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Cardiovascular - Electrophysiology - Extrinsic Cardiac Conduction System

This document provides an overview of the extrinsic cardiac conduction system, including: 1) It defines the extrinsic cardiac conduction system as the autonomic nervous system modifying the intrinsic cardiac conduction and contractility based on the body's needs through the sympathetic and parasympathetic nervous systems. 2) It describes the anatomy and function of the parasympathetic nervous system, which decreases heart rate and conduction through the release of acetylcholine. 3) It describes the anatomy and function of the sympathetic nervous system, which increases heart rate, conduction, and contractility through the release of norepinephrine and epinephrine. 4) It explains the intracellular mechanisms of how the sympathetic and parasympathetic

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Saransh Jain
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28 views2 pages

Cardiovascular - Electrophysiology - Extrinsic Cardiac Conduction System

This document provides an overview of the extrinsic cardiac conduction system, including: 1) It defines the extrinsic cardiac conduction system as the autonomic nervous system modifying the intrinsic cardiac conduction and contractility based on the body's needs through the sympathetic and parasympathetic nervous systems. 2) It describes the anatomy and function of the parasympathetic nervous system, which decreases heart rate and conduction through the release of acetylcholine. 3) It describes the anatomy and function of the sympathetic nervous system, which increases heart rate, conduction, and contractility through the release of norepinephrine and epinephrine. 4) It explains the intracellular mechanisms of how the sympathetic and parasympathetic

Uploaded by

Saransh Jain
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Last edited: 8/13/2021

1. EXTRINSIC CARDIAC CONDUCTION SYSTEM


Cardiovascular | Electrophysiology | Extrinsic Cardiac Conduction System Medical Editor: Dr. Sofia Centenaro

OUTLINE

I) DEFINITION
II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)
III) SYMPATHETIC NERVOUS SYSTEM (SNS)
IV) REFRACTORY PERIOD
V) REVIEW QUESTIONS
VI) REFERENCES

I) DEFINITION
Definition: The Autonomic Nervous System modifies the
intrinsic Cardiac Conduction and Contractility based on
body’s needs
System Innervation of Heart (SNS & PSNS)

II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)

(A) ANATOMY
1) Anterior Hypothalamus
2) ↑ Cardiac Inhibitory Center in Medulla
3) ↑ Preganglionic Vagus Nerve fibers
4) ↑ Postganglionic Vagus nerve fibers in Intramural
Ganglia
5) ↑ Cervical and Thoracic Cardiac nerves
6) Heart Figure 1. Mechanism of action of SNS and PSNS on nodal cells

(B) FUNCTION
↓Heart Rate III) SYMPATHETIC NERVOUS SYSTEM (SNS)
o ↓Chronotropy (keeps the sinus rhythm)
o slow depolarization → decreased rate of action (A) ANATOMY
potentials (APs) 1) Posterior Hypothalamus
whenever HR< 60 bpm → Bradycardia 2) ↑ Cardioacceleratory Center in the Medulla
3) ↑ Preganglionic Fibers in T1-T5 region of spinal cord
↓Conduction 4) ↑ Postganglionic Fibers in Sympathetic Chain
o ↓ Dromotropy Ganglia
No effect on Contractility 5) ↑ Superior, Middle and Inferior cardiac nerves
6) Heart
(C) INTRACELLULAR MECHANISM OF ACTION
(B) FUNCTION
PSNS fibers
↑ Acetylcholine (Ach) release ↑ Increases Heart Rate
↑ Muscarinic Type 2 receptors activity o ↑ Chronotropy
↑ Gs inhibitory protein activity o more rapid depolarization
↑ dissociation of alpha (𝛼𝛼) subunit from beta (𝛽𝛽) and o → ↑ increased rate of action potentials (Aps)
gamma (𝛾𝛾) whenever HR >100 bpm → Tachycardia
o ↑ beta/gamma activity
 → ↑ binding to K+ channels ↑Increases conduction
 → ↑ K+ efflux o ↑ Dromotropy
 → ↑ hyperpolarization of cells ↑Increases Contractility
 → ↓ AP’s o ↑ Inotropy
 → ↓ HR & ↓Conduction
o ↑ alpha activity
 → ↓ AC activity
 → ↓ cAMP
 → ↓ PKA
 → ↓ phosphorylation of L-type Ca++ channels
 → ↓Calcium influx in nodal cells
 → ↓AP’s
 → ↓HR

Figure 2. Effects of SNS and PSNS on HR

extrinsic cardiac conduction system CARDIOVASCULAR PHYSIOLOGY : Note #1. 1 of 2


(C) INTRACELLULAR MECHANISM OF ACTION IV) REFRACTORY PERIOD
(1) on nodal cells: During phases 3 and 4 (repolarization and RMP)
SNS fibers absolute, relative, super
↑ release NE and Epi normal heart is resting
↑ 𝛽𝛽1 adrenergic receptor activity 250 ms
↑ Gs protein activity In the relative refractory period if you provide enough
↑ AC activity stimulus to the heart, you can take it out of refraction and
↑ cAMP trigger another action potential – but you want to obey the
↑ PKA absolute refractory period
↑ phosphorylate proteins:
o ↑ phosphorylation of L type Ca++ channels
 → ↑ Calcium influx in nodal cells
 → ↑ depolarization rate
 → ↑ AP’s
 → ↑ HR & ↑Conduction & ↑Contractility
(2) on contractile cells:
SNS fibers
↑ release NE and Epi (from adrenal medulla)
↑ Beta 1 adrenergic receptor activity
↑ CAMP
↑ PKA
↑phosphorylate proteins: Figure 3. Phases of cardiac action potentials in a myocyte
o ↑ phosphorylation of Phospholamban
 → ↑influx of Ca++ back into Sarcoplasmic
V) REVIEW QUESTIONS
reticulum
 → ↑ speed of relaxation Bradycardia occurs when HR is:
• so it can be stimulated again quickly a. < 60 bpm
o ↑ phosphorylation of L-type Ca++ channels b. > 60 bpm
 → ↑ Calcium influx contractile cells c. <100 bpm
 → ↑ Ryr-2 activity d. Equal to 60 bpm
 → ↑ Ca++ in the SR
 → ↑↑ Ca++ released into the sarcoplasm Tachycardia occurs when HR is:
a. > 120 bpm
 → ↑ interactions with troponin
b. < 100 bpm
 → ↑ cross-bridge formation (interaction actin-
c. > 100 bpm
myosin)
d. > 60 bpm
 → contraction rate and speed → ↑ heart pumping
 → ↑ SV → ↑ CO The refractory period lasts about:
a. 150 ms
Definitions: b. 250 ms
Stroke volume (SV) = volume of blood pumped out of the c. 50 ms
ventricle in one heartbeat d. 500 ms
Cardiac Output (CO) = amount of blood pumped out of the
ventricle in one minute Which type of channels are phosphorylated by
stimulation of the SNS?
Remember: a. L- type Ca++ channels
CO = HR x SV b. T- type Ca++ channels
BP = CO x TPR (total peripheral resistance) c. K+ channels
↑HR  ↑CO  ↑BP d. Na+ channels
↓HR ↓ CO  ↓BP
The PSNS can affect the contractility of the heart.
a. True
b. False

The SNS has a positive chronotropic action.


a. True
b. False

During the relative refractory period APs can be


triggered.
a. True
b. False

CHECK YOUR ANSWERS

VI) REFERENCES
• Guyton and Hall, Textbook of Medical Physiology,
Edra, 2021

Figure 1.1. MoA of PSNS & SNS on contractile cells

2 of 2 CARDIOVASCULAR PHYSIOLOGY: Note #1. extrinsic cardiac conduction system

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