Heart as a Pump

Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera Utara
CARDIAC CYCLE
 Systole
Iso-volumetric contraction :
Contraction begins but valves still 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)
QRS
T P

120

V wave a wave C wave

(venous (atrial (ventricular
return) Contraction) contraction)

0 mmHg

IVR Filling IVC Ejection

 Left Ventricular Pressure (120/0 mmHg)
QRS
T P

120

Atrial
Contraction Aortic Valve Closes
Opens at at 100
80 mmHg mmHg

0 mmHg

IVR Filling IVC Ejection

 Aortic Pressure (120/80 mmHg)
QRS
T P

120

80

Aortic Valve Closes

Opens at at 100
Aortic blood Flow
80 mmHg mmHg
to circulation continues despite zero
ventricular output
0 mmHg

IVR Filling IVC Ejection

 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: 80 mmHg
lowest systemic arterial pressure, during diastole.
Diastole: Relaxation of the heart.
Systolic pressure: 120 mmHg
Systole: Contraction of the heart highest systemic arterial pressure, during systole

Blood volume 5l
 ejection fraction, percent of
end-diastolic ventricular
volume that is ejected with
each stroke, is about 65% (EF
= SV/ EDV)
NOTE: Resting Ejection
Fraction (EF) is the best
indicator of both heart
performance and heart
disease prognosis
 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 Frank-
Starling 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

Normal
Stroke volume

Fungsi jantung

Syok
Kardiogenik

End Diastolic Volume

 HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

After-load

Isovolumetric
PRESSURE

Phase

Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 E D Y HEART
A S LI T
R E TI SYSTOLIC PRESSURE CURVE
C C
IN TRA
O N
C

Isotonic (Ejection) Phase

After-load

Isovolumetric
PRESSURE

Phase

Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 ED T Y
HEART
S
A I LI
E
R CT SYSTOLIC PRESSURE CURVE
C
DE TRA
O N
C

Isotonic (Ejection) Phase

After-load

Isovolumetric
PRESSURE

Phase

Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 HEART
G D
IN E
LL AS
SYSTOLIC PRESSURE CURVE
FI RE
C
IN

Isotonic (Ejection) Phase

After-load

Isovolumetric
PRESSURE

Phase

Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

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 Aritmia

dan sinkron
Katup jantung Stenose, Regurgitasi
(normal)
Kontraksi kuat Failure

Pengisian adequat abnormal filling

(diastole)
 Thank You

Let it
beat!