Sistem Kardiovaskular

LILIK HERAWATI lilik_wahyu99@yahoo.com lilik_heraw@fk.unair.ac.id

Nutrisi jantung
Sirkulasi koroner
Arteri koronaria kanan & kiri cabang dari aorta

Penyakit jantung koroner nyeri khas (ANGINA PEKTORIS)

PERUBAHAN ALIRAN DARAH KORONER

SISTOLE : Penekanan kuat otot jantung Aliran darah DIASTOLE :Relaksasi otot jantung Darah mengalir cepat Penurunan aliran darah di ventrikel berlawanan dengan aliran darah di semua jaringan tubuh Aliran darah koroner : 225 ml / min (4-5 % CO)

Atherosklerosis

Penyakit jantung koroner

etiol: aterosklerosis 1. endapan lemak (bercak lemak) 2. penimbunan lemak 3. plak fibrosa 4. plak ateroma 5. perubahan degenaratif

perub patologis pemb darah belum menunjukkan tanda-tanda gangguan prosesnya berlangsung selama 20-40 tahun timbul keluhan klinis jika lumen telah tertutup >75%

lumen sempit perdarahan pada plak aterom trombus embolus

Risk factors
tidak dapat diubah umur sex ras riwayat keluarga dapat diubah mayor
lipid serum, glukosa... HT merokok diet tinggi...

minor
gaya hidup kurang gerak stres tipe kepribadian

Sistem konduksi
SA node (pace maker) AV node Berkas His Berkas purkinye

Siklus jantung
= periode mulai dari akhir kontraksi s.d akhir kontraksi berikutnya Sistole Diastole Normal denyut jantung = denyut nadi (cermin siklus jantung)

Suara jantung
Didengar dgn telinga & alat bantu Suara 1 = S1
Lub Menutupnya katup atrio-ventrikular

Suara 2 = S2
Dub Menutupnya katup semilunar

Daya pompa jantung

Heart rate (denyut jantung) Stroke volume (volume sekuncup) Cardiac Output (curah jantung) HR x SV = CO 70 bpm x 70 ml = 4900 ml/mnt 5 liter/mnt

Pengaturan faal jantung

Instriksik nodus & sistem konduksi

Ekstrinsik saraf otonom (> dominan)

Simpatis Parasimpatis

Faktor yg mempengaruhi pompa jantung:

1. tekanan darah 2. kadar ion 3. suhu 4. hiperkapnea hipoksia asidosis 5. Obat , mis: Digitalis,Barbiturat,Cafein, teofilin 6. exercise

Capillary beds

Pengukuran

Tekanan darah Pulse pressure (Mean arterial pressure)

Pengukuran TD

Velocity

Regulasi
Jangka pendek: Kimiawi

Hormon (adrenalin & noradrenalin) Atrial natriuretic peptide (ANP)

disekresi atrium jantung antagonis aldosteron efek: vadil

ADH Angiotensin II

vakonst menrang aldosteron

EDF (endothelium-derived factors)

naril A

SIRKULASI SISTEMIK SIRKULASI PARU SIRKULASI OTAK SIRKULASI SPLANCNICH SIRKULASI KORONER DLL

Pembuluh LIMFE
Muara akhir saluran / pembuluh limfe ada di pembuluh darah yaitu vena subklavia Fungsi a.l: Membantu aliran darah Tempat absorpsi lemak (misal khilomikron)

Faal DARAH
(singkat)

LILIK HERAWATI
Physiology Departement Faculty of Medicine Airlangga University

lilik_wahyu99@yahoo.com

The blood functions

transports materials: oxygen and carbon dioxide food molecules (glucose, lipids, amino acids) ions (e.g., Na+, Ca2+, HCO3) wastes (e.g., urea) hormones heat defense of the body against infections and other foreign materials

Plasma
roles in homeostasis ==> such as maintaining:
normal plasma pH osmolality

composed:
mostly of water (91%) Proteins 6-8% lipids (fats) 0,6% Glucose 0,1% amino acids vitamins minerals hormones wastes cofactors gases electrolytes

Red Blood Cells (Erythrocytes)

Fungsi utama: mengandung hemoglobin yang membawa oxygen The other functions:
they contain a large quantity of carbonic anhydrase, an enzyme that catalyzes CO2 + H2O H2CO3
acid-base buffer

Guyton, 2005

 The period from stem cell to the reticulocyte in the circulation normally takes approximately 1 week Maturation of reticulocyte to erythrocyte takes approximately 24 to 48 hours
the red cell loses its mitochondria and ribosomes, along with its ability to produce hemoglobin and engage in oxidative metabolism

Most maturing red cells enter the blood as reticulocytes ==> Approximately 1% ==> erythropoietic activity of the bone marrow

Bahan baku eritrosit

a.l: protein vitamin B12 asam folat besi

Regulasi pembentukan eritrossit

hipoksia jaringan kemampuan fungsional eritrosit & tubuh mentranspor O2 ke jaringan BUKAN HANYA oleh konsentrasi eritrosit dalam darah

 Umur 120 hari

Terutama di lien diameter 3

Disease
Anemia (kekurangan eritrosit/ Hb)
Perdarahan akut; kronik Umur pendek: hemolytic anemia Produksi terganggu; pabrik rusak; bahan kurang; EPO <<<

Polisitemia (eritrosit berlebih (> 6 juta/ mm3)

Relatif : dehidrasi Absolut: Sekunder Vera (eritrema)

Fungsi Leukosit
the mobile units of the bodys protective system Mekanisme kekebalan:
(1)phagocytosis (2)forming antibodies and sensitized lymphocytes

WBCs

Fungsi
Neutrofil : fagositosis bakteri & benda asing Eosinofil : Fagosit lemah menanggulangi inf.parasit terlibat dlm proses radang pd kead. : alergi

Fungsi
Basofil : produksi histamin, bradikinin, serotonin, heparin, enzim lisosom berperan dalam terjadi alergi Ig E terikat dengan basofil Ada Ag, & Ag terikat di IgE basofil ruptur sekresi zat Monosit-makrofag Fagositosis monosit-makrofag system/ reticuloendothelial sytem

Respon leukosit terhadap Keradangan

1st line defense makrofag jaringan 2nd line defense : netrofil
1. pembuluh darah netrofil marginasi, diapedesis & kemotaksis 2. Mengirim sinyal ke sutul mobilisasi leukosit leukositosis/neutrofilia

3rd line defense : Monosit makrofag Butuh waktu

Respon leukosit terhadap Keradangan

4th line defense : memicu stem cell (di bone marrow) Utk meningkatkan pembentukan lekosit baru granulosit, monosit dan limfosit

Vaccination and Antibody Response

Platelet / Trombosit
the megakaryocytes fragment 1 to 4 micrometers; nuclei - & reproduction normal = 150,000 - 300,000 per microliter lifespan: 15 to 45 days in the circulation Production: in the bone marrow from megakaryocytes

 Hemostasis means prevention of blood loss (whenever a vessel is severed or ruptured) Mechanisms in hemostasis:

DEFINITION & MECHANISMS

(1) vascular constriction (2) formation of a platelet plug (3) formation of a blood clot as a result of blood coagulation (4) growth of fibrous tissue to close the hole in the vessel permanently

Platelet Plug Formation

If the cut in the blood vessel ==> sealed by a platelet plug

BLOOD CLOT ~ Coagulation cascade

Blood Types
ABO
according to antigens on red blood cells Type A: A antigens Type B: B antigens Type O: no antigens (universal donor) Type AB: A and B antigens (universal recipient)

Rhesus
5 main Rhesus antigens (C, c, D, E and e) a. Rh factor positive: D antigen is present b. Rh factor negative: D antigen is not present antibodies are developed against the Rh factor ==> through placental sensitization or translation

What are Blood Types?

Karl Landsteiner in the early 1900s. There are four types of blood in the ABO system: A, B, AB, O.

Blood Transfusions whole blood fractionated into components, including: RBCs platelets plasma

Good Luck