LESSON 4

THE CARDIAC CYCLE, HEART

SOUNDS and BLOOD PRESSURE
Learning Objectives:
• Describe the role of the heart’s valves during the cardiovascular cycle.
• Describe he sequence of events that happen when the heart beats.
• Explain how the heart sounds are produced
• Explain the mechanism for controlling heartbeat
 What are heart valves?
The heart has 4 chambers, 2 upper chambers (atria) and 2 lower
chambers (ventricles). Blood passes through a valve before
leaving each chamber of the heart. The valves prevent the
backward flow of blood. Valves are actually flaps (leaflets) that
act as one-way inlets for blood coming into a ventricle and one-
way outlets for blood leaving a ventricle. Normal valves have 3
flaps (leaflets), except the mitral valve. It only has 2 flaps.

Tricuspid valve. This valve is located between the right atrium

and the right ventricle.
Pulmonary valve. The pulmonary valve is located between the
right ventricle and the pulmonary artery.
Mitral valve. This valve is located between the left atrium and
the left ventricle. It has only 2 leaflets.
Aortic valve. The aortic valve is located between the left
ventricle and the aorta.
 How do the heart valves work?
As the heart muscle contracts and relaxes, the valves open and shut. This lets blood flow into the ventricles and atria
at alternate times. Here is a step-by-step description of how the valves work normally in the left ventricle:

When the left ventricle relaxes, the aortic valve closes and the mitral valve opens. This lets blood flow from the left
atrium into the left ventricle.

The left atrium contracts. This lets even more blood to flow into the left ventricle.

When the left ventricle contracts, the mitral valve closes and the aortic valve opens. This is so blood flows into the
aorta and out to the rest of the body.

While the left ventricle is relaxing, the right ventricle also relaxes. This causes the pulmonary valve to close and the
tricuspid valve to open. This lets blood flow into the right ventricle that was returned to the right atrium from the
body.

When the left ventricle contracts, the right ventricle also contracts. This causes the pulmonary valve to open and the
tricuspid valve to close. Blood flows out from the right ventricle to the lungs before it is returned to the left atrium as
fresh, oxygenated blood.
THE CARDIAC CYCLE
The two main phases of the cardiac cycle are systole
and diastole, and they follow each other in sequence.
Each stage in the cardiac cycle contains important steps
which direct the flow of blood properly. These steps include
contractions of heart chambers and the proper opening and
closing of specific heart valves.
 1
1. Diastole
The diastole phase begins with the relaxation of
all the heart muscles. During diastole, blood
returns to the heart and begins to fill the atria
and ventricles. The lack of pressure in the
ventricle allows the mitral and tricuspid valves
to open, which allow blood from the atria into
the left and right ventricles, respectively. This
phase of the cardiac cycle can be seen in the
image on the right
 2. A signal sent to the sinoatrial node
induces the muscles of both atria to
contract. In unison, this forces blood out
of the atria and into the ventricles. Most
of the blood leaves the atria at this point
in the cardiac cycle. As the atria squeeze,
the action potential is passed through the
muscles and nerves of the heart to the 2

ventricles.
3. Systole
Another wave of contraction starts as the
ventricles enter ventricular systole and
begin contracting themselves. The
increased pressure in the ventricles
closes the mitral and tricuspid valves.
3
The pressure pushes open the aortic and
pulmonary valves. This can be seen in
the image below. This starts the systole
part of the cycle.
HEART SOUNDS
The closing of the heart valves produces a sound. This sound may be described as either
a “lub” or a “dub” sound. Heart sounds are a useful indicator for evaluating the health of
the valves and the heart as a whole.

S1
The first heart sound, called S1, makes a “lub” sound caused by
the closure of the mitral and tricuspid valves as ventricular
systole begins.
S2
The second heart sound, called S2, makes a “dub” sound caused
by the closure of the semilunar (aortic and pulmonary) valves
following ventricular systole.
 Abnormal Heart Sounds
Abnormal heart sounds may indicate problems with the
health of the valves. Heart murmurs sound like a
“whoosh” or “slosh” and indicate regurgitation or
backflow of blood through the valves because they
cannot close properly.
Mechanisms That Control Heartbeat

The heart's electrical system

The atria and ventricles work together, alternately contracting and
relaxing to pump blood through your heart. The electrical system of
your heart is the power source that makes this possible.

Your heartbeat is triggered by electrical impulses that travel down a

special pathway through your heart:
SA node (sinoatrial node) – known as the heart’s
natural pacemaker. The impulse starts in a small bundle of
specialized cells located in the right atrium, called the SA node. The
electrical activity spreads through the walls of the atria and causes
them to contract. This forces blood into the ventricles. The SA node
sets the rate and rhythm of your heartbeat. Normal heart rhythm is
often called normal sinus rhythm because the SA (sinus) node fires
regularly.

AV node (atrioventricular node). The AV node is a

cluster of cells in the center of the heart between the atria and
ventricles, and acts like a gate that slows the electrical signal before it
enters the ventricles. This delay gives the atria time to contract before
the ventricles do.
His-Purkinje Network. This pathway of fibers sends the impulse to
the muscular walls of the ventricles and causes them to contract. This
forces blood out of the heart to the lungs and body.
The SA node fires another impulse and the cycle begins again.
His-Purkinje Network. This pathway of
fibers sends the impulse to the muscular walls
of the ventricles and causes them to contract.
This forces blood out of the heart to the lungs
and body.
 BLOOD PRESSURE AND ITS MEASUREMENT

The heart supplies the organs and tissues of the body with blood. With every
beat, it pumps blood into the large blood vessels of the circulatory system. As
the blood moves around the body, it puts pressure on the walls of the vessels.
Blood pressure readings are made up of two values:

• Systolic blood pressure is the pressure when the heart beats – while the
heart muscle is contracting (squeezing) and pumping oxygen-rich blood
into the blood vessels.
• Diastolic blood pressure is the pressure on the blood vessels when the
heart muscle relaxes. The diastolic pressure is always lower than the
systolic pressure.
Blood pressure is measured in units of millimeters of mercury (mmHg). The
readings are always given in pairs, with the upper (systolic) value first, followed by
the lower (diastolic) value.

So someone who has a reading of 132/88 mmHg (often spoken “132 over 88”) has a:

Systolic blood pressure of 132 mmHg, and a

Diastolic blood pressure of 88 mmHg.
Sphygmomanometer: An instrument for measuring blood pressure, particularly in arteries.
The two types of sphygmomanometers are a mercury column and a gauge with a dial face.
The sphygmomanometer in most frequent use today consists of a gauge attached to a rubber
cuff which is wrapped around the upper arm and is inflated to constrict the arteries.
What is normal blood pressure, and when is blood pressure considered to be
high?

Blood pressure is always measured on a number of different days and when you are at
rest. If several of these measurements are too high, you are said to have high blood
pressure, even if only one of the two – either the systolic or the diastolic one – is high.

The medical term for high blood pressure is hypertension. In adults, blood pressure is
considered to be normal under a systolic value of 140 mmHg and under a diastolic
value of 90 mmHg.
What is the pulse?

The pulse is the expansion of the arteries. This expansion is caused by an

increase in blood pressure pushing against the elastic walls of the arteries each
time the heart beats.

These expansions rise and fall in time with the heart as it pumps the blood and
then rests as it refills. The pulsations are felt at certain points on the body
where larger arteries run closer to the skin.

The pulse is a crucial measure of heart rate.

• A pulse that is too quick may indicated high

blood pressure
• In an injured individual, an extremely low
• pulse with shock may indicate internal bleeding
Simple steps needed to take a pulse at the wrist.(This is
known as the radial pulse):
• Turn one hand over, so it is palm-side up.
• Use the other hand to place two fingertips gently in the groove on the forearm, down
from the fold of the wrist and about an inch along from the base of the thumb.
• When the position is right, you should feel the pulsation of your heart beat.
Once the pulse has been found by following the steps above, hold still and carry out the
following steps:

• Use a timepiece or watch with a second hand, or look at a clock with a second hand.
• Over the course of a minute or 30 seconds, count the number of beats felt.
• The number of pulses over a minute is the standard heart rate measurement. This can
also be calculated by doubling the number of pulses felt over 30 seconds.
• The pulse should be between 60 and 100 bpm.

RECORD YOUR PULSE: __________

SUMMARY:

• The cardiac cycle consists of the heart’s alternate and rhythmic systole and
diastole of the atria and ventricles

• A distinct heart sound called “lub-dub” is produced as the heart alternately

contracts and relaxes.

• Blood pressure (BP) is the force exerted by the circulating blood upon the walls
of the blood vessels.