3/31/2014

Anatomy, Physiology, and Electrophysiology

I. Structures
A. Heart has 4 chambers RA, RV, LA, LV
1. RA & LA are reservoirs for blood being sent to the RV &
LV
2. RV & LV are the main pumping chambers of the heart
B. Heart contains 4 valves
1. AV valves & 2 semilunar valves
2. Tricuspid valve is between the RA & RV (AV valve)
3. Bicuspid or Mitral valve is between the LA & LV (AV
valve)
4. Pulmonic valve is between the RV & pulmonary artery
(semilunar valve)
5. Aortic valve is between the LV & aorta (semilunar valve)
6. Valves open and close in response to pressure changes in
the heart
7. Valves act as one way doors to keep blood moving
forward
II. Circulation it is important to understand blood flow through the heart in
order to understand overall function of the heart and how changes in
electrical activity affect peripheral blood flow.
A. Deoxygenated blood from the body returns to the heart via the
superior and inferior vena cava ---- empties into the right atrium ---through the tricuspid valve ---- into the right ventricle ---- through the
pulmonic valve ---- into the pulmonary artery ---- lungs through the
pulmonary circulation, contacting alveoli and exchanging gasses ---to the pulmonary vein ---- into the left atrium ---- through the mitral
valve (bicuspid valve) ---- into the left ventricle ---- through the aortic
http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

1/8

3/31/2014

Anatomy, Physiology, and Electrophysiology

valve ---- into the aorta ----then to the capillary beds throughout the
whole body for gas exchange.
B. Blood supply to the heart is provided by the right and left
coronary arteries which arise from the aorta, just above and behind
the aortic valve
III. Nervous system Heart is supplied by 2 branches of the autonomic
nervous system
A. Sympathetic nervous system (or Adrenergic)
1. Accelerates the heart
2. Two chemicals are influenced by the sympathetic system
epinephrine & norepinephrine
3. These chemicals increase heart rate, contractibility,
automaticity, and AV conduction
B. Parasympathetic nervous system ( or Cholinergic)
1. Slows the heart
2. The vagus nerve is one of this systems nerves, when
stimulated slows heart rate and AV conduction.
IV. Electrophysiology
A. Cardiac cells two types, electrical and myocardial (``working")
1. Electrical cells
a) Make up the conduction system of the heart
b) Are distributed in an orderly fashion through the
heart
c) Possess specific properties
(1) automaticity the ability to spontaneously
generate and discharge an electrical impulse
(2) excitability the ability of the cell to respond
to an electrical impulse
(3) conductivity the ability to transmit an
electrical impulse from one cell to the next
2. Myocardial cells
http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

2/8

3/31/2014

Anatomy, Physiology, and Electrophysiology

a) Make up the muscular walls of the atrium and

ventricles of the heart
b) Possess specific properties
(1) contractility the ability of the cell to shorten
and lengthen its fibers
(2) extensibility the ability of the cell to stretch
B. Depolarization and Repolarization
1. Cardiac cells at rest are considered polarized, meaning no
electrical activity takes place
2. The cell membrane of the cardiac muscle cell separates
different concentrations of ions, such as sodium, potassium,
and calcium. This is called the resting potential
3. Electrical impulses are generated by automaticity of
specialized cardiac cells
4. Once an electrical cell generates an electrical impulse, this
electrical impulse causes the ions to cross the cell membrane
and causes the action potential, also called depolarization
5. The movement of ions across the cell membrane through
sodium, potassium and calcium channels, is the drive that
causes contraction of the cardiac cells/muscle
6. Depolarization with corresponding contraction of
myocardial muscle moves as a wave through the heart
7. Repolarization is the return of the ions to their previous
resting state, which corresponds with relaxation of the
myocardial muscle
8. Depolarization and repolarization are electrical activities
which cause muscular activity
9. The action potential curve shows the electrical changes in
the myocardial cell during the depolarization repolarization
cycle
10. This electrical activity is what is detected on ECG, not the
muscular activity
C. Action Potential
1. The action potential curve consists of 5 phases, 0 to 4
http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

3/8

3/31/2014

Anatomy, Physiology, and Electrophysiology

2. The 5 phases:
a) Phase 4 rest
(1) this is the cells resting phase
(2) the cell is ready to receive an electrical
stimulus
b) Phase 0 upstroke
(1) is characterized by a sharp, tall upstroke of
the action potential
(2) the cell receives an impulse from a
neighboring cell and depolarizes
(3) during this phase the cell depolarizes and
begins to contract
c) Phase 1 spike
(1) contraction is in process
(2) the cell begins an early, rapid, partial
repolarization
d) Phase 2 plateau
(1) contraction completes, and the cell begins
relaxing
(2) this is a prolonged phase of slow
repolarization
e) Phase 3 downslope
(1) this is the final phase of rapid repolarization
(2) repolarization is complete by the end of
phase 3
f) Phase 4 rest
(1) return to the rest period
(2) the period between action potentials
3. Refractory and supernormal periods
a) Absolute refractory period
http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

4/8

3/31/2014

Anatomy, Physiology, and Electrophysiology

(1) a period in which no stimulus, no matter how

strong, can cause another depolarization
(2) onset of phase 0 begin the absolute refractory
period, and extends midway through phase 3
(3) begins with the onset of the Q wave and ends
at about the peak of the T wave
b) Relative refractory period
(1) the cell has partially repolarized, so a very
strong stimulus could cause a depolarization
(2) also called the vulnerable period of
repolarization (a strong stimulus occurring
during the vulnerable period may push aside
the primary pacemaker and take over
pacemaker control)
(3) occurs in the 2nd half of phase 3
(4) corresponds with the downslope of the T
wave
c) Supernormal period
(1) near the end of the T wave, just before the
cell returns to its resting potential
(2) is NOT a normal period in a healthy heart
(3) a period in which a stimulus weaker than
normally required can cause a depolarization
(4) this is a short period at the very end of phase
3 into early phase 4
(5) extends the relative refractory period
V. Conduction system
A. Inherent firing rate is the rate at which the SA node or another
pacemaker site normally generates electrical impulses
B. SA Node - Sinoatrial node
1. Dominant or primary pacemaker of the heart
2. Inherent rate 60 100 beats per minute
http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

5/8

3/31/2014

Anatomy, Physiology, and Electrophysiology

3. Located in the wall of the right atrium, near the inlet of the
superior vena cava
4. Once an impulse is initiated, it usually follows a specific path
through the heart, and usually does not flow backward
C. Intra-atrial tracts - Bachmann's bundle
As the electrical impulse leaves the SA node, it is conducted through
the left atria by way of the Bachmann's bundles, through the right
atria, via the atrial tracts
D. AVJunction - Made up of the AV node and the bundle of His
1. AV node
a) Is responsible for delaying the impulses that reach it
b) Located in the lower right atrium near the interatrial
septum
c) Waits for the completion of atrial emptying and
ventricular filling, to allow the cardiac muscle to stretch
to it's fullest for peak cardiac output
d) The nodal tissue itself has no pacemaker cells, the
tissue surrounding it (called the junctional tissue) contains
pacemaker cells that can fire at an inherent rate of 40
60 beats per minute
2. Bundle of His
a) Resumes rapid conduction of the impulses through
the ventricles
b) Makes up the distal part of the AV junction then
extends into the ventricles next to the interventricular
septum
c) Divides into the Right and Left bundle branches
3. Purkinje Fibers
a) Conduct impulses rapidly through the muscle to assist
in depolarization and contraction
b) Can also serve as a pacemaker, discharges at an
inherent rate of 20 40 beats per minute or even more
slowly
a) Are not usually activated as a pacemaker unless
http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

6/8

3/31/2014

Anatomy, Physiology, and Electrophysiology

conduction through the bundle of His becomes blocked

or a higher pacemaker such as the SA node or AV
junction do not generate an impulse
b) Extends form the bundle branches into the
endocardium and deep into the myocardial tissue
VI. Ectopic beats & arrhythmias
A. Any cardiac impulse originating outside the SA node is considered
abnormal and is referred to as an ectopic beat
B. Ectopic beats can originate in the atria, the AV junction, or the
ventricles, and are named according to their point of origin
C. Rate suppression can occur following an ectopic beat, but after
several cycles return to basic rate
D. A series of 3 or more consecutive ectopic beats is considered a
rhythm
E. The two causes for ectopic beats include:
1. Failure or excessive slowing of the SA node
a) ectopic beats resulting from sinus node failure serve
as a protective function by initiating a cardiac impulse
before prolonged cardiac standstill can occur; these
beats are called escape beats
b) if the sinus node fails to resume normal function, the
ectopic site will assume the role of pacemaker and
sustain a cardiac rhythm; this is referred to as an escape
rhythm
c) after the sinus node resumes normal function, the
escape focus is suppressed
2. Premature activation of another cardiac site
a) impulses occur prematurely before the sinus node
recovers enough to initiate another beat; these beats are
called premature beats
b) premature beats are produced by either increased
automaticity, or by reentry
3. Abnormal conduction system
VII. Automaticity
http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

7/8

3/31/2014

Anatomy, Physiology, and Electrophysiology

A. Special characteristic of cardiac cells to generate impulses

automatically
B. If the cell automaticity is increased or decreased an arrhythmia can
occur
1. Reentry events reexcitation of a region of cardiac tissue
by a single impulse, continuing for one or more cycles and
sometimes resulting in ectopic beats or tachyarrhythmias
2. Retrograde conduction
a) When an impulse begins below the AV node
b) Can be transmitted backward toward the AV node
c) Conduction usually takes longer than normal and can
cause the atria and ventricles to be ``out of synch"

http://www.andrews.edu/~schriste/Course_Notes/Anatomy__Physiology__and_Elect/anatomy__physiology__and_elect.html

8/8