ECG and the Hearts Internal Conduction System 18

ECG and the Heart’s Internal Conduction System 18 -19 March 2015

What is surprising about this video of a diseased heart that has been removed from a patient prior to transplant surgery? The heart continues to beat after being removed from the body! Unlike skeletal muscle, the heart does NOT need to be stimulated by the nervous system to contract. Instead, the heart has its own pacemakers and intrinsic conduction system to regulate contraction.

Quick Review of Skeletal Muscle Contraction � What events lead to skeletal muscle contraction? What part of this process involves an electric current? ◦ Nerve releases neurotransmitter into synaptic cleft The action potential! ◦ Neurotransmitter causes action potential along sarcolemma During the action potential, the membrane first depolarizes then repolarizes. ◦ Action potential causes sarcoplasmic reticulum to release Contraction occurs shortly after the depolarization of the calcium membrane. ◦ Calcium exposes the myosin binding sites on actin, leading to muscle contraction

Instrinsic conduction system � SA node is the heart’s natural pacemaker. ◦ It depolarizes ~75 times / min, to start each heartbeat. Ø Impulse travels throughout the atria and to the AV node o Ø Travels cell-to-cell through gap junctions in intercalated discs – another unique feature of cardiac muscle AV node delays impulse transmission to allow atria to finish contracting

Instrinsic conduction system � The AV bundle (aka bundle of His) transmits the impulse to the bundle branches and Purkinje fibers. o These bundles and fibers speed the transmission of the impulse throughout the ventricles, to coordinate ventricular contraction Interestingly, all the cells of the conduction system are autorhythmic. That is, all will depolarize at a certain rate. The SA node has the fastest rate of depolarization, though, so it sets the pace for the entire heart.

Quick Review: Instrinsic conduction system � What is the function of: ◦ AV node – delays impulse so atria can finish contracting, and conducts to AV bundle ◦ Gap junctions – Allow impulse to spread cell-tocell ◦ SA node heart’s pacemaker – depolarizes to start contraction ◦ Purkinje fibers carry impulse to cells of ventricles

Quick Review: Instrinsic conduction system Name 3 differences between cardiac and skeletal muscle contraction & explain why each is important to cardiac function. 1. Cardiac muscles do not need to be stimulated by nerves. This allows heart to beat even if nervous system doesn’t function well. 2. Cardiac muscles have autorhythmic / natural pace-makers to keep the heart beating an an appropriate rate. 3. Cardiac muscle has special features to speed impulse conduction from one cell to another, including special cells (the AV bundle, branch bundles and Purkinje fibers) and gap junctions between cells.

Electrocardiogram � An electrocardiogram (ECG or EKG) records the electrical current through the heart. �A normal ECG has three distinct waves: ◦ P wave – atrial depolarization ◦ QRS complex – ventricular depolarization AND atrial repolarization ◦ T wave – ventricular repolarization Watch me!

Electrocardiogram - Questions A normal ECG has three distinct waves: ◦ P wave – atrial depolarization ◦ QRS complex – ventricular depolarization AND atrial repolarization ◦ T wave – ventricular repolarization What is responsible for these delays? • Delay between P wave and QRS complex is caused by AV node • Delay between T and next P wave is determined by heart rate / speed at which SA node depolarizes

Electrocardiogram Questions “LUB” - closing of AV valves as ventricle begins to contract systole diastole “DUP” - closing of SL valves as ventricle begins to relax Examine this normal ECG. � When would the ventricles be in systole? � When would they be in diastole? � When would the heart sounds occur, and what do the heart sounds correspond to?

Abnormal ECGs � Identify how the abnormal ECGs differ from the normal one, and match them to their disease. a) All waves present and normal shape. Heart beat is about twice as fast. TACHYCARDIA

Abnormal ECGs � Identify how the abnormal ECGs differ from the normal one, and match them to their disease. b) No relationship between p waves and QRS complex AV block

Abnormal ECGs � Identify how the abnormal ECGs differ from the normal one, and match them to their disease. c) Waves are more-orless correct shape. Heart rate is about 1. 5 times slower than normal. Bradycardia

Abnormal ECGs � Identify how the abnormal ECGs differ from the normal one, and match them to their disease. d) No obvious p waves, wandering baseline (not so obvious) Atrial fibrillation

Regulation of Heart Rate Earlier, we said that the SA node depolarizes at a rate of ~75 beats per minute, and that this acts as a pace maker for heart contraction. Does this mean our hearts always beat at ~75 bpm? Of course not! Our hearts do not require stimulation from the nervous system to beat, however, they do respond to stimulation from the nervous system by either speeding up or slowing down.

Regulation of Heart Rate Earlier, we said that the SA node depolarizes at a rate of ~75 beats per minute, and that this acts as a pace maker for heart contraction. Does this mean our hearts always beat at ~75 bpm? Of course not! Our hearts do not require stimulation from the nervous system to beat, however, they do respond to stimulation from the nervous system by either speeding up or slowing down.

Regulation of Heart Rate What are the two branches of the autonomic nervous system, and how do they affect heart rate? � Sympathetic (fight-or-flight / stress) – increases HR � Parasympathetic (rest & digest) – decreases HR

Regulation of Heart Rate Other factors that influence heart rate � Age (fastest in fetus, young children) � Gender (faster in females) � Temperature (faster in heat) � Exercise (faster with exercise) � Ions imbalances & medicines (faster or slower) � Weak / damaged heart (can be either faster / slower)

Closure � Think back to the list of questions we made last class. Were any answered today? � Have you developed any new questions? � Remember HW assignment: research one question and be ready to answer.

Exit Ticket 1) 2) 3) 4) 5) What serves as the heart’s natural pacemaker? What event does a T wave correspond with? Name one the stimulation of cardiac muscle differs from skeletal muscle. What does tachycardia refer to? Which system slows down the heart? E. C. What does ECG stand for?