Cardiac cycle:

The relationship between the phases of the cardiac cycle along with their durations, ECG components.

Cardiac Cycle Phase Duratio Events ECG component

n
Diastole 0.5 sec Ventricular filling, atrial P wave (atrial
contraction depolarization)
Early Diastole 0.15 sec Rapid ventricular filling
Mid Diastole 0.15 sec Reduced ventricular filling
Late Diastole (Atrial 0.2 sec Atria contract to complete
Systole) ventricular filling
Systole 0.3 sec Ventricular contraction, QRS complex (ventricular
ventricular ejection depolarization)
Isovolumetric 0.05 sec Ventricles contract with no
Contraction volume change
Ventricular Ejection 0.25 sec Blood is ejected from ST segment (beginning of
ventricles ventricular repolarization)
Isovolumetric Relaxation 0.08 sec Ventricles relax with no T wave (ventricular
volume change repolarization)
Total Cardiac Cycle 0.8 sec Combination of all phases Complete PQRST sequence

Heart sounds:
S1 (First Heart Sound):
 Phase: Isovolumetric contraction
 Duration: Occurs at the beginning of systole (0.3 sec total)
 Event: Closing of atrioventricular (AV) valves (mitral and tricuspid)
 ECG Correlation: Coincides with the end of the QRS complex
 Location: Best heard at the apex of the heart (5th intercostal space, midclavicular line)
S2 (Second Heart Sound):
 Phase: Isovolumetric relaxation
 Duration: Occurs at the beginning of diastole ( 0.08 sec)
 Event: Closing of semilunar (SL) valves (aortic and pulmonary)
 ECG Correlation: Follows the T wave
 Location: Best heard at the base of the heart (2nd intercostal space, left and right sternal
border)
S3 (Third Heart Sound):
 Phase: Early diastole
 Duration: 0.15 sec during rapid ventricular filling
 Event: Rapid filling of the ventricles causing vibration (normal in children and young adults,
can indicate heart failure in older adults)
 ECG Correlation: Occurs after the T wave, during rapid filling phase
 Location: Best heard at the apex of the heart or along the left lower sternal border (using the
bell of the stethoscope)
S4 (Fourth Heart Sound):
 Phase: Late diastole (atrial systole)
 Duration: 0.2 sec
 Event: Atrial contraction causing vibration due to stiff ventricles (often indicates pathology
such as left ventricular hypertrophy or ischemia)
 ECG Correlation: Coincides with the P wave
 Location: Best heard at the apex of the heart (using the bell of the stethoscope)
Conducting system of the heart:

Blood supply:

#Coronary dominance (SA node) : Gives raise to posterior descending coronary artery:
 85% population: Rt coronary artery
 15% population: Lt circumflex artery
Angiogram results are needed for diagnosing blockage of dominance.
Junctional tissue of heart:
Rate of generation:
SA>AV>Bundle of HIS> Purkinje fiber
Conduction speed:
Purkinje>Bundle>AV>SA
Stimulation sequence:
a. SA-node →Atria
b. AV-node
c. Left side of interventricular septum
d. Direction of septal activation Lt>Rt
e. Depolarization:
Endocardium>Myocardium>Epicardium
Repolarization:
Epicardium>Myocardium>Endocardium
Last activation: Posterolateral part of Lt-ventricle
The clinical conditions associated with blocks alt junctional points:
1. Atrioventricular (AV) Block:
 First-degree AV block:
Condition: Often benign, may be associated with ischemic heart disease,
myocarditis, or medications (e.g., beta-blockers, calcium channel blockers).
ECG: Prolonged PR interval (>200 ms) with a consistent length in every cycle.
 Second-degree AV block:

 Mobitz Type I (Wenckebach):

Condition: Often benign, can be associated with inferior myocardial infarction or vagal
tone.
ECG: Progressive prolongation of the PR interval until a beat (QRS complex) is dropped.
 Mobitz Type II:
Condition: More serious, often associated with anterior myocardial infarction or structural
heart disease.
ECG: Sudden, non-conducted P waves without prior PR interval prolongation. PR intervals
of conducted beats are constant.
 Third-degree AV block (Complete heart block):
Condition: Can result from ischemic heart disease, myocarditis, degenerative diseases, or
drug toxicity.
ECG Correspondence: No relationship between P waves and QRS complexes. Atrial rate is
independent of the ventricular rate (ventricular escape rhythm).
2. Bundle Branch Blocks:
Right Bundle Branch Block (RBBB):
Condition: May be associated with right ventricular hypertrophy, pulmonary embolism, or congenital heart
disease.
ECG Correspondence: QRS duration >120 ms, rsR' pattern in lead V1, and wide S waves in leads I and V6.
Left Bundle Branch Block (LBBB):
Condition: Often associated with left ventricular hypertrophy, ischemic heart disease, or cardiomyopathy.
ECG Correspondence: QRS duration >120 ms, broad and notched or slurred R waves in leads I, aVL, V5, and
V6, and absent Q waves in these leads