Last edited: 8/13/2021
1. EXTRINSIC CARDIAC CONDUCTION SYSTEM
Cardiovascular | Electrophysiology | Extrinsic Cardiac Conduction System Medical Editor: Dr. Sofia Centenaro
OUTLINE
I) DEFINITION
II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)
III) SYMPATHETIC NERVOUS SYSTEM (SNS)
IV) REFRACTORY PERIOD
V) REVIEW QUESTIONS
VI) REFERENCES
I) DEFINITION
Definition: The Autonomic Nervous System modifies the
intrinsic Cardiac Conduction and Contractility based on
body’s needs
System Innervation of Heart (SNS & PSNS)
II) PARASYMPATHETIC NERVOUS SYSTEM (PSNS)
(A) ANATOMY
1) Anterior Hypothalamus
2) ↑ Cardiac Inhibitory Center in Medulla
3) ↑ Preganglionic Vagus Nerve fibers
4) ↑ Postganglionic Vagus nerve fibers in Intramural
Ganglia
5) ↑ Cervical and Thoracic Cardiac nerves
6) Heart Figure 1. Mechanism of action of SNS and PSNS on nodal cells
(B) FUNCTION
↓Heart Rate III) SYMPATHETIC NERVOUS SYSTEM (SNS)
o ↓Chronotropy (keeps the sinus rhythm)
o slow depolarization → decreased rate of action (A) ANATOMY
potentials (APs) 1) Posterior Hypothalamus
whenever HR< 60 bpm → Bradycardia 2) ↑ Cardioacceleratory Center in the Medulla
3) ↑ Preganglionic Fibers in T1-T5 region of spinal cord
↓Conduction 4) ↑ Postganglionic Fibers in Sympathetic Chain
o ↓ Dromotropy Ganglia
No effect on Contractility 5) ↑ Superior, Middle and Inferior cardiac nerves
6) Heart
(C) INTRACELLULAR MECHANISM OF ACTION
(B) FUNCTION
PSNS fibers
↑ Acetylcholine (Ach) release ↑ Increases Heart Rate
↑ Muscarinic Type 2 receptors activity o ↑ Chronotropy
↑ Gs inhibitory protein activity o more rapid depolarization
↑ dissociation of alpha (𝛼𝛼) subunit from beta (𝛽𝛽) and o → ↑ increased rate of action potentials (Aps)
gamma (𝛾𝛾) whenever HR >100 bpm → Tachycardia
o ↑ beta/gamma activity
→ ↑ binding to K+ channels ↑Increases conduction
→ ↑ K+ efflux o ↑ Dromotropy
→ ↑ hyperpolarization of cells ↑Increases Contractility
→ ↓ AP’s o ↑ Inotropy
→ ↓ HR & ↓Conduction
o ↑ alpha activity
→ ↓ AC activity
→ ↓ cAMP
→ ↓ PKA
→ ↓ phosphorylation of L-type Ca++ channels
→ ↓Calcium influx in nodal cells
→ ↓AP’s
→ ↓HR
Figure 2. Effects of SNS and PSNS on HR
extrinsic cardiac conduction system CARDIOVASCULAR PHYSIOLOGY : Note #1. 1 of 2
(C) INTRACELLULAR MECHANISM OF ACTION IV) REFRACTORY PERIOD
(1) on nodal cells: During phases 3 and 4 (repolarization and RMP)
SNS fibers absolute, relative, super
↑ release NE and Epi normal heart is resting
↑ 𝛽𝛽1 adrenergic receptor activity 250 ms
↑ Gs protein activity In the relative refractory period if you provide enough
↑ AC activity stimulus to the heart, you can take it out of refraction and
↑ cAMP trigger another action potential – but you want to obey the
↑ PKA absolute refractory period
↑ phosphorylate proteins:
o ↑ phosphorylation of L type Ca++ channels
→ ↑ Calcium influx in nodal cells
→ ↑ depolarization rate
→ ↑ AP’s
→ ↑ HR & ↑Conduction & ↑Contractility
(2) on contractile cells:
SNS fibers
↑ release NE and Epi (from adrenal medulla)
↑ Beta 1 adrenergic receptor activity
↑ CAMP
↑ PKA
↑phosphorylate proteins: Figure 3. Phases of cardiac action potentials in a myocyte
o ↑ phosphorylation of Phospholamban
→ ↑influx of Ca++ back into Sarcoplasmic
V) REVIEW QUESTIONS
reticulum
→ ↑ speed of relaxation Bradycardia occurs when HR is:
• so it can be stimulated again quickly a. < 60 bpm
o ↑ phosphorylation of L-type Ca++ channels b. > 60 bpm
→ ↑ Calcium influx contractile cells c. <100 bpm
→ ↑ Ryr-2 activity d. Equal to 60 bpm
→ ↑ Ca++ in the SR
→ ↑↑ Ca++ released into the sarcoplasm Tachycardia occurs when HR is:
a. > 120 bpm
→ ↑ interactions with troponin
b. < 100 bpm
→ ↑ cross-bridge formation (interaction actin-
c. > 100 bpm
myosin)
d. > 60 bpm
→ contraction rate and speed → ↑ heart pumping
→ ↑ SV → ↑ CO The refractory period lasts about:
a. 150 ms
Definitions: b. 250 ms
Stroke volume (SV) = volume of blood pumped out of the c. 50 ms
ventricle in one heartbeat d. 500 ms
Cardiac Output (CO) = amount of blood pumped out of the
ventricle in one minute Which type of channels are phosphorylated by
stimulation of the SNS?
Remember: a. L- type Ca++ channels
CO = HR x SV b. T- type Ca++ channels
BP = CO x TPR (total peripheral resistance) c. K+ channels
↑HR ↑CO ↑BP d. Na+ channels
↓HR ↓ CO ↓BP
The PSNS can affect the contractility of the heart.
a. True
b. False
The SNS has a positive chronotropic action.
a. True
b. False
During the relative refractory period APs can be
triggered.
a. True
b. False
CHECK YOUR ANSWERS
VI) REFERENCES
• Guyton and Hall, Textbook of Medical Physiology,
Edra, 2021
Figure 1.1. MoA of PSNS & SNS on contractile cells
2 of 2 CARDIOVASCULAR PHYSIOLOGY: Note #1. extrinsic cardiac conduction system