Cardiac Cycle and Sounds - Karius Flashcards
Electrical event vs mechanical event for heart contraction
The electrical event happens first Quality of electrical event doesn’t effect quality of mechanical event
EKG x and y axis
X : time Y : voltage
P wave is initiated by the
SA node
Conduction velocity in the AV node
Is slow causing pause = PR interval (end of P, start of R)
AV node transmits AP by purkinje fibers where in what order
Septum Apex Back up lateral walls of each V
Which direction does the heart contract of V
Towards the septum
Q wave R wave S wave
First - wave + wave Second - wave
What happens from S to T
Phase 2 (plateau phase) CA+ influx
When is heart relaxed
End of T wave
The 1st cell to depolarize in the myocytes
Is the last to repolarize
The last of the myocytes to depolarize
Is the first to repolarize
Mechanical event of heart ventricle from Q—> end of T-wave
SYSTOLE of ventricle Contracted
When is Ventricular Diastole
Relaxed From end of T-wave to beginning of QRS
When is arterial 1. Systole 2. Diastole
- Beginning of P- wave to QRS 2. QRS to strat of next P-wave
Atrial P increases when (long steady)
End of QRS to start of next P wave As it fills with blood
Ventricular Pressure increases a lot when and what effects height of this spike
QRS to end of T wave The Systemic BP determines height
Aortic P is how much at its peak
Just slight hair above the ventricular P during its peak = causes the decrease in V contraction and ejection of blood
Diastolic P on Aorta and in V
V = 0mmHg Aorta = higher like can be around 80mmHg
How much blood does the V have at end of Diastole
Around 100-120mL
How much blood does the V have at end of Systole
Ejects 50%-60% of Ventricle Maybe around 80mL
When is diastole short of long
SHORT = fast HR LONG = slow HR
Jugular P is how
Only slight hair above the Artrial P lines Decreases a little when during Ventricular repolarization or (decrease in P)
Jugular P comes from
The Jugular V going into the Atria
Reason Aortic P has
This is when the Aortic Valve closes and stays at a steady P inside Aorta before blood starts flowing down = end of ventricular ejection + systole = the V Pressure decreases a little earlier
Reason AV node has delay
Allows the atrium to contract and eject all blood to the ventricle Before ventricle contracts
What causes the spike of the ventricular Pressure to 100mmgh -120mmgh
The purkinje fibers getting signal from AV node
What makes the ventricular pressure to come down from its peak
Aortic valve opens
BP 120/70 meaning
120 : Systolic Pressure of Ventricle 70 : Diastolic Pressure of Aorta
After T wave the aortic P
Is ABOVE Atrial and Ventricular P Stays decreasing even into the start of ventricular contraction*
When does tricuspid and mitral valve close
When ventricle is contracting by AV node signal
What happens right when AV valve closes
The ventricle starts to contract (increases) The VENTRICULAR VOLUME = stays the SAME Atrial P (slight bump of increase)
What happens after AV valves have been closed for a while
The V pressure reaches a point that makes pulmonary artery Valve open V Pressure continues to increase to its peak A Pressure goes back down until venous filling later
Isovolumetric contraction
Blood volume stays the same has the pressure increases a lot Also called isometric contraction
Normal Aortic Pressure
120/70 * Aorta has to decrease to 70 mmHg for the Aortic valve to open
Normal Pulmonary artery pressure
25/15 * pulmonary A has to decrease to 15mmHg for the pulmonary valve to open
Aortic and pulmonary Valves open dictated by
DIASTOLE
When does the Aortic valve close
When the ventricular P is a hair slight higher P then aortic P Then Around 120mmHg, both decrease *end of isometric contraction
During the downward part of the ventricular and aortic peak
The aortic P is now a slight hair above P when ventricular P *POINT OF DIVERGENCE HAPPENS
Point of divergence
*dicrotic notch* When the pulmonary or aortic valve closes = the Aorta P is steady high for a bit, (due to blood bouncing back) = V P continues to decrease = A P has a tiny spike (due to blood bouncing back)
When is isometric relaxation
After all blood has been ejected into aorta or pulmonary
What happens as the AV valves are open
The atrium does not contract The ventricle is just filling
Pressure of Ventricle for blood to ENTER from Atria RIGHT LEFT
RIGHT : 25/0 LEFT : 120/ 0 *must be at 0mmHG
How fast does the aortic P decrease and what determines this
Slowish (medium) slope down TPR : peripheral resistance Low TPR = high slope decrease High TPR = low slope decrease
Diastolic BP determined by
TPR
Importance of the jugular pressure reading
See the health of the heart If heart doesn’t pump blood effectively then blood backs up
Jugular a wave
When atrium contracts , ,some blood goes back
Jugular c wave
When ventricle is in isometric contraction Ends as soon as aortic or pulmonary valve opens
V wave
As atrium fills by venous return , some blood goes back the more it gets full
LUB sound
S1 AV valve close = sound from the blood in A coming in from venous return hitting the valve that is closed causing a vibration
DUB sound
S2 Second heart sound due to closing of aortic and pulmonary valve = sound from blood in aorta or pulmonary bounces back on the valve
Reason backflow happens
Gravity, until all blood can flow away
S3 sound
When AV valve opens and the blood fills the ventricle from the atrium Right before ventricular filling start, right after S2 *normal in children or adults for only fast HR
S4 sound
During atrial contraction Last little bit of blood ejected into V * normal in children, right before S1
What causes HEART MURMUR
- Blood is moving in direction it shouldn’t (incompetent valve) 2. Blood has hard time moving in direction it should (stenosis of valve) *in either systole or diastole
Incompetent valve
Regurgitation Valve allows blood to flow through = blood moving in direction it shouldn’t *
Stenosis of valve
Valve cant open all the way * blood has hard time moving in direction it should*
Mitral regurgitation and happens when
Blood moves back in to atria DURING SYSTOLE
Blood cant move effectively into aorta or pulmonary a is a murmur when
During SYSTOLE
2 ways to get DIASTOLE murmur
- Blood moves from pulmonary a + aorta to the ventricle 2. Blood has hard time moving into ventricle from the atrium (stenosis)
Sound of systole murmur
Swish sound between LUB and DUB
Sound of Diastole murmur
Swish sound after LUB DUB More a wosh sound



