Cardiac cycle

Departemen Fisiologi
Fakultas Kedokteran
Universitas Sumatera Utara
 PACEMAKER POTENTIAL
• “Fastest” cells located
in SA node :100 x/i,
• SA node sets pace.
• AV node: 40-60 x/i
• Bundle of His &
Purkinje fibers: 20-40
x/i.
• Bundle of His can
provide ectopic
pacemaker
 Intrinsic Conducting System
• Sinoatrial node.
– Electrical pace maker.
• Atrioventricular node.
– Receives impulses
originating from SA node.
• Bundle of His
– Electrical link between atria
and ventricles.
• Purkinje fibres.
– Distribute impulses to
ventricles.
 • Sino-atrial (SA) node
PACEMAKERS • Atrio-ventricular (AV) node
(in order of • Bundle of His
• Bundle branches
their inherent • Purkinje fibers
rhythm)
Electrical Events
Atrio-ventricular (AV) node • Autorhythmicity: heart contracts
without help of hormonal or neuronal
stimulation.
• The conduction or nodal system of the
heart consists of the AV and SA nodes,
the AV bundle and bundle branches
and Purkinje fibers.
• This system coordinates the
depolarization and ensures the heart
beats as one.
• The SA acts as the heart’s pacemaker
and sets the sinus rhythm.
Spread of cardiac excitation
Impulse pathway
• SA node sends stimulus->reaches
AV node-->internodal
pathways->atrial contraction->IV
septum->bundle branches, Purkinje
fibers, papillary muscles->Purkinje
relay to ventricular
myocardium->ventricular
contraction->blood pushed to
aortic and pulmonary trunks.
• Ectopic pacemaker: an abnormal
cell generates action potential
which overrides those of SA or AV
nodes. Disrupts timing of
ventricular contraction. Heart
efficiency is reduced.
CARDIAC CYCLE
 Systole
• Iso-volumetric contraction :
– Contraction begins but valves still closed.
– Tension develops but no shortening of cells.
– Pressure builds up until pressures in left and right
ventricles > aorta (80 mm Hg) and pulmonary artery
(10 mm Hg) (lasts about 0.05 s).
• Ventricular ejection:
– Pventricles > Paortic/pulmonary trunk.
– Semilunar valves open (aortic and pulmonary).
– Muscle cells shorten.
– Blood expelled: end systolic volume (ESV) remains.
 Diastole
• Iso-volumetric relaxation:
– Ventricles begin to relax.
– Semilunar valves and AV valves all closed.
– Ventricular volume remains unchanged.
• Ventricular filling :
– Patria > Pventricles.
– Mitral valve (left) and tricuspid valve (right) open.
– Ventricle begin to fill (80% complete).
– Atrial contraction completes filling.
– Volume achieved: end diastolic volume (EDV)
 ELECTROCARDIOGRAM

⦿ The record of potential fluctuation during

cardiac cycle.
⦿ ECG may be recorded by using :
⚫ unipolar recording; an active or
exploring electrode connected to an
indifferent electrode at zero potential
⚫ bipolar recording; using two active
electrodes
⦿ Einthoven's triangle; A
triangle with heart at its
center.
⦿ These are three standard
limb leads used in
electrocardiography.

• Depolarization moving toward an active

electrode produces positive deflection,
whereas depolarization moving in opposite
direction produces negative deflection
• P wave; atrial
depolarization,
• QRS complex;
ventricular
depolarization,

⦿ ST segment and T wave; ventricular

repolarization.
⦿ U wave inconstant finding; slow
repolarization papillary muscles
ECG intervals
 Bipolar leads

lead I, upward
LA
deflection; left arm RA
- -
and right arm
(left arm
positive) RA - + LA
lead II, left leg LEAD I
and right arm
(leg positive)
lead III, left arm
LEAD III + LL
and left leg, (leg LL
+
LEAD II
positive)

Remember, the RL is always the ground

and never takes on a positive or negative
charge.
Unipolar (V) leads
• 6 unipolar chest leads
(precordial leads)
designated V1-V6
• 3 unipolar limb leads: VR
(right arm), VL (left arm),
and VF (left foot).
Augmented limb leads,
designated by the letter a
(aVR, aVL, aVF), are
generally used
 The Concept of a “Lead”

Summary of the LEAD AVR

“Limb Leads” LEAD AVL
-150o -30o
Each of the limb leads (I,
II, III, AVR, AVL, AVF)
0o
can be assigned an LEAD I
angle of clockwise or
counterclockwise
rotation to describe its 60o
position in the frontal 120o o LEAD II
90
plane. Downward LEAD III
LEAD AVF
rotation from 0 is positive
and upward rotation from
0 is negative.
 The Concept of a “Lead”
The “Precordial Leads”

4th
intercostal V V
Each of the 6 1 2 V
precordial leads is space V V V
3
unipolar (1 electrode 4 5 6
constitutes a lead)
and is designed to
view the electrical
activity of the heart
in the horizontal or V1 - 4th intercostal space - right margin of sternum
transverse plane V2 - 4th intercostal space - left margin of sternum
V3 - linear midpoint between V2 and V4
V4 - 5th intercostal space at the mid clavicular line
V5 - horizontally adjacent to V4 at anterior axillary line
V6 - horizontally adjacent to V5 at mid-axillary line
 ECG Paper and related Heart Rate & Voltage Computations

Memorize
These 2
 Heart Sounds
• Normally heard by a stethoscope
• First sound : low, slightly prolonged “lub”,
caused by closure of mitral and tricuspid
valves, at ventricular systole. Duration 0.15
s & fequency 25-45 Hz.
• Second sound ; shorter, high-pitched “dup”,
caused by closure aortic and pulmonary
valves, after end of ventricular systole. 0.12
s & 50 Hz.
• Third sound : soft, low-pitched, at one-third
diastole, period rapid ventricular filling , due to
inrush of blood. In young individuals. 0.1 s.
• Fourth sound : when atrial pressure is high and
ventricle is stiff in ventricular hypertrophy , due
to ventricular filling, before first sound.
 Murmurs or Bruits
• abnormal sounds heard in various parts of
the vascular system.
• Bruits heard over a large, highly vascular
goiter, over carotid artery when its lumen is
narrowed & distorted by atherosclerosis.
• Murmurs heard over aneurysmal dilation of
large arteries, an arteriovenous (A-V)
fistula, or patent ductus arteriosus.
• Soft systolic murmur are common in
individuals, escpecially in children, who have
no cardiac disease.
• Systolic murmurs are also common in anemic
patients as a result of low viscosity of blood
and rapid flow.
Let it beat!