CVM6901: Cardiovascular Physiology

John P. Collister

Electrical Properties of the Heart

Major Concepts and Objectives

1. Know the functional anatomy of the heart.

2. Know the origin of electrical activity in the heart and the pathway of
electrical conduction throughout.
3. Understand how the characteristics of a cardiac action potential differ
from a nerve or skeletal muscle axon.
4. Understand the ionic basis (driving forces, conductances, etc.) for all
phases of an action potential in a contractile cell.
5. Know how action potentials in cardiac muscle cells differ from nodal
cells (sinoatrial, atrioventricular) and the ionic basis for these differences.
6. Understand the ionic basis of the cardiac pacemaker potential.
7. Know how heart rate (pacemaker frequency) is modulated by
parasympathetic and sympathetic neurotransmitters (acetyl choline and
norepinephrine respectively).

I. Functional anatomy of the heart

A. The flow pathway through the heart (think of a red blood cell entering
the heart)
1. Cranial and caudal vena cava (carries blood low in oxygen from the
body)
2. Right atrium
3. Right atrioventricular valve (tricuspid valve)
4. Right ventricle
5. Pulmonic valve
6. Pulmonary artery (carries blood low in oxygen to the lungs)
7. Pulmonary veins (carries blood high in oxygen from the lungs)
8. Left atrium
9. Left atrioventricular valve (mitral valve)
10. Left ventricle
11. Aortic valve
12. Aorta (carries blood high in oxygen to the body)
B. Types of cardiac muscle fibers and the role of gap junctions

1. Contractile fibers and what they do.

Similar to skeletal muscle cells in that they shorten when
depolarized. Located in the atria and ventricles.

2. Conducting fibers and what they do.

Specialized muscle cells (not nerve cells), which conduct action
potentials but do not generate force.

a. Sinoatrial node (SA node; pacemaker)

1. Normal pacemaker of heart
2. Unstable resting membrane potential, referred
to as pacemaker potential (more later)

b. Internodal pathways
1. Conduct action potential/electrical activity
throughout atria to the AV node.

c. Atrioventricular node (AV node)

1. Lies at junction of right atrium and tricuspid
valve.
2. Delays action potential transmission to the
ventricles due to slower depolarization (giving
time for ventricular filling)

d. Bundle of His
1. Also called common bundle or AV bundle
2. Conducts electrical activity to the left and right
bundles.

e. Bundle Branches
1. Main branches conducting electrical activity to
each respective ventricle

f. Purkinje fibers
1. Continuation of the bundle branches to each of
the ventricles

3. Gap junctions and the “All or none law of the heart”

II. Review of basic principles of electrical and chemical driving forces in
cardiac cells.

When the membrane potential of an excitable cell reaches its threshold an action
potential occurs. Action potentials have been discussed in nerve and skeletal
muscle. The cardiac action potential is different for several reasons:

A. In addition to sodium and potassium, the membrane is also

permeable to calcium, and this adds to the properties of the cardiac
action potential.
B. The action potential can spontaneously arise in several cardiac
areas of cells (SA and AV node primarily)
C. The action potential is longer than seen in nerve and muscle.
D. The action potential can be conducted directly from cell to cell.

So…what determines the membrane potential?

That depends on the Nernst potential for each significant ion (Na+, K+ & Ca++)
and its membrane permeability, and is described by the
Chord Conductance Equation:

Vm = gNa/gT(ENa) + gK/gT(EK) + gCa/gT(ECa)

Vm=membrane voltage

gNa=membrane conductance or permeability to sodium

gK=membrane conductance or permeability to potassium
gCa=membrane conductance or permeability to calcium
gT=total membrane conductance or permeability

ENa=Nernst equilibrium potential for sodium

EK=Nernst equilibrium potential for potassium
ECa=Nernst equilibrium potential for calcium

So…what is a Nernst potential?

________________________________________________________________

Things to remember:
A. In general, sodium concentrations are high outside the cell relative
to the inside. Nernst equilibrium potential is approximately = 72mV
B. In general, K+ concentrations are LOW outside the cell relative to
the inside. Nernst equilibrium potential is approx = -84 mV
C. In general, calcium concentrations are high outside the cell relative
to the inside. Nernst potential approximately = 100mV
The membrane potential (Vm) of any cell changes because of
channels opening or closing for specific ions. In nerve axons those are
sodium and potassium channels. The same is true in cardiac cells
with the addition of calcium as an ion that contributes to the action
potential.

Cardiac Cell

-80 mV
Ca++ Na+
K+

Ions move across cell membranes as a result of their electrical and

chemical driving forces. The net driving force for any ion is based on
the concentration gradient for that ion across the membrane and the
membrane voltage (i.e. electrical gradient). The balance of these
forces for each ion is called the electrochemical equilibrium (Nernst
potential). Because the concentrations of Na and Ca are higher
outside the cell and the membrane potential is negative, opening a Na
or Ca channel will allow these ions to move into the cell and depolarize
it. But for K, it has a high enough concentration inside the cell so
opening a K channel will allow it to go down it’s electrochemical
gradient and hyperpolarize the cell (positive charge leaving the cell).
So, for any cardiac cell, the only way the membrane potential will
change is by the following:

Depolarization Hyperpolarization
Open Na channel Close Na channel
Open Ca channel Close Ca channel
Close K channel Open K channel
III. Ionic basis of action potentials in myocardial contractile cells (atria and
ventricles)

A. Ionic mechanisms of the ventricular action potential

1. Rapid depolarization (Phase 0):

voltage dependent activation of sodium
(green) channels (similar to nerve axon)

2. Initial repolarization (Phase 1):

inactivation of sodium (green) channels
(similar to nerve axon)

3. Plateau (Phase 2): increased calcium

(purple) conductance (“slow channel”,
unique to cardiac cells) and decreased
potassium (yellow) conductance. This is
unique to cardiac muscle!

4. Repolarization (Phase 3):

Inactivation of calcium (purple) channels
and conductance returns to normal – and
increased potassium (yellow)
conductance returns to normal.
IV. Ionic basis of the cardiac pacemaker: The sinoatrial node
A. SA node is the normal pacemaker of the heart.
1. Hallmark feature is an unstable resting membrane potential that
continuously drifts towards threshold. This is an intrinsic property
of SA node cells (due to slowly decreased permeability to K+ and
increased permeability to Ca++ and Na+).
2. Resting membrane potential relatively depolarized (-60 mV)
compared to cardiac contractile cells (-90 mV)
3. No rapid depolarization phase due to lack of voltage activated
sodium channels.

B. Ionic basis of the pacemaker potential

 C. Control of heart rate (SA pacemaker activity)
1. Intrinsic heart rate: rate independent of neural or hormonal
signals.
2. Bradycardia: low heart rate
3. Tachycardia: high heart rate

4. Sympathetic stimulation increases heart rate

EPI NE a. neurotransmitter is norepinephrine.
b. epinephrine from adrenal gland.
c. mediated by beta1 adrenergic receptor
b1
d. increases calcium conductance

5. Parasympathetic (vagus nerve) stimulation

decreases heart rate
a. neurotransmitter is acetylcholine
b. mediated by the cholinergic-muscarinic receptor
c. increases potassium conductance

D. Other pacemaker sites in the heart

The SA node is not the only site with pacemaker activity in the
heart. The AV node and His-purkinje system also exhibits
pacemaker activity. However, the site with the highest intrinsic
frequency drives the rest of the heart. This is referred to as
overdrive suppression. An ectopic pacemaker occurs whenever
a region of the heart other than the SA node assumes the role of
the cardiac pacemaker.