The cardiac cycle

Describing the sequence of events in one heart beat

Cardiac Contraction

Contraction is initiated by action potentials that normally originates in SA node in right atrium Action potential depolarizes cells, causing contraction Sequence of contractionAtria and ventricles AV node delays impulses by 0.1 seconds.

Definitions

Systole = Begins with ventricular contraction and ends when ejection ceases. Diastole = Begins when ejection ceases as ventricles relax, ventricular filling starts after sufficient relaxation occurs. Duration = Each Cardiac cycle - 0.80 sec, systole 0.27,diastole 0.53 (HR = 75/MIN)

Cardiac cycle
General Principles

Contraction of the myocardium generates pressure changes which result in the orderly movement of blood. Blood flows from an area of high pressure to an area of low pressure, unless flow is blocked by a valve. Events on the right and left sides of the heart are the same, but pressures are lower on the right.

Phases of cardiac cycle

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Phase 6 Phase 7

ATRIAL CONTRACTION ISOVLUMETRIC CONTRACTION RAPID EJECTION REDUCED EJECTION ISOVOLUMETRIC RELAXATION RAPID FILLING REDUCED FILLING

Atrial systole

The heart is full of blood and the ventricles are relaxed (diastole) Both the atria contract and blood passes down to the ventricles 70% of the blood flows passively down to the ventricles so the atria do not have to contract a great amount Narrows the vena cava orifices but some there is some regurgitation of blood in to the veins.

Atrial Diastole

Blood continuously enter atria except when transiently impeded during atrial systole Occurs throughout ventricular systole and diastole until p wave on ECG. AV valve suddenly opens when ventricular pressure falls below atria (creating v wave)

Ventricular Systole

AV valve closes Isovolumetric ventricular contraction(0.05 sec), AV valve bulges. Pressures in ventricles exceeds than aorta(80 mmhg) and pulmonary artery(10mmhg). Aortic and Pulmonary valves open, rapid ejection phase begins. Pressures in ventricles rises to 120 and 25 mmhg (left and right

Ventricular Diastole

Aortic and pulmonary valves closes. Isovolumetric relaxation. Ventricular pressures falls below atrial and AV valves opens, permitting ventricles to fill. Filling is rapid at first, then slows as next cardiac contraction approaches. Atrial pressures continues to rise after vent. systole until AV valves open and slowly rises again until the next atrial systole.

Heart Sounds

First Low pitched, slightly prolonged ``LUB, caused by vibrations due to sudden closure of AV valves. Second High pitched, shorter ``DUB caused by vibrations associated with closure of semi lunar valves. Third Soft, low pitched due to rapid ventricular filling (normal in young) Fourth some times heard before first heard sound when atrial pressures are high (rare in normal individuals)

STROKE VOLUME

Ventricular stroke volume is difference between ventricular end diastolic (EDV) and end systolic volumes (ESV) SV(70 to 90) = EDV(130) (50)ESV In normal heart stroke volume is the volume of blood as ejected in to aorta during each contraction.

Ejection Fraction (EF)

EF is fraction of blood ejected by ventricle relative to its filled volume (EDV) EF = SV / EDV EF is a measure of ability of heart to eject blood. Normally about .55 to .65 (55 to 65%)

Length of systole and diastole

High heart rate- duration of systole decreases from 0.27 (65) to 0.16 (200 beats/min) Duration of diastole decreases from 0.62 seconds to 0.14 (200 beats/min) This fact has important clinical and physiological implications because during diastole heart muscle rests, coronary blood flow to subendocardial portion of LV occurs and most of ventricle filling occurs. At heart rates up to 180, filling is adequate as long as there is ample venous return and CO per minute is increased by an increase in rate. At very high HR, filling may be compromised to such a degree that CO per minute falls.

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