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    Elektrofisiologi Jantung: Irawan Yusuf

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    Tenri Ola Oddang
    The document discusses the ionic basis of the cardiac action potential and electrophysiology of the heart. It describes: 1. The ion concentrations inside and outside cardiac cells and the ion channels that regulate ion flow. 2. The five phases of the cardiac action potential and the underlying ionic currents. 3. How the cardiac conduction system propagates action potentials through the heart, from the sinoatrial node to the ventricles. 4. Factors that can cause cardiac arrhythmias at the ion channel or cellular level.

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    Elektrofisiologi Jantung: Irawan Yusuf

    Uploaded by

    Tenri Ola Oddang
    84 views44 pages
    The document discusses the ionic basis of the cardiac action potential and electrophysiology of the heart. It describes: 1. The ion concentrations inside and outside cardiac cells and the ion channels that regulate ion flow. 2. The five phases of the cardiac action potential and the underlying ionic currents. 3. How the cardiac conduction system propagates action potentials through the heart, from the sinoatrial node to the ventricles. 4. Factors that can cause cardiac arrhythmias at the ion channel or cellular level.

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    electrophysiology

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    The document discusses the ionic basis of the cardiac action potential and electrophysiology of the heart. It describes: 1. The ion concentrations inside and outside cardiac cells and the ion channels that regulate ion flow. 2. The five phases of the cardiac action potential and the underlying ionic currents. 3. How the cardiac conduction system propagates action potentials through the heart, from the sinoatrial node to the ventricles. 4. Factors that can cause cardiac arrhythmias at the ion channel or cellular level.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    84 views44 pages

    Elektrofisiologi Jantung: Irawan Yusuf

    Uploaded by

    Tenri Ola Oddang
    The document discusses the ionic basis of the cardiac action potential and electrophysiology of the heart. It describes: 1. The ion concentrations inside and outside cardiac cells and the ion channels that regulate ion flow. 2. The five phases of the cardiac action potential and the underlying ionic currents. 3. How the cardiac conduction system propagates action potentials through the heart, from the sinoatrial node to the ventricles. 4. Factors that can cause cardiac arrhythmias at the ion channel or cellular level.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 44

    ELEKTROFISIOLOGI JANTUNG

    Irawan Yusuf

    Tujuan Pokok Bahasan


    1. 2. Discuss the ionic basis of the resting potential in atrial and ventricular cells. Discuss the ionic basis of each of the four phases of the action potential in "working" myocardial (atrial and ventricular) cells and Purkinje cells, and of the two phases of the action potential in (S-A and A-V) nodal cells. Discuss the ionic basis of diastolic depolarization (phase 4); explain why these mechanisms differ between nodal and Purkinje cells; list the pacemakers of the heart and their approximate firing rates in order of fastest to slowest. Discuss the ionic basis of the absolute and relative refractory periods, and how faster heart rates shorten these periods. Discuss the ionic basis of propagation of action potentials throughout the heart; list the factors that affect conduction velocity; list approximate conduction velocities, in the different regions of the heart, from slowest to fastest; explain why such velocities are fast or slow. Describe the mechanisms that underlie the positive and negative chronotropic and dromotropic effects of sympathetic and parasympathetic neurotransmitters. Given clinically relevant situations of electrophysiological disturbances.

    3.

    4. 5.

    6. 7.

    Pendahuluan
    Mengawali aktifitas mekanik jantung Potensial aksi yang lebih lama dibandingkan sel saraf dan otot rangka Setiap bagian jantung mempunyai karakteristik potensial aksi yang khas Menjadi dasar untuk memahami kelainan irama jantung

    Heart Valves and Major Blood Vessels


    Aorta (to the systemic circulation) Pulmonary Arteries (to lungs) Semilunar valves (aortic & pulmonary) RA Tricuspid (AV) Valve Inferior Vena cava RV
    apex

    Superior Vena cava

    LA

    Pulmonary Veins (from lungs) Bicuspid (AV; mitral) Valve

    LV

    interatrial septum interventricular septum

    ventricular muscle

    RA: right atria LA: left atria RV: right ventricle LV: left ventricle

    Dasar Ionik Aktifitas Listrik Jantung


    Disebabkan oleh pergerakan arus ion dari luar sel kedalam sel atau sebaliknya melalui saluran ion (ion channel) Pergerakan ion terjadi akibat perbedaan konsentrasi ion di dalam dan di luar sel

    Konsentrasi ion di dalam dan diluar sel


    Ion
    Na+

    Ekstrasel (mM)
    145

    Intrasel (mM)
    12

    K+
    Ca2+

    4
    2

    135
    10-4

    Cl-

    150

    Struktur dan Fungsi Saluran Ion


    Merupakan protein integral pada membran sel otot jantung dan pacemaker cells Bersifat selektif terhadap ion tertentu Arah pergerakan ion ditentukan oleh perbedaan konsentrasi ion di luar dan di dalam sel Proses gating diatur oleh rangsangan listrik, kimia dan mekanik

    Potensial Aksi Pada Otot Jantung


    Mempunyai lima fase, masing-masing:
    Fase 0 (upstroke, fast depolarization) Fase 1 (early repolarization) Fase 2 (plateau) Fase 3 (fast repolarization) Fase 4 (resting membrane potential)

    Terdapat dua jenis potensial aksi:


    Potensial aksi cepat (fast responses) Potensial aksi lambat (slow responses)

    Cardiac Action Potential


    (differ from cell to cell: size

    and channel numbers)

    Length Plateau Ca++ (Em and contraction) K+ channel closure

    Cardiac contractile cells have a stable resting potential

    Time (msec)

    Cardiac versus Skeletal Muscle AP

    Cardiac Muscle Cells are Electrically Connected via Gap Junctions


    desmosome (protein fibres)

    Cardiac Muscle Cells

    intercalated disk

    Gap Junction
    desmosome resist stretching important as it occurs every time the heart fills (cardiac cycle) gap junction passage of current Plasma membrane

    hypertrophy: reduced contraction steps in conduction

    Dasar Ionik Potensial Membran Istirahat


    Potensial membran istirahat berkisar antara -80 mV sampai -90 mV pada otot ventrikel, lebih positif pada otot atrium, nodus AV dan nodus SA Ditentukan oleh pergerakan ion K+ keluar sel, dan aktifitas pompa Na+-K+ (Na+-K+ pump)

    Dasar Ionik Potensial Aksi


    Fase 0 (depolarisasi cepat)
    Disebabkan oleh arus ion Na+ kedalam sel (INa) melalui activation gate (m gate) Pada saat potensial membran (Vm) mencapai 30 mV-40 mV terjadi proses inaktifasi saluran Na+, inactivation gate (h gate) mulai tertutup Proses inaktifasi saluran Na+ mendasari masa refrakter

    Dasar Ionik Potensial Aksi


    Fase 1 (repolarisasi awal)
    Merupakan repolarisasi awal yang berlangsung singkat Terjadi akibat inaktifasi saluran Na+ dan aktifasi saluran K+ Terjadi pergerakan K+ keluar sel yang berlangsung singkat (Ito, transient outward current) Fase ini sangat menonjol pada potensial aksi di serabut Purkinje

    Dasar Ionik Potensial Aksi


    Fase 2 (plateau)
    Merupakan fase yang paling panjang Terjadi akibat INa, ICa dan IK, IK1 dan Ito ICa masuk melalui saluran Ca2+ tipe L dan T ICa berperan dalam proses kontraksi jantung dengan memicu pelepasan Ca2+ intrasel di retikulum sarkoplasma (Ca2+-induced Ca2+ release) Modifikasi ICa melalui saluran Ca2+ dengan obat-obatan dapat mengurangi atau meningkatkan kontraksi jantung

    Dasar Ionik Potensial Aksi


    Fase 3 (repolarisasi cepat)
    Fase ini terjadi bila arus K+ keluar sel melebihi masuknya arus Ca2+ (ICa) Ito menentukan lamanya fase 2 atau awal fase 3, terutama pada atria IK1 (inwardly rectified), memegang peranan paling penting pada proses repolarisasi

    SISTIM KONDUKSI JANTUNG


    Sistem konduksi jantung berfungsi untuk menyebarkan aktifitas listrik ke seluruh otot jantung Sistim konduksi jantung terdiri dari:
    nodus SA (pacemaker utama jantung) traktus internodal nodus AV berkas His serabut Purkinje

    The Conduction System of the Heart


    (pacemaker conduction fibres contractile fibres )
    conduction fibres: larger diameter atria ventricles: separated by fibrous bundles

    2. Internodal pathways 1. Sinoatrial (SA) node 3. Atrioventricular (AV) node 4. AV bundle (Bundle of His)

    6. Purkinje fibres 5. Right and left bundle branches coordinated contraction RV

    LV
    gap junctions

    a. AP is initiated in the SA node

    a. AP is initiated in the SA node

    b. AP are conducted throughout the atria very rapid large cells

    a. AP is initiated in the SA node

    b. AP are conducted throughout the atria very rapid large cells


    fibrous septum

    c. Conduction slows at the AV node small cells

    SA node versus AV node


    (frequency and refractory period)

    Allows full ventricular filling before contraction

    a. AP is initiated in the SA node

    b. AP are conducted throughout the atria very rapid large cells c. Conduction slows at the AV node small cells d. AP travel rapidly through the bundle of His and the branch bundles

    a. AP is initiated in the SA node

    e. AP spread through the ventricles (bottom to top)

    b. AP are conducted throughout the atria very rapid large cells contraction: apex to top c. Conduction slows at the AV node small cells d. AP travel rapidly through the branch bundles

    a. AP is initiated in the SA node

    f. rest

    e. AP spread through the ventricles (bottom to top)

    b. AP are conducted throughout the atria very rapid large cells c. Conduction slows at the AV node small cells d. AP travel rapidly through the branch bundles

    SISTIM KONDUKSI JANTUNG Penyebaran Potensial aksi


    Kecepatan penghantaran potensial aksi tergantung dari struktur dan sifat sel masingmasing sistem konduksi Terjadi perlambatan penyebaran potensial aksi dari atria ke ventrikel karena:
    memungkinkan pengisian ventrikel yang optimal optimasi kontraksi ventrikel memaksimalkan proses ejeksi ventrikel

    Depolarisasi berakhir pada bagian posterobasal ventrikel kiri, konus pulmonal dan bagian atas septum

    Kecepatan konduksi pada jaringan sel otot jantung


    Jaringan Kecepatan konduksi (m/det) 0.05 1.0-1.2 0.02-0.05 1.2-2.0 2.0-4.0 0.3-1.0 Lama konduksi (det) 0.15 0.15 0.08 0.08 0.08 0.08 Frekwensi kali/menit) 60-100 40-45 25-40 25-40

    Nodus SA Otot atrial Nodus AV Berkas His Purkinje Otot Ventrikel

    Gangguan Irama Jantung


    Gangguan pembentukan impuls Gangguan penghantaran impuls Gangguan pembentukan dan penghantaran impuls

    Dasar-dasar ionik aritmia


    Perubahan pada potensial membran istirahat
    Menurunnya potensial membran istirahat

    Perubahan kecepatan fase 0


    Menurunnya membran potensial istirahat Berubahnya aktifitas saluran Na+ dan Ca2+

    Perubahan pada fase 1 sampai 3


    Lamanya fase 2 Lamanya proses repolarisasi (fase3)

    Gangguan Pembentukan Impuls


    Otomatisitas normal
    Kecepatan abnormal : Takikardi dan Bradikardi Irama abnormal : Impuls premature

    Otomatisitas abnormal Trigger activity


    Early after depolarization (EAD) Delayed after depolarization (DAD)

    Gangguan Konduksi Impuls

    Perlambatan dan hambatan konduksi


    Blok SA Blok AV Blok percabangan berkas His

    Mekanisme reentry

    ELECTROCARDIOGRAM
    As the heart undergoes depolarization and repolarization, the electrical currents that are generated spread not only within the heart, but also throughout the body. This electrical activity generated by the heart is generally measured by an array of electrodes placed on the body surface and the resulting tracing is called an electrocardiogram (ECG, or EKG). The different waves that comprise the ECG represent the sequence of depolarization and repolarization of the atria and ventricles.

    ELECTROCARDIOGRAM
    Uses of the EKG
    Heart Rate Conduction in the heart Arrythmias Direction of the cardiac vector Damage to the heart muscle Provides NO information about pumping or mechanical events in the heart

    Normal ECG

    ELECTROCARDIOGRAM
    The P-wave represents the wave of depolarization that spreads from the SA node throughout the atria and is usually 0.08 to 0.1 seconds (80-100 ms) in duration. The period of time from the onset of the P-wave to the beginning of the QRS is termed the PR interval and normally ranges from 0.12 to 0.20 seconds. This interval represents the time between the onset of atrial depolarization and the onset of ventricular depolarization. The QRS complex represents ventricular depolarization. The duration of the QRS complex is normally 0.06 to 0.1 seconds indicating that ventricular depolarization normally occurs very rapidly.

    ELECTROCARDIOGRAM
    The isoelectric period (ST segment) following the QRS is the time at which the entire ventricle is depolarized and roughly corresponds to the plateau phase of the ventricular action potential. The T-wave represents ventricular repolarization and is longer in duration than depolarization (i.e., conduction of the repolarization wave is slower than the wave of depolarization). The QT interval represents the time for both ventricular depolarization and repolarization to occur, and therefore roughly estimates the duration of an average ventricular action potential. This interval can range from 0.2 to 0.4 seconds depending upon heart rate.

    The Normal EKG recorded on the Bipolar Limb Leads

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