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Fakultas Kedokteran UPN Veteran Jakarta

Lauralee Sherwood,
Human Physiology: From Cells to
Systems,
7
th
Ed, 2010
FIGURE 9-6 Organization of cardiac muscle fibers. Bundles of cardiac muscle fibers are
arranged spirally around the ventricle. Adjacent cardiac muscle cells are joined end to end by
intercalated discs, which contain two types of specialized junctions: desmosomes, which act
as spot rivets mechanically holding the cells together; and gap junctions, which permit action
potentials to spread from one cell to adjacent cells.
Anatomi-Fisiologi Otot Jantung
Miokardium:
- otot atrium
- otot ventrikel
- serat otot khusus: sistem eksitasi otot
jantung
Otot tak sadar
Cara kontraksi: mirip otot rangka
Singsisium

Lauralee Sherwood,
Human Physiology: From Cells to
Systems,
7
th
Ed, 2010
FIGURE 9-6 Organization of cardiac muscle fibers. Bundles of cardiac muscle fibers are
arranged spirally around the ventricle. Adjacent cardiac muscle cells are joined end to end by
intercalated discs, which contain two types of specialized junctions: desmosomes, which act
as spot rivets mechanically holding the cells together; and gap junctions, which permit action
potentials to spread from one cell to adjacent cells.
Struktur Otot Jantung
Sarkolema
Miofibril
Filamen: - Aktin
- Miosin
Sarkoplasma
Retikulum sarkoplasmik
Struktur Otot Jantung

Lauralee Sherwood,
Human Physiology: From Cells to
Systems,
7
th
Ed, 2010
FIGURE 9-6 Organization of cardiac muscle fibers. Bundles of cardiac muscle fibers are
arranged spirally around the ventricle. Adjacent cardiac muscle cells are joined end to end by
intercalated discs, which contain two types of specialized junctions: desmosomes, which act
as spot rivets mechanically holding the cells together; and gap junctions, which permit action
potentials to spread from one cell to adjacent cells.
Despopoulos, Color Atlas of Physiology 5
TH
ed 2003 Thieme
AKTIVITAS LISTRIK JANTUNG
Sel otoritmik
Sel Kontraktil (Miokardium)
Potensial Aksi Pada Otot Jantung
Polarisasi
Depolarisasi: - Plato
- Ritmisitas
Repolarisasi
Kecepatan konduksi
Masa Refrakter
Potensial Aksi Pada Otot Jantung
Potensial Aksi Pada Otot Jantung
Figure 15-19 Typical action potentials (in
millivolts) recorded from cells in the
ventricle (A), SA node (B), and atrium (C).
Sweep velocity in B is one-half that in A or
C. (From Hoffman BF, Cranefield PF:
Electrophysiology of the heart, New York,
1960, McGraw-Hill.)
Figure 22.
Action potentials from these cell types are referred to as "fast response"
and "slow response" action potentials, respectively.

Panel A: fast response action potentials are characterized by
a rapid depolarization (phase 0) with a substantial overshoot (positive
inside voltage),
a rapid reversal of the overshoot potential (phase 1),
a long plateau (phase 2),
and a repolarization (phase 3)
a stable, high (ie, large negative) resting membrane potential (phase
4).

Panel B: the slow response action potentials are characterized by a
slower initial depolarization phase, a lower amplitude overshoot, a
shorter and less stable plateau phase, and a repolarization to an
unstable, slowly depolarizing "resting" potential. The unstable resting
potential seen in pacemaker cells with slow response action potentials is
variously referred to as the phase 4 depolarization, diastolic
depolarization, or pacemaker potential.
Figure 102
Rhythmical discharge of a sinus nodal fiber. Also, the sinus nodal action potential is compared
with that of a ventricular muscle fiber.
Guyton & Hall: Textbook of Med Physiol 11
th
ed, 2006

FIGURE 9-8 Specialized conduction system of the heart and spread of cardiac excitation.
Human Physiology:
From Cells to Systems,
Seventh Edition,
Lauralee Sherwood, 2010
Impulse Transmission

AV delay
AV node conduction: 0.09 sec
Penetrating portion of AV bundle: 0.04 sec
------------------------------------
PR segment 0.13 sec

Atrial impulse conduction
SA node Internodes AV node: 0.03 sec
------------------------------------
PR interval 0.16 sec




AV Node Slow Conduction

Small cells
Thin cell membrane slow conduction velocity

Resting Em < Myocardium resting Em
Small amplitude of action potential slow conduction
velocity

Few intercalated disc
Great intercellular electrical resistance slow conduction
velocity

Human Physiology:
From Cells to Systems,
Seventh Edition
Lauralee Sherwood, 2010
Cardiac Output
Definisi : volume darah yang dipompa oleh masing2 ventrikel per menit

Cardiac Output dipengaruhi 2 faktor :

- Stroke Volume = volume darah yang dipompa per denyut
- Heart Rate = denyut jantung per menit

Cardiac Output = SV x HR
CO = 70 ml/b (SV) x 70 b/m (HR)
= 4900 ml/m = 4,9 l/m






Heart Rate
Nilai HR dapat naik / turun

Naik : Efek Stimulasi Simpatis
Turun : Efek Stimulasi Parasimpatis

Untuk meningkatkan HR :
1. Memblock input parasimpatik = HR 100 b/m
2. Menambahkan input simpatik = HR 100++ b/m


Stroke Volume
SV = End Diastolic Volume (135 ml) End Sistolic Volume (65 ml)

EDV = Volume darah yang mengisi ventrikel selama diastole
EDV dipengaruhi : aliran balik vena , kemampuan jantung
mengembang

ESV = Volume darah sisa setelah sistole
ESV dipengaruhi : Kontraktilitas , afterload
Hukum Frank Starling
Semakin jantung teregang, kontraksi semakin kuat

Jika aliran balik vena meningkat --> banyak darah di ventrikel (ventrikel
mengembang) ->> kontraksi semakin kuat


End Sistolic Volume
Afterload : beban kerja yg dibebankan kepada jantung setelah
kontraksi dimulai (hipertensi, stenosis katup)

Kontraktilitas : kekuatan kontraksi di setiap EDV
Naik : Efek stimulus NE , E
Turun : B-Blocker
EFEK SISTEM SARAF OTONOM
OTOT JANTUNG
Efek Parasimpatis
mempengaruhi nodus SA yang mengurangi kecepatan
jantung.Asetikolin yang dibebaskan pada pengaktifan
parasimpatis meningkatkan permeabilitas nodus SA
terhadap ion Kalium dengan cara memperlambat penutpan
saluran kalium
Efek Simpatis
mempengaruhi nodus SA dengan cara mempercepat
depolarisasi sehingga ambang batas lebih cepat
tercapai.Norepinefrin yang dikeluarkan ujung saraf simpatis
ini mempengaruhi penurunan permeabilitas terhadap kalium
dengan cara mempercepat inaktivasi saluran kalium.