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Anatomy & Physiology

CARDIOVASCULAR SYSTEM
Teuku Heriansyah

THE HEART

Lokasi Jantung

Di dalam Pericardium di rongga mediastinum dalam rongga Thorak Tepat di belakang tulang dada ( sternum ) Kurang lebih 2/3 bagian terletak di sebelah kiri dari garis tengah

Fungsi dan Ukuran

Fungsi : sebagai pompa ganda agar terjadi aliran dalam pembuluh darah yang disebabkan adanya pergantian antara kontraksi ( sistolik ) dan relaksasi ( diastolik ) Ukuran : 250 350 gram ( kira-kira sebesar kepalan tangan )

Fibrous Skeleton
Kerangka jantung yang terdiri dari jaringan kolagen yang tebal dan kuat

Penunjang fisik jantung Pegangan katup Mencegah kelebihan regangan otot jantung Electrical insulation

Anatomy of the Heart

Pericardium : Outer fibrous sack Myocardium : Thick muscle walls Endocardium : Innermost surface Endothelium Simple squamous epithelium

Perikardium

Perikardium Fibrosa Lapisan paling luar rongga Pericardium Menjaga kedudukan jantung di rongga mediastinum

Perikardium Serosa Lapisan parietalis Lapisan bagian dalam dari rongga pericardial

Lapisan visceralis / epicardium

Rongga Perikardium Cairan pericardium Mengurangi gesekan saat jantung bergerak

Anatomy of the Heart

Heart chambers :

Left & right atria Left & right ventricles Atrioventricular valves : Right : Tricuspid Left : Bicuspid/Mitral Semilunar valves Right : Pulmonary valve Left : Aortic valve

Heart valves :

Anatomy of the Heart


Coronary circulation

Aorta Coronary arteries Arterioles Capillaries Venules Coronary sinus Right atrium

Tipe-tipe sel Otot Jantung

Autoritmik

autoritmik mampu berdepolarisasi spontan produce pacemaker potentials menyalurkan aksi potensial ( impulses ) melewati myocardium tidak berkontraksi

Kontraktil

Potensial aksi menimbulkan kontraksi Aliran darah ditimbulkan oleh pergantian dari kontraksi ( SISTOLIK ) dan Relaksasi ( DIASTOLIK )

Intrinsic Conducting System

Sinoatrial node

Electrical pace maker


Receives impulses originating from SA node Electrical link between atria and ventricles Distribute impulses to ventricles

Atrioventricular node

Bundle of His

Purkinje fibres

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

Cardiac Action Potentials

Cardiac Muscle Tissue

The Electrocardiogram ( ECG )

P wave : atrial depolarisation


QRS complex : ventricular depolarisation T wave : ventricular repolarisation Atrial repolarisation hidden by QRS

The Electrocardiogram (ECG)

II

+/

III

Leads can be placed on wrists and left ankle ( right ankle is earthed ) Voltages are measured across each point as shown

I = L wrist to R wrist II = R wrist to L ankle III = L ankle and L wrist

The heart sits in the centre of the triangle

The Electrocardiogram

The three standard measurements can be used to electronically calculate the currents flowing towards each limb

aVR aVL aVF

The Cardiac Cycle

Systole :

Period of ventricular contraction Blood ejected from heart


Period of ventricular relaxation Blood filling

Diastole :

The Cardiac Cycle

Stroke Volume The amount of blood ejected from the heart in one beat Average is 60 - 100 ml Depends on preload, contractile force and afterload
Cardiac Output The amount of blood ejected from the heart in one minute Cardiac output = heart rate x stroke volume

Starlings Law The more the myocardium is stretched, the greater the stroke volume Has limits Dependent upon venous return Blood Pressure BP = cardiac output x systemic vascular resistance

Definitions

Chronotropy Inotropy

Change in heart rate Change in contractile force Dromotropy Change in conduction velocity Can be positive or negative

The Electrocardiogram

Thank You