THE HEART ELECTRICITY

The Heart: A Matchless Pump

The blood reaches every corner of the body by means of the heart, with its dual pumping mechanism. The two left chambers of the heart pumps fresh oxygen-rich blood to the entire body, while the right chambers send returning blood to the lungs for carbon dioxide to be extracted and replaced with oxygen. The left-hand chambers possess thicker muscles, since they pump at a higher pressure in order to send blood to reach the whole body. The hearts most important feature is how it works non-stop, beating approximately 70 times a minute, 100,000 times a day, and 40 million times a year.36 During the course of an average lifetime, it beats more than 2 billion times and pumps enough blood to fill an average of 100 swimming pools.

No man-made pump can match the hearts ability to work tirelessly for an entire lifetime and to regulate the quantity pumped according to prevailing circumstances. The extraordinary nature of the heart reveals an important fact. Allah created many matchless structures, such as the heart, in the billions of human beings.

Hearts Electronic System and Generator

The energy that allows the heart to beat does not reach it from the outside. Instead, the heart is an engine that produces its own energy used during its pumping process. Electricity is produced by the contraction of the heart muscles. Conductor cells transmit these electrical signals to the muscle cells that are responsible for pumping blood at approximately 70 times a minute. The heart begins beating when the human being is still an embryo in the womb, before any nerves have connected the heart to the brain. The heart is able to continue beating even during heart-transplant operations when all the nerves have been severed and the organ is removed from the patients chest cavity. Under a microscope, a heart cell even continues to beat by itself as long as fresh oxygenated blood can reach it.39 That is because there is a generator in the heart cells that produce their own energy. In the event of a cut in the energy supply, a generator is a device that can take over and continue producing energy that prevents machinery from halting or being damaged. The heart, one of the most vital organs in the human body, has also been granted a similar form of protection to prevent its coming to harm, since for the heartbeat to stop for

even a moment could lead to serious bodily damage, and might even prove fatal. Therefore, the electrical system that keeps the heart working must itself work without interruption. Scientists investigating its electrical system encouraged some astonishing facts. The heart functions thanks to an ensemble of programmed and systematic electronic circuits, with a great many interconnections. This electronic control-and-management system co-operates with a large number of other organs, from the kidneys to the brain, from the arteries to the hormonal glands.

Electrical System in the Heart

The electrical system in your heart controls the speed of your heartbeat. The system includes a network of electrical pathways, similar to the electrical wiring in your home. The pathways carry electrical signals through your heart. The movement of the signals is what makes your heart beat. When working properly, your heart's electrical system automatically responds to your body's changing need for oxygen. It speeds up your heart rate as you climb stairs, for example, and slows it down when you sleep. When your heart rate speeds up, it means your heart pumps faster and your body gets more oxygen-rich blood. Your heart's electrical system is also called thecardiac conduction system.

Parts of the Electrical System

The heart's electrical system includes three important parts: S-A node (sinoatrial node) A-V node (atrioventricular node) His-Purkinje system

The S-A Node: Your Heart's Natural Pacemaker

The S-A node is a bundle of specialized cells in your right atrium. The S-A node cells are special because they create the electricity that makes your heart beat. The S-A node normally produces 60-100 electrical signals per minute this is your heart rate, or pulse. The S-A node is called the "natural pacemaker" of your heart because it controls your heart rate.

The A-V Node: Your Heart's Electrical Bridge

The A-V node is a bundle of specialized cells between your heart's upper and lower chambers (between the atria and ventricles). The A-V node cells are special because they allow electricity to pass through them. Except in rare conditions, no other cells between the atria and ventricles allow this. So, the A-V node is the "electrical bridge" between the atria and ventricles. Some types of slow heart rhythms (bradycardias) are caused by problems in the A-V node.

The His-Purkinje System

The His-Purkinje system is in your heart's ventricles. Electricity travels through the His-Purkinje system to make your ventricles contract. The parts of the His-Purkinje system include: His Bundle (the start of the system) Right bundle branch Left bundle branch Purkinje fibers (the end of the system)

What makes the heart beat?

The electric activity starts at the top of the heart and spreads down. A normal heart beat is initiated by a small pulse of electric current. This tiny electric "shock" spreads rapidly in the heart and makes the heart muscle contract. If the whole heart muscle contracted at the same time, there would be no pumping effect. Therefore the electric activity starts at the top of the heart and spreads down, and then up again, causing the heart muscle to contract in an optimal way for pumping blood.

Where does the electricity come from?

In the heart there are cells specialized in producing electricity. These are called pacemaker cells. They produce electricity by quickly changing their electrical charge from positive to negative and back. The first electric wave in a heartbeat is initiated at the top of the heart. Because of the heart muscle cell's ability to "spread" its electric charge to adjacent heart muscle cells, this initial wave will be enough to start a chain reaction.

The challenge of registering millivolts

Making the electrodes sensitive enough was a challenge in the early days of the ECG. In the late 1800's early attempts to measure the electric activity in frog's hearts were successful only when the hearts were exposed directly to the measuring equipment. The measuring conditions were indeed difficult; the scientists wanted to be able to measure the electric signals without having to enter inside the body. The problem was that the electric wave got weaker since it had to travel through bone and body tissue before reaching an electrode applied on the skin. This problem was solved a couple of decades later by Willem Einthoven. He managed to improve the sensitivity of the ECG by using a string galvanometer.

Willem Einthoven

The Nobel Prize in Physiology or Medicine 1924 was awarded to Willem Einthoven"for his discovery of the mechanism of the electrocardiogram".

A lot of Einthoven's terminology is still being used and his original research remains fundamental to electrocardiography today.

From electrode to paper

The electric waves in the heart are recorded in millivolts by the electrocardiograph. The waves are registered by electrodes placed on certain parts of the body. Each electrode controls an ink needle that writes on a grid paper. The higher the intensity of the electric wave, the higher up the needle will move on the paper. The paper moves at a certain speed beneath the needle, resulting in an ink curve.

Sensitive electrodes are placed on certain parts of the body.

The leads & Einthoven's triangle

The electrodes are typically twelve in number. The stretch between two limb (arm or leg) electrodes is called a lead. Einthoven named the leads between the three limb electrodes "standard lead I, II and III" referring to the two arm electrodes and the left leg electrode. He studied the relationship between these electrodes, forming a triangle where the heart electrically constitutes the null point. The relationship between the standard leads is called Einthoven's triangle. Einthoven's triangle is used when determining the electrical axis of the heart.

The standard leads (top) and the augmented leads (bottom) reflect the limb electrodes (left arm, right arm, left leg) used to record the heart's electrical axis in the frontal plane. Illustration by Urban Frank.

Mountains & valleys

An ECG curve has different characteristics depending on the location of the electrode recording it. When the curve falls below the base line it shows a negative deflection and when it rises above the base line it is a result of positive deflection. A negative deflection indicates that the recorded wave has traveled away from the electrode and a positive deflection means it has traveled towards it.

An ECG curve reflects the perspective of the electrode recording it.

Abnormal heartbeats & conduction defects

If the electric or muscular function of the heart is disturbed for some reason, it will affect how the electric signals spread through the heart muscle. One example is arrythmia, a condition where the heart beats irregularly due to a defect in the electric conduction system. A cardiac infarction is another condition which results in dead tissue in a part of the heart muscle, and therefore the electric signal cannot travel through that area. A left or right bundle branch block delays the electric wave from spreading to the left or right part of the heart. Sometimes these conditions affect the heart's ability to pump blood.

Cardiac infarction

Left bundle branch block

Cells directing the heart muscle

When the heart muscle is at rest, the pacemaker cells are negatively charged and when the heart contracts they are positively charged. When a positive wave is recorded by a positive electrode, the ECG curve will be pointing upwards and vice versa.

Repolarization and depolarization

The cells change their electric charge by means of depolarization and repolarization. Depolarization occurs when negatively charged ions inside the cell travel out from the cell through the cell membrane and positively charged ions travel in (repolarization).

Assisting the heart

A pacemaker's job is to deliver a steady and regular electric impulse to the heart.

Pacemaker is also the name of a device that can help stabilize the electric conduction system when the heart's electric function is not working properly. The pacemaker is surgically placed in the chest, and delivers a steady rhythm of "starting" waves where this function is defective.

Long QT Syndrome
Long QT syndrome (LQTS) is a disorder of the heart's electrical activity that may cause dangerous heart rhythms in response to exercise or stress

Symptoms
what are the symptoms of Long QT Syndrome? The signs and symptoms of LQTS-related arrhythmias include unexplained fainting or seizures, drowning or near drowning (due to fainting while swimming), sudden cardiac arrest and sudden death

Diagnosis
how is Long QT Syndrome diagnosed? To diagnose LQTS, your doctor will consider your electrocardiogram (ECG or EKG) results, your personal and family medical histories, and genetic test results

Description
what is Long QT Syndrome? Long QT syndrome (LQTS) is a disorder of the heart's electrical activity. It may cause you to develop a sudden, uncontrollable, and dangerous heart rhythm in response to exercise or stress. Arrhythmias also can develop for no known reason in people who have LQTS. Not everyone who has LQTS develops dangerous heart rhythms. However, if one does occur, it may be fatal. The term "long QT" refers to an abnormal pattern seen on an electrocardiogram (ECG or EKG). An ECG is a test that detects and records the heart's electrical activity. The QT interval, recorded on the ECG, corresponds to the time

during which the ventricles lower chambers of your heart) are triggered to contract and then build the potential to contract again.

With each beat, the heart contracts and relaxes. If the heart takes longer than usual to contract and relax, there is a wider space between the Q and T. This could mean that the person has long QT syndrome. The timing of the heartbeat's electrical activity is complex, and the body carefully controls it. Normally the QT interval of the heartbeat lasts about a third of each heartbeat cycle on the ECG. However, in people who have LQTS, the QT interval usually lasts longer than normal. This can upset the careful timing of the heartbeat and trigger a dangerous, abnormal rhythm. If you have inherited LQTS, you received the faulty gene(s) from one or both of your parents. Inherited LQTS is a lifelong condition. Other names for Long QT Syndrome include the following: y y Romano-Ward syndrome, affecting 1 in 5,000 people worldwide Jervell and Lange-Nielsen syndrome affecting 1 in 6 million people worldwide, associated with deafness

Treatment
how is Long QT Syndrome treated? The goal of treating long QT syndrome (LQTS) is to prevent life-threatening, abnormal heartbeats and fainting spells. Treatment isn't a cure for this condition and may not restore a normal QT interval on an ECG. But treatment does greatly improve survival. People at higher risk are those who have fainted or who have developed dangerous heart rhythms from their LQTS in the past. Common treatment options for people with LQTS include the following:

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Make lifestyle changes that reduce the risk of fainting or SCA. These may include avoiding competitive sports and strenuous exercise, such as swimming, which can cause abnormal heartbeats. Avoid medicines that may trigger symptoms. This may include some medicines used to treat allergies, infections, high blood pressure, high blood cholesterol, and depression. The type of LQTS you have will determine which medicines you take to avoid abnormal heart rhythms. For example, doctors usually only will prescribe sodium channel blocker medicines for people who have LQTS 3.

Take medicines, such as beta-blockers, which reduce the risk of symptoms by slowing your heart rate. If your doctor thinks you are at higher risk for LQTS complications, he or she may suggest a variety of treatments, including medicines and lifestyle changes. Other treatments include:

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A surgically implanted device, such as a pacemaker or implantable cardioverter defibrillator (ICD). These devices help regulate your heartbeat. Surgery on the nerves that regulate your heartbeat.