- HEART PHYSIOLOGY DAN ECG

INTERPRETATION -

Reza Ramadhansyah
1910211099
 Heart Physiology
CARDIAC CYCLE CORONARY FLOW CARDIAC OUTPUT
 CARDIAC
CYCLE

Ventricular Fast Filling

Ventricular Slow Filling
Atrial Contraction
End Diastolic Ventricular
 CARDIAC
CYCLE

Ventricular Systole
Isovolumetric Contraction
 CARDIAC
CYCLE

Ventricular Ejection
Stroke Volume = EDV – ESV
Heart mainly ejects 70 ml of blood.
CARDIAC
CYCLE
Relaxation

Diastole Ventricular
Takik Dikrotik
Isovolumetric Relaxation
Ventricullar Filling
CARDIAC CYCLE
HIGHLIGHT!!
!
(a) Ventricular Filling
ESV : 65mL
EDV : 135 mL

(b) Isovolumetric Contraction

Ventricular Pressure increase

(c)Ventricular Ejection

(d) Isovolumetric Relaxation

 CORONARY
FLOW
Coronary flows much higher when heart in
diastolic phase.
Aorta valve closed  Dicrotic Notch
Coronary artery received 5% of Cardiac
output total volumes.
CARDIAC OUTPUT
CO = HR x SV

Cardiac output presents as blood

volume (mL / L) that pumped
from each ventricle per minutes
(min)

Heart Rate x Stroke Volume

Beats mL
x
Minute Beat
HEART RATE
SYMPATHETIC NERVE
HEART RATE
SYMPATHETIC NERVE
HEART RATE
PARASYMPATHETIC
NERVE
HEART RATE
PARASYMPATHETIC
NERVE
 HEART RATE
(+) Chronotropic (-) Chronotropic
Sistem Saraf Simpatis Sistem Saraf Parasimpatis
Hormon T3-T4 ↓Ca⁺⁺
↑Suhu Tubuh ↑K⁺
↑Ca⁺⁺
↓PO2
↓PCO2
↓pH
STROKE VOLUME
SV = EDV - ESV

End Diastolic Volume

Venous return will influence

preload and heart contractility
through Frank-starling Law
FACTORS DETERMINE VENOUS
RETURN
 FRANK-STARLING LAW
Frank-Straling Law

The Frank-Starling relationship is based

on the link between the initial length of
myocardial fibers and the force generated
by contraction.

Venous Return affects amount

of Stroke Volume
 FRANK-STARLING LAW
Venous Return affects amount
of Stroke Volume
 AFTERLOAD

the “load” against which the heart must contract to eject blood.
A major component of the afterload for the left ventricle is the
aortic pressure, or the pressure the ventricle must overcome to
eject blood.
 AFTERLOAD AFFECTS
FRANK-STARLING LAW
 VENTRICULAR
INOTROPY
The ability of myocardium of hearts to
contract

Inotropy increases stroke

volume
 VENTRICULAR
INOTROPY
The ability of myocardium of hearts to
contract

Inotropy increases stroke

volume
STROKE VOLUME
SUMMARY
 Ecg Interpretation
SINUS TACHYCARDIA HYPERTROPHY NSTEMI

LEFT AXIS DEVIATION OLD MI

 CASE REPORT

Left Axis
Deviation
Left Ventricular
NSTEMI Hypertrophy
 SINUS TACHYCARDIA
Rhythm?
Check RR Intervals on
strips (equal or not)

Rate?
Count Big box for each
RR interval. 300/amount
of big box = Heart Rate

P Wave, PR Segment,
ECG LEAD SINUS TACHYCARDIA
QRS Wave, ST Segment.
300 : 2,4 = 125 Beats / min
LEFT AXIS DEVIATION

Normal Axis of heart electrical

vector is from upper right
towards left inferior
 LEFT AXIS DEVIATION EKG

Lead I shows positive deflection and Lead aVF shows negative

deflection in Left Axis Deviation
 If left ventricular muscle is
hypertrophed, all the
electrical vector will
towards more to the left
axis

CAUSE OF LEFT AXIS

DEVIATION
HYPERTROPHY

Lead S V1 + Lead R V5 > 35 mm

Lead R V6 > R V5
Lead R V5 > 26mm
 NSTEMI
ST deppresion appear in Lead V1-V4
indicates NSTEMI on Anteroseptal of heart

Kasus
ECG SHOWS IN MYOCARDIAL INFARK
 OLD MYOCARDIAL INFARCTION

Q Wave caused by infarcted tissues are dead so

electrical will towards other vector

Lead III and aVF shows Pathologic Q wave may appear in patients who was
had MI but it also in acute phase (30 mins later)
 REFERENCES
• Barrett, K. E., et al. 2012. Ganong Buku Ajar Fisiologi Kedokteran Edisi 24. New
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• Hall, J. E. 2011. Guyton and Hall Textbook of Medical Physiology 12th Edition.
Philadelphia : Saunders Elsevier.
• Juzar, D. A. 2018. Pedoman Tata Laksana Sindrom Koroner Akut PERKI 2018.
Jurnal Kardiologi Indonesia.
• Klabunde, R. E. 2012. Cardiovascular Physiology Concepts. Philadelphia :
Lippincott Williams & Wilkins, a Wolters Kluwer business.
• Sherwood, L. 2016. Fisiologi Manusia dari Sel ke Sistem Edisi 9. Jakarta : EGC.
• Thaler, M. S. 2015. The Only EKG Book You’ll Ever Need 8th Edition.
Philadelphia. Lippincott Williams & Wilkins, a Wolters Kluwer business.