A report on Cardiac muscle

3D rendering showing thick myocardium within the heart wall.
The swirling musculature of the heart ensures effective pumping of blood.
Cardiac muscle
Illustration of a cardiac muscle cell.
Intercalated discs are part of the cardiac muscle cell sarcolemma and they contain gap junctions and desmosomes.
Dog cardiac muscle (400X)

One of three types of vertebrate muscle tissue, with the other two being skeletal muscle and smooth muscle.

- Cardiac muscle

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Overall

As an action potential (nerve impulse) travels down an axon there is a change in electric polarity across the membrane of the axon. In response to a signal from another neuron, sodium- (Na+) and potassium- (K+) gated ion channels open and close as the membrane reaches its threshold potential. Na+ channels open at the beginning of the action potential, and Na+ moves into the axon, causing depolarization. Repolarization occurs when the K+ channels open and K+ moves out of the axon, creating a change in electric polarity between the outside of the cell and the inside. The impulse travels down the axon in one direction only, to the axon terminal where it signals other neurons.

Action potential

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Action potential occurs when the membrane potential of a specific cell location rapidly rises and falls.

Action potential occurs when the membrane potential of a specific cell location rapidly rises and falls.

As an action potential (nerve impulse) travels down an axon there is a change in electric polarity across the membrane of the axon. In response to a signal from another neuron, sodium- (Na+) and potassium- (K+) gated ion channels open and close as the membrane reaches its threshold potential. Na+ channels open at the beginning of the action potential, and Na+ moves into the axon, causing depolarization. Repolarization occurs when the K+ channels open and K+ moves out of the axon, creating a change in electric polarity between the outside of the cell and the inside. The impulse travels down the axon in one direction only, to the axon terminal where it signals other neurons.
Shape of a typical action potential. The membrane potential remains near a baseline level until at some point in time, it abruptly spikes upward and then rapidly falls.
Approximate plot of a typical action potential shows its various phases as the action potential passes a point on a cell membrane. The membrane potential starts out at approximately −70 mV at time zero. A stimulus is applied at time = 1 ms, which raises the membrane potential above −55 mV (the threshold potential). After the stimulus is applied, the membrane potential rapidly rises to a peak potential of +40 mV at time = 2 ms. Just as quickly, the potential then drops and overshoots to −90 mV at time = 3 ms, and finally the resting potential of −70 mV is reestablished at time = 5 ms.
Action potential propagation along an axon
Ion movement during an action potential.
Key: a) Sodium (Na+) ion. b) Potassium (K+) ion. c) Sodium channel. d) Potassium channel. e) Sodium-potassium pump. In the stages of an action potential, the permeability of the membrane of the neuron changes. At the resting state (1), sodium and potassium ions have limited ability to pass through the membrane, and the neuron has a net negative charge inside. Once the action potential is triggered, the depolarization (2) of the neuron activates sodium channels, allowing sodium ions to pass through the cell membrane into the cell, resulting in a net positive charge in the neuron relative to the extracellular fluid. After the action potential peak is reached, the neuron begins repolarization (3), where the sodium channels close and potassium channels open, allowing potassium ions to cross the membrane into the extracellular fluid, returning the membrane potential to a negative value. Finally, there is a refractory period (4), during which the voltage-dependent ion channels are inactivated while the Na+ and K+ ions return to their resting state distributions across the membrane (1), and the neuron is ready to repeat the process for the next action potential.
When an action potential arrives at the end of the pre-synaptic axon (top), it causes the release of neurotransmitter molecules that open ion channels in the post-synaptic neuron (bottom). The combined excitatory and inhibitory postsynaptic potentials of such inputs can begin a new action potential in the post-synaptic neuron.
In pacemaker potentials, the cell spontaneously depolarizes (straight line with upward slope) until it fires an action potential.
In saltatory conduction, an action potential at one node of Ranvier causes inwards currents that depolarize the membrane at the next node, provoking a new action potential there; the action potential appears to "hop" from node to node.
Comparison of the conduction velocities of myelinated and unmyelinated axons in the cat. The conduction velocity v of myelinated neurons varies roughly linearly with axon diameter d (that is, v ∝ d), whereas the speed of unmyelinated neurons varies roughly as the square root (v ∝√d). The red and blue curves are fits of experimental data, whereas the dotted lines are their theoretical extrapolations.
Cable theory's simplified view of a neuronal fiber. The connected RC circuits correspond to adjacent segments of a passive neurite. The extracellular resistances re (the counterparts of the intracellular resistances ri) are not shown, since they are usually negligibly small; the extracellular medium may be assumed to have the same voltage everywhere.
Electrical synapses between excitable cells allow ions to pass directly from one cell to another, and are much faster than chemical synapses.
Phases of a cardiac action potential. The sharp rise in voltage ("0") corresponds to the influx of sodium ions, whereas the two decays ("1" and "3", respectively) correspond to the sodium-channel inactivation and the repolarizing eflux of potassium ions. The characteristic plateau ("2") results from the opening of voltage-sensitive calcium channels.
Giant axons of the longfin inshore squid (Doryteuthis pealeii) were crucial for scientists to understand the action potential.
As revealed by a patch clamp electrode, an ion channel has two states: open (high conductance) and closed (low conductance).
Tetrodotoxin is a lethal toxin found in pufferfish that inhibits the voltage-sensitive sodium channel, halting action potentials.
Image of two Purkinje cells (labeled as A) drawn by Santiago Ramón y Cajal in 1899. Large trees of dendrites feed into the soma, from which a single axon emerges and moves generally downwards with a few branch points. The smaller cells labeled B are granule cells.
Ribbon diagram of the sodium–potassium pump in its E2-Pi state. The estimated boundaries of the lipid bilayer are shown as blue (intracellular) and red (extracellular) planes.
Equivalent electrical circuit for the Hodgkin–Huxley model of the action potential. Im and Vm represent the current through, and the voltage across, a small patch of membrane, respectively. The Cm represents the capacitance of the membrane patch, whereas the four g's represent the conductances of four types of ions. The two conductances on the left, for potassium (K) and sodium (Na), are shown with arrows to indicate that they can vary with the applied voltage, corresponding to the voltage-sensitive ion channels. The two conductances on the right help determine the resting membrane potential.

Using voltage-sensitive dyes, action potentials have been optically recorded from a tiny patch of cardiomyocyte membrane.

A microscope image of myocarditis at autopsy in a person with acute onset of heart failure

Myocarditis

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A microscope image of myocarditis at autopsy in a person with acute onset of heart failure
Diffuse ST elevation in a young male due to myocarditis and pericarditis
Lymphocytic myocarditis (white arrow points to a lymphocyte), commonly showing myocyte necrosis (black arrow), seen as hypereosinophilic cytoplasm with loss of striations.
Endomyocardial biopsy specimen with extensive eosinophilic infiltrate involving the endocardium and myocardium (hematoxylin and eosin stain)

Myocarditis, also known as inflammatory cardiomyopathy, is an acquired cardiomyopathy due to inflammation of the heart muscle.

Leads aVL and aVF of an electrocardiogram showing atrial fibrillation. There are irregular intervals between heart beats. No P waves are seen and there is an erratic baseline between QRS complexes. The heart rate is about 125 beats per minute.

Atrial fibrillation

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Abnormal heart rhythm (arrhythmia) characterized by rapid and irregular beating of the atrial chambers of the heart.

Abnormal heart rhythm (arrhythmia) characterized by rapid and irregular beating of the atrial chambers of the heart.

Leads aVL and aVF of an electrocardiogram showing atrial fibrillation. There are irregular intervals between heart beats. No P waves are seen and there is an erratic baseline between QRS complexes. The heart rate is about 125 beats per minute.
Normal rhythm tracing (top) Atrial fibrillation (bottom)
How a stroke can occur during atrial fibrillation
Non-modifiable risk factors (top left box) and modifiable risk factors (bottom left box) for atrial fibrillation. The main outcomes of atrial fibrillation are in the right box. BMI=Body Mass Index.
A 12-lead ECG showing atrial fibrillation at approximately 132 beats per minute
Diagram of normal sinus rhythm as seen on ECG. In atrial fibrillation the P waves, which represent depolarization of the top of the heart, are absent.
ECG of atrial fibrillation (top) and normal sinus rhythm (bottom). The purple arrow indicates a P wave, which is lost in atrial fibrillation.
3D Medical Animation still shot of Left Atrial Appendage Occlusion

All of these mutations affect the processes of polarization-depolarization of the myocardium, cellular hyper-excitability, shortening of effective refractory period favoring re-entries.

Mouse heart slice showing dilated cardiomyopathy

Dilated cardiomyopathy

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Condition in which the heart becomes enlarged and cannot pump blood effectively.

Condition in which the heart becomes enlarged and cannot pump blood effectively.

Mouse heart slice showing dilated cardiomyopathy
Illustration of a Normal Heart vs. Heart with Dilated Cardiomyopathy
Serial 12-lead ECGs from a 49-year-old black man with cardiomyopathy. (TOP): Sinus tachycardia (rate about 101/min) with LBBB accompanied by RAD (here about 108°). Frequent multifocal PVCs (both singly and in pairs) and left atrial enlargement. (BOTTOM): Same patient about 5 months later status-post orthotopic heart transplant.
Dilated cardiomyopathy on CXR
Dilated cardiomyopathy on CT

It is a type of cardiomyopathy, a group of diseases that primarily affects the heart muscle.

Walls of the heart, showing pericardium at right.

Pericardium

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Double-walled sac containing the heart and the roots of the great vessels.

Double-walled sac containing the heart and the roots of the great vessels.

Walls of the heart, showing pericardium at right.
A transverse section of the thorax, showing the contents of the middle and the posterior mediastinum. The pleural cavity and the pericardial cavity are exaggerated since normally there is no space between the pleurae or between the pericardium and heart. Pericardium is also known as cardiac epidermis.
The pericardial cavity in this image is labeled d and is part of the inferior mediastium. Here we can see its relation to the superior mediastinum a, the pleural cavities c, and the diaphragm e.
3D still showing the pericardium layer.
Fibrous pericardium

The visceral serous pericardium, also known as the epicardium, covers the myocardium of the heart and can be considered its serosa. It is largely made of a mesothelium overlying some elastin-rich loose connective tissue. During ventricular contraction, the wave of depolarization moves from the endocardial to the epicardial surface.

A cartoon section of skeletal muscle, showing T-tubules running deep into the centre of the cell between two terminal cisternae/junctional SR. The thinner projections, running horizontally between two terminal cisternae are the longitudinal sections of the SR.

Sarcoplasmic reticulum

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Membrane-bound structure found within muscle cells that is similar to the smooth endoplasmic reticulum in other cells.

Membrane-bound structure found within muscle cells that is similar to the smooth endoplasmic reticulum in other cells.

A cartoon section of skeletal muscle, showing T-tubules running deep into the centre of the cell between two terminal cisternae/junctional SR. The thinner projections, running horizontally between two terminal cisternae are the longitudinal sections of the SR.

There are three types of ryanodine receptor, RyR1 (in skeletal muscle), RyR2 (in cardiac muscle) and RyR3 (in the brain).

Hypertrophic cardiomyopathy

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Condition in which the heart becomes thickened without an obvious cause.

Condition in which the heart becomes thickened without an obvious cause.

An ECG showing HOCM
Pressure tracings demonstrating the Brockenbrough–Braunwald–Morrow sign AO = Descending aorta; LV = Left ventricle; ECG = Electrocardiogram. After the third QRS complex, the ventricle has more time to fill. Since there is more time to fill, the left ventricle will have more volume at the end of diastole (increased preload). Due to the Frank–Starling law of the heart, the contraction of the left ventricle (and pressure generated by the left ventricle) will be greater on the subsequent beat (beat #4 in this picture). Because of the dynamic nature of the outflow obstruction in HCM, the obstruction increases more than the left ventricular pressure increase. This causes a fall in the aortic pressure as the left ventricular pressure rises (seen as the yellow shaded area in the picture).
Echocardiography of hypertrophic-obstructive cardiomyopathy (HOCM) in a cat.
Saddle thrombus in the feline aorta. 1 opened Aorta with thrombus, 2 A. iliaca externa, 3 common trunk for both Aa. iliacae internae, 4 A. circumflexa ilium profunda, 5 A. mesenterica caudalis, 6 Colon descendens.

It is often due to mutations in certain genes involved with making heart muscle proteins.

The cardiac cycle at the point of beginning a ventricular systole, or contraction: 1) newly oxygenated blood (red arrow) in the left ventricle begins pulsing through the aortic valve to supply all body systems; 2) oxygen-depleted blood (blue arrow) in the right ventricle begins pulsing through the pulmonic (pulmonary) valve en route to the lungs for reoxygenation.

Systole

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Part of the cardiac cycle during which some chambers of the heart muscle contract after refilling with blood.

Part of the cardiac cycle during which some chambers of the heart muscle contract after refilling with blood.

The cardiac cycle at the point of beginning a ventricular systole, or contraction: 1) newly oxygenated blood (red arrow) in the left ventricle begins pulsing through the aortic valve to supply all body systems; 2) oxygen-depleted blood (blue arrow) in the right ventricle begins pulsing through the pulmonic (pulmonary) valve en route to the lungs for reoxygenation.
Electrical waves track a systole (a contraction) of the heart. The end-point of the P wave depolarization is the start-point of the atrial stage of systole. The ventricular stage of systole begins at the R peak of the QRS wave complex; the T wave indicates the end of ventricular contraction, after which ventricular relaxation (ventricular diastole) begins.
The cardiac cycle at beginning of atrial systole: The left (red) and right (blue) ventricles begin to fill during ventricular diastole. Then, after tracing the P wave of the ECG, the two atria begin contracting (systole), pulsing blood under pressure into the ventricles.
A Wiggers diagram, showing various events during systole (here primarily displayed as ventricular systole, or ventricular contraction). The very short interval (about 0.03 second) of isovolumetric, or fixed-volume, contraction begins (see upper left) at the R peak of the QRS complex on the electrocardiogram graph-line. + Ejection phase begins immediately after isovolumetric contraction—ventricular volume (red graph-line) begins to decrease as ventricular pressure (light blue graph-line) continues to increase; then pressure drops as it enters diastole.

Cardiac systole is the contraction of the cardiac muscle in response to an electrochemical stimulus to the heart's cells (cardiomyocytes).

As long as the stimulus reaches the threshold, the full response would be given. Larger stimulus does not result in a larger response, vice versa.

All-or-none law

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Principle that if a single nerve fibre is stimulated, it will always give a maximal response and produce an electrical impulse of a single amplitude.

Principle that if a single nerve fibre is stimulated, it will always give a maximal response and produce an electrical impulse of a single amplitude.

As long as the stimulus reaches the threshold, the full response would be given. Larger stimulus does not result in a larger response, vice versa.

It was first established by the American physiologist Henry Pickering Bowditch in 1871 for the contraction of heart muscle.

Immunohistochemical analysis of L-type calcium channel Cav1.3 (CACNA1D) in human adrenal cortex. Marked immunoreactivity was detected in the zona glomerulosa. In the figure: ZG = zona glomerulosa, ZF = zona fasciculata, AC = adrenal capsule. Immunohistochemistry was performed according to published methods.

L-type calcium channel

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Part of the high-voltage activated family of voltage-dependent calcium channel.

Part of the high-voltage activated family of voltage-dependent calcium channel.

Immunohistochemical analysis of L-type calcium channel Cav1.3 (CACNA1D) in human adrenal cortex. Marked immunoreactivity was detected in the zona glomerulosa. In the figure: ZG = zona glomerulosa, ZF = zona fasciculata, AC = adrenal capsule. Immunohistochemistry was performed according to published methods.
An L-type calcium channel with its subunits labeled along with some drugs known to inhibit the channel.
Alpha subunit of a generic voltage-gated ion channel

L-type calcium channels are responsible for the excitation-contraction coupling of skeletal, smooth, cardiac muscle, and for aldosterone secretion in endocrine cells of the adrenal cortex.