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7/31/2019 Suara Jantung Presentasi

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Anatomy of the Heart

Heart chambers:

Left & right atria.

Left & right

ventricles.

Heart valves:

Atrioventricularvalves:

Right: Tricuspid.

Left: Bicuspid/Mitral

Semilunar valves

Right: Pulmonary

valve.


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Anatomy of the Heart

Venae cavae.

Right atrium.

Right ventricle.

Pulmonary artery.

Pulmonary vein.

Left atrium.

Left ventricle.

Aorta.

Cardio-pulmonary circulation.


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The Heart Valves

Four types of valves regulate blood flow through your heart:


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Cardiac Muscle Tissue


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Cardiac Muscle Fibers

Cardiac contain myofibrils consisting of typicalsarcomeres.

Adjacent cardiac cells are connected byintercalated discs containing desmosomes and

gap junctions, which convey the force ofcontraction from cell to cell and conduct actionpotentials.

Cardiac muscle has abundant mitochondria anddepends primarily on aerobic respiration to form

ATP.


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ELECTRICAL PROPERTIES OFCARDIAC MUSCLE

Resting membran potential = -90 mV

Initial depolarization is due Na+ influx throughrapidly opening Na+ channel (overshoot)

Ca2+ influx through more slowly opening Ca2+channels produces the plateau phase,repolarization is due to net K+ efflux.

Depolarization lasts about 2 ms, but the plateauphase and repolarization last 200 ms or more


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Action potential of the cardiacmuscle


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MECHANICAL PROPERTIES OFCARDIAC MUSCLE

The contractile response of cardiacmuscle begins just after the start ofdepolarization and last about 1.5times as long as action potential

During depolarization and half ofrepolarization cardiac musclecannot be excited again its in itsabsolute refractory periode,therefore tetanus cant occur in

cardiac muscle Compared to skeletal muscle,

cardiac muscle has a longerrefractory period


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ACTION POTENTIAL OF CARDIAC MUSCLE


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Autorythmicity cells ofcardiac muscle

Noncontractile cardiac muscle cells exhibitautomaticity and rhythmicity and can

independently initiate action potentials. Such cells have an unstable resting potential

called a pacemaker potential that graduallydepolarizes drifting toward threshold for firing.

These cells comprise the intrinsic conductionsystem of the heart.


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POTENTIAL CARDIAC PACEMAKER

The structures that make up theconduction system are the sinoatrial node(SA node), the internodal atrial pathways,

the atrioventricular node (AV node), thebundle of His and its branches and thePurkinje system

The action potentials in SA and AV nodesare largely due to Ca2+, with littlecontribution by Na+ influx


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PACEMAKER POTENTIAL

Fastest cellslocated in SA node(100/minute).

SA node sets pace. Bundle of His can

provide ectopicpacemaker (25-40/min)


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Pacemaker and Action Potentialsof the Heart

Figure 18.13


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Intrinsic Conducting System

Sinoatrial node. Electrical pace maker.

Atrioventricular node.

Receives impulsesoriginating from SA node.

Bundle of His

Electrical link between

atria and ventricles. Purkinje fibres.

Distribute impulses toventricles.


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This system coordinates the depolarization and ensures the

heart beats as one.


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Sinoatrial

Node

AtrioventricularNode


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Cardiac Conductive System

Excitability (Irritability) : Ability of cardiacmuscle cells to respond to an external

stimulus (chemical, electrical, mechanical)

Conductivity : Ability of cardiac cell toreceive an electrical stimulus and conduct

that impulse to an adjacent cell


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Cardiac Conductive System

Automaticity : Ability of cardiac pacemakercells to spontaneously initiate an electrical

impulse

Contractility : Ability of cardiac cells toshorten, causing muscle contraction in

response to electrical stimulus


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The cardiovascular system is

composed of blood, blood vessels

and the heart.

Our heart beats nearly 100,000

times daily.

Blood vessels are fractionated into a

pulmonary circuit and systemiccircuit.

Artery:vessels that carry blood away

from the heart. Usually oxygenated

vein: vessels that carry blood

towards the heart. Usuallydeoxygenated.

Capillaries: a small blood vessel

that allow diffusion of gases,

nutrients and wastes between

plasma and interstitial fluid.
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Heart Sounds

Heard with aid of stethoscope.

Two sounds/vibration can be heard.

Caused by closure of valves.

First sound: Soft low pitched sound: closure of AV valves.

Occurs at onset of systole.

Second sound: Louder sound: closure of aortic and pulmonary

valves.

Onset of diastole and isovolumetric relaxation.


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ELECTROCARDIOGRAM

Because the body fluids are goodconductors, fluctuations in potential thatrepresent the algebraic sum of action

potentials of myocardial fibers can berecorded extracellularly

The record of these potential fluctuations

during cardiac cycle is theelectrocardiogram (ECG)


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STANDARD LEADS

Einthovens triangle : a triangle with theheart at its center

1. Bipolar : I (left arm right arm), II(right arm - left leg), III (left arm leftleg)

2. Unipolar (V): Precordial (V1 - V6),Augmented limb (aVR, aVL, aVF)


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Relationship of limb and chest leads

The chest leads look atthe heart across thehorizontal plane

The limb leads look at the

heart in a vertical plane

Leads aVR, aVL and aVFlook from three separatedirections

Leads I, II and III aresummation of potentialdifferences between limbleads

I

II III

V1

V2V3

V4

V6

V5

aVR aVL

aVF


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The limb leads

Positioning the limbleads

RA LA

RL LL

Black Green

Red

Yellow

Position of theelectrodes for limbleads

Right wrist

aVR Left wrist aVL

Left leg aVF

Right leg (earth)


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The chest leads

V1 - 4th ICS RSE V2 - 4th ICS LSE

V3 - midway between V2 & V4

V4 - 5th ICS MCL

V5 - 5th ICS AAL V6 - 5th ICS MAL

V1 V2 V3 V4 V5 V6

Sternomanubrial joint - Angle of Louis


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Electrocardiogram (EGC)


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ELECTROCARDIOGRAM

A recording of electrical activities in the heart The P wave reflects atrial depolarization.

The QRS complex indicates ventricular

depolarization. T wave indicates ventricular repolarization.

Segmen PR : Perlambatan AV node

ST Segmen : Waktu yang diperlukan ventrikel

berkontraksi dan mengosongkan dirinya TP : Waktu yang diperlukan ventrikel

berelaksasi dan mengisi diri


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P

Q

R

S

T


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P

Q

R

S

T


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The Cardiac Cycle

Period between start ofone heart beat and thestart of the next

Systole: Period of ventricular

contraction. Blood ejected from

heart.

Diastole:

Period of ventricularrelaxation. Blood filling.


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Systole

Iso-volumetric contraction:

Contraction begins but valves still closed.

Tension develops but no shortening of cells.

Pressure builds up.

Ventricular ejection:

Pventricles > Paortic/pulmonary trunk.

Semilunar valves open (aortic and pulmonary).

Muscle cells shorten.

Blood expelled: end systolic volume (ESV)remains.


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Diastole Iso-volumetric relaxation:

Ventricles begin to relax.

Semilunar valves and AV valves all closed.

Ventricular volume remains unchanged.

Ventricular filling :

Patria > Pventricles.

Mitral valve (left) and tricuspid valve (right)

open.Ventricle begin to fill (80% complete).

Atrial contraction completes filling.

Volume achieved: end diastolic volume (EDV)


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LATE DIASTOLE

ATRIALSYSTOLE

ISOMETRIC VENTRICULARCONTRACTION

VENTRICULAR

EJECTION

ISOMETRICVENTRICULARRELAXATION

THE CARDIAC CYCLE

DIASTOLE

Human Cardiovascular System


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Human Cardiovascular System

The cardiac cycle. During early diastole, all chambers are relaxed and theventricles begin filling with blood. At the end of diastole, the atria contract and theventricles are filled with blood. During systole, the ventricles contract, ejectingblood from the heart.


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Operation of Cardiac Valves

Four Phases of Cardiac Cycle

EKG, LV Volume, LA Pressure, LV

Pressure, Aortic Pressure, and CardiacSounds During Cardiac Cycle


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Operation of Cardiac Valves

LA LV AortaMitral Valve Aortic Valve

PLA < PLV Closed

PLA > PLV Open

PLV < PAO Closed

PLV > PAO Open


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EKG and LV Volume

IVR Filling IVC Ejection

EKG TP

QRS

End-Systolic

Volume

(ESV)

End-

Diastolic

Volume

(EDV) Passive

Filling

Active

Filling

EDV

ESV = Stroke Volume


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Left Ventricular Pressure (120/0 mmHg)


TP

QRS

0 mmHg

120

Atrial

Contraction Aortic Valve

Opens at

80 mmHg

Closes

at 100

mmHg


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Aortic Pressure (120/80 mmHg)


TP

QRS

Aortic Valve

Opens at

80 mmHg

Closes

at 100

mmHg

120

0 mmHg

80

Aortic blood Flow

to circulation continues despite

zero ventricular output


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Left Atrial Pressure (7/0 mmHg)


TP

QRS

a wave(atrial

Contraction)

120

0 mmHg

C wave(ventricular

contraction)

V wave(venous

return)


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Heart Sounds

Heard with aid of stethoscope. Two sounds/vibration can be heard.

Caused by closure of valves.

First sound: Soft low pitched sound: closure of AV valves.

Occurs at onset of systole.

Second sound: Louder sound: closure of aortic and pulmonary

valves.

Onset of diastole and isovolumetric relaxation.

ISOVOLUMETRIC RELAXATION

EJECTION


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ISOVOLUMETRIC RELAXATIONRAPID INFLOW

DIASTASISATRIAL SYSTOLE

ISOVOLUMETRICCONTRACTION

SYSTOLE DIASTOLE SYSTOLE

AORTICPRESSURE

ATRIALPRESSURE

VENTRICLEPRESSURE

ECG

PHONO-CARDIOGAM

VOLU

ME(ml)

PRESSURE(mmHg)


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