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cvs nursing 10.1.23 (1).pdf

  1. 1. Slow response action potential • Mainly of 3 components: 1. Phase 0: depolarization 2. Phase 3: repolarization 3. Phase 4: slow depolarization • Phase 1 and phase 2 are usually absent in this type of AP • In SA node , phase 4 is characterized by pacemaker potential
  2. 2. Slow response action potential
  3. 3. • It is the membrane potential of the rhythmically discharging cells, that after each impulse, declines to firing level and triggers next impulse. Pacemaker potential
  4. 4. • Phase 0: rapid Depolarization – due to 1. opening of L (long) type calcium channel causing Ca influx 2. Increase in Na+ influx
  5. 5. • Phase 3: Repolarization - due to : • 1. Closure of calcium channels • 2. opening of K+ channel causing K+ efflux
  6. 6. • Slow depolarization • Ist part due to – slow decrease in K efflux . • Later part due to– opening of T (transient) calcium channels and potential become less negative.  Thus, phase 4 shows spontaneous depolarization from RMP to firing potential which triggers the next AP Phase 4 or Pacemaker potential
  7. 7. • RMP of pacemaker tissue is -55mV. • Pacemaker tissues has an unstable resting membrane potential because of the continuous change in membrane permeability[The ion channels in the cell membrane of pacemaker tissues appear to open and close spontaneously] . • Therefore, membrane potential decreases steadily after each AP until firing level is reached and another AP is fired. • So, When potential reaches -40mV[firing level in pacemaker tissue] an action potential is generated.
  8. 8. • Vagal /parasympathetic stimulation---flattens the slope of prepotential /pacemaker potential----decreased heart rate • sympathetic stimulation- makes the slope of prepotential /pacemaker potential steep---- increased heart rate
  9. 9. Electrical activity in the Sino-atrial node or Pacemaker Potential • Pacemaker tissues: SA node, AV node • SA node is the pacemaker of heart since it produce maximum number of impulse in unit time.
  10. 10. Cardiac conducting system • The heartbeat originates in a specialized conduction system of the heart called cardiac conduction/conducting system • Peculiarities are : - it can generate rhythmical electrical impulses - It can conduct these impulses rapidly throughout the heart to cause rhythmical contraction of the myocardium - the purkinje system allows all portions of the ventricle to contract simultaneously so that sufficient pressure is created in the ventricles to pump blood into arterial trunks
  11. 11. EXCITATORY AND CONDUCTING SYSTEM OF HEART Components of Cardiac Conducting System 1. Sinoatrial node ( SA node ) 2. Internodal pathways 3. Atrioventricular node (AV node) 4. Bundle of His 5. Purkinje fibers
  12. 12. SA Node • Situated immediately below the opening of superior vena cava in the right atrium. • Contains P cells called Pacemaker cells. • P cells have the property of self excitation & can spontaneously generate action potentials. • SA node discharge rapidly & depolarization of other part of the conducting system occurs before they discharge spontaneously. • So SA node is considered as pacemaker of heart.
  13. 13. Internodal Atrial Pathways • Conduct impulse at a faster rate to AV node and are called internodal pathways. 1. Anterior internodal tract of Bachmann 2. Middle internodal tract of Wenckebach. 3. Posterior internodal tract of Thorel.
  14. 14. AV Node & Bundle of His • AV node is located in the posterior wall of right atrium immediately behind the tricuspid valve. • AV node & Bundle of His is the only conducting pathway between atria & ventricle. • Impulse reaching the AV node are not immediately transmitted to bundle of His. There is a delay of 0.08-0.1 second, called AV nodal delay. • Because of AV nodal delay atria gets enough time to empty blood into the ventricle.
  15. 15. • Causes of AV nodal delay AV node made of small diameter fibers, which have low conduction velocity. Multiple branching system in AV node. Number of gap junction is less between successive cells. So, velocity of conduction is reduced.
  16. 16. • AV node is continuous with bundle of his • Bundle of his gives off left bundle branch at the top of interventricular septum & continues as the right bundle branch. • Left bundle branch divides into an anterior fascicle & posterior fascicle.
  17. 17. Purkinje fibers • Are fast conducting fibers. • Has maximum number of tight junctions.
  18. 18. Spread of Cardiac Impulse • Action potential generated in the SA node spreads through the atria and converge on the AV node. • Atrial depolarization is completed in 0.1 seconds. • In AV node there is delay of 0.1s before the impulse reaches the ventricle. • In the interventricular septum the depolarization wave spread rapidly through the Purkinje fibers to all parts of ventricles.
  19. 19. • Depolarization is always from endocardial surface to epicardial surface. • Depolarization of papillary muscles occurs when the impulse reaches the middle of interventricular septum.
  20. 20. Spread of impulse from SA node to AV node causing atrial activation Interventricular
  21. 21. late activation of posterobasal portion of left ventricle, pulmonary conus and upper part of interventricular septum to epicardial surfaces

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