Electrical Control of the Heart

The chambers of the heart must contract in a synchronized and predictable pattern for blood to move
efficiently through the pulmonary and systemic circuits. It relies on electrical signals that regulate when the
cardiac muscle cells contract. There are four major features of electrical control of the heart: 1) Intercalated
discs 2) the Sinoatrial Node 3) the Atrioventricular Node and 4) Purkinje Fibers.

1) Intercalated Discs Musclecell

 __________________________
intercalated discs = _____________________ between cardiac muscle fibers
junction
 They are __________________
linked so that the muscle cells do not ____________________
seperate
during
________________________
contraction

 iÉÉÉ to pass _____________________

_____________ between the discs allow __________ between muscle cells
gaps
 Intercalated discs create a, “____________________________________,”
functional syncytium meaning the myocardium
contracts as a single _______________ not as separate cells
unit

synctogether
cytcell

µ
striations

nuclei
2) Sinoatrial Node Isan
 The Sinoatrial Node is called the ____________________
pacemaker
of the heart because it begins the depolarization of the
_____________
atria and sets the ________________ of the
rhythm
heartrate
 It is a _________________
bundle of cells in the right atrium that
sympathetic
flightor
is influenced by the _______________________
autonomic nervous
O
tight system but is capable of _____________________ its
generating
_________ electrical impulses AVN
parasympathetic ow
restingand  The heart has an “________________________”
autorhythmic
nature
digesting thanks to the Sinoatrial Node. This means the heart can
_________________
contract on its _______
own
 Its _________________ pace is rather fast (~______ bpm)
default 75
purkinje
fibers
3) Atrioventricular Node AVN
 The __________________________
atrioventricular Node depolarizes ____________
after the Sinoatrial Node
 It ___________________
delays
depolarization _______ seconds so that the atria can finish contracting
before the ventricles start to contract (allows __________________________
atriasystole to finish before
________________________________
ventricular begins)
systole

4) Purkinje Fibers
 The ____________________
electrical signal sent by the Atrioventricular
Node travels throughout the ___________________
ventricles thanks to the
___________________________
purkinjefibers
 These fibers depolarize the ventricles from the _______________
apex
up causing the ventricles to contract from the ____________________
bottom
so that their blood is pumped ____ and _____ of the ______________
up out arteries

pulmonary
I
aorta
artery

Electrocardiograms (ECG/EKG)

What does each 1 mm tiny

square represent?
- 0.04 seconds xaxis
- 0.10 millivolts axis
y
What about each 5 mm box
i n z z z with bolded lines?
- 0.20 seconds
- 0.50 millivolts

So, how many 5 mm bolded

boxes are necessary to make
one second and one
millivolt?
1 second = __________ boxes
5
1 millivolt = __________ boxes
2
 Key Features of ECG Graph Paper
1. Allows visual measurement of time.
 Measured in seconds
 Found on the X- axis
2. Reports the voltage used during different depolarizations and repolarizations.
 The amplitude (height) of each wave indicates the amount of voltage produced
 Measured in millivolts
 Found on the Y- axis signals
3. Reads from left to right. ventricles
R
tocontract
systole
Labeling the Components of a Wave
ventricles
signalsatriatocont signals
1. Label the peaks. reset
2. Label when you’d hear “lub”
systole
L torelax
diastole
and when you’d hear “dup.”
p

S
On the graphs below,
 Label the axes and their units  Calculate total # of seconds
 Mark each full second of the strip  Find the peak value of R in millivolts
Two Example ECGs Showing Normal Sinus Rhythm
psec psee psee
316sec

R0.9mV
Éo

timesea
0
1psec 2psec 13sec
ilse 15sec

E
H am

j 706pm

timesea
Method to Analyze ECGs
You will need to assess the following features in order to have a complete picture of what is happening in your
patient’s heart.
I. Heart rate
- Count the number of QRS complexes in a 6 second strip
- Multiply that number by 10
Why do those instructions make sense given what you know about heartrate and its unit?
____________________________________________________________________________________
Thismakessenseble60secondsin aminuteand heartrateistoldinbeatsperminuteso multiplying
____________________________________________________________________
by
it 10youare togetan
able ofwhat h
the eart
r in
ate BPM
by estimate

II. Heart rhythm

What are some reasons you can think of for an irregular heartbeat?
____________________________________________________________________________
heartattack drink
obesityenergy
- Look to see if the spacing between R waves is consistent or not
- For example, if there are three 5 mm boxes between two R waves then six 5 mm boxes between the
next two, the rhythm is irregular.

III. P wave
- Check that it is rounded and upright
- Verify that each QRS complex has its own P wave and that they’re all similar heights
- No… there could be a problem with the sinoatrial node (SAN).
- Yes… then the heart is in what’s called “sinus rhythm” because SAN is in charge of regulating the
heart rate as is expected.

IV. QRS wave

- Normally lasts 0.06 to 0.12 seconds
How many 1 mm tiny boxes would be spanned by normal QRS complexes?
____________________________________________________________________________
1.53boxes
Cardiovascular Disorders on Electrocardiograms
xno
Asystole
Omyontactions
3see 3see
 cham whencontracting
puppet lackofsyncoonization
musclecells contract
prematurely
certain
Atrial Fibrillation whileother late
contract

6 sec
v5 us v4 v5 v3
v70bpm

may

can'tcontractnormally
sinceatria
alsohateagthythemia bloodpoolsinthem'sclotscanform
Thrombus

plowedmate's sameas
above
Ventricular fibrillation

dangerousfibrillation
more

tooirregularto calculateheartrate

Sinus Arrhythmia
Tp waveison simatrialnodepacemakerstillincontrol

v5 v7.5 6see
closehis farhis v50bpm
ca
alsohasbrody

irregular pacerhythmble relaxationperiodlength

varies
 rate
slowheart 260bpm
go
Sinus Bradycardia
pwave

exerciseinducedbradycardiais agoodthing
Strong thatcanmovebloodwillbeatsorest

wave fastheart
rate
pp y yoobpm
Sinus Tachycardia
SA

6sec
N130bpm

to speed upHR time is cutfromrelationperiod