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Cardiovascular System

disampaikan oleh : dr. Endah Citra P,M.Kes


I. Anatomi Jantung
A. Coverings
1. Pericardium
• fibrous pericardium
• parietal pericardium
• visceral pericardium
B. Heart wall layers
1. Epicardium – (visceral pericardium)
• protects heart
2. Myocardium – cardiac muscle
3. Endocardium – epithelial/ connective/ fibers
Cardiac muscle
Cardiac muscle
striated
Blue arrows point
to intercalated
discs (allows
action potentials
to travel quickly)
Four chambered, muscular organ
Adult
12 cm long
9 cm wide at the widest point
6 cm thick
Weight is 250 to 350 grams
Receives 7% of the cardiac output.
The heart is extensively innervated by
nerves
C. Chambers, Vessels, and Valves
1. Empat chambers
• upper chambers – right and left atria
Menampung darah
• lower chambers – right and left ventricle
memompa darah keluar dari jantung
2. Arteri
• membawa darah dari jantung
3. Vena
• membawa darah menuju jantung
4. Valves (Katup)
• AV valves
Tricuspid – right atrium
Bicuspid or mitral - left atrium
• Semilunar valves
Pulmonary semilunar (pulmonary trunk)
Aortic semilunar (aortic arch/arcus aorta)
II. Pulmonary and Systemic Circulation
A. Pulmonary pathway/ sirkulasi ke paru-paru
oxygenated blood –rt ventricle from rt atrium
myocardium (rt ventricle) contracts
low oxygen blood through pulmonary semilunar
pulmonary trunk -> arteries -> lungs
oxygenated blood -> rt & lt pulmonary veins ->
left atrium
B. Systemic pathway/ Sirkulasi sistemik
Oxygenated blood -> lt atrium to lt ventricle
Left ventricle contracts ->aortic semilunar
Aortic arch -> arteries to tissues
oxygen depleted blood from tissues ->
veins to heart -> rt atrium (vena cava)
III. Cardiac cycle and heart sounds
1. Diastole - relax
• atrial diastole – atria fill – semilunar valves closed
• ventricular diastole – ventricles fill
2. Systole - contraction
• atrial systole – contracts – blood to ventricles
• ventricular systole – closes AV valves & open semilunar

3. Sounds
Lubb (systole) – dubb (diastole)
Lubb – AV close dubb – semilunar close
IV. Cardiac Conduction/ Sistem penghantar jantung
A. Cardiac muscle
• sarcomeres
• contraction similar to skeletal
• intercalated disks
B. Signal conduction
• specialized cardiac cells
Undergo AP spontaneously

Sinoatrial (SA node)  pacemaker Atrioventricular node


Letak di pertemuan V.Cava (AV node) di aspek
superior & right atrium bawah septum atrium
Sinoatrial Node

The SA node
surrounds the
nodal artery
from which it
receives a rich
blood supply
Signal pathway
• SA action potentials -> contraction in atrium
• AV action potentials (slower) -> bundle of HIS->
through septum -> Purkinje fibers -> contraction
C. Electrocardiography
• electrical events corresponding to mechanical
• P wave: atrial fibers depolarize
• QRS complex: ventricles depolarize
• T wave: ventricles repolarize
Sistem perdarahan jantung
 Arteri koroner kanan 1. LAD: left anterior
dan kiri  cabang dari descendend artery,
aorta memperdarahi ddg
 75% aliran Arteri anterior ventr kiri,
koroner tjd saat diatole septum ventr bag
(minimal diastole anterior dan apeks
60mmHg) ventr kiri
 Rigt coronary artery
(RCA) memperdarahi rt 2. Arteri sirkumfleksi :
atria, rt ventricle, bag. mperdarahi atrium kiri,
Bawah lt ventr, ddg permukaan lateral dan
septum bag.posterior, posterior ventr kiri dan
SA node dan AV node septum interventrikel
 Left coronary artery bag posterior
(LCA)  2 cabang :
SIFAT FUNGSIONAL JANTUNG
 1. Irritabilitas = eksitabilitas = kemampuan jantung utk
mengadakan respons bila dirangsang (terdapat plateau
atau dataran agar penampungan darah lbh banyak ke
jantung)
 2. Kontraktilitas = kemampuan jantung utk mengadakan
kontraksi (sistol) & relaksasi (diastol)masa diastol lbh
panjang dari sistol
 3. Konduktivitas = kemampuan jantung utk merambatkan
impuls dr bg jantung
 4. Otomatisitas & ritmisitas = kemampuan jantung untuk
berdenyut secara otomatis & ritmis
 5. Masa refrakter yg lama(refrakter=kehilangan sifat no. 1)
Konduktivitas
(perambatan impuls)
 SA node (sinoaurikularis)  0,04 m/detik
 Atrium  1 m/detik
 AV node (auriventrikularis)  0,2 m/detik
 Berkas His  2 m/detik
 Jaringan Purkinye  4 m/detik
 Ventrikel  0,4 m/detik
D. Regulasi
• ANS (aoutonom nerve system): Sympathetic &
Parasympathetic
Sympathetic: Norepinephrine  increase (Na+)

Parasympathetic: Acetylcholine
decrease (K+)
• Hormones:
Epinephrine/Norepinephrine/T3,T4
• Ions: K+/Ca2+
 Simpatis: bersifat meningkatkan

 frekuensi denyut jantung (kromotropik +)


 kuat kontraksi jantung (inotropik +)
 perambatan impuls (dromotropik +)

 Parasimpatis: bersifat mengurangkan

 Kromotropik –
 Inotropik –
 Dromotropik -

V. Physiology of Circulation
A. Pulse
• ejection of blood from lft ventricle (wave)
• pressure through arteries = heart beat/min
B. Blood Pressure
• pressure blood exerts on walls of arteries
• measurements: systolic pressure
peak of ventricular contraction
diastolic pressure: ventricles relaxed 120/70
C. Factors affecting pressure
• Neuronal: in CO2,O2,pH
increase in CO2 / decrease pH
-> Sympathetic norepinephrine -> vasoconstriction
• Chemicals: Histamine –(immune response)
-> vasodilation
• Temperature: cold exposure -> vasoconstriction
FUNGSIONAL SIRKULASI
 JANTUNG: memompa darah
 Isi sekuncup : jumlah drh yg dipompakan
setiap kali sistole
 Curah jantung:jumlah darah yg
dipompakan ventrikel dlm 1 menit
 Curah jantung :
isi sekuncup x frekuensi denyut jtg /mnt
FUNGSIONAL SIRKULASI
 AORTA & ARTERI: mengalirkan darah,
mempunyai ddg yg tebal & kuat
 ARTERIOL: cabang kecil arteri berfungsi
mendistribusikan darah
 KAPILER:sgt tipis & permeabel, bfungsi
utk pertukaran gas, cairan, makanan,
elektrolit, hormon.
 VENULA: menampung darah dari kapiler
 VENA: ddg vena tipis tp berotot, bfungsi
mengembalikan darah ke jantung
Tekanan darah
 Tkn.sistolik:tkn drh tertinggi saat jantung
dlm keadaan sistolik
 Tkn.diastolik:tkn drh terendah pd saat
jantung dlm keadaan diastolik
 Tkn nadi: perbedaan (selisih ) antara
sistolik dan diastolik