Heart muscle

PY5.1 Describe the functional anatomy of heart including

chambers, sounds; and Pacemaker tissue and conducting
system.

PY5.2 Describe the properties of cardiac muscle including its

morphology, electrical, mechanical and metabolic functions

PY5.3 Discuss the events occurring during the cardiac cycle

PY5.4 Describe generation, conduction of cardiac impulse

 HEART
a compact, powerful, untiring & adjustable pump
 Structural component of heart
• Pericardium {peri, around + kardia, heart}
-- Epicardium
• Myocardium {myo, muscle + kardia, heart}
• Endocardium
• Fibrous skeleton - central fibrous body
Pericardium and heart wall
Thickness of right and left ventricles
 Fibrous skeleton of the heart.
showing the heart valves and fibrous rings.
Both inlet and outlet valves lie on the same plane through the heart.
Orientation of cardiac muscle in myocardium
Direction of ventricle wall motion during contraction (middle) and orientation of muscle fibres in
the ventricle wall (bottom).
The longitudinal shortening of the left ventricle length during systole accounts for ~60% of the
stroke volume
 Cardiac muscle fibres

• Working cardiomyocyte/myocyte

• Specialized myocyte, i.e. conducting system of heart:

a) SA node
b) AV node
c) Bundle of His
d) Bundle branch
e) Purkinje fibre
Human cardiac myocytes. A: Working ventricular myocytes contain cross striations, central nuclei, and
intercalated discs. B: Purkinje fibers are large, poorly staining cells with sparse cross striations. The
sinoatrial node (C) and atrioventricular node (D) are networks of small, sparsely cross-striated cells. E:
Transition cells are seen where Purkinje fibers (left) impinge on the working myocardium
Schematic section of myocardium parallel to fibre axis, based on electron micrographs.
 Structure of Cardiac muscle
Mitochondria 25 – 30% + intercalated disc
Syncytial, interconnecting nature of cardiac muscle fibers
Structure of intercalated disc
Peculiarity of T-tubule
Conductive system of the heart
 Specialized conduction system of the heart and spread of cardiac excitation.
An action potential initiated at the SA node first spreads throughout both atria
through interatrial and internodal pathways. The AV node is the only point where an
action potential can spread from the atria to the ventricles.
 SA Node
• P-cell – small, ovoid, few organelles, paucity of
gap-junction
-- electrically coupled oscillators
Transitional cell – elongated,
size & complexity intermediate
 Electrical connections between cardiac muscle cells
An action potential generated spontaneously in cells of the SA node spreads to
adjacent muscle cells by means of electrical current passing through gap junction
 AV node
• Transitional cell – elongated but smaller than
atrial cells
Nodal cell – cell spherical
- small size
-- few gap junction
-- RMP more negative
 Atrioventricular node, annulus fibrosus, and the bundle of His.
AV node becomes Bundle of His at the point where it enters central fibrous body
 Bundle of His
• Small size of fibres
• Few gap junctions
• RMP more negative
 Purkinje fibres
• They are actually tract of single cells.
• Cell small, with large dia.,
thin sparse myofibrils,
lack of T-tubule and
extensive gap junctions
Intracellular potential during electrical
quiescence
SA nodal cell → -50 to -60 mV

AV nodal cell → -60 to -70 mV

Atrial + Ventricular muscle cell → -80 to -90 mV

Purkinje cell → -90 to -100 mV

An action potential recorded from a ventricular muscle cell
PNa increases during
phase 0 (green) &
decreases during
phase 1 (yellow)

PCa increases and PK

decreases during
phase 2 (orange)

PCa decreases and PK

increases during
phase 3 (purple)

During phase 4 (blue),

all ion channels are
in their resting
state (PK high, PCa
and PNa low)
Membrane potential recording from a ventricular muscle cell. Labels indicate
key ionic movements in each phase.
Action potential in cardiac contractile cell -- May be OMITTED
 Refractory Period
• Duration of AP:
in atria – 200 msec
in ventricle – 300 msec

• Refractory Period (RP):

• Absolute RP (Phase 0 to ½ of Phase 3)
in atria – 150 msec
in ventricle – 250 msec
• Relative RP:
in atria – 30-50 msec
in ventricle – 50 msec

• Effective Refractory Period

 Conducting system of the heart with typical transmembrane action potentials for the SA
and AV nodes, other parts of the conduction system, and the atrial and ventricular muscles
Action potentials recorded from a single atrial muscle cell and a
single ventricular muscle cell,
 Membrane potential recording from a cardia nodal cell. Labels indicate key ionic
movements in each phase.
A gradual reduction in K+ permeability also contributes to the pacemaker potential
and the Na+ entry in this phase is through nonspecific cation channels
 Pacemaker activity of cardiac autorhythmic cells (May be OMITTED)
Pacemaker potential is the result of simultaneous opening of unique funny
channels, which permits inward Na+ current, and closure of K+ channels, which
reduces outward K+ current.
Ionic Basis of the Autorhythmic Cell Action Potential
Cardiac muscle contraction
EC COUPLING IN CARDIAC MUSCLE
 Excitation–contraction coupling in cardiac muscle and the modulation of cardiac
contractility. ATP, adenosine triphosphate; cAMP, cyclic adenosine monophosphate; RYR,
ryanodine receptor; SR, sarcoplasmic reticulum
A) Cardiac action potential and (B) the resulting
cardiac contraction
 Properties of cardiac muscle fibre
• functional syncytium,
• excitability,
• conductivity,
• contractility,
• extensibility,
• Automaticity – affected by nerve supply
• Rhythmicity,
• tonicity,
• all-or-none response,
• refractory period,
• staircase phenomenon,
 Excitability
• Manifests as constellation of different events:
-- Electrical event
-- Mechanical event
-- Thermal event
-- Chemical event → O2 supply by Kreb`s cycle of fatty acid (50%) + Carbohydrate
(30%)

• Affected by:
Nerve supply – autonomic nerve
Hormones – catecholamines, thyroxin,
Temperature of medium/surrounding -
high temp increases excitability and conductivity
ions of medium/surrounding –
↑ K+ → ↓ K+ efflux → inactivation gate of Na+-channel closed
↑Ca++ α strength of contraction------------------→ Ca++ rigor
pH of medium/surrounding
low pH → low excitability & vice versa
Nutrition
drugs
 Nerve supply of Heart
• Sympathetic
• Parasympathetic
Cardiac sympathetic and parasympathetic nerves
Effect of Parasymapthetic stimulation
Effect of Symapthetic stimulation
 CATECHOLAMINES INCREASE CARDIAC CONTRACTION
Phospholamban alters sarcoplasmic reticulum Ca++ ATPase activity
Effect of sympathetic (noradrenergic) and vagal (cholinergic) stimulation
on the membrane potential of the SA node.
 conductivity
• Always anterograde from atria to ventricle,
but conduction velocity differs according to
type of fibres.
• Conduction delay in AV node:
-- due to small size of fibres, gap junctions very
few, RMP more negative
-- allow atria to eject its content fully before
ventricular contraction
Conduction of excitation
 Organization of the atrioventricular (A-V) node
The numbers represent the interval of time from the origin of the impulse in the sinus node.
(The values have been extrapolated to human beings).
Note the conduction delay in AV node
 Conduction Velocity of Different Conductive Tissues

Cardiac tissue Conduction velocity (m/sec)

SA node 0.05

Interatrial pathway 1.00

Atrial muscle 0.3 - 1.00

AV node 0.05

Bundle of His 1.00

Purkinje fibres 4.00

 Transmission of the cardiac impulse through the heart, showing
the time of appearance (in fractions of a second after initial
appearance at the sinoatrial node) in different parts of the heart.
 contractility
• Same as skeletal muscle but
-- duration is mainly function of AP
-- contractile strength mainly depends on
extracellular Ca++

• Leads to:
-- shortening or
-- force/tension generation
 automaticity
• Capability of cardiac muscle to generate
spontaneously the propagated Action potential

• All cardiac muscles have this inherent property but

normally it manifests only in SA node – due to phase
4 depolarization (Pace maker potential/Prepotential)

• Significance of phase 4 depolarization → determine

the heart rate
 rhythmicity
• Inherent rate of discharge –
in SA node – 70-80/minute – sinus rhythm
in AV node – 40-60/minute – nodal rhythm
in Purkinje fibre -- 20-40/minute – idio-ventricular
rhythm

• Definition of Pacemaker –
When a cell or group of cells undergo self-excitation by
phase 4 depolarization and initiate an impulse that
propagates to the resrt of the heart, it is called pacemaker.
Modulation of pacemaker activity
Analogy of pacemaker activity
Analogy of pacemaker activity
 Tonicity

• Cardiomyocyte possesses tone, which is

adjustable & independent of nerve supply, so
even at rest heart is slightly contracted.

• Hence denervated cardiac muscle is able to

regulate its volume during ventricular filling.
Extrasystole, Post-systolic potentiation
Staircase phenomenon
 Summation of cardiac contraction.
Positive staircase effect occurs when a quiescent heart starts beating
or when there is a sudden increase in heart rate. Negative staircase
effect occurs following a sudden decrease in heart rate