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Myocardial contractility represents the intrinsic ability of the heart/myocardium to contract. Changes in the ability to produce force during contraction result from incremental degrees of binding between myosin (thick) and actin (thin) filaments. The degree of binding that occurs depends on concentration of calcium ions in the cell. Within an in vivo intact heart, it is generally the action/response of the sympathetic nervous system driven by precisely time released catecholamine that determines the concentration of calcium ions in the cytosol of cardiac muscle cells. All factors that cause an increase in contractility work by causing an increase in intracellular () during contraction. ==Mechanisms for altering contractility== Increasing contractility is done primarily through increasing the influx of calcium or maintaining higher calcium levels in the cytosol of cardiac myocytes during an action potential. This is done by a number of mechanisms: * 1. Sympathetic activation. Increased circulating levels of catecholamines (which can bind to β-Adrenergic activation) as well as stimulation by sympathetic nerves (which can release norepinepherine that binds to β1-adrenoceptors on myocytes) causes the Gs subunit of the receptor to render adenylate cyclase activated, resulting in increase of cAMP - which has a number of effects including dephosphorylating phospholamban. * 2. Phosphorylating phospholamban. When phospholamban is not phosphorylated, it inhibits the calcium pumps that pump calcium back into the sarcoplasmic reticulum. When it's phosphorylated by PKA, levels of calcium stored in the sarcoplasmic reticulum are increased, allowing a higher rate of calcium being released at the next contraction. * 3. Sensitizing troponin-C to the effects of calcium. * 4. Phosphorylating L-type calcium channels. This will increase their permeability to calcium, allowing more calcium into the myocyte cells, increasing contractility. * 5. An abrupt increase in afterload can cause a small increase in inotropy (Anrep effect) by a mechanism that is not fully understood. * 6. An increase in heart rate also stimulates inotropy (Bowditch effect; treppe; frequency-dependent inotropy). This is probably due to the inability of Na+K+-ATPase to keep up with the sodium influx at the higher frequency of action potentials at elevated heart rates * 7. Drugs. Drugs like digitalis can act as a positive inotropic agent by inhibiting the Na+/K+ pump. High Na+ concentration gradient is necessary to pump out sarcoplasmic calcium via a the Na+/Ca+ antiporter. Inhibition of the Na+/K+ causes extra sodium to accumulate inside the cell. The build up the Na+ concentration inside the cell will cause the gradient from inside the cell to the outside of the cell to decrease slightly. This action will make it more difficult for calcium to leave the cell via the Na+/Ca+ antiporter. * 8. Increase the amount of calcium in the sarcoplasm or in the T-tubules. More calcium available for Troponin to use will increase the force developed. Decreasing contractility is done primarily through decreasing the influx of calcium or maintaining lower calcium levels in the cytosol of cardiac myocytes during an action potential. This is done by a number of mechanisms: * 1. Parasympathetic activation. * 2. Phosphorylating phospholamban. When phospholamban is phosphorylated, it can no longer inhibit the calcium pumps that pump calcium back into the sarcoplasmic reticulum. This allows the cell to reuptake calcium from the cytosol more quickly, decreasing contractility. * 3. If the heart is experienceing anoxia, hypercapnia (increased CO2) or acidosis, the heart cells will enter a state of dysfunction and not work properly. Correct sarcomere crossbridges will not form the heart becomes less efficient (leading to myocardial failure). * 4. Loss of parts of the myocardium. Heart attack can cause a section of the ventricular wall dies off, that portion cannot contract and there is less force developed during systole. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Myocardial contractility」の詳細全文を読む スポンサード リンク
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