THE CONDUCTING SYSTEM

AND CARDIAC ACTION

POTENTIAL

Course on Electrocardiography
Indonesian Heart Association
Bandung
 2 Types of Cardiac Muscle Cells
• Conducting system:
– controls and coordinates heartbeat
• Contractile cells:
– produce contractions
The Conducting System

Figure 20–12
 The Conducting System
• A system of specialized cardiac muscle cells:
– initiates and distributes electrical impulses that
stimulate contraction
• Automaticity:
– cardiac muscle tissue contracts automatically
 Structures of the
Conducting System
• Sinoatrial (SA) node
• Atrioventricular (AV) node
• Conducting cells
 Conducting Cells
• Interconnect SA and AV nodes
• Distribute stimulus through myocardium
• In the atrium:
– internodal pathways
• In the ventricles:
– AV bundle and bundle branches
 Prepotential
• Also called pacemaker potential
• Resting potential of conducting cells:
– gradually depolarizes toward threshold
• SA node depolarizes first, establishing heart
rate
 Heart Rate
• SA node generates 80–100 action potentials
per minute
• Parasympathetic stimulation slows heart rate
• AV node generates 40–60 action potentials
per minute
Impulse Conduction
through the Heart

Figure 20–13
 The Sinoatrial (SA) Node
• In posterior wall of right atrium
• Contains pacemaker cells
• Connected to AV node by internodal pathways
• Begins atrial activation (Step 1)
 The Atrioventricular (AV) Node
• In floor of right atrium
• Receives impulse from SA node (Step 2)
• Delays impulse (Step 3)
• Atrial contraction begins
 The AV Bundle

• In the septum
• Carries impulse to left and right bundle
branches:
– which conduct to Purkinje fibers (Step 4)
and to the moderator band:
– which conducts to papillary muscles
• The Purkinje fibers distribute impulse
through ventricles (Step 5)
 The AV Bundle

• Atrial contraction is completed

• Ventricular contraction begins
 Abnormal Pacemaker Function
• Bradycardia: abnormally slow heart rate
• Tachycardia: abnormally fast heart rate

Ectopic Pacemaker:
• Abnormal cells
• Generate high rate of action potentials
• Bypass conducting system
• Disrupt ventricular contractions
 What events take
place during an action potential
in cardiac muscle?
 Action Potentials in
Skeletal and Cardiac Muscle

Figure 20–15
 Resting Potential
• Resting membrane potential (RMP) present
• Of a ventricular cell about —90 mV,
• Of an atrial cell about —80 mV
 3 Steps of
Cardiac Action Potential

1. Rapid depolarization:
– voltage-regulated sodium channels (fast
channels) open
2. As sodium channels close:
– voltage-regulated calcium channels (slow
channels) open
– balance Na ions pumped out
+

– hold membrane at 0 mV plateau

 3 Steps of
Cardiac Action Potential

3. Repolarization:
– plateau continues
– slow calcium channels close
– slow potassium channels open
– rapid repolarization restores resting
potential
 The Refractory Periods
• Absolute refractory period:
– long
– cardiac muscle cells cannot respond
• Relative refractory period:
– short
– response depends on degree of stimulus
 Timing of Refractory Periods
• Length of cardiac action potential in
ventricular cell:
– 250–300 msecs
• 30 times longer than skeletal muscle fiber
• long refractory period prevents summation and
tetany
Skeletal muscle

Refractory
period in
skeletal and
cardiac muscles

Cardiac muscle
Action Potential
Action Potential
Action Potential & ECG
Depolarization of a Single Cardiac
Muscle Cell
A. Resting state
B. Stimulation, initiates
depolarization
C. Depolarization spreads
D. Fully depolarized
E. If voltmeter electrodes
reversed
(depolarization traveled
away  deflection)
Sequence of Repolarization of a
Single Cardiac Muscle Cell
A. Repolarization
commence
B. Repolarization
progress
C. Repolarization
complete
Thank You