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Sarah Claudine S. Santos, MD, DPPS
cardiac events that occur from the beginning of one heartbeat to the beginning of the next initiated by the spontaneous generation of an action potential in the sinus node normal delay during the passage of the impulse from the atria into the ventricles allows the atria to contract ahead of the ventricles thus pumping blood into the ventricles before its strong contraction occurs
± period of contraction to propel the blood out of the heart into the body s vascular system
± period of relaxation to allow the heart to fill with blood
6 mm Hg ± LA pressure = 7 8 mm Hg c wave = ventricle begins to contract ± due mainly to the bulging of the A-V valves backward toward the atria because of the increase in ventricular pressure ± due partly to the slight backflow of blood into the atria at the onset of ventricular contraction v wave = end of ventricular contraction ± due to slow flow of blood into the atria from the great veins while the A-V valves are closed during ventricular contraction .Pressure Changes in the Atria a wave = atrial contraction ± RA pressure = 4 .
Atrial Pressures .
the higher atrial pressures immediately push the A-V valves open and allow blood to flow rapidly into the ventricles middle 1/3 blood continues to empty into the atria from the veins and passes on through the atria directly into the ventricles last 1/3 atria contract giving an additional thrust to the inflow of blood into the ventricles . ventricular pressures fall.Diastole 1st third = period of rapid filling of the ventricles after systole.
Ventricular Volume Curve .
Ventricular Pressure Period of Isovolumic or Isometric Contraction Period of Ejection Period of Isovolumic or Isometric Relaxation .
± ventricular contraction w/o emptying occurs .Ventricular Pressure Period of Isovolumic or Isometric Contraction ± occurs immediately after ventricular contraction when the ventricular pressure rises causing the A-V valves to close ± build up of sufficient pressure to push the semilunar valves open against the pressures of the aorta and pulmonary a.
Ventricular Pressure Period of Ejection ± ventricular pressures rises (RV above 8 mm Hg and LV above 80 mm Hg) ± pushing the semilunar valves open ± blood begins to pour out of the ventricles ± period of rapid ejection (1st third) 70% emptying ± period of slow ejection (next 2/3) remaining 30% .
03 0.Ventricular Pressure Period of Isovolumic or Isometric Relaxation ± rapid decrease in intraventricular pressures ± elevated pressures in the distended large arteries push blood back toward the ventricles closing the semilunar valves ± 0.06 secs ± A-V valves open to begin a new cycle .
Ventricular Pressure .
Cardiac Volumes End-Diastolic Volume -filling of the ventricles during diastole (110 120 ml) Stroke Volume Output volume ejected by the ventricles during systole (70 ml) End-Systolic Volume remaining volume in the each ventricle (40 50 ml) Ejection Fraction fraction of the end-diatolic volume that is ejected (60%) .
Atrioventricular Valves tricuspid and mitral valves prevent backflow of blood from the ventricles to the atria during systole open and close passively ± close when a backward pressure gradient pushes blood backward ± open when a forward pressure gradient forces flood in the forward direction .
Semilunar Valves aortic and pulmonic valves prevent backflow of blood from the aorta and pulmonary arteries into the ventricles during diastole open and close passively well-adapted to withstand the extra physical stress .
due to rapid closure and rapid ejection. the velocity of blood ejection is greater 3. the edges of the semilunar valves are subjected to much greater mechanical abrasion 4. A-V valves are supported by chordae tendineae . due to the smaller openings of the semilunar valves. high pressures in the arteries at the end of systole cause the semilunar valves to snap close vs softer closure of the A-V 2.A-V vs Semilunar Valves 1.
Papillary Muscles Attach the vanes of the A-V valves by the chordae tendineae contract when the ventricular walls contract don t help close the valves but pull the vanes of valves inward toward the ventricles to prevent their bulging too far backward toward the atria during ventricular contraction .
Papillary Muscles .
followed by sudden cessation of the backflow . caused a short period of backward flow of blood immediately before closure of the valve.Aortic Pressure Curve entry of blood into the arteries causes their walls to stretch and the pressure to increase to 120 mm Hg end of systole elastic recoil of the arteries maintains a high pressure in the arteries even during diastole Incisura occurs when the aortic valve closes.
Aortic Pressure Curve After closure of the aortic valve. aortic pressure decreases slowly throughout diastole because blood stored in the distended elastic arteries flows continually through the peripheral vessels back to the veins aortic pressure before ventricular contraction = 80 mm Hg (diastolic pressure) .
Aortic Pressure Curve .
Heart Sounds opening of the valves make no noise because this is a relatively slowly developing process valves close vanes of the valves and the surrounding fluids vibrate under the influence of the sudden pressure differentials that develop heart sounds .
Heart Sound 1st Heart Sound ± closure of the A-V valves ± low in pitch and relatively long continued 2nd Heart Sound ± closure of the semilunar valves ± relatively rapid snap since they close rapidly and the surroundings vibrate for a short period .
Heart Sound .
Work Output of the Heart Stroke Work Output ± amount of E that the heart converts to work during each heartbeat while pumping blood into the arteries Minute Work Output ± total amount of E converted to work in 1 minute ± equal to SWO x HR per minute .
Work Output of the Heart 2 forms 1. Volume Pressure Work = External Work work to move the blood from the low pressure veins to the high pressure arteries LV external work > RV external work 2. Kinetic E of Blood Flow E used to accelerate the blood to its velocity of ejection through the semilunar valves proportional to the mass of blood ejected x square of the velocity of ejection .
Volume Pressure Curve Diastolic Pressure Curve filling the heart with progressively greater quantities of blood Systolic Pressure Curve pressure during ventricular contraction .
Volume Pressure Diagram Phase I = Period of Filling Phase II = Period of Isovolumic Contraction Phase III = Period of Ejection Phase IV = Period of Isovolumic Relaxation .
Volume Pressure Diagram (Phase I = Period of Filling) End-Systolic Volume (45 ml) ± amount of blood that remains in the ventricle after the previous heartbeat ± diastolic pressure = near 0 End-Diastolic Volume (115 ml) ± amount of blood in the ventricle after blood flows from the atrium ± diastolic pressure = 5 mm Hg .
Volume Pressure Diagram (Phase II = Period of Isovolumic Contraction) all valves are closed no change in ventricular volume intraventricular pressure = aortic pressure 80 mm Hg .
Volume Pressure Diagram (Phase III = Period of Ejection) rise in systolic pressure due to cardiac contraction ventricular volume decreases since semilunar valves are open and blood flows out of the ventricles into the aorta and pulmonary artery .
Volume Pressure Diagram (Phase IV = Period of Isovolumic Relaxation) closure of the seminlunar valves ventricular pressures falls back to the diastolic pressure no change in volume .
Volume Pressure Diagram .
Preload and Afterload Preload ± degree of tension on the muscle when it begins to contract ± end-diastolic pressure Afterload ± load against which the muscle exerts its contractile force ± pressure in the artery leading from the ventricle .
Efficiency of the Heart = efficiency of the cardiac contraction ratio of the work output to total chemical E expenditure 20% .25% .