3. Pengendalian Aliran & Tekanan Darah
-
Upload
galuharkaciedha -
Category
Documents
-
view
117 -
download
0
description
Transcript of 3. Pengendalian Aliran & Tekanan Darah
![Page 1: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/1.jpg)
Local Control of Blood Flow
![Page 2: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/2.jpg)
Introduction
The greater the metabolism the greater its blood flow– Liver: 95 ml/min/100 g of liver tissue.– Kidneys: 1100 ml/min cleansing the
blood. The importance of blood flow control
effective & efficient– Serving metabolic need– Efficient heart workload.
![Page 3: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/3.jpg)
Mechanism of Blood Flow Control
Acute control (rapid changes in local vasodilatation / vasoconstriction):– Effect of tissue metabolism– The availability of oxygen changes.– Two basic theories:
Vasodilator theory: adenosine; CO2; histamine; K+ & H+
Oxygen lack theory: vasomotion in metarterioles & precapillary sphincters.
– Other nutrients besides Oxygen:– Lack of glucose vasodilatation– Vitamin B deficiency vasodilatation
![Page 4: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/4.jpg)
![Page 5: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/5.jpg)
The examples of acute metabolic control of local blood
flow1. Reactive hyperemia
• Blocked (seconds – hours) unblocked• Blood flow increases to 4 – 7 times
normal• Depend on how long it is blocked.
2. Active hyperemia• Tissue activity lack of nutrient &
release vasodilator substances.• Local blood flow increases 20 times in
muscle during heavy exercise.
![Page 6: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/6.jpg)
Blood flow control & The arterial pressure changes
Acute autoregulation theory:1. The metabolic theory2. The myogenic theory (still doubtful !!)
Endothelial-Derived Relaxing Factor “EDRF” (NO):
– Rapid flow of blood shear stress NO release relaxes the local arterial wall.
![Page 7: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/7.jpg)
![Page 8: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/8.jpg)
Long Term Blood Flow Regulation
1. Change in Tissue Vascularity– Reconstruction to meet the needs of
the tissues– Role of Oxygen in Long-Term
Regulation.– Vascular Endothelial Growth Factors:
1. VEGF2. FGF3. Angiogenin
2. Collateral Circulation:
![Page 9: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/9.jpg)
Humoral Regulation of The Circulation
1. Vasoconstrictor Agents:1. Norepinephrine & Epinephrine2. Angiotensin3. Vasopressin4. Endothelin
2. Vasodilator Agents:1. Bradikynin2. Histamin
3. Effects of Ion & Other Chemical Factors1. Calcium vasoconstriction2. Potasium Vasodilatation3. Magnesium powerful vasodilatation4. Hydrogen vasodilatation5. Acetate & Citrate mild degree
vasodilatation
![Page 10: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/10.jpg)
Rapid Control of Arterial Pressure by
Nervous System
TIM BLOK CARDIOVASKULER
![Page 11: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/11.jpg)
Pengendalian sirkulasi oleh sistem saraf
Peran sistem saraf dalam pengendalian aliran darah lokal sangat kecil.
Sistem saraf lebih berperan pada fungsi global dalam hal:
1. Pendistribusian darah ke area tubuh tertentu
2. Kekuatan pompa jantung3. Pengendalian cepat tekanan darah
![Page 12: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/12.jpg)
Three Major Changes
If sympathetic nervous system are stimulated
1. Almost all arterioles are constricted• Increases the total peripheral resistance
2. The veins especially & other large vessels are strongly constricted• Increases venous return increase cardiac out
put (Starling Law)
3. The heart enhancing cardiac pumping• Increases heart rate• Increases cardiac contractility
![Page 13: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/13.jpg)
Anestesi spinal menyebabkan penurunan tekanan darah akibat hilangnya tonus vasomotor
![Page 14: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/14.jpg)
Reflex Mechanism for Maintaining Normal Arterial Pressure
Baroreceptor Reflexes:– The receptors: Baroreceptors or
Pressoreceptors Located in the wall of several of large systemic
arteries Sinus caroticus n. Hering n.
Glossopharyngeus tr. Solitarius Med. Oblongata.
Arcus aortae n. Vagus– The Response: Feedback signals to reduce
arterial pressure Vasodilatation of the veins and arterioles Decreased heart rate & the strength of heart
contraction
![Page 15: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/15.jpg)
Efek perubahan tekanan arteri (ΔP) terhadap perubahan transmisi impuls n. Hering dari sinus Caroticus (ΔI)
Baroreseptor lebih merespons perubahan tekanan daripada tekanan stasioner
![Page 16: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/16.jpg)
Penjepitan a. carotis communis menyebabkan peningkatan tekanan arteri (MAP), pelepasan jepitan menurunkan tekanan arteri
![Page 17: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/17.jpg)
Function of Baroreceptor Reflex
During changes in Body Posture– To maintain relatively constant arterial
pressure in the upper body Pressure Buffer Function
– Opposes either increases or decreases in arterial pressure.
Unimportance of Baroreceptor System for Long Regulation– The resetting of baroreceptor systems
![Page 18: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/18.jpg)
Pencatatan tekanan darah selama 2 jam pada kondisi NORMAL (gambar atas) dan pada beberapa minggu setelah DENERVASI sinus caroticus dan Sinus aorticus
![Page 19: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/19.jpg)
Frekuensi distribusi MAP selama 24 jam pada anjing NORMAL dan beberapa minggu setelah denervasi baroreseptor
![Page 20: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/20.jpg)
Chemoreceptors Reflex:– The receptors sensitive to:
Lack of oxygens; CO2 excess and H+ excess. Located in the wall of small arteries; Carotid Bodies &
Aortic Bodies.– Not a powerful control in a normal arterial
pressure range Important in below 80 mmHg
Low-pressure Receptors:– Stretch receptors– Located in the wall of: Pulmonary arteries &
Atrium– Role: to minimize arterial pressure changes in
response to changes in blood volume.
Reflex Mechanism for Maintaining Normal Arterial Pressure (Cont.)
![Page 21: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/21.jpg)
Volume Reflex (Atrial Reflex that Activate the Kidney)– Stimulation: Stretch of the atria– Response:
1.Dilatation of the afferent arteriole in the kidney2.To Hypothalamus Decrease ADH secretion 3.Release of Atrial Natriuretic Peptide (ANP)
The Bainbridge Reflex– Stimulation: Stretch of the atria– Response: n. Vagus Med. Oblongata Increase
the heart rate & strength of the heart contraction
Reflex Mechanism for Maintaining Normal Arterial Pressure (Cont.)
![Page 22: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/22.jpg)
CA
CI
HIGHER CENTER
VASOMOTORCENTERCI CA
JANTUNG
SV Hr
C.O.PX
TPR
“Blood Pressure”O2
H
CO2
PH
CHEMORECEPTOR
+
VCVD
+
“Baroreceptor”
-
BARORESEPTORCONTROL “Blood Pressure”
![Page 23: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/23.jpg)
TEKANAN DARAH
C.O.P T.P.R
S.V Hr
EDV
IVFP
VR
VC
BV
VD
ESV
MC
SK
CPM
S
PS
PEGVMC
LVMC
VK/VD
NEUROHUMO-RAL CONTROL
BHN LOKALO2,CO2,H,K
EMP
B.VISC.
HT
FAKTOR YG MEMPENGARUHI “BP”
![Page 24: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/24.jpg)
KONTROL TEK. DARAH SISTIM SARAF:
CNS : VASOMOTORCENTER ( CA & CI ) LUAR CNS: “BR” & “CR”
SISTIM HUMORAL / KIMIA / HORMON: RENIN-ANGIOTENSIN, ALDOSETRON, VASOPRESIN ADRENALIN, NOR ADRENALIN, ACETYLKOLIN K, Mg, H, Ca, Na, CO2,CO, ROS, LAKTAT,
PYRUVAT. SISTIM HEMODINAMIK:
VOLUME DARAH & TEK. OSMOTIK/HIDROSTATIK Pada sistim ini lebih banyak dipengaruhi oleh
perubahan-2 tek hidrostatik, osmotik & oncotik yg terdapat diluar dan didalam sistim vaskuler
Mekanismenya berjalan secara simultan & saling melengkapi & Tujuannya: menunjang “homeostatics”
![Page 25: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/25.jpg)
BRAINSTRESS STRESS PSIKOLOGIFISIKSUHUTOXIN
HIPOTHALAMUS
REAKSI HORMONAL REAKSI NEURAL
VASOPRESIN CRF
RETENSI Na & H2O
VMC SIMPATIS
HEART VASKULER
INOTROPIK, EDVVENT.DIST,FILLING P
CPM
SV X Hr
COP “R”X
“BP”
BV
VASOKONS-TRIKSI
![Page 26: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/26.jpg)
JGA
RENINANGIOTENSINOGEN+ ANGIOTENSIN I
CONVERTING ENZYM
ANGIOTENSIN II PARU
LIVER
ADRENAL CORTEX
ALDOSTERON BRAINVMC
Intake H2O
“S”retensi Na
& H2O
BV JANTUNG
ARTERI
GLOMERULUS
VASOKONSTRIKSI
RCOP
“BP”
SVHr
RBF
RENIN-ANGIOTENSINCONTROL”BP”
x
![Page 27: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/27.jpg)
CA
CI
HIGHER CENTER
VASOMOTORCENTERCI CA
JANTUNG
SV Hr
C.O.PX
TPR
“BP”O2
H
CO2
PH
CHEMORECEPTOR
+
VKVD
+“BR”
-
BARORESEPTORCONTROL “BP”
![Page 28: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/28.jpg)
SHORTTERM CONTROL “BP” VIA BARORECEPTOR REFLEX
F:CARDIACPHYSIOLOGY/CHAP.18B/IBNU/NEW/PAPI/CARDIOVASKULERPHYSIOLOGY/2004
![Page 29: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/29.jpg)
KELAINAN TEK. DARAH HIPERTENSI: Tek.darah melebihi nilai nor-
malnya. N Bp: 120/80 & MAP=93,33 mmHg misalnya : 130/95 mmHg atau lebih besar.
HIPOTENSI : Tek. Darah kurang dari nilai nor- malnya.Biasanya ada hub.nya dengan shock! Misalnya: 80-90/60- 55 mmHg atau lebih kecil.
KLASIFIKASI HIGH BLOOD PRESSURE : Hipertensi essensiil: penyebab tak jelas, mungkin
karena kacaunya sistim kontrolnya (saraf,hemodinamik,humoral)
Hipertensi skunder: penyebab jelas, ada kelainan organ seperti peny. ginjal; tumor cortex adrenalis;toximia gravidarum;obat
Klasifikasi lain: Hipertensi ringan, Hipertensi sedang dan Hipertensi berat
![Page 30: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/30.jpg)
HIPERTENSI ESSENSIILFAKTOR
Genetik,makanan;minumanEmosi & stress psikosial; obat; merokok; olah raga
Pemicu fisiogenesis:
Kacau sistim kontrol“Bp” (neural,hemodinamik
& humoral)
Ht .Ess
Ubah “life style”
Cara mengatasi
Tdk merokok
Tdk minum alkohol
Kurangi makan garam
OR Hilangkan stress
Tidur cukup
Health Wellness
Stop obat
Obat anti hipertensi2
1
![Page 31: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/31.jpg)
HIPERTENSI SKUNDERHt.skunder: suatu Ht dengan
penyebab yg dapat di identifikasikanPenyebab:1. peny. Ginjal;2.hiper
sekresi aldos- teron krn kelainan cortex adrenalis; 3.tumor kel medulla adrenalis (feokromositoma); 4.toxae- mia gravidarum; 5.grave`s disease?; 6.peny. Kardiovaskuler.
Gejala: Tek.drh > normal (S/D ) & jika D > 120 mmHg dikenal Ht. Maligna dng gejala se- perti papil edema, stroke,gagal jantung &ginjal.
![Page 32: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/32.jpg)
PENYEBAB HYPERTENSION
HYPER-TENSION
Tu.med Adr
Tu cortex
ald
Renin-Agt
Retensi Na &H2O
KVS defect:
CNS
Cushing
COR
Head injury,tu-Mor,psychiatricdisturbances
Stenosis Ao
atherosclerosis
hipertiroidism
Ht renal
Spasme
Constr.renal
Hidronefrosis,pyelonefritis,GNA/C
Toxaemia,
![Page 33: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/33.jpg)
KOMPLIKASI HIPERTENSI JANTUNG:
Ht. Menyebabkan beban kerja jantung & merusak pembuluh darah sehingga “TPR” meningkat.
Hipertropi ventrikel kiri left heart failure Ht. Meningkatkan faktor “after load” O2D > O2S SEHINGGA TERJADI INSUFISIENSI
KORONER OTAK:
Stroke ( transient cerebral ischemia attack/bleeding)
Hypertensive encephalopathy (gejala prodromalnya mual-muntah,insomnia, sulit konsentrasi, akhirnya coma & kejang2.
ARTERI: proses sklerosis, trombosis dan pembuluh drh mudah pecah (jantung,ginjal,otak dll).
![Page 34: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/34.jpg)
140
130
115
90
155
N
Border line
95S
D
Area
Area
peningkatan
190
60
Area
Abnormal
VARIASI
BLOOD PRESSURE
![Page 35: 3. Pengendalian Aliran & Tekanan Darah](https://reader030.fdocuments.in/reader030/viewer/2022033007/55cf926e550346f57b9676f3/html5/thumbnails/35.jpg)
OBAT ANTI HIPERTENSI TUJUAN: MENGEMBALIKAN “PERAN SISTIM
CONTROL Bp” AGAR DAPAT BERFUNGSI & MENGHINDARI KOMPLIKASINYA
OBAT : BETA BLOKERS: PROPANOLOL, ATENOLOL,
OXYPRENOLOL,NADOLOL,CARTEOLOL. DIURETIKA: HCT; FUROSEMIDE, DIAMOX.,
SPIRONOLACTON,ALDACTON,C.THALIDONE. VASODILATATOR: KALSIUM ANTAGONIST
MISALNYA: DILTIAZEM, NIFEDIPINE, VERAPAMIL, AMIODIPINE.
ANTICONVERTING ENZYM/ACE INHIBITORS: CAPTOPRIL ( CAPOTEN,CAPTENSIN)
GABA : HEXAMOTHONIUM. ANXIOLYTIC:MENCEGAH STIMULASI HIGHCENTER.