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FISIOLOGI KARDIORESPIRASI

IRFAN SILABAN
Tujuan pembelajaran
1. Sirkulasi darah (aliran pada jantung)
2. Eksitasi dan konduksi
3. Tekanan darah, rsistensi dan hubungannya
4. Bunyi jantung normal
5. Bunyi nafas normal
6. Sistem pertukaran gas
Fisiologi dasar
Sistem sirkulasi memiliki 3 komponen dasar:
1. Jantung, memberi tekanan pada darah untuk
menghasilkan gradien tekanan yang dibutuhkan
untuk mengalirkan darah ke jantung
2. Pembuluh darah, Saluran untuk menyebarkan
darah dari jantung ke semua bagian tubuh
3. Darah, medium pengangkut tempat larutnya
bahan bahan (O2, Co2, Nutrien,dll)
LAPISAN JANTUNG
Perikardium : Lapisan luar jantung yang melindungi
lapisan dalam dan organ dalam jantung
Myokardium : Bagian tengah otot jantung, yang
terdapat diseluruh atrium dan ventrikel. Gunanya
adalah kontraksi jantung.
Endokardium :Berhubungan dengan pembuluh
darah termasuk struktur intrakardiak (otot-otot
parilarry dan katup).
A
B
M

C
L D
E
K

J F

I
H G
KATUP JANTUNG
Katup jantung merupakan jaringan fibrosa fleksibel, dilapisi
oleh endokardium.
Membuka/menutup katup dapat terjadi secara pasif
maupun aktif, tergantung kepada tekanan gradien dikedua
sisi katup
Katup atrioventrikular :
Trikuspidalis : 3 katup
Bikuspidalis : 2 katup
Katup semilunar :
Katup pulmonik : 3 buah katup
Katup aortik : 3 buah katup
GAMBAR
KATUP JANTUNG & RUANG JANTUNG

KATUP JANTUNG
Eksitasi dan konduksi
(Aktivitas Listrik Jantung)
HEART
(PUMP)
AUTOREGULATION

REGULATION
CARDIOVASCULAR SYSTEM
NEURAL

HORMONAL

VESSELS
(DISTRIBUTION SYSTEM) RENAL-BODY FLUID
CONTROL SYSTEM
Otoritmis jantung
Terdapat dua sel khusus otot jantung :
1. Sel kontraktil : 99% otot jantung, kerja
mekanis memompa darah. Dalam keadaan
normal tidak membentuk sendiri potensial
aksi nya
2. Sel otoritmik : Tidak berkontraksi, tetapi
khusus memulai adanya potensial aksi yang
menyebabkan kontraksi sel-sel kontraktil
Electricity
Intrinsic Cardiac Conduction System
Approximately 1% of cardiac muscle cells are autorhythmic rather than contractile

70-80/min

40-60/min

20-40/min
Sinoatrial (SA) Node
Normal cardiac impulse originates
here
Natural pacemaker
Inherent rate: 60-100 bpm
Atrial depolarization occurs cell to
cell
Four conduction pathways
transmit impulse to AV node:
Bachmans Bundle and 3 internodal
pathways (anterior, middle &
posterior tracts).
Spreads impulse throughout
the atrium
Atriovenous (AV) Node
Located inferiorly in RA
All impulses initiated in atria will
be conducted to ventricles via AV
node alone.
Impulse slows here to allow
diastolic filling time
Inherent rate: 40-60 bpm
Conduction delay at AV node so
that ventricular filling from atrial
contraction
Bundle of HIS
Electrical impulses conducted
to ventricles via Bundle of HIS
& purkinjie fibers
Divides into bundle branches
Right
Left
Anterior Fascicle
Posterior Fascicle
Purkinje Fibers

Impulse stimulates
ventricular myocardial
cells
Inherent rate: 20-40 bpm
Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)
Characteristics of Pacemaker Cells
Unstable membrane potential
bottoms out at -60mV
drifts upward to -40mV, forming a pacemaker potential
Myogenic
The upward drift allows the membrane to reach threshold
potential (-40mV) by itself
This is due to
1. Slow leakage of K+ out & faster leakage Na+ in
Causes slow depolarization
Occurs through If channels (f=funny) that open at negative
membrane potentials and start closing as membrane approaches
threshold potential
2. Ca2+ channels opening as membrane approaches threshold
At threshold additional Ca2+ ion channels open causing more rapid
depolarization
These deactivate shortly after and
3. Slow K+ channels open as membrane depolarizes causing an
efflux of K+ and a repolarization of membrane
Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)

Altering Activity of Pacemaker Cells


Sympathetic activity
NE and E increase If channel activity
Binds to 1 adrenergic receptors which activate cAMP and
increase If channel open time
Causes more rapid pacemaker potential and faster rate of action
potentials
Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)
Altering Activity of Pacemaker Cells
Parasympathetic activity
ACh binds to muscarinic receptors
Increases K+ permeability and decreases Ca2+ permeability =
hyperpolarizing the membrane
Longer time to threshold = slower rate of action potentials
Myocardial Physiology
Contractile Cells
Special aspects
Intercalated discs
Highly convoluted and interdigitated
junctions
Joint adjacent cells with
Desmosomes & fascia adherens
Allow for synticial activity
With gap junctions
More mitochondria than skeletal muscle
Less sarcoplasmic reticulum
Ca2+ also influxes from ECF reducing storage
need
Larger t-tubules
Internally branching
Myocardial contractions are graded!
Myocardial Physiology
Contractile Cells
Special aspects
The action potential of a contractile cell
Ca2+ plays a major role again
Action potential is longer in duration than a normal action potential
due to Ca2+ entry
Phases
4 resting membrane potential @ -90mV
0 depolarization
Due to gap junctions or conduction fiber action
Voltage gated Na+ channels open close at 20mV
1 temporary repolarization
Open K+ channels allow some K+ to leave the cell
2 plateau phase
Voltage gated Ca2+ channels are fully open (started during initial
depolarization)
3 repolarization
Ca2+ channels close and K+ permeability increases as slower activated
K+ channels open, causing a quick repolarization
Depolarization of atrium and ventricle
Heart Excitation Related to ECG

P wave: atrial
START depolarization
P

The end
R PQ or PR segment:
conduction through
T AV node and A-V
P
bundle
QS P

Atria contract.
T wave:
ventricular Repolarization ELECTRICAL
Repolarization R EVENTS
OF THE
P T CARDIAC CYCLE
QS
P Q wave
Q
ST segment
R

R wave
P R
QS
R P
Ventricles contract.
Q
P S wave
QS
PENGATURAN TEKANAN DARAH

Pusat kardiovaskular di MO
Neuronal: reflex baroreseptor, reflex
kemoreseptor
Hormonal:
RAA
Epinefrin dan NE
ADH
Atrial natriuretic Peptide (ANP)
Autoregulasi
PENGATURAN JANGKA PENDEK TERHADAP PENURUNAN TD
PENGATURAN JANGKA PENDEK TERHADAP PENINGKATAN TD
Efek gravitasi terhadap tekanan darah (perubahan
posisi)
Faktor lain yang mempengaruhi tekanan darah
Tekanan vena dan faktor yang mempengaruhi