CARDIOVASCULAR SYSTEM

CARDIAC CYCLE

Dr Syed Shahid Habib

Professor & Consultant Clinical Neurophysiology
Dept. of Physiology
College of Medicine & KKUH
King Saud University
2/23/2020
 OBJECTIVES
At the end of the lecture you should be able to …
[Link] the phases of cardiac cycle
[Link] the effect of heart rate on duration of systole and diastole
[Link] the pressure, electrical, sound and volume changes
during cardiac cycle
[Link] different phases of cardiac cycle with various changes in
events.
[Link] and contrast left and right ventricular pressures and
volumes during the normal cardiac cycle.
[Link] atrial pressure waves & their relationship to cardiac cycle
[Link] the use of the pressure-volume loop in describing the
phases of the cardiac cycle

SOURCE GUYTON 13TH ED. CHAPTER9: PAGE:113-119

 CARDIAC CYCLE

• Definition: Cardiac Cycle is the time duration

comprising all the events from beginning of
one heart contraction to the beginning of
next heart contraction.

• At heart rate of 75 beats per minute

duration of one Cardiac cycle is 0.8 second.

What are the Events?

 EVENTS OF CARDIAC CYCLE
Mechanical Events:
1. Pressure changes during cardiac cycle
2. Volume changes during cardiac cycle
3. Heart sounds
Electrical Events
5. Electrocardiogram (ECG)
The Events of the Cardiac Cycle
 PHASES OF CARDIAC CYCLE
Atrial Events
Atrial systole: 0.1 second
Atrial diastole : 0.7 seconds

Ventricular Events
Ventricular systole : 0.3 seconds
Ventricular diastole : 0.5 seconds
CARDIAC CYCLE
0.8 SECONDS
 CARDIAC CYCLE
0.8 SECONDS (when HR = 75 beats/min)

ATRIAL
ATRIAL DIASTOLE 0.7
SYSTOLE
SECONDS
0.1 SEC

VENTRICULAR SYSTOLE VENTRICULAR DIASTOLE

0.3 SECONDS 0.5 SECONDS

Importance of longer •Coronary blood flow

ventricular diastole? •Ventricular filling
 VENTRICULAR EVENTS
• Ventricular systole
[Link] contraction
[Link] phase
• Rapid ejection
• Slow ejection
• Ventricular Diastole
1. Isovolumetric relaxation phase
2. Filling phase
• Rapid filling
• Slow filling (Continued filling)
• Last rapid filling (Atrial Systole)
PHASES OF CARDIAC CYCLE
VENTRICULAR SYSTOLE 0.30 sec
(Peak of R wave of QRS complex to the end of T wave)
[Link]-VOLUMETRIC CONTRACTION 0.05 sec
[Link] EJECTION [Duration 1/3] (2/3 or 70% blood is ejected) 0.10 sec
[Link] EJECTION [Duration 2/3] (1/3 or 30% blood is ejected) 0.15 sec
VENTRICULAR DIASTOLE 0.50 sec
(End of T wave to the peak of R wave of QRS complex)
PROTODIASTOLE ??? 0.04 sec
[Link]-VOLUMETRIC RELAXATION 0.06 sec
[Link] INFLOW/RAPID FILLING 0.11 sec
[Link] INFLOW/SLOW FILLING / DIASTASIS 0.22 sec
[Link] SYSTOLE (after P wave) 0.11 sec

7 Phases of CARDIAC CYCLE 0.8 Sec

 ISOVOLUMETRIC CONTRACTION

Increase in ventricular pressure >

atrial pressure → AV valves close
After 0.06s, semilunar valves open
Period between AV valve closure
and semilunar valve opening →
heart prepares for contraction
without shortening→ occurs
without emptying
Tension develops without change in
muscle length
(Isometric/Isovolumetric)
 EJECTION

• When LV pres > 80 mm Hg

RV pres > 8 mm Hg,
The semilunar valves open.
• Rapid Ejection – 70% emptying in
first 1/3 duration
• Slow Ejection – 30% in last 2/3 time
• The pressure in the ventricle keeps
decreasing until it becomes lower
than that of the great vessels
 ISOVOULUMETRIC RELAXATION
•When ventricle pressure < arterial
pressure→ backflow of blood → forces
semilunar valves to close.
•For 0.06 s, ventricle relaxes despite no
change in its volume
• AV and Semilunar valves are closed
•Meanwhile, atria fill up and atrial
pressure gradually rises
•Pressures in ventricle keep falling till
it is < atrial pressure
PROTODIASTOLE???
Once the ventricular muscle is fully
contracted, the already falling ventricular
pressures drop more rapidly (0.04 Sec)
 VENTRICULAR FILLING
Begins with the
opening of AV valves
• Rapid filling
– first 1/3 of diastole
(60-70% blood flows)
• Reduced filling
(Diastasis) – middle 1/3 of
diastole (<5% blood flows)
• Atrial contraction –
last 1/3 of diastole (25 %
blood)

As the atrial pressures fall, the AV valves close and left

ventricular volume is now maximum → EDV (120 ml in LV)
PRESSURE CHANGES
 PRESSURE CHANGES IN CARDIAC CYCLE

Remember: Events are the same in the right &

left sides of the heart, but with lower pressures
in the right side
VOLUME CHANGES
• End Diastolic Volume: Volume of blood in each
ventricle at the end of diastole.

It is about 110 – 130 ml.

• End Systolic Volume: Volume of blood in each

ventricle at the end of Systole. It is about 40 to
60 ml

• Stroke Volume: It is a volume of blood pumped

out by each ventricle per beat. It is about 70 ml.
Stroke volume (SV) = EDV – ESV
EJECTION FRACTION (EF) is the percentage of
ventricular end diastolic volume (EDV) which is
ejected with each stroke (60-65%).

SV or (EDV – ESV)
EF = X 100
EDV

75
X 100 = 62.5%
120
Normal ejection fraction is about 60 – 65 %.
Ejection fraction is good index of ventricular function.
 ATRIAL SYSTOLE
Atrial Depolarization

Atrial contraction

Atrial pressures rise

Blood flows across AV valves

ATRIA act as PRIMER PUMPS Ventricular filling :

& increase the ventricular pumping • 60-70% - direct flow from VR
• 25% - atrial contraction.
effectiveness by as much as 20-25%
 At Rest Hear Rate & Cardiac Cycle
What is the
HR??
After
HR = 60 /CC Duration Exercise

When the heart rate is 

diastole is shortened to a much
greater degree than systole.
 Heart Rate & Cardiac Cycle
• Higher the rate lesser is duration of Cardiac cycle.
• However, the duration of systole is much more
fixed than that of diastole.
Physiologic and clinical implications of shortened diastole:
The heart muscle rests during diastole. Coronary blood flows
to the subendocardial portions of the left ventricle only
during diastole. Furthermore, most of the ventricular filling
occurs in diastole.

Up to about 180/min, filling is adequate as long as there is

enough venous return, and cardiac output per minute is
increased by an increase in rate. However, at very high heart
rates, filling may be compromised to such a degree that
cardiac output per minute falls.
 EFFECT OF ATRIAL CONTRACTION ON
VENTRICLE FILLING

 At rest, atrial
contraction adds little
extra blood to the
ventricles.
 When the heart rate is
high, ventricle filling time
is reduced.
 During exercise, atrial
contraction adds a MORE
amount of blood to the
ventricles.
AORTIC PRESSURE CURVE
a. Ascending or anacrotic limb:
 This coincides with the
‘rapid ejection phase’
 The amount of blood
enters aorta > leaves
 Aortic pressure ↑ up to
120 mmHg
b. Descending or catacrotic
limb: (Has 4 stages)

Pulmonary artery pressure changes

are similar to the aortic pressure
changes [Magnitude 3-4 times Less].
Normal pulmonary artery pressure
during the cardiac cycle ≈ 25-30/4-
12 mmHg
 Descending / Catacrotic limb - 4 STAGES
1. ↓ Aortic pressure:
 This coincides with the ‘reduced
ejection phase’
 The amount of blood enters aorta
< leaves
2. Dicrotic notch (incisura):
Due to closure of aortic valve
 There is sudden drop in aortic
pressure
 This notch is seen in the aortic
pressure curve at end of
ventricular systole
3. Dicrotic wave:
Due to elastic recoil of the aorta
 Slight ↑ in aortic pressure
4. Slow ↓ in aortic pressure: up to
80 mmHg Due to continued flow of
blood from aorta → systemic
circulation
Atrial pressure changes during the cardiac cycle
THE JUGULAR VENOUS PULSE (JVP)
 Atrial pressure changes during the
cardiac cycle
The 3 wave (a, c, & v) are equal
to ONE cardiac cycle = 0.8 sec

DIASTOLE SYSTOLE DIASTOLE

3 upward waves:
 a, c, & v waves 2 downward deflection
 2 components in each (waves):
wave: +ve (↑ pr), -ve  x & y waves
(↓ pr)
 Atrial pressure waves

‘a’ wave: Atrial systole:

↑ atrial pressure during atrial contraction

‘c’ wave: Ventricular systole

+ve as a result of bulging of AV valve
into the atria during ‘isovolumetric
contraction phase’
 -ve as a result of pulling of the atrial
muscle & AV cusps down during ‘rapid
ejection phase’, resulting in ↓ atrial
pressure
 Atrial pressure waves
‘v’ wave: Atrial diastole
+ve: atrial pressure ↑ gradually
due to continuous VR
-ve as a result of ↓ atrial
pressure during ‘rapid filling
phase’
‘x’ descent:
Downward displacement of AV
valves during ‘reduced ejection
phase’
‘y’ descent:
↓ atrial pressure during
‘reduced filling phase’
 ABNORMALITIES OF “a” WAVE
• Elevated a wave
Tricuspid stenosis
Decreased ventricular compliance (ventricular failure,
pulmonic valve stenosis, or pulmonary hypertension)
• Cannon a wave
Atrial-ventricular asynchrony (atria contract against a closed
tricuspid valve)
complete heart block, following premature ventricular
contraction, during ventricular tachycardia, with
ventricular pacemaker
• Absent a wave
Atrial fibrillation or atrial standstill
Atrial flutter
CORRELATING EVENTS TOGETHER
Horizontal Integration

Vertical Integration
4TH 26
• Phase of atrial contraction at end of
diastole (JVP – ‘a’ wave ) [ ≈ 0.11 sec]
ATRIAL SYSTOLE: 1
• Preceded by atrial depolarization ( P wave).
• Valves: A-V valves open (semilunar
valves closed). blood goes from atria to
ventricles.
• Ventricular volume: up to 130 ml (EDV) .
• Ventricular pressure: First slightly ↑ due
to entry of blood from atria. Then ↓ due to
dilatation of ventricles. In both cases, it is
less than atrial P.
• Atrial pressure: First ↑ due to systole of
R
atria. Then ↓ due to blood passage into
ventricles. P T

• 4th (S4) Heart sound heard (Vibration of

the vent wall during atrial contraction).
 ISOVOLUMETRIC CONTRACTION: 2
• Start of ventricular systole [≈ 0.04 sec]
• Starts with closure of A-V valves.
• Heart Sounds: S1
• Semilunar valves: Still closed
• Ventricle contracts with no changes in
volume ( isometrically, no shortening)
• ECG: End of QRS complex
• Volume in ventricle: EDV (120 ml)
• Ventricular pressure: ↑ suddenly
• Aortic valve opens at the end of this
phase, when LV exceeds 80mmHg.
• Atrial pressure: ↑ due to doming of cusps R

of closed A-V valves into atria. P T

• JVP – ‘c’ wave → due to the bulging of the
Tricuspid valve into RA
 Rapid EJECTION 3 Rapid, 4 Slow
• The ventricles contract isotonically (with
shortening) ejecting 75% of stroke volume.
• Duration: ≈ 0.10 sec.
• Semilunar valves open at beginning of this
phase when LV pressure exceeds 80 mmHg.
• AV valves: Still closed.
• Ventricular pressure: 
• Ventricular volume: 
• Atrial pressure: First  because when
ventricles contract, they pull fibrous AV ring
with AV valves downward
• Heart sounds: none R

• Aortic pressure:  P T

• ECG – T wave
• Heart sounds – none
 Slow EJECTION 3 Rapid, 4 Slow
• The ventricles contract with lesser force and
less blood is ejected (end of systole).
• Almost 25% of Stroke Volume is ejected.
• Duration: ≈ 0.15 sec.
• AV valves: Still closed.
• Semilunar valves: Still opened.
• Atrial pressure: Still  gradually due to
venous return.
• Ventricular volume: Continue to .
• Ventricular pressure: 
• Heart sounds: none
• Aortic pressure:  Even at the end of R
systole pressure in the aorta is maintained
P T
at 80-90 mm Hg (Why?)
• ECG: T wave
• Heart sounds: none
 ISOVOLUMETRIC RELAXATION: 5
• The ventricles relax at the start of
diastole.
• It lasts for ≈ 0.06 sec.
• Ventricular volume: is constant at the
ESV (60 ml).
• Semilunar valves: close at the beginning
of the phase (Result in S2).
• A-V valves: Still closed.
• Ventricular pressure:  rapidly,
• Atrial pressure: Still  gradually due to
accumulation of venous blood. (JVP: ‘v’
wave)
• ECG: End of T wave T
• Aortic pressure curve: INCISURA -
backflow of blood coming across a
closed aortic valve
 Rapid filing VENTRICULAR FILLING
Rapid filing 6: Reduced filling 7: Atrial contraction 1
• About 60-70% of blood passes
passively to the ventricles [≈ 0.11
sec].
• Heart sound: [S3] due to rush of blood
into ventricles and vibration in
ventricular wall.
• Semilunar valves: Still closed.
• Atrial pressure: First sudden ↓ due to
rush of blood from atria to ventricles.
Then gradually  due to entry of R
venous blood.
P T
• Ventricular volume:  because it is
being filled with blood.
• Ventricular pressure: Slightly  but <
atrial pressure
 Reduced filling VENTRICULAR FILLING
Rapid filing 6: Reduced filling 7: Atrial contraction 1

• Remaining atrial blood flows

slowly into ventricles by pressure
gradient <5%. [≈ 0.22 sec]
• A-V valves: still open.
• Semilunar valves: Still closed.
• Atrial pressure: Still ↑
• Ventricular volume: Still ↑
• Ventricular pressure: Slightly ↑ R
gradually T
P

JVP – ‘y’ descent in first 2/3 & ‘a’

wave in last 1/3
ECG – P wave before atrial systole
“Volume-Pressure Diagram” During the Cardiac Cycle;
Cardiac Work Output.
 VENTRICULAR PRESSURE - VOLUME LOOP
End of Systole Plots LV pressure
against LV volume
through one
SBP complete cardiac
cycle

DBP

Start of Systole
→ Late Diastole

(Filling phase)
A. Increased preload:  venous return → increase in SV based on the
Frank–Starling relationship….reflected in increased width of the PV loop.
B. Increased afterload: due to an increase in aortic pressure →
decrease in stroke volume….is reflected in decreased width of the PV
loop.
C. Increased contractility: → increased width & height of the PV loop.
VENTRICULAR VOLUME CHANGES
VENTRICULAR PRESSURE CHANGES
HEART SOUNDS & CARDIAC CYCLE
ECG CHANGES IN CARDIAC CYCLE