CARDIOVASCULAR

By
Dr. Agung Kurniawan, MKes
Location Of our Heart
Parts of our heart
 HEART AS A PUMP
Heart (COR) consists of two separated pumps,
which are: right COR (dextra) which pumps blood to
the lung; and left COR (sinistra) which pumps blood to
peripheral organs. Each part of the COR is separated
as a beating pump space., consists of one atrium and
one ventricle. Atrium is the weak primary pump that
helps flowing the blood to the ventricle. There is a
special mechanism inside the pulmonal/peripheral
circulation that is responsible to preserve the heart
rythm by spreading the act potensial to the entire
myocardium. The COR cycle consists of one relaxation
periode  diastole (The blood filling phase of the COR)
 and one constriction periode  systole.
HEART AS A PUMP
HEART AS A PUMP
 HEART PUMP REGULATION
• The heart is able to pump about 4 to 6 litres of blood in
rest condition, and up to 4 to 7 times in work hard
condition.
• Intrinsic Regulation / Frank-Starling Mechanism
– The heart’s intrinsic ability to adapt of differences volume
consequences of the blood entered.
– In physiology confine, heart pump the entered blood avoid to
create the dike of excessive blood in vein.
• Autonomic Nerve Regulation
– The effectiveness if heart pump is reins by the sympatic and
parasympatic nerves.
– Total blood that pump by the heart for each minute (COP) can
increase more than 100% through the sympatic stimulation and
the other way through parasympatic stimulation.
 THE RELATION BETWEEN
THE NORMAL HEART SOUND
AND THE HEART PUMP

1.FIRST HEARTS SOUND

2.SECOND HEART SOUND
3.THIRD HEART SOUND
4.FOURTH HEART SOUND
1.FIRST HEARTS SOUND

A. The effect closing of

atrioventrikular spillway ( A-V) at
beginning sistole and the closing of
semilunaris valve( aorta and
pulmonalis) end of systole ventrikel
contraction.
B. With stethoscope the tone is low
and relative long
2.SECOND HEART SOUND

A. Cause of quickly closing semilunaris

valve and suddenly.
B. With stethoscopefrek > more highly
from heart sound I.
3.THIRD HEART SOUND

A. From the effect of blood stream

step into ventrikel, by the end of first
one-third fase diastole
B. Fonocardiografi low frequency /
weakness and thundering
4.FOURTH HEART SOUND

A. Atrium sound
B. The effect from atrium
contractionglide blood in to ventrikel
C. Fonocardiografilow frequenc
( SEE THE FIGURE BELOW
TO MAKE IT CLEAR )
 THE PHASES OF HEART
CYCLE

Mid diastolic ( diastasis )

When atrium and ventrikel in a state of
rest, ventrikel filled slow. Blood which is
come in to atrium by vein, flow
passively to the ventrikel by opened AV
valve. Semilunar valve close.
 THE PHASES OF HEART
CYCLE

Continued diastolic
Depolarisasion disseminate to through
atrium and desist at AV nodus.Atrium
mucle contractedvolume of ventrikel
increase until 20
 THE PHASES OF HEART
CYCLE
Early systolic
Depolarisation disseminate from AV nodus
through branch bind  myocard of ventrikel
 ventrikel conytracted  ventrikel pressure
mount to exceed atrium pressure  AV
valve close  first heart sound. aorta and
artery pulmonalis pressure exceed ventrikel
pressure, semulunar valve still close ~
volumetric contraction ( ventrikel volume
constant )
 THE PHASES OF HEART
CYCLE

Continued systolic
Ventrikel pressure exceed vein pressure
 semilumar valve open  blood flow
to the systemic and pulmoner
circulation.
 THE PHASES OF HEART
CYCLE

Early diastolic
Repolarisation pass myocard of ventrikel 
ventrikel in a state of rest  relaxation 
ventrikel pressure decrease lower than
atrium pressure  semilunar valve close 
second heart sound  AV valve open 
ventrikel filled by vein blood from atrium (
80 )
THE PHASES OF HEART
CYCLE
THE PHASES OF HEART
CYCLE
 CARDIAC OUTPUT

• Definition : blood volume that pushed by every ventricle

per minute.
• Effect of myocardiaccontraction that sincrone – blood to
the pulmonal circulation and systemic. Cardiac output 5
lt/minute, depend of perifer tissue of oxygen, nutrition,
and size of the body – need a heart function indicator
that more accurately – blood index 2,8 – 4,2 lt/minute.
• Blood volume that go out by ventricle per second – heart
stroke. 2/3 of the blood volume in the ventricle end of
diastolic go out during systolic – ejection draction, blood
volume that end of systolic – end volume of systole.
Decreasing function of ventricle block ventricle ability to
empty the heart – reduce blood volume and ejection
fraction – raising of ventricle volume.
 CARDIAC OUTPUT
DETERMINING
• Cardiac output (COP) = heart rate x stroke volume.
• In a stabil condition, the COP can remains still. If
there is any changes in any variable above, then it
should be balanced by the other variable. If the heart
rate decreasingthe relaxation periode getting
slowerincreasing the ventricular filling
timeventricle volume is biggerthe number of
blood produced each minute is also much more
plenty. On the other side, if the stroke volume
decreasingCOP is stabilized by incresing the heart
rate (to maintain the COP in the normal level).
HEART RATE REGULATION

• Most of heart rate is in extrinsic regulation of

autonomic nervous system; sympathetic and
parasympathetic filament excite SA node and AV
node, influence velocity and frequency impuls
condition. Stimulation of parasympathetic filament 
decrease heart rate. Stimulation of sympathetic
filament  increase heart rate. In normal resting
heart  parasympathetic system endurance heart
rate in 80 pulses per minutes. If the influence of
hormonal and nerve in retarded  intrinsic velocity
100 pulses per minutes.
HEART RATE REGULATION
HEART RATE REGULATION
STROKE VOLUME
REGULATION
 STROKE VOLUME
REGULATION

Stroke volume depends on :

1. First Load
Starling’s rule for the heart : the
miocardium fiber’s contraction as long
as diastolic duration will raise upthe
strength of contraction during the sis
tolic duration.
 STROKE VOLUME
REGULATION
Stroke volume depends on :
2. Contraction Capacity
Contraction capacity is the change of contraction
strength which it is in-dependent from the length of
miocardium fibers.This act will takes effect to the
second contraction volume of the heart. The rise of
contraction load is as the intensification interaction
through actin-myosin bridge on the sar- comerre.
Addition of calcium or cathecolamine will raise up
the contraction load of the contraction volume by the
emptying ventricle mechanism during the sistolic
duration. Acidosis or hipoksia will suppress the
normal function of miocardium.
 STROKE VOLUME
REGULATION

3. Last Load
Last load is the resultant of the ventricle
contraction during the sistolic in order
to open the semilunaric valve and
push the blood in. This act is called
third contraction volume. Arterial
pressure and the size ventricle hold
the main function.
Lapplace’s formulation :

• Ventricle contraction = arterial pressure

x ventricle radius
• The rise of arterial pressure  raise the
resultant of ventricle contraction to eject
the blood out  normal sistolic pressure
( 120 mmHg )
• An increasing of arterial pressure  increase
the resistance of blood flow  increase the
ventricle pressure  increse the arterial
pressure and the ventricle dilatation 
overloaded end volume  affect the
ventricular emptying  decrease stroke
volume  decrease the COP.
• The integrated mechanism that regulate the
heart rate and the stroke volume will
determine the ventricle function and the COP.
 BLOOD FLOW TO THE
PERIPHERAL SYSTEM

The dynamics of the peripheral blood flow

id the most critical thing from all the
circulation, because
1.The COP to the peripheral side
depends on the nature and the
condition of the vascular tissue.
2.The COP volume depends on the
number of blood returning to the heart.
 THE PRINCIPAL OF THE
BLOOD FLOW
The blood flow depends on:
1. The pressure to push the blood
The blood flow will increase if the pressure of the blood
flow increase, and it will decrease when the resistance
increase. The blood flowing along the systemic
circulation from the artery to the veins as a respond to
the pressure gradient. The mean arterial pressure at
the end of the artery is 100mmHg. Mean capillary
pressure is 25mmHg. The pressure at the end of the
vein almost 0mmHg. Pressure gradient between the
artery and vein of the systemic circulation is 100mmHg.
 THE PRINCIPAL OF THE
BLOOD FLOW
The blood flow depends on:
2. Blood flow resistancy
The resistancy is determined by the half of the vessel’s
diameter, blood viscocity, and the vessel’s length.
Resistancy of blood flow is so sensitive with the
changes inside the vessel’s lumen. Poiseuille Law:
R = 1/r^4. Arteriole is the main part of the vascular
resistance. Changes on the smooth musles tones of
the arteriole wall regulate the resistancy and the
number of blood flowing to the capillary. The flow is
in proportional with the pressure gradient, and
inversely in proportional with the resistancy.
Vascular : F = P/R
 BLOOD FLOW
DISTRIBUTION

• Blood flow distribution through many organ,

suitable for the metabolism needed and
tissues function. Increase of the tissues
metabolism → blood flow increase for
preparing the oxsigen, nutrition and excretion
of metabolism product.
• Double regulation of the heart output
distribution through the extrinsic and intrinsic
regulation mechanism.
 BLOOD FLOW
DISTRIBUTION
 EXTRINSIC REGULATION
Blood flow to the organ system can be increase with
enlarge the heart output or transfer the blood from non-
active organ system to active.
Activity ( stimulation) symphathetic nervous system :
1. Increase of total heart output with increase heart
frequency and strengthen the contraction effect.
2. Adrenergic symphathetic fibre also spread until perifer
blood vessel tissue, especially arteriol. The changes of
symphathetic stimulation with selective way → excite
alfa and beta recetor, narrowing some of the arteriola
and expansion the others for spread a blood into capiler
tissue to fit in with needed.
Medula adrenal secrete catelcolamin, epinefrin and
norepinefrin as a respone to symphathetic activity in
perifer vessles.
 INTRINSIC CONTROL

• Tissue ischemia hypoxia  stimulate

the release of adenosin vasodilator 
dilatates the blood vessel. On the vital
organs which depend on the blood flow
(barin and heart)  intrinsic mechanism
rules.
 HEART RESERVE

• It is normal condition of the heart to

increase its ability, to pump much more
than when it is on rest condition  so
the COP is up to 5 times than usual. Or
it is the increasing of the COP with the
heart rate / stroke volume increasing
(COP = HRXSV).
On rest condition with 60-100 dpm up to 180 dpm, mostly
with sympathetic stimulation, a higher heart rate will be
a disturbing condition, because:
1. Heart rate increase  diastolic periode shorter 
ventricular filling decrease  stroke volume decrease
 it’s usefull to increase heart rate.
2. Heart rate affects the myocard oxigenation process
because the heart works harder, while the diastolic
periode decrease at the coronary blood flow.
When the contraction power increase or the diastolic filling
increase  the stroke volume increase also with the
increasing of the ventricular emptying so the blood
volume is ejected.
The increasing of the contraction power and the
ventricular volume will increase the heart work and
the demand of oxygen.
If the heart is overloaded by an excessive volume
continuallythe ventricle muscle:
1. Dilatatin to increase the contraction power, based on
the Straling’s Law, and increase the heart work by
stretching the muscles to aim a substance pressure
based on the Laplace’s Law.
2. Muscle Hipertrophy to increase the number of the
muscles that need nutrition and oxygen, and also to
get the pumping power as a natural compensator 
heart decompesation.
CIRCULATION SYSTEM

The physical characteristic of circulation

system, and the kind of:
1. Systemic Circulation: to supply blood
to the body tissues.
2. Pulmonal Circulation: to supply the
lung
CIRCULATION SYSTEM
CIRCULATION SYSTEM
 Functional Unit of The
Circulation:
1. Artery: to transport, caused by the
high pressure to the tissues, the thick
wall, and the fast flow.
2. Arteriole: end branch of the artery, as a
valve to control the blood flow, flowing
bloods to capillar.
3. Capillar: difussion of fluid and electrolytes, and
nutrition.
4. Venula: to collect blood from capillar, and flowing it to
the veins.
5. Veins: Shelter canals, to flow the blood bask to the
heart.
Functional Unit of The
Circulation:
 HEART PRESSURE FROM
VARIOUS CIRCULATION
- The heart continously pump the blood to aorta 
arterial pressure 100 mmHg
- Pulsatif pumping of the heart-arterial pressure ~
systole more or less 120 of mmHg and diastole more
or less 80 mmHg
- Passing systematic circulation the pressure
progressively decrease 0 mmHg in cava vein of right
heart atrium
- Capillary pressurre35 mmHg , arteriole 10 of mmHg
and vena 17 mmHg
- The pressure of pulmonary artery systole 25 of
mmHg, diastole 8 mmHg and capillary 7 mmHg
 THE BASIC PRINCIPLE OF
THE CIRCULATION SYSTEM
1. Blood flowing to each body tissue is
regulated based on the tissue’s needs. The
active tissue needs the blood flow 20-30
times much more than when it is non active.
2. The stroke volume is determined by the
bloof flow contain at site. When there is an
increasing of the blood flow, the heart will
respond it by driving it to the artery, based
on the demand of the tissue body.
3. Arterial pressure is autonomically regulated
by the stroke volume.
• The blood circulation system is
determined by an extensive regulation
system toward to arterial pressure. If the
arterial pressure decreasing and
becoming lower than normal  the
nervous system will respond to increase
the heart pump and the venous return
 then the arterial pressure will be
normal again.
THE CONNECTION BETWEEN
THE PRESSURE, FLOW, AND
THE RESISTANCE
The blood flow is determined by:
1. Arterial difference:
Between the arterial ands (the gradient of the
pressure)  the strength that push the blood
through the vessels
2. Vascular resistance:
The barrier of the blood flow along the vessel
The connection between the pressure, flow, and
the ressistance can be seen at any segment
inside the vessel.
The connection between the
pressure, flow, and
ressistance
P1 = The pressure on the vessel’s surface
P2 = The pressure on the other ends of the vessel
R = Resistance along the vessel
BLOOD FLOW  OHM’S FORMULA : Q = P / R
Q = Blood flow
P = The difference between the two ends (P1-P2)
The blood flow is in proportional to the pressure
gradient and inversely propotional to the resistance. If
the pressure of the two ends segments is 100mmHg,
and there is no diference between the two ends 
than there will be no flow along the pressure.
The connection between
the pressure, flow, and
ressistance
 BLOOD FLOW

• Blood flow is a number of the blood that

flow through the circulation point in a
time called in ml or in minutes; ml per
second.
• The total blood flows of an adult in relax
condition ± 5.000 ml minutes – stroke
volume is caused by pumped blood in a
certain time.
Blood flow measuring methods – flow meter:
• Electromagnetics:
The creation of an electromagnetics power in
blood when it is moving through magnetic
field.
• Dopper Ultrasonic:
Ultrasonic in piezo electric shown on skin –
sound is bounced by erytrocyte which follow
the blood flow – crystal piezo electric.
 Blood flow type:

• Laminar Type:
The blood flows along the vessel with regular
speed every lap blood still has the same
distance from central part of wall, blood is in
the middle of blood vessel.
• Turbulance Type:
The blood flows to every ways and continualky
mixed and form a rotation.
Blood flow type

LAMINER

TURBULENT
 THE BLOOD FLOW
RESISTANCE

• Barriers to the blood flow is determined by

the meassure of the blood flow and the
pressure gradient inside the blood flow.
• The unit of the blood flow resistance,
determined by :
– Peripheral unit (peripheral resistance unit /
PRU)-Pressure gradient
– Spot inside the blood vessel 1mmHg and the
flow 1ml/minute
 SYSTOLIC AND DIASTOLIC
PRESSURE
• The meassurment of the systolic and diastolic is by the indirect
way AUSCULTATION.
• Put the manset around the arm  blow it  make a pressure till the
artery close if there is no sound anymoreslowly decrease the
pressure in the manset the blood flow will through some partial
turbulance flow a “snap shot” sound
• First Korotkoff Sound  systolic pressure. The pressure is
decreased more further the “snap shot” sound missing  a roash
sound  Fifth Korotkoff Sound  Diastolic pressure.
• There will be a progressive increasing of the blood pressure while
someone’s getting older because of the degradating influences on
the regulating mechanism. The systolic increasing on people over
than 60 y.o is caused by the arteriosclerosis process and that will
increase the blood pressure.
f:CARDIACPHYSIOLOGY/ACRDIAC.A&P.PPT/IBNU/NEW/PAPI/WELCOMEPHYSIOLOGY/2004
PENGUKURAN TEKANAN
DRH

F:CARDIOVASCULERPHYSIOLOGY/CH21.PPT/IBNU/NEW/PAPI/WELCOMEPHYSIOLOGY
 MEAN ARTERIAL
PRESSURE (MAP)
• is the rate from the total pressure, that is counted
milisecond per milisecond in such periode. The
resistance = systolic and diastolic pressure. Because
it’s almost the same with the diastolic pressure than
the systolic, then the number of MAP consists of 60%
diastolic pressure and 40% of the systolic pressure.
The MAP is almost the same on all ages (near the
diastolic pressure),especially on the elder. The
hydrostatic pressure (HP) influence the arterial
pressure on the peripher and capillarso when
someone’s standing, the HP will be 100mHg as heart
level, and 190mmHg as feet level.
MEAN ARTERIAL
PRESSURE (MAP)
MEAN ARTERIAL
PRESSURE (MAP)
VEIN AND ITS FUNCTION

Vein is the vessel tract to flow blood back

to the heart. Its functions are:
1.Contraction/dilatation  to preserve
blood from the other part of the body
circulation.
2.To push the blood  Vein pump and to
help regulating the COP.
 THE EFFECTS OF THE
HYDROSTATIC PRESSURE
TO THE VEIN PRESSURE
• The hydrostatic pressure is gained from the weight of the blood
volume inside the vessels. If someone stands then the vein
pressure on the:
1. Right Atrium : 0 mmHg, because the heart pumps every excessive
blood load to the artery.
2. Feet: 90 mmHg, it’s caused by the weight of the blood hydrostatic
between the heart and the capillar.
3. Arm: 6 mmHg, it’s caused by the Subclavia Vein when passing the
ribs.
4. Hand: 35 mmHG, and it’s decreasing along the arn.
5. Neck : 0 mmHg because the veins collaps along the cranial, caused
by the atmospher pressure and by the vein pressure gowing down.
It also can cause emboly at the heart, and if the heart valves do not
work well, it will cause death.
 THE EFFECTS OF THE
HYDROSTATIC PRESSURE
TO THE VEIN PRESSURE