Heart as a Pump

Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera Utara
Stroke volume
amount of blood
ejected by each
ventricle at rest is
70-90 mL.
(SV = EDV – ESV)

End-diastolic
ventricular
volume is about End-systolic ventricular
130 mL volume : blood remains
in each ventricle at the end
of systole is about 50 mL
• 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
Length of Systole & Diastole
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

Hati&GIT Ginjal Otak Jantung Hati&GIT Ginjal Otak Jantung

Skel. Mus. Kulit Lain2 Skel.mus. Kulit Lain2

10%
14%
25%
8%
2% 30%

20% 20%

20% 6%

4%
13% 10%
18%
 Some Definitions
Heart Rate: 60-100 beats/min Stroke Volume: 70-90 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
 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
 Resistensi
Ukuran
perifer
Preload ventrikel
kiri
Tekanan
Darah
Stroke
Pemendekan volume
Kontraktilitas serabut miokard
Cardiac
output

Heart
Afterload rate
• 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)
Kemampuan Pompa Jantung
( Cardiac Performance)

 Kontraktilitas
Denyut jantung
Preload ( beban awal)
dipengaruhi oleh end diastolic volume (EDV)

Afterload (beban susulan )

ditentukan oleh resistensi perifer
SYSTOLE DIASTOLE

COMPLIANCE

RIGID
 Resistensi
Ukuran
perifer
Preload ventrikel
kiri
Tekanan
Darah
Stroke
Pemendekan volume
Kontraktilitas serabut miokard
Cardiac
output

Heart
Afterload rate
THE HEART AS A PUMP
 REGULATION OF CARDIAC
OUTPUT
– Heart Rate via sympathetic &
parasympathetic nerves
– Stroke Volume
 Frank-Starling “Law of the
Heart”
 Changes in Contractility
 MYOCARDIAL CELLS
(FIBERS)
– Regulation of Contractility
– Length-Tension and Volume-
Pressure Curves
– The Cardiac Function Curve
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)
 Cardiac Innervation
• Impulses in noradrenergic sympathetic
nerves to the heart increase cardiac rate
(chronotropic effect) and force of cardiac
contraction (inotropic effect), also inhibit
effects of vagal stimulation, probably by
release of neuropeptide Y
Vasomotor Control; groups of neurons in
medulla oblongata that control of blood
pressure
• Neurons that mediate increased sympathetic
discharge to blood vessels and heart project
directly to sympathetic preganglionic neurons
in intermediolateral gray column (IML) of the
spinal cord.
• Impulses reaching the medulla also affect the
heart rate via vagal discharge to the heart.
 Vital centers of medulla
Cardiac Center
Cardioaccelerator center
Activates sympathetic neurons that increase HR
Cardioinhibitory center
Activates
parasympathetic
neurons that decrease
HR
Cardiac center receives
input from higher
centers (hypotha-lamus),
monitoring blood
pressure and dissolved
gas concentrations
 The parasympathetic
nervous system slows
heart rate.
The sympathetic
nervous system speeds
heart rate.
 Sympathetic and Parasympathetic
• Sympathetic – speeds heart rate by  Ca++ & I-f
channel flow
• Parasympathetic – slows rate by  K+ efflux & 
Ca++ influx

• Rate of discharge SA node and other nodal tissue is influenced by:

– Temperature; fever -> tachycardia
– Drugs; digitalis -> effect like vagal stimulation
 Hormonal Regulation

• Adrenaline and noradrenaline

– Sympathetic hormones released from
adrenal medulla.
–  CO ( HR and force of contraction)
– Arteriolar vasoconstriction in skin and
abdominal organs ( PR)
Renin-Angiotensin Mechanism