Lecture 3 - 4

Cardiac Cycle

•Red: important
•Black: in male / female slides
•Pink: in female slides only
•Blue: in male slides only Physiology
•Gray: extra information MED438
Editing file
Objectives:
● Enumerate the phases of cardiac cycle.
● Explain the effect of heart rate on duration of systole and diastole.
● Recognize the pressure, electrical, sound and volume changes during
cardiac cycle.
● Correlate different phases of cardiac cycle with various in events.
● Compare and contrast left and right ventricle during the cardiac cycle.
● Describe atrial pressure waves & their relationship to cardiac cycle.
● Describe the use of the pressure-volume loop in describing the phases of
the cardiac cycle.
 Valves of the heart Female slides

Atrioventricular(AV) valves: Semilunar valves:

1- Tricuspid valves: Between 1- Pulmonary valve:

the right atrium and right ventricle between the right
ventricle and pulmonary
artery
2- Mitral valve: between the
left atrium and left ventricle 2- Aortic valve:
between the left
ventricle and aorta

● These valves open and close in response to pressure changes in the heart.
● They only allow blood to flow in ONE direction.
● Both of them can stay closed at the same time, but they CANNOT stay open simultaneously.
Cardiac Cycle
Definition:
The cardiac cycle is the time duration comprising all events from one heart contraction to the
beginning of the next heart contraction.
Each cycle is initiated by depolarization of the SA node, followed by atrial systole (0.1 sec) →
ventricular systole (0.3 sec) → diastole of whole heart (0.4 sec).

Events:
1. Mechanical events: pressure, volume, and sound changes
2. Electrical events (ECG): action potentials

Cardiac cycle time:

● To calculate the duration of one complete cardiac cycle:
Duration = 60 / HR
● For example, if a person’s HR is 75 bpm, his/her cardiac cycle duration = 60/75 = 0.8 s
● Duration is inversely proportional to the HR
Cardiac Cycle -Notice how when heart rate increased,
Diastole was more affected than systole

The cardiac cycle has two phases: -Both events occur simultaneously

Atrial Events

Systole (0.1 s) Diastole (0.7 s)

Ventricular Events

Systole (0.3 s) Diastole (0.5 s)

After exercise: After exercise:
Systole (0.14) Diastole (0.16)

The total time for the cardiac cycle (HR = 75 bpm)

0.8 seconds
Ventricular diastole is long for three important reasons:
1- Coronary blood flow
2- Ventricular filling
3- Rest
General principles of Cardiac Cycle

The main function of the heart is to pump blood throughout the

1 body through pulmonary (lungs) and systemic (whole body)
circulations.

Contraction of the heart generates pressure change that allows

2 blood movement

3 Blood flows from areas of high pressure to areas of low pressure

Events in right and left ventricles are the same, but with lower
4 pressure gradients in the right side

Atrial & ventricular systole do not occur at same time, but their
5 relaxation occurs at same time during diastole of whole heart which
lasts for 0.4 sec
Phases of the Cardiac Cycle

Ventricular systole Ventricular diastole

(0.3 seconds) (0.5 seconds)
1- Isovolumetric contraction 4- Isovolumetric relaxation
(Early systole) (Early diastole)
2- Rapid Ejection 5- Rapid filling
(Late systole) (Late diastole)
3- Reduced Ejection 6- Slow filling
(Late systole) (Late diastole)

7- Atrial systole
Volume Changes

ESV Volume of blood left in a ventricle at the end of systole (40-60 ml)
End-systolic volume

EDV Volume of blood in a ventricle at the end of diastole (120-130 ml) MAX
End-diastolic volume

SV Volume of blood ejected by a ventricle during systole (~70 ml) (Per beat)
Stroke volume

Ejection Fraction: the ratio of ejected blood (SV) to the blood in a ventricle right before a
diastole (EDV). It is a good indicator of ventricular function.
*Normal range: 60-65%
EF = SV / EDV x 100
SV = EDV - ESV
Atrial Systole
The atria contract, pushing the last 25% of blood to the
Description
ventricles.

Duration 0.11 seconds

AV Open
Valves
Semilunar Closed

Ventricular Ventricular volume rise to EDV (120-130 ml) at the end of this
volume phase

Ventricular First a slight ↑ (blood entry) Atrial First ↑ (by systole)

pressure Then slight ↓ (ventricular dilation) pressure Then ↓ (blood exit)

Sounds 4th heart sound (S4)

Isovolumetric contraction (AKA Isometric contraction)

The ventricle builds up tension without changing its length to

Description open the semilunar valves
It occurs at the beginning of ventricular systole

Duration 0.05 seconds

AV Closed
Valves
Semilunar Closed

Ventricular
Maximum EDV = 120-130 ml
volume

Sudden rise up to 80 ↑ Due to doming of

Ventricular Atrial
mmHg which will open closed A-V cusps into
pressure pressure
the aortic valve atria

Sounds 1st heart sound (S1) (AV valve closure)

Ejection (Rapid & Reduced)
The ventricle shortens its wall (isotonically) ejecting blood
through the aorta and pulmonary artery in two phases, marking
Description
the end of systole:
Rapid (ejecting 70%) & Reduced (ejecting 30%)

Rapid: 0.10 seconds

Duration
Reduced: 0.15 seconds

AV Closed
Valves
Semilunar Open

Ventricular
Decrease to ESV = 50 ml
volume

Rapid: increase to 120 First ↓ because when

Ventricular Atrial ventricles contract, they
mmHg
pressure pressure pull the AV fibrous ring &
Reduced: decrease valves down then increase.

Sounds None
Isovolumetric relaxation
The ventricles relax, causing a drop in pressure which leads to
Description
backflow of blood from the aorta (closing the valves)

Duration 0.06 -0.04 seconds

AV Closed
Valves
Semilunar Closed

Ventricular
Volume does not change ESV= 50 ml
volume

Decreases rapidly to
diastolic levels (2-10 mmHg) Increases gradually
Ventricular Atrial
because the valves are due to accumulation
pressure pressure
closed & the relaxation is of venous blood
isometric

Sounds 2nd heart sound (S2) (Sudden Aortic valve closure)

Filling phase (Rapid & Slow)
The AV opens, filling the ventricle in 3 phases:
Description
Rapid (70%) & Slow/Diastasis (5%) & Atrial systole (25%)

Duration Rapid: 0.11 seconds Slow (diastasis): 0.22 seconds

AV Open
Valves
Semilunar Closed

Ventricular
Volume is increased in ventricles and decreased in atria
volume

First sudden ↓ due

↑ slightly due to increase in to rush of blood into
Ventricular Atrial
volume, but is still less than ventricles.
pressure pressure
atrial pressure Then ↑ due to
venous blood entry.

3rd heart sound (S3) during rapid filling phase (rush of blood
Sounds
and vibrations in ventricular wall)
 Aortic pressure curve 1
Pulmonary artery pressure curve is
similar but 3-4 times less in
magnitude than aortic curve
1- Ascending phase (anacrotic limb): 3
Aortic pressure increases to 120 mmHg, coincides
with rapid ejection.

2- Descending phase (catacrotic limb): Can be split

4
into 4 stages:
1. Decrease in aortic pressure
Coincides with reduced ejection (blood entering aorta 2
is less than blood leaving it)

2. Dicrotic notch (incisura)

Sudden drop in pressure caused by closure of aortic
valve at the end of ventricular systole.

3. Dicrotic wave
Slight increase in aortic pressure caused by the aortic
elastic recoil
Arterial curve is similar to aortic, but sharper.
4. Slow aortic pressure decrease - systolic peak pressure of 110-130 mmHg.
Down to 80 mmhg due to continuous blood flow in - diastolic pressure of 70-85 mmHg.
systemic arteries.
 Atrial pressure waves
1. “a” wave (atrial systole):
increase due to atrial contraction
decrease due to blood passing into ventricles

2. “c” wave (ventricular systole):

Increase due to bulging of AV valve in isometric contraction
decrease due the downward pulling of AV valve during
ventricular rapid ejection

3. “x” descent:
decrease due continued pulling of AV valve during ventricular
reduced ejection

4. “v” wave (atrial diastole):

Increase due to venous return
decrease due to blood entry into the ventricles during rapid
filling phase
5. “y” descent: In Jugular venous pulse(JVP), the same
Decrease due to continued blood flow during reduced filling waves can be seen but are delayed
phase.
Volume changes
7

Ventricular
6
5
2
1
3 4

# Phases Ventricular Volume Atria Volume

1 Isometric Contraction Constant (EDV) Increase

2 Rapid Ejection Decrease rapidly Increase

3 Reduced Ejection Decrease slowly Increase

4 Isometric Relaxation Constant (ESV) Increase

5 Rapid Filling Increase rapidly Decrease

6 Reduced Filling Increase slightly Decrease

7 Atrial Systole Increase moderately Decrease

Pressure changes

# Phases Ventricular Pressure

1 Isovolumetric Increase suddenly (80mmHg) 120/80

Contraction
25/10
2 Rapid Ejection Increase rapidly (120mmHg)

3 Reduced Ejection Decrease slowly

2-10
4 Isovolumetric Decrease rapidly
Relaxation
2-7
5 Rapid Filling Increase slightly
120/10
6 Reduced Filling Increase gradually
25/6
7 Atrial Systole Increase slightly then
decrease
Different pressures in the chambers of the heart
 Ventricular-Pressure Volume Loop For further
Pressure: 2-3 mmHg explanation
Phase I Click here
(filling phase) Volume: rises to EDV=120 ml
Valves: Systolic BP
(A-B)
A- mitral valve opens
B- mitral valve closes
III
Pressure: rises to 80 mmHg Diastolic BP
Phase II End of
Volume: EDV, remains constant
(Isovolumetric
Valves: Systole
contraction)
B- all closed
(B-C)
C- Aortic valve opens

Phase III Pressure: rises from 80 to 120 mmHg.

(Ejection phase)
Volume: drops to ESV= 50 ml IV
Valves:
(C-D) II
C-aortic valve stays open
D-Aortic valve closes
Start of
Phase IV Pressure: drops to 2-3 mmhg systole
(Isovolumic Volume: ESV, remains constant
relaxation) Valves:
D- Aortic valve stays closed I
(D-A)
A- Mitral valve opens
 Ventricular-Pressure Volume Loop Fig. A

Importance:
1. calculating cardiac work output.
2. “EW” represents the net external work output of the ventricle during cardiac
cycle.
Changes to PV loop:
● An increase in Contractility (Figure A) as seen during exercise. Fig. B

● An Increase in preload (Figure B) correlates with more venous

return, which will increase the stroke volume, as shown by
the increased width of the graph.
- Preload: the degree of tension on the muscle when it begins
to contract (end-diastolic pressure)

● An increase in afterload (Figure C) means there is an increase in Fig. C

aortic pressure and a decrease in stroke volume (high pressure,

less blood gets pumped out). as shown by the increased height of the
graph. This can be seen in aortic stenosis. will be discussed in
detail in future
- Afterload: Arterial pressure against which the ventricle exerts lectures
its contractile force.
Summary
 Quiz
1. Venous return increases atrial pressure in which of the 4. The average diastolic pressure in the left ventricle is?
following waves? A. 80 mmHg
A. C wave B. 25 mmHg
B. A wave C. 10 mmHg
C. V wave D. 120 mmHg
D. Y wave
2. Calculate the ejection fraction if EDV is 135 ml and ESV is 5. Which of the following valves is stimulated during the
65. ejection phase?
A. 52% A. Mitral valve
B. 48% B. Aortic valve
C. 65% C. Tricuspid
D. 55% D. Pulmonary
SAQ:
3. The closure of the mitral and tricuspid valves causes 1- Explain the effects of increased Afterload on the PV
which of the following sounds? loop
A. S1 Increased aortic pressure, leads to decreased stroke volume because
less blood is getting pumped out. Fig c
B. S2
2- Enumerate the different phases of the aortic pressure
C. S3
curve.
D. S4 Answers: C - A - A - C - B
Slide 14
 Leaders
Sedra Elsirawani Abdulrahman Alhawas

Members
● Lama AlZamil ● Badr Almuhanna
● Arwa AlEmam ● Abdulrahman Almezaini
● Noura AlTurki ● Omar Aldosari
● Ghada AlSadhan ● Omar Alghadir
● Nouf AlShammari ● Ibrahim Alshaqrawi
● Nouf AlHumaidhi ● Abdullah Aldawood
● Taibah AlZaid ● Abdullah Shadid
● Ajeed AlRashoud ● Meshari Alzeer
● Reem AlGarni ● Mohammed Alhamad
● Raghad AlKhashan ● Abdullah Alassaf
● Leen AlMazroa ● Khalid Alkhani
● Nouran Arnous ● Amjad Albaroudi
● Maha AlNahdi ● Mohammed Alhuqbani