ARRYTHMIAS
NORMOTROPIC ARRYTHMIAS SINUS TACHYCARDIA SINUS BRADYCARDIA SINUS ARRYTHMIAS ECTOPIC ARRYTHMIAS HEART BLOCKS:
SA nodal BLOCKS AV nodal BLOCKS(1st,2nd, 3rd degree).

EXTRASYSTOLE ( atrial, AV
nodal and ventricular).

PAROXYSMAL TACHYCARDIA ( atrial, AV nodal, ventricular ).

OTHERS ( atrial flutter, atrial

fibrillation, ventricular fibrillation).

SINUS TACHYCARDIA
Normal heart rate (normocardia) = 60-100 beats/min. In this case heart rate is greater than 100 beats/min Causes:
Exercise (physiological) emotional states (physiological) anxiety (physiological) hyperthyroidism (pathological) Epinephrine Sympathetic stimulation (physiological) Atropine (anticholinergic drug) Increased body temperature e.g. fever (pathological)

Calculate the heart rate by the formula: HR = 1500/no. of smallest squares between two successive R waves.

SINUS TACHYCARDIA (cont..)

Effect of temperature on heart rate: With each degree Fahrenheit heart rate increases by 10 beat/min (18 beat/min for each degree Celsius) upto 105 F. beyond 105 F, the heart rate may decrease because of progressive debility of the heart muscle as a result of the fever. MECHANISM: Fever causes tachycardia because increased temperature increases the rate of metabolism of the sinus node, which in turn directly increases its excitability and rate of rhythm.

increased temperature Increase in the rate of metabolism of the sinus node Increase in excitability

SINUS BRADYCARDIA

It means a slow heart rate usually less than 60 beats /min. Causes of sinus bradycardia:
Bradycardia in athletes (physiological) *** Carotid sinus syndrome (pathological) Vagal stimulation such as during vomiting, Hypothyroidism (pathological) hypothermia, severe depression, (pathological) raised intracranial pressure (pathological) In some infections e.g. enteric fever (typhoid fever) there is relative bradycardia.*** Antiadrenergic (propranolol) and cholinergic drugs.

Calculate the heart rate by the formula: HR = 1500/no. of smallest squares between two successive R waves.

SINUS BRADYCARDIA (cont..)

Bradycardia In athletes: Cardiac output (C.O) = stroke volume (S.V)* heart rate (H.R). In athletes, there is physiological hypertrophy of heart (forceful heart). stroke volume (SV) is permanently increased. So, at rest the cardiac output is maintained at 5.5 L/min by decreasing heart rate.

SINUS BRADYCARDIA (cont..)

Carotid sinus syndrome:
In some individuals if we apply slight pressure on carotid sinus, it causes bradycardia. It is due to arteriosclerosis or calcification of carotid sinus which increases the sensitivity of baroreceptors and thus causing bradycardia.

When we perform carotid massage there is slowing of heart rate.

SINUS ARRHYTHMIA
It is a physiological condition i.e. heart rate is increased during inspiration and decreases during expiration. This variation of heart rate becomes more marked during deep breathing. This variation can be recorded by cardiotachometer.

SINUS ARRHYTHMIA (cont..)

Mechanism of sinus arrythmia: it involves three possible mechanisims: 1. There is spread of excitation from the inspiratory neurons to nearby vasomotor center to increase heart rate during inspiration. 2. Impulses from stretch receptors in the lungs go to vasomotor centre to increase heart rate when lungs expand during inspiration. 3. Bainbridge reflex: during inspiration there is more negative intrathoracic pressure, so venous return increases to the right atrium. Impulses originate from the low pressure stretch receptors in the wall of atria and large vessels and these impulses go along the sensory fibers in vagi to vasomotor centre to increase heart rate during inspiration.