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The Cardiac Cycle

The four chambers of the heart are continually contracting and relaxing in a sequence known as the cardiac cycle. Contraction of a chamber is SYSTOLE (pronounced sistolee) and relaxation DIASTOLE (pronounced diastole). The left and right sides of the heart actually contract simultaneously but in order to understand how blood moves through the circulatory system we will consider each half separately. Right atrium receives blood from o Superior vena cava (SVC) - carries blood from upper body (head, arms) o Inferior vena cava (IVC) - carries blood from lower body (chest, abdomen, legs) Blood flows from right atrium, across tricuspid valve, into right ventricle Blood leaves right ventricle and enters pulmonary artery o Backflow into RV prevented by semilunar pulmonic valve o Deoxygenated blood arrives at lungs via pulmonary artery o Oxygenated blood leaves lungs via pulmonary vein Blood from pulmonary vein enters left atrium Blood flows from left atrium, across mitral valve, into left ventricle Left ventricle has a thick muscular wall / generates high pressures during contraction Blood from LV is ejected, across aortic valve, into aorta

TASK: using a simple diagram (boxes will do), draw arrows showing how the blood moves through the chambers and blood vessels. A common exam question at both GCSE and A Level is why is the muscle of left ventricle is thicker than right ventricle? If youve done a heart dissection at school, this will certainly be something which the teachers pointed out and there is in fact a considerable difference between the two chambers. The reasons for this are outlined below: The pressure of the blood in the aorta is higher than pulmonary artery The left ventricle must therefore generate more pressure to overcome pressure of aorta Therefore, thicker muscle required in left ventricle

The problem of backflow: Between each chamber of the heart are valves which prevent the blood being forced back into the chamber from which it was just pushed out. Between the atria and the ventricles are the tricuspid and mitral valves (mitral is on the left and tricuspid on the right). These are known as the atrioventricular valves. If youve dissected a heart you will have seen fibrous strands leading from flaps at the top of the ventricles. These strands (cordae tendinae) are attached to papillary muscles which contract during ventricular systole which generates tension pulling the AV valves shut. The pulmonary artery and the aorta also contain valves to prevent the blood from these vessels falling back into the ventricles. These are known as the Semilunar valves (pulmonic and aortic). They do not work in the same way as the AV valves. Instead, the pressure of blood within the vessel actually causes the closure of the semilunar valves.

Pressure Changes
At several points so far, pressure has been mentioned. It is an important aspect of the cardiac cycle and a factor which can be used to identify which stage of the cardiac cycle a heart is in. In fact, examiners love to provide you with pressure graphs and ask you to analyse the cardiac cycle. It is therefore worth us spending a little time going over the principles of Isovolumetric contraction - it sounds worse than it is! As a chamber fills with blood, the pressure is going to rise. When a chamber contracts, the pressure is going to rise. Changes in pressure affect whether a valve is open or closed. Fluids always move

from areas of high pressure to areas of low pressure. Let us think through the cardiac cycle in terms of pressure: As the blood passes into the atria, the valves are open so most will fall immediately into the ventricle. There is a gradual rise in pressure in the atria until the end of atrial systole when the blood has moved into the ventricles. The intraventricular pressure rises as the ventricles fill with blood. This closes the AV valves. Contraction of the ventricles means that the intraventricular pressure is higher than the pressure in the artery which forces the blood out of the ventricle and into the aorta or pulmonary artery (depending on which side of the heart youre looking at). The increase in pressure of the artery causes the closing of the semilunar valves preventing the back flow of blood into the ventricle.

H5.1 Cardiac cycle

The cardiac cycle is the repetitive sequence of events in which the heart chambers contract and relax in a co-ordinated manner to send blood continuously around the circulatory system. As with all cycles there is strictly speaking no one point that can be considered the beginning. The notes provided here follow the lead of other authors in terms of the beginning of the cycle and the associated diagrams. Basic Heart Structure: This diagram covers the basic internal structure of the heart. The heart should be regarded as a double pump (left side and the right side). Each side of the heart works in synchrony with the other side in the cardiac cycle. The events on one side of the heart are mirrored by those on the other side. The left ventricle is larger than the right ventricle in both the ventricular volume and the thickness of the surrounding muscular walls. Heart Valves: As with all pressurised fluid system there is a valve system to maintain the one way flow of blood. The atrio-ventricular valves prevent backflow of pressurised blood from the ventricle to the atria. The right atrio-ventricular valve has three cusps (tricuspid). The left side of the heart has two cusps and is also known as the bicuspid valve.

The semi-lunar valves prevent back flow from arteries to the ventricles when the heart relaxes (diastole). Heart Sounds are caused by closure of the heart valves.

Diastole: All heart muscle in state of relaxation. - Arterial blood pressure is greater than ventricle pressure. - The semilunar valves are closed. - Ventricle pressures are still higher than atrial pressures - Atrio-ventricular valves closed. Atrial Distention At this point the atria are both filling with blood from both the pulmonary veins and the vena cava. Graph ref: (10)

Atrial Distention: - The heart is still in a state of diastole. - All the valves are all closed. = The passive return of blood to the atria along veins causes the pressure to rise within the atria and the walls to distend. (swell) Graph Ref (10 to 1 ) but rising pressure

Note that this stage is still diastole: - The pressure in the atria is greater than the pressure in the ventricles. - The pressure difference causes the atrioventricular valve to open. - The ventricle passively fills with blood. - Note the semi-lunar valves are still closed. Graph ref (1) note the rise in ventricle pressure

Early Atrial Systole - The atria contract together (see myogenic contraction). - The contraction of the atrial muscle reduces the volume of the atria. - This volume reduction increases the pressure on the blood within the atria. - The pressure increases forces the additional volume of blood into the ventricle. - This stretches the ventricle walls Graph ref: peak of (1)

Systole: Contraction of the ventricles. graph ref (b) - The ventricle walls contract on both sides. - There is a sudden pressure increase within the ventricles. - The pressure in the ventricles is greater than the pressure in the atria - Atrio-ventricular valves close. (First heart sound "Lub"). - Ventricle pressure is lower than arterial pressure. - Semi-lunar valves remain closed. Graph ref: (2) Iso-volumetric contraction, in which the ventricle contracts increasing the blood pressure but the blood cannot yet pass out into the artery. This gives a sudden and large pressure increase. Graph ref (3)

Systole continues - Ventricle pressure is greater than arterial pressure. - The semi-lunar valves open. - Blood ejects into the arteries (a pulse). Graph ref (4) - Pressure in the ventricles peaks rapidly as we come to the end of systole. - Note the atrio-ventricular valves are still closed graph ref (5) - As pressure falls in the ventricle the arterial blood will backflow closing the semilunar valves and creating the second heart sound, "dub". Graph ref: (6) We now return to the first diagram in the cycle as we are back in a relaxed condition called diastole. graph ref: (a) diastole

(a) Diastole (ventricles are relaxed) (b) Systole (ventricles contracted) (1) Atrial systole (2) Ventricular Systole , atrioventricular valves close, first heart sound. (3) Iso-volumetric contraction (4) Opening semi-lunar valves (5) Peak of systolic pressures (6) End of ventricular systole, closure of the semi-lunar valves, second heart sound. Beginning of diastole (7) Aorta pressure during ventricular diastole (8) Falling ventricular pressure (Diastole) (9) Passive atrial filling with blood/ compression from systole (10) Passive filling blood by venus return