Conduction system

Fig. 3. (a) Coronary arteries which form the heart s own blood supply (b) electrical conduction system which powers the human heart. 

Arrhythmias. The first solution to cardiovascular problems arising from arrhythmias came about as a result of a complication caused by open-heart surgery. During procedures to correct congenital defects in children s hearts, the electrical conduction system often became impaired, and until it healed, the heart could not contract sufficiently without outside electrical stimulation. A system that plugged into a wall outlet was considered adequate until an electrical storm knocked out power, lea ding to the development of the first battery-powered external pacemaker. 

The conduction of an impulse can be slowed or stopped at any point along the conduction system of the heart. Slowing of conduction is called first-degree block, block of some impulses is called second-degree block, and a block of all impulses is called third-degree block. 

Equation (3-42) is not valid for conducting systems consisting of several conducting phases (e.g., steel pipeline in soil). Figure 3-15 shows an example for the measured results (3). 

Mechanisms of Cardiotoxicity Chemical compounds often affect the cardiac conducting system and thereby change cardiac rhythm and force of contraction. These effects are seen as alterations in the heart rate, conduction velocity of impulses within the heart, and contractivity. For example, alterations of pH and changes in ionic balance affect these cardiac functions. In principle, cardiac toxicity can be expressed in three different ways (1) pharmacological actions become amplified in an nonphysiological way (2) reactive metabolites of chemical compounds react covalently with vital macromolecules... 

Halogenated hydrocarbons depress cardiac contractility, decrease heart rate, and inhibit conductivity in the cardiac conducting system. The cardiac-toxicity of these compounds is related to the number of halogen atoms it increases first as the number of halogen atoms increases, but decreases after achieving the maximum toxicity when four halogen atoms are present. Some of these compounds, e.g., chloroform, carbon tetrachloride, and trichloroethylene, sensitize the heart to catecholamines (adrenaline and noradrenaline) and thus increase the risk of cardiac arrhythmia. 

C. A. Kraus, The Properties of Electrically Conducting Systems, Chemical Catalog Co., 1922. 

Block of propagation may occur in the specific conduction system leading to bradyarrhythmia... 

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. 

Sites of endothelin-receptor expression. ETA receptors are expressed in the smooth muscle cells of the vascular medial layer and the airways, in cardiac myocytes, lung parenchyma, bronchiolar epithelial cells and prostate epithelial cells. ETB receptors are expressed in endothelial cells, in bronchiolar smooth muscle cells, vascular smooth muscle cells of certain vessels (e.g. saphenous vein, internal mammary artety), in the renal proximal and distal tubule, the renal collecting duct and in the cells of the atrioventricular conducting system. 

The sinus rhythm is the heart rhythm in which the sinus node generates an electrical impulse that travels through specialized cells (that form a conduction system) and leads to a ventricular contraction. 

The cardiotonics affect the transmission of electrical impulses along the pathway of the conduction system of tiie heart. The conduction system of die heart is a group of specialized nerve fibers consisting of die SA node, die AV node, the bundle of His, and die branches of Purkinje (Fig. 39-2). Each heartbeat (or contraction of tiie ventricles) is tiie result of an electrical impulse tiiat normally starts in tiie SA node, is tiien received by die AV node, and travels down die bundle of His and through tiie Purkinje fibers (see Fig. 39-2). The heartbeat can be felt as a pulse at the wrist and otiier areas of die body where an artery is close to the surface or lies near a bone When the electrical impulse reaches the... 

Figure 39-2. The conducting system of the heart. Impulses originating in the node are transmitted through the atria to the AV node down the bundle of His and the bundle branches through the Flirkinje fi bers to the ventrides.

Mosses and liverworts (Bryophyta) are more complex than algae. Some of the larger species have structures that superficially appear similar to roots, stems and leaves, but they lack the internal conducting systems present in the vascular plants (Tracheophyta). Internal transport systems (vascular systems) make possible the large sizes of terrestrial plants where the soil is the source of some requisites (water, mineral nutrients) and the air is the source of others (CO2, sunlight). The different groups of vascular plants are characterized primarily by their methods of reproduction. Vascular plants are the source of all wood. 

Polymers for these conductive systems may be synthesised by a variety of means including Ziegler-Natta polymerisation or nucleophilic displacement reactions. The molecules tend to be rigid because of the need for them to possess extended conjugation. This lack of free rotation about carbon-carbon bonds within the molecule imposes a high energy barrier to solvation, thus making these molecules difficult to dissolve. This lack of solubility in turn... 

Cardiovascular Effects. Eesions in the heart and blood vessels have been reported in humans acutely intoxicated with methyl parathion (Wofatox) (Fazekas 1971) and are discussed in Section 3.2.2.2. However, many of these lesions may be secondary to the effects of methyl parathion on the conduction system of the heart, to other components ingested, or to therapeutic regimens that some of these patients received. 

Renal Effects. Acute nephrosis has been reported in humans after acute, lethal intoxication (Fazekas 1971) by methyl parathion (Wofatox). This may be a secondary effect of hypoxia related to the neurologic effects of methyl parathion on vascular smooth muscle and on the electrical conduction system of the heart. It could also be related to therapeutic efforts. 

The mechanical activity of the heart (contraction of the atria and ventricles) occurs as a result of the electrical activity of the heart. The heart possesses an intrinsic electrical conduction system (Fig. 6-1). Normal myocardial contraction cannot occur without proper and normal function of the heart s electrical conduction system. Electrical depolarization of the atria results in atrial contraction, and ventricular depolarization is... 

FIGURE 6-1. The cardiac conduction system. AV, atrioventricular. (Reprinted with permission from Cummins RO, (ed.) ACLS Provider Manual. Dallas American Heart Association 2003 253.)... 

Following initiation of the electrical impulse from the SA node, the impulse travels through the internodal pathways of the specialized atrial conduction system and Bachmann s bundle (Fig. 6-1 j.1 The atrial conducting fibers do not traverse the entire breadth of the left and right atria, as impulse conduction occurs across the internodal pathways, and when the impulse reaches the end of Bachmann s bundle, atrial depolarization spreads as a wave similar to that which occurs upon throwing a... 

Describe the components of the specialized electrical conduction system of the heart... 

The specialized excitation and electrical conduction system in the heart consists of ... 

From the AV node, the electrical impulse spreads through the AV bundle or the bundle of His. This portion of the conduction system penetrates the fibrous tissue separating the atria from the ventricles and enters the interventricular septum where it divides into the left and right bundle branches. The bundle branches travel down the septum toward the apex of the heart and then reverse direction, traveling back toward the atria along the outer ventricle walls. This route of conduction of the impulse facilitates ejection of blood from the ventricles. If the impulse were to be conducted directly from the atria to the ventricles, the ventricular contraction would begin at the top of the chambers and proceed downward toward the apex. This would trap the blood at the bottom of the chambers. Instead, the wave of ventricular electrical stimulation and, therefore, contraction moves from the apex of the heart toward the top of the chambers where the semilunar valves are located and ejection takes place. 

The final portion of the specialized conduction system consists of the Purkinje fibers that extend from the bundle branches. These fibers, which... 

Polymeric conducting systems were also prepared by in situ polymerization of vinyl monomers in ionic liquids [22], with a conductivity of 1 mS/cm. A conductive polymer electrolytes were also prepared by polymerization in liquid EMIm(HF)nF leading to a composite poly(2-hydroxyethyl methacrylate)-EMIm(HF)nF. Recently, polymer electrolytes were prepared in the form of thin foils, by incorporating ionic liquids in a polymer matrix [13-15], Conductivities of polymer-IL or polymer-IL-solvent systems are collected in Table 4. 

AF is characterized as an extremely rapid (400 to 600 atrial beats/min) and disorganized atrial activation. There is a loss of atrial contraction (atrial kick), and supraventricular impulses penetrate the atrioventricular (AV) conduction system in variable degrees, resulting in irregular ventricular activation and irregularly irregular pulse (120 to 180 beats/min). 

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