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CARDIOVASCULAR SYSTEM
NEURAL
Sirkulasi
The sino-atrial node in the Electrophysiology of the heart right atrium- the pacemaker cells. to the atrio-ventricular node. to the bundle of His divides into right and left branches - spreads out from the base of the ventricles across the myocardium - Purkinje fibres. The atria then re-fill as the myocardium relaxes.
The SA node by parasympathetic nervous system fibers (CN X: Vagus Nerve) by sympathetic nervous system fibers (T1-4, Spinal Nerves).
Receptor type
Alpha-1 Alpha-2 Beta-1
Location
Blood vessels Blood vessels Heart
Effects
Vasoconstriction Vasoconstriction Increase heart rate Increase force of contraction Vasodilatation Bronchodilatation
Beta-2
aortic pressure (AP) left ventricular pressure (LVP) left atrial pressure (LAP) left ventricular volume (LV Vol) left ventricular end diastolic volume (LVEDV) left ventricular end systolic volume (LVESV) heart sounds (S)
LATE DIASTOLE
DIASTOLE
ATRIAL SYSTOLE
VENTRICULAR EJECTION
ATRIAL FIBER
ENDOCARDIAL FIBER
EPICARDIAL FIBER
1 mV
ECG
P QS Depolarization of atria
The P wave - atrial depolarisation The Q wave - depolarisation at the bundle of His The R wave - main spread of depolarisation, from the inside out, through the base of the ventricles The S wave - subsequent depolarisation of the rest ventricles upwards from the base. The T wave - repolarisation of the myocard after systole is complete.
Heart Sounds
S1 = closer mitral valve & closer tricuspid valve (split 0.04 sec) S2 = closer aortic & pulmonary valve S3 = tensing of chordae tendineae and AV ring during ventricular relaxation and filling S4 = vibration ventricular wall during atrial contraction
Left atrium
Left ventricle Aorta
8-10
120 sys / 10 diast 120 sys / 80 dias
Stroke volume = ventricular end diastolic end systolic volume SV = EDV ESV ml In a healthy 70-kg man, EDV is 120 mL and ESV is 50 mL, giving a difference of 70 mL for the stroke volume. N = 55 - 100 ml Cardiac output CO = SV x HR N = 5 L/min
L/min
Ejection fraction is blood ejected by the ventricle relative to its filled volume (end diastolic volume) = measure ability of heart to eject blood EF = SV = EDV ESV % / min EDV EDV N = 55 to 70% / min
3 principle determinants SV: the degree of filling of the ventricle = preload the contractility myocard the resistance against which the ventricle has to work, or afterload = SVR Preload is the ventricular volume at the end of diastole. preload leads to an SV dependent on the return of venous blood from the body. Afterload is the resistance to ventricular ejection. = the resistance to flow in the systemic circulation and is the systemic vascular resistance (SVR). The resistance = the diameter of the arterioles & precapillary sphincters
The relationship between VEDV & SV = Starling's law of the heart = energy of contraction of the muscle is related/proportional to the initial length of the muscle fibre.
Mean pressure the average over each complete cardiac cycle. = average pressure that propels the blood to the tissues MAP = diastolic pressure + 1/3 pulse pressure N = 90-100mmHg.
Blood Pressure Depends on Volume of blood forced into the vessel Compliance (distensibility/elasticity) of vessel walls
Systolic pressure Peak pressure exerted by ejected blood against vessel walls during cardiac systole (ventricular contraction) Averages 120 mm Hg Diastolic pressure Minimum pressure in arteries when blood is draining off into vessels downstream, lowest level of arterial pressure during ventricular cycle Averages 80 mm Hg
Dynamics of blood circulation involves: Pressure Flow Resistance Control mechanisms that regulate blood pressure Blood flow through vessels
The differences in BP within the vascular system = driving force - blood move from higher to lower pressure areas
Pulse pressure = systolic - diastolic N = 40 mmHg Increases when stroke volume or vascular compliance = a pulse to determine heart rate and rhythmicity Central venous pressure (CVP) = right atrial pressure = right ventricular end diastolic volume (preload) N = 3 8 mmHg = 5 10 cm H2O
Oxygen extraction
This oxygen extraction is determined by the ratio of oxygen consumption to coronary blood flow as described by the Fick Principle. Oxygen extraction : the difference between the arterial and venous concentrations of oxygen (CaO2-CvO2). Fick Principle = MVO2 = CBF (CaO2 CvO2) MVO2 = myocard O2 consumption CBF = coronary blood flow
Oxygen extraction
Blood flow
Hagen-Poisseuille formula. flow rate: Driving pressure x Radius Length x Viscosity
Venous Return
is influenced by changes in position Venous pressure is driving force for return of blood to the heart. adequate blood return is aided by: Respiratory pump Muscular pump Valves prevent backflow during venous return
Capillary Network Blood flows from arterioles metarterioles - capillary network Venules drain network Smooth muscle in arterioles, metarterioles, precapillary sphincters regulates blood flow Capillary wall consists mostly of endothelial cells True capillaries exchange vessels Oxygen and nutrients cross to cells Carbon dioxide and metabolic waste products cross into blood
Capillary Exchange & Interstitial Fluid Volume Regulation Blood pressure, capillary permeability, & osmosis affect movement of fluid from capillaries A net movement of fluid occurs from blood into tissues bulk flow. Fluid gained by tissues removed by lymphatic system.
Exchange of Fluid between Capillaries &Tissues Distribution of fluid between plasma and interstitial compartments Is in state of dynamic equilibrium. Balance between tissue fluid and blood plasma.
Fisiologi Respirasi
Anatomi
Fisiologi
Ventilasi Atmosfer ke alveolus Diffusi Alveolus ke darah Transport Oxygen carriage oleh darah Perfusi
1. spirometri Tidal volume Inspiratory reserve vol Expiratory reserve vol Inspiratory capacity = TV + IRV Vital capacity = IC + ERV 2. spirometri+analisis gas Residual vol Functional residual capacity = ERV + RV Total lung = VC + RV
Tekanan interpleura
Permukaan luar paru - pleura visceralis Permukaan dalam thorak - pleura parieratalis Antara kedua pleura terdapat cairan sliding Tekanan cairan -10 cmH2O PPL = 6 10 = -4 cmH2O (-3 sd -5)
Inspirasi Tekanan intra-alveolar Tekanan intrapleural Perbedaan tekanan (Pressure Gradient) -3.0 mm Hg -6.0 mm Hg +3.0 mm Hg [ -3 - (-6) = +3 ]
Seluruh tekanan di tabel dibandingkan dengan atmospheric pressure pada lokasi manapun.
Tegangan permukaan
Atmosfer ke alveolus
Udara atmosfer - 760 mmHg (1 atmosfer = 760mmHg = 101kPa = 15lbs/sq. in). 21% O2 78% Nitrogen CO2, argon and helium. Pada 37oC tekanan kelembaban air trachea : 47 mmHg PO2 trachea - breathing = (760-47) x 21/100 = 150 mmHg PO2 alveoli 100 mmHg Breathing = the removal O2 by the pulmonary capillaries and its continual supply by alveolar ventilation
Difusi
O2 berdifusi dari alveolus ke kapiler sampai PO2 di kapiler = alveolus Difusi : gerak molekul gas dari tekanan tinggi ke rendah melalui membran semipermeabel
Alveolus ke darah
CO2 berdifusi dari kapiler paru ke alveoli O2 berdifusi dari alveoli ke kapiler paru
Ficks Law The diffusion of gas takes place according to Ficks Law: V gas = A x D x (P1 P2) T V gas = amount of gas diffuses from one point to another A = surface area D = diffusion constant P1 P2 = partial pressure difference T = thickness of the membrane
V / Q ratio
Angka ini dari rasio rata-rata = laju ventilasi alveolar normal (4-6 liter/menit) curah jantung normal (5 liter/menit) Keadaan normal dari ventilasi dan perfusi paru-paru yang seimbang mendekati nilai 0,8-1,2. Nilai rata-rata rasio antara ventilasi terhadap perfusi (V/Q) = 0,13.
3 faktor dapat menyebabkan PO2 pulmonary veins < PAO2 alveolar: ventilation/perfusion mismatch shunt slow diffusion
VA / Q ratio
Ventilation/perfusion mismatch
Beberapa alveoli relatif overventilated sedang lain relatif over-perfused. Paru normal - some degree of ventilation/ perfusion mismatch Area atas relatif overventilated sedang area bawah relatif over perfused & under-ventilated.
Shunt
Shunt sejati/ anatomis VA =0 Q =N V/Q = 0 unchanged PO2 (40 mmHg)
VA Q V/Q
=N =N =N
= rendah =N = rendah
Oxygen di darah
O2 dibawa dalam 2 bentuk Dengan Hb (figure 2b) Di plasma (kecil) Tiap gr Hb: 1.31 ml O2 - fully saturated. Tiap 100 ml darah - Hb 15g/dl membawa 20 ml O2 dg PO2 >100 mmHg = O2 capacity
O2 capacity : jumlah O2 yg terikat Hb scr max di 100 ml darah O2 content : jumlah O2 yg terikat Hb di 100 ml darah pada waktu tertentu (tidak maksimal) Saturation O2 (%): O2 content x 100% O2 capacity
Oxygen delivery
Jumlah O2 yang dibutuhkan tubuh dalam satu menit = CO x arterial O2 content = 5000 ml blood/min x 200 mlO2/1000 ml blood = 1000 ml O2/min. O2 delivery (mls O2/min) = DO2 = CO (litres/min) x Hb concentration (g/litre) x 1.31 (mls O2/g Hb) x % sat
Oxygen consumption
250 ml O2 / min dipakai sewaktu istirahat (O2 consumption) = 25% arterial O2 / min. Hb mixed venous blood = 70% saturated (95% less 25%).
Oxygen stores
Principle stores of oxygen in the body While breathing AIR In the lungs (FRC) In the blood Dissolved or bound in tissues(FRC) Total 450ml 850ml While breathing 100% O2 3000ml 950ml
250ml
300ml
1550ml
4250ml
Transport CO2
Jaringan ke paru Bentuk:
Regulasi
Pusat : - Medula oblongata pons involunter - Cortex volunter Perifer : - Aferen - Eferen
Afferent Supply
(1) Central chemoreceptors cells in the floor of the 4th ventricle - acidity of CSF measured by the pH = jumlah ion H (2) Peripheral chemoreceptors. respond to O2 & CO2 concentrations in arterial blood from carotid body glossopharyngeal nerve (N IX) from the aortic body vagus nerve (N X) (3) Brain (4) Lung --> vagus wall of the bronchi - irritant elastic tissues of the lung and the chest wall stretch blood vessels - stretch
Efferent Supply
N phrenicus (N cervicalis 3-5) diafragma N. X - laryngeal and all pharyngeal muscles N. XI - sternocleidomastoid and trapezius muscles Segmental intercostal nerves vert TI and TI2 intercostal muscles Cervical plexus - accessory muscles in the neck
Perifer
TERIMA KASIH