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http://manila.lpu.edu.ph/about.php?test=what-caused-the-civil-war-essay what caused the civil war essay Reentry is often initiated as a result of an viagra man commercial abnormal premature electrical impulse (abnormal automaticity). Therefore, in these situations, the mechanism of the arrhythmia is both abnormal impulse formation (automaticity) and abnormal 140  section 1  |  cardiovascular disorders impulse conduction (reentry). For reentry to occur, three conditions must be present. There must be (a) at least two pathways down which an electrical impulse may travel (which is the case in most cardiac fibers). (b) a “unidirectional block” in one of the conduction pathways (this “unidirectional block” reflects prolonged refractoriness in this pathway, or increased “dispersion of refractoriness,” defined as substantial variation in refractory periods between cardiac fibers). And (c) slowing of the velocity of impulse conduction down the other conduction pathway. The process of reentry is depicted in figure 9–3. 2 under normal circumstances, when a premature impulse is initiated, it cannot be conducted in either direction down either pathway because the tissue is in its absolute refractory period from the previous impulse. A premature impulse may be conducted down both pathways if it is only slightly premature and arrives after the tissue is no longer refractory. However, when refractoriness is prolonged down one of the pathways, a precisely timed premature beat may be conducted down one pathway but cannot be conducted in either direction in the pathway with prolonged refractoriness because the tissue is still in its absolute refractory period. 2 refractoriness may be prolonged to a greater degree in one pathway than in the other as a result of increased dispersion of repolarization. When the third condition for reentry is present, that is, when the velocity of impulse conduction in one pathway is slowed, the impulse traveling forward down the other pathway still cannot be conducted. However, because the impulse in one pathway is traveling more slowly than normal, by the time it circles around and travels upward along the other pathway, sufficient time has passed so the pathway is no longer in its absolute refractory period, and now the impulse may travel upward in that pathway. In other words, the electrical impulse “reenters” a previously stimulated pathway in the a b figure 9–3. The process of initiation of reentry. There are two pathways for impulse conduction, slowed impulse conduction down pathway a and a longer refractory period in pathway b.

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