Action potential cardiac

Sino-atrial node Action potentials Cardiac contraction... 

The Class III antiarrhythmic agents markedly prolong action potential duration and effective refractory period of cardiac tissue. The QT interval of the ECG is markedly prolonged. 

Antiarrhythmic drugs are substances that affect cardiac ionic channels or receptors, thereby altering the cardiac action potential or its generation or propagation. This results in changes of the spread of activation or the pattern of repolarization. Thereby, these drugs suppress cardiac arrhythmia. 

In the following, the cardiac action potential is explained (Fig. 1) An action potential is initiated by depolarization of the plasma membrane due to the pacemaker current (If) (carried by K+ and Na+, which can be modulated by acetylcholine and by adenosine) modulated by effects of sympathetic innervation and (3-adrenergic activation of Ca2+-influx as well as by acetylcholine- or adenosine-dependent K+-channels [in sinus nodal and atrioventricular nodal cells] or to dqjolarization of the neighbouring cell. Depolarization opens the fast Na+ channel resulting in a fast depolarization (phase 0 ofthe action potential). These channels then inactivate and can only be activated if the membrane is hyperpolarized... 

Antiarrhythmic Drugs. Figure 1 Transmembrane ionic currents of the cardiac action potential. In the middle of the figure, a typical cardiac action potential is shown as can be obtained from the ventricular myocardium (upper trace). Below, the contribution of the various transmembrane currents is indicated. Currents below the zeroline are inward currents above the zero line are outward fluxes. In the left column the name of the current is given and in the right column the possible clone redrawn and modified after [5]. 

Antiarrhythmic drugs are antagonists of the fast Na+ channel, which slow the propagation of the cardiac action potential. Class I drugs suppress the fast upstroke of the action potential. 

Cardiac IKi is the major K+ current responsible for stabilizing the resting membranepotential and shaping the late phase of repolarization of the action potential in cardiac myocytes. The name should not be confused with that of an Intermediate conductance calcium-activated K+ channel, which sometimes is also called IK1. 

Excitability refers to the capacity of nerves and other tissues (e.g. cardiac), as well as individual cells, to generate and sometimes propagate action potentials, signals that serve to control intracellular processes, such as muscle contraction or hormone secretion, and to allow for long- and short-distance communication within the organism. Examples of excitable cells and tissues include neurons, muscle and endocrine tissues. Examples of nonexcitable cells and tissues include blood cells, most epithelial and connective tissues. 

Inward Rectifier K+ Channels. Figure 1 The role of inward rectifier (Kir) channels in cardiac action potentials. Depolarization is generated and maintained by Na and Ca currents (/Na, /Ca). Voltage-gated K currents (Kv) and Kir channels contribute to repolarization and maintenance of a negative resting potential. 

Clarkson CW, Hondeghem LM (1985) Mechanism for bupivacaine depression of cardiac conduction fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology 62 396-405... 

Kvl.5 In human atria, the Kvl.5 presents the ultrarapid delayed rectifier that contributes to the repolarization in the early phase of cardiac action potential. Selective blockers of Kvl.5 channels could be potentially beneficial in the treatment of atrial fibrillation because blocking Kvl. 5 could delay repolarization and prolong refractoriness selectively in cardiac myocytes. Examples for Kvl.5 blockers include AVE0118, S9947, and analogs of diphenyl phosphine oxide (DPO). 

T-tubule is a transverse invagination of the plasma membrane, which occurs at the specified sites characteristic to animal species and organs, i.e. at the Z-line in cardiac ventricle muscle and non-mammalian vertebrate skeletal muscle and at the A-I junction in mammalian skeletal muscle. It is absent in all avian cardiac cells, all cardiac conduction cells, many mammalian atrial cells and most smooth muscle cells. T-tubule serves as an inward conduit for the action potential. 

The LVA channels are expressed in a wide variety of tissues. In the cardiac sinus node and the thalamus, activation of LVA channels seems to be necessary to generate action potentials upon depolarising the membrane. 

Flecainide (Tambocor) and propafenone (Rythmol) are examples of class I-C drags. These drugs have a direct stabilizing action on the myocardium, decreasing the height and rate of rise of cardiac action potentials, thus slowing conduction in all parts of the heart. 

Tarr, M. and Valenzeno, D.P. (1989). Modification of cardiac action potential by photosensitizer-generated reactive oxygen. J. Mol. CeU. Cardiol. 21, 539-543. 

Describe the phases of the cardiac action potential, compare and contrast the cellular ionic changes corresponding to each phase, and explain the relationship between the cardiac action potential and the electrocardiogram (ECG). 

Kollias-Baker C, Rubl J, Dennis D, Bruns RF, Linden J, Belardinelli L. Allosteric enhancer PD 81,723 acts by novel mechanism to potentiate cardiac actions of adenosine. Circ Res 1994 75 961-971. 

Skeletal muscle is neurogenic and requires stimulation from the somatic nervous system to initiate contraction. Because no electrical communication takes place between these cells, each muscle fiber is innervated by a branch of an alpha motor neuron. Cardiac muscle, however, is myogenic, or self-excitatory this muscle spontaneously depolarizes to threshold and generates action potentials without external stimulation. The region of the heart with the fastest rate of inherent depolarization initiates the heart beat and determines the heart rhythm. In normal hearts, this "pacemaker region is the sinoatrial node. 

---