CHAPTER I

PRELIMINARY

1.1 Background
The cardiovascular system is a system that explains the circulatory processes
that occur in the human body. Based on the circulation path, there are 3 types of
circulation in the human body, systemic circulation, pulmonary circulation, and
special circulation (circulation to the fetus, coronary heart circulation). Circulation
does not only explain blood circulation but also circulates lymph fluid which plays
a role in the immune system and regulates fluid balance in the interstitial space.
The cardiovascular system consists of: heart, blood vessels (veins and arteries),
lymph vessels and blood. The heart is one of the organs of the human body that is
very important because it has a very important function for the survival of humans,
namely pumping blood to the tissues, supplying oxygen and other nutrients while
transporting carbon dioxide and waste from metabolic products.
The heart functions to pump blood to provide oxygen, nutrients and hormones
throughout the body and transport the rest of metabolism throughout the body such
as carbon dioxide, uric acid and urea. To function as a pump, the heart can contract
and relax. The process of contraction and relaxation of the heart is known as the
heart rate. When pulsing, each space of the heart relaxes and is filled with blood,
then the heart contracts and pumps out of the heart.
While the blood vessels function as a channel to distribute blood from the heart
to all parts of the body and return it back to the heart. And blood as a transportation
medium where blood will carry oxygen and nutrients. While the lymph channel
system is closely related to the blood circulation system. Blood leaves the heart
through the arteries and is returned through the vein. Some of the fluid that leaves
the circulation is returned through the lymph channels, which seeps in tissue spaces.
The cardiovascular system plays an important role for the human body, so we need
to know the parts and benefits of the cardiovascular system.
1.2 Formulation of the problem
From the background above, the problems that we can examine in this paper
include:
1. What is the anatomy of the cardiovascular system?
2. What is the physiology of the cardiovascular system?
3. What is the biophysical process on the cardiovascular system?
4. What are the biochemical processes in the cardiovascular system?

1.3 Writing purpose

1. To find out the anatomy of the cardiovascular system.
2. To find out the physiology of the cardiovascular system.
3. To find out the biophysical process in the cardiovascular system.
4. To find out the biochemical processes in the cardiovascular system.
 CHAPTER II
DISCUSSION

2.1 Anatomy of the Cardiovascular System

Figure 1. Anatomy of the heart system

The heart is a hollow muscular organ, its shape resembles a pyramid or a banana
heart which is the center of blood circulation throughout the body, located in the
thoracic cavity in the mediastinum section. The end of the heart is downward,
forward the left side: The heart base is the aortic stem of the lung, the upper and
lower vessels and the pulmonary vessels.
Relationship of the heart to surrounding devices:
a. The front wall is associated with the sternum and the high costal cartilage
cost III-I.
b. The side is related to the lungs and mediastilais facies.
c. Upper thoracic IV and cervical II height, associated with pulmonary aorta,
right bronchus and left bronchus.
 d. Behind the posterior mediastinal devices, esophagus, descending aorta,
azygotic vein, and thoracic vertebral column.
e. The lower part is related to the diaphragm.
The heart is fixed in place so it is not easy to move. The main heart support is the
lung which suppresses the heart from the side of the diaphragm to support from
below, the large blood vessels that come out and enter the heart so the heart does
not move easily.
 Factor that affects the position of the heart:
a. Age factor: in old age the tools in the piston cavity, including the heart, go
down.
b. Shape of the chest cavity: permanent changes in piston shape for example
chronic tuberculosis sufferers decreased the heart while the piston asthma
widened and rounded.
c. Location of the diaphragm: supports the heart from below, if there is
suppression of the diaphragm, it will push the lower part of the heart up.
d. Changes in body position: normal heart projections are determined by
changes in body position, such as bending, sleeping tilted left or right.

 The heart layer consists of:

a. Pericardium
The layer, which is a heart-wrapping bag, is located in the minus
mediastinum, located behind the corpus sterni and prone to ribs II-IV.
1) Pericardium fibrosum (visceral): a part of the pocket that limits the
movement of the heart bound to the center of the tendinium diaphragm
united with a large blood vessel, attached to the sternum through the
sternopericardial ligament.
2) Periakrdium serosum (parietal), divided into two parts: the parietal
pericardium limits the pericardium fibrosum, often called the epicardium,
and the visceral pericardium (pericardial cavity) which contains a small
amount of fluid which functions to lubricate the heart to facilitate
movement.
 Between these two layers of the heart there are lenders as pelican to keep
the friction between the pericardium causing no interference to the heart. On
the posterior surface of the heart there is a serosum pericarium around the
large veins forming sinus obliges and transfersus sinuses.
b. Myocardium
The heart muscle layer receives blood from the coronary artery. The left
coronary artery branches into an anterior desending artery and circumflex
artery. The right coronary artery provides blood for the sinoatrial node ,
right ventricle, right ventricular diaphragm surface. The coronary vein
returns blood to the sinuses and then circulates directly into the lungs.
Myocardial arrangement:
1) Atria muscle structure: very thin and irregular, the fibers are
arranged in two layers. The outer layer includes the two atria. These
outer fibers are most visible on the front of the atria. Some fibers
enter the atrioventricular septum. The inner layer consists of circular
fibers.
2) Ventricular muscle arrangement: forms the heart chambers starting
from atrioventicular to the apex of the heart.
3) The atrioventicular muscle arrangement is the dividing wall
between the porch and the chamber (atrium and ventricle).
c. Endocardium (surface in the heart)
The inner wall of the atrium is covered by a shiny membrane, consisting of
endothelial tissue or the lining of the endocardium, except the auricle and the
front of the cranium. Towards the auricle from the lower end of the terminal
crust there is a prominent endocardium fold known as the inverior vena cava,
running in front of the inferior vein estuary to the edge called the ovalic fossa.
Between the right atrium and the right ventricle there is a relationship through
the articular orifice.
Parts of the heart:
a. Base cord: the upper part of the heart associated with large blood vessels
(ascending aorta, pulmonary artery / pulomal vein and superior vena cava: formed
by the left atrium and a portion of the right atrium. The posterior part borders the
 descending, esophageal, azygos vein, ductal aorta) thoracic, is as high as the
thoracic vertebrae (vertebrae segment VIII)
b. Cordis apex: the lower part of the heart is a blunt cone shaped. This part is formed
by the left ventricular end and the right ventricle. The musty part is covered by the
lung and the left pleura from the thoracic wall.

Heart surface (cord fascies):

a. Sternocostal fascia: the front-facing surface borders the thoracic front wall, formed
by the right atrium, the right ventricle and the slightest left ventricle.
b. Dorsal fascies: the surface of the heart is backward, rectangular bordering the
posterior mediastinum, formed by the walls of the left atrium, a portion of the right
atrium, and a small portion of the left ventricular wall.
c. Diaphragmatic fascies: the lower surface of the heart which is bounded by the
sternum tendinium is formed by the left ventricular wall and a small portion of the
right ventricle.
Heart edge (margo cord):
a. Right margin: the right side of the heart extends from the superior vena cava to the
cord apex, formed by the right atrial wall and the right ventricular wall, separating
the sternocostal fascies from the right diaphragmatic fascies.
b. Margo is left: the edge of the heart next to the edge extends from the lower estuary
of the left pulmonary vein to the cord apex, formed by the left atrial wall (above)
and the inner ventricle (below) separating the sternocostal fascies with the left
diaphragmatic fascies.
Heart surface flow:
a. Atrioventricularis sulcus: surrounds the lower border of the cord base, located
between the boundaries of both the heart atrium and the two ventricles of the heart.
b. Anterior longitudinal sulkuls: these grooves are located in the sternocostal fascies
starting from the gap between the polmonary artery and the left auricle, walking
downward towards the cord apex. This sulcus is the boundary between the two
ventricles from the front.
c. Posterior longitudinal sulcus: this groove is found in the diaphragmatic cord fascia,
expansion of the right coronary sulcus of the inferior vena cava estuary towards the
 cord apex. This sulkus is the boundary between the two ventricles from the lower
back.
Heart chambers:
a. Right atrium: consists of the main cavity and the outer auricle, the inner part
forming a rigi or the terminal crista. The main part of the atrium that is posterior to
the teeth is a smooth wall embryologically originating from the sinus venosus. The
atrial portion which is located in front of the rigi undergoes trabeculation due to the
bundle of muscle fibers that travel from the terminal crest
1) Estuary in the right atrium:
a) Superior Vena cava: empties into the upper part of the right atrium. This estuary
does not have a valve, returning blood from half of the body.
b) The inferior vena cava: larger than the superior vena cava, empties into the lower
part of the right atrium, returning sacred blood from the lower half of the body.
c) Coronary sinus: empties into the right atrium between the inferior vena cava and
osteum ventriculare, protected by a malfunctioning valve.
d) Right atrioventricular osteology: the anterior part of the inferior vena cava is
protected by the bicuspid vulva. In addition, many boils down to small veins that
drain blood from the heart wall into the right atrium.
2) Fetal remnants in the right atrium. Fossa ovalis and annulus ovalis are two
structures located in the interartrial septum that separate the right atrium from the
left atrium. Fossa ovalis is a shallow notch where the foramen ovale in vetus and
ovalis annulus forms an edge, is a septum in the heart of the embryo.
b. Right ventricle: associated with the right atrium through the osteum
atrioventricular dextrum and with the pulmonary tract through pulmonary osteum.
The right ventricular wall is much thicker than the pulmonary right atrium. The
right ventricular wall is much thicker than the right atrium.
1) Tricuspid Valvula: protects osteum atrioventicular, formed by the endocardium
fold accompanied by a small amount of fibrous tissue, consisting of three
endocardium folds accompanied by a little fibrous tissue, consisting of three cusps
or sieves (anterior, septic, and inferior). The cusp base attaches to the fibrous ring
of the heart frame. When the ventricle contracts M. papillary contraction prevents
 the cuspis from being pushed into the atrium and reverses when intraventricular
pressure increases.
2) Pulmonary valvula: protects pulmonary osteum, consisting of a semilunarary
pulmonary artery, formed by the endocardium fold accompanied by a small amount
of fibrous tissue. The mouth of the mouth of the cusp is upward, into the pulmonary
trunk. During the ventricular systolic valve the cusp is compressed to the pulmonary
trunk wall by the blood coming out. During diastolic, blood flows back to the heart
into the sinus. The cusp valve is filled and closes the pulmonary osteum.
c. The left atrium: consists of the main cavity and the auricle, located behind the right
atrium, forming most of the base (posterior fascies), behind the left atrium, there is
a sinus obliged pericardium serosum and pericardium fibrosum. The interior of the
sinistral atrium is smooth and the auricular portion has a muscular ridge like the
right auricle. The pulmonary venous atrial estuary of each lung empties into the
posterior wall and has a left atrioventricular osteum valvula, protected by the
valvula mitralis.
d. Left ventricle: the left ventricle is associated with the left atrium through the left
osteum atrioventriculer and with the aorta through the osteum aorta. The left
ventricular wall is three times thicker than the right ventricle. Left intraventricular
blood pressure is six times higher than pressure from the right ventricle.
1) Valvula mitralis (bikuspidalis): protects atrioventricular osteum consisting of two
cusps (anterior cusps and posterior cuspis). The larger anterior cuspis is located
between atrioventricular and aortic osteum.
2) Valvula semilunaris aorta: protects osteum aorta the structure is the same as
semilunar valvula pulmonary artery. One of the cusps is located on the anterior wall
and two are located on the posterior wall behind the cusps. The aortic wall forms
the anterior aortic sinus which is the origin of the right coronary artery. The left
posterior sinus is the origin of the left coronary artery.
Heart blood circulation:
a. Right coronary artery: originating from the anterior sinus of the aorta running
forward between the pulmonary trunk and the right auricle, giving branches to the
right atrium and ventricle desktra. At the inferior edge of the heart towards the
 atrioventricular sulcus to anastomosis with the left coronary artery bleeding the
right ventricle.
b. Left coronary artery: larger than the right coronary artery, from the posterior
sinuses of the aorta running forward between the pulmonary trunk and the left
auricular into the atrioventricularis sulcus to the cardiac apex giving the arm to the
right ventricle and interventricular septum.
c. Cardiac venous flow: a portion of the blood from the heart wall flows into the right
atrium through the coronary sinus which is located at the back of the atrioventricular
sulcus, followed by the cardiac V. magna which empties into the right atrium to the
left of the inferior vena cava. V. cardiac minimae and the media are branches of the
coronary sinus, the rest return to the right atrium through the anterior cardiac vein,
through a small vein directly into the heart chambers.
The heart is innervated by the autonomic nervous system's sympathetic and
parasympathetic fibers through the cardiac plexus. Sympathetic nerves originate
from the upper cervical and thoracic sympathetic trunk and the sympathetic nerve
originates from the vagus nerve. Post-ganglion efferent fibers travel to the atrial
sinus node and the atrioventricular node spreads to other parts of the heart. Afferent
fibers running along the vagus nerve act as cardiovascular reflexes, walking with
the sympathetic nerves.
2. Exitable Cells
a. Understanding
Cell excitations are cells that can carry impulses or action potentials. An
exclusive network when stimulated adequately will respond to an action potential.
b. Cell Structure and Composition
Cell membrane is the outermost part of the cell that limits the inside of the cell
with the outside environment. Membrane cells are permeable selective membranes,
meaning that only certain molecules can be passed such as glucose, amino acids,
glycerol, and various ions. Based on chemical analysis it can be seen that almost all
cell membrane consists of a layer of protein and lipid layer (lipoprotein). Membrane
plasma consists of two layers, namely in the form of a double lipid layer (lipid
bilayer). Lipid layer is composed by phospholipids. Phospholipids are lipids
containing phosphate groups and consist of head parts ( polar head) and tail section
 (nonpolar tail). The head section is hydrophilic (likes water), while the ekorbers are
hydrophobic (do not like water). Lipids consist of phospholipids, glycolipids, and
sterols.
1) Phospholipids, which are lipids containing phosphate groups.
2) Glycolipids, which are lipids that contain carbohydrates.
3) Sterol, which is lipid alcohol especially cholesterol.
The protein membrane of the cell consists of glycoproteins. Layer proteins form
two kinds of layers, namely peripheral or extrinsic protein layers and integral or
intrinsic protein layers. Peripheral protein layers wrap the polar head of the outer
double lipids. Integral protein layers wrap around the head (polar head) Inner
double lipid.
c. Intrasel Electrolyte Composition and Extrasel
In intracellular and extracellular fluids there is electrolyte, an important
element for the body other than water. The electrolyte composition in the two fluid
compartments is different. Calcium and phosphate are the main electrolytes in CIS,
while sodium and chloride are CES main electrolytes. Sodium and potassium play
a role in acid balance -basa, fluid balance, and nerve cell function. Phosphate is an
energy-forming molecule (adenosine triphosphate-ATP), and plays a role in bone
and tooth formation. Chloride plays a role in acid-base balance and fluid. In addition
there are other electrolytes which have important functions, such as calcium and
magnesium. Calcium plays a role in the formation of bones and teeth, the process
of blood clotting, muscle contraction, and nerve cell functions. Magnesium plays a
role in enzyme activity, bone formation, and muscle and nerve cell activity.
Electrolyte deficiency will cause various organ function disorders, therefore the
need for electrolytes must always be fulfilled.
Liquid volume and electrolyte concentration are always maintained in a
balanced state. The fluid and electrolyte balance is maintained by adjusting the
water and electrolyte inputs and outputs. Input of water and electrolyte (water and
electrolite gain) is obtained mainly through eating and drinking. Water and
electrolyte output (water and electrolite loss) by excretion through urination and
defecation, and by evaporation through breathing and skin in the form of sweat.
Entering and output of water is controlled by the brain, namely in the hypothalamus.
 Changes in CES volume and electrolyte concentration stimulate the hypothalamus
to reduce or increase water output and input by regulating thirst and excretion of
water through the kidneys.
d. Electrolyte Transportation Through Cell Membranes
Plasma membrane is a membrane of the cell outside the cytoplasm. In the
cytoplasm there are parts called organelles. All organelles are limited by the
membrane. A membrane that limits organelles has the same molecular structure as
a plasma membrane consisting of fat and protein molecules.
Cell membranes are useful as a barrier between organelles on the inside of cells
and fluids that wet all cells. Membrane cells are so thin that they can only be
observed with high magnification using an electron microscope. singer and E.
Nicolson (1972) put forward a theory of cell membranes known as the liquid mosaic
membrane theory. This theory states that cell membranes are composed of protein
layers. Proteins are arranged mosaic or scattered and each inserted or submerged
between the phospholipid double layers ( phospholipid bilayer).
The cell membrane consists of about 50% lipids and 50% protein, lipids are
mainly phospholipids and are arranged in two layers and proteins spread between
phospholipid bilayers are called intrinsic (integral) proteins that are hydrophobic or
water-repellent.
Because of the arrangement of such cell membranes, the cell membrane is
semipermeable. Membrane cells are not symmetrical, extrinsic proteins that
combine with the outer surface of the membrane are very different from extrinsic
proteins that join the inner membrane. Membrane cells function to regulate the
movement of matter or transport from or out of cells.
e. Membrane potential
Membrane potential is the voltage across a cell membrane which ranges from
about -50 to -200 millivolts (a minus sign indicates that the cell is negative
compared to the outside). All cells have voltage across their plasma membrane,
where voltage is electric potential energy- opposite charge separation. Negatively
charged cell cytoplasm compared to extracellular fluid is caused by distribution of
dankation on the opposite side of the membrane which is not the same. Potential
membranes act like batteries, an energy source that affects traffic of all charged
 substances that cross the membrane. compared to the outside, this membrane
potential supports passive transport of cations into cells and anions to the outside
of the cell. Thus, two forces drive ion diffusion across a membrane: chemical forces
(ion concentration gradients) and electrical forces (the effect of membrane potential
on ion movement) . The second combination g what works on one ion is called an
electrochemical gradient. Environmental changes can affect the membrane
potential and the cell itself. For example, depolarization of the plasma membrane is
thought to trigger apoptosis (programmed cell death).
f. Potential Action About Cells, Tissues, Organs, and Organ Systems
In a cell in a state of rest there is a potential difference between the two sides of
the membrane. This state of the cell is called a polarization state. If the cell in a state
of rest / polarization is given the appropriate stimulation and with sufficient levels,
the cell will change from a resting state to an active state. In an active state, the cell
membrane potential changes from the negative on the inner side to positive on the
inside. Cell conditions like this are called depolarization. This polarization starts
from a point on the cell membrane surface and propagates to the entire surface of
the membrane. the membrane is positively charged on the inner side, so the cell is
called a perfect depolarization state.
After perfect depolarization, the cell then repolarizes. In a state of
repolarization, the membrane potential changes from positive on the inside to
returning to the negative on the inside. Repolarization starts from a point and
propagates to the entire surface of the cell membrane. If the entire cell membrane
has a negative charge on the inside, then the cell is said to be in a state of rest or a
state of polarisai back and ready to receive the next stimulus.
Cell activity from polarization to depolarization and then back to polarization
is again accompanied by changes in cell membrane potential. The change is from
the negative on the inside and turns positive and then returns to negative. This
change results in a voltage impulse called an action potential (action potential). The
action potential of a cell can trigger the activity of other cells around it. The
following will describe how the process of action potential occurs from a cell that
was originally in a state of rest.
3. Blood vessel
 Blood vessels are road infrastructure for blood flow throughout the body. This
blood channel is a closed system and the heart is pumping blood. The function of
blood vessels is to transport (transport) blood from the heart to all parts of the body
and transport back blood that has been used back to the heart. This function is called
blood circulation. Besides blood, blood also transports gases, food substances,
metabolic waste, hormones, antibodies, and electrolyte balance.
The blood vessels consist of arteries and veins. Arteries are directly related to
veins in parts of the capillaries and venules which are connected by the
partendothelium.
Arteries and veins are located side by side. Wall arteries are thicker than vein
walls. Walls of arteries and veins have three layers, namely the inner layer
consisting of the endothelium, the middle layer consisting of smooth muscle with
elastic fibers and the outer layer consisting of connective tissue coupled with elastic
fibers. The smallest branches of arteries and veins are called capillaries. Capillary
veins have a very small diameter and only have one layer of singleendothelium and
a basement membrane.
The differences in the structure of each blood vessel are related to the functional
differences of each of these blood vessels.
Blood vessels are divided into:
a. Arterial Vessels
1) Where blood is pumped from the chamber
2) It is a clayy and elastic vessel
3) Vessel pressure is stronger than the back vein
4) Has a valve (valvula semilunaris) which is right outside the heart
5) Consists of:
a) The aorta is the vessel from the left ventricle to the whole body
b) Arterioles, which are branching of arteries
c) Capillary:
(1) Diameter is smaller than arteries and veins
(2) The wall consists of a single layer of endothelium and a basement membrane
6) The walls consist of 3 layers, namely:
a) Inner layer consisting of Endothelium
b) The middle layer consists of smooth muscle with elastic fibers
c) The outermost layer consists of elastic fiber connective tissue
b. Veins (Veins)
1) Located near the surface of the skin making it easy to recognize
2) The walls of the vessels are thinner and less elastic.
3) Vessel pressure is weaker than the arteries
4) There is a valve that is shaped like a crescent moon (valvula semi lunaris) and
keeps blood from turning around.
5) Consists of :
a) The superior Vena cava is in charge of carrying blood from the upper part of the
body to the right foyer of the heart.
b) The inferior Vena cava is responsible for carrying blood from the lower part of
the body to the right foyer of the heart.
c) Vena cava pulmonary is responsible for carrying blood from the lungs to the left
ventricle of the heart.
4. Lymph vessels
The lymphatic system is an additional pathway where fluid can flow from the
interstitial space into the blood. Lymph vessels can transport proteins and
substances with large particles, outside the tissue space that are not removed by
absorption directly into the blood capillaries. The lymph system is closely related
to blood circulation , contains moving fluids, comes from the blood, and has
lymphatic tissue.
The lymph system is also one of the main ways to absorb nutrients from the
gastrointestinal tract which is responsible for fat absorption and is one of the body's
defense mechanisms against infection. Lymph vessels are larger vessels formed by
the union of lymphatic capillaries. Transparent lymphatic vessels have many valves
that look like beads. Superficial lymph vessels flow through the skin, deeper lymph
vessels drain deeper body structures, pass through and enter the lymph nodes
carrying lymphocyte cells.
Lymph flow is strongly influenced by muscle activity which can accelerate
and regulate the flow. The flow will increase due to the influence of peristaltic,
respiratory movements, cardiac activity, massage, passive movement, and pulsation
 of the arteries around it. The walls of the lymph vessels are so permeable that
particles that are very large in molecular size in the bridge can be passed.
The small lymph vessels converge to become large, many have valves so that
the flow of lymph fluid goes in one direction, namely the subclavian vein. Every
time the lymph vessels bulge because they are filled with fluid from the tissue, these
lymph vessels contract so that the lymph fluid is pushed through the open valve
This event occurs for about 10 seconds, dynamically the interstitial fluid continues
to move and returns to the blood vessels.

2.2 Cardiovascular System Physiology

1. Heart Hemodynamics
Regulation of blood pressure is more likely to be played by changes in osmotic
pressure and intravascular and extravascular hydrostatic pressure. The main role is
carried out by sodium levels which directly affect the osmotic value of fluids, so
that it will affect the process of aldosterone secretion and antidiuretic hormones.
Furthermore, these hormones affect blood volume and blood pressure.
Changes in osmotic and hydrostatic pressure also affect blood pressure. The
direct effect of increased blood volume by an intravenous fluid administration,
during bleeding events, is able to maintain blood pressure within normal limits. In
regulating blood pressure, the hemodynamic system is played by changes in
osmotic pressure and hydrostatic pressure both intravascular and extravascular. The
main role is by sodium levels which directly affect the osmotic value of fluids, thus
affecting the process of aldosterone secretion and antidiuretic hormones.
Furthermore, these two hormones will affect blood volume and blood pressure.
2. Cardiac Electrophysiology
The electrical activity of the heart is a result of changes in the permeability of
the cell membrane that allows the movement of ions through the membrane. With
the entry of ions the electrical charge along this membrane undergoes relative
changes. There are three types of ions which have important functions in
electrophysiological cells namely potassium (K), sodium (Na), and calcium (Ca).
More potassium is found in cells, while more calcium and potassium are found
outside the cell.
 In the resting state the heart muscle cells have a positive charge on the
outside of the cell and a negative charge on the inside of the cell. This can be proven
by the galvanometer. The difference in the outer and inner charge of the cell is
called resting membrane potential. When cells are stimulated there will be a change
in charge in the cell to be positive, while outside the cell becomes negative. The
process of changes in charge due to stimulation is called depolarization. After
stimulation of cells trying to return to the state of the original charge this process is
called repolarization. The whole process is called potential action.
Potential actions occur due to electrical, chemical, mechanical, and
thermal stimuli. Potential actions are divided into five phases.
a. Resting phase
The outside of the heart cell is positively charged and the inner part is negatively
charged (polarization). Cell membranes are more permeable to potassium than
sodium so a small portion of potassium seeps out of the cell. With the loss of
potassium, the inside of the cell becomes relatively negative.

b. Depolarization phase (fast)

Caused by increased membrane permeability to sodium, so sodium menglir from
outside in. As a result, the charge in the cell becomes positive while outside the cell
becomes negative.
c. Partial polarization phase
Immediately after depolarization there is a slight change due to the entry of calcium
into the cell, so that the positive charge in the cell decreases.
d. Plateau phase (stable state)
The depolarization phase is followed by a stable state that is rather long in
accordance with the absolute refractor period of the myocardium. During this phase
there is no change in electric charge. There is a balance between positive and
incoming ions. The flow of calcium and sodium into the cell is slowly balanced
with the outflow of calcium. from inside the cell.
e. Repolarization phase (fast)
In this phase the charge of calcium and sodium gradually does not flow again and
the potassium permeability is greatly increased so that potassium exits the cell
 quickly. As a result the positive charge in se becomes greatly reduced so that at the
end the charge in the cell becomes relatively negative and the load outside cells are
relatively positive.
3. The Mechanism of the Heart as a Pump
At each heart cycle occurs systole and diastole sequentially and regularly in
the presence of open and closed heart valves. At that time the heart can work as a
pump so that blood can circulate throughout the body. During one work cycle the
heart changes pressure inside the heart cavity. so that there is a pressure difference.
This difference causes blood to flow from the cavity where the pressure is higher
to lower pressure.
a. The function of the atrium as a pump
In normal circumstances blood flows continuously from large veins into the atrium.
Approximately 70% of this flow directly flows from the atrium to the ventricles
even though the atrium has not contracted. Atrial contractions fill an additional 30%
because the atrium functions only as a primary pump that increases effectiveness
ventricle as a pump. About 30% additional effectiveness, the heart can continue to
work very satisfactorily in a normal resting state.
b. Ventricular function as a pump
a. Ventricular filling
During the ventricular systole, some blood is buried in the atrium because the atrial
valve to the ventricle is closed. Right after the systolic ends ventricular pressure
drops back to low diastolic pressure. Pressure in the high atrium immediately
pushes the valve between the atrium and ventricle to open and allows blood to flow
rapidly into the ventricles. This is called the ventricular fast filling period. The
period of filling lasts about the first 1/3 of the diastolic. During the middle 1/3 of
the blood diastolic slightly flows into the ventricles. The bleeding blood enters the
atrium of the veins and travels through the atrium directly into the ventricles.
b. Ventricular emptying during systole
When ventricular contractions begin, ventricular pressure increases rapidly, causing
the atrial and ventricular valves to close. It is necessary to add 0.02-0.03 seconds to
the ventricles to increase the pressure sufficient to push the semilunar valves of the
aorta and the semilunaris of the pulmonary artery, opening up against pressure in
 the aorta and pulmonary artery. During this period there is contraction in the
ventricles but no emptying occurs. This period is called the period of systemic
contraction.
c. Ejection period
If left ventricular pressure rises slightly above 80mmHg, right ventricular pressure
is slightly above 8 mmHg, ventricular pressure now pushes open the semilunary
valve immediately blood begins to be removed from the ventricles. About 60%
occur during the first ¼ systole, and the remaining 40% is discharged during the
next 2/4, ¾ this part of the systole is called the ejection period.
d. Diastole
During the last ventricular diastole there is almost no blood flow from the vetricle
into the large artery even though the ventricular muscle remains contracted.
e. Isometric (isovolemic) Relaxation Period
At the end of the ventricular systole relaxation starts suddenly, maybe the pressure
in the ventricles drops rapidly. An increase in pressure in a large artery suddenly
pushes blood back into the ventricles, causing a loud closing of the aortic and
pulmonary valves for 0.03-0.06 seconds. Furthermore, the ventricular muscle
relaxation and pressure in the ventricle drop rapidly back to very low diastolic
pressure. The atrial and ventricular open valves begin the new ventricular pump
cycle.
During diastole, ventricular filling under normal circumstances increases the
volume of each ventricle by around 120-130 ml. This volume is called the diastolic
end volume. At the time of the empty ventricle during systole, the volume decreases
by about 70 ml, called the key content. The volume remaining in each ventricle is
around 50-60 ml called the final systolic volume.
The tricuspidal valve and the bicuspidal valve prevent the backflow of blood
from the ventricles to the atrium during systole. The semilunar aortic valve and
semilunar valve of the pulmonary artery prevent the reverse flow of the aorta and
pulmonary artery into the ventricles during the diastole period. All of these valves
open and close passively that will close when the pressure difference that reverses
pushes the blood back and opens when the front pressure difference pushes the
blood towards the front.
 Someone who rests his heart pumping blood 4-6 liters / minute, in severe
working conditions may require blood pumping as much as 5 times that amount.
Two basic ways of controlling pumping work.
a. Intrinsic autoregulation pumping due to changes in the volume of blood flowing
into the heart. Frank and Starling's Law: The more the heart fills up during diastole
the greater the amount of blood pumped into the aorta. Within the physiological
limit, the heart pumps all the blood that enters the heart without the possibility of
excessive blood dams in the vein. When the ventricle is filled with higher atrial
pressure the strength of the heart contraction increases, causing the heart to pump
greater amounts of blood into the arteries.
b. Reflexes monitor the speed and strength of the heart's contraction through the
autonomic nerves. This nerve affects the heart's pumping power in two ways,
namely by changing the frequency of the heart and changing the strength of the
heart's contractions.
4. Conduction System
The heart conduction system includes:
a. Sinoatrial node (SA node)
A small pile of neuromuscular tissue is inside the wall of the right atrium at the end
of the terminal terminal. This node is a precursor of heart contraction. From here
the impulse is forwarded to the atriovenricular node.
b. Atrioventricular node (AV node)
The arrangement is the same as the sinoatrial node, located inside the atrial septum
near the mouth of the coronary sinus. Impulses are passed to the atrioventricular
bundle through the Wenkebach file.
c. Atrioventricular bundle
Starting from the AV bundle it runs forward at the posterior edge and the lower
edge of the interventriculare septum membrane. In the part of the ring between the
atrium and ventricle, the analus fibrosus stimulation stops 1/10 second, then leads
to the two-branched cord and apex:
1) Pars septalis dektra: Continues to the AV bundle in the parse muscularis
interventricular septum leading to the front wall of the ventricle dektra.
 2) Left lateral septalis: Runs between the membranes and the muscularis to the left
side of the interventricular septum towards the base of the inferior M. papillary of
the left ventricle. Septic septic fibers then branch into terminal fibers (purkinje
fibers).
d. Terminal connecting fibers (purkinje fibers): webbing in the endocardium
spreads to both ventricles.
The heart gets innervation from the sympathetic and parasympathetic branches
of the autonomic nervous system. The sympathetic system activates the work of the
heart while the parasympathetic system is to stifle the heart's work. The cardiac
sympathetic stimulation has the effect of accelerating the heart rate, causing
tachycardia and stronger heart contraction, especially contraction of ventricular
myocardium.
Every work of the heart is regulated and adjusted to the needs through
controlling the nerves. In the resting state the influence of the vagus nerve is greater
than the sympathetic nerve. Muscle working time or increased sympathetic tone
stress and vagus tone decrease. The regulation of the heart by innervation occurs
reflexively. For reflexes, a stimulus and reflex curve are needed to allow for
answers in the form of activating or inhibiting the work of the heart.
In the sinus carotid reflex the stimulation changes blood pressure. When blood
pressure increases, the work of the heart will be inhibited by an increase in
parasympathetic tone and a decrease in sympathetic tone. Conversely, if low blood
pressure will activate the work of the heart through increased sympathetic tone and
decreased vagus tone. The influence of oxygen and carbon dioxide on the heart is
difficult to assess from the results of experiments, because these substances directly
or through reflexes also affect blood vessels and work the heart
5. Arterial Vein, Veins and Capillary System
a. Arteries
Arteri atau pembuluh darah nadi merupakan pembuluh darah yang keluar dari
jantung yang membawa darah ke seluruh tubuh dan alat tubuh.Pembuluh darah
yang paling besar keluar dari ventrikel sinistra, disebut aorta.Arteri mempunyai
dinding yang tebal dan kuat tetapi mempunyai sifat yang sangat elastis, terdiri dari
tiga lapisan:
 1) Tunika intima (interna): lapisan yang paling dalam, berhubungan dengan darah,
terdiri dari lapisan endothelium dan jaringan fibrosa.
2) Tunika media: lapisan tengah yang terdiri dari jaringan otot polos sifatnya sangat
elastis, mempunyai sedikit jaringan fibrosa, karena susunan otot tunika ini arteri
dapat berkontraksi dan berdilatasi.
3) Tunika eksterna (adventitia): lapisan yang paling luar terdiri dari jaringan ikat
gembur untuk memperkuat dinding arteri, jaringan fibrotic yang elastis.
Arteri mendapat darah dari pembuluh darah halus yang mengalir di dalanya,
berfungsi memberi nutrisi pada pembuluh tersebut yang disebut vosa
vasorum.Arteri dapat berkontraksi dan berdilatasi disebabkan pengaruh susunan
saraf otonom.
b. Vena
Pembuluh darah vena merupakan kebalikan dari pembuluh darah arteriyang
membawa darah dari alat-akat tubuh masuk ke jantung. Bentuk dan susunannya
hampir sama denga arteri. Katup pada vena terdapat di sepanjang pembuluh darah
untuk mencegah darah tidak kembali lagi ke sela atau jaringan.Vena yang terbesar
adalah vena pulmonalis. Vena mempunyai cabang yaitu venolus, selanjutnya
menjadi kapiler.
c. Sistem Kapiler
Kapiler adalah pembuluh darah yang sangat kecil sehingga disebut juga pembuluh
rambut. Pada umumnya kapiler-kapiler meliputi sel-sel jaringan karena secara
langsung berhubungan dengan sel. Kapiler terdiri dari:
1) Capillary arteries, where arteries end. The smaller the arterioles, the more missing
the wall layer of the arteries so that the arterial capillary wall layer only becomes
one layer, namely the endothelium layer. This very thin layer allows blood / lymph
fluid to seep out to form tissue fluid, carrying water, minerals and nutrients through
gas exchange between capillaries and cell tissue. Capillaries also provide oxygen
and get rid of carbon dioxide.
2) Capillary veins, the layers are almost the same as arterial capillaries. Its function
is to carry waste substances that are not used by cell tissue in the form of excretion
and carbon dioxide. Blood is taken out of the body through the venolus, vein and
so on out of the body through three processes, namely breathing, sweat and feces.
 Capillary function:
1) As a link between arteries and veins.
2) The place for exchange of substances between blood and tissue fluids.
3) Take the result of the gland.
4) Absorbing food substances found in the intestine.
5) Filter blood in the kidneys.
The entrance to the capillary is circled by sphincter which is formed from smooth
muscle. When the sphincter is open, blood enters the capillary and if the sphincter
is closed, blood directly from the arteriole to the venolus and not through the
capillary. Blood pressure in the arterial capillaries is reduced to 30 mmHg, when it
reaches the capillary end of the vein to 10 mmHg. Capillary pressure will increase
if the arteriole is dilated and the capillary sphincter relaxes, so that much blood
enters the capillaries.
Capillaries open and close at a rate of 6-12 times / minute. Capillary relaxation
occurs in response to any increase in the amount of carbon dioxide and lactic acid
in the blood or a decrease that occurs in oxygen levels. This relaxation causes a lot
of blood to reach the tissue if there is an increase in metabolic activity. The capillary
sphincter leading to the skin relaxes in response to increased body temperature and
increased circulation through capillaries due to lower body temperature.
The mechanism of capillary fluid shift regulates blood pressure. In addition to
the nervous and hormonal mechanisms to regulate arterial pressure quickly, the
intrinsic mechanism of circulation also helps regulate arterial pressure. Usually the
mechanism of capillary fluid shift starts working in minutes and is fully functional
within a few hours. This is a mechanism of capillary fluid transfer, which is a
change in arterial pressure accompanied by changes in capillary pressure which
causes fluid to begin to move across the capillary membrane between the blood and
the interstitial fluid space.
If arterial pressure rises too high resulting in loss of fluid through the capillaries
into the interstitial space, causing blood volume to fall. Thus arterial pressure
returns to normal. Conversely, if the pressure drops too low, the liquid is absorbed
into the blood and an increase in fluid volume will increase the pressure back to
normal.
6. Blood Pressure and Regulatory System
The difference between systolic and diastolic pressure is called pressure ( pulse
pressure) . For example, systolic pressure of 120 mmHg and diastolic pressure of
80 mmHg, the pulse pressure is equal to 40 mmHg. Blood pressure is generally not
always constant, changing from time to time according to health conditions. Pulse
pressure will also change according to changes in a person's blood pressure.
Changes in pulse pressure are influenced by factors that affect blood pressure. For
example, the influence of age and arteriosclerosis. In arteriosclerosis the elasticity
of blood vessels decreases and even disappears completely, so that the pulse
pressure increases.
Blood pressure is very important in the blood circulation system and is always
needed for thrust to drain blood in the arteries, arterioles, capillaries and venous
systems so that a steady stream of blood is formed. The heart works as a blood
pump can transfer blood from veins to arteries in the closed circulation system.
Cardiac pump activity takes place by contracting and relaxing, giving rise to
changes in blood pressure in the circulatory system.
In recording pressure in the arterial system, an increase in arterial pressure
appears to peak at around 120 mmHg. This pressure is called systole pressure, this
increase causes the aorta to distend so that the pressure in it drops slightly. At
diastole, ventricular aortic pressure tends to decrease up to 80 mmHg. This pressure
in the examination is called diastolic pressure. With these changes in the heart cycle,
this is what causes blood flow in the closed circulatory system in the human body.
Monitoring center and regulation of blood pressure changes:
1. Nervous system: consists of centers located in the brain stem (eg vasomotor
center), outside the central nervous system (eg baroreceptors) and systemic.
2. Humoral or chemical system: takes place locally or systemically. For example,
renin-angiotensin, vasopressin, epinephrine, acetylcholine, serotonin, adenosine
calcium, magnesium, hydrogen and valium.
3. Hemodynamic system, is more influenced by blood volume, capillary
arrangement, changes in osmotic pressure, and external and internal hydrostatic
vascular systems.
 The center of blood pressure control in the two proximal third medulla
oblongata and distal third pons, the vasomotor center is responsible for
vasoconstriction of blood vessels. The heart always beats automatically because the
cells have a labile resting potential. impulses or stimuli always occur and are sent
through the nerve pathways in the spinal cord and through the sympathetic nerves
to the keo organs they maintain, such as the heart and blood vessels.

2.3 Biophysics in the Cardiovascular System

1. Electric Heart
The heart actually depends on a conductive medium. If one part of the ventricle
becomes electronegative when compared to the rest, the electric current flows from
the depolarizing region to the polarized area in a large rotating path.
During the remainder of the cycle the depolarization of the electric current
continues to flow in the direction from the base of the heart to the apex, when the
impulse spreads from the endocarnial surface outward through the ventricular
muscle.
In making electrocardiographic recording, a variety of standard positions for
electrode placement are used and positive or negative recording polarity during
each cardiac cycle is determined by the orientation of the electrode keeping in mind
the flow of current in the heart. some conventional electrode systems are usually
called electrocardiographic stumbling.
2. Cardiac Conduction
Inside the heart muscle there is a special network that conducts electricity. The
network has special characteristics, namely:
a. Automation, the ability to generate impulses spontaneously.
b. Rhythm, the ability to form regular impulses.
c. Conduction, the ability to channel impulses.
d. Stimulating power, the ability to react to various pairs.
Based on the properties mentioned above, then spontaneously and regularly the
heart will produce impulses that are channeled through the delivery system to
stimulate the heart muscle and can cause muscle contractions. The impulse travels
from the SA node to the AV node, to the purkinye fibers.
 On the right atrial wall there is a sinoatrial node (SA). Cells from the SA node
have automation. Because the SA node normally releases impulses at a faster rate
than other heart cells with 60-100 beats / minute automation. This special network
works as a normal pacemaker. At the bottom of the interatrial septum there is an
atrioventricular (AV) node. This network works to deliver, slow down, atrial action
potential before it sends it to the ventricles. The action potential reaches the AV
node at different times. The AV node slows the delivery of this action potential until
all the action potential has been removed at the atrium and enters the AV node.
After this slight slowdown, the AV node surpasses the action potential at once,
into the ventricular conduction tissue, allowing simultaneous contraction of all
ventricular cells. This AV node slowdown also allows time for the atrium to fully
mimic the excess blood into the ventricles, in preparation for ventricular systole.
From the AV node, the impulse travels to the beam in the interventricular
septum to the right and left bundles, and then through one of several purkinye fibers
to the ventricular myocardial tissue itself. The action potential can cross the delivery
tissue 3-7 times faster than through the ventricular myocardium. Then the bundles,
branches and purkinye fibers can approach simultaneous contractions of all parts of
the ventricles, allowing maximum pump unification to occur.
3. Cardiac Viscosity
Resistance to blood flow is determined not only by the blood vessels but also
by blood viscosity. Plasma is about 1.8 times thicker than water, while blood is 3-
4 times thicker than water. So the viscosity depends largely on the hematocrit,
which is the percentage of the volume of blood occupied by red blood cells. The in
vivo viscosity effect deviates from that predicted by the Poiseuille-Hagen formula.
In large vessels, an increase in hematocrit causes a considerable increase in
viscosity. However in the smaller diameter veins, namely in arterioles, capillaries
and venules, the viscosity changes less per unit hematocrit changes than changes in
viscosity in large vessels. This matter because of the difference in the nature of the
flow through the small vessels. Therefore the change in netviscosity of the unity of
hematocrit changes is much smaller in body than in changes in vitro. This is the
reason why changes in hematocrit have a relatively small effect on peripheral
resistance except in large changes. In severe polycythemia, an increase in blood
 pressure clearly increases the work of the heart. On the other hand, in anemia,
peripheral resistance decreases, as a result of decreased viscosity. Of course the
decrease in hemoglobin decreases the ability of the blood to transport O2, but it
improves the relative viscosity of blood flow.

2.4 Biochemistry in the Cardiovascular System

1. Structure and Function of Enzymes
Analysis of cardiac enzymes in the plasma is part of the diagnostic profile,
which includes history, symptoms, and electrocardiogram, to diagnose myocardial
infarction. The enzyme is released from the cell if the cell is injured and the
membrane breaks. Most enzymes are not specific in relation to certain damaged
organs. However, various isoenzymes are only produced by myocardial cells and
are released when cells are damaged by old hypoxia and cause infarction.
Isoenzymes leak into the interstitial cavity of the myocardium and are then
transported to general blood circulation by the lymphatic system and coronary
circulation, resulting in increased levels in the blood.
Because different enzymes are released into the blood at different periods after
myocardial infarction, it is very important to evaluate the levels of enzymes
associated with the onset of chest pain or other symptoms. Creatinine kinase (CK)
and its isoenzyme (CK-MB) are the most specific enzymes analyzed to diagnose
acute cardiac infarction, and are the first enzymes to increase. Lactate
dehydrogenase (LDH) and its isoenzymes also need to be examined in patients who
arrive late for treatment, because new levels increase and reach a peak at 2-3 days,
much slower than CK.
Enzyme structure:
Enzymes are generally globular proteins and their size ranges from only 62
amino acids to 4-oxalocrotonate tautomerase monomers, to more than 2,500
residues in fatty acid synthase. There are also a small number of RNA catalysts,
with the most common being theribosome; This type of enzyme is referred to as
RNA-enzyme or ribozyme. Enzyme activity is determined by its three-dimensional
structure (quaternary structure). Although the structure of the enzyme determines
 its function, predictions of the activity of new enzymes that are only seen from the
structure are very difficult.
Most enzymes are larger than the substrate, but only a small portion of the
enzyme amino acid (about 3-4 amino acids) is directly involved in catalysis. Areas
containing catalytic residues that will bind the substrate and then undergo this
reaction are known as active sites. Enzymes can also contain binding sites that are
required for catalysis. Some enzymes also have binding sites for small molecules,
which are often direct or indirect products of catalyzed reactions. This binding can
increase or decrease enzyme activity. Thus it functions as a feedback regulation.
Just like other proteins, enzymes are a chain of amino acids that fold. Each
sequence of amino acids produces a folding structure and distinctive chemical
properties. Single protein chains can sometimes gather together and form protein
complexes. Most enzymes can be denatured (ie open from their folds and become
inactive) by heating or chemical regulation. Depending on the types of enzymes,
denaturation can be reversible or irreversible.
a. Specificity
Enzymes are usually very specific to the reactions that they catalyze and to the
substrate involved in the reaction. The shape, content and characteristics of the
hydrophilic / hydrophobic enzymes and substrates are responsible for this
specificity. Enzymes can also show a very high degree of stereospecicity, resonance
and chemoselectivity. Some enzymes that show the highest accuracy and specificity
are involved in copying and expression of the genome. These enzymes have a "re-
checking system" mechanism. Enzymes such as the DNA polymerase catalyze the
reaction in the first step and check whether the reaction product is correct in the
second step. This bi-step process decreases the error rate by 1 error for every 100
million reactions in the mammalian polymerase. The same mechanism can also be
found in RNA polymerase,aminoacil tRNA synthetase and ribosome. Some
enzymes that produce secondary metabolites are said to be "not picky", namely that
they can work on different types of substrates. It is proposed that the very broad
specificity of the substrate is very important for the evolution of the new
biosynthetic pathway.
b. " Lock & key " model
 Enzymes are very specific. In 1894, Emil Fischer proposed that this was due to both
enzymes and substrates having geometric shapes that met each other. This is often
referred to as the "Lock and Padlock" model. When this model explains the
specificity of an enzyme, it fails to explain the stabilization of the transition state
achieved by the enzyme. This model has been proven to be inaccurate, and the
induction accuracy model is now the most widely accepted.
2. Apoptosis, Cell Injury and Cell Adaptation
Apoptosis (from Greek; apo = "from" and ptosis = "fall") is a biological
mechanism which is one type of programmed cell death. Apoptosis is a cell death
that was previously planned. Apoptosis is a part of life; cells that are old or damaged
will be programmed to die for survival or maintain the functionality of a particular
organ.
Apoptosis is different from necrosis. Apoptosis generally lasts a lifetime and
is beneficial to the body. A concrete example of the benefits of apoptosis is the
separation of the fingers at the embryo. Apoptosis experienced by cells located
between the fingers causes each finger to be separated from one another. When the
cell loses the ability to do apoptosis, the cell can divide indefinitely and eventually
become cancerous.
Apoptosis has distinctive morphological features such as plasma membrane
blebbing, cell shrinkage, chromatin condensation and DNA fragmentation, and
begins with the Caspase enzyme of the cysteine protease group forming a complex
sub-unit protease activation called the apoptosome. Apoptosomes are synthesized
in the cytoplasm after an increase in the outer perforation of the mitochondrial
membrane and the release of cytochrome c into the cytoplasm, after an interaction
between the double sardiolipinmitochondrial membrane and anionic phospholipids
which triggers peroxidase activity. Apoptosome is a protein complex consisting of
cytochrome c, Apaf-1 and procase-9.
Apoptosis Function:
a. Associated with cell damage or infection. Where the occurrence of apoptosis when
the cell is damaged is irreparable. The decision to do apoptosis comes from the cell
itself, from the tissue surrounding it, or from cells that originate from the immune
system.
b. In response to stress or DNA damage
Conditions that cause cells to experience stress, such as starvation, or toxic DNA
damage or exposure to ultraviolet or radiation (such as gamma radiation or X-rays),
can cause cells to begin the apoptotic process
1) In an effort to maintain the stability of the number of cells
2) As part of growth
3) Immune system regulation
B cells and T cells are the main players of the body's defense against foreign
substances that can infect the body. "Killer T cells" become active when exposed
to imperfect pieces of protein (eg due to mutations), or exposure to foreign antigens
due to a viral infection. After the T cells become active, these cells migrate out of
the lymph nodes, find and recognize imperfect or infected cells, and make these
cells programmed cell death.
The morphological process of apoptosis:
Cells that experience apoptosis show unique morphology that can be seen using a
microscope
a. Cells look rounded. This is because the structure of the protein that crosses the
skeleton is cut by peptidase known as aspase. Caspase is activated by the cell
mechanism itself.
b. Chromatin undergoes initial degradation and condensation.
c. Chromatin undergoes further condensation and forms solid pieces on the core
membrane.
d. The core membrane is fragmented and the DNA inside is fragmented.
e. The inner layer of the cell membrane, the phosphatidyl serine lipid layer will stick
out and be recognized by phagocytes, and then the cell experiences phagocytosis,
or
f. Cells rupture into several parts called apoptotic bodies, which are then
phagocytosis.

3. Cell Necrosis
a. Definition of Necrosis
 Necrosis is cell death as a result of damage or trauma (for example: lack of
oxygen, extreme temperature changes, and mechanical injury), where cell death
occurs uncontrollably which can cause damage to cells, an inflammatory response
and has the potential to cause serious health problems. Stimulus that is too heavy
and lasts longer and exceeds the cell's adaptive capacity will cause cell death where
the cell is no longer able to compensate for the demands of change. A group of cells
that experience death can be identified by the presence of lysis enzymes that
dissolve various cell elements and the onset of inflammation. Leukocytes will help
digest dead cells and morphologically changes begin to occur. Necrosis is usually
caused by a pathological stimulus. Apart from due to pathological stimuli,cell death
can also occur through the mechanism of programmed cell death where after
reaching a certain lifetime, the cell will die. This mechanism is called apoptosis, the
cell will destroy itself (suicide / suicide), but apoptosis can also be triggered by a
state of ischemia.
b. Types of Necrosis
There are seven typical morphological patterns of necrosis:
1) Liquefactive necrosis (or colliquative necrosis) is usually associated with cellular
damage and pus formation (eg pneumonia). This is typical of bacterial or fungal
infections, sometimes, because of their ability to stimulate an inflammatory
reaction. Ischemia (restriction of blood supply) in the brain produces liquefactive,
not coagulative necrosis due to the absence of substantial stromal support.
2) Gummatous necrosis is limited to necrosis involving spirochaetalin infection (eg
syphilis).
3) Dengue necrosis is due to blockage of venous drainage from an organ or tissue
(for example, in the testicular office).
4) Caseous necrosis is a specific form of coagulation necrosis usually caused by
mycobacteria (eg tuberculosis), fungi, and some foreign substances. This can be
considered a combination of coagulative and liquefactive necrosis.
5) Necrotic fat results from lipased action in fat tissue (for example, acute
pancreatitis, breast tissue necrosis).
6) Fibrinoid necrosis is caused by vascular disorders mediated by damage. This is
characterized by fibrillary deposition such as protein in the art of the wall, which
appears opaque and eosinophilic in a light microscope.
c. Causes of Necrosis
1) Iskhemi
Iskhemi can occur because the supply of oxygen and food for a body device is cut
off. Ischemia occurs in infaq, which is tissue death due to blocked arteries.
Blockages can occur due to thrombus formation. Blockage results in anoxia.
Necrosis mainly occurs when the affected area does not get the help of collateral
circulation. Necrosis is easier for tissues that are susceptible to anoxia. The tissue
that is very susceptible to anoxia is the brain.
2) Biological agent
Bacterial toxins can cause damage to blood vessel walls and thrombosis. This toxin
usually comes from virulent bacteria, both endo and exotoxin. If the toxin is less
hard, it usually only causes inflammation. Viruses and parasites can secrete various
enzymes and toxins, which directly or indirectly affect the tissue, resulting in
necrosis.
3) Chemical agent
Can be exogenous or endogenous. Although chemicals are also substances
commonly found in the body, such as sodium and glucose, but if the concentration
is high it can cause necrosis due to interference with the cosmic balance of cells.
Some certain substances in low concentrations can be toxic and kill cells, while
others only cause tissue damage if the concentration is high.
4) Physical agent
Trauma, extreme temperature, both heat and cold, electric power, sunlight, radiation
power. Cell damage can occur due to the occurrence of damage to the potoplasm
due to ionization or physical exertion, resulting in chaos of the potoplasmic and
core chemical system.
5) Vulnerability (hypersensitivity)
Network vulnerability can arise spontaneously or acquired (acquired) and cause
immunological reactions. People with sensitivity to sulfa drugs can develop
necrosis of the renal tubular epithelium when they eat sulfa drugs. Necrosis can also
 occur in the blood vessels. In immunology Schwartzman's reaction was known and
the reaction of Arthus.

CHAPTER III
APPLICATION

3.1 Conclusion
 The cardiovascular system consists of blood, heart and blood vessels. The heart
is located in the mediastium rib in the chest cavity. 2/3 is located on the left, 1/3 is
located on the right side and the center line is the body. Visually right heart
projection on the anterior surface is below the sternum and ribs.
The heart is a hollow muscular organ that looks like a pyramid and is located
inside the pericardium in the mediastinum. The heart has three surfaces:
sternocostal facies, diaphragmatica, and base cordis. The heart is divided by a
vertical septa into four chambers: dextrum atrium, sinistrum atrium, dexter
ventriculus, and sinus ventriculus.
3.2 Suggestion
In the making of this paper the author also realizes that in making papers there
are many errors, shortcomings and irregularities both in writing and in the
preparation of material. For that reason, the author really expects criticism and
suggestions that build a better future and the writer hopes that all student readers in
particular, to be further improved in making future papers.

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