ELEKTROFISIOLOGI JANTUNG.ppt

8/18/2019 ELEKTROFISIOLOGI JANTUNG.ppt

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ELEKTROFISIOLOGIJANTUNG

Irawan Yusuf


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Tujuan Pokok BahasanTujuan Pokok Bahasan

1. !s"uss #h$ !on!" %as!s of #h$ r$s#!n& 'o#$n#!a( !n a#r!a( an) *$n#r!"u(ar "$((s.

+. !s"uss #h$ !on!" %as!s of $a"h of #h$ four 'has$s of #h$ a"#!on 'o#$n#!a( !n

,work!n&, -o"ar)!a( /a#r!a( an) *$n#r!"u(ar0 "$((s an) Purk!nj$ "$((s an) of

#h$ #wo 'has$s of #h$ a"#!on 'o#$n#!a( !n /S2A an) A230 no)a( "$((s.

4. !s"uss #h$ !on!" %as!s of )!as#o(!" )$'o(ar!5a#!on /'has$ 607 $8'(a!n wh #h$s$-$"han!s-s )!ff$r %$#w$$n no)a( an) Purk!nj$ "$((s7 (!s# #h$ 'a"$-ak$rs of #h$

h$ar# an) #h$!r a''ro8!-a#$ f!r!n& ra#$s !n or)$r of fas#$s# #o s(ow$s#.

6. !s"uss #h$ !on!" %as!s of #h$ a%so(u#$ an) r$(a#!*$ r$fra"#or '$r!o)s an) how

fas#$r h$ar# ra#$s shor#$n #h$s$ '$r!o)s.

9. !s"uss #h$ !on!" %as!s of 'ro'a&a#!on of a"#!on 'o#$n#!a(s #hrou&hou# #h$ h$ar#7

(!s# #h$ fa"#ors #ha# aff$"# "on)u"#!on *$(o"!#7 (!s# a''ro8!-a#$ "on)u"#!on*$(o"!#!$s !n #h$ )!ff$r$n# r$&!ons of #h$ h$ar# fro- s(ow$s# #o fas#$s#7 $8'(a!n

wh su"h *$(o"!#!$s ar$ fas# or s(ow.

:. $s"r!%$ #h$ -$"han!s-s #ha# un)$r(!$ #h$ 'os!#!*$ an) n$&a#!*$ "hrono#ro'!"

an) )ro-o#ro'!" $ff$"#s of s-'a#h$#!" an) 'aras-'a#h$#!" n$uro#rans-!##$rs.

;. G!*$n "(!n!"a(( r$($*an# s!#ua#!ons of $($"#ro'hs!o(o&!"a( )!s#ur%an"$s.


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P$n)ahu(uanP$n)ahu(uan

•


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asar Ion!k Ak#!f!#as L!s#r!kasar Ion!k Ak#!f!#as L!s#r!k

Jan#un&Jan#un&

• !s$%a%kan o($h '$r&$rakan arus !on

)ar! (uar s$( k$)a(a- s$( a#au s$%a(!kna-$(a(u! sa(uran !on /ion channel 0

• P$r&$rakan !on #$rja)! ak!%a# '$r%$)aan

kons$n#ras! !on )! )a(a- )an )! (uar s$(


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Kons$n#ras! !on )! )a(a- )an )!(uar s$(

Ion Eks#ras$( /-(2 19? 9


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S#ruk#ur )an Fun&s! Sa(uran IonS#ruk#ur )an Fun&s! Sa(uran Ion

•


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Po#$ns!a( Aks! Pa)a O#o# Jan#un&Po#$ns!a( Aks! Pa)a O#o# Jan#un&

•


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>ar)!a" versus Sk$($#a(


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asar Ion!k Po#$ns!a(asar Ion!k Po#$ns!a(


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asar Ion!k Po#$ns!a( Aks!asar Ion!k Po#$ns!a( Aks!

Fas$ ? /)$'o(ar!sas! "$'a#0Fas$ ? /)$'o(ar!sas! "$'a#0

• !s$%a%kan o($h arus !on Na= k$)a(a- s$(/ I Na0 -$(a(u! activation gate /m &a#$0

• Pa)a saa# 'o#$ns!a( -$-%ran /3-0-$n"a'a! 4? -326? -3 #$rja)! 'ros$s!nak#!fas! sa(uran Na= inactivation gate /h

&a#$0 -u(a! #$r#u#u'• Pros$s !nak#!fas! sa(uran Na= -$n)asar!

-asa r$frak#$r


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Fas$ 1 /r$'o(ar!sas! awa(0Fas$ 1 /r$'o(ar!sas! awa(0•


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Fas$ + /'(a#$au0Fas$ + /'(a#$au0• a %$r'$ran )a(a- 'ros$s kon#raks! jan#un&

)$n&an -$-!"u '$($'asan >a+= !n#ras$( )!

r$#!ku(u- sarko'(as-a /Ca2+-induced Ca2+

release0• a -$(a(u! sa(uran >a+= )$n&an o%a#2

o%a#an )a'a# -$n&uran&! a#au -$n!n&ka#kan

kon#raks! jan#un&


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Fas$ 4 /r$'o(ar!sas! "$'a#0Fas$ 4 /r$'o(ar!sas! "$'a#0

• Fas$ !n! #$rja)! %!(a arus K = k$(uar s$(

-$($%!h! -asukna arus >a+= / I >a0

• I #o -$n$n#ukan (a-ana fas$ + a#au awa(

fas$ 4 #$ru#a-a 'a)a a#r!a

• I K1 /inwardly rectified 0 -$-$&an&

'$ranan 'a(!n& '$n#!n& 'a)a 'ros$s

r$'o(ar!sas!


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SISTI< KONUKSI JANTUNGSISTI< KONUKSI JANTUNG

• S!s#$- kon)uks! jan#un& %$rfun&s! un#uk-$n$%arkan ak#!f!#as (!s#r!k k$ s$(uruho#o# jan#un&

• S!s#!- kon)uks! jan#un& #$r)!r! )ar!@

– no)us SA / pacemaker u#a-a jan#un&0

– #rak#us !n#$rno)a(

–

no)us A3 – %$rkas C!s

– s$ra%u# Purk!nj$


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SISTI< KONUKSI JANTUNGSISTI< KONUKSI JANTUNG

P$n$%aran Po#$ns!a( aks!P$n$%aran Po#$ns!a( aks!• K$"$'a#an '$n&han#aran 'o#$ns!a( aks! #$r&an#un&)ar! s#ruk#ur )an s!fa# s$( -as!n&2-as!n& s!s#$-kon)uks!

• T$rja)! '$r(a-%a#an '$n$%aran 'o#$ns!a( aks!)ar! a#r!a k$ *$n#r!k$( kar$na@ – -$-un&k!nkan '$n&!s!an *$n#r!k$( an& o'#!-a(

– o'#!-as! kon#raks! *$n#r!k$(

– -$-aks!-a(kan 'ros$s $j$ks! *$n#r!k$(

• $'o(ar!sas! %$rakh!r 'a)a %a&!an 'os#$ro%asa(*$n#r!k$( k!r! konus 'u(-ona( )an %a&!an a#ass$'#u-


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K$"$'a#an kon)uks! 'a)aK$"$'a#an kon)uks! 'a)a

jar!n&an s$( o#o# jan#un& jar!n&an s$( o#o# jan#un&

Jar!n&an K$"$'a#an La-a Fr$kw$ns!

kon)uks! /-D)$#0 kon)uks! /)$#0 ka(!D-$n!#0

No)us SA ?.?9 ?.19 :?21??

O#o# a#r!a( 1.?21.+ ?.19

No)us A3 ?.?+2?.?9 ?.? 6?269

B$rkas C!s 1.+2+.? ?.? +926?

Purk!nj$ +.?26.? ?.? +926?O#o# 3$n#r!k$( ?.421.? ?.?


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Gan&&uan Ira-a Jan#un&Gan&&uan Ira-a Jan#un&

• Gan&&uan '$-%$n#ukan !-'u(s

• Gan&&uan '$n&han#aran !-'u(s

• Gan&&uan '$-%$n#ukan )an

'$n&han#aran !-'u(s


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asar2)asar !on!k ar!#-!aasar2)asar !on!k ar!#-!a

• P$ru%ahan 'a)a 'o#$ns!a( -$-%ran !s#!raha# –


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Gan&&uan P$-%$n#ukanGan&&uan P$-%$n#ukan

I-'u(sI-'u(s

• O#o-a#!s!#as nor-a(

– K$"$'a#an a%nor-a( @ Tak!kar)! )an Bra)!kar)!

–

Ira-a a%nor-a( @ I-'u(s 'r$-a#ur$• O#o-a#!s!#as a%nor-a(

• Trigger activity

– Ear( af#$r )$'o(ar!5a#!on /EA0

– $(a$) af#$r )$'o(ar!5a#!on /A0


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Gan&&uan Kon)uks! I-'u(sGan&&uan Kon)uks! I-'u(s

• P$r(a-%a#an )an ha-%a#an kon)uks!

– B(ok SA

– B(ok A3

– B(ok '$r"a%an&an %$rkas C!s

•


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ELE>TRO>ARIOGRATRO>ARIOGRA<

• As the heart undergoes depolarization and

repolarization , the electrical currents that are

generated spread not only within the heart, ut also

throughout the ody!• This electrical activity generated y the heart is

generally measured y an array of electrodes placed

on the ody surface and the resulting tracing is

called an electrocardiogram "#C$, or #%$&!

• The different waves that comprise the #C$ represent

the se'uence of depolarization and repolarization of

the atria and ventricles!

http://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htm


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(ses of the #%$

• )eart *ate

• Conduction in the heart

• Arrythmias

• irection of the cardiac vector

• amage to the heart muscle• rovides . information aout pumping or

mechanical events in the heart


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Normal ECGNormal ECG


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• The -wave represents the wave of depolarization thatspreads from the /A node throughout the atria and isusually 0!01 to 0! seconds "10-00 ms& in duration!

• The period of time from the onset of the -wave to theeginning of the 3*/ is termed the * interval andnormally ranges from 0!2 to 0!20 seconds! This intervalrepresents the time etween the onset of atrialdepolarization and the onset of ventricular

depolarization!• The 3*/ comple4 represents ventricular depolarization!

The duration of the 3*/ comple4 is normally 0!05 to 0!seconds indicating that ventricular depolarization normally occurs very rapidly!

http://www.cvphysiology.com/Arrhythmias/A002.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A002.htm


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• The isoelectric period "/T segment& following the 3*/ isthe time at which the entire ventricle is depolarized androughly corresponds to the plateau phase of theventricular action potential!

• The T-wave represents ventricular repolarization and islonger in duration than depolarization "i!e!, conductionof the repolarization wave is slower than the wave ofdepolarization&!

•

The 3T interval represents the time for oth ventriculardepolarization and repolarization to occur, and thereforeroughly estimates the duration of an average ventricularaction potential! This interval can range from 0!2 to 0!6seconds depending upon heart rate!

http://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htmhttp://www.cvphysiology.com/Arrhythmias/A006.htm


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Th$ Nor-a( EKG r$"or)$) on #h$ B!'o(ar L!-% L$a)s

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ELEKTROFISIOLOGI JANTUNG.ppt