SlideShare una empresa de Scribd logo
1 de 41
Cardiac  Electrophysiology
Cardiac Electrophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object]
OVERVIEW: ELECTRICAL ACTIVITY IN THE  NORMAL HEART
Terms action potential or "AP" :  stereotyped voltage change with time depolarize :  make voltage more positive hyperpolarize : make voltage more negative depolarization repolarization Action potential from a heart cell -80 mV +60 mV 300 ms
Channel- types Voltage-gated channels:   channels that open or close in response to changes in membrane potential.  Central to the AP and conducted AP. "Background" channels:  channels that are NOT voltage-gated and NOT ligand gated.  Generally they are open.  Important to set "resting" or "diastolic" potential. Ligand-gated channels:   channels that open or close in response to a drug, neurohormone, etc.  We will discuss later. voltage-gated background
Membrane currents that underlie the cardiac AP Voltage-gated Channels of interest to us Na + ( I Na ) Ca 2+  (L-type; T-type)   I Ca,L   and I Ca,T K +  (rapid, slow,   transient outward)   I KR , I KS , I TO ) Both Na +  and K +   ("funny")   I F Transporter N + /Ca 2+  exchanger   I NCX heart cell
Effect of channels opening 1.  When channel is closed, no current flows through channel  2.  When cations (+) enter cell ("inward current"), cell depolarizes  (becomes more positive inside) The effect of the opening of a particular kind of channel on the cardiac AP depends on: 1. The permeant ion (e.g. Na + , Ca 2+ , K + , etc)  2. The Nernst potential for "X", the relevant ion, (E X ) 3. The membrane potential (V M ) when the channels open 4. When V M  is negative to E X , there is inward (depolarizing) current  4. When V M  is positive to E X , there is outward (repolarizing) current  1.  When channel is closed, no current flows through channel  2.  When cations (+) enter cell ("inward current"), cell depolarizes  (becomes more positive inside) 3.  When cations (+) exit cell ("outward current"), cell polarizes  (becomes more negative inside) depolarizing inward (+)  current + repolarizing outward (+)  current +
Nernst potential for ions in heart -41
Nernst Potential for Ion "X" if K o  were 1 mM and K i  were 100 mM then E K  = -120 mV For a positive monovalent ion R="gas constant" T=temperature ( o  K) Z=valence F=Faraday  10 5  Coulomb/Mole E X  = 60 mV log ([X + ] o /[X + ] i ) .
AP and "Nernst" or "Reversal" Potentials -80 mV +60 mV -97 E K  - Nernst potential for K +  = "reversal" potential -37 E F  or E Cl   + 70 E Na   +124  E Ca   time voltage
Phases of the Cardiac Action Potential (AP) -80 mV +60 mV Phase 0 (upstroke) Phase 2 (plateau) Phase 1 (early repolarization) Phase 4 (diastole) Phase 4 (diastole) Phase 3 (repolarization)
Comparison of APs pacemaker depolarization spontaneous depolarization No pacemaker depolarization conducted AP to cell triggers depolarization No pacemaker depolarization conducted AP to cell triggers depolarization AP from VENTRICULAR MUSCLE -80 mV -80 mV 0 maximum diastolic  potential AP from ATRIAL MUSCLE AP from SA node or AV node
Currents in the heart repolarizing potassium currents = "I K "
Genes for key channels
Purpose of currents
Electrical Activity in the heart SA Node Ventricular Muscle pacemaker
The Conducted Action Potential (AP) AP originates in SA node and is conducted through atria through AV node to His-Purkinje fiber system through ventricular muscle.  For this discussion we first examine a region of ventricular muscle just before the AP arrives....  Before AP arrives 1. The AP is being conducted from the left to the right (in this example) 3. The "voltage-gated" ion channels in the SL (sarcolemma) are responsible for the AP.  voltage-gate 4.  Gap junction channels between the heart cells are always open and permit the AP to be conducted from cell to cell.  Current can flow. gap junctions cell A  cell B  cell C  cell D  cell E  cell F  cell G  2. The resting potential of the heart cells is negative (between -80 and -90  mV) controlled by "background" ion channels (i.e. NOT voltage-gated). -90 mV -90 mV -90 mV -90 mV -90 mV -90 mV -90 mV
The Conducted Action Potential (AP) AP is being conducted from left to right  B A negative = inward =  depolarizing current distance time voltage V A Time V B Time V B -V A 0 + - Time current flowing into region "B" from region "A" is given by Ohm's law: I AB  = (V B -V A )/R AB I AB  is proportional to (V B -V A ) R AB  is the resistance between "A" and "B"
The Conducted AP When the AP is very far away from point "B" the intracellular resistance is very high and there is little effect of the AP on the voltage at "B". As the AP approaches "B" the depolarizing effect of the AP increases until the threshold potential is reached and a "regenerative" AP is produced at "B" AP is being conducted from left to right  6 6 7 7 5 5 2 2 3 3 4 4 1 1 B THRESHOLD FOR REGENERATIVE AP AT "B" voltage time (Right) Plot of V B  as a function of time as the propagated AP approaches "B"
AP propagation is slower when....  ,[object Object],[object Object],[object Object],[object Object]
AP conduction velocity in different tissues  ,[object Object],[object Object],[object Object],[object Object]
Conduction velocity in different tissue very slow fast very fast
What is V m  when multiple channels are activated?
GKH = Goldman-Hodgkin-Katz R="gas constant" T=temperature ( o  K) F=Faraday  10 5  Coulomb/Mole P X  = permeability of   ion "X"
Chord Conductance g X  = conductance of ion "X" E X  = Nernst potential of ion "X" g X   g K  + g Na  + g Cl is the fraction of the total conductance due to ion "X"
Action potential:  Balance of Current ,[object Object],[object Object],[object Object],[object Object]
AP’s in heart ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SA Node ,[object Object],[object Object],[object Object],[object Object],[object Object]
How does a pacemaker develop spontaneous activity?
Pacemaker Activity in SA node pacemaker depolarization
Ca 2+  current in SA node ,[object Object],[object Object]
Properties of I Ca I Ca  shows "inactivation": This means that after the current is activated by a depolarized voltage, and the "activation" is maintained by the continued depolarization, the current decreases with time. I Ca  shows recovery from "inactivation": This means that after the current is de-activated by a repolarized voltage, it still takes time before the effect of "inactivation" is removed.  In SA node, I Ca  remains slightly activated at the maximum diastolic potential (MDP) of -65 mV: This means that during phase 4 in the SA node, recovery from inactivation produces a growing inward current!  voltage current inactivation (recovery from inactivation) activation ( de activation)
Repolarizing K +  currents in SA node deactivation takes place slowly for the repolarizing K currents decreasing outward current
“ F” current in SA Node ,[object Object],[object Object]
Pacemaker depolarization in SA node depends on  K, F and Ca currents
Normal pacemaker depolarization in heart ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ventricular Muscle has no pacemaker depolarization RRP= relative refractory period ERP= effective refractory period ERP due to mainly Na +  channel inactivation
Ventricular AP depends on Na, Ca and K currents I Na I Ca I K
Modulation of AP properties by adrenergic and cholinergic systems
THANK YOU

Más contenido relacionado

La actualidad más candente

Electrical activity of heart
Electrical activity of heartElectrical activity of heart
Electrical activity of heart
Ameel Yaqo
 
Cardiac Electrophysiology
Cardiac ElectrophysiologyCardiac Electrophysiology
Cardiac Electrophysiology
TeleClinEd
 
Ecg basics & cardicac physiology
Ecg basics & cardicac physiologyEcg basics & cardicac physiology
Ecg basics & cardicac physiology
Subhanjan Das
 
Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區
Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區
Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區
Taiwan Heart Rhythm Society
 
Heart Physiology, Schleich
Heart Physiology, SchleichHeart Physiology, Schleich
Heart Physiology, Schleich
Tariq Abdulla
 

La actualidad más candente (20)

Cardiac action potential
Cardiac action potentialCardiac action potential
Cardiac action potential
 
Coronary circulation
Coronary circulationCoronary circulation
Coronary circulation
 
Cardiac electrophysiology
Cardiac electrophysiologyCardiac electrophysiology
Cardiac electrophysiology
 
Av node
Av nodeAv node
Av node
 
Electrical activity of heart
Electrical activity of heartElectrical activity of heart
Electrical activity of heart
 
ECG BASICS IN DETAIL
ECG BASICS IN DETAILECG BASICS IN DETAIL
ECG BASICS IN DETAIL
 
ELECTROCARDIOGRAM BASIC
ELECTROCARDIOGRAM BASICELECTROCARDIOGRAM BASIC
ELECTROCARDIOGRAM BASIC
 
Properties of cm, plateau potential & pacemaker by Pandian M this PPT for I ...
Properties of  cm, plateau potential & pacemaker by Pandian M this PPT for I ...Properties of  cm, plateau potential & pacemaker by Pandian M this PPT for I ...
Properties of cm, plateau potential & pacemaker by Pandian M this PPT for I ...
 
ECG Interpretation
ECG InterpretationECG Interpretation
ECG Interpretation
 
Atrial enlargement
Atrial enlargementAtrial enlargement
Atrial enlargement
 
Cardiac Electrophysiology
Cardiac ElectrophysiologyCardiac Electrophysiology
Cardiac Electrophysiology
 
Ecg basics & cardicac physiology
Ecg basics & cardicac physiologyEcg basics & cardicac physiology
Ecg basics & cardicac physiology
 
P wave abnormalities in ECG
P wave  abnormalities in ECGP wave  abnormalities in ECG
P wave abnormalities in ECG
 
Ecg fundamentals
Ecg fundamentalsEcg fundamentals
Ecg fundamentals
 
Regulation of Coronary Blood Flow
Regulation of Coronary Blood FlowRegulation of Coronary Blood Flow
Regulation of Coronary Blood Flow
 
Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區
Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區
Basic Cardiac Electrophysiology and ECG Concepts_20120902_北區
 
Ekg presentation
Ekg presentationEkg presentation
Ekg presentation
 
Anatomy of Cardiac Conduction System
Anatomy of Cardiac Conduction SystemAnatomy of Cardiac Conduction System
Anatomy of Cardiac Conduction System
 
Myocardial action potential and Basis of Arrythmogenesis
Myocardial action potential and Basis of ArrythmogenesisMyocardial action potential and Basis of Arrythmogenesis
Myocardial action potential and Basis of Arrythmogenesis
 
Heart Physiology, Schleich
Heart Physiology, SchleichHeart Physiology, Schleich
Heart Physiology, Schleich
 

Destacado

Action potential
Action potential Action potential
Action potential
Jinny Shaw
 
Vigeland Sculpture Park Oslo (Norway) (V M )
Vigeland Sculpture Park  Oslo (Norway) (V M )Vigeland Sculpture Park  Oslo (Norway) (V M )
Vigeland Sculpture Park Oslo (Norway) (V M )
Valeriu Margescu
 
Electrical activity of heart
Electrical activity of heartElectrical activity of heart
Electrical activity of heart
Aftab Badshah
 

Destacado (20)

Cardiac Action Potential
Cardiac Action PotentialCardiac Action Potential
Cardiac Action Potential
 
Electrophysiology study basics
Electrophysiology study basicsElectrophysiology study basics
Electrophysiology study basics
 
Introduction To Electrophysiology
Introduction To ElectrophysiologyIntroduction To Electrophysiology
Introduction To Electrophysiology
 
Action Potential
Action Potential Action Potential
Action Potential
 
The Cardiac Cycle7
The Cardiac Cycle7The Cardiac Cycle7
The Cardiac Cycle7
 
ELectrophysiology basics part4
ELectrophysiology basics part4ELectrophysiology basics part4
ELectrophysiology basics part4
 
Electrophysiology basics,part1(lecture)
Electrophysiology basics,part1(lecture)Electrophysiology basics,part1(lecture)
Electrophysiology basics,part1(lecture)
 
Cardiac muscle
Cardiac muscleCardiac muscle
Cardiac muscle
 
Action potential
Action potential Action potential
Action potential
 
Vom Gipfel der überzogenen Erwartungen zum Plateau der Produktivität
Vom Gipfel der überzogenen Erwartungen zum Plateau der ProduktivitätVom Gipfel der überzogenen Erwartungen zum Plateau der Produktivität
Vom Gipfel der überzogenen Erwartungen zum Plateau der Produktivität
 
M Morales Sealed Rpcs
M Morales Sealed RpcsM Morales Sealed Rpcs
M Morales Sealed Rpcs
 
The Effects of Power Line on Environmental Radiation Levels in Jos and Enviro...
The Effects of Power Line on Environmental Radiation Levels in Jos and Enviro...The Effects of Power Line on Environmental Radiation Levels in Jos and Enviro...
The Effects of Power Line on Environmental Radiation Levels in Jos and Enviro...
 
Plateau Final 2010
Plateau Final 2010Plateau Final 2010
Plateau Final 2010
 
Rampazzo - Automated EP
Rampazzo - Automated EPRampazzo - Automated EP
Rampazzo - Automated EP
 
LM315x Synchronous Simple Switcher® Controller Series
LM315x Synchronous Simple Switcher® Controller SeriesLM315x Synchronous Simple Switcher® Controller Series
LM315x Synchronous Simple Switcher® Controller Series
 
Vigeland Sculpture Park Oslo (Norway) (V M )
Vigeland Sculpture Park  Oslo (Norway) (V M )Vigeland Sculpture Park  Oslo (Norway) (V M )
Vigeland Sculpture Park Oslo (Norway) (V M )
 
2009 terni, università di medicina, i farmaci nel trattamento delle tachicar...
2009 terni, università di medicina, i farmaci nel trattamento delle tachicar...2009 terni, università di medicina, i farmaci nel trattamento delle tachicar...
2009 terni, università di medicina, i farmaci nel trattamento delle tachicar...
 
Transistor 1 lecture
Transistor 1 lectureTransistor 1 lecture
Transistor 1 lecture
 
General Physiology - Cardiovascular sys.
General Physiology - Cardiovascular sys.General Physiology - Cardiovascular sys.
General Physiology - Cardiovascular sys.
 
Electrical activity of heart
Electrical activity of heartElectrical activity of heart
Electrical activity of heart
 

Similar a Cardiac+Electrophysiology

Similar a Cardiac+Electrophysiology (20)

Basics of arrhythmias&antiarrhythmic drugs
Basics of arrhythmias&antiarrhythmic drugsBasics of arrhythmias&antiarrhythmic drugs
Basics of arrhythmias&antiarrhythmic drugs
 
Properties of CM, Plateau Potential & Pacemaker.pptx
Properties of  CM, Plateau Potential & Pacemaker.pptxProperties of  CM, Plateau Potential & Pacemaker.pptx
Properties of CM, Plateau Potential & Pacemaker.pptx
 
Electrical Activity of the Heart
Electrical Activity of the HeartElectrical Activity of the Heart
Electrical Activity of the Heart
 
arrhythmia-211205224744.pdf33333333333333
arrhythmia-211205224744.pdf33333333333333arrhythmia-211205224744.pdf33333333333333
arrhythmia-211205224744.pdf33333333333333
 
Arrhythmia
ArrhythmiaArrhythmia
Arrhythmia
 
Anti arrhythmic drugs
Anti arrhythmic drugsAnti arrhythmic drugs
Anti arrhythmic drugs
 
Ecg 1
Ecg 1Ecg 1
Ecg 1
 
BASIC ECG INTERPRETATION.pptx
BASIC ECG INTERPRETATION.pptxBASIC ECG INTERPRETATION.pptx
BASIC ECG INTERPRETATION.pptx
 
Cardiac contractility
Cardiac contractilityCardiac contractility
Cardiac contractility
 
Cardiac electrophysiology by Dr. Vaibhav Yawalkar , MD,DM Cardiology
Cardiac electrophysiology by Dr. Vaibhav Yawalkar , MD,DM CardiologyCardiac electrophysiology by Dr. Vaibhav Yawalkar , MD,DM Cardiology
Cardiac electrophysiology by Dr. Vaibhav Yawalkar , MD,DM Cardiology
 
Cardiovascular system
Cardiovascular systemCardiovascular system
Cardiovascular system
 
IVMS-CV Pharmacology- Antiarrhythmic Agents
IVMS-CV  Pharmacology- Antiarrhythmic AgentsIVMS-CV  Pharmacology- Antiarrhythmic Agents
IVMS-CV Pharmacology- Antiarrhythmic Agents
 
CVS PSL and Monitoring
CVS PSL and Monitoring	CVS PSL and Monitoring
CVS PSL and Monitoring
 
Cvs introduction 2018.ms
Cvs introduction 2018.msCvs introduction 2018.ms
Cvs introduction 2018.ms
 
Basic Cardiac Electrophysiology
Basic Cardiac ElectrophysiologyBasic Cardiac Electrophysiology
Basic Cardiac Electrophysiology
 
Cardiovascular system
Cardiovascular systemCardiovascular system
Cardiovascular system
 
genesis and spreading of cardiac impulses
genesis and spreading of cardiac impulsesgenesis and spreading of cardiac impulses
genesis and spreading of cardiac impulses
 
March Cardio Review
March Cardio ReviewMarch Cardio Review
March Cardio Review
 
Electrocardiography
ElectrocardiographyElectrocardiography
Electrocardiography
 
ECG basics
ECG basicsECG basics
ECG basics
 

Más de dhavalshah4424

Management+of+Diabetic+Neuropathy
Management+of+Diabetic+NeuropathyManagement+of+Diabetic+Neuropathy
Management+of+Diabetic+Neuropathy
dhavalshah4424
 
Diabetes+and+Pregnancy
Diabetes+and+PregnancyDiabetes+and+Pregnancy
Diabetes+and+Pregnancy
dhavalshah4424
 
Legg+Calve+Perthes+Disease
Legg+Calve+Perthes+DiseaseLegg+Calve+Perthes+Disease
Legg+Calve+Perthes+Disease
dhavalshah4424
 
Legg+Calve+Perthes+Disease
Legg+Calve+Perthes+DiseaseLegg+Calve+Perthes+Disease
Legg+Calve+Perthes+Disease
dhavalshah4424
 
Complications+of+Diabetes
Complications+of+DiabetesComplications+of+Diabetes
Complications+of+Diabetes
dhavalshah4424
 
Interventional+Procedures
Interventional+ProceduresInterventional+Procedures
Interventional+Procedures
dhavalshah4424
 
Polypharmacy+in+Schizophrenia
Polypharmacy+in+SchizophreniaPolypharmacy+in+Schizophrenia
Polypharmacy+in+Schizophrenia
dhavalshah4424
 
Depression+and+Diabetes
Depression+and+DiabetesDepression+and+Diabetes
Depression+and+Diabetes
dhavalshah4424
 
Antidepressants+in+Psychiatric+Disorder
Antidepressants+in+Psychiatric+DisorderAntidepressants+in+Psychiatric+Disorder
Antidepressants+in+Psychiatric+Disorder
dhavalshah4424
 
Juvenile+Rheumatoid+Arthritis+slides
Juvenile+Rheumatoid+Arthritis+slidesJuvenile+Rheumatoid+Arthritis+slides
Juvenile+Rheumatoid+Arthritis+slides
dhavalshah4424
 
Juvenile+Rheumatoid+Arthritis+slides+
Juvenile+Rheumatoid+Arthritis+slides+Juvenile+Rheumatoid+Arthritis+slides+
Juvenile+Rheumatoid+Arthritis+slides+
dhavalshah4424
 

Más de dhavalshah4424 (20)

CAD+And+ACS
CAD+And+ACSCAD+And+ACS
CAD+And+ACS
 
Hypertension
HypertensionHypertension
Hypertension
 
Management+of+Diabetic+Neuropathy
Management+of+Diabetic+NeuropathyManagement+of+Diabetic+Neuropathy
Management+of+Diabetic+Neuropathy
 
Diabetes+and+Pregnancy
Diabetes+and+PregnancyDiabetes+and+Pregnancy
Diabetes+and+Pregnancy
 
Legg+Calve+Perthes+Disease
Legg+Calve+Perthes+DiseaseLegg+Calve+Perthes+Disease
Legg+Calve+Perthes+Disease
 
Osteoid+Osteoma
Osteoid+OsteomaOsteoid+Osteoma
Osteoid+Osteoma
 
Osteoid+Osteoma
Osteoid+OsteomaOsteoid+Osteoma
Osteoid+Osteoma
 
Osteoid+Osteoma
Osteoid+OsteomaOsteoid+Osteoma
Osteoid+Osteoma
 
Osteoid+Osteoma
Osteoid+OsteomaOsteoid+Osteoma
Osteoid+Osteoma
 
Legg+Calve+Perthes+Disease
Legg+Calve+Perthes+DiseaseLegg+Calve+Perthes+Disease
Legg+Calve+Perthes+Disease
 
Osteoid+Osteoma
Osteoid+OsteomaOsteoid+Osteoma
Osteoid+Osteoma
 
Complications+of+Diabetes
Complications+of+DiabetesComplications+of+Diabetes
Complications+of+Diabetes
 
Interventional+Procedures
Interventional+ProceduresInterventional+Procedures
Interventional+Procedures
 
Angiogram
AngiogramAngiogram
Angiogram
 
Polypharmacy+in+Schizophrenia
Polypharmacy+in+SchizophreniaPolypharmacy+in+Schizophrenia
Polypharmacy+in+Schizophrenia
 
Depression+and+Diabetes
Depression+and+DiabetesDepression+and+Diabetes
Depression+and+Diabetes
 
Antidepressants+in+Psychiatric+Disorder
Antidepressants+in+Psychiatric+DisorderAntidepressants+in+Psychiatric+Disorder
Antidepressants+in+Psychiatric+Disorder
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
Juvenile+Rheumatoid+Arthritis+slides
Juvenile+Rheumatoid+Arthritis+slidesJuvenile+Rheumatoid+Arthritis+slides
Juvenile+Rheumatoid+Arthritis+slides
 
Juvenile+Rheumatoid+Arthritis+slides+
Juvenile+Rheumatoid+Arthritis+slides+Juvenile+Rheumatoid+Arthritis+slides+
Juvenile+Rheumatoid+Arthritis+slides+
 

Último

College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
perfect solution
 
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Dipal Arora
 

Último (20)

Lucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomLucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
 
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
 
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Haridwar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Haridwar Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Haridwar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Haridwar Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Ooty Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Ooty Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Ooty Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
 
Bangalore Call Girls Nelamangala Number 9332606886 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 9332606886  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 9332606886  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 9332606886 Meetin With Bangalore Esc...
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
 
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
 

Cardiac+Electrophysiology

  • 2.
  • 3. OVERVIEW: ELECTRICAL ACTIVITY IN THE NORMAL HEART
  • 4.
  • 5. Terms action potential or "AP" : stereotyped voltage change with time depolarize : make voltage more positive hyperpolarize : make voltage more negative depolarization repolarization Action potential from a heart cell -80 mV +60 mV 300 ms
  • 6. Channel- types Voltage-gated channels: channels that open or close in response to changes in membrane potential. Central to the AP and conducted AP. "Background" channels: channels that are NOT voltage-gated and NOT ligand gated. Generally they are open. Important to set "resting" or "diastolic" potential. Ligand-gated channels: channels that open or close in response to a drug, neurohormone, etc. We will discuss later. voltage-gated background
  • 7. Membrane currents that underlie the cardiac AP Voltage-gated Channels of interest to us Na + ( I Na ) Ca 2+ (L-type; T-type) I Ca,L and I Ca,T K + (rapid, slow, transient outward) I KR , I KS , I TO ) Both Na + and K + ("funny") I F Transporter N + /Ca 2+ exchanger I NCX heart cell
  • 8. Effect of channels opening 1. When channel is closed, no current flows through channel 2. When cations (+) enter cell ("inward current"), cell depolarizes (becomes more positive inside) The effect of the opening of a particular kind of channel on the cardiac AP depends on: 1. The permeant ion (e.g. Na + , Ca 2+ , K + , etc) 2. The Nernst potential for "X", the relevant ion, (E X ) 3. The membrane potential (V M ) when the channels open 4. When V M is negative to E X , there is inward (depolarizing) current 4. When V M is positive to E X , there is outward (repolarizing) current 1. When channel is closed, no current flows through channel 2. When cations (+) enter cell ("inward current"), cell depolarizes (becomes more positive inside) 3. When cations (+) exit cell ("outward current"), cell polarizes (becomes more negative inside) depolarizing inward (+) current + repolarizing outward (+) current +
  • 9. Nernst potential for ions in heart -41
  • 10. Nernst Potential for Ion "X" if K o were 1 mM and K i were 100 mM then E K = -120 mV For a positive monovalent ion R="gas constant" T=temperature ( o K) Z=valence F=Faraday  10 5 Coulomb/Mole E X = 60 mV log ([X + ] o /[X + ] i ) .
  • 11. AP and "Nernst" or "Reversal" Potentials -80 mV +60 mV -97 E K - Nernst potential for K + = "reversal" potential -37 E F or E Cl + 70 E Na +124 E Ca time voltage
  • 12. Phases of the Cardiac Action Potential (AP) -80 mV +60 mV Phase 0 (upstroke) Phase 2 (plateau) Phase 1 (early repolarization) Phase 4 (diastole) Phase 4 (diastole) Phase 3 (repolarization)
  • 13. Comparison of APs pacemaker depolarization spontaneous depolarization No pacemaker depolarization conducted AP to cell triggers depolarization No pacemaker depolarization conducted AP to cell triggers depolarization AP from VENTRICULAR MUSCLE -80 mV -80 mV 0 maximum diastolic potential AP from ATRIAL MUSCLE AP from SA node or AV node
  • 14. Currents in the heart repolarizing potassium currents = "I K "
  • 15. Genes for key channels
  • 17. Electrical Activity in the heart SA Node Ventricular Muscle pacemaker
  • 18. The Conducted Action Potential (AP) AP originates in SA node and is conducted through atria through AV node to His-Purkinje fiber system through ventricular muscle. For this discussion we first examine a region of ventricular muscle just before the AP arrives.... Before AP arrives 1. The AP is being conducted from the left to the right (in this example) 3. The "voltage-gated" ion channels in the SL (sarcolemma) are responsible for the AP. voltage-gate 4. Gap junction channels between the heart cells are always open and permit the AP to be conducted from cell to cell. Current can flow. gap junctions cell A cell B cell C cell D cell E cell F cell G 2. The resting potential of the heart cells is negative (between -80 and -90 mV) controlled by "background" ion channels (i.e. NOT voltage-gated). -90 mV -90 mV -90 mV -90 mV -90 mV -90 mV -90 mV
  • 19. The Conducted Action Potential (AP) AP is being conducted from left to right B A negative = inward = depolarizing current distance time voltage V A Time V B Time V B -V A 0 + - Time current flowing into region "B" from region "A" is given by Ohm's law: I AB = (V B -V A )/R AB I AB is proportional to (V B -V A ) R AB is the resistance between "A" and "B"
  • 20. The Conducted AP When the AP is very far away from point "B" the intracellular resistance is very high and there is little effect of the AP on the voltage at "B". As the AP approaches "B" the depolarizing effect of the AP increases until the threshold potential is reached and a "regenerative" AP is produced at "B" AP is being conducted from left to right 6 6 7 7 5 5 2 2 3 3 4 4 1 1 B THRESHOLD FOR REGENERATIVE AP AT "B" voltage time (Right) Plot of V B as a function of time as the propagated AP approaches "B"
  • 21.
  • 22.
  • 23. Conduction velocity in different tissue very slow fast very fast
  • 24. What is V m when multiple channels are activated?
  • 25. GKH = Goldman-Hodgkin-Katz R="gas constant" T=temperature ( o K) F=Faraday  10 5 Coulomb/Mole P X = permeability of ion "X"
  • 26. Chord Conductance g X = conductance of ion "X" E X = Nernst potential of ion "X" g X g K + g Na + g Cl is the fraction of the total conductance due to ion "X"
  • 27.
  • 28.
  • 29.
  • 30. How does a pacemaker develop spontaneous activity?
  • 31. Pacemaker Activity in SA node pacemaker depolarization
  • 32.
  • 33. Properties of I Ca I Ca shows "inactivation": This means that after the current is activated by a depolarized voltage, and the "activation" is maintained by the continued depolarization, the current decreases with time. I Ca shows recovery from "inactivation": This means that after the current is de-activated by a repolarized voltage, it still takes time before the effect of "inactivation" is removed. In SA node, I Ca remains slightly activated at the maximum diastolic potential (MDP) of -65 mV: This means that during phase 4 in the SA node, recovery from inactivation produces a growing inward current! voltage current inactivation (recovery from inactivation) activation ( de activation)
  • 34. Repolarizing K + currents in SA node deactivation takes place slowly for the repolarizing K currents decreasing outward current
  • 35.
  • 36. Pacemaker depolarization in SA node depends on K, F and Ca currents
  • 37.
  • 38. Ventricular Muscle has no pacemaker depolarization RRP= relative refractory period ERP= effective refractory period ERP due to mainly Na + channel inactivation
  • 39. Ventricular AP depends on Na, Ca and K currents I Na I Ca I K
  • 40. Modulation of AP properties by adrenergic and cholinergic systems

Notas del editor

  1. W. J. Lederer -- Cardiac electrophysiology
  2. W. J. Lederer -- Cardiac electrophysiology
  3. W. J. Lederer -- Cardiac electrophysiology
  4. W. J. Lederer -- Cardiac electrophysiology
  5. W. J. Lederer -- Cardiac electrophysiology
  6. W. J. Lederer -- Cardiac electrophysiology
  7. W. J. Lederer -- Cardiac electrophysiology
  8. W. J. Lederer -- Cardiac electrophysiology
  9. W. J. Lederer -- Cardiac electrophysiology
  10. W. J. Lederer -- Cardiac electrophysiology
  11. W. J. Lederer -- Cardiac electrophysiology
  12. W. J. Lederer -- Cardiac electrophysiology
  13. W. J. Lederer -- Cardiac electrophysiology
  14. W. J. Lederer -- Cardiac electrophysiology
  15. W. J. Lederer -- Cardiac electrophysiology
  16. W. J. Lederer -- Cardiac electrophysiology
  17. W. J. Lederer -- Cardiac electrophysiology
  18. W. J. Lederer -- Cardiac electrophysiology
  19. W. J. Lederer -- Cardiac electrophysiology
  20. W. J. Lederer -- Cardiac electrophysiology
  21. W. J. Lederer -- Cardiac electrophysiology
  22. W. J. Lederer -- Cardiac electrophysiology
  23. W. J. Lederer -- Cardiac electrophysiology
  24. W. J. Lederer -- Cardiac electrophysiology
  25. W. J. Lederer -- Cardiac electrophysiology
  26. W. J. Lederer -- Cardiac electrophysiology
  27. W. J. Lederer -- Cardiac electrophysiology
  28. W. J. Lederer -- Cardiac electrophysiology
  29. W. J. Lederer -- Cardiac electrophysiology
  30. W. J. Lederer -- Cardiac electrophysiology
  31. W. J. Lederer -- Cardiac electrophysiology
  32. W. J. Lederer -- Cardiac electrophysiology
  33. W. J. Lederer -- Cardiac electrophysiology
  34. W. J. Lederer -- Cardiac electrophysiology
  35. W. J. Lederer -- Cardiac electrophysiology
  36. W. J. Lederer -- Cardiac electrophysiology
  37. W. J. Lederer -- Cardiac electrophysiology
  38. W. J. Lederer -- Cardiac electrophysiology
  39. W. J. Lederer -- Cardiac electrophysiology
  40. W. J. Lederer -- Cardiac electrophysiology