Mechanical events of the cardiac cycle Flashcards
cardiac cycle
recurring atrial and ventricular contractions and relaxations
systole
ventricular contraction and blood ejection
diastole
alternating period of ventricular relaxation and blood filling
how long does the cardiac cycle last?
for typical rate of 72 beats/min
0.8 sec - 0.3 in systole and 0.5 in diastole
2 parts of systole
isovolumetric ventricular contraction
ventricular ejection
isovolumetric ventricular contraction
ventricles are contracting but all valves in the heart are closed, so no blood is ejected. atria are relaxed
ventricular walls are developing tension and squeezing on blood, increasing ventricular blood pressure
ventricular muscle fibres can’t shorten because volume of blood is constant and blood is incompressible
ventricular ejection
increasing pressure in the ventricles exceeds pressure in the aorta and pulmonary trunk - aortic and pulmonary valves open. blood is forced into the aorta and pulmonary trunk.
ventricular muscle fibres shorten
atria are relaxed and AV valves are closed
what is the stroke volume?
volume of blood ejected from each ventricle during systole
parts of diastole
isovolumetric ventricular relaxation
ventricular filling
isovolumetric ventricular relaxation
ventricles begin to relax and aortic and pulmonary valves close
AV valves are closed, no blood is entering or leaving the ventricles
atria are relaxed
ventricular filling
AV valves open, blood flows in from the atria
after most of ventricular filling, the atria contract
approx. 80% of ventricular filling occurs before atrial contraction
mid-diastole to late diastole: 1
left atrium and ventricle are both relaxed
atrial pressure slightly higher than ventricular pressure because it’s filled with blood entering from the veins
mid-diastole to late diastole: 2
AV valve held open by the pressure difference, and blood entering the atrium from the pulmonary veins continues into the ventricles
mid-diastole to late diastole: 3
aortic valve is closed because aortic pressure is higher than the ventricular pressure
mid-diastole to late diastole: 4
throughout diastole, pressure in the aorta is slowly decreasing because blood is moving out of the arteries and through the vascular system
mid-diastole to late diastole: 5
ventricular pressure is increasing slightly due to blood entering relaxed ventricle from the atrium and expanding ventricular volume
mid-diastole to late diastole: 6
near the end of diastole, the SA node discharges and the atria depolarise
mid-diastole to late diastole: 7
contraction of the atrium increases atrial pressure
mid-diastole to late diastole: 8
elevated atrial pressure forces a small additional volume of blood into the ventricle (atrial kick)
mid-diastole to late diastole: 9
end of ventricular diastole
amount of blood in ventricle is the end-diastolic volume
systole: 10
from the AV node, the wave of depolarisation passes into and throughout ventricular tissue, triggering contraction (QRS complex)
systole: 11
as ventricle contracts, the ventricular pressure increases immediately, exceeding the atrial pressure
systole: 12
change in pressure gradient forces AV valve to close, preventing blood from flowing back into the atria
systole: 13
aortic pressure still exceeds ventricular pressure, so the aortic valve is closed.
isovolumetric ventricular contraction
backward bulging of the AV valves causes a small upward deflection in the atrial pressure wave
systole: 14
rapidly increasing ventricular pressure exceeds aortic pressure
systole: 15
pressure gradient forces aortic valve to open, and ventricular ejection begins
systole: 16
ejection is rapid at first, then slows down
systole: 17
amount of blood remaining in ventricle after ejection is the end systolic volume
stroke volume and typical values
edv - esv
sv = 70 mL
edv = 135 mL
esv = 65 mL
systole: 18
aortic pressure increases with the ventricular pressure as blood flows into the aorta
very small pressure changes exist between the ventricles and aorta due to the aortic valve having little resistance to flow
systole: 19
peak ventricular and aortic pressures are reached before the end of ventricular ejection
start to decrease in last part despite continued contraction
systole: 20
force reduction evidenced by reduced rate of blood ejection in last part of systole
systole: 21
volume and pressure in the aorta decreases as the rate of blood ejection from the ventricles becomes slower than the rate at which blood drains from arteries into tissues
early diastole: 23
ventricles relax. ventricular pressure decreases below aortic pressure (elevated due to blood having entered). change in pressure gradient forces aortic valve to close.
AV valves also closed due to ventricles having higher pressure than atria
what is the dichrotic notch
combination of elastic recoil of the aorta and blood rebounding against the valve causes a rebound of aortic pressure
early diastole: 24
isovolumetric ventricular relaxation. ends when rapidly decreasing ventricular pressure decreases below atrial pressure
early diastole: 25
change in pressure gradient causes AV valve to open
early diastole: 26
venous blood that accumulated in the atria since the AV valve closed flows into the ventricles
how is the rate of blood flow enhanced in early filling?
rapid decrease in ventricular pressure
what is the rapid decrease in ventricular pressure caused by?
previous contraction compressed elastic elements of the chamber so ventricle tends to recoil outward after systole
may create subatmospheric pressure
some energy is stored within the myocardium during contraction, and its release in relaxation aids filling
importance of filling occurring in early diastole
ensures filling is not impaired when heart beats very rapidly - total filling time reduced
early filling and conduction defects
conduction defects eliminating atria as effective pumps don’t seriously impair ventricular filling
atrial fibrillation
cells of atria contract in uncoordinated manner, so atria don’t work as effective pumps
pressure changes in pulmonary circulation
qualitatively similar
quantitative differences
systemic arterial pressures vs pulmonary arterial pressures
systemic arterial systolic (120mmHg) and diastolic (80mmHg)
pulmonary arterial systolic (25mmHg) and diastolic (10mmHg)
how are heart sounds heard?
stethoscope placed on chest wall
first and second sounds and their associations
1st: soft, low-pitched lub - closure of AV valves
2nd: louder dup - closure of pulmonary and aortic valves
lub is onset of systole
dup is onset of diastole
what do heart sounds result from?
vibrations caused by the closing valves
heart murmurs
sounds other than 2 normal heart sounds
what can heart murmurs be caused by?
heart defects causing blood flow to be turbulent
laminar flow
blood flows in smooth concentric layers
turbulent flow causes
stenosis
insufficiency
septal defect
what is stenosis?
blood flowing in usual direction through an abnormally narrowed valve
what is insufficiency?
blood flowing backwards through a damaged, leaky valve
what is a septal defect?
blood flowing between 2 atria or 2 ventricles through a small hole in the wall separating them
murmur heard throughout systole
suggests stenotic pulmonary or aortic valve, insufficient AV valve or hole in interventricular septum
murmur heard throughout diastole
stenotic AV valve or insufficient pulmonary or aortic valve