Cardiac cycle and its events

OBJECTIVES
Define cardiac cycle
List and describe the changes that occur during each heart
beat
Atrial pressure
Ventricular pressure and volume
Heart sounds
Aortic pressure
Venous pressure
Electrocardiogram
The cardiac cycle includes all events associated with one heartbeat,
including diastole (relaxation phase) and systole (contraction phase) of both the atria and the ventricles.
In each cycle, atria and ventricles alternately contract and relax.
During atrial systole, the ventricles are relaxed.
During ventricle systole, the atria are relaxed.
Anatomy of the Cardiac Conduction System
VENTRICULAR SYSTOLE
VENTRICULAR DIASTOLE
Valve Function (contd)
Bicuspid (AV) Valve
Chordae Tendineae
Papillary Mucle
CARDIAC CYCLE
In the CARDIAC CYCLE
SYSTOLE is followed by DIASTOLE
Mechanical,
Physical and
Electrical
events that take place during each heart beat are repeated
in every beat
DURATION OF CARDIAC CYCLE
If the heart rate is 75 BEATS/MINUTE
75 beats take 60 seconds then 1 beat will take 60/75 OR
0.8 seconds.
Thus the normal average DURATION OF A CARDIAC CYCLE
= 0.8 SEC.
When heart rate increases the duration of cardiac cycle
Decreases.
When the HR is 120 /MIN then the duration is 0.5 SEC
When the HR is 60/min
The duration of CARDIAC CYCLE IS 1 SEC, AND
SOME IMPORTANT FACTS OF CARDIAC CYCLE
During ATRIAL SYSTOLE Both the ATRIA CONTRACTS
simultaneously.
Same thing happens during ventricular systole.
The systole never overlap.
ATRIAL AND VENTRICULAR diastole overlap.
When the HR increases there is the reduction in the CARDIAC
CYCLE
REDUCTION IN DURATION OF DIASTOLE IS GREATER THAN
THAT OF SYSTOLE.
EVENTS DURING THE CARDIAC CYCLE
MECHANI CAL EVENTS I NCLUDE :
A. Pressures changes in ventricles.
B. Pressure changes in the atria
C. Changes in aortic pressures
D. Opening and closure of the valves.
E. Heart sounds
F.Changes in left ventricular volume
ELECTRI CAL CHANGES I NCLUDE :
CHANGES IN ECG
Cardiac Cycle
The sequence of events in one cardiac cycle is
shown in Figure.
ATRIAL EVENTS
ATRIAL SYSTOLE (0.1 SEC) :
During this phase the atria
contracts: the pressure in atria
exceeds that of the ventricles;
blood passes from the atria to
ventricles.
ATRIAL DIASTOLE (0.7 SEC) : During this phase the atria
relax and receive blood from vena cava and pulmonary veins.
ATRIAL EVENTS =
ATRIAL SYSTOLE (0.1)
+
ATRIAL DIASTOLE (0.7)
= 0.8 SEC
Phase 1
Atrial Contraction
RV
LV
LA
PA
RA
A
RV
LV
LA
PA
RA
A
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
VENTRICULAR SYSTOLE ( 0.3 SEC )
2. ISOMETRIC CONTRACTION PERIOD /
ISOVOLUMETRIC CONTRACTION (0.05 SEC):
A. THE VENTRICULAR
PRESSURE RISES ABOVE THE
ATRIAL PRESSURE. THIS
CLOSES THE ATRIO
VENTRICULAR VALVES.
THIS PRODUCES THE
FI RST HEART SOUND.
B. BOTH A-V AND SEMILUNAR
VALVES CLOSED
C. PRESSURE RISES BUT NO
CHANGE IN THE VOLUME.
THEREFORE I T I S KNOWN AS
I SOMETRI C CONTRACTI ON
PERI OD.
Phase 2
Isovolumetric
Contraction
RV
LV
LA
PA
RA
A
P
P 120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
Phase 2
Isovolumetric
Contraction
RV
LV
LA
PA
RA
A
P
P
RV
LV
LA
PA
RA
A
P
P 120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
VENTRICULAR SYSTOLE ( 0.3 SEC )
3. RAPID EJECTION PHASE (0.11 SEC)
THE PRESSURE INSIDE THE
VENTRICLES EXCEED THAT
OF AORTA AND PULMONARY
ARTERY.
THE SEMILUNAR VALVES
OPEN AND BLOOD IS EJECTED
FORCEFULLY.
70% OF THE STROKE VOLUME
IS EJECTED DURING THIS
PHASE.
Phase 3
Rapid Ejection
RV
LV
LA
PA
RA
A
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
Phase 3
Rapid Ejection
RV
LV
LA
PA
RA
A
RV
LV
LA
PA
RA
A
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
VENTRICULAR SYSTOLE ( 0.3 SEC )
4. REDUCED EJECTION PHASE (0.14 SEC):
BLOOD CONTINUES TO BE EJECTED
FROM THE VENTRICLES.
THE PEAK PRESSURE REACHED IS
120 mm Hg FOR THE LEFT
25 mm Hg FOR THE RIGHT
VENTRICLE.
ABOUT 30% OF STROKE VOLUME IS
EJECTED DURING THIS PHASE.
VENTRICULAR SYSTOLE
ISOVOLUMETRIC CONTRACTION PHASE (0.05 SEC)
+
RAPID EJCTION PHASE (0.11 SEC)
+
REDUCED EJECTION PHASE (0.14 SEC)
=
0.3 SEC
RV
LV
LA
PA
RA
A
Phase 4
Reduced Ejection
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
RV
LV
LA
PA
RA
A
Phase 4
Reduced Ejection
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
VENTRICULAR DIASTOLE
A. PROTODIASTOLE
PROTODIASTOLE (0.04 SEC) :
THIS IS THE FIRST PHASE OF VENTRICULAR DIASTOLE.
VENTRICLES RELAX,
PRESSURE IN THEM REDUCES AND FALLS BELOW THAT OF THE
ARTERIES (aorta & pulmonary artery).
THIS CAUSES BACK FLOW OF BLOOD TOWARD THE VENTRICLES.
SLAPS THE VALVES CLOSED PRODUCING THE
SHARP SECOND HEART SOUND.
VENTRICULAR DIASTOLE
ISOMETRIC RELAXATION PHASE /
ISOVOLUMETRIC RELAXATION PHASE (0.08 SEC)
NOW THE VENTRICLE RELAXES
WITH BOTH THE VALVES
CLOSED.
SINCE THE VENTRICLES RELAX
AS CLOSED CAVITIES, THE
PRESSURE CHANGE BUT THE
VOLUMES DO NOT CHANGE.
THEREFORE IT IS KNOWN AS
ISOMETRIC RELAXATION PHASE
RV
LV
LA
PA
RA
A
Phase 5
Isovolumetric
Relaxation
P
P 120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
RV
LV
LA
PA
RA
A
Phase 5
Isovolumetric
Relaxation
P
P 120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
VENTRICULAR DIASTOLE
FIRST RAPID FILLING PHASE (0.11 SEC)
NOW THE VENTRICULAR
PRESSURE FALLS BELOW
THE PRESSURE OF ATRIA.
THE ATRIO-VENTRICULAR
VALVES OPEN AND BLOOD
RUSHES FROM ATRIA TO
VENTRICLES PRODUCING
THE THIRD HEART SOUND.
Time (sec)
RV
LV
LA
PA
RA
A
Phase 6
Rapid Filling
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
Time (sec)
RV
LV
LA
PA
RA
A
Phase 6
Rapid Filling
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
VENTRICULAR DIASTOLE
DIASTASIS (REDUCED FILLING PHASE) (0.17 SEC)
LONGEST PHASE.
THE BLOOD FLOWS
SLOWLY FROM ATRIA
TO VENTRICLES AND
THE CUSPS OF A-V
VALVE FLOATS IN THE
BLOOD.
THOUGH THIS IS THE
LONGEST PHASE THE
AMOUNT OF BLOOD
WHICH ENTERS THE
VENTRICLES IS
COMPARATIVELY LESS.
RV
LV
LA
PA
RA
A
Phase 7
Reduced Filling
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
RV
LV
LA
PA
RA
A
Phase 7
Reduced Filling
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
VENTRICULAR DIASTOLE
LAST RAPID FILLING PHASE (0.1 SEC)
THIS PHASE COINCIDES WITH
ATRIAL SYSTOLE.
THE ATRIA CONTRACT, IT
FORCE BLOOD TO THE
VENTRICLES THROUGH A-V
OPENING.
25% OF TOTAL VENTRICULAR
FILLING OCCUR DURING THIS
PHASE.
THE RUSH OF BLOOD
PRODUCES THE 4
TH
HEART
SOUND.
Phase 1
Atrial Contraction
RV
LV
LA
PA
RA
A
RV
LV
LA
PA
RA
A
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
120
40
80
0
40
80
120
LV
Vol
(ml)
Press
(mmHg)
1 2 3 4 5 6 7
Phase
0 0.4 0.8
Time (sec)
Heart
Sounds
ECG
LV Press
Aortic
Pressure
LA Press
LVEDV
LVESV
I II III IV
a c
v
HEART SOUNDS
THERE ARE 4 HEART SOUNDS.
THE FIRST 2 CAN BE DETECTED EASILY BY
STETHOSCOPE ( clinically important).
ALL 4 HEART SOUNDS CAN BE RECORDED BY
PHONOCARDIOGRAM.
CHARACTER OF SOUNDS :
1
ST
: LUBB IS LONG ( 0.15 Sec) LOW PITCHED (25 45 Hz)
2
ND
: DUP IS SHORTER ( 0.12 Sec) AND HIGH PITCHED
(50 Hz).
CAUSE OF HEART SOUNDS
1
ST
HEART SOUND IS DUE TO
CLOSURE OF A-V VALVES AT
THE BEGINNING OF
VENTRICULAR SYSTOLE.
2
ND
HEART SOUND IS DUE TO
CLOSURE OF SEMILUNAR
VALVES AT THE BEGINING OF
VENTRICULAR DIASTOLE.
3
RD
HEART SOUND IS DUE TO
RUSH OF BLOOD FROM ATRIA
TO VENTRICLES DURING THE 1
ST
RAPID FILLING PHASE.
4
TH
HEART SOUND IS DUE TO
RUSH OF BLOOD FROM ATRIA
TO VENTRICLES DURING THE
LAST RAPID FILLING PHASE.
ATRIAL PRESSURE PULSE /
VENOUS PRESSURE PULSE
SINCE THERE IS NO VALVE BETWEEN THE
VENA CAVA AND THE ATRIA, A CHANGE OF
ATRIAL PRESSURE IS REFLECTED IN THE
VEINS AND THE PRESSURE EVENTS ARE
SIMILAR.
IT HAS 3 POSITIVE WAVES DESIGNATED BY
a, c & v waves.
a WAVE IS DUE TO INCREASE IN INTRA
ATRIAL PRESSURE DURING ATRIAL SYSTOLE.
c WAVE IS DUE TO BULGING OF A-V VALVE
TOWARDS THE ATRIA DURING ISOMETRIC
CONTRACTION PHASE.
v WAVE IS DUE TO FILLING OF ATRIA WITH
VENOUS BLOOD TILL THE A-V VALVE OPENS
AT THE END OF ISOMETRIC RELAXATION
PHASE.
AORTIC PRESSURE CURVE
AORTIC PRESSURE IS
LOWEST (80 mm Hg) AT
THE BEGINNING OF
VENTRICULAR SYTOLE.
DURING THE MAXIMUM
EJECTION PHASE BLOOD
IS PUMPED OUT BY THE
VENTRICLES TO
ARTERIES. THIS
INCREASES THE AORTIC
PRESSURE TO 120 mm Hg.
AORTIC PRESSURE CURVE
WHEN THE BLOOD STRIKES
AGAINST THE CLOSED
SEMILUNAR VALVES, THE
PRESSURE WAVE IS
REFLECTED BACK GIVING
USE TO INCISURA OR
DICROTIC NOTCH.
THROUGH OUT THE
DIASTOLIC PHASE OF
VENTRICLES THE AORTIC
PRESSURE FALLS AND
GRADUALLY REACHES THE
LOWEST VALUE (80 mm Hg)
TILL THE BEGINNING OF
MAXIMUM EJECTION PHASE.
IN PULMONARY ARTERY,
THE MAXIMUM AND
MININMUM PRESSURE
ACHIEVED ARE 25 mm Hg AND
10 mm Hg RESPECTIVELY.
ELECTRO CARDIOGRAM (ECG)
ECG IS THE ELECTRICAL ACTIVITIES OF THE
HEART RECORDED FROM THE SURFACE OF THE
BODY USING LEADS (ELECTRODES).
THE COMMONLY USED LEADS TO RECORD ECG
ARE
A. STANDARD LIMB LEADS
B. AUGMENTED LIMB LEADS AND
C. CHEST LEADS
THE WAVES RECORDED ARE P Q R S T.
ECG Recording
How many cardiac cycles are
represented in this ECG
recording?
Describe the electrical events
corresponding to each wave
of the ECG.
Label the mechanical events
(including when they happen)
related to each wave of the
ECG.
lub
dub
ECG
P WAVE IS DUE TO
ATRIAL DEPOLARIZATION
QRS WAVE IS DUE TO
VENTRICULAR DEPOLARIZATION
T WAVE IS DUE TO
VENTRICULAR REPOLARIZATION.
THE ATRIAL REPOLARIZATION WAVE IS
SUBMERGED IN MUCH LARGER QRS WAVE
AND DO NOT GET RECORDED.
VENTRICULAR VOLUMES
End diastolic volume (EDV)
= 135 ml
Ventricular ejection (stroke volume, SV)
= 70 ml
End systolic volume (ESV)
= End diastolic volume - stroke volume
= 65 ml
Blood Pressure
Normal BP varies by age, but is approximately 120 mm Hg systolic
over 80 mmHg diastolic in a healthy young adult ( in females, the
pressures are often 810 mm Hg less.)
People who are in good physical condition or who have a
favorable genetic predisposition have lower BPs.
It is often best to refer to the blood pressure as a single number, called
the mean arterial pressure (MAP) .
MAP is roughly 1/3 of the way between the diastolic and systolic
BP. It is defined as 1/3 (systolic BP diastolic BP) + diastolic BP.