THE CARDIAC CYCLE

BY:- SUDIPTA BHOWMICK BPT FINAL YR.

DEFINITION
It is defined as the sequence of co-ordinated events which take place during heart beat. Each heart beat consist of 2 major periods:  Systole  Diastole During systole there is contraction of cardiac muscle. During diastole there is relaxation of cardiac muscle.

DIVISION OF CARDIAC CYCLE
Contraction of atria = Atrial systole Relaxation of atria = Atrial diastole Contraction of ventricles = Ventricular systole Relaxation of ventricals = Ventricular diastole In clinical practice systole means ventricular systole & diastole means ventricular diastole.

Continue….
So cardiac cycle is divided in two phases:-systole -diastole

SUB DIVISION & DURATION OF CARDIAC CYCLE When the heart beats at the normal rate of 72/min the duration of each cardiac cycle is about 0. Duration of systole = 0.53sec .27sec Duration of diastole = 0.8 sec.

22sec DIASTOLE  Protodiastole = 0.19sec  Atrial systole = 0.11sec  Slow filling phase = 0.04sec  Isovolumetric relaxation = 0.11sec . SYSTOLE  Isometric contraction = 0.08sec  Rapid filling phase = 0..CONTINUE….05sec  Ejection period = 0.

ATRIAL SYSTOLE The end of diastole .

Also called as second or last rapid filling phase or presystole.ATRIAL SYSTOLE . Atrial contraction is complete before the ventricle begins to contract.Heart      It occurs during last phase of venticular diastole.11sec. During atrial systole the atrium contracts and tops off the volume in the ventricle with only a small amount of blood. . Prior to atrial systole. Lasts for 0. blood has been flowing passively from the atrium into the ventricle through the open AV valve.

increasing atrial pressure slightly about 5mmHg(yellow). . Atrial pressure drops when the atria stop contracting.ATRIAL SYSTOLE Pressures & Volumes   The "a" wave occurs when the atrium contracts.

The PR segment is electrically quiet as the depolarization proceeds to the AV node. . This brief pause before contraction allows the ventricles to fill completely with blood.ATRIAL SYSTOLE ECG     An impulse arising from the SA node results in depolarization and contraction of the atria (the right atrium contracts slightly before the left atrium). The P wave is due to this atrial depolarization.

ATRIAL SYSTOLE Heart Sounds   A fourth heart sound (S4) abnormal and is associated with the end of atrial emptying after atrial contraction. massive pulmonary embolism. It occurs with hypertrophic congestive heart failure. tricuspid incompetence. or cor pulmonale. .

ISOVOLUMETRIC CONTRACTION The Beginning of systole .

As the presssure rises steeply AV valve bulges inside the atria Mechanically it is a phase between closing of AV valve & opening of semilunar valve.ISOVOLUMETRIC CONTRACTION Heart       Last for 0. As the contraction starts he IV pressure rises & AV valves closes firmly. . Ventricles contract as a closed chamber..05sec In the beginning of venticular contraction semilunar valves are closed but the AV valves are not firmly closed.

.ISOVOLUMETRIC CONTRACTION Pressures & Volumes    The AV valves close when the pressure in the ventricles (red) exceeds the pressure in the atria (yellow).their volume does not change (white) -.the pressure inside increases. approaching the pressure in the aorta and pulmonary arteries (green). As the ventricles contract isovolumetrically -. The ‘c’wave in atrial pressure curve(yellow)is seen at this time & is due to the buldging of AV valves with in the atrum which causes slight increase in atrial pressure.

.so later half of R WAVE is in this phase. and it marks the beginning of ventricular systole.ISOVOLUMETRIC CONTRACTION ECG   Ventricular complex of ECG begins slightly before this phase. It is so large that it masks the underlying atrial repolarization signal. the ventricles to fill completely with blood. The QRS complex is due to ventricular depolarization.

. "lub") is due to the closing AV valves and associated blood turbulence.ISOVOLUMETRIC CONTRACTION Heart Sounds  The first heart sound (S1.

RAPID EJECTION .

blood is ejected out rapidly from both ventricles. .the semilunar (aortic and pulmonary) valves open and due to contraction of ventricles.RAPID EJECTION Heart   As soon as the IV pressure exceeds hydrostatic pressue of aorta.13sec. Lasts for 0.

As more blood enters the arteries the presssure there builds until the flow of blood reaches the peak.RAPID EJECTION Pressures & Volumes    Volume in the ventricles decreases rapidly (white). . Aortic pressure rises steeply but it remains lower than that of ventricles.

RAPID EJECTION ECG  ST segment occurs in this phase .

RAPID EJECTION Heart Sounds  None .

REDUCED EJECTION The end of systole .

During this rate of ventricular ejection falls.REDUCED EJECTION Heart    It is end of systole.15sec. Lats for about 0. . total blood ejected is less than that in rapid ejection phase.

This marks the end of ejection phase. mean while ventricular pressure also falls & a time comes when IV pressure falls below the aortic pressure.REDUCED EJECTION Pressures & Volumes   After the peak in ventricular and arterial pressures (red and green). . The rate of run off exceeds the rate of inflow into the aorta. so aortic blood pressue falls. blood flow out of the ventricles decreases and ventricular volume decreases more slowly (white).

The end of the T wave marks the end of ventricular systole electrically. .REDUCED EJECTION ECG  The T wave is due to ventricular repolarization.

REDUCED EJECTION Heart Sounds  None .

AV valves are already closed so no other changes occur in heart during this phase.PROTODIASTOLE     It is the first stage of ventricular diastole. Lasts for 0. . When the IV pressure decreases than aortic & pulmonary pressure the semilunar valves closes.04sec Due to ejection of blood. the pressure in pressure in aorta & pulmonary artery increases & pressure in ventricles drop.

ISOVOLUMETRIC RELAXATION .

Hence here is no change in length & volume of muscle fibres.ISOVOLUMETRIC RELAXATION Heart     Starts with the closure of semilunar valve. .08sec AV valves are still closed. Therefore the ventricles act as closed cavity & at the same time ventricles start relaxing. Lasts for 0.

. The pressure in the ventricles (red) continues to drop and may reach 0mmHg.ISOVOLUMETRIC RELAXATION Pressures & Volumes     Throughout this phase the atrium in diastole has been filling with blood on top of the closed AV valve. causing atrial pressure to rise gradually (yellow). The "v" wave is due to the back flow of blood after it hits the closed AV valve. Ventricular volume (white) is at a minimum and is ready to be filled again with blood.

ISOVOLUMETRIC RELAXATION ECG  No Deflections .

"dup") occurs when the semilunar (aortic and pulmonary) valves close. S2 is normally split because the aortic valve closes slightly earlier than the pulmonary valve. .ISOVOLUMETRIC RELAXATION Heart Sounds  The second heart sound (S2.

RAPID VENTRICULAR FILLING .

19sec .RAPID VENTRICULAR FILLING Heart    Once the AV valves open. blood flows from the atrium to ventricles with a gush. Lasts for about 0. About 70% filling of the ventricles occurs during this phase.

The atrial pressure falls slightly but still remains more than that of ventricles.RAPID VENTRICULAR FILLING Pressures & Volumes   Ventricular volume (white) increases rapidly as blood flows from the atria into the ventricles. .

RAPID VENTRICULAR FILLING ECG  No Deflections .

or mitral incompetence. .RAPID VENTRICULAR FILLING Heart Sounds  A third heart sound (S3) is usually abnormal and is due to rapid passive ventricular filling. severe hypertension. myocardial infarction. It occurs in dilated congestive heart failure.

REDUCED VENTRICULAR FILLING (Diastasis) .

the ventricles filling slows.19sec . It lasts for 0. About 20% of the filling occur s during this phase.REDUCED VENTRICULAR FILLING Heart    After the sudden rush of blood.

.REDUCED VENTRICULAR FILLING Pressures & Volumes  Ventricular volume (white) increases more slowly now. The ventricles continue to fill with blood until they are nearly full.

.REDUCED VENTRICULAR FILLING ECG  No Deflections is seen but it usually corresponds the phase between the end of T wave & next P wave.

REDUCED VENTRICULAR FILLING Heart Sounds  None .

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