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The Cardiac Cycle

The cardiac cycle refers to one complete heartbeat and includes five main stages: 1) ventricular filling where blood moves from the atria to the ventricles, 2) isovolumic contraction where the ventricles contract but volume does not change, 3) ventricular ejection where blood is pumped out of the ventricles through the semilunar valves, 4) isovolumic relaxation where pressure decreases in the ventricles but no blood enters or leaves, and 5) ventricular filling where the process repeats. The cardiac cycle is coordinated by electrical impulses from the sinoatrial and atrioventricular nodes and takes around 2.8 seconds on average in healthy adults.

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40 views

The Cardiac Cycle

The cardiac cycle refers to one complete heartbeat and includes five main stages: 1) ventricular filling where blood moves from the atria to the ventricles, 2) isovolumic contraction where the ventricles contract but volume does not change, 3) ventricular ejection where blood is pumped out of the ventricles through the semilunar valves, 4) isovolumic relaxation where pressure decreases in the ventricles but no blood enters or leaves, and 5) ventricular filling where the process repeats. The cardiac cycle is coordinated by electrical impulses from the sinoatrial and atrioventricular nodes and takes around 2.8 seconds on average in healthy adults.

Uploaded by

Alvin
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© © All Rights Reserved
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The cardiac cycle refers to a complete heartbeat from its generation to the beginning of the next

beat, and so includes the diastole the systole and the intervening pause. The frequency of the
cardiac cycle is described by the heart rate, which is typically expressed as beats per minute. Each
beat of the heart involves five major stages. The first two stages, often considered together as the
"ventricular filling" stage, involve the movement of blood from the atria into the ventricles. The next
three stages involve the movement of blood from the ventricles to the pulmonary artery (in the case
of the right ventricle) and the aorta (in the case of the left ventricle).[1]
The first stage, "early diastole," is when the semilunar valves (the pulmonary valve and the aortic
valve) close, the atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the
whole heart is relaxed. The second stage, "atrial systole," is when the atrium contracts, and blood
flows from atrium to the ventricle. The third stage, "isovolumic contraction" is when the ventricles
begin to contract, the AV and semilunar valves close, and there is no change in volume. The fourth
stage, "ventricular ejection," is when the ventricles are contracting and emptying, and the semilunar
valves are open. During the fifth stage, "isovolumic relaxation time", pressure decreases, no blood
enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves
close due to the pressure of blood in the aorta.
Throughout the cardiac cycle, blood pressure increases and decreases. The cardiac cycle is
coordinated by a series of electrical impulses that are produced by specialized heart cells found
within the sinoatrial node and the atrioventricular node. The cardiac muscle is composed
ofmyocytes which initiate their own contraction without the help of external nerves (with the
exception of modifying the heart rate due to metabolic demand). Under normal circumstances, each
cycle takes 2.8 seconds.[2]

In medicine, ischemia, also spelled as ischaemia or ischmia[a] (/skim/[1][2]), is a restriction in


blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular
metabolism (to keep tissue alive).[3] Ischemia is generally caused by problems with blood vessels,
with resultant damage to or dysfunction of tissue. It also means local anemia in a given part of a
body sometimes resulting from congestion (such as vasoconstriction, thrombosis or embolism).

Diastole /dastli/ is the period of time when the heart refills with blood
after systole (contraction). Ventricular diastole is the period during which the ventricles are
relaxing, while atrial diastole is the period during which the atria are relaxing. The
term diastole originates from the Greek word , meaning dilation.[1]

The cardiac cycle can be divided into three phases.


Isovolumetric Relaxation (early diastole)
During this phase ventricles relax causing a drop in the pressure there. The blood flows back
towards the ventricles from the aorta and the pulmonary trunk, closing the semilunar valves
(aortic and pulmonary). Rebound of blood off the closed valve causes a brief rise in the
aortic pressure, which is called the dicrotic wave in the aortic pressure curve. The closure of
the semilunar valves is followed by a short period in which all the valves (the AV and
semilunar) are closed, causing no change in the volume of the blood in the ventricles; this is
what is called isovolumetric relaxation. Relaxation of ventricles continues causing a quick
drop in the ventricular pressure. As the ventricular pressure becomes less than the atrial
pressure, the AV valves open and the ventricular filling starts.
Ventricular Filling (mid- to- late diastole)
In this phase the blood flows from the atria to the ventricles. The major part of the
ventricular filling takes place just after the AV valves open. The first third of ventricular
filling is rapid and called the rapid ventricular filling. The middle third is
called diastasis and is when a smaller amount of blood is ejected to the ventricles. The
isovolumertric relaxation phase, rapid ventricular filling and diastasis, all happen while all
chambers of the heart (the atria and ventricles) are in diastole. This period is called the
relaxation period and lasts for 0.4 seconds. In the last third of ventricular filling which lasts
for 0.1 seconds, the atrial systole (contraction) happens. During this third only 20-25 mL
of blood is pumped to the ventricles. At the end of the ventricular diastole, each ventricle
contains 130 mL of blood which is called end diastolic volume (EDV). In this phase the AV
valves are open and the semilunar valves are closed.
Ventricular Systole
This phase lasts for 0.3 seconds, and is when the atria relax and the ventricles contract.
When the ventricle systole starts the blood is pushed backwards causing closure of the AV
valves. At this stage the four valves (the AV and semilunar) are closed for 0.05 seconds
which is called isovloumetric contraction.
As the ventricular contraction continues, the ventricular pressure rises sharply. When the
pressure in the left ventricle becomes higher than the aortic pressure (80 mmHg), the aortic
semilunar valve opens and the blood is ejected to the aorta. In the right side the semilunar
pulmonary valve opens and the blood is ejected to the pulmonary trunk, where the pressure
in the right ventricle surpasses the pulmonary trunk pressure (20 mmHg). The pressure
climbs to about 120mmHg in the left ventricle and 30 mmHg in the right ventricle. The
semilunar valves stay open for 0.25 seconds and this period is called ventricular ejection.
Then the ventricles start to relax, the pressure declines and another relaxation phase starts.
The amount of blood that remains in each ventricle at the end of ventricular systole is called
end-systolic volume (ESV). At rest ESV is about 60 mL. The volume of blood that is ejected
by the ventricle in each beat is called stroke volume.
Stroke volume = end-diastolic volume end systolic volume

Heart sounds are the noises generated by the beating heart and the resultant flow
of blood through it. Specifically, the sounds reflect the turbulence created when
the heart valves snap shut. In cardiac auscultation, an examiner may use
astethoscope to listen for these unique and distinct sounds that provide
important auditory data regarding the condition of the heart.
In healthy adults, there are two normal heart sounds often described as a lub and
a dub (or dup), that occur in sequence with each heartbeat. These are the first
heart sound (S1) and second heart sound (S2), produced by the closing of the AV
valves and semilunar valves, respectively. In addition to these normal sounds, a
variety of other sounds may be present including heart murmurs, adventitious
sounds, and gallop rhythms S3 and S4.
Heart murmurs are generated by turbulent flow of blood, which may occur inside or
outside the heart. Murmurs may be physiological (benign) or pathological
(abnormal). Abnormal murmurs can be caused by stenosis restricting the opening of
a heart valve, resulting in turbulence as blood flows through it. Abnormal murmurs
may also occur with valvular insufficiency (regurgitation), which allows backflow of
blood when the incompetent valve closes with only partial effectiveness. Different
murmurs are audible in different parts of the cardiac cycle, depending on the cause
of the murmur.

Tachycardia is a heart rate that exceeds the normal range. In general, a resting
heart rate over 100 beats per minute is accepted as tachycardia. Tachycardia can
be caused by various factors that often are benign. However, tachycardia can be
dangerous, depending on the speed and type of rhythm. Note that, if it is
pathological, a tachycardia is more correctly defined as atachyarrhythmia.

Bradycardia (/brdkrdi/; from the Greek , bradys "slow", and , kardia, "heart"), in
the context of adult medicine, is the resting heart rate of under 60 beats per minute (BPM), although
it is seldom symptomatic until the rate drops below 50 BPM. It sometimes results in fatigue,
weakness, dizziness, and at very low rates fainting.[1] A waking heart rate below 40 BPM is
considered absolute bradycardia.

During sleep, a slow heartbeat with rates around 4050 BPM is common, and is considered normal.
Highly trained athletes may also have athletic heart syndrome, a very slow resting heart rate that
occurs as a sport adaptation and helps prevent tachycardia during training. (e.g., professional
cyclist Miguel Indurain had a resting heart rate of 28 BPM).[2] Martin Brady holds the world record for
the slowest heartbeat in a healthy human, with a heart rate measured in 2005 of just 27 bpm. [3]
The term relative bradycardia is used in explaining a heart rate that, although not actually below
60 BPM, is still considered too slow for the individual's current medical condition.

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