MECHANICAL AND ELECTRICAL

EVENTS OF THE CARIDAC CYCLE

HETAL GOHIL
MMED PAEDIATRIC SURGERY
Facilitated by Dr Bukachi
 CARDIAC CYCLE
The electrical, pressure and volume
changes that occur in a functional heart
between successive heart beats.

• Three cycles
1.Electrical cycle
2.Mechanical cycle
3.Volume and pressure change cycle
 Cardiac cycle
• At 75b/min 1 beat = 0.8sec
• Systole =0.3sec
• Diastole =0.5sec
• In tachycardia, diastolic phase decreases more
than systolic phase
 Mechanical Cardiac cycle
The sequence of events in one cardiac cycle is
shown below :

a) Inflow phase
b) Isovolumetric contraction
c) Outflow phase
d) Isovolumetric relaxation
 ATRIAL SYSTOLE
A-V valves open & semilunar valves close

•Blood normally flows continually from great

veins into the atria
•80% flows directly through atria into ventricles
before atria contracts
•20% of filling of ventricles – atrial contraction
•Atrial contraction is completed before the
ventricles begin to contract
 Atrial systole cont;
• At higher heart rate atrial contraction may
account upto 40% of ventricular filling
• This atrial contraction refered to as atrial kick
• Therefore atria simply function as primer
pumps that increase the ventricular pumping
effectiveness as much as 20%
 VENTRICULAR FILLING

The moderately increased pressures that have

developed in the atria during ventricular
diastole immediately push the A-V valves
open and allow blood to flow rapidly into the
ventricles.
• This is the period of rapid filling of the
ventricles. Lasts the first 1/3rd of diastole
• During the middle 1/3rd of diastole-only a small
amount of blood flows into the ventricles

• During the last 1/3rd of diastole - the atria

contract and give an additional thrust to the
inflow of blood into the ventricles

• This accounts for ~20%of the filling of the

ventricles during each cardiac cycle
 VENTRICULAR EMPTYING
• Isovolumetric contraction: occurs immediately before
ventricular contraction begins. All valves are closed.
There is muscle tension with no fibre shortening.
Ventricles build up sufficient pressure to push open
semilunar valves.
• Ejection: semilunar valves open at beginning of this
phase. Divided into two phases: Rapid ejection 70%
of blood ejected during first third of ejection phase.
Slow ejection remaining 30% of blood emptying
occurs during last two third of ejection.
 Ventricular emptying cont:
• Isovolumetric relaxation: at end of systole,
ventricular relaxation begins suddenly,
allowing both intraventricular pressures to fall
rapidly. The semilunar valves are closed by
back flow of blood towards the ventricles from
the large arteries. Ventricular muscles
continue to relax for another 0.03 to 0.06 sec
 VOLUMES
• End diastolic volume: during diastole filling of
ventricle increases volume of each ventricle to
110mls to 120mls
• End systolic volume: remaining amount of blood in
ventricles after systole 40 to 50mls
• Ejection fraction: fraction of end diastolic volume
that is ejected. Usually equals 60%
• Stroke volume: amount of blood ejected from
ventricles in one contraction
• SV=EDV-ESV
I – slight increase in pressure during diastole.
(AB & BC)
II – sharp pressure increase (isovolumetric )
CD
III – ejection (DE & EF)
IV – sharp fall in pressure(isovolumetric) FA

CDEF = Systole
FABC = Diastole
 Pressure changes in atria
• The a wave is caused by atrial contraction. The
right atrial pressure increases 4 to 6 mm Hg
during atrial contraction, and the left atrial
pressure increases about 7 to 8 mm Hg.
• The c wave occurs when the ventricles begin to
contract; it’s partly due to slight backflow of
blood into the atria and by bulging of the
tricuspid backward toward the atria because of
increasing pressure in the ventricles.
• The v wave occurs toward the end of ventricular
contraction; due to slow flow of blood into the
atria from the veins while the A-V valves are
closed during ventricular contraction.
Wigger’s diagram
 Heart sounds
• First sound (lub) – closure of mitral & tricuspid
valve at start of ventricular systole.
• Second sound (dub) – closure of aortic &
pulmonary semilunar valves just after the end
of ventricular systole
• Third sound – coincides with inrush of blood
during rapid ventricular filling
• Fourth heart sound – atrial contraction
• First and second heart sound audible. Third
and fouth heart sounds are inaudible.
 Action potential of cardiac cells
• Resting membrane 1
PNa PX = Permeability to ion X

+20
potential is -90mv. 0
2 PK and PCa

• Na+ passes through

Membrane potential (mV)

-20

3 PK and PCa
double gated voltage -40 0

-60 PNa
channels
-80
4 4

• Plateau results from -100

decreased K+ and 0 100 200

Time (msec)
300

increased Ca++ Phase Membrane channels

0 Na+ channels open

• Plateau end when flux is 1 Na+ channels close

2 Ca2+ channels open; fast K+ channels close

reversed 3 Ca2+ channels close; slow K+ channels open

4 Resting potential
 Electrical conduction
11
SA node
AV node
2

THE CONDUCTING SYSTEM 1 SA node depolarizes.

OF THE HEART

2 Electrical activity goes

rapidly to AV node via
SA node internodal pathways.
3
Internodal
pathways
3 Depolarization spreads
more slowly across
atria. Conduction slows
through AV node.

AV node
4 Depolarization moves
A-V bundle rapidly through ventricular
4
conducting system to the
Bundle branches
Purkinje apex of the heart.
fibers

5 Depolarization wave
5 spreads upward from
the apex.

Purple shading in steps 2–5 represents depolarization.

Normal ECG
 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.
• The PR segment is electrically quiet as the
depolarization proceeds to the AV node.
(0.12-0.2s)
• This brief pause before contraction allows the
ventricles to fill completely with blood.
 ECG cont:
• The electrical impulse propagates from the AV node
through the His bundle and Purkinje system to allow
the ventricles to contract from the apex of the heart
towards the base.
• The QRS complex is due to ventricular depolarization,
and it marks the beginning of ventricular systole. It is
so large that it masks the underlying atrial
repolarization signal (<0.12s).
• The T wave is due to ventricular repolarization. The end
of the T wave marks the end of ventricular systole
electrically. (QT interval = 0.42s)
End