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An Evening With Mark Cleary. New Year, New Celebrations — Our Star Magic With Jerry Sergeant. An Evening With Les Flitcroft: Creating a Collaborative Experience. Peace on the Ancient Pilgrimage Sandy Newbigging — Sneak Peek. Speed Dating From the Heart. Without any nervous stimulation, the SA node would establish a sinus rhythm of approximately bpm. Since resting rates are considerably less than this, it becomes evident that parasympathetic stimulation normally slows HR.

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This is similar to an individual driving a car with one foot on the brake pedal. In the case of the heart, decreasing parasympathetic stimulation decreases the release of ACh, which allows HR to increase up to approximately bpm. Any increases beyond this rate would require sympathetic stimulation.

The cardiovascular centres receive input from a series of visceral receptors with impulses traveling through visceral sensory fibers within the vagus and sympathetic nerves via the cardiac plexus. Among these receptors are various proprioreceptors , baroreceptors , and chemoreceptors , plus stimuli from the limbic system which normally enable the precise regulation of heart function, via cardiac reflexes. Increased physical activity results in increased rates of firing by various proprioreceptors located in muscles, joint capsules, and tendons.

The cardiovascular centres monitor these increased rates of firing, suppressing parasympathetic stimulation or increasing sympathetic stimulation as needed in order to increase blood flow. Similarly, baroreceptors are stretch receptors located in the aortic sinus, carotid bodies, the venae cavae, and other locations, including pulmonary vessels and the right side of the heart itself.

Rates of firing from the baroreceptors represent blood pressure, level of physical activity, and the relative distribution of blood.

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The cardiac centers monitor baroreceptor firing to maintain cardiac homeostasis, a mechanism called the baroreceptor reflex. With increased pressure and stretch, the rate of baroreceptor firing increases, and the cardiac centers decrease sympathetic stimulation and increase parasympathetic stimulation. As pressure and stretch decrease, the rate of baroreceptor firing decreases, and the cardiac centers increase sympathetic stimulation and decrease parasympathetic stimulation. There is a similar reflex, called the atrial reflex or Bainbridge reflex , associated with varying rates of blood flow to the atria.

Increased venous return stretches the walls of the atria where specialized baroreceptors are located. However, as the atrial baroreceptors increase their rate of firing and as they stretch due to the increased blood pressure, the cardiac center responds by increasing sympathetic stimulation and inhibiting parasympathetic stimulation to increase HR.

The opposite is also true. Increased metabolic byproducts associated with increased activity, such as carbon dioxide, hydrogen ions, and lactic acid, plus falling oxygen levels, are detected by a suite of chemoreceptors innervated by the glossopharyngeal and vagus nerves. These chemoreceptors provide feedback to the cardiovascular centers about the need for increased or decreased blood flow, based on the relative levels of these substances. The limbic system can also significantly impact HR related to emotional state. During periods of stress, it is not unusual to identify higher than normal HRs, often accompanied by a surge in the stress hormone cortisol.

Individuals experiencing extreme anxiety may manifest panic attacks with symptoms that resemble those of heart attacks. These events are typically transient and treatable. Meditation techniques have been developed to ease anxiety and have been shown to lower HR effectively.

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Using a combination of autorhythmicity and innervation, the cardiovascular center is able to provide relatively precise control over the heart rate, but other factors can impact on this. These include hormones, notably epinephrine, norepinephrine, and thyroid hormones; levels of various ions including calcium, potassium, and sodium; body temperature; hypoxia; and pH balance. The catecholamines , epinephrine and norepinephrine, secreted by the adrenal medulla form one component of the extended fight-or-flight mechanism.

The other component is sympathetic stimulation. Epinephrine and norepinephrine have similar effects: The rate of depolarization is increased by this additional influx of positively charged ions, so the threshold is reached more quickly and the period of repolarization is shortened. However, massive releases of these hormones coupled with sympathetic stimulation may actually lead to arrhythmias. There is no parasympathetic stimulation to the adrenal medulla.

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In general, increased levels of the thyroid hormones thyroxine T4 and triiodothyronine T3 , increase the heart rate; excessive levels can trigger tachycardia. The impact of thyroid hormones is typically of a much longer duration than that of the catecholamines. The physiologically active form of triiodothyronine, has been shown to directly enter cardiomyocytes and alter activity at the level of the genome.

Calcium ion levels have a great impact on heart rate and contractility: High levels of calcium ions result in hypercalcemia and excessive levels can induce cardiac arrest. Drugs known as calcium channel blockers slow HR by binding to these channels and blocking or slowing the inward movement of calcium ions.

Caffeine and nicotine are both stimulants of the nervous system and of the cardiac centres causing an increased heart rate. Caffeine works by increasing the rates of depolarization at the SA node, whereas nicotine stimulates the activity of the sympathetic neurons that deliver impulses to the heart.

Both surprise and stress induce physiological response: In the data collected, there was a noticeable trend between the location of actors onstage and offstage and their elevation in heart rate in response to stress; the actors present offstage reacted to the stressor immediately, demonstrated by their immediate elevation in heart the minute the unexpected event occurred, but the actors present onstage at the time of the stressor reacted in the following 5 minute period demonstrated by their increasingly elevated heart rate. The heart rate can be slowed by altered sodium and potassium levels, hypoxia , acidosis , alkalosis , and hypothermia.

The relationship between electrolytes and HR is complex, but maintaining electrolyte balance is critical to the normal wave of depolarization. Of the two ions, potassium has the greater clinical significance. Initially, both hyponatremia low sodium levels and hypernatremia high sodium levels may lead to tachycardia. Severely high hypernatremia may lead to fibrillation, which may cause CO to cease. Severe hyponatremia leads to both bradycardia and other arrhythmias. Hypokalemia low potassium levels also leads to arrhythmias, whereas hyperkalemia high potassium levels causes the heart to become weak and flaccid, and ultimately to fail.

Heart muscle relies exclusively on aerobic metabolism for energy. Hypoxia an insufficient supply of oxygen leads to decreasing HRs, since metabolic reactions fueling heart contraction are restricted. Normal blood pH falls in the range of 7. Enzymes, being the regulators or catalysts of virtually all biochemical reactions - are sensitive to pH and will change shape slightly with values outside their normal range. These variations in pH and accompanying slight physical changes to the active site on the enzyme decrease the rate of formation of the enzyme-substrate complex, subsequently decreasing the rate of many enzymatic reactions, which can have complex effects on HR.

Severe changes in pH will lead to denaturation of the enzyme. The last variable is body temperature. Elevated body temperature is called hyperthermia , and suppressed body temperature is called hypothermia. Slight hyperthermia results in increasing HR and strength of contraction. Hypothermia slows the rate and strength of heart contractions.


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This distinct slowing of the heart is one component of the larger diving reflex that diverts blood to essential organs while submerged. If sufficiently chilled, the heart will stop beating, a technique that may be employed during open heart surgery. Excessive hyperthermia and hypothermia will both result in death, as enzymes drive the body systems to cease normal function, beginning with the central nervous system.

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Heart rate is not a stable value and it increases or decreases in response to the body's need in a way to maintain an equilibrium basal metabolic rate between requirement and delivery of oxygen and nutrients. The normal SA node firing rate is affected by autonomic nervous system activity: Normal pulse rates at rest, in beats per minute BPM: The basal or resting heart rate HR rest is defined as the heart rate when a person is awake, in a neutrally temperate environment, and has not been subject to any recent exertion or stimulation, such as stress or surprise.

A large body of evidence indicates that the normal range is beats per minute. For example, all-cause mortality is increased by 1. The maximum heart rate HR max is the highest heart rate an individual can achieve without severe problems through exercise stress, [18] [ unreliable medical source?