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Apakah fungsi Sistem

Kardiovaskular kita?
• Deliver oxygen and other nutrients to the
body
System Kardiovaskular • Removal of carbon monoxide and other
metabolic waste
• Transport of hormones
• Maintenance of acid-base balance and
overall body fluid balance
• Immune function

The Cardiovascular System Jantung

• The heart is located between the lungs
• Three major circulatory elements
behind the sternum and above the
1. A pump (heart) diaphragm.
2. Channels or tubes (blood vessels)
• It is surrounded by the pericardium.
3. A fluid medium (blood)
• Its size is about that of a fist, and its
• Heart generates pressure to drive blood weight is about 250-300 g.
through vessels • Its center is located about 1.5 cm to the
• Blood flow must meet metabolic demands left of the midsagittal plane.

Figure 18.2a Location of the heart in the mediastinum. Figure 18.2b Location of the heart in the mediastinum.

Mediastinum
Midsternal line
2nd rib Heart
Sternum Left lung
Diaphragm Location of
apical impulse Body of T7
vertebra

Posterior
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Figure 18.2c Location of the heart in the mediastinum.

The Heart

Superior Aorta
vena cava Parietal pleura
• The heart is a double pump – what does
(cut)
Pulmonary Left lung
it mean?
trunk
Pericardium (cut)

Apex of heart • Four chambers

Diaphragm
– Right and left atria (RA, LA): top, receiving
chambers
– Right and left ventricles (RV, LV): bottom,
pumping chambers
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Figure 6.1

The double pump

The Heart Valves Blood Flow Through the Heart

• The tricuspid valve regulates blood • Right heart: pulmonary circulation
flow between the right atrium and right
ventricle. – Pumps deoxygenated blood from body to
• The pulmonary valve controls blood lungs
flow from the right ventricle into the – Superior, inferior vena cavae
RA

pulmonary arteries tricuspid valve
RV
pulmonary valve

• The mitral valve lets oxygen-rich blood pulmonary arteries
lungs
from your lungs pass from the left
atrium into the left ventricle. • Left heart: systemic circulation
• The aortic valve lets oxygen-rich blood – Pumps oxygenated blood from lungs to body
pass from the left ventricle into the
aorta, then to the body – Lungs
pulmonary veins
LA
mitral
valve
LV
aortic valve
aorta

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Figure 18.1 The systemic and pulmonary circuits.

Capillary beds of
lungs where gas
exchange occurs
Layers of the Heart Wall
Pulmonary Circuit
Pulmonary
arteries Pulmonary veins • Three layers of heart wall:
Aorta and branches
Venae
cavae
– Epicardium
Left
atrium – Myocardium
Left
Right
atrium
ventricle – Endocardium
Heart
Right
ventricle
Systemic Circuit

• Epicardium
– Visceral layer of serous pericardium
Capillary beds of all
body tissues where
Oxygen-rich,
gas exchange occurs
CO2-poor blood
Oxygen-poor,
CO2-rich blood © 2013 Pearson
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Layers of the Heart Wall Layers of the Heart Wall

• Myocardium • Endocardium continuous with endothelial
– Spiral bundles of contractile cardiac muscle lining of blood vessels
cells – Lines heart chambers; covers cardiac
– Cardiac skeleton: crisscrossing, interlacing skeleton of valves
layer of connective tissue
• Anchors cardiac muscle fibers
• Supports great vessels and valves
• Limits spread of action potentials to specific paths

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Figure 18.3 The pericardial layers and layers of the heart wall. Figure 18.4 The circular and spiral arrangement of cardiac muscle bundles in the myocardium of the heart.

Pulmonary
trunk Fibrous pericardium
Parietal layer of serous
Pericardium pericardium
Myocardium
Cardiac
Pericardial cavity
muscle
Epicardium (visceral bundles
layer of serous
pericardium) Heart
Myocardium wall
Endocardium
Heart chamber

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Figure 18.12a Microscopic anatomy of cardiac muscle.

Myocardium

• Myocardium: cardiac muscle Nucleus

Intercalated
discs
Cardiac
muscle cell Gap junctions Desmosomes

• LV has most myocardium

– Must pump blood to entire body
– Thickest walls (hypertrophy)
– LV hypertrophies with exercise and with
disease
– But exercise adaptations versus disease
adaptations very different
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Figure 18.12b Microscopic anatomy of cardiac muscle.

Microscopic Anatomy of Cardiac

Muscle Cardiac muscle
cell Mitochondrion Nucleus
Intercalated
• Intercalated discs - junctions between disc

cells - anchor cardiac cells

– Desmosomes prevent cells from separating
during contraction Mitochondrion
T tubule
– Gap junctions allow ions to pass from cell to Sarcoplasmic
reticulum Z disc
cell; electrically couple adjacent cells
• Allows heart to be functional syncytium
Nucleus
– Behaves as single coordinated unit Sarcolemma
I band A band I band

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Coronary Circulation Myocardial Blood Supply

• Functional blood supply to heart muscle
itself
– Delivered when heart relaxed
– Left ventricle receives most blood supply
• Arterial supply varies among individuals
• Contains many anastomoses (junctions)
– Provide additional routes for blood delivery
– Cannot compensate for coronary artery
occlusion
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• Right coronary artery
– Supplies right side of heart
– Divides into marginal, posterior
interventricular
• Left (main) coronary artery
– Supplies left side of heart
– Divides into circumflex, anterior descending
• Atherosclerosis
coronary artery
disease

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Figure 18.11a Coronary circulation.

Aorta
Pulmonary
Superior
vena cava trunk Coronary Circulation: Veins
Left atrium
Anastomosis
(junction of • Cardiac veins collect blood from capillary beds
vessels) Left
coronary • Coronary sinus empties into right atrium;
Right artery
atrium formed by merging cardiac veins
Right Circumflex – Great cardiac vein of anterior interventricular sulcus
coronary artery
– Middle cardiac vein in posterior interventricular
artery Left sulcus
Right ventricle
ventricle Anterior – Small cardiac vein from inferior margin
Right interventricular • Several anterior cardiac veins empty directly
marginal Posterior artery
artery interventricular into right atrium anteriorly
artery
The major coronary arteries
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Figure 18.11b Coronary circulation. Figure 18.5d Gross anatomy of the heart.

Aorta Superior vena cava

Superior Left pulmonary artery Right pulmonary artery
vena cava Right pulmonary veins
Left pulmonary veins
Auricle of left atrium Right atrium
Left atrium
Inferior vena cava
Anterior Great Great cardiac vein
Coronary sinus
cardiac cardiac Right coronary artery
vein Posterior vein of (in coronary sulcus)
veins left ventricle Posterior interventricular
Coronary Left ventricle artery (in posterior
interventricular sulcus)
sinus Middle cardiac vein
Right ventricle
Small Apex
cardiac vein Middle cardiac vein Posterior surface view

The major cardiac veins

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Figure 18.5a Gross anatomy of the heart.

Aortic arch (fat covered)

Pulmonary trunk
Auricle of right atrium

Auricle of left atrium

Anterior interventricular
REHAT…
artery

Right ventricle

Apex of heart (left ventricle)

Anterior aspect (pericardium removed)
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Figure 18.7 The atrioventricular (AV) valves.

Heart Valves 1 Blood returning to the heart fills

atria, pressing against the AV valves. Direction of
The increased pressure forces AV blood flow
valves open. Atrium

Cusp of
• Ensure unidirectional blood flow through heart 2 As ventricles fill, AV valve flaps
hang limply into ventricles.
atrioventricular
valve (open)
Chordae
• Open and close in response to pressure 3 Atria contract, forcing additional tendineae
blood into ventricles. Papillary
changes Ventricle muscle
AV valves open; atrial pressure greater than ventricular pressure
• Two atrioventricular (AV) valves
– Prevent backflow into atria when ventricles contract Atrium
Cusps of
– Tricuspid valve (right AV valve) 1 Ventricles contract, forcing
blood against AV valve cusps.
atrioventricular
valve (closed)

– Mitral valve (left AV valve, bicuspid valve) 2 AV valves close. Blood in

ventricle
– Chordae tendineae anchor cusps to papillary 3 Papillary muscles contract and
chordae tendineae tighten,
preventing valve flaps from everting
muscles into atria.

• Hold valve flaps in closed position AV valves closed; atrial pressure less than ventricular pressure

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Figure 18.6a Heart valves.

Pulmonary valve

Heart Valves Aortic valve

Area of cutaway
Mitral valve
Tricuspid valve
• Two semilunar (SL) valves
– Prevent backflow into ventricles when Myocardium
Mitral
ventricles relax (left atrioventricular)
valve
– Open and close in response to pressure
Tricuspid
changes (right atrioventricular)
valve
– Aortic semilunar valve Aortic valve
– Pulmonary semilunar valve Pulmonary valve

Cardiac
skeleton
Anterior
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Figure 18.6b Heart valves.

Pulmonary valve
Aortic valve Homeostatic Imbalance
Area of cutaway
Mitral valve
Tricuspid valve • Two conditions severely weaken heart:
– Incompetent valve
Myocardium
Mitral • Blood backflows so heart repumps same blood
(left atrioventricular) over and over
valve
Tricuspid – Valvular stenosis
(right atrioventricular)
valve • Stiff flaps – constrict opening
heart must exert
Aortic valve more force to pump blood
Pulmonary valve • Valve replaced with mechanical, animal, or
cadaver valve
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Sistem Konduksi Kardium

• Cardiac muscle has the unique ability to

generate its own electrical signal.
REST… • Dikenali sebagai “spontaneous
rhythmicity”
• Allows it to contract without any external
stimulation.

Figure 18.15a Intrinsic cardiac conduction system and action potential succession during one heartbeat. Slide 1
Superior vena cava Right atrium

Sistem Konduksi Kardiak (3) 1 The sinoatrial (SA)

node (pacemaker)
generates impulses.

Internodal pathway

2 The impulses Left atrium

pause (0.1 s) at the
atrioventricular
(AV) node.

3 The Subendocardial
atrioventricular conducting
(AV) bundle network
connects the atria (Purkinje fibers)
to the ventricles.
4 The bundle branches
conduct the impulses Inter-
through the ventricular
interventricular septum. septum

5 The subendocardial
conducting network
depolarizes the contractile
cells of both ventricles.

Anatomy of the intrinsic conduction system showing the sequence of

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KAWALAN JANTUNG
EKSTRINSIK
• Walaupun jantung menghasilkan
impulsnya tersendiri, kadar denyutan
jantung boleh dipengaruhi oleh
rangsangan luar.
– Sistem saraf parasimpatetik
– Sistem saraf simpatetik
– Sistem hormon (Endocrine system)

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Blood Vessels

• Delivery system of dynamic structures that

begins and ends at heart
– Arteries: carry blood away from heart;
oxygenated except for pulmonary circulation
and umbilical vessels of fetus
– Capillaries: contact tissue cells; directly serve
cellular needs
– Veins: carry blood toward heart

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SISTEM VASKULAR (2) Blood Vessels

• Vessels vary in length, diameter, wall
thickness, tissue makeup
• See figure 19.2 for interaction with
lymphatic vessels

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Figure 19.2 The relationship of blood vessels to each other and to lymphatic vessels. Table 19.1 Summary of Blood Vessel Anatomy (1 of 2)
Venous system Arterial system

Large veins Heart

(capacitance
vessels)
Elastic
Large arteries
lymphatic (conducting
vessels arteries)

Lymph
node Muscular
arteries
Lymphatic (distributing
system arteries)

Small veins
(capacitance
vessels)
Arteriovenous
anastomosis

Lymphatic
capillaries
Sinusoid
Arterioles
(resistance
vessels)
Terminal
arteriole
Postcapillary
venule Metarteriole
Thoroughfare Capillaries Precapillary
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Capillaries Capillaries

• Microscopic blood vessels • In all tissues except for cartilage, epithelia,

• Walls of thin tunica intima cornea and lens of eye
– In smallest one cell forms entire • Provide direct access to almost every cell
circumference • Functions
• Pericytes help stabilize their walls and – Exchange of gases, nutrients, wastes,
control permeability hormones, etc., between blood and interstitial
• Diameter allows only single RBC to pass fluid
at a time
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Figure 19.3a Capillary structure.

Pericyte
Capillaries
Red blood
cell in lumen
• Three structural types
1. Continuous capillaries Intercellular
cleft
2. Fenestrated capillaries Endothelial
3. Sinusoid capillaries (sinusoids) cell
Basement
membrane
Tight junction Pinocytotic
Endothelial vesicles
nucleus
Continuous capillary. Least permeable, and most
common (e.g., skin, muscle).
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Figure 19.3b Capillary structure. Figure 19.3c Capillary structure.

Pinocytotic
vesicles
Endothelial
cell

Red blood Red blood

cell in lumen cell in lumen

Fenestrations Large
(pores) intercellular
cleft

Endothelial Intercellular
nucleus cleft Tight junction
Basement membrane Incomplete Nucleus of
Endothelial basement endothelial
Tight junction membrane cell
cell
Fenestrated capillary. Large fenestrations (pores) Sinusoid capillary. Most permeable. Occurs in special
increase permeability. Occurs in areas of active locations (e.g., liver, bone marrow, spleen).
absorption or filtration (e.g., kidney, small intestine).
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Venous System: Venules Veins

• Formed when capillary beds unite • Formed when venules converge

– Smallest postcapillary venules • Have thinner walls, larger lumens
– Very porous; allow fluids and WBCs into compared with corresponding arteries
tissues
• Blood pressure lower than in arteries
– Consist of endothelium and a few pericytes
• Thin tunica media; thick tunica externa of
• Larger venules have one or two layers of collagen fibers and elastic networks
smooth muscle cells
• Called capacitance vessels (blood
reservoirs); contain up to 65% of blood
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Figure 19.5 Relative proportion of blood volume throughout the cardiovascular system.

Pulmonary blood
vessels 12%
Veins
Systemic arteries
and arterioles 15%
Heart 8% • Adaptations ensure return of blood to
heart despite low pressure
– Large-diameter lumens offer little resistance
Capillaries 5% – Venous valves prevent backflow of blood
• Most abundant in veins of limbs
Systemic veins
and venules 60%
– Venous sinuses: flattened veins with
extremely thin walls (e.g., coronary sinus of
the heart and dural sinuses of the brain)

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Table 19.1 Summary of Blood Vessel Anatomy (2 of 2)

Perbezaan ant Arteri, Vena &

Kapilari

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Denyutan Jantung
• Jantung menguncup and mengendur
secara berulang
• Penguncupan jantung – sistol
• Pengenduran jantung – diastol
• Semasa sistol ventrikel (ventrikel
menguncup), tekanan darah dalam
ventrikel meningkat – injap biskupid dan
triskupid tertutup lalu menghasilkan bunyi
pertama (lab)
NADI
• Denyutan jantung menghasilkan tekanan
darah dalam arteri
• Tekanan ini boleh dirasai sebagai nadi
pada arteri yang berdekatan dengan kulit
Tekanan Darah (2)
• Tekanan sistolik adalah tekanan terhasil
semasa penguncupan ventrikel kiri untuk
menolak darah ke aorta dan seterusnya ke
arteri
• Tekanan sistolik memberikan nilai yang
paling tinggi semasa sistolik ventrikular.
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Denyutan Jantung (2)
• Semasa diastol ventrikel (ventrikel
mengendur), tekanan darah dalam
ventrikel rendah berbanding dalam aorta
and arteri pulmonari – injap semilunar
tertutup lalu menghasilkan bunyi denyutan
kedua (dap)
• Denyutan jantung boleh didengar dengan
menggunakan stetoskop.
Tekanan Darah
• Tekanan darah adalah tekanan darah ke
atas dinding salur darah dalam mana
darah mengalir.
• Merujuk kepada tekanan darah pada arteri
– Tekanan darah sistolik
– Tekanan darah diastolik
Tekanan Darah (3)
• Tekanan diastol merujuk kepada tekanan
darah paling rendah dan terhasil semasa
pengenduran jantung (diastolik)
• Ini adalah masa ventrikel dipenuhi dengan
darah.
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Distribusi Darah
Kawalan Peredaran Darah Secara
Intrinsik
• Essentially three types of intrinsic control
– Metabolic (strongest stimulus for local
vasodilation)
– Other chemical produced by the endothelium
(inner lining) of arteriols to initiate vasodilation
– Pressure changes (myogenic response)
• Contrcts when pressure is high
• Dilate when pressure is low
Kawalan Peredaran Darah Secara
Intrinsik
• Blood flow largely regulated by the
sympathetic nervous system.
• The circular layers of smooth muscle
within the artery and arteriole walls are
supplied by sympathetic nerves.
– In most cases - increase sympathetic activity
induces muscle cells of contract – decreasing
blood flow
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Kawalan Peredaran Darah Secara
Intrinsik
• Refers to the ability of the local tissues to
vasodilate (pengenduran) or vasoconstrict
(penguncupan) the arteriols that serve
them and alter regional blood flow
depending on the immediate needs of
those tissues.
• With exercise and increased metabolic
demand, the arteriols undergo locally
mediated vasodilation, opening up to allow
more blood to enter that highly active
tissue.
Kawalan Peredaran Darah Secara
Ekstrinsik
• The concept of intrinsic local control
explains redistribution of blood within an
organ or tissue mass; however, the
cardiovascular system must divert blood
flow to where it is needed, beginning at the
site upstream of the local environment.
– Known as extrinsic neural control
Kawalan Peredaran Darah Secara
Ekstrinsik
• In normal condition, sympathetic nerves
transmit impulses continuously to keep
blood vessels moderately constrict –
regulate blood pressure.
– Vasomotor tone
• When sympathetic stimulation increases,
flood flow to certain area decrease,
allowing more blood to flow to other areas.
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BLOOD BLOOD(2)

• Blood serves many useful purposes in • Blood is composed of plasma (55% - 60%)
regulating normal body function. and formed elements (40% - 45%)

– Transportation – Plasma: 90% H2O, 7% plasma proteins, 3%

– Temperature regulation others
– Acid-base (pH) balance – Formed elements: >99% red blood cells
(hemoglobin), <1% white blood cells and
platelets

BLOOD(3) Blood Vicosity

• Plasma normally constitute 55 – 60% of • Vicosity refers to the thickness of the
total blood volume, blood.
– can decrease by 10% of its normal amount or
more with intense exercise in heat,
• The vicosity of blood is about twice that of
– can increase by 10% or more with endurance
water.
training.

• As blood vicosity increases, so does

resistance to blood flow.

LATIHAN
• Lukis dan labelkan suatu gambarajah jantung
serta huraikan aliran darah melalui jantung.
Huraikan dengan teliti apa yang berlaku apabila
SELAMAT MAJU JAYA! suatu jantung dalam keadaan rehat terpaksa
membekalkan oksigen kepada badan yang
sedang bersenam? (10 markah)

• Apakah bezanya antara sistol dan diastol dan

apakah hubungan mereka dengan tekanan
darah sistolik dan tekanan darah diastolik? (5
markah)

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