Siklus Jantung (sistole

dan distole)

Peristiwa mekanis siklus jantung (sistole dan diastole)

Suara jantung
Curah jantung / cardiac output
Pengaturan fungsi jantung
Autoregulasi intrinsik
Pengaturan saraf

Topik

Structure of the heart, and course of blood flow

through the heart chambers and heart valves.

Structure of the heart, and course of blood flow

through the heart chambers and heart valves.

PERISTIWA MEKANIS SIKLUS

JANTUNG (SISTOLE DAN DIASTOLE)

 The cardiac events that occur from the beginning of one

heartbeat to the beginning of the next are called the
cardiac cycle.
Each cycle is initiated by spontaneous generation of an
action potential in the sinus node, the action potential
travels from here rapidly through both atria and then
through the A-V bundle into the ventricles.

The Cardiac Cycle

 The atria act as primer pumps for the ventricles,

and the ventricles in turn provide the major
source of power for moving blood through the
bodys vascular system.

The Cardiac Cycle

 The cardiac cycle consists of :

a period of relaxation called diastole - during
which the heart fills with blood, followed by
a period of contraction called systole.

Diastole and Systole

Events of the cardiac cycle for left ventricular

function, showing changes in left atrial
pressure, left ventricular pressure, aortic
pressure, ventricular volume, the
electrocardiogram, and the phonocardiogram

 Atria as primer pumps

Ventricle as pumps
Emptying of ventricle during systole Isovolumic (Isometric) contraction
Period of ejections (fast and slow ejections)
Period of Isovolumic (Isometric) Relaxation
End-Diastolic Volume, End-Systolic Volume, and
Stroke Volume Output

Heart cylce

Relationship between left ventricular volume and

intraventricular pressure during diastole and
systole.

 Atrioventricular ValvesThe
the tricuspid and mitral valves - prevent backflow of blood from
the ventricles to the atria during systole, and
the semilunar valves (the aortic and pulmonary artery valves)
prevent backflow from the aorta and pulmonary arteries into the
ventricles during diastole

Function of the Papillary Muscles

Aortic and Pulmonary Artery Valves

Function of the Valves

Mitral and aortic valves (the left ventricular valves).

SUARA JANTUNG

 When listening to the heart with a stethoscope, one does

not hear the opening of the valves because this is a
relatively slow process that normally makes no noise.
However, when the valves close, the vanes of the valves
and the surrounding fluids vibrate under the influence
of sudden pressure changes, giving off sound that travels
in all directions through the chest.

Relationship of the Heart

Sounds to Heart Pumping

 When the ventricles contract,

a sound caused by closure of the A-V valves.
The vibration is low in pitch and relatively long-lasting and
is known as the first heart sound.

When the aortic and pulmonary valves close at the end of

systole,
a rapid snap because these valves close rapidly, and the
surroundings vibrate for a short period.
This sound is called the second heart sound.

Relationship of the Heart

Sounds to Heart Pumping

 Listening with a stethoscope to a normal heart, one hears a

sound usually described as lub, dub, lub, dub.
The lub is associated with closure of the atrioventricular (A-V)
valves at the beginning of systole, and
the dub is associated with closure of the semilunar (aortic and
pulmonary) valves at the end of systole.

The lub sound is called the first heart sound, and the dub is
called the second heart sound, because the normal pumping
cycle of the heart is considered to start when the A-V valves
close at the onset of ventricular systole.

Heart Sounds

 The duration of each of the heart sounds is

slightly more than 0.10 secondthe first sound
about 0.14 second, and the second about 0.11
second.

 Vibration of the taut valves immediately after closure,

along with vibration of the adjacent walls of the heart and
major vessels around the heart.
Contraction of the ventricles first causes sudden backflow
of blood against the A-V valves (the tricuspid and mitral
valves), causing them to close and bulge toward the atria
until the chordae tendineae abruptly stop the back bulging.
The elastic tautness of the chordae tendineae and of the
valves then causes the back surging blood to bounce
forward again into each respective ventricle

Causes of the First and

Second Heart Sounds

 This causes the blood and the ventricular walls, as well as

the taut valves, to vibrate and causes vibrating turbulence
in the blood.
The vibrations travel through the adjacent tissues to the
chest wall, where they can be heard as sound by using the
stethoscope.

Causes of the First and

Second Heart Sounds

 The second heart sound results from sudden closure of the

semilunar valves at the end of systole.
When the semilunar valves close, they bulge backward toward the
ventricles, and their elastic stretch recoils the blood back into the
arteries, which causes a short period of reverberation of blood back
and forth between the walls of the arteries and the semilunar valves,
as well as between these valves and the ventricular walls.

The vibrations occurring in the arterial walls are then transmitted

mainly along the arteries. When the vibrations of the vessels or
ventricles come into contact with a sounding board, such as
the chest wall, they create sound that can be heard.

Causes of the First and

Second Heart Sounds

Amplitude of different-frequency vibrations in the

heart sounds
and heart murmurs in relation to the threshold of
audibility,
showing that the range of sounds that can be heard
is between
40 and 520 cycles/sec.

Chest areas from which sound from each valve is

best heard.

Phonocardiograms from normal and

abnormal hearts.

 many abnormal heart sounds, known as heart

murmurs, occur when there are abnormalities of the
valves

Systolic Murmur of Aortic Stenosis

Diastolic Murmur of Aortic Regurgitation
Systolic Murmur of Mitral Regurgitation
Diastolic Murmur of Mitral Stenosis

Heart Murmurs Caused by

Valvular Lesions

CURAH JANTUNG (CARDIAC

OUTPUT)

 Cardiac output : quantity of blood pumped into the aorta

each minutes by the heart
Venous return : quantity of blood flowing from the vein
into the right atrium
VENOUS RETURN = CARDIAC OUTPUT

Concepts

 Varies with the level of activity

Factors :

Level of body metabolism

Activity (exercise)
Age
Body size

Cardiac index : cardiac output /m2 body surface are

Normal values for cardiac output at

rest and during activity

 CARDIAC OUT (CO) =

HEART RATE (HR) X
STROKE VOLUME (SV)

CARDIAC OUTPUT

Role of the Frank-Starling mechanism of the heart

Related to venous return
Heart has a built-in mechanism to pump automatically
Heart rate increase increase of heart stretch SA
node :
HR increase
Brainbridge reflex

Control of cardiac output

by venous return

 Person in rest : 4 6 liter / minutes

Exercise : 4 7 times of rest
Regulated by :
Intrinsic cardiac regulation of pumping in response to
changes in volume of blood flowing into the heart
Control of heart rate and strength of heart pumping by the
autonomic nervous system

Heart pumping

 Venous return rate of blood flow into the heart from the
veins
Consist of peripheral tissues flow
Affect to Cardiac output
Heart will pumps into the systemic arteries

Intrinsic ability of heart to adapt to changing volumes of

inflowing blood Frank-Starling mechanism of the heart

Intrinsic regulation of heart pumping

The Frank-Starling Mechanism

EXTRA
AMOUNT OF
BLOOD TO
VENTRICLE

CARDIAC
MUSCLE
STRETCH

MUSCLE
CONTRACT
WITH INCREASE
FORCE

VENTRICLE
PUMPS EXTRA
BLOOD TO
ARTERIES

Frank-starling mechanism

Cardiac index for the human being (cardiac output

per square meter of surface area) at different ages.

Effect of increasing levels of exercise to increase

cardiac output (red solid line) and oxygen
consumption (blue dashed line).

 Sum of blood flow regulation in all local tissue of body

tissue metabolism local blood flow
Cardiac output = arterial pressure / total peripheral resistance

Hypereffective heart
Nervous stimulation
Hypertrophy of heart muscle

Hypoeffective heart
Inhibition of nervous excitation
Pathological factors, etc

Cardiac output regulation

Chronic effect of different levels of total peripheral

resistance on cardiac output, showing a reciprocal
relationship between total peripheral resistance
and cardiac output.

Cardiac output curves for the normal heart and for

hypoeffective and hypereffective hearts.

Cardiac output in different pathological conditions.

The numbers in parentheses indicate number of
patients studied in each condition.

Cardiac output curves at different levels of

intrapleural pressure and at different degrees of
cardiac tamponade.

Combinations of two major patterns of

cardiac output curves showing the effect
of alterations in both extracardiac
pressure and effectiveness of the heart as
a pump.

PENGATURAN FUNGSI JANTUNG

(AUTOREGULASI INTRINSIK DAN
PENGATURAN SARAF)

 What are some of the specific needs of the tissues for blood
flow?
Delivery of oxygen to the tissues.
Delivery of other nutrients, such as glucose, amino acids, and
fatty acids.
Removal of carbon dioxide from the tissues.
Removal of hydrogen ions from the tissues.
Maintenance of proper concentrations of other ions in the tissues.
Transport of various hormones and other substances to the
different tissues.

Local Control of Blood Flow

in Response to Tissue Needs

Blood Flow to Different Organs and Tissues Under

Basal Conditions

 Increased of arterial pressure cause an immediate rise of

blood flow
Metabolic theory
Myogenic theory

Specific tissue
Juxtaglomerular apparatus in kidney
Brain : O2, CO2, H

Auto regulation of blood

flow

 Regulation by substances secreted or absorbed into the

body fluids
Vasoconstrictor agent
Norepinephrine epinephrine
Angiotensin
Vasopressin (ADH)

Vasodilator agents
Bradykinin
Histamine

Humoral regulation

Calcium vasoconstriction
Potassium vasodilatation
Magnesium vasodilatation
Acetate and citrate vasodilatation
Hydrogen dilatation of arterioles

Effect of ion and other chemical

factors on vascular control

 The nervous system controls the circulation almost

entirely through the autonomic nervous system.
By far the most important part of the autonomic nervous
system for regulating the circulation is
the sympathetic nervous system
the parasympathetic nervous system

Nervous Regulation of the

Circulation

 Important : when venous return and cardiac output

increase
In exercise : providing additional signals to raise the
arterial pressure increase cardiac output

Role nervous system in

controlling cardiac output

Anatomy of sympathetic nervous control of the circulation.

Also shown by the red dashed line is a vagus nerve that
carries parasympathetic signals to the heart.

Anatomy of sympathetic nervous control of the circulation.

Also shown by the red dashed line is a vagus nerve that
carries parasympathetic signals to the heart.

Sympathetic innervation of the systemic circulation.

 Most arterioles of the systemic circulation are

constricted.
The veins especially (but the other large vessels
of the circulation as well) are strongly
constricted.
The heart itself is directly stimulated by the
autonomic nervous system, further enhancing
cardiac pumping.

Role of the Nervous System in

Rapid Control of Arterial Pressure

 The nervous mechanisms for arterial pressure control is

the baroreceptor reflex.
initiated by stretch receptors, called either baroreceptors or
pressoreceptors
A rise in arterial pressure stretches the baroreceptors and
causes them to transmit signals into the central nervous
system.
Feedback signals are then sent back through the
autonomic nervous system to the circulation to reduce
arterial pressure downward toward the normal level.

The Baroreceptor Arterial Pressure

Control SystemBaroreceptor
Reflexes

 After the baroreceptor signals have entered the tractus

solitarius of the medulla
secondary signals inhibit the vasoconstrictor center of the
medulla and
excite the vagal parasympathetic center.

The net effects are

(1) vasodilation of the veins and arterioles throughout the
peripheral circulatory system and
(2) decreased heart rate and strength of heart contraction.

Circulatory Reflex Initiated by the

Baroreceptors

 Therefore, excitation of the baroreceptors by high pressure in the

arteries reflexly causes the arterial pressure to decrease because of
both a decrease in peripheral resistance and a decrease in cardiac
output.
Conversely, low pressure has opposite effects, reflexly causing the
pressure to rise back toward normal.
Because the baroreceptor system opposes either increases or
decreases in arterial pressure, it is called a pressure buffer system,
and the nerves from the baroreceptors are called buffer nerves.

Circulatory Reflex Initiated by the

Baroreceptors

 Sympathetic :
Increase heart rate
Increase the force of contraction
Increase cardiac output

Parasympathetic (vagal)
Decrease heart rate
Decrease the force of contraction

Effect of sympathetic and

parasympathetic

 Potassium Hyperkalemia :

heart dilated and flaccid

slow of heart rate
block impulse from atria
abnormal rhythm
Decrease the resting membrane potential

Calcium hypercalcemia :
Spastic contraction

Temperature :
Fever : increase heart rate

Heart function and its

function

 During heavy exercise, the muscles require greatly

increased blood flow. Part of this increase results from
local vasodilation of the muscle vasculature caused by
increased metabolism of the muscle cells.
Additional increase results from simultaneous elevation
of arterial pressure caused by sympathetic stimulation of
the overall circulation during exercise.
In most heavy exercise, the arterial pressure rises about 30
to 40 per cent, which increases blood flow almost an
additional twofold.

Increase in Arterial Pressure During Muscle

Exercise and Other Types of Stress

 Abdominal Compression Reflex

Increased Cardiac Output and Arterial Pressure Caused
by Skeletal Muscle Contraction During Exercise

Role of the Skeletal Nerves and Skeletal

Muscles in Increasing Cardiac Output and
Arterial Pressure

 Most nervous control of blood pressure is achieved by :

the baroreceptors,
the chemoreceptors, and
the low-pressure receptors
When blood flow to the vasomotorcenter in the lower
brain stem becomes decreased severely enough to cause
nutritional deficiencythat is, to cause cerebral ischemia
the vasoconstrictor and cardioaccelerator neurons in
the vasomotor center respond directly to the ischemia and
become strongly excited
Central Nervous System Ischemic ResponseControl of
Arterial Pressure by the Brains Vasomotor Center in
Response to Diminished Brain Blood Flow

 The degree of sympathetic vasoconstriction

caused by intense cerebral ischemia is often so
great that some of the peripheral vessels become
totally or almost totally occluded.

Central Nervous System Ischemic ResponseControl of

Arterial Pressure by the Brains Vasomotor Center in
Response to Diminished Brain Blood Flow

 With each cycle of respiration, the arterial pressure

usually rises and falls 4 to 6 mm Hg in a wavelike
manner, causing respiratory waves in the arterial
pressure.

Respiratory Waves in the

Arterial Pressure

 When the body contains too much extracellular fluid, the

blood volume and arterial pressure rise.
The rising pressure in turn has a direct effect to cause the
kidneys to excrete the excess extracellular fluid, thus
returning the pressure back toward normal.
The renalbody fluid system for arterial pressure control,
is the fundamental basis for long-term arterial pressure
control.

RenalBody Fluid System for Arterial

Pressure Control

Experiment in a dog to demonstrate the importance

of nervous maintenance of the arterial pressure as a
prerequisite for cardiac output control.

 Shock usually results from inadequate cardiac output.

Therefore, any condition that reduces the cardiac output
far below normal will likely lead to circulatory shock.
Cardiac abnormalities that decrease the ability of the heart
to pump blood
Factors that decrease venous return

Circulatory Shock Caused by

Decreased Cardiac Output

 Occasionally, the cardiac output is normal or even greater

than normal, yet the person is in circulatory shock.
(1) excessive metabolism of the body, so that even a normal
cardiac output is inadequate, or
(2) abnormal tissue perfusion patterns, so that most of the
cardiac output is passing through blood vessels besides
those that supply the local tissues with nutrition.

Circulatory Shock That Occurs

Without Diminished Cardiac Output

Effect of hemorrhage on cardiac output and arterial

pressure.

 Hypovolemia means diminished blood volume.

Hemorrhage is the most common cause of hypovolemic
shock.
Hemorrhage decreases the filling pressure of the circulation
and, as a consequence, decreases venousreturn.
As a result, the cardiac output falls below normal, and shock
may ensue

Shock Caused by
HypovolemiaHemorrhagic Shock

Time course of arterial pressure in dogs after

different degrees of acute hemorrhage. Each curve
represents average results from six dogs.

 These reflexes stimulate the sympathetic vasoconstrictor

system throughout the body, resulting in three important
effects:
(1) The arterioles constrict in most parts of the systemic
circulation, thereby increasing the total peripheral resistance.
(2) The veins and venous reservoirs constrict, thereby helping
to maintain adequate venous return despite diminished blood
volume.
(3) Heart activity increases markedly, sometimes increasing the
heart rate from the normal value of 72 beats/min to as high as
160 to 180 beats/min.

Sympathetic Reflex Compensations in Shock

Their Special Value to Maintain Arterial
Pressure.

Different types of positive feedback that can lead

to progression of shock.

Cardiac output curves of the heart at different times

after hemorrhagic shock begins.

Necrosis of the central portion of a liver lobule in

severe circulatory shock

 Loss of plasma from the circulatory system, even without

loss of red blood cells, can sometimes be severe enough
to reduce the total blood volume hypovolemic shock
1. Intestinal obstruction is often a cause of severely reduced
plasma volume.
2. In almost all patients who have severe burns or other
denuding conditions of the skin

Hypovolemic Shock
Caused by Plasma Loss

 an increase in vascular capacity or a decrease in blood

volume reduces the mean systemic filling pressure, which
reduces venous return to the heart. Diminished venous
return caused by vascular dilation is called venous
pooling of blood.
Deep general anesthesia
Spinal anesthesia
Brain damage

Neurogenic ShockIncreased
Vascular Capacity

 Anaphylaxis is an allergic condition in which the cardiac

output and arterial pressure often decrease drastically.
The histamine causes
(1) an increase in vascular capacity because of venous
dilation,
(2) dilation of the arterioles, resulting in greatly reduced
arterial pressure; and
(3) greatly increased capillary permeability, with rapid loss
of fluid and

Anaphylactic Shock and

Histamine Shock

 A condition that was formerly known by the popular

name blood poisoning is now called septic shock

Septic Shock

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