Cardiovascular physiology and anethesia

Boby Suryawan, S.Ked

Fadilla Octovini, S.Ked
 The cardiovascular system consists of 3
components :
 The heart – a muscular pump that drives the flow
of blood through the vessels.
 Blood vessels – closed conduit system through
which the blood flows
 Blood – carry materials to and from the cells
Cardiac anotomy
 The heart is located in
the chest cavity exactly
in the left medial
mediastinum
 Weight ± 250 to 360 gr
 The size of a clenched
fist
 Covered by a layer of
pericardium that bind
the heart to the thoracic
cavity.
Cardiac border
 Limit the heart of the
surrounding organs:
Left boundary
Left lung
Right Limit
Right lung
Lower limit
Diaphragm
Heart Border
 Front Boundary
 Sternum
 Thymus
 Rear Boundary
 Vertebrae
 Oesophagus
 Aortic descenden
 Upper Limit
 Aortic arch
 Vena cava superior
 Trachea
Pericardium
 Consisting of 2 layers:
visceralis pericardium
parietal pericardium
 Network is relatively
inflexible.
 Serous fluid containing
30-50ml of between
pericardium and
epicardium
 as a protector
 prevent friction during
contraction
Cardiac chamber
The cardiac has 4 chamber:
 right atrium

 right ventrikel

 left atrium

 left ventrikel
Cardiac valve
 Serves to maintain blood flow to run the same direction
through the heart chambers.
 There are 2 types:
Valve atrioventrikularis
Valve semilunaris (separating the pulmonary and aortic a. of
the respective ventricles).
Atrioventicular valve
 Leaf valve smooth and durable
 Tricuspid valve:
valve has 3 leaves
separating the right atrium and ventricle
 Valve mitralis:
Valve has 2 leaves
Separates the left atrium and ventricle
Semilunaris valve
 Consists of 3 valves that resembles a symmetrical funnel and
attached aanulus fribosus
 Serves to prevent blood flowing back into the ventricles.
 Aortic valve (between the left ventricle and aorta), above the
valve leaves there Valsalva sinus which is the estuary of the
coronary arteries
 Pulmonary valve (between the left ventricle and pulmonary
artery)
Heart Vascularitation
 Heart get nutrients and oxygen through the blood vessels of
the heart coronary arteries that branch directly from the aorta
ascenden which empties into the sinus Valsalva.
 There are 2 pieces A. coronary:
A. Right coronary
A. Left coronary arteries:
A. left anterior descending
A. left circumflex
Coronaria circulation
Heart Vascularitation
 A. Right coronary arteries supplying blood to the
 Right atrium
 Right ventrikel
 Inferior wall of left ventricle
 A. Left circumfleks blood supply to:
 Left atrium
 Posterior wall of left ventricle
 A. Descenden left anterior blood supply to the:
 Anterior wall of left ventricle
Heart Vein
 Thebesia vein
 Cardiaka anterior vein
 Coronarius sinus
Anesthetic effect
 Most volatile anesthetic agents are coronary
vasodilators.
 Volatile agents appear to exert beneficial
effects in the setting of myocardial ischemia
and infarction.
Cardiac physiology
Heart contraction and relaxation mechanism
Heart contraction
mechanism
Anesthesia in electric mechanism of
cardiac
 Halothane, enflurane, and isoflurane depress
SA node automaticity.
 Intravenous induction agents have limited
electrophysiological effects in usual clinical
doses. Opioids, particularly fentanyl and
sufentanil, can depress cardiac conduction,
increasing AV node conduction and refractory
period and prolonging the duration of the
Purkinje fiber action potential.
Anesthesia in electric mechanism of
cardiac
 Local anesthetics have important
electrophysiological effects on the heart at
blood concentrations that are generally
associated with systemic toxicity.
 Calcium channel blockers are organic
compounds that block calcium influx through
L-type but not T-type channels.
Heart control
mechanism
Heart control mechanism
 Main sensor
 Kemoreceptor
 Baroreceptor in aortic arch dan carotid arteries
 This receptor influence by :
 Decrease O2 artery
 Increase PCO2
 Increase [H+] atau acidosis condition
Contraction miocardium
Anastetic effect in contraction miocard
 Studies suggest that all volatile anesthetics
depress cardiac contractility by decreasing the
entry of Ca2+ into cells during depolarization
(affecting T- and L-type calcium channels),
altering the kinetics of its release and uptake
into the sarcoplasmic reticulum, and
decreasing the sensitivity of contractile
proteins to calcium.
Anastetic effect in contraction miocard
 all the major intravenous induction agents,
ketamine appears to have the least direct
depressant effect on contractility.
 Local anesthetic agents also depress cardiac
contractility by reducing calcium influx and
release in a dose-dependent fashion.
Circulation system
Pembuluh Darah
 5 blood vessel in the sistemic circulation :
1. Artery
2. Arteriol
3. Capiler
4. Venula
5. Venous
Pembuluh Darah
 Blood vessel wall :
1. Tunica adventitia / tunica externa

2. Tunica media

3. Tunica intima / tunica intern

Capillary Exchange