CARDIOVASCULAR

PHYSIOLOGY

Dr. A. HANAFIE, SpAn KIC

Instalasi Anestesi & Reanimasi/ICU
FK-USU/RSUP. Haji Adam Malik Medan
RSU. Dr. Pirngadi Medan 1
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 FUNCTIONS OF THE
CARDIOVASCULAR SYSTEM

 RAPID CONVECTIVE TRANSPORT

 O2 , Glucose, Amino acids, Fatty acids, Vitamins
 Drugs and Water

 RAPID WASHOUT OF METABOLIC WASTE PRODUCT

 CO2 , Urea, Creatinine

 CONTROL SYSTEM
 Distributes hormones to the tissues
 Even secretes some hormones itself (Atrial
Natriuretic Peptide )

 TEMPERATURE REGULATION
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 REPRODUCTION
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The structure of the cardiovascular
system is based around :

A pump (the heart)

A vast network of tubes ( blood vessel )

The transport of fluid ( blood )

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 HEART PUMP
“OUT PUT”

PRELOAD AFTERLOAD
CONTRACTILITY
BP = CO X TPR
SV HR Volume,
Viscositas,
Diameter 16
 OVERVIEW OF FACTORS AFFECTING TISSUE PERFUSSION

MYOCARDIAL CONTRACTILITY

PRE-LOAD AFTER-LOAD

STROKE VOLUME HEART RATE

CARDIAC OUTPUT PERIPHERAL RESISTANCE

VOLUME

BLOOD PRESSURE
DIAMETER

VISCOSITAS
TISSUE PERFUSSION 17
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OXYGEN DELIVERY = “O2 FLUX”
DO2 = CO X CaO2

(ml / menit) (ml O2 / 100 ml Blood)

= 1000 ml O2 / menit

CaO2 = (SaO2 x Hb x 1,341) + (PaO2 x 0,0003)

= 20 ml O2 / 100 ml Blood 22
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 OXYGEN TRANSPORT
OXYGEN “CASCADE”
INSPIRATION 160 TOR = mmHg
ALVEOLUS 103
ARTERIAL 100
CAPILLARY 50
CELLULAR 1 - 10
(MITOCHONDRIA)
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 HYPOTENSION
Remember : BP = CO x SVR
BP = (SV x HR) x SVR

1. Low SVR :
• sympathetic blockade
• vasodilators
• spinal shock
• anaphylaxis
• blood transfusion
• septic shock
2. Low HR ( see bradycardia )
3. Low Stroke Volume
4. Medicine :
• SVR lowering : nipride
• preload lowering : NTG
• contractility lowering : beta blockers
5. Surgeons disturbing baroreceptors
carotid artery surgery 29
 HYPERTENSION
1. Pain / Light anesthesia
2. Hypermetabolic state (fever / sepsis,
thyroid storm, MH crisis)
3. Catecholamine  (hypoxia, hypercarbia,
acidosis, awareness during surgery)
4. Medicine (eg, epinephrine injection )
5. Endocrine (pheochromacytoma, MH,
thyroid crisis)
6. Renal (parenchymal, renovascular)
7. Cushing’s reflex
8. Coarctation
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9. Full bladder
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 TACHYCARDIA
1. Light anesthesia / pain
2. Hypovolemic Shock
3. Hypermetabolic State :
• shivering
• fever
• MH
• thyroid
• alcohol “withdrawal”
4. Catecholamine  :
• hypoxia, hypercarbia
• acidosis
• pheochromacytoma
5. Sepsis
6. Medicine :
• atropin, gallamine
• pancuronium, ketamin
7. Arrhytmia :
• Atrial : SVT, Atrial fibrillation ,
Atrial flutter, pre-excitation
• Ventricular : VT (remember epi + halothane ) 32
 BRADYCARDIA
1. HYPOXEMIA !!
2. Athletic heart
3. Deep anesthesia
4. Vagal Causes :
• occulocardiac
• maxillary traction
• peritoneal traction
• cervical dilatation
• laryngoscopy
5. Cushing’s reflex
6. Medicine :
• neostigmine, edrophonium,
pyridostigmine
• beta blocker
7. Arrhytmias 33
 OBAT INTRAVENA :

BARBITURAT * METHOHEXITONE
* THIOPENTONE

BP  ok : * CAPACITANCE VENODILATATION

PRELOAD 

* SVR 

* MYOCARDIAL CONTRACTILITY 

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BENZODIAZEPIN :
* DIAZEPAM
* MIDAZOLAM

BP PENGARUHNYA TIDAK KENTARA

CARDIAC INDEX
PERUBAHAN
SVR MINIMAL

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 KETAMIN :

HEART RATE 
CONTRACTILITY  BP 
SVR  O2 Consumption 

Risk MCI 

CONTRA INDICATION : Hypertension ( + )

Hyperthyroid
History of MCI
Intra Cranial Pressure 

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 OPIAT
MORPHINE HIPOTENSI ( + ) , ok :
- VASOMOTOR TONE 
- CAPACITANCE VESSEL 
- HISTAMIN RELEASE 

PETIDINE HEART RATE 

- ANTICHOLENERGIC ACTION 
(PARASYMPHATOLITIC,
ATROPIN LIKE ACTION)

BLOOD PRESSURE 
- CONTRACTILITY 
- SVR 
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 INHALASI
N2 O  circulation effect minimal
SVR, PVR 
HALOTHANE contractility 

ENFLURANE cardiac output  BP 

SVR 

HALOTHANE provocator :
“catecholamine induced dysrhytmias”
HALOTHANE + ADRENALINE  EMERGENCY 38
ETHER

ISOFLURANE SYMPHATIC STIMULATION

CYCLOPROPAN

BP N @ 

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 RESPON KARDIOVASKULAR
TERHADAP PEMBEDAHAN DAN
ANESTESI
 TEKNIK PREANESTETIK & MONITORING

 LARINGOSKOPI & INTUBASI

 PERUBAHAN FUNGSI VENTILASI

 POSISI TUBUH

 PERDARAHAN

 STIMULASI DARI PEMBEDAHAN

 KEDALAMAN ANESTESI
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