Cardiovascular system

The heart

Functional properties of myocardium:

1. Automaticity – spontenous formation of the impulse
2. Rythmicity – regularity of the impulse formation (60-80 per min)
3. Exaitability – accaptation of stimuli and reaction to them
4. Conductivity – conduction of stimuli through the myocardium
5. Contractility – haemodynamic function (to pump the blood)
The law “everything or nothing” - after a stimulation by the suprathreshold stimulus the heart reacts by
contraction of all cells or does not react when the stimulus was subthreshold. However, the contraction
force can be changed.

Cardiac conductive system: morphologically & functionally heterogenous

Slow (Nodal) cells – low resting potential & amplitude, slow channels and conduction
Fast Cells (His-Purkyne system) – high resting potential, fast Na channel and conduction.
• Sinoartrial (sinus) node – P cells = normal pacemaker (60 – 80/min)
• internodal atrial pathways: Bachmann, Throell, Wenkebach tracts
• atrio-ventricular node – AN (upper), N (middle), NH (lower) parts, secondary pacemaker (40 –
60/min), conduction delay --> contraction of the ventricles not immediately after the atria.
• Bundle of His – connection between the atria and ventricles, AV node + His bundle = AV
junction.
• Tawara branches – rights, left anterior, left posterior.
• Purkyne cells – the last part, the largest cells, tertiary pacemaker (20-40/min)
• transient cells – connection between the CS and working myocardium very sensitive to some
pathological changes.
Function of the conductive system
• connection between the atria and ventricles
• formation of the cardiac impulse
• synchronized contraction of the whole heart.

Cardiac electrophysiology

Resting membrane petential (RMP) = the potential difference between the intra and extracellular space
(result of displacement of ions).

-85 to -100 mV (working myocardium), less in the conductive system.

Nerst equation – RMP is the equilibrium potential of K+

RMP – fixed (constant) during the diastole

– slow diastolic depolarization (SDD) – prepotential

Action potential, in working myocardium – phases 0,1,2,3,4

0 – rapid depolarization (fast inward Na channels)
1 – initial repolarization (outflux of K+)
2 – plateau (delayed repolarization) – influx of Ca & Na through the slow non-specific Ca-Na channels
+ efflux of K+

Importance of plateau: transmission of Ca into myocytes, no tetanic contraction, filling the heart by the
blood.

3 – final repolarization (fast K channel – efflux of K+)

4 – psotpotentials (post – depolarization + post-hyperpolarization) + resting potential

Pacemaker cells – SDD, no phase 1, only slow channels, slow changes -65 mV – threshold level of MP,
-35 mV – critical level of MP voltage dependent channels – level of AP opens or closes the channel
Different AP in different parts of the heart.

Changes of the MP:

Depolarization – phase 0, from the RMP to overshoot (spike)
Repolarization – 1,2,3 (from the spike back to the RMP)
Transpolarization – during the positive MP (above 0) – a part of de- and re-polarization
Hyperpolarization – more negative potential than the normal RMP

Excitability of the cardiac muscle

Refractory period – period of decreased excitability

Absolute RP (effective) – depolarization + transpolarization
Relative RP – phase 3 (-65 to -35 mV), AP through the slow channel only, it is smaller, deformed,
slower conduction.
Supranormal phase – at the end of the AP, between phases 3 and 4, oncreased excitability (lower
threshold)
Vulnerable period – even weak stimuli can produce an answer, up to VFL.
Excitability threshold – very high during ARP, low during SNP, normal during the late diastole.

Measuring of the ARP:

• extrastimulation (S1,S2) (ARP = period S1-S2)
• increasing rate of pulse (ARP = period between 2 impulses)
Measuring of VP – one single overthreshold pulse (top of T wave)
• inner border (beginning) – shifting of the pulse to the right from QRS
• out border (enG) – shifting to the left from the diastole