A synthetic replacement for the heart remains one of the holy grails of modern medicine. Although the heart is conceptually simple it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. Consequences of these issues include severe foreign-body rejection and external batteries that limit patient mobility. These complications limited the lifespan of early human recipients to hours or days.
There are two types of artificial heart:
1. Total Artificial Heart (TAH) implantation involves the removal of the native heart. It is a surgical procedure similar to heart transplantation with a human donor heart.
2. Cardiac (heart) assist devices differ, in that the patient’s heart is not removed during implantation. Assist devices may include either a Left Ventricular Assist Device (LVAD) or a Right Ventricular Assist Device (RVAD) or both. As opposed to TAH implantation, the assist device serves to provide only a part of the total cardiac output of the patient’s heart.
Patients who have some remaining heart function but who can no longer live normally may be candidates for ventricular assist devices which do not replace the heart, but boost its output. The first heart assist device was FDA approved in 1994, and two more received approval in 1998. While the original assist devices emulated the pulsating heart newer versions, such as the Heartmate II, developed by the Texas Heart Institute of Houston, Texas, provide continuous flow. These pumps (which may be cetrifugal or axial flow) are smaller and potentially more durable and long-lasting than the current generation of total heart replacement pumps. Several continuous flow ventricular assist devices have been approved for use in the European Union and as at August 2007 were undergoing clinical trials for FDA approval.
Showing posts with label heart. Show all posts
Showing posts with label heart. Show all posts
Saturday, April 11, 2009
Sunday, May 20, 2007
Cardiac Pacemaker
The heart cells that create rhythmical impulses are called pacemaker cells, and they directly control the heart rate. Artificial devices also called pacemakers can be used after damage to the body's intrinsic conduction system to produce these impulses synthetically.
Although all of the heart's cells possess the ability to generate these electrical impulses (or action potentials), a specialised portion of the heart, called the sinoatrial node, is responsible for the whole heart's beat.
The sinoatrial node (SA node) is a group of cells positioned on the wall of the right atrium, near the entrance of the superior vena cava. These cells are modified cardiac myocytes. They possess some contractile filaments, though they do not contract.
Cells in the SA node will naturally discharge (create action potentials) at about 70-80 times/minute. Because the sinoatrial node is responsible for the rest of the heart's electrical activity, it is sometimes called the primary pacemaker.
If the S.A node doesn't function, or the impulse generated in the SA node is blocked before it travels down the electrical conduction system, a group of cells further down the heart will become the heart's pacemaker. These cells form the atrioventricular node (AV node), which is an area between the atria and ventricles, within the atrial septum.
The cells of the AV node normally discharge at about 40-60 beats per minute, and are called the secondary pacemaker.
Further down the electrical conducting system of the heart, the Bundle of His, the left and right branches of this bundle, and the Purkinje fibres, will also produce a spontaneous action potential if they aren't inhibited by other electrical activity. These tertiary pacemakers fire at a rate between 30-40 per minute.
Even individual cardiac muscle cells will contract rhythmically on their own.
The reason the SA node controls the whole heart is that its action potentials are released most often; this triggers other cells to generate their own action potentials. In the muscle cells, this will produce contraction. The action potential generated by the SA node, passes down the cardiac conduction system, and arrives before the other cells have had a chance to generate their own spontaneous action potential.
Although all of the heart's cells possess the ability to generate these electrical impulses (or action potentials), a specialised portion of the heart, called the sinoatrial node, is responsible for the whole heart's beat.
The sinoatrial node (SA node) is a group of cells positioned on the wall of the right atrium, near the entrance of the superior vena cava. These cells are modified cardiac myocytes. They possess some contractile filaments, though they do not contract.
Cells in the SA node will naturally discharge (create action potentials) at about 70-80 times/minute. Because the sinoatrial node is responsible for the rest of the heart's electrical activity, it is sometimes called the primary pacemaker.
If the S.A node doesn't function, or the impulse generated in the SA node is blocked before it travels down the electrical conduction system, a group of cells further down the heart will become the heart's pacemaker. These cells form the atrioventricular node (AV node), which is an area between the atria and ventricles, within the atrial septum.
The cells of the AV node normally discharge at about 40-60 beats per minute, and are called the secondary pacemaker.
Further down the electrical conducting system of the heart, the Bundle of His, the left and right branches of this bundle, and the Purkinje fibres, will also produce a spontaneous action potential if they aren't inhibited by other electrical activity. These tertiary pacemakers fire at a rate between 30-40 per minute.
Even individual cardiac muscle cells will contract rhythmically on their own.
The reason the SA node controls the whole heart is that its action potentials are released most often; this triggers other cells to generate their own action potentials. In the muscle cells, this will produce contraction. The action potential generated by the SA node, passes down the cardiac conduction system, and arrives before the other cells have had a chance to generate their own spontaneous action potential.
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