PUNJAB UNIVERSITY COLLEGE OF PHARMACY

PHYSIOLOGY

1ST Proff. Evening DR. YAR RIZWAN

 These notes are prepared from Slides:

PROPERTIES OF HEART MUSCLES

• Electrical

– Excitability (Bathmotropic action)

– Autorhythmicity

– Conductivity (Dromotropic action)

• Mechanical

– Contractility (Inotropic action)

– Refractory period

– Staircase /Treppe effect

1.EXCITABILITY
• Ability of living tissue to give response to a stimulus of adequate strength and duration.

• Response in form of development of action potential (AP).

• AP initiated by SA Node → travels along conductivity pathway → excite the atrial and ventricular
muscle fibers.

ACTION POTENTIAL IN CARDIAC MUSCLE:

• AP in single cardiac muscle occurs in four stages:

1. Initial Depolarization:

• It is very rapid and lasts for about 2 msec.

• Amplitude of depolarization is about +20mV.

• Rapid opening of fast Sodium Channels and rapid influx of Sodium ions.

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 2. Initial Repolarizaton:

• Rapid repolarization for short period of 2msec.

• Rapid repolarization is represented by the notch, just before the plateau.

• ransient opening o K+ channels and e ux o s all uan ty o K+.

• Simultaneously, fast Na+ channels closed.

3. Plateau- Final Depolarization:

• Plateau(stable period) lasts for 0.2 sec in atrial muscle fibers and 0.3 sec in ventricular muscle
fibers.

• Because of this contraction time of cardiac muscles in longer about 5-15 times than in skeletal
muscles.

• Slow Ca+ channels opens for a longer period and influx of Ca+ ions. These Ca+ ions play very
important role in contractile process.

4. Final Repolarization:

• Slow process and lasts for about 0.05-0.08 sec.

• Efflux K+ of ions increases.

• It makes negativity inside which results in final repolarization.

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FACTORS AFFECTING EXITABILITY
Factors that increase excitability

• Sympathetic stimulation - Lowers the resting membrane potential.

• Mild Hyperkalemia (increase in potassium concentration) - partial depolarization.

• Hypocalcaemia (decrease in calcium concentration) - partial depolarization

• Digitalis - increase atrial muscle excitability

• Mild Hypoxia - Partial depolarization.

Factors that decrease excitability

• Parasympathetic Stimulation - decreases excitability only of the atrial muscle cells.

• Hyponatremia (decrease in Na+ concentration)

• Hypokalemia - Hyperpolarization

• Hypercalcemia - decreases permeability to sodium

• Digitalis - decreases ventricular muscle excitability

PATHOLOGICAL CONDITIONS OF EXCITABILITY

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 1. Pulsus Alternans

2. Extra-systoles

3. Paroxysmal Tachycardia

4. Atrial Flutter: Atria beating at rate of 200-300/min.

5. Atrial Fibrillation: Atria beating at very high rate of >350 beats/min.

6. Ventricular Flutter: Ventricles beating at a high rate of 200-350/min.

7. Ventricular Fibrillation: Ventricles beat at an extremely high rate of >350 beats/min.

2. RHYTHMICITY
• Rhythmicity is the ability of a tissue to generate its own impulses regularly. (OR)

• The ability of the heart to initiate its beat continuously and regularly without external
stimulation.

• More appropriately named as Autorhythmicity or Self-Excitation.

• Normal Heart Rate: 72 beats/min.

• The heart contains special excitatory and conductive system each capable of discharging at
regular intervals and of conducting impulses known as PACEMAKER.

• Myogenic in origin i.e. independent from nerve supply.

• Due To The Specialized Excitatory & Conductive

• System Of The Heart

• ↓

• Intrinsic Ability Of Self-excitation

• (Waves Of Depolarization)

• ↓

• Cardiac Impulses

AUTORYTHMIC FIBERS
• Forms 1% of the cardiac muscle fibers

• Have two important functions:

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 1. Act as a Pacemaker (Set the rhythm of electrical

excitation)

2. Conductive system (Network of

specialized cardiac muscle fibers that provide a path for each cycle of cardiac excitation to

progress through the heart).

LOCATIONS OF AUTORHYTHMIC CELLS

1. Sino-atrial node (SA node): Specialized region in right atrial wall near opening of superior vena
cava.

2.Atrio-ventricular node (AV node): Small bundle of specialized cardiac cells located at base of right
atrium.

3.Bundle of His: Originate from AV node and enters interventricular septum. Divides to form right and
left bundle branches.

4.Purkinje fibers: Small, terminal fibers that extend from bundle of His and spread throughout
ventricular myocardium.

MECHANISM OF AUTORHYTHMICITY

• Auto-rhythmic cells do not have stable resting membrane potential (RMP).

• The membrane of these specialized tissue is leaky membrane i.e. not all of Na+/Ca+ channels
close during repolarization stage.

• This inflow of Na+/Ca+ results in partial depolarization → increase in per eability to Na+/Ca+ .

• Unstable resting membrane potential = pacemaker potential.

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FACTORS AFFECTING RHYTHMICITY
i. Sympathetic Stimulation

ii. Parasympathetic Stimulation

iii. Inorganic Ions

iv. Temperature

v. Oxygen supply

vi. pH

vii. Drugs & Toxins

3. CONDUCTIVITY
• Property by which excitation is conducted through the cardiac tissue.

• Impulses from SA node are transmitted to other cardiac tissues.

• Specialized conducting system ensure that excitation travels to all the heart muscle fibers and in
a certain pre-defined pattern.

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CONDUCTIVE SYSTEM OF HUMAN HEART
• Made up of modified cardiac muscle fibers.

• Conduct impulses rapidly from SA Node to the ventricles.

• Conductive tissues are also called as Junctional Tissues.

• It is consisting of:

i. AV node.

ii. Bundle of His

iii. Right & left bundle branches

iv. Purkinje fibers

• SA node is situated in right atrium below the opening of superior vena cava.

• AV node is present in right posterior of intra-arterial septum.

• I pulses ro SA node → right & le t atria → AV node via so e special ibers called internodal
fibers.

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 • Fro AV node → Bundle o His → divides in right & le t branches → Purkinje ibers → spread in
ventricular myocardium.

VELOCITY OF IMPULSES

TISSUE CONDUCTION RATE (m/s)

Atrial muscle 0.3

Internodal fibers 1

AV node 0.05

Bundle of His 0.12

Purkinje system 4

Ventricular muscle 0.5

HEART BLOCK

• Failure of impulses arising at Atria to reach Ventricles

• Blockage at AV node or Bundle of His.

• Types of Heart Block

I. Partial: When some impulses fail to pass.

II. Complete: when all atrial impulses fail to reach the ventricles, atria and
ventricles beat at their own rhythm and there is no coordination.

Another classification heart block is divided into three types:

• 1st degree: Delay in conduction

• 2nd degree: Partial block

• 3rd degree: Complete block

4. CONTRACTILITY
• Ability of tissue to shorten in length after receiving a stimulus.

• Contraction of the heart is called systole while relaxation of the heart is called diastole.

• One systole and its following diastole is called one cardiac cycle.

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 • The contractile properties are:

• All or none law

• Staircase phenomenon

• Summation of subliminal stimuli

• Refractory period

i. ALL OR NONE LAW

. “When a sti ulus is applied, whatever ay be the strength, the whole cardiac uscle give
axi u response or it does not give any response at all”.

. If the stimulus is below the threshold level, muscles give no response.

. It is due to syncytial arrangement of cardiac muscles.

ii. STAIRCASE PHENOMENON

. Also known as Treppe Phenomenon or Bowditch Effect.

.“When stimuli of same strength are applied at short intervals, an increase in the height of
contraction is observed”.

. This is due to the BENEFICIAL EFFECT, mild increase in temperature and increase in the level of
calcium ions.

iii. SUMMATION OF SUBLIMINAL STIMULI

• When a series of sub-minimal stimuli are applied to the cardiac muscle, it responds with a
contraction once all the sub –minimal add up to produce a threshold stimulus.

iv. REFRACTORY PERIOD

• It is a period in which the muscles do not show any response to a stimulus.

• Two types:

i. Absolute Refractory Period

ii. Relative Refractory Period

1. Absolute Refractory Period

• Muscle does not show any response whatever may be the strength of stimulus.

• Depolarization occurs in this period so 2nd depolarization is not possible.

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 2. Relative Refractory Period

• In this case, muscle shows the response if the strength of the stimulus is increased to maximum.

• Muscle is in repolarizing stage.

• Long refractory period (250 msec) compared to skeletal muscle (3msec).

• During this period membrane is refractory to further stimulation until contraction is over.

• Gives time to heart to relax after each contraction, prevent from fatigue.

• It allows time for the heart chambers to fill during diastole before next contraction.

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