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Control of Excitation and Conduction in the Heart
Wacker 3/9/11 lecture -1 hr
59
Physiology
Undergraduate 4
03/07/2011

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Term
contractile cells, and pacemaker cells
Definition
what are the 2 types of cardiac myocytes?
Term
contractile cells
Definition
which type of cardiac myocytes do excitation contraction coupling?
Term
SA node
AV node
Perkinje fibers
Definition
give examples of pacemaker cells in the heart (3)
Term
cardiac myocytes
Definition
what spreads the action potential through the heart?
Term
forceful contraction
Definition
what is the main role of contractile cells of the heart?
Term
pacemaker cells
Definition
what cell initiate depolarization and are autorythmic in the heart?
Term
sarcomeres
Definition
how are contractile fibers arranged in the heart?
Term
1)large t-tubules (to help get action potential into cell and release Ca++ from SR)
2)lots of mitochondria
3)large SR to hold a lot of Ca++
4) intercalated discs
Definition
list the main features of a contractile cardiac muscle cell
Term
gap junctions (intercalated discs)
Definition
what allows cardiac myocytes to contract as a functional unit?
Term
-85 mV
Definition
resting potential of a cardiac myocyte
Term
sodium: phase 1
potassium: phase 3,4,0,1
Calcium: phase 2
Definition
in which phase is a cardiac myocyte most permeable to sodium? potassium? calcium?
Term
phase 0: depolarization
phase 1: initial repolarization
phase 2: plateau
phase 3: rapid repolarization
phase 4: resting membrane potential
Definition
what occurs in each phase of an action potential in terms of overall cellular effects
Term
cardiac muscle has a plateau phase, it is caused by calcium channels
Definition
what phase of an action potential for cardiac muscle differs in skeletal muscle? what causes this?
Term
sodium: phase 1-4
potassium: phase 2
calcium: phases 3,4,0,1
Definition
in which phase is a cardiac myocyte least permeable to sodium? potassium? calcium?
Term
0: Na + channels open
1: Na+ channels close
2: Ca+ channels open, K+ channels close
3: Ca+ channels close, K+ channels open
4:Resting potential (close to K+)
Definition
describe the phases of an action potential in a cardiac myocyte in terms of what ion channels open/close
Term
both are longer in cardiac muscles, also cardiac muscle cannot fuse contractions (no tetany)
Definition
compared the length of the action potential and refractory period in skeletal muscle and cardiac muscle
Term
potassium
Definition
what ion sets the resting membrane potential for cardiac muscle?
Term
0.25-0.3 s
Definition
what is the normal refractory perior for cardiac muscle cells?
Term
0.05 s
Definition
what is the relative refractory period for cardiac myocytes?
Term
yes, but it takes a stringer excitatory signal (and the contraction is weaker)
Definition
can an action potential occur during the relative refractory period of cardiac myocytes?
Term
cardiac muscle ryanodine receptors are not attached to the DHPR thing, but they both cause the calcium release from the SR
Definition
how do ryanodine receptors differ in cardiac muscle cells compared to skeletal muscle?
Term
skeletal muscle uses SR calcium, but cardiac muscle is dependent on outside Ca++ (25% of the calcium)
Definition
compare calcium sources for skeletal muscle and cardiac muscle
Term
phospholambin
Definition
what inhibits the SERCA pump in cardiac muscle to prolong contraction?
Term
the sodium/calcium pump which pumps out 1 calcium per 3 sodium in this is "coupled"
Definition
to pump the calcium out of a cardiac myocyte, what method is used primarily?
Term
yes, does the same actin myosin interaction skeletal muscle does
Definition
is there troponin in cardiac muscles?
Term
pumps Calcium back into the SR to allow muscle relaxation (this is inhibited by phospholambin)
Definition
what does the SERCA pump do?
Term
1) action potential
2) VGCC calcium channel opens, allowing Ca++ to flow into the cell
3) Calcium activates ryanodine receptors in the SR
4) calcium binds to troponin, allowing the actin, myosin interaction
5) relaxation: 25% of Calcium is pumped out with the sodium coupled channels/ATPase, and 75% is pumped back into the SR via SERCA
Definition
list the steps (in the diagram) that a cardiac muscle takes to contract
Term
cardiac muscle cannot recruit more fibers or increase the rate of the action potentials, so it has to control things by regulating the calcium levels
Definition
how is cardiac muscle contraction force controlled?
Term
they allow calcium into the cell allowing for stronger contractions
Definition
what do L-type calcium channels (VGCC's or voltage gated calcium channels) do to cardiac muscle contraction when adrenergic receptors are stimulated?
Term
1)L-type calcium channels (more Ca in)
2)Inhibition of phospholambin (inhibit the calcium re-uptake inhibitor)
Definition
what 2 things are activated with adrenergic stimulation of cardiac muscle?
Term
1) adrenergic receptors have been stimulated
2) calcium an be taken up into the SR more rapidly allowing the heart to contract and relax faster
Definition
what happens if phospholambin is inhibited?
Term
they decrease strength of contraction (usually in order to decrease blood pressure)

since they block adrenergic stimulation, there is less calcium in the cell because the VGCC's are not activated to pump in outside calcium
Definition
what do beta blockers do to cardiac muscle cells?
Term
they inhibit L type calcium channels, decreasing the amount of calcium available to the myocyte
Definition
how do verapamil and nifedipine work?
Term
congestive heart failure -> it increases cardiac contraction and cardiac output
Definition
what is digoxin used for clinically?
Term
inhibits the Na/K+ pump, so sodium builds up inside the cell since it can't pump out. This slows the Na/Ca exchanger or reverses it even, so calcium builds up improving contraction
Definition
how does digoxin work on the cell bio level?
Term
fox glove, related to the digitalis plant(James bond was poisoned with this)
Definition
what plant does digoxin come from? what is this related to?
Term
it can trigger arrythmias because the electrolyte balance gets messed up, because the pumps are messed up
Definition
what is the down side of using digoxin?
Term
he went into ventricular tachycardia, so he tried to use his AED to stop his heart so the rhythm would reset but he did this after shooting up with some mystery cocktail to reverse the poison effects (ok so actually the girl connected his lead, you get the point -> arryhtmia)
Definition
when bond was poisoned with digitalis, what did he do, why?
Term
SA node, AV node, bundle of His, Purkinje fibers (the pacemaker cells)
Definition
what cells have a funny current?
Term
pacemaker cells are contractile, but have fewer contractile fibers, no organized sarcomeres, and a faster conducting rate

they also dont have t-tubules, and auto depolarize
Definition
describe the contractile fibers, sarcomeres, and conducting rate of pacemaker cells compared to contractile
Term
leaky sodium channels
Definition
why do pacemaker cells autodepolarize?
Term
phase 2 (where calcium channels open)
Definition
if you give someone verapamil, what phase of the action potential is inhibited?
Term
If, or funny current in pacemaker cells
Definition
what does HCN or hyperpolarization activated cyclic nucleotide gated describe?
Term
it is not constant, it slowly depolarizes due to the funny current(leaky sodium channels)
Definition
describe the resting potential of the conductile(pacemaker) cells
Term
SA: 60-80/min
AV: 40-50/min
Purkinje fibers: 20/min
Definition
describe the intrinsic depolarization rate of SA nodal cells, AV nodal cells, and Purkinje fibers.
Term
they have a faster funny current
Definition
why do the atria beat faster than the ventricles?
Term
1) there is no phase 1 in pacemaker cells(no sodium channels for fast depolarization)
2) there is no phase 2 (no L type calcium receptors, so no plateaus)
3) pacemaker cells have a funny current

both have potassium channels
Definition
how do pacemaker(like the SA node) action potentials differ from contractile cell action potentials?
Term
1)SA node
2) internodal pathways
3a) atria
3b) AV node
4) bundle of His
5) L & R bundle branches (septa -> apex)
6) Purkinje fibers
7) ventricle muscles (last being upper left ventricle)

also depolarization spreads from endocardium to epicardium
Definition
describe the order structures are depolarized in the heart
Term
gap junctions
Definition
an action potential begins in the SA node, travels through conductile cells, then spreads through the muscle cells via ____
Term
SA node(pacemaker cells)
Definition
what cells undergo automatic depolarization to initiate an action potential?
Term
near the vena cava as far as Wacker is concerned
Definition
where is the SA node?
Term
0.03 seconds
Definition
how long does it take the an action potential to reach the AV node from the SA node?
Term
1 m/s
Definition
what is the conducting velocity of the heart?
Term
a fibrous tissue band (which is an insulator) that has fewer gap junctions -this slows down the AP
Definition
this separates the atria and ventricle so that action potentials only spread via the bundle of His
Term
it creates a pause in contraction (slows the action potential down) so that blood has time to fill up the ventricles
Definition
why is the fibrous tissue band important in the heart?
Term
0.12 seconds
Definition
how long does it take an action potential to reach the bundle of his (AV bundle) from the AV node?
Term
0.16 seconds
Definition
how long does it take an action potential to reach the bundle branches(ventricular septum)?
Term
large, it is 1.5-4.0 m/s
in the muscles the conduction is 0.3-0.5 m/s
Definition
describe the conduction velocity of Purkinje fibers, what is the conduction velocity here? what is the conduction velocity in the cardiac muscles?
Term
wider (slower) QRS
Definition
if an action potential is spreading through the muscle rather than the purkinje fibers, what would the EKG show?
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