In heart failure, to compensate for decreased CO, the RAAS system does which of the following? Select all that apply.

A. Fibers: Muscle fibers refer to the individual elongated cells of cardiac or skeletal muscle, containing myofibrils responsible for contraction. While fibers make up the structural unit of the myocardium, they do not provide specialized junctions for direct ionic communication between cells and therefore do not synchronize cardiac contraction.

B. Gap junctions: Gap junctions are specialized intercellular connections located within intercalated discs of cardiac muscle. They consist of connexin proteins that form channels allowing ions, such as sodium and calcium, to flow directly between adjacent cardiomyocytes. This electrical coupling enables rapid propagation of action potentials and synchronized contraction of the myocardium during each heartbeat.

C. Desmosomes: Desmosomes are structural protein complexes within intercalated discs that mechanically anchor cardiac muscle cells to one another. They prevent cells from separating during the high mechanical stress of contraction but do not facilitate ionic flow or electrical coupling between cells.

D. Sarcolemma: The sarcolemma is the plasma membrane of a muscle cell, including cardiac myocytes, which encases the cytoplasm and myofibrils. It propagates action potentials along individual cells but does not form intercellular channels for direct ion passage between adjacent cardiac cells.

A. Skeletal muscle fibers are activated by somatic motor neurons, while cardiac cells generate action potentials via pacemaker activity: Skeletal muscle fibers are innervated by somatic motor neurons, and each action potential originates from an external neural stimulus at the neuromuscular junction. Cardiac contractile cells, in contrast, can depolarize spontaneously due to pacemaker cells in the sinoatrial node, generating intrinsic action potentials that propagate through gap junctions without direct neural input.

B. Cardiac contractile cells require anaerobic metabolism, whereas skeletal fibers depend solely on aerobic metabolism: Both cardiac and skeletal muscle fibers primarily rely on aerobic metabolism to meet energy demands. Cardiac muscle has a high density of mitochondria for continuous aerobic ATP production, whereas skeletal muscle can use both aerobic and anaerobic pathways depending on activity intensity.

C. Cardiac cells require direct stimulation from motor neurons, while skeletal fibers generate their own action potentials: Cardiac contractile cells do not require direct neural stimulation; they depolarize via pacemaker activity and conduct impulses through the myocardium. Skeletal fibers, on the other hand, rely entirely on motor neuron input to initiate contraction and cannot generate spontaneous action potentials.

D. Skeletal muscle fibers have a long refractory period, unlike cardiac cells: The refractory period of cardiac contractile cells is much longer than that of skeletal muscle fibers. This prolonged refractory period prevents tetanic contractions in the heart, allowing sufficient time for filling between beats.