CARDIAC CYCLE

Physiological functions of the different parts of the heart:

Atria: Reservoir
Ventricles: Pressure pump
Atrioventricular (AV) ring:

It contains the atrio-ventricular (A-V) valves.

It acts as skeleton for the heart by giving the attachment of the cardiac muscle.
It causes complete electrical separation between atria and ventricles.

Cardiac Cycle

A.V valves

Tricuspid:
Between right atria
& ventricle

Semilunar valves

Mitral:
Between left atria
& ventricle

Pulmonary valve:
Between right
ventricle &
pulmonary artery

Aortic valve:
Between left
ventricle & aorta

Cardiac valves open and close passively, according to pressure gradient.

Cardiac systole =cardiac contraction.

Cardiac diastole = cardiac relaxation.

Action potential of the cardiac contraction = cardiac depolarization and repolarization.

SA Node (sinoatrial node) is a pacemaker of the heart i.e. responsible for initiation of action
potential.

Electrical activities can be recorded by electrocardiography, Electrocardiogram (ECG):

o P wave: Atrial depolarization.
o QRS wave: Ventricular depolarization.
o T wave: Ventricular repolarization.

Cardiac contraction (Systole) must be preceded by spreading of electrical activity (Action

potential) through the heart starting from the atria to the ventricles.

Why SA node is a pacemaker of the heart?

SAN: 60-90 beats/min

AVN: 40-60 beats/min
Purkinje fibers: 15-40 beats/min

Propagation of the Cardiac Action Potential:

-Action potential (AP) starts at SA node.
-AP conducted through atrial muscle, interatrial band and internodal pathways.
-The AP is delayed at the AV node before entering the Bundle of His.
-Conduction through the Bundle of His and Purkinje fibres is extremely rapid.
-The ventricles depolarise from endocardium to pericardium and from apex to base.

CARDIAC CYCLE
Each cardiac cycle is initiated by spontaneous generation of an action potential in the S-A node
which rapidly over both atria. After a delay of 0.1 sec, and while the atria are contracting, the
excitation wave spreads from the A-V node down through the A-V bundle to the ventricles.
If, Heart Rate (HR) = 72 cardiac cycles /minute
So, each cycle = 0.8 second
One cardiac cycle = One heartbeat.
Tachycardia = increased heart rate.
Bradycardia = decreased heart rate.

Phonocardiogram (Heart sounds recording):

-First heart sound due to closure of atrioventricular valves.

-Second heart sound due to closure of aortic and pulmonary valves.
-Third heart sound due to rushing of blood into the relaxed ventricles.
-Fourth heart sound due to atrial contraction.

Divisions of the cardiac cycle:

1- Atrial systole= 0.1 sec +
Atrial diastole= 0.7 sec = 0.8 sec
2-Ventricular systole= 0.3 sec + ventricular diastole 0.5 sec = 0.8 sec
During Atrial systole, the ventricle is in diastole.
During Atrial diastole, the ventricle is in systole and diastole.
The atria and ventricles never be in systole together.

1. Atrial systole:
-Duration: 0.1 sec. It causes 30% filling of the ventricles
-Atrial pressure: slight increase (5 mmHg), then it decreases again
-Ventricular volume: slightly increased.
-Ventricular pressure: Slightly increased then decreased again.
-Aortic pressure: decreases due to continuous escape of blood to the peripheral circulation.
-Orifices surround venae cavae: contracted to prevent regurgitation of the blood into these
veins.
-A-V valves: are opened.
-Semilunar valves: are closed.
-Heart sound: the 4th heart sound occurs during this phase.
-ECG: P wave starts 0.02 seconds before atrial systole.

2. Ventricular Systole:
Its of 0.3 seconds and composed of 3 phases:

Isometric contraction phase.

Rapid ejection phase.
Slow ejection phase.

a) Isometric contraction phase:

-Duration: 0.05 sec.
-Atrial pressure: increases slightly.
-Ventricular volume: Not changed.
-Ventricular pressure: the interventricular pressure rises rapidly.
-Aortic pressure: decreases due to continuous escape of blood to the peripheral circulation.
-A-V valves: are closed as results of rising of the pressure in the ventricles
-Semilunar valves: are closed.
-Heart sound: the 1st heart sound occurs during this phase due to closure of the A-V valves.
-Q wave: starts 0.02 sec before this phase and then remaining part of the QRS complex occurs
during it.

b) Rapid ejection phase:

-Duration: 0.15 sec.
-Atrial pressure: Falls due to downward pull of the A-V ring, then increases gradually due to
venous return
-Ventricular volume: decreases rapidly.
-Ventricular pressure: The interventricular pressure rises to a maximum, about 130 mmHg in
the left ventricle and 35 mm Hg in the right ventricle due to ventricular contraction.
-Aortic pressure: increased due to ejection of blood from the LV. The amount of blood entering
the aorta exceeds the amount of blood leaving it to the periphery, but remains lower than VP.
-A-V valves: are closed.
-Semilunar valves: are opened.
-Heart sound: the 1st heart sound continued during this phase.
-T wave: starts in the end of this phase.

c) Reduced ejection phase:

-Duration: 0.1 sec.
-Atrial pressure: increases due to accumulation of more venous return.
-Ventricular volume: still decreases.
-Ventricular pressure: slightly decreased.

-Aortic pressure: slightly decreases because blood pumped into aorta is smaller than amount
leaving to the peripheral vessels.
-A-V valves: are closed.
-Semilunar valves: are opened.
-T wave: major portion of the T wave.

3. Ventricular Diastole
It consists of 4 phases:

Isometric relaxation phase.

Rapid filling phase.
Reduced filling phase.

a) Isometric relaxation phase:

-Duration: 0.06 sec.
-Atrial pressure: is till increasing.
-Ventricular volume: remains constant.
-Ventricular pressure: ventricular relaxation begins suddenly, allowing the interventricular
pressure to fall rapidly without any changes in the ventricular volume.
-Aortic pressure: dicrotic notch or incisura. This is followed by a rise in aortic pressure called
the dicrotic wave.
-A-V valves: are still closed.
-Semilunar valves: are closed.
-T wave: ends during this phase.
-Heart sound: 2nd heart sound is heard due to closure of aortic and pulmonary valves.

b) Rapid filling phase:

-Duration: 0.1 sec.
-Atrial pressure: decreases.
-Ventricular volume: increases rapidly.
-Ventricular pressure: the interventricular pressure fall below the pressure in the atrium, the AV valves open and the ventricles begin to fill.

-Aortic pressure: falls as the blood runs off to the periphery.

-A-V valves: are opened.
-Semilunar valves: are closed.
-3rd heart sound: may be heard during this phase due to vibration of the wall of the relaxed
ventricular wall resulting from rapid inflow of blood.

c) Reduced filling phase:

-Duration: 0.2 sec.
-The changes occurring during this phase are just continuous to those occurring in the preceding
phase. The filling of the ventricles is slow and there is slight increase in ventricular volume.

Remarks on cardiac cycle:

-Ventricular filling occurs at different rates:

30% of the blood passes actively during atrial systole.

70% of the blood passes passively during ventricular diastole.

-During isometric phases (contraction and relaxation), all valves are closed so, marked increase
in pressure without change in volume.
-The changes of right side are similar to those of the left side but of lower pressure values.

Methods of studying cardiac cycle:

1- Study pressure changes in the right atrium:
Jugular venous pulse.
2- Study pressure changes in the aorta:
Arterial pulse curve.
3- Study electrical activities of the heart:
ECG (Electrocardiography).
4-Study the relationship of heart sounds to heart changes:
Hearing Heart sounds by stethoscope.