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have time to repolarize. In these cases, the active impulse reenters

the same area and produces another impulse.

Repeating itself
An injured pacemaker (or nonpacemaker) cell may partially de-
polarize, rather than fully depolarizing. Partial depolarization can
lead to spontaneous or secondary depolarization, which involves
repetitive ectopic firings called triggered activity.
The resultant depolarization is called afterdepolarization.
Early afterdepolarization occurs before the cell is fully repolarized
and can be caused by hypokalemia, slow pacing rates, or drug tox-
icity. If it occurs after the cell has been fully repolarized, it’s called
delayed afterdepolarization. These problems can be caused by
digoxin toxicity, hypercalcemia, or increased catecholamine re-
lease. Atrial or ventricular tachycardias may result. You’ll learn
more about these and other arrhythmias in later chapters.

That’s a wrap!

Cardiac anatomy and physiology review

The heart’s valves • Oxygenated blood is pumped to the
• Tricuspid — AV valve between the aorta and the body by the left ventricle.
right atrium and right ventricle
Coronary arteries and veins
• Mitral — AV valve between the left
• Right coronary artery — supplies blood
atrium and left ventricle
to the right atrium and ventricle and part
• Aortic — semilunar valve between the
of the left ventricle
left ventricle and the aorta
• Left anterior descending artery — sup-
• Pulmonic — semilunar valve between
plies blood to the anterior wall of the left
the right ventricle and the pulmonary
ventricle, interventricular septum, right
bundle branch, and left anterior fascicu-
Blood flow lus of the left bundle branch
• Deoxygenated blood from the body re- • Circumflex artery — supplies blood to
turns to the right atrium and then flows to the lateral walls of the left ventricle, left
the right ventricle. atrium, and left posterior fasciculus of
• The right ventricle pumps blood into the the left bundle branch
lungs where it’s oxygenated. Then the • Cardiac veins — collect blood from the
blood returns to the left atrium and flows capillaries of the myocardium
to the left ventricle. • Coronary sinus — returns blood to the
right atrium

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Cardiac anatomy and physiology review (continued)

Cardiac cycle dynamics • Conductivity — the ability of a cell to
• Atrial kick — atrial contraction, contrib- transmit an electrical impulse to another
uting about 30% of the cardiac output cardiac cell
• Cardiac output — the amount of blood • Contractility — how well the cell con-
the heart pumps in 1 minute, calculated tracts after receiving a stimulus.
by multiplying heart rate times stroke
Depolarization-repolarization cycle
Cardiac cells undergo the following
• Stroke volume — the amount of blood
cycles of depolarization and repolariza-
ejected with each ventricular contraction
tion as impulses are transmitted:
(it’s affected by preload, afterload, and
• Phase 0: Rapid depolarization — the
cell receives an impulse from a nearby
• Preload — the passive stretching ex-
cell and is depolarized
erted by blood on the ventricular muscle
• Phase 1: Early repolarization — early
at the end of diastole
rapid repolarization occurs
• Afterload — the amount of pressure
• Phase 2: Plateau phase — a period of
the left ventricle must work against to
slow repolarization occurs
pump blood into the aorta
• Phase 3: Rapid repolarization — the
• Contractility — the ability of the heart
cell returns to its original state
muscle cells to contract after depolar-
• Phase 4: Resting phase — the cell rests
and readies itself for another stimulus.
Innervation of the heart
Cardiac conduction
Two branches of the autonomic nervous
• The electrical impulse begins in the
system supply the heart:
SA node and travels through the inter-
• Sympathetic nervous system —
nodal tracts and Bachmann’s bundle to
increases heart rate, automatic-
the AV node.
ity, AV conduction, and contractility
• From the AV node, the impulse travels
through release of norepinephrine and
down the bundle of His, along the bundle
branches, and through the Purkinje fibers.
• Parasympathetic nervous system —
vagus nerve stimulation reduces heart Intrinsic firing rates
rate and AV conduction through release • SA node — 60 to 100/minute
of acetylcholine. • AV junction — 40 to 60/minute
• Purkinje fibers — 20 to 40/minute
Transmission of electrical impulses
Generation and transmission of electrical Abnormal impulses
impulses depend on these cell charac- • Automaticity — the ability of a cardiac
teristics: cell to initiate an impulse on its own
• Automaticity — a cell’s ability to spon- • Retrograde conduction — impulses that
taneously initiate an impulse, such as are transmitted backward toward the atria
found in pacemaker cells • Reentry — when an impulse follows a
• Excitability — how well a cell responds circular, rather than the normal, conduc-
to an electrical stimulus tion path

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