Cardiac Cycle

DR RIDA AJMAL KHAN

 Learning Objectives
• By the end of this lecture students will be able
to:
1. Define cardiac cycle
2. Understand the mechanical changes of heart
during one cardiac cycle
3. Understand correlation of mechanical
changes with ECG, valvular changes (heart
sounds) and pressure and volume changes.
 DEFINITION

• The cardiac events that occur from the

beginning of one heartbeat to the beginning of
the next are called the cardiac cycle
• Period between start of one beat to start of
next beat is known as one cardiac cycle.
• Time for one cardiac cycle is =0.83secs
• It consists of one complete heart beat.
 INITIATION OF CARDIAC CYCLE:

• Initiated by Cardiac Impulse, which originates

from SA node.
 EVENTS THAT OCCUR
DURING CARDIAC CYCLE

1-Electrical Changes (ECG recording)

2-Mechanical changes(shortening and
lengthening or systole and diastole of atria and
ventricles)
3-Pressure Changes.
4-Volume Changes.
5-Closure & Opening of Cardiac Valves
6-Production of Heart Sounds.
 CARDIAC CYCLE
• Mechanical changes are considered the main
changes during cardiac cycle includes
• When the heart beat is 72/min, the duration of
cardiac cycle 0.8 sec.
• The duration of systole is 0.31 sec & diastole
is 0.53 sec.
PHASES OF CARDIAC CYCLE
• Following are the phases of cardiac cycle
• SYSTOLE :
1. Isometric contraction
2. Rapid ventricular ejection
3. Slow ventricular ejection
• DIASTOLE:
1. Protodiastole
2. Isometric relaxation
3. Rapid filling
4. Diastasis
5. Atrial systole
VENTRICULAR SYSTOLE 0.31 sec
(Peak of R wave of QRS
complex to the end of T wave)
ISO-VOLUMETRIC CONTRACTION 0.06 sec
MAXIMUM EJECTION (2/3) 0.11 sec
REDUCED EJECTION (1/3) 0.14 sec
VENTRICULAR DIASTOLE 0.52 sec
(End of T wave to the peak
of R wave of next QRS complex)
PROTODIASTOLE 0.04 sec
ISO-VOLUMETRIC RELAXATION 0.06 sec
RAPID INFLOW 0.11 sec
SLOW INFLOW / DIASTASIS 0.2 sec
ATRIAL SYSTOLE (after P wave) 0.11 sec
8 Phases of CARDIAC CYCLE- 0.83sec
ventricular events
 DESCRIPTION OF EVENTS OF
CARDIAC CYCLE

• For the sake of better understanding, the

description of events of cardiac cycle is
commenced with “atrial systole”.
 Atrial events

• Atrial systole=0.11sec---pumping of blood to

ventricle.
• Atrial diastole=0.72sec---relaxation and
filling with blood from SVC and IVC.
 Atrial events----ATRIAL SYSTOLE

Atrial Depolarization

Atrial contraction

Atrial pressures rise

Blood flows across AV valves

• Ventricular filling : 80% - direct flow from SVC and IVC

20% - atrial contraction.

ATRIA = PRIMER PUMPS .

 Ventricular Systole

a) Isovolumetric contrction (0.06 second)

b) Maximal ejection (0.11 second)
c) Reduced ejection (0.14 second)
0.06+0.11+0.14=0.31seconds
 ISOVOLUMETRIC CONTRACTION
•Increase in ventricular pressure > atrial
pressure → AV valves close. This phase
starts from closure of AV valves. Ventricles
muscle is contracting powerfully but
isometrically.
•Rapid increase in the ventricular pressure.
•No change in the blood volume in
ventricle.
•It lasts for 0.06 seconds ends at opening of SL
valves.
 RAPID EJECTION AND SLOW EJECTION
• When LV pres > 80 mm Hg
• RV pres > 8 mm Hg
•The semi lunar valves open.
•Ventricular Muscle are contracting powerfully and isotonically,duration is
0.14 seconds..
• Rapid Ejection of blood in arteries – 70% emptying
• Slow Ejection – 30%
• Arteries become distended due to presence of elastic tissue. The pressure in
the ventricle keeps decreasing until it becomes lower than that of the great
vessels.
• This phase ends when the ventricular pressure becomes equal or slightly less
than the aortic pressure.
 Ventricular Diastole

a) Protodiastole (0.04 second)

b) Isovolumetric relaxation (0.06 second)
c)Rapid filling (0.11second)
d) Slow filling/Diastasis (0.20 scond)
e) Atrial systole (0.11 second)
(0.52 second)
 a-PROTODIASTOLE
• It is the first stage of ventricular diastole. Duration is 0.04
sec. Ventricular pressure falls.

• Pressure Becomes less in the ventricles than in the aorta and

the pulmonary artery.

• The semi lunar valves are closed at once and do not permit
the backward entry of any blood into the ventricles and with
the closure of this valve, the phase ends.

• Thus, this phase only indicates end of systole & beginning

of diastole
 b-ISOVOULUMETRIC RELAXATION PERIOD
• Ventricular muscle is undergoing relaxation
• Rapid fall in the ventricular pressure.
• No change in blood volume as both valves are
closed
• When the left ventricular pressure becomes lower
than the left atrial pressure, there is opening of
mitral valve. And then this phase ends.
• Duration is 0.06 sec
• Meanwhile, atria fill up and atrial pressure
gradually rises
 c-RAPID INFLOW/FILLING PHASE:

• Starts with the opening of mitral valve.

• Blood flows rapidly from left atrium into left ventricle.
• Ventricle is undergoing relaxation so no rise in pressure.
• There is 2/3rd filling of ventricle.
• Rapid filling phase remains for 0.11 sec.

D-SLOW FILLING PHASE/ DIASTASIS:

• Stasis during the diastole. Both left atrium and left ventricle acts
as a single chamber so it appears no blood is flowing into left
ventricle.
• Only slight filling occurs in this phase.
• Duration is 0.20 sec
 e-Last rapid inflow phase or Atrial systole

• Left atrium contracts to push the blood from its cavity into
left ventricle.
• With atrial systole, ventricular diastole is completed.
• Atria contracts towards the end of the ventricular diastole.
• Remaining 20-25% of the ventricular filling occurs.
• Duration is 0.11 sec
• As the atrial pressures fall, the AV valves close and
left ventricular volume is now maximum → EDV
(120 ml in LV)
 Pressure changes in the left ventricle.
1.Isovolumic contraction.
At its start, pressure in the ventricle is above 0mmHg which is a result of
atrial systole.
The intraventricular pressure rises and the AV valves become closed.
An abrupt increase in the pressure results which may reach 80mmHg at
the end of this stage.
2.Maximum ejection phase. Pressure rises still further and exceeds that
in the aorta 125 mmHg.
3.Reduced ejection phase.
Pressure in the ventricles start falling.
At the end of this stage, it becomes less than that of the aorta.
4.Protodiastole.
Intraventricular pressure falls resulting in the closure of the aortic valve.
Pressure changes in the left ventricle.

• Isovolumetric relaxation.
• For 0.03-0.06 sec ventricular muscle continue
to relax, even though the ventricular volume
does not change.
• During this phase the intraventricuar pressure
rapidly decreases.
• Then the AV valves open A-V valve open to
begin a new cycle of ventricular pumping.
 END DIASTOLIC VOLUME, END
SYSTOLIC VOLUME
• EDV: 110-120ml
• ESV: 40-50ml
• Stroke Volume: 70ml
• The fraction of EDV that is ejected is called
“ejection fraction” which is equal to 0.6 (60%)
 Pressure changes in the aorta
• Maximum pressure in the aorta during the systole of
left ventricle is 125mmHg and during the diastole is
about 80 mmHg.
• Pulse pressure.
• The difference between these two pressures is called
as the pulse pressure.
• An “incisura” occurs in the aortic pressure curve when
the aortic valve closes. This is caused by a short period
of backward flow of blood immediately before the
closure of valve
 VARIOUS PRESSURE VALUES

CHAMBERS NORMAL RANGE (mm of Hg)

Right Atrium 2–6
Right Ventricle ( systolic) 15 – 25

(diastolic) 2 -8
Pulmonary Artery (systolic) 15 – 25

(diastolic) 8 - 15

Left Atrium 6 - 12
Left Ventricle (systolic) 100 – 140

(diastolic) 3 – 12
 Pressure Changes in the Atria—The a, c, and
v Waves-Atrial pressure wave

The a wave is caused by atrial contraction. Right atrial pressure increases 4 to 6 mm

Hg during atrial contraction, and the left atrial pressure increases at 7 to 8 mm Hg.

The c wave occurs when the ventricles begin to contract; it is caused by mainly by
buldging of the A-V valves backward toward the atria during ventricular contraction
because of increasing pressure in the ventricles.

The v wave occurs toward the end of ventricular contraction; it results from slow flow
of blood into the atria from the veins while the A-V valves are closed during ventricular
contraction. Then, when ventricular contraction is over, the A-V valves open, allowing
this stored atrial blood to flow rapidly into the ventricles and causing the v wave to
disappear
THAT’S ALL!