elektrofisiologi jantung.ppt
Post on 07-Jul-2018
226 Views
Preview:
TRANSCRIPT
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
1/30
ELEKTROFISIOLOGIJANTUNG
Irawan Yusuf
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
2/30
Tujuan Pokok BahasanTujuan Pokok Bahasan
1. !s"uss #h$ !on!" %as!s of #h$ r$s#!n& 'o#$n#!a( !n a#r!a( an) *$n#r!"u(ar "$((s.
+. !s"uss #h$ !on!" %as!s of $a"h of #h$ four 'has$s of #h$ a"#!on 'o#$n#!a( !n
,work!n&, -o"ar)!a( /a#r!a( an) *$n#r!"u(ar0 "$((s an) Purk!nj$ "$((s an) of
#h$ #wo 'has$s of #h$ a"#!on 'o#$n#!a( !n /S2A an) A230 no)a( "$((s.
4. !s"uss #h$ !on!" %as!s of )!as#o(!" )$'o(ar!5a#!on /'has$ 607 $8'(a!n wh #h$s$-$"han!s-s )!ff$r %$#w$$n no)a( an) Purk!nj$ "$((s7 (!s# #h$ 'a"$-ak$rs of #h$
h$ar# an) #h$!r a''ro8!-a#$ f!r!n& ra#$s !n or)$r of fas#$s# #o s(ow$s#.
6. !s"uss #h$ !on!" %as!s of #h$ a%so(u#$ an) r$(a#!*$ r$fra"#or '$r!o)s an) how
fas#$r h$ar# ra#$s shor#$n #h$s$ '$r!o)s.
9. !s"uss #h$ !on!" %as!s of 'ro'a&a#!on of a"#!on 'o#$n#!a(s #hrou&hou# #h$ h$ar#7
(!s# #h$ fa"#ors #ha# aff$"# "on)u"#!on *$(o"!#7 (!s# a''ro8!-a#$ "on)u"#!on*$(o"!#!$s !n #h$ )!ff$r$n# r$&!ons of #h$ h$ar# fro- s(ow$s# #o fas#$s#7 $8'(a!n
wh su"h *$(o"!#!$s ar$ fas# or s(ow.
:. $s"r!%$ #h$ -$"han!s-s #ha# un)$r(!$ #h$ 'os!#!*$ an) n$&a#!*$ "hrono#ro'!"
an) )ro-o#ro'!" $ff$"#s of s-'a#h$#!" an) 'aras-'a#h$#!" n$uro#rans-!##$rs.
;. G!*$n "(!n!"a(( r$($*an# s!#ua#!ons of $($"#ro'hs!o(o&!"a( )!s#ur%an"$s.
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
3/30
P$n)ahu(uanP$n)ahu(uan
•
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
4/30
asar Ion!k Ak#!f!#as L!s#r!kasar Ion!k Ak#!f!#as L!s#r!k
Jan#un&Jan#un&
• !s$%a%kan o($h '$r&$rakan arus !on
)ar! (uar s$( k$)a(a- s$( a#au s$%a(!kna-$(a(u! sa(uran !on /ion channel 0
• P$r&$rakan !on #$rja)! ak!%a# '$r%$)aan
kons$n#ras! !on )! )a(a- )an )! (uar s$(
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
5/30
Kons$n#ras! !on )! )a(a- )an )!(uar s$(
Ion Eks#ras$( /-(2 19? 9
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
6/30
S#ruk#ur )an Fun&s! Sa(uran IonS#ruk#ur )an Fun&s! Sa(uran Ion
•
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
7/30
Po#$ns!a( Aks! Pa)a O#o# Jan#un&Po#$ns!a( Aks! Pa)a O#o# Jan#un&
•
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
8/30
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
9/30
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
10/30
>ar)!a" versus Sk$($#a(
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
11/30
asar Ion!k Po#$ns!a(asar Ion!k Po#$ns!a(
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
12/30
asar Ion!k Po#$ns!a( Aks!asar Ion!k Po#$ns!a( Aks!
Fas$ ? /)$'o(ar!sas! "$'a#0Fas$ ? /)$'o(ar!sas! "$'a#0
• !s$%a%kan o($h arus !on Na= k$)a(a- s$(/ I Na0 -$(a(u! activation gate /m &a#$0
• Pa)a saa# 'o#$ns!a( -$-%ran /3-0-$n"a'a! 4? -326? -3 #$rja)! 'ros$s!nak#!fas! sa(uran Na= inactivation gate /h
&a#$0 -u(a! #$r#u#u'• Pros$s !nak#!fas! sa(uran Na= -$n)asar!
-asa r$frak#$r
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
13/30
asar Ion!k Po#$ns!a( Aks!asar Ion!k Po#$ns!a( Aks!
Fas$ 1 /r$'o(ar!sas! awa(0Fas$ 1 /r$'o(ar!sas! awa(0•
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
14/30
asar Ion!k Po#$ns!a( Aks!asar Ion!k Po#$ns!a( Aks!
Fas$ + /'(a#$au0Fas$ + /'(a#$au0• a %$r'$ran )a(a- 'ros$s kon#raks! jan#un&
)$n&an -$-!"u '$($'asan >a+= !n#ras$( )!
r$#!ku(u- sarko'(as-a /Ca2+-induced Ca2+
release0• a -$(a(u! sa(uran >a+= )$n&an o%a#2
o%a#an )a'a# -$n&uran&! a#au -$n!n&ka#kan
kon#raks! jan#un&
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
15/30
asar Ion!k Po#$ns!a( Aks!asar Ion!k Po#$ns!a( Aks!
Fas$ 4 /r$'o(ar!sas! "$'a#0Fas$ 4 /r$'o(ar!sas! "$'a#0
• Fas$ !n! #$rja)! %!(a arus K = k$(uar s$(
-$($%!h! -asukna arus >a+= / I >a0
• I #o -$n$n#ukan (a-ana fas$ + a#au awa(
fas$ 4 #$ru#a-a 'a)a a#r!a
• I K1 /inwardly rectified 0 -$-$&an&
'$ranan 'a(!n& '$n#!n& 'a)a 'ros$s
r$'o(ar!sas!
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
16/30
SISTI< KONUKSI JANTUNGSISTI< KONUKSI JANTUNG
• S!s#$- kon)uks! jan#un& %$rfun&s! un#uk-$n$%arkan ak#!f!#as (!s#r!k k$ s$(uruho#o# jan#un&
• S!s#!- kon)uks! jan#un& #$r)!r! )ar!@
– no)us SA / pacemaker u#a-a jan#un&0
– #rak#us !n#$rno)a(
–
no)us A3 – %$rkas C!s
– s$ra%u# Purk!nj$
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
17/30
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
18/30
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
19/30
SISTI< KONUKSI JANTUNGSISTI< KONUKSI JANTUNG
P$n$%aran Po#$ns!a( aks!P$n$%aran Po#$ns!a( aks!• K$"$'a#an '$n&han#aran 'o#$ns!a( aks! #$r&an#un&)ar! s#ruk#ur )an s!fa# s$( -as!n&2-as!n& s!s#$-kon)uks!
• T$rja)! '$r(a-%a#an '$n$%aran 'o#$ns!a( aks!)ar! a#r!a k$ *$n#r!k$( kar$na@ – -$-un&k!nkan '$n&!s!an *$n#r!k$( an& o'#!-a(
– o'#!-as! kon#raks! *$n#r!k$(
– -$-aks!-a(kan 'ros$s $j$ks! *$n#r!k$(
• $'o(ar!sas! %$rakh!r 'a)a %a&!an 'os#$ro%asa(*$n#r!k$( k!r! konus 'u(-ona( )an %a&!an a#ass$'#u-
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
20/30
K$"$'a#an kon)uks! 'a)aK$"$'a#an kon)uks! 'a)a
jar!n&an s$( o#o# jan#un& jar!n&an s$( o#o# jan#un&
Jar!n&an K$"$'a#an La-a Fr$kw$ns!
kon)uks! /-D)$#0 kon)uks! /)$#0 ka(!D-$n!#0
No)us SA ?.?9 ?.19 :?21??
O#o# a#r!a( 1.?21.+ ?.19
No)us A3 ?.?+2?.?9 ?.? 6?269
B$rkas C!s 1.+2+.? ?.? +926?
Purk!nj$ +.?26.? ?.? +926?O#o# 3$n#r!k$( ?.421.? ?.?
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
21/30
Gan&&uan Ira-a Jan#un&Gan&&uan Ira-a Jan#un&
• Gan&&uan '$-%$n#ukan !-'u(s
• Gan&&uan '$n&han#aran !-'u(s
• Gan&&uan '$-%$n#ukan )an
'$n&han#aran !-'u(s
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
22/30
asar2)asar !on!k ar!#-!aasar2)asar !on!k ar!#-!a
• P$ru%ahan 'a)a 'o#$ns!a( -$-%ran !s#!raha# –
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
23/30
Gan&&uan P$-%$n#ukanGan&&uan P$-%$n#ukan
I-'u(sI-'u(s
• O#o-a#!s!#as nor-a(
– K$"$'a#an a%nor-a( @ Tak!kar)! )an Bra)!kar)!
–
Ira-a a%nor-a( @ I-'u(s 'r$-a#ur$• O#o-a#!s!#as a%nor-a(
• Trigger activity
– Ear( af#$r )$'o(ar!5a#!on /EA0
– $(a$) af#$r )$'o(ar!5a#!on /A0
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
24/30
Gan&&uan Kon)uks! I-'u(sGan&&uan Kon)uks! I-'u(s
• P$r(a-%a#an )an ha-%a#an kon)uks!
– B(ok SA
– B(ok A3
– B(ok '$r"a%an&an %$rkas C!s
•
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
25/30
ELE>TRO>ARIOGRATRO>ARIOGRA<
• As the heart undergoes depolarization and
repolarization , the electrical currents that are
generated spread not only within the heart, ut also
throughout the ody!• This electrical activity generated y the heart is
generally measured y an array of electrodes placed
on the ody surface and the resulting tracing is
called an electrocardiogram "#C$, or #%$&!
• The different waves that comprise the #C$ represent
the se'uence of depolarization and repolarization of
the atria and ventricles!
http://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htm
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
26/30
ELE>TRO>ARIOGRATRO>ARIOGRA<
(ses of the #%$
• )eart *ate
• Conduction in the heart
• Arrythmias
• irection of the cardiac vector
• amage to the heart muscle• rovides . information aout pumping or
mechanical events in the heart
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
27/30
Normal ECGNormal ECG
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
28/30
ELE>TRO>ARIOGRATRO>ARIOGRA<
• The -wave represents the wave of depolarization thatspreads from the /A node throughout the atria and isusually 0!01 to 0! seconds "10-00 ms& in duration!
• The period of time from the onset of the -wave to theeginning of the 3*/ is termed the * interval andnormally ranges from 0!2 to 0!20 seconds! This intervalrepresents the time etween the onset of atrialdepolarization and the onset of ventricular
depolarization!• The 3*/ comple4 represents ventricular depolarization!
The duration of the 3*/ comple4 is normally 0!05 to 0!seconds indicating that ventricular depolarization normally occurs very rapidly!
http://www.cvphysiology.com/Arrhythmias/A002.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A002.htm
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
29/30
ELE>TRO>ARIOGRATRO>ARIOGRA<
• The isoelectric period "/T segment& following the 3*/ isthe time at which the entire ventricle is depolarized androughly corresponds to the plateau phase of theventricular action potential!
• The T-wave represents ventricular repolarization and islonger in duration than depolarization "i!e!, conductionof the repolarization wave is slower than the wave ofdepolarization&!
•
The 3T interval represents the time for oth ventriculardepolarization and repolarization to occur, and thereforeroughly estimates the duration of an average ventricularaction potential! This interval can range from 0!2 to 0!6seconds depending upon heart rate!
http://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htm
-
8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt
30/30
Th$ Nor-a( EKG r$"or)$) on #h$ B!'o(ar L!-% L$a)s
top related