‫بسم اهلل الرحمن الرحيم‬

The Cardiac Cycle continue

Abu ahmed
2019
 Ventricular ejection
 Blood starts to be ejected while
the ventricles continue to
contract & the pressures
continue to rise
 Ejection is rapid at first then

slow down as systole progress.

The maximum pressure
reached in the;
◦left ventricle = 120mmHg
◦right ventricle = 25mmHg
 About 70 ml of blood are ejected
from each ventricle per beat
(stroke volume (SV)).
 About 50 ml remain in each

ventricle (end systolic volume,

ESV).
 Before systole there are 120 ml

in each ventricle (end diastolic

volume, EDV).
 Atrial & Ventricular Diastole
 Atrial
diastole:-
◦precedes ventricular diastole.
◦continues throughout most of
the cycle (0.7 s).
◦during this phase blood enters
the atria (venous return).
Atrial & Ventricular Diastole
 Ventriculardiastole:-
◦The ventricles start to relax.
◦The pressures inside them
start to decrease.
◦When the ventricular pressure
becomes lower than the
arterial pressure, the
semilunar valves close (aorta &
pulmonary valves).
 semilunar valves closure results
in the second heart sound.
 The ventricles continue to relax
 The pressures inside them

continue to decrease and all

valves are closed.
 This is called isovolumetric

relaxation phase.
 When the pressures inside the
ventricles become lower than the
pressures in atria the AV valves
open.
 This allows passive filling of

ventricles.
 Then the atria contract:-

◦to complete filling & to start a

new cycle.
Pressure volume curve
S2

S1
S4
S3
A: passive ventricular filling
B: atrial systole.
C: Isovolumetric contraction

phase.
D: Rapid ejection.
E: Isovolumetric relaxation

phase.
 Ejection fraction
 Is the fraction of the end
diastolic volume that is ejected
in one stroke volume.
 Ejection fraction =SV/EDV
 Is 56-65%.
 It is an index for ventricular

function.
 Atrial pressure Changes
 the atrial pressure changes are

transmitted to the great veins

Can be recorded from the

jugular veins.
Normal jugular venous pressure

(JVP) ≤ 8 cm H2O.
appears as three waves (a , c , v).
 Atrial waves
a wave:- due to atrial systole
 c wave:- by the bulging of the

tricuspid valve into the right

atrium .
 v wave :-due to rise in atrial

pressure before tricuspid valve

opens during diastole.
 Jugularpulse waves are:-
◦decreased during inspiration
◦increased during expiration
 Abnormalities
 Giant a wave :-
1.pulmonary hypertension.
2.pulmonary valve Stenosis .
3.Tricuspid insufficiency.
4.Complete heart block.
 atrial contraction while Tricuspid

Valve is closed lead to Cannon

wave.
Thank you for attention