Conduction, cardiac physiology

Although blood pressure control follows Ohm s law and seems to be simple, it underlies a complex circuit of interrelated systems. Hence, numerous physiologic systems that have pleiotropic effects and interact in complex fashion have been found to modulate blood pressure. Because of their number and complexity it is beyond the scope of the current account to cover all mechanisms and feedback circuits involved in blood pressure control. Rather, an overview of the clinically most relevant ones is presented. These systems include the heart, the blood vessels, the extracellular volume, the kidneys, the nervous system, a variety of humoral factors, and molecular events at the cellular level. They are intertwined to maintain adequate tissue perfusion and nutrition. Normal blood pressure control can be related to cardiac output and the total peripheral resistance. The stroke volume and the heart rate determine cardiac output. Each cycle of cardiac contraction propels a bolus of about 70 ml blood into the systemic arterial system. As one example of the interaction of these multiple systems, the stroke volume is dependent in part on intravascular volume regulated by the kidneys as well as on myocardial contractility. The latter is, in turn, a complex function involving sympathetic and parasympathetic control of heart rate intrinsic activity of the cardiac conduction system complex membrane transport and cellular events requiring influx of calcium, which lead to myocardial fibre shortening and relaxation and affects the humoral substances (e.g., catecholamines) in stimulation heart rate and myocardial fibre tension. 

Dead space. Anatomical dead space is equal to the volume of the conducting airways. This is determined by the physical characteristics of the lungs because, by definition, these airways do not contain alveoli to participate in gas exchange. Alveolar dead space is the volume of air that enters unperfused alveoli. In other words, these alveoli receive airflow but no blood flow with no blood flow to the alveoli, gas exchange cannot take place. Therefore, alveolar dead space is based on functional considerations rather than anatomical factors. Healthy lungs have little or no alveolar dead space. Various pathological conditions, such as low cardiac output, may result in alveolar dead space. The anatomical dead space combined with the alveolar dead space is referred to as physiological dead space ... 

Direct effects on the heart are determined largely by Bi receptors, although B2 and to a lesser extent a receptors are also involved, especially in heart failure. Beta-receptor activation results in increased calcium influx in cardiac cells. This has both electrical and mechanical consequences. Pacemaker activity—both normal (sinoatrial node) and abnormal (eg, Purkinje fibers)—is increased (positive chronotropic effect). Conduction velocity in the atrioventricular node is increased (positive dromotropic effect), and the refractory period is decreased. Intrinsic contractility is increased (positive inotropic effect), and relaxation is accelerated. As a result, the twitch response of isolated cardiac muscle is increased in tension but abbreviated in duration. In the intact heart, intraventricular pressure rises and falls more rapidly, and ejection time is decreased. These direct effects are easily demonstrated in the absence of reflexes evoked by changes in blood pressure, eg, in isolated myocardial preparations and in patients with ganglionic blockade. In the presence of normal reflex activity, the direct effects on heart rate may be dominated by a reflex response to blood pressure changes. Physiologic stimulation of the heart by catecholamines tends to increase coronary blood flow. 

The calcium ion liquid-membrane electrode is a valuable tool for physiological investigations because this ion plays important roles in such processes as nerve conduction, bone formation, muscle contraction, cardiac expansion and contraction, renal tubular function, and perhaps hypertension. Most of these processes are influenced more by the activity than the concentration of the calcium ion activity, of course, is the parameter measured by the membrane electrode. Thus, the calcium ion electrode (and the potassium ion electrode and others) is an important tool in studying physiological processes. 

Tinker, A., Lindsay, A.R., and Williams, A.J. (1993) Cation conduction in the calcium release channel of the cardiac sarcoplasmic reticulum under physiological and pathophysiological conditions. Cardiovascular Research, 27 1820-1825. 

The calcium membrane electrode is a vaittable Uh>I for physiological studies because calcium play s important roles in nerve conduction, bone furmati on, muscle contraction, cardiac conduction and contraction, and renal tubular function. At least some of these processes are influenced more by calcium ion activity than by calcium ion concentration activity, of course, is measured by the electrode. 

I. Pharmacology. Potassium is the primary intracellular cation, which is essential for maintenance of acid-base balance, intracellular tonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle, and maintenance of normal renal function (and ability to alkalinize urine). Potassium also acts as an activator in many enzyme reactions and participates in many physiological processes such as carbohydrate metabolism, protein synthesis, and gastric secretion. Potassium is critical in regulating nerve conduction and muscle contraction, especially in the heart. A variety of toxins cause alterations in serum potassium levels (see Table 1-27, p 38). 

---