The heart is a hollow muscular organ composed of two pumps - the right heart pumps blood through the lungs while the left heart pumps blood through the body. The heart's rhythm is controlled by a conduction system that generates electrical impulses, causing the muscles to contract. These electrical impulses can be monitored by an electrocardiogram (ECG), which shows distinct waves representing the depolarization and repolarization of the heart's chambers during each heartbeat. The P wave corresponds to atrial depolarization, the QRS complex corresponds to ventricular depolarization, and the T wave corresponds to ventricular repolarization.

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PHYSIOLOGY & ELECTROPHYSIOLOGY
A PRESENTATION BY SURYA PRAJAPAT

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Some Basics
▪ The heart is a hollow muscular organ that pumps blood throughout the
blood vessels to various parts of the body by repeated, rhythmic
contractions.
▪ The heart is actually 2 separate pumps:
Each Heart
Heart
Right Heart:
that pumps blood through
lungs
Left Heart:
that pumps blood through
peripheral organs
Atrium:
helps to move
blood into
ventricle
Ventricle:
provide the
pumping force
which propels
the blood
through
pulmonary
circulation by
the right
ventricle
through
peripheral
circulation by
the left ventricle

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Cardiac Electrophysiology
▪ Special mechanism in the heart causes a continuing succession of heart
contractions called Cardiac Rhythmicity, transmitting Action Potential throughout
heart muscle to cause heart rhythmical beat.
▪ It has 4 processes:
1. Impulse generation
2. Conduction
Myocardial
3. Excitability
Fibres
4. Refractory period
1. Impulse generation
There are 2 types of myocardial fibres:
Non-Autonomic:
cannot generate impulse by
their own
Autonomic:
generate impulse by their
own. pressent at AV, SA
nodes & His of Purkinje
system.

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▪ Phase 0 : when stimulated they
depolarize very rapidly.
▪ Phase 1 : rapid return to near isoelectric
level
▪ Phase 2 : maintain membrane potential
for sometime during which Ca+2 ions
flow in and bring contraction.
▪ Phase 3 : rapid repolarization during
which Na+K+ pump activates and restore
ionic distribution to resting potential.
▪ Stable Phase 4 : RMP attained does not
decay

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2. Conduction:
▪ Conduction occur in atrial, ventricle and Purkinje Fibres (fast channel fibres which
depolarise by Na+ channel.
▪ A drug which reduces the shape of 0 Phase will shift the membrane
responsiveness curve towards right and impede conduction.
▪ The drug which shifts the curve toward left causes conduction.
▪ So the rate of conduction through a fibre is a function of its membrane
responsiveness which is defined by the rate of increase of AP.

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3. Excitability
▪ This property of a fibre is defined by the strength of stimulus required to elicit a response
or to produce an AP.
▪ Hyperpolarization ↓ excitability.
▪ Small ↓ in RMP ↑ excitability.
4. Refractory Period
▪ It is the minimal interval between two Action Potential (AP).
Note : Na+ channel gets progressively inactivated as RMP drops over -80mv to -60mv.
Consequently less –ve the RMP (at which activation occur), fewer are the Na+ channel
available for activation - so, slope of 0 phase depolarization, AP amplitude and conduction
velocity ↓.

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ECG (Electrocardiogram)
▪ An electrocardiograph monitors and amplifies the electrical signals of the heart and
records it as an electrocardiogram (ECG).
▪ The main waves on the ECG are given the
names P, Q, R, S and T.
▪ Each wave represents depolarization
(electrical discharging) or repolarization
(electrical recharging) of a certain region
of the heart.

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Where do the waves come from?
In the normal heart, each beat begins with the discharge (depolarization) of the sinoatrial (SA)
node, high up in the right atrium.
▪ The first detectable wave appears when impulse spread from the
SA node to depolarize the atria. This produce the P wave.
▪ After flowing through the atria the electrical impulse reaches
the atrioventricular (AV) node, located low in the right atrium.
The AV node is the only route by which an electrical impulse
can reach the ventricles.
▪ Activation of AV node does not produce any wave in ECG, but
is does contribute to the time interval between the P wave and
the subsequent Q or R wave.

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▪ The time taken for the depolarization wave to pass from its
origin in the SA node, across the atria, and through the AV
node into the ventricular muscle is called PR interval. This is
measured from the beginning of P wave to the beginning of
R wave.
▪ Once the impulse has passed the AV node, it enters the
Bundle of His.
▪ Current normally flows between the bundle branches in the
interventricular septum, from left to right, and this is
responsible for the first deflection of the QRS complex.
▪ if the first deflection of the QRS complex is downwards, it is
called a Q wave. The first upward deflection is called R wave.
A downward deflection after an R wave is called an S wave.

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▪ The right bundle branch conducts the wave of
depolarization to the right ventricle, while the left
bundle branch conducts to the left ventricle. The
conducting pathways end by dividing into Purkinje
Fibres that distribute the wave of depolarization
rapidly throughout both ventricles, represented by
QRS complex.
▪ QRS complexes are ‘positive’ or ‘negative’
depending on whether the R wave is bigger or the
S wave.
▪ The dominant R wave means a +ve QRS complex.
▪ The dominant S wave means a -ve QRS complex.

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▪ The ST segment is a transient period when no further electric current can be
passed through the myocardium. It is measured from the end of the S wave to
the beginning of the T wave. The ST segment is of particular interest in the
diagnosis of myocardial infarction and ischemia.
▪ The T wave represents the repolarization (recharging) of ventricular myocardium
to its resting electric state. The QT interval measures the total time for the
activation of the ventricles and recovery of the normal resting state.
▪ The origin of the U wave is uncertain, but it may represents the slow
repolarization of the ventricles.

14. THANK YOU
A PESENTATION BY SURYA PRAJAPAT