Cardiac

Cycle
Dr Parthasarathy Sinha
Definition:
The electrical and mechanical events that occur in a
cyclical manner from beginning of one heartbeat to
the beginning of the next.

Heart Area Systole Diastole

Duration:
Atrial 0.1s 0.7s
0.8s if Heart Rate is 75 beats/min (60/75)
Ventricle 0.3s 0.5s

Phases: Duration
Systole: contraction (atrial and ventricular)
Diastole: relaxation (atrial and ventricular)
 Phases

Ventricle Cycle:
• Systole:
• Iso-volumetric Contraction (IVC)→ 0.05s
• Rapid Ejection Phase→ 0.1s (0.05+0.1=0.15)

Atrial Cycle: • Slow Ejection Phase→ 0.15s

• Atrial Systole→ 0.1s • Diastole:
• Atrial Diastole→ 0.7s • Protodiastole→ 0.04s (0.04+0.06=0.1)

• Iso-volumetric Relaxation (IVR)→ 0.06s

• 1st Rapid Passive Filling Phase→ 0.1s (1)

• Reduced Filling Phase (Diastasis)→ 0.2s (2)

• Last Rapid Filling Phase → 0.1s (1)

Atrial Cycle:

• Atrial Systole:
• Contribute 25% filling of ventricles.
• Coincides with Last Rapid Filling Phase of ventricular cycle.
• Intra-atrial pressure→ rise by 4-6 mm Hg (right) & 7-8 mm Hg (left).
• Atrial Diastole:
• Coincides with the ventricular systole and most of the ventricular
diastole.
• Gradual filling of the atria due to continuous venous return and
pressure gradually ↑ in the atria.
• Intra-atrial pressure becomes almost zero with opening of AV valves→
beginning of atrial systole.
Ventricular Systole:
• Isovolumetric contraction:
• Isometric contraction: no change in fibre length.
• Ventricular pressure > atrial pressure→ closure of AV valves→ 1st heart sound (S1).
• AV and Semilunar valves closed & ventricle contracts→ ↑↑ intra-ventricular pressure
with no change in volume.
• Rapid Ejection Phase:
• Starts with opening of Semilunar (Aortic & Pulmonary) valves when intra-ventricular
pressure > aorta/pulmonary artery.
• Rapid ejection of blood→ 2/3rd CO ejected.
• Rapid rise of intra-ventricular pressure- 120 mm Hg (left), 25 mm Hg (right).
• Slow Ejection Phase:
• Ejection of rest 1/3rd of CO.
• ↓ intra-ventricular pressure, may fall below aortic pressure but blood flows due to
inertia.
Ventricular Diastole:
• Protodiastole:
• Ventricles start relaxing and intra-ventricular pressure falls rapidly.
• Initially Intraventricular pressure < Aortic pressure, still blood flows
in aorta due to inertia.
• Finally, Aortic + Pulmonary artery pressure > Intra-ventricular
pressure→ closure of semilunar valves→ 2nd Heart Sound (S2).
• Isovolumic Relaxation Phase:
• Both semilunar valves and AV valves are closed.
• Ventricles relax with no change in volume→ rapid fall in pressure
(2-3 mm Hg in left ventricle)
• End with opening of the A-V valves.
• 1st Rapid Passive Filling Phase:
• Intra-atrial pressure >> Intra-ventricular pressure→ rapid filling of ventricles.
• 3rd heart sound (S3).
• Reduced filling Phase- Diastasis:
• Little difference in intra-atrial & intra-ventricular pressure → blood flows
slowly.
• Complete ventricular relaxation has occurred.
• This phase shortens most during tachycardia.
• Last Rapid Filling Phase:
• Coincides with atrial systole.
• Only 25% blood flows in this phase.
• Rapid filling of ventricles → 4th heart sound (S4).
❑End Diastolic Volume (EDV):
➢ Ventricular volume at end of diastole. Value- 130 mL.

❑End Systolic Volume (ESV):

➢ Ventricular volume at end of systole. Value: 50 mL

❑Stroke Volume (SV):

➢ Blood is ejected out by each ventricle during each systole.

➢ SV = EDV – ESV→ 130-50 mL = 80 mL

Iso-volumetric Rapid Ejection Slow Ejection
Contraction Phase Phase

Atrial Diastole

1st Rapid
Iso-volumetric
Passive Filling Protodiastole
Relaxation
Phase

Reduced Filling
Last Rapid Atrial Systole
Phase
Filling Phase
(Diastasis)
 Phase of Cardiac Best Heard at
Heart Sound Characteristics Relevant Points
Cycle (Auscultation Area)
- Closure of mitral (M1) and
Apex of the heart
S1 - "Lubb" sound Isovolumetric tricuspid (T1) valves.
(Mitral area – 5th
(First Heart Sound) - Low frequency contraction Vibration of ventricles and
ICS, MCL)
turbulence of blood
- Closure of aortic (A2)
- "Dub" sound Base of the heart and pulmonary (P2)
S2 - Higher frequency Isovolumetric (Aortic area – 2nd valves

(Second Heart Sound) than S1 relaxation ICS, RSB; Pulmonary - Physiological splitting:
- Shorter than S1 area – 2nd ICS, LSB) A2 occurs before P2 and
increases with inspiration
- Caused by rapid
S3 - Low-pitched, soft 1st Rapid Filling Apex (Mitral area,
ventricular filling against
(Third Heart Sound) sound Phase using bell)
a compliant ventricle
Last rapid Filling
S4 - Low-frequency Apex (Mitral area, - Due to atrial contraction
Phase
(Fourth Heart Sound) sound using bell) against a stiff ventricle
(Atrial systole)
 Pressure-Volume Loop
(P-V Loop)

Ejection Systolic Blood Pressure

AoV Closes

AoV Opens
Diastolic Blood Pressure
Pressure→

Stroke Vol.

End-Diastolic Volume
End-Systolic Volume
MV Opens MV Closes
Filling

50 Volume→ 120
Pressure-Volume Loop
Normal Vs Systolic Failure P-V Loop
Wigger’s Diagram
Definition:
The cardiac output refers to the amount of blood ejected by each ventricle per minute.

Calculation:

CO = SV X HR

Where SV = Stroke Volume (amount of blood pumped out by each ventricle per beat or
per contraction)
HR = Heart Rate

When HR = 70 beats/min, SV is about 80mL

Then CO = 80 X 70 = 5.6 L

Normally CO varies form 5-6 L (amount of blood pumped by EACH ventricle per minute)

Cardiac Index = CO expressed in relation to body surface area

Normal value→ 3.2 L/min/m2 ( 5.6/1.7)
 • Preload refers to the initial stretching of the myocardial muscle
fibers just before contraction.

• Preload is directly related to the End-diastolic Volume (EDV), which

PRELOAD is the volume of blood in the ventricles at the end of diastole, right
before the heart contracts.

• It represents the load or tension placed on the ventricular walls due

to the filling of blood during diastole.
• Afterload refers to the resistance the heart must overcome to eject
blood during systole (contraction).

• For the left ventricle, it is primarily determined by Systemic Vascular

AFTERLOAD
Resistance (SVR) and the compliance of the aorta and systemic
arteries. For the right ventricle, it is influenced by Pulmonary
Vascular Resistance (PVR).
• Contractility refers to the intrinsic ability of cardiac muscle fibers to
CONTRACTILITY generate force and contract, independent of preload or afterload.
Thank You