Download - anfis_jantung
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CARDIOVASCULAR SYSTEM
Anatomy & Physiology
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THE HEART
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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
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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 )
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LETAK JANTUNG
• 2/3 bagian jantung terletak di sebelah kiri garis median sternum
• Apeks di sela iga ke 4 – 5 dekat garis medio-klavikularis
• Batas cranial dibentuk oleh aorta asendens, arteri pulmonal dan vena kava superior
• Berada di ruang mediastinum, jantung dibungkus perikardium
msn_prie_nwu
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Superior vena cave
Right Atrium
Right Ventricl
e
De-oxygenated
Oxygenated
Aorta
Left Atrium
Aorta
Left Ventricl
e
Inferior vena cava
Lung
Gaseous exchang
e
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Fibrous Skeleton
Kerangka jantung yang terdiri dari jaringan kolagen yang tebal dan kuat
Fungsinya :• Penunjang fisik
jantung• Pegangan katup • Mencegah kelebihan
regangan otot jantung• Electrical insulation
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Anatomy of the Heart
• Pericardium : – Outer fibrous sack
• Myocardium :– Thick muscle walls
• Endocardium : – Innermost surface– Endothelium– Simple squamous
epithelium
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Interventriculer Septum
Papillary muscle
Semilunar Valve
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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
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Anatomy of the Heart
• Heart chambers :– Left & right atria– Left & right ventricles
• Heart valves :– Atrioventricular valves :
• Right : Tricuspid• Left : Bicuspid/Mitral
– Semilunar valves• Right : Pulmonary valve• Left : Aortic valve
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Rongga jantung
• Terdiri dari 4 ruangan yang saling berhubngan
• a. Atrium kanan
• b. Ventrikel kanan
• c. Atrium kiri
• d. Ventrikel kiri
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THE HEARTTHE HEART
ATRIUMRIGHT
LEFT
ATRIUM
RIGHT
VENTRICLE
LEFT VENTRICLE
Low O2 Blood from Lower Body
Low O2 Blood from Upper Body
High O2 Blood from Lungs
Low O2 Blood to Lungs
Septum
Valves in the heart are one-way only and stop blood running back from the ventricles
into the atria.
AORTAAORTA
High O2 Blood to rest of body
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a. Atrium kanan
• Tebal ± 2mm, permukannya licin, elastis, terdapat sinoatrial node, atrioventrikular node
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b. Ventrikel kanan
• Tebal ± 4mm, tak rata, bagian dalam tonjolan muskularis papilaris. Pada ujungnya terbentang tali-tali jaringan ikat menuju ujung-ujng katup (chorda tendinae). Fungsi….?
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c. Atrium kiri
• Tebal ± 3mm, permukaan licin & bersifat elastis fungsi…….?
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d. Ventrikel kiri
• Tebal 8-15mm penuh trabekula, terdapat muskularis papilaris, otot-otot lebih tebal fungsi…….?
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RUANG JANTUNG
ATRIUM• Atrium kanan
penampung darah yg rendah oksigen• Atrium kiri
menerima darah yg kaya oksigen dari kedua paruVENTRIKEL• Ventrikel kanan
menerima darah dari atrium kanan-dipompakan ke paru• Ventrikel kiri
menerima darah dari atrium kiri dipompa ke seluruh tubuh
msn_prie_nwu 20
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Katup-katup Jantung
• Dua jenis katup :1. Atrio ventrikular2. Semilunaris
• Atrio ventrikular : memisahkan atrium & ventrikel
• Semilunar : memisahkan ventrikel kanan dgn arteri pulmo, dan aorta dgn ventrikel
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Atrioventrikular
• Trikuspid : atrium kanan ke ventrikel kanan
• Biskupid : atrium kiri ke ventrikel kiri (mitral)
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Katup semilunaris
• Terdiri dari katup aorta + katup pulmonalis yang menghubungkan ventrikel kanan + arteri pulmo
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Perdarahan jantung
• Otot jantung di perdarahi oleh a. koronaria kanan (right coronary artery) & a. koronaria kiri yang berasal dari pangkal aorta kiri
Mempunyai 2 cabang besar yaitu aorta desending anterior & a.sirkumpleks.
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Sistem vaskuler Jantung
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• a. Koronaria : memberi nutrisi + oksigen pada atrium kanan, ventrikel kanan & dinding setelah dalam ventrikel kiri.
• a. Sirkumplek memberi nutrisi + oksigenisasi pada atrium kiri & dinding samping, bawah ventrikel kiri
• a. desending anterior : memberi nutrisi, oksigen pada dinding depan ventrikel kiri yang masif.
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Anatomy of the Heart
• Aorta• Coronary arteries• Arterioles• Capillaries• Venules• Coronary sinus• Right atrium
Coronary circulationCoronary circulation
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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 )
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Intrinsic Conducting System
• Sinoatrial node– Electrical pace maker
• Atrioventricular node– Receives impulses
originating from SA node
• Bundle of His– Electrical link between
atria and ventricles
• Purkinje fibres– Distribute impulses to
ventricles
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Sel AutoritmikSel Autoritmik
• Fase Fase DepolarisasiDepolarisasi
• Fase Fase RepolarisasiRepolarisasi
• Fase IstirahatFase Istirahat
Sel KontraktilSel Kontraktil
• Fase Fase DepolarisasiDepolarisasi
• Fase PlateuFase Plateu
• Fase Fase RepolarisasiRepolarisasi
• Fase IstirahatFase Istirahat
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Conduction System
SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction
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Cardiac Action Potentials
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The Electrocardiogram ( ECG )
• P wave : atrial depolarisation
• QRS complex : ventricular depolarisation
• T wave : ventricular repolarisation
• Atrial repolarisation hidden by QRS
P
Q
R
S
T
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The Cardiac Cycle
• Systole : – Period of ventricular contraction– Blood ejected from heart– Menghasilkan bunyi jantung 1 “LUP”
• Diastole :– Period of ventricular relaxation– Blood filling– Menghasilkan bunyi jantung 2 “ DUP”
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Sifat Jantung
• Automaticity : untuk menimbulkan impuls
• Konduktifitas : daya hantar• Kontraksi : kontraksi bila di rangsang
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Cardiac Output
• Sejumlah darah yang dikeluarkan ventrikel / mnt ± 5 L.
• Jadi cardiac output = cardiac rate x stroke volume5040 ml = 72 / mnt x 70 ml
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Stroke Volume
• Jumlah darah yang dipompakan ventrikel pada setiap kontraksi
• Normal ventrikel terisi selama relaksasi sampai End Dyastolic Volume (EDV) ± 100 ml darah. Kontraksi mendorong 2/3 darah ± 70 ml ke arteri & tersisa ± 30 ml sampai akhir sistolik (ESV)
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• Perbedaan EDV + ESV menimbulkan perubahan stroke volume.
• EDV banyak memberi efek cardiac rate + venus return.
• EDV + ESV dipengaruhi ….• 1. Pre load : Frank Starling• 2. Kontraktil • 3. After load
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1. Pre load
• Frank Starling : kekuatan kontraksi akan meningkat sebagai hasil ketegangan serabut otot
• Contoh : bila darah masuk atrium , maka tekanan atrium , mempengaruhi tekanan ventrikel.
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2. Kontraktilitas
• Perubahan ketegangan kontraksi otot jantung selain akibat preload, kontraktil karena dilepaskannya ion kalsium, norepeneprin + simpatis.
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3. After load
• Usaha mendorong darah kedalam arteri selama sistolik. Berfungsi terhadap tekanan darah + pembesaran ventrikel , & menggambarkan kerja jantung dalam kondisi +++.
• Contoh : bila tekanan arteri darah tertahan, tidak dapat keluar dari jantung, otot jantung berusaha memompa agar CO adekuat.
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• Definitions
– Chronotropy Change in heart rate– Inotropy Change in contractile
force– Dromotropy Change in conduction
velocity
– Can be positive or negative
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TERIMA KASIH