5/28/2018 Curah Jantung (Cardiac Output)
1/50
Curah Jantung (C ar d i ac O u t p u t ) ,Alir Balik Vena (V en o u s R et u r n )
dan Pengaturannya
SuhendiwijayaBagian Fisiologi FK Unswagati
1
5/28/2018 Curah Jantung (Cardiac Output)
2/50
Sasaran Belajar
Mahasiswa mampu menjelaskan :
Mekanisme Alir Balik Vena(Venous Return)
Mekanisme Frank - Starling
Suhendiwijaya, VI/20092
5/28/2018 Curah Jantung (Cardiac Output)
3/50
Cardiac Cycle (Siklus Jantung)
3 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
4/50
Cardiac Pump Cycle - Terminology
Systole (to contract) :
1. Chamber Muscles are active
4 Suhendiwijaya, VI/2009
. ventricular pressure increases circumferentialshortening ejection
3. Remember, the ventricle does not completely empty, the
residual volume = ESV
4. This is measured by CONTRACTILITY
5. This is affected by- Function of Muscle
- Initial Volume (PRELOAD)
- Initial Pressure (AFTERLOAD)
Thus, the stroke volume (SV) = EDV - ESV
5/28/2018 Curah Jantung (Cardiac Output)
5/50
Cardiac Pump Cycle - Terminology
Diastole (to expand) :1. Ventricular filling occurs, flowing down a pressure
gradient from the vena cavae and pulmonary veins
5 Suhendiwijaya, VI/2009
. usc es n t e c am er wa s are re axe
3. Volume at the end of the filling phase = EDV
4. Diastolic (resting) pressure develops as the walls are
stretched and elastic structures in the walls tend to
recoil.
The pressure at the end of this process = EDP
5. This relationship is measured by COMPLIANCE6. This is affected by
- Connective Tissue- Venous Pressure- Venous Resistance
Preload
5/28/2018 Curah Jantung (Cardiac Output)
6/50
Basic Myocardial Muscle Mechanics
Preload : Passive load that establishes the initial muscle
length of the cardiac fibers prior to contraction
6 Suhendiwijaya, VI/2009
er oa : um o a oa s aga ns w c e e myocar afibers must shorten during systole. (aortic
impedance, arterial R, PVR, intraventricular P,
mass and viscosity of blood in the great arteries)
Contractility : Speed and shortening capacity at a given
instantaneous load (inotropy)
Diastolic Compliance : The ability to fill at a given diast. P
Heart Rate : Frequency of contraction
5/28/2018 Curah Jantung (Cardiac Output)
7/50
Konsep Preload dan Afterload
Preload(Beban Awal)
- derajat regangan ketika otot tsb mulai
berkontraksi
- Tekanan diastolik akhir(End-diatolic
Pressure)
7 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
8/50
Konsep Preload dan Afterload
Afterload(Beban Akhir)
- beban yang di lawan oleh kekuatan
kontraksi otot
- Tekanan di dalam arteri yang berasal dari
ventrikel
-berhubungan dengan tekanan sistolik- tahanan perifer
8 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
9/50
Curah Jantung
Metode Pengukuran :
- F l o w m e t er elektromagnetik
-
a. Metode langsung Fick
b. Metode pengenceran indikator(Indicator
Dilution Methode)
9 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
10/50
Curah Jantung
Curah jantung (cardiac output): jumlah darah yg dipompa olehtiap ventrikel dalam waktu 1 menit dan jumlah darah yangmengalir dalam sirkulasi
Pada orang dewasa (istirahat) 5 L/menit; meningkat sesuai
10Suhendiwijaya, VI/2009
g e u u an Curah jantung (CO) = Isi sekuncup (SV) x denyut jantung per
menit(HR)
Isi sekuncup (stroke volume) : volume darah yang dipompaventrikel tiap denyut.
Setiap berdenyut, ventrikel memompa 2/3 volume
ventrikel;- jumlah darah yang dipompa : fraksi ejeksi- sisa darah yang masih ada di ventrikel setelah sistol berakhir:
volume akhir sistol (ESV = end systolic volume)- jumlah darah yang dapat ditampung ventrikel sampai diastol
berakhir: volume akhir diastol(ESD = end diastolic volume)
5/28/2018 Curah Jantung (Cardiac Output)
11/50
Faktor Yang MempengaruhiCO
Metabolisme basal tubuh
Aktifitas fisik
Umur
Ukuran tubuh
11Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
12/50
Faktor Yang MengontrolCO
12 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
13/50
Faktor Yang MengontrolCO
13 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
14/50
Cardiac Output (Curah Jantung)
14
CO
Cardiacoutput
(ml/min)
=
HR
Heart rate
(beats/min)X
SV
Strokevolume
(ml/beat)
5/28/2018 Curah Jantung (Cardiac Output)
15/50
A Simple Model of Stroke Volume
15 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
16/50
Factors Affecting Heart Rate
Autonomic innervation
Cardiac reflexes
16 Suhendiwijaya, VI/2009
one
SA node
Hormones
Epinephrine (E), norepinephrine(NE), and thyroid
hormone (T3) Venous return
5/28/2018 Curah Jantung (Cardiac Output)
17/50
Factors Affecting stroke volume
EDV
Frank-Starling principle
17 Suhendiwijaya, VI/2009
Preload
Contractility
Afterload
5/28/2018 Curah Jantung (Cardiac Output)
18/50
PengontrolanKerja Jantung
Suhendiwijaya, VI/200918
5/28/2018 Curah Jantung (Cardiac Output)
19/50
All of these factors are tightly interrelated
19 Suhendiwijaya, VI/2009Ganong, 2003
5/28/2018 Curah Jantung (Cardiac Output)
20/50
Aliran Balik Vena (V en o u s R et u r n )
Sirkulasi perifer yang mempengaruhi yang
mempengaruhi aliran darah ke dalam
Peran mekanisme Frank-Starling :
Energi kontraksi setara dengan panjang
awal serat otot jantung
20 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
21/50
How are changes in the cardiac
volumes related to cardiac output andvenous return ?
Loading Volume
(from veins)
Because veins are high
compliance vessels, pressure
drops slightly
21
Stroke Volume
HR x (EDV ESV) = CO70 x (120 60) = 4200 ml/min
Therefore, a pressure gradient
develops (flow)
Because arteries are low compliance
vessels, there is a large increase in
pressure as blood is ejected
Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
22/50
A Summary of the Factors
Affecting Cardiac Output
22Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
23/50
Multi-System Interactions
Autnonomous
Nervous
Sysetm
Respiratory
System
(thoracic
pressure)
Hormonal
System
(Epinephrine,
Insulin)
contractilityresistance
arterial pressure
venous pressure
venous return
Suhendiwijaya, VI/2009
2
3
Cardiac
Electrical
System
Cardiac
Mechnical
System
ascular
Mechnical
System
action potentials blood flow
preload, afterloadpacemaker ra e compliance
Electrocardiogram
Echocard
iogram/Doppler
Phonocardiogram
Pressure
wave
5/28/2018 Curah Jantung (Cardiac Output)
24/50
Keterbatasan Curah Jantung
24 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
25/50
Keterbatasan Curah Jantung
Jantung Hiperefektif
- Perangsangan saraf
- Hipertrofi otot jantung
25 Suhendiwijaya, VI/2009
Jantung Hipoefektif
- Blok A. Koroner
- Penghambatan perangsangan saraf jantung
- Gangguan irama dan frekuensi- Penyakit katup jantung
- Hipertensi
5/28/2018 Curah Jantung (Cardiac Output)
26/50
Curah Jantung Patologis
H ig h O u t p u t
- Penurunan tahanan perifer total
- Beriberi
- Fistula arteriovenosus
- Hipertiroidisme
- Anemia
26 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
27/50
Curah Jantung Patologis
L o w O u t p u t ,ada 2 kategori
1. kelianan an men ebabkan efektifitaspompa jantung turun rendah sekali
2. kelainan yang menyebabkan aliran balik
vena turun sangat rendah
27 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
28/50
Low output akibat pompa jantung lemah
Infark miokard
Penyakit katup jantung berat
Miokarditis
Tamponade jantung
Kekacauan metabolisme jantung
28 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
29/50
Low output akibat v e n o u s r e t u r n yang
rendah
Penurunan volume darah
Dilatasi vena akut
Penyumbatan vena-vena besar
Berkurangnya masa jaringan, terutama
berkurangnya masa otot rangka
29 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
30/50
30Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
31/50
31 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
32/50
Homeostasis KardiovaskulerDalam Sehat dan Sakit
Suhendiwijaya, VI/200932
5/28/2018 Curah Jantung (Cardiac Output)
33/50
33 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
34/50
34 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
35/50
Hipotensi Postural
35 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
36/50
Perubahan Sirkulasi Sistemik
36 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
37/50
37 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
38/50
Peradangan dan Penyembuhan Luka
38 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
39/50
Syok
Perfusi jaringan yang tidak adekuat disertai
curah jantung yang tidak adekuat baik secara
Macam Syok :
a. Syok Hipovolemik
b. Syok Distributif, Vasogenik, atau
Resistensic. Syok Kardiogenik
d. Syok Obstruktif39 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
40/50
Syok Hipovolemik
Perdarahan
Trauma
Pembedahan
Luka Bakar
Dehidrasi : Muntah atau Diare
40Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
41/50
Syok Distributif
Pingsan (syok neurogenik)
Anafilaksis
Sepsis
41 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
42/50
Syok Kardiogenik
Infark Miokard
Gagal Jantung Kongestif
Aritmia
42 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
43/50
Syok Obstruktif
Tension Pneumotoraks
Emboli Paru
Tumor Jantung
Tamponade Jantung
43
5/28/2018 Curah Jantung (Cardiac Output)
44/50
Syok Distributif
Pingsan (syok neurogenik)
Anafilaksis
Sepsis
44 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
45/50
Hipertensi
Peningkatan Tekanan Darah yang menetap
Hipertensi Sistemik
Hipertensi Paru
45
5/28/2018 Curah Jantung (Cardiac Output)
46/50
Gagal Jantung
Disfungsi Sistolik :
- Kontraksi ventrikel melemah
- Isi sekuncup berkurang
- Peningkatan vol akhir-sistolik ventrikel
- Fraksi ejeksi menurun
46 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
47/50
Gagal Jantung
Disfungsi Diastolik :
- elastisitas ventrikel berkurang
- mengurangi pengisian ventrikel selama
diastol
- menyebabkan kongesti vena
47 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
48/50
48 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
49/50
Gagal Jantung
Kor pulmonale
Gagal jantung kongestif
Gagal jantung curah tinggi
49 Suhendiwijaya, VI/2009
5/28/2018 Curah Jantung (Cardiac Output)
50/50