1. PATHOPHYSIOLOGY OF THE CONDUCTION SYSTEM


2. Cardiac arrhythmias = deviation from normal rate, rhythm

    

   1. Heart block (types) = conduction system damage
      1. Complete Heart Block = 3rd degree block
         1. idioventricular beat (35-45/min)
         2. Atria at normal sinus rhythm
         3. Periods of asystole (dizziness, fainting)
         4. Causes = myocardial infarction of ventricular septum, surgical correction of interseptal defects, drugs
      2. Incomplete Heart Block = 2nd degree block
         1. Not all atrial beats reach ventricle
         2. Ventricular beat every 2nd, 3rd, etc. atrial beat, (2:1 block, 3:1 block)
      3. Incomplete Heart Block = 1st degree block
         1. All atrial beats reach ventricle
         2. PR interval abnormally long = slower conduction
      4. Bundle branch blocks (right or left)
         1. Impulses travel down one side and cross over
         2. Ventricular rate normal, QRS prolonged or abnormal
   2. Fibrillation
      1. Asynchronous contractions = twitching movements
      2. Loss of synchrony = little to No output
      3. Atrial Fibrillation
         1. Irregular ventricular beat & depressed pumping efficiency
         2. Atrial beat = 125 - 150/min, pulse feeble = 60 - 70/min
         3. Treatment = Digitalis - reduces rate of ventricular contraction, reduces pulse deficit
      4. Ventricular Fibrillation
         1. Almost no blood pumped to systemic system
         2. ECG = extremely bizarre
         3. Several minutes = fatal
         4. Treatment = defibrillation, cardiac massage can maintain some cardiac output

Membrane Potential

• Membrane potentials will occur across cell membranes if
  • 1) there is a concentration gradient of an ion
  • 2) there is an open channel in the membrane so the ion can move from one side to the other

The Sodium Pump Sets Up Gradients of Na and K Across Cell Membranes

• All cells have the Na pump in their membranes
  • Pumps 3 Nas out and 2 Ks in for each cycle
  • Requires energy from ATP
    • Uses about 30% of body's metabolic energy
  • This is a form of active transport- can pump ions "uphill", from a low to a high concentration
  • This produces concentration gradients of Na & K across the membrane
  • Typical concentration gradients:

•  
• The ion gradients represent stored electrical energy (batteries) that can be tapped to do useful work
• The Na pump is of ancient origin, probably originally designed to protect cell from osmotic swelling

Inhibited by the arrow poisons ouabain and digitalis

Proteinuria—Protein content in urine, often due to leaky or damaged glomeruli.

Oliguria—An abnormally small amount of urine, often due to shock or kidney damage.

Polyuria—An abnormally large amount of urine, often caused by diabetes.

Dysuria—Painful or uncomfortable urination, often from urinary tract infections.

Hematuria—Red blood cells in urine, from infection or injury.

Glycosuria—Glucose in urine, due to excess plasma glucose in diabetes, beyond the amount able to be reabsorbed in the proximal convoluted tubule.

Properties of cardiac muscle

Cardiac muscle is a striated muscle like the skeletal muscle , but it is different from the skeletal muscle in being involuntary and syncytial .

Syncytium means that cardiac muscle cells are able to excite and contract together due to the presence of gap junctions between adjacent cardiac cells.

Cardiac muscle has four properties , due to which the heart is able to fulfill its function as a pumping organ. Studying and understanding these properties is essential for students to understand the cardiac physiology as a whole.

1. Rhythmicity ( Chronotropism )
2. Excitability ( Bathmotropism ) 
3. Conductivity
4. Contractility

SPECIAL SOMATIC AFFERENT (SSA) PATHWAYS

Hearing

The organ of Corti with its sound-sensitive hair cells and basilar membrane are important parts of the sound transducing system for hearing. Mechanical vibrations of the basilar membrane generate membrane potentials in the hair cells which produce impulse patterns in the cochlear portion of the vestibulocochlear nerve (VIII)

Special somatic nerve fibers of cranial nerve VIII relay impulses from the sound receptors (hair cells) in the cochlear nuclei of the brainstem

These are bipolar neurons with cell bodies located in the spiral ganglia of the cochlea.

Vestibular System

The vestibulocochlear nerve serves two quite different functions.

The cochlear portion, conducts sound information to the brain,

The vestibular portion conducts proprioceptive information.

It is the central neural pathways

Special somatic afferent fibers from the hair cells of the macula utriculi and macula sacculi conduct information into the vestibular nuclei on the ipsilateral side of the pons and medulla.

These are bipolar neurons with cell bodies located in the vestibular ganglion.

 Some of the fibers project directly into the ipsilateral cerebellum to terminate in the uvula, flocculus, and nodulus, but most enter the vestibular nuclei and synapse there.

Vision

The visual system receptors are the rods and cones of the retina.

Special somatic afferent fibers of the optic nerve (II) conduct visual signals into the brain

Fibers from the lateral (temporal) retina of either eye terminate in the lateral geniculate body on the same side of the brain as that eye.

SSA II fibers from the medial (nasal) retina of each eye cross over in the optic chiasm to terminate in the contralateral lateral geniculate body.

Area 17 is the primary visual area, which receives initial visual signals.

Neurons from this area project into the adjacent occipital cortex (areas 18 and 19) which is known as the secondary visual area. It is here that the visual signal is fully evaluated.

The visual reflex pathway involving the pupillary light reflex - in which the pupils constrict when a light is shined into the eyes and dilate when the light is removed.

Some SSA II fibers leave the optic tract before reaching the lateral geniculates, terminating in the superior colliculi instead.

From here, short neurons project to the Edinger­Westphal nucleus (an accessory nucleus of III) in the midbrain, which serves as the origin of the preganglionic parasympathetic fibers of the oculomotor nerve (GVE III).

The GVE III fibers in turn project to the ciliary ganglia, from which arise the postganglionic fibers to the sphincter muscles of the iris, which constrict the pupils.

Cell, or Plasma, membrane

• Structure - 2 primary building blocks include

protein (about 60% of the membrane) and lipid, or

fat (about 40% of the membrane).

The primary lipid is called phospholipids, and molecules of phospholipid form a 'phospholipid bilayer' (two layers of phospholipid molecules). This bilayer forms because the two 'ends' of phospholipid molecules have very different characteristics: one end is polar (or hydrophilic) and one (the hydrocarbon tails below) is non-polar (or hydrophobic):

• Functions include:
  • supporting and retaining the cytoplasm
  • being a selective barrier .
  • transport
  • communication (via receptors)