Last edited: 7/11/2022

8. CARDIAC CYCLE
Cardiovascular | Cardiac Cycle Medical Editor: Mariel Antoinette Perez

OUTLINE OVERVIEW OF THE CARDIAC CYCLE

OVERVIEW OF THE CARDIAC CYCLE ● The flow of blood in and out of the heart takes an average
I) PHASE 1: MID TO LATE VENTRICULAR DIASTOLE of 0.8 seconds performed in 4 phases
II) PHASE 2: ISOVOLUMETRIC
CONTRACTION/SYSTOLE (A) COMPONENTS OF THE CARDIAC CYCLE
III) PHASE 3: MID TO LATE VENTRICULAR SYSTOLE ● Atrial vs Ventricular Pressure
IV) PHASE 4: ISOVOLUMETRIC RELAXATION o Tricuspid valve between RA and RV
V) APPENDIX o Bicuspid valve or Mitral valve between LA & LV
VI) REVIEW QUESTIONS
VII) REFRENCES ● Arterial vs Ventricular Pressure
● Atrial-Ventricular Valves
FYI: Abbreviations used in the note ● Semilunar Valves
● EKG/ECG
● RV: Right Ventricle
● LV: Left Ventricle (B) FOUR PHASES OF THE CARDIAC CYCLE
● RA: Right Atrium
● LA: Left Atrium ● Ventricular Filling
● SA: Sino-Atrial ● Isovolumetric Contraction
● AV: Atrio-ventricular ● Ventricular Ejection
● Isovolumetric Relaxation

I) PHASE 1: II) PHASE 2:

MID TO LATE VENTRICULAR DIASTOLE ISOVOLUMETRIC CONTRACTION/SYSTOLE
● Diastole = Relaxation
● “Phase of Ventricular Filling”

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Figure 8.1 Phase 1

(A) RAPID FILLING PHASE
● Blood from the venous circulation is returning to the heart
and accumulates into the atria
o From the IVC, SVC, Coronary Sinus, Pulmonary
Veins into the atria
● Atrial Pressure > Ventricular Pressure
● AV valves open
● Without contraction, 70-80% of the blood passively flows
down from the atria into the ventricles due to gravity
● Atrial Pressures are still higher than the Ventricular
Pressure  Semilunar valves remain closed
o Pressure in the aorta is higher than in the LV
o Pressure in the pulmonary trunk higher than in the RV
(B) REDUCED FILLING PHASE
● Towards the late end of ventricular diastole, SA node fires
o Depolarizes the atria
o Atria then contracts and actively pushes the
remaining blood down into the ventricles
o Shows up in the ECG as a p wave
● Ventricles haven’t started to contract yet
o Ventricular pressure <<< Arterial pressure
▪ Semilunar valves stay closed
Figure 8.2 Phase 2
● Phase where no blood enters or leaves the ventricles
when its contracting
● End Diastolic Volume
o Blood accumulated in the LV before it contracts
● Ventricles start to slowly depolarize and contract →
↑ventricular pressure
o Myocardium (cardiac muscle layer) contracts to
squeeze the chambers and slowly push the blood up
into the pulmonary trunk and aorta
● Ventricular Pressures are still lower than the Arterial
pressures  semilunar valves remain closed
o Aorta (80 mmHg) > LV (60 mmHg)
o Pulmonary Trunk (10 mmHg) > RV (7 mmHg)
● Ventricular Pressures rise above the Atrial Pressure
o Causes the AV valves to shut close
o Produces S1
▪ The first heart sound
▪ Commonly known as “lub” in “lub-dub”

CARDIAC CYCLE CARDIOVASCULAR PHYSIOLOGY : Note #8 1 of 3

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III) PHASE 3: IV) PHASE 4:
MID TO LATE VENTRICULAR SYSTOLE ISOVOLUMETRIC RELAXATION

Figure 8.4 Phase 4

● Phase where no blood enters or leaves the ventricles
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● End Systolic Volume
o Amount of blood left in the LV after it contracts
Figure 8.3 Phase 3 ● Ventricles are repolarizing and relaxing → ↓ventricular
● “Phase of Ventricular Ejection” pressure
o Blood leaving the ventricles ● The ↓ventricular pressure is still greater than the atrial
pressure keeping the semilunar valves closed
● Ventricles are still depolarizing and contracting more ● The arteries are extremely elastic
intensely  ventricular pressure continue to rise o Allows it to take on a high pressure and stretch
o ECG is still QRS Complex
o Ventricular pressure has risen enough that it’s greater ● Arterial Pressures higher than Ventricular Pressures
than the pressure in the arteries  semilunar valves o Causes the SL valves to shut close
open  blood moves from ventricles to arteries  o Produces S2
arterial pressure starts to rise ▪ Second heart sound
▪ Commonly known as “dub” in “lub-dub”
● Ventricular pressure >>> Atrial pressure
o Keeps the AV valves closed ● Atrial pressure < Ventricular pressure
o AV vales remain closed
● Some blood can go back down due to increase in
pressure
o Ventricles are relaxed and repolarized
o ECG: T wave

V) APPENDIX

Figure 8.5. Cardiac Cycle Overview

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 VI) REVIEW QUESTIONS
1) The p wave in an ECG represents which phase of
the cardiac cycle?
a. Rapid Filling Phase
b. Isovolumetric Contraction
c. Reduced Filling Phase
d. Isovolumetric Relaxation

2) What is end systolic volume?

a. Amount of blood left in the LV after it relaxes
b. Amount of blood left in the RV after it relaxes
c. Amount of blood left in the RV after it contracts
d. Amount of blood left in the LV after it contracts

3) Atrial contraction is triggered by:

a. AV node
b. SA node AfraTafreeh.com
c. Ventricular Contraction
d. Arterial Contraction

VII) REFRENCES
● Le T, Bhushan V, Sochat M, Chavda Y, Zureick A. First Aid for the
USMLE Step 1 2018. New York, NY: McGraw -Hill Medical; 2017
● Mancini MC. Heart Anatomy. In: Berger S Heart Anatomy. New York,
NY: WebMD.https://emedicine.medscape.com/article/905502-overview.
● Hill M. Cardiovascular System - Heart Histology.
https://embryology.med.unsw.edu.au/embryology/index.php/Cardiovasc
ular_System_-_Heart_Histology.
● Standring S. Gray's Anatomy: The Anatomical Basis of Clinical
Practice. Elsevier Health Sciences; 2016
● Leslie P. Gartner, James L. Hiatt. Color Textbook of Histology. New
York (NY): Grune & Stratton Inc.; 2006
● Maceira AM, Prasad SK, Khan M, Pennell DJ. Reference right
ventricular systolic and diastolic function normalized to age, gender and
body surface area from steady-state free precession cardiovascular
magnetic resonance. Eur Heart J .2006; 27(23): p.2879-88. doi:
10.1093/eurheartj/ehl336.
● Marieb EN, Hoehn K. Anatomy & Physiology. Hoboken, NJ:
Pearson; 2020.
● Boron WF, Boulpaep EL. Medical Physiology.; 2017. AfraTafreeh.com

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