Showing posts with label Anatomy-Physiology. Show all posts
Showing posts with label Anatomy-Physiology. Show all posts

Sunday, 10 July 2011

MEDICAL IMAGE DATABASES

Wednesday, 23 February 2011

MRI OF CARDIOMYOPATHIES

This video explains about mri techniques, delayed enhancement, myocardial infarction injury, infarct enhancement, non ischemic enhancement, dilated cardiomyopathy, differences between ischemic & non ischemic cardiomyopathies, sarcoidosis




CARDIOMYOPATHY MRI

This video shows various magnetic resonance images of cardiomyopathy.

ANATOMY,PHYSIOLOGY TERMS USED IN CARDIAC MAGNETIC RESONANCE

AA - Ascending Aorta
AAA - Abdominal Aortic Aneursym
ABG - Arterial Blood Gas
AF - Arterial Fibrillation
AI - Aorta Insufficiency
AM - Acute Myocarditis
AO - AOrta
AoCo - Aortic Coarctation
AP - Anterio-Posterior
ALCAPA - Anomalous Left Coronary Artery of Pulmonary Artery
APVR - Anomalous Pulmonary Venous Return
AR - Aortic Regurgitation
ARVC - Arrhythmogenic Right Ventricular Cardiomyopathy
ARVD - Arrhythmogenic Right Ventricular Dysplasia
AS - Aortic Stenosis
ASD - Aterial Septal Defect
ASL - Antero Superior Leaflet
ASO - Arterial Stitch Operation
AV - Atrio Ventricular
AVB - AV Block
AVC - AV Connection
AVM - Aterio Venous Malfunction
AVSD - AV Septal Defect
Azy - Azygous Vein
BB - Black Blood
BBB - Bundle Branch Block
BCPC - Bidirectional Cavo Pulmonary Communication
BCV - Brancho Cephalic Vein
BP - Blood Pressure
BOLD - Blood Oxygenation Level Dependent
bpm - Beats per Minute
BT Shunt - Blalock Taussig Shunt (Blalock Thomas Taussig Shunt)
CA - Cavernous Angiomas
CABG - Coronary Artery Bypass Grafting
CAD - Coronary Atery Disease
CCTGA - Congenitally Corrected Transposition of Great Arteries
CFR - Coronary flow Reserve
CHF - Coronary Heart Failure
CT - Circulation Time, Capillary Telangiectasias
CO - Cardiac Output
CoA - Coarctation
DA / DAo - Descending Aorta
DAF - Dural Artero Venous Fistula
DCCF - Direct Carotid Cavernous Fistula
DCM - Dilated Cardio Myopathy
DIAG - Diagnosis
DILV - Double Inlet Left Ventricle
DKS - Damus Kaye Stansel
DobE - Dobutamine Echocardiography
DORV - Double Outlet Right Ventricle
DSE - Dobutamine Stress Echo-Cardiography
DSMR - Dobutamine Stress Magnetic Resonance
ECG - Electro Cardio Graphy
ECD - Endo Cardial Cushion Defect
EDV - End Diastolic Volume
EF - Ejection Fraction
ESV - End Systolic Volume
FF - Forward Flow
GA - General Anaesthesia
Gd - Gadolinium
HARP - HARmonic Phase Image
HCM - Hyper-Trophic Cardiomyopathy
HLA - Horizontal Long Axis
HOCM - Hypertrophic Obstructive Cardiomyopathy
HR - Heart Rate
HTN - Hyper TensioN
IAD - Inter Arterial Defect
IBL - Inferior Briding Leaflet
IE - Infectious Endocarditis
IHD - Ischemic Heart Disease
IM - Intra Muscular
IMH - Intra Mural Hematoma
IA - Innominate Artery
IV - Innominate Vein
IVC - Inferior Vena Cava


JVD - Jagular Venous Distension
LA - Left Atrium, Long Axis
LAA - Left Atrial Appendage
LAD - Left Anterior Descending Artery
LBL - Left Bridging Leaflet
LCA - Left Coronary Artery
LCC - Left Common Carotid Artery
LCX - Left Circumflex Artery
LIL - Left Inferior Leaflet
LLL - Left Lateral Leaflet
LLPA - Left Lower Pulmonary Artery
LLPV - Left Lower Pulmonary Vein
LMCA - Left Main Coronary Artery
LML - Left Mural Leaflet
LMS - Left Main Stem
LPA - Left Pulmonary Artery
LPV - Left Pulmonary Vein
LSL - Left Superior Leaflet
LV - Left Ventricle
LVD - Left Ventricular Dysfunction
LVNC - Left Ventroicular Non-Compaction
LVOT - Left Ventricular Outflow Tract
LVOTO - LVOT Obstruction
LVSV - Left Ventricular Stroke Volume
MAPCA - Major Aorto Pulmonary Collateral Arteries
MBF -Myocardial Blood Flow
MI - Myocardial Infarction
MPA - Main Pulmonary Artery
MR - Mitral Regurgitation
MV - Mitral Valve
MVP - Mitral Valve Prolapse
NSR - Non Sinus Rhythm
PA - Pulmonary Artery
PAA - Proximal Ascending Aorta
PAD - Peripheral Arterial Disease
PAPVR - Partial Anomalous Pulmonary Venous Return
PAU - Penetrating Atherosclerotic Ulcer
PCTA / PTA - Percutaneous Transluminal Angioplasty
PDA - Proximal Descending Aorta
PDA - Patent Ductus Ateriosus
PICA - Posterio Inferior Cerebral Artery
PFR - Peak Filling Rate
PLE - Protein Losing Entropathy
PM - Papillary Muscles
PPC - Peri Partum Cardiomyopathy
PPVI - Percutaneous Pulmonary Valve Implant
PR - Pulmonary Regurgitation
PS - Pulmonary Stenosis
PT - Pulmonary Trunk
PVD - Peripheral Vascular Disease
PVR - Pulmonary Vascular Resistance
Qp - Pulmonary Flow
Qs - Systematic Flow
RA - Right Atrium
RAA - RA Appendage
RAH - Right Atrium Hypertrophy
RBBB - right Bundle Block
RCA - Right Coronary Artery
RF - Regurgitant Flow
RHD - Rheumatic Heart Disease
RIL - Right Inferior Leaflet
RIPV - Right Inferior Pulmonary Vein
RLL - Right Lateral Leaflet
RLPV - Right Lower Pulmonary Vein
ROMI - Rule Out Myocardial Infarction
RPA - Right Pulmonary Artery
R-R - Time between successive R peaks in ECG wave
RSL - Right Superior Leaflet
RV - Right Ventricle
RVH - Right Ventricular Hypertrophy
RVOT - Right Ventricular Outflow Tract
RVOTO - RVOT Obstruction
RVSV - RV Stroke Volume
SA - Sino Atrial, Saccular Aneurysms, Short Axiz
SAM - Systolic Anterior Motion
SBL - Superior Bridging Leaflet
SCD - Sudden Cardiac Death
SEMI - Sub Endocardial Myocardial Infarction
SMA - Superior Mesentric Artery
SV - Stroke Volume
SVC - Superior Vena Cava
SVR - systemic Vascular Resistance
SVT - Supra Ventricular Tachycardia
TAPVD - Total Anamalous Pulmonary Venous Drainage
TAPVR - Total Anamalous Pulmonary Venous Return
TCPC - Total Cavo Pulmonary connection
TIA - Transient Ischemic Attack
TEA - Thrombo Endo Arterectomy
TEE - Trans Esophageal Echocardiography
Tet / TOF - Tetralogy of Fallot
TGA - Transposition of Great Arteries
TIMI - Thrombolysis in Myocardial Infarction
TMMI - Trans Mural Myocardial Infarction
TOS - Thoracic Outlet Syndrome
TTE - Trans Thoracic Echo Cardiography
VA - Venous Angiomas
VCG - Vector ECG
VCATS - Volume Coronary Angiography with Targeted Scans
VD - Venous Dysplasia
VF - Ventricular Fibrillation
VLA - Vertical Long Axis
VPS - View Per Segment
VSD - Ventricular Septal Defect
WMSI - Wall motion Score Index

Sunday, 29 November 2009

ABBREVIATIONS IN RESPIRATORY VENTILATION

ETT: Endotracheal Tube
PEEP: Positive End Expiratory Pressure
CPAP: Continuous Positive Airway Pressure, PEEP with no rate
PIP: Peak inspiratory pressure
MAP: Mean Airway Pressure
RR: Respiratory Rate
Ti,Te: Inspiratory and expiratory times
I:E: Ratio of inspiratory to expiratory time
Vt: Tidal Volume, volume of each breath
SaO2 : arterial oxygen saturation determined by arterial blood gas analysis
SpO2 : arterial oxygen saturation determined by pulse oximetry
FiO2 : Fractional inspired oxygen
HFV: High Frequency Ventilation
HFOV: High Frequency Oscillatory Ventilator/Ventilation

Wednesday, 21 October 2009

CARDIOLOGY EXPLAINED BOOK


Cardiology explained

Authors:
Euan Ashley: Stanford University, USA
Josef Niebauer: Herssentrum der Universität Leipzig, Germany

Description:

This book is ideal for the hospital doctor, generalist, senior medical student, and anyone who may need a cardiology opinion. Or, for that matter, anyone who simply wants some of Cardiology – explained!

One of the most time-consuming tasks in clinical medicine is seeking the opinions of specialist colleagues. There is a pressure not only to make referrals appropriate, but also to summarize the case in the language of the specialist. Cardiology explained is an essential tool in this task. It explains basic physiologic and pathophysiologic mechanisms of cardiovascular disease in a straightforward and diagrammatic manner, gives guidelines as to when referral is appropriate, and, uniquely, explains what the specialist is likely to do. Specific sections focus on conquering the ECG, and explaining the basic science so often discussed without introduction in seminars and lectures.

Readership:
Physicians, clinicians, trainee cardiolgists.

Content:
Cardiac arrest; Cardiovascular examination; Conquering the ECG; Understanding the echocardiogram; Coronary artery disease; Hypertension; Heart failure; Arrhythmia; Valve disease; Infective endocarditis; Cardiomyopathy; Aneurysm and dissection of the aorta; Pericardial disease; Adult congenital heart disease.

View online "CARDIOLOGY EXPLAINED" book.

Monday, 8 September 2008

OSTEOPOROSIS

Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture.

Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP). Given its influence on the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life.

Osteoporosis can be prevented with lifestyle advice and sometimes medication, and in people with osteoporosis treatment may involve lifestyle advice, preventing falls and medication (calcium, vitamin D, bisphosphonates and several others).

SIGNS & SYMPTOMS

Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.

Fractures
The symptoms of a vertebral collapse ("compression fracture") are sudden back pain, often with radiculopathic pain (shooting pain due to nerve compression ) and rarely with spinal cord compression or cauda equina syndrome. Multiple vertebral fractures lead to a stooped posture, loss of height, and chronic pain with resultant reduction in mobility.

Fractures of the long bones acutely impair mobility and may require surgery. Hip fracture, in particular, usually requires prompt surgery, as there are serious risks associated with a hip fracture, such as deep vein thrombosis and a pulmonary embolism, and increased mortality.

Falls risk

The increased risk of falling associated with aging leads to fractures of the wrist, spine and hip. The risk of falling, in turn, is increased by impaired eyesight due to any cause (e.g. glaucoma, macular degeneration), balance disorder, movement disorders (e.g. Parkinson's disease), dementia, and sarcopenia (age-related loss of skeletal muscle). Collapse (transient loss of postural tone with or without loss of consciousness) leads to a significant risk of falls; causes of syncope are manifold but may include cardiac arrhythmias (irregular heart beat), vasovagal syncope, orthostatic hypotension (abnormal drop in blood pressure on standing up) and seizures. Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with a gait or balance disorder, are most at risk.



RISK FACTORS

Risk factors for osteoporotic fracture can be split between non-modifiable and (potentially) modifiable. In addition, there are specific diseases and disorders in which osteoporosis is a recognized complication. Medication use is theoretically modifiable, although in many cases the use of medication that increases osteoporosis risk is unavoidable.

Nonmodifiable

The most important risk factors for osteoporosis are advanced age (in both men and women) and female sex; estrogen deficiency following menopause is correlated with a rapid reduction in BMD, while in men a decrease in testosterone levels has a comparable (but less pronounced) effect. While osteoporosis occurs in people from all ethnic groups, European or Asian ancestry predisposes for osteoporosis. Those with a family history of fracture or osteoporosis are at an increased risk; the heritability of the fracture as well as low bone mineral density are relatively high, ranging from 25 to 80 percent. There are at least 30 genes associated with the development of osteoporosis. Those who have already had a fracture are at least twice as likely to have another fracture compared to someone of the same age and sex.

Potentially modifiable

1.)Excess alcohol - small amounts of alcohol do not increase osteoporosis risk and may even be beneficial, but chronic heavy drinking(Alcohol intake greater than 2 units/day), especially at a younger age, increases risk significantly.

2.)Vitamin D deficiency - low circulating Vitamin D is common among the elderly worldwide. Mild vitamin D insufficiency is associated with increased Parathyroid Hormone (PTH) production. PTH increases bone reabsorption, leading to bone loss. A positive association exists between serum 1,25-dihydroxycholecalciferol levels and bone mineral density, while PTH is negatively associated with bone mineral density.

3.)Tobacco smoking - tobacco smoking inhibits the activity of osteoblasts, and is an independent risk factor for osteoporosis. Smoking also results in increased breakdown of exogenous estrogen, lower body weight and earlier menopause, all of which contribute to lower bone mineral density.

4.)High body mass index - being overweight protects against osteoporosis, either by increasing load or through the hormone leptin.

5.)Malnutrition - low dietary calcium intake, low dietary intake of vitamins K and C . Also low protein intake is associated with lower peak bone mass during adolescence and lower bone mineral density in elderly populations.

6.)Physical inactivity - bone remodeling occurs in response to physical stress. Weight bearing exercise can increase peak bone mass achieved in adolescence. In adults, physical activity helps maintain bone mass, and can increase it by 1 or 2%. Conversely, physical inactivity can lead to significant bone loss.

7.)Excess physical activity - excessive exercise can lead to constant damages to the bones which can cause exhaustion of the structures as described above. There are numerous examples of marathon runners who developed severe osteoporosis later in life. In women, heavy exercise can lead to decreased estrogen levels, which predisposes to osteoporosis. Intensive training is often associated with low body mass index.

8.)Heavy metals - a strong association between cadmium, lead and bone disease has been established. Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in the elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone).

9.)Soft drinks - some studies indicate that soft drinks (many of which contain phosphoric acid) may increase risk of osteoporosis; Others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis.

Diseases and disorders

Many diseases and disorders have been associated with osteoporosis. For some, the underlying mechanism influencing the bone metabolism is straight-forward, whereas for others the causes are multiple or unknown.

1.)In general, immobilization causes bone loss (following the 'use it or lose it' rule). For example, localized osteoporosis can occur after prolonged immobilization of a fractured limb in a cast. This is also more common in active patients with a high bone turn-over (for example, athletes). Other examples include bone loss during space flight or in people who are bedridden or wheelchair-bound for various reasons.

2.)Hypogonadal states can cause secondary osteoporosis. These include Turner syndrome, Klinefelter syndrome, Kallmann syndrome, anorexia nervosa, andropause, hypothalamic amenorrhea or hyperprolactinemia. In females, the effect of hypogonadism is mediated by estrogen deficiency. It can appear as early menopause (<45 years) or from prolonged premenopausal amenorrhea (>1 year). A bilateral oophorectomy (surgical removal of the ovaries) or a premature ovarian failure cause deficient estrogen production. In males, testosterone deficiency is the cause (for example, andropause or after surgical removal of the testes).

3.)Endocrine disorders that can induce bone loss include Cushing's syndrome, hyperparathyroidism, thyrotoxicosis, hypothyroidism, diabetes mellitus type 1 and 2, acromegaly and adrenal insufficiency. In pregnancy and lactation, there can be a reversible bone loss.

4.)Malnutrition, parenteral nutrition and malabsorption can lead to osteoporosis. Nutritional and gastrointestinal disorders that can predispose to osteoporosis include coeliac disease, Crohn's disease, lactose intolerance, surgery (after gastrectomy, intestinal bypass surgery or bowel resection) and severe liver disease (especially primary biliary cirrhosis). Patients with bulemia can also develop osteoporosis. Those with an otherwise adequate calcium intake can develop osteoporosis due to the inability to absorb calcium and/or vitamin D. Other micro-nutrients such as vitamin K or vitamin B12 deficiency may also contribute.

5.)Patients with rheumatologic disorders like rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and polyarticular juvenile idiopathic arthritis are at increased risk of osteoporosis, either as part of their disease or because of other risk factors (notably corticosteroid therapy). Systemic diseases such as amyloidosis and sarcoidosis can also lead to osteoporosis.

6.)Renal insufficiency can lead to osteodystrophy.

7.)Hematologic disorders linked to osteoporosis are multiple myeloma and other monoclonal gammopathies, lymphoma and leukemia, mastocytosis, hemophilia, sickle-cell disease and thalassemia.

8.)Several inherited disorders have been linked to osteoporosis. These include osteogenesis imperfecta, Marfan syndrome, hemochromatosis, hypophosphatasia, glycogen storage diseases, homocystinuria, Ehlers-Danlos syndrome, porphyria, Menkes' syndrome, epidermolysis bullosa and Gaucher's disease.

9.)People with scoliosis of unknown cause also have a higher risk of osteoporosis. Bone loss can be a feature of complex regional pain syndrome. It is also more frequent in people with Parkinson's disease and chronic obstructive pulmonary disease.


Medication

Certain medications have been associated with an increase in osteoporosis risk; only steroids and anticonvulsants are classically associated, but evidence is emerging with regard to other drugs.

1.)Steroid-induced osteoporosis (SIOP) arises due to use of glucocorticoids - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug prednisone is a main candidate after prolonged intake. Some professional guidelines recommend prophylaxis in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months.Alternate day use may not prevent this complication.

2.)Barbiturates, phenytoin and some other enzyme-inducing antiepileptics - these probably accelerate the metabolism of vitamin D.

3.)L-Thyroxine over-replacement may contribute to osteoporosis, in a similar fashion as thyrotoxicosis does. This can be relevant in subclinical hypothyroidism.

4.)Several drugs induce hypogonadism, for example aromatase inhibitors used in breast cancer, methotrexate and other anti-metabolite drugs, depot progesterone and gonadotropin-releasing hormone agonists.

5.)Anticoagulants - long-term use of heparin is associated with a decrease in bone density, and warfarin (and related coumarins) have been linked with an increased risk in osteoporotic fracture in long-term use.

6.)Proton pump inhibitors - these drugs inhibit the production of stomach acid; it is thought that this interferes with calcium absorption. Chronic phosphate binding may also occur with aluminium-containing antacids.

7.)Thiazolidinediones (used for diabetes) - rosiglitazone and possibly pioglitazone, inhibitors of PPARγ, have been linked with an increased risk of osteoporosis and fracture.

8.)Chronic lithium therapy has been associated with osteoporosis.

Saturday, 1 September 2007

BODY FLUIDS

The body's water is effectively compartmentalized into several major divisions.

INTRACELLULAR FLUID

Intracellular Fluid (ICF) comprises 2/3 of the body's water.

i.)If your body has 60% water, ICF is about 40% of your weight.

ii.)The ICF is primarily a solution of potassium and organic anions, proteins etc.

iii.)The cell membranes and cellular metabolism control the constituents of this ICF.

iv.)ICF is not homogeneous in your body. It represents a conglomeration of fluids from all the different cells.

EXTRACELLULAR FLUID

Extracellular Fluid (ECF) is the remaining 1/3 of your body's water.

i.)ECF is about 20% of your weight.

ii.)The ECF is primarily a NaCl and NaHCO3 solution.

BODY FLUID COMPOSITIONS

The ECF is further subdivided into three subcompartments:

i.)Interstitial Fluid (ISF) surrounds the cells, but does not circulate. It comprises about 3/4 of the ECF.

ii.)Plasma circulates as the extracellular component of blood. It makes up about 1/4 of the ECF.

iii.)Transcellular fluid is a set of fluids that are outside of the normal compartments. These 1-2 liters of fluid make up the CSF, Digestive Juices, Mucus, etc.

PERCENTAGE OF BODY COMPOSITIONS
(PERCENTAGE OF BODY COMPOSITIONS)
(PV-PLASMA VOLUME, ISF-INTERSTITIAL FLUID, PV+ISF=ECF, ECF-EXTRACELLULAR FLUID, ICF-INTRACELLULAR FLUID, ECF+ICF=TOTAL BODY WATER)


NOTES :

i.)All the body's fluid compartments are in osmotic equilibrium (except for transient changes).

ii.)The ions and small solutes that constitute the ECF are in equilibrium with similar concentrations in each subcompartment.

iii.)The ECF volume is proportional to the total Na content.

COMPOSITIONS OF BODY FLUID

PRINCIPAL ELECTROLYTES OF BODY FLUIDS

PRINCIPAL BODY ELECTROLYTES

HUMAN CELL

HUMAN CELL STRUCTURE

The cell is one of the most basic units of life. There are millions of different types of cells. There are cells that are organisms onto themselves, such as microscopic amoeba and bacteria cells. And there are cells that only function when part of a larger organism, such as the cells that make up your body.

HUMAN CELL

The cell is the smallest unit of life in our bodies. In the body, there are brain cells, skin cells, liver cells, stomach cells, and the list goes on. All of these cells have unique functions and features. And all have some recognizable similarities.

HUMAN CELL STRUCTURE

i.)All cells have a 'skin', called the plasma membrane, protecting it from the outside environment. The cell membrane regulates the movement of water, nutrients and wastes into and out of the cell. Inside of the cell membrane are the working parts of the cell.

PLASMA MEMBRANE
(PARTS INSIDE PLASMA MEMBRANE)

ii.)At the center of the cell is the cell nucleus. The cell nucleus contains the cell's DNA, the genetic code that coordinates protein synthesis.

HUMAN CELL NUCLEUS STRUCTURE

HUMAN CELL DNA

iii.)In addition to the nucleus, there are many organelles inside of the cell - small structures that help carry out the day-to-day operations of the cell.

HUMAN CELL ORGANELLES

iv.)One important cellular organelle is the ribosome. Ribosomes participate in protein synthesis. The transcription phase of protein synthesis takes places in the cell nucleus. After this step is complete, the mRNA leaves the nucleus and travels to the cell's ribosomes, where translation occurs.

RIBOSOMES, mRNA FORMATION

v.)Another important cellular organelle is the mitochondrion. Mitochondria (many mitochondrion) are often referred to as the power plants of the cell because many of the reactions that produce energy take place in mitochondria.

MITOCHONDRIA
(MITOCHONDRIA">

vi.)Also important in the life of a cell are the lysosomes. Lysosomes are organelles that contain enzymes that aid in the digestion of nutrient molecules and other materials.

LYSOSOMES, DIGESTION OF NUTRIENT MOLECULES

Tuesday, 7 August 2007

CARDIAC ACTION POTENTIAL

1.) The cardiac action potential is a specialized action potential in the heart, with unique properties necessary for function of the electrical conduction system of the heart.



2.)The cardiac action potential differs significantly in different portions of the heart. This differentiation of the action potentials allows the different electrical characteristics of the different portions of the heart. For instance, the specialized conduction tissue of the heart has the special property of depolarizing without any external influence. This is known as automaticity.

3.)The electrical activity of the specialized conduction tissues are not apparent on the surface electrocardiogram (ECG). This is due to the relatively small mass of these tissues compared to the myocardium.

CARDIAC POTENTIAL

1.)Cardiac muscle has some similarities to neurons and skeletal muscle, as well as important unique properties. Like a neuron, a given myocardial cell has a negative membrane potential when at rest.



2.)Stimulation above a threshold value induces the opening of voltage-gated ion channels and a flood of cations into the cell. When the threshold is met, an action potential initiates. This causes the positively charged ions to enter the cell [depolarization].



3.)Like skeletal muscle, depolarization causes the opening of voltage-gated calcium channels and entry of Ca2+ from the t-tubules. This influx of calcium causes calcium-induced calcium release from the sarcoplasmic reticulum, and the increase in myoplasmic free Ca2+ concentration causes muscle contraction.



4.)After a delay (the absolute refractory period), Potassium channels reopen and the resulting flow of K+ out of the cell causes repolarization to the resting state.

Note that there are important physiological differences between nodal cells and ventricular cells; the specific differences in ion channels and mechanisms of polarization give rise to unique properties of SA node cells, most importantly the spontaneous depolarizations (automaticity) necessary for the SA node's pacemaker activity.




































Intra- and extracellular ion concentrations (mmol/L)
IonExtracellularIntracellularRatio
Na+135 - 1451014:1
K+3.5 - 5.01551:16
Cl-95 - 11020 - 304:1
Ca2+210-42 x 104
Although intracellular Ca2+ content is about 2 mm, most of this is bound or sequestered in intracellular organelles (mitochondria and sarcoplasmic reticulum).










































































Major currents during the cardiac ventricular action potential
IonCurrentα subunit proteinα subunit genePhase / role
Na+INaNaV1.5SCN5A0
Ca2+ICa(L)CaV1.2CACNA1C0-2
K+Ito1KV4.2/4.3KCND2/KCND31, notch
K+IKsKV7.1KCNQ12,3
K+IKrKV11.1 (hERG)KCNH23
K+IK1Kir2.1/2.2/2.3KCNJ2/KCNJ12/KCNJ43,4
Na+, Ca2+INaCa3Na+-1Ca2+-exchangerNCX1 (SLC8A1)ion homeostasis
Na+, K+INaK3Na+-2K+-ATPaseATP1Aion homeostasis
Ca2+IpCaCa2+-transporting ATPaseATP1Bion homeostasis


Calcium channels

Two voltage-dependent calcium channels play critical roles in the physiology of cardiac muscle: L-type calcium channel ('L' for Long-lasting) and T-type calcium channels ('T' for Transient) voltage-gated calcium channels.

These channels respond differently to voltage changes across the membrane: L-type channels respond to higher membrane potentials, open more slowly, and remain open longer than T-type channels.

Because of these properties, L-type channels are important in sustaining an action potential, while T-type channels are important in initiating them.

Because of their rapid kinetics, T-type channels respond better to rhythmic stimulation and are also found in some neuron cell bodies, where they play an important role in rhythmic processes such as heartbeat, breathing, and spinal cord pattern generators used in walking.

L-type channels are selectively blocked by dihydropyridines.

Resting membrane potential

The resting membrane potential is caused by the difference in ionic concentrations and conductances across the membrane of the cell during phase 4 of the action potential. The normal resting membrane potential in the ventricular myocardium is about -85 to -95 mV. This potential is determined by the selective permeability of the cell membrane to various ions. The membrane is most permeable to K+ and relatively impermeable to other ions. The resting membrane potential is therefore dominated by the K+ equilibrium potential according to the K+ gradient across the cell membrane. The membrane potential can be calculated using the Goldman-Hodgkin-Katz voltage equation. The maintenance of this electrical gradient is due to various ion pumps and exchange mechanisms, including the Na+-K+ ion exchange pump, the Na+-Ca2+ exchanger current and the IK1 inwardly rectifying K+ current.

Intracellularly (within the cell), K+ is the principal cation, and phosphate and the conjugate bases of organic acids are the dominant anions. Extracellularly (outside the cell), Na+ and Cl- predominate.

PHASES OF CARDIAC ACTION POTENTIAL



The cardiac action potential has five phases.

The standard model used to understand the cardiac action potential is the action potential of the ventricular myocyte. The action potential has 5 phases (numbered 0-4). Phase 4 is the resting membrane potential, and describes the membrane potential when the cell is not being stimulated.

Once the cell is electrically stimulated (typically by an electric current from an adjacent cell), it begins a sequence of actions involving the influx and efflux of multiple cations and anions that together produce the action potential of the cell, propagating the electrical stimulation to the cells that lie adjacent to it. In this fashion, an electrical stimulation is conducted from one cell to all the cells that are adjacent to it, to all the cells of the heart.



Phase 4

Phase 4 is the resting membrane potential. This is the period that the cell remains in until it is stimulated by an external electrical stimulus (typically an adjacent cell). This phase of the action potential is associated with diastole of the chamber of the heart.

Certain cells of the heart have the ability to undergo spontaneous depolarization, in which an action potential is generated without any influence from nearby cells. This is also known as automaticity. The cells that can undergo spontaneous depolarization the fastest are the primary pacemaker cells of the heart, and set the heart rate. Usually, these are cells in the SA node of the heart. Electrical activity that originates from the SA node is propagated to the rest of the heart. The fastest conduction of electrical activity is via the electrical conduction system of the heart.

In cases of heart block, in which the activity of the primary pacemaker does not propagate to the rest of the heart, a latent pacemaker (also known as an escape pacemaker) will undergo spontaneous depolarization and create an action potential.

The mechanism of automaticity involves the so-called pacemaker channels of the HCN family, Hyperpolarization-gated, Cyclic Nucleotide-gated channels. These poorly selective cation channels conduct more current as the membrane potential becomes more negative, or hyperpolarized. They conduct both potassium and sodium. The activity of these channels in the SA node cells causes the membrane potential to slowly become more positive (depolarized) until, eventually, calcium channels are activated and an action potential is initiated.

Phase 0

Phase 0 is the rapid depolarization phase. The slope of phase 0 represents the maximum rate of depolarization of the cell and is known as Vmax. This phase is due to the opening of the fast Na+ channels causing a rapid increase in the membrane conductance to Na+ (GNa) and thus a rapid influx of Na+ ions (INa) into the cell; a Na+ current.

The ability of the cell to open the fast Na+ channels during phase 0 is related to the membrane potential at the moment of excitation. If the membrane potential is at its baseline (about -85 mV), all the fast Na+ channels are closed, and excitation will open them all, causing a large influx of Na+ ions. If, however, the membrane potential is less negative, some of the fast Na+ channels will be in an inactivated state insensitive to opening, thus causing a lesser response to excitation of the cell membrane and a lower Vmax. For this reason, if the resting membrane potential becomes too positive, the cell may not be excitable, and conduction through the heart may be delayed, increasing the risk for arrhythmias.

The fast Na+ channel

The fast sodium channel can be modeled as being controlled by a number of gates. Each gate (or gating variable) can attain a value between 1 (fully open) and 0 (fully closed). The product of all the gates denotes the percentage of channels available to conduct Na+. Following the model of Hodgkin and Huxley, the sodium channel contains three gates: m, h, and j. In the resting state, the m gate is closed (zero) and the h and j gates are open (one). Hence, the product denoting the percentage of conducting channels is also zero. Upon electrical stimulation of the cell, the m gate opens quickly while simultaneously the h and j gates close more slowly. For a brief period of time, all gates are open (i.e. non-zero) and Na+ can enter the cell following its electrochemical gradient. If, as above, the resting membrane potential is too positive, the h or j gates may be considerably less than one, such that the product of m, h and j becomes too small upon depolarization.

Phase 1

Phase 1 of the action potential occurs with the inactivation of the fast Na+ channels. The transient net outward current causing the small downward deflection of the action potential is due to the movement of K+ and Cl- ions, carried by the Ito1 and Ito2 currents, respectively. Particularly the Ito1 contributes to the "notch" of some ventricular cardiomyocyte action potentials.

It has been suggested that Cl- ions movement across the cell membrane during Phase I is as a result of the change in membrane potential, from K+ efflux, and is not a contributory factor to the initial repolarisation ("notch").

Phase 2

This "plateau" phase of the cardiac action potential is sustained by a balance between inward movement of Ca2+ (ICa) through L-type calcium channels and outward movement of K+ through the slow delayed rectifier potassium channels, IKs. The sodium-calcium exchanger current, INa,Ca and the sodium/potassium pump current, INa,K also play minor roles during phase 2.

Phase 3

During phase 3 of the action potential, the L-type Ca2+ channels close, while the slow delayed rectifier (IKs) K+ channels are still open. This ensures a net outward current, corresponding to negative change in membrane potential, thus allowing more types of K+ channels to open. These are primarily the rapid delayed rectifier K+ channels (IKr) and the inwardly rectifiyng K+ current, IK1. This net outward, positive current (equal to loss of positive charge from the cell) causes the cell to repolarize. The delayed rectifier K+ channels close when the membrane potential is restored to about -80 to -85 mV, while IK1 remains conducting throughout phase 4, contributing to set the resting membrane potential.

ABNORMAL AUTOMATICITY & ARRHYTMIA

The normal activity of the pacemaker cells of the heart is to spontaneously depolarize at a regular rhythm, generating the normal heart rate. Abnormal automaticity involves the abnormal spontaneous depolarization of cells of the heart. This typically causes arrhythmias (irregular rhythms) in the heart.



VARIOUS CARDIAC ACTION POTENTIALS

Monday, 6 August 2007

ACTION POTENTIAL

i.)An action potential is a "spike" of electrical discharge that travels along the membrane of a cell. Action potentials are essential features of animal life, rapidly carrying information within and between tissues. They also occur in some plants.

ii.)Action potentials can be created by many types of cells, but are used most extensively by the nervous system for communication between neurons and for transmitting information from neurons to other body tissues such as muscles and glands.

iii.)Action potentials are not the same in all cell types and can even vary in their properties at different locations in the same cell. For example, cardiac action potentials are significantly different from the action potentials in most neurons. This article is primarily concerned with the "typical" action potential of axons.

ACTION POTENTIAL DIAGRAM

PICTURE A. A schematic view of an idealized action potential illustrates its various phases as the action potential passes a point on a cell membrane.
PICTURE B. Actual recordings of action potentials are often distorted compared to the schematic view because of variations in electrophysiological techniques used to make the recording.

DESCRIPTION

i.)There is always a difference in electrostatic potential between the inside and outside of a cell: the cell is polarized. This membrane potential is the result of the distribution of ions across the cell membrane and the permeability of the membrane to these ions. The voltage of an inactive cell remains close to a resting potential with excess negative charge inside the cell. When the membrane of an excitable cell becomes depolarized beyond a threshold, the cell undergoes an action potential (it "fires"), often called a "spike" (see Threshold and initiation).

ii.)An action potential is a rapid change of the polarity of the voltage from negative to positive and then vice versa, the entire cycle lasting on the order of milliseconds. Each cycle — and therefore each action potential — has a rising phase, a falling phase, and finally an undershoot . In specialized muscle cells of the heart, such as cardiac pacemaker cells, a plateau phase of intermediate voltage may precede the falling phase, extending the action potential duration into hundreds of milliseconds.



iii.)Action potentials are measured with the recording techniques of electrophysiology and more recently with neurochips containing EOSFETs. An oscilloscope recording the membrane potential from a single point on an axon shows each stage of the action potential as the wave passes. These phases trace an arc that resembles a distorted sine wave; its amplitude depends on whether the action potential wave has reached that point on the membrane or has passed it and if so, how long ago.


iv.)The action potential does not dwell in one location of the cell's membrane, but travels along the membrane. It can travel along an axon for long distances, for example to carry signals from the spinal cord to the muscles of the foot. In large animals, such as giraffes and whales, the distance traveled can be many meters. After traveling the whole length of the axon, the action potential reaches a synapse, where it stimulates the release of neurotransmitters. These neurotransmitters can immediately induce an action potential in the next neuron to propagate the signal, but the response is usually more complex.


v.)Both the speed and complexity of action potentials vary between different types of cells, but their amplitudes tend to be roughly the same. Within any one cell, consecutive action potentials are typically indistinguishable. Neurons are thought to transmit information by generating sequences of action potentials called "spike trains". By varying both the rate as well as the precise timing of the action potentials they generate, neurons can change the information that they transmit.



MECHANISM OF ACTION POTENTIAL

Resting potential



i.)The resting potential is what would be maintained were there no action potentials, synaptic potentials, or other changes to the membrane potential. In neurons the resting potential is approximately -70 mV (the negative sign signifies excess negative charge inside the cell relative to the outside). The resting potential is mostly determined by the ion concentrations in the fluids on both sides of the cell membrane and the ion transport proteins in the cell membrane. The term resting is somewhat misleading, for the cell must constantly do work to maintain the resting potential. The establishment of this potential difference involves several factors, the most important of which are the transport of ions across the cell membrane and the selective permeability of the membrane to these ions.



ii.)The active transport of potassium and sodium ions into and out of the cell, respectively, is accomplished by a number of sodium-potassium pumps scattered across the cell membrane. Each pump transports two ions of potassium into the cell for every three ions of sodium pumped out. This establishes a particular distribution of positively charged ions across the cell membrane, with more sodium present outside the cell than inside, and more potassium inside the cell than outside. In some situations, the electrogenic sodium-potassium pumps make a significant contribution to the resting membrane potential, but in most cells there are potassium leak channels that dominate the value of the resting potential.


iii.)Sodium and potassium ions diffuse through open ion channels under the influence of their electrochemical gradients. At the resting potential, the net movement of sodium into the cell equals the net movement of potassium out of the cell. However, the resting cell membrane is approximately 75 times more permeable to potassium than to sodium because potassium leak channels are always open. As a result, the cell's resting membrane potential is closer to the equilibrium potential of potassium (=EK=−80 mV) than the equilibrium potential of sodium (=ENa=+70 mV).

iv.)Like the resting potential, action potentials depend upon the permeability of the cell membrane to sodium and potassium ions. Transient changes in conductance for different ions cause the changes in membrane potential necessary to initiate, sustain, and terminate action potentials.

PHASES OF ACTION POTENTIAL



1.)Resting potential

At resting potential some potassium leak channels are open but the voltage-gated sodium channels are closed. Even though no net current flows, potassium, the major ion species, moves across the membrane, thus pulling the resting potential close to the K+ equilibrium potential.



2.)Stimulation

A local membrane depolarization caused by an excitatory stimulus causes some voltage-gated sodium channels in the neuron cell surface membrane to open and sodium ions diffuse in through the channels along their electrochemical gradient. Because they are positively charged, they begin a reversal in the potential difference across the membrane from negative-inside to positive-inside. Initially, the inward movement of sodium ions is also favored by the negative-inside membrane potential. Overall the ions are under the influence of the driving force, the difference between the membrane potential and the equilibrium potential of sodium.



3.)Rising phase - depolarization

As sodium ions enter and the membrane potential becomes less negative, more sodium channels open, causing an even greater influx of sodium ions. This is an example of positive feedback. As more sodium channels open, the sodium current dominates over the potassium leak current and the membrane potential becomes positive inside. Recent experiments on cortical neurons suggest, that sodium channels open cooperatively allowing for a much faster uptake than is possible for Hodgkin-Huxley–type dynamics.

4.)Peak

By the time the membrane potential has reached a peak value of around +40 mV, voltage-sensitive inactivation gates on the sodium channels have already started to close, reducing and finally preventing further influx of sodium ions. While this occurs, the voltage-sensitive activation gates on the voltage-gated potassium channels begin to open.

5.)Falling phase - repolarization

As voltage-gated potassium channels open, there is a large outward movement of potassium ions driven by the potassium concentration gradient and initially favored by the positive-inside electrical gradient. As potassium ions diffuse out, this movement of positive charge causes a reversal of the membrane potential to negative-inside and repolarization of the neuron back towards the large negative-inside resting potential.

6.)Undershoot

Closing of voltage-gated potassium channels is both voltage- and time-dependent. As potassium exits the cell, the resulting membrane repolarization initiates the closing of voltage-gated potassium channels. These channels do not close immediately in response to a change in membrane potential; rather, voltage-gated potassium channels (also called delayed rectifier potassium channels) have a delayed response, such that potassium continues to flow out of the cell even after the membrane has fully repolarized. Thus the membrane potential dips below the normal resting membrane potential of the cell for a brief moment; this dip of hyperpolarization is known as the undershoot.

7.)Refractory Period

During the next ~ 1 msec, the Na+ and K+ Channels cannot be opened by a stimulus. The Na+/K+ Pump actively pumps Na+ out of the neuron and K+ into the neuron. This reestablishes the initial ion distribution of the resting neuron. The refractory period is important because it ensures unidrectional (one way) propagation of the action potential.



THRESHOLD & INITIATION OF ACTION POTENTIAL

1.)Action potentials are triggered when an initial depolarization reaches the threshold. This threshold potential varies, but generally is about 15 millivolts more positive than the cell's resting membrane potential, occurring when the inward sodium current exceeds the outward potassium current. The net influx of positive charges carried by sodium ions depolarizes the membrane potential, leading to the further opening of voltage-gated sodium channels. These channels support greater inward current causing further depolarization, creating a positive-feedback cycle that drives the membrane potential to a very depolarized level.

2.)The action potential threshold can be shifted by changing the balance between sodium and potassium currents. For example, if some of the sodium channels are in an inactivated state, then a given level of depolarization will open fewer sodium channels and a greater depolarization will be needed to trigger an action potential. This is the basis for the refractory period.

3.)Action potentials are largely dictated by the interplay between sodium and potassium ions (although there are minor contributions from other ions such as calcium and chloride), and are often modeled using hypothetical cells containing only two transmembrane ion channels (a voltage-gated sodium channel and a non-voltage-gated potassium channel). The origin of the action potential threshold may be studied using I/V curves (right) that plot currents through ion channels against the cell's membrane potential. (Note that the illustrated I/V is an "instantaneous" current voltage relationship. It represents the peak current through channels at a given voltage before any inactivation has taken place (i.e. ~ 1 ms after stepping to that voltage) for the Na current. The most positive voltages in this plot are only attainable by the cell through artificial means - i.e. voltages imposed by the voltage-clamp apparatus).



4.)Four significant points in the I/V curve are indicated by arrows in the figure:

i.)The green arrow indicates the resting potential of the cell and also the value of the equilibrium potential for potassium (Ek). As the K+ channel is the only one open at these negative voltages, the cell will rest at Ek.

ii.)The yellow arrow indicates the equilibrium potential for Na+ (ENa). In this two-ion system, ENa is the natural limit of membrane potential beyond which a cell cannot pass. Current values illustrated in this graph that exceed ENa are measured by artificially pushing the cell's voltage past its natural limit. Note however, that ENa could only be reached if the potassium current were absent.

iii.)The blue arrow indicates the maximum voltage that the peak of the action potential can approach. This is the actual natural maximum membrane potential that this cell can reach. It cannot reach ENa because of the counteracting influence of the potassium current.

iv.)The red arrow indicates the action potential threshold. This is where Isum becomes net-inward. Note that this is a zero-current crossing, but with a negative slope. Any such "negative slope crossing" of the zero current level in an I/V plot is an unstable point. At any voltage negative to this crossing, the current is outward and so a cell will tend to return to its resting potential. At any voltage positive of this crossing, the current is inward and will tend to depolarize the cell. This depolarization leads to more inward current, thus the sodium current become regenerative. The point at which the green line reaches its most negative value is the point where all sodium channels are open. Depolarizations beyond that point thus decrease the sodium current as the driving force decreases as the membrane potential approaches ENa.

v.)The action potential threshold is often confused with the "threshold" of sodium channel opening. This is incorrect, because sodium channels have no threshold. Instead, they open in response to depolarization in a stochastic manner. Depolarization does not so much open the channel as increases the probability of it being open. Even at hyperpolarized potentials, a sodium channel will open very occasionally. In addition, the threshold of an action potential is not the voltage at which sodium current becomes significant; it is the point where it exceeds the potassium current.

vi.)Biologically in neurons, depolarization typically originates in the dendrites at synapses. In principle, however, an action potential may be initiated anywhere along a nerve fiber. In his discovery of "animal electricity," Luigi Galvani made a leg of a dead frog kick as in life by touching a sciatic nerve with his scalpel, to which he had inadvertently transferred a negative, static-electric charge, thus initiating an action potential.

CIRCUIT MODEL


Cell membranes that contain ion channels can be modeled as RC circuits to better understand the propagation of action potentials in biological membranes. In such a circuit, the resistor represents the membrane's ion channels, while the capacitor models the insulating lipid membrane. Variable resistors are used for voltage-gated ion channels, as their resistance changes with voltage. A fixed resistor represents the potassium leak channels that maintain the membrane's resting potential. The sodium and potassium gradients across the membrane are modeled as voltage sources (batteries).



PROPAGATION OF ACTION POTENTIALS

In unmyelinated axons, action potentials propagate as an interaction between passively spreading membrane depolarization and voltage-gated sodium channels. When one patch of cell membrane is depolarized enough to open its voltage-gated sodium channels, sodium ions enter the cell by facilitated diffusion. Once inside, positively-charged sodium ions "nudge" adjacent ions down the axon by electrostatic repulsion (analogous to the principle behind Newton's cradle) and attract negative ions away from the adjacent membrane. As a result, a wave of positivity moves down the axon without any individual ion moving very far. Once the adjacent patch of membrane is depolarized, the voltage-gated sodium channels in that patch open, regenerating the cycle. The process repeats itself down the length of the axon, with an action potential regenerated at each segment of membrane.



Speed Propagation

i.)Action potentials propagate faster in axons of larger diameter, other things being equal. They typically travel from 10 – 100 m/s. The main reason is that the axial resistance of the axon lumen is lower with larger diameters, because of an increase in the ratio of cross-sectional area to membrane surface area. As the membrane surface area is the chief factor impeding action potential propagation in an unmyelinated axon, increasing this ratio is a particularly effective way of increasing conduction speed.



ii.)An extreme example of an animal using axon diameter to speed action potential conduction is found in the Atlantic squid. The squid giant axon controls the muscle contraction associated with the squid's predator escape response. This axon can be more than 1 mm in diameter, and is presumably an adaptation to allow very fast activation of the escape behavior. The velocity of nerve impulses in these fibers is among the fastest in nature. Squids are notable examples of organisms with unmyelinated axons; the first tests to try to determine the mechanism by which impulses travel along axons, involving the detection of a potential difference between the inside and the surface of a neuron, were undertaken in the 1940s by Alan Hodgkin and Andrew Huxley using squid giant axons because of their relatively large axon diameter. Hodgkin and Huxley won their shares of the 1963 Nobel Prize in Physiology or Medicine for their work on the electrophysiology of nerve action potentials.

iii.)In the autonomic nervous system in mammals, postganglionic neurons are unmyelinated. The small diameter of these axons (about 2 µ) results in a propagatory speed of approximately 1 m/s, as opposed to approximately 18 m/s in myelinated nerve fibers of comparable diameter, thus highlighting the effect of myelination on the speed of transmission of impulses.

Saltatory conduction

i.)In myelinated axons, saltatory conduction is the process by which an action potential appears to jump along the length of an axon, being regenerated only at uninsulated segments (the nodes of Ranvier). Saltatory conduction increases nerve conduction velocity without having to dramatically increase axon diameter.



ii.)Saltatory conduction has played an important role in the evolution of larger and more complex organisms whose nervous systems must rapidly transmit action potentials across greater distances. Without saltatory conduction, conduction velocity would need large increases in axon diameter, resulting in organisms with nervous systems too large for their bodies.



Detailed mechanism

i.)The main impediment to conduction speed in unmyelinated axons is membrane capacitance. In an electric circuit, the capacitance of a capacitor can be decreased by decreasing the cross-sectional area of its plates, or by increasing the distance between plates. The nervous system uses myelin as its main strategy to decrease membrane capacitance. Myelin is an insulating sheath wrapped around axons by Schwann cells and oligodendrocytes, neuroglia that flatten their cytoplasm to form large sheets made up mostly of plasma membrane. These sheets wrap around the axon, moving the conducting plates (the intra- and extracellular fluid) farther apart to decrease membrane capacitance.



ii.)The resulting insulation allows the rapid (essentially instantaneous) conduction of ions through a myelinated segment of axon, but prevents the regeneration of action potentials through those segments. Action potentials are only regenerated at the unmyelinated nodes of Ranvier which are spaced intermittently between myelinated segments. An abundance of voltage-gated sodium channels on these bare segments (up to four orders of magnitude greater than their density in unmyelinated axons) allows action potentials to be efficiently regenerated at the nodes of Ranvier.



iii.)As a result of myelination, the insulated portion of the axon behaves like a passive wire: it conducts action potentials rapidly because its membrane capacitance is low, and minimizes the degradation of action potentials because its membrane resistance is high. When this passively propagated signal reaches a node of Ranvier, it initiates an action potential, which subsequently travels passively to the next node where the cycle repeats.

Resilience to injury

The length of myelinated segments of axon is important to saltatory conduction. They should be as long as possible to maximize the length of fast passive conduction, but not so long that the decay of the passive signal is too great to reach threshold at the next node of Ranvier. In reality, myelinated segments are long enough for the passively propagated signal to travel for at least two nodes while retaining enough amplitude to fire an action potential at the second or third node. Thus, the safety factor of saltatory conduction is high, allowing transmission to bypass nodes in case of injury.

Role in disease

Some diseases degrade saltatory conduction and reduce the speed of action potential conductance. The most well-known of these diseases is multiple sclerosis, in which the breakdown of myelin impairs coordinated movement.

TERMINATION OF ACTION POTENTIALS

i.)An action potential proceeding along a membrane is prevented from reversing its direction by the refractory period, and will eventually depolarize the entire cell. When the action potential reaches an area where all the cell membrane is already depolarized or still in the refractory period, the action potential can no longer propagate. Because an action potential propagates only along contiguous membrane, another mechanism is necessary to transmit action potentials between cells. Neurons communicate with each other at a chemical synapse. Other cell types, such as cardiac muscle cells, can communicate action potentials via electrical synapses.



ii.)The synapse is a very small gap between neurons that allows one-way communication. As the presynaptic neuron undergoes an action potential, voltage-sensitive calcium channels open and cause the release of neurotransmitters into the synapse. These chemical transmitters can initiate an action potential in the postsynaptic neuron, allowing communication between neurons. Some neurotransmitters inhibit action potentials, and the interaction of excitatory and inhibitory signals allows complex modulation of signals in the nervous system.

EVOLUTIONARY ADVANTAGE OF ACTION POTENTIAL

The action potential, as a method of long-distance communication, fits a particular biological need seen most readily when considering the transmission of information along a nerve axon. To move a signal from one end of an axon to the other, nature must contend with physics similar to those that govern the movement of electrical signals along a wire. Due to the resistance and capacitance of a wire, signals tend to degrade as they travel along that wire over a distance. These properties, known collectively as cable properties set the physical limits over which signals can travel. Thus, nonspiking neurons (which carry signals without action potentials) tend to be small. Proper function of the body requires that signals be delivered from one end of an axon to the other without loss. An action potential does not so much propagate along an axon, as it is newly regenerated by the membrane voltage and current at each stretch of membrane along its path. In other words, the nerve membrane recreates the action potential at its full amplitude as it travels down the axon, thus overcoming the limitations imposed by cable physics.

Sunday, 5 August 2007

ABC of CLINICAL ECG - Book Review



Book Title : ABC of Clinical Electro-Cardiography

Authors : Francis Morris, June Edhouse, William Brandy, John Camm

Publisher : BMJ Books

BOOK DESCRIPTION

1.)Electrocardiography is an essential tool in diagnosing cardiac disorders. This book allows readers to become familiar with the wide range of patterns seen in the electrocardiogram both normal and of the different conditions. Edited and written by leading experts, the ABC of Clinical electrocardiography is a valuable text for anyone managing patients with heart disorders, both in general practice and in hospitals.

2.)This introductory reference will familiarize novice and experienced clinicians with the range of electrocardiogram patterns seen in clinical practice. Early chapters cover basic terminology and leads, rate, rhythm, and cardiac axis, while later chapters cover patterns seen in specific conditions and give information on pediatric electrocardiography and pacemakers.

CONTENTS

1.) Leads, Rate, Rhythn & Cardiac axis
2.)Basic Terminology of ECG
3.)Bradycardias & Atrioventricular Conduction Block
4.)Atrial Arrhythmias
5.)Junctional Tachycardias
6.)Broad Complex Tachycardia - Part1
7.)Broad Complex Tachycardia - Part2
8.)Acute Myocardial Infarction - Part1
9.)Acute Myocardial Infarction - Part2
10.)Myocardial Ischaemia
11.)Exercise Tolerance Testing
12.)Conditions Affecting Right side of Heart
13.)Conditions Affecting Left side of Heart
14.)Conditions not primarily affecting Heart
15.)Paediatric ElectroCardiography
16.)Cardiac Arrest Rhythms
17.)Pacemakers & ElectroCardiography
18.)Pericarditis, Myocarditis, Drug Effects & Congenital Heart Disease

CLICK TO READ


BIOMEDICAL BOOKS

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