Cardiac Cycle

And Physical
Examination

Yos Akbar Irmansyah

Yoga Yudhistira

Pembimbing

dr Adi Bestara SpJP, FIHA

 At the resting membrane voltage,
sodium and calcium channels are closed

This is the final phase of repolarization that returns the transmembrane

voltage back to the resting potential o approximately -90 mV. A
continued outward potassium current exceeds the low inward current o
other cations and is thus responsible or this period o rapid
repolarization. Phase 3 completes the action potential cycle, with a
return to resting phase 4, preparing the cell or the next stimulus or
depolarization
 PHYICAL EXAM CONSIST OF
Clues from INSPECTION :
◦ General appearance; skin, face, eyes, edema, extremiti es, chest,
and abdomen; in correlati on with heart diseases
◦ Jugular veins pulsati on
◦ precordial
Clues from PALPATION:
◦ Arterial pulse
◦ Precordial – apical movement
 Clues from AUSCULTATION :
◦ Blood pressure
◦ Breath sounds
◦ heart sounds & heart murmurs
 JVP is related to body position & respiration
 Measure JVP indirectly:
◦ Use right internal jugular vein
◦ 3 0 ’ - 4 5 ’ position
◦ Patient’s head looks t o the left side
◦ Not too bright room lighting
◦ Maneuver : tangential lighting or cross viewing
◦ Find the top level of pulsation at inspiration
◦ Measurement in cm with angulus sterni of Louis as
the zero point difficulties: position, respiration,
distinguish f rom carotid beat
* Compare t o abdomino-jugular reflux
Pemeriksaan Hepatojugular Refleks
 Macam-Macam Pulsasi

Pulsus Alternans
–  Is an arterial pulse with alternating strong and weak beats. Ie: Left ventricular alternans occurs in
the setting of severe left ventricular dysfunction. This includes cardiomyopathy, aortic stenosis, and
coronary artery disease. Right ventricular alternans occurs as a result of right ventricular strain,
often precipitated by a pulmonary embolus or pulmonary hypertension. 

Bisferiens Pulse
– Also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one
followed by a strong and broad one. I.e Aortic Regugirtation

Pulsus Paradoxus
– Pulsus paradoxus is the term used to describe an exaggerated blood pressure variation with the
respiratory cycle.

Pulsus Tardus
– Pulsus tardus et parvus, also pulsus parvus et tardus, slow-rising pulse and anacrotic pulse, is weak
(parvus), and late (tardus) relative to its expected characteristics. It is caused by a stiffened aortic
valve that makes it progressively harder to open.
One explanation or normal splitting o S2 is as ollows. Expansion o the chest
during inspiration causes the intrathoracic pressure to become more
negative. The negative pressure transiently increases the capacitance (and
reduces the impedance) of the intrathoracic pulmonary vessels. As a result,
there is a temporary delay in the diastolic “back pressure” in the pulmonary
artery responsible for the closure of the pulmonic valve. Thus, P2 is delayed;
that is, it occurs later during inspiration than during expiration .
– EXTRA SYSTOLIC HEART
SOUND
What caused the murmur?
Murmur
Systolic Murmurs
Diastolic Murmurs
Continous Murmur
Resume
Thankyou…