Risna Yekti Mumpuni

Pump
Heart

 Pipes
 Fluid
Blood Vessels
Blood
 Flow = Perfusion

Adequate Flow = Inadequate Flow =

Adequate Perfusion InAdequate
Perfusion
(Hypoperfusion)

Hypoperfusion =
Shock
 Pump Failure
 Pipe Failure
 Loss of Volume
 Pre load : ventricular volume at the end of distole

 Contractility
 After load : left ventricular wall tension required to over

come the impedance to the ejection of blood from ventricle during systole.

 Stroke volume : amount of blood secretes during systolic / second

 Cardiac Out Put : stroke volume x heart beat per minute
 Afterload = determined by:
- The total peripheral resistance (which is
determined by the sympathetic tone,
baroreceptor activity, the renin-angiotensin-
aldosterone axis, and the tissue oncotic
pressure), and
- The systolic wall tension (which follows the:
law of Laplace = TMP x r / 2 h
[transmural pressure x radius / 2 x wall thickness]).
 The Starling Concept equates preload with
stroke volume.

 Stroke volume = EDV-ESV

 Ejection fraction = EDV – ESV x 100% / EDV

 “Dalam batas fisiologis,
jantung akan memompakan
semua darah dari vena menuju
aorta tanpa bendungan”
atau after load sama dengan
preload
 Ventricular stroke volume (SV) is the
difference between the ventricular end-
diastolic volume (EDV) and the end-systolic
volume (ESV).

 EDV is about 120 ml of blood and the ESV

about 50 ml of blood. The difference in these
two volumes, 70 ml, represents the SV
 Increased by inotropic agents:
Adrenaline / Nor adrenaline
Dobutamine / Dopamine
Calcium
 Decreased by:
Acidosis
Hypoxia
Hypocalcaemia
 The maximal change in aortic pressure during
systole (from the time the aortic valve opens
until the peak aortic pressure is attained
represents the aortic pulse pressure

 Pulse Pressure = Systolic Pressure ─ Diastolic

Pressure
 value is determined by the compliance
of the aorta as well as the ventricular
stroke volume. If the aorta were a rigid
tube, the pulse pressure would be very
high.
 The more compliant the aorta, the
smaller the pressure change during
ventricular ejection (i.e., smaller pulse
pressure)
 Therefore, aortic compliance is a major
determinant, along with stroke volume,
of the pulse pressure
 Determined by the cardiac output (CO),
systemic vascular resistance (SVR), and
central venous pressure (CVP)

 is based upon the relationship between flow,

pressure and resistance
 MAP = (CO × SVR) + CVP

 MAP = CO × SVR
 Gallops rhythm
 Basilar ronchi
 Jugular venous distension
 Decreasing M A P
 Fluids
 Inotropes
 Vasoconstrictors
 Vasodilators