Electrical and Biochemical aspects of cardiac physiology - PowerPoint PPT Presentation

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Electrical and Biochemical aspects of cardiac physiology

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Other Bio-electrical aspects of cardiac physiology ... Glycogen phosphorylase and adrenaline. Glycogen synthetase and adrenaline. Regulation of glycogen ... – PowerPoint PPT presentation

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Title: Electrical and Biochemical aspects of cardiac physiology


1
Electrical and Biochemical aspects of cardiac
physiology
2
Overview
  • Electrical aspects of cardiac physiology
  • Biochemical aspects of cardiac physiology
  • Other Bio-electrical aspects of cardiac
    physiology
  • Tightly integrated

3
Electrical aspects of cardiac physiology
  • Anatomy
  • Action potential
  • Travel in conduction system
  • Ion channels
  • Receptors

4
Biochemical aspects of cardiac physiology
  • Structural
  • Metabolic
  • Contractile
  • Endothelial

5
Other Bio-electrical aspects of cardiac physiology
  • ANP
  • Cardioplegia
  • Hibernating myocardium
  • Stunned myocardium
  • Digoxin
  • GIK
  • Rigor mortis

6
Electrical aspects of cardiac physiology
7
Electrical Anatomy
8
Travel in the conduction system
9
Action potential of pacemaker tissue
10
Action Potential Of Myocyte
O Depolarisation 1 Rapid
repolarisation 2 Plateau
3 Late repolarisation 4 baseline
11
Effect of sympathetic or parasympathetic
stimulation
12
Nerve endings on the heart
13
Electrical Mechanical Association ARP vs RRP Vu
lnerable Point or R on T
14
(No Transcript)
15
Receptors
  • Sympathetic
  • Beta 1
  • alpha
  • Para sympathetic
  • Muscurinic
  • Atria and ventricles
  • Dopamine
  • Adenosine
  • Ischaemic conditioning

16
Beta receptor 7 trans membrane family of receptors
17
STIM
Enoximone
Catalytic regulatory aspects of cAMP
18
cAMP pathway
19
IP3 pathway
20
Noradrenergic neuron
21
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

22
Cardiac ion channels
1 2 3 4
23
Ca2 antagonists
  • Calcium entry blockers NOT direct calcium
    antagonists

24
Biochemical aspects of cardiac physiology
  • Structural
  • Metabolic
  • Contractile
  • Endothelial

25
Heart structure
Discs Nucleus Cytoplasm Membrane Connective tissue
26
Metabolic
  • Glycolysis
  • Pyruvate
  • TCA
  • Fat - the main source of cardiac energy
  • Lactate or Cori cycle
  • ATP
  • Adrenaline
  • Q10

27
Carbohydrate metabolism
28
Glycolysis
29
Glucose transport
  • GLUT 1 to 4
  • 1 and 4 on heart
  • 4 on heart - insulin sensitive
  • ?GIK mechanism

30
Fate Of Pyruvate
31
TCA
32
Fat metabolism
33
Lactate metabolism Cori cycle
34
Sources of ATP
35
Hormonal milieu
  • Glucose metabolism affected by
  • Catecholamines
  • Insulin
  • Glucagon
  • Thyroid hormones
  • Acetylcholine
  • Bradykinin
  • TNF

36
Adrenaline
Inotropic Chronotropic Metabolic
37
Glycogen phosphorylase and adrenaline
38
Glycogen synthetase and adrenaline
39
Regulation of glycogen
40
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

41
Q10
100
Metabolic Rate
50
10oC
Temp
42
Metabolic cardiac disease
  • McArdles

43
Contraction
44
Muscle structure
45
Contractile assembly 1 light chains
46
Contractile assembly 2 heavy chains
47
Actin myosin ATP
48
Contraction movement
49
Sarcoplasmic reticulum
Sarcoplasmic reticulum
Troponin C
Ca 2 Mobilisation for contraction
50
Frank Starling
51
Frank Starling
52
Contractile cardiac disease
  • HOCM
  • Duchenne
  • Beckers

53
Endothelium
  • Blood flow
  • Cholesterol
  • Diabetes
  • NO

54
Acetylcholine metabolism
55
Endothelium And NO
56
Other aspects of cardiac physiology
57
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

58
Cardioplegia
  • Extracellular
  • Rely on K
  • St Thomass
  • Intracellular
  • No Ca, little/no Na, low osmolarity Mannitol
  • Transplant solutions LKD

59
Stunned myocardium
  • Ischaemia
  • Reperfusion
  • Support
  • Recovery
  • ? 2nd protein denaturisation

60
Hibernating myocardium
  • Viable myocardium with no contraction
  • 2nd ischaemia
  • Protective mechanism
  • Reversible
  • Diagnosis
  • Thallium
  • Dobutamine
  • PET
  • Hope ?

61
Digoxin
Na
Na
Plasma Membrane
K
-Ve
Ca
Inc Na
Digoxin
Na-K-ATPase
Na-Ca exchange pump
62
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 ?

63
Rigor mortis
64
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