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The Final Stretch · Cardiovascular · Physiology

The electrical heartbeat.

A pacemaker sets the rhythm. A myocyte contracts. Their action potentials explain the difference.

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01

Set the pace.

The sinoatrial (SA) node—the heart’s primary pacemaker—sits in the right atrium near the SVC. Its action potential lacks a true plateau: phase 0 depolarization uses L‑type Ca²⁺ channels, phase 3 repolarizes via K⁺ efflux, and phase 4 exhibits spontaneous diastolic depolarization through If (funny) channels—a mixed Na⁺/K⁺ inward current that underlies automaticity.

02

Build the beat.

Same heart · Different electrical jobs

SA node

Sets the pace

Phase 0 → Ca²⁺
Phase 4 rises spontaneously.

Ventricular myocyte

Supports contraction

Phase 0 → Na⁺
Phase 2 forms a plateau.

Schematic action potentials for comparison. Horizontal direction represents time; vertical direction represents membrane potential. Scales are illustrative, not measured recordings.

Ventricular myocyte action potential has five phases: phase 0 depolarization is driven by fast Na⁺ channels (target of Class I antiarrhythmics; see Pharmacology), phase 2 is the Ca²⁺-K⁺-balanced plateau that prolongs the refractory period and prevents tetanic contraction; phase 4 rests at ≈ –90 mV. Excitation–contraction coupling begins when L‑type Ca²⁺ entry during phase 2 triggers Ca²⁺‑induced Ca²⁺ release (CICR) from the sarcoplasmic reticulum via ryanodine receptors (RyR2). Cardiac muscle depends heavily on extracellular Ca²⁺, so CCBs → negative inotropy.

03

Close the loop.

Pause & recall

Which channel carries phase 0 of the SA-node action potential?

L-type Ca²⁺ channels.

Pause & recall

Which channel carries phase 0 of the ventricular myocyte action potential?

Fast Na⁺ channels.

Pause & recall

What does the phase-2 plateau accomplish?

It prolongs the refractory period and prevents tetanic contraction.

Pause & recall

What triggers Ca²⁺-induced Ca²⁺ release, and via which receptor?

L-type Ca²⁺ entry; release is via ryanodine receptors (RyR2).

About this excerpt & further reading

Selected passages and recall questions from “Cardiac Electrophysiology and Conduction,” Cardiovascular / Physiology in The Final Stretch. Selected published passages retrieved September 15, 2026. The diagrams and recall presentation were prepared for this public preview. This is a selection, not the complete chapter. Recall answers stay on this page; no study history is recorded.

Further reading: NCBI Bookshelf

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