Académique Documents
Professionnel Documents
Culture Documents
2. Semilunar
a. pulmonic--
three leaflets
b. aortic--three
leaflets
Heart Valves
Diastole
Systole
Section 1 The Heart as a Pump
I. The Cardiac Cycle3
1. Concept:
The period from the end of one heart contraction to the end of the next
Properties:
1) Diastole is
longer than systole
2) The sequence of
systole and diastole
2 The Phases of the Cardiac Cycle
(1) Period of isometric (isovolumetric
or isovolumic) contraction
Events:
ventricular muscle relax
the ventricular pressure
fall
lower than the aortic
pressure
aortic valve close
the ventricular pressure
fall sharply
Period: 0.06-0.08 s
Importance: Enable the ventricular pressure fall to
the level near the atrial pressure
(4) Period of filling of the ventricles
Events: Ventricular muscle relax continuously
the ventricular pressure is equal or lower than the atrial
pressure
atrioventricular valve open
blood accumulated in
the atria rushes into the
ventricular chambers
quickly from the atrium
to the ventricle.
1) Period of rapid filling. (0.11s, amount of filling, 2/3)
2) Period of reduced filling (0.22s, little blood fills into the
ventricle)
(5) Atrial systole
1) Significance, 30% of the filling
During high output states or in the failing heart,
the amount added by atrial contraction may be of major importance
in determining the final cardiac output.
LEFT VENTRICULAR PRESSURE (mmHg) LEFT VENTRICULAR
PRESSURE/VOLUME P/V LOOP
120 F
E
80 D
40
A B
C
0
50 100 150
LEFT VENTRICULAR VOLUME (ml)
2) Pressure changes in the atria, the a, c, and v waves.
a wave, the atrial contraction
c wave, bulging of
the A-V valves
when the ventricles
begin to contract
v wave, at the end of ventricle contraction, caused by
the accumulated blood in the atria while the A-V
valves are closed
Heart Sounds
opens
Aortic
Mitral
Closes
CARDIAC CYCLE
Atrial Systole
Isovolumic contract.
S1
Rapid Ejection
Reduced Ejection
S2
Isovolumic Relax.
Rapid Ventricular
Filling
Reduced Ventricular
Filling
Atrial Systole
:>D
opens
closes
Mitral
Aortic
II Cardiac Output
1. Stroke Volume – The volume pumped by the heart
with each beat,
= end diastole volume – end systole volume,
about 70 ml
2. Ejection Fraction – Stroke volume accounts for the
percentage of the end diastolic volume,
= stroke volume / end diastole volume X 100%,
normal range, 55-65%
3. Minute Volume, or Cardiac Output – the volume of
the blood pumped by one ventricle,
= stroke volume X heart rate.
It varies with sex, age, and exercise
4. Cardiac Index, the cardiac output per square meter
of body surface area.
the normalized data for different size individuals,
the normal range is about 3.0 – 3.5 L/min/m2
Determinants of Cardiac Output (CO)
Contractility
Cardiac
Output
Definitions
• Preload
– amount of stretch on the ventricular myocardium
prior to contraction
• Afterload
– the arterial pressure (or some other measure of the
force) that a ventricle must overcome while it
contracts during ejection
– impedance to ventricular ejection
Definitions
• Contractility
– myocardium’s intrinsic ability to efficiently
contract and empty the ventricle
– (independent of preload & afterload)
Determinants of Cardiac Output
1. Preload
Determinants of Cardiac
Output- Preload
Preload = ventricular filling or volume
Determinants of Cardiac Output - Preload