Dr Rahimah Zakaria

Dept Of Physiology
Definitions   

 A cardiac cycle is defined as one complete

sequence of cardiac contraction and
relaxation.
 Is equal to one heart beat.
Components of the cardiac cycle
Atrial contraction
(atrial systole): 0.15 sec
Atrial relaxation
(atrial diastole): 0.65 sec

Ventricular contraction
(systole): 0.3 sec
Ventricular relaxation
(diastole: filling time): 0.5 sec.
Variation in length of cardiac cycle

Duration Heart Rate Heart Rate

(seconds) 75 bpm 200 bpm
Each cardiac cycle 0.80 0.30

Systole 0.3 0.16

Diastole 0.5 0.14

Events during one cardiac cycle
Electrical events
ECG changes

Mechanical events
Changes in pressure and volume in the left atria, left
ventricles and aortic
Opening and closure of the mitral and aortic valves
Generation of heart sounds
Electrical Events
Electrical conduction in myocardial cells
Electrical conduction in the heart
 Electrocardiogram (ECG)

ECG
graphic recording of
electrical events
The electrical activity of the heart originates in
the sino-atrial node. The impulse then rapidly
spreads through the right atrium to the AV
node and directly from the right atrium to the
left atrium. This generates the P-wave

The first area of the ventricular muscle to be

activated is the interventricular septum, which
activates from left to right. This generates the
Q-wave

Next the bulk of the muscle of both ventricles

gets activated, with the endocardial surface
being activated before the epicardial surface.
This generates the R-wave
A few small areas of the ventricles
(posterobasal portion) are activated at a
rather late stage. This generates the S-wave

Finally, the ventricular muscle repolarizes.

This generates the T-wave
Mechanical Events
 General Principles   

Contraction of the myocardium generates pressure

changes which result in the orderly movement of
blood.
Blood flows from an area of high pressure to an area
of low pressure, unless flow is blocked by a valve.
Events on the right and left sides of the heart are the
same, but pressures are lower on the right.
Pressure and Volume Relationships in the Cardiac Cycle
Mechanical events of one cardiac cycle can be divided
into 7 phases

Phase 1

Phase 5-7

Phase 2-4
 Phase 1: Atrial systole (0.15 s)

 Atria contract (atrial systole)  increase in

atrial pressure
 Regurgitation of blood into the veins 
shown by a-wave in JVP
 Contributes to 25% of ventricular diastolic
filling at rest

 S4 is caused by vibration of the ventricular

wall during atrial contraction (in "stiff"
ventricle e.g. in ventricular hypertrophy and
in older individuals)
26/10/09
 Phase 2: Isovolumetric ventricular
contraction (0.05 s)
 Ventricles contract  ventricular pressure
> atrial pressure, AV valves closed,
corresponds to S1
 A sharp rise in the intraventricular
pressure (from 0 – 80 mmHg).
 Ventricular volume is constant (all valves
are closed)
 The c-wave in the JVP is due to bulging
of mitral valve leaflets back into left
atrium. Just after the peak of the c wave
is the x-descent

26/10/09
 Phase 3: Rapid ventricular ejection (0.15 s)
 Ventricles continue to contract 
ventricular pressure reaches its
maximum value (120 mmHg).
 When ventricular pressure > aortic
pressure, the aortic valve opens.
 This is rapid ejection of blood into the
aorta  aortic pressure increases and
reaches maximum.
 Ventricular volume decreases
dramatically since most of the stroke
volume is ejected during this phase.
 LAP rises due to venous return.

26/10/09
 Phase 4: Reduced ventricular
ejection (0.10 s)
 Ventricular pressure begins to fall.
 Aortic pressure falls because run-
off of blood from large arteries into
smaller arteries > the flow of blood
from ventricle into the aorta
 Because the aortic valve is still
open, blood continues to be ejected
but at a reduced rate; and
ventricular volume continues to fall
but at a reduced rate.
 LAP gradually rises due to
continued venous return

26/10/09
 Phase 5: Isovolumetric ventricular
relaxation (0.10 s)
 Ventricle is relaxed  aortic pressure >
ventricular pressure  aortic valve
closes corresponds to S2
 A sharp drop of intraventricular
pressure (from 110 – 0 mm Hg in the
left ventricle).
 The valve closure is associated with a
small backflow of blood in the aorta
toward the ventricle (incisura or
dicrotic notch in aortic tracing) 
 The ventricular volume is constant (all
the valves are closed)
 Atrial filling continues and peak LAP at
the end of this phase v-wave

26/10/09
 Phase 6: Rapid ventricular filling
(0.10 s)
 Atrial pressure > ventricular
pressure, the mitral valve opens
 Opening of the mitral valve
causes a rapid fall in LAP, y-
descent. 
 55% of the ventricular diastolic
filling volume flows into the
ventricle.
 Aortic pressure continues to fall
because blood continues to run
off into smaller arteries.
 S3 represents tensing of chordae
tendineae and AV ring during
ventricular filling (can be normal
in children, in adult caused by
ventricular dilatation)
26/10/09
Phase 7: Reduced
ventricular filling (0.15 s)
 As the ventricles continue
to fill with blood and
expand, become less
compliant and the
intraventricular pressures
rise.  This reduces the
pressure gradient across
the AV valves so that the
rate of filling falls.
 20 % of the ventricular
filling volume flows into the
ventricle.
 Atrial pressure changes and JVP
 The right atrial pressure changes
are transmitted to the great veins
producing 3 characteristic waves
in the jugular pulse.
 a wave is due to atrial systole
 c wave is due to a rise in atrial
pressure produced by bulging of
the tricuspid valve into atria
during isovolumetric ventricular
contraction
 v wave is due to a rise in atrial
pressure before the tricuspid
valve opens during ventricular
diastole
Heart sounds

S1 S2

Duration 0.15 0.12

(sec)

Frequency 25-45 50
(Hz)
 Another way to look at cardiac function:
Pressure - Volume Loops

ESV EDV
Stroke Volume = EDV – ESV
Ejection Fraction = SV/EDV
Regarding a normal cardiac cycle
a) Systole lasts about 1/3 of the total period in resting
adult
b) Atrial contraction is the main contributor for
ventricular filling
c) The first heart sound lasts longer than the second
heart sound
d) Isovolumetric contraction of the left ventricle occurs
until intraventricular pressure is about 80 mmHg
e) ‘a’ wave coincides with ventricular systole
Match the letter on the graph to the following events
 Semi-lunar valves open
 Atrio-ventricular valves close,
 Semi-lunar valves close
 Atrio-ventricular valves open
semi-lunar valves open
semi-lunar valves close

atrio-ventricular valves close atrio-ventricular valves open