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Electrical and Biochemical aspects of cardiac physiology. Overview. Electrical aspects of cardiac physiology Biochemical aspects of cardiac physiology Other Bio-electrical aspects of cardiac physiology Tightly integrated. Electrical aspects of cardiac physiology. Anatomy Action potential

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overview
Overview
  • Electrical aspects of cardiac physiology
  • Biochemical aspects of cardiac physiology
  • Other Bio-electrical aspects of cardiac physiology
  • Tightly integrated
electrical aspects of cardiac physiology
Electrical aspects of cardiac physiology
  • Anatomy
  • Action potential
  • Travel in conduction system
  • Ion channels
  • Receptors
biochemical aspects of cardiac physiology
Biochemical aspects of cardiac physiology
  • Structural
  • Metabolic
  • Contractile
  • Endothelial
other bio electrical aspects of cardiac physiology
Other Bio-electrical aspects of cardiac physiology
  • ANP
  • Cardioplegia
  • Hibernating myocardium
  • Stunned myocardium
  • Digoxin
  • GIK
  • Rigor mortis
slide10

Action

Potential

Of

Myocyte

O Depolarisation 1 Rapid repolarisation

2 Plateau 3 Late repolarisation

4 baseline

slide13

Electrical

Mechanical

Association

ARP

vs

RRP

&

Vulnerable

Point or R on T

receptors
Receptors
  • Sympathetic
    • Beta 1
      • alpha
  • Para sympathetic
    • Muscurinic
      • Atria and ventricles
  • Dopamine
  • Adenosine
    • Ischaemic conditioning
slide16

Beta receptor

7 trans membrane family of receptors

slide17

STIM

Enoximone

Catalytic regulatory aspects of cAMP

ion channels
Ion channels
  • Na+
  • K+
  • Ca2+ at least 2 types
    • T transient - depolarisation
    • L long acting – less voltage dependent
  • H+
  • Exchange channels Na+ -K +
  • Exchange channels Na+ -Ca2+
ca 2 antagonists
Ca2+ antagonists
  • Calcium entry blockers NOT direct calcium antagonists
biochemical aspects of cardiac physiology1
Biochemical aspects of cardiac physiology
  • Structural
  • Metabolic
  • Contractile
  • Endothelial
slide25

Heart

structure

Discs

Nucleus

Cytoplasm

Membrane

Connective

tissue

metabolic
Metabolic
  • Glycolysis
  • Pyruvate
  • TCA
  • Fat - the main source of cardiac energy
  • Lactate or Cori cycle
  • ATP
  • Adrenaline
  • Q10
glucose transport
Glucose transport
  • GLUT 1 to 4
  • 1 and 4 on heart
  • 4 on heart - insulin sensitive
  • ?GIK mechanism
slide30

Fate

Of

Pyruvate

hormonal milieu
Hormonal milieu
  • Glucose metabolism affected by
    • Catecholamines
    • Insulin
    • Glucagon
    • Thyroid hormones
    • Acetylcholine
    • Bradykinin
    • TNF
adrenaline
Adrenaline

Inotropic

Chronotropic

Metabolic

glycogen importance
Glycogen importance
  • Conflicting views
    • Glycogen depletion
    • Increased deposition
    • Increased utilisation
    • Decreased utilisation
  • May be important in preconditioning and ischaemia reperfusion
  • Poullis point
  • ? Importance of pre operative starvation
slide41
Q10

100%

Metabolic

Rate

50%

10oC

Temp

slide49

Sarcoplasmic

reticulum

Sarcoplasmic

reticulum

Troponin C

Ca 2+ Mobilisation for contraction

contractile cardiac disease
Contractile cardiac disease
  • HOCM
  • Duchenne
  • Beckers
slide53

Endothelium

  • Blood flow
  • Cholesterol
  • Diabetes
  • NO
slide57
ANP
  • ANP atria
  • BNP atria, pig brain
  • CNP human brain
  • In general opposite effects of angiotensin II
  • ANP receptors
    • A, B & C
  • Short half life
  • Metabolised by NEP
  • Released secondary to atrial stretch
cardioplegia
Cardioplegia
  • Extracellular
    • Rely on K
    • St Thomas’s
  • Intracellular
    • No Ca, little/no Na, low osmolarity + Mannitol
    • Transplant solutions LKD
stunned myocardium
Stunned myocardium
  • Ischaemia
  • Reperfusion
  • Support
  • Recovery
  • ? 2nd protein denaturisation
hibernating myocardium
Hibernating myocardium
  • Viable myocardium with no contraction
  • 2nd ischaemia
  • Protective mechanism
  • Reversible
  • Diagnosis
    • Thallium
    • Dobutamine
    • PET
    • Hope ?
digoxin
Digoxin

Na

Na

Plasma

Membrane

K

-Ve

Ca

Inc Na

Digoxin

Na-K-ATPase

Na-Ca exchange pump

slide62
GIK
  • Increases cardiac glucose via GLUT 4
  • Increases cellular ATP
  • Increases intra cellular K
  • Increases efflux of Ca
  • Poullis point 1
  • 50mL of 50% dextrose (Km of GLUT-4 normal plasma range) and BP
  • Poullis point 2
  • Do you need insulin with a normal pancreas ?