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Heart as a Pump

Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera Utara

CARDIAC CYCLE

Systole
Iso-volumetric contraction :
Contraction begins but valves still closed.
closed
Tension develops but no shortening of cells.
Pressure builds up until pressures in left and right
ventricles > aorta (80 mm Hg) and pulmonary artery
(10 mm Hg) (lasts about 0.05 s).

Ventricular ejection:

Pventricles > Paortic/pulmonary trunk.


Semilunar valves open (aortic and pulmonary).
Muscle cells shorten.
Blood expelled: end systolic volume (ESV) remains.

Left Atrial Pressure (7/0


mmHg)
P

QRS

120
V wave
(venous
return)

C wave
(ventricular
contraction)

a wave
(atrial
Contraction)

0 mmHg
IVR

Filling

IVC

Ejection

Left Ventricular Pressure (120/0 mmHg)


P

QRS

120

Atrial
Contraction

Aortic Valve
Opens at
80 mmHg

0 mmHg
IVR

Filling

IVC

Ejection

Closes
at 100
mmHg

Aortic Pressure (120/80 mmHg)


P

QRS

120

80
Aortic Valve
Opens at
80 mmHg

Aortic blood Flow


to circulation continues despite zero
ventricular output
0 mmHg
IVR

Filling

IVC

Ejection

Closes
at 100
mmHg

Heart Sounds
Normally heard by a stethoscope
First sound : low, slightly prolonged lub,
caused by closure of mitral and tricuspid
valves, at ventricular systole. Duration 0.15 s
& fequency 25-45 Hz.
Second sound ; shorter, high-pitched dup,
caused by closure aortic and pulmonary
valves, after end of ventricular systole. 0.12 s
& 50 Hz.

Third sound : soft, low-pitched, at one-third


diastole, period rapid ventricular filling , due to
inrush of blood. In young individuals. 0.1 s.
Fourth sound : when atrial pressure is high and
ventricle is stiff in ventricular hypertrophy , due
to ventricular filling, before first sound.

Murmurs or Bruits
abnormal sounds heard in various parts of
the vascular system.
Bruits heard over a large, highly vascular
goiter, over carotid artery when its lumen is
narrowed & distorted by atherosclerosis.
Murmurs heard over aneurysmal dilation of
large arteries, an arteriovenous (A-V)
fistula, or patent ductus arteriosus.

Soft systolic murmur are common in


individuals, escpecially in children, who have
no cardiac disease.
Systolic murmurs are also common in anemic
patients as a result of low viscosity of blood
and rapid flow.

Cardiac Output (CO)

Volume darah yang dipompakan


ventrikel dalam unit waktu
CO = HR X SV
Contoh :
HR (denyut jantung) = 70 X/1mnt
SV (stroke volume) = 70 ml/1 X
CO = 70 X 70 ml = 4.900 ml/1
menit

CO laki-laki +/- 5,5 ltr/menit


wanita
+/- 4,15ltr/menit

Distribusi Cardiac Output


Cardiac Output

Konsumsi oksigen

Some Definitions
Heart Rate: 60-100 beats/min Stroke Volume: 70-80 ml
number of contractions per unit time.

volume pumped by a ventricle in one


contraction.

Cardiac Output:

5-5.5 l/min
flow rate out of the heart, volume pumped per unit time.

Cardiac Output = Heart Rate x Stroke Volume

Venous return:

5-5.5 l/min

flow rate into the heart.


Diastolic pressure:

Diastole: Relaxation of the heart.


Systole: Contraction of the heart
Blood volume

80 mmHg

lowest systemic arterial pressure, during diastole.

Systolic pressure:

120 mmHg

highest systemic arterial pressure, during systole

5l

CARDIAC OUTPUT
Method

of Measurement

direct Fick method and indicator


dilution method
Ficks principle : Amount of a
substance taken up by an organ
(whole body) per unit time = arterial
level of the substance minus venous
level (A V difference) times blood
flow.

Cardiac

index = cardiac output per


square meter of body surface ,
averages 3,2 L

Indicator

dilution technique
Cardiac output = amount of
indicator injected divided by its
average concentration in arterial
blood after a single circulation
through the heart.
thermodilution, indicator used is
cold saline

Cardiac Output in Various Conditions

Factors Controlling Cardiac Output

Cardiac accelerator action of catecholamines


liberated by sympathetic stimulation :
chronotropic action, whereas their action on the
strength of cardiac contraction : inotropic action.
force of contraction of cardiac muscle is
dependent upon its preloading and its
afterloading.
preload is the degree to which the myocardium is
stretched before it contracts (= EDV)
afterload is the resistance against which blood is
expelled (= Aortic Pressure & MAP)

Relation of Tension to Length in Cardiac


Muscle
Starling's law of the heart or FrankStarling law = "energy of contraction is
proportional to the initial length of cardiac
muscle fiber."
= relation between ventricular stroke
volume and end-diastolic volume

= Length of muscle fiber = preload

Kurva Frank Starling


Stimulasi
Adrenergik

Stroke volume

Normal
Fungsi jantung
Syok
Kardiogenik

End Diastolic Volume

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

D Y
E
S LI T
A
E TI
R
C
C
IN TRA
N
CO

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

ED T Y
S
A I LI
E
R CT
C
DE TRA
N
CO

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

IN
C
FI RE
LL AS
IN E
G D

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

Myocardial Contractility

Kondisi Jantung Normal


Kontraksi reguler
dan sinkron
Katup jantung
(normal)
Kontraksi kuat
Pengisian adequat
(diastole)

Kondisi Jantung Normal


Kontraksi reguler
dan sinkron
Katup jantung
(normal)
Kontraksi kuat
Pengisian adequat
(diastole)

Aritmia
Stenose, Regurgitasi
Failure
abnormal filling

Let it
beat!