Sino-atrial node

The sinoatrial node (also known as the SA node or the sinus node) is a group of cells located in the wall of the right atrium of the heart. These cells have the ability to spontaneously produce an electrical impulse (action potential; see below for more details), that travels through the heart via the electrical conduction system (see figure 1) causing it to contract. In a healthy heart, the SA node continuously produces action potential, setting the rhythm of the heart and so is known as the heart's natural pacemaker. The rate of action potential production (and therefore the heart rate) is influenced by nerves that supply it.The sinoatrial node is a banana-shaped structure that varies in size, usually between 10-30 millimeters (mm) long, 5–7 mm wide, and 1–2 mm deep.The main role of a sinoatrial node cell is to initiate action potentials of the heart, so that it can pass throughout the heart and cause contraction. An action potential is a change in voltage (membrane potential) across the membrane of the cell, produced by the movement of charged atoms (ions). Non-pacemaker cells (including the ventricular and atrial cells) have a period, immediately after an action potential, where the membrane potential remains relatively constant; this is known as a resting membrane potential. This resting phase (see cardiac action potential, phase 4) ends when another action potential reaches the cell. This produces a positive change in membrane potential (known as depolarisation), which initiates the start of the next action potential. Pacemaker cells, however, don’t have this resting phase. Instead, immediately after one action potential, the membrane potential of these cells begins to depolarise again automatically, this is known as the pacemaker potential. Once the pacemaker potential reaches a set value, known as the threshold value, it then produces an action potential. Other cells within the heart (including the purkinje fibers and atrioventricular node; AVN) can also initiate action potentials; however, they do so at a slower rate and therefore, if the SA node is working, it usually beats the AVN to it.Heart rate depends on the rate at which the sinoatrial node produces action potentials. At rest, heart rate is between 60 and 100 beats per minute. This is a result of the activity of two sets of nerves, one acting to slow down action potential production (these are parasympathetic nerves) and the other acting to speed up action potential production (sympathetic nerves).Sinus node dysfunction describes an irregular heartbeat caused by faulty electrical signals of the heart. When the heart's sinoatrial node is defective, the heart’s rhythms become abnormal – typically too slow or exhibiting pauses in its function or a combination, and very rarely faster than normal.The sinoatrial node was first discovered by a young medical student, Martin Flack, in the heart of a mole, whilst his mentor, Sir Arthur Keith, was on a bicycle ride with his wife. They made the discovery in a makeshift laboratory set up in a picturesque farmhouse in Kent, England, called Mann's Place. Their discovery was published in 1907.Heart; conduction system (SA node labeled 1)Schematic representation of the atrioventricular bundle