Heart as a Pump

Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera Utara
Kondisi Jantung Normal

Kontraksi reguler
dan sinkron
Katup jantung
(normal)
Kontraksi kuat
Pengisian adequat
(diastole)
 Cardiac Cycle
• Each cardiac cycle has two phases:
– diastole, the time during which cardiac muscle
relaxes, (diastole, dilation) and
– systole, the time during which the muscle contracts
(systole, contraction)
• Remember that blood flows from an area of
higher pressure to one of lower pressure, and
that contraction increases pressure while
relaxation decreases pressure.
 Diastole
• Iso-volumetric relaxation:
= Early diastole=Protodiastole
– The atria are filling with
blood from the veins
– Ventricles begin to relax.
– Last in 0,04 s
– Semilunar valves and AV
valves all closed.
– Ventricular volume remains
unchanged.
 Diastole
• Ventricular filling:
– Late diastole &
Atrial systole
– Patria > Pventricles.
– Mitral valve (left)
and tricuspid valve
(right) open.

– Ventricle begin to fill (80% complete).

– Atrial contraction completes filling.
– Volume achieved: end diastolic volume (EDV) = 130
mL
 Systole
• Iso-volumetric
contraction :
– Contraction begins but
valves still closed.
– Tension develops but no
shortening of cells.
– Pressure builds up until
pressures in left and right
ventricles > aorta (80 mm
Hg) and pulmonary artery
(10 mm Hg) (lasts about
0.05 s).
 Systole
• Ventricular ejection:
– Pventricles > Paortic/pulmonary
trunk.(L/R 120mmHg/25 mHg)
– Semilunar valves open
(aortic and pulmonary).
– Muscle cells shorten.
– Blood expelled= Stroke
Volume = 70-90 mL
– End systolic volume (ESV)
remains = 50 mL
• The ejection
fraction is a
valuable index
of ventricular
function.

• Ejection Fraction= the percentage of the end-

diastolic ventricular volume that is ejected with each
stroke, is about 65%.=> EF = SV/EDV (Normal
=55% - 67%)
• If, SV = 70 ml and EDV = 135 ml
EF = 52%
 ARTERIAL PRESSURE
• The blood forced into the aorta during systole not
only moves the blood in the vessels forward but also
sets up a pressure wave that travels along the arteries.
• The pressure wave expands the arterial walls as it
travels, and the expansion is palpable as the pulse.
• The rate at which the wave travels, which is
independent of and much higher than the velocity of
blood flow, is about 4 m/s in the aorta, 8 m/s in the
large arteries, and 16 m/s in the small arteries of
young adults.
• The strength of the pulse is determined by
the pulse pressure and bears little relation to
the mean pressure.
• The pulse is weak (“thready”) in shock.
• It is strong when stroke volume is large; for
example, during exercise or after the
administration of histamine.
• The pulse in aortic insufficiency is called a
collapsing, Corrigan, or water-hammer
pulse
 ATRIAL PRESSURE CHANGES
& THE JUGULAR PULSE
• The atrial pressure changes are transmitted to
the great veins, producing three characteristic
waves in the record of jugular pressure:
– a wave is due to atrial systole, some blood
regurgitates into the great veins when the atria
contract, when venous inflow stops, and the
resultant rise in venous pressure contributes to the a
wave.
– c wave is the transmitted manifestation of the rise in
atrial pressure produced by the bulging of the
tricuspid valve into the atria during isovolumetric
ventricular contraction.
 – v wave mirrors the rise in atrial pressure before
the tricuspid valve opens during diastole.
• The jugular pulse waves are superimposed on
the respiratory fluctuations in venous
pressure.
• Venous pressure falls during inspiration as a
result of the increased negative intrathoracic
pressure and rises again during expiration.
 Left Atrial Pressure (7/0 mmHg)
QRS
T P

120

V wave a wave C wave

(venous (atrial (ventricular
return) Contraction) contraction)

0 mmHg

IVR Filling IVC Ejection

 Left Ventricular Pressure (120/0 mmHg)
QRS
T P

120

Atrial
Contraction Aortic Valve Closes
Opens at at 100
80 mmHg mmHg

0 mmHg

IVR Filling IVC Ejection

 Aortic Pressure (120/80 mmHg)
QRS
T P

120

80

Aortic Valve Closes

Opens at at 100
Aortic blood Flow
80 mmHg mmHg
to circulation continues despite zero
ventricular output
0 mmHg

IVR Filling IVC Ejection

 HEART SOUNDS
• First sound : low, slightly prolonged “lub”, caused by sudden
closure of AV valves, at the start of ventricular systole.
Duration 0.15 s & fequency 25-45 Hz.
• Second sound ; shorter, high-pitched “dup”, caused by
vibration associated with closure aortic and pulmonary
valves, just after the end of ventricular systole. 0.12 s & 50
Hz.
• Third sound : soft, low-pitched, at one-third diastole, period
rapid ventricular filling , due to vibration set up by inrush of
blood. In many normal young individuals. 0.1 s.
• Fourth sound : when atrial pressure is high or ventricle is stiff
in ventricular hypertrophy , due to ventricular filling,
immediately before first sound, rarely heard in normal adult.
• First sound : low, slightly prolonged “lub”, caused by sudden closure of AV valves, at the start of
ventricular systole. Duration 0.15 s & fequency 25-45 Hz.
• Second sound ; shorter, high-pitched “dup”, caused by vibration associated with closure aortic and
pulmonary valves, just after the end of ventricular systole. 0.12 s & 50 Hz.
• Third sound : soft, low-pitched, at one-third diastole, period rapid ventricular filling , due to vibration
set up by inrush of blood. In many normal young individuals. 0.1 s.
• Fourth sound : when atrial pressure is high or ventricle is stiff in ventricular hypertrophy , due to
ventricular filling, immediately before first sound, rarely heard in normal adult
 Murmurs or Bruits
• Murmurs, or bruits, are abnormal sounds
heard in various parts of the vascular system.
• The two terms are used interchangeably, though
“murmur” is more commonly used to denote
noise heard over the heart than over blood
vessels.
• The major—but certainly not the only—cause
of cardiac murmurs is disease of the heart
valves.
• When the orifice of a valve is narrowed
(stenosis), blood flow through it is
accelerated and turbulent.
• When a valve is incompetent, blood flows
through it backward ( regurgitation or
insufficiency ), again through a narrow
orifice that accelerates flow.
• Soft systolic murmur are common in
individuals, escpecially in children, who have
no cardiac disease.
• Systolic murmurs are also common in anemic
patients as a result of low viscosity of blood
and rapid flow.
• One of the loudest murmurs is that produced
when blood flows backward in diastole
through a hole in a cusp of the aortic valve.
• Most murmurs can be heard only with the aid
of the stethoscope, but this high-pitched
musical diastolic murmur is sometimes audible
to the unaided ear several feet from the patient.
 ECHOCARDIOGRAPHY
• Wall movement and other aspects of cardiac
function can be evaluated by the noninvasive
technique of echocardiography.
• Pulses of ultrasonic waves are emitted from a
transducer that also functions as a receiver to
detect waves reflected back from various parts
of the heart.
• When combined with Doppler techniques,
echocardiography can be used to measure
velocity and volume of flow through valves.
 Some Definitions
Heart Rate: 60-100 beats/min Stroke Volume: 70-80 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
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)
 Referensi:
• Barret KE, Barman SM, Boitano S, Brooks HL, Ganong’s
Review of Medical Physiology, 24th edition, McGraw Hill,
Lange, 2012.
• Silverthorn DU, Human Physiology, an Integrated
approach, 6th edition, Pearson education, 2013.
• Sherwood L, Fundamentals of Physiology, a Human
Perspective, 3rd edition, Thomson Brooks/Cole, 2006
Let it beat!