Phases of The Cardiac Action Potential

Phases of the cardiac action potential
The cardiac action potential has five phases.
The standard model used to understand the cardiac action potential is the action potential of the
ventricular myocyte. The action potential has 5 phases (numbered 0-4). Phase 4 is the resting membrane potential,
and describes the membrane potential when the cell is not being stimulated.
Once the cell is electrically stimulated (typically by an electric current from an adjacent cell), it begins a sequence
of actions involving the influx and efflux of multiple cations andanions that together produce the action potential of
the cell, propagating the electrical stimulation to the cells that lie adjacent to it. In this fashion, an electrical
stimulation is conducted from one cell to all the cells that are adjacent to it, to all the cells of the heart.
[edit]Phase 4
Phase 4 is the resting membrane potential. This is the period that the cell remains in until it is stimulated by an
external electrical stimulus (typically an adjacent cell). This phase of the action potential is associated
with diastole of the chamber of the heart.
In addition to stimulus from adjacent cells, certain cells of the heart have the ability to undergo spontaneous
depolarization, in which an action potential is generated without any influence from nearby cells. This is also known
as cardiac muscle automaticity.
[edit]Phase 0
Phase 0 is the rapid depolarization phase. The slope of phase 0 represents the maximum rate of depolarization of
the cell and is known as Vmax. This phase is due to the opening of the fast Na+ channels causing a rapid increase in
the membrane conductance to Na+ (GNa) and thus a rapid influx of Na+ ions (INa) into the cell; a Na+ current.
The ability of the cell to open the fast Na+ channels during phase 0 is related to the membrane potential at the
moment of excitation. If the membrane potential is at its baseline (about -85 mV), all the fast Na+ channels are
closed, and excitation will open them all, causing a large influx of Na+ ions. If, however, the membrane potential is
less negative, some of the fast Na+ channels will be in an inactivated state insensitive to opening, thus causing a
lesser response to excitation of the cell membrane and a lower Vmax. For this reason, if the resting membrane
potential becomes too positive, the cell may not be excitable, and conduction through the heart may be delayed,
increasing the risk forarrhythmias.
[edit]The fast Na+ channel
The fast sodium channel can be modeled as being controlled by a number of gates. Each gate (or gating variable)
can attain a value between 1 (fully open) and 0 (fully closed). The product of all the gates denotes the percentage
of channels available to conduct Na+. Following the model of Hodgkin and Huxley, the sodium channel contains
three gates: m, h, and j. In the resting state, the m gate is closed (zero) and the h and jgates are open (one). Hence,
the product denoting the percentage of conducting channels is also zero. Upon electrical stimulation of the cell,
the m gate opens quickly while simultaneously the h and j gates close more slowly. For a brief period of time, all
gates are open (i.e. non-zero) and Na+ can enter the cell following its electrochemical gradient. If, as above, the
resting membrane potential is too positive, the h or j gates may be considerably less than one, such that the
product of m, h and j becomes too small upon depolarization.
[edit]Phase 1
Phase 1 of the action potential occurs with the inactivation of the fast Na+ channels. The transient net outward
current causing the small downward deflection of the action potential is due to the movement of K+ and Cl- ions,
carried by the Ito1 and Ito2 currents, respectively. Particularly the Ito1 contributes to the "notch" of some ventricular
cardiomyocyte action potentials.
It has been suggested that Cl- ions movement across the cell membrane during Phase I is as a result of the change
in membrane potential, from K+ efflux, and is not a contributory factor to the initial repolarisation ("notch").
[edit]Phase 2
This "plateau" phase of the cardiac action potential is sustained by a balance between inward movement of
Ca2+ (ICa) through L-type calcium channels and outward movement of K+ through the slow delayed
rectifier potassium channels, IKs. The sodium-calcium exchanger current, INa,Ca and the sodium/potassium
pump current, INa,K also play minor roles during phase 2.
[edit]Phase 3
During phase 3 (the "rapid repolarization" phase) of the action potential, the L-type Ca2+ channels close, while
the slow delayed rectifier (IKs) K+channels are still open. This ensures a net outward current, corresponding to
negative change in membrane potential, thus allowing more types of K+ channels to open. These are primarily
the rapid delayed rectifier K+ channels (IKr) and the inwardly rectifying K+ current, IK1. This net outward, positive
current (equal to loss of positive charge from the cell) causes the cell to repolarize. The delayed rectifier
K+ channels close when the membrane potential is restored to about -80 to -85 mV, while IK1 remains conducting
throughout phase 4, contributing to set the resting membrane potential.

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Phases of the cardiac action potential

The cardiac action potential has five phases.

with diastole of the chamber of the heart.

as cardiac muscle automaticity.

increasing the risk forarrhythmias.

[edit]The fast Na+ channel

product of m, h and j becomes too small upon depolarization.

cardiomyocyte action potentials.

pump current, INa,K also play minor roles during phase 2.

throughout phase 4, contributing to set the resting membrane potential.

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