Cardiac cycle

Contractility SV EF ESV

140

120 Aortic valve closes 2

Afterload Aortic pressure SV ESV

Pressure (mmHg)

100

80 Stroke volume (EDV-ESV)

Aortic valve opens

60 3 40 Mitral valve opens

1 Mitral valve closes Preload SV

Phasesleft ventricle: 1. Isovolumetric contractionperiod between mitral valve closure and aortic valve opening; period of highest O2 consumption 2. Systolic ejectionperiod between aortic valve opening and closing 3. Isovolumetric relaxationperiod between aortic valve closing and mitral valve opening 4. Rapid llingperiod just after mitral valve opening 5. Reduced llingperiod just before mitral valve closure Sounds: S1mitral and tricuspid valve closure. Loudest at mitral area. S2aortic and pulmonary valve closure. Loudest at left sternal border. S3in early diastole during rapid ventricular lling phase. Associated with lling pressures and more common in dilated ventricles (but normal in children). S4 (atrial kick)high atrial pressure. Associated with ventricular hypertrophy. a waveatrial contraction. c waveRV contraction (tricuspid valve bulging into atrium). v wave atrial pressure due to lling against closed tricuspid valve. S2 splitting: aortic valve closes before pulmonic; inspiration this difference.
Normal: Expiration | || S1 A2 P2 Inspiration | | | Wide splitting (associated with pulmonic stenosis): Expiration | | | S1 A2 P2 Inspiration | | | Fixed splitting (associated with ASD): Expiration | | | S1 A2 P2 Inspiration | | | Paradoxical splitting (associated with aortic stenosis): Expiration | | | P2 A2 S1 Inspiration | | |

20

4&5

H IG H-YI E LD SYSTE MS

Volume

Systole Rapid ejection Isovolumetric contraction

Dicrotic notch Rapid ventricular filling Isovolumetric relaxation

120 Pressure (mmHg) 100 80 60 40 20 0 S4

Aortic valve opens

Aortic valve closes Aortic pressure Left ventricular pressure Left atrial pressure Mitral valve opens

Reduced ventricular filling

Reduced ejection

Atrial systole

CARDIOVASC U LAR

Mitral valve closes

S1

S2

S3

Heart sounds

Ventricular volume

a R P Q S 0 0.1

c x v y Jugular venous pulse ECG P

0.2

0.3

0.4 0.5 Time (sec)

0.6

0.7

0.8

(Adapted, with permission, from Ganong WF. Review of Medical Physiology, 22nd ed. New York: McGraw-Hill, 2005.)

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