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PHYSIOLOGY OF THE CARDIAC

SYSTEM

DR PINKI TAK

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ISOVOLUMETRIC RELAXATIONRAPID INFLOW

DIASTASIS ATRIAL SYSTOLE

EJECTION

ISOVOLUMETRICCONTRACTION

SYSTOLE DIASTOLE SYSTOLE

 AORTICPRESSURE

 ATRIALPRESSURE

 VENTRICLEPRESSURE

ECG

PHONO-CARDIOGAM

   V   O   L   U   M

   E    (  m    l    )

   P   R   E

   S   S   U   R   E    (  m  m   H  g    )

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THE CARDIAC CYCLE

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ATRIAL SYSTOLE

The end of diastole

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ATRIAL SYSTOLE - Heart

Prior to atrial systole, blood hasbeen flowing passively from theatrium into the ventricle throughthe open AV valve.

During atrial systole the atriumcontracts and tops off the volumein the ventricle with only a smallamount of blood. Atrialcontraction is complete before the

 ventricle begins to contract.

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ATRIAL SYSTOLE

Pressures & Volumes

The "a" wave occurs when theatrium contracts, increasing atrialpressure (yellow).

Blood arriving at the heart cannotenter the atrium so it flows back upthe jugular vein, causing the firstdiscernible wave in the jugular

 venous pulse.  Atrial pressure drops when the

atria stop contracting. During atrial systole the atrium

contracts and tops off the volumein the ventricle with only a smallamount of blood.

 Atrial contraction is completebefore the ventricle begins tocontract. 

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ATRIAL SYSTOLE

ECG

 An impulse arising from the SA node results in depolarization andcontraction of the atria (the right atrium contracts slightly before theleft atrium).

The P wave is due to this atrial depolarization. The PR segment is electrically quiet as the depolarization proceeds to

the AV node. This brief pause before contraction allows the ventricles to fill

completely with blood.

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ATRIAL SYSTOLE

Heart Sounds

 A fourth heart sound (S4) is abnormal and is associated with the end ofatrial emptying after atrial contraction.

It occurs with hypertrophic congestive heart failure, massive pulmonary

embolism, tricuspid incompetence, or cor pulmonale.

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ISOVOLUMETRIC CONTRACTION 

The Beginning of systole

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ISOVOLUMETRIC CONTRACTION

Heart

The atrioventricular (AV) valvesclose at the beginning of thisphase.

Electrically, ventricular systole is

defined as the interval between theQRS complex and the end of the T

 wave (the Q-T interval).

Mechanically, ventricular systole isdefined as the interval between the

closing of the AV valves and theopening of the semilunar valves(aortic and pulmonary valves).

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ISOVOLUMETRIC CONTRACTION

Pressures & Volumes

The AV valves close when thepressure in the ventricles (red)exceeds the pressure in the atria(yellow).

 As the ventricles contractisovolumetrically -- their volumedoes not change (white) -- thepressure inside increases,approaching the pressure in the

aorta and pulmonary arteries(green).

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ISOVOLUMETRIC CONTRACTION

ECG

The electrical impulse propagates from the AV node through the Hisbundle and Purkinje system to allow the ventricles to contract from theapex of the heart towards the base.

The QRS complex is due to ventricular depolarization, and it marks thebeginning of ventricular systole. It is so large that it masks theunderlying atrial repolarization signal. the ventricles to fill completely

 with blood.

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ISOVOLUMETRIC CONTRACTION

Heart Sounds

The first heart sound (S1, "lub") is due to the closing AV valves andassociated blood turbulence.

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RAPID EJECTION

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RAPID EJECTION

Heart

The semilunar (aortic andpulmonary) valves open at thebeginning of this phase.

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RAPID EJECTION

Pressures & Volumes

 While the ventricles continuecontracting, the pressure in the ventricles(red) exceeds the pressure in the aortaand pulmonary arteries (green); thesemilunar valves open, blood exits the

 ventricles, and the volume in the

 ventricles decreases rapidly (white).  As more blood enters the arteries,

pressure there builds until the flow ofblood reaches a peak.

The "c" wave of atrial pressure is notnormally discernible in the jugular

 venous pulse. Right ventricular

contraction pushes the tricuspid valveinto the atrium and increases atrialpressure, creating a small wave into the

 jugular vein. It is normally simultaneous with the carotid pulse.

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RAPID EJECTION

ECG

No Deflections

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RAPID EJECTION

Heart Sounds

None

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REDUCED EJECTION

The end of systole

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REDUCED EJECTION

Heart

 At the end of this phase thesemilunar (aortic and pulmonary)

 valves close.

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REDUCED EJECTION

Heart Sounds

None

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ISOVOLUMETRIC RELAXATION

The beginning of Diastole

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ISOVOLUMETRIC RELAXATION

Heart

 At the beginning of this phase the AV valves are closed.

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ISOVOLUMETRIC RELAXATION

Pressures & Volumes

Throughout this and the previoustwo phases, the atrium in diastolehas been filling with blood on topof the closed AV valve, causingatrial pressure to rise gradually

(yellow). The "v" wave is due to the back

flow of blood after it hits the closed AV valve. It is the seconddiscernible wave of the jugular

 venous pulse.

The pressure in the ventricles (red)continues to drop.  Ventricular volume (white) is at a

minimum and is ready to be filledagain with blood.

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ISOVOLUMETRIC RELAXATION

ECG

No Deflections

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RAPID VENTRICULAR FILLING

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RAPID VENTRICULAR FILLING

Heart

Once the AV valves open, bloodthat has accumulated in the atriaflows rapidly into the ventricles.

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RAPID VENTRICULAR FILLING Pressures

& Volumes

 Ventricular volume (white)increases rapidly as blood flowsfrom the atria into the ventricles.

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RAPID VENTRICULAR FILLING ECG

No Deflections

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RAPID VENTRICULAR FILLING

Heart Sounds

 A third heart sound (S3) is usually abnormal and is due to rapidpassive ventricular filling. It occurs in dilated congestive heart

failure, severe hypertension, myocardial infarction, or mitralincompetence.

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REDUCED VENTRICULAR FILLING

(Diastasis)

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REDUCED VENTRICULAR FILLING

Heart

Rest of blood that has accumulatedin the atria flows slowly into the

 ventricles.

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REDUCED VENTRICULAR FILLING

ECG

No Deflections

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REDUCED VENTRICULAR FILLING

Heart Sounds

None

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