ANATOMY AND PHYSIOLOGY OF

THE CONDUCTION SYSTEM

Dream House
STAIRCASE
Hallway
Toilet
Bathtub
Dinning Room
Door
 TOPIC OUTLINE
• ANATOMY OF THE HEART

• ELECTRICAL CONDUCTION SYSTEM

• ACTION POTENTIAL

• ECG COMPLEX
Your heart….
Heart Walls
• ENDOCARDIUM

• MYOCARDIUM

• EPICARDIUM
PERICARDIUM
• VISCERAL

• PERICARDIAL
CAVITY

• PARIETAL
CORONARY ARTERIES

• Right Coronary Artery

• Left Coronary Artery
• Left Anterior
Descending Artery
• Left Circumflex Artery
 The Heart
• It pumps blood
• Cardiac Output
– Amount of blood pumped by the heart per
minute

CO= SV x HR

– Stroke Volume- amount of blood pumped by

the heart per contraction
 The Heart
• Neural Control Autonomic Nervous System
– Excitability
– Rate of Pacemaker Discharge
– Speed of Conduction

– Sympathetic fibers
– Parasympathetic fibers
Electrical Conduction of the Heart
 Conduction system
SA Node
◦ Dominant pacemaker
◦ located in upper portion of right atrium
◦ Intrinsic rate 60–100 bpm.

AV Node
◦ Slows conduction, creating a slight delay
before impulses reach ventricles.
◦ Intrinsic rate 40–60 bpm.
 CONDUCTION SYSTEM
Bundle of His
◦ Transmits impulses to bundle branches.
◦ Located below AV node.

Purkinje fibers
◦ Spreads impulses rapidly throughout
ventricular walls.
◦ Located at terminals of bundle branches.
◦ Intrinsic rate 20–40 bpm.
 ELECTROLYTES IN CELLULAR
PHYSIOLOGY
• ACTION POTENTIAL
– Electrical process that stimulates each
muscle cell in the heart to contract

• POTASSIUM
– Major cation inside the cell at rest

• SODIUM AND CALCIUM

– Major cations outside the cell at rest
 CARDIAC ACTION POTENTIAL
• PHASE 4- movement of Ions while muscle
cells are at rest

• PHASE 0 – sodium and calcium enter the cell

– Stage of DEPOLARIZATION
– ATRIA- P WAVE
– VENTRICLES- QRS COMPLEX
 CARDIAC ACTION POTENTIAL
• PHASES 1, 2,3- repolarization phenomenon
– Restoration of polarity
– PHASES OF REPOLARIZATION
– PHASE 1- fast Na channels suddenly close
» Slow Ca channel remains open
– PHASE 2-plateau phase; flow Ca is balance with K
» ST SEGMENT
– PHASE 3 –Ca Channel close but K continues to leak
» T Wave
ACTION POTENTIAL
CARDIAC CYCLE
 THE ECG COMPLEX
• P WAVE
– Depolarization of atrial muscle cells
– First positive deflection
– Height- less than 3mm; Width 0.06-0.12 sec.
• QRS COMPLEX
– Depolarization of ventricular muscle cells
– Height- less than 25 mm; Width 0.06-0.10 sec.
 THE ECG COMPLEX
• ST SEGMENT
– Interval of time between the end of QRS
complex and the beginning of the T wave
– Isoelectric line
– 0.14-0.16 SEC
• T WAVE
– End of repolarization of ventricles
– U wave
 ECG COMPLEX
• PR INTERVAL
– Beginning of the P wave to the beginning of
QRS complex
– Duration is 0.12-0.20 sec.

• QT INTERVAL
– Total time required for depolarization and
repolarization of the ventricles
– Duration is 0.35-0.45 sec.
ECG strip
Standard Limb leads
Augmented Limb Leads
Chest lead placement