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    Cardiac Electrophysiology: William Makdinata

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    William Makdinata
    - Pacemaker cells in the sinoatrial node generate spontaneous action potentials around 70-80 times per minute, setting the heart rate. These slow action potentials are caused by funny (If) channels and T-type calcium channels. - Non-pacemaker cells are excited by pacemaker cells. They have fast action potentials initiated by sodium channels, with phases of repolarization mediated by various potassium channels and calcium influx through L-type calcium channels. - The conduction system transmits action potentials from the sinoatrial node through the atrioventricular node and Purkinje fibers to coordinate ventricular contraction and relaxation.

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    Cardiac Electrophysiology: William Makdinata

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    William Makdinata
    24 views13 pages
    - Pacemaker cells in the sinoatrial node generate spontaneous action potentials around 70-80 times per minute, setting the heart rate. These slow action potentials are caused by funny (If) channels and T-type calcium channels. - Non-pacemaker cells are excited by pacemaker cells. They have fast action potentials initiated by sodium channels, with phases of repolarization mediated by various potassium channels and calcium influx through L-type calcium channels. - The conduction system transmits action potentials from the sinoatrial node through the atrioventricular node and Purkinje fibers to coordinate ventricular contraction and relaxation.

    Original Description:

    Medical Lecture

    Original Title

    Electro Physiology

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    - Pacemaker cells in the sinoatrial node generate spontaneous action potentials around 70-80 times per minute, setting the heart rate. These slow action potentials are caused by funny (If) channels and T-type calcium channels. - Non-pacemaker cells are excited by pacemaker cells. They have fast action potentials initiated by sodium channels, with phases of repolarization mediated by various potassium channels and calcium influx through L-type calcium channels. - The conduction system transmits action potentials from the sinoatrial node through the atrioventricular node and Purkinje fibers to coordinate ventricular contraction and relaxation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    24 views13 pages

    Cardiac Electrophysiology: William Makdinata

    Uploaded by

    William Makdinata
    - Pacemaker cells in the sinoatrial node generate spontaneous action potentials around 70-80 times per minute, setting the heart rate. These slow action potentials are caused by funny (If) channels and T-type calcium channels. - Non-pacemaker cells are excited by pacemaker cells. They have fast action potentials initiated by sodium channels, with phases of repolarization mediated by various potassium channels and calcium influx through L-type calcium channels. - The conduction system transmits action potentials from the sinoatrial node through the atrioventricular node and Purkinje fibers to coordinate ventricular contraction and relaxation.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 13

    CARDIAC

    ELECTROPHYSIOLOGY
    William Makdinata
    CONCEPT OF CARDIAC ELECTROPHYSIOLOGY

    Conduction System
    Cells to Cells

    Non-Pacemaker
    Cells
    • Autorhytmicity • Excitation and
    • Changes of Electrolyte Contraction Coupling
    in Myocyte
    • Resting Membrane
    Potensial to Action
    Pacemaker Potensial Myocardial
    Contraction
    cells

    Conduction System
    Cells to Cells
    RESTING MEMBRANE POTENTIALS

    • Resting membrane potensials/ RMP


    • The voltage difference across a cell plasma membrane in the resting or
    quiescent state

    •  There are two specialized types of cardiac muscle cells:


    • Pacemaker Cells
    • Pacemaker cells have no true resting potential but instead generate regular,
    spontaneous action potentials (Pacemaker Potensials)
    • Non-Pacemaker Cells
    • Non-Pacemaker cells have true resting potential
    RESTING MEMBRANE POTENTIALS

    • Many different ions present inside and outside of cells, the concentrations
    of Na , K , Cl , and Ca  are most important in determining the membrane
    potential across the cell membrane
    •  Of the four ions, K+  is the most important in determining the resting
    membrane potential
    ION INSIDE (mM) OUTSIDE (mM)

    Na+ 20 145
    K+ 150 4
    Ca2+ 0.0001 2.5
    Cl- 25 140
    RESTING MEMBRANE POTENTIALS

    chemical gradient
    (concentration difference)
    Net Electrochemical force for K = -90mV – (-96mV)=
    + 6mV
    a small net outward driving force is acting on K, K slowly
    leaks outward from the cell.
    equilibrium potential
    for K

    the Em in a resting, nonpacemaker cell is very near


    EK . This agreement occurs because the membrane is
    much more permeable to K  in the resting state than
    to other ions
    ACTION POTENTIALS

    •  The two general types of cardiac action


    potentials include
    • Nonpacemaker action potentials
    • Fast AP
    • Pacemaker action potentials
    • Slow AP ( Nodal Cells)
    SLOW ACTION POTENTIALS
    • Phase 4: Pacemaker Potensials
    • Increased inward Na+ current
    • funny, or If, channels :
    • The hyperpolarization-induced inward current
    • Decreased outward K+ current
    • The K+ channels that opened during the falling phase of the
    preceding action potential slowly close at negative potentials
    • Increased inward Ca2+ current
    • In the second half of the pacemaker potential, If channels close
    and transient Ca2+ channels (T-type Ca2+ channels) which open at
    membrane potensial (–50 mV), bringing it to threshold
    • Phase 0: Slow Depolarization
    • Once threshold is reached (± -40mV), the rising phase of the action
    potential occurs in response to activation of a long-lasting voltage-
    gated Ca2+ channel (L-type Ca2+ channel; “L” standing for long-
    lasting) subsequently large influx of Ca2+
    • The rate of depolarization (the slope of phase 0) is much slower than
    that found in other cardiac cells (e.g., in Purkinje cells)
    • Phase 3: Repolarization
    • K+ efflux that occurs when K+ permeability increases on activation of
    voltage-gated K+ channels coupled with closure of the L-type Ca2+
    channels.
    • Phase 3 ends when the membrane potential reaches about –65 mV.
    AUTORHYTMIC CELLS
    •  The number of action potentials per minute each type of autorhythmic cell can generate
    under resting conditions is as follows:
    • ■  The rate for the SA node is 70–80
    • ■  The rate for the AV node is 40–60
    • ■  The rate for the Bundle of His and Purkinje fibers is 20–40

    Other pacemaker cells exist within the atrioventricular node and ventricular conduction system,
    but their firing rates are driven by the higher rate of the SA node because the intrinsic
    pacemaker activity of the secondary pacemakers is suppressed by a mechanism termed
    overdrive suppression.
    This mechanism causes the secondary pacemaker to become hyperpolarized when driven at a
    rate above its intrinsic rate.
    FAST ACTION POTENTIALS

     A fast AP has five distinct phases


    •  Phase 0: upstroke of the action potential
    Fast Na+ Channels opening
    •  Phase 1: rapid repolarization to the
    plateau
    Fast Na+ Channels closed
    Transient outward K+ channels opening
    • Phase 2: (Plateau Phase)
    The AP plateau is maintained by Ca2 influx
    through
    L-type Ca2 channels opening
    • Phase 3: repolarization
    L-type Ca2 channels closed
    Delayed rectifier K Channels (Ikr) opening
    •  Phase 4:
    Delayed rectifier K Channels (Ikr) closed
    Inward rectifier untuk mempertahankan RMP
    CONDUCTION SYSTEM
    THANK YOU

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