Cardiac pacemaker and

cardiac muscle contraction

❖ The heart has a special system for
1. Generating rhythmical electrical impulses to cause
rhythmical contraction of the heart muscle
2. Conducting these impulses rapidly through the heart
❖ EXCITATORY AND CONDUCTIVE SYSTEM OF
HEART
Consist of
1. SA node
2. Internodal pathway
3. AV node
The Sinus Node as the Pacemaker
of the Heart
⚫ In the discussion thus far of the genesis and transmission
of the cardiac impulse through the heart, we have noted
that the impulse normally arises in the sinus node. In some
abnormal conditions, this is not the case. A few other parts
of the heart can exhibit intrinsic rhythmical excitation in
the same way that the sinus nodal fibers do; this is
particularly true of the A-V nodal and Purkinje fibers.
CONTINUE
⚫ The A-V nodal fibers, when not stimulated from some
outside source, discharge at an intrinsic rhythmical rate of
40 to 60 times per minute, and the Purkinje fibers
discharge at a rate somewhere between 15 and 40 times
per minute. These rates are in contrast to the normal rate
of the sinus node of 70 to 80 times per minute
CONTINUE
⚫ Thus, the sinus node controls the beat of the heart because
its rate of rhythmical discharge is faster than that of any
other part of the heart. There fore,the sinus node is
virtually always the pacemaker of the normal heart.
⚫ AV Bundle and Purkinji fibers
Purkinji fibers originate in AV nodes make AV
bundle(bundle of His) in fibrous tissue between two valves
and interventricular septum
AV bundle is divided in to right and left bundle branches
which run downward thru septum towards apex and
divided in to small branches that spread backward toward
base of ventricles

Purkinji fibers rapidly transmits cardiac impulse from AV

node throughout ventricle to cause synchronous contraction
of entire ventricle.
⚫ The action potential is initiated at the SA node and spreads
as a wave through the atrial muscle.
⚫ When the impulse reaches the AV node there is a delay
before the AV node fires. This gives the atria time to
squeeze blood into the ventricles before they fire.
⚫ The impulse is then carried by way of the AV bundle and
the right and left bundle branches to the apex of the heart
and then spread through the walls of the ventricles towards
the base of the heart.
⚫ This enables the heart to pump more efficiently as the
contraction starts at the apex and travels towards the base
where the blood is finally ejected from the ventricles.
Excitation-Contraction Coupling
⚫ The excitation-contraction is similar to that for skeletal
muscle except that the calcium that comes into the cell
during the plateau phase prolongs the cross bridge cycling
and stimulates release of more calcium from the
sarcoplasmic reticulum
Abnormal Pacemakers—“Ectopic”
Pacemaker
⚫ Occasionally some other part of the heart develops a
rhythmical discharge rate that is more rapid than that of
the sinus node. For instance, this sometimes occurs in the
A-V node or in the Purkinje fibers when one of these
becomes abnormal.
⚫ In either case, the pacemaker of the heart shifts from the
sinus node to the A-V node or to the excited Purkinje
fibers
⚫ Under rarer conditions, a place in the atrial or ventricular
muscle develops excessive excitability and becomes the
pacemaker.
⚫ A pacemaker elsewhere than the sinus node is called an
“ectopic” pacemaker. An ectopic pacemaker causes an
abnormal sequence of contraction of the different parts of the
heart and can cause significant debility of heart pumping.

⚫ RATE OF REHYTHMIC DISCHARGE

⚫ The A-V nodal fibers = 40 to 60 times per minute
⚫ the Purkinje fibers discharge = 15 and 40 times per minute.
⚫ the sinus node = 70 to 80 times per minute.
PRELOAD:
⚫ The degree of tension on the muscle when it begins to
contract, which is called the preload
⚫ Pre load = end diastolic volume
⚫ End-diastolic volume influences stroke volume by
stretching the ventricular myocardium. This effect is
intrinsic to the heart itself and is called Starling's law of
the heart.
Starling's Law
⚫ According to Starling's law the heart automatically
adjusts its output to match the end-diastolic volume. In
other words, as end-diastolic volume increases, the force
of ventricular contraction increases, and as end-diastolic
volume decreases, the force of ventricular contraction
decreases.
After load
⚫ After load is due to arterial pressure which places pressure
or a "load" on the ventricular myocardium after a
contraction begins. For the left ventricle, pressure in the
aorta during ventricular ejection determines the afterload.
Afterload increases with mean arterial pressure.
⚫ Afterload = pressure in aorta and pulmonary trunk
Heart rate
Normal heart rate = 72 (70 -80) beats / min

⚫ FACTORS AFFECTING HEART RATE

⚫ Impulses from higher centers
⚫ Respiration
⚫ Reflexes
⚫ Anoxia
⚫ Moderate increase in co2
⚫ Body temperature
⚫ Increase in intracranial pressure
⚫ Adrenaline
⚫ Throxine
⚫ Muscular exercise
REGULATION OF HEART RATE
LOCALMECHANISM
⚫ Intrinsic cardiac regulation of pumping in response to
changes in volume of blood flowing into the heart

NERVOUS MECHANISM
⚫ control of heart rate and strength of heart pumping by the
autonomic nervous system.
⚫ The heart is controlled by the autonomic nervous system.
⚫ The sympathetic nervous system releases norepinephrine
and the parasympathetic nervous system releases
acetylcholine. Sympathetic and parasympathetic neurons
exert opposite effects.

SYMPATHATIC NERVOUS SYS.

⚫ Sympathetic preganglionic nerves emerge from the upper
thoracic regions of the spinal cord and synapse with
postganglionic neurons in the sympathetic trunk.
⚫ Sympathetic neurons to the SA node increases the
frequency of action potentials. Postganglionic neurons
release norepinephrine which bind to ß1 receptors on the
SA nodal cells activating the cAMP (Cyclic adenosine
monophosphate) second messenger system. cAMP
augments the opening of channels and T-type Ca++
channels which increases the slope of spontaneous
depolarization. The frequency of action potentials increase
and increases the heart rate.
 PARASYMPATHATIC NERVOUS SYSTEM
⚫ Preganglionic fibers emerge from the medulla oblongata
in the vagus nerve and synapse with postganglionic
neurons in the heart
⚫ Parasympathetic neurons to the SA node decreases the
frequency of action potentials. Postganglionic neurons
release acetylcholine which bind to muscarinic cholinergic
receptors. The receptors open potassium channels through
stimulatory G proteins and close funny channels and
T-type calcium channels through an inhibitory G protein.
The frequency of action potentials as a result decreases
and decreases the heart rate
Thank you.