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    Cardiovascular - Electrophysiology - Extrinsic Cardiac Conduction System

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    Saransh Jain
    This document provides an overview of the extrinsic cardiac conduction system, including: 1) It defines the extrinsic cardiac conduction system as the autonomic nervous system modifying the intrinsic cardiac conduction and contractility based on the body's needs through the sympathetic and parasympathetic nervous systems. 2) It describes the anatomy and function of the parasympathetic nervous system, which decreases heart rate and conduction through the release of acetylcholine. 3) It describes the anatomy and function of the sympathetic nervous system, which increases heart rate, conduction, and contractility through the release of norepinephrine and epinephrine. 4) It explains the intracellular mechanisms of how the sympathetic and parasympathetic

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    Cardiovascular - Electrophysiology - Extrinsic Cardiac Conduction System

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    Saransh Jain
    22 views2 pages
    This document provides an overview of the extrinsic cardiac conduction system, including: 1) It defines the extrinsic cardiac conduction system as the autonomic nervous system modifying the intrinsic cardiac conduction and contractility based on the body's needs through the sympathetic and parasympathetic nervous systems. 2) It describes the anatomy and function of the parasympathetic nervous system, which decreases heart rate and conduction through the release of acetylcholine. 3) It describes the anatomy and function of the sympathetic nervous system, which increases heart rate, conduction, and contractility through the release of norepinephrine and epinephrine. 4) It explains the intracellular mechanisms of how the sympathetic and parasympathetic

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    This document provides an overview of the extrinsic cardiac conduction system, including: 1) It defines the extrinsic cardiac conduction system as the autonomic nervous system modifying the intrinsic cardiac conduction and contractility based on the body's needs through the sympathetic and parasympathetic nervous systems. 2) It describes the anatomy and function of the parasympathetic nervous system, which decreases heart rate and conduction through the release of acetylcholine. 3) It describes the anatomy and function of the sympathetic nervous system, which increases heart rate, conduction, and contractility through the release of norepinephrine and epinephrine. 4) It explains the intracellular mechanisms of how the sympathetic and parasympathetic

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views2 pages

    Cardiovascular - Electrophysiology - Extrinsic Cardiac Conduction System

    Uploaded by

    Saransh Jain
    This document provides an overview of the extrinsic cardiac conduction system, including: 1) It defines the extrinsic cardiac conduction system as the autonomic nervous system modifying the intrinsic cardiac conduction and contractility based on the body's needs through the sympathetic and parasympathetic nervous systems. 2) It describes the anatomy and function of the parasympathetic nervous system, which decreases heart rate and conduction through the release of acetylcholine. 3) It describes the anatomy and function of the sympathetic nervous system, which increases heart rate, conduction, and contractility through the release of norepinephrine and epinephrine. 4) It explains the intracellular mechanisms of how the sympathetic and parasympathetic

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    of 2

    Last edited: 8/13/2021

    1. EXTRINSIC CARDIAC CONDUCTION SYSTEM


    Cardiovascular | Electrophysiology | Extrinsic Cardiac Conduction System Medical Editor: Dr. Sofia Centenaro

    OUTLINE

    I) DEFINITION
    II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)
    III) SYMPATHETIC NERVOUS SYSTEM (SNS)
    IV) REFRACTORY PERIOD
    V) REVIEW QUESTIONS
    VI) REFERENCES

    I) DEFINITION
    Definition: The Autonomic Nervous System modifies the
    intrinsic Cardiac Conduction and Contractility based on
    body’s needs
    System Innervation of Heart (SNS & PSNS)

    II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)

    (A) ANATOMY
    1) Anterior Hypothalamus
    2) ↑ Cardiac Inhibitory Center in Medulla
    3) ↑ Preganglionic Vagus Nerve fibers
    4) ↑ Postganglionic Vagus nerve fibers in Intramural
    Ganglia
    5) ↑ Cervical and Thoracic Cardiac nerves
    6) Heart Figure 1. Mechanism of action of SNS and PSNS on nodal cells

    (B) FUNCTION
    ↓Heart Rate III) SYMPATHETIC NERVOUS SYSTEM (SNS)
    o ↓Chronotropy (keeps the sinus rhythm)
    o slow depolarization → decreased rate of action (A) ANATOMY
    potentials (APs) 1) Posterior Hypothalamus
    whenever HR< 60 bpm → Bradycardia 2) ↑ Cardioacceleratory Center in the Medulla
    3) ↑ Preganglionic Fibers in T1-T5 region of spinal cord
    ↓Conduction 4) ↑ Postganglionic Fibers in Sympathetic Chain
    o ↓ Dromotropy Ganglia
    No effect on Contractility 5) ↑ Superior, Middle and Inferior cardiac nerves
    6) Heart
    (C) INTRACELLULAR MECHANISM OF ACTION
    (B) FUNCTION
    PSNS fibers
    ↑ Acetylcholine (Ach) release ↑ Increases Heart Rate
    ↑ Muscarinic Type 2 receptors activity o ↑ Chronotropy
    ↑ Gs inhibitory protein activity o more rapid depolarization
    ↑ dissociation of alpha (𝛼𝛼) subunit from beta (𝛽𝛽) and o → ↑ increased rate of action potentials (Aps)
    gamma (𝛾𝛾) whenever HR >100 bpm → Tachycardia
    o ↑ beta/gamma activity
     → ↑ binding to K+ channels ↑Increases conduction
     → ↑ K+ efflux o ↑ Dromotropy
     → ↑ hyperpolarization of cells ↑Increases Contractility
     → ↓ AP’s o ↑ Inotropy
     → ↓ HR & ↓Conduction
    o ↑ alpha activity
     → ↓ AC activity
     → ↓ cAMP
     → ↓ PKA
     → ↓ phosphorylation of L-type Ca++ channels
     → ↓Calcium influx in nodal cells
     → ↓AP’s
     → ↓HR

    Figure 2. Effects of SNS and PSNS on HR

    extrinsic cardiac conduction system CARDIOVASCULAR PHYSIOLOGY : Note #1. 1 of 2


    (C) INTRACELLULAR MECHANISM OF ACTION IV) REFRACTORY PERIOD
    (1) on nodal cells: During phases 3 and 4 (repolarization and RMP)
    SNS fibers absolute, relative, super
    ↑ release NE and Epi normal heart is resting
    ↑ 𝛽𝛽1 adrenergic receptor activity 250 ms
    ↑ Gs protein activity In the relative refractory period if you provide enough
    ↑ AC activity stimulus to the heart, you can take it out of refraction and
    ↑ cAMP trigger another action potential – but you want to obey the
    ↑ PKA absolute refractory period
    ↑ phosphorylate proteins:
    o ↑ phosphorylation of L type Ca++ channels
     → ↑ Calcium influx in nodal cells
     → ↑ depolarization rate
     → ↑ AP’s
     → ↑ HR & ↑Conduction & ↑Contractility
    (2) on contractile cells:
    SNS fibers
    ↑ release NE and Epi (from adrenal medulla)
    ↑ Beta 1 adrenergic receptor activity
    ↑ CAMP
    ↑ PKA
    ↑phosphorylate proteins: Figure 3. Phases of cardiac action potentials in a myocyte
    o ↑ phosphorylation of Phospholamban
     → ↑influx of Ca++ back into Sarcoplasmic
    V) REVIEW QUESTIONS
    reticulum
     → ↑ speed of relaxation Bradycardia occurs when HR is:
    • so it can be stimulated again quickly a. < 60 bpm
    o ↑ phosphorylation of L-type Ca++ channels b. > 60 bpm
     → ↑ Calcium influx contractile cells c. <100 bpm
     → ↑ Ryr-2 activity d. Equal to 60 bpm
     → ↑ Ca++ in the SR
     → ↑↑ Ca++ released into the sarcoplasm Tachycardia occurs when HR is:
    a. > 120 bpm
     → ↑ interactions with troponin
    b. < 100 bpm
     → ↑ cross-bridge formation (interaction actin-
    c. > 100 bpm
    myosin)
    d. > 60 bpm
     → contraction rate and speed → ↑ heart pumping
     → ↑ SV → ↑ CO The refractory period lasts about:
    a. 150 ms
    Definitions: b. 250 ms
    Stroke volume (SV) = volume of blood pumped out of the c. 50 ms
    ventricle in one heartbeat d. 500 ms
    Cardiac Output (CO) = amount of blood pumped out of the
    ventricle in one minute Which type of channels are phosphorylated by
    stimulation of the SNS?
    Remember: a. L- type Ca++ channels
    CO = HR x SV b. T- type Ca++ channels
    BP = CO x TPR (total peripheral resistance) c. K+ channels
    ↑HR  ↑CO  ↑BP d. Na+ channels
    ↓HR ↓ CO  ↓BP
    The PSNS can affect the contractility of the heart.
    a. True
    b. False

    The SNS has a positive chronotropic action.


    a. True
    b. False

    During the relative refractory period APs can be


    triggered.
    a. True
    b. False

    CHECK YOUR ANSWERS

    VI) REFERENCES
    • Guyton and Hall, Textbook of Medical Physiology,
    Edra, 2021

    Figure 1.1. MoA of PSNS & SNS on contractile cells

    2 of 2 CARDIOVASCULAR PHYSIOLOGY: Note #1. extrinsic cardiac conduction system

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