Cardiac Cycle: With Thad Wilson

Cardiac Cycle
With Thad Wilson
DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

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Cardiac Cycle Systole and Diastole
Active relaxation (end of

4, 5, and start of 6)
Active contraction (2, 3, and start of 4)
Ventricular ejection (3 and 4) Ventricular filling (6, 7, and 1)
Systole Diastole

LV Systole
Pressure 1 23 4 5 6 7
2) Isovolumetric contraction (mm Hg) Systole Diastole
• Prior to contraction = left-ventricular (LV) 120
end-diastolic volume (LVEDV)
100
• Electrical: LV depolarization (QRS complex) 80
60
• Pressure: LVP increases 40
20
• Valve: Mitral valve closes 0
130
• LV Volume is maintained 90 LVEDV
Ventricular pressure
(LVP)
.... Aortic pressure
Atrial pressure
50
LV volume
(ml)
Ventricular volume Electrocardiogram
0 Time (s) 0.4 0.8
LV Systole
Pressure 1 23 4 5 6 7
100
60
20
130
• LV Volume is maintained 90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Systole
Pressure 1 23 4 5 6 7
100
60
20
130
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Systole
Pressure 1 23 4 5 6 7
• Prior to contraction = left-ventricular 120
100
60
20
130
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Systole
Pressure 1 23 4 5 6 7
3) and 4) Ejection (mm Hg) Systole Diastole
• Valve: aortic valve opens 120
100
• Pressure: LVP increases and then decreases
80
• Electrical: LV repolarization (T wave) 60
40
• Volume: after ejection = left-ventricular
end-systolic volume (LVESV) 20
0
LV volume decreases rapidly 130
then at a reduced rate
90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Systole
Pressure 1 23 4 5 6 7
100
80
40
0
LV volume decreases rapidly 130
90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Systole
Pressure 1 23 4 5 6 7
100
80
40
0
LV volume decreases rapidly 130 LVESV
90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Diastole
Pressure 1 23 4 5 6 7
5) Isovolumetric relaxation (mm Hg) Systole Diastole
• Valve: aortic valve closure 120
100
• Pressure: LVP decreases
80
• Volume: LV volume is maintained 60
40
• Electrical: isoelectric
20
0
130
90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Diastole
Pressure 1 23 4 5 6 7
5) Isovolumetric relaxation (mm Hg) Systole Diastole
• Valve: aortic valve closure 120
100
• Pressure: LVP decreases
80
• Volume: LV volume is maintained 60
40
• Electrical: isoelectric
20
0
130
90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Diastole
Pressure 1 23 4 5 6 7
6) and 7) Filling (mm Hg) Systole Diastole
• Valve: mitral valve opens 120
100
• Volume: LV volume increases rapidly
and then at a reduced rate 80
60
• Pressure: LVP decreases and then 40
is maintained 20
• Electrical: isoelectrical 0
130
90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
LV Diastole
Pressure 1 23 4 5 6 7
6) and 7) Filling (mm Hg) Systole Diastole
• Valve: mitral valve opens 120
100
• Volume: LV volume increases rapidly
and then at a reduced rate 80
60
• Pressure: LVP decreases and then 40
is maintained 20
• Electrical: isoelectrical 0
130
90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
Ventricular Ejection Fraction
EDV  ESV SV
EF  
EDV EDV
• EF is the fraction of blood ejected from the ventricle relative to the end-diastolic volume
(EDV)
• In a normal heart, the EF is about 55 60%
• In a weakened, failing heart, the EF is < 50% and may be as low as 15%

Atrial Systole
Pressure 1 23 4 5 6 7
1) Atrial systole (mm Hg) Systole Diastole
• Electrical: atrial depolarization (P wave) 120
100
• Mechanical: transient increase in LAP
(a wave) to force additional blood into 80
ventricles 60
40
• Accounts for ~10% of ventricular 20
filling at resting conditions 0
130
• Accounts for up to 40% of ventricular
filling during exercise conditions 90
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
Atrial Diastole
Pressure 1 23 4 5 6 7
2) 7) Atrial filling (mm Hg) Systole Diastole
• Blood continuously enters atria, except when 120
transiently impeded during atrial systole 100
(creating the a wave). 80
• During the contraction of the left ventricles 60
there is a transient pressure reverberation 40
into the atria (creating the c wave). 20 a c v
0
• AV valves suddenly open when ventricular 130
pressure falls below atrial pressure 90
(creating the v wave).
(LVP)
Atrial pressure
50
LV volume
(ml)
0 Time (s) 0.4 0.8
Complete Picture of the Cardiac Cycle
Pressure 1 23 4 5 6 7 Left ventricular
(mm Hg) Systole Diastole pressure (mm Hg)
120 140
100
120
80
60 100 D
40
80 C
20 LAP
Stroke volume
0 60
130
LVEDV End-systolic End-diastolic
90 40
volume volume
50 LVESV 20
LV volume A B
(ml) ECG
0
50 70 120
0 Time (s) 0.4 0.8 LV volume (ml)
Left-ventricular Pressure-volume Relations
Taking time out of the equation in Left ventricular
pressure (mm Hg)
the cardiac cycle the construction
140
of pressure-volume curves
120
A Mitral valve opens
100 D
B Mitral valve closes
80 C
C Aortic valve opens Stroke volume
60
D Aortic valve closes End-systolic End-diastolic

40
volume volume
20
A B
0
Ventricular filling Ventricular ejection 50 70 120
Isovolumetric contraction Isovolumetric relaxation Left ventricular volume (ml)
© by Lecturio DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph
Average, Normal Intracardiac and Vascular Pressures (mmHg)
120/80
25/10
A
LA
Right 8 10 Left
PA
RA
0 4
120/10*
LV
25/4* RV
* End-diastolic pressure
Pressure Circuits
Low pressure High pressure

CO2 O2
120 mm Hg
Lungs
20 mm Hg
A A
V V
(Right) Heart (Left)
Heart Sounds
1 23 4 5 6 7
Systole Diastole
Pressure 120
(mm Hg)
100 AP
80
LVP
S1: mitral and tricuspid closure 60
• Follows QRS and occurs at 40
onset of 2) Isovolumetric 20 LAP
contraction 0
LV volume 130
• Mitral precedes tricuspid (ml) 90 LVEDV
50 LVESV
S4 S1 S2 S3
Heart sounds
0 Time (s) 0.4 0.8

Heart Sounds
1 23 4 5 6 7
Systole Diastole
Pressure 120
(mm Hg)
100 AP
80
LVP
S2: aortic and pulmonic closure 60
• Follows T wave and occurs at 40
onset of isovolumetric 20 LAP
relaxation 0
LV volume 130
• Aortic precedes pulmonic, (ml) 90 LVEDV
producing a split sound 50 LVESV
S4 S1 S2 S3
Heart sounds
0 Time (s) 0.4 0.8

Heart Sounds
1 23 4 5 6 7
Systole Diastole
Pressure 120
(mm Hg)
100 AP
80
LVP
S3: early diastolic filling 60
• Caused by rapid expansion of 40
ventricle during early, rapid 20 LAP
filling phase 0
LV volume 130
• Normal in children (ml) 90 LVEDV
50 LVESV
• Pathologic in adults; associated S4 S1 S2 S3
with dilated ventricles Heart sounds
0 Time (s) 0.4 0.8

Heart Sounds
1 23 4 5 6 7
Systole Diastole
Pressure 120
(mm Hg)
100 AP
80
LVP
S4: associated with atrial 60
contraction 40
• Caused by atrial contraction 20 LAP
forcing blood into stiff ventricle 0
LV volume 130
• Heard in hypertrophied hearts (ml) 90 LVEDV
and hearts of older people 50 LVESV
S4 S1 S2 S3
Heart sounds
0 Time (s) 0.4 0.8

This document is a property of: DARRYL JOHN PASAMBA
Note: This document is copyright protected. It may not be copied, reproduced, used, or
distributed in any way without the written authorization of Lecturio GmbH.


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Cardiac Cycle

With Thad Wilson

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Active relaxation (end of

Active contraction (2, 3, and start of 4)

Ventricular ejection (3 and 4) Ventricular filling (6, 7, and 1)

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

D Aortic valve closes End-systolic End-diastolic

Low pressure High pressure

0 Time (s) 0.4 0.8

0 Time (s) 0.4 0.8

0 Time (s) 0.4 0.8

0 Time (s) 0.4 0.8

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

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