دستگاه تحريک هدايتی قلب

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ظ ۳. <" ظ ۰ ۳ ظ رس . ظ هاى بور كبنه 0 07 0 0 ا ا 

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Superior i atrium vena cava Bundle of His Bundle Sinoattial branches node ١ Left ventricle Right atrium Purkinje fibers Papillary muscle Atrioventricular Right ventricle Purkinje fibers node 

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Right bundle Left bundle branch 2 5 5 

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Internodal CS pathways Transitional fibers 7 AV node “— atrioventricular fibrous tissue —Penetrating portion of A-V bundle ——Distal portion of A-V bundle ~ Left bundle branch —Right bundle brane اس Ventricular septum Organization of the A-V node. The numbers represent the interval of time from the or have been extrapol ans 

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20 Transmission of the cardiac impulse through the heart showing th time of appearance (in fractions of a second after initial appearance at the S-A node) in different parts of the heal 

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oN awe 

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Sarcomere Aband 1 Ain ‏سید‎ ‘in = Zine Relaxed Zine Contracted ۷ ] \ Ziine Thick Thin filament filament Mine SENS | palin ۱ 9۹ ‏رو ی‎ D Tropomyosin Troponin ere eT SPY 0 0 ‏تب‎ ‎Sits 2‏ ا هی هنم ‎EEE‏ ] و کر ا ‎SSA ND‏ رتم 0 ات سس ‎ ‎ ‎ ‎actin Myosin ‎ 

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| Basal lamina Sarcolemma 

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۰ 0 0 7 0 0 0 0 Myosin Myosin head ‏بت‎ 0 0 0 1 

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Right ventricle Left ventricle 3 E 2 5 8 2 6 s 2 2 ‏ع‎ ‎2 ‎> 0 +4 +8 412 Atrial pressure (mm Hg) 

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Normal range =I 8 ° 1 8 9 50 100 150 200 0 Arterial pressure (mm Hg) 

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Sympathetic chains —__ Sympathetic nerves 

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Maximum sympathetic stimulation Normal sympathetic stimulation Zero sympathetic stimulation ع 5 2 5 +4 +8 Right atrial pressure (mm Hg) Effect on the cardiac output curve of different degrees of sympathetic and parasympathetic stimulation 

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Cardiac cell ye ACh) M intermeuronal and intracellular mechanisms The msible for the interactions between the sympathetic s in the neural control of cardiac function, wetyleholine; NPY, ide Y; B, ptor; Gs and Gi, stimula parasympathetic syste NE, Norepinephrine; AC Bradrenergic receptor; M, muscarinic ry G proteins; Ad. cyel., adenylyl cyclase: ATP, AMP, cyclic adenosine monophosphate adenosine triphosphate (From Levy MN. In Kulbertus HE, Franck G, editors ogy, Mi. Kisco, NY, 1988, Futura 

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stimulation stimulation Figure 28-3. Effect of sympathetic (noradrenerg} and vagal (cholinergic) stimulation on the membr. potential of the SA node. 

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— Increases EN! — Atrial right atrial receptors pressure stimulated / =P ‏مه لب‎ Intravenous infusion Increases 7 Increases hy cardiac arterial yea output pressure I. reflex W Fig. 17-8. nzavenos infusions of foo or electrolyte solutions tend to increase heart rate via the Bainbridge reflex and to decrease heart rate via the baroreceptor reflex. The actual change in heart rate induced by such infusions is the result ofthese two opposing effects 

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