A LOOK AT CARDIAC PHYSIOLOGY

19

have time to repolarize. In these cases, the active impulse reenters

the same area and produces another impulse.

Repeating itself
An injured pacemaker (or nonpacemaker) cell may partially de-
polarize, rather than fully depolarizing. Partial depolarization can
lead to spontaneous or secondary depolarization, which involves
repetitive ectopic firings called triggered activity.
The resultant depolarization is called afterdepolarization.
Early afterdepolarization occurs before the cell is fully repolarized
and can be caused by hypokalemia, slow pacing rates, or drug tox-
icity. If it occurs after the cell has been fully repolarized, it’s called
delayed afterdepolarization. These problems can be caused by
digoxin toxicity, hypercalcemia, or increased catecholamine re-
lease. Atrial or ventricular tachycardias may result. You’ll learn
more about these and other arrhythmias in later chapters.

That’s a wrap!

Cardiac anatomy and physiology review

The heart’s valves
• Tricuspid — AV valve between the
right atrium and right ventricle
• Mitral — AV valve between the left
atrium and left ventricle
• Aortic — semilunar valve between the
left ventricle and the aorta
• Pulmonic — semilunar valve between
the right ventricle and the pulmonary
artery
Blood flow
• Deoxygenated blood from the body re-
turns to the right atrium and then flows to
the right ventricle.
• The right ventricle pumps blood into the
lungs where it’s oxygenated. Then the
blood returns to the left atrium and flows
to the left ventricle.
• Oxygenated blood is pumped to the
aorta and the body by the left ventricle.
Coronary arteries and veins
• Right coronary artery — supplies blood
to the right atrium and ventricle and part
of the left ventricle
• Left anterior descending artery — sup-
plies blood to the anterior wall of the left
ventricle, interventricular septum, right
bundle branch, and left anterior fascicu-
lus of the left bundle branch
• Circumflex artery — supplies blood to
the lateral walls of the left ventricle, left
atrium, and left posterior fasciculus of
the left bundle branch
• Cardiac veins — collect blood from the
capillaries of the myocardium
• Coronary sinus — returns blood to the
right atrium
(continued)

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 CARDIAC ANATOMY AND PHYSIOLOGY
20

Cardiac anatomy and physiology review (continued)

Cardiac cycle dynamics
• Atrial kick — atrial contraction, contrib-
uting about 30% of the cardiac output
• Cardiac output — the amount of blood
the heart pumps in 1 minute, calculated
by multiplying heart rate times stroke
volume
• Stroke volume — the amount of blood
ejected with each ventricular contraction
(it’s affected by preload, afterload, and
contractility)
• Preload — the passive stretching ex-
erted by blood on the ventricular muscle
at the end of diastole
• Afterload — the amount of pressure
the left ventricle must work against to
pump blood into the aorta
• Contractility — the ability of the heart
muscle cells to contract after depolar-
ization
Innervation of the heart
Two branches of the autonomic nervous
system supply the heart:
• Sympathetic nervous system —
increases heart rate, automatic-
ity, AV conduction, and contractility
through release of norepinephrine and
epinephrine
• Parasympathetic nervous system —
vagus nerve stimulation reduces heart
rate and AV conduction through release
of acetylcholine.
Transmission of electrical impulses
Generation and transmission of electrical
impulses depend on these cell charac-
teristics:
• Automaticity — a cell’s ability to spon-
taneously initiate an impulse, such as
found in pacemaker cells
• Excitability — how well a cell responds
to an electrical stimulus
• Conductivity — the ability of a cell to
transmit an electrical impulse to another
cardiac cell
• Contractility — how well the cell con-
tracts after receiving a stimulus.
Depolarization-repolarization cycle
Cardiac cells undergo the following
cycles of depolarization and repolariza-
tion as impulses are transmitted:
• Phase 0: Rapid depolarization — the
cell receives an impulse from a nearby
cell and is depolarized
• Phase 1: Early repolarization — early
rapid repolarization occurs
• Phase 2: Plateau phase — a period of
slow repolarization occurs
• Phase 3: Rapid repolarization — the
cell returns to its original state
• Phase 4: Resting phase — the cell rests
and readies itself for another stimulus.
Cardiac conduction
• The electrical impulse begins in the
SA node and travels through the inter-
nodal tracts and Bachmann’s bundle to
the AV node.
• From the AV node, the impulse travels
down the bundle of His, along the bundle
branches, and through the Purkinje fibers.
Intrinsic firing rates
• SA node — 60 to 100/minute
• AV junction — 40 to 60/minute
• Purkinje fibers — 20 to 40/minute
Abnormal impulses
• Automaticity — the ability of a cardiac
cell to initiate an impulse on its own
• Retrograde conduction — impulses that
are transmitted backward toward the atria
• Reentry — when an impulse follows a
circular, rather than the normal, conduc-
tion path

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