ANATOMI SISTEM

KARDIOVASKULER
EMBRYOGENESIS
 First 20 days  mesenchymal cells  Middle of 4th week  Septation 
proliferation  genesis of heart atrial septum primum, atrial septum
secundum, ventricular septum,
 Mesenchymal cells (located in splanchnic
mesoderm) = angiogenic cluster  form a aorticopulmonary septum, septum of
network of small blood vessels the atrioventricular canal, canal
septum, and truncal septum
 Anterior central part of network = cardiogenic
area  formation of the heart and dorsal  End of 4th week  ventricles form
aortas
 End of 3rd week  2 endocardial heart tubes  5th week  SA & AV nodes,
 primitive heart artrioventricular bundle form (well
developed at 8th week)
 Appear : Truncus arteriosus, bulbus cordis,
ventricle, atrium, sinus venosus
 7th week  SVC presents
Mediastinum
PERICARDIUM
Pericardium
Anterior: The fibrous pericardium is related to the
sternum and the costal cartilages, but is Lateral: Mediastinal
separated from them, for the most part, by the pleurae, phrenic nerves,
anterior medial reflections of the left and right and pericardiacophrenic
pleurae (the costomediastinal reflections). The vessels
pericardium is thus covered by the pleurae,
except over a small bare area on the left at the Inferior: Diaphragm,
level of the fourth to sixth cartilages. This is peritoneum, and inferior
known as the "bare area of Edwards," or the vena cava
"cardiac dull space." The latter term is attributable
to the lack of resonance to percussion at this Superior: Roots of the
point. great vessels, the left
brachiocephalic vein, the
left recurrent laryngeal
nerve, and the left
Posterior: The right and left bronchi, lymph superior intercostal vein
nodes, esophagus and its nerve plexus,
descending thoracic aorta, and vertebral
reflection of pleura
Arteries
About 80 percent of the blood to the
pericardium comes from the right and
left internal thoracic arteries by way of
their pericardiacophrenic branches.

In addition, the lower pericardium is

supplied by branches of the superior
phrenic arteries. The posterior portion
receives branches from the bronchial
and esophageal arteries and
mediastinal twigs from the descending
thoracic aorta. All of these vessels
anastomose freely.
 Veins : The veins follow the arteries. They empty into the azygos and hemiazygos veins,
the internal thoracic veins, and the superior phrenic veins.

 Lymphatics : The pericardium is drained by three groups of lymph nodes:

 Anterior mediastinal nodes
 Diaphragmatic nodes
 Inferior tracheobronchial nodes

 Innervation : Nerve fibers from the vagus nerves, the phrenic nerves, and the cardiac
branches of the recurrent laryngeal nerves supply the parietal pericardium. Sympathetic
fibers arise from the cervical and upper thoracic parts of the sympathetic chains, and from
the stellate ganglia. The fibers reach the pericardium by way of the aortic and cardiac
plexuses
HEART
 Superior vena cava
Second right intercostal space or third
right costal cartilage, 1.2 cm lateral to
the right sternal margin
Inferior vena cava
Sixth right costal cartilage,
1 cm lateral to the right
sternal line
Tip of left auricle
Second left costal cartilage,
1.2 cm lateral to the left
sternal margin
Apex
Fifth left intercostal
space, 6 cm lateral to the
left sternal line or 9 cm
lateral to the midline
 Valve Projection Best aucultation
Pulmonary valve Third left sternochondral junction Second left intercostal space, adjacent to the sternum

Aortic valve Left sternal line at third left intercostal space, just below
and medial to the pulmonary valve projection
Mitral valve Fourth left sternochondral junction
Tricuspid valve Right sternal line at fourth left intercostal space
Second right intercostal space, adjacent to the sternum
Fourth or fifth left intercostal space, near the
midclavicular line (apex beat)
Fourth or fifth left sternochondral junction, near the end
of the sternum (right lower sternal line)
ANTERIOR VIEW POSTERIOR VIEW
Atrioventricular (Coronary) Sulcus
 The atrioventricular sulcus almost encircles the heart. It is interrupted only by the conus or infundibulum of the right ventricle
(pulmonary trunk) anteriorly. Beginning to the right of the infundibulum, the sulcus descends to the right side of the diaphragmatic border,
passing to the left of the entrance of the inferior vena cava. It continues deeply under the coronary venous sinus and left atrium, and
ascends again to the left side of the infundibulum.
 Anteriorly, the atrioventricular sulcus separates the right atrium from the right ventricle, and contains the right coronary artery and the
small cardiac vein. Posteriorly, it separates the left atrium from the left ventricle, and contains the coronary sinus, the great cardiac vein,
and the circumflex branch of the left coronary artery.

Interventricular Sulcus
 The interventricular sulcus indicates the position of the underlying interventricular septum between the right and left ventricles. On the
anterior surface, it leaves the coronary sulcus just to the left of the infundibulum (the pulmonary trunk), and curves gracefully in a reverse
sigmoid form to the diaphragmatic surface, to the right of the apex. It continues on the posterior surface, ascending to join the coronary
sulcus at the "crux." The crux is the small posterior region where all four major chambers are most closely approximated.
 The anterior portion of the interventricular sulcus contains the anterior interventricular (left anterior descending) branch of the left
coronary artery and the great cardiac vein of Galen. In the majority of people, the posterior portion contains the posterior interventricular
(posterior descending) branch of the right coronary artery (which can sometimes arise from the left circumflex) and the middle cardiac
vein.

Interatrial Sulcus
 The interatrial sulcus separates the atria. Anteriorly, it is covered by the pulmonary trunk and aorta; posteriorly, it is very faint. The
interatrial sulcus is not a useful landmark.
SKELETON OF HEART
Right Atrium

The chief external features of the right atrium

include the following, from above downward:
 Superior vena cava
 Right auricle over the root of the aorta
 Coronary sulcus separating the right atrium
from the right ventricle
 Sulcus terminalis
 Inferior vena cava
REMEMBER….
 Waterston's groove: The superior limbus is a fold of the interatrial sulcus, which is named Waterston's groove. It
is located between the fossa ovalis and the opening of the superior vena cava. There is no inferior limbus.
 Tendon of Todaro: Todaro's tendon is a fibrous cord under the endocardium, 1 mm in diameter (see Fig. 7-15). It
extends from the right fibrous trigone of the heart (elliptical mass between the aortic, mitral, and tricuspid
openings) to the valve of the inferior vena cava. To be more anatomically correct, its pathway is from the right
atrial wall to the medial end of the valve of the inferior vena cava.
 Triangle of Koch: The triangle of Koch is the home of the atrioventricular node. Its inferior border is Todaro's
tendon; the superior border is the septal leaflet of the tricuspid valve. The base is the post-eustachian sinus.
 Sinus of Keith: The sinus of Keith is a pouch above the orifice of the coronary sinus. It is related to the tricuspid
valve and to the extension of the terminal crest
Right Ventricle
The right ventricle lies behind the sternum and to the
left of the right atrium. It receives blood from the
right atrium, and expels it through the pulmonary
artery. The myocardium of the right ventricle is
thicker than that of the atria, and thinner than that of
the left ventricle.

The relations of the right ventricle are:

• Superior: Right auricle and pulmonary trunk
• Anterior: Pericardium, left pleura, anterior margin
of the left lung, sternum, and costal wall of the
thorax
• Posterior: Interventricular septum
• Inferior: Pericardium, central tendon of diaphragm
The right atrioventricular opening is oval, 4 cm in its
longest axis, and admits the tips of three fingers. The
opening is guarded by three leaflets (anterior,
posterior, and septal [medial]) of the tricuspid valve.
The leaflets arise peripherally from the fibrous
atrioventricular (tricuspid) anulus of the cardiac
skeleton. Their free margins are attached by several
complex tiers of chordae tendineae to the papillary
muscles
Left Atrium
The left atrium forms two-thirds of the base of the heart. It receives the blood carried by the
pulmonary veins, and discharges its blood to the left ventricle. It is related to other structures as
follows:
 Superior: Left bronchus and right pulmonary artery
 Anterior: Proximal ascending aorta and proximal pulmonary trunk
 Posterior: Anterior wall of the oblique sinus of the pericardial cavity, esophagus, right
pulmonary veins
 Right: Right atrium and interatrial septum
 Left: Pericardium and left pulmonary veins
 Inferior: Left ventricle
Left Ventricle

The left ventricle forms the apex and the left surface of the heart, and participates in
forming the sternocostal and diaphragmatic surfaces. Its myocardium is three times as
thick as that of the right ventricle, and produces about three times the pressure. It
receives blood from the left atrium, and expels it through the ascending aorta.

The relations of the left ventricle to other structures:

• Superior: Left atrium
• Anterior: Pericardium, left sternocostal wall of the thorax, lingula of the left lung
• Lateral: Pericardium, left mediastinal pleura, left lung, left phrenic nerve, and
pericardiacophrenic vessels
• Medial: Interventricular septum
• Inferior: Diaphragm
Two leaflets guard the opening forming
the mitral valve. The anterior (septal)
leaflet is large, and semicircular or
triangular in shape. The smaller
posterior leaflet is known as the Merklin
leaflet.
The aortic orifice lies in the superior wall of the
ventricle, to the right of the atrioventricular
opening and posterior to the orifice of the
pulmonary trunk. Three semilunar cusps (right,
left, and posterior) form the aortic valve. Behind
each of the cusps is an expanded region at the
aortic base called the aortic sinus (of Valsalva)
Each of the cusps of the aortic semilunar valve
has a free, crescentic border called a lunule. The
lunule has a small, thickened nodule at its
midpoint, the nodule of Arantius. The
pulmonary semilunar valve possesses similarly
named nodules, which strengthen the central
point of apposition of the cusps in diastole.
VASCULAR SUPPLY
CORONARY ARTERY The left coronary artery arises from a
single ostium in the left coronary
sinus behind the left cusp of the
aortic valve. It divides rather quickly
to form the anterior descending
(anterior interventricular) artery and
the left coronary circumflex artery

After its origin from the right

coronary sinus of Valsalva, the right
coronary artery usually supplies all
of the right atrium (together with the
sinoatrial node) and the right
ventricle. Right coronary arterial
dominance results when the right
coronary artery supplies the posterior
descending artery. In this
circumstance, it also provides supply
to part of the left atrium posteriorly,
part of the posterior surface of the
left ventricle, the posterior papillary
muscle of the left ventricle, and the
atrioventricular node.
For the most part, the
coronary veins pass with the
coronary arteries, usually
lying superficial to them
INNERVATION
Intrinsic Innervation

The intrinsic innervation of the heart

is provided by the cardiac conduction
system. The parts of the system are
named the sinoatrial node, the
atrioventricular node, the three
internodal pathways, the
atrioventricular bundle (bundle of
His), the left bundle and its branches,
the right bundle, and the ventricular
system of Purkinje fibers
Extrinsic Innervation

The nerve supply of the heart

originates from cardiac
branches of the vagus nerves
(parasympathetic), and from
fibers of the sympathetic trunk
Sympathetic

The sympathetic system includes cervical

cardiac branches, cervicothoracic branches
from the stellate ganglion, and thoracic
visceral nerve branches from the first four
thoracic levels of the sympathetic chains.
These fibers are cardio-accelerators,
vasodilators, and sensory (for pain).
Parasympathetic

The parasympathetic fibers of the vagus

nerve are principally cardio-inhibitory, the
cholinergic fibers effecting a reduction of
the rate of depolarization of cardiac
pacemaker muscle fibers. Most of the nerve
fibers carried by the vagus are sensory, with
those from the heart carrying information
from baroreceptors, stretch receptors,
chemoreceptors, and so on

Functional components of vagus nerve.

For purposes of simplification, each
component shown as a single fiber.
Distinction between accessory and vagal
components not shown. Heavy lines,
motor fibers; light lines, parasympathetic
fibers; dashed lines, sensory fibers
The cardiac plexus is formed by the
meeting of the sympathetic and
parasympathetic fibers at the base of the
heart. It is formed anterior to the
bifurcation of the trachea, superior to
the bifurcation of the pulmonary trunk
(very close to its adventitial wall), and
at the posteromedial aspect of the arch.
The right vagus nerve acts
especially upon the sinoatrial node.
The left vagus nerve acts chiefly
upon the atrioventricular node. This
is reflective of embryonic
association of the right vagus with
the right horn of the sinus venosus
and the left vagus with the left horn,
each of which contained specialized
pacemaking cells.
Fisiologi Jantung
Sistem Sirkulasi
Memiliki 3 Komponen :
- Jantung
- Pembuluh Darah
- Darah

Perbandingan Tekanan
Kanan (CO2) < Kiri (O2)
Aktivitas listrik di jantung

 Jantung berkontraksi  secara ritmis

akibat potensial aksi yang dihasilkan
sendiri  otoritmisitas.
 Terdapat 2 jenis khusus sel otot jantung:
 Sel kontraktil : kerja mekanis
 Sel otoritmik : tidak berkontraksi,
namun khusus memulai dan
menghantarkan potensial aksi yang
menyebabkan kontraksi sel jantung
kontraktil
 39

Sel-sel jantung non-kontraktil yang

mampu melakukan otoritmisitas
terletak di tempat-tempat berikut :
• Nodus SA (70-80/m)
• Nodus AV (40-60/m)
• Berkas His dan Serat Purkinje (20-
40/m)
 Curah Jantung dan Kontrolnya
 Curah jantung (CJ) : Volume darah yang dipompa oleh masing-masing
ventrikel per menit.
 Penentu CJ  kecepatan jantung x isi sekuncup
= 70 denyut/menit x 70 ml/denyut
= 4900 ml/menit = 5 liter/menit
42