Cardiac conducting system Anatomy and Physiology
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Transcript of Cardiac conducting system Anatomy and Physiology
Cardiac conducting systemAnatomy and Physiology
QUIZ
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1. Overview
Label the diagram.
2. Membrane potentials 1
The graph shows the changing membrane potentials for a sinus nodal fiber and a muscle fibre.Which is which?
a)
b)
2. Membrane potential timing – extra info
3. Membrane potentials 2
Where on the Y-axis is the zero millivolt level?
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4. Pacemaker membrane potential
Identify the currents
IbBackground inward Na+ current
ICaLLong lasting Ca++ channels
ICaTTransient Ca++ channels
IfFunny current (inward K+/Na+, hyperpolarised voltage gated )
IKDelayed rectifier K+ current
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b)
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e)d)
5. Ectopic membrane potential
Identify the currents: ICaL, IK, IK1, INa, Ito
ICaLLong lasting Ca++ channels
IKDelayed rectifier K+ current
IK1Inwards rectifier K+ current
INaInward Na+ current
ItoTransient outward K+ current
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6. Histology
Match the labels a) Endocardiumb) Myocardium
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c) Bundle Branch fibresd) Purkinje fibres
H&E x150 H&E/Elastin x400
(a) shows the left branch bundle of conducting fibres in the interventricular septum beneath the endocardium.At this level the conducting fibres are separated from the myocardial fibres by a layer of fibrous tissue.The conducting fibres are specialised cardiac muscle fibres, and contain few myofibrils, mainly located beneath the cell membrane, but abundant glycogen granules and mitochondria. This makes these fibres paler staining than normal myocardial fibres by most stains.
(b) shows the Purkinje fibres beneath the thin endocardium.These fibres are larger than cardiac muscle fibres and have a pale staining central area with most of the red-staining myofibrils around the periphery of the cell. Purkinje and other conducting fibres have no T tubule system, and connect with each other by desmosomes and gap junctions rather than intercalated discs.
6. Histology explained
In what order does the impulse activate the labelled parts?Bonus points – give an expected time in seconds for the impulse to reach each part.
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7. Propagation of cardiac impulse
In a non-pathological heart, does a particular cross-section of the ventricle wall depolarize:
A. Outer to innerB. Inner to outerC. All at onceD. Middle to inner and outer
8. Easy multi-choice
The SA node is located near the juncture of the:
A. Left atrium and left pulmonary veinsB. Left atrium and right pulmonary veinsC. Right atrium and superior vena cavaD. Right atrium and inferior vena cava
9. Easy multi-choice
If cardiac impulses are completely blocked at the bundle of His, then the atricular beat will be:
A. NormalB. SlowC. FastD. ceased
10. Multi-choice
If cardiac impulses are completely blocked at the bundle of His, then the ventricular beat will be:
A. NormalB. SlowC. FastD. ceased
11. Multi-choice
Which of the following would be expected to result in a decrease in ventricular contractility?
A. hypercalcemiaB. hypocalcemiaC. hypokalemiaD. hypernatremia
12. Multi-choice
14. Nasty
During an acute MI, extracellular potassium rises rapidly to 10-20mM. This will produce:
A. Decreased Na+ channel inactivation
B. Decreased thresholdC. Membrane
hyperpolarizationD. Slowing of conduction
The decreased K+ concentration gradient will increase the resting potential. This mean some Na channels will stay inactivated, reducing the available Na current. This will slow or block conduction.
In a patient with atrial tachyarrhythima, giving a drug that increases the effective refractory period in the AV node would be expected to:
A. Abolish the arrhythmiaB. Increase the PR interval (the time to conduct
an impulse through the AV node)C. Slow the ventricular rateD. Induce a third degree AV block
15. Nasty
A rise in intracellular concentration of which ion can indirectly result in an increase in ventricular contractility?
A. Cl-B. K+D. Na+C. HCO3-
16. Nasty
Reducing the Na+ gradient makes the Na/Ca pump less effective, so less calcium is pumped out of the cell.The excess calcium is sucked into the sarcoplasmic reticulum, which then releases extra calcium on subsequent impulses, for more contractility.
The following condition can result in an increase in ectopic automaticity, resulting in an increased incidence of ventricular arrhythmias:
A. hypercalcemiaB. hyperkalemiaC. hypokalemiaD. hypermagnesemiaE. hyponatremia
17. Nasty
Don’t understand why. Something to do with the K1 current?