USMLE Step 1 Web Prep Electrical Activity of the Heart

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Cardiac Muscle
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Chapter 1: Electrical Activity of the Heart

The Highest Yield Section of Physiology 3 ions we consider in ventricul r ction !otenti l "# inside higher th n outside $n regul r contr ction t rest e%tre&ely high !er&e 'ility for "( nd resting !otenti l )uite close to " &e&'r ne !otenti l *'ut doesn+t re ch it,. # outside higher th n inside- /uring 0P never re ch 120 &3 on the ventricul r fi'er- $f during ventricul r 0P . ch nnels 'e o!en( . influ%- 0t rest ll . ch nnel 4 closed5 # outside higher th n inside free 5 * l&ost 0,( never re ch 5 e)uili'riu& during 0P- $f 5 ch nnel o!en# 5 influ%- 0t rest# 5 ch nnels 4closed( nd !er&e 'ility t rest in very lowIon conc. out K+ Na+ Ca+
+

conc. in 135 10 10-4

equil. pot. -94 mV +70mV +132mV

permeabil ity high low low

4 145 2

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SLIDE 3 of 12

Me !rane Channels
*1-, 7ng ted !ot ssiu& *", ch nnels 0lw ys o!en 0lw ys efflu% .ever re ch !ot ssiu& e)uili'riu& *2-, 3olt ge#g ted *de!endent, sodiu& *. , ch nnels 8f st ch nnels8 5losed t rest 9!en nd close r !idly 9!en during de!ol ri: tion /e!ol ri: tion# sign l to o!en f st nd close f st *3-, 3olt ge#g ted *de!endent, c lciu& *5 , ch nnels 8slow ch nnels8 5losed t rest 9!en nd close slowly 9!en during !l te u /e!ol ri: tion is lso sign l to o!en nd close slowly

*6-, 3olt ge#g ted !ot ssiu& *", ch nnels 4 different for& neuron " 9!en t rest 4 *unli;e to neuron, 4 'oth ty!es of " ch nnel re o!en# very high " !er&e 'ility# very close to " e)uili'riu&( 'ut not re ch it <egin closing during de!ol ri: tion 4 sign l to closing volta"e #"ated " ch nnel 5losed during !l te u =eo!en with re!ol ri: tion
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SLIDE $ of 12

AC%I&' (&%E'%IAL &) A *E'%+IC,LA+ )I-E+ .)AS% +ES(&'SE/

(hase 0 1 depolari2ation $ncre se sodiu& *. , conduct nce # influ% > st ch nnels o!en during de!ol ri: tion llowing sodiu& to enter (hase 1 1 Sli"ht +epolari2ation /ue to special potassium ch nnel efflu% through volt ge g ted !ot ssiu& ch nnels *the new det ils, 4 not i&!ort nt for ste! 1 (hase 2 1 (lateau phase # very i portant Slow ch nnels o!en *volt ge# g ted c lciu& ch nnels, incre sing c lciu& conduct nce 5 lciu& influ% occurs o P rtici! te in contr ction o =ele se ddition l c lciu& fro& s rco!l s&ic reticulu& o 3ery low !ot ssiu& *", conduct nce resulting in del yed re!ol ri: tion nd st 'le !l te u .ot only ! rtici! te in contr ction( <7T =?@?0S? 5 fro& S= 4 volt ge #g ted ch nnel closed( 'ut ung ted " ch nnel 4 o!enA so we h ve " influ% through ung ted ch nnel * lw ys o!en,- They ' l nce e ch other in the !l te u nd we h ve st 'le !l te u- B? wouldn+t h ve st 'le !l te u if we h ve volt ge# g ted ch nnel o!en(hase 3 1 +epolari2ation
o o o

3olt ge g ted c lciu& ch nnels close 3olt ge g ted !ot ssiu& *", ch nnels reo!en incre sing !ot ssiu& conduct nce C ssive !ot ssiu& efflu%

5 n 'e tested: $f /rug in ventricular uscle .re"ular contracted/ !revented o!ening volt ge 4 g ted " ch nnel 4 in re!ol ri: tion you will not h ve & ssive " efflu%( 'ut still h ve s& ll efflu% of " through ung ted " ch nnel( 'ut you still h ve slow re!ol ri: tion$f in neuron drug volt ge 4g ted . # 'loc; 4 no 0P( 'ut in ventricul r &uscle# 'loc; of f st ch nnel# you don+t 'loc; 0P( 'ec use slow 5 c n re!l ce f st ch nnel nd

will h ve

slow de!ol ri: tion st 'le

(hase $ 1 +est 1 only in re"ular contractin" fi'er of the he rt h ve resting !otenti l *very long !l te u !h se,

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SLIDE 3 of 12

ELEC%+ICAL *E+S,S MECHA'ICAL E*E'%S

9ne electric l event !er &ech nic l event /ue to very lon" a!solute refractory period in ventricul r &uscle 4 i&!ossi'le to s tur te the interior with free 5 $&!ossi'le to tet ni:e he rt &uscle

?lectric l event in c rdi c &uscle 4 longer th n s;elet l &uscle$n s;elet l 4 we h ve sever l electric l event for every &ech nic l event 'ec use the electric l event is short we h ve tet ni: tion152525 >>> 0:28:06

SLIDE 4 of 12

AC%I&' (&%E'%IAL CHA+AC%E+IS%ICS &) S(ECIALI5ED CELLS

SA node 5ont in fe6 f st ch nnels /e!ol ri: tion due to slow calciu ch nnels( not f st sodiu& ch nnels =e!ol ri: tion due to !ot ssiu& efflu% $nnerv ted 'y sy&! thetic nd ! r sy&! thetic neurons Bill 'e tested: /o not h ve very & ny f st ch nnels =e!ol ri: tion# " efflu% 7nst 'le Ph se 6 in ll s!eci li:ed cell 4 gr du l de!ol ri: tion *P ce& ;ers !otenti l or !re!otenti l, tow rd threshold Dr du l de!ol ri: tion is !ro' 'ly due to decre se " conduct nce( or influ% of . or 5 ( or due to ll 3 &ech nis&s( So it won+t 'e tested on ste! 1 A* node (ur7in8e fi!ers
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SLIDE 9 of 12

Effect of Sy pathetics on SA node

$ncre se slo!e of !re!otenti l =e ch threshold sooner $ntrinsic firing r te incre sed

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SLIDE : of 12

Effect of (arasy pathetics on SA node

Hy!er!ol ri: tion of Ph se 6 T ;e longer to re ch threshold *decre sed slo!e, $ntrinsic r te slows down

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SLIDE ; of 12

Conduction path6ays and velocity of conduction S0 node tri l &uscle 03 node *del y, Pur;inEe fi'ers ventricul r &uscle > stest conducting fi'er F Pur;inEe cell Slowest conducting fi'er F 03 node Auto 123aticity S0 nod l cells # Highest intrinsic r te 4 !ri& ry ! ce& ;er 03 nod l cell # Second highest intrinsic r te# second ry ! ce& ;er Pur;inEe cells # Slowest intrinsic r te

$f he rt r te # 100 'e tsG&in nd it+s nor& l he rt( # firing r te of 03 nod l cell# lso 100 'e tG&in( nd ll cells 'e t t 100 'e tG&in $f he rt h ve 03 rhyth&s *S0 ;noc;ed out,( nd 'e ts H0 then every cell will 'e t t H0 'e tG&in152565 >>> 0:38:21

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ELEC%+&CA+DI&<+A(H=1 supple ental topic

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HEA+% -L&C>
1? (artial .first1de"ree/ !loc7 Slowed conduction through the 03 node P # = interv l is incre sed ?very i&!ulse will t ;e longer to convey P r sy&! thetic in!ut *l rge,# could induce 1#st degree he rt 'loc; 2? Second1de"ree !loc7 # ost tested So&e i&!ulses re not tr ns&itted through the 03 node 2 su'c tegories 4 not HY if you h ve ?5D# then it is 2#nd degree?very 6 or 3 will not 'e followed 'y I=S co&!le% 3? Co plete .third1de"ree !loc7/

.o i&!ulses conducted fro& the tri to ventricles They 'e ting inde!endently Be don+t need to ;now ?5D( 'ut & y 'e s;ed1- tri nd ventricles 'e ting inde!endently# no correl tion 'tw P w ves nd I=S co&!le% 2- ! ce& ;ers tissue in tri h ve higher intrinsic r ted th n ventricle tissue# the fre)uency of P w ve is gre ter of I=S co&!le%

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EI'%H&*E'@S %+IA'<LE # supple ental topic

$f you h ve left %is devi tion# left ventricul r hy!ertro!hy $f you h ve right %is devi tion# right ventricul r hy!ertro!hy