回顧心臟電生理學 review of cardiac electrophysiology
TRANSCRIPT
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Review of Cardiac Electrophysiology
Yuan Chieh Chang
Book: Goldman-Cecil Medicine, 25th Ed.
Tex Heart Inst J 2006;33:40-7
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Review of Cardiac Electrophysiology
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Review of Cardiac Electrophysiology
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Review of Cardiac Electrophysiology
Na
Na
Na
Ca
CaK
K
Phase 0
INa: voltage-gated sodium currents (Fast)
INa
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Review of Cardiac Electrophysiology
Na
NaNa
Ca
CaK
K
Phase 1
(Vm) (+40 mV)
Ito: transient outward potassium current
Inactivation gate of sodium channel close
Ito
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Review of Cardiac Electrophysiology
Na
Na
Na
Ca
CaK
K
Phase 2 phase 0
ICa-L: inward L-type calcium current
IKs: slow component of the delayed rectier K current IKr: delayed rectier potassium current
INa/Ca: electrogenic Na-Ca exchanger sarcoplasmic reticulum
ICa
IKr/s INa/Ca
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Review of Cardiac Electrophysiology
Na
Na
Na
Ca
CaK
K
Phase 3
IK1: inward rectier K current
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Review of Cardiac Electrophysiology
Na
Na
Na
Ca
CaKK
Phase 3
IK1: inward rectier K current
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Review of Cardiac Electrophysiology
Phase 4
Na Na
Na
Ca
CaKK
Na-K
IK1: inward rectier K current
IK1
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Review of Cardiac Electrophysiology
Phase 4 SA node &AV node
IK1 IK1
If activated by Hyperdepolarized
INa/Ca
INa ICa L, ICa T
Na Na
Na
Ca
CaKK
If INa/CaIK1
ICaL,T
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Review of Cardiac Electrophysiology
Phase 4 SA node &AV node
IK1 IK1
INa/Ca
INa ICa L, ICa T
Na
Na
Na
Ca
CaKK
If INa/CaIK1
ICaL,T
If activated by Hyperdepolarized
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Review of Cardiac Electrophysiology
I KATP channels: inwardly rectifying K currentATP
inwardly rectifying
Re-entry arrththmia
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Review of Cardiac Electrophysiology
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Review of Cardiac Electrophysiology
J-wave syndromeEspecially Brugada syndrome
Key: (INa or ICa) (Ito, IK-ATP)
Phase 2 epicardialendocardial
Ito,fast epicardial
epicardial
Ito epicardial
ST-T wave change
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Review of Cardiac Electrophysiology
Phase 2 reentry Phase 2 epicardialendocardial
local reentry
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Review of Cardiac Electrophysiology
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Review of Cardiac Electrophysiology
37C
61.5 mV log ( )[]
[]Eeq =
61.5 mV log ( )[][]
Eeq =
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Review of Cardiac Electrophysiology
EKGP, PR interval, QRS
Tex Heart Inst J 2006;33:40-7
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Review of Cardiac Electrophysiology
Phase 2, 3 Phase 3 ()I kr
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Review of Cardiac Electrophysiology
-90mV
Phase 0()
Phase 3()
ST-T depression, peaked T waves, and Q-T interval shortening
: Tex Heart Inst J 2006;33:40-7