Last edited: 10/9/2021

1. CARDIAC CYCLE
Cardiovascular | Cardiac Cycle Medical Editor: Mariel Antoinette Perez

Ventricles haven’t started to contract yet

OUTLINE
o Ventricular pressure <<< Arterial pressure
I) OVERVIEW OF THE CARDIAC CYCLE  Semilunar valves stay closed
II) PHASE 1: MID TO LATE VENTRICULAR DIASTOLE
III) PHASE 2: ISOVOLUMETRIC III) PHASE 2:
CONTRACTION/SYSTOLE ISOVOLUMETRIC CONTRACTION/SYSTOLE
IV) PHASE 3: MID TO LATE VENTRICULAR SYSTOLE Phase where no blood enters or leaves the ventricles
V) PHASE 4: ISOVOLUMETRIC RELAXATION
when its contracting
VI) APPENDIX
VII) REVIEW QUESTIONS End Diastolic Volume
VIII) REFRENCES o Blood accumulated in the LV before it contracts
Ventricles start to slowly depolarize and contract →
↑ventricular pressure
FYI: Abbreviations used in the note o Myocardium (cardiac muscle layer) contracts to
RV: Right Ventricle squeeze the chambers and slowly push the blood up
LV: Left Ventricle into the pulmonary trunk and aorta
RA: Right Atrium Ventricular Pressures are still lower than the Arterial
LA: Left Atrium
pressures  semilunar valves remain closed
SA: Sino-Atrial
AV: Atrio-ventricular o Aorta (80 mmHg) > RV (60 mmHg)
o Pulmonary Trunk (10 mmHg) > LV (7 mmHg)
I) OVERVIEW OF THE CARDIAC CYCLE Ventricular Pressures rise above the Atrial Pressure
o Causes the AV valves to shut close
The flow of blood in and out of the heart takes an average
o Produces S1
of 0.8 seconds performed in 4 phases
 The first heart sound
COMPONENTS OF THE CARDIAC CYCLE  Commonly known as “lub” in “lub-dub”
Atrial vs Ventricular Pressure IV) PHASE 3:
o Tricuspid valve between RA and RV MID TO LATE VENTRICULAR SYSTOLE
o Bicuspid valve or Mitral valve between LA & LV
“Phase of Ventricular Ejection”
Arterial vs Ventricular Pressure
o Blood leaving the ventricles
Atrial-Ventricular Valves
Semilunar Valves Ventricles are still depolarizing and contracting more
EKG/ECG intensely  ventricular pressure continue to rise
o ECG is still QRS Complex
FOUR PHASES OF THE CARDIAC CYCLE o Ventricular pressure has risen enough that it’s greater
Ventricular Filling than the pressure in the arteries  semilunar valves
Isovolumetric Contraction open  blood moves from ventricles to arteries 
Ventricular Ejection arterial pressure starts to rise
Isovolumetric Relaxation Ventricular pressure >>> Atrial pressure
o Keeps the AV valves closed
II) PHASE 1:
MID TO LATE VENTRICULAR DIASTOLE V) PHASE 4:
Diastole = Relaxation ISOVOLUMETRIC RELAXATION
“Phase of Ventricular Filling” Phase where no blood enters or leaves the ventricles
RAPID FILLING PHASE when its relaxing
End Systolic Volume
Blood from the venous circulation is returning to the heart o Amount of blood left in the LV after it contracts
and accumulates into the atria
o From the IVC, SVC, Coronary Sinus, Pulmonary Ventricles are repolarizing and relaxing → ↓ventricular
Veins into the atria pressure
The ↓ventricular pressure is still greater than the atrial
Atrial Pressure > Ventricular Pressure pressure keeping the semilunar valves closed
AV valves open The arteries are extremely elastic
Without contraction, 70-80% of the blood passively flows o Allows it to take on a high pressure and stretch
down from the atria into the ventricles due to gravity
Arterial Pressures are still higher than the Ventricular Arterial Pressures higher than Ventricular Pressures
Pressure  SL valves remain closed o Causes the SL valves to shut close
o Pressure in the aorta is higher than in the RV o Produces S2
o Pressure in the pulmonary trunk higher than in the LV  Second heart sound
 Commonly known as “dub” in “lub-dub”
REDUCED FILLING PHASE Atrial pressure < Ventricular pressure
Towards the late end of ventricular diastole, SA node fires o AV vales remain closed
o Depolarizes the atria Some blood can go back down due to increase in
o Atria then contracts and actively pushes the pressure
remaining blood down into the ventricles o Ventricles are relaxed and repolarized
o Shows up in the ECG as a p wave o ECG: T wave

CARDIAC CYCLE CARDIOVASCULAR PHYSIOLOGY : Note #8 1 of 2

 VI) APPENDIX

Figure 1.1. Cardiac Cycle Overview

VII) REVIEW QUESTIONS

The p wave in an ECG represents which phase of
the cardiac cycle?
a. Rapid Filling Phase
b. Isovolumetric Contraction
c. Reduced Filling Phase
d. Isovolumetric Relaxation

What is end systolic volume?

a. Amount of blood left in the LV after it relaxes
b. Amount of blood left in the RV after it relaxes
c. Amount of blood left in the RV after it contracts
d. Amount of blood left in the LV after it contracts

Atrial contraction is triggered by:

a. AV node
b. SA node
c. Ventricular Contraction
d. Arterial Contraction

VIII) REFRENCES
● Le T, Bhushan V, Sochat M, Chavda Y, Zureick A. First Aid for the
USMLE Step 1 2018. New York, NY: McGraw-Hill Medical; 2017
● Mancini MC. Heart Anatomy. In: Berger S Heart Anatomy. New York,
NY: WebMD.https://emedicine.medscape.com/article/905502-overview.
● Hill M. Cardiovascular System - Heart Histology.
https://embryology.med.unsw.edu.au/embryology/index.php/Cardiovasc
ular_System_-_Heart_Histology.
● Standring S. Gray's Anatomy: The Anatomical Basis of Clinical
Practice. Elsevier Health Sciences; 2016
● Leslie P. Gartner, James L. Hiatt. Color Textbook of Histology. New
York (NY): Grune & Stratton Inc.; 2006
● Maceira AM, Prasad SK, Khan M, Pennell DJ. Reference right
ventricular systolic and diastolic function normalized to age, gender and
body surface area from steady-state free precession cardiovascular
magnetic resonance. Eur Heart J .2006; 27(23): p.2879-88. doi:
10.1093/eurheartj/ehl336.
● Marieb EN, Hoehn K. Anatomy & Physiology. Hoboken, NJ:
Pearson; 2020.
● Boron WF, Boulpaep EL. Medical Physiology.; 2017.

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