LAPORAN PRAKTIKUM FISIOLOGI

“CARDIOVASCULAR DYNAMICS
AND
CARDIOVASCULAR PHYSIOLOGY”

BLOK 14 SISTEM KARDIOVASKULAR

Disusun Oleh :

Kelompok 3B :

1. Stacia Nathania Claresta Siahaan (1961050010)

2. Christian Kalvario Leiwakabessy (1961050023)

3. Sinthia Uli Aritonang (1961050045)

4. Fransisco Riski Samderubun (1961050052)

5. Carissa Wijaya (1961050061)

6. Venska Adriana Kadakolo (1961050071)

7. Renita Ayu Lazuardini (1961050073)

FAKULTAS KEDOKTERAN

UNIVERSITAS KEDOKTERAN INDONESIA

DAFTAR ISI
L Pendahuluan

la Cardiovascular dynamics..........................................................................................

Ib Cardiovascular physiology ......................................................................................

II. Metode praktikum

IIa. Alat dan bahan……………………………………………....................................

IIb. Cara kerja................................................................................................................

IIc. Tujuan praktikum………………………………………………………………....

III. Hasil dan pembahasan

IIIa. Cardiovascular dynamics…………………...........................................................

IIIb. Cardiovascular physiology.....................................................................................

Daftar pustaka..............................................................................................................................

PENDAHULUAN

1a. CARDIOVASCULAR DYNAMICS

I. Exercise Overview
The cardiovascular system is composed of a pump-the heart-and blood vessels that
distribute blood containing oxygen and nutrients to every cell of the body. The principles
governing blood flow are the same physical laws that apply to the flow of liquid through a
system of pipes. For example, one very basic law in fluid mechanics is that the flow rate of a
liquid through a pipe is directly proportional to the difference between the pressures at the
two ends of the pipe (the pressure gradient) and inversely proportional to the pipe's resistance
(a measure of the degree to which the pipe hinders, or resists, the flow of the liquid).

Flow = pressure gradient/resistance = Ap/R

This basic law also applies to blood flow. The "liquid" is blood, and the "pipes" are
blood vessels. The pressure gradient is the difference between the pressure in arteries and the
pressure in veins that results when blood is pumped into arteries. Blood flow rate is directly
proportional to the pressure gradient and inversely proportional to resistance. Blood flow is
the amount of blood moving through a body area or the entire cardiovascular system in a
given amount of time. Total blood flow is proportional to cardiac output (the amount of blood
the heart is able to pump per minute).

Blood flow to specific body areas can vary dramatically in a given time period.
Organs differ in their requirements from moment to moment, and blood vessels have different
sized diameters in their lumen (opening) to regulate local blood flow to various areas in
response to the tissues' immediate needs. Consequently, blood flow can increase to some
areas and decrease to other areas at the same time. Resistance is a measure of the degree to
which the blood vessel hinders, or resists, the flow of blood. The main factors that affect
resistance are (1) blood vessel radius, (2) blood vessel length, and (3) blood viscosity.

Radius
The smaller the blood vessel radius, the greater the resistance, because of frictional
drag between the blood and the vessel walls. Contraction of smooth muscle of the blood
vessel, or vasoconstriction, results in a decrease in the blood vessel radius. Lipid deposits can
also cause the radius of an artery to decrease, preventing blood from reaching the coronary
tissue, which frequently leads to a heart attack. Alternately, relax- ation of smooth muscle of
the blood vessei, or vasodilation, causes an increase in the blood vessel radius. Blood vessel
radius is the single most important factor in determining blood flow resistance.

Length

The longer the vessel length, the greater the resis tance-again, because of friction
between the blood and vessel walls. The length of a person's blood vessels change only as a
person grows. Otherwise, the length generally remains constant.

Viscosity

Viscosity is blood "thickness," determined primarily by hematocrit-the fractional

contribution of red blood cells to total blood volume. The higher the hematocrit, the greater
the viscosity. Under most physiological conditions, hematocrit does not vary much and blood
viscosity remains more or less constant.
 CARDIOVASCULAR PHYSIOLOGY

II. Exercise Overview

Cardiac muscle and some types of smooth muscle contract spontaneously, without
any external stimuli. Skeletal muscle is unique in that it requires depolarizing signals from
the nervous system to contract. The heart's ability to trigger its own contractions is called
autorhythmicity. If you isolate cardiac pacemaker muscle cells, place them into cell culture,
and observe them under a microscope, you can see the cells contract. Autorhythmicity occurs
because the plasma membrane in cardiac pacemaker muscle cells has reduced permeability to
potassium ions but still allows sodium and calcium ions to slowly leak into the cells. This
leakage causes the muscle cells to slowly depolarize until the action potential threshold is
reached and L- type calcium channels open, allowing Ca21 entry from the extracellular fluid.
Shortly thereafter, contraction of the remaining cardiac muscle occurs prior to potassium-
dependent repolarization.

Picture 1. The cardiac action potential

The cardiac action potential depolarization-repolarization events occur in a regular

and continuous manner in cardiac pacemaker muscle cells, leading to cardiac action
potentials in the majority of cardiac muscle. There are five main phases of membrane
polarization in a cardiac action potential. (Picture 1) Phase 0 is similar to depolarization in the
neuronal action potential. Depolarization causes voltage-gated sodium channels in the cell
membrane to open, increas-ing the flow of sodium ions into the cell and increasing the
membrane potential. In phase 1, the open sodium channels begin to inactivate, decreasing the
flow of sodium ions into the cell and causing the membrane potential to fall slightly. At the
same time, voltage-gated potassium channels close and voltage-gated calcium channels open.
The subsequent decrease in the flow of potassium out of the cell and increase in the flow of
calcium into the cell act to depolarize the membrane and curb the fall in mem-brane potential
caused by the inactivation of sodium channels. In phase 2, known as the plateau phase, the
membrane remains in a depolarized state. Potassium channels stay closed, and long-lasting
(L-type) calcium channels stay open. This plateau lasts about 0.2 seconds, or 200
milliseconds. • In phase 3, the membrane potential gradually falls to more negative values
when a second set of potassium channels that began opening in phases 1 and 2 allows
significant amounts of potassium to flow out of the cell. The falling membrane potential
causes calcium channels to close, reducing the flow of calcium into the cell and repolarizing
the membrane until the resting potential is reached. • In phase 4, the resting membrane
potential is again established in cardiac muscle cells and is maintained until the next
depolarization arrives from neighboring cardiac pacemaker cells. The iotal cardiac action
potential lasts 250-300 milliseconds.

METODE PRAKTIKUM

IIa. Alat dan Bahan

Cardiovascular Dynamics
1. Software PhysioEx
a. Beaker glass kiri (ukuran 3.5mm)
 i. sebagai stimulasi darah dari paru
b. Flow tube connecting (beaker glass kiri)
i. simulasi vena pulmonary
c. Beaker glass tengah/Pump (tekanan 120 mm H)
i. sebagai pemompa dari ventrikel kiri
d. Flow tube connecting (beaker glass tengah/pump)
i. simulasi vena pulmonary
e. Beaker glass kanan
i. Simulasi aliran sistemik
Cardiovascular Physiology
2. Software PhysioEx
a. Oscilloscope
i. Tampilan aktivitas kontraktil
b. Stimulus Elektrik
i. Untuk mengejutkan jantung kodok
c. Holder Elektroda
d. Elektroda stimulasi Nervus Vagus
e. Apparatus
i. Untuk menjaga jantung kodok
f. Cairan Ringer
g. Jantung Kodok

IIb. Cara Kerja

2.1 Experiment Instructions Cardiovascular Dynamic
Go to the home page in the PhysioEx software and click Exercise 5: Cardiovascular
Dynamics. Click Activity 5: Compensation: Studying the Effect of Blood Vessel Radius on
Pump Activity and take the online Pre-lab Quiz for Activity 5. After you take the online
Prelab Quiz, click the Experiment tab and begin the experiment. The experiment instructions
are reprinted here for your reference. The opening screen for the experiment is shown below.

Picture 1Cardiovascular Dynamics.

1. So that you can study the effect of vessel radius on pump activity, the other variables
in this experiment will be main tained at the following conditions: Left beaker
pressure: 40 mm Hg Pump pressure: 120 mm H Right beaker pressure: 80 mm Hg
Starting pump volume (EDV): 120 ml Ending pump volume (ESV): 50 ml. Note that
the left flow tube radius is set to 3.5 mm and the right flow tube radius is set to 3.0
mm.Select Single to initiate a single stroke and then watch the pump action.
 2. Select Auto Pump to initiate 10 strokes and then watch the pump action. The flow rate
is shown in the flow rate display and the pump rate is shown in the pump rate display
after the left beaker has finished draining.
3. Select Record Data to display your results in the grid (and record your results in Chart
5).
4. Select Refill to replenish the left beaker
5. Increase the right flow tube radius to 3.5 mm by select ing the 1 button beside the
right flow tube radius display. Select Auto Pump to initiate 10 strokes and then watch
the pump action.
6. Select Record Data to display your results in the grid (and record your 6. results in
Chart 5).
7. Select Refill to replenish the left beaker. 8. You will now observe the effect of
incremental increases in the right flow tube radius. • Increase the right flow tube
radius by 0.5 mm. • Select Auto Pump to initiate 10 strokes and then watch the pump
action. display your results in the grid (and record your results in Chart 5)
8. Select Refill to replenish the left beaker. Repeat this step until you reach a right flow
tube radius of 5.0 mm.
9. Select Plot Data to view a summary of your data on a plotted grid. Right flow tube
radius will be displayed on the Xaxis and flow rate will be displayed on the Yaxis.
Select Submit to record your plot in the lab report.

2.2 Experiment Instructions Cardiovascular Physiology

Go to the home page in the PhysioEx software and click Exercise 6: Cardiovascular
Physiology. Click Activity 2: Examining the Effect of Vagus Nerve Stimulation, and take the
online Pre-lab Quiz for Activity 2. After you take the online Pre-lab Quiz, click the
Experiment tab and begin the experiment. The experiment instructions are reprinted here for
your reference. The opening screen for the experiment is shown below.

Picture 2. Activity 2. Examining The Effect Of Vagus Nerve Stimulation

1. Watch the contractile activity from the frog heart on the oscilloscope. Enter the number of
ventricular contractions per minute (from the heart rate display) in the field below and then
select Submit Data to record your answer in the lab report________beats/min
2. Drag the vagus nerve stimulation electrode to the elec-trode holder to the right of the heart.
Note that, when the elec-trode locks in place, the vagus nerve is draped over the electrode.
Stimuli will go directly to the vagus nerve and indirectly to the heart.

3.Enter the number of ventricular contractions per minute (from the heart rate display) in the
field below and then select Submit Data to record your answer in the lab report.

4. Select Multiple Stimuli to deliver electrical shocks to the vagus nerve at a rate of 50
stimuli/sec. The Multiple Stimuli button changes to a Stop beats/min Stimuli button as soon
as it is selected. Observe the effects of stimulation on the contractile activity and, after
waiting at least 20 seconds (the tracing will make two full sweeps across the oscilloscope),
select Stop Stimuli to stop the stimuli and then select Submit Data to record your answer in
the lab report.

IIc. Tujuan Praktikum

2c.1 ACTIVITY 5. Studying the Effect of Blood Vessel Radius on Pump Activity
OBJECTIVES:
1. To understand the terms systole and diastole.
2. To predict how a change in blood vessel radius will affect flow rate.
3. To predict how a change in blood vessel radius will affect heart rate.
4. To observe the compensatory mechanisms for maintaining blood pressure.

2c.2 Activity 2. Examining The Effect Of Vagus Nerve Stimulation OBJECTIVES:

1. To the role that the sympathetic and parasympathetic nervous systems have on heart
activity.
2. To explain the consequences of vagal stimulation and vagal understand escape. 3. To
explain the functionality of the sinoatrial node.

HASIL DAN PEMBAHASAN

IIIa. Cardiovascular Dynamics

HASIL 1

PRE LAB QUESTION

1. The heart is resting during … C.Ventricular diastole

2. The right side of the heart pumps blood … D. To the lungs

3. The layer of the blood vessel that is stimulated by the B. Smooth muscle
autonomic nervous system is …

4. In the experiment, the pump simulates … B. The left ventricle of the heart
 5. If the right beaker simulates the flow of blood to the D. Aortic valve and aorta
systemic circuit of the body,what do the right valve and
flow tube represent ? …

A. Experiment

So, that you can study the effect of vessel radius on pump
activity, the other variables in this experiment will be
maintained at the following conditions:
Left beaker pressure : 40 mmHg
Pump pressure : 120 mmHg
Right beaker pressure : 80 mmHg
Starting pump volume (EDV): 120ml
Ending pump volume : 50 ml
Note that the left flow tube radius is set to 3.5mm and the
right flow tube radius is set to 3.0mm.

Stop and think question

When the piston of the pump reaches its b. End systolic volume
lowest point, the volume remaining in
the pump is the…

If you increase the right flow tube b. Flow rate will increase and resistance will decrease
radius, what will happen to resistance
and flow rate?

Dengan menggunakan rumus pada tabel

diatas maka bisa dijawab jika diameter
dari pipa dibesarkan maka resistensi
akan menurun, karena mengikuti rumus
R∝1/radius pangkat 4. Maka semakin
besar radius dari pembuluh darah maka
akan menurun resistennya.

Predict question

If you increase the flow tube radius, what a. The pump rate will increase
will happen to the pump rate to maintain Resistensi : 1/radius pangkat 4
constant pressure? Saat radius dari pipa diperbesar maka resistensi akan
menurun, resisten (TPR) berkaitan dengan diastole. Pada
saat aliran darah balik ke vena sedikit, maka yang akan
terjadi untuk mempertahankan tekanan darah adalah
akan meningkatkan denyut nadi supaya cardiac output
nya dapat kembali seperti normal. Karena cardiac output
adalah perkalian dari heart rate dengan stroke volume.
CO = HR x SV

Stop and think question

If the left flow tube represents the d. blood coming from the lung
pulmonary veins, what does the left
source beaker represent?

Gelas kiri adalah paru-paru, gelas tengah adalah jantung

kiri dan gelas kanan mewakili sistem tubuh. Jadi gelas
kiri mempresentasikan paru-paru yang akan mengalirkan
darah menuju atrium kiri jantung.

POST LAB QUESTION

1. The pump piston in the simulation is up during … B.Diastole

2. The right side of the heart pumps blood … D. To the lungs

3. The amount of blood flowing into the destination beaker D.Stroke volume
(right beaker) with a single pump is called the …

4. In this experiment,the increase in right flow tube radius B. An increase in flow

resulted in … rate,which increased
the pump rate

5. Which chamber should be present in the flow pattern of D. Left atrium

the experiment,given that the vessels and surrounding it
are present (the chamber was omitted from the
experiment for simplicity)? …
 REVIEW SHEET

Answer: C. the pump rate will not change

Both the resistance and pump rate increase
when the blood vessel radius increases

Alasan: meningkatkan radius tabung aliran

kanan akan meningkatkan laju aliran , lalu
menurunkan resistensi akan meningkatkan
laju pompa

Answer: the left beakers is the left ventricle

while the right beaker corresponds to the
aortic valve and aorta

Alasan: gelas kiri berhubungan dengan

darah yang berasal dari paru [aru dan gelas
kanan berhubungan dengan darah yang
menuju ke seluruh tubuh atau sirkuit
sistemik

Answer: the human heart either reduces or

increases the pump rate in orders to maintain
blood pressure

Alasan: jantung manusia dapat

mengkompensasi perubahan laju aliran
untuk mempertahankan tekanan darah
dengan mengubah detak jantung. ketika
detak jantung meningkat, begitu juga
tekanan darah. Ketika detak jantung
menurun, begitu juga tekanan darah.

Hasil 2
PRE-TEST QUESTION

Jawaban: A
Setiap perubahan tekanan arteri rata-rata
(MAP) dan tekanan nadi akan dideteksi oleh
baroreseptor yang terutama berada di sinus
carotid dan arcus aorta, hal inilah yang
nantinya akan mengaktifkan sistem saraf
parasimpatis/simpatis.
Ketika tekanan arteri rata-rata dan tekanan
nadi meningkat, hal ini akan dideteksi oleh
baroreseptor untuk selanjutnya mengirim
sinyal ke medulla oblongata. Selanjutnya
yang akan terjadi adalah penurunan aktivitas
saraf simpatis pada jantung dan penurunan
aktivitas saraf simpatis pada pembuluh darah,
sementara aktivitas saraf parasimpatis akan
meningkat. Hal ini akan menyebabkan
menurunnya denyut jantung dan isi sekuncup
(HR dan SV) serta vasodilatasi pembuluh
arteri dan vena, yang berikutnya akan
menyebabkan tekanan darah kembali normal.

Jawaban: B
Ketika berolahraga, kebutuhan oksigen tubuh
akan meningkat dan hasil metabolisme tubuh
untuk membentuk energi akan menghasilkan
karbon dioksida. Hal-hal inilah yang akan
dideteksi oleh kemoreseptor di sinus carotid
dan aorta.
Selanjutnya kemoreseptor akan meningkatkan
aktivitas respirasi untuk membawa oksigen
masuk ke dalam tubuh lebih banyak atau
untuk mengeluarkan karbon dioksida yang
menumpuk dalam tubuh hasil metabolisme,
dan juga meningkatkan tekanan darah dengan
mengirim impuls ke pusat kardiovaskular di
medula oblongata (dibantu melalui refleks
baroreseptor).
Perubahan kardiovaskular lainnya yang
terjadi saat berolahraga juga mencakup
peningkatan aliran darah di otot rangka dan
otot jantung (disebabkan oleh efek epinefrin
secara lokal yang lebih besar daripada efek
vasokonstriksi simpatis), peningkatan denyut
jantung, peningkatan aliran balik vena
(vasokonstriksi vena karena diinduksi saraf
simpatis dan meningkatnya aktivitas pompa
otot rangka dan pompa respirasi),
peningkatan stroke volume (akibat
 peningkatan aliran balik vena - mekanisme
Frank-Starling) yang nantinya bersama
dengan peningkatan denyut jantung
menyebabkan cardiac output yang meningkat
secara signifikan, penurunan tahanan perifer
total (karena terjadi vasodilatasi pada otot-
otot rangka meskipun terjadi vasokonstriksi di
berbagai arteri yang memperdarahi berbagai
organ) dan peningkatan tekanan arteri rata-
rata.
Walaupun terjadi perubahan aliran darah di
berbagai tempat pada tubuh, tetapi aliran
darah ke otak tetap tidak berubah, hal ini
disebabkan oleh mekanisme kontrol lokal
yang menjaga aliran darah ke otak tetap
konstan terlepas dari berbagai kondisi yang
sedang terjadi dalam tubuh.

Jawaban: D
Perubahan tekanan arteri rata-rata dan
tekanan nadi >> dideteksi baroreseptor >>
kirim sinyal ke medula oblongata >>
merangsang
cardioinhibitor/cardioaccelerator >> nervus
vagus/ganglion saraf simpatis dari medulla
spinalis thoracalis >> nodus SA dan nodus
AV.
Perangsangan parasimpatis akan menuju
jantung melalui nervus vagus yang termasuk
dalam nervus cranial (nervus X).

POST-TEST QUESTION
Jawaban: A
Badan sel saraf preganglionik terletak dalam
nuclei vagal (dorsal motor neuron pada vagus
dan ambiguus nuclei). Axon dari neuron ini
terbagi menjadi biltaeral vagus nervus yang
melewati ujung arteri carotis dan sinaps
neuron postganglionik yang terletka pada
permukaan jantung yang sangat dekat pada
nodus SA dan nodus AV.
Walaupun terjadi overlap, vagus kanan
inervasi terbesar pada jantung dan
bersentuhan langsung dengan nodus SA,
sedangkan vagus kiri berpengaruh besar pada
nodus AV. Karena itu, perangsangan elektrik
pada vagus kanan akan menurunkan
otomatisasi dari nodus SA (memperlambat
kerja jantung, bahkan sampai henti jantung),
sedangkan rangsangan pada vagus kiri akan
menghasilkan AV blok yang bervariasi.
Potensial aksi pada postganglionik saraf
parasimpatis akan menyebabkan pelepasan
neurotransmiter asetilkolin (ACh), dimana
ACh akan berikatan dengan reseptor
kolinergik muskarinik dan secara cepat akan
membuka saluran ion ligan-gated
menyebabkan konduktansi K+ menjadi
meningkat dalam sel pacemaker. Akibatnya
akan segera terjadi hiperpolarisasi potensial
membran serta menurunkan kecepatan fase
ke-4 depolarisasi dan automatisasi pacemaker
dan hal inilah yang menyebabkan terjadinya
perlambatan kontraksi jantung.
Sistem saraf parasimpatis berinervasi secara
efektif hanya pada beberapa area jantung,
yakni nodus SA, nodus AV dan saluran
konduksi atrial, sementara pada serabut
kontraktil jantung kurang berpengaruh.
Rangsangan yang kuat pada sistem saraf
parasimpatis jantung akan menyebabkan
kontraksi jantung sangat lambat bahkan
sampai terjadi henti jantung, hal ini
disebabkan oleh konduksi yang melewati
jantung telah dihambat dan menjadi sangat
lambat terutama pada nodus AV.
 Jawaban: C
Perangsangan nervus vagus menyebabkan
penurunan denyut jantung sehingga tekanan
darah akan menurun, hal ini akan dideteksi
oleh baroreseptor untuk berikutnya mengirim
sinyal ke medulla oblongata untuk
meningkatkan denyut jantung dan isi
sekuncup melalui ganglion saraf simpatis dari
medulla spinalis thoracalis lalu akan
disampaikan sinyalnya ke nodus SA dan
nodus AV.

Jawaban: B

Jawaban: C

Stop & Think Question Predict Question

 Answer is C. The heart rate will decrease and the
Answer is A. Signals that decrease the heart rate. heart will stop.

REVIEW SHEET 2

Menurunkan Denyut Jantung bahkan bisa

menyebabkan denyut jantung berhenti,tetapi
ventrikel akan kembali berdenyut tidak lama
kemudian (adanya reflex simpatis) dan serabut
purkinje.

Efektifitas pompa jantung dikendalikan oleh saraf

parasimpatis (saraf vagus) yang sangat banyak
menyuplai jantung dan saraf simpatis.

Kontraksi jantung,sebab ion kalsium mempunyai

peran yang sangat kuat dalam merangsang proses
kontraksi miofibril otot jantung,sehingga dapat
bersifat inotropik positif.

Sympathetic increases HR Parasympathetic

decreases HR.

Saat kondisi istirahat, sistem saraf simpatik dan

parasimpatik berperan dengan dominasi sistem
parasimpatik. Sistem saraf simpatik aktif saat
dibutuhkan selama periode latihan dan saat
menghadapi stress (fight or flight). Stimulasi
simpatis meningkatkan frekuensi dan kekuatan
kontraksi jantung. Sebaliknya, stimulasi
parasimpatis menurunkan frekuensi denyut
jantung tanpa menimbulkan perubahan kekuatan
kontraksi.

Jika N. Vagus terputus, maka akan menyebabkan

jantung berkontraksi lebih cepat, sehingga akan
ada suatu titik denyut jantung akan berhenti yang
disebabkan oleh aktivitas jantung yang berlebihan.
 DAFTAR PUSTAKA

Guyton A.C., Hall J.E. 2012. Buku ajar fisiologi kedokteran. Edisi 11. Jakarta: Penerbit Buku
Kedokteran EGC.

Sherwood L. Human physiology: From cells to systems. Australia: Cengage Learning; 2016.

Berek PA. Efektivitas vagal nerve stimulation (VNS) TERHADAP Disritmia Jantung. Jurnal
Sahabat Keperawatan. 2020;2(01):7–20.