CARDIAC CYCLE

Eka Hendryanny
 The cardiac cycle is a complete round of
systole and diastole

➢ Cardiac cycle = the period between

start of one heartbeat and the next
➢ Two atria contract first to fill ventricles;
two ventricles then contract to pump
blood into pulmonary and systemic
circuits
➢ Two phases:
• Contraction (systole)—blood
leaves the chamber
• Relaxation (diastole)—chamber
refills
 Sequence of Contractions
1. Atria contract together first (atrial systole)
• Push blood into the ventricles
• Ventricles are relaxed (diastole) and filling
2. Ventricles contract together next (ventricular systole)
• Push blood into the pulmonary and systemic circuits
• Atria are relaxed (diastole) and filling
Typical cardiac cycle lasts 800 msec
 Phases of cardiac cycle for a heart rate of 75 bpm

The cardiac cycle creates

pressure gradients that
maintain blood flow
Phases of The Cardiac Cycle
➢ VentricularFilling :
▪ Passive Ventricular Filling :
✓ Rapid Ventricular Filling
✓ Reduced Ventricular Filling/Diastasis
▪ Atrial Systole
➢ Isovolumetric Ventricular Contraction
➢ Ventricular Ejection:
▪ Rapid Ejection
▪ Reduced Ejection
➢ Isovolumetric Ventricular Relaxation
Cardiac Cycle
• Systole and Diastole
• Pressure (atrial chambers, ventricle chambers, aortic/pulmonary
artery)
• Blood flow
• Volume
• Open and close of AV valve and Semilunar valve
• Heart sounds
• ECG
• Venous pulse
Wiggers Diagram
• The a wave reflects left
atrial contraction at the
end of diastole.
• The c wave results from
bulging of the mitral
valve toward the left
atrium as it closes in
early systole.
• The v wave represents
passive filling of the left
atrium from the
pulmonary veins during
systole, when the mitral
valve is closed.
• The downward
deflection that follows
the c wave is known as
the x descent.
• The downward
deflection after the v
wave is called the y
descent.
 Atrial Contraction
A-V Valves Open; Semilunar Valves Closed
➢ It is initiated by the P wave of the electrocardiogram (ECG), which represents
electrical depolarization of the atria.
➢ Atrial depolarization initiates contraction of the atrial musculature.
➢ As the atria contract, the pressure within the atrial chambers increases, which forces
more blood flow across the open atrioventricular (AV) valves, leading to a rapid flow
of blood into the ventricles.
➢ Blood does not flow back into the vena cava because of inertial effects of the venous
return and because the wave of contraction through the atria moves toward the AV
valve thereby having a "milking effect."
➢ Atrial contraction does produce a small increase in venous pressure that can be
noted as the "a-wave" of the left atrial pressure (LAP). Just following the peak of the
a-wave is the x-descent.
Atrial Contraction
➢ Atrial contraction normally accounts for about 20% of left ventricular filling
when a person is at rest because most of ventricular filling occurs prior to
atrial contraction as blood passively flows from the pulmonary veins, into the
left atrium, then into the left ventricle through the open mitral valve.
➢ At high heart rates when there is less time for passive ventricular filling, the
atrial contraction may account for up to 40% of ventricular filling. This is
sometimes referred to as the "atrial kick."
➢ The atrial contribution to ventricular filling varies inversely with duration of
ventricular diastole and directly with atrial contractility.
Atrial Contraction
➢ After atrial contraction is complete, the atrial pressure begins to fall causing
a pressure gradient reversal across the AV valves. This causes the valves to
float upward (pre-position) before closure.
➢ At this time, the ventricular volumes are maximal, which is termed the end-
diastolic volume (EDV). The left ventricular EDV which is typically about 120
ml, represents the ventricular preload and is associated with end-diastolic
pressures of 8-12 mmHg and 3-6 mmHg in the left and right ventricles,
respectively.
➢ A heart sound is sometimes noted during atrial contraction (fourth heart
sound, S4). This sound is caused by vibration of the ventricular wall during
atrial contraction. Generally, it is noted when the ventricle compliance is
reduced ("stiff" ventricle) as occurs in ventricular hypertrophy and in many
older individuals.
Isovolumetric Contraction
All Valves Closed
➢ This phase of the cardiac cycle begins with the appearance of the QRS complex of
the ECG, which represents ventricular depolarization.
➢ This triggers excitation-contraction coupling, myocyte contraction and a rapid increase
in intraventricular pressure. Early in this phase, the rate of pressure development
becomes maximal.
➢ The AV valves close when intraventricular pressure exceeds atrial pressure.
Ventricular contraction also triggers contraction of the papillary muscles with their
chordae tendineae that are attached to the valve leaflets. This tension on the AV valve
leaflets prevent them from bulging back into the atria and becoming incompetent
(“leaky”).
➢ Closure of the AV valves results in the first heart sound (S1). This sound is normally
split (~0.04 sec) because mitral valve closure precedes tricuspid closure.
Isovolumetric Contraction
➢ During the time period between the closure of the AV valves and the
opening of the aortic and pulmonic valves, ventricular pressure rises rapidly
without a change in ventricular volume (no ejection occurs).
➢ Ventricular volume does not change because all valves are closed during
this phase.
➢ Contraction isometrically (no change in length)
➢ Therefore, is said to be "isovolumic" or "isovolumetric."
➢ The "c-wave" noted in the left atrial pressure may be due to bulging of mitral
valve leaflets back into left atrium. Just after the peak of the c wave is the
x'-descent.
Rapid Ejection
Aortic and Pulmonic Valves Open; AV Valves Remain Closed
➢ This phase represents initial, rapid ejection of blood into the aorta and pulmonary
arteries from the left and right ventricles.
➢ Ejection begins when the intraventricular pressures exceed the pressures within the
aorta and pulmonary artery, which causes the aortic and pulmonic valves to open.
➢ Blood is ejected because the total energy of the blood within the ventricle exceeds the
total energy of blood within the aorta. There is an energy gradient to propel blood into
the aorta and pulmonary artery from their respective ventricles.
➢ Left atrial pressure initially decreases as the atrial base is pulled downward, expanding
the atrial chamber. Blood continues to flow into the atria from their respective venous
inflow tracts and the atrial pressures begin to rise. This rise in pressure continues until
the AV valves open.
Reduced Ejection
Aortic and Pulmonic Valves Open; AV Valves Remain Closed
➢ Approximately 200 msec after the QRS and the beginning of ventricular
contraction, ventricular repolarization occurs as shown by the T-wave of the
electrocardiogram.
➢ Repolarization leads to a decline in ventricular active tension and pressure
generation; therefore, the rate of ejection (ventricular emptying) falls.
Ventricular pressure falls slightly below outflow tract pressure; however,
outward flow still occurs due to kinetic (or inertial) energy of the blood.
➢ Left atrial and right atrial pressures gradually rise due to continued venous
return from the lungs and from the systemic circulation, respectively.
Isovolumetric Relaxation
All Valves Closed
➢ When the intraventricular pressures fall sufficiently at the end of phase reduced
ejection, the aortic and pulmonic valves abruptly close (aortic precedes pulmonic)
causing the second heart sound (S2) and the beginning of isovolumetric relaxation.
➢ Valve closure is associated with a small backflow of blood into the ventricles and a
characteristic notch (incisura or dicrotic notch) in the aortic and pulmonary artery
pressure tracings.
➢ After valve closure, the aortic and pulmonary artery pressures rise slightly (dicrotic
wave) following by a slow decline in pressure.
➢ The rate of pressure decline in the ventricles is determined by the rate of relaxation of
the muscle fibers, which is termed lusitropy. This relaxation is regulated largely by the
sarcoplasmic reticulum that are responsible for rapidly re-sequestering calcium
following contraction.
Isovolumetric Relaxation
➢ Although ventricular pressures decrease during this phase, volumes do not
change because all valves are closed. The volume of blood that remains in a
ventricle is called the end-systolic volume and is ~50 ml in the left ventricle.
The difference between the end-diastolic volume and the end-systolic volume
is ~70 ml and represents the stroke volume.
➢ Left atrial pressure (LAP) continues to rise because of venous return from the
lungs. The peak LAP at the end of this phase is termed the v-wave.
Rapid Filling
A-V Valves Open
➢ As the ventricles continue to relax at the end of phase isovolumetric relaxation, the
intraventricular pressures will at some point fall below their respective atrial pressures.
➢ When this occurs, the AV valves rapidly open and passive ventricular filling begins.
➢ Despite the inflow of blood from the atria, intraventricular pressure continues to briefly
fall because the ventricles are still undergoing relaxation. Once the ventricles are
completely relaxed, their pressures will slowly rise as they fill with blood from the atria.
➢ The opening of the mitral valve causes a rapid fall in left atrial pressure.
➢ The peak of the left atrial pressure just before the valve opens is the "v-wave." This is
followed by the y-descent of the left atrial pressure. A similar wave and descent are
found in the right atrium and in the jugular vein.
Rapid Filling
➢ Ventricular filling is normally silent. When a third heart sound (S3) is audible
during rapid ventricular filling, it may represent tensing of chordae tendineae
and AV ring during ventricular relaxation and filling.
➢ This heart sound is normal in children and young adult; but is often
pathological in older adults and caused by ventricular dilation.
Reduced Filling
A-V Valves Open
➢ As the ventricles continue to fill with blood and expand, they become less
compliant and the intraventricular pressures rise. The increase in
intraventricular pressure reduces the pressure gradient across the AV valves
so that the rate of filling falls late in diastole.
➢ In normal resting hearts, the ventricle is about 80% filled by the end of this
phase. In other words, about 80% of ventricular filling occurs before atrial
contraction and therefore is passive.
➢ Aortic and pulmonary arterial pressures continue to fall during this period.
 Heart Sounds
➢ S1 (“lubb”)—when AV valves close; marks start of
ventricular contraction
➢ S2 (“dupp”)—when semilunar valves close
➢ S3 and S4—very faint; rarely heard in adults
• S3—blood flowing into ventricles
• S4—atrial contraction
When the heart beats, the AV valves close before the semilunar
valves open, and the semilunar valves close before the AV valves
open
When ventricles are relaxed, they fill
▪ AV valves—open
• Chordae tendineae are
loose

▪ Semilunar valves—closed
• Blood pressure from
pulmonary and systemic
circuits keeps them closed
 When ventricles contract, they empty

▪ AV valves—closed
• Pressure from contracting
ventricles pushes cusps together
• Papillary muscles tighten chordae
tendineae so cusps can’t invert
into atria; prevents backflow
(regurgitation)

▪ Semilunar valves—open
• Ventricular pressure overcomes
pressure in pulmonary trunk and
aorta that held them shut
The Atrioventricular (AV) Valves
The Semilunar (SL) Valves
Normal Pressures in The Cardiac Chambers and Great Vessels
Normal Intracardiac Pressures

Average values of pressure and oxygen

saturation in normal children