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Physiology

Cardiovascular

Question 24 of 180

In cardiac myocyte excitation-contraction coupling, Ca2+ is released from intracellular stores directly in response to:

Answer:

Although Ca2+ entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+ stores in the sarcoplasmic reticulum (SR). APs travel down invaginations of the sarcolemma called T-tubules, which are close to, but do not touch, the terminal cisternae of the SR. During the AP plateau, Ca2+ enters the cell and activates Ca2+ sensitive Ca2+ release channels in the sarcoplasmic reticulum allowing stored Ca2+ to flood into the cytosol; this is called Ca2+-induced Ca2+ release. The amount of Ca2+ released is dependent on how much is stored, and on the size of the initial Ca2+ influx during the AP.

Cardiac Excitation-Contraction Coupling

Cardiac muscle contracts when intracellular Ca2+ rises (> 100 nmol/L).

Contraction

Although Ca2+ entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+ stores in the sarcoplasmic reticulum (SR).

APs travel down invaginations of the sarcolemma called T-tubules, which are close to, but do not touch, the terminal cisternae of the SR. During the AP plateau, Ca2+ enters the cell and activates Ca2+ sensitive Ca2+ release channels in the sarcoplasmic reticulum allowing stored Ca2+ to flood into the cytosol; this is called Ca2+-induced Ca2+ release. The amount of Ca2+ released is dependent on how much is stored, and on the size of the initial Ca2+ influx during the AP.

By OpenStax [CC BY 4.0 , via Wikimedia Commons

Excitation-Contraction Coupling. (Image by OpenStax [CC BY 4.0 , via Wikimedia Commons)

Relaxation

In relaxation, about 80% of Ca2+ is rapidly pumped back into the SR (sequestered) by Ca2+ ATPase pumps. The Ca2+ that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+ exchanger in the membrane which pumps one Ca2+ ion out in exchange for three Na+ ions in, using the Na+ electrochemical gradient as an energy source. This is relatively slow and continues during diastole.

Treppe Effect

When more action potentials occur per unit time, more Ca2+ enters the cell during the AP plateau, more Ca2+ is stored in the SR, more Ca2+ is released from the SR and thus more Ca2+ is left inside the cell and greater tension is produced during contraction. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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