1. Excitable tissue- cardiac muscle Dr. Shafali Singh

2. Learning Objectives To know the structure and function of cardiac muscle( as a syncytium, intercalated disc, gap junctions) and how it differs from skeletal muscle and other smooth muscle. Characteristics of resting ventricular muscle cell Action potential in a cardiac muscle cell fast response fiber The mechanisms underlying contraction, relaxation, and regulation of the force of contraction of cardiac muscle cells

3. Cardiac muscle: syncytium of myocytes with intercalated disc and gap junctions

4. Characteristics of a Resting Ventricular Muscle Cell

5. MEMBRANE CHANNELS Ungated Potassium Channels Always open and unless the membrane potential reaches the potassium equilibrium potential (~ –94 mV), a potassium efflux is maintained through these channels.

6. Voltage-Gated Sodium Channels (fast channels) These are closed under resting conditions. Membrane depolarization is the signal that causes these channels to quickly open and then close. These channels have the same characteristics as the voltage-gated sodium channels in the neuron axon. Once closed, they will not respond to a second stimulus until the cell repolarizes.

7. Voltage-Gated Calcium Channels (slow channels) Closed under resting conditions, when the membrane potential is highly negative. Depolarization is the signal that causes these channels to open. They open more slowly than the sodium channels. Consequently, they are sometimes called the slow channels. They are also called L-type, for long-acting channels.

8. Because they allow sodium as well as calcium to pass, they are also called slow calcium-sodium channels. The calcium entering the cell through these channels will participate in contraction and will also be involved in the release of additional calcium from the sarcoplasmic reticulum.

10. Voltage-Gated Potassium Channels There are several types of voltage-gated potassium channels, of which two are more important. Delayed rectifying channels, iK Control is more like voltage gated potassium channels in nerves; the iK channel opens with depolarization and closes when the cell is repolarized. However, they are very slow to open (delayed). They typically open late in the plateau phase of the action potential to speed repolarization. They close very slowly and thus remain open into the resting potential and contribute to the extended period of the relative refractory period.

11. Inward rectifying channels, iK1 Open under resting conditions (negative membrane potentials), depolarization is the signal to close these channels. They start closing with depolarization and remain closed during the main part of the plateau phase. They reopen again during repolarization. Low potassium conductance is extremely important for the development of plateau phase.

12. Q. Which of the following changes would be expected to make the membrane potential of a muscle cell more positive than normal (resting cell)? A. Increased conductance to calcium B. Increased conductance to potassium C. Increased conductance to chloride D. Decreased conductance to sodium

13. the fast response, occurs in normal atrial and ventricular myocytes and in the specialized conducting fibers (Purkinje fibers of the heart)

14. Phases of Action Potent ial

16. Ionic Basis of the Action Potential Phase 0, Upstroke Fast channels open, ↑ gNa. Sodium influx causes depolarization. The channels open and close quickly, and they have closed by the time the main part of the plateau phase is entered. Phase 1, Early Repolarization This slight repolarization is due to a net transient potassium current and the closing of the sodium channels. Subendocardial fibers lack phase 1.

17. Phase 2, Plateau L-type Ca2+ channels are open, gCa ↑ permitting a calcium influx. Voltage-gated potassium channels, the iK1, are closed; gK ↓ compared with resting membrane. Potassium efflux continues through the ungated potassium channels Calcium channel antagonists shorten the plateau. L-type channels are blocked by Ca ++ channel antagonists such as verapamil, amlodipine, and diltiazem Potassium channel antagonists lengthen the plateau.

18. IN THE CLINIC- Ca ++ channel antagonists Verapamil, Amlodipine, and Diltiazem. Decrease g Ca and thereby impede the influx of Ca ++ into myocardial cells. Decrease the duration of the action potential plateau and diminish the strength of the cardiac contraction Also depress the contraction of vascular smooth muscle and thereby induce generalized vasodilation. This diminished vascular resistance reduces the counterforce (afterload) that opposes the propulsion of blood from the ventricles into the arterial system.Hence, vasodilator drugs such as the Ca ++ channel antagonists are often referred to as afterload-reducing drugs

20. Phase 3, Final Repolarization L-type Ca2+ channels close, gCa ↓; this eliminates any influx through these channels. Voltage-gated potassium channels, the delayed rectifier iK, then the iK1 are opening, gK ↑ leading to a large potassium efflux, and the cell quickly repolarizes. If the voltage-gated potassium channels did not open, the cell would still repolarize but more slowly, because of closure of calcium channels and potassium efflux through the ungated potassium channels.

21. Phase 4, Restoration of Ionic Concentrations gK high; voltage-gated and ungated potassium channels open. The delayed rectifiers, iK, gradually close but are responsible for the relative refractory period during early phase 4 with the cell in hyperpolarized state.

22. Which phase is most affected if the voltage gated Potassium channels (delayed rectifier) are blocked?

23. High Calcium conductance is seen in which of the following phases?

24. Permeability

25. Voltage and current

27. EXCITATION-CONTRACTION COUPLING

37. Relaxation

40. Force of contraction is relatively insensitive to extracellular Ca2+ A. Cardiac muscle B. Skeletal muscle C. Smooth muscle

41. CONTRACTLITY REGULATION

42. I. Intracellular Calcium

43. II.Sympathetic Activation

47. III. Preload Dependence

48. Pre load/Stretch Limits

50. Correlation between Muscle Fiber Length & Tension

51. Hypertrophy of the heart In response to exercise -beneficial, with improved cardiac performance, increased oxygen consumption, and normal relaxation Chronic pressure overload, -- progress to dilated cardiac hypertrophy characterized by decreased contractile ability Genetic mutations --familial hypertrophic cardiomyopathy, in which a mutation in a single intracellular protein may alter contractile function and promote a hypertrophic response

54. V. Energy Source < 1 sec,cardiac mus contraction duration. It maintains modest ATP stores that support short contra and then regenerate these stores using aerobic pathway when relaxed. Limited anaerobic capacity creates high dependence on O2. Prolonged O2 deprivation (min)causes irreversible hypoxic mus damage and myocardial infraction.