JANTUNG SEBAGAI POMPA.ppt

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The Heart as a Pump

Dr. Poland Room 3-007, Sanger Hall, Phone: 828-9557

E-mail: poland@h!."!#.ed#

Departemen Fisiologi

Fakultas Kedokteran

Universitas Sumatera

Utara

http://www.harthosp.org/cardi/images/beat_heart.gif



TheThe

heart asheart as

a pumpa pump

• Alternate contraction (systole) and

relaxation (diastole) of the muscular

all of the heart

• !hen the heart muscle is relaxed"

intracardiac pressure is lo

• Atria fill ith #lood from vessels

expansion of the upper cham#ers

• !hen the heart contracts" the

cham#er is s$uee%ed #y muscular

contraction" forcing #lood loer

cham#ers (ventricles) circulation



The Cardiac CycleThe Cardiac Cycle

&eriod #eteen start of&eriod #eteen start ofone heart #eat and theone heart #eat and thestart of the nextstart of the next

Systole:Systole:

– Period of ventricularPeriod of ventricularcontraction.contraction.– Blood ejected fromBlood ejected from

heart.heart. DiastoleDiastole::

– Period of ventricularPeriod of ventricularrelaxation.relaxation.

– Blood lling.Blood lling.





DiastoleDiastole Iso-volumetric relaxation:Iso-volumetric relaxation:

– entricles !egin to relax.entricles !egin to relax.

– Semilunar valves and " valves all closed.Semilunar valves and " valves all closed.

– entricular volume remains unchanged.entricular volume remains unchanged.

entricular lling :entricular lling :– PPatriaatria # P# Pventricles.ventricles.

– $itral valve %left& and tricus'id valve %right&$itral valve %left& and tricus'id valve %right&

o'en.o'en.

– entricle !egin to ll %()* com'lete&.entricle !egin to ll %()* com'lete&.

– "trial contraction com'letes lling."trial contraction com'letes lling.

– olume achieved: end diastolic volume %+D&olume achieved: end diastolic volume %+D&



SystoleSystole

Iso-volumetric contraction:Iso-volumetric contraction: – ,ontraction !egins !ut valves still closed.,ontraction !egins !ut valves still closed.

– ension develo's !ut no shortening of cells. ension develo's !ut no shortening of cells.

– Pressure !uilds u'.Pressure !uilds u'.

entricular ejection:entricular ejection:

– PPventriclesventricles # P# Paortic'ulmonary trun/aortic'ulmonary trun/..

– Semilunar valves o'en %aortic and 'ulmonary&.Semilunar valves o'en %aortic and 'ulmonary&.

– $uscle cells shorten.$uscle cells shorten.– Blood ex'elled: end systolic volume %+S&Blood ex'elled: end systolic volume %+S&

remains.remains.



MECHANICAL EVENTS OF THECARDIAC CYCLE

Blood 0o1 in the heart and great vessels during the cardiac cycle. he'ortions of the heart contracting in each 'hase are indicated in color.2" and 3"4 right and left atria5 2 and 34 right and left ventricles.







Stroke Volume

SVSV== EDVEDV -- ESVESVStroke volume End diastolic vol. End systolic vol.Stroke volume End diastolic vol. End systolic vol.

At rest: SV =At rest: SV = 70ml70ml,, EDV =EDV = 135ml135ml,, ESV =ESV = 65ml65ml

Stroke Volume :Stroke Volume : 70-80 ml volume pumped by a ventricle

in one contraction



Ejection Fraction( EF)

Ejection Fraction is a measure of cardiac contractility

= is about 65%.

Stroke Volume

End-Diastolic Volume





Heart Sounds

• Heard with aid of stethoscope.Heard with aid of stethoscope.• wo sounds!"ibration can be heard.wo sounds!"ibration can be heard.

• #aused b$ closure of "al"es.#aused b$ closure of "al"es.

• irst sound&irst sound& sli'htl$ prolon'ed (lub( ) Soft low pitched sound& closure of *V "al"es.

) +ccurs at onset of s$stole.

• Second sound&Second sound& a shorter, hi'h-pitched(dup( ) ouder sound& closure of aortic and pulmonar$ "al"es.ouder sound& closure of aortic and pulmonar$ "al"es.

) +nset of diastole and iso"olumetric relaation.+nset of diastole and iso"olumetric relaation.



Heart /urmurs• 0seful in dia'nosin' heart disease.0seful in dia'nosin' heart disease.

• #aused b$ poor openin' or closin' of "al"es.#aused b$ poor openin' or closin' of "al"es.

) 1arrowed "al"e& stenosis. 1arrowed "al"e& stenosis.

) eak$ "al"e& insufficienc$.eak$ "al"e& insufficienc$.

• Holes in the heart&Holes in the heart&

) Either connectin' atria or "entricles.Either connectin' atria or "entricles.



http://rd.yahoo.com/M=239730.2732130.4105624.572210/D=yahoo/P=m1d0jod311vv1900/S=2766679:N/A=1364628/R=3/*http://www.proxyconn.com/dispatch.asp?from=YAHOO_1.text0.3



• he timing %systolic or diastolic& of a murmurdue to stenosis or insu6ciency of any

'articular valve can !e 'redicted from a/no1ledge of the mechanical events of thecardiac cycle.



3eft "trial Pressure %7)mm8g&

2V3 illin' 2V# E4ection

3S

a wa"e7atrial

#ontraction8

9:;

; mmH'

# wa"e

7"entricular

contraction8

V wa"e

7"enous

return8



eft Ventricular ressure 79:;!; mmH'8


3S

; mmH'

9:;

*trial

#ontraction *ortic Val"e

+pens at

<; mmH'

#loses

at 9;;

mmH'



*ortic ressure 79:;!<; mmH'8


3S

*ortic Val"e

+pens at

<; mmH'

#loses

at 9;;

mmH'

9:;

; mmH'

<;

*ortic blood low

to circulation continues despite =ero

"entricular output











Distribusi Cardiac Outut

$ardia! %#&p#&

'on#mi o(igen



Distributio! o" Cardiac OututDistributio! o" Cardiac Outut



Cardiac Output (CO)

• Volume darah $an' dipompaka

"entrikel dalam unit waktu

• CO = HR X SV

• #ontoh &

H3 7den$ut 4antun'8 > ?; @!9mnt

SV 7stroke "olume8 > ?; ml!9 @

#+ > ?; @ ?; ml > A.B;; ml!9

menit

• #+ laki-laki C!- 5,5 ltr!meni

wanita C!- A,95ltr!meni



CARDIAC O#T$#T

• Methods o" Measure%e!t

In ex'erimental animals4 cardiac out'ut can!e measured 1ith an electromagnetic

0o1 meter 'laced on the ascending aorta. 1o methods of measuring out'ut that are

a''lica!le to humans4 in addition toDo''ler com!ined 1ith

echocardiogra'hy4 are the direct Fic&%ethod and the i!dicator dilutio!%ethod'



MES!REME"T OF CR#$C O!TP!T

THE FICK METHOD:

VO% = (&O%'a &O%') * F+o,

F+o, =VO%

&O%'a &O%'

S'irometry %9) mlmin&

"rterial Blood %9) ml*&Pulmonary "rtery Blood %; ml*&

CR#$C O!TP!T

PER$PHER-.-OO# F-O/

VE"O!S RET!R"

P!-MO"R0 .-OO# F-O/



CR#$C O!TP!T (1) =VO%

&O%'a &O%'

%23 m+4min

%3 m+5 62 m+5=

= 2 -4min

7

1 = HR * SV7

SV =1

HR

7

= 2 -4min83 9eats4min

= 37386: - or 867: m+

CR#$C $"#EX =1

m% 9od; sur<ace

area

7

2 -4min

67 m%=

= >76 -4min4m%























Some Definitions

Heart RateHeart Rate? 3633 9eats4minnum9er o< contractions per unit time7 Stro@e Vo+ume?Stro@e Vo+ume? 83A3 m+

o+ume pumped 9; a entric+e in one

contraction7

Cardiac Output?Cardiac Output? 2272 +4min

<+o, rate out o< the heartB o+ume pumped per unit time7Cardiac Outut ( Heart Rate ) Stro&e Volu%e

Venous return? 2272 +4min

<+o, rate into the heart7

#iasto+e? Re+a*ation o< the heart7

S;sto+e? Contraction o< the heart

#iasto+ic pressure? A3 mmH+o,est s;stemic arteria+ pressureB durin diasto+e7

S;sto+ic pressure? 6%3 mmHhihest s;stemic arteria+ pressureB durin s;sto+e

Blood volume 5 l



Demampuan Pompa antun

( Cardiac Performance)

Dontra@ti+itas

#en;ut jantun

Preload ( 9e9an a,a+)dipengar!i ole! end diastolic "olme (ED# )

<ter+oad (9e9an susu+an ) ditent$an ole! resistensi perifer



SS+E D2*S+E

#+/2*1#E

322D



Pre+oad

Dontra@ti+itas

<ter+oad

!@uran

entri@e+@iri

Pemende@an

sera9ut mio@ard

Stro$e

"olme

Heart

rate

Cardiac

output

Te@anan

#arah

Resistensi

peri<er



• Interactions !et1een the com'onents that regulatecardiac out'ut and arterial 'ressure. Solid lines indicateincreases4 and the dashed line indicates a decrease.



Relatio! o" Te!sio! to Le!*thi! Cardiac Muscle

• he length-tension relationshi' in cardiac muscleis similar to that in s/eletal muscle as the muscleis stretched4 the develo'ed tension increases to amaximum and then declines as stretch !ecomesmore extreme.



<actors that normally increase ordecrease the length of ventricular



& ' ( S S U ' (

DAST*+,

&'SSU' ,U'-

S.ST*+, &'SSU' ,U'-

/A'T

nd Diastolic -olumend Systolic -olume

sovolumetric

&hase

sotonic (0ection) &hase

Stroke

-olume

&re1load

After1load



& ' ( S S U ' (

DAST*+,

&'SSU' ,U'-

S.ST*+, &'SSU' ,U'-

/A'T


sovolumetric

&hase


Stroke

-olume

&re1load

After1load

) 2 , '

( A S (

D

, * 2 T

' A , T

) + ) T .



& ' ( S S U ' (

DAST*+,

&'SSU' ,U'-

S.ST*+, &'SSU' ,U'-

/A'T


sovolumetric

&hase


Stroke

-olume

&re1load

After1load

D ( , '

( A S (

D

, * 2 T

' A , T

) + ) T .



& ' ( S S U ' (

DAST*+,

&'SSU' ,U'-

S.ST*+, &'SSU' ,U'-

/A'T


sovolumetric

&hase


Stroke

-olume

&re1load

After1load

) 2 , ' ( A

S ( D

F

) + + ) 2 3



THE HEART AS A $#M$THE HEART AS A $#M$

RE+#LATION OF CARDIACRE+#LATION OF CARDIAC

O#T$#TO#T$#T– 8eart 2ate via sym'athetic =8eart 2ate via sym'athetic =

'arasym'athetic nerves'arasym'athetic nerves

– Stro/e olumeStro/e olume Fra!&,Starli!* -La. o" theFra!&,Starli!* -La. o" the

Heart/Heart/

Cha!*es i! Co!tractilityCha!*es i! Co!tractility

MYOCARDIAL CELLSMYOCARDIAL CELLS

0FI1ERS20FI1ERS2– Re*ulatio! o" Co!tractilityRe*ulatio! o" Co!tractility

– Le!*th,Te!sio! a!d Volu%e,Le!*th,Te!sio! a!d Volu%e,

$ressure Cur3es$ressure Cur3es

– The Cardiac Fu!ctio! Cur3eThe Cardiac Fu!ctio! Cur3e



4o!disi 5a!tu!* Nor%al

Dontra@si reu+er

dan sin@ron

Datup jantun(norma+)

Dontra@si @uat

Penisian adeuat

(diasto+e)



Dondisi antun "orma+

• Dontra@si reu+er

dan sin@ron

• Datup jantun

(norma+)

• Dontra@si @uat

• Penisian adeuat

(diasto+e)

ritmia

StenoseB Reuritasi

Fai+ure

a9norma+ <i++in



Let it

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