eLFH - Cardiovascular Physiology Part 1 Flashcards
Cardiac cycle definition
Time taken to complete one systole and one diastole
Ratio of cycle spent in systole vs diastole
At rest one third systole, 2 thirds diastole
At faster heart rates ratio approaches 50:50
Normal peak LV pressures
120 mmHg
Normal peak RV pressures
25 mmHg
Total volume ejected into aorta per cycle (stroke volume)
70 ml
Pressure-time curve for LV, Aorta, LA and ECG
How would pressure- time curve differ for RV compared to LV
Same morphology as LV curve but at much lower pressures
Pressure-time curve for LV, Aorta and LA with key processes labelled
Explanations of each follows
Atrial systole
Pressure from atrial ejection of blood into ventricular cavity
Mitral valve closes
Atrial systole completes ventricular filling
Pressure in LV > LA
MV closes
Isovolumetric contraction
Both mitral and aortic valves closed
Pressure in LV increases until exceeds aortic pressure and AV opens
Aortic valve opens
AV opens at ~ 80 mmHg
Ejection
Ventricular ejection into aorta as LV pressure > aortic pressure
Initially ejection is rapid and then slows
Aortic valve closes
As ejection continues, LV pressure falls
AV closes once aortic pressure > LV pressure
Isovolumetric relaxation
Both MV and AV closed
Steep fall in pressure
Metabolically active process
Mitral valve opens
As LV pressure falls below LA pressure, MV opens and passive ventricular filling begins
Why does aortic pressure fall during diastole after aortic valve closes
Run off of blood into the vascular tree
What causes dichrotic notch on aortic pressure trace
Elastic recoil of aortic walls
Percentage of LV filling from atrial contraction vs passive filling
30% atrial contraction
70% passive filling
Left atrium pressure-time curve with key waves identified
Explanation of each follows
a wave
Atrial contraction
c wave
Small increase in LA pressure as isovolumetric contraction bulges back of the closed mitral valve
x descent
As ventricle contracts, pulls fibrous atrio-ventricular rings towards the apex of the heart
This comparatively lengthens the atria and causes pressure in LA to fall
v wave
LA pressure rises due to venous return accumulating in atria during systole whilst mitral valve remains closed
y descent
Mitral valve opens and blood flows into ventricle
Therefore LA pressure falls
Changes to LA pressure-time curve in AF
Absent a waves
Changes to LA pressure-time curve in Tricuspid regurgitation
Giant c wave
Loss of x descent
Merging of v wave
Changes to LA pressure-time curve in AV junction block
Regular cannon a waves
Changes to LA pressure-time curve in Complete heart block
Irregular cannon a waves
Pressure-volume loop for LV
Valves on Pressure-Volume loop for LV
A = MV open
B = MV closes
B to C = Isovolumetric contraction
C = AV opens
C to D = Ejection
D = AV closes
D to A = Isovolumetric relaxation
Stroke volume on Pressure-Volume loop for LV
SV = LVEDV - LVESV
Left ventricular end diastolic volume - Left ventricular end systolic volume
Work done by LV from pressure-volume loop
Work done = Pressure x Volume
Therefore Work done = area inside the loop
Three factors which modify the pressure-volume loop for LV
Preload
Contractility
Afterload
Preload definition
End diastolic stretch or tension of the ventricular wall
Represented on pressure-volume loop as LVEDV