07-04-2023

Define ventricular cycle

Phases of • The sequence of
ventricular electrical and
mechanical events
cycle occurring repeatedly
within the ventricles
during each heart beat

Dr. Narayan Khurde

Dr. Narayan Khurde 1 Dr. Narayan Khurde 2

Enlist the phases Which changes are seen ?

in ventricular cycle
Contraction Iso-volumic C
• Ventricular pressure • Rise/ falls
SYSTOLE
Rapid Ejection • Valvular events • Closes/ opens
Ejection
Slow Ejection • Heart sounds • Audible/ Non-audible
• Blood flow • Rapid/ Sluggish
Relaxation Iso-volumic R • Ventricular blood • Increases/ decreases
DIASTOLE
First Rapid filling volume / Remains constant

Filling Slow filling Contraction  Pressure Blood flow

Last Rapid filling
Dr. Narayan Khurde 3 Dr. Narayan Khurde 4

At the ‘beginning’ Cardiac Cycle

phase 1 Isovolumic contraction
• All the 4 chambers
are relaxed Cardiac impulse
• A-V valves are open
• Pressure in each Ventricles contract
chamber is almost
equal
 Ventricular Pressure
• Blood flows from
great veins into atria
• Blood flows from Ventricular P > Atrial P
atria into ventricles
• Atrium & ventricle AV valves closed
are in continuity

Dr. Narayan Khurde 5 Dr. Narayan Khurde

1st Heart sound 6

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 07-04-2023

Cardiac Cycle
phase 1 Isovolumic contraction
Phase of Isovolumic Contraction
AV valves closed and
SL valves are closed • Starts with the closure of mitral valve
• Ends with the opening of aortic valve
Ventricular chamber • Ventricular volume the remains constant
is a closed cavity
• Ventricular muscle contracts without any change in the
blood volume in the ventricle
Blood can NOT enter
And can NOT exit • Ventricular pressure rises abruptly from 0 to 80 mm Hg
in LV and to 8 mm Hg in RV
• Inspite of forceful contraction, ventricular size (the
Blood volume in vent. muscle length) apparently remains the same (isometric
remains constant contraction).
• First heart sound appears
“Iso-volumic”
7
Dr. Narayan Khurde Dr. Narayan Khurde 8

Cardiac Cycle Cardiac Cycle

phase 2 Rapid Ejection phase 3 Slow Ejection

Ventricles contract
Aortic valve is open

 LV Pressure
LV pressure > Aortic P
Ventricular P
Exceeds Aortic P Blood keeps flowing
into the aorta

Opens Aortic valves
STROKE VOLUME

Blood flows into aorta CARDIAC OUTPUT
Dr. Narayan Khurde 9 Dr. Narayan Khurde 10

Phase of Isovolumic
Contraction Phase of Ventricular Ejection
• Starts with the closure of • Opening of the aortic valve marks the onset of the
mitral valve
phase of ejection.
• Ends with the opening of
aortic valve • This phase is further divided into 2 parts:
• Ventricular volume the 1. phase of Rapid Ejection (lesser duration)
remains same
2. phase of Slow Ejection (longer duration)
Phase of Ventricular
• The phase of rapid ejection is differentiated from the
Ejection phase of slow ejection by 2 features:
• Starts with the opening of a) Quick  in ventricular and aortic pressures
aortic valve
• Ends with the closure of b) Greater  in ventricular volume that occurs due to
aortic valve abrupt  in aortic blood flow (stroke volume)
• Ventricular blood volume
is reduced
Dr. Narayan Khurde 11 Dr. Narayan Khurde 12

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 07-04-2023

L V Pressure RV
Pressure In fetal life, the ratio of
120 thickness of LV to RV is 1:1
110
50
In adults, LV is 3 times thicker than RV
100
45 Thickness : LV wall : RV wall = 3 : 1
90
Aortic 40
80 LVP > AoP Aortic valve opens SV Physiological hypertrophy of LV
Pressure 35
60
30
70
Pul. A. 25 RVP > PAP Pul valve opens SV
50 Pressure
20
40
15
30
10
20
RA 5 RVP > RAP Tricuspid valve closes S1
LA LVP exceeds LAP MV closes S1 Pressure
10
Pressure 0
0 Dr. Narayan Khurde 15 Dr. Narayan Khurde 16

120 130 Cardiac Cycle

mm ml phase 4 Isovolumic Relaxation
Hg
Summary of
Ventricular Systole Ventricles Relax
Aortic valve Blood flows from
opens LV into Aorta
S 80
V ml
 Pressure in vent.
Pul. Valve Blood flows from
opens RV into Pul. A
25
L R LVP falls below AoP
V E E
0 P
V
P D S 50 AV valves 1st Heart
V V ml
Sound SL valves closed
Increases Reduces Closed

Ventricular Ventricular Valvular changes

pressure volume and sound production 2nd Heart sound
Dr. Narayan Khurde 17 Dr. Narayan Khurde 19

Cardiac Cycle
Isovolumic Relaxation
phase 4 Recognize the phase of cardiac cycle
SL valves closed and
AV valves are closed

Ventricular chamber
is a closed cavity

Blood can NOT enter

And can NOT exit

Blood volume in vent.

remains constant

“Iso-volumic”
20
Dr. Narayan Khurde Dr. Narayan Khurde 21

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 07-04-2023

Cardiac Cycle Cardiac Cycle

phase 5 First Rapid Filling phase 6 Slow Filling phase
Ventricles relax Ventricles
continue to relax

 Ventricular Pressure
VR continues to
fill atria & vent
Ventricular P falls
below Atrial P
Rise in EDV;
but slowly
Opens AV valves
No change in LAP,
Bl flow into ventricles LVP and AOP

Diastasis
Dr. Narayan Khurde
3rd Heart sound 23 Dr. Narayan Khurde 24

Cardiac Cycle 120

phase 7 Last Rapid Filling mm
Hg
130
ml

Atrial Ventricles are relaxing

Summary of AV valve Blood flows from
systole Ventricular opens atria into ventricles
Vent. pressure is falling Diastole
3rd Heart Sound
4th Heart Sound
50
Atria contracts 25 ml
L R
V E E
V
Atrial pressure rises P 0 P S D SL valves 2nd Heart
V V
Sound
Decreases Increases Closed
 Bl flow into ventricles
Ventricular Ventricular Valvular Sound
Pressure Volume changes production
4th Heart sound
Dr. Narayan Khurde 25 Dr. Narayan Khurde 26

Valvular Events
LRF IVC

C AV valves closed
RE
SL valves open
VS
E
Cardiac SL valves closed
Cycle SE
SF AV valves open

VD
F R

IVR
FRF

Dr. Narayan Khurde Dr. Narayan Khurde 28

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Heart as a Contraction Ejection

pump Relaxation Filling IVC
AV valves SL valves
closed open
Contraction
FRF, RE
SF& &
LRF SE
Filling Ejection

AV valves SL valves
open closed
Relaxation IVR

Dr. Narayan Khurde 29 Dr. Narayan Khurde 30

Valvular AV valves closed

Events SL valves open

Pressure changes in LV
IVC
LRF
RE

during ventricular cycle

AS
0.10

SF SE
AD
0.70

SL valves closed
FRF IVR
AV valves open

Atrial systole occurs in the last part of vent diastole

Dr. Narayan Khurde 31 Dr. Narayan Khurde 32

Pressure
LV Pressure during cardiac cycle
Pressure changes in LV mmHg

during ventricular cycle 120

110

Before systole begins 0 → 8 mm Hg 100

90
Systole begins 10 mm Hg 80

During IVC 80 mm Hg 60

70
During RE 120 mm Hg
50
During SE 80 mm Hg 40

During IVC 10 mm Hg 30
Systole Diastole
20
During Filling phase 10 → 0 → 8
10

Dr. Narayan Khurde 33 0 Dr. Narayan Khurde 34

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 07-04-2023

Pressure
mmHg Wigger’s diagram
Reality LVP < AoP
120 LVP < AoP
110 SLV closes
SLV closes
100 Aortic Pressure
90
AoP
LVP > AoP
80 LVP > AoP
SLV opens
60 SLV opens
70 LV Pressure
50 LVP
40
30LVP > LAP LVP < LAP

20 AVV open
AVV closed LAP
10
0 Dr. Narayan Khurde 35 Dr. Narayan Khurde 36

PRESSURE CHANGES DURING CARDIAC CYCLE PRESSURE CHANGES DURING CARDIAC CYCLE

0
0 0
0

SYSTOLE DIASTOLE

Wigger’s diagram
Dr. Narayan Khurde 37 Dr. Narayan Khurde 38

Wigger’s
diagram
IVC EJECTION IVR VENTRICULAR FILLING
VOLUME changes during
Ventricular Cycle

Dr. Narayan Khurde 39 Dr. Narayan Khurde 40

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 07-04-2023

Wigger’s diagram
Changes in LV blood volume

End-diastolic volume 130 ml

During filling phase

Stroke Volume 80 ml
During ejection phase

End-systolic volume 50 ml Systole Diastole Systole

After the ejection phase

Dr. Narayan Khurde 41 Dr. Narayan Khurde 42

Ejection Fraction VOLUME CHANGES DURING CARDIAC CYCLE

End-diastolic volume 130 ml

SV
• Fraction of EDV that is = X 100
ejected out by each Stroke volume 80 ml
EDV
ventricle per beat End-systolic volume
80 ml 50 ml
• From 130 ml of EDV, 80 ml = X 100
is ejected out by each 130 ml
Ejection fraction 60 %
ventricle
Significance of ejection fraction
• Normal value: 60% to 65% = 61.5 %
• Measure of LV function
• Index for ventricular contractility
• Reduced in MI & cardiomyopathy
Dr. Narayan Khurde 43 Dr. Narayan Khurde 44

Wigger’s
diagram

Heart
Failure
4th

Dr. Narayan Khurde 45 Dr. Narayan Khurde 46

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 07-04-2023

Types of heart failure Types of heart failure

• Systolic heart failure • Right heart failure
– Pumping of heart –  ability to pump of RV
– Leads to backpressure
– May left sided or right sided
– Liver congestion, Pedal edema & Ascites
• Diastolic heart failure – Seen in pulmonary HTN following long-standing COPD,
–  ability of ventricles to relax Asthma, pul. stenosis
– Blood accumulates in ventricles • Left heart failure
–  ability to pump of LV
– Blood accumulates in lungs
– Leads to pulmonary edema

Dr. Narayan Khurde 47 Dr. Narayan Khurde 48