Heart rate

Dr Caroline Priyadarshini
Department of Physiology
Associate Professor
PESIMSR

PES Institute of Medical Sciences & Research

LEARNING OBJECTIVES
• Describe normal range of heart rate
• Define tachycardia and bradycardia and list
causes
• Describe the physiological and pathological
variations in heart rate
• Explain how heart rate is regulated in the body
• Explain chronotropic response and
chronotropic index and heart rate variability

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 CARDIAC INNERVATION
• Parasympathetic nerves originate in 3 vagal nuclei in
the medulla called nucleus of tractus solitarius,
dorsal motor nucleus and nucleus ambiguus
• Preganglionic fibers are in the vagus nerves on both
sides
• Ganglionic cells are located in the heart and post
ganglionic fibers are short
• Right vagus innervates SA node and right atrium
and left vagus innervates left atium, AV node and
Bundle of His but overlap of innervation is also
present
• Ventricles are sparsely or poorly innervated
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QUESTIONS
• Since the SA node is the normal pacemaker of
the heart
• Discuss how vagal stimulation will affect the
function of the heart in relation to the rate or
how many times it beats per minute
• How will it affect the force of contraction?

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EFFECT OF VAGUS ON
HEART
1. Negative chronotropic effect ( decreased heart
rate )
2. Negative dromotropic effect ( decreased rate of
conduction)
3. Negative bathmotropic effect ( decreased
excitability)
4. Negative inotropic effect ( decreased myocardial
contractility, effect is less )
• What is basal heart rate and intrinsic heart rate ?

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SYMPATHETIC INNERVATION

• Originate in the intermediolateral gray column of

spinal cord from lower 2 cervical and upper 5
segments of spinal cord
• Preganglionic fibers emerge and enter
paravertebral chain
• Cell bodies are located in superior, middle and
inferior cervical ganglia
• Post ganglionic fibers reach the heart and supply
atria, nodal tissues, conducting pathway and
ventricles

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 Effect of Sympathetic
Stimulation
• Right sympathetic nerves supply SA node, RA and
RV
• Left sympathetic fibers supply the AV node, LA and
LV however overlap of innervation occurs
Questions:
How will right sympathetic stimulation differ from left
sympathetic stimulation?

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Effect of Sympathetic
Stimulation

1. Positive chronotropic effect ( increased heart

rate)
2. Positive inotropic effect ( increased force of
contraction)
3. Positive dromotropic effect( increased rate of
conduction)
4. Positive bathmotropic effect ( increase
excitability of the heart)

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HEART RATE
• Normal heart rate is 60 to 100 per min
• Bradycardia: HR< 60 per min
• Tachycardia : HR > 100 per min
• Average HR 72 per min

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Physiological variations
• Age : more in fetus, newborn, child
• Less in elderly
• Gender : HR is less in females due to lesser
metabolic rate and higher vagal tone
• Diurnal: more in day and related to amt of
activity done
• Respiration: more during inspiration and less
during expiration due to differences in vagal
activity : sinus arrhythmia ( venous return
increases during inspiration)
• Sleep: heart rate decreases
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• Body temperature: increase in body temperature
increases heart rate
( 10 beats per degree F. rise in body temperature)
• Environmental conditions: more in summer
• Food intake : heart rate increases
• Posture: from supine to standing increases tge
heart rate
• Exercise : increases due to sympathetic
stimulation but athletes have low resting heart
rates
• Anxiety, emotional disturbances
• Yoga can decrease resting heart rate

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Pathological variations
Tachycardia:
• fever, anemia , Beri-beri, Pagets disease,AV
fistula
• Thyrotoxicosis ( hyperthyroidism)
• Cardiac failure, cardiac arrhythmias
• Circulatory shock
Bradycardia
• Myxedema( hypothyroidism)
• Heart block
• Beta blockers , digitalis
• Severe griefPES Institute of Medical Sciences & Research
REGULATION OF HEART
RATE

1. Autonomic regulation
2. Reflex regulation
3. Regulation by higher cemters
4. Chemical regulation

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AUTONOMIC REGULATION
• Parasympathetic control: more dominating
Basal heart rate during rest is more than
intrinsic heart rate ( denervated heart wher HR is
approx 110 per min)
More vagal influence on SA node
Vagal fibers originate in the nucleus of tractus
solitarius, dorsal motor nucleus of vagus and
nucleus ambiguus
Right vagus supplies SA node and left vagus
supplies AV node , vagus depresses heart rate
Controlling its changes ( vagal tone)
acetylcholine is neurotransmitter
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Sympathetic regulation

• Lower 2 cervical and upper 5 thoracic

segments
• Sympathetic stimulation lasts longerand
neurotransmitter is norepinephrine
• Sympathetic stimulation increases heart rate

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 REFLEX REGULATION
• These regulate heart rate and blood pressure and
involve mechanisms that control blood pressure as
well
• Baroreceptors are pressure sensors stimulated due to
changes in BP
• Located in carotid sinus and aortic arch
• When BP increases the vasomotor center is inhibited
and vagal nucleus is stimulated
• Sympathetic discharge is decreased and
• heart rate is reduced due to both these effects and
blood pressure and cardiac output also decrease to
normal
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REFLEX REGULATION
• Chemoreceptor reflex
• Mediated by chemoreceptors which are
present in the aortic arch and carotid body
Sense chemical changes in blood hypoxia,
hypercapnia and acidosis
Diminished blood flow can produce these effects
Again vasomotor center is stimulated and vagal
nucleus is inhibited increasing blood pressure
Heart rate is increased ( direct activation can
produce bradycardia)

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REFLEX REGULATION
• Bainbridge reflex : first described by Bainbridge
in 1915
• Rapid infusion of saline or blood increases the
heartrate
• Stretch receptors are at junction of great veins
into atria
• No change in force of contraction

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REFLEX REGULATION

• Cushings reflex: activated when blood flow to

vasomotor center is reduced like in
hypotension and hypovolemia
• Direct stimulation increases blood pressure
and induces tachycardia and vasoconstriction
• Stretch receptors in atria can reflexly increase
heart rate and Atrial natriuretic peptide is
released ( ANP)
• Stimulation of left ventricular stretch receptors
can reflexly decrease heart rate

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REFLEX REGULATION
• Bezold- Jarisch reflex
• Stimulation of these receptors can cause
bradycardia, vasodilation and hypotension and
apnoea
• Stimulated by stretch, chemical substances or
drugs ex: veratridine, serotonin
• Receptors are C fiber afferents in walls of
ventricles

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Other control of heart rate
• Stimulation of motor cortex, frontal lobe,
thalamus, hypothalamus and limbic system can
increase heart rate
• Thyroxine and catecholamines increase the heart
rate

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Chronotropic index
• Peak heart rate- resting heart rate /220- age –
resting heart rate
• Normal value= 0.8 to 1.3
• Decreased value can predict cardiac morbidity

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Heart rate variability
• Fluctuation of Interval between heart beats
• Good HRV indicates cardiovascular health and
cognitive health and adaptability of heart and
body systems

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Thank you ☺

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