Ion Adventures : Dr. Dale Dublin
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Cardiac Monitors
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This is an educational web site by Dr. Dale Dubin (Dale Dubin, M.D.), which includes important EKG (ECG) information about EKG tracings, 12 lead EKG's, and cardiac monitors. All web sites offer free PDF downloads.

To order Rapid Interpretation of EKG's, scroll to the bottom of the page.

Ion Adventure in the Heartland
Readers will understand and retain –
how the heart functions at the ionic-molecular level including:

• The teleology of the ion-kinetic mechanisms of the ionic-molecular microcosm
• How three little ions produce conduction through, and contraction of, the heart
• The simple ionic mechanism of cell-to-cell myocardial conduction
• How ion movement translates into vectors
• The movement of ions that produces EKG recordings
• How the atria contract without backflow into the great veins and pulmonary veins
• Why there are automaticity foci in the large vein ostia of the atria
• The homeostatic necessity of automaticity foci in emergency situations
• A simplified methodology for understanding autonomic function
• How troponin components participate in myocyte contraction and relaxation
• TnC, TnI, and TnT function
• Size of ions matters
• Why ion-kinetic (ion-moving) structures like ion channels are essential to cell function
• How the ion pumps produce the gradients that drive ions through ion channels and ion exchangers
• Evolution of the Na/Ca ATPase pump
• How the Autonomic Nervous System (ANS) controls ion-kinetic structures by phosphorylation and dephosphorylation
• The nature of sympathetic stimuli and parasympathetic inhibition on the ionic-molecular level
• Voltage versus ligand activation of ion channels
• The peculiar Cl- channels and their purpose during the Action Potential
• How ion channels select certain ions
• How Ca++ ions produce myocyte contraction on the ion level
• The function of the CICR
• How the CICR produces effective myocyte contraction and generates an outward Ca++ ion gradient
• The necessity of ryanodine Ca++ channels
• The tandem function of L-type and ryanodine-type Ca++ channels
• How the sarcoplasmic reticulum (SR) functions
• How the SR stores and releases Ca++ ions
• How myocytes employ Ca++ binding proteins
• The ionic-molecular function that initiates and maintains the myocyte power stroke
• Why T tubules are necessary in the myocyte yet absent from Purkinje cells
• Why myocytes need both superficial and deep cisternae
• The ionic-molecular physiology of myocyte relaxation (diastole) following contraction (systole)
• Why both the cell membrane and the sarcoplasmic reticulum need Ca++ ATPase pumps
• The functions of Na/Ca exchangers
• How and why Na/Ca exchanger function is linked to Na+ channel function
• Explanation of why Na/Ca exchanger function fluctuates during the Action Potential
• Although the cell membrane Ca++ATPase pump and the Na/Ca exchanger remove free Ca++ ions from the myocyte, most Ca++ ions go elsewhere
• Why the myocardium acts like a syncytium to conduct with negligible resistance
• Why gap junction terminology is being replaced by the more specific connexon/connexin protein model
• How gradients move ions through connexons
• The exact nature of cell-to-cell conduction
• The fascinating mechanisms of cell-to-cell depolarization
• How ion channel threshold potential perpetuates cell-to-cell conduction
• Homeostatic function of the Na/H pump and its emergency response
• How myocytes, AV node cells, and Purkinje cells depolarize
• How advancing Na+ ion waves produce the vectors of myocardial conduction
• The nature of “fast” and “slow” Na+ currents
• The anatomy, physiology, and kinetics of Na+ channel opening
• Why ion channel flow is described in terms of open probability
• Why ion channel function requires three operational states
• The necessity of closed versus inactivated ion channel status
• The specific peptide loop dynamics of fast and slow inactivation
• Why ion channels have periods of refractoriness and responsiveness
• The clinical importance of ion channel recovery from inactivation
• The ionic-molecular dynamics of repolarization
• How K+ channels repolarize the myocyte to baseline potential
• Methodology of rectification of ion channel currents; how and why
• The repolarizing K+ channels and the K+ channels that maintain baseline potential
• The teleology of the delayed-rectifier K+ channels
• The physiological reason for the extended plateau of the action potential
• IK1 function and baseline potential
• The ion-kinetic structures that participate in the plateau
• The pathophysiology of Long QT (LQT) syndromes
• Autonomic modulation via G protein intermediaries
• How autonomic function affects automaticity
• How autonomic function affects myocardial conduction and contraction
• How the autonomic nervous system (ANS) regulates AV node conduction
• Discovery of the ionic-molecular etiology of Wenckebach conduction
• ANS input via sensor-receptors provides the data for cardiac homeostasis
• How sympathetic and parasympathetic receptors modulate the function of ion-kinetic structures
• How sympathetic and parasympathetic receptors affect each other’s function
• How parasympathetic influence interferes with sympathetic phosphorylation of ion-kinetic structures
• Bouton-bouton parasympathetic inhibition of sympathetic stimulation
• Parasympathetic inhibition of sympathetic ganglia
• G protein participation in phosphorylation and dephosphorylation activity
• Adenosine – where and why it originates, and how it works
• Phospholamban and Ca++ sequestration in the sarcoplasmic reticulum
• Homeostatic parasympathetic-sympathetic interaction and interdependance
• Wenckebach conduction as vital homeostatic emergency mechanism
• How K+ channel modulation modifies the action potential and affects the heart
• The function of A1 receptors and M2 receptors
• Na/K ATPase pumps produce and maintain of K+ and Na+ gradients
• The AV node as a homeostatic necessity
• Filtering effects of the AV node
• The role of automaticity foci
• Why AV node cells lack Na+ channels, but Na+ ion influx initiates AV node depolarization
• How Ca++ channels select Ca++ ions from a sea of Na+ ions
• Ca++ channel: structural kinetics of activation
• Fast and slow inactivation kinetics of Ca++ channels
• Slow AV node conduction at the ionic-molecular level
• Calmodulin-assisted fast inactivation of Ca++ channels
• Peptide loop slow inactivation of Ca++ channels
• Sympathetic stimulation of ion-kinetic structures of AV node cells and their parasympathetic inhibition
• Parasympathetic IK(ACh) channel activation inhibits AV node conduction
• Purkinje cell conduction and the ventricular conduction system
• Ionic-molecular mechanisms that facilitate rapid conduction through Purkinje cells
• Na+ channel and Na/Ca exchanger participation in Purkinje depolarization
• Refractoriness of Purkinje cells and Mobitz AV block
• How Mobitz block at normal sinus rates or high degree Mobitz block causes dangerous bradycardia
• Purkinje repolarization and K+ channel activity
• The relation between Purkinje depolarization and conduction
• Ionic-molecular explanation of refractoriness of the ventricular conduction system
• LQT3 and Na+ channel function
• Autonomic regulation of the SA node and automaticity foci
• Autonomic sensor-receptors and SA node homeostasis
• The ion-kinetic structures of the P (pacing) cells of the SA node
• Autonomic modulation of P cell pacing
• Sympathetic/parasympathetic modulation of ion-kinetic structures of the SA node
• IK(ACh) channels and parasympathetic inhibition of the sinus pacing rate
• Ion-kinetic structures are responsible for every aspect of cardiac physiology and pathophysiology.

Ion Adventure in the Heartland, Volume I
by Dale Dubin, M.D.

Hardbound, 81/2" by 11" • 390 pages • Weighs 5 Pounds
Profusely illustrated in full color
ISBN 0-912912-11-1
Price $85

Cover Publishing Co.
P.O. Box 1092, Tampa, FL 33601
e-mail: [email protected]
Telephone: 800-441-8398

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Ion Adventure in the Heartland, Volume I
by Dale Dubin, M.D.

Hardbound, 81/2" by 11" • 390 pages
Weighs 5 Pounds
Profusely illustrated in full color
ISBN 0-912912-11-1
Price $59.95
To order:
Ion Adventure in the Heartland
Canada: The most efficient and least
expensive way to order for Canada
is through:
Credit Card orders by telephone, please call:
  In North America: 1 (800) 441-8398
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