Cardiac Cycle

(See cardiac cycle graph printout for left side of heart)

1. just before P wave on ECG
o SA node fires
o AV valves are open
o semi-lunar valves are closed
a. atrial pressure > ventricular pressure, so AV valves are open
aortic pressure is at a minimum = diastolic pressure
b. Ventricular volume is around 100ml (not zero) due to blood refilling
the heart after the previous systole
c. Start of P wave
d. Hear blood turbulence at start of atrial contraction with a high atrial
pressure = S4 (quiet)
2. after P wave on ECG
o atrial contraction to force blood into ventricles
o AV valves are open
o Semi-lunar valves are closed
a. increase atrial pressure as volume is smaller
AV valve is open so also increases pressure in ventricles
b. small increase in ventricular volume
c. end of P wave
d. no sound
3. AV nodal delay
o Atria finish contracting
o AV valves are open
o Semi-lunar valves are closed
a. Atrial and ventricular pressures decrease
b. Maximum ventricular volume
c. No net current
d. No sound
4. ventricles start contracting, AV valves close
o isovolumetric ventricular contraction
o AV valves are closing (mitral valve shuts just before tricuspid valve)
o Semi-lunar valves are closed
a. ventricular pressure increases a lot as volume decreases and both
valves are shut so blood cant leave
atrial pressure increases a little as AV valves are open and get some
backflow, then AV valves bulge into atria to increase pressure further
ventricular pressure > atrial pressure so AV valves close
b. ventricular volume stays the same as both valves are shut so blood
stays in ventricle = isovolumetric ventricular contraction
c. QRS complex
d. vigorous closing of AV valves to produce lub sound = S1 (loud)
5. semi-lunar valves open

o AV valves are closed

o Semi-lunar valves are opening
a. Ventricular pressure > aortic pressure to open semi-lunar valves
Aortic and ventricular pressures rise further as ventricles still
contracting
Atrial pressure decreases due to torsion as heart moves laterally and
anteriorly during cardiac cycle to pull atria
b. Ventricular volume decreases as blood leaves ventricles
Not all blood leaves (falls to 50-60ml) due to systolic reserve
During exercise your ejection fraction increases to leave less systolic
reserve to increase cardiac output
Systolic reserve = amount of blood remaining in the ventricle when the semi-lunar
valves close (or end-systolic volume ESV)
Ejection fraction = fraction of blood ejected from the ventricles in one heart beat
c. End of QRS complex
d. No sound
e. Aortic blood flow:
o Zero blood flow when semi-lunar valves are closed
o Large increase in flow when semi-lunar valves open
o Negative backflow when semi-lunar valves close as blood sucked
backwards to help promote flow through coronary arteries
o Ventricular contraction = close coronary arteries
o Ventricular relaxation = perfusion through coronary arteries

6. ventricular diastole
o AV valves are closed
o Semi-lunar valves are closing (aortic before pulmonary)
a. Pressure in ventricles and aorta fall together, similar pressures as semilunar valves are open
Pressure in aorta > ventricular to close semi-lunar valves
Blip in aortic pressure due to semi-lunar valves closing

Ventricular pressure falls

Atrial pressure slowly increases as blood is constantly returning to
heart
b. ventricular volume stays the same as both valves are shut so blood
stays in ventricle = isovolumetric ventricular relaxation
c. T wave
d. Vigorous closing of semi-lunar valves to produce dup sound = S2
(loud)
7. AV valves open
o AV valves are opening
o Semi-lunar valves are closed
a. Ventricular pressure < atrial pressure to open AV valves
Atrial pressure decreases a little as blood moves into ventricles when
AV valves open
b. As AV valves open, blood rushes into ventricles to increase ventricular
volume rapidly
c. End of T wave
d. Can hear blood turbulence moving from atria to ventricles in a
stethoscope = S3 (quiet)
8. whole heart diastole
o AV valves are open
o Semi-lunar valves are closed
a. atrial and ventricular pressures rise slowly as blood continues to enter
heart
aortic pressure falls as blood moves away from heart
b. ventricular volume increases as blood enters heart
c. diastole, no electrical activity
d. no sound
**Jugular venous pressure mimics atrial pressure as there are no valves between them
so pressures are similar**
Asynchrony
- differences between left and right sides of heart
- due to pressure differences in the systemic circulation (high) and the
pulmonary circulation (low)
- gives rise to sound splitting
- sound splitting of S2/dup occurs especially during inspiration as:
1. intrathoracic pressure decreases
2. increases venous blood return through vena cavas to right atrium and
ventricle and decreases venous blood return through pulmonary vein to left
atrium and ventricle (as want to stay in lungs due to low pressure)
3. more blood in right than left ventricle during ventricular contraction
4. pulmonary valve stays open for longer to eject more blood from right
ventricle
5. aortic valve stays open for less to eject the less blood from the left
ventricle

o can get a fixed S2 split when it is split independently of inspiration, as

there is an increase in venous return to right ventricle compared to left
ventricle due to an atrial septal defect that shunts blood to right atrium
1. right atria contracts before left atria, as SA node is in right atrium
2. left ventricle contracts before right ventricle
3. right ventricle ejection before left ventricle as:
o right ventricle ejects into pulmonary circulation which is a low
pressure so only needs to increase pressure by a little to open semilunar valves
o left ventricle ejects into systemic circulation which is a high pressure
so needs to build pressure more to open semi-lunar valves
Heart Sounds
- due to closing of valves, turbulence of blood flow and movement of heart
walls
- blood turbulence is due to increased velocity of blood or narrowed vessels
- sounds can be split into 2 as left and right valves do not close at exactly the
same time (see asynchrony above) especially during inspiration
1. S1 = vigorous closing of AV valves (predominantly due to mitral valve) and
stopping of movement of blood into atria to produce loud, low pitched lub
sound which lasts for 50-100 milliseconds at end of QRS complex at start of
ventricular contraction
2. S2 = vigorous closing of semi-lunar valves to produce loud, high pitched dup
sound which lasts for 25-50 milliseconds at end of T wave at ventricular
relaxation (can split with inspiration, see asynchrony above)
3. S3 = blood turbulence moving from atria to ventricles and vibrations in heart
walls to produce a quiet sound at end of T wave (just after S2) at ventricular
relaxation
4. S4 = atrial sound = blood turbulence and contraction of atria to produce a
quiet, low frequency, low amplitude sound at start of P wave at start of atrial
contraction