Kuliah 4 Respirasi + cardiovasculer

Respiratory System

Dr. Thontowi Djauhari NS, MKesProgramStudi FarmasiUniversitas Muhammadiyah Malang

Respiratory System: Functions1. Provides extensive surface area within the lungs in the alveoli for gas exchange between outside air & blood.2. Moves air to & from exchange surfaces of lung.3. Purifies, warms, and humidifies the incoming air in passageways to the lungs 4. Defends against invading microorganisms.5. Produces sounds involved in speech.

NosePharynxLarynxTracheaBronchiRespiratoryportion

Lungs alveoliFigure 13.1Organs of the Respiratory systemConducting portion

Upper vs. Lower Respiratory SystemUpper respiratory system Nose to pharynx.Functions:Filters airWarms airHumidifies airLower respiratory system larynx to smallest structures of lungs.Functions: Same as aboveGas exchange

Upper Respiratory TractFigure 13.2NCOC

Larynx (Voice Box)Routes air and food into proper channelsPlays a role in speechMade of eight rigid hyaline cartilages and a spoon-shaped flap of elastic cartilage (epiglottis)Thyroid cartilageLargest hyaline cartilageProtrudes anteriorly (Adams apple)EpiglottisSuperior opening of the larynxRoutes air to the trachea & food to the esophagus.Vocal cords (vocal folds)Vibrate with expelled air to create sound (speech)Glottis opening between vocal cords

Anatomy of the larynxThyroidepiglottisE

EVocal foldAnatomy of the larynx:epiglottis, glottis, and vocal folds

Trachea (Windpipe)

The trachea (windpipe) connects larynx with bronchi.Trachea

Walls reinforced with C-shaped hyaline cartilage which prevent collapse of the trachea.

Trachea lined with ciliated mucosa that beat continuously; trachea expels mucus loaded with dust & other debris away from lungs.Trachea

Coverings of the Lungs (Serous Membrane)Pulmonary (visceral) pleura covers the lung surfaceParietal pleura lines the walls of the thoracic cavityPleural (serous) fluid fills the area between layers of pleura to allow gliding

hilusEach lung is divided into lobes by fissures

Left lung two lobesRight lung three lobesLungs

Primary BronchiFormed by division of the tracheaEnters the lung at the hilusBronchi subdivide into smaller and smaller branches

Respiratory Tree DivisionsPrimary bronchiSecondary bronchiTertiary bronchiBronchiolesTerminal bronchioles

The trachea and primary bronchi have cartilage rings.

Secondary and tertiary bronchi have cartilage plates arranged around lumen.

Bronchioles lack cartilage.

BronchiolesFigure 13.5aSmallest branches of the bronchiAll but the smallest branches have reinforcing cartilageTerminal bronchioles end in alveoli

Respiratory ZoneRespiratory bronchiolesAlveoliAlveolar ductAlveolar sacAlveolus (Alveoli)Gas exchange takes place within the alveoliSites of gas exchangePulmonary capillaries cover external surfaces of alveoli

Respiratory Membrane (Air-Blood Barrier)Figure 13.6Thin flat epithelial layer lining alveolar wallsMacrophages add protectionSurfactant coats gas-exposed alveolar surface

Events of RespirationRespiratory gas transport transport of oxygen and carbon dioxide via the bloodstreamInternal respiration gas exchange between blood and tissue cells in systemic capillaries

Mechanics of Breathing (Pulmonary Ventilation)Completely mechanical processDepends on volume changes in the thoracic cavityVolume changes lead to pressure changes, which lead to the flow of gases to equalize pressureTwo phasesInspiration flow of air into lungExpiration air leaving lung

Figure 13.7aDiaphragm and intercostal muscles contract The size (volume) of the thoracic cavity increases.The pressure inside the thoracic caivity decreases and draws external air into the lungs down the pressure gradient.Inspiration

Largely a passive process which depends on natural lung elasticityAs muscles relax, air is pushed out of the lungsForced expiration can occur mostly by contracting internal intercostal muscles to depress the rib cageExpiration

Normal pressure within the pleural space (cavity) is always negative (intrapleural pressure)Pressure differences between the lungs (intrapulmonary) and pleural spaces keep the lungs from collapsingPressure Differences in the Thoracic Cavity

Respiratory Volumes and CapacitiesNormal breathing moves about 500 ml of air with each breath (tidal volume [TV])Many factors that affect respiratory capacityA persons Size; Sex; Age; Physical conditionResidual volume of air after exhalation, about 1200 ml of air remains in the lungsRespiratory capacities are measured with a spirometer

Respiratory Volumes and CapacitiesInspiratory reserve volume (IRV)Amount of air that can be taken in forcibly over the tidal volumeUsually between 2100 and 3200 mlExpiratory reserve volume (ERV)Amount of air that can be forcibly exhaledApproximately 1200 ml

Respiratory Volumes and CapacitiesVital capacityThe total amount of exchangeable airVital capacity = TV + IRV + ERV

Respiratory Volumes and CapacitiesDead space volume (about 150 ml)Air that remains in conducting zone and never reaches alveoliFunctional volume (about 350 ml)Air that actually reaches the respiratory zone

The Cardiovascular System:Program Studi FarmasiFakultas Ilmu KesehatanUniversitas Muhammadiyah Malang

HeartAnatomy4 chambersAV valvesTricuspidBicuspid - mitralSemilunar valvesRight - pulmonaryLeft - aorticInferior view of valves

Heart AnatomyApproximately the size of your fistLocationSuperior surface of diaphragmLeft of the midlineAnterior to the vertebral column, posterior to the sternum

Heart AnatomyFigure 18.1

Coverings of the Heart: AnatomyPericardium a double-walled sac around the heart composed of:A superficial fibrous pericardiumA deep two-layer serous pericardiumThe parietal layer lines the internal surface of the fibrous pericardiumThe visceral layer or epicardium lines the surface of the heartThey are separated by the fluid-filled pericardial cavity

Coverings of the Heart: PhysiologyThe pericardium:Protects and anchors the heartPrevents overfilling of the heart with bloodAllows for the heart to work in a relatively friction-free environment

Pericardial Layers of the HeartFigure 18.2

Heart WallEpicardium visceral layer of the serous pericardiumMyocardium cardiac muscle layer forming the bulk of the heartFibrous skeleton of the heart crisscrossing, interlacing layer of connective tissueEndocardium endothelial layer of the inner myocardial surface

Vessels returning blood to the heart include:Superior and inferior venae cavaeRight and left pulmonary veinsVessels conveying blood away from the heart include:Pulmonary trunk, which splits into right and left pulmonary arteriesAscending aorta (three branches) brachiocephalic, left common carotid, and subclavian arteriesExternal Heart: Major Vessels of the Heart (Anterior View)

Arteries right and left coronary (in atrioventricular groove), marginal, circumflex, and anterior interventricular arteriesVeins small cardiac, anterior cardiac, and great cardiac veinsExternal Heart: Vessels that Supply/Drain the Heart (Anterior View)

External Heart: Anterior ViewFigure 18.4b

Vessels returning blood to the heart include:Right and left pulmonary veinsSuperior and inferior venae cavaeVessels conveying blood away from the heart include:AortaRight and left pulmonary arteriesExternal Heart: Major Vessels of the Heart (Posterior View)

Arteries right coronary artery (in atrioventricular groove) and the posterior interventricular artery (in interventricular groove)Veins great cardiac vein, posterior vein to left ventricle, coronary sinus, and middle cardiac veinExternal Heart: Vessels that Supply/Drain the Heart (Posterior View)

Pathway of Blood Through the Heart and LungsFigure 18.5

ArteriesAortic archDescending aortaLeft subclavianLeft common carotidBrachiocephalicRight subclavianRight common carotid

ArteriesBrachiocephalicRight subclavianRight common carotidRight internal carotidRight internal carotidRight external carotid

VeinsSuperior vena cavaPulmonary veinsCardiac veinsCoronary sinusInferior vena cava

VeinsBrachiocephalicRight subclavianAxillaryRight external jugularRight internal jugular

Fetal Circulation

Coronary CirculationCoronary circulation is the functional blood supply to the heart muscle itselfCollateral routes ensure blood delivery to heart even if major vessels are occluded

Coronary CircuitAortaCoronary arteriesCardiac veinsCoronary sinus

Coronary Vessels Anterior---LAC RPM---

Coronary Vessels Posterior---LAC RPM---

Heart ValvesHeart valves ensure unidirectional blood flow through the heartAtrioventricular (AV) valves lie between the atria and the ventriclesAV valves prevent backflow into the atria when ventricles contractChordae tendineae anchor AV valves to papillary muscles

Heart ValvesAortic semilunar valve lies between the left ventricle and the aorta Pulmonary semilunar valve lies between the right ventricle and pulmonary trunkSemilunar valves prevent backflow of blood into the ventricles

Heart ValvesFigure 18.8a, b

Heart Valves

Valve AnatomyThe AV valves, the tricuspid and bicuspid (mitral) valves

AV Valve MechanicsVentricles relax, pressure drops, semilunar valves close, AV valves open, blood flows from atria to ventriclesVentricles contract, AV valves close (papillary m. contract and pull on chordae tendineae to prevent prolapse), pressure rises, semilunar valves open, blood flows into great vessels

Operation of Atrioventricular Valves

Operation of Semilunar Valves

Blood Flow Through Heart

Pathway of Blood Through the Heart and LungsRight atrium tricuspid valve right ventricleRight ventricle pulmonary semilunar valve pulmonary arteries lungsLungs pulmonary veins left atriumLeft atrium bicuspid valve left ventricleLeft ventricle aortic semilunar valve aortaAorta systemic circulation

Conduction pathwayHeart rate fluctuationsSympatheticCardiac nerveNorepinephrine (Na+, Ca++ influx)ParasympatheticVagus nerveAcetycholine (K+ efflux)

Intrinsic Cardiac Conduction SystemApproximately 1% of cardiac muscle cells are autorhythmic rather than contractile75/min40-60/min30/min

Intrinsic Conduction SystemFunction: initiate & distribute impulses so heart depolarizes & contracts in orderly manner from atria to ventricles.SA nodeAV nodeBundle of HisBundle Branches

TERIMA KASIH

******************************Approximately 1% of the cardiac muscle cells are autorhythmic rather than contractile. * These specialized cardiac cells dont contract but are specialized to initiate and conduct impulses through the heart to coordinate its activity. * These constitute the intrinsic cardiac conduction system. These autorhythmic cells constitute the following components of the intrinsic conduction system:* the sinoatrial (SA) node, just inferior to the entrance of the superior vena cava into the right atrium, * the atrioventricular node (AV) node, located just above the tricuspid valve in the lower part of the right atrium,* the atrioventricular bundle (bundle of HIS), located in the lower part of the interatrial septum and which extends into the interventricular septum where it splits into right and left bundle branches * which continue toward the apex of the heart and the purkinje fibers * which branch off of the bundle branches to complete the pathway into the apex of the heart and turn upward to carry conduction impulses to the papillary muscles and the rest of the myocardium. Although all of these are autorhythmic, they have different rates of depolarization. * For instance, the SA node * depolarizes at a rate of 75/min. * The AV node depolarizes at a rate of 40 to 60 beats per minute, * while the rest have an intrinsic rate of around 30 depolarizations/ minute. * Because the SA node has the fastest rate, it serves as the pacemaker for the heart. *

*As indicated previously, the function of the intrinsic conduction system is to initiate and distribute impulses so the heart depolarizes and contracts in an orderly manner from atria to ventricles. * As you must be able to identify the parts of the conduction system and trace the path of depolarization from the SA node to the purkinje fibers, we will review this. * Since the SA node * has the highest rate of depolarization (75/min) , it starts the process by sending a wave of depolarization * through the myocardium of the atria. When this reaches the AV node * it depolarizes * and causes the Bundle of His * to depolarize.The depolarization travels into the septum through the bundle branches * * and from the bundle branches into the Purkinje fibers * * which cause depolarization of the ventricular myocardium. When the cardiac muscle cells of the myocardium, including the papillary muscles, the ventricles contract forcing blood out of the ventricles. *

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Kuliah 4 Respirasi + cardiovasculer