AKTIVITAS ELEKTRIK

JANTUNG

Rahmatina B. Herman
Bagian Fisiologi
Fakultas Kedokteran -
Unand
 Anatomy - Physiology of Heart
Two separate parts: left and right Respectively:
-left atrium and ventricle
-right atrium and ventricle
Atrial function: primary pumps for ventricular
Ventricular function: pumping blood to all parts
of body and to the lungs
Ventricles pump more powerful than the atria
Atria contract prior to ventricles
Structure of the heart, and course of blood flow through the heart
chambers and heart valves.
 Anatomy – Physiology of Cardiac
Muscles
Myocardium:
-Atrial muscles
-Ventricular muscles
-Specialized excitatory and conductive system
of the heart
Involuntary muscles
Similar manner to skeletal muscle contraction
Syncytium
Specialized excitatory and conductive system of the heart
Structure of Cardiac Muscle Fibers
Sarcolemma
Myofibril
Filaments: - Actin
- Myosin

Sarcoplasma
Sarcoplasmic reticulum
StƌuĐtuƌe of CaƌdiaĐ MusĐle
Fiďeƌs…..
 StƌuĐtuƌe of CaƌdiaĐ MusĐle
Fiďeƌs…..

Intercalate Disc
͞SLJŶĐLJtial,͟ iŶteƌĐoŶŶeĐtiŶg Ŷatuƌe of ĐaƌdiaĐ ŵusĐle
StƌuĐtuƌe of CaƌdiaĐ MusĐle
Fiďeƌs…..
 Electrical Activity of Cardiac Muscle
Fibers
Polarization
Depolarization: - Plateau
- Rhythmicity

Repolarization
Conductivity
Refractory period
EleĐtƌiĐal AĐtiǀitLJ of CaƌdiaĐ MusĐle
Fiďeƌs…..
EleĐtƌiĐal AĐtiǀitLJ of CaƌdiaĐ MusĐle
Fiďeƌs…..
EleĐtƌiĐal AĐtiǀitLJ of CaƌdiaĐ MusĐle
Fiďeƌs…..
EleĐtƌiĐal AĐtiǀitLJ of CaƌdiaĐ MusĐle
Fiďeƌs…..
 Causes of
Plateau
1. Action potential in cardiac muscle is caused by
opening of two types of channels:
- fast sodium channels as those in skeletal muscle
- calcium-sodium channels
slower to open remain open for several tenths of a
seĐoŶd → ƋuaŶtitLJ of both Ca++ and Na+ flows
into cardiac muscle fiber → prolonged period of
depolarization → plateau in action potential
Ca++ that enter during plateau phase activate the
muscle contractile process, derived from the
intracellular sarcoplasmic reticulum
 Causes of Plateau…..
2. Decreased of permeability of cardiac muscle membrane
for K+ ± 5 times, that does not occur in skeletal
muscle
- May result from the excess Ca++ influx
- Decreased K+ peƌŵeaďilitLJ → greatly decreases the
outflux of K+ during action potential plateau →
prevents early return to resting level
When slow Ca – Na channels close at the end of 0.2 to
0.3 second and the influx of Ca++ and Na+ ceases,
membrane permeability for K+ also increases rapidly →
rapid loss of K+ fƌoŵ the fiďeƌ → immediately returns
the membrane potential to its resting level → ending
 Rhythmicity of Cardiac Action
Potential
Specialized excitatory and conductive system of heart have
capability of self-excitation
Basically, due to inherent leakiness of sinus nodal fibers to
Na+ and Ca++
Why does this leakiness not cause sinus nodal fibers to
remain depolarized all the time?
1.Na-Ca channels become inactivated within ± 100 to 150
msec afteƌ opeŶiŶg → influx of Na+ and Ca++ ceases
2.At about the same time, greatly increased numbers of K
ĐhaŶŶels opeŶ →i large quantities of K+ diffuse out
Both of these → ƌeduĐe iŶtƌaĐellulaƌ potential back to its
resting leǀel → terminate the action
potential
 Rhythmicity of Cardiac Action
PoteŶtial…..
K channels remain open for another few tenths of a
second
→ continuing movement of positive charges out of cell →
excess negativity inside fiber, called hyperpolarization →
͞ƌestiŶg͟ membrane potential down to more negative
Why hyperpolarization is not maintained forever
During next few tenths of a second after action potential is
over, K channels Đlose pƌogƌessiǀelLJ → iŶǁaƌd-leaking
Na+ and Ca++ overbalance the outward flux of K+ → ͞ƌestiŶg͟
potential to drift upward once more, finally reaching
threshold level for discharge at a potential of ± -40
mV
Then the entire process begins again
Rhythmicity of Cardiac Action
PoteŶtial…..
RhLJthŵiĐitLJ of CaƌdiaĐ AĐtioŶ
PoteŶtial…..
 Refractory Period of Cardiac
Muscle
Cardiac muscle, like all excitable tissue, is refractory to
restimulation during the action potential (absolute)
Normal refractory period of ventricle is 0.25 to 0.30
second, duration of prolonged plateau action
potential
There is an additional relative refractory period of ±
0.05 seĐoŶd → more difficult than normal to excite,
but can be excited by a very strong excitatory signal,
as demonstrated by early ͞pƌeŵatuƌe͟ ĐoŶtƌaĐtioŶ
Refractory period atrial muscle is much shorter than
that for ventricles (± 0.15 second for atria, and 0.25
Force of ventricular heart muscle contraction, showing also duration of refractory period
and relative refractory period, plus effect of premature contraction.
Note: premature contractions do not cause wave summation, as occurs in skeletal
 Conductivity Of Cardiac Action
Potential
Conduction velocity in atrial and ventricular
muscle fibers:
 0,3 – 0,5 m/second
 = 1/250 conduction velocity of action
potential in large nerve fibers
 = 1/10 conduction velocity of action
potential in skeletal muscle fibers
Conduction velocity in Purkinye system
0,02 – 4 m/second depend on location
 Mechanism of Contraction
The term ͞edžĐitatioŶ-ĐoŶtƌaĐtioŶ ĐoupliŶg͟ refers to
mechanism by which the action potential causes
myofibrils of muscle to contract
When an action potential passes over cardiac muscle
ŵeŵďƌaŶe → spreads to the interior of cardiac muscle
fiber along the membranes of the transverse (T)
tubules → act on membranes of longitudinal
sarcoplasmic tubules → release of Ca++ into muscle
sarcoplasm from saƌĐoplasŵiĐ ƌetiĐuluŵ → Ca++
diffuse into myofibrils → catalyze chemical reactions
that promote sliding of the actin and myosin filaments
along one another → muscle contraction
Mechanism of Contraction
 Duration of Contraction
Duration of contraction = duration of action
potential:
-In atrial: 0,2 second
-In ventricular 0.3 second

Greatly influenced by frequency of heart rate (HR)

-The faster the frequency of HR, the shorter the
duration of contraction, especially diastolic period
-HR 72x/sec  syst period : diast period = 40:60
-HR increased 3x  syst period : diast period = 65:35
 Conductive System of Heart
SA Node (sinoatrial node)/ sinus node :
-located in the superior lateral wall of right atrium,
immediately below and slightly lateral to the
opening of the superior vena cava
Internodal pathways:
-conductive system from SA node to AV node
AV node (atrioventricular node):
-located in the posterior septal wall of right atrium,
immediately behind tricuspid valve and adjacent to
the opening of coronary sinus
AV bundle/ His bundle
Purkinje System
CoŶduĐtiǀe SLJsteŵ of
Heaƌt…..
Organization of AV node
Transmission of Cardiac Impulse
TABLE. Conduction speeds in cardiac
tissue
Conducting system of the heart.
Left: Anatomical depiction of human heart with focus on areas of the conduction system.
Right: Typical transmembrane action potentials for the SA and AV nodes, other parts of
conduction system, and atrial and ventricular muscles, along electrocardiogram (ECG) LAF,
left anterior fascicle
Effect of sympathetic (noradrenergic) and vagal (cholinergic) stimulation on membrane
potential of SA node.
Note: the reduced slope of the prepotential after vagal stimulation and the increased
spontaneous discharge after sympathetic stimulation.