HISTOLOGI SISTEM KARDIOVASKULER

Rahmawati Minhajat

BAGIAN HISTOLOGI
FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
SISTEM KARDIOVASKULER

Jantung (Cor/Kardio)

Vaskuler (pembuluh darah)

Dinding jantung
Cardiac muscle
Fibrous skeleton
Conduction system
SISTEM KARDIOVASKULER

Jantung
Endocardium
Myocardium Lapisan dinding jantung

Epicardium

Pembuluh darah
Arteri
Vena
 Jantung Arteri
besar

Vena Arteri
besar sedang

Vena Arteri
sedang kecil

Vena Kapiler
kecil
 Jantung
MAKROSKOPIK (4 bagian) :
- Atria Kanan
- Atrium kiri
- Ventrikel kanan
- Ventrikel kiri
NOTE:
- The heart serves as a mechanical
pump to supply the entire body with
blood, both providing nutrients and
removing waste products.
- The great vessels exit the base of the
heart.
- Blood flow: bodyvena cavaright
atriumright ventriclelungsleft
atriumleft ventriclebody
- The heart consists of 3 layers the
endocardium, myocardium, and
epicardium. The epicardium (bottom
left) consists of arteries, veins, nerves,
connective tissue, and variable
amounts of fat.
- The myocardium contains branching,
striated muscle cells with centrally
located nuclei. They are connected by
intercalated disks (arrowheads).
 MIKROSKOPIK (3 lapisan) :
Endokardium
Miokardium
Epikardium
 ENDOKARDIUM
Endokardium tampak lebih tebal di
atrium dan lebih tipis di ventrikel
Pada atrium :
Lapisan Endotelium
Lapisan Subendotelium
Lapisan Elastikamuskular
Lapisan Subendokardium
ATRIAL AND VENTRICULAR
ENDOCARDIUM
 Endocardium of Atrium and Ventricle
- These sections of heart are both taken near
the atrio-ventricular sulcus that contains a
coronary artery and cardiac vein. They also
exhibit all 3 layers of the heart wall
epicardium, myocardium, and
endocardium.
- The myocardium in the ventricle is
much thicker than that in the atrium.
- The endocardium (marked by the black
bracket) is magnified in the lower panel
and compared between the atrium and the
ventricle.
- The atrial endocardium is much thicker
than the ventricular endocardium and
contains a well-developed network of
elastic fibers.
- Right beneath the ventricular endocardium
are conducting fibers
 MIOKARDIUM

Bagian paling tebal dari dinding jantung

Miokardium lebih tebal di bagian ventrikel dari pada
bagian atrium
Lebih tebal di bagian ventrikel kiri dari pada kanan
Diskus interkalaris (Intercalated disks/glanz streinfen)
terdapat pada miokardium:
Fasciae adherens
Gap junctions
Desmosome
The ID is a specialized cell-to-cell
adhesion/communications site. These
structures are found only in cardiac
muscle.
 EPIKARDIUM

Dinding paling luar dari jantung:

- Jaringan penyambung fibroelastis
(collagenous fibers + elastics fibers)
- Mesothel
Epikardium perikardium
Cavum pericard
- perikardium viseralis
- perikardium parietalis
 EPIKARDIUM terdiri dari:
1. Pembuluh darah >>
2. Nervus
3. Pembuluh limfe
4. Jaringan lemak
SKELETON JANTUNG

Annulus fibrosus (Jar. Ikat irreguler yg tebal)

Trigonum fibrosum kanan (Right fibrous trigonum)
Trigonum fibrosum kiri (Left fibrous trigonum)
Septum intraventrikulare (terdapat lapisan endokardium
dan miokardium kecuali didaerah membranosa)
Septum interatrial (lebih tipis daripada septum
interventrikularis, terdapat lapisan endokardium dan
miokardium kecuali pada daerah yg terdapat jaringan
fibrosa)
KATUP JANTUNG
(terdiri dari lapisan endokardium dan jaringan ikat)

1. KATUP TRICUSPIDAL
2. KATUP BICUSPIDAL (MITRAL)
3. KATUP PULMONAL
4. KATUL AORTA
 Cardiac Valves
- The heart contains 4 valves the tricuspid,
pulmonary, mitral, and aortic valves. The valves
prevent regurgitation of blood flow.
- The cardiac valves are essentially plates of dense
connective tissue extending from the cardiac
skeleton covered with endothelium. They are
avascular.
- The side of the valve that faces oncoming blood
flow exhibits an extensive elastic fiber network.
As the blood is squeezed out of the heart chamber,
the increased blood pressure pushes the valve
open. As the blood flows past the valve and the
pressure drops, the elastic fibers recoil and help
the valve to close. The other side of the valve
contains abundant collagen fibers.
- Both atrial valves, the tricuspid and mitral valves,
are attached to papillary muscles in the ventricles
via chordae tendineae. The papillary muscles and
chordae tendineae do NOT pull open the valves. All
valves open and close passively. Instead, these
structures hold the tricuspid and mitral valves shut
to prevent regurgitation of blood back into the atria
when the ventricles contract. The blood exits the
ventricles via the pulmonary and aortic valves.
 REISZLEISTUNS SYSTEM
(CONDUCTIVE SYSTEM OF THE HEART)

Sino-atrial node
(Keith-Flack)
AV node/
Bundel tawara
(interatriorum)
Bundle of HIS
(Berkas His)
Purkinje fibers
SIN KF SIN AV HIS Purkinje fibers
 Low magnification micrograph of a
sinoatrial node (center-right on image)
and its surrounding tissue. The SA node
surrounds the (sinuatrial) nodal artery (on
SA Node lumen in the image), a branch of the right
coronary artery, abuts cardiac myocytes (of
the right atrium) on its deep aspect (left of
image) and adipose tissue on its superficial
(epicardial) aspect (right of image). H&E
stain.

The SA node fibre

vaguely resemble cardiac
myocytes; however, they
are thinner, squiggly and
stain less intensely (on
H&E) than cardiac
myocytes. Adjacent to
nodal tissue is nerve
fibre. The SA node
interacts with fibres from
the vagus nerve.
 AV Node

Atrial myocardium

Trigona
fibrosa AV Node
- This section was taken near the interventricular septum. The nerve tissue of the AV
bundle, or bundle of His (lighter staining enclosed in bracket), must travel through the
cardiac skeleton down a small fascicle of muscle fibers. The nerve fibers then travel
down the interventricular septum towards the apex of the heart as Purkinje fibers.
- The cardiac skeleton consists of dense connective tissue surrounding the cardiac
valves, on which all the muscle fibers of the heart insert. When the cardiac muscles
contract, they pull toward these insertion points and empty the atria and ventricles.
 Bundle of His

This is a Masson trichrome stain marking fibrous tissue blue and muscle light red.

The bundle of His (arrow) is in the membranous portion of interventricular

septum, which is part of the cardiac skeleton. The atrial and ventricular septums
are on the left and right, respectively. The bundle is modified myocardium.

The loose valve structure below the atrial septum is the tricuspid valve.
 Conducting System of the Heart
- The heart continuously pumps blood to
the entire body without input from
elsewhere.
- Nerve impulses initiate from the sinoatrial
(SA) node and travel down to the
atrioventricular (AV) node. They
continue down the bundle of His and
spread out among the Purkinje fibers
towards the apex of the heart. This
mechanism provides regular, synchronous
contractions of the myocardium.
- The Purkinje fibers can be found
immediately beneath the endocardium of
the ventricular papillary muscle or in other
regions immediately underneath the
ventricular endocardium.
- The Purkinje conducting fibers are
modified cardiac muscle cells, specialized
for the conduction of electrochemical
impulses. They appear much larger and
paler than cardiac muscle fibers.
 Purkinje fibers bundles of impulse-conducting fibers
extending from AV node
It can be found beneath the endocardium lining the interventricular
septum

It can be distinguished from

Regular cardiocytes by their
-Location
- Larger size
- Lighter cytoplasmic staining
 VASKULARISASI

HEART LARGE
ARTERIES

LARGE MEDIUM
VEINS ARTERIES

MEDIUM SMALL
VEINS ARTERIES

SMALL
VEINS CAPILLER
 PEMBULUH DARAH

ARTERI VENA

ARTERI BESAR VENA BESAR

VENA SEDANG
ARTERY SEDANG

VENA KECIL
ARTERI KECIL

KAPILER
PREKAPILER

KAPILER
 ARTERI BESAR= ELASTICS TYPE
Lokasi : paling dekat dengan jantung
Mikroskopik :
T. INTIMA
Selapis sel endotel
Subendotel
Tidak ada lamina elastika interna
T. MEDIA
banyak serat elastis fenestrated membrane by OsO4 coklat
Tidak ada lamina elastika eksterna
Lpisan otot polos
Terdapat daerah yang mengandung kondroitin sulfat diantara
fenestrated membrane dengan otot polos.
T. ADVENTITIA
Lapisan yang tipis
terdapat vasa vasorum, nervus dan sel adiposa
 AORTA (intima)
- All vessel walls are divided into 3 tunica
(starting from inside): intima, media, and
adventitia.
- The inner intima layer consists of simple
squamous epithelium and underlying
connective tissue.
- The border between the tunica intima and
tunica media may not be easy to recognize.
As a general rule of thumb, the intima ends
and the media begins where the first distinct
elastic sheet or lamella is located.
- In the figure below, the elastic sheet is
indicated by arrowheads, and the intima is
indicated by the bracket.
 AORTA (media)
- The tunica media consists of circularly
arranged smooth muscle and
abundant elastic tissue. In the H&E
stain below, the arrows point to a
smooth muscle cell nucleus and elastic
lamella (E).
- The Masson-aldehyde fuchsin stain
accentuates the abundance of elastic
lamellae within the tunica media.
- .
 AORTA (adventitia)
- The outermost layer of the vessel wall, the
tunica adventitia, is mainly a connective
tissue sheath surrounding the vessel.
- The media ends and adventitia begins where
the elastic lamellae are not found.
- The H&E stain below shows the border
between the media and adventitia. In larger
vessels, such as the aorta in this case, the
adventitia contains small arteries and veins,
also called vasa vasorum, and their smaller
branches (arrowheads) that supply
nourishment to the outer half of the media.
 Perubahan dari arteri elastika (arteri besar) menjadi
arteri tipe muskular area transisi a. tipe muskular :
A. Karotis eksterna

A. Axillaris

A. Iliaca communis

Juga terdapat perubahan arteri tipe elastika menjadi tipe

muskular hybrid type arteries memiliki 2 lapisan
pada t.media:
elastics lamina (di dalam)
elastics lamina (di luar)
 ARTERI SEDANG = MUSCULAR TYPE
MAKROSKOPIK : pada T.media terdapat sel-sel otot polos berwarna
kemerahan muscular type

MIKROSKOPIS :
T. INTIMA
Sel Endothel
Subendotel
Lamina elastika Internal
T. MEDIA
Lapisan otot polos yang tebal
Serat elastis yang tipis
Lamina elastika eksterna
T. ADVENTISIA
Serat Colagen
Serat Elastis
Sel Fibrosit
Vasa vasorum
 ARTERI KECIL = ARTERIOLE
Secara umum terdiri dari otot polos
lebih proksimal dari kapiler
< 0,5 mm
Secara umum lumennya kecil
Diantara arteriole and capiller PRECAPILLARY
MIKROSKOPIK :
TUNIKA INTIMA

TUNIKA MEDIA

TUNIKA ADVENTITIA
 TUNIKA INTIMA :
Endotelium
Subendotelium
Membran elastika interna

TUNIKA MEDIA :
Sel otot polos

TUNIKA ADVENTITIA :
Serat elastis, colagen dan
fibrous
KAPILER (exchange vessels):
Terdiri dari satu lapisan selapis sel endotel yang bersifat permeabel yang
dilapisi oleh lamina/membran basalis
MIKROSKOPIK :
Pembuluh darah paling kecil Dindingnya terdiri dari :
4,5-12, umumnya 6-7
<< RBC, tetapi RBC dapat lewat Selapis sel endotel
dalam kapiler karena elastis Lamina basalis (serat
WBC dapat lewat juga karena kolagen+retikuler)
diapedesiss
 3 TIPE KAPILER (Struktur endotel) :
1. Countinous capiller
2. Fenestrated capiller
3. Discontinous / sinusoid capiller

Countinous capiller Fenestrated capiller

 VENA
Pembuluh darah yang membawa darah kembali ke jantung
Semakin dekat ke jantung diameternya lebih besar dan dinding
lebih tebal
Lapisan dinding vena berbeda dengan arteri
Vasa vasorum pada vena >> arteri
Mikroskopi :
Tunika intima
Batas antara ketiga lapisan
dindingnya tidak jelas
Tunika media
Sel otot polos dan serat elastis
Tunika adventitia sedikit
 VENA KECIL
Mikroskopik :
T. Intima : Selapis sel endotel
T. Media : Otot polos yang bersusun sirkular
T. Adventitia : Sel Fibroblas, serat colagen dan elastis
 VENA SEDANG
Mikroskopik :
T. Intima :
Sel endothel (polygonal)
Serat elastis tipis
T. Media :
Otot polos yang bersusun sirkular
Serat kolagen
<< sel fibroblas
T. Adventitia :
Lebih tebal dari T. media media
Sel fibroblast
Serat kolagen
Serat elastis
 MiKrosKopiK :
VENA BESAR
T. Intima :

Sama dengan vena sedang

Pada lapisan subendotel,
jaringan penyambung lebih tebal
T. Media :

<< otot polos/ tdk ada

T. Adventitia :

Lebih tebal dari T. intima dan T.

media
Sel fibroblas
Serat kolagen
Serat elastis
Otot polos
 Comparison of Artery and Vein
Adventitia of vein
There are several criteria that can help you
distinguish between arteries and veins.
- Arteries experience a much higher blood
pressure than veins and therefore have a
much higher wall-to-lumen ratio (structure
correlates with function). On the other hand,
venous pressure is much lower and thus
veins have a lower wall-to-lumen ratio, or
wider lumen and thin wall.
- Veins are more variably shaped than
arteries.
- Most arteries contain a distinct internal
elastic membrane, while veins do not.
- In an artery, the media is thicker than the
adventitia. Once again, the media contains
abundant smooth muscle and elastic fibers.
The adventitia does not contain any muscle.
- In a vein, the adventitia is thicker than the
media. The media consists of
circumferentially oriented smooth muscle
fibers, while the adventitia contains
longitudinal smooth muscle fibers. The
adventitia is the thickest layer.
 PERBEDAAN ANTARA ARTERI DAN VENA
VEINS ARTERIES
THE WALL Not clear Clear
ELASTIC L. (-) (-)/(+)
LUMEN >> <<
T.MEDIA Thin Thicker
RBC (+) (-)
LYMPH CAP. (+) (-)
VALVULA (+) (-)
O2
BRANCH Same Smaller
collaps
 VALVULA VENA
Exist in inferior extremity veins
Open into blood flow
The vessels are thin
Sinus are exist
No exist in thorax and abdomen
Endothel are exist at both surfaces of layer, there are
connective tissue in the middle
To regulate blood flow reflux not happen
If valvula tears vein will be wider varices
ulcus varicosum
 ANASTOMOSIS ARTERIOVENOUS

Hubungan langsung antara arteriole and venule

GLOMUS
Terutama pada ujung jari dan telinga
Fungsi glomus :
Regulasi blood flow

Regulasi temperature dan conservasi panas pada

area tertentu
ARTERIOVENOUS ANASTOMOSES
 Endothelial cell

Sel endotel merupakan selapis sel yang melapisi permukaan dalam dinding vaskuler, sel
ini berespon terhadap setiap rangsang fisik maupun kimia dengan cara melepaskan
substansi yang tepat sehingga dapat memelihara keseimbangan vasomotor dan juga
hemostasis vaskuler. Keadaan dimana sel endotel kehilangan kemampuannya untuk
menjaga keseimbangan tersebut dan ketika endotel kehilangan kemampuan fisiologi
untuk mempromosikan vasodilatasi, fibrinolisis, dan antiagregasi, disebut sebagai
disfungsi endotel
 Endothelial cells The endothelium is a specialized form of
mesenchymally-derived epithelial
tissue. This simple squamous epithelium
forms a thin, delicate lining of all blood
vessels as well as the heart and the
lymphatic system. The endothelium is
arguably the most significant feature of the
vessel.

Although only a simple monolayer, the healthy endothelium is optimally placed

and is able to respond to physical and chemical signals by production of a wide
range of factors that regulate vascular tone, cellular adhesion, thromboresistance,
smooth muscle cell proliferation, and vessel wall inflammation. The importance
of the endothelium was first recognized by its effect on vascular tone. This is
achieved by production and release of several vasoactive molecules that relax or
constrict the vessel, as well as by response to and modification of circulating
vasoactive mediators such as bradykinin and thrombin. This vasomotion plays a
direct role in the balance of tissue oxygen supply and metabolic demand by
regulation of vessel tone and diameter, and is also involved in the remodeling of
vascular structure and long-term organ perfusion.