Natural pacemaker: The natural pacemaker of the heart is the sinus node, one of the major elements in the cardiac conduction system, the system that controls the heart rate. This stunningly designed system generates electrical impulses and conducts them throughout the muscle of the heart, stimulating the heart to contract and pump blood.

The sinus node consists of a cluster of cells that are situated in the upper part of the wall of the right atrium (the right upper chamber of the heart). The electrical impulses are generated there. The sinus node is also called the sinoatrial node or, for short, the SA node.

The electrical signal generated by the sinus node moves from cell to cell down through the heart until it reaches the atrioventricular node (AV node), a cluster of cells situated in the center of the heart between the atria and ventricles. The AV node serves as a gate that slows the electrical current before the signal is permitted to pass down through to the ventricles. This delay ensures that the atria have a chance to fully contract before the ventricles are stimulated. After passing the AV node, the electrical current travels to the ventricles along special fibers embedded in the walls of the lower part of the heart.

The autonomic nervous system, the same part of the nervous system as controls the blood pressure, controls the firing of the sinus node to trigger the start of the cardiac cycle. The autonomic nervous system can transmit a message quickly to the sinus node so it in turn can increase the heart rate to twice normal within only 3 to 5 seconds. This quick response is important during exercise when the heart has to increase its beating speed to keep up with the body's increased demand for oxygen.

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