Seminar Conduction System of Heart

Conduction
system of the
Heart
By Dr Kirtish Acharya
PG Resident 1st year
Department of Physiology
Contents
• Introduction
• Properties of cardiac muscles
• Conduction system of the Heart
• Conduction system in detail
• Impulse conduction
• Blood supply
• CNS control
• Applied Aspects – Medical conditions
Introduction
The human heart has a special system for rhythmic self-excitation
and repetitive contraction approximately 100,000 times each day
or 3 billion times in the average human lifetime.
The heart is endowed with a special system for
1.Generating electrical impulse to initiate rhythmic contraction of
heart muscles
2.Conduct this impulse rapidly through the heart
When this system functions normally, the atria contracts about
1/6th of a second ahead of ventricular contraction
History
• Discovery of SA node was credited to Keith And Flack. British
anatomist Arthur Keith described SA node around 1866. Martin
Flack described physiology and function of SA node
• German pathologists Ludwig Aschoff and Sunaao Tawara are
credited for discovery of AV node. Hence its also called Tawara’s
node.
• German Clinician William His discovered AV conduction bundle
and they were termed ‘Bundle of His’
• Czech Physiologist Johannes Purkinje is credited for discovery of
ventricular Purkinje fibres.
Conduction
Process
• Ectopic Pacemakers- A pacemaker elsewhere
other than SA node is called ectopic pacemaker,
Primary reason is blockage of Sa node. Most
commonly, AV node becomes new site of pace
making.
Applied • Stokes Adams Syndrome- Consequence of AV
nodal block. There is a gap of almost 5-30
Aspects seconds before purkinje system takes over
pacemaking ability. During this brief time gap, a
person may faint and show syncopal attack until
ventricular rhythmicity takes over
• Bundle Branch Conduction Blocks- Divided into
Left bindle branch block (LBBB) and Right Bundle
branch Block( RBBB)
Heart Blocks
Block within conduction pathways. Can be classified on basis of
block at individual parts of conduction system/
On basis of parts of conduction system
• SA Nodal Block
• Atrioventricular Block- Incomplete And complete
• Bundle of His block, further divided into
1. Left bundle branch block (LBBB)
2. Right bumdle branch block (RBBB)
SA Nodal Block
• Impulse from SA node is blocked before entering atrial muscles.
• On ECG , sudden cessation of P waves indictes inactivity of
Atria, but ventricles pick up rhythm due to AV nodal activity,
hence no change in QRS complex and T wave.
• Caused By – Myocardial ischemia, well trained athletes.
Atrioventricular Block
• Blockage or decrease in impulse conduction in atrioventricular
pathway.
• Caused by – AV node ischaemia, Compression of AV bundle by
Scar tissue or calcification, inflammation of AV node, age
related degeneration or by drugs like β blockers and digitalis.
Further classified as
• Incomplete AV block – First and Second degree blocks
• Complete AV block – Third Degree Blocks
Incomplete AV blocks
First Degree Block-
On basis of ECG , interval b/w P wave and QRS complex is about 0.16
sec normally( PR interval).
The PR interval is prolonged (about 0.30 secs). It doesn’t increase
beyond 0.45sec , because beyond that conduction stops entirely.
Second Degree Block
• On an ECG if PR interval is beyond 0.45 sec, action potential is
weak and doesn’t conduct to ventricles, hence there's no
ventricular contraction and absent QRS-T wave. Further classified
into Mobitz type 1 and Mobitz Type 2
• Mobitz Type 1 - is characterized by progressive prolongation of the
P-R interval until a ventricular beat is dropped and is then followed
by resetting of the P-R interval and repeating of the abnormal cycle.
• Mobitz Type 2 - there is usually a fixed number of non conducted P
waves for every QRS complex. For example, a 2:1 block implies
that there are two P waves for every QRS complex. At other times,
rhythms of 3:2 or 3:1 may develop.
Second degree Heart Blocks
Complete Heart Block (Third Degree
Block)
When the condition causing poor conduction in the A-V node or A-
V bundle becomes severe, complete block of the impulse from
the atria into the ventricles occurs. In this case, the ventricles
spontaneously establish their own signal, usually originating in the
A-V node or A-V bundle distal to the block. Therefore, the P
waves become dissociated from the QRS-T complexes
Bundle Branch Blocks
• Ordinarily, the lateral walls of the two ventricles depolarize at almost
the same instant because both the left and right bundle branches of
the Purkinje system transmit the cardiac impulse to the two
ventricular walls at almost the same time. As a result, the potentials
generated by the two ventricles (on the two opposite sides of the
heart) almost neutralize each other.
• However, if only one of the major bundle branches is blocked, the
cardiac impulse spreads through the normal ventricle before it
spreads through the other ventricle. Therefore, depolarization of the
two ventricles does not occur, even nearly at the same time, and the
depolarization potentials do not neutralize each other.
Left Bundle Branch block
• When the left bundle branch is blocked, cardiac
depolarization spreads through the right
ventricle two to three times as rapidly as through
the left ventricle. Consequently, much of the left
ventricle remains polarized for as long as 0.1
second after the right ventricle has become totally
depolarized.
• Thus, the right ventricle becomes electronegative,
whereas the left ventricle remains electropositive
during most of the depolarization process, and a
strong vector projects from the right ventricle
toward the left ventricle. In other words, intense
left axis deviation of about −50 degrees occurs
because the positive end of the vector points
toward the left ventricle
Right bundle Branch Block
• When the right bundle branch is blocked,
the left ventricle depolarizes far more
rapidly than the right ventricle, and thus the
left side of the ventricles becomes
electronegative as long as 0.1 second before
the right.
• Therefore, a strong vector develops, with its
negative end toward the left ventricle and its
positive end toward the right ventricle. In
other words, intense right axis deviation
occurs
Artificial Pacemakers
• Device used in case of heart block.
• It can generate external electrical
impulse , enough to initiate and
maintain myocardial contraction
rhythm, thus mimicking action of SA
node.
Thank You !!

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