The Heart as a Pump

Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera
Utara
Dr. Poland Room 3-007, Sanger Hall, Phone: 828-9557
E-mail: poland@hsc.vcu.edu

The
heart as
a pump

Alternate contraction (systole) and

relaxation (diastole) of the muscular
wall of the heart
When the heart muscle is relaxed,
intracardiac pressure is low
Atria fill with blood from vessels
expansion of the upper chambers
When the heart contracts, the
chamber is squeezed by muscular
contraction, forcing blood lower
chambers (ventricles) circulation

The Cardiac Cycle

Period between start of

one heart beat and the
start of the next

Systole:

Period of ventricular
contraction.
Blood ejected from
heart.
Diastole:
Period of ventricular
relaxation.
Blood filling.

Diastole
Iso-volumetric

relaxation:

Ventricles begin to relax.

Semilunar valves and AV valves all closed.
Ventricular volume remains unchanged.
Ventricular

filling :

Patria > Pventricles.

Mitral valve (left) and tricuspid valve (right)
open.
Ventricle begin to fill (80% complete).
Atrial contraction completes filling.
Volume achieved: end diastolic volume (EDV)

Systole
Iso-volumetric

Contraction begins but valves still closed.

Tension develops but no shortening of cells.
Pressure builds up.

Ventricular

contraction:

ejection:

Pventricles > Paortic/pulmonary trunk.

Semilunar valves open (aortic and pulmonary).
Muscle cells shorten.
Blood expelled: end systolic volume (ESV)
remains.

MECHANICAL EVENTS OF THE

CARDIAC CYCLE

Blood flow in the heart and great vessels during the cardiac cycle. The
portions of the heart contracting in each phase are indicated in color.
RA and LA, right and left atria; RV and LV, right and left ventricles.

StrokeVolume
StrokeVolume:7080mlvolumepumpedbyaventricle
inonecontraction

SV = EDVESV
StrokevolumeEnddiastolicvol.Endsystolicvol.
Atrest:SV=70ml,

EDV=135ml,

ESV=65ml

Ejection Fraction( EF)

Stroke Volume
End-Diastolic Volume

Ejection Fraction is a measure of cardiac contractility

= is about 65%.

Heart Sounds

Heard with aid of stethoscope.

Two sounds/vibration can be heard.
Caused by closure of valves.
First sound: slightly prolonged "lub"
Soft low pitched sound: closure of AV valves.
Occurs at onset of systole.

Second sound: a shorter, high-pitched

"dup"
Louder sound: closure of aortic and pulmonary valves.
Onset of diastole and isovolumetric relaxation.

Heart Murmurs
Useful in diagnosing heart disease.
Caused by poor opening or closing of valves.
Narrowed valve: stenosis.
Leaky valve: insufficiency.

Holes in the heart:

Either connecting atria or ventricles.

 The timing (systolic or diastolic) of a murmur

due to stenosis or insufficiency of any
particular valve can be predicted from a
knowledge of the mechanical events of the
cardiac cycle.

Left Atrial Pressure (7/0

mmHg)
P

QRS

120
V wave
(venous
return)

C wave
(ventricular
contraction)

a wave
(atrial
Contraction)

0 mmHg
IVR

Filling

IVC

Ejection

Left Ventricular Pressure (120/0 mmHg)

P

QRS

120

Atrial
Contraction

Aortic Valve
Opens at
80 mmHg

0 mmHg
IVR

Filling

IVC

Ejection

Closes
at 100
mmHg

Aortic Pressure (120/80 mmHg)

P

QRS

120

80
Aortic Valve
Opens at
80 mmHg

Aortic blood Flow

to circulation continues despite zero
ventricular output
0 mmHg
IVR

Filling

IVC

Ejection

Closes
at 100
mmHg

Distribusi Cardiac Output

Cardiac Output

Konsumsi oksigen

Distribution of Cardiac Output

Cardiac Output (CO)

Volume darah yang dipompakan

ventrikel dalam unit waktu
CO = HR X SV
Contoh :
HR (denyut jantung) = 70 X/1mnt
SV (stroke volume) = 70 ml/1 X
CO = 70 X 70 ml = 4.900 ml/1
menit

CO laki-laki +/- 5,5 ltr/menit

wanita
+/- 4,15ltr/menit

CARDIAC OUTPUT
Methods of Measurement
In experimental animals, cardiac output can
be measured with an electromagnetic
flow meter placed on the ascending aorta.
Two methods of measuring output that are
applicable to humans, in addition to
Doppler combined with
echocardiography, are the direct Fick
method and the indicator dilution
method.

MEASUREMENT OF CARDIAC OUTPUT

THE FICK METHOD:
VO2 = ([O2]a - [O2]v) x Flow
Flow =

VO2
[O2]a - [O2]v

Spirometry (250 ml/min)

Pulmonary Artery Blood (15 ml%)

Arterial Blood (20 ml%)

PULMONARY BLOOD FLOW

CARDIAC OUTPUT

VENOUS RETURN
PERIPHERAL
BLOOD FLOW

CARDIAC OUTPUT (Q) =

VO2
[O2]a - [O2]v
=

250 ml/min
20 ml% - 15 ml%

= 5 L/min
.
Q = HR x SV
.
Q
SV =
HR
=

5 L/min
70 beats/min

.
Q
m2 body surface
area

CARDIAC INDEX =

5 L/min
1.6 m2

= 0.0714 L or 71.4 ml
= 3.1 L/min/m2

Some Definitions
Heart Rate: 60-100 beats/min Stroke Volume: 70-80 ml
number of contractions per unit time.

volume pumped by a ventricle in one

contraction.

Cardiac Output:

5-5.5 l/min
flow rate out of the heart, volume pumped per unit time.

Cardiac Output = Heart Rate x Stroke Volume

Venous return:

5-5.5 l/min

flow rate into the heart.

Diastolic pressure:

Diastole: Relaxation of the heart.

Systole: Contraction of the heart
Blood volume

80 mmHg

lowest systemic arterial pressure, during diastole.

Systolic pressure:

120 mmHg

highest systemic arterial pressure, during systole

5l

Kemampuan Pompa Jantung

( Cardiac Performance)
Kontraktilitas

Denyut jantung

Preload ( beban awal)

dipengaruhi oleh end diastolic volume (EDV)

Afterload (beban susulan )

ditentukan oleh resistensi perifer

SYSTOLE

DIASTOLE

COMPLIANCE

RIGID

Preload

Resistensi
perifer

Ukuran
ventrikel
kiri

Tekanan
Darah

Kontraktilitas

Afterload

Pemendekan
serabut miokard

Stroke
volume
Cardiac
output

Heart
rate

 Interactions between the components that regulate

cardiac output and arterial pressure. Solid lines indicate
increases, and the dashed line indicates a decrease.

Relation of Tension to Length

in Cardiac Muscle

The length-tension relationship in cardiac muscle

is similar to that in skeletal muscle as the muscle
is stretched, the developed tension increases to a
maximum and then declines as stretch becomes
more extreme.

Factors that normally increase or

decrease the length of ventricular

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

D Y
E
S LI T
A
E TI
R
C
C
IN TRA
N
CO

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

ED T Y
S
A I LI
E
R CT
C
DE TRA
N
CO

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

IN
C
FI RE
LL AS
IN E
G D

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

PRESSURE

After-load
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
PRESSURE CURVE

Pre-load

End Systolic Volume

End Diastolic Volume

THE HEART AS A PUMP

REGULATION OF CARDIAC
OUTPUT
Heart Rate via sympathetic &
parasympathetic nerves
Stroke Volume
Frank-Starling Law of the
Heart
Changes in Contractility

MYOCARDIAL CELLS
(FIBERS)
Regulation of Contractility
Length-Tension and VolumePressure Curves
The Cardiac Function Curve

Kondisi Jantung Normal

Kontraksi reguler
dan sinkron
Katup jantung
(normal)
Kontraksi kuat
Pengisian adequat
(diastole)

Kondisi Jantung Normal

Kontraksi reguler
dan sinkron
Katup jantung
(normal)
Kontraksi kuat
Pengisian adequat
(diastole)

Aritmia
Stenose, Regurgitasi
Failure
abnormal filling

Let it
beat!